Differential expression of miRNAs involved in biological processes responsible for inflammation and immune response in lichen sclerosus urethral stricture disease.

PURPOSE: To better understand the pathophysiology of lichen sclerosus (LS) urethral stricture disease (USD), we aimed to investigate expression profiles of microRNAs (miRNAs) in tissue samples from men undergoing urethroplasty. METHODS: Urethral stricture tissue was collected from 2005-2020. Histologic features diagnostic of LS were the basis of pathologic evaluation. Foci of areas diagnostic for LS or non-LS strictures were chosen for RNA evaluation. In an initial screening analysis, 13 LS urethral strictures and 13 non-LS strictures were profiled via miRNA RT-qPCR arrays for 752 unique miRNA. A validation analysis of 23 additional samples (9 LS and 14 non-LS) was performed for 15 miRNAs. Statistical analyses were performed using SPSS v25. Gene Ontology (GO) analysis was performed using DIANA-mirPath v. 3.0. RESULTS: In the screening analysis 143 miRNAs were detected for all samples. 27 were differentially expressed between the groups (false discovery p-value <0.01). 15 of these miRNAs individually demonstrated an area under the curve (AUC)>0.90 for distinguishing between between LS and non-LS strictures. 11-fold upregulation of MiR-155-5p specifically was found in LS vs. non-LS strictures (p<0.001, AUC = 1.0). In the validation analysis, 13 of the 15 miRNAs tested were confirmed to have differential expression (false discovery p-value <0.10). CONCLUSIONS: To our knowledge this is the first study evaluating miRNA expression profiles in LS and non-LS USD. We identified several miRNAs that are differentially expressed in USD caused by LS vs other etiologies, which could potentially serve as biomarkers of LS USD. The top eight differentially expressed miRNAs have been linked to immune response processes as well as involvement in wound healing, primarily angiogenesis and fibrosis.

Medical Malpractice and Nephrolithiasis: U.S. Appellate Cases from 2001 to 2018.

INTRODUCTION: Kidney stones are one of the most litigated diagnoses in urological practice. To better understand the cause for and outcomes of medical malpractice cases related to nephrolithiasis we analyzed United States medical malpractice appeals court cases from 2001 to 2018. METHODS: We searched LexisNexis for "kidney stone/nephrolithiasis" and "malpractice" from 2001 to 2018. Individual case data were compiled and analyzed with descriptive statistics, including involved parties, outcome of the initial case/appeal, alleged physician negligence, monetary awards granted and size of awards. RESULTS: Our search yielded 45 cases, of which 33 met criteria for analysis. The patient/spouse was the plaintiff in 23/33 (69%) cases, and the patient's estate was the plaintiff in 10/33 (30%) cases. A urologist was a defendant in 19/33 (57%) cases and nonurological providers were named in 10/33 (30%) cases. A hospital was named in 21/33 (64%) lawsuits. A total of 30/33 (91%) suits cited an error in treatment as the primary negligence. Of all cases, 10% were reversed on appeal and the majority of cases were found in favor of the defendant initially and on appeal. Overall, the defendant prevailed in 21/33 (63%) of cases. Four trials involved payment to a plaintiff and the average payout was $1,075,439 (range $193,000-$3,000,000). CONCLUSIONS: The majority of nephrolithiasis malpractice suits involve a verdict in favor of the urologist, physician or hospital, even after appeal. Errors in treatment are much more commonly litigated than errors in diagnosis. Although the prevalence of plaintiff payout was low, awards granted averaged over a million dollars per case.

Novel Education and Simulation Tools in Urologic Training.

PURPOSE OF REVIEW: Postgraduate medical training has evolved considerably from an emphasis on hands-on, autonomous learning to a paradigm where simulation technologies are used to introduce and augment certain skill sets. This review is intended to provide an update on surgical simulators and tools for urological trainee education. RECENT FINDINGS: We provide an overview of simulation platforms for robotics, endoscopy, and laparoscopic practice and training. In general, these simulators provide face, content, and construct validity. Various educational and evaluation tools have been adopted. Simulation platforms have been developed for technical and non-technical surgical skills, educational bootcamps, and tools for evaluation and feedback. While trainees find the opportunity to practice their skills beneficial, there may be difficulty with access due to cost and availability. Additionally, there is a need for more objective metrics demonstrating improvement in skill or patient outcome.