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Bentonite-polymer composite (BPC) geosynthetic clay liners (GCLs) containing a mixture of air-dry granules of bentonite and polymer have been developed for containment of wastes that generate leachates that are too aggressive for conventional sodium bentonite GCLs. Sufficient polymer loading is essential for BPC GCLs to maintain low hydraulic conductivity, and expedient methods are needed for manufacturing quality control and construction quality control to confirm that BPC GCLs contain sufficient polymer. In this study, a methodology for developed to estimate the polymer loading based on viscosity testing of slurries prepared with the BPC. A simplified version of the method can be used to determine if polymer is present in a BPC. Factors influencing the viscosity measurement were evaluated systematically, including water-to-BPC ratio, tempering time, and mixing method. The method that was developed consists of (1) adding deionized water to dry BPCs to achieve a water-to-BPC ratio of 30, (2) blending the BPC-water mixture with an overhead stirrer at 5000 rpm for 30 min to create a homogeneous slurry, (3) tempering the slurry in a zip-top bag for 24 hr, and (4) measuring the viscosity of the slurry in a viscometer at 300 and 600 rpm. Linear relationships were developed between polymer loading and viscosity for two BPC GCLs. Independent validation confirmed that the polymer loading estimated with the method is ±0.25% of the actual polymer loading.

Experiments were conducted to evaluate the hydraulic conductivity of two commercially available geosynthetic clay liners (GCLs) with similar properties but different bentonite granule sizes (D50=1.0 mm or 0.3 mm). A synthetic municipal solid waste (MSW) leachate prepared in the laboratory and four actual coal combustion product (CCP) leachates collected from the field were used as permeant solutions to represent different permeant chemical conditions for waste containment applications. The two GCLs had comparable hydraulic conductivity to dilute or moderate ionic strength (I) leachates (< 0.1 M). With more concentrated leachates (I > 0.1 M), hydraulic conductivity of the GCL containing finer bentonite granules (FG) was 10 to 500 times lower than the hydraulic conductivity of the GCL containing coarser bentonite granules (CG) under the same equilibrium conditions. These results suggest that GCLs containing finer bentonite granules may be less vulnerable to permeant chemistry.

The impact of granular size, distribution, total intergranular porosity, mobile intergranular porosity, and the tortuosity of the flow paths on the hydraulic conductivity of geosynthetic clay liners (GCLs) was assessed using a COMSOL hydrodynamic model. Results showed that as the intergranular pore spaces become smaller as the bentonite granules swell, the hydraulic conductivity of the GCL decreases. This effect is more significant when the density of the bentonite is lower. Outcomes from the model also illustrate that flow in GCLs with low hydraulic conductivity occurs in fine pore spaces with a width on the order of 1 um. The mobile intergranular porosity through which flow occurs is approximately 0.05 after the bentonite swells, and is small relative to the total intergranular porosity. This indicates that most water within bentonite having low hydraulic conductivity is occluded within isolated pores. As the hydraulic conductivity decreases, the tortuosity of intergranular flow paths increases, varying from 1.38 to 1.03. The findings provide insight into the complex flow behavior in GCLs and factors that affect achieving low hydraulic conductivity.

The identity and origin of the stem/progenitor cells for adult joint cartilage repair remain unknown, impeding therapeutic development. Simulating the common therapeutic modality for cartilage repair in humans, i.e., full-thickness microfracture joint surgery, we combined the mouse full-thickness injury model with lineage tracing and identified a distinct skeletal progenitor cell type enabling long-term (beyond 7 days after injury) articular cartilage repair in vivo. Deriving from a population with active Prg4 expression in adulthood while lacking aggrecan expression, these progenitors proliferate, differentiate to express aggrecan and type II collagen, and predominate in long-term articular cartilage wounds, where they represent the principal repair progenitors in situ under native repair conditions without cellular transplantation. They originate outside the adult bone marrow or superficial zone articular cartilage. These findings have implications for skeletal biology and regenerative medicine for joint injury repair.

