Assessing the readability and quality of online information about benign prostatic hyperplasia.

PURPOSE: Benign prostatic hyperplasia (BPH) affects nearly half of men in their fifties. Patients often search the Internet to better understand their diagnosis, but online health information is not well regulated and can be difficult for patients to comprehend. This study aims to evaluate not only readability, but also the quality of online information about BPH, as well as the effect of commercial bias on readability and quality. METHODS: Three search engines (Google, Bing, and DuckDuckGo) were used with broad search terms including "BPH," "BPH treatment," and "BPH surgery," to mimic a patient diagnosed with BPH seeking further information. 204 total websites were identified, of which 62 were unique websites. Among those unique websites, 23 were advertisements. Three readability formulas (Flesch-Kincaid Grade Level, Flesch-Kincaid Reading Ease, SMOG) were used to generate readability scores. DISCERN standardized questionnaire was used to evaluate website quality. RESULTS: Average reading level of online information about BPH was significantly higher than the recommended level by the American Medical Association (AMA) and United States Department of Health and Human Services (USDHHS). Advertisements had significantly easier readability than nonadvertisements. Average website quality was "excellent" for nonadvertisements, but only "fair" for advertisements. CONCLUSION: Although advertisements may hold optimal search result positions and have better readability than nonadvertisements, they have biased and lower quality information. It is important to guide patients to high quality online information of appropriate reading level. Continued efforts should be made to create and share with patients high quality resources with improved readability to facilitate comprehension and minimize misinformation.

Online interest in surgical treatment for benign prostatic hyperplasia using Google trends.

PURPOSE: Online health information-seeking behavior has increased over the past 15 years; however, little is known about the online interest for surgical treatment of men with benign prostatic hyperplasia. We used Google Trends to evaluate online interest for various surgical procedures for benign prostatic hyperplasia in the US and worldwide. METHODS: Transurethral resection of the prostate, photoselective vaporization of the prostate, Holmium laser enucleation of the prostate, Urolift, and Rezum were selected as search terms of interest within Google Trends. Google Trends normalizes the popularity of search terms on a 0-100 scale. ANOVA and the average rate of change in popularity scores were conducted from July 2015 to February 2019. RESULTS: From 2004 to 2019, online interest in transurethral resection of the prostate and photoselective vaporization of the prostate remained stable in the US and worldwide; meanwhile, there was an upward trend for Urolift and Rezum. There was a statistically significant increase in the online interest for Holmium laser enucleation of the prostate in the US and worldwide; however, the mean popularity score was significantly higher worldwide. CONCLUSIONS: A shift in online interest towards minimally invasive surgical therapies for benign prostatic hyperplasia was demonstrated in the US and worldwide and parallels clinical practice patterns, such as HoLEP and Urolift surgical volumes in Indiana and Australia, respectively. Google Trends can be used in real-time to gauge online interest for surgical procedures and help guide physician-patient counseling.

Comparison of magnetic resonance imaging to ultrasound for prostate sizing.

INTRODUCTION: To compare pelvic ultrasound (PUS) and transrectal ultrasound (TRUS) to magnetic resonance imaging (MRI) in the estimation of prostate size. MATERIALS AND METHODS: After IRB approval, we performed a single-center, retrospective study of 91 patients who had prostate sizing between August, 2013 and June, 2017. Correlation, reliability, and agreement between PUS, TRUS, and MRI were calculated through the Pearson coefficient, intraclass correlation coefficient, and Bland-Altman analysis, respectively. Data was stratified by prostate size, body mass index, and time between imaging acquisition. RESULTS: A total of 91 patients underwent all three imaging methods. Median age was 64, median body mass index (BMI) was 27 kg/m2, and median PSA value prior to PUS was 7.1 ng/mL. Pearson coefficient for MRI versus TRUS and MRI versus PUS was 0.90 and 0.87, respectively. Intraclass correlation coefficient was 0.90 (0.87-0.93) comparing all three modalities. BA analysis for MRI versus TRUS and MRI versus PUS showed that for prostates ≤ 50 cc, greater than 79% of the data fell within limits of agreement. Percentages decreased with increasing prostate size to 46% and 41% for prostates > 50 cc and ≤ 80 cc and to 28% and 25% for prostates > 80 cc for MRI versus TRUS and MRI versus PUS, respectively. CONCLUSIONS: MRI may be considered clinically interchangeable with TRUS and PUS for prostate sizing at prostate volumes ≤ 50 cc. For larger prostates and when minor changes in prostate size would drastically alter surgical management, cross-sectional imaging should be considered.

