Three Distinct Urethral Fistulae 35 Years After Pelvic Radiation

Introduction: While the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage. Case Presentation: We describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. These complications were managed successfully after multiple surgical procedures. Discussion: We subsequently discuss the different approaches currently employed for the management of radiation induced urinary fistulas and describe the rationale behind our approach towards their surgical management

Anterior Urethral Stricture Disease Negatively Impacts the Quality of Life of Family Members

Purpose. To quantify the quality of life (QoL) distress experienced by immediate family members of patients with urethral stricture via a questionnaire given prior to definitive urethroplasty. The emotional, social, and physical effects of urethral stricture disease on the QoL of family members have not been previously described. Materials and Methods. A questionnaire was administered prospectively to an immediate family member of 51 patients undergoing anterior urethroplasty by a single surgeon (SBB). The survey was comprised of twelve questions that addressed the emotional, social, and physical consequences experienced as a result of their loved one. Results. Of the 51 surveyed family members, most were female (92.2%), lived in the same household (86.3%), and slept in the same room as the patient (70.6%). Respondents experienced sleep disturbances (56.9%) and diminished social lives (43.1%). 82.4% felt stressed by the patient's surgical treatment, and 83.9% (26/31) felt that their intimacy was negatively impacted. Conclusions. Urethral stricture disease has a significant impact on the family members of those affected. These effects may last decades and include sleep disturbance, decreased social interactions, emotional stress, and impaired sexual intimacy. Treatment of urethral stricture disease should attempt to mitigate the impact of the disease on family members as well as the patient

Case Report Testicular Interposition Flap for Repair of Perineal Urinary Fistulae: A Novel Surgical Technique

Rectourinary fistulae and urinary-cutaneous fistulae are a rare yet devastating complication. Current options for tissue interposition include rectus, gracilis, or gluteal muscle, omentum, or intestine for use in coloanal pull-through procedures. In elderly patients, testicular interposition flaps may be an excellent tissue option to use when vitalized tissue is necessary to supplement fistula repair. Elderly patients frequently have increased spermatic cord length, potentially offering a longer flap reach than use of a muscle flap. Additionally, mobilizing one of the testicles and developing it through the external inguinal ring may be a less morbid and less costly procedure than harvesting and tunneling a muscle flap. Longer follow-up and further studies are needed to determine the outcomes of this novel technique

Testicular Interposition Flap for Repair of Perineal Urinary Fistulae: A Novel Surgical Technique

Rectourinary fistulae and urinary-cutaneous fistulae are a rare yet devastating complication. Current options for tissue interposition include rectus, gracilis, or gluteal muscle, omentum, or intestine for use in coloanal pull-through procedures. In elderly patients, testicular interposition flaps may be an excellent tissue option to use when vitalized tissue is necessary to supplement fistula repair. Elderly patients frequently have increased spermatic cord length, potentially offering a longer flap reach than use of a muscle flap. Additionally, mobilizing one of the testicles and developing it through the external inguinal ring may be a less morbid and less costly procedure than harvesting and tunneling a muscle flap. Longer follow-up and further studies are needed to determine the outcomes of this novel technique

Contemporary trends in the management of renal trauma in the United States: A national community hospital population-based analysis

Objective: To better define the shift in the management of renal trauma throughout the United States, with a population-based assessment of community hospital practice patterns. To investigate how hospital, patient, and injury-specific factors influence management strategy by both urologists and nonurologists.Materials and methods: Using the Premier Hospital database, we performed a retrospective study of all patients with renal trauma between 2003 and 2013. We identified patients using International Classification of Diseases, Ninth Revision diagnosis codes (866.0x, 866.1x), determined management strategy by International Classification of Diseases, Ninth Revision procedure codes, and dichotomized grouping by surgeon specialty. We stratified hospitals by annual renal trauma volume categorized a priori into low, \u3c10 cases per year; intermediate, 10-20 cases per year; and high, \u3e20 cases per year. We performed descriptive statistics and univariate and multivariate regression analyses adjusting for survey weighting and for patient, hospital, and injury-specific characteristics.Results: Our study cohort included a weighted sample size of 21,531 patients. Higher renal trauma hospitals (12.6%) were significantly less likely than low (26.4%) and intermediate (31.3%) volume hospitals to undergo surgical intervention for renal trauma on adjusted models. There was a statistically significant increase in nonoperative management from 65.2% in 2003 to 81.8% in 2013.Conclusion: National rates of surgical intervention for renal trauma are significantly higher than those frequently quoted by the literature, especially among low- and intermediate-volume renal trauma hospitals. Although operative rates are decreasing, further consideration may need to be given to centralization of care in higher-volume teaching hospitals to improve renal salvage

