Open forearm fractures (FFs) are common injuries in pediatric patients with variable management, including operative and nonoperative debridement. In this study, we aim to assess trends in management and determine differences in infection rates and costs between operative and nonoperative management for type I and II open both-bone forearm fractures in pediatric patients. This is a retrospective cohort study utilizing the Pediatric Health Information System database. Patients were included if they were aged 16 or younger and had open forearm fractures between 2018 and 2022. Descriptive statistics, χ2 tests, t -tests, linear regression, and logistic regression were used to assess associations between operative and nonoperative management, infection rates, and costs. A total of 3279 patients were included in this study. Approximately 73% of patients were treated with an operative irrigation and debridement (I&D), and 27% of patients were treated nonoperatively. There was no significant trend in management over the study period ( P  = 0.91). Non-White patients and younger patients were more likely to be treated nonoperatively ( P  < 0.01). The rate of infection was 2.2% and increased over time ( P  = 0.03). There was no difference in infection between operative and nonoperative I&D (odds ratio: 1.10, 95% confidence interval: 0.63-1.94, P  = 0.74). However, operative management was significantly more expensive ($13 132 vs. $2930; P  < 0.01). There has been no significant change in the management of types I and II open forearm fractures over the past 5 years. While there is no significant difference in the infection rate between patients treated operatively and nonoperatively, operative management is significantly more expensive. LEVEL OF EVIDENCE:Level III.

To evaluate the association between frailty and surgical outcomes using frailty indices and to assess tool performance. Genitourinary prosthetics, including artificial urinary sphincter (AUS), urethral sling, and penile prosthesis, are standard therapeutic interventions but are susceptible to complications. These procedures are often performed on older, frail patients, necessitating a deeper understanding of the relationship between frailty and postoperative morbidity. We utilized data from the NSQIP database (2011–2020) to identify patients undergoing urologic prosthetic procedures, including artificial urinary sphincter, sling, and penile prosthesis. Frailty was assessed using the modified frailty index-5 (mFI-5), the Risk Analysis Index (RAI-A) and ASA Class. Primary outcomes focused on 30-day postoperative morbidity, with secondary outcomes including mortality, length of stay, discharge disposition, readmissions, and reoperations. Logistic and linear regression models were constructed, adjusting for relevant clinical variables, and ROC curve plotted to compare the predictive abilities of mFI-5, RAI-A, and ASA classification. We identified 4,734 patients who underwent AUS, sling, or penile prosthesis surgeries. Frailty, as measured by RAI-A (OR 2.05, 95

Background Scant data exists on the impacts of prostate radiation on ejaculatory function. We performed a systematic review and meta-analysis to assess ejaculatory outcomes in men after prostate radiation.Methods We queried PubMed, Embase, and Web of Science to identify 17 articles assessing ejaculatory function post-radiation. The primary outcome was anejaculation rate and secondary outcomes included ejaculatory volume (EV), ejaculatory discomfort, and mean decline in ejaculatory function scores (EFS). We assessed study quality with the Newcastle-Ottawa scale. We calculated pooled proportions using inverse variance and random effects models.Results We identified 17 observational studies with 2,115 patients reporting ejaculatory profiles post-radiation. Seven studies utilized external beam radiation therapy, 7 brachytherapy, 1 stereotactic RT and 2 utilized either external or brachytherapy. Ten studies reported an anejaculation rate. Pooled proportion of patients having anejaculation, decreased EV and EjD were 18% (95% CI, 11–36%), 85% (95% CI, 81–89%) and 24% (95% CI, 16–35%), respectively. Five studies reported decline in EFS post-radiation.Conclusions Patients receiving radiation treatment may experience significant changes in their ejaculation, such as the absence of ejaculation, reduced EV, and EjD. It is important to counsel them about these potential side effects.