Ureteral stenting after routine ureteroscopy: Is earlier stent removal feasible?

INTRODUCTION: Ureteroscopy and laser lithotripsy is a common treatment option for upper urinary tract calculi. Currently, ureteral stents are placed after uncomplicated ureteroscopy for up to 1 week, but the optimal length of placement is not well defined. Ureteral stents are associated with significant morbidity, particularly stent discomfort. This study aims to determine differences in postoperative unplanned clinic or ED visits based on duration of stent placement. MATERIALS AND METHODS: This is a single-institution, IRB-approved, retrospective cohort study of 559 ureteroscopy cases with laser lithotripsy for urinary tract calculi performed from 2016 to 2018. The primary outcome was unplanned ED or clinic visits within 30 days following surgery and there. The patients were separated into three groups based on stent duration: 1 (0-3 days), 2 (4-6 days), and 3 (> 6 days). RESULTS: Fifty-eight (10.31%) patients experienced an unplanned visit within 30 days of the procedure. There was no significant difference in unplanned visits among groups for stent duration (p = 0.45). A Clavien grade analysis showed no difference in grades between groups (p = 0.59). A Cox regression model showed no difference in risk of unplanned visit comparing those in groups 2 and 3 to group 1 (p = 0.157 and 0.374, respectively). This also remains to be the case after adjusting for age, sex, and surgeon (p = 0.166 and 0.376, respectively). CONCLUSIONS: We found no difference in unplanned visits in patients based on the duration of stent placement following routine ureteroscopy. Stent removal within 3 days of surgery appears to be sufficient to minimize morbidity after uncomplicated ureteroscopy.

Correlates of nephrolithiasis in US black women: data from the black women's health study.

Nephrolithiasis is a common urologic condition and a significant source of patient morbidity and healthcare expenditure. There are few epidemiologic studies of kidney stones focusing exclusively on Black women. We retrospectively assessed the prevalence and correlates of self-reported kidney stones within the Black Women's Health Study (BWHS). Descriptive statistics and multivariable logistic regression models were used to explore factors associated with nephrolithiasis. As of the 2005 follow-up questionnaire, a cumulative total of 1063 women among 43,178 reported ever being diagnosed with kidney stones for a prevalence of 2.64%. Women with a history of nephrolithiasis were older, slightly heavier, and were more likely to have a comorbid condition (e.g., type-2 diabetes, gallstones), drink alcohol, and consume a Western-style diet. A history of gallstone disease was associated with an odds ratio (OR) of 3.59 (95% confidence interval (CI) 3.09-4.17). The OR for consuming ≥ 7 alcoholic beverages/week, compared to none was 0.61 (0.39-0.94), while the OR for high adherence to the Western diet, compared to low adherence was 1.53 (1.23-1.90). Our findings are consistent with previous studies of primarily white populations relating lifestyle-associated risk factors with nephrolithiasis. Despite their lower prevalence of kidney stones, it is important to focus on vulnerable populations such as Black women given their disproportionate burden of metabolic conditions (e.g., obesity, diabetes) related to kidney stone disease.

Ureteroscopic biopsy of upper tract urothelial carcinoma using a novel ureteroscopic biopsy forceps.

