Molecular Biophysics
Current Status of Ureteric Stents on Extraction Strings and Other Non-cystoscopic Removal Methods in the Paediatric Setting: A Systematic Review on Behalf of the European Association of Urology (EAU) Young Academic Urology (YAU) Urolithiasis Group
Ureteric stents are an important tool in urology and have a wide range of indications. While they offer a number of advantages, limitations remain despite modern advancements. These include discomfort, migration and encrustation. Standard removal is via cystoscopy but in the paediatric setting this mandates general anaesthetic, which holds disadvantages. Alternative removal methods include use of extraction strings and magnetic retrieval devices, which can be performed in the outpatient setting.Hemi-Kock Continent Stoma With Augmentation Cystoplasty: Modifications and Outcomes
To evaluate the long-term outcomes and impact of surgical modifications on the need for secondary surgery of the Hemi-Kock continent catheterizable stoma, comprising a detubularized ileal segment with an attached stapled ileoileal intussusception of the catheterizable channel, in patients with complex lower urinary tract disorders. The technique may be used for augmentation in patients with reduced bladder capacity who require a continent catheterizable channel. Compared to the flap and ileocecal valve procedures, the hemi-Kock technique has not been widely adopted.We Must Stop Misusing the Term Prostatitis
Chief complaints and referrals continue to include the word “prostatitis.” A recent PubMed search revealed the persistence of “CP/CPPS” (Chronic Prostatitis/Chronic Pelvic Pain), whether mood, semen quality, weather or brain functional connectivity were being correlated, and whether the interventions employed acupuncture, psychotherapy or low intensity shockwave therapy.Concomitant Repair of Meatal Stenosis and Urethral Fistula Does Not Increase the Risk of Fistula Recurrence Post Hypospadias Surgery
To evaluate whether meatal stenosis treated concomitantly with urethral fistula repair alters the results of fistula closure.Intraoperative Ventilatory Pressures During Robotic Assisted vs Open Radical Cystectomy
To investigate whether Robotic assisted radical cystectomy (RARC) is associated with increased postoperative pulmonary complications compared to open radical cystectomy (ORC). RARC poses challenges for ventilation with positioning and abdominal insufflation. Conventionally protective mechanical ventilation may be challenging, especially in patients with obesity or pulmonary comorbidities. Given the proven benefits of RARC compared to ORC, the risk of postoperative pulmonary complications merits further investigation.Sigmoid Vaginoplasty Using the Modified Single Monti Tube Following Vaginectomy for Rhabdomyosarcoma
Options for vaginal reconstruction include buccal mucosal grafts, skin grafts, skin flaps, peritoneal flaps and different bowel segments. Sigmoid vaginoplasty has several advantages including natural lubrication, lower stenosis rates, regular dilation is not usually required and the anatomic proximity that allows the neovagina to reach the perineum.1 Vaginoplasty using non-tailored bowel segments requires a long bowel segment and may cause tension on the vascular pedicle that may result in ischemia and stenosis of the neovagina.Distance From Critical Pelvic Structures: Radiographic Comparison of High Submuscular and Space of Retzius IPP Reservoir Placement Techniques
To evaluate the distance from critical pelvic structures (CPS, defined as bladder and iliac vessels) among inflatable penile prosthesis (IPP) reservoirs placed into the space of Retzius (SOR) and high submuscular (HSM) locations using cross-sectional imaging. IPP reservoir placement into the HSM location has been proposed as a strategy to prevent injury due to greater distance from CPS.Developing a Patient-Centered Model of Prostate Cancer Care: Patient Satisfaction With a Survivorship Program Embedded in Urologic-Oncologic Care
To evaluate patients’ and partners’ satisfaction with a prostate cancer survivorship program embedded in urologic-oncologic care. As a part of quality improvement activity, we developed a patient and partner-centered, biopsychosocial support program for men and partners coping with the urinary and sexual side-effects of surgical treatment for prostate cancer. The program became a part of usual care for all prostate cancer patients.Prospective Evaluation of Intradetrusor Injections of OnabotulinumtoxinA in Adults With Spinal Dysraphism
To prospectively evaluate the effectiveness of OnabotulinumtoxinA (BTX-A) on neurogenic overactive bladder (nOAB) in adults with congenital spinal dysraphism (CSD).Detection Rate of Carcinoma In Situ During TURBT Following Shift from Photodynamic Diagnosis to Narrow Band Imaging in a Single University Hospital
To examine whether or not the detection rate of Carcinoma In Situ (CIS) was significantly higher after switching from Photodynamic Diagnosis (PDD) guided TURBT to Narrow Band Imaging (NBI) guided TURBT.Robotic Assisted Caval Replacement for Recurrent Renal Cell Carcinoma Invading the Wall of the Inferior Vena Cava
To describe a case of robotic inferior vena cava (IVC) resection for an advanced case of renal cell carcinoma with accompanying robotic caval replacement using a synthetic graft.Bladder Cancer in a Long-term Survivor of the Prune Belly Syndrome
Prune belly syndrome (PBS) is a rare but morbid complexity of congenital anomalies that consists of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. With the recent advances in perinatal care, the life expectancy of patients with PBS has improved. Although renal and sexual outcomes are frequently discussed in the literature, little is known about urinary tract malignancies in adulthood. Herein, we present a case of advanced bladder cancer in a 38-year-old man with PBS.Systematic Review and Meta-analysis on Effect of Carnitine, Coenzyme Q10 and Selenium on Pregnancy and Semen Parameters in Couples With Idiopathic Male Infertility
To study the effect of 3 antioxidants viz. selenium, carnitine and coenzyme Q10, alone or in combination, on both semen parameters and pregnancy rates in couples with male factor infertility.Surgeon-administered Transversus Abdominis Plane (TAP) Block is Associated With Decreased Opioid Usage and Length of Stay Following Radical Cystectomy
To study the effect of surgeon-administered Transversus Abdominis Plane block (sTAP) on opioid usage and length of stay (LOS).EDITORIAL COMMENT
The increased use of cross-sectional imaging has led to significant stage migration in renal cell carcinoma (RCC). As more computed tomography (CT) and magnetic resonance imaging scans are performed for unrelated conditions, more RCCs have been detected – particularly small, asymptomatic lesions. For larger RCCs, obtaining chest imaging to rule out synchronous lung metastasis (sLM) remains an important clinical principle, supported by current guidelines. However, regarding chest imaging, guidelines do not necessarily reflect the stage migration in RCC over the past decade.AUTHOR REPLY
We thank Dr. Singer and colleagues for their thoughtful comments on our investigation of synchronous lung metastasis (sLM) in patients with newly identified renal masses (RMs). As stated in our original investigation and by the editors, we assessed a large cohort of 253,818 patients. Of these patients, 120,386 (47%) had a RM size <40 mm. Furthermore, only 0.9% of patients with a RM size <40 mm displayed sLM. When examining only patients with confirmed sLM we found that only 8% (1,135/14,524) had a RM <40 mm.EDITORIAL COMMENT
The COVID-19 pandemic drastically changed the world that we live almost overnight. Never before have simple acts, like shaking hands, seemed so unusual. Wearing masks in public has become as reflexive as wearing a seatbelt. The application cycle for the 2021 urology match, coincided with the pandemic surging in multiple states in the Union. Vaccines were still a distant hope, and therefore urology programs had to adapt to the challenges of conducting residency interviews for prospective applicants, while complying with National and local restrictions.AUTHOR REPLY
We echo the editorial comments made regarding our original article and applaud the ingenuity demonstrated by urology programs while transitioning to a virtual application cycle amidst a pandemic. Indeed, necessity is the mother of invention. The Society of Academic Urologists announced that the 2021-2022 cycle will again be virtual, but how will the lessons learned during the pandemic shape the future of the urology match?Editorial Comment
The virtues of any mobile application that enhances real time feedback, improves communication, and is easy to use in resident surgical evaluation are self-evident. This article amplifies another opportunity of the times, namely using smartphone apps to provide optimal surgical skills feedback to trainees in real time.Author Reply
We appreciate the thoughtful editorial regarding our manuscript. Medicine has long been the pillar of society slowest to adapt to the rapidly shifting technology of the times. The new era of technology driven healthcare is here to stay but has brought with it unique issues that we are still navigating. The sheer number of new gizmos, gadgets, and apps make it difficult to discern which tools improve & simplify surgical education from those that just add more complexity and burden. While not glorious, it is our duty as educators to constantly analyze these new technologies to find those with merit.EDITORIAL COMMENT
The authors have pursued a thoughtful analysis of the complexities of generating and interpreting the letters of recommendation (LORs) that form a critical component of applications to urology residency.AUTHOR REPLY
After years of emphasizing only penile straightening procedures in our Peyronie's reconstruction cases, our patients have taught us that penile concavity deformities (notching and hourglass) are often just as troubling. The extra-tunical grafting (ETG) technique is a promising innovation for addressing these deformities and our series is only the second known published series on the technique. Preservation of the tunica albuginea avoids disruption of the veno-occlusive apparatus at the area of grafting, thus likely lowering the risk of complications.EDITORIAL COMMENT
Penile “hourglass” deformity (PHD) is a rare condition that affects about 1% of patients with Peyronie's disease.1 PHD develops from the Peyronie's disease plaque and the tunica albuginea retraction due to the inflammatory process. The final aspect of a penis during tumescence consists of a “clepsydra” shaped shaft and a subsequent psychological and functional impact on the relational life of the patients.2 Erectile dysfunction was reported in 61% – 68% of the patients although it is not clear if this dysfunction could be considered as psychologically or anatomically related.EDITORIAL COMMENT
The manuscript entitled “Opioid-Free Discharge is Not Associated with Increased Unplanned Healthcare Encounters after Ureteroscopy: Results from a Statewide Quality Improvement Collaborative” from the University of Michigan demonstrates how a concerted effort by a healthcare system can lead to significant change. In the state of Michigan surgeons are incentivized by the major insurance carrier to limit narcotic prescribing; however, incentivizing surgeons is not enough for a program to succeed. Success requires buy in from all parties- physicians, nurses, residents, and physician's assistants- along with proactive patient education.AUTHOR REPLY
We appreciate the author's thoughtful assessment and comments on our study. We agree that successful implementation of a post-operativeopioid-free pathway necessitates buy-in from all members of the patient's care team. For surgeons, financial incentives (such as the ability to apply a modifier 22 to a surgery code when no post-operative opioids are prescribed) may influence prescribing patterns; however, at the time of our study no such incentive programs were in place in the state of Michigan.
