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Foamy gland carcinoma is a variant of prostatic acinar adenocarcinoma characterized by abundant foamy cytoplasm and often pyknotic nuclei. Limited data exist regarding outcome and the clinicopathologic attributes of this variant. We screened 477 radical prostatectomies for foamy gland carcinoma to determine the incidence, amount, and Gleason grade/score of foamy gland carcinoma within the prostate. Time until prostate-specific antigen biochemical recurrence after radical prostatectomy was compared for both foamy and control/nonfoamy cases. For validation of incidence, Gleason grade, and pathologic stage, a second series of 100 consecutive radical prostatectomies was screened for foamy gland carcinoma. Foamy gland carcinoma was found in 69 (14.5%) of 477 cases. The median Gleason score of the foamy component was 7, which was not significantly different from the Gleason score of the nonfoamy component within those cases or the 408 nonfoamy cases. The most common Gleason score was 7 (44/69). There was no difference between foamy gland and nonfoamy gland cases in recurrence rate (23% versus 22%) or the average time to prostate-specific antigen recurrence (130 versus 151 months). In the second series, foamy gland carcinoma was found in 23% of cases and had a median Gleason score of 7; and the most common Gleason score was 7 (11/23). Foamy gland carcinoma exists in a significant subset of prostatic carcinomas. This variant does not appear to harbor a different prognosis compared with usual acinar adenocarcinoma, but diagnostic recognition of foamy gland carcinoma is important because there is a Gleason grade 4 element in the majority of cases.

Objective To perform a population-based comparison of inflatable vs semirigid penile prostheses and to determine contemporary rates of reoperation and identify factors impacting the type of prosthetic implanted. Methods Patient-level discharge data and revisit files from the Agency for Healthcare Research and Quality for semirigid and inflatable prosthesis procedures performed for erectile dysfunction from 2006 to 2009 in the state of California were examined. Regression analysis was performed to determine differences between the procedures in terms of infectious and noninfectious failure. Regression analysis was performed to identify factors associated with revision and to identify associations between potential risk factors and the type of implant performed. Results A total of 2263 cases were included in the study (1824 inflatable and 439 semirigid). The overall reoperation rate was 7.42%. There was no difference in the overall revision rate between the 2 groups (7.52% semirigid and 7.40% inflatable; P = .94). The reoperation rate secondary to infectious complications was 3.6% (4.5% semirigid vs 3.23% inflatable; P = .18). The revision rate secondary to noninfectious failure was 2.96% in the semirigid vs 4.17% in the inflatable group ( P = .25). Medicaid insurance (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.41-3.61), African American race (OR, 1.7; 95% CI, 1.20-2.49), age >80 ( P = .046), and diabetes (OR, 1.67; 95% CI, 1.07-2.59) were associated with receiving a semirigid implant. Conclusion Reoperation rates for infectious and noninfectious failure are equivalent between the semirigid and inflatable penile prostheses. Sociodemographic factors appear to significantly influence the type of prosthesis a patient receives.

Objective To investigate the bacterial colonization rate of the InterStim connector and lead during staged testing and the infectious outcome. Methods A total of 38 consecutive patients who were scheduled to undergo staged InterStim surgery were enrolled in the present prospective study. During the second stage procedure, immediately after the connector incision was opened, aerobic and anaerobic cultures were obtained by swabbing the connector pocket, the connector, and the permanent lead itself with sterile swabs. Results Of the 38 patients, 9 (24%) had a positive culture at the connector or lead site after the incision was opened during the second stage procedure. Of the 9 patients who had a colonized connector or lead, 3 (33%) subsequently developed device infection that required explantation. In contrast, only 3% of those who did not have colonization developed an infection afterward (P = .038). Longer percutaneous testing period was associated with a greater colonization rate. Of the 10 patients who underwent >14 days of staged testing, 5 (50%) developed connector and/or lead colonization. However, only 4 of the 28 patients (14%) who underwent ≤14 days of testing did so (P = .036, relative risk 3.5, 95% confidence interval 1.2-10.5). Conclusion The risk of InterStim colonization is significant using the staged, tined lead testing approach. Testing for >14 days between the 2 stages was associated with greater colonization rates. Patients should be evaluated on an ongoing basis during staged testing, with attempts to perform generator implantation once efficacy has been unequivocally demonstrated to reduce the risk of colonization.

We defined the relevant skin flora during genitourinary prosthetic surgery, evaluated the safety of chlorhexidine-alcohol for use on the male genitalia and compared chlorhexidine-alcohol to povidone-iodine in decreasing the rate of positive bacterial skin cultures at the surgical skin site before prosthetic device implantation.In this single institution, prospective, randomized, controlled study we evaluated 100 consecutive patients undergoing initial genitourinary prosthetic implantation. Patients were randomized to a standard skin preparation with povidone-iodine or chlorhexidine-alcohol. Skin cultures were obtained from the surgical site before and after skin preparation.A total of 100 patients were randomized, with 50 in each arm. Pre-preparation cultures were positive in 79% of the patients. Post-preparation cultures were positive in 8% in the chlorhexidine-alcohol group compared to 32% in the povidone-iodine group (p = 0.0091). Coagulase-negative staphylococci were the most commonly isolated organisms in post-preparation cultures in the povidone-iodine group (13 of 16 patients) as opposed to propionibacterium in the chlorhexidine-alcohol group (3 of 4 patients). Clinical complications requiring additional operations or device removal occurred in 6 patients (6%) with no significant difference between the 2 groups. No urethral or genital skin complications occurred in either group.Chlorhexidine-alcohol was superior to povidone-iodine in eradicating skin flora at the surgical skin site before genitourinary prosthetic implantation. There does not appear to be any increased risk of urethral or genital skin irritation with the use of chlorhexidine compared to povidone-iodine. Chlorhexidine-alcohol appears to be the optimal agent for skin preparation before genitourinary prosthetic procedures.

In selecting a medical student for a urology residency, a set of preconceived criteria as to what will predict a successful resident are generally applied. To determine what factors predict an "excellent" clinical resident and a successful in-service test taker, we analyzed 10 years of urology resident files. PARTICIPANTS AND STUDY DESIGN: Retrospective chart review of 29 urology residents at Washington University graduating from July 2000 to July 2009. Medical student applications and interview evaluations were compared with future performance as a general surgical intern and then as a urology resident, in terms of clinical performance and in-service examination scores.Of 29 residents, based on clinical evaluations over 4 years of urology residency, 12 were "excellent," 17 "average and needing improvement." "Excellent" residents had higher applicant rank submitted to the "match" (7.2 vs. 12.1, p = 0.04) and better letters of recommendation (3.0 vs. 2.5, 0.018). "Excellent" residents also had better evaluations as an intern (3.9 vs 2.7, p0.001). "Good" urology in-service examination test takers compared with "below average" test takers noted higher rank on the match list (7.8 vs 12.1, p = 0.04), better quality med school (2.6 vs 2.0; p = 0.002), higher USMLE scores (92.5 vs 86.6% tile, p = 0.02), American Board of Surgery in-training examination (ABSITE) score (58.6 vs 37.2% tile, p = 0.04), and were more likely to pass the board examination (100% vs 76.9%, p = 0.03). Residents with higher clinical evaluations were also more likely to go into fellowships (83.3% vs 16.2%, OR = 23.3) and academic careers (41.6 vs 11.1%, OR = 5.71).Performance as a surgery intern predicts future performance as a GU Resident. "Good" test takers as medical students and as interns continue to test well as GU residents. Early identification, intervention, and mentoring while still an intern are essential. Selection criteria we currently use to select GU residents are surprisingly predictive.