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Competing Interests: Declaration of Competing Interest Dr. Jacqueline Zillioux declares no conflict of interest.

Purpose: Cognitive ability and manual dexterity sufficient to operate an artificial urinary sphincter (AUS) are critical for device function and safety. We aimed to define the incidence of cognitive and/or dexterity disorders among men after AUS. We secondarily aimed to assess for association between these disorders and postimplant complications., Materials and Methods: This is a retrospective cohort study using the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database (2000-2018). We included men ≥ 66 years diagnosed with prostate cancer between 2001 to 2015 who subsequently underwent AUS placement. We excluded patients with < 1-year continuous fee-for-service Medicare enrollment or cognitive and/or manual dexterity disorder diagnoses prior to AUS implant. Subsequent cognitive/dexterity disorders and implant-related complications were queried using appropriate ICD (International Classification of Diseases)-9/10 and/or CPT (Current Procedural Terminology) codes. Associations between cognitive/dexterity disorders and postimplant complications were assessed using extended Cox proportional hazards modeling. Secondary analysis focused on serious complications (device revision/removal, Fournier's gangrene, urethral erosion)., Results: We identified 1560 men who underwent AUS who met inclusion criteria. Median age was 73.0 (IQR 70-77) years. Cumulative incidence function analysis estimated 44% and 17% incidence of cognitive and manual dexterity disorder, respectively, at 15 years post-AUS. Presence of cognitive with/without manual dexterity disorder was associated with increased hazard of any, but not serious, complication during follow-up., Conclusions: A significant proportion of patients develop cognitive and/or manual dexterity disorders following AUS. These data support the need for close longitudinal monitoring after implant.

Introduction/purpose: Sacral neuromodulation (SNM) is effective therapy for overactive bladder refractory to oral therapies, and non-obstructive urinary retention. A subset of SNM devices is associated with infection requiring surgical removal. We sought to compare microbial compositions of explanted devices in the presence and absence of infection, by testing phase, and other clinical factors, and to investigate antibiotic resistance genes present in the biofilms. We analyzed resistance genes to antibiotics used in commercially-available anti-infective device coating/pouch formulations. We further sought to assess biofilm reconstitution by material type and microbial strain in vitro using a continuous-flow stir tank bioreactor, which mimics human tissue with an indwelling device. We hypothesized that SNM device biofilms would differ in composition by infection status, and genes encoding resistance to rifampin and minocycline would be frequently detected., Materials/methods: Patients scheduled to undergo removal or revision of SNM devices were consented per IRB-approved protocol (IRB 20-415). Devices were swabbed intraoperatively upon exposure, with controls and precautions to reduce contamination of the surrounding field. Samples and controls were analyzed with next-generation sequencing and RT-PCR, metabolomics, and culture-based approaches. Associations between microbial diversity or microbial abundance, and clinical variables were then analyzed using t-tests and ANOVA. Reconstituted biofilm deposition in vitro using the bioreactor was compared by microbial strain and material type using plate-based assays and scanning electron microscopy., Results: Thirty seven devices were analyzed, all of which harbored detectable microbiota. Proteobacteria, Firmicutes and Actinobacteriota were the most common phyla present overall. Beta-diversity differed in the presence versus absence of infection (p = 0.014). Total abundance, based on normalized microbial counts, differed by testing phase (p < 0.001), indication for placement (p = 0.02), diabetes mellitus (p < 0.001), cardiac disease (p = 0.008) and history of UTI (p = 0.008). Significant microbe-metabolite interaction networks were identified overall and in the absence of infection. 24% of biofilms harbored the tetA tetracycline/minocycline resistance gene and 53% harbored the rpoB rifampin resistance gene. Biofilm was reconstituted across tested strains and material types. Ceramic and titanium did not differ in biofilm deposition for any tested strain., Conclusions: All analyzed SNM devices harbored microbiota. Device biofilm composition differed in the presence and absence of infection and by testing phase. Antibiotic resistance genes including to rifampin and tetracycline/minocycline, which are used in commercially-available anti-infective pouches, were frequently detected. Isolated organisms from SNM devices demonstrated the ability to reconstitute biofilm formation in vitro. Biofilm deposition was similar between ceramic and titanium, materials used in commercially-available SNM device casings. The findings and techniques used in this study together provide the basis for the investigation of the next generation of device materials and coatings, which may employ novel alternatives to traditional antibiotics. Such alternatives might include bacterial competition, quorum-sensing modulation, or antiseptic application, which could reduce infection risk without significantly selecting for antibiotic resistance., (© 2024 The Author(s). Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Radical cystectomy in women results in numerous deleterious anatomic impacts to the pelvic floor that can result in sexual dysfunction, pelvic organ prolapse, and other disorders of pelvic floor function. A comprehensive understanding of this relationship and the quality-of-life impacts of radical cystectomy in women is important. This narrative review provides an overview of female pelvic floor disorders in the setting of radical cystectomy, with focus on present understanding of related anatomy, incidence, and prevention strategies, as well as the importance of both provider and patient education., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Urinary incontinence (UI) is highly prevalent in low- and middle-income countries (LMIC). Concurrently, the availability of surgical or conservative UI treatments in LMIC is limited., Methods: We conducted a prospective feasibility study of Belize women with UI treated with pelvic floor physical therapy (PFPT) and education (PFE). Patients received individual PFPT/PFE over 2 days, consisting of biofeedback-enhanced PFMT in addition to behavioral, dietary, and general pelvic education. Patient completed a daily 6-month home regimen including 7 PFMT exercises (total 70 repetitions) comprising both endurance and quick flick exercises. Patients also performed comprehensive dietary and behavioral modification activities. Outcomes were assessed at baseline and 6-months, including validated symptom (ICIQ-FLUTS) and QOL (IIQ-7) questionnaires, and strength testing (PERFECT score, perineometry)., Results: Twenty-eight patients underwent baseline assessment. Four patients were lost to in-person 6-month follow-up, with two of these patients completing subjective assessment only by telephone. The mean (±SD) patient age, BMI, and parity were 50.0 (±10.0) years, 33.2 (±5.8), and 2.8 (±1.5). Provider assessment demonstrated patient comprehension of basic, endurance, and quick flick pelvic floor contractions in 28 (100%), 24 (86%), and 24 (86%) patients, respectively. At 6-month follow-up, significant improvements were seen across multiple validated questionnaire and strength measurement assessments. Median patient-reported improvement level was 7.0 on a 10-point Likert scale., Discussion: Study patients demonstrated good understanding of PFMT/PFE and program completion was associated with significant improvements across a variety of subjective incontinence and quality of life outcomes, as well as objective strength testing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Rapp, Zillioux, Sun, Jones, Little and Mitchell.)

