Search

Introduction Inflatable penile prostheses (IPP) consist of 2 cylinders implanted into the corpora cavernosa, a pump placed in the scrotum, and a saline-filled reservoir traditionally placed in the space of Retzius. IPPs are used to treat refractory erectile dysfunction with few rare, but serious, complications. Cases of reservoirs causing erosion into the bladder, small bowel obstructions, vascular compression, and inguinal herniation have been described. Aim We highlight the importance of keeping a broad differential diagnosis when assessing patients with bowel obstructions. Methods A 68-year-old man with a previous IPP placement presented with left lower quadrant abdominal pain, constipation and obstipation for 5 days. On exam, he was afebrile, and noted to have a firm, distended, tympanic abdomen. CT scan showed a distended cecum at 11 cm, narrowing of the proximal sigmoid with adjacent inflammatory changes, and minimal peri-colonic air, suggestive of a localized perforation. The IPP reservoir was seen in the left iliac fossa, coinciding with the lead point of the obstruction, suggesting that the reservoir may have itself caused the obstruction. The patient was taken to the operating room for an emergent exploratory laparotomy, which revealed a mass in the colon abutting the IPP reservoir. Main Outcome Measures Considerations for IPP component explantation, factors considered for reintervention, and preservation of penile length with avoidance of penile fibrosis. Results A left colectomy with transverse colostomy was successfully performed and the IPP reservoir was explanted. Intraoperative frozen section revealed adenocarcinoma. Upon initial review of the imaging, it was thought that the IPP reservoir may have caused the obstruction, but intraoperatively, the colonic tumor was found to be the culprit. Conclusion Although complications related to IPPs, including bowel obstructions, have been previously described in the literature, treatment for large bowel obstructions must take into account all possible etiologies, including malignancy. Atri E, Mallory C, Perez A, et al. A Case Report of Large Bowel Obstruction in a Patient With an Inflatable Penile Prosthesis. Sex Med 2021;9:100391.

Objectives To present a multi-institutional experience with functional and patient-reported outcomes among men undergoing excision and primary anastomosis (EPA) urethroplasty for pendulous urethral strictures. Methods We describe the technique and present our experience with EPA for focal penile strictures. Patients undergoing urethroplasty (2004-2017) at 2 tertiary referral centers were reviewed, of whom 14 (0.7%) underwent EPA of radiographically confirmed pendulous urethral strictures. Validated questionnaires were utilized to evaluate overall improvement (Patient Global Impression of Improvement), urinary bother (International Prostate Symptom Score), and sexual function (International Index of Erectile Function-5). Treatment success was defined as urethral patency without need for subsequent reconstruction. Results Among 14 men undergoing penile EPA, 13/14 (93%) had durable treatment success over a median follow-up of 43 months. No patient reported penile curvature postoperatively. Stricture etiology in most cases was posttraumatic (12/14), of which 4 had a history of urethral disruption secondary to penile fracture and 8 iatrogenic trauma. Median age was 51 years (IQR 30-60) and stricture length 1.0 cm (IQR 1.0-1.4). Erectile function was normal in 8/14 patients preoperatively, and postoperative median International Index of Erectile Function was 21. Most men reported significant global improvement in condition (median Patient Global Impression of Improvement 2, IQR 1-3) and most had only mild urinary bother (median International Prostate Symptom Score 4, quality of life 1). The single treatment failure had a history of hypospadias with multiple prior urethral procedures. Conclusion For men with short strictures of the pendulous urethra, EPA has a high success rate, without adverse sequelae such as erectile function or penile curvature.

