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Purpose To evaluate the burden of incisional glaucoma surgery (trabeculectomy and glaucoma drainage device implantation) after laser trabeculoplasty (LTP) in the United States. Design Retrospective, matched, case-comparison study. Participants Medicare beneficiaries who underwent LTP between January 2012 and December 2014 were identified using the 5% Medicare Current Beneficiary Survey. Methods Subjects aged 35 years or older at the time of LTP with ocular hypertension, suspected glaucoma, or mild open-angle glaucoma (OAG) were matched to a comparison group without LTP on the basis of age, gender, race, geographic region, and glaucoma diagnosis codes. Survival analysis and Cox proportional hazard analysis were performed. Main Outcome Measures Primary analysis included risk of incisional glaucoma surgery. Secondary analysis included risk of conversion to moderate or severe OAG based on billing data. Results The mean age of study participants was 75.0 ± 8.9 years. After 2 years, 40 of 2435 eyes required incisional glaucoma surgery after LTP, and 51 of 2435 eyes required glaucoma surgery in the comparison group (P = 0.27, adjusted for covariates). Regardless of intervention, Black Americans were more likely to require glaucoma surgery (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.13–3.17). Patients with a diagnosis of OAG were more likely to require surgery than glaucoma suspects (HR, 2.03; 95% CI, 1.12–3.69). Black Americans were also more likely to require surgery or convert to more severe glaucoma (HR, 3.21; 95% CI, 1.92–5.37) versus White Americans. Conclusions Laser trabeculoplasty did not alter the need for subsequent incisional glaucoma surgery among glaucoma suspects or patients with mild OAG. Regardless of treatment with LTP, African heritage and OAG diagnosis status were risk factors for requiring glaucoma surgery.

Introduction: The main aim of this article was to study the retinal peripapillary and macular vascular structures in eyes with primary angle-closure suspects (PACS) using optical coherence tomography angiography (OCTA). Methods: In this cross-sectional study, control and PACS subjects were recruited from a community screening. Only one eye per subject was used for analysis. All participants underwent a questionnaire survey, physical and ophthalmic examinations, ocular biometry measurements, and OCTA. We compared basic demographics and vessel structure parameters between control and PACS eyes. Univariate and multivariate linear regression analyses were performed to investigate factors associated with vascular parameters in both groups. Results: Data from 254 subjects including 155 PACS and 99 controls were analyzed. In the peripapillary region, PACS eyes showed similar retina nerve fiber layer (RNFL) and vessel densities (VDs) including and excluding large vessels compared to control eyes. Compared to control eyes, all macular OCTA parameters showed significant differences in PACS eyes, including decreased superficial VD (p = 0.006) and deep VD (p = 0.004), larger fovea avascular zone (FAZ) area (p = 0.006), and longer FAZ perimeter (p = 0.004). Gender (p = 0.039), age (p < 0.001), and Garway-Heath superior hemisphere RNFL (p < 0.001) were risk factors influencing optic disc VD excluding large vessels. Axial length was the major factor affecting macula superficial and deep VDs (p = 0.004 and 0.001 respectively), while PACS was an independent factor associated with larger FAZ perimeter (p = 0.046). Conclusion: While PACS and control eyes have comparable RNFL and vascular structure around the optic nerve head, macular vascular structures are significantly different.

PRCIS The multiplicity of treatment options for lowering intraocular pressure (IOP) is both a blessing and a challenge. Some attention to cost-analysis might assist in choosing an optimal therapy, especially in a cost-constrained, international setting. PURPOSE The aim of this study was to quantify and to analyze the relative cost of various glaucoma surgical procedures and selective laser trabeculoplasty surgery per mm Hg IOP reduction ($/mm Hg) since standard cost-utility methods are not well suited to the study of glaucoma which characteristically only claims visual acuity in its end stages. METHODS Published glaucoma treatment studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for a given treatment modality. A US perspective was adopted, using Medicare allowable costs were used to calculate a newly introduced parameter-cost per mm Hg IOP reduction-at 1 year postoperatively. RESULTS The cost per mm Hg IOP reduction after 1 year of treatment ranged from $190/mm Hg for trabeculectomy to $1376/mm Hg for iStent. For reference, the cost of selective later trabeculoplasty surgery was $121/mm Hg. After the first year, cost/mm Hg ranged from $12 to $61/mm Hg. CONCLUSIONS Conventional glaucoma surgeries and selective laser trabeculoplasty surgery were the most cost-efficient surgical methods to lower IOP compared with the various minimally invasive glaucoma surgeries options. They may be more appropriate management when cost is an important issue.

Reporting treatment outcomes of slow coagulation transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in pseudophakic patients with glaucoma.Retrospective case series.This single academic center study reviewed 74 pseudophakic patients who had a diagnosis of glaucoma and no previous glaucoma surgeries (mean age 82.6 ± 12.5 years; mean follow-up 18.7 ± 9.1 months). The intervention used was slow coagulation continuous wave TSCPC (1250-mW power and 4-second duration). The primary outcome measure was surgical success defined as an intraocular pressure (IOP) of 6-21 mm Hg with a ≥20% reduction from baseline, no reoperation for glaucoma, and no loss of light-perception vision. Secondary outcome measures included glaucoma medication use, visual acuity (VA), and complications.IOP decreased from 27.5 ± 9.8 mm Hg preoperatively to 16.1 ± 6.3 mm Hg postoperatively (P.001). The preoperative number of glaucoma medications was 4.1 ± 0.9 and 3.1 ± 1.3 post-TSCPC (P.001). The cumulative probabilities of success at 1 and 2 years were 60.6 % and 58.5%, respectively. When patients were divided into 2 groups based on their baseline IOP being21 mm Hg (high group) or ≤21 mm Hg (low group), success rates at 2 years were 64.9% and 45.5%, respectively (P = .144). The mean logarithm of the minimum angle of resolution VA changed from 0.70 ± 0.64 to 1.04 ± 0.87 at the last follow-up visit (P = .01). No serious complications were observed and most of the complications were mild and transient.Slow coagulation TSCPC has good efficiency, especially in patients with baseline IOP21 mm Hg, and safety profile as an initial surgical intervention in pseudophakic patients with glaucoma.