Anticholinergics have been used in the treatment of overactive bladder (OAB), but their use is limited by poor tolerability and anticholinergic-related side effects. Increasingly, providers are discontinuing anticholinergic prescribing because of growing evidence of the association of anticholinergic use with increased risk of cognitive decline and other adverse effects. Newer medications for OAB, the β 3 -adrenergic receptor agonists mirabegron and vibegron, do not have anticholinergic properties and are typically well tolerated; however, many insurance plans have limited patient access to these newer OAB medications by requiring step therapy, meaning less expensive anticholinergic medications must be trialed and/or failed before a β 3 -agonist will be covered and dispensed. Thus, many patients are unable to easily access these medications. Step therapy and other drug utilization strategies (e.g., prior authorization) are often used to manage the growing costs of pharmaceuticals, but these policies do not always follow treatment guidelines and may harm patients as a result of treatment delays, discontinuations, or related increases in adverse events. Medical professionals have called for reform of drug utilization strategies through partnerships that include clinicians and policymakers. This narrative review discusses prescribing patterns for OAB treatment and the effect of switching between drugs, as well as the costs of step therapy and prior authorization on patients and prescribers., (© 2023. The Author(s).)

Background and Objective: With the general population aging and thus more patients developing bothersome erectile dysfunction, stress urinary incontinence and overactive bladder, there will likely be a higher demand for three common interactive implants in urology, the penile prosthesis, artificial urinary sphincter (AUS) and sacral neuromodulation (SNM). Further, the prevalence of mild and major neurocognitive disorders (also known as mild cognitive impairment and dementia, respectively) is expected to increase. While the aforementioned urologic implants have excellent short and long term outcomes, there are also known device issues such as malfunction or misuse that may require surgical removal and/or revision. The objective of this narrative review is to describe the association of cognitive impairment and urologic implants., Methods: We performed a search on PubMed between the years 1975-2023 for English language articles that reported on any type or severity of cognitive impairment and its association with penile prosthesis, AUS and/or SNM. While peer-reviewed published manuscripts were prioritized, abstracts that fit our search criteria were also included., Key Content and Findings: Data assessing outcomes of patients with cognitive impairment who undergo placement of a urologic implant are limited. There is an association between AUS failure or misuse with cognitive impairment. SNM is efficacious in this population in the short term. In patients who develop dementia, an inflatable penile prosthesis can be deflated via in-office needle puncture and an AUS can be deactivated. The Memory Alteration Test, Quick Screen for Mild Cognitive Impairment and the Saint Louis University Mental Status Examination are relatively quick screening tests with good sensitivity and specificity for mild cognitive impairment., Conclusions: While data on the association between urologic implants and cognitive impairment are sparse, there are tools that urologists can use to screen patients for cognitive impairment. With screening, urologists can provide appropriate preoperative counseling (including recommending against implantation) and can provide closer postoperative monitoring. Further study is required to assess which patients should be excluded from device implantation and how to properly assess for cognitive impairment in a manner that is both beneficial for the patient and convenient and efficient for a urologist., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-23-226/coif). RPS serves as an unpaid editorial board member of Translational Andrology and Urology from August 2022 to July 2024. JZ reports co-investigator on independent, investigator-initiated study grant, payments made to institution from Medtronic. DER receives payment for expert review from Ethicon. The other authors have no conflicts of interest to declare., (2023 Translational Andrology and Urology. All rights reserved.)

Purpose: Stress urinary incontinence (SUI) is a well-known adverse outcome following robotic-assisted laparoscopic prostatectomy (RALP). Although postoperative SUI has been extensively studied, little focus has been placed on understanding the natural history and impact of urgency symptoms following RALP. The UVA prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimize continence outcomes following RALP. The present study focuses on assessing urgency outcomes in this cohort., Methods: PFOP patients with a minimum of 6-months follow up following RALP were included. The PFOP includes prospectively assessed incontinence and quality of life outcomes utilizing ICIQ-MLUTS, Urgency Perception Score (UPS), and IIQ-7 questionnaires. The primary study outcome was urgency urinary incontinence (UUI) as determined by ICIQ-MLUTS UUI domain. Secondary outcomes included urgency (UPS score) and quality of life (IIQ-7)., Results: Forty patients were included with median age 63.5 years. Fourteen (35%) patients reported UUI at baseline. UUI and QOL scores worsened compared to baseline at all time-points. Urgency worsened at 3-weeks and 3-months but returned to baseline by 6-months. Notably, 63% of patients without baseline UUI reported de-novo UUI at 6 months. Although QOL was lower in patients with versus without UUI (IIQ-7 score 3.0 vs 0.0, p = 0.009), severity of UUI was not associated with QOL when controlling for SUI severity., Conclusion: Our data demonstrate significantly worsened UUI from baseline and a large incidence of de-novo UUI following RALP. Further study is needed to inform how urgency and UUI and its treatment affect health-related quality of life following RALP., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To assess the prevalence and predictors of chronic pelvic pain in a general urology population presenting for evaluation of unrelated non-painful complaints.Generalized pelvic pain is estimated to afflict between 6% and 26% of women and is often multifactorial in aetiology. A paucity of prospective research exists to characterize chronic pelvic pain patterns and to understand related predictors., Materials and Methods: This is a prospective, cross-sectional survey-based study of female patients presenting to a general urology clinic over a 10-month period (7/2018-5/2019). Patients completed a 32-item survey with questions pertaining to demographics, comorbidities and chronic pelvic pain characteristics. Comparison tests (chi-squared, Fisher's exact) and stepwise multivariable logistic modelling were performed to assess for predictors of chronic pelvic pain., Results: A total of 181 women completed the survey, with a mean age of 56 years. Overall, 75 (41%) women reported chronic pelvic pain. Those with chronic pelvic pain were younger compared to those without (52 vs 59 years, p  = 0.001). Univariable logistic regression analysis identified BMI, depression, fibromyalgia, overactive bladder and any bowel symptoms as possible positive predictors of chronic pelvic pain. Final best-fit multivariable model found overactive bladder, fibromyalgia and presence of bowel symptoms as independent positive predictors of chronic pelvic pain., Conclusions: Our study is one of the few studies that has prospectively analysed chronic pelvic pain and its predictors. The present study identified significant associations with overactive bladder, fibromyalgia and bowel symptoms. Further research is needed to better understand the aetiologies of chronic pelvic pain and the possible relationship with identified clinical predictors., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)