Objectives To report our multi-institutional experience using penoscrotal decompression (PSD) for the surgical treatment of prolonged ischaemic priapism (PIP). Materials and methods We retrospectively reviewed clinical records for patients with PIP treated with PSD between 2017 and 2020. Priapisms were confirmed as ischaemic based on clinical presentations and cavernosal blood gas abnormalities. Treatment with irrigation and injection of α-agonists in all patients had failed prior to PSD. Patient characteristics, peri-operative variables and outcomes, and changes in International Index of Erectile Function (IIEF) scores were evaluated. Results We analysed 25 patients who underwent a total of 27 PSD procedures. The mean duration of priapism at initial presentation was 71.0 h. Irrigations and injections in all patients had failed, while corporoglanular shunt treatment in 48.0% of patients (12/25) had also failed prior to PSD. Of the 10 patients who underwent unilateral PSD, two (20.0%) had priapism recurrence. Both were treated with bilateral PSD, with prompt and lasting detumescence. Among the 15 patients undergoing primary bilateral PSD, none had priapism recurrence. Of the 15 patients with documented sexual function status at last follow-up, nine (60%) reported spontaneous erectile function adequate for penetration, while six (40%) reported erectile dysfunction. The median (interquartile range) decrease in IIEF-5 score was 3.5 (0-6.75) points after PSD. Two patients underwent uneventful inflatable penile prosthesis placement following PSD. Conclusions Penoscrotal decompression presents a simple, safe, highly effective and easily reproducible procedure for resolution of PIP. PSD should be considered as a viable salvage or alternative strategy to corporoglanular shunt procedures.

Objective To report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra. Materials and Methods From our institutional artificial urinary sphincter database of 512 patients from 2010 to 2016, 10 men underwent permanent urethral ligation with concurrent suprapubic tube diversion following recurrent artificial urinary sphincter cuff erosion. Clinical characteristics and outcomes were evaluated. Quality of life was assessed using the Michigan Incontinence Symptom Index and the Patient Global Index of Improvement. Results Urethral ligation resulted in resolution of incontinence in 8 men (80%), including 7 (70%) after 1 surgery and in 1 (10%) after a single revision. The average American Society of Anesthesiologists physical status rating was 2.7 (range 2-3). Seven patients (70%) experienced postoperative complications (4 Clavien-Dindo grade II complications [1 Clostridium difficile infection, 3 refractory bladder spasms) and 5 grade III complications (2 abscesses, 2 urethrocutaneous fistula, and 1 bladder stone formation]). Overall, satisfactory Michigan Incontinence Symptom Index urinary scores were reported in 8 (80%) men. On the Patient Global Index of Improvement, 6 (60%) men reported improvement in overall condition following surgery. All men (10/10) stated that they would recommend this procedure to others. Conclusion For debilitated men with end-stage urethra and severe refractory stress urinary incontinence, permanent urethral ligation with chronic suprapubic tube drainage can restore continence and improve quality of life without the need for more invasive formal urinary diversion, though with a high risk of complication.

Introduction We identified clinical and/or surgical factors contributing to failure of penile plication for Peyronie’s reconstruction and assessed outcomes of repeat plications. Methods We conducted a retrospective review of patients who underwent penile plication between 2007 and 2016. Plication was performed after inducing an artificial erection intraoperatively using corrective longitudinal 2-zero Ethibond™ sutures placed systematically in a uniform manner without circumcision. Penile length, and angle and direction of curvature were recorded, along with number and location of plication sutures and clinical outcome. Results Of 340 patients undergoing penile plication during the study period 7 (2.1%) underwent repeat plication for insufficient straightening. Two additional patients underwent salvage plication after initial surgery performed elsewhere. Median time to revision was 6 months (range 3.4 to 27.4). The most common clinical features at reoperation were severe erectile dysfunction in 5 cases (71%), multiplanar curvature in 5 (71%) and severe curvature (60 degrees or greater) in 3 (43%). Most revisions involved a greater number of sutures during revision (mean 9) compared to initial plication (6), and in 4 cases (44%) sutures were placed on the proximal shaft. After revision all cases were noted to be functionally straight, with a mean postoperative curvature of 4 degrees (range 0 to 20) at a median followup of 27 months (3 to 76). Conclusions Inadequate correction of Peyronie’s disease curvature by penile plication is rare but salvageable by a second plication procedure. Poor erectile response to intracavernous injection intraoperatively may mask the severity of the deformity, thus leading to inadequate numbers of corrective sutures.

