Urethral Slings for Irradiated Patients With Male Stress Urinary Incontinence: A Meta-analysis.

OBJECTIVE: To systematically compare success, cure and complication rates of urethral sling surgeries in stress urinary incontinence patients with and without a history of pelvic radiotherapy (RT). MATERIALS AND METHODS: We searched PUBMED, EMBASE, and Web of Science to identify relevant articles. The primary outcomes were the success and cure rates. The secondary outcomes included the rates of infection, urethral erosion, total complications, explantation, and satisfaction. Outcomes were analyzed using a random-effects model to calculate the unadjusted odds ratio (OR) in patients with a history of RT compared with those without prior RT. RESULTS: On pooled analysis, we found significantly lower odds of success (OR 0.68; 95% confidence interval [CI] 0.53-0.87, P < .001) and cure (OR 0.67; 95% CI 0.55-0.82, P < .001) in radiated patients than in nonirradiated patients. Subgroup analysis by type of sling showed significantly lower odds of success in Advance subgroup (OR 0.66; 95% CI 0.45-0.95, P < .001) and significantly lower odds of cure in Advance (OR 0.59; 95% CI 0.36-0.95, P < .001) and Atoms subgroups (OR 0.70; 95% CI 0.54-0.93, P < .001). We also found significantly greater odds of sling explantation (OR 2.93; 95% CI 1.62-5.29, P < .001) and infection (OR 3.06, 95% CI 1.03-9.07, P < .001) in radiated patients than in nonradiated patients. CONCLUSION: Patients with a history of pelvic RT have lower odds of success and cure and higher odds of infection and sling explantation than those without a history of pelvic RT.

Defining the incidence and management of postoperative scrotal hematoma after primary and complex three-piece inflatable penile prosthesis surgery.

Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and assess for any associated factors in a large multi-institutional penile implant cohort. This was a retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis implantation at 2 high volume implant centers. Cases were defined as "complex" if they involved revision, salvage with removal/replacement, or were performed with concurrent penile, scrotal or intra-abdominal surgeries. The incidence of scrotal hematoma among primary and complex IPP recipients was measured and modifiable and innate risk factors associated with hematoma formation within the two cohorts were tracked. Of 246 men who underwent penile prosthesis surgery, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although hematoma formers in the complex group had comparable drain outputs to primary patients on postoperative day 0 (66.8cc ± 32.5 vs 48.4 ± 27.7, p = 0.470) and postoperative day 1 (40.3cc ± 20.8vs 21.8 ± 11.3 p = 0.125), hematomas in the complex group had a higher propensity for OR evacuation (p = 0.03). Difference in duration of temporary device inflation between 2 (64, 26%) and 4 weeks (182, 74%) did not contribute to hematoma formation (p = 0.562). The incidence of postoperative hematoma formation in complex cases was 9.6% (5/52) and 3.6% in primary cases (7/194) (HR = 2.61, p = 0.072). Complex IPP surgery performed for revision or with ancillary procedures are more likely to result in clinically significant hematomas that require surgical management, suggesting a need for heightened caution in managing these individuals.

Salmonella enterica serovar Typhimurium STM1266 encodes a regulator of curli biofilm formation: the brfS gene.

The major biofilm pathway in Salmonella enterica serovar Typhimurium involves specific growth conditions that induce the csgA gene whose product forms surface curli fibers that mediate biofilm formation. We have found that the previously uncharacterized STM1266 gene in S. Typhimurium plays a role in regulating biofilm formation via the curli pathway. S. Typhimurium ΔSTM1266 strains display a biofilm defect, and overexpression of STM1266 results in enhanced biofilm formation. STM1266 deletion resulted in lowered csgA expression using promoter-reporter ß-galactosidase assays, and csgA and csgD deletions abrogate the effects of STM1266 overexpression on biofilm formation while deletion of bcsA (encoding an essential enzyme for cellulose formation) has no effect. In a mouse infection model, the ΔSTM1266 strain displayed results similar to those seen for previously reported ΔcsgA strains. The STM1266 gene is predicted to encode a DNA-binding transcriptional regulator of the MerR family and is homologous to the Escherichia coli BluR regulator protein. We respectfully propose to ascribe the name brfS (biofilm regulator for Salmonella Typhimurium) to the STM1266 gene.