Introduction: Incontinence and urgency are common after prostatectomy. The University of Virginia prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimise continence outcomes following robotic-assisted laparoscopic prostatectomy (RALP). Patients are prospectively evaluated by a Female Pelvic Medicine and Reconstructive Surgery specialist. This study assessed for predictors of 3- and 6-month stress urinary incontinence (SUI) and urgency symptom outcomes following RALP., Methods: We performed a post hoc review of patients from our PFOP receiving a minimum of 6-month follow-up. Urinary symptoms are prospectively assessed using the validated International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) questionnaire and daily pad use (pads per day [PPD]). Primary study outcomes included ICIQ-MLUTS SUI and urgency domain scores and PPD. Multivariable linear regression was performed to identify variables associated with outcomes at 3 and 6 months postoperatively. Variables included patient, oncologic and surgical factors. Each variable was run in a separate model with pelvic floor muscle therapy and surgeon to reduce confounding and prevent overfitting., Results: Forty men were included. In assessment of ICIQ-MLUTS SUI domain score, at 3 months, body mass index (BMI) was associated with worse scores, and at 6 months, BMI, hypertension and estimated blood loss (EBL) were associated with worse scores, whereas bilateral nerve-sparing technique was associated with better scores. For ICIQ-MLUTS Urgency domain score, at 3 months, preoperative use of benign prostatic hyperplasia (BPH) medication was associated with better scores. No covariates predicted 6-month ICIQ-MLUTS Urgency domain scores. For PPD use, at both 3 and 6 months, BMI was a positive predictor, while preoperative use of BPH medication was a negative predictor., Conclusion: Increased BMI, EBL and hypertension are associated with worsened SUI outcomes following RALP, whereas bilateral nerve-sparing technique and preoperative BPH medication are associated with improved SUI outcomes. These data may inform patient counselling and help identify patients who may benefit from closer surveillance and earlier anti-incontinence intervention., (© 2023 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)

Objective: To evaluate the impact of cognitive impairment (CI) diagnoses on sacral neuromodulation (SNM) outcomes in older patients., Materials and Methods: We completed a retrospective review of all patients aged ≥55 years who underwent test-phase SNM (peripheral nerve evaluation (PNE) or stage 1) for overactive bladder (OAB) between 2014 and 2021 within a large multi-regional health system. Patient demographics, relevant comorbidities, CI diagnoses (dementia or mild CI), and SNM procedures were recorded. Logistic regression modeling was performed to evaluate the impact of CI on SNM implantation rates., Results: Five-hundred and ten patients underwent SNM test phase (161 PNE, 349 Stage 1) during the study period. The mean age was 71.0(8.5) years, and most (80.6%) were female. Overall, 52(10.1%) patients had a CI diagnosis at the time of SNM, and 30 (5.8%) were diagnosed at a median of 18.5 [9.25, 39.5] months after SNM. Patients with CI diagnoses were older, with more comorbidities, and were more likely to undergo PNE. Univariable comparison found no difference in implantation rate based on pre-SNM CI (85.4% vs. 76.9%, p = 0.16). Multivariable analysis identified PNE (OR 0.43, 95% CI 0.26-0.71), age (OR 0.96, 95%CI 0.93-0.98), and prior beta-3 agonist use (OR 0.60, 95% CI 0.37-0.99) but not CI or dementia as independent negative predictors of implantation. Implanted patients had a median follow-up of 25 [12.0, 55.0] months. Explant and revision rates did not differ according to CI., Conclusion: Patients with OAB and CI diagnoses proceed to SNM implant at rates similar to patients without CI diagnoses. A diagnosis of CI should not necessarily exclude patients from SNM therapy for refractory OAB., (© 2023 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Introduction and Hypothesis: Intradetrusor onabotulinumtoxinA (BTX-A) is a third-line therapy for overactive bladder (OAB), however several gaps exist in periprocedural care. Prior studies have demonstrated BTX-A efficacy at 2-3 weeks, but there are limited data documenting when patients should begin to note symptom improvement. The primary aim of this study was to evaluate patient-reported temporal improvement in symptoms, with secondary aim to evaluate medication resumption rates, following initial BTX-A injection., Methods: A prospective, single-arm cohort study of patients with non-neurogenic urgency incontinence undergoing initial BTX-A injection was performed. Intradetrusor 100 units BTX-A was administered in standard 20-site template. Patients discontinued OAB medication(s) at BTX-A injection and completed a daily Patient Global Impression of Improvement (PGI-I) diary for 3 weeks. Data were collected at 1 month, including final satisfaction score, medication resumption rates, and adverse outcomes., Results: Fifty-one patients were included, with 25 patients (49%) actively taking an OAB medication. Median time to first improvement was 3 days, at least "much better" (PGI-I <2) was 5 days, and maximal improvement was 7 days. Twenty of 25 patients (80%) opted to remain off OAB medications at 1 month based on symptomatic improvement following injection. Adverse outcomes included urinary tract infection in three patients (6%) and symptomatic incomplete emptying requiring temporary intermittent catheterization in two patients (4%)., Conclusions: Median time to first and maximal improvement was 3 and 7 days, respectively, following initial 100 units BTX-A. Eighty percent of patients on medications opted to remain off at 1 month. These data may help further counsel patient expectations following initial BTX-A therapy., (© 2022. The International Urogynecological Association.)

Importance: Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications., Objectives: The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment., Study Design: The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets., Results: Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk., Conclusions: The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment., Competing Interests: K.L.D. is a speaker (Education): Pacira, Inc. J.Z. received grant funding from Medtronic. A.W. is consultant and research support for Essity Hygiene & Health. Speaker bureau for Urovant Sciences. Research support for Pfizer Corp. C.E.DB. is part of the American Geriatric Society Beers Criteria Revision Panel. M.F.A.'s spouse is from Johnson & Johnson Corporate and received grant funding from National Institute on Aging, Alzheimer's Association, Tamara Harris Foundation. M.A. is part of MAB, Renovia, Inc. H.H.L. received grant funding from NIH, Medtronic: Interstim registry study, Neurspera: DSMB, Astella: Consultant, Ironwood, Biohaven, MicrogenDx: Consultant, V.W.S. received grant funding from NICHD. The remaining authors have declared that there are no conflicts of interest., (Copyright © 2023 American Urogynecologic Society. All rights reserved.)