Introduction In 2013 injection of collagenase clostridium histolyticum became the first nonsurgical FDA (Food and Drug Administration) approved treatment for Peyronie’s disease. We evaluated the cost effectiveness of collagenase injection compared to penile plication. Methods A decision tree model using TreeAge Pro Healthcare (TreeAge Software, Inc., Williamstown, Massachusetts) was developed for cost analysis comparing collagenase clostridium histolyticum and penile plication. Treatment success was defined as penile curvature of 30 degrees or less. Data from IMPRESS (Investigation for Maximal Peyronie’s Reduction Efficacy and Safety Studies) I and II were used to calculate the probability of success, and stratified by severity of disease (moderate defined as 30 to 60 degrees and severe as 61 to 90 degrees). We assumed that 50% of injection failures proceeded to secondary plication. Material costs of medications, office visits, and facility and surgical fees, and predicted costs of complications were obtained from our billing department using real-world patient data. For penile plication 90% success was assumed based on published series. All failed plications were assumed to undergo repeat plication. Results The calculated probability of treatment success after injection was 49.5% for moderate curvature (30 to 60 degrees) and 12% for severe curvature (61 to 90 degrees). Per patient plication cost was $3,039, while injection pathway was $25,856 for moderate disease and $26,375 for severe disease. One-way sensitivity analyses revealed cost equivalence at $2,558 for injection. No increase in efficacy of collagenase injection accomplished cost equivalence at current pricing. Conclusions Collagenase clostridium histolyticum treatment was at least 8 times more expensive than penile plication. Achieving cost equivalence would require a significant decrease in drug cost. Collagenase clostridium histolyticum appears to be most appropriate for men with moderate, as opposed to severe, penile deformities.

Objective To evaluate contemporary outcomes of excision and primary anastomosis (EPA) for the treatment of radiation-induced urethral strictures (RUS). Patients and Methods A retrospective review of 72 patients undergoing EPA for RUS from 2007 to 2015 by a single surgeon was performed. We analyzed overall and long-term success rates of EPA urethroplasty and compared patient cohorts from two groups, 2007-2012 vs 2013-2015 (post-Urolume). Results During the course of the study, we noted a near doubling of patient volume from the earlier (6.2 patients/year) to later (11.7 patients/year) cohorts. Among the 37 men treated from 2007 to 2012, we identified an EPA success rate of 70% compared with the improved 86% success rate in the subsequent cohort of 35 men treated from 2013 to 2015 ( P = .07). Single dilation was successful in 50% of initial and 40% of subsequent cohort patients in the treatment of recurrence. Initial and subsequent cohorts varied only in regard to stricture length (mean 2.0 cm vs 3.0 cm in initial and subsequent cohorts, P = .001) and number treated with Urolume stent (initial 5 vs none in the later cohort, P = .03). Length of follow-up (median 50 [17-97] months for the initial and 22 [6-34] months for the later cohort) was not associated with recurrence. Conclusion Increasing numbers of RUS patients are presenting for urethral reconstruction in the post-Urolume era. With increasing experience, we improved success rates of EPA urethroplasty to over 85% despite increased stricture length.

Penile plication has become the preferred surgical technique for Peyronie's disease (PD) as it can be performed efficiently, safely, with a high success rate, low morbidity and a low complication rate. Here in we describe two modern plication techniques in detail: the Kiels Knot plication and the minimally invasive penoscrotal plication. Benefits of the techniques include no palpable sutures for the Kiels Knot Plication and less surgical trauma for the penoscrotal plication. Plication has a low rate of failure. However, when it does occur it is usually secondary to under-correction. Failures typically present early postoperatively and a contributing factor to underestimating the deformity is a poor intraoperative artificial erection. Complex, severe, or multiplanar deformities will require more sophisticated intraoperative decision-making, but can be managed effectively with penile plication nonetheless.

Melanotan II, an injectable melanocortin analog, is illicitly available on the internet to generate a sunless tan through melanocyte induction. It is also used as a sexual stimulant in unlicensed performance enhancement clinics, and has been investigated as a possible treatment agent in erectile dysfunction. We describe in this case report a patient presenting with acute ischemic priapism after subcutaneous injection of melanotan II. The patient was initially managed with cavernosal aspiration and irrigation, and intracavernous injection of phenylephrine without achieving detumescence. After failing initial management, the patient underwent operative management with penoscrotal decompression, a promising alternative technique for the management of refractory ischemic priapism. Priapism after melanotan II injection has only been reported in the literature twice before. This case report highlights a rare presentation of acute ischemic priapism after melanotan II use, managed with surgical decompression. Future therapeutic applications of these agents and updated management guidelines should consider priapism as a possible side effect. CW. Mallory, DM Lopategui, BH. Cordon. Melanotan Tanning Injection: A Rare Cause of Priapism. Sex Med 2021;9:100298.

The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point.

