Incidence of Urethral Stricture in Patients with Adult Acquired Buried Penis

Introduction. Concealed-buried penis is an acquired condition associated with obesity, challenging to both manage and repair. Urethral stricture is a more common disorder with multiple etiologies. Lichen sclerosus is a significant known cause of urethral stricture, implicated in up to 30%. We hypothesize that patients with buried penis have a higher rate of urethral stricture and lichen sclerosus than the general population. Methods. We retrospectively reviewed a single surgeon’s (CM) case logs for patients presenting with a buried penis. All patients were evaluated for urethral stricture with cystoscopy or retrograde urethrogram either prior to or at the time of repair for buried penis. Those that had surgical repair or biopsy were reviewed for presence of lichen sclerosus. Results. 39 patients met inclusion criteria. Of these, 13 (33%) had associated stricture disease. The location of the strictures was bulbar urethra (38%), penile urethra (15%), and meatus or fossa navicularis (62%). Five patients had lichen sclerosus and urethral stricture disease, while 3 had lichen sclerosus without stricture. 11/13 stricture patients were treated. Six underwent dilation, 3 underwent meatotomy, and 2 underwent urethroplasty. No significant recurrences of stricture were seen. Conclusion. Patients with a concealed penis are more likely than the general population to have a urethral stricture and/or LS. Patients presenting with concealed penis should also be evaluated for a urethral stricture

Development of the human bladder and ureterovesical junction.

The urinary bladder collects urine from the kidneys and stores it until the appropriate moment for voiding. The trigone and ureterovesical junctions are key to bladder function, by allowing one-way passage of urine into the bladder without obstruction. Embryological development of these structures has been studied in multiple animal models as well as humans. In this report we review the existing literature on bladder development and cellular signalling with particular focus on bladder development in humans. The bladder and ureterovesical junction form primarily during the fourth to eighth weeks of gestation, and arise from the primitive urogenital sinus following subdivision of the cloaca. The bladder develops through mesenchymal-epithelial interactions between the endoderm of the urogenital sinus and mesodermal mesenchyme. Key signalling factors in bladder development include shh, TGF-β, Bmp4, and Fgfr2. A concentration gradient of shh is particularly important in development of bladder musculature, which is vital to bladder function. The ureterovesical junction forms from the interaction between the Wolffian duct and the bladder. The ureteric bud arises from the Wolffian duct and is incorporated into the developing bladder at the trigone. It was previously thought that the trigonal musculature developed primarily from the Wolffian duct, but it has been shown to develop primarily from bladder mesenchyme. Following emergence of the ureters from the Wolffian ducts, extensive epithelial remodelling brings the ureters to their final trigonal positions via vitamin A-induced apoptosis. Perturbation of this process is implicated in clinical obstruction or urine reflux. Congenital malformations include ureteric duplication and bladder exstrophy

Use of an Online Crowdfunding Platform for Unmet Financial Obligations in Cancer Care.

This cross-sectional study identified characteristics of patients using an online crowdfunding platform for unmet financial obligations associated with cancer care

Use of GoFundMe® to crowdfund complementary and alternative medicine treatments for cancer.

PurposeComplementary and alternative medicine (CAM) use is common amongst cancer patients. However, there is growing concern about its safety and efficacy. Online crowdfunding campaigns represent a unique avenue to understand the cancer patient's perspective for using CAM or declining conventional cancer therapy (CCT).MethodsFive hundred GoFundMe campaigns from 2012 to 2019 detailing financial need for cancer treatment were randomly selected and reviewed for endorsement of CAM use, reasons for using CAM, and reasons for declining CCT. Descriptive statistics were used to compare patient and campaign characteristics between 250 CAM users and 250 non-CAM users.ResultsCompared to non-CAM users, CAM users were more likely to be female (70% vs. 54%, p < 0.01), to report more stage IV cancer (54% vs. 12%, p < 0.01), and to have a history of delayed, missed, or misdiagnosis (10% vs. 4%, p < 0.01). Reasons for using CAM include endorsing curative/therapeutic effects 212 (85%), pain/stress reduction 137 (55%), and dissatisfaction with current or past medical treatment options 105 (42%). 87 (35%) CAM users that declined CCT reported that they wanted to try to fight off cancer using CAM first 57 (61%), that CCT was too "toxic" to the body 39 (42%), and cancer was already too advanced, so that CCT would be futile or too aggressive 25 (27%).ConclusionCancer patients on GoFundMe using CAM highly value quality of life, comfort, and autonomy. Physicians should educate themselves on CAM to set realistic expectations and provide comprehensive counseling of the risks and benefits of CAM usage to patients who choose to use CAM to either augment or completely replace CCT