Abstract: This article outlines an evidence-informed, interdisciplinary, multidimensional, comprehensive action plan for the American Urogynecologic Society to improve care of women with overactive bladder (OAB) while minimizing treatment-related adverse events, including cognitive impairment. It is a "call to action" to advance basic, translational, and clinical research and summarizes initiatives developed at the State-of-the-Science Conference on OAB and Cognitive Impairment to (1) develop framework for a new OAB treatment approach in women, (2) define research gaps and future research priorities, (3) champion health equity and diversity considerations in OAB treatment, (4) foster community and promote education to remove stigma surrounding OAB and urinary incontinence, and (5) elevate visibility and impact of OAB, by creating partnerships through education and engagement with health care professionals, industry, private and public payers, funding agencies, and policymakers., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2023 American Urogynecologic Society. All rights reserved.)

Introduction: Overactive bladder (OAB) disproportionally affects older adults in both incidence and severity. OAB pharmacotherapy is often problematic in the elderly due to polypharmacy, adverse side effect profiles and contraindications in the setting of multiple comorbidities, and concerns regarding the risk of incident dementia with anticholinergic use. The burden of OAB in older patients coupled with concerns surrounding pharmacotherapy options should motivate optimization of nonpharmacologic therapies in this population. At the same time, several aspects of aging may impact treatment efficacy and decision-making. This narrative review critically summarizes current evidence regarding third-line OAB therapy use in the elderly and discusses nuances and treatment considerations specific to the population., Methods: We performed an extensive, nonsystematic evidence assessment of available literature via PubMed on onabotulinumtoxinA (BTX-A), sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS) for OAB, with a focus on study in elderly and frail populations., Results: While limited, available studies show all three third-line therapies are efficacious in older populations and there is no data to support one option over another. BTX-A likely has a higher risk of urinary tract infection and retention in older compared to younger populations, especially in the frail elderly. PTNS incurs the lowest risk, although adherence is poor, largely due to logistical burdens., Conclusion: Advanced age and frailty should not preclude third-line therapy for refractory OAB, as available data support their efficacy and safety in these populations. Ultimately, treatment choices should be individualized and involve shared decision-making., (© 2022 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Aims: Anticholinergic medications are widely used in the treatment of overactive bladder (OAB), as well as for short-term treatment of bladder symptoms following a variety of urologic surgeries. Mounting evidence points to an association between anticholinergic medications and the increased risk of incident dementia. The Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) thus convened a committee of subject experts to contextualize the current understanding of the cognitive risks of anticholinergic medications in the urologic patient population and to provide practical clinical guidance on this subject., Methods: Statements are based on an expert literature review and the committee's opinion. The document has been reviewed and approved by the SUFU board., Results: Chronic use (&gt;3 months) of OAB anticholinergic medications is likely associated with an increased risk of new-onset dementia. Short-term (&lt;4 weeks) use of most OAB anticholinergic medications is likely safe in most individuals. Clinicians should consider potential cognitive risks in all patient populations when prescribing OAB anticholinergics for chronic use. Consideration should be given to progressing to advanced therapy (botulinum toxin or neuromodulation) earlier in the OAB treatment paradigm CONCLUSIONS: The current body of literature supports a likely small but significant increased risk of dementia with chronic exposure to OAB anticholinergic medications. Potential harms should be balanced against potential quality of life improvement with treatment., (© 2022 Wiley Periodicals LLC.)

Introduction: Urological disease is prevalent in low- and middle-income countries. Concurrently, the inability to maintain employment or provide family care contributes to poverty. We assessed the microeconomic impacts of urological disease in Belize., Methods: We conducted a prospective survey-based assessment of patients evaluated during surgical trips by the charity Global Surgical Expedition. Patients completed a survey focusing on impact of urological disease on work and caretaker responsibilities, as well as its economic impact. The primary study outcome was income loss resulting from work impairment or work time missed related to urological disease. Income loss was calculated using the validated Work Productivity and Activity Impairment Questionnaire., Results: A total of 114 patients completed surveys. Overall, 87.7% and 37.2% of respondents reported a negative impact of urological disease on job and caretaking responsibilities, respectively. Nine (7.9%) patients were unemployed secondary to their urological disease. Sixty-one (53.5%) patients provided financial data sufficient for analysis. In this cohort, median weekly income was $250 Belize dollars (approximately $125 United States Dollars), while median weekly cost for urological disease treatment was $25 Belize dollars. Among the 21 (34.5%) patients who missed work due to urological disease, median weekly income loss was $35.6 Belize dollars, representing 55% of their total income. A vast majority (88.6%) of patients reported that cure of urological disease would increase ability to work and/or care for family., Conclusions: In Belize, urological disease results in significant impairment of work and caretaking responsibilities, as well as income loss. Efforts are necessary to provide urological surgeries in low- and middle-income countries as urological disease impacts not only quality of life, but also financial health.

Condyloma acuminatum is a benign genital lesion associated with low-risk human papillomavirus subtypes. Approximately 20% of HPV-associated genital warts occur in the urethra. Topical treatment of urethral condyloma in women can be challenging to treat due to difficulty applying the medication such that it maintains contact with the urethra long enough to be effective. We present a case of a successfully cleared urethral condyloma acuminatum treated via self-application using a Q-tip.