INTRODUCTION:Hip hemiarthroplasty (HHA) is one of the most common types of orthopedic surgery. With the prevalence and utilization of the surgery increasing year after year, this procedure is found to be associated with severe postoperative complications and eventually mortality. Thus, it is crucial to understand the factors that increase the risk of mortality following HHA. METHODS:Using the Nationwide Inpatient Sample (NIS) database, patients undergoing HHA from 2016 to 2019 were identified. This sample was stratified into a mortality group and a control group. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups. RESULTS:Of the 84,067 patients who underwent the HHA procedures, 1,327 (1.6%) patients died. Additionally, the mortality group had a higher percentage of patients who were non-electively admitted (P < 0.001) and diabetic patients with complications (P < 0.001), but lower incidences of tobacco-related disorders (P < 0.001). Significant differences were also seen in age (P < 0.001), length of stay (P < 0.001), and total charges (P < 0.001) between the two groups. Preoperatively, those aged > 70 years (OR: 2.11, 95% CI [1.74, 2.56], P < 0.001) had diabetes without complications (OR: 0.32, 95% CI [0.23, 0.44], P < 0.001), tobacco-related disorders (OR: 0.24, 95% CI [0.17, 0.34], P < 0.001) and increased rates of mortality after HHA. Postoperatively, conditions, such as pulmonary embolisms (OR: 6.62, 95% CI [5.07, 8.65], P < 0.001), acute renal failure (OR: 4.58 95% CI [4.09, 5.13], P < 0.001), pneumonia (95% CI [2.72, 3.83], P < 0.001), and myocardial infarctions (OR: 2.65, 95% CI [1.80, 3.92], P < 0.001) increased likelihood of death after undergoing HHA. Patients who were electively admitted (OR: 0.46 95% CI [0.35, 0.61], P < 0.001) had preoperative obesity (OR: 0.67, 95% CI [0.44, 0.84], P = 0.002), and a periprosthetic dislocation (OR: 0.51, 95% CI [0.31, 0.83], P = 0.007) and were found to have a decreased risk of mortality following THA. CONCLUSIONS:Analysis of pre- and postoperative complications relating to HHA revealed that several comorbidities and postoperative complications increased the odds of mortality. Old age, pulmonary embolisms, acute renal failure, pneumonia, and myocardial infraction enhanced the odds of post-HHA mortality.

Background: Penile squamous cell carcinoma is an aggressive malignancy with significant physical and psychological impacts. Socioeconomic factors influence prognosis in genitourinary cancers, making the investigation of insurance status critical for reducing cancer burden and promoting health equity. Materials and Methods: Men diagnosed with primary penile squamous cell carcinoma from 2007 to 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) national database. Participants were categorized based on insurance status: privately insured, Medicaid, and uninsured. Pearson’s chi-squared test assessed the distribution of observed frequencies between the patient demographics, socioeconomic status, tumor characteristics, and surgical variables across the insurance groups. Overall and cancer-specific survival was estimated using a multivariate Cox hazards proportional model analysis. Results: The multivariate Cox hazards proportional model showed that, compared to privately insured patients, Medicaid patients had an increased risk for overall death (hazard ratio [HR] = HR 1.54; 95% CI, 1.12–2.07). For cancer-specific mortality, Medicaid patients had an increased risk of death compared to privately insured patients (HR 1.58; 95% CI, 1.11–2.25). Conclusions: Medicaid does not mitigate the differences caused by health insurance status due to health insurance disparities for overall or cancer-specific mortality. Lower Medicaid reimbursements and out-of-pocket costs lead to a narrow network of physicians, hospitals, and treatment modalities that compromise health equity. Increasing awareness of health insurance disparities and improving access to care via a clinician–community–governmental partnership can potentially lead to improved predictive outcomes.

Pernicious anemia (PA) is an autoimmune condition resulting in impaired vitamin B12 absorption that commonly presents with gastritis and neurological symptoms. In rare cases, associated vitamin B12 deficiency can contribute to significant red blood cell lysis, and patients can present with PA -induced pseudo -thrombotic microangiopathy (TMA) hemolytic anemia. This case describes a 59 -year -old male presenting with a two-week history of gastrointestinal pain with bleeding who had anemia and hemodynamic instability on initial evaluation. After the endoscopy/colonoscopy did not reveal any active sources of bleeding and packed red blood cells failed to stabilize the patient, it was found that he had low serum B12 with anti -intrinsic factor and anti -parietal cell antibodies. A coordinated clinical approach, including parenteral cyanocobalamin and daily oral folic acid supplementation, stabilized the patient, highlighting the importance of distinguishing PA -induced pseudo-TMA from true TMA hemolytic anemia.

