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Research paper thumbnail of Urologic Problems in Spina Bifida Patients Transitioning to Adult Care

Urology, 2014

To identify the urologic needs of adult patients with spina bifida (SB) at the time of their tran... more To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems. We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions. We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems. On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.

Research paper thumbnail of A Practical Approach for Primary Care Practitioners to Evaluate and Manage Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia

Federal Practitioner, 2021

• FEDERAL PRACTITIONER • 573 mdedge.com/fedprac Background: Benign prostatic hyperplasia (BPH) an... more • FEDERAL PRACTITIONER • 573 mdedge.com/fedprac Background: Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are common clinical encounters for most primary care practitioners (PCPs). More than 50% of men aged > 50 years will develop significant lower urinary tract symptoms. Managing these symptoms can be complicated and requires an informed discussion between the PCP and the patient. This article provides a comprehensive review for PCPs regarding the evaluation and management of LUTS in men and when to consider a urology referral. Observations: Over the past 3 decades, medications have become the most common BPH and LUTS therapy, but recently, newer minimally invasive surgeries have challenged this paradigm. PCPs are in a unique position to help many patients who present with early stage LUTS. Conclusions: A clear understanding of the available treatment options will help PCPs counsel patients appropriately about lifestyle modification, medications, and surgical treatment options for their symptoms.

Research paper thumbnail of PD63-03 Patency and Incontinence Rates of Robotic Bladder Neck Reconstruction for Recalcitrant Bladder Neck Contractures: The Turns Experience

The Journal of Urology

urethroplasty success. Our aim is to examine factors associated with posterior urethroplasty fail... more urethroplasty success. Our aim is to examine factors associated with posterior urethroplasty failure. METHODS: A retrospective review of 140 patients undergoing posterior urethroplasty over a 13-year period at a single center was performed. Urethroplasty failure was defined as stricture <16Fr identified on cystoscopy with a minimum of 12 months' follow-up. Clinical covariates included patient age, obesity (BMI>35), smoking, Charlson comorbidity index, etiology (pelvic fracture, radiation, or iatrogenic), stricture length, previous endoscopic treatments, previous urethroplasty and type of urethroplasty (anastomotic or tissue transfer with onlay). All patients underwent preoperative staging with retrograde urethrography, voiding cystourethrogram and cystoscopy. Descriptive statistics were used to summarize data while univariate and multivariate Cox regression analyses were used to delineate clinical associations. RESULTS: Average stenosis length was 2.2 cm with a mean patient age of 52.1 years. Overall urethral patency was 86.4% with a mean follow-up of 61.6 months (12-156). 63.6% of patients failed previous endoscopic treatment, while 6.4% failed previous urethroplasty. 91.4%% of patients underwent anastomotic urethroplasty with the remaining required tissue transfer with onlay using either a buccal mucosal graft or penile island flap. On univariate Cox regression analysis stricture length (p<0.0001) and tissue transfer (p¼0.008) were associated with stricture recurrence while patient age (p¼0.85), smoking (p¼0.11), obesity (p¼0.57), overall comorbidity (p¼0.21), stricture etiology (p¼0.57), prior endoscopic treatment (p¼0.54) and prior urethroplasty (p¼0.83) were not. On multivariate assessment stricture length remained independently associated with stricture recurrence (p¼0.03; H.R. 1.4; 95%CI 1.1-1.9) while tissue transfer was not (p¼0.73). CONCLUSIONS: Although without the variability in length found in anterior urethral strictures, stricture length is independently associated with recurrence stenosis after posterior urethroplasty. This emphasizes the importance of accurate preoperative staging preoperatively in order to determine accurate stricture length and thus provide appropriate preoperative patient counselling.

