Non-obstetrical robotic-assisted laparoscopic surgery in pregnancy: a systematic literature review.

Urologic and gynecologic surgeons are the top utilizers of robotic surgery; however, non-obstetrical robotic-assisted laparoscopic surgery (RALS) in pregnant patients is infrequent. A systematic literature review was performed to ascertain the frequency, indication and complications of RALS in pregnancy. Results showed thirty-eight pregnancies from eleven publications between 2008-2020. Five cases were for urologic indication and thirty-three for gynecologic indication. Minimal surgical alterations were required. Although no adverse maternal-fetal outcomes were reported, there are not enough cases published to determine safety. This review demonstrates the feasibility of RALS for the pregnant population in the hands of competent robotic surgeons

Robotic Adrenalectomy for Functional Adenoma in Second Trimester Treats Worsening Hypertension.

A 33-year-old G6P3023 was found to have a 4.2 cm right adrenal incidentaloma during an admission for right pyelonephritis. Computed tomography (CT) was performed to rule out perinephric abscess in the setting of worsening leukocytosis while on antibiotics ( Fig. 1). Initial differential diagnosis from endocrinology included pheochromocytoma and primary aldosteronism. Due to the lack of typical physical exam stigmata, Cushing syndrome was initially of low concern. Of note, her past medical history included hypertension treated with amlodipine 10 mg and hydrochlorothiazide 12.5 mg. During admission, extensive endocrine laboratory workup demonstrated an elevated aldosterone:plasma renin activity, suppressed dehydroepiandrosterone (DHEA), normal 24-hour urine metanephrine and catecholamine, and hypokalemia ( Table 1). This initial biochemical workup did not provide any definitive diagnosis; however, it did convincingly rule out pheochromocytoma due to the normal catecholamine levels in the serum and urine. Eliminating this pathology was critical due to the mortality of hypertensive crisis in the perioperative period

Impact of Tumor Regional Involvement on Active Surveillance Outcomes: Validation of the Cumulative Cancer Location Metric in a US Population.

BACKGROUND: Treatment progression for men on active surveillance (AS) for prostate cancer (PCa) is driven primarily by grade and volume progression on isolated prostate biopsies (PBx). As PCa is a multifocal disease, regional disease progression over time should be accounted for. OBJECTIVE: To validate the utility of the cumulative cancer location (CCLO) metric, which assesses regional core involvement, as described by Erickson et al (Cumulative cancer locations is a novel metric for predicting active surveillance outcomes: a multicenter study. Eur Urol Oncol 2018;1:268-75), in predicting AS outcomes in a North American cohort. DESIGN, SETTING, AND PARTICIPANTS: A single-institutional retrospective chart review of all AS patients evaluated between 2015 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: CCLO defined as the total number of cancer-positive sextant locations among all PBx to that point in time (range 1-6). Baseline demographics and clinical characteristics of the entire cohort were stratified by CCLOΔ, defined as the difference between the first and the last CCLO. CCLOΔ then correlated with progression to treatment and treatment outcomes. RESULTS AND LIMITATIONS: A total of 261 men met the inclusion criteria. Though the mean number of biopsies was slightly higher in the CCLOΔ 3-5 cohort than in the CCLOΔ 0-2 cohort (p =  0.006), mean AS follow-up time (3.3 yr) was not significantly different (p =  0.327). As CCLOΔ increased, the proportion of men remaining on AS decreased, while the proportion of men receiving treatment increased (p \u3c  0.001). In men undergoing radical prostatectomy, a higher CCLOΔ was not associated with higher rates of Gleason 7-10 (p =  0.38) or pT3 (p =  0.52) disease. However, as CCLOΔ increased, upgrading from final PBx to RP pathology increased, while downgrading decreased (p =  0.12). In Kaplan-Meier analyses, lower CCLOΔ and lower initial cancer location scores were associated with the highest 5-yr treatment-free survival rates (p \u3c  0.001). CONCLUSIONS: Higher regional cancer core involvement is associated with higher rates of progression to treatment in AS patients. The CCLO metric is a potentially useful modality in stratifying AS patients among the North American cohort for treatment, while not compromising disease outcomes. PATIENT SUMMARY: In the North American population, cumulative cancer-positive locations among biopsies can be used to predict active surveillance outcomes in men with prostate cancer

A scoping review of penile implant biofilms-what do we know and what remains unknown?