The surgical gold standard treatment for severe erectile dysfunction (ED) is inflatable penile prosthesis (IPP). During IPP placement, penile curvature can also be addressed, and may be corrected in up to 90% of cases with inflation alone. However, for severe deformities, adjunctive maneuvers are needed. Our preference is to place plicating sutures for deformities greater than 30 degrees. We find this technique to be quick and reliable, without additional risks. Here we describe penile plication with simultaneous IPP.

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.

For ventral buccal mucosa graft onlay during bulbar urethroplasty, spongioplasty with advancement and closure of the corpus spongiosum is ordinarily performed to stabilize the graft. In the pendulous and distal bulbar urethra the spongiosum is often too thin to allow complete graft coverage. We describe the results of what to our knowledge is a novel technique for ventral graft coverage using periurethral vascularized tissue. We compared these results to those of conventional spongioplasty.We retrospectively reviewed all urethroplasties performed by 2 surgeons at separate tertiary care facilities from July 2007 to July 2012. One-stage urethroplasties involving ventral buccal mucosa graft placement were selected for analysis. Conventional spongioplasty was performed when possible. When spongiosal tissue was inadequate for graft coverage, periurethral tissue flaps were mobilized bilaterally and sutured together in the midline as pseudospongioplasty to provide coverage. We compared the outcomes of the 2 techniques.Of 637 urethroplasties performed during the 5-year study period 102 (16%) with a buccal mucosa graft onlay met study inclusion criteria. Pseudospongioplasty was performed in 46 of 102 cases (45%), predominantly in the pendulous urethra (34 of 46 or 74%), with success in 37 of 46 (80%) at a mean followup of 41 months. Conventional spongioplasty had a similar 84% success rate (47 of 56 cases) at a mean followup of 39 months (p = 0.645). For conventional spongioplasty mean stricture length was 4.7 cm compared to 5.8 cm for pseudospongioplasty (p = 0.028).Ventral buccal mucosa grafts can be applied reliably to various locations throughout the anterior urethra. For distal grafts, flaps of periurethral tissue provide a suitable host bed for revascularization with results equivalent to those of conventional spongioplasty.

Introduction Synchronous ipsilateral high submuscular placement of artificial urinary sphincter (AUS) pressure-regulating balloons (PRBs) and inflatable penile prosthesis (IPP) reservoirs in a single submuscular tunnel is a novel strategy that could be advantageous for patients who have had major pelvic surgery. Aim To report our initial experience with synchronous ipsilateral vs bilateral placement of AUS PRBs and IPP reservoirs in men undergoing implant surgery. Methods We retrospectively reviewed all patients undergoing synchronous AUS and IPP placement from 2007 through 2015 by a single surgeon at our tertiary center. Patients were stratified according to ipsilateral vs bilateral placement of the AUS PRB and IPP reservoir. Main Outcome Measures Reoperation rates because of infectious or erosive complications and mechanical failure were assessed. Results Of the 968 implant surgeries during the study period, 47 men had synchronous device placement, of whom 17 (36%) underwent ipsilateral placement of the PRB and reservoir. During a median follow-up of 19 months (range = 1–84 months), reoperations were necessary in 12 of 47 (26%) and were similar between groups (ipsilateral, 5 of 17, 29%; bilateral, 7 of 30, 23%; P = .73). Most reoperations were due to AUS-related complications (10 of 12, 83%) and nearly all patients with reoperation (10 of 12, 83%) had compromised urethras (ie, prior urethral surgery, radiation, or prior AUS implantation). The most common indication for reintervention was cuff erosion (4 of 47, 9%), with no difference between groups (ipsilateral, 3 of 17, 18%; bilateral, 1 of 30, 3%; P = .13). Conclusion Synchronous ipsilateral high submuscular placement of urologic prosthetic balloons could safely facilitate prosthetic surgery in patients with a history of major pelvic and inguinal surgery.