To report treatment outcomes of primary transscleral cyclophotocoagulation (TSCPC) in glaucomatous eyes.Retrospective noncomparative study.Forty-eight eyes with a diagnosis of glaucoma and no previous incisional ocular surgery.Continuous-wave TSCPC was applied to the ciliary body.The primary outcome measure was surgical success defined as an IOP ≤ 21 mmHg and reduced by 20% or more from baseline, IOP5 mmHg, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures included visual acuity (VA) and complications.Glaucoma eyes were stratified into 2 groups: (1) those with pretreatment IOP21 mmHg (high group) and (2) those with pretreatment IOP ≤ 21 mmHg (low group). Mean ± standard deviation (SD) IOP at baseline was 30.6 ± 6.3 mmHg in the high group and 16.2 ± 2.8 mmHg in the low group. Mean ± SD number of glaucoma medications at baseline was 4.1 ± 0.8 in the high group and 3.6 ± 1.1 in the low group. Based on our success criteria, the cumulative probability of success during the first year of follow-up was 58.3% in the high group and 28.1% in the low group (P = 0.052). Postoperative mean IOP was significantly lower than baseline IOP in the high group at 1-, 3-, 6-, 12-, and 18-month postoperative visits (P0.05). No significant change was observed in IOP at follow-up visits after 1 month in the low IOP group. Throughout the first year of follow-up, both groups required fewer glaucoma medications compared with baseline at the 1-, 3-, 6-, and 12-month postoperative visits (P0.05). The most frequent cause of postoperative decrease in VA was cataract in 9 eyes. Decrease in vision resulting from glaucoma was observed in 3 eyes. Complications included prolonged inflammation (11 eyes), iris neovascularization (2 eyes), cystoid macular edema (4 eyes), and hyphema (1 eye). No severe or long-term complications were observed.Continuous-wave TSCPC was effective in lowering IOP in glaucoma patients without prior incisional ocular surgery whose disease was recalcitrant to medical therapy, particularly those with baseline IOP of more than 21 mmHg.

Novel minimally invasive therapies like the prostatic urethral lift are among the many endoscopic options for the treatment of benign prostatic enlargement and lower urinary tract symptoms (BPE/LUTS). To further understand the relative uptake, complications and retreatment rates of contemporary endoscopic procedures for BPE/LUTS across diverse practice types, we performed a retrospective study of inpatient and ambulatory surgery encounters in the Premier Healthcare database.We included men who underwent endoscopic procedures for BPE/LUTS between 2000 and 2018. We determined the utilization of endoscopic therapies for BPE/LUTS, 30-day and 90-day readmission rates, and retreatment rate. Multivariable logistic regression was used to assess the association of procedure type with outcomes for the 3 most commonly performed procedures.We identified 175,150 men treated with endoscopic surgery for BPE/LUTS. The annual percent utilization of the prostatic urethral lift increased from1% in 2014 to 10.4% in 2018. Compared to transurethral resection of the prostate and prostate photovaporization, prostatic urethral lift was associated with a lower odds of readmission at 30 (OR 0.58, p0.01) and 90 (OR 0.55, p0.01) days and a higher odds of retreatment within 2 years of followup (OR 1.78, p0.01).Providers have rapidly adopted prostatic urethral lift which accounted for more than 1 in 10 endoscopic procedures captured for BPE/LUTS in 2018. Men treated with prostatic urethral lift are readmitted less within 30 and 90 days but are more likely to be retreated within 2 years of their index procedure as compared to men treated with transurethral resection of the prostate or prostate photovaporization.

Objective To determine whether the academic achievement of Department Chairperson (DC) and Research Director (RD), when present, is associated with increased scholarly productivity and National Institutes of Health (NIH) funding of faculty members in academic urology departments. Materials and Methods We identified the DC, RD and faculty members of 145 academic urology departments. The scholarly productivity and NIH funding for each individual faculty member was assessed from 2018 to 2019 using an h-index extrapolated from the Scopus database and the NIH RePORTER tool, respectively. The Spearman correlation coefficient was employed to define the correlation of these parameters. Hypothesis testing was conducted using the Mann-Whitney U test. Results After excluding 13 departments due to missing faculty listing, our final sample included 132 departments and 2227 faculty members. In 2018, the NIH provided $55,243,658 in urology research grants to 24.2% of departments and 4.0% of faculty members. Of departments with NIH funding, 68.8% employed a RD. DC and RD h-index were positively correlated with departmental h-index. DC h-index positively correlated with department NIH funding. Moreover, NIH funding was significantly higher for departments with a RD vs those without a RD ($1,268,028 vs $62,941, P Conclusion Academic success of a DC and RD was associated with urology departmental scholarly productivity and NIH funding. The presence of a RD, funded or unfunded, was associated with increased departmental NIH funding.

The mammalian retina displays incomplete intrinsic regenerative capacities; therefore, retina degeneration is a major cause of irreversible blindness such as glaucoma, age-related macular degeneration and diabetic retinopathy. These diseases lead to the loss of retinal cells and serious vision loss in the late stage. Stem cell transplantation is a great promising novel treatment for these incurable retinal degenerative diseases and represents an exciting area of regenerative neurotherapy. Several suitable stem cell sources for transplantation including human embryonic stem cells, induced pluripotent stem cells and adult stem cells have been identified as promising target populations. However, the retina is an elegant neuronal complex composed of various types of cells with different functions. The replacement of these different types of cells by transplantation should be addressed separately. So far, retinal pigment epithelium transplantation has achieved the most advanced stage of clinical trials, while transplantation of retinal neurons such as retinal ganglion cells and photoreceptors has been mostly studied in pre-clinical animal models. In this review, we opine on the key problems that need to be addressed before stem cells transplantation, especially for replacing injured retinal ganglion cells, may be used practically for treatment. A key problem we have called the Switchboard Dilemma is a major block to have functional retinal ganglion cell replacement. We use the public switchboard telephone network as an example to illustrate different difficulties for replacing damaged components in the retina that allow for visual signaling. Retinal ganglion cell transplantation is confronted by significant hurdles, because retinal ganglion cells receive signals from different interneurons, integrate and send signals to the correct targets of the visual system, which functions similar to the switchboard in a telephone network - therefore the Switchboard Dilemma.

Overactive bladder syndrome is a prevalent condition impacting quality of life, activities of daily living, work productivity, physical and psychological health, sleep, and sexuality. Published guideline recommendations and effective behavioral, pharmacologic, and neuromodulatory therapies exist; however, adherence can be poor. Clinicians have important roles educating patients, setting treatment expectations, and providing follow-up. Determining patient goals, routinely assessing and adjusting therapy, and combining treatment strategies may improve outcomes. We review the benefits and challenges of overactive bladder treatments and propose approaches to improve patient management, with the goals of initiating therapy earlier and achieving better patient satisfaction, functioning, and quality of life.