Single incision artificial urethral sphincter

We demonstrate a technique for artificial urinary sphincter placement using a single perineal incision. This incision allows for good exposure of the urethra, allowing for more proximal placement as needed. Perineal dissection and exposure are done in the usual manner for a perineal AUS. Once the cuff is in place, we dissect through the inguinal ring on either side. The reservoir is placed submuscularly, similar to the placement of an IPP reservoir. A finger is then used to displace the scrotum lateral to the testicle and spermatic cord. The pump is passed into this space. The skin of the scrotum over it is then bluntly dissected back to expose the dartos fascia overlying the pump. The overlying dartos is incised, and the pump is passed through it. The pump is then contained in the space between the skin and dartos, ensuring that it will not slip back out. The incision is then closed. This technique has reduced operative time compared to a normal perineal AUS

Incidence of Urethral Stricture in Patients with Adult Acquired Buried Penis

Introduction. Concealed-buried penis is an acquired condition associated with obesity, challenging to both manage and repair. Urethral stricture is a more common disorder with multiple etiologies. Lichen sclerosus is a significant known cause of urethral stricture, implicated in up to 30%. We hypothesize that patients with buried penis have a higher rate of urethral stricture and lichen sclerosus than the general population. Methods. We retrospectively reviewed a single surgeon's (CM) case logs for patients presenting with a buried penis. All patients were evaluated for urethral stricture with cystoscopy or retrograde urethrogram either prior to or at the time of repair for buried penis. Those that had surgical repair or biopsy were reviewed for presence of lichen sclerosus. Results. 39 patients met inclusion criteria. Of these, 13 (33%) had associated stricture disease. The location of the strictures was bulbar urethra (38%), penile urethra (15%), and meatus or fossa navicularis (62%). Five patients had lichen sclerosus and urethral stricture disease, while 3 had lichen sclerosus without stricture. 11/13 stricture patients were treated. Six underwent dilation, 3 underwent meatotomy, and 2 underwent urethroplasty. No significant recurrences of stricture were seen. Conclusion. Patients with a concealed penis are more likely than the general population to have a urethral stricture and/or LS. Patients presenting with concealed penis should also be evaluated for a urethral stricture

Alternative Method of Securing a Mini-Jupette Sling

In this video we present our technique for mini jupette sling (MJS) placement during the placement of an inflatable penile prosthesis (IPP). MJS could be considered in patients who are experiencing incontinence or climacturia, common complications of radical prostatectomy and prostate cancer treatment. The technique is initially described by Dr Andrianne, and our technique is modified from the mini-jupette as employed by Dr Yafi. The standard dissection and exposure is done using a typical penoscrotal or subcoronal approach. The corporotomies and dilation are done in the typical fashion. However, instead of placing stay sutures on either side of the corporotomies, we only place them on the lateral sides. When the mini jupette is placed it is secured with a running suture, and a loop is tied in the middle and divided to create four free ends, after the start and end of the running suture are completed. These four free ends match up with the four stay sutures placed lateral to the corporotomies. The pairs are tied together once the cylinders are placed, closing the corporotomies and securing the mini-jupette at the same time. The corporotomies are eventually closed by tying the stay sutures across the incision. This technique allows for a secure sling placement, without bunching of the sling. Since the corporotomies can be tied closed, there is no risk of needle injury to the cylinders. Operative time is not significantly increased when adding this procedure. We have encountered no complications related to the mini-jupette with this method

Expertise and Anchoring Bias in Medical Decision Making

Anchoring bias describes the tendency to base an estimate around a previously given value, the anchor. Herein, a cohortof 124 medical providers and trainees, from medical students to practicing physicians, were shown to display anchoringbias when faced with medical scenarios including an anchoring value in the form of a prior assessment. Anchoringbias did not vary significantly with participants level of training although tolerance to risk did. However, they showedincreased reliance on the anchor when its source had greater expertise. Analyses showed no correlation between anchoringsusceptibility and participants preference for Rationality or Intuition as measured by the Decision Styles Scale. The resultssuggest that medical decisions can be vulnerable to anchoring effects, particularly when the anchor is sourced from anauthoritative source. Given that authoritative sources should be more knowledgeable, this is reasonable, but will hold trueregardless of the accuracy of the anchoring value