Research paper thumbnail of PD50-07 Non-Inferiority of a Novel Capacitance Fluid Height Design Compared to Rotating Disc and Weight Transducer Designs for Home Uroflowmetry Applications

The Journal of Urology

floor and urogenital symptoms correlated to women with a deeper sacral curvature (PFDI r¼0.16, p<... more floor and urogenital symptoms correlated to women with a deeper sacral curvature (PFDI r¼0.16, p<0.05; UDI-6 r¼0.15, p<0.05). Worse colorectal symptoms correlated with higher ratio of dominant fibroid diameter to the pelvic diameter (distance measured from sacral promontory to the superior symphysis) (CRAD-8 r¼0.19, p<0.01). CONCLUSIONS: Contrary to common belief, LUTS appear to inversely correlate with uterine volume. Women with a smaller pelvis or deeper sacral curvature relative to fibroid size may report worse symptoms unless the fibroid is displaced into the abdomen. Fibroid size relative to bony parameters may help providers counsel patients on whether removal of fibroids will provide symptom relief.

Research paper thumbnail of 384 Urologic Problems in Spina Bifida Patients Transitioning to Adult Care

The Journal of Urology, 2013

Research paper thumbnail of Patency and Incontinence Rates After Robotic Bladder Neck Reconstruction for Vesicourethral Anastomotic Stenosis and Recalcitrant Bladder Neck Contractures: The Trauma and Urologic Reconstructive Network of Surgeons Experience

Urology, Jan 16, 2018

To review a robotic approach to recalcitrant bladder neck obstruction and to assess success and i... more To review a robotic approach to recalcitrant bladder neck obstruction and to assess success and incontinence rates. Patients with a recalcitrant bladder neck contracture or vesicourethral anastomotic stenosis who underwent robotic bladder neck reconstruction (RBNR) were identified. We reviewed patient demographics, medical history, etiology, previous endoscopic management, cystoscopic and symptomatic outcomes, urinary continence, and complications. Stricture success was anatomic and functional based upon atraumatic passage of a 17 Fr flexible cystoscope or uroflowmetry rate >15 ml/s. Incontinence was defined as the use of >1 pad per day or procedures for incontinence. Between 2015 and 2017, 12 patients were identified who met study criteria and underwent RBNR. Etiology of obstruction was endoscopic prostate procedure in 7 and radical prostatectomy in 5. The mean operative time was 216 minutes (range 120-390 minutes), with a mean estimated blood loss of 85 cc (range 5-200 cc). ...

Research paper thumbnail of An antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy

World Journal of Urology, 2015

To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in pa... more To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy in our Veterans Affairs population. Between June 1, 2013, and June 1, 2014, we implemented an antimicrobial prophylaxis protocol using rectal swab cultures on selective media containing ciprofloxacin for all men scheduled for TRUS-guided prostate biopsy. Data from 2759 patients from Jan 1, 2006 to May 31, 2013, before protocol implementation served as historical controls. Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy, while those with FQ-resistant organisms received targeted prophylaxis. Our objective was to compare the rate of infectious complications 30 days after prostate biopsy before and after implementation of our antimicrobial protocol. One hundred and sixty-seven patients received rectal swab cultures using our protocol. Seventeen (14 %) patients had FQ-resistant positive cultures. Patients with positive FQ-resistant culture results were more likely to have had a history of previous prostate biopsy and a positive urine culture in the last 12 months (p = 0.032, p = 0.018, respectively). The average annual infectious complication rate within 30 days of biopsy was reduced from 2.8 to 0.6 % before and after implementation of our antimicrobial prophylaxis protocol using rectal swab cultures, although this difference was not statistically significant (p = 0.13). An antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications. After implementation of an antimicrobial prophylaxis protocol, we observed a nonsignificant decrease in the rate of post-biopsy infectious complications when compared to historical controls.

Research paper thumbnail of 346 COST DISCREPANCIES BETWEEN PERCEIVED AND ACTUAL COSTS OF UROLOGIC AND OPERATIVE SUPPLIES IN AN ACADEMIC UROLOGY PRACTICE

Research paper thumbnail of 346 COST DISCREPANCIES BETWEEN PERCEIVED AND ACTUAL COSTS OF UROLOGIC AND OPERATIVE SUPPLIES IN AN ACADEMIC UROLOGY PRACTICE

The Journal of Urology, 2010

Research paper thumbnail of Urologic Problems in Spina Bifida Patients Transitioning to Adult Care

Urology, 2014

To identify the urologic needs of adult patients with spina bifida (SB) at the time of their tran... more To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems. We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions. We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems. On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.