INTRODUCTION: We sought to assess the adequacy of surgical specimens obtained utilizing the BIGopsy (Cook Medical, Bloomington, IN, USA) biopsy forceps both ex vivo and in vivo and compare them to traditional 3Fr biopsy forceps in patients with suspected upper tract urothelial carcinoma. MATERIALS AND METHODS: Patients undergoing nephroureterectomy for suspected upper tract transitional cell carcinoma were recruited. Surgical specimens, immediately after extirpation were examined and alternatively biopsied ex vivo with the BIGopsy and 3Fr biopsy forceps. We then retrospectively reviewed our most recent experience with ureteroscopic biopsy. The biopsy device, size, depth, grade, stage, pathologic diagnosis and subjective biopsy quality were assessed. RESULTS: Three ex vivo nephroureterectomy specimens were evaluated. The average biopsy size from the 3Fr biopsy forceps was 3.5 +/- 2.8 mm2 and for the BIGopsy was 31.2 +/- 34.6 mm2. Subjectively, the BIGopsy specimens revealed less distortion and fragmentation and were easier to interpret by the pathologist. Sixteen patients underwent 19 ureteroscopic procedures. The mean size in maximal diameter (mm +/- SD) of the biopsies in each group were; 3Fr 1.2 +/- 0.4, BIGopsy 3.4 +/- 2.0, nitinol basket 4.9 +/- 4.0 and laser 11 +/- 8.5. Lamina propria was identified in 3/13 (23%) biopsies with 3Fr biopsy forceps, 6/11 (55%) biopsies with the BIGopsy forceps, 6/8 (75%) biopsies with the nitinol basket and 2/2 (100%) biopsies with the holmium laser. Six patients underwent biopsies with both the BIGopsy and 3Fr biopsy forceps. A definitive diagnosis was made in 2/6 cases with the 3Fr biopsy forceps compared with all 6/6 cases with the BIGopsy biopsy forceps. Grade and stage matched final surgical grade and stage in 3/3 cases biopsied with the BIGopsy. CONCLUSION: For lesions with stalks, the holmium laser and basket biopsy provided larger specimens than either of the forceps. For flat or sessile lesions, the BIGopsy biopsy forceps provided larger, deeper less distorted specimens than the 3Fr biopsy forceps and correlated well with ultimate grade and stage. Improved biopsy quality may translate into improved ability to diagnose both benign and malignant ureteral and renal pelvic mucosal lesions endoscopically.

Assessing the Content and Readability of Robotic and Laparoscopic Sacrocolpopexy Information Online.

IMPORTANCE: Apical pelvic organ prolapse is a common condition that affects women. Currently, sacrocolpopexy is considered the criterion standard surgical treatment, with an increasing preference for minimally invasive techniques. OBJECTIVE: In this study, the content and readability of select internet pages describing robotic and laparoscopic sacrocolpopexy were evaluated. STUDY DESIGN: Using an online key word planner, the phrases "robotic sacrocolpopexy" and "laparoscopic sacrocolpopexy" were determined to be the most popular search terms. These terms were systematically browsed in incognito mode in 3 of the most popular web search engines: Google, Yahoo, and Bing. Links that were nontext primary, duplicate, irrelevant, and non-English were excluded. The Flesch-Kincaid Grade Level and Flesch-Kincaid Reading Ease indices were used to assess readability. RESULTS: The average readability of all sites was 12.9, requiring at least a 12th-grade reading level, which is significantly higher than the recommended American Medical Association/National Institutes of Health (AMA/NIH) level of sixth-grade or below. One hundred percent of all analyzed sites were above this recommended sixth-grade reading level. There was no significant difference between mean grade level or reading ease score from the type of web source (P = 0.32 and 0.34, respectively), approach of surgery (P = 0.91, 0.70), or specialty (P = 0.48, 0.36). CONCLUSIONS: Almost all websites require at least a high school education to properly comprehend, regardless of source or specialty. It is important that health care providers be aware of available information, so they may direct patients to specific resources that are personally validated or provide in-office materials at an appropriate reading level.

Opioid Prescribing Practices of U.S. Urology Trainees after Urological Surgery.

INTRODUCTION: We surveyed U.S. urology trainees to determine current prescribing practices after common endourological procedures. METHODS: An institutional review board approved, 22-item survey was distributed to all U.S. urology residents through the Society of Academic Urologists. The survey was divided into demographics including American Urological Association section, prescribing patterns after ureteroscopy, shockwave lithotripsy, percutaneous nephrolithotomy and transurethral prostate procedures, as well as attitudes surrounding opioid prescription. RESULTS: A total of 148 U.S. urology residents completed the survey (response rate 13%). All American Urological Association sections were represented, including Northeastern (12.8%), New England (8.1%), New York (6.1%), Mid-Atlantic (3.4%), Southeastern (19.6%), North Central (29.05%), South Central (10.1%) and Western (10.8%). By procedure, 72.3% of respondents prescribe opioids after ureteroscopy, 37.8% after shockwave lithotripsy, 93.9% after percutaneous nephrolithotomy, and 53.4% after transurethral prostate procedures. By procedure, the average number of tablets prescribed, were 7.5 (range 0-30) for ureteroscopy, 4.2 (0-20) for shockwave lithotripsy, 14.1 (0-40) for percutaneous nephrolithotomy and 6.7 (0-30) for transurethral prostate procedures. The average number of tablets prescribed by region varied significantly for ureteroscopy, percutaneous nephrolithotomy and transurethral prostate procedures (all p <0.0001), but did not vary significantly for shockwave lithotripsy (p=0.067). CONCLUSIONS: Opioid prescribing practices among U.S. urology residents for common urological procedures varied by regional American Urological Association section, and attitudes surrounding opioid dispensing influenced prescription patterns. While attitudes regarding opioid prescriptions after urological surgery are improving, residents may benefit from additional training, best practice policies and/or society guidelines.

A case of epididymoorchitis without testicular infarction presenting with reversal of diastolic testicular flow on Doppler ultrasonography.

An acute scrotum is a common clinical scenario prompting urologic involvement. Scrotal ultrasonography with Doppler is the main imaging modality utilized for the evaluation of an acute scrotum and can help distinguish testicular torsion from epididymoorchitis, two common causes of testicular pain. Testicular infarction is a rare but potential complication of epididymoorchitis. We report a case of epididymoorchitis presenting with reversal of testicular diastolic flow concerning for impending testicular infarction but with a non-ischemic testis on scrotal exploration and repeat scrotal ultrasonography post-operatively.

Economic Evaluation of 1470 nm Diode Laser Enucleation vs Bipolar Transurethral Resection of the Prostate.

Purpose: Large meta-analyses demonstrate the noninferiority of laser enucleation to transurethral resection of the prostate (TURP) with regard to long-term efficacy and reoperation rate. Although the 1470 nm diode laser enucleation of the prostate (DiLEP) is superior in hemostasis and surgical visibility, its complexity and associated longer operative time limit its widespread usage. The objective of this study was to generate long-term cost estimates for bipolar TURP and DiLEP, taking into account perioperative and adverse event costs. Materials and Methods: This is a retrospective review of patients who underwent DiLEP (n = 114; November 2016 to February 2020) or TURP (n = 194; January 2016 to December 2018). A decision analysis model was constructed to compare costs of the primary procedure and subsequent complications taking into account disposable costs, operating room time, length of stay, reoperation rates, and readmissions. Costs were estimated from internal data, published literature and Medicare procedure costs. Markov modeling was used to create cost projections up to 10 years. Results: DiLEP was associated with shorter length of stay and fewer total complications, but longer operative times and greater initial costs. Cost were recuperated at 8 years postoperatively. At 10 years postoperatively, DiLEP represented approximately $664 cost savings per patient over TURP. Conclusions: DiLEP is a cost-effective alternative to TURP for the treatment of benign prostatic hyperplasia in the properly selected patient. DiLEP has greater initial costs due to longer operative times. Costs are recuperated by 10 years postoperatively due to higher rate of same-day discharges, and lower complication and reoperation rates, incurring a $664 cost savings per patient treated by DiLEP relative to TURP.

Comparison of Transabdominal and Transrectal Ultrasound for Sizing of the Prostate.

OBJECTIVE: To compare the accuracy of prostate sizing between pelvic abdominal (PUS) and transrectal (TRUS) ultrasound in a large, diverse cohort of men at our institution. Prostate volume plays a vital role in all types of prostate disease. American Urological Association guidelines (2018) for surgical management of benign prostatic hyperplasia now include consideration of prostate volume measurement prior to surgical intervention. Ultrasound is a quick and radiation-free imaging modality. METHODS: We performed a single-center, retrospective study of 299 patients with prostate sizing between January 1, 2012 and August 31, 2017. Prostate volume was derived from ellipsoid volume calculation using dimensions measured on ultrasound. PUS and TRUS were compared by calculating the Pearson correlation coefficient and intraclass correlation coefficient, and agreement between modalities assessed using the Bland Altman analysis. This analysis was done for the whole sample population as well as for specific groupings according to body mass index, prostate size, and time between exams. RESULTS: A total of 236 patients had PUS followed by TRUS and met study inclusion criteria. Median age was 63, median prostate specific antigen value prior to PUS was 7.6 ng/mL, and only 20% were white. Mean volume differences between the two modalities for the data (volPUS - volTRUS) were (-0.3 ± 1.1) cm3. Bland-Altman analysis showed agreement between PUS and TRUS only for prostates ≤ 30 cm3. CONCLUSION: For prostates less than 30 cc, we found that PUS is interchangeable with TRUS in estimating prostate volume. However, for larger prostates where size may alter surgical management, we would recommend TRUS or cross-sectional imaging.

Robotic dismembered pyeloplasty surgical simulation using a 3D-printed silicone-based model: development, face validation and crowdsourced learning outcomes assessment.

Ureteropelvic junction obstruction (UPJO) is an uncommonly encountered pathology, posing a challenge for resident training. We describe the development and face validation of a robotic pyeloplasty simulation using a 3D-printed silicone-based model of UPJO for surgical training, in combination with crowdsourced scoring to objectively assess performance and learning outcomes. The organs were created using 3D modeling software and printed using a silicone-based material by Lazarus 3D, LLC. They were secured in a laparoscopic box trainer and the robotic system was docked. Eight residents and three faculty each performed two robotic-assisted right dismembered pyeloplasties on separate occaisions. Face validity was evaluated on a 5-point Likert scale. Crowd-Sourced Assessment of Technical Skills (C-SATS Inc.) scored surgical performance using the Global Evaluative Assessment of Robotic Skills (GEARS) criteria, based on video review of each simulation. All participants completed the simulation twice with fully patent anastomoses. Average time to complete the first and second trials was 44.4 min and 43.2 min, respectively. The average GEARS score was 17.1 and 17.6 for the first and second trials respectively. Participants improved on average in all 5 GEARS categories, with significant improvement in depth perception (p = 0.006). The model received mean scores (out of 5) of 4.36 for aesthetics, 4.18 for overall feel, 3.55 for realism, 4.72 for usability, and 4.72 for suturability. Residents had a significant increase in confidence between initial and final surveys on a 5-point Likert Scale: 1.63 vs. 2.38 (p = 0.03). Using 3D-printed silicone-based models, participants completed robotic-assisted dismembered pyeloplasties for training and skill acquisition. We demonstrated face validity of the simulation, which was also found to improve participant speed and significantly improve resident confidence. Crowdsourced assessment demonstrated significant improvement in depth perception.

The Effect of Holmium Laser Fiber Bending Radius on Power Delivery During Flexible Ureteroscopy.

Introduction: Flexible ureteroscopy is a mainstay of upper urinary tract stone treatment. Holmium laser lithotripsy is a particularly common and notable technique for the dusting and fragmenting of renal stones. During ureteroscopy, optical fibers are subject to sharp bends in pursuit of stones, particularly those at the lower pole. Following from principles of fiber optics, subjecting these fibers to sharp bending angle has the potential to reduce the efficiency of power transmission at the fiber tip. Due to the potential implications this hypothesis could have on endourological practice and research, we aimed to explore the potential impact of fiber bending on end-fiber power output. Materials and Methods: Using a highly sensitive oscilloscope and a urological holmium laser, we assessed the end-fiber power output under a variety of bending conditions. To ensure maximal confidence in our results, the maximal bending conditions explored substantially exceeded any condition, which could occur during ureteroscopic surgery. Results: We found evidence that bending radius alone has a clinically insignificant impact on the light power transmission in the fiber. At certain bending conditions, we observed a clinically unimportant but statistically significant reduction in power transmission. This was verified using two commonly used delivery fiber types exposed to 8-second bursts for each bending condition.

Impact of a decision aid on newly diagnosed prostate cancer patients' understanding of the rationale for active surveillance.

OBJECTIVE: To compare newly diagnosed localized prostate cancer patients who did and did not view a decision aid (DA) on their knowledge of the rationale for active surveillance (AS). METHODS: A cross-sectional study was conducted among 452 newly diagnosed low-risk localized prostate cancer patients. Patients were mailed the video/DVD DA and completed a web-based questionnaire that contained two multiple choice questions assessing knowledge of the rationale for AS. Multivariable logistic regression was used to estimate the effect of the DA on knowledge of the rationale for AS. RESULTS: Patients who watched the DA were more likely to correctly respond to each rationale for AS question; both comparisons were statistically significant. After adjustment, men who viewed the DA were 2.9 times as likely to correctly respond to both rationale for AS questions than men who did not view the DA (95% CI: 1.9-4.5). CONCLUSION: Patients who viewed a DA better understand the reasons why AS is a viable treatment option for localized prostate cancer than patients who did not view a DA. PRACTICE IMPLICATIONS: Urology clinics and practices should implement the utilization of a treatment DA for newly diagnosed, localized prostate cancer prior to the patients' first cancer consultation.