Objective: To assess the impact of duration of antibiotic prophylaxis on incidence of urinary tract infection (UTI) after intravesical OnabotulinumtoxinA (BTX) injection., Methods: A retrospective cohort study of patients with overactive bladder who underwent office BTX injections from 2014 to 2020. UTI incidence within 30 days of BTX was compared between 3 durations of antibiotic prophylaxis: no antibiotic, single day, or multiple day course. Association of UTI with units of BTX, body mass index, history of diabetes, immunosuppression, neurogenic overactive bladder, chronic catheter, or recurrent UTI were investigated., Results: Two hundred ninety patients and 896 cycles of BTX injections were included: 877 injections (97.7%) were women, with mean age 61.4 years (range 20-96; SD 13.3). No antibiotic prophylaxis was given to 112 (12.5%) patients, 595 (66%) received a single day, and 189 (21%) received a multiple day regimen (3-7 days). Overall incidence of UTI within 30 days was 11.4%. On multivariable logistic regression, use of any antibiotic prophylaxis was associated with a lower incidence of UTI (single odds ratio [OR] 0.34; 95% confidence interval [CI] 0.19-0.61; P < .001; multiple OR 0.47; 95% CI 0.24-0.92; P = .029), with no difference between single and multiple day regimens (OR 1.38; 95% CI 0.80-2.38; P = .249). History of recurrent UTI (OR 3.77; 95% CI 2.23-6.39; P < .001) and chronic suprapubic catheter (OR 2.88; 95% CI 1.04-7.95; P = .041) were additional predictors., Conclusion: A multiple day regimen of antibiotic prophylaxis was not more effective than a single day in preventing UTI for intravesical BTX injection. Use of any antibiotic prophylaxis was associated with a significantly lower incidence of UTI compared to no antibiotic., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction and Objective: Parkinson's disease (PD) is the second-most common degenerative neurologic disease worldwide. Overactive bladder (OAB) is prevalent in this population but can be challenging to treat. Sacral neuromodulation (SNM) is an attractive option but remains understudied. We have utilized SNM in PD patients and herein describe our outcomes., Methods: We performed a retrospective chart review of PD patients who underwent peripheral nerve evaluation (PNE) or Stage 1 SNM from 2000 to 2020. The primary outcome was progression to a permanent implant. The impact of PD stage and preprocedural urodynamic (UDS) parameters on test-phase outcome were investigated. Long-term efficacy was assessed using Wilcoxon matched-pairs test looking at a change in urinary symptoms (frequency, nocturia, incontinence episodes, and pad use) documented at follow-up visits and further need for treatment., Results: Thirty-four patients underwent test phase SNM (7 PNE and 27 Stage 1). Median follow-up was 11 (interquartile range 5.8-29.8) months. Indications included refractory OAB (30/34) and nonobstructive urinary retention (4/34). Overall, 82% (28/34) of patients proceeded to a permanent implant. 71% (5/7) of PNEs were successful. Test-phase success did not differ based on PD disease severity or UDS parameters. In patients with OAB/urgency incontinence who progressed to the permanent implant, there was a statistically significant improvement in their urinary symptoms from baseline. Most (68%) patients were able to discontinue OAB medications post-implant. The overall lead revision rate was 14% (4/28) and 3 devices required removal., Conclusions: SNM is an efficacious treatment option for PD patients with a high percentage of patients having improvement in their urinary symptoms., (© 2022 Wiley Periodicals LLC.)

Objectives: This study aimed to determine factors associated with prolonged hospital admission following outpatient female pelvic reconstructive surgery (FPRS) and associated adverse clinical outcomes., Methods: Using the National Surgical Quality Improvement Program database, we identified outpatient FPRS performed 2011-2016. Isolated hysterectomy without concurrent prolapse repair was excluded. Surgeries were classified as major or minor for analysis. The primary outcome was prolonged length of stay (LOS), defined as admission of ≥2 days. Secondary outcomes included complications, readmission and reoperation associated with prolonged LOS. We abstracted data on covariates, and following univariable analysis, performed backward stepwise regression analysis., Results: A total of 29645 women were included: 12311 (41.5%) major and 17334 (58.5%) minor procedures. A total of 6.9% (2033) had a prolonged LOS. On full cohort multivariable regression analysis, patient characteristics associated with prolonged LOS were older age (odds ratio [OR]: 1.1 per 10 years, confidence interval [CI]: 1.06-1.1, p < 0.001), frailty (OR: 1.8, 95% CI: 1.3-2.6, p = 0.001), and Caucasian race (OR: 1.2, CI: 1.02-1.3, p = 0.024). Associated surgical factors included having a major surgical procedure (OR: 1.3, CI: 1.2-1.4, p < 0.001), use of general anesthesia (OR: 2.0, CI: 1.5-2.6, p < 0.001) and longer operative time (OR: 2.0, CI: 1.8-2.2, p < 0.001). The occurrence of any complication (10.3% vs. 4.7%, p < 0.001), hospital readmission (4.3% vs. 1.7%, p < 0.001), and reoperation (2.7% vs. 1.0%, p < 0.001) were more likely with prolonged LOS., Conclusions: After outpatient FPRS, 6.9% of patients experience an admission of ≥2 days. Prolonged LOS is more common in patients who are older, frail and Caucasian, and in those who have major surgery with long operative time and general anesthesia., (© 2022 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Introduction: To assess the character and prevalence of dyspareunia in a general urology population presenting for evaluation of unrelated non-painful complaints., Materials and Methods: This is an IRB-approved, prospective, cross-sectional survey-based assessment of dyspareunia in a general cohort of female patients presenting to a urology clinic over a 10-month period (7/2018-5/2019). Patients presenting specifically for acute painful complaints were excluded. Participating patients completed an original 23-item survey with questions pertaining to dyspareunia. Specific focus was placed on pain characteristics, including location, quality, frequency, severity, and quality of life. Descriptive analysis, pain mapping, and plotting analyses were performed to assess pain patterns., Results: A total of 181 women completed the survey, with a mean age of 56 years. Overall, 53 (29%) women reported dyspareunia. However, among currently sexually active women the prevalence of dyspareunia was 46% (38/83). Patients reported a significant variety of pain locations and qualities. Women most commonly reported multiple pain locations (median 2 (IQR 1,4)), with 33 distinct combinations identified. The majority (70%) of women endorsed only one pain quality, although eight unique combinations were nonetheless seen. A significant proportion (34%) reported high or very high pain severity, with 45% having pain most or all times of sexual activity. A majority (53%) of patients indicated moderate to severe dissatisfaction with their sexual activity. Despite this finding, a significant proportion (33%) of patients with dyspareunia reported having at least weekly sexual activity., Conclusions: A significant percentage of women presenting to a general urology clinic experience dyspareunia. Notably, patient-reported pain characteristics, including location and quality, varied significantly across women assessed. Further study is needed to understand how these characteristics may relate to different and specific etiologies of sexual pain and directed treatment options.

Introduction: Enhanced recovery after surgery protocols and increased attention to value-based care have led to the reconsideration of routine postoperative admission in female pelvic medicine and reconstructive surgery (FPMRS) cases. We aimed to assess trends in same-day discharge (SDD) and associated readmissions and emergency room visits in a single-surgeon 10-year experience., Methods: The electronic medical record was queried for 30-day outcomes (readmission and emergency department visits with associated indications) for all cases performed between June 2010 and August 2020 by a single FPMRS surgeon. Non-FPMRS specialty cases were excluded. Patient characteristics and 30-day outcomes were compared based on SDD status for the overall cohort as well as the subset of cases traditionally involving an overnight stay (i.e., robotic transabdominal, apical prolapse repair)., Results: 1793 surgeries were identified and analyzed, including 357 apical prolapse repairs, 370 slings, 392 neuromodulation and 114 complex mesh excisions. The majority (79.1%) had SDD. For admitted patients, mean length of stay was 1.5 (1.3) days. Among cases traditionally involving overnight stay, rates of SDD were significantly higher in 2020 than 2010 (84% vs. 32%, p < 0.001), and increased over time. Overall rates of 30-day readmission and ED visits were low (1.9% and 2.6%, respectively) and did not differ based on SDD status (p = 0.76). Readmissions occurred at mean 11.6 (7.0) days, most commonly for urinary tract infection (13/34)., Conclusions: SDD is not associated with increased 30-day readmission or ED visits across a wide breadth of FPMRS cases. SDD is safe and feasible in the majority of FPMRS cases., (© 2021 Wiley Periodicals LLC.)