Objective: To determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury., Methods: Adult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score., Results: There were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001)., Conclusion: In PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose of Review: There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications., Recent Findings: A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Radical cystectomy (RC) and urinary diversion in the treatment of muscle-invasive bladder cancer is associated with peri-operative complication rates as high as 60%. Ureteroenteric anastomotic stricture (UEAS) is a potential source significant morbidity often requiring secondary interventions. We sought to evaluate our experience with benign UEAS in our open ileal orthotopic neobladder (ON) population., Methods: After Internal Review Board (IRB) approval, we performed a retrospective review of patients who had RC and ON between 2000 and 2015 at MD Anderson Cancer Center and had at least 6 months of follow-up. Baseline demographics and treatment characteristics, peri-operative and post-operative outcomes, as well as information regarding anastomosis technique and suture types were evaluated. Patients with malignant ureteral obstruction were excluded from the analysis., Results: 418 patients had ON creation and the mean age was 59 years (SD 9.4 years) and 90% were males. The mean follow-up was 57 months (6-183 months). 37 patients (8.9%) developed UEAS in 42 renal units and the mean time to diagnosis was 15.8 months (0.85-90 months). Anastomosis and suture type were not predictive of UEAS (p = 0.594, p = 0.586). Perioperative UTI within 30 days of surgery, and recurrent UTI were predictive of UEAS, HR 2.4 p = 0.03, HR 5.1 p < 0.001, respectively., Conclusions: UEAS are associated with potentially significant morbidity following ON creation. UEAS may occur early following ON, but may occur as late as 7 years following surgery. Indeed, technical factors and surgeon experience contribute to the rates of UEAS, but perioperative UTI appears to herald future stricture development.

Background: Female sexual dysfunction (FSD) after pelvic fracture (PFx) has garnered little attention in the urology literature., Aim: To review and summarize the current evidence regarding female PFx-related sexual function., Methods: We performed a systematic review in accordance with PRISMA guidelines, including PubMed, EMBASE, and MEDLINE. We included only English-language manuscripts and abstracts with sufficient data for inclusion. We used the search terms "female sexual dysfunction AND pelvic fracture," "sexual dysfunction AND pelvic fracture," and "female pelvic fracture AND sexual dysfunction." A total of 177 articles were identified; 41 abstracts were reviewed; of which, 19 manuscripts were reviewed. Fifteen met inclusion criteria for analysis., Outcomes: The main outcome measures of this study are rates and types of female sexual dysfunction after pelvic fracture., Results: FSD is prevalent after PFx, with reported rates between 25% and 62%. Three studies used the validated Female Sexual Function Index. The other 12 used non-validated questionnaires or adapted quality-of-life questionnaires with specific questions regarding FSD. The most common complaints include difficulty with intercourse, dyspareunia, orgasmic dysfunction, genitourinary pain, decreased interest in intercourse, decreased satisfaction with intercourse, and pelvic floor dysfunction. Only 1 study addressed resolution of dysfunction (30 of 98 patients [30.4%])., Clinical Implications: FSD is prevalent and an under-recognized sequela of pelvic fracture. This requires future prospective study to better characterize sexual dysfunction and identify effective treatments in trauma survivors., Strength and Limitations: To Increase awareness of FSD after pelvic trauma and the impact on the quality of life in trauma survivors. The current literature is limited by a lack of standardized assessment of FSD, limited follow-up, and minimal discussion of treatment options, in addition to the inherent bias of retrospective studies., Conclusions: FSD after traumatic PFx is not uncommon, occurs mostly in young women, and can be morbid. FSD after PFx is underreported in the urology literature. Thus, all female PFx patients should be screened for FSD by validated questionnaires. The published literature offers little knowledge as to the epidemiology, evaluation, definition, and potential treatments of FSD after PFx. Prospective studies are needed to better understand female sexual function in trauma survivors and the potential methods for prevention and rehabilitation, all within the context of a multidisciplinary approach. Walton AB, Leinwand GZ, Raheem O, et al. Female Sexual Dysfunction After Pelvic Fracture: A Comprehensive Review of the Literature. J Sex Med 2021;18:467-473., (Published by Elsevier Inc.)