Research paper thumbnail of Urologic Problems in Spina Bifida Patients Transitioning to Adult Care

Urology, 2014

To identify the urologic needs of adult patients with spina bifida (SB) at the time of their tran... more To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems. We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions. We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems. On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.

Research paper thumbnail of A Practical Approach for Primary Care Practitioners to Evaluate and Manage Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia

Federal Practitioner, 2021

• FEDERAL PRACTITIONER • 573 mdedge.com/fedprac Background: Benign prostatic hyperplasia (BPH) an... more • FEDERAL PRACTITIONER • 573 mdedge.com/fedprac Background: Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are common clinical encounters for most primary care practitioners (PCPs). More than 50% of men aged > 50 years will develop significant lower urinary tract symptoms. Managing these symptoms can be complicated and requires an informed discussion between the PCP and the patient. This article provides a comprehensive review for PCPs regarding the evaluation and management of LUTS in men and when to consider a urology referral. Observations: Over the past 3 decades, medications have become the most common BPH and LUTS therapy, but recently, newer minimally invasive surgeries have challenged this paradigm. PCPs are in a unique position to help many patients who present with early stage LUTS. Conclusions: A clear understanding of the available treatment options will help PCPs counsel patients appropriately about lifestyle modification, medications, and surgical treatment options for their symptoms.

Research paper thumbnail of PD63-03 Patency and Incontinence Rates of Robotic Bladder Neck Reconstruction for Recalcitrant Bladder Neck Contractures: The Turns Experience

The Journal of Urology

urethroplasty success. Our aim is to examine factors associated with posterior urethroplasty fail... more urethroplasty success. Our aim is to examine factors associated with posterior urethroplasty failure. METHODS: A retrospective review of 140 patients undergoing posterior urethroplasty over a 13-year period at a single center was performed. Urethroplasty failure was defined as stricture <16Fr identified on cystoscopy with a minimum of 12 months' follow-up. Clinical covariates included patient age, obesity (BMI>35), smoking, Charlson comorbidity index, etiology (pelvic fracture, radiation, or iatrogenic), stricture length, previous endoscopic treatments, previous urethroplasty and type of urethroplasty (anastomotic or tissue transfer with onlay). All patients underwent preoperative staging with retrograde urethrography, voiding cystourethrogram and cystoscopy. Descriptive statistics were used to summarize data while univariate and multivariate Cox regression analyses were used to delineate clinical associations. RESULTS: Average stenosis length was 2.2 cm with a mean patient age of 52.1 years. Overall urethral patency was 86.4% with a mean follow-up of 61.6 months (12-156). 63.6% of patients failed previous endoscopic treatment, while 6.4% failed previous urethroplasty. 91.4%% of patients underwent anastomotic urethroplasty with the remaining required tissue transfer with onlay using either a buccal mucosal graft or penile island flap. On univariate Cox regression analysis stricture length (p<0.0001) and tissue transfer (p¼0.008) were associated with stricture recurrence while patient age (p¼0.85), smoking (p¼0.11), obesity (p¼0.57), overall comorbidity (p¼0.21), stricture etiology (p¼0.57), prior endoscopic treatment (p¼0.54) and prior urethroplasty (p¼0.83) were not. On multivariate assessment stricture length remained independently associated with stricture recurrence (p¼0.03; H.R. 1.4; 95%CI 1.1-1.9) while tissue transfer was not (p¼0.73). CONCLUSIONS: Although without the variability in length found in anterior urethral strictures, stricture length is independently associated with recurrence stenosis after posterior urethroplasty. This emphasizes the importance of accurate preoperative staging preoperatively in order to determine accurate stricture length and thus provide appropriate preoperative patient counselling.