PURPOSE:Overactive bladder (OAB) syndrome significantly impairs quality of life, often necessitating pharmacological interventions with associated risks. The fragility of OAB trial outcomes, as measured by the fragility index (FI: smallest number of event changes to reverse statistical significance) and quotient (FQ: FI divided by total sample size expressed as a percentage), is critical yet unstudied. MATERIALS AND METHODS:We conducted a systematic search for randomized controlled trials on OAB medications published between January 2000 and August 2023. Inclusion criteria were trials with two parallel arms reporting binary outcomes related to OAB medications. We extracted trial details, outcomes, and statistical tests employed. We calculated FI and FQ, analyzing associations with trial characteristics through linear regression. RESULTS:We included 57 trials with a median sample size of 211 participants and a 12% median lost to follow-up. Most studies investigated anticholinergics (37/57, 65%). The median FI/FQ was 5/3.5%. Larger trials were less fragile (median FI 8; FQ 1.0%) compared to medium (FI: 4; FQ 2.5%) and small trials (FI: 4; FQ 8.3%). Double-blinded studies exhibited higher FQs (median 2.9%) than unblinded trials (6.7%). Primary and secondary outcomes had higher FIs (median 5 and 6, respectively) than adverse events (FI: 4). Each increase in 10 participants was associated with a +0.19 increase in FI (p < 0.001). CONCLUSIONS:A change in outcome for a median of five participants, or 3.5% of the total sample size, could reverse the direction of statistical significance in OAB trials. Studies with larger sample sizes and efficacy outcomes from blinded trials were less fragile.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence (MP03)1 May 2024MP03-03 FRAILTY IN MEN UNDERGOING PROSTHETIC UROLOGIC PROCEDURES ASSOCIATES WITH POST-OPERATIVE SEPSIS, CARDIOVASCULAR COMPLICATIONS, AND DISCHARGE TO CONTINUED CARE Umar Ghaffar, Nikit Venishetty, Behzad Abbasi, Adrian Fernandez, Robert Pearce, Nizar Hakam, Kevin D. Li, Hiren Patel, and Benjamin N. Breyer Umar GhaffarUmar Ghaffar , Nikit VenishettyNikit Venishetty , Behzad AbbasiBehzad Abbasi , Adrian FernandezAdrian Fernandez , Robert PearceRobert Pearce , Nizar HakamNizar Hakam , Kevin D. LiKevin D. Li , Hiren PatelHiren Patel , and Benjamin N. BreyerBenjamin N. Breyer View All Author Informationhttps://doi.org/10.1097/01.JU.0001009488.55564.85.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Frailty has yet to be explored as a risk factor for urologic prosthetics post-operative complications. Our objective is to assess the impact of modified frailty index-5 (mFI-5) on post-surgery outcomes in patients undergoing urologic prosthetic procedures. METHODS: National Surgical Quality Improvement Program (NSQIP) 2015-2020 were reviewed. Male patients undergoing artificial urinary sphincter (AUS), urethral sling procedures and penile prosthesis (PP) were identified using CPT codes. The mFI-5 was calculated by assigning one point for each comorbidity present: diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status. Outcomes included morbidity (presence of any complication), mortality, Clavien grade 4/5 complications, prolonged length of stay (PLOS), operative time (OT), readmission, reoperation, discharge to continued care (DCC) and healthcare resource utilization (HU) (composite of PLOS, readmissions, DCC and reoperation). RESULTS: 3,608 patients (AUS 63.3%; Sling 25.7%; penile prosthesis 11.0%) were identified. Mean age was 69.2, and 21.7% of patients were very frail (mFI-5 ≥ 2). Frailty (mFI-5≥2 vs <2) was significantly associated with post-operative sepsis (OR 2.26; 1.02-5.00; p=0.044), cardiovascular complications (OR 4.33; 1.32-14.2, p=0.016), DCC (OR 6.5; 2.18-19.5; p<0.001) and OT (OR 1.01; 1.01-1.01; p<0.001). Frailty was not associated with overall morbidity, PLOS, reoperation, healthcare utilization, Clavien Grade 4/5 complications or mortality. CONCLUSIONS: Our study shows frailty in adults receiving urologic protheses is associated with greater odds of post-operative sepsis and cardiovascular complications. Additional research is warranted to investigate interventions aimed at optimizing the well-being of frail patients. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e22 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Umar Ghaffar More articles by this author Nikit Venishetty More articles by this author Behzad Abbasi More articles by this author Adrian Fernandez More articles by this author Robert Pearce More articles by this author Nizar Hakam More articles by this author Kevin D. Li More articles by this author Hiren Patel More articles by this author Benjamin N. Breyer More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:This analysis uses current national-population-based data to elucidate trends in racial minority access to and utilization of palliative care services (PCS). BACKGROUND:Intracerebral hemorrhage (ICH) is the second-highest cause of stroke-related mortality, and its long-term effects can be difficult for survivors to cope with. Palliative care has emerged as a compassionate, effective strategy to manage critically ill patients by focusing on improving quality of life for patients and their loved ones. DESIGN/METHODS:This analysis utilized pooled data from the 2016-2019 United States Government Agency for Healthcare Research and Quality National Inpatient Sample (NIS), which contains >7 million unweighted hospital stays for each year. When weighted, it estimates >35 million hospitalizations yearly (95% of annual American hospitalizations). NIS' International Classification of Diseases (ICD-10) codes were used for data extraction. After weighting, 84,840 adult patients admitted with intracerebral hemorrhage were included. Patients with a hospital stay less than 24 hours were excluded, as patients likely passed away before being able to receive PCS counseling. T- and chi-square-tests compared groups. RESULTS:16,940 (20%) of ICH patients received PCS. Patients who received PCS were significantly older (mean age 75 years, SD 13 vs. 68 years, SD 15, p<0.001) and were more likely to be female (57.2%, p<0.001) than patients who did not receive PCS. Caucasian ICH patients were significantly more likely to receive palliative care services (p<0.001). 23% of Caucasian ICH patients (n=11,940 of 52,125) received PCS. In comparison, only 12% of African American (n=1,740 of 13,835), 15% of Hispanic (n=1,285 of 8,690), and 19% of Asian/Pacific Islander (n=829 of 4,394) ICH patients received PCS. CONCLUSIONS:Intracerebral hemorrhage patients of racial minority status were disproportionately less likely to receive palliative care services. These findings emphasize the need for improvement in provider- and patient-education or modification of PCS resources to fit patients' differing cultural needs to improve care accessibility. Disclosure: The institution of Ms. Trivedi has received research support from American Academy of Neurology. Mr. Venishetty has nothing to disclose. Dr. Chaudhry has nothing to disclose. The institution of Dr. Cruz-Flores has received research support from University of Texas System.