Objective: The objective is to summarize and characterize the long-term success of anterior augmentation urethroplasty (AU) in published series. The current literature on AU consists largely of retrospective series reporting intermediate follow-up and incompletely characterize the long term outcomes of AU., Materials and Methods: A systematic literature review was performed consistent with PRISMA guidelines to characterize long-term outcomes of AU with a minimum upper limit follow-up of 100 months. Penile/preputial skin flaps and graft and oral mucosal graft urethroplasties were included. The primary outcome was stricture-free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU and fixed and random effect models were fitted to the data. Additional subset analysis, removing potential confounders (lichen sclerosus, hypospadias and penile skin graft), was performed., Results: Ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and thus were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948, 5 years 0.766, 10 years 0.587, and 15 years 0.45. Subset analysis of the 4 select and homogeneous studies noted 1, 5, 10, and 15 years survival rates of 0.97, 0.96, 0.74, and 0.63, respectively., Conclusions: The long-term success rates of augmentation urethroplasty are appear to be worse than previously appreciated and patients should be counseled accordingly. Available at. https://www.intbrazjurol.com.br/pdf/aop/2019-0242RW.pdf., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objective: To characterize the safety and practice patterns of artificial urinary sphincter (AUS) placement on a population level. Increasingly AUS implantation has shifted to be an outpatient surgery; however, there is a lack of large-scale research evaluating factors associated with early (≤ 24 hours) versus late (>24 hours) discharges and complications in men following AUS placement. We utilized the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach., Methods: NSQIP database was queried for men undergoing AUS placement between 2007 and 2016. Patients were classified as either early discharge (ED ≤ 24 hours) and late discharge (LD > 24 hours). Baseline demographics, operating time, and complications were compared between the 2 groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications., Results: A total of 1176 patients were identified and were classified as ED in 232 and LD in 944 patients. Operative time was shorter in ED (83 minutes) compared to LD (95 minutes, P < .001). Hypertension was more prevalent among LD patients (60.3% vs 69.1% for ED and LD respectively, P < .001). The 30-day complication rate was similar in both groups (ED: 4.3% vs LD: 3.4%, P = .498). Multivariable analysis revealed that surgery after 2012 was associated with ED (OR = 3.66, P < .001)., Conclusion: At the national level, there are no differences in postoperative morbidity between early and late discharges. There is a trend toward more ED, specifically after 2012. A prospective study on the feasibility and safety of outpatient AUS is needed., (Published by Elsevier Inc.)

Purpose: Hysterectomy (Hys) is the most common non-urologic surgery associated with iatrogenic genitourinary (GU) injury. We present the largest known population-based evaluation of GU injury related to benign Hys., Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) was queried by ICD-9 and CPT codes. SPARCS for women from 1995 to 2014, who underwent laparoscopic or robotic Hys (minimally invasive surgery = MIS), abdominal Hys (AH), and vaginal Hys (VH) for benign diagnoses. Bladder and ureteral repairs were captured based on the procedure codes. Codes for ureteroneocystotomy (UNC) were compared to any other ureteral repairs, to elucidate injury patterns. Statistical analysis was conducted using Chi squared test, ANOVA, Mann-Whitney test and Poisson Regression and multivariable analysis were performed., Results: 516,340 women underwent Hys for a benign etiology. 69% were AH, 25% VH, and 6% were MIS. 7490 patients (1.45%) had a concomitant GU injury. Compared to VH, MIS and AH were associated with greater odds of bladder and ureteral injury (p < 0.001). MIS and AH, compared to VH, were associated with reduced odds of UNC compared to complex reconstruction (OR 0.27, p < 0.001 and OR 0.12, p < 0.00, respectively). The injured cohort had higher total mean charges ($29,889 vs $15,808) and length of hospitalization (6.32 vs 3.56 days) (p < 0.001)., Conclusions: Bladder and ureteral injuries during hysterectomy are uncommon in contemporary practice and are lower than historical rates. GU injury increases hospitalization cost. VH is associated with the lowest rate of GU injury, and thus appears to be a valuable approach, when feasible.

Introduction: To evaluate flexible pediatric cystoscopy (FPC) as an adjunctive procedure to retrograde urethrography (RUG) and voiding cystourethrography (VCUG) in the preoperative setting for male urethral strictures. Since imaging interpretation of stricture length and caliber can be difficult at times, we sought to evaluate diagnostic utility of FPC to predict reconstructive surgery., Materials and Methods: Reconstructive urology databases at Washington University and Columbia University were queried from 2010-2017. A total of 185 anterior urethroplasty patients met inclusion criteria. All surgeries were performed by a single surgeon. There were 102 patients that underwent preoperative FPC (7.5 Fr in diameter). Surgical urethroplasty techniques employed were: ventral or dorsal onlay buccal mucosa graft, fasciocutaneous penile skin flap, excision and primary anastomosis or augmented anastomotic. We analyzed the RUG, VCUG, FPC, and intraoperative details of the urethral strictures by univariate and multivariate statistics., Results: Mean patient age was 47.2 (+/-16.5) years. Of the patients who underwent FPC, 42.2% were narrower than the FPC, and 57.8% were wider. Intraoperative stricture length better correlated with FPC findings compared to RUG/ VCUG (r = 0.834 versus r = 0.766) (p < 0.001). Moreover, inability to pass the FPC through the stricture correlated with the need to perform urethral stricture excision or complete reconstruction of the urethral plate (p = 0.005), rather than onlay urethroplasty., Conclusion: Preoperative FPC is a useful adjunctive tool in the evaluation of urethral strictures. FPC facilitates stricture assessment by accurately correlating with intraoperative stricture length and predicting the need to excise or graft during reconstruction.