Percutaneous transhepatic holmium laser lithotripsy of a large common bile duct stone.

A 58-year-old woman presented with a 4 cm obstructing choledocolith within the proximal common bile duct. She had an extensive operative history resulting in common bile duct to jejunum anastomosis after cholecystectomy. Endoscopic retrograde cholangiopancreatography (ERCP) removal was unsuccessful, and surgical exploration was contraindicated due to multiple comorbidities. Interventional radiologist placement of bilateral transhepatic ureteral access sheaths allowed Urologist evaluation of the biliary tract by ureteroscope. Holmium laser lithotripsy was performed with successful fragmentation of the stone and clearance of the obstruction, without complication. The case is relevant to the growing literature on the management of refractory biliary stones after failed ERCP.

Robotic-Assisted Ureteral Re-implantation: A Case Series.

INTRODUCTION: Minimally invasive surgical techniques are currently used for numerous urologic disorders and generally offer decreased morbidity and equivalent outcomes compared with open surgery. There is a relative paucity of data on robot-assisted ureteral re-implantation (RAUR) in adult patients for benign stricture disease. PATIENTS AND METHODS: We retrospectively reviewed our recent experience with mid-/distal ureteral reconstruction at a single tertiary-care center. From 2010 to 2012, 13 consecutive patients presenting with benign obstruction of mid-/distal ureters were managed with RAUR. RESULTS: In all cases the operative procedure was undertaken with six-port transperitoneal access, and all procedures were completed robotically. All ureters (left, n=5; right, n=7; bilateral, n=1) were re-implanted in a standard Bricker fashion into the dome of the bladder with (n=8) or without (n=6) a psoas hitch. Catheters were removed 4-11 days postoperatively, and all cystograms were negative for leak. Stents were removed 14-48 days after surgery. All were negative for hydronephrosis. Average follow-up was 10 (range, 2-20) months. There were two grade 1, two grade 2, two grade 3, and no grade 4 or 5 complications in 3 patients. CONCLUSIONS: RAUR is a safe and effective procedure. Extensive laparoscopic lysis of adhesions represents the primary challenge to an otherwise straightforward minimally invasive surgery. At our institution, RAUR has replaced open ureteral re-implantation as the preferred treatment for benign mid-/distal ureteral stricture disease.

Transrectal electrical impedance tomography of the prostate: spatially coregistered pathological findings for prostate cancer detection.

PURPOSE: Prostate cancer ranks as one of the most common malignancies and currently represents the second leading cancer-specific cause of death in men. The current use of single modality transrectal ultrasound (TRUS) for biopsy guidance has a limited sensitivity and specificity for accurately identifying cancerous lesions within the prostate. This study introduces a novel prostate cancer imaging method that combines TRUS with electrical impedance tomography (EIT) and reports on initial clinical findings based on in vivo measurements. METHODS: The ultrasound system provides anatomic information, which guides EIT image reconstruction. EIT reconstructions are correlated with semiquantitative pathological findings. Thin plate spline warping transformations are employed to overlay electrical impedance images and pathological maps describing the spatial distribution of prostate cancer, with the latter used as reference for data analysis. Clinical data were recorded from a total of 50 men prior to them undergoing radical prostatectomy for prostate cancer treatment. Student's t-tests were employed to statistically examine the electrical property difference between cancerous tissue and benign tissue as defined through histological assessment of the excised gland. RESULTS: Example EIT reconstructions are presented along with a statistical analysis comparing EIT and pathology. An average transformation error of 1.67% is found when 381 spatially coregistered pathological images are compared with their target EIT reconstructed counterparts. At EIT signal frequencies of 0.4, 3.2, and 25.6 kHz, paired-testing demonstrated that the conductivity of cancerous regions is significantly greater than that of benign regions ( p < 0.0304). CONCLUSIONS: These preliminary clinical findings suggest the potential benefits electrical impedance measurements might have for prostate cancer detection.

Urologic synechiae.

Synechiae are intracavitary adhesions; although rarely reported, they may occur within the urinary tract. They are well recognized within the gynecologic literature but are rarely reported as a cause of urologic pathology. We describe the endoscopic appearance of two such lesions, describing their pathologic role and the endoscopic management in two patients.