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In this review, the current literature addressing sexual health in common neurologic conditions will be summarized. Conditions discussed include stroke, multiple sclerosis, spinal cord injury, and spina bifida. There is an increasing awareness of sexual dysfunction in patients with neurologic injury and of the role of sexual therapy in improving quality of life. Sexual health in a neurogenic patient is dependent upon a variety of factors. Determining the most influential sources of sexual dysfunction is important for providing effective treatment.

Objective To compare differences in the characteristics and outcomes of inpatient consults between academic and private practice urologists. Materials and Methods We performed a retrospective review of urology consults at a large tertiary-care hospital from June 1st, 2017 to June 30th, 2018. Patient demographics, timing of consult, location of consult, reasons for consult, requesting physicians, and procedures performed were analyzed and compared. Results A total of 613 consults were identified. The most common consults were for a Foley catheter/suprapubic tube (16%), urinary retention (15%), kidney/bladder stones (11%), and hematuria (11%). Seventy-seven percent of the consults were seen in the day time and 79% were seen on the weekdays. One hundred and ten (18%) consults resulted in an operative intervention during the same admission. The others required a Foley catheter placement or suprapubic exchange (17%), bedside procedure (9%), or interventional radiology procedure (4%). The remaining 319 consults (52%) required no intervention and were considered potentially unnecessary. There were no differences in the timing of the consults and the need for intervention between academic and private practice urologists (P = .20). Only 37% of patients followed up as an outpatient. These potentially unnecessary consults resulted an annual loss of 265.8 hours for the urologists and $44,376.09 in excess health care costs. Conclusion Over half of inpatient urologic consultations required no urologic intervention and therefore represented potential overuse of urgent inpatient specialty care. This may contribute towards the growing epidemic of burnout in urology. Further work needs to be done to educate other hospital services and nurses to minimize these unnecessary consults.

INTRODUCTION AND OBJECTIVE:Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which cause neuropathy and myopathy, respectively. The study hy...

Background To describe our experience with outpatient transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. Methods In our retrospective review, we compared the TPB to TRB in our institution for outpatient prostate biopsies with local anesthesia from June 1st, 2017 to June 1st, 2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI. Results Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. Conclusion Outpatient TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes.

Background Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which may cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as lower urinary tract dysfunction (LUTD). Procedure Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5-10 years completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well-child clinic visits. Exclusion criteria included pelvic-based malignancy, pelvic irradiation, pre-existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and presence of LUTD, defined as DVSS scores above gender-specific thresholds (males ≥9, females ≥6), were compared across cohorts. Results Median DVSS scores were higher in the study cohort (6 vs. 4, p = .003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs. 21%, p = .014; OR 1.8). Subanalysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs. 30%, p = .013, OR 1.9). This did not hold true for males (20% vs. 12.2%, p = .339). Conclusions Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to suffer from LUTD than males. Further study with a positive control cohort of cancer survivors who received non-VCR, non-DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD.

Background: To describe our experience with office-based transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. Methods: In our retrospective review, we compared the TPB to TRB in our institution for in-office prostate biopsies with local anesthesia from 06/2017-06/2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI. Results: Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. Conclusion: In-office TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes.

INTRODUCTION AND OBJECTIVE:Management of recurrent post-radiation urethral stenosis is notoriously difficult due to poorer success rates and the risk of de-novo stress urinary incontinence (SUI) fo...

INTRODUCTION AND OBJECTIVES:Recurrent ureteral strictures have higher complexity for repair compared to initial surgery for ureteral reconstruction. We describe a series of patients treated with robotic assisted laparoscopic (RAL) buccal mucosal graft (BMG) ureteroplasty and demonstrate techniques utilized to improve efficiency in these complex cases.METHODS:Retrospective review was conducted for the initial four cases of RAL ureteroplasty with BMG performed by a single surgeon between July and October 2017. Video recordings of these cases were reviewed to identify techniques utilized to facilitate completion of these complex cases using a RAL approach.RESULTS:All four cases were completed using RAL approach without need for conversion to an open procedure. Average patient age was 55 years. Two patients had lower ureteral strictures that initially resulted from prior pelvic surgery. Both of these patients developed recurrent lower ureteral strictures after prior ureteroneocystostomy with psoas hitch. The ...