Amines are ubiquitous in the chemical industry and are present in a wide range of biological processes, motivating the development of amine-sensitive sensors. There are many turn-on amine sensors, however there are no examples of turn-on sensors that utilize the amine's ability to react by single electron transfer (SET). We investigated a new turn-on amine probe with a 4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BODIPY) fluorophore. BODIPY fluorescence is first preprogrammed into an off state by internal photoinduced electron transfer (PET) to an electron-deficient quinolinium ring, resulting in fluorescence quenching. At low concentrations of aliphatic amine (0 to 10 mM), this PET pathway is shut down by external SET from the amine to the photoexcited charge-transfer state of the probe and the fluorescence is turned on. At high concentrations of amine (50 mM to 1 M), we observed collisional quenching of the BODIPY fluorescence. The probe is selective for aliphatic amines over aromatic amines, and aliphatic thiols or alcohols. The three molecular processes modulate the BODIPY fluorescence in a multi-mechanistic way with two of them producing a direct response to amine concentrations. The totality of the three molecular processes produced the first example of a multi-state and dose-responsive amine sensor.

Objective: To examine population-based practice patterns and outcomes related to urethroplasty for urethral stricture management., Methods: We conducted a retrospective study of adult males with urethral stricture disease treated from January 2001 to June 2015 using the Clinformatics Data Mart Database. Treatment was defined as urethral dilation, direct visualized internal urethrotomy, and urethroplasty. We then examined anterior or posterior urethroplasty outcomes defining failure as any subsequent procedure specific to urethral stricture disease occurring >30 days after urethroplasty. We used multivariable and time-to-event analysis to examine factors associated with failure., Results: We identified 75,666 patients treated for urethral stricture disease, with 420 and 367 undergoing anterior and posterior urethroplasty, respectively. Urethroplasty utilization doubled from 2005 to 2015. One- and 5-year failure rates for anterior and posterior urethroplasty were 25% and 18%, and 40% and 25%, respectively, with median times to failure of 5.1 and 4.1 months. Failures were salvaged primarily with direct visualized internal urethrotomy, with salvage urethroplasty in 19% and 12% of anterior and posterior repairs, respectively., Conclusion: Despite increasing population-based urethroplasty utilization over the past decade in our insured cohort, we found higher rates of salvage treatments than reported by high-volume and expert surgeon reports. Further efforts appear warranted to balance workforce expertise and quality of urethroplasty care to meet increasing urethral stricture population needs., (Copyright © 2018. Published by Elsevier Inc.)

The coordinated motion of many individual components underpins the operation of all machines. However, despite generations of experience in engineering, understanding the motion of three or more coupled components remains a challenge, known since the time of Newton as the "three-body problem." Here, we describe, quantify, and simulate a molecular three-body problem of threading two molecular rings onto a linear molecular thread. Specifically, we use voltage-triggered reduction of a tetrazine-based thread to capture two cyanostar macrocycles and form a [3]pseudorotaxane product. As a consequence of the noncovalent coupling between the cyanostar rings, we find the threading occurs by an unexpected and rare inchworm-like motion where one ring follows the other. The mechanism was derived from controls, analysis of cyclic voltammetry (CV) traces, and Brownian dynamics simulations. CVs from two noncovalently interacting rings match that of two covalently linked rings designed to thread via the inchworm pathway, and they deviate considerably from the CV of a macrocycle designed to thread via a stepwise pathway. Time-dependent electrochemistry provides estimates of rate constants for threading. Experimentally derived parameters (energy wells, barriers, diffusion coefficients) helped determine likely pathways of motion with rate-kinetics and Brownian dynamics simulations. Simulations verified intercomponent coupling could be separated into ring-thread interactions for kinetics, and ring-ring interactions for thermodynamics to reduce the three-body problem to a two-body one. Our findings provide a basis for high-throughput design of molecular machinery with multiple components undergoing coupled motion., Competing Interests: Conflict of interest statement: The authors report a patent awarded on “poly-cyanostilbene macrocycles” that covers the composition of matter of cyanostar macrocycles.