Introduction Frequently encountered morbidities after prostatectomy include stress urinary incontinence and erectile dysfunction. Patients with severe disease may undergo placement of both a penile prosthesis (PP) and an artificial urethral sphincter (AUS). Aim We hypothesized that concomitant PP may promote AUS cuff erosion by impaired corporal blood flow and/or direct pressure on the cuff. The aim of this study was to compare the rate of AUS cuff erosion in patients with and without a PP. Methods We reviewed 366 AUS operations at our tertiary center between 2007 and 2015 with a mean follow-up of 41 months (range 6–104). Included in the analysis were first-time AUS cuff erosions. Patients with recurrent erosions, AUS revisions, and iatrogenic erosions were excluded. In a separate analysis, we analyzed AUS explantations for all causes. Cohorts were compared by demographic information, preoperative characteristics, and rates of erosion and explantation. Main Outcome Measures Erosion confirmed by cystourethroscopy and explantation of the AUS for all causes. Results Among 366 AUS surgeries at a mean follow-up of 41 months, there were 248 (67.8%) AUS alone cases compared to 118 (32.2%) AUS and PP cases (AUS/PP). Sixty-two patients met exclusion criteria for first-time cuff erosion. Among 304 evaluable AUS patients, we found a significantly higher rate of erosion in the AUS/PP group (11/95, 11.6%) compared to the AUS alone group (9/209, 4.3%, P = .037). When examining explantations for all causes in the entire cohort (n = 366), we observed a significantly higher rate of device removal, (20/118, 17%) in the AUS/PP group compared to the AUS group (23/248, 9.2%, P = .044). Conclusion AUS/PP patients appear to have a higher risk of AUS cuff erosion and explantation compared to men with AUS alone.

METHODS: We retrospectively reviewed all patients that underwent SPT placement at our institution from 2008-2015. We identified 68 patients that received SPTs for radiation-induced urethral strictures and had a minimum of 6 months follow-up. Patient and stricture characteristics were recorded. RESULTS: Among 68 patients with radiation-induced urethral strictures who underwent SPT placement at our institution, 31/68 (46%) chose to continue with a chronic SPT whereas 37/68 (54%) elected to subsequently undergourethral reconstruction. Patients electing a chronic SPTwere slightly older than those undergoing reconstruction (72.9 years versus 70.1 years, p1⁄4 0.16), but otherwise shared similar characteristics. Stress urinary incontinence (SUI) at time of initial presentation was reported by 22/31 (71%) patients and resolved after SPT placement in 9/22 (41%) patients. The majority of patients (16/31 (51.2%)) managed with a chronic SPT reported no side effects. Development of bladder stones occurred in 7/31 (22.6%) patients and 12/31 (38.7%) patients reported irritative bladder symptoms, the majority of whom (7/12 (58.3%)) had radiation-induced cystitis. Five patients with refractory radiation cystitis ultimately underwent ileal conduit urinary diversion for their symptoms. CONCLUSIONS: Chronic SPT can be a successful initial management strategy for refractory radiation-induced urethral strictures in patients unwilling to undergo open urethral reconstruction. SPT is overall well tolerated and can resolve incontinence in nearly half of patients.

Objective To evaluate renal mobilization with downward nephropexy as an adjunct maneuver to facilitate various methods of reconstruction of the upper urinary tract with limited ureteral length. Materials and Methods We retrospectively reviewed all upper urinary tract reconstructive procedures performed from 2007 to 2015 to identify those requiring downward renal mobilization with nephropexy. Data including concomitant maneuvers, stricture location, prior surgeries, and intraoperative details were analyzed. Success rates, defined by resolution of symptoms and avoidance of further intervention, and complications were evaluated. Results Of 92 patients undergoing ureteral reconstruction during the study period, 18 (19.6%) involved renal mobilization with downward nephropexy to gain additional ureteral length (5/7 [71.4%] of ureterocalycostomies, 8/26 [30.1%] of Boari flap bladder reconfigurations, 4/12 [33.3%] of ureteroureterostomies, and 1/12 [8.3%] of ileal ureters). Two-thirds of patients (12/18, 66.7%) had undergone unsuccessful prior open, laparoscopic, or endoscopic reconstruction attempts. Renal mobilization was performed open in 15/18 (83.3%) cases and laparoscopically in 3/18 (16.7%). After renal mobilization, the average distance of downward movement achieved was 3.3 cm (range 3-5 cm). With a mean follow-up of 50.4 months (range 3-87 months), overall success rate defined as ureteral patency was 88.9%, with 2/18 patients (11.1%) requiring a subsequent nephrectomy for failed upper tract reconstruction and persistent symptomatic hydronephrosis. Conclusion Downward renal mobilization and nephropexy is a safe and versatile technique that can be effectively combined with many other reconstructive maneuvers.