Objectives: As the emphasis on player safety in the national football league (NFL) has increased in recent years, numerous risk factors for injury have been closely scrutinized for their roles in placing players at increased risk. One such factor, the use of artificial turf football fields, has become a controversial topic, with many current and former players stating that turf fields place players at higher risk for injury while alternative sources have suggested there is no significant injury rate between artificial and natural grass surfaces. The purpose of this study was to quantify the rate of lower extremity injuries occurring in NFL players on artificial turf compared to natural grass surfaces and to characterize the degree of time missed with injury and the proportion of injuries requiring surgery. We hypothesized that major lower extremity injuries requiring surgical intervention occurred on artificial turf surfaces at a higher rate than on natural grass. Methods: Lower extremity Injury data for the 2021 and 2022 NFL seasons were obtained using publicly available records from the internet. All reported lower extremity injuries during the regular and playoff seasons were analyzed. Upper extremity, head, and back injuries were excluded. Preseason data was also excluded. Data collected included player position and age, playing surface of the field on which, the injury occurred, injury type, weeks missed with injury, and whether the patient underwent season-ending or minor surgery. Statistical analysis was performed using R Software (Rlabs). Descriptive statistics were used to summarize data, including percentages and counts for categorical and ordinal data and means with interquartile ranges for continuous data. Incidences of injury on both grass and turf fields were calculated for the 2021 and 2022 seasons by taking a ratio of the number of injuries that occurred and the number of games played on respective fields. Additionally, injuries were stratified by subsequent number of games missed: 0 games missed, 1-2 games missed, >6 games missed. Multivariable logistic regression was performed to determine the influence of field type on the risk of major surgery. A p-value less than 0.05 was statistically significant. Results: In total there were 327 (44.12%) lower extremity injuries in 2021 and 391 (54.45%) lower extremity injuries in 2022, resulting in a total of 718 lower extremity injuries. A demographic summary of these injuries by position, age, field, and history of previous injury is displaced in Table 1. Combining the 2021/2022 seasons, the incidence rate of lower extremity injury on natural grass surfaces was 1.22 injuries/game while for turf surfaces, the incidence rate was 1.42 injuries/game (Table 2). Injury severity was stratified by weeks missed. Odds of a season-ending surgery were found to be significantly higher on turf surfaces compared to natural grass surfaces (OR 1.60, 95% CI 1.28-1.99, p<0.05), while additional variables, including weather, age, position, and week of injury occurrence and history of prior injury were not found to influence the odds of season-ending surgery. In total, there were 50 players injured on the grass who required lower extremity surgery and 83 players injured on turf who required lower extremity surgeries. The most common surgeries after a lower extremity on grass were ACL repair (17), Achilles repair (9), and ankle or syndesmosis ORIF (7). The most common surgeries after a lower extremity on turf were ACL repair (30), Achilles repair (12), patella ORIF, or patellar tendon repair (8) (Table 3). Conclusions: The debate about playing on artificial turf versus natural grass has persisted for several years; however, there is a discrepancy in data reported on these overall injury rates. Our study showed that NFL athletes were more likely to get injured on artificial surfaces and that turf dramatically increased the likelihood of suffering a serious injury requiring surgery. These findings support earlier research, highlighting the necessity of putting player safety first and reducing dangers on pitches with artificial turf. For players, coaches, and teams to make wise decisions about playing surfaces, the study offers useful information regarding playing safety. Overall, it indicates that there is a higher risk of lower extremity injuries on artificial grass in the NFL, confirming the continuing discussion about field safety.