Objective: To determine whether the recovery window (RW) between neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) affects 90-day postoperative morbidity and incidence of lymph node metastasis., Patients and Methods: We reviewed patients treated with NAC and RC from 1995 to 2013 for ≤cT 4 N 0 M 0 bladder cancer. The association of the RW with 90-day perioperative morbidity and lymph node metastasis was determined. Generalised linear models were used to determine predictors of each endpoint. Patients were stratified into four RWs by 21-day intervals (18-42; 43-63; 64-84; and ≥85 days) from last day of NAC to RC., Results: We evaluated 306 patients with RW information during the study period. The median (range) RW was 46 (18-199) days. There was no difference in overall morbidity, re-admission, or major complication rates amongst the four RWs. In the multivariable analysis extravesical disease was an independent predictor of overall morbidity (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.16-3.26; P = 0.011). Age (OR 1.05, 95% CI: 1.02-1.09; P = 0.004), and surgical duration ≥7 h (OR 2.87, 95% CI: 1.52-5.42; P = 0.001) were independent predictors of major complications. Only surgical duration ≥7 h was a predictor of re-admission (OR 2.24; 95% CI: 1.26-3.98; P = 0.006). A RW of ≥85 days had the highest incidence of node-positive disease (pN+; 40%). In a separate multivariable model that included clinical predictors for pN+, a RW of ≥85 days was an independent predictor of nodal metastasis (OR 2.92, 95% CI: 1.20-7.09; P = 0.018)., Conclusion: Patients treated with NAC for bladder cancer can undergo RC between 18 and 84 days (2.5-12 weeks) after NAC with no difference in the risk of perioperative morbidity. Delaying surgery beyond 12 weeks was associated with a significant risk of lymph node metastasis., (© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.)

Introduction: Urethral stricture disease accounts for 5,000 hospitalizations and 1.5 million office visits per year. Urethral reconstruction has become more commonplace with the recognition of the poor long-term success of the endoscopic management of stricture disease. Sexual dysfunction related to the surgical management of urethral strictures is an under-recognized sequela., Aim: To characterize and elucidate the various factors that contribute to sexual dysfunction after urethroplasty and hypospadias reconstruction to improve surgical decision making and patient counseling., Methods: A Medline PubMed search was used to identify articles of interest related to sexual dysfunction and urethral stricture disease. The following were included in the search for articles of interest: "urethroplasty and sexual dysfunction," "urethral stricture and erectile dysfunction," "urethroplasty and ejaculatory dysfunction," and "sexual function and hypospadias.", Main Outcome Measure: Rates and types of sexual dysfunction after urethral reconstructive surgery., Results: Urethral reconstructive surgery has the potential to affect many domains of sexual function and thus negatively affect quality of life for patients with urethral stricture disease and hypospadias. These domains include erectile function, ejaculatory function, penile shortening, penile curvature, and altered penile sensation. The etiology, location, length and type of urethral stricture, and importantly the reconstructive technique have different repercussions on sexual function., Conclusion: Sexual dysfunction after urethral reconstruction is underappreciated and has a significant consequence on quality of life. Thus, it is important to recognize these sequelae and counsel patients accordingly. Benson CR, Hoang L, Clavell-Hernández J, Wang R. Sexual Dysfunction in Urethral Reconstruction: A Review of the Literature. Sex Med Rev 2018;6:492-503., (Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: We present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy., Materials and Methods: We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model., Results: The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications., Conclusions: We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Encapsulation of unstable guests is a powerful way to enhance their stability. The lifetimes of organic anions and their radicals produced by reduction are typically short on account of reactivity with oxygen while their larger sizes preclude use of traditional anion receptors. Here we demonstrate the encapsulation and noncovalent stabilization of organic radical anions by C-H hydrogen bonding in π-stacked pairs of cyanostar macrocycles having large cavities. Using electrogenerated tetrazine radical anions, we observe significant extension of their lifetimes, facile molecular switching, and extremely large stabilization energies. The guests form threaded pseudorotaxanes. Complexation extends the radical lifetimes from 2 h to over 20 days without altering its electronic structure. Electrochemical studies show tetrazines thread inside a pair of cyanostar macrocycles following voltage-driven reduction (+e - ) of the tetrazine at -1.00 V and that the complex disassembles after reoxidation (-e - ) at -0.05 V. This reoxidation is shifted 830 mV relative to the free tetrazine radical indicating it is stabilized by an unexpectedly large -80 kJ mol -1 . The stabilization is general as shown using a dithiadiazolyl anion. This finding opens up a new approach to capturing and studying unstable anions and a radical anions when encapsulated by size-complementary anion receptors.