Objectives: The study aims to evaluate the outcomes of adult circumcision with the use of intracavernosal injection (ICI) of prostaglandin to induce an erection at time of operation. Methods: Twenty patients undergoing circumcision received ICI with prostaglandin prior to surgery. Demographics of all patients along with outcomes and complications at 2-week and 3-month follow-up were recorded. Results: No complications were evident at 2-week and 3-month follow-up. All 20 patients were satisfied with cosmetic result. Conclusions: Circumcisions performed with ICI is a novel technique that allows accurate removal of foreskin and can be safely applied to current surgical technique for improved cosmetic results.

To explore the association of non-neoplastic parenchymal changes (nNPC) with patients’ health and renal function recovery after partial nephrectomy (PN). This retrospective review identified 800 pT1a patients who underwent PN at Memorial Sloan Kettering Cancer Center from 2007 to 2012. Pathology reports were reviewed for nNPC graded as mild or severe: vascular sclerosis (VS), glomerulosclerosis (GS), and fibrosis/scarring. Correlations between nNPC and known preoperative predictors of renal function [age, sex, African-American race, estimated glomerular filtration rate (eGFR), American Society of Anesthesiologists (ASA) score, body mass index, coronary artery disease, and hypertension (HTN)] were assessed using Spearman’s rank correlation (ρ). Multivariable linear regression, adjusted for the described known preoperative risk predictors, was performed to evaluate whether the parenchymal features were able to predict 6-month postoperative eGFR. In this study, 46 % of tumors had benign surrounding parenchyma. We noted statistically significant yet weak associations of VS with age (ρ = 0.19; p

Objective To assess the ability of reflex UroVysion fluorescence in situ hybridization (FISH) testing to predict recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC) with suspicious cytology but negative cystoscopy. Patients and Methods Patients under NMIBC surveillance were followed with office cystoscopy and urinary cytology every 3–6 months. Between March 2007 and February 2012, 500 consecutive patients with suspicious cytology underwent reflex FISH analysis. Clinical and pathological data were reviewed retrospectively. Predictors for recurrence, progression and findings on subsequent cystoscopy (within 2–6 months after FISH) were evaluated using univariate and multivariate Cox regression. Results In all, 243 patients with suspicious cytology also had negative surveillance cystoscopy. Positive FISH was a significant predictor of recurrence (hazard ratio [HR] = 2.35, 95% confidence interval [CI]: 1.42–3.90, P = 0.001) in multivariate analysis and for progression (HR = 3.01, 95% CI: 1.10–8.21, P = 0.03) in univariate analysis, compared with negative FISH. However, positive FISH was not significantly associated with evidence of tumour on subsequent surveillance cystoscopy compared with negative FISH (odds ratio = 0.8, 95% CI: 0.26–2.74, P = 1). Conclusions Positive FISH predicts recurrence and progression in patients under NMIBC surveillance with suspicious cytology but negative cystoscopy. However, there was no association between the FISH result and tumour recurrence in the immediate follow-up period. Reflex FISH testing for suspicious cytology might have limited ability to modify surveillance strategies in NMIBC.

Objective To analyze the etiology, diagnosis, and long-term outcomes of iatrogenic nonendoscopic bladder injuries over a 24-year period. Methods All iatrogenic bladder injuries were entered prospectively into our database from 1990 to 2014. Information gathered included causative procedure, injury characteristics, management, and outcome. Results A total of 127 patients with nonendoscopic iatrogenic bladder injuries were included (111 women [87%], 16 men [13%]; mean age 51 years [range, 23-84]). Risk factors were identified in 92 patients (79%) including prior surgery, inflammation, and extensive tumor. Obstetric-gynecologic surgery accounted for most injuries (65%), with hysterectomy the most common procedure, followed by cesarean section. General surgery and nonendoscopic urologic injuries accounted for 22% and 13% respectively. Most injuries occurred during open surgery (77%) compared with vaginal (12%) and laparoscopic surgeries (11%). Laparoscopic surgery was associated with a delay in diagnosis, P = .002. Bladder injuries with concomitant ureteral injuries were more likely to have long-term complications, P = .001. Conclusion In analyzing iatrogenic bladder injuries at our institution over 24 years, we observed that hysterectomy and cesarean sections were the 2 most common causative procedures. A delay in diagnosis was more likely to occur during laparoscopic surgery. Complications occurred more commonly with a concomitant ureteral injury.