Objective To describe a novel surgical technique for reconstruction of a case of refractory bladder neck contracture (BNC) using a robotic-assisted laparoscopic (RAL) transvesical approach for subtrigonal inlay of buccal mucosal graft. BNC is a well-described yet uncommon adverse event after BPH surgery. Endoscopic management is successful in many patients but refractory cases may require reconstructive surgery. Materials and Methods A 70-year-old male presented with a history of prior photovaporization of the prostate 2 years prior to our initial consultation. He developed a refractory BNC that did not resolve after multiple endoscopic interventions. For definitive treatment of the BNC, he underwent RAL repair with subtrigonal inlay of buccal mucosal graft. The surgical approach is demonstrated in our video. Results The patient underwent RAL subtrigonal inlay of buccal mucosal graft without intraoperative complication or need to convert to an open procedure. The graft harvested for repair measured 5 × 5 × 4 cm. He was discharged home on postoperative day 2. Urethral catheter was left in place for 2 weeks and suprapubic catheter was removed 4 weeks postoperatively. Voiding cystourethrogram at time of suprapubic catheter removal demonstrated no evidence of obstruction or extravasation. Uroflow qmax improved from 2 to 27 mL/s. Postvoid residual urine volume improved from 200 to 3 mL. At last follow-up, there was no evidence of recurrence. Conclusion Refractory cases of BNC can be successfully managed with reconstructive surgery. In this case report, we describe a novel technique for RAL reconstruction with subtrigonal inlay of buccal mucosal graft.

As we move into the mobile era, many functionalities in standard web services are being re-implemented in mobile apps and services, including many security-related functionalities. However, it has been observed that security features that are standardized in the PC and web space are often not implemented correctly by app developers resulting in serious security vulnerabilities. For instance, prior work has shown that the standard SSL/TLS certificate validation logic in browsers is not implemented securely in mobile apps. In this paper, we study a related question: given that many web services are offered both via browsers/webpages and mobile apps, are there any discrepancies between the security policies of the two?

Tissue-simulating phantoms provide the opportunity to evaluate the performance of optical and spectroscopic instruments under controlled experimental conditions. Recent efforts have advanced phantom fabrication methods to provide more tissue realistic phantoms, both in terms of a) incorporating absorbing agents that more faithfully mimic in vivo tissue chromophores spanning visible and near infrared regimes and b) accounting for multi-layer tissue structures with distinct optical properties. The spectral scattering properties in these phantoms, however, are typically based only on a single scattering agent, thereby locking the spectral scattering properties to a single particle size distribution. However, in both healthy tissue as well as pathologic tissue, regions of distinct and differentiated scattering may be present. With differing mean size and distribution of scattering objects in these tissue regions, the relative wavelength-dependent scattering spectra may vary. For example, partial thickness burns exhibit significant cellular damage and collagen denaturation that will significantly alter the wavelength-dependent scattering properties resembling large Mie-like scatterer distributions in both visible and near infrared regimes. We present a low-cost method to fabricate silicone tissue-simulating phantoms with tunable scattering spectra properties that span visible and near infrared wavelengths. We use optical polishing agents (white aluminum oxides powders) at various grit sizes to approximate Mie scattering across multiple mean particle sizes. Mean particle sizes used in this study range from 17-3 micron. The optical properties of these phantoms are verified using an integrating sphere in combination with inverse adding-doubling methods. The tolerances of this fabrication method will be discussed.

Polydimethylsiloxane (PDMS) has been a popular medium to fabricate tissue simulating optical phantoms. Recently, its use has significantly expanded in instrument calibration and performance testing, validation of advanced models of light transport of complex tissue geometries and evaluation of novel measurement modalities. To meet these demands, fabrication methods of these optical phantoms have become more refined and its structure and constituent components (i.e. dyes and scattering agents) have evolved to better mimic optical properties of tissue spanning both visible and near infrared regimes. We present efforts at the Beckman Laser Institute that address these challenges through PDMS phantoms.

We present a method for low-cost fabrication of polydimethylsiloxane (PDMS) tissue simulating phantoms with tunable scattering spectra, spanning visible, and near-infrared regimes. These phantoms use optical polishing agents (aluminum oxide powders) at various grit sizes to approximate in vivo tissue scattering particles across multiple size distributions (range: 17 to 3 μm). This class of tunable scattering phantoms is used to mimic distinct changes in wavelength-dependent scattering properties observed in tissue pathologies such as partial thickness burns. Described by a power-law dependence on wavelength, the scattering magnitude of these phantoms scale linearly with particle concentration over a physiologic range [μ's=(0.5 to 2.0 mm−1)] whereas the scattering spectra, specific to each particle size distribution, correlate to distinct exponential coefficients (range: 0.007 to 0.32). Aluminum oxide powders used in this investigation did not detectably contribute to the absorption properties of these phantoms. The optical properties of these phantoms are verified through inverse adding-doubling methods and the tolerances of this fabrication method are discussed.

We report high-throughput optical coherence tomography (OCT) that offers 1,000 times higher axial scan rate than conventional OCT in the 800 nm spectral range. This is made possible by employing photonic time-stretch for chirping a pulse train and transforming it into a passive swept source. We demonstrate a record high axial scan rate of 90.9 MHz. To show the utility of our method, we also demonstrate real-time observation of laser ablation dynamics. Our high-throughput OCT is expected to be useful for industrial applications where the speed of conventional OCT falls short.