Epididymo-Orchitis Leading to Global Testicular Infarction in a Pediatric Patient - A Case Report.

Epididymo-orchitis (EO) is a common urologic condition that rarely requires surgical intervention. Global testicular infarction is an exceedingly uncommon complication of EO and is thought to occur when severe epididymal edema compresses testicular vessels. We present a rare case of global testicular infarction secondary to EO in a 17-year-old boy. Predicting which cases of EO will progress to testicular ischemia is challenging, as no clear risk factors have been identified. Early recognition of testicular compromise requires a high degree of clinical suspicion and may provide the opportunity for testis-sparing intervention.

Distinct mutational status in GATA3-Positive clear cell adenocarcinoma of the urinary tract: A CASE report.

•Clear cell adenocarcinoma of the lower urinary tract is rare and poses diagnostic challenge.•GATA3, which is frequently expressed in urothelial carcinoma, can be expressed in clear cell adenocarcinoma.•ARID1A, PBRM1, ERBB4, and SMARCA4 mutations were identified in the current CASE.•Molecular studies may aid in the diagnosis, and optimal treatment decision-making process.

Co-chaperones TIMP2 and AHA1 Competitively Regulate Extracellular HSP90:Client MMP2 Activity and Matrix Proteolysis.

The extracellular molecular chaperone heat shock protein 90 (eHSP90) stabilizes protease client the matrix metalloproteinase 2 (MMP2), leading to tumor cell invasion. Although co-chaperones are critical modulators of intracellular HSP90:client function, how the eHSP90:MMP2 complex is regulated remains speculative. Here, we report that the tissue inhibitor of metalloproteinases-2 (TIMP2) is a stress-inducible extracellular co-chaperone that binds to eHSP90, increases eHSP90 binding to ATP, and inhibits its ATPase activity. In addition to disrupting the eHSP90:MMP2 complex and terminally inactivating MMP2, TIMP2 loads the client to eHSP90, keeping the protease in a transient inhibitory state. Secreted activating co-chaperone AHA1 displaces TIMP2 from the complex, providing a "reactivating" mechanism for MMP2. Gene knockout or blocking antibodies targeting TIMP2 and AHA1 released by HT1080 cancer cells modify their gelatinolytic activity. Our data suggest that TIMP2 and AHA1 co-chaperones function as a molecular switch that determines the inhibition and reactivation of the eHSP90 client protein MMP2.

Narrative Comments about Urologists on Physician Rating Websites Provide Insight into What Drives Patient Satisfaction Surveys.

INTRODUCTION: We examined publicly available narrative comments on physician rating websites and how they may provide valuable insight on what motivates patients to provide positive or negative feedback. METHODS: Searches of all American urologists who are members of the Northeastern Section of the American Urological Association were performed across 5 major physician rating websites. Narrative comments were classified by reviewers as positive or negative, and assessed for mention of 7 factors including punctuality/ease of appointment, bedside manner, time spent with the patient, communication/education skills, quality of staff, technical aspects of care and followup care. Providers without narrative comments were excluded from analysis, as were neutral comments. RESULTS: Bedside manner, technical aspects of care and communication/education skills were the more frequently citied aspects of care throughout all narrative comments. However, negative comments were more likely to mention staff quality than communication/education skills. In addition, female urologists received more comments and higher ratings than male urologists, and urban urologists received more comments and higher ratings than rural urologists. CONCLUSIONS: Bedside manner, technical aspects of care and communication/education skills are key elements that influence the satisfaction of urological patients. Furthermore, staff quality and punctuality are patient care areas in which urologists may benefit from improving. Further research is warranted to better understand the effects of practitioner gender and geography on patient reported satisfaction with care.

Predictors of genitourinary malignancy in patients with asymptomatic microscopic hematuria.

OBJECTIVES: To report the incidence of genitourinary malignancy and identify associated risk factors in patients undergoing urologic evaluation for asymptomatic microscopic hematuria (AMH) according to the 2012 American Urologic Association guidelines. SUBJECTS/PATIENTS AND METHODS: A retrospective institutional review of patients who underwent evaluation for AMH between 2012 and 2015 was conducted. Covariates analyzed included age, sex, smoking status, history of other malignancy, history of pelvic irradiation, presence of irritative voiding symptoms, use of anticoagulation, number of red blood cells on microscopic urinalysis, and guideline adherence. Univariate analysis was performed to explore the association between these risk factors and the presence of genitourinary malignancy. RESULTS: Of the 1,049 patients analyzed with AMH, urologic malignancy was diagnosed in 12 patients (1.1%), including 1 upper-tract urothelial cancer, 5 renal tumors, and 6 bladder tumors. All patients with malignancy were over 50 years old. Older age, male sex, smoking history, and irritative voiding symptoms were associated with malignancy on univariate analysis. CONCLUSIONS: Our data adds to the growing evidence that the incidence of malignancy among patients with AMH is low. Risk factors associated with urinary tract cancer are male sex, age>50 years, smoking history, and irritative voiding symptoms. Further prospective, randomized trials would be useful for developing a more tailored screening protocol for low-risk patients.