Objectives To evaluate the association between frailty and surgical outcomes using frailty indices and to assess tool performance. Genitourinary prosthetics, including artificial urinary sphincter (AUS), urethral sling, and penile prosthesis, are standard therapeutic interventions but are susceptible to complications. These procedures are often performed on older, frail patients, necessitating a deeper understanding of the relationship between frailty and postoperative morbidity Methods We utilized data from the NSQIP database (2011-2020) to identify patients undergoing urologic prosthetic procedures, including artificial urinary sphincter, sling, and penile prosthesis. Frailty was assessed using the modified frailty index-5 (mFI-5), the Risk Analysis Index (RAI-A) and ASA Class. Primary outcomes focused on 30-day postoperative morbidity, with secondary outcomes including mortality, length of stay, discharge disposition, readmissions, and reoperations. Logistic and linear regression models were constructed, adjusting for relevant clinical variables, and ROC curve plotted to compare the predictive abilities of mFI-5, RAI-A, and ASA classification. Results We identified 4,734 patients who underwent AUS, sling, or penile prosthesis surgeries. Frailty, as measured by RAI-A (OR 2.05, 95% CI 1.59-2.65, p<0.001) and ASA Class (OR 1.55, 95% CI 1.19-2.01, p=0.001), was significantly associated with postoperative morbidity, while mFI-5 was not. Cardiovascular complications and discharge to continued care were associated with all tools. ROC curve analysis showed that RAI-A had significantly greater predictive ability for postoperative morbidity than mFI-5 (p=0.023). Conclusions RAI-A and ASA are more effective than the mFI-5 in predicting postoperative morbidity, mortality, and other adverse outcomes in patients undergoing urologic prosthetic surgeries.

