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Purpose The purpose of this study was to compare in-person and telepractice evaluations of stuttering with adult participants. The research questions were as follows: Is an evaluation for stuttering via telepractice equivalent to an in-person evaluation in terms of (a) duration of individual evaluation tasks and overall length of the evaluation, (b) clinical outcomes across evaluating clinicians, and (c) participant experience? Method Participants were 14 adults who stutter (males = 11; age range: 20–68) who were simultaneously assessed via telepractice and in-person. Comprehensive evaluations included analysis of the speaker's stuttering, evaluation of the speaker's perceptions and attitudes about stuttering, and language testing. Evaluations were administered by either an in-person clinician or a telepractice clinician but were simultaneously scored by both clinicians. Participants were randomly assigned to the in-person-led assessment condition or the telepractice-led assessment condition. Results No statistically significant differences were found between the in-person and telepractice-led evaluations in terms of overall evaluation task duration, evaluation clinical outcomes, or participants' reported experiences. That is, telepractice evaluations for stuttering in adults may be an equivalent option to in-person evaluations. Conclusions Results of this preliminary study indicate that telepractice evaluations of stuttering may be comparable to in-person evaluations in terms of duration, clinical outcomes, and participant experiences. The current study supports the notion that telepractice evaluations may be a viable option for adult clients who stutter. Clinical considerations and future directions for research are discussed.

INTRODUCTION: We developed an objective clinical grading scale to characterize post-prostatectomy incontinence (PPI) and evaluated its use as a tool to facilitate male anti-incontinence procedure selection. PROTOCOL: Between September 2014 and July 2015, we prospectively implemented a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI patients based on incontinence severity. Patients included were those referred for PPI who had no prior anti-incontinence surgery. During the initial outpatient consultation, each patient was prospectively assigned an incontinence grade score of 0 through 4 based on the consensus of 2 examiners performing a standing cough test (SCT). All patients refrained from voiding for at least 60 minutes prior to the SCT. Men with mild SUI (MSIGS grades 0–2) were offered AdVance sling surgery while those with heavier SUI (MSIGS grades 3–4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to patient-reported pads-per-day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed. OUTCOME: Of 62 consecutive new PPI patients, 20 were graded as mild based on SCT [five (8%) grade 0, 10 (16%) grade 1, five (8%) grade 2] while 42 were graded as moderate-severe [10 (16%) grade 3, 32 (52%) grade 4]. MSIGS grade demonstrated a strong correlation with preoperative PPD (r=0.74). Among the 53 patients who underwent surgical intervention for PPI, 14 with mild SUI were treated with AdVance® male urethral sling (MSIGS grade 0, 1, or 2) while 39 more severe cases received AUS (MSIGS grade 3 or 4). Patient-reported improvement was high overall (median 95%) and similar for sling and AUS patients (95% and 96.5% respectively, p=0.596). The median time from radical prostatectomy to anti-incontinence surgery was 5.4 years (range 1–20). DISCUSSION: The Male Stress Incontinence Grading Scale provides a rapid, simple, non-invasive, objective assessment of PPI severity which strongly correlates with patient-reported pads-per-day and appears to facilitate anti-incontinence surgical procedure selection.

Objective To examine the association between decreased serum testosterone levels and artificial urinary sphincter (AUS) cuff erosion. Materials and Methods We evaluated serum testosterone levels in 53 consecutive patients. Low testosterone was defined as t tests, Kaplan-Meier analysis, binary logistic regression, and Cox regression analysis were used to determine statistical significance. Results Nearly all men with AUS cuff erosions had low serum testosterone (18/20, 90.0%) compared to those without erosions (12/33, 36.4%, P P = .009) and Kaplan-Meier analysis demonstrated decreased erosion-free follow-up (log-rank P = .002). Low testosterone was the sole independent risk factor for erosion in a multivariable model including coronary artery disease and radiation (odds ratio 15.78; 95% confidence interval 2.77-89.92, P = .002). Notably, history of prior AUS, radiation, androgen ablation therapy, or concomitant penile implant did not confound risk of cuff erosion in men with low testosterone levels. Conclusion Men with low testosterone levels are at a significantly higher risk to experience AUS cuff erosion. Appropriate counseling before AUS implantation is warranted and it is unclear whether testosterone resupplementation will mitigate this risk.

