Robot-assisted Laparoscopic Prostatectomy After SpaceOAR Placement.

BACKGROUND: Patients with prostate cancer are offered a wide range of treatments from radiation therapy to chemotherapy to surgery. When giving radiation therapy, SpaceOAR hydrogel has been part of the standard treatment for the last decade to reduce unnecessary radiation exposure to the rectum. In rare cases, SpaceOAR may be placed but the patient cannot go through with radiation. The hydrogel ideally persists in the body for 3months then gets absorbed at 6months. OBJECTIVES: In this video presentation, we discuss our unique surgical case involving robot-assisted laparoscopic prostatectomy in a patient with SpaceOAR placement for 2months. RESULTS: A 58-year-old Caucasian male presented with screening prostate-specific antigen 48.47 and a biopsy showed grade group (GG) 3 in three cores, GG2 in one core, and GG1 in five cores. Patient was seen by urology and radiation oncology and initially opted for radiation therapy. He underwent SpaceOAR placement and was given a 6months dose of androgen deprivation therapy. However, during CT planning, small bowel was seen in the radiation field, in proximity to the prostate. As a result, the radiation was thought to be unsafe and he was referred back to urology. We considered options of immediate prostatectomy or waiting 6months until the hydrogel had been fully absorbed. Due to concerns of the hydrogel causing scarring after absorption, we decided to proceed with surgery. The area of SpaceOAR placement created the plane between the prostate and the rectum, however, there was dense scarring around the lateral aspects where the gel had started to absorb. This made the case difficult, but feasible. There were no complications. Final pathology showed pT2N0 with negative margins. CONCLUSION: Robot-assisted Radical Prostatectomy after SpaceOAR placement can be safe with good oncologic and functional outcomes. Although it is unknown how the tissues will ultimately heal after full absorption of the gel, it may be prudent to perform the surgery before the hydrogel is absorbed in order to maintain the anatomic planes of dissection.

Unmet Sexual Health Needs of Patients and Female Partners Following Diagnosis and Treatment for Prostate Cancer.

BACKGROUND: Prostate cancer (PCa) and its treatment can have significant and pervasive sexual side effects for patients and their partners; however, partner needs are not well understood, and most resources do not incorporate partner priorities. AIM: Our objective was to perform a qualitative study to identify unmet sexual needs of patients and female partners after PCa diagnosis. METHODS: We conducted a qualitative study of posts to the Inspire Us TOO Prostate Cancer Online Support and Discussion Community. Overall, 6,193 posts were identified in the Sexual Health & Intimacy forum of the community, of which 661 posts were from female authors. A random sample of 10% (n = 66) of posts from female partners and an equal number of randomly selected posts from male patients were analyzed. OUTCOMES: We assessed sexual health themes among patients and female partners. RESULTS: Multiple themes emerged that were unique to female partners of PCa survivors. These included expanding the sexual repertoire, feeling invisible, contextualizing sexual intimacy within the broader picture of survival, and addressing relationship concerns. Patients and their partners also shared common sexual health themes, including coming to terms with changes in sexual function and frustration with clinicians. Both patients and their partners use online health communities to get support and share their experiences with sexual recovery and use of sexual aids. Psychosocial treatments were infrequently mentioned, and may be particularly helpful to address partner concerns. CLINICAL IMPLICATIONS: A common concern for couples was not receiving sufficient information from healthcare providers regarding sexual side effects from PCa and its treatment. STRENGTHS AND LIMITATIONS: Strengths of the study include leveraging a unique data source to address an understudied topic of sexual health concerns among partners after PCa diagnosis. However, members of an online community may not be representative of all couples facing PCa. Also, this analysis is limited to female partners of patients with PCa, and further study is underway to examine the sexual health needs among gay and bisexual couples. CONCLUSION: Both patients and female partners have many unmet sexual health needs during PCa survivorship, and designing interventions to incorporate partner perspectives may improve the management of sexual side effects of PCa for couples. Li R, Wittmann D, Nelson CJ, et al. Unmet Sexual Health Needs of Patients and Female Partners Following Diagnosis and Treatment for Prostate Cancer. J Sex Med 2022;19:1797-1803.