BackgroundSex hormones play a critical role in sex differences and cardiovascular disease risk associated with metabolic syndrome (MS) and inflammation. However, the associations of sex hormone ratios with metabolic and inflammatory markers are unclear according to sex and age differences. We evaluated the associations of sex hormone ratios with MS and inflammation among males and females.MethodsA retrospective cross-sectional study was conducted by including all adults from the National Health and Nutrition Examination Survey cycles 2013-2016 and excluding any pregnant women, heart disease, diabetes, and those currently taking insulin. MS was defined using the National Cholesterol Education Program criteria and a high-sensitivity C-reactive protein (CRP) level>3 mg/L was defined as a high CRP. Measures of MS components and CRP concentrations were also analyzed. The primary exposures were testosterone to estradiol (excess androgen index), testosterone to sex hormone-binding globulin (free androgen index), and estradiol to sex hormone-binding globulin (free estradiol index). The adjusted associations were summarized with a relative risk (RR) and 95% confidence interval (CI).ResultsThis study included 9167 subjects with 4360 males and 4807 females. Increases in free estradiol index were positively associated with MS (RR=1.48; 95%CI: 1.39, 1.58; RR=1.31; 95%CI: 1.22, 1.40) and high CRP (RR=1.49; 95%CI: 1.25, 1.77; RR=1.26; 95%CI: 1.06, 1.50) in men with age<50 years and age≥50 years, respectively. Similarly, higher free estradiol index was also robustly associated with increased prevalence of MS (RR=1.22; 95%CI: 1.15, 1.28) and high CRP (RR=1.68; 95%CI: 1.48, 1.90) in women with age ≥50 years. Among women with age<50 years, a higher free androgen index was associated with MS (RR=1.34; 95%CI: 1.25, 1.42) and high CRP (RR=1.13; 95%CI: 1.02, 1.25). These associations were unchanged even after adjusting for all sex hormones.ConclusionFree estradiol index was consistently and positively associated with MS and high CRP in males of all ages and older females. Free androgen index was positively associated with MS and high CRP in females with age<50 years.

Introduction:Since the integration of the intern year into urology residencies, programs are mandated to introduce fundamental skills to junior residents. Our goal was to assess the impact of one such program: the 2023 New York Section of the AUA (NYS-AUA) EMPIRE (Educational Multi-institutional Program for Instructing REsidents) Boot Camp.Methods:Junior urology residents from all 10 NYS-AUA institutions attended a free EMPIRE Boot Camp on June 9, 2023. The seminar covered procedural skills including urethral catheterization, cystoscopy, renal and bladder ultrasound, transrectal prostate ultrasound with biopsy, and an introduction to robotics/laparoscopy. Sessions focused on urologic emergencies and postoperative scenarios. Participants completed questionnaires before, immediately after, and 6 months post course, assessing comfort with procedures and overall program quality using a 5-point Likert scale and free text responses. t Tests compared pre and immediate/6-month post scores.Results:Forty junior residents, along with faculty and resident instructors from all 10 NYS-AUA programs, participated. Of the 40 trainees, 35 (87.5%) completed pre- and immediate post-boot camp surveys, while 23 (57.5%) responded to the 6-month follow-up survey. Ratings showed significant improvement in comfort with basic urologic technical skills for 13 out of 14 domains (93%) immediately after the course and at the 6-month mark. Attendees reported notably higher comfort levels in managing obstructive pyelonephritis (P = .003) and postoperative complications (P = .001) following didactic sessions.Conclusions:A skills-based, free collaborative urology boot camp for junior residents is feasible and can be effective. Trainees reported improved comfort performing certain technical skills and managing urologic emergencies both immediately after the course and at 6 months of follow-up.

Male infertility has affected an increasingly large population over the past few decades, affecting over 186 million people globally. The advent of assisted reproductive technologies (ARTs) and artificial intelligence (AI) has changed the landscape of diagnosis and treatment of male infertility. Through an extensive literature review encompassing the PubMed, Google Scholar, and Scopus databases, various AI techniques such as machine learning (ML), artificial neural networks (ANNs), deep learning (DL), and natural language processing (NLP) were examined in the context of evaluating seminal quality, predicting fertility potential, and improving semen analysis. Research indicates that AI models can accurately estimate the quality of semen, diagnose problems with sperm, and provide guidance on reproductive health decisions. In addition, developments in smartphone-based semen analyzers and computer-assisted semen analysis (CASA) are indicative of initiatives to improve the price, portability, and accuracy of results. Future directions point to possible uses for AI in ultrasonography assessment, microsurgical testicular sperm extraction (microTESE), and home-based semen analysis. Overall, AI holds significant promise in revolutionizing the diagnosis and treatment of male infertility, offering standardized, objective, and efficient approaches to addressing this global health challenge.