Research paper thumbnail of PD50-07 Non-Inferiority of a Novel Capacitance Fluid Height Design Compared to Rotating Disc and Weight Transducer Designs for Home Uroflowmetry Applications

The Journal of Urology

floor and urogenital symptoms correlated to women with a deeper sacral curvature (PFDI r¼0.16, p<... more floor and urogenital symptoms correlated to women with a deeper sacral curvature (PFDI r¼0.16, p<0.05; UDI-6 r¼0.15, p<0.05). Worse colorectal symptoms correlated with higher ratio of dominant fibroid diameter to the pelvic diameter (distance measured from sacral promontory to the superior symphysis) (CRAD-8 r¼0.19, p<0.01). CONCLUSIONS: Contrary to common belief, LUTS appear to inversely correlate with uterine volume. Women with a smaller pelvis or deeper sacral curvature relative to fibroid size may report worse symptoms unless the fibroid is displaced into the abdomen. Fibroid size relative to bony parameters may help providers counsel patients on whether removal of fibroids will provide symptom relief.

Research paper thumbnail of 384 Urologic Problems in Spina Bifida Patients Transitioning to Adult Care

The Journal of Urology, 2013

Research paper thumbnail of Patency and Incontinence Rates After Robotic Bladder Neck Reconstruction for Vesicourethral Anastomotic Stenosis and Recalcitrant Bladder Neck Contractures: The Trauma and Urologic Reconstructive Network of Surgeons Experience

Urology, Jan 16, 2018

To review a robotic approach to recalcitrant bladder neck obstruction and to assess success and i... more To review a robotic approach to recalcitrant bladder neck obstruction and to assess success and incontinence rates. Patients with a recalcitrant bladder neck contracture or vesicourethral anastomotic stenosis who underwent robotic bladder neck reconstruction (RBNR) were identified. We reviewed patient demographics, medical history, etiology, previous endoscopic management, cystoscopic and symptomatic outcomes, urinary continence, and complications. Stricture success was anatomic and functional based upon atraumatic passage of a 17 Fr flexible cystoscope or uroflowmetry rate >15 ml/s. Incontinence was defined as the use of >1 pad per day or procedures for incontinence. Between 2015 and 2017, 12 patients were identified who met study criteria and underwent RBNR. Etiology of obstruction was endoscopic prostate procedure in 7 and radical prostatectomy in 5. The mean operative time was 216 minutes (range 120-390 minutes), with a mean estimated blood loss of 85 cc (range 5-200 cc). ...

Research paper thumbnail of An antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy

World Journal of Urology, 2015

To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in pa... more To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy in our Veterans Affairs population. Between June 1, 2013, and June 1, 2014, we implemented an antimicrobial prophylaxis protocol using rectal swab cultures on selective media containing ciprofloxacin for all men scheduled for TRUS-guided prostate biopsy. Data from 2759 patients from Jan 1, 2006 to May 31, 2013, before protocol implementation served as historical controls. Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy, while those with FQ-resistant organisms received targeted prophylaxis. Our objective was to compare the rate of infectious complications 30 days after prostate biopsy before and after implementation of our antimicrobial protocol. One hundred and sixty-seven patients received rectal swab cultures using our protocol. Seventeen (14 %) patients had FQ-resistant positive cultures. Patients with positive FQ-resistant culture results were more likely to have had a history of previous prostate biopsy and a positive urine culture in the last 12 months (p = 0.032, p = 0.018, respectively). The average annual infectious complication rate within 30 days of biopsy was reduced from 2.8 to 0.6 % before and after implementation of our antimicrobial prophylaxis protocol using rectal swab cultures, although this difference was not statistically significant (p = 0.13). An antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications. After implementation of an antimicrobial prophylaxis protocol, we observed a nonsignificant decrease in the rate of post-biopsy infectious complications when compared to historical controls.

Research paper thumbnail of 346 COST DISCREPANCIES BETWEEN PERCEIVED AND ACTUAL COSTS OF UROLOGIC AND OPERATIVE SUPPLIES IN AN ACADEMIC UROLOGY PRACTICE

Research paper thumbnail of 346 COST DISCREPANCIES BETWEEN PERCEIVED AND ACTUAL COSTS OF UROLOGIC AND OPERATIVE SUPPLIES IN AN ACADEMIC UROLOGY PRACTICE

The Journal of Urology, 2010

Research paper thumbnail of Urologic Problems in Spina Bifida Patients Transitioning to Adult Care

Urology, 2014

To identify the urologic needs of adult patients with spina bifida (SB) at the time of their tran... more To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems. We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions. We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems. On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.