Posterior urethral stenosis: a comparative review of the guidelines.

PURPOSE: We aimed to provide a thorough comparative review of the available guidelines on the diagnosis, management, and follow-up for patients with posterior urethral stenosis by the American Urologic Association (2016), Société Internationale d'Urologie (2010), and European Urologic Association (2022). METHODS: The AUA, SIU, and EAU guidelines were evaluated for recommendations on the diagnosis, evaluation, and treatment of posterior urethral stenosis. We also included the EAU and AUA urologic trauma guidelines for the trauma-related stenosis. The level or strength of recommendations is included in case of disparity between the guidelines. RESULTS: The three guidelines align considerably in recommendations provided for the diagnosis, management, and follow-up of patients with posterior urethral stenosis. SIU and EAU emphasize the role of repeat endoscopic treatment in guidelines compared to AUA. CONCLUSION: The preferred method to repair bulbo-membranous stricture/stenosis following radiation therapy remains an area of active interest, focusing on continence preservation. Additionally, there may be a role for advanced endoscopic treatments with or without adjunct therapies to manage even obliterated stenoses.

COVID-19 Misinformation and Social Network Crowdfunding: Cross-sectional Study of Alternative Treatments and Antivaccine Mandates.

BACKGROUND: Crowdfunding is increasingly used to offset the financial burdens of illness and health care. In the era of the COVID-19 pandemic and associated infodemic, the role of crowdfunding to support controversial COVID-19 stances is unknown. OBJECTIVE: We sought to examine COVID-19-related crowdfunding focusing on the funding of alternative treatments not endorsed by major medical entities, including campaigns with an explicit antivaccine, antimask, or antihealth care stances. METHODS: We performed a cross-sectional analysis of GoFundMe campaigns for individuals requesting donations for COVID-19 relief. Campaigns were identified by key word and manual review to categorize campaigns into "Traditional treatments," "Alternative treatments," "Business-related," "Mandate," "First Response," and "General." For each campaign, we extracted basic narrative, engagement, and financial variables. Among those that were manually reviewed, the additional variables of "mandate type," "mandate stance," and presence of COVID-19 misinformation within the campaign narrative were also included. COVID-19 misinformation was defined as "false or misleading statements," where cited evidence could be provided to refute the claim. Descriptive statistics were used to characterize the study cohort. RESULTS: A total of 30,368 campaigns met the criteria for final analysis. After manual review, we identified 53 campaigns (0.17%) seeking funding for alternative medical treatment for COVID-19, including popularized treatments such as ivermectin (n=14, 26%), hydroxychloroquine (n=6, 11%), and vitamin D (n=4, 7.5%). Moreover, 23 (43%) of the 53 campaigns seeking support for alternative treatments contained COVID-19 misinformation. There were 80 campaigns that opposed mandating masks or vaccination, 48 (60%) of which contained COVID-19 misinformation. Alternative treatment campaigns had a lower median amount raised (US $1135) compared to traditional (US $2828) treatments (P<.001) and a lower median percentile of target achieved (11.9% vs 31.1%; P=.003). Campaigns for alternative treatments raised substantially lower amounts (US $115,000 vs US $52,715,000, respectively) and lower proportions of fundraising goals (2.1% vs 12.5%) for alternative versus conventional campaigns. The median goal for campaigns was significantly higher (US $25,000 vs US $10,000) for campaigns opposing mask or vaccine mandates relative to those in support of upholding mandates (P=.04). Campaigns seeking funding to lift mandates on health care workers reached US $622 (0.15%) out of a US $410,000 goal. CONCLUSIONS: A small minority of web-based crowdfunding campaigns for COVID-19 were directed at unproven COVID-19 treatments and support for campaigns aimed against masking or vaccine mandates. Approximately half (71/133, 53%) of these campaigns contained verifiably false or misleading information and had limited fundraising success. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1001/jamainternmed.2019.3330.