Background: It has been argued that the use of artificial turf football fields in the National Football League (NFL) increases player injury risk compared with natural grass surfaces. Purpose/Hypothesis: The purpose of this study was to quantify the rate of lower extremity injuries occurring in NFL players on artificial turf compared with natural grass surfaces and characterize the time missed due to injury and proportion of injuries requiring surgery. It was hypothesized that lower extremity injuries requiring surgical intervention would occur at a higher rate on artificial turf than on natural grass. Study Design: Descriptive epidemiology study. Methods: Lower extremity injury data for the 2021 and 2022 NFL seasons were obtained using publicly available records. Data collected included injury type, player position, player age, playing surface, weeks missed due to injury, and whether the patient underwent season-ending or minor surgery. Multivariable logistic regression was performed to determine the risk of season-ending surgery according to playing surface. Results: When combining injuries for the 2021 and 2022 seasons (N = 718 injuries), the incidence rate of lower extremity injury was 1.22 injuries/game for natural grass and 1.42 injuries/game for artificial turf. The odds of a season-ending surgery were found to be significantly higher on artificial turf compared with natural grass (odds ratio = 1.60; 95% CI, 1.28-1.99; P < .05), while additional variables, including weather, age, position, week of injury occurrence, and history of prior injury, did not influence the odds of season-ending surgery. Conclusion: The 2021 and 2022 NFL seasons of our analysis demonstrated a higher incidence rate of injuries on artificial turf surfaces compared with natural grass surfaces. In addition, the odds of injury requiring season-ending surgery were found to be significantly higher on artificial turf compared with natural grass.

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes I (PD05)1 May 2024PD05-09 PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA AT MINORITY SERVING HOSPITALS ARE LESS LIKELY TO UNDERGO DEFINITIVE TREATMENT Christopher S. Connors, Micah Levy, Daniel Wang, Juan Sebastian Arroyave, Olamide Omidele, Nikit Venishetty, and Michael Palese Christopher S. ConnorsChristopher S. Connors , Micah LevyMicah Levy , Daniel WangDaniel Wang , Juan Sebastian ArroyaveJuan Sebastian Arroyave , Olamide OmideleOlamide Omidele , Nikit VenishettyNikit Venishetty , and Michael PaleseMichael Palese View All Author Informationhttps://doi.org/10.1097/01.JU.0001008624.07191.ab.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Healthcare for racial minorities is densely concentrated at a small subset of hospitals in the United States, often referred to as minority serving hospitals (MSH). Given that Black patients have been shown to suffer worse outcomes from upper tract urothelial carcinoma (UTUC), understanding if this disparity is related to differences in care at MSHs is crucial towards alleviating it. In this study, we investigate the effect of treatment at a MSH on the receipt of definitive treatment for UTUC. METHODS: The National Cancer Database was queried for non-metastatic UTUC cases from 2004 to 2020. Similar to prior studies, a MSH was defined as a facility in the top decile of proportion of Black and Hispanic patients in the UTUC cohort. Definitive treatment was defined as local excision for low-risk UTUC or radical nephroureterectomy for high-risk UTUC. Demographics and clinical information were compared between patients at MSHs and non-MSHs. Univariate and multivariate logistic regression was performed to identify predictors of definitive treatment. RESULTS: 29,532 non-metastatic UTUC patients were identified (MSH=2058; non-MSH=27,474). Compared to a non-MSH, patients at a MSH were more likely to be uninsured (4.3 vs 1.2%) and be treated at an academic institution (40.5 vs 34.9%), all p<0.001. Moreover, the average time from diagnosis to definitive treatment was comparable between groups (MSH: 44.6 days, non-MSH: 43.6 days, p=0.685). Rates of definitive treatment were lower at MSHs compared to non-MSHs (84.1 vs 88.2%, p<0.001). On univariate analysis, receiving care at a MSH was a negative predictor of definitive treatment (OR=0.785, p<0.001). On multivariate analysis, treatment at a MSH continued to negatively predict receipt of definitive treatment (OR=0.447, p=0.020) [Table 1]. Furthermore, increased UTUC surgery volume at the hospital and higher T stage predicted definitive treatment while Medicaid/Medicare or no insurance and lymph node involvement were negative predictors. CONCLUSIONS: Patients with UTUC at a MSH are less likely to undergo definitive treatment. This association is modulated by insurance status and facility volume which suggests that a combination of health access, socioeconomic, and facility-level factors contribute towards racial disparities in UTUC care. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e93 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Christopher S. Connors More articles by this author Micah Levy More articles by this author Daniel Wang More articles by this author Juan Sebastian Arroyave More articles by this author Olamide Omidele More articles by this author Nikit Venishetty More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF downloadLoading ...