Aim Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. Methods This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. Results Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR, 3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. Conclusion This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.

Aim To report outcomes of patients after intraocular lens (IOL) repositioning or exchange for the version of the uveitis-glaucoma-hyphema (UGH) syndrome that does not include closed loop anterior chamber IOL (nUGH). Methods Chart review of patients with nUGH who underwent IOL repositioning or exchange by one surgeon were reviewed. The main outcome measures were best corrected visual acuity (BCVA) as a decimal fraction preoperatively and postoperatively after IOL repositioning or exchange. Clinical findings evaluated included the presence of uveitis, hyphema, elevated intraocular pressure (IOP), and other complications such as pigment dispersion or vitreous hemorrhage. The number of anti-inflammatory and glaucoma medications were assessed before and after IOL repositioning or exchange. Results The study included 14 pseudophakic eyes. The median time at the onset of contemporary UGH after cataract extraction and IOL implantation (CE/IOL) was 7.5y. IOL repositioning or exchange was performed at a mean duration of 8.1±4.7mo (median: 4mo) after onset of UGH. The mean BCVA was improved from 0.45±0.26 preoperatively after onset of UGH syndrome to 0.76±0.22 (P=0.016) after IOL repositioning or exchange. Among the 14 eyes, uveitis, elevated IOP, and hyphema were present preoperatively in 13, 13, and 6 eyes, respectively. Uveitis and hyphema resolved in all cases after IOL surgery. The mean IOP was reduced from 26.4±4.5 mm Hg preoperatively to 14.7±4.9 postoperatively (P=0.01). The mean number of glaucoma medications used was reduced from 1.7±1.1 medications preoperatively to 0.8±1.08 (P=0.04) postoperatively. Conclusion IOL repositioning or exchange is an effective treatment in many cases for medically resistant contemporary UGH syndrome.

A minimum number of index procedures is required for graduation. Without thresholds for surgical technique, it is unclear if robotic and open learning is balanced. We assessed the distribution of robotic and open surgeries performed by residents upon graduation.Voluntary Accreditation Council for Graduate Medical Education resident case logs from 11 institutions were de-identified and trends in robotic and open major surgeries were compared using Wilcoxon rank sum and 2-sample t-tests.A total of 89,199 major cases were recorded by 209 graduates from 2011 to 2017. The median proportion of robotic cases increased from 2011 to 2017 in reconstruction (4.7% to 15.2%), oncology (27.5% to 54.2%) and pediatrics (0% to 10.9%) (all values p0.001). Robotic and open cases remained most divergent in reconstruction, with a median of 12 robotic (IQR 9-19) to 70 open cases (IQR 55-106) being performed by residents in 2017. Similar observations occurred in pediatrics. In oncology the number of robotic procedures superseded that of open in 2016 and rose to a median of 148 robotic (IQR 108-214) to 121 open cases (IQR 90-169) in 2017, with the driver being robotic prostatectomy. Substantial differences in surgical technique were observed between institutions and among graduates from the same institution.Although robotic volume is increasing, the balance of surgical technique and the pace of change differ in reconstruction, oncology and pediatrics, as well as among individual institutions and graduates themselves. This raises questions about whether more specific guidelines are needed to ensure equity and standardization in training.

Overactive bladder (OAB) is a widely prevalent urinary condition affecting women of all ages, with increasing incidence in advancing age. A primary care provider is likely to encounter a significant proportion of women experiencing lower urinary tract symptoms (LUTS). This review serves primary care physicians as a thorough reference for a common condition causing LUTS in women. Most emerging data addressing overactive bladder relates to the different treatment modalities available. The side effect profile of antimuscarinic drugs remains an ongoing concern among OAB patients, especially with recent data linking the use of this class of drugs with Alzheimer’s and future development of dementia. In addition, it was recently demonstrated that individuals taking medications of medium-to-high anticholinergic activity had reduced brain glucose metabolism and increased brain atrophy. Combination treatments seem to be more efficacious than monotherapies, as has been proven when using mirabegron with antimuscarinics. Many studies have also validated the use of neuromodulation as a safe and effective treatment for OAB. Overactive bladder is a widely prevalent urinary condition affecting women of all ages. It is regarded as multifactorial with several proposed theories to explain its occurrence. Several tests are available to aid in diagnosing OAB. Symptom severity and patient-related factors including patient preferences drive treatment.

Purpose To compare the long-term safety and efficacy of amniotic membrane–umbilical cord (AM–UC) and pericardium patch grafts in reducing glaucoma shunt tube exposure. Design Multicenter, prospective, randomized clinical trial. Participants Adults with uncontrolled glaucoma undergoing glaucoma drainage device (GDD) implantation. Methods Patients were randomized to receive GDD with either AM-UC or pericardium patch grafts to cover GDD tubes. Patients were followed up clinically with anterior segment (AS) OCT to assess patch graft stability and host–tissue integration prospectively. Main Outcome Measures Tube exposure, graft thinning, and graft-related complications. Results A total of 81 eyes of 81 patients (50 women, 31 men) with a mean age of 67±13 years underwent GGD implantation using Baerveldt (n = 72) or Ahmed valve (n = 9). Tubes were inserted in the anterior chamber (n = 71), sulcus (n = 6), or pars plana (n = 4). Tube ligation was performed with Baerveldt GDD along with fenestration (n = 51) or orphan trabeculectomy (n = 21). Tubes were covered with AM–UC (n = 41) or pericardium (n = 40). The mean follow-up time was 29±8 months (range, 13–40 months). Tube exposure occurred in 1 eye (2%) in the AM–UC group at 3 months and in 2 eyes (5%) in the pericardium group at 2 and 6 months (P = 0.54). Sequential AS OCT showed better host–tissue integration and significantly less graft thinning in the AM–UC group. Early graft thinning (≤3 months) occurred in 5 eyes (12%) in the AM–UC group and in 17 eyes (43%) in the pericardium group (P = 0.002). Late thinning occurred in 2 eyes (5%) and 11 eyes (28%) in the AM–UC and pericardium groups, respectively (P = 0.007). Graft translucency and cosmetic appearance of the AM–UC graft were superior to those of the pericardium graft. No evidence of graft rejection or infection was associated with the patch grafts in either group. Conclusions Amniotic membrane–umbilical cord grafts are well tolerated and offer an alternative to pericardium for safe and stable tube shunt coverage. Its high-tensile strength, low immunogenicity, and excellent host–tissue integration significantly reduced graft thinning.