30-Day Adverse Events Following Cystectomy for Bladder Cancer Versus Benign Bladder Conditions

Introduction: Cystectomy is a first line treatment for muscle invasive bladder cancer and a last resort option for several benign bladder conditions. It is currently unknown how the perioperative outcomes of cystectomy for cancer differ from those of cystectomy for benign conditions. Methods: Using the National Surgical Quality Improvement Program database we extracted data on cystectomy between 2006 and 2013. Bivariate comparison of baseline characteristics was performed and multivariate logistic regression analyses were conducted to assess the effect of cystectomy indication on 30-day outcomes. Results: Overall 3,166 and 248 cystectomies were performed for cancer and benign conditions, respectively. Patients in the noncancer group were younger (median age 62.5 vs 70.0 years), had worse American Society of Anesthesiologists scores (3-4, 81.5% vs 73.8%) and functional health status (19.0% vs 1.6%), and more frequently had preoperative sepsis (3.2% vs 1.1%) and paresis (4.8% vs 0.3%) compared to patients in the cancer group (all values p ≤0.013). On adjusted analyses patients without cancer were more likely to experience prolonged length of stay (OR 2.14, 95% CI 1.60–2.86) and to be discharged to a special care facility (OR 3.08, 95% CI 2.13–4.47) compared to patients with cancer (all values p \u3c0.001). Conclusions: Cystectomy performed for benign conditions is associated with higher odds of prolonged length of stay and adverse discharge disposition, which may be the result of worse baseline functional status and comorbid conditions. Adapting postoperative pathways after cystectomy in consideration of patients’ baseline characteristics might be one approach to mitigate such outcome differences

Supporting Materials - Tables S1 and S2 from Aquaporin graphene interface: relevance to point-of-care device for renal cell carcinoma and desalination

Aquaporins superfamily of hydrophobic integral membrane proteins constitutes water channels essential to the movement of water across the cell membrane maintaining homeostatic equilibrium. During the passage of water between the extracellular and intracellular sides of the cell, aquaporins act as ultra-sensitive filters. Owing to their hydrophobic nature, aquaporins self-assemble in phospholipids and if a proper choice of lipids is made then the aquaporin biomimetic membrane can be used in the design of artificial kidney. In combination with graphene, aquaporin biomimetic membrane finds practical application in desalination and water recycling using mostly <i>Escherichia coli</i> AqpZ. Recently, human aquaporin 1 has emerged as an important biomarker in renal cell carcinoma. At present, the ultra-sensitive sensing of renal cell carcinoma is cumbersome and hence we are discussing usage of epitopes from monoclonal antibody as a probe for point-of-care device for sensing renal cell carcinoma by immobilizing the antibody on the surface of a single-layer graphene as a microfluidic device for sensing renal cell carcinoma which is pursued in our laboratories

Supporting Materials - Tables S1 and S2 from Aquaporin–graphene interface: relevance to point-of-care device for renal cell carcinoma and desalination

The aquaporin superfamily of hydrophobic integral membrane proteins constitutes water channels essential to the movement of water across the cell membrane, maintaining homeostatic equilibrium. During the passage of water between the extracellular and intracellular sides of the cell, aquaporins act as ultra-sensitive filters. Owing to their hydrophobic nature, aquaporins self-assemble in phospholipids. If a proper choice of lipids is made then the aquaporin biomimetic membrane can be used in the design of an artificial kidney. In combination with graphene, the aquaporin biomimetic membrane finds practical application in desalination and water recycling using mostly <i>Escherichia coli</i> AqpZ. Recently, human aquaporin 1 has emerged as an important biomarker in renal cell carcinoma. At present, the ultra-sensitive sensing of renal cell carcinoma is cumbersome. Hence, we discuss the use of epitopes from monoclonal antibodies as a probe for a point-of-care device for sensing renal cell carcinoma. This device works by immobilizing the antibody on the surface of a single-layer graphene, that is, as a microfluidic device for sensing renal cell carcinoma