Objective: To identify the incidence of radiation-induced urologic complication requiring procedural intervention following high-dose radiotherapy for cervical carcinoma, and to identify predictors of complication occurrence., Materials and Methods: We performed a retrospective chart review of cervical cancer patients undergoing radiotherapy with primary focus on procedural complications (Clavien-Dindo ≥ III). Clinical data were collected including radiation dose, procedure performed, timing of complication, and need for additional procedures. Univariate and multivariate logistic regression modeling was performed to assess predictive value of demographic and clinical variables., Results: A total of 126 patients with FIGO stage 1A2-4B cervical cancer were included in study analysis, with 18 patients experiencing procedural complication (14.3%). A total of 22 complications were identified, representing an average of 1.2 complications per patient with complication. The most common complications were ureteral stricture and radiation cystitis. The most common nononcologic procedures performed in the treatment of these complications were ureteral stenting, percutaneous nephrostomy tube placement, and cystoscopy. Notably, a total of 259 procedures were performed in the treatment of urologic complications, representing 14.4 procedures per patient and 24.6 procedures per patient with ureteral stricture. Logistic regression demonstrated active smoking at the time of diagnosis to be a predictor of procedural complication., Conclusion: Radiotherapy in the treatment of cervical cancer is associated with a high rate of urologic procedural complication. These complications often require numerous procedures and long-term management given their complexity. These findings suggest a need for awareness and plans for multidisciplinary management of urologic complications in this patient population., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To assess the character and prevalence of female pelvic pain in a general urology population presenting for evaluation of unrelated non-painful complaints., Methods: This is an IRB-approved, prospective, cross-sectional survey-based assessment of pelvic pain in a general cohort of female patients presenting to a urology clinic over a 10-month period (7/2018-5/2019). Patients presenting specifically for acute painful complaints (eg, kidney stones) were excluded. Participating patients completed an original 22-item survey with questions pertaining to pelvic pain. Specific focus was placed on pain characteristics, including location, quality, frequency, exacerbating factors, and severity. Descriptive analysis, pain mapping, and plotting analyses were performed to assess pain patterns., Results: A total of 181 women (mean age 56 years) completed the survey. Overall, 75 (41%) women reported pelvic pain. Two-thirds reported experiencing pain "often" to "always" over the preceding month. Patients described a significant variety of pain locations and qualities. The most common sites of pain were lower back (73%) and bladder (72%), while "dull/aching" was the most common pain quality. A majority (84%) of patients had multiple concurrent pain locations, with 40 unique pain location combinations being reported. Similarly, 13 and 10 unique combinations were seen with pain quality and eliciting activity, respectively., Conclusion: A significant percentage of women presenting to a general urology clinic experience pelvic pain. There was wide variety of pain characteristics and unique patterns. Further research is needed to comprehensively assess pain characteristics and develop related diagnostic pathways., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To evaluate trends in female authorship in the recent urologic literature., Methods: We examined articles published in 2012 and 2017 from 5 urologic journals: Journal of Urology, Journal of Endourology, Neurourology and Urodynamics, Urologic Oncology, and Urology. Gender was recorded for first, supplemental, and last authors. Articles were further categorized by subspecialty focus of the published article. Chi-square tests and multiple logistic regression modeling were used to assess for differences in female authorship by year, journal, and article subspecialty., Results: One thousand four hundred and thirty-three and 1374 articles were published in 2012 and 2017, respectively. There was a significant increase in all female authorship categories between years: first (19%-25%), last (12-16%), and any (67%-74%) (P<.01, all). By journal, the highest proportion of articles with any female authors for both years was in Neurourology and Urodynamics (80%, 2012; 85%, 2017) while lowest was in Journal of Endourology (49%, 2012; 54%, 2017). Likewise, female authorship was generally higher in female/voiding dysfunction /incontinence and lower in endourology subspecialty articles. Controlling for journal and subspecialty, multiple logistic regression analysis showed no change in last authorship between years., Conclusion: Overall female authorship in the urologic literature has increased in recent years. However, after controlling for journal and subspecialty we found no increase in female last authorship between years, suggesting that disparities in senior authorships exist based on journal and subspecialty topic. Our findings further suggest an authorship plateau, highlighting the importance of efforts to optimize advancement and promotion of women in academic urology., (Copyright © 2020. Published by Elsevier Inc.)