Purpose The HGF/MET pathway is involved in cell motility, angiogenesis, proliferation, and cancer invasion. We assessed the clinical utility of plasma HGF level as a prognostic biomarker in patients with MIBC. Methods We retrospectively analyzed 565 patients with MIBC who underwent radical cystectomy. Logistic regression and Cox regression models were used, and predictive accuracies were estimated using the area under the curve and concordance index. To estimate the clinical utility of HGF, DCA and MCID were applied. Results Plasma HGF level was significantly higher in patients with advanced pathologic stage and LN metastasis (p = 0.01 and p p p p p Conclusion Preoperative HGF identified MIBC patients who harbored features of clinically and biologically aggressive disease. Plasma HGF could serve, as part of a panel, as a biomarker to aid in preoperative treatment planning regarding intensity of treatment in patients with clinical MIBC.

There have been significant advancements in male infertility microsurgery over time, and there continues to be significant promise for new and emerging techniques, technologies, and methodologies. In this review, we discuss the history of male infertility and the evolution of microsurgery, the essential role of education and training in male infertility microsurgery, and new technologies in this space. We also review the potentially important role of artificial intelligence (AI) in male infertility and microsurgery.

Purpose To describe a unique incidence of inadvertent filtering bleb creation after intravitreal injections. Observations An 84-year-old woman with a history of wet age-related macular degeneration requiring intravitreal injections presented with a Seidel-positive conjunctival cyst. The cyst was in an area where she had received multiple injections and was suspected to be an inadvertent filtering bleb secondary to a full-thickness scleral hole created by these injections. She underwent surgical closure of the fistula and repair of the bleb. Conclusions and Importance This case emphasizes the importance of recognizing this potential complication of intraocular injections and outlines steps that should be taken to prevent poor outcomes and vision loss.

AimsTo report treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in patients with neovascular glaucoma (NVG).MethodsA retrospective study including 53 patients (mean age of 69.6±16.6 years and mean follow-up of 12.7±8.9 months) with a diagnosis of NVG and no previous incisional glaucoma or cyclophotocoagulation surgeries. All patients underwent slow-coagulation continuous-wave TSCPC (1250-milliwatt power and 4-second duration).Primary outcome measure was surgical success defined as an intraocular pressure (IOP) from 6 to 21 mm Hg with a reduction ≥20% from baseline, no reoperation for glaucoma and no loss of light perception vision. Secondary outcome measures include IOP, glaucoma medications, visual acuity (VA) and complications.ResultsIOP decreased from 40.7±8.6 mm Hg preoperatively to 18.4±12.2 mm Hg postoperatively (pConclusionsSlow-coagulation TSCPC is an effective and relatively safe initial surgical intervention in medically uncontrolled NVG.

The present study aims to investigate the effect of temporary cerebrospinal fluid pressure (CSFP) reduction on optic nerve head (ONH) and macular vessel density (VD) using optical coherence tomography angiography. Forty-four eyes of 44 adults with diagnostic lumbar puncture and CSFP reduction were recruited. Thirty-two eyes of 32 healthy volunteers were controls. ONH and macular VD images were evaluated differences between baseline and after CSFP reduction. The results showed that the mean CSFP decreased from (11.6±2.1) mmHg to (8.2±3.4) mmHg (P 0.05). In the study group, decreased VD in the macular parainferior region was associated with CSFP reduction (R2=0.192, P=0.003), the reduction of macular VD in parafoveal (R2=0.098, P=0.018), parainferior (R2=0.104, P=0.021), parasuperior (R2=0.059, P=0.058), paranasal (R2=0.057, P=0.042), paratemporal (R2=0.079, P=0.026) was associated with mean ocular perfusion pressure decrease following CSFP reduction. ONH vessel density did not differ after CSFP reduction (all P>0.05). In conclusion, macular vessel density decreased in association with CSFP reduction. Retinal vessel density in the macular region is more sensitive than that in peripapillary region after CSFP reduction.

Objective To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. Methods The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. Results The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). Conclusion NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.

Male circumcision (MC) is one of the oldest surgical procedures still completed today. Medical indications for MC include phimosis, recurrent balanitis, cosmesis, and infection prevention. In this review, we mainly focus on the role of MC in the prevention of human immunodeficiency virus, human papillomavirus, herpes simplex virus, gonorrhea, chlamydia, chancroid, and syphilis, and the subsequent impact of these genitourinary infections on male fertility. Overall, many compelling data support that MC may play an essential role in both genitourinary infection prevention and male fertility.

Mohamed M Khodeiry,1,2 Xiangxiang Liu,1,3 Mohamed S Sayed,1 Raquel Goldhardt,1 Giovanni Gregori,1 Thomas A Albini,1 Richard K Lee1 1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; 2Research Institute of Ophthalmology, Department of Ophthalmology, Giza, 12557, Egypt; 3Beijing Eye Institute, Beijing Tongren Eye Center, Beijing Tongren Eye Hospital, Capital Medical University, Beijing, 100730, People’s Republic of ChinaCorrespondence: Richard K LeeBascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, 900 NW 17 th Street, Miami, FL 33136, USATel +1 305 326-6400Fax +1 305 547-3658Email rlee@med.miami.eduPurpose: Peripapillary halos (PPH) are peripapillary changes observed surrounding the optic nerve head in normal eyes and eyes with different disorders. Recognizing the microstructure and mechanism of development of these halos will help clinicians understand the different associated retinal and optic nerve head pathologies. We describe the in vivo histological characteristics of PPH in birdshot chorioretinopathy (BSCR).Patients and Methods: This was a prospective observational case-series in a single tertiary referral center. Six eyes of three patients with PPH associated with BSCR were determined through clinical examination, fundus photography, and fundus autofluorescence (FAF). Patients underwent swept-source optical coherence tomography (SS-OCT) imaging of the optic nerve head and peripapillary region.Results: In SS-OCT B-scans across the area of PPH, we observed thinning and interruption of retinal pigment epithelium (RPE)-Bruch’s membrane complex. These halos are a circumferential form of alpha zone RPE-associated crescentic peripapillary atrophy (PPA), unlike the PPH observed with myopia and normal aging.Conclusion: PPH in BSCR patients may be a sign of prior inflammatory optic neuropathy.Keywords: birdshot chorioretinitis, optical coherence tomography, optic nerve head, peripapillary halo, peripapillary atrophy