Comparison of Robotic Surgery Video Quality Between YouTube and Curated Sources Using GEARS Criteria.

OBJECTIVE: To compare the quality of robotic prostatectomy surgical videos on the popular website YouTube with more curated, professional sources using the Global Evaluative Assessment of Robotic Skills (GEARS) criteria. METHODS: A search was performed on YouTube for robotic prostatectomy. Results were sorted by views and the first ten that met inclusion criteria were selected for review. To represent curated sources five robotic prostatectomy videos were selected from the DaVinci Surgery Community (DVS) video repository and the AUA Surgical Video Library in order of publishing from present to past. Videos were edited to be deidentified. The videos were reviewed blindly in parallel and graded using the GEARS criteria. Concordance among reviewers was measured using Chronbach's alpha. Comparisons between groups were made using student t-test. RESULTS: There was a high level of reliability of overall GEARS scores between reviewers for each video (α = 0.843). There was no significant difference between overall GEARS scores between the YouTube videos (mean 24.8, SDEV 1.85) and the AUA group (mean 24.3, SDEV 6.18) (P = 0.78). YouTube videos scored higher than the DVS videos (mean 22.1, SDEV 2.34) (P 0.03). CONCLUSION: Despite concerns about the quality of surgical videos on YouTube for education, the most viewed surgical videos for robot assisted laparoscopic prostatectomy score as well or better than more curated sources using the GEARS criteria. This may represent selection via crowd sourcing of the best videos amongst a much larger overall quantity.

Penile Dorsal Vein Rupture Identified by Emergency Department Ultrasound.

CASE PRESENTATION: We present the case of a young male with high clinical suspicion of a penile fracture found to have dorsal vein rupture by emergency department point-of-care ultrasound. This false form of penile fracture was subsequently confirmed intraoperatively. DISCUSSION: Penile fracture is a rare clinical entity that may be separated into true vs false penile fracture, with only true fracture requiring surgery. The images submitted here add to the sparse literature evidence that point-of-care ultrasound can be used to differentiate between these two clinical entities. Additionally, this case report highlights an opportunity for further research into and application of point-of-care ultrasound to the evaluation of suspected penile fractures.

Standardized protocol for voiding cystourethrogram: Are recommendations being followed?

BACKGROUND: Voiding cystourethrogram (VCUG) images the urethra and bladder during filling and emptying, as well as ureters and kidneys when vesicoureteral reflux (VUR) is present, providing detailed information about both anatomical and functional status of the urinary tract. Given the importance of information obtained, and the varying quality depending on VCUG technique and radiology reporting, the American Academy of Pediatrics Sections on Urology and Radiology published a joint standardized VCUG protocol in 2016. OBJECTIVE: We compared VCUG reports from multiple institutions before and after publication of the protocol to determine adherence to recommendations. STUDY DESIGN: VCUG reports generated during two separate time periods were assessed - before and after publication - to evaluate impact of the protocol. Adherence to the reporting template was evaluated. Studies performed on patients >18 years of age and those obtained for trauma evaluation were excluded from study. RESULTS: A total of 3121 VCUG reports were analyzed, 989 (31.7%) were generated before and 2132 (68.3%) after protocol publication. Comparing cohorts, there was no difference in gender (62.6% female versus 61.4%; p = 0.53) though children in the post-cohort were slightly older (3.34 ± 3.82 versus 3.68 ± 4.19 years; p = 0.03). A significant increase in scout image reporting (91.5%) and cyclic studies (20.5%) were observed in the post-cohort, in comparison to 79.2% and 13.1%, respectively, in the pre-protocol cohort (p < 0.001) [Figure]. Measured PVR and recorded infused volume actually decreased between study periods (84.7% vs 72.8% and 97.2% vs 91.5%, p < 0.001). There was no statistically significant difference between VUR grade reporting (99.4 vs 98.5%, p = 0.25). