Re-operation within 30 days of radical cystectomy: Identifying high-risk patients and complications using American College of Surgeons National Surgical Quality Improvement Program database.

INTRODUCTION: Radical cystectomy (RC) is a highly morbid procedure, with 30-day complication rates approaching 31%. Our objective was to determine risk factors for re-operation within 30 days following a RC for non-metastatic bladder cancer. METHODS: We included all patients who underwent a RC for non-metastatic bladder cancer using The American College of Surgeons National Surgical Quality Improvement Program database between January 1, 2007 and December 31, 2014. Logistic regression analyses were used to evaluate predictors of re-operation. RESULTS: A total of 2608 patients were included; 5.8% of patients underwent re-operation within 30 days. On multivariable analysis, increasing body mass index (BMI) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07), African American race (vs. Caucasian OR 2.29, 95% CI 1.21-4.34), and history of chronic obstructive pulmonary disease (COPD) (OR 2.33, 95% CI 1.45-3.74) were significant predictors of re-operation within 30 days of RC. Urinary diversion type (ileal conduit vs. continent) and history of chemotherapy or radiotherapy within 30 days prior to RC were not. Patients who underwent re-operation within this timeframe had a significantly higher mortality rate (4.0% vs. 1.6%) and were more likely to experience cardiac (7.2% vs. 1.9%), pulmonary (23.0% vs. 3.0%), neurological (2.0% vs. 0.49%), and venous thromboembolic events (10.5% vs. 5.4%), as well as infectious complications (64.5% vs. 24.1%), with a significantly longer hospital length of stay (16.5 vs. 7.0 days). CONCLUSIONS: Recognizing increasing BMI, COPD, and African American race as risk factors for re-operation within 30 days of RC will allow urologists to preoperatively identify such high-risk patients and prompt them to adopt more aggressive approaches to minimize postoperative surgical complications.

Epidemiology and treatment modalities for the management of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting men. BPH can lead to a number of symptoms for patients commonly referred to as lower urinary tract symptoms (LUTS). Over the last decade, increased modifiable risk factors, such as metabolic disease and obesity, have resulted in an increased incidence of BPH. This increasing incidence has brought about a multitude of treatment modalities in the last two decades. With so many treatment modalities available, physicians are tasked with selecting the optimal therapy for their patients. Current therapies can first be divided into medical or surgical intervention. Medical therapy for BPH includes 5-alpha-reductase inhibitors and alpha-blockers, or a combination of both. Surgical interventions include a conventional transurethral resection of the prostate (TURP), as well as newer modalities such as bipolar TURP, holmium laser enucleation of the prostate (HoLEP), Greenlight and thulium laser, and prostatic urethral lift (PUL). Emerging therapies in this field must also be further investigated for safety and efficacy. This narrative review attempts to consolidate current and emerging treatment options for BPH and highlights the need for additional investigation on optimizing treatment selection.

Metal accumulation from dietary exposure in the sea urchin, Strongylocentrotus droebachiensis.

Metal contamination is a common problem in aquatic environments and may result in metal bioaccumulation and toxicity in aquatic biota. Recent studies have reported the significance of dietary metal accumulation in aquatic food chains, particularly in species of lower trophic levels. This research investigated the accumulation and effects of dietary metals in a macroinvertebrate. The seaweed species Ulva lactuca and Enteromorpha prolifera were concurrently exposed to five metals (copper, nickel, lead, cadmium, and zinc) and then individually fed to the green sea urchin Strongylocentrotus droebachiensis for a period of 2 weeks. Body mass, test length, total length, and coelomic fluid ion concentration and osmolality were measured. The sea urchins were also dissected and their organs (esophagus, stomach, intestine, gonads, and rectum) digested and analyzed for metals. The results demonstrated that metal accumulation and distribution varied between seaweed species and among metals. In general, there were greater concentrations of metals within the sea urchins fed E. prolifera compared with those fed U. lactuca. All of the metals accumulated within at least one organ of S. droebachiensis, with Cu being most significant. These results indicate that E. prolifera may accumulate metals in a more bioavailable form than within U. lactuca, which could impact the grazer. In this study, no significant differences in body length, growth, or coelomic fluid ion concentration and osmolality were detected between the control and metal-exposed sea urchins after the 2-week testing period. This research presents new data concerning metal accumulation in a marine herbivore after dietary metal exposure.