Context In recent years, new technologies have been developed to treat benign prostatic enlargement (BPE). Three of these devices may be utilized in office and are promising additions. Objective To systematically review all clinical trials investigating prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND), with emphasis on clinical efficacy and complications. Evidence acquisition We performed a systematic review of PubMed/Medline database in November 2020 according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Evidence synthesis Of 168 articles identified, 18 met the inclusion criteria. Evidence consisted of few randomized controlled trials, and multiple single-arm prospective and retrospective studies. Among the three modalities, PUL demonstrates rare occurrence of serious complications but higher retreatment rates at short- and long-term follow-up. WVTT offers lower retreatment rates with a similar safety profile. TIND studies report varying rates of retreatment and complications. All technologies offer low rates of erectile and ejaculatory dysfunction, although the risk appears to be highest for WVTT ( Conclusions Among the emerging technologies introduced to treat BPE, the in-office PUL, WVTT, and TIND systems are valuable additions to the current surgical options. These systems offer unique advantages that should be considered in the shared decision-making process. Patient summary In this report, we identified all clinical trials reporting on the efficacy and safety of the in-office prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND) systems for the treatment of benign prostatic enlargement. We found that PUL and WVTT demonstrate acceptable outcomes in terms of functional improvement, retreatment, and complications. More data with longer follow-up are required to further evaluate TIND, but early results are promising.

Pseudoexfoliation syndrome (PEX) is characterized by the production of white extracellular fluffy clumps of microfibrillar material that aggregates in various organs throughout the body but is known to cause disease in the eye. The accumulation of PEX material (PEXM) in the anterior segment ocular structures is believed to cause an increase in intraocular pressure (IOP) resulting in pseudoexfoliation glaucoma (PEXG). The onset of PEXG is often bilateral but asymmetric-one eye often presents with glaucoma prior to the other eye. Proteomics has been used to identify key proteins involved in PEXM formation with the end goal of developing effective treatments for PEX and PEXG which may act through inhibiting the formation of the PEX aggregates. To date, a variety of proteins with various molecular functions have been identified from extracted anterior segment structures and fluids, such as aqueous humor (AH) and blood serum of patients affected by PEX. From past studies, some proteins identified in AH, lens capsule epithelium, iris tissue, and blood serum samples include vitamin D binding protein (GC), apolipoprotein A4 (APOA4), lysyl oxidase like-1 (LOXL1), complement C3, beta-crystalline B1, and B2, and antithrombin-III (SERPINC1). Each of these proteins have been observed in eyes with PEX at varying levels within the different eye structures. In this review, we further examine the anterior segment ocular proteomics of PEXM from past studies to better understand the mechanism of PEX and PEXG development. Both genetic and environmental risk factors have been implicated to be involved in the development of PEX and PEXG. This field is at an early stage of investigation identifying how these factors modify proteins both at the expression and functional level to cause changes leading to the pathophysiology of PEX glaucoma.

Testicular torsion (TT) is a common urologic emergency that can occur at any age. It is most common in newborns and during puberty. Prompt evaluation and management is required to salvage the testis following an episode of torsion. TT brings about damage to testicular tissue and spermatogenesis through various hypothesized mechanisms; however there is a consensus that the effects of ischemia, ischemia-reperfusion injury, and oxidative stress account for the most destructive effects. Numerous studies have examined the effects of various agents and therapies in limiting the effects of TT on the testis.

The optic nerve transfers visual information from the retina to the brain through the axons of retinal ganglion cells (RGCs). In adult mammals, optic nerve injuries and progressive degenerative diseases lead to the irreversible loss of RGCs, resulting in vision loss and blindness. Optogenetic models have proved useful in manipulating the growth of RGCs through expression and stimulation of channelrhodopsins (Chr2) in RGCs using the RGC-specific thy-1 promoter. Using transgenic Chr2 mouse (Thy1-ChR2-EYFP) as a model of regeneration, we profile the lipid changes which occur after traumatic optic nerve crush, light stimulation and forced RGC axonal growth. Thy1-ChR2-EYFP and control (C57BL/6) mice were divided in four groups each - 1) no crush and no stimulation, 2) no crush with stimulation, 3) crush and without stimulation, and 4) crush with stimulation. After euthanasia, the optic nerves were collected for lipidomic analysis. The Bligh and Dyer method was used for lipid extraction, followed by mass spectrometry lipid profiling with a Q-Exactive Orbitrap Liquid Chromatography-Mass Spectrometer (LC MS-MS). The raw scans were analysed with LipidSearch 4.1.3 and the statistical analysis was conducted through Metaboanalyst 4.0. This data is available at Metabolomics Workbench, study ID ST001381: [https://www.metabolomicsworkbench.org/data/DRCCMetadata.php?Mode=Study&StudyID=ST001381&StudyType=MS&ResultType=5].

Background To investigate the distribution of peripheral anterior chamber depth (ACD) and the relationship between peripheral ACD and gonioscopy compared to other ocular parameters for primary angle closure disease (PACD) screening. We performed a population-based survey in Pudong New District of Shanghai, China, in 2011. Methods Cross-sectional study. Adults 50 and older were enrolled from a population-based study using cluster random sampling in Pudong New District, Shanghai. Remote ocular screening was performed with digital anterior eye structure photography. Van Herrick measurements were used to evaluate the peripheral ACD, the depth of the peripheral anterior chamber, and corneal thickness (CT), and the ACD to CT ratio was calculated. Subjects with peripheral ACD less than 0.5 CT were made follow-up appointments for clinical examination with gonioscopy. Receiver operating characteristic curves (ROC) were generated to show the performance of different tests in screening for primary angle closure disease (PACD). Results Two thousand five hundred twenty-eight adults participated in the study with 91 patients diagnosed with PACD. Two thousand four hundred sixty-three subjects had valid data in the right eye available for analysis. The mean peripheral ACD values for men and women were significantly different: 1.04 ± 0.46 (range 0.11–2.93) CT and 0.87 ± 0.41 (range 0.12–2.96) CT respectively (t = − 4.18; PP P P Conclusions Peripheral ACD measurement is recommended for PACD screening in community elderly Chinese.

A 42-year-old Hispanic female underwent intravitreal autologous adipose-tissue derived stem cell injection to her left eye in the Dominican Republic for treatment of retinitis pigmentosa associated with Usher Syndrome. Prior to intravitreal injection, the patient's best-corrected-visual-acuity (BCVA) was 1/200. The patient experienced decreased vision gradually over a 3-month period. The patient presented with no light perception (NLP) vision with a total funnel retinal detachment, as well as hyphema, iris neovascularization, and nearly 360 posterior synechiae of the iris to the lens capsule. The patient suffered from ocular pain with an intraocular pressure (IOP) of 37 mm Hg. Transcleral cyclophotocoagulation was performed. The IOP was 6 mm Hg six weeks after treatment and the patient was pain free.

Traumatic optic neuropathy leads to bidirectional degeneration of retinal ganglion cells and axons and results in optic nerve scaring, which inhibits the regeneration of damaged axons. Compared with its glial counterpart, the fibrotic response causing nerve scar tissue is poorly permissive to axonal regeneration. Using collagen1α1-GFP reporter mice, we characterize the development of fibrotic scar formation following optic nerve crush injury. We observe that perivascular collagen1α1 cells constitute a major cellular component of the fibrotic scar. We demonstrate that extracellular molecules and monocytes are key factors contributing to the pathogenesis of optic nerve fibrotic scar formation, with a previously unrecognized encapsulation of this scar. We also characterize the distribution of collagen1α1 cells in the retina after optic nerve crush injury based on in vivo and whole-mount retinal imaging. Our results identify collagen1α1 cells as a major component of fibrotic scarring following ONC and are a potential molecular target for promoting axonal regeneration after optic nerve injury.

INTRODUCTION AND OBJECTIVE:The World Health Organization (WHO) has established a target of 27 million male circumcisions (MC) by the year 2021 for HIV prevention in sub-Saharan Africa, with an emph...

Spectral-domain optical coherence tomography (SD-OCT) is a key tool in the diagnosis and evaluation of glaucoma. On OCT printouts, measurements of the retinal nerve fiber layer (RNFL), macula, and optic nerve are compared to a normative database of age-matched normals and then color-coded. A color-coding of green (“within normal limits”) suggests that the patient is normal and has nerve tissue values similar to age-matched normals. Yellow (“borderline”) is a warning and suggests that the patient’s values may be slightly thinner than normal. Red (“outside normal limits”) indicates that the patient has glaucoma and has very thin nerve tissue.

Sports-related eye injury is a significant cause of morbidity and disability and accounts for a significant proportion of ocular trauma, especially in the young. Although some sports-related ocular injuries can be self-resolving and require little to no intervention, many other injuries have long-term sequelae that require extensive treatment and follow-up. A thorough evaluation of the mechanism of and circumstances surrounding the ocular injury is important to guide further management of the case. Blunt trauma has a significantly different pathophysiologic process compared to trauma by a sharp object, and the evaluation of the injury should be cognizant of the ocular trauma expected. The conjunctiva is most frequently involved in sports-related ocular injuries, and the nature of the conjunctival injury can often indicate involvement of other potential ocular structures. Examples of other anterior segment injuries that can result from sports-related ocular trauma include structural or functional damage to the cornea, iris injury leading to iris prolapse or laceration, ciliary body injury resulting in ciliary body detachment, lens injury resulting in cataract or subluxation/dislocation of the lens, and traumatic glaucoma. In this chapter, we provide a comprehensive review of the pathogenesis, clinical findings, treatment options, and prognosis of sports-related injuries of the anterior segment.

Purpose To compare the outcomes of standard pop-titrated transscleral cyclophotocoagulation (TSCPC) and slow-coagulation TSCPC in the treatment of glaucoma. Design Retrospective case series. Participants Seventy-eight eyes with glaucoma of any type or stage that underwent TSCPC as part of their treatment course. Methods This study compared 52 eyes treated with slow-coagulation TSCPC with 26 eyes treated with standard pop-titrated TSCPC. Patient demographics, treatment course, surgical techniques, settings, and outcomes were assessed. Main Outcome Measures Visual acuity (VA), intraocular pressure (IOP), and postsurgical complications. Results The initial mean VA was 1.94 logarithm of the minimum angle of resolution (logMAR; standard deviation [SD], 0.73 logMAR) in the slow-coagulation TSCPC group and 1.71 logMAR (SD, 0.90 logMAR) in the standard TSCPC group (P = 0.507). Initial IOP was 37 mmHg (SD, 13 mmHg) in the slow-coagulation group and 39 mmHg (SD, 13 mmHg) in the standard group (P = 0.297). The follow-up periods were 16.36 and 24.68 months for the slow-coagulation and standard groups, respectively (P = 0.124). Visual acuity remained better than light perception in 71.1% of slow-coagulation TSCPC patients and 65.0% of standard TSCPC patients (P = 0.599). Intraocular pressure remained less than 20 mmHg in 46% of slow-coagulation TSCPC patients and 44% of standard TSCPC patients (P = 0.870). The mean number of complications was higher in the standard group (1.46; SD, 1.24) versus the slow-coagulation group (0.62; SD, 0.75; P = 0.002). The incidence of the need for a second procedure (slow-coagulation group, 28.8%; standard group, 23.1%; P = 0.588) and maximum number of medications needed to control IOP after surgery (P = 0.771) were similar between the 2 groups. Conclusions In this case series, slow-coagulation TSCPC and standard pop-titrated TSCPC resulted in similar VA and IOP outcomes in the treatment of glaucomatous eyes. The complication profiles of the techniques also were comparable, although standard TSCPC showed a higher incidence of prolonged inflammation after surgery. This study suggests that slow-coagulation TSCPC may achieve equivalent control of IOP while reducing the incidence of prolonged postoperative inflammation—a feared complication of TSCPC—when compared with standard pop-titrated TSCPC.

PURPOSE: Gray crescents characterized by darkly pigmented regions on the optic nerve head (ONH) could make assessment of cupping difficult by obscuring the true anatomic disc border. On slit lamp examination, two morphologically distinct types of gray crescents at the curved disc boundary exist. The in vivo histological characteristics differentiating these two types are described using spectral domain optical coherence tomography (SD-OCT). METHODS: A prospective interventional case series in a single tertiary referral center. Sixteen eyes of 10 patients with gray crescents determined through clinical exam and fundus photography underwent cross-sectional optic nerve head and parapapillary imaging using high resolution SD-OCT. In vivo histology of gray crescents was characterized. RESULTS: In SD-OCT images across the areas of gray crescent, type A gray crescents represent regions where the retinal pigmented epithelium (RPE)-Bruch’s membrane complex is absent and the dark underlying choroid is directly visible. In contrast, Type B gray crescents represent regions of the retina where the RPE is clumped or thickened, typically appearing to be folded upon itself, revealing the embryonic continuity of the RPE and neuro-retina. CONCLUSION: Shields Type A and B gray crescents appear different clinically because histologically they represent differences in RPE. Type A grey crescents lack RPE, whereas Type B crescents have thickened, folded RPE. Gray crescents can obscure the true disc border and result in pseudo-cupping of the ONH. Identification of gray crescents is clinically important since failure to recognize pseudo-cupping can contribute to over diagnosis of glaucoma.

Uncorrected refractive error is the leading cause of visual impairment worldwide and has significant quality of life and economic implications. Treatment with subjective refraction and custom-made spectacles requires expensive equipment and highly trained personnel. We examine several alternatives.Patients were taught to self-refract using two devices: AdSpecs and the I-test Vision Screener. Ready-made spectacles were fit to the self-refraction and visual acuity (VA) was measured. Donated-spectacles were fit to subjective refraction and VA was measured. Self-refraction and donated spectacles spherical equivalent (SE) and VA were compared to subjective refraction SE and VA.About 57 patients (102 eyes) were enrolled in the study. Patients accurately determined refractive power with self-refraction by both AdSpecs and the I-test (compared to subjective refraction SE, rPatients accurately self-refract using both devices and ready-made spectacles fit to self-refraction have excellent visual outcomes. Donated spectacles have worse visual outcomes but might be useful in a subset of patients. Ready-made spectacles fit to self-refraction may provide a treatment alternative to uncorrected refractive error.

Introduction: We examined temporal trends in urology residency applicant statistics and characteristics through time.Methods: Match statistics during 2006 to 2016 were obtained from the Ame...

Prostate artery embolization (PAE) is a promising new treatment option for men with symptomatic benign prostatic hyperplasia (BPH). Our goal is to review the data on PAE with regard to outcomes, risks versus benefits, and safety. Current data suggests that PAE is safe and effective for men with symptomatic BPH. The two most robust randomized controlled trials comparing PAE with TURP both found comparable short-term results with regard to improvements in symptoms. However, the side effects of PAE were higher than those of TURP. There remain ongoing randomized controlled trials comparing the two modalities of treatment. Though the largest randomized controlled trials comparing these two modalities of treatment of BPH are still underway, current data suggest PAE may be a promising, safe, and effective treatment option for men with symptomatic BPH. Additionally, PAE can be safely performed on larger prostates of any size and is generally performed via a single, femoral artery puncture under local anesthesia. Therefore, it is particularly appealing for patients with prostate glands > 80 g and who are poor candidates for general anesthesia.

Lower urinary tract symptoms (LUTS) consist of a common set of urologic symptoms that can affect the elderly. The prevalence of LUTS is expected to rise owing to the continued increase of numbers of the elderly. Although benign prostatic hyperplasia is considered a common cause of LUTS, the broader potential causes of LUTS are myriad. A wide range of diagnostic modalities and treatments are available to manage patients with LUTS and their utilization should not be limited to the urologist.

Transurethral resection of the prostate (TURP) is considered the gold standard for minimally invasive treatment of lower urinary tract symptoms due to benign prostate enlargement of

To compare the vertical and horizontal cup-to-disc ratio (VCDR, HCDR) by an updated optical coherence tomography (OCT) Bruch membrane opening (BMO) algorithm and stereoscopic optic disc photograph readings by glaucoma specialists.Reliability analysis.A total of 195 eyes (116 glaucoma and 79 glaucoma suspect) of 99 patients with stereoscopic photographs and OCT scans of the optic discs taken during the same visit were compared. Optic disc photographs were read by 2 masked glaucoma specialists for VCDR and HCDR estimation. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used to assess the agreement between photograph reading and OCT in estimating CDR.OCT images computed significantly larger VCDR and HCDR than photograph reading before and after stratifying eyes based on disc size (P.001). The difference in CDR estimates between the 2 methods was equal to or greater than 0.2 in 29% and 35% of the eyes for VCDR and HCDR, respectively, with a mean difference of 0.3 in each case. The ICCs between the readers and OCT ranged between 0.50 and 0.63. The size of disagreement in VCDR correlated weakly with cup area in eyes with medium (rOCT and photograph reading by clinicians agree poorly in CDR assessment. The difference in VCDR between the 2 methods was depended on cup area in medium and large discs. These differences should be considered when making conclusions regarding CDRs in clinical practice.

Purpose To design a robust and automated estimation method for measuring the retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT). Methods We developed a deep learning–based image segmentation network for automated segmentation of the RNFL in SD-OCT B-scans of mouse eyes. In total, 5500 SD-OCT B-scans (5200 B-scans were used as training data with the remaining 300 B-scans used as testing data) were used to develop this segmentation network. Postprocessing operations were then applied on the segmentation results to fill any discontinuities or remove any speckles in the RNFL. Subsequently, a three-dimensional retina thickness map was generated by z-stacking 100 segmentation processed thickness B-scan images together. Finally, the average absolute difference between algorithm predicted RNFL thickness compared to the ground truth manual human segmentation was calculated. Results The proposed method achieves an average dice similarity coefficient of 0.929 in the SD-OCT segmentation task and an average absolute difference of 0.0009 mm in thickness estimation task on the basis of the testing dataset. We also evaluated our segmentation algorithm on another biological dataset with SD-OCT volumes for RNFL thickness after the optic nerve crush injury. Results were shown to be comparable between the predicted and manually measured retina thickness values. Conclusions Experimental results demonstrate that our automated segmentation algorithm reliably predicts the RNFL thickness in SD-OCT volumes of mouse eyes compared to laborious and more subjective manual SD-OCT RNFL segmentation. Translational Relevance Automated segmentation using a deep learning–based algorithm for murine eye OCT effectively and rapidly produced nerve fiber layer thicknesses comparable to manual segmentation.