Objective: To assessed rates of positive publications within the urologic literature, comparing the years 2012 and 2017., Materials and Methods: All studies published in Journal of Urology, Neurourology and Urodynamics, Urologic Oncology, Journal of Endourology, and Urology in 2012 and 2017 were reviewed. The primary study outcome was proportion of positive studies. Additional article characteristics, including associated citations and subspecialty focus, were recorded and statistical analyses used to assess for differences in negative publication rates based on these variables., Results: A total of 1,796 articles meeting inclusion criteria were analyzed (2012, 959; 2017, 837). The overall proportion of positive studies decreased in comparison of 2012 and 2017. (90%-86%, P =.01). A statistically significant decrease was seen in 2 of 5 journals: Neurourology and Urodynamics (97%-87%, P = .01) and Journal of Endourology (93%-83%, P <.01). There were no significant differences in associated citations for positive vs negative studies in either year. Logistic regression focused on year and journal revealed that studies published in 2017 and Urology were more likely to be negative., Conclusion: The vast majority of studies within the urologic literature are positive, with only a small increase in negative study publication comparing 2012 vs 2017. Continued efforts are needed to identify publication bias and promote dissemination of negative research findings., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Patients are increasingly using online rating websites to obtain information about physicians and to provide feedback. We performed an analysis of urologist online ratings, with specific focus on the relationship between overall rating and urologist subspecialty. We conducted an analysis of urologist ratings on Healthgrades.com. Ratings were sampled across 4 US geographical regions, with focus across 3 practice types (large and small private practice, academic) and 7 urologic subspecialties. Statistical analysis was performed to assess for differences among subgroup ratings. Data were analyzed for 954 urologists with a mean age of 53 (±10) years. The median overall urologist rating was 4.0 [3.4-4.7]. Providers in an academic practice type or robotics/oncology subspecialty had statistically significantly higher ratings when compared to other practice settings or subspecialties ( P < 0.001). All other comparisons between practice types, specialties, regions, and sexes failed to demonstrate statistically significant differences. In our study of online urologist ratings, robotics/oncology subspecialty and academic practice setting were associated with higher overall ratings. Further study is needed to assess reasons underlying this difference., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Suburothelial hemorrhages (Antopol-Goldman lesions) are a rare but important condition. When unsuspected in a patient with a bleeding diathesis on anticoagulation therapy, computed tomography may lead to incorrect diagnoses of renal or transitional cell carcinoma resulting in inappropriate nephrectomy. We present a patient with supratherapeutic international normalized ratio and thigh hematoma who was found to have nonenhancing solid lesions of the bilateral renal pelves consistent with suburothelial hemorrhage. The patient's INR was controlled, and he was discharged with hematology follow-up 4 weeks later., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction and Hypothesis: The opioid epidemic is a recent focus of national initiatives to reduce opioid misuse and related addiction. As interstitial cystitis (IC) is a chronic pain state at risk for narcotic use, we sought to assess opioid prescription use in patients with IC., Methods: Data were accessed from the Virginia All Payers Claims Database. We identified female patients diagnosed with IC from 2011 to 2016 using International Classification of Disease codes. A patient identifier was used to link diagnoses with outpatient prescription claims for opioids using generic product identifiers. We then analyzed opioid prescriptions within 30 days of a claim with a diagnosis of IC., Results: A total of 6,884 patients with an IC diagnosis were identified. The median number of IC claims per patient was 2 (IQR 1 to 4). Mean patient age was 47.8. Twenty-eight percent of patients received at least 1 opioid prescription, with a median of 2 (IQR 1, 4) per patient. Among those receiving opioids, 185 (9.5%) had more than 10 opioid prescriptions, with a maximum of 129. The most common prescriptions were hydrocodone (n = 2,641, 32.3%), oxycodone (n = 2,545, 31.2%), and tramadol (n = 1,195, 14.6%). There was a decline in opioid prescriptions per month for IC, although the rate per IC diagnosis remained stable., Conclusions: A significant number of patients with IC are treated with opioids. Although the overall number of opioid prescriptions associated with IC had declined, the prescription rate per IC diagnosis had not. As part of the national initiative to reduce opioid use, our data suggest that IC treatment strategies should be examined.

Background: Physician-rating websites are being increasingly used by patients to help guide physician choice. As such, an understanding of these websites and factors that influence ratings is valuable to physicians., Objective: We sought to perform a comprehensive analysis of online urology ratings information, with a specific focus on the relationship between number of ratings or comments and overall physician rating., Methods: We analyzed urologist ratings on the Healthgrades website. The data retrieval focused on physician and staff ratings information. Our analysis included descriptive statistics of physician and staff ratings and correlation analysis between physician or staff performance and overall physician rating. Finally, we performed a best-fit analysis to assess for an association between number of physician ratings and overall rating., Results: From a total of 9921 urology profiles analyzed, there were 99,959 ratings and 23,492 comments. Most ratings were either 5 ("excellent") (67.53%, 67,505/99,959) or 1 ("poor") (24.22%, 24,218/99,959). All physician and staff performance ratings demonstrated a positive and statistically significant correlation with overall physician rating (P<.001 for all analyses). Best-fit analysis demonstrated a negative relationship between number of ratings or comments and overall rating until physicians achieved 21 ratings or 6 comments. Thereafter, a positive relationship was seen., Conclusions: In our study, a dichotomous rating distribution was seen with more than 90% of ratings being either excellent or poor. A negative relationship between number of ratings or comments and overall rating was initially seen, after which a positive relationship was demonstrated. Combined, these data suggest that physicians can benefit from understanding online ratings and that proactive steps to encourage patient rating submissions may help optimize overall rating., (©C William Pike, Jacqueline Zillioux, David Rapp. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.07.2019.)

Clomiphene citrate (CC) is commonly used off-label for the treatment of male infertility, yet there is limited data to guide patient selection. To identify a subset of patients more likely to benefit from CC, we aimed to define predictors of improvement in semen parameters among men receiving CC. We retrospectively analysed 151 men treated with at least 25 mg CC daily for male infertility and/or hypogonadism at two institutions between 2004 and 2014. Men previously on testosterone were excluded. The primary outcome was change in semen parameters. Variables included baseline patient characteristics, pre-treatment hormone profiles and pre-treatment semen analyses. A total of 77 men met inclusion criteria. Median length of therapy was 2.8 months. There was significant improvement in sperm concentration (14-21 million/ml; p = 0.002) and total motile count (TMC; 13-28 million; p = 0.04). One third of patients who began with fewer than 5 million motile spermatozoon improved to a TMC > 5 million, increasing reproductive options to include intrauterine insemination. Patient characteristics, pre-treatment hormone profile and degree of oligozoospermia did not predict treatment response. While no predictors of improvement were identified, clinically useful response rates are described for use in shared decision-making., (© 2019 Blackwell Verlag GmbH.)

Introduction: To evaluate complications following urinary diversion for non-malignant conditions., Materials and Methods: We performed a retrospective review of patients undergoing urinary diversion for benign indications between 2000 and 2017. Data collected including patient demographic and clinical characteristics, surgical characteristics, and complications. Complications were graded using Clavien-Dindo classification and were categorized as early versus delayed (≤ versus > 90 day postoperatively). Logistic regression assessed for predictors of developing any postoperative complication., Results: A total of 68 patients were identified for study analysis with median follow up of 24 (7-72) months. Sixty-eight and 25% of patients underwent diversion for neurogenic bladder and complications related to pelvic radiation, respectively. A majority (90%) underwent ileal conduit with the remainder undergoing continent diversion. A total of 121 complications were identified, comprising 50 early and 72 delayed. Overall, 77% of patients had at least one complication during the follow up period. Fifty-one percent of patients experienced early complication, while 66% of patients experienced delayed complications. Complications of Clavien-Dindo Score ≥ IIIB were seen in 48% of patients. The most common early complication was wound infection (12%); delayed was urinary tract infection (39%). Multivariable logistic regression modeling found no independent predictors of complication, although the best-fit model included BMI, diabetes, presence of multiple comorbidities, and operative time (hr) as positive predictors of complication., Conclusion: Our study demonstrates that urinary diversion for benign etiologies is associated with a significant rate of complication. A large percentage of these complications occur in the delayed period and are classified as severe complications.