A major global health concern, male infertility affects 8–12% of couples globally. Leukocytospermia is a complicated illness that is distinguished from other reasons causing male infertility by having high white blood cell counts in semen. The complex mechanisms behind leukocytospermia’s effects on sperm function and fertility are examined in this review. Leukocytospermia induces oxidative stress and reactive oxygen species (ROS) that impair DNA integrity, mitochondrial function, cytoplasmic extrusion, and sperm quality overall. Leukocytospermia is exacerbated by non-infectious factors, such as substance abuse and varicocele, even though genital tract infections are a common cause. The usefulness and dependability of diagnostic techniques range from immunochemistry to direct counting. Although there is still disagreement on the most effective course of action, clinical-care techniques, such as antioxidant supplementation and antibiotic therapy, attempt to address underlying causes and reduce ROS-induced damage. Prospectively, the combination of artificial intelligence with the latest developments in artificial reproductive technologies presents opportunities for more precise diagnosis and customized treatments.

As the fourth most frequent disease in men, bladder cancer has a significant financial impact on healthcare. Because atypical dysplasia and papillary forms in bladder cancer are uncommon, there is a dearth of information on them. This study attempts to fill that gap. In the case study that is being presented, a 65year -old man with a history of prostate cancer was admitted due to unusual urine cytology results that showed bladder papillary atypia. A distinct lesion on the bladder's dome that resembled a raspberry color was discovered by cystoscopy and transurethral resection of the bladder tumor (TURBT), which led to numerous biopsies and resections. Pathology demonstrated a significant urothelial proliferation. The study highlights the variety of morphologies found in atypical dysplastic lesions and the possibility that these lesions could develop into cancer. The significance of identifying atypical dysplastic lesions is emphasized in the study's conclusion, notably in patients with a history of prostate cancer, and highlights the need for further investigation in this domain.

Prostate cancer (PCa) represents a significant health burden globally, ranking as the most diagnosed cancer among men and a leading cause of cancer-related mortality. Conventional treatment methods such as radiation therapy or radical prostatectomy have significant side effects which often impact quality of life. As our understanding of the natural history and progression of PCa has evolved, so has the evolution of management options. Active surveillance (AS) has become an increasingly favored approach to the management of very low, low, and properly selected favorable intermediate risk PCa. AS permits ongoing observation and postpones intervention until definitive treatment is required. There are, however, challenges with selecting patients for AS, which further emphasizes the need for more precise tools to better risk stratify patients and choose candidates more accurately. Tissue-based biomarkers, such as ProMark, Prolaris, GPS (formerly Oncotype DX), and Decipher, are valuable because they improve the accuracy of patient selection for AS and offer important information on the prognosis and severity of disease. By enabling patients to be categorized according to their risk profiles, these biomarkers help physicians and patients make better informed treatment choices and lower the possibility of overtreatment. Even with their potential, further standardization and validation of these biomarkers is required to guarantee their broad clinical utility. Active surveillance has emerged as a preferred strategy for managing low-risk prostate cancer, and tissue-based biomarkers play a crucial role in refining patient selection and risk stratification. Standardization and validation of these biomarkers are essential to ensure their widespread clinical use and optimize patient outcomes.