Background The authors present their experience with reconstructive strategies for men with various manifestations of adult buried penis syndrome, and propose a comprehensive anatomical classification system and treatment algorithm based on pathologic changes in the penile skin and involvement of neighboring abdominal and/or scrotal components. Methods The authors reviewed all patients who underwent reconstruction of adult buried penis syndrome at their referral center between 2007 and 2015. Patients were stratified by location and severity of involved anatomical components. Procedures performed, demographics, comorbidities, and clinical outcomes were reviewed. Results Fifty-six patients underwent reconstruction of buried penis at the authors' center from 2007 to 2015. All procedures began with a ventral penile release. If the uncovered penile skin was determined to be viable, a phalloplasty was performed by anchoring penoscrotal skin to the proximal shaft, and the ventral shaft skin defect was closed with scrotal flaps. In more complex patients with circumferential nonviable penile skin, the penile skin was completely excised and replaced with a split-thickness skin graft. Complex patients with severe abdominal lipodystrophy required adjacent tissue transfer. For cases of genital lymphedema, the procedure involved complete excision of the lymphedematous tissue, and primary closure with or without a split-thickness skin graft, also often involving the scrotum. The authors' overall success rate was 88 percent (49 of 56), defined as resolution of symptoms without the need for additional procedures. Conclusion Successful correction of adult buried penis often necessitates an interdisciplinary, multimodal approach. Clinical question/level of evidence Therapeutic, IV.

Despite the surge of corporate corruption scandals in recent years, corruption research tends to focus on public-sector corruption through the lens of political economy using widely used corruption...

The liability of foreignness is that foreign multinationals pay higher costs of doing business abroad than to domestic firms due to their lack of social embeddedness and lack of institutional knowl...

Purpose To (1) analyze verbatim wording used by adults who stutter (AWS) to self-disclose stuttering, (2) determine contexts in which AWS may self-disclose, (3) examine the use of self-disclosure by AWS about other aspects of their identity, and (4) investigate the ways in which speech-language pathologists (SLPs) develop self-disclosure statements with AWS. Method Web-based questionnaires were administered to AWS (N = 42) and SLPs (N = 33) who work with AWS. The AWS questionnaire asked about the verbatim wording of self-disclosure statements used by AWS and the contexts in which they utilize them. For SLPs, the questionnaire probed how and why they work with AWS to formulate self-disclosure statements. Responses were openly coded and then funneled into concepts for analysis. Results The majority of AWS provided verbatim self-disclosure statements which were educational in nature. However, when responding to fixed choices and when reporting on self-disclosing other aspects of their lives, the majority of participants selected a direct statement. The majority of AWS reported that they self-disclose when interviewing for a job. SLPs reportedly instruct their clients to use educational self-disclosure statements. SLPs also reported that they use an individualized approach to brainstorming self-disclosure statements. Finally, SLPs reported that they find self-disclosure beneficial because it facilitates self-empowerment for AWS. Conclusion AWS may benefit from learning about the type of self-disclosure statements and the contexts in which other AWS chose to disclose. Additionally, SLPs who work with AWS may benefit from the reported procedures for and types of self-disclosure statements formulated by AWS.

Purpose: The purpose of the current systematic review is to (1) guide and inform speech language pathologists involved in the treatment of persons who stutter in the development and implem...

We compared the results of initial excision and primary anastomosis urethroplasty to the excision and primary anastomosis outcomes of other challenging reoperative clinical settings, including secondary cases (prior urethroplasty of any technique other than excision and primary anastomosis) and repeat cases (prior excision and primary anastomosis).We reviewed our database of patients who underwent excision and primary anastomosis urethroplasty for bulbar urethral stricture at our tertiary referral center from 2007 to 2014. Patients without available data and those with a history of lichen sclerosus, radiation, pelvic fracture urethral injuries, distal strictures and/or hypospadias were excluded from analysis. Patient characteristics and outcomes were compared between those undergoing initial, secondary, and repeat excision and primary anastomosis urethroplasty for bulbar urethral stricture.Among 898 urethroplasties performed during the study period we identified 305 men who underwent excision and primary anastomosis urethroplasty of the bulbar urethra, including an initial procedure in 268 of 305 (88%) and reoperation in 37 (12%). Of patients with reoperation 18 of 37 (49%) underwent secondary excision and primary anastomosis following a different type of prior urethroplasty and 19 (51%) underwent repeat excision and primary anastomosis. Repeat excision and primary anastomosis in the bulbar urethra was successful in 18 of 19 patients (95%), which was comparable to the success rate of initial bulbar excision and primary anastomosis (251 of 268 or 94%) as well as secondary bulbar excision and primary anastomosis (17 of 18 or 94%, p = 0.975) with a similar mean stricture length. Mean followup for all patients was 41.5 months (range 6 to 90) and mean followup in each group was greater than 30 months.Repeat excision and primary anastomosis urethroplasty has excellent results for short bulbar strictures, comparable to those achieved in the initial and secondary setting.

We compared functional outcomes in patients who received an artificial urinary sphincter in the space of Retzius vs the same device placed at a high submuscular location.We reviewed a prospectively maintained database of patients who received an artificial urinary sphincter between July 2007 and December 2014. After cuff placement was completed via a perineal incision, a 61 to 70 cm H2O pressure regulating balloon was placed through a separate high scrotal incision in the space of Retzius or in a high submuscular tunnel. Demographics, perioperative comorbidities and functional outcomes were compared between the groups.A total of 294 consecutive patients underwent artificial urinary sphincter placement. Mean followup was 23 months. Space of Retzius and high submuscular placement was performed in 140 (48%) and 154 patients (52%), respectively. Functional outcomes were similar between the groups, including the continence rate (defined as 0 or 1 pad daily) in 81% vs 88% (p = 0.11), the erosion rate in 9% vs 8% (p = 0.66) and the explantation rate in 10% vs 11% (p = 0.62). Artificial urinary sphincter revision for persistent incontinence was required in a similar proportion of the 2 groups (13% vs 8%, p = 0.16) with a comparable mean followup (24 vs 23 months, p = 0.30). Kaplan-Meier analysis revealed no difference between the groups in the rate of explantation (p = 0.70) or revision (p = 0.06).High submuscular placement of a pressure regulating balloon at artificial urinary sphincter surgery is a safe, effective alternative with functional outcomes equivalent to those of traditional placement in the space of Retzius.

Objective: Many patients who undergo inflatable penile prosthesis (IPP) replacement are often upsized to larger cylinders, suggesting the IPP may serve as a tissue expander and increase internal penile length. The objective of this study is to evaluate whether cylinder length increases with subsequent IPP insertion. Materials and Methods: We queried American Medical Systems and Coloplast Patient Information Form databases to identify patients who underwent IPP placement and replacement between 2004-2013. Patients were grouped by device type and time to replacement (0.5 cm and 40% demonstrated increases of ≥1 cm. Conclusions: As demonstrated, the IPP may provide tissue expansion over time. Further evaluation is needed to determine if increased cylinder length correlates to increased functional length and patient satisfaction.

Introduction A preoperative negative urine culture is generally advised before implantation of urologic prosthetics to prevent device infection. However, a review of the medical literature indicates sparse evidence to support this practice. Aim To describe outcomes for patients undergoing prosthetic implantation without preoperative urine cultures. Methods The cases of men undergoing artificial urinary sphincter (AUS) and/or inflatable penile prosthesis (IPP) placement at a tertiary care center from 2007 through 2015 were reviewed. Of 713 devices implanted in 681 patients (337 AUSs in 314 patients, 376 IPPs in 367), 259 cases without preoperative urine cultures were analyzed (41%). Patients received standard perioperative antibiotics. Main Outcome Measures Device infection was diagnosed clinically. Average follow-up was 15 months. Results Device infection occurred in 4 of 259 patients (1.5%) with no difference noted in infection rate between device groups (AUS = 3 of 174 [2%]; IPP = 1 of 85 [1%]; P = .99); this rate appears to be consistent with the infection rate of numerous other published prosthetic series. Common skin organisms were implicated as the infectious agents in half the infected devices. Only one patient (0.4%) developed an Escherichia coli infection. Conclusion This study suggests that prosthetic urologic surgery can be safely performed without preoperative urine cultures. Kavoussi NL, Viers BR, Pagilara TL, et al. Are Urine Cultures Necessary Prior to Urologic Prosthetic Surgery? Sex Med Rev 2017;X:XXX–XXX.

Institutions are one of the most important factors that determine corporate strategy. However, firm response is not homogeneous but heterogeneous to these institutions. Even firms try to strategize...

Introduction Refractory ischemic priapism (RIP) can be difficult to treat, consuming significant healthcare-related resources. Acute insertion of a malleable penile prosthesis (MPP) has been reported as an effective therapy that treats the priapism and restores sexual function. Aim We report our 6-year, urban public hospital experience with acute insertion of MPP in patients with RIP. Methods We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007 to 2013. Data analyzed included duration of erection, number of emergency room (ER) visits, hospital admissions, days of hospitalization, and postoperative course. Costs were estimated using standard Medicare reimbursement rates. Main Outcome Measure Healthcare-related costs of treatment of RIP episodes in men presenting to our institution. Results During the study period, 14 men underwent MPP placement acutely for refractory priapism. Thirteen presented with RIP, and one had stuttering priapism over a 14-day hospitalization. Etiologies included sickle cell anemia (4/13, 29%), medication-induced (3/14, 21%), and idiopathic (7/14, 50%). Average preoperative duration of RIP was 82 hours with considerable consumption of health-care resources (average US $83,818 estimated cost, 4 ER visits [range 1–27], 2 hospital admissions [range 1–5], 1.5 shunt procedures [range 1–3], 5 irrigation and drainage procedures using phenylephrine injection [range 2–20], and 5 hospital admission days [range 2–14]). All patients were discharged within 24 hours of MPP surgery. Conclusions The management of RIP is associated with multiple ER visits, prolonged hospital admissions, and significant resource utilization. MPP insertion is efficacious for the immediate resolution of refractory priapism, with potential cost and resource benefits.

Traditionally, studies on entrepreneurship are focused on individual dispositions and motivations that make a person more or less likely to become an entrepreneur. More recent work, however, has dr...

The symposium on Causes and Consequences of Corporate Corruption will discuss new theory and new findings from multiple disciplinary perspectives. By coming together across the disciplinary divide,...