Purpose Symptomatic hydronephrosis of pregnancy (SHOP) presents with flank pain but may include fever, bacteremia, or sepsis that is harmful to the mother and fetus. Current literature focuses on double-J stents (DJS) in SHOP patients with sparse reporting on percutaneous nephrostomy (PCN) outcomes. We assess the safety of PCN for SHOP. Methods We used CPT codes to identify women with SHOP who underwent PCN at our institution. Gravid women with maternal kidney infection were identified by ICD10 code and selected as a comparative high-risk (HR) group. Retrospective analysis was used to gather data on initial clinical presentation and demographics. Outcomes included fetal data, APGAR scores, and neonatal intensive care unit (NICU) admission. The number of procedures a mother underwent involving all PCN placements and subsequent changes, along with total procedural radiation dose measured in milligray (mGy), was collected. Multivariable regression analysis was performed to assess significance. Results HR ( n = 43) and SHOP ( n = 44) groups included a similar number of patients. No statistical differences were noted between groups regarding BMI, body temperature, creatinine, and CBC. No differences were noted in maternal or fetal outcomes between groups. The average patient had 4.6 procedures with mean and median radiation exposure of 108 mGy and 58.2 mGy, respectively. Conclusion Maternal and fetal outcomes are acceptable with PCN placement and demonstrate non-inferiority to comparative HR pregnancy groups. PCN is a reasonable option for patients requiring intervention for SHOP. Further studies should consider randomization between treatment modalities to better identify the optimal treatment for women with SHOP.
Patients are becoming increasingly active consumers of health information on the internet with urologic concerns being no exception. Our objective was to explore online search trends for topics related to men's health and identify information-seeking patterns related to news and media coverage of these topics. We used Google Trends (http://google.com/trends) to explore search trends for various search terms related to men's health in the United States over a 5-year period. Search queries provided graphs depicting search volume as a function of time, geographical data, and related topics and queries. Isolated spikes in search volume were further explored to identify a related event. Erectile dysfunction was the most-searched topic over the last 5 years in the United States. Prostate cancer and benign prostatic hyperplasia were the second and third most-searched topics, respectively. Other popular topics involved symptoms or pathologies of the testicles and penis. Most topics had relatively stable search volumes, with the exceptions of premature ejaculation and Peyronie's disease. Several observed spikes in search volume were attributable to singular events, mostly in the form of online article publications or social media posts. We believe it may be helpful for providers to stay informed of cultural events relating to medical conditions to anticipate patient concerns.
Inflatable penile prosthesis (IPP) involves placement of the fluid reservoir into an abdominal or pelvic location. While the space of Retzius (SOR) was the preferred site for many years, the change from open to robotic prostatectomy made this space less desirable due to the violation of the peritoneum with the robotic approach. Other factors like previous abdominal or pelvic surgeries (particularly inguinal hernia repair with mesh) may also require a change in location of the reservoir during IPP placement. In this report, we discuss a previously undescribed result of alternative reservoir placement (ARP) with erosion of the reservoir through the colon and out of the anus in a man with multiple previous abdominal surgeries. Management of this clinical problem is also discussed.