Purpose To create a mouse traumatic optic neuropathy (TON) model that is reproducible, reliable, and easy to manipulate with high specificity to retinal ganglion cell (RGC) layer and no mortality. The model will be useful for understanding the pathophysiology of retinal ganglion cell death and for testing neuroprotective therapeutics. Methods An Nd:YAG laser was used to generate focal photodisruptive retinal damage. Noninvasive in vivo ophthalmologic imaging technologies such as optical coherence tomography (OCT) and confocal laser scanning ophthalmoscopy (CSLO) were used to longitudinally track the retinal nerve fiber layer (RNFL) thickness and RGC number change, respectively. Immunostaining and pattern electroretinography (PERG) were also used to evaluate structure and functional change after laser injury. Results Our ND:YAG laser generates a concussive photodisruptive laser shockwave force which induces focal RGC death in the targeted area. We observed a correlative decrease in RGCs number, RNFL, and PERG function of RGC in the laser zone. The pattern of RNFL thinning and RGC soma loss correlates with the pattern and amount of fluorescence loss on OCT and CSLO images, respectively. The ND:YAG laser does not cause any damage to other layers in the retina nor any side effects including changes in intraocular pressure, corneal edema, and calcification or mortality (which has been observed in other TON models). Conclusions We have created a new and novel RGC TON death model that confers no mortality and produces a quantifiable decrease in RGC number and function. The laser targeted regions of the retina correlate with both in vivo imaging by OCT and CSLO and histologically with regions of RGC loss without ophthalmic side effects. Translational relevance This laser-based TON injury model is simple to implement, is reproducible, and is useful for determining the molecular and cellular pathophysiology of TON and RGC death and for testing neuroprotective therapeutics.

// Sander R. Dubovy 1,3,* , Maria P. Fernandez 1,* , Jose J. Echegaray 1,5,* , Norman L. Block 3,4 , Noriyuki Unoki 1 Roberto Perez 2,4 , Irving Vidaurre 2 , Richard K. Lee 1 , Mehrdad Nadji 3 and Andrew V. Schally 2,3,4 1 Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA 2 Miami Veterans Affairs Medical Center, Miami, Florida, USA 3 Department of Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA 4 Divisions of Hematology/Oncology, Endocrinology, Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida, USA 5 Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR, USA * These authors have contributed equally to this work Correspondence to: Andrew V. Schally, email: // Keywords : eye neuropeptides, ocular endocrinology, hormone-analog therapy Received : May 07, 2017 Accepted : May 20, 2017 Published : June 03, 2017 Abstract Extrapituitary roles for hypothalamic neurohormones have recently become apparent and clinically relevant, based on the use of synthetic peptide analogs for the treatment of multiple conditions including cancers, pulmonary edema and myocardial infarction. In the eye, it has been suggested that some of these hormones and their receptors may be present in the ciliary body, iris, trabecular meshwork and retina, but their physiological role has yet to be elucidated. Our study intends to comprehensively demonstrate the expression of some hypothalamic neuroendocrine hormones and their receptors within different retinal and extraretinal structures of the human eye. Immunofluorescence, Western blot analysis, and RT-PCR were used to evaluate the qualitative and quantitative expression of Luteinizing Hormone Releasing Hormone (LHRH), Growth Hormone Releasing Hormone (GHRH), Thyrotropin Releasing Hormone (TRH), Gastrin Releasing Peptide (GRP) and Somatostatin as well as their respective receptors (LHRH-R, GHRH-R, TRH-R, GRP-R, SST-R1) in cadaveric human eye tissue and in paraffinized human eye tissue sections. The hypothalamic hormones LHRH, GHRH, TRH, GRP and Somatostatin and their respective receptors (LHRH-R, GHRH-R, TRH-R, GRPR/BB2 and SST-R1), were expressed in the conjunctiva, cornea, trabecular meshwork, ciliary body, lens, retina, and optic nerve.

Purpose of Review The clinical utility of the digital rectal exam (DRE) in the workup of lower urinary tract symptoms has been questioned in the literature. This review aims to critically examine the recent literature regarding the accuracy and reliability of the DRE in the assessment of lower urinary tract symptoms (LUTS) and benign prostatic hypertrophy (BPH). Here, we specifically focus on the clinical importance of the DRE in the evaluation of nocturia.

Item does not contain fulltext Primary open-angle glaucoma (POAG) is the most common chronic optic neuropathy worldwide. Epidemiological studies show a robust positive relation between intraocular pressure (IOP) and POAG and modest positive association between IOP and blood pressure (BP), while the relation between BP and POAG is controversial. The International Glaucoma Genetics Consortium (n=27 558), the International Consortium on Blood Pressure (n=69 395), and the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database (n=37 333), represent genome-wide data sets for IOP, BP traits and POAG, respectively. We formed genome-wide significant variant panels for IOP and diastolic BP and found a strong relation with POAG (odds ratio and 95% confidence interval: 1.18 (1.14-1.21), P=1.8 x 10(-27)) for the former trait but no association for the latter (P=0.93). Next, we used linkage disequilibrium (LD) score regression, to provide genome-wide estimates of correlation between traits without the need for additional phenotyping. We also compared our genome-wide estimate of heritability between IOP and BP to an estimate based solely on direct measures of these traits in the Erasmus Rucphen Family (ERF; n=2519) study using Sequential Oligogenic Linkage Analysis Routines (SOLAR). LD score regression revealed high genetic correlation between IOP and POAG (48.5%, P=2.1 x 10(-5)); however, genetic correlation between IOP and diastolic BP (P=0.86) and between diastolic BP and POAG (P=0.42) were negligible. Using SOLAR in the ERF study, we confirmed the minimal heritability between IOP and diastolic BP (P=0.63). Overall, IOP shares genetic basis with POAG, whereas BP has limited shared genetic correlation with IOP or POAG.

Introduction To evaluate access to urological care and potential work force shortages it is essential to understand geographic variation in physician supply and practice patterns among urologists. We sought to quantify differences between urban and nonurban urologists in the United States and evaluate these trends with time. Methods We obtained procedural case logs from the ABU (American Board of Urology) for 9,390 urologists undergoing ABU initial certification or recertification during 2003 through 2015. We performed summary statistics to characterize the practice patterns and case mix of nonurban urologists (practice setting less than 100,000 population) and urban urologists (practice setting greater than 100,000 population). Results Of 8,180 urologists (87.1%) with practice setting information 6,907 (84.4%) practiced in an urban setting vs 1,273 (15.6%) in a nonurban setting. The proportion of nonurban urologists decreased from 2003 to 2015 (19.4% to 14.2%, p = 0.06). A higher proportion of urban urologists were female (9.5% vs 6.8%, p = 0.007). Nonurban urologists were more likely to be general urologists (88.0% vs 71.8%, p Conclusions Imbalance in the geographic distribution of urologists appears to be growing. With an aging nonurban urological work force that is performing fewer major operations Americans residing in nonurban areas may face barriers in access to care.