Urology News Feeds

Predictive Analytics and Modeling Employing Machine Learning Technology: The Next Step in Data Sharing, Analysis and Individualized Counseling Explored with A Large, Prospective Prenatal Hydronephrosis Database

Urology (Gold Journal) In Press - Mon, 07/02/2018 - 00:00
To explore the potential value of utilizing a commercially available cloud based machine learning platform to predict surgical intervention in infants with prenatal hydronephrosis (HN).
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Is having vaginal pressure during pregnancy normal?

MedicalNewsToday - Thu, 06/28/2018 - 17:00
It is normal to feel a heaviness or pressure on the vagina or pelvis during pregnancy. The common causes of vaginal or pelvic pressure are different in the early and late trimesters but are not usually cause for concern. In this article, we look at common causes, when to see a doctor, and how to relieve symptoms.
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Reply

Urology (Gold Journal) In Press - Thu, 06/28/2018 - 00:00
Noncancer indications for simultaneous genitourinary and fecal diversion mainly include (1) complex enteral, fecal, and urinary fistulas; (2) refractory urinary and fecal incontinence from neurogenic bladder or bowel, or associated with complications from previous pelvic radiation, or from iatrogenic complication at the time of urologic, colorectal, or gynecologic surgery; (3) (promotion of healing of) complex decubitus ulcers affecting the coccygeal, perianal, perineal, and scrotal area. The natural disease progression of these catastrophic conditions is not well understood, and both urinary and fecal diversions are usually offered as the last therapeutic resort with curative or many times with palliative intent.
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Editorial Comment

Urology (Gold Journal) In Press - Thu, 06/28/2018 - 00:00
Patients requiring urinary and bowel diversion for non-oncologic indications constitute a poorly studied cohort in reconstructive urology. Scant literature exists to guide the colorectal surgeon or urologist on the impact of staged diversions as compared to simultaneous diversions. Oftentimes when faced with these patients, the historical wisdom is to perform staged diversions, as there is significant concern for increased morbidity, prolonged operative time, and delayed convalescence with after simultaneous “double” diversion.
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Reply by Authors

Several years ago one of our fellows, Andrew Stec, who was a biomedical engineer, thought it would be helpful to obtain 3-D MRIs in all newborn exstrophy cases before and after closure. Our main interest at that time was distribution of the pelvic floor musculature before and after closure with and without pelvic osteotomy (reference 11 in article). Using this technology, along with new Brainlab technology intraoperative imaging, we have undertaken a U.S. Food and Drug Administration approved study that allows newborn and delayed closure under 3-D intraoperative guidance.
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Editorial Comment

The authors present a landmark and novel finding in the female patient with classic bladder exstrophy. Although the study is a retrospective analysis with a small sample size, the data and knowledge gained add vast amounts of information regarding the anatomy of female patients with bladder exstrophy. As with most good studies, this one generates more questions than answers. The immediate clinical value of this article should make anybody who performs closure of female bladder exstrophy cautious when dissecting the pelvic floor.
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Reply by Authors

We acknowledge that the missing information on serum levels of testosterone among the included TC survivors is a limitation of the current study. We recently performed a systematic review in which we found that radiotherapy, cisplatin based chemotherapy and more than 1 treatment line increase the risk of testosterone deficiency (total testosterone less than 10 nmol/l) compared to orchiectomy alone.1 However, to our knowledge it remains unknown whether mild biochemical testosterone deficiency causes symptoms such as decreased sexual desire and erectile dysfunction, and whether testosterone substitution should be offered to more than the approximately 5% of TC survivors reported in the current study.
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Editorial Comment

With 2,260 patients (a 60% response rate) and an impressive 17-year followup this study is the largest cohort and longest followup ever reported on sexual function among testis cancer survivors. This robust analysis from Bandak et al demonstrated that while the majority of survivors maintained normal erectile function, patients with testis cancer who underwent adjuvant treatment after orchiectomy were at higher risk for erectile dysfunction than those who underwent orchiectomy alone. These significant findings should guide patient discussions regarding the long-term effects of testis cancer treatment.
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Editorial Comment

The authors raise 3 important points. First, the familial incidence of hypospadias is underestimated and is more prevalent than previously reported (22.3%). Also, a positive family history is not correlated with type of hypospadias. Finally, genetic mutations are more frequently detected in familial cases.
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A Review of the FAERS Data on 5-Alpha Reductase Inhibitors: Implications for Post-Finasteride Syndrome

Urology (Gold Journal) In Press - Wed, 06/27/2018 - 00:00
To quantify reports made to the Food and Drug Administration Adverse Event Reporting System (FAERS), create a demographic of patient reports, and examine the cluster of symptoms to correlate consistency of post-finasteride syndrome (PFS) complaints. PFS is a provisional diagnosis encompassing a cluster of sexual, physical, and psychological/neurologic symptoms associated with 5-alpha reductase inhibitor (5ARI) use that emerge or continue after discontinuation of medication.
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Reevaluating Warm Ischemia Time as a Predictor of Renal Function Outcomes After Robotic Partial Nephrectomy

Urology (Gold Journal) In Press - Wed, 06/27/2018 - 00:00
: To explore whether variation of warm ischemia time (WIT) is associated with functional and perioperative outcomes following robotic partial nephrectomy (RPN).
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Patient-specific virtual simulation - a state of the art approach to teach renal tumor localization

Urology (Gold Journal) In Press - Wed, 06/27/2018 - 00:00
To test a novel visuospatial testing platform improve trainee ability to convert two-dimensional (2D) to three-dimensional (3D) space.
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