Enhanced recovery strategies after penile implantation: a narrative review.

Optimizing pain management strategies in penile implantation has historically been a challenge to urologists assuming care of patients post-operatively. In addition to the complex pathophysiology of male genital pain, the responsibility of opioid stewardship in the face of the ongoing narcotics epidemic presents its own set of challenges to experienced implanters. Recent innovations in pre- and intra-operative analgesia have provided some improvement in patient-reported pain outcomes. When used together in protocols spanning each phase of operative care, multimodal analgesia (MMA) regimens provide superior patient pain control and successfully decrease opioid usage compared to traditional opioid-based pain control. This review will systematically present literature that discusses interventions in the preoperative and intraoperative spaces aimed at optimally controlling pain. We will also highlight surgical techniques that have been demonstrated to help ameliorate post-operative pain in penile implant recipients. We will discuss the impact of MMA protocols across urology and further explore its larger impact on reducing opioid burden in the ongoing epidemic.

Optimal Modeling: an Updated Method for Safely and Effectively Eliminating Curvature During Penile Prosthesis Implantation.

OBJECTIVES: To assess outcomes of a variant of traditional modeling ("optimal modeling," OM) in patients with residual curvature following prosthesis implantation. METHODS: We performed a retrospective review of all patients who underwent penile implant insertion. Patients with >30° of residual curvature after cylinder placement and inflation underwent OM and were compared 1:1 to a demographically-matched cohort who received implantation without ancillary straightening. Optimal modeling was performed by forcibly bending the erect penis in the direction opposite the point of maximal curvature while maintaining glanular pressure to prevent urethral injury. This was performed for 90-second intervals for as many cycles as necessary to achieve <15° curvature. RESULTS: Eighty patients were included in the final analysis; 40 (50.0%) underwent optimal modeling while 40 (50.0%) did not need additional straightening following surgery. The mean premodeling curvature was 47.8° (range 30°-90°) while post-modeling curvature improved to a mean of 10.6° (range 0°-30°, P < .001); 87.5% of patients had <15° of residual curvature. Patients in the OM cohort experienced longer operative times (82.7 vs 75.8 min, P = .15). No patient in either group experienced an intraoperative or postoperative complication at a mean follow-up of 29.9 months. CONCLUSION: Although many prosthetic urologists forego manual modeling in cases of moderate-severe penile curvature, our contemporary series shows it to be both safe and effective. OM may preclude the need for more time-consuming and complex surgical procedures.

Ludwig's angina and steroid use: A narrative review.

BACKGROUND: Ludwig's angina, a rapidly progressive cellulitis causing airway obstruction, has traditionally been managed with antibiotics and surgical intervention. More controversial is the use of steroids in the management of patients with this condition. This article summarizes the literature of steroid use in the management of Ludwig's angina. METHODS: The study used a narrative review method alongside the PRISMA guidelines for systematic reviews. PubMed, Ovid Medline, Cochrane, and Web of Science were searched for cases of Ludwig's angina with documented steroid use in patient management. Inclusion criteria were articles in the English language with direct patient outcomes. There were 17 articles selected with 31 patient cases. RESULTS: Most reports of steroid use in Ludwig's angina in the literature are case reports, with one retrospective review, and one letter to the editor. Dexamethasone was the steroid of choice in most cases reviewed. All patient cases reported used antibiotics alongside their steroid use, and 27 out of 31 patient cases required surgery. Most patients recovered with no further sequelae or complications. Three (9.68%) patients suffered mortality due to unrelated causes. CONCLUSIONS: Primary literature reporting the use of steroids in the management of Ludwig's angina includes few cases. While the role steroids have in these cases remains uncertain, the articles summarized do not suggest an adverse influence, and may suggest a benefit.