Bacteria of the NC10 phylum link anaerobic methane oxidation to nitrite denitrification through a unique O2-producing intra-aerobic methanotrophy pathway. A niche for NC10 in the pelagic ocean has not been confirmed. We show that NC10 bacteria are present and transcriptionally active in oceanic oxygen minimum zones (OMZs) off northern Mexico and Costa Rica. NC10 16S rRNA genes were detected at all sites, peaking in abundance in the anoxic zone with elevated nitrite and methane concentrations. Phylogenetic analysis of particulate methane monooxygenase genes further confirmed the presence of NC10. rRNA and mRNA transcripts assignable to NC10 peaked within the OMZ and included genes of the putative nitrite-dependent intra-aerobic pathway, with high representation of transcripts containing the unique motif structure of the nitric oxide (NO) reductase of NC10 bacteria, hypothesized to participate in O2-producing NO dismutation. These findings confirm pelagic OMZs as a niche for NC10, suggesting a role for this group in OMZ nitrogen, methane and oxygen cycling.

The existence of two rings in [3]pseudorotaxanes presents opportunities for those rings to undergo double switching and cooperative mechanical coupling. To investigate this capability, we identified a new strategy for bringing two rings into contact with each other and conducted mechanistic studies to reveal their kinetic cooperativity. A redox-active tetrazine ligand bearing two binding sites was selected to allow for two mobile copper(I) macrocycle ring moieties to come together. To realize this switching modality, ligands were screened against their ability to serve as stations on which the rings are initially parked, ultimately identifying 5,5'-dimethyl-2,2'-bipyridine. The kinetics of switching a macrocycle in a single-site [2]pseudorotaxane between bipyridine and single-site tetrazine stations were examined using electrochemistry. The forward movement was rate-limited by the bimolecular reaction between reduced tetrazine and bipyridine [2]pseudorotaxane. Two bipyridines were then used with a double-site tetrazine to verify double switching of two rings. Our results indicated stepwise movements, with the first ring moving 4 times more frequently (faster) than the second. While this behavior is indicative of anticooperative kinetics, positive thermodynamic cooperativity sets the two rings in motion even though just one tetrazine is reduced with one electron. Double switching in this [3]pseudorotaxane uniquely demonstrates how a series of independent thermodynamic states and kinetic paths govern an apparently simple mechanical motion.

Background: The ability to accurately determine tumor stage in bladder cancer is critical because it impacts the management paradigm and overall prognosis. There is often discrepancy between clinical and pathologic staging. Historically, exam under anesthesia (EUA) has been recommended to assist in the staging of bladder cancer., Objective: In this era of modern imaging technology, we sought to determine if EUA still contributes meaningfully to the local staging of bladder cancer., Methods: We retrospectively reviewed the charts of 1898 patients from 1994-2013 in our radical cystectomy database at MD Anderson Cancer Center. There were 414 patients that had complete information including EUA and whose surgery was performed by one of two surgeons and included in the final analysis. Univariate and multiple logistic regression models were generated to determine the ability of EUA, imaging, and other patient characteristics to predict pathological fat extension at the time of cystectomy., Results: 38% of patients had≥pT3 disease at the time of cystectomy. 30.9% of patients had findings on EUA suggestive of T3 disease and 28.7% had radiologic findings suggestive of T3 disease. In a model including age, BMI, ethnicity, year of operation, and neoadjuvant chemotherapy among other factors, the only factors predictive of pT3 disease were EUA and imaging (p = 0.002). The combination of EUA and imaging improved the accuracy of clinical staging compared to either modality alone., Conclusions: Despite modern advances in imaging, EUA contributes meaningfully to accurate determination of local bladder cancer stage.

