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Introduction:We evaluated the adherence of urologists within an integrated health care system to Choosing Wisely®, an initiative aimed at avoiding unnecessary medical tests. In urology, 2 o...

Introduction Peyronie’s disease (PD) is an acquired wound-healing disorder of the penis involving fibrosis and scar formation within the tunica albuginea that can lead to various penile deformities resulting in penile pain, sexual dysfunction, low self-esteem, and emotional distress. While many studies highlight the psychosocial impact of PD on the patient, little is known about the female partner’s experience regarding PD and its management. Objectives To evaluate and summarize the available clinical data on the effects of the disease and its management on female sexual partners of patients with PD. Methods A search of the available medical literature using the MEDLINE and PubMed databases was performed. The queried terms included the following: Peyronie’s disease, partner, female, dyspareunia, relationship, satisfaction, survey, and outcome. Studies were included only if the female sexual partners were directly evaluated or interviewed. Results PD can have a significant impact on the sexual function and satisfaction of female sexual partners. Most female sexual partners reported an improvement in their relationship, a decrease in sexual dysfunction, and improved overall satisfaction after both surgical and nonsurgical treatment. Conclusion PD can be emotionally debilitating for patients and their partners. It has been associated with depression, social stigmatization, isolation, diminished self-worth, and avoidance of intimacy. A partner’s experience with PD, as well as its management and outcomes, is an understudied entity that warrants further investigation and may be useful in guiding future treatment approaches. Kern T, Ye N, Abdelsayed GA. Peyronie's Disease: What About the Female Sexual Partner?. Sex Med Rev 2021;9:230–235.

Neuropeptides are abundant signaling molecules in the central nervous system. Yet remarkably little is known about their spatiotemporal spread and biological activity. Here, we developed an integrated optical approach using Plasmonic nAnovesicles and cell-based neurotransmitter fluorescent engineered reporter (CNiFER), or PACE, to probe neuropeptide signaling in the mouse neocortex. Small volumes (fL to pL) of exogenously supplied somatostatin-14 (SST) can be rapidly released under near-infrared light stimulation from nanovesicles implanted in the brain and detected by SST2 CNiFERs with nM sensitivity. Our measurements reveal reduced but synchronized SST transmission within 130 μm, and markedly smaller and delayed transmission at longer distances. These measurements enabled a quantitative estimation of the SST loss rate due to peptide degradation and binding. PACE offers a new tool for determining the spatiotemporal scales of neuropeptide volume transmission and signaling in the brain.

Neuropeptides are essential signaling molecules in the nervous system involved in modulating neural circuits and behavior. Although hypothesized to signal via volume transmission through G-protein coupled receptors (GPCR), remarkably little is known about their extrasynaptic diffusion. Here, we developed an all-optical approach to probe neuropeptide volume transmission in mouse neocortex. To control neuropeptide release, we engineered photosensitive nanovesicles with somatostatin-14 (SST) that is released with near-infrared light stimulation. To detect SST, we created a new cell-based neurotransmitter fluorescent engineered reporter (CNiFER) using the SST2 GPCR. Under two-photon imaging, we determined the time to activate SST2R at defined distances as well as the maximal distance and loss rate for SST volume transmission in neocortex. Importantly, we determined that SST transmission is significantly faster in neocortex with a chemically degraded extracellular matrix, a diseased condition indicated in neuroinflammation and Parkinson’s disease. These new neurotechnologies can reveal important biological signaling processes previously not possible, and provide new opportunities to investigate volume transmission in the brain.

Introduction Primary renal carcinoid tumors are a rare subset of neuroendocrine tumors arising in the kidneys. Although carcinoid syndrome has occasionally been described, most patients are asymptomatic at presentation. Case presentations We present 2 cases of primary renal carcinoid tumor and describe the workup, immunohistochemical analysis, treatment, and surveillance of each female patient. The first patient was found to have a renal mass on imaging during a workup of chronic abdominal pain and subsequently underwent a robotic radical nephrectomy. The second patient was found to have an incidental renal mass on imaging and subsequently underwent renal biopsy, followed by robot-assisted laparoscopic partial nephrectomy. In both cases, a gallium dotatate Ga 68-enhanced positron emission tomography/computed tomography scan was used to further assess disease burden. Discussion This report describes 2 cases of primary renal carcinoid tumor with unique presentations and management in our regional health care system. Because primary renal carcinoid tumors are quite uncommon, there are no clear established guidelines on preoperative imaging or posttreatment surveillance in patients with these tumors. There remains a large amount of variability in the diagnosis, workup, immunohistochemical analysis, treatment, and surveillance of patients with primary renal carcinoid tumors. As we learn more about this disease, we hope to optimize patient outcomes and standardize pretreatment workup and posttreatment surveillance.

INTRODUCTION AND OBJECTIVE:Choosing Wisely® is an initiative to avoid unnecessary medical workup and expenditure. In Urology, Statements 1 and 7 (published 2013 and 2015 respectively) state bone sc...

INTRODUCTION: Vasectomy is the most common and most effective method of achieving permanent male sterility. However, there is a low risk of vasectomy failure. To our knowledge, there is no symptom complex that has been identified and described that is predictive of early recanalization and vasectomy failure. CASE PRESENTATION: A 44-year-old man underwent a routine bilateral vasectomy without complication. Two months after the procedure, the patient experienced an acute onset of scrotal pain and hematospermia. Several semen analyses were performed during the following months, the results of which demonstrated progressively rising numbers of motile sperm and were indicative of vasal recanalization. The patient underwent repeated vasectomy, during which he was found to have right vasal recanalization leading to vasectomy failure. DISCUSSION: Delayed postvasectomy scrotal pain associated with hematospermia may be a sign of vasal recanalization. We propose that this symptom complex should prompt an investigation for vasal recanalization, during which the patient should be instructed to refrain from intercourse without the use of an additional method of contraception.

INTRODUCTION Rapid adoption of robotics has introduced a paradigm change in prostate cancer treatment, with more than 80% of prostatectomies performed robotically in 2015. For treatment of renal cell carcinoma (RCC), this change has not previously been reported. We evaluated trends in surgical management of RCC in Kaiser Permanente Southern California (KPSC) within the last 16 years, especially after adoption of robotics. METHODS From January 1999 to September 2015, all KPSC members who underwent surgical treatment of suspected RCC were included retrospectively. Surgical approach, patient age, sex, clinicopathology, Charlson Comorbidity Index, and chronic kidney disease status were analyzed using robust Poisson multivariate regression. RESULTS The study included 5237 patients. Partial nephrectomy was increasingly used during the study period, and its use surpassed radical nephrectomy in 2012. In a multivariate model, partial nephrectomy was associated with lower pathologic tumor stage (p < 0.001) and lower Charlson Comorbidity Index (p = 0.004) vs radical nephrectomy. Robot-assisted laparoscopic partial nephrectomy (RALPN) started in KPSC in March 2011, and its relative use among all RCC surgeries increased in the following 3 years by 125%, 45%, and 14%. Laparoscopic partial nephrectomy and laparoscopic radical nephrectomy were the most frequently used surgical approaches for localized RCC when RALPN started in 2011. However, RALPN surpassed laparoscopic partial nephrectomy and laparoscopic radical nephrectomy in 2012 and 2014, respectively. CONCLUSION During our study, partial nephrectomy became the most common surgery for treatment of localized RCC. Since 2014, RALPN has become the most common renal oncologic surgical modality in KPSC.