Background: Penile prosthesis (PP) is a gold standard for treatment of erectile dysfunction given its reliability and efficacy. Infection remains the most feared complication of prosthetic surgery, which usually results in device removal, and places a significant economic burden on the healthcare system. While biofilms have shown to support the persistence of microorganisms, the degree by which this matrix is truly pathogenic remains unknown given its high prevalence even in asymptomatic patients. We aim to review and summarize the current literature pertaining to biofilm formation in the setting of PP surgeries in clinically infected and non-infected cases. Methods: Searches were performed in the MEDLINE online database through PubMed using a combination of keywords “penile prosthetic” OR “penile prosthesis” OR “penile implant” AND “biofilm” OR “revision” OR “removal” OR “infection” OR “explant”. Eleven articles met inclusion criteria. There were only three studies that explicitly listed the number of biofilms identified in their cohort, but we also included eight articles that mentioned swabbing and culturing of any bacterial biofilm during revision procedures for both clinically infected and non-infected implants. Results: Infected PP yielded a 11–100% rate of biofilm presence, while non-infected PP yielded a 3–70% rate of biofilm presence. Time to reoperation from initial PP placement were also largely variable, ranging from 2 weeks to over 2 years. Coagulase-negative staphylococcus (i.e., Staphylococcus epidermidis) were the most commonly reported organisms among non-infected implants, however, newer studies have identified a change towards more virulent organisms. Conclusions: Since the advent of PP surgery, diabetes control, revision washout protocols and antibiotic-impregnated devices have led to an overall decrease in biofilm formation and infectious complications. There is an overall paradigm shift in microbial profiles with more virulent organisms, such as Escherichia coli, Pseudomonas aeruginosa, Enterococcus species, and even fungal species beginning to replace the more common coagulase-negative staphylococcal species, especially in clinically infected implants. Additional studies are necessary to define the significance of bacterial presence in biofilms using impactful technologies such as next-generation sequencing. Currently, preliminary and experimental biofilm-control strategies are also underway to further address this clinical issue

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening

Robotic Adrenalectomy for Functional Adenoma in Second Trimester Treats Worsening Hypertension

Robotic adrenalectomy is a feasible surgical alternative in the second trimester and can reverse the hypertensive disease and its associated maternal-fetal complicationshttps://jdc.jefferson.edu/obgynposters/1010/thumbnail.jp

Anxiety, motivation, and competence in mathematics and reading for children with and without learning difficulties

Knowledge of the relations among learners’ socio-emotional characteristics and competencies as they engage in mathematics and reading is limited, especially for children with academic difficulties. This study examined the relations between anxiety, motivation, and competence in mathematics and reading, within and across domains, in an academically-diverse set of 8–13-year-old learners (n = 146). To measure anxiety and motivation across domains, we paired existing measures of math anxiety and reading motivation with researcher-developed analogues for reading anxiety and math motivation. Participants completed standardized assessments of mathematics and reading, anxiety and motivation surveys for math and reading, and a measure of nonverbal cognitive ability. Results showed high internal consistency for all anxiety and motivation scales (Cronbach’s alpha = 0.76-0.91). Pearson correlations showed that within and across domains, participants with higher competence had lower anxiety and higher motivation. Higher anxiety was also associated with lower motivation. Regression analyses showed that for both math and reading, within-domain motivation was a stronger predictor of competence than anxiety. There was a unidirectional across-domain relation: socio-emotional characteristics for reading predicted math competence, after accounting for nonverbal cognitive ability, age, gender, and within-domain anxiety and motivation. Results contribute to knowledge of the socio-emotional characteristics of children with and without learning difficulties in association with reading and math activities. Implications of a unidirectional socio-emotional link between the two domains can advance research and theory of the relations among socio-emotional characteristics and competence for academically-diverse learners

Anxiety, Motivation, and Competence in Mathematics and Reading for Children With and Without Learning Difficulties

Knowledge of the relations among learners' socio-emotional characteristics and competencies as they engage in mathematics and reading is limited, especially for children with academic difficulties. This study examined the relations between anxiety, motivation, and competence in mathematics and reading, within and across domains, in an academically-diverse set of 8–13-year-old learners (n = 146). To measure anxiety and motivation across domains, we paired existing measures of math anxiety and reading motivation with researcher-developed analogs for reading anxiety and math motivation. Participants completed standardized assessments of mathematics and reading, anxiety and motivation surveys for math and reading, and a measure of nonverbal cognitive ability. Results showed high internal consistency for all anxiety and motivation scales (Cronbach's alpha = 0.76–0.91). Pearson correlations showed that within and across domains, participants with higher competence had lower anxiety and higher motivation. Higher anxiety was also associated with lower motivation. Regression analyses showed that for both math and reading, within-domain motivation was a stronger predictor of competence than anxiety. There was a unidirectional across-domain relation: socio-emotional characteristics for reading predicted math competence, after accounting for nonverbal cognitive ability, age, gender, and within-domain anxiety and motivation. Results contribute to knowledge of the socio-emotional characteristics of children with and without learning difficulties in association with reading and math activities. Implications of a unidirectional socio-emotional link between the two domains can advance research and theory of the relations among socio-emotional characteristics and competence for academically-diverse learners