An unexpected doubling in redox storage emerging from a new pincer ligand upon bis-ligation of iron(ii) is described. When tetrazine arms are present at the two ortho positions of pyridine, the resulting bis-tetrazinyl pyridine (btzp) pincer ligand displays a single one-electron reduction at ca. -0.85 V vs. Ag/AgCl. Complexation to iron, giving the cation Fe(btzp)2(2+), shows no oxidation but four reduction waves in cyclic voltammetry instead of the two expected for the two constituent ligands. Mossbauer, X-ray diffraction and NMR studies show the iron species to contain low spin Fe(ii), but with evidence of back donation from iron to the pincer ligands. CV and UV-Vis spectroelectrochemistry, as well as titration studies as monitored by CV, electronic spectra and EPR reveal the chemical reversibility of forming the reduced species. DFT and EPR studies show varying degrees of delocalization of unpaired spin in different species, including that of a btzp(-1) radical anion, partnered with various cations.

Mechanistic understanding of the translational movements in molecular switches is essential for designing machine-like prototypes capable of following set pathways of motion. To this end, we demonstrated that increasing the station-to-station distance will speed up the linear movements forward and slow down the movements backward in a homologous series of bistable rotaxanes. Four redox-active rotaxanes, which drove a cyclobis(paraquat-p-phenylene) (CBPQT(4+)) mobile ring between a tetrathiafulvalene (TTF) station and an oxyphenylene station, were synthesized with only variations to the lengths of the glycol linker connecting the two stations (n = 5, 8, 11, and 23 atoms). We undertook the first mechanistic study of the full cycle of motion in this class of molecular switch using cyclic voltammetry. The kinetics parameters (k, ΔG(‡)) of switching were determined at different temperatures to provide activation enthalpies (ΔH(‡)) and entropies (ΔS(‡)). Longer glycol linkers led to modest increases in the forward escape (t(1/2) = 60 to <7 ms). The rate-limiting step involves movement of the tetracationic CBPQT(4+) ring away from the singly oxidized TTF(+) unit by overcoming one of the thiomethyl (SMe) speed bumps before proceeding on to the secondary oxyphenylene station. Upon reduction, however, the return translational movement of the CBPQT(4+) ring from the oxyphenylene station back to the neutral TTF station was slowed considerably by the longer linkers (t(1/2) = 1.4 to >69 s); though not because of a diffusive walk. The reduced rate of motion backward depended on folded structures that were only present with longer linkers.

Prostate cancer is the most common solid cancer in men and the second leading cause of cancer death in men. A favored treatment option for organ-confined prostate cancer in a middle-aged healthy man is radical prostatectomy (RP). Despite advances in techniques for RP, there remain concerns among physicians and patients alike on its adverse effects on sexual function. Although post-RP erectile dysfunction has been extensively studied, little attention has been focused on the other domains of sexual function, namely loss of libido, ejaculatory dysfunction, orgasmic dysfunction, penile shortening, and Peyronie disease. The aim of this review is to discuss the most recent literature regarding post-RP sexual dysfunctions.

Data on 5,130 unsupplemented Hereford range cattle were used to evaluate genetic and phenotypic parameters of growth to 2 yr of age under extensive range conditions. From those data, records on 769 heifers saved as replacements were used to evaluate the relationship between growth and subsequent productivity expressed as most probable producing ability (MPPA). Variation in weight largely was due to the year effect. Also, age of dam, the interaction between age of dam and year and the regression on day of birth significantly affected weaning weight. Heritabilities among males and females, respectively, were: birth weight, .53 +/- .09 and .52 +/- .09; weaning weight, .05 +/- .03 and .18 +/- .05; 12-mo gain, .24 +/- .10 and .10 +/- .04; 20-mo gain, .62 +/- .18 and .29 +/- .08; 24-mo gain, .45 +/- .16 and .17 +/- .07. The traits evaluated may have been a response to nutritional stress as well as gainability. The genetic correlation between gain from weaning to 12 mo (a period of weight loss) and gain from 12 to 20 mo (greatest weight gain) was -.93 +/- .45. Metabolic processes favoring growth in a good nutritional environment may result in greater weight loss in a stressful nutritional environment. The genetic correlation between a heifer's gain from weaning to 12 mo and her subsequent MPPA was .47 +/- 28, whereas the correlation between gain from 12 to 20 mo and subsequent MPPA was -.55 +/- .23.(ABSTRACT TRUNCATED AT 250 WORDS)