Introduction: Despite its widespread use in pediatric urology clinics, portable bladder scanning is an insufficiently studied tool that lacks standardized protocols. Workflow at the present clinic can be impeded by scanning in the supine position, due to multiple trips to the restroom and back to the exam room., Objective: The current study sought to test accuracy of bladder scanning, and hypothesized that it would be equally accurate in the standing versus traditional supine position in children, given the intra-abdominal location of their bladders., Design: Sixty children from the bladder/bowel clinic were prospectively recruited. Patients had a formal supine renal/bladder ultrasound and pre-void and/or post-void assessment with scans in both the standing and supine positions. The methods were compared using repeated measures one-way ANOVA., Results: Mean age was 9.2 years. The majority (85%) were female. All bladder scan estimates except for post-void supine significantly correlated with ultrasound volume. Pre-void standing had the strongest correlation (r = 0.83). There was no difference between ultrasound and standing estimates for pre-void volumes, but supine underestimated volumes by 44.8 ml (P < 0.01) (Summary Figure). Sub-group analysis of children aged <10 years showed that pre-void scans in both positions significantly underestimated volume (12% of estimated bladder capacity for standing, 24% for supine, P < 0.05). For post-void volumes, both standing and supine overestimated measurements by 29.4 ml and 18.3 ml, respectively (both P < 0.001). Sub-group analysis based on age yielded comparable results., Discussion: It is believed that this is the first study to examine bladder scanning in different positions. Limitations included small sample size, and the study fell short of cost-effectiveness and outcome analysis to assess the real-life impact of the proposed use of standing bladder scanning in the clinic., Conclusion: Standing bladder scanning may be used in place of supine. However, bladder scanning generally appeared to have poor accuracy, especially in younger children, and thus should be used with caution. In practical terms, it may decrease specificity of detecting elevated post-void residuals compared to ultrasound., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Atezolizumab is a promising immunotherapy for advanced urothelial carcinoma. Like other immune checkpoint inhibitors, it can produce rare immune-related adverse events (IRAEs). Here we present the recent case of a patient with metastatic bladder cancer who developed diarrhea and abdominal pain months after beginning atezolizumab therapy. He presented to our institution with an ileal perforation secondary to atezolizumab-induced enterocolitis. After surgical repair, the patient's condition improved, and he was discharged. We discuss the management of atezolizumab-induced enterocolitis, including the importance of early recognition and intervention to prevent more devastating complications.

Although erectile dysfunction is the most common disorder of male sexual health, ejaculatory dysfunction is the most common form of sexual dysfunction experienced by men. Ejaculatory dysfunction covers a broad range of disorders that we have divided into four main categories: premature ejaculation, delayed ejaculation (DE)/anorgasmia, unsatisfactory sensation of ejaculation (including painful ejaculation and ejaculatory anhedonia), and absent ejaculate (including retrograde ejaculation and aspermia). We also cover several special scenarios including hematospermia, spinal cord injury and fertility with anejaculation. In this paper, we will review the anatomy and pathophysiology of normal ejaculation to establish the baseline knowledge of how this pathway can go awry. We will then briefly review the critical diagnostic criteria, pertinent steps in evaluation, risk factors, and causes (if known) for each of the ejaculatory disorders. Finally, the bulk of the paper will discuss current management strategies of each disorder., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Introduction: Congenitalism is an emerging field that recognizes the complex needs of adult patients with congenital urologic issues. Despite the onset of transitional care clinics, these patients remain difficult to care for due to resource availability, insurance coverage, and multi-disciplinary needs., Objective: The current study sought to characterize practice patterns and opinions regarding care for urologic transition patients., Design: An anonymous 20-question survey was sent to members of the Society of Pediatric Urology listserv. Questions pertained to physician background, practice demographics, clinic structure, and quality. Five-point Likert scales were used to assess quality markers (5 = most/best). Data were analyzed in R, and subgroup analyses were performed. Subgroups included presence of formal transition clinic, city size, and practice type., Results: The response rate was 53%, with 124 respondents. A formal transition clinic was reported by 32%. Those with formal clinics reported higher enthusiasm (3.9 vs 3.4, P < 0.01) for care of these patients and believed they provided better care compared to other institutions (P < 0.001) Summart Table. There was no significant difference in perceived quality between respondents in academic vs other practices. There was a small trend towards higher-quality ratings in smaller cities (3.8 vs 3.5, P = 0.13). The majority (64%) felt that transition patients are best cared for by specialized adult providers; however, these formalized clinics found to be staffed primarily by pediatric providers (54%)., Discussion: This study supported the general consensus in the literature that transition clinics improve care for urologic transition patients, while underlining discordance between current practice patterns and recommendations for optimal care., Conclusion: The majority of practices appeared to lack a formal transition clinic, and there was variation in their structure. Those with formal clinics tended to rate themselves as providing higher-quality care. The majority of respondents believed that adult specialists in either reconstructive or neuro-urology are best suited to care for these complex patients., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

The continued and rapid expansion of the Earth's population mandates the need for safe and effective measures of contraception. While a plethora of options exist for women, methods of contraception for the male partner are limited to condoms and vasectomy. The sequela of this discrepancy has led to the family planning burden falling disproportionately on the female partner. For the past several decades, extensive research has been undertaken exploring the feasibility of hormonal male contraception. This proposed method of contraception has focused on suppressing spermatogenesis by exploiting the hypothalamic-pituitary-gonadal (HPG) axis. Beginning with proof of concept studies in the early nineties, administration of testosterone in healthy male subjects has been shown to be an efficacious method of inducing sterility. Owing to ethnic differences in spermatogenesis suppression and the comparatively low rate of azoospermia in Caucasian men with androgen-only regimens, investigators have explored the addition of progestins to further enhance the efficacy of hormonal contraception. Though studies have revealed promise with androgen-progestin regimens, the lack of long-term studies has precluded the development of a marketable product. Recently, more research has been directed towards identifying non-hormonal alternatives to male contraception. These non-hormonal options have ranged from the development of devices facilitating reversible occlusion of the vas deferens lumen to medications disrupting various pathways in the process of spermatogenesis. Underlying the development of hormonal and non-hormonal strategies is the shared enthusiasm men and women have towards these male directed methods. The willingness of couples to pursue these alternatives combined with the global need to reduce the psychological and socioeconomic implications of unintended pregnancy ensures that research will continue to bring this goal to fruition., Competing Interests: Conflicts of Interest: Kevin Eisenfrats is the Co-Founder/Chief Executive Officer of Contraline, Inc. and holds financial stake in the company. Ryan Smith is the Director of Clinical Research for Contraline, Inc. He does not hold any financial ties with company. The other authors have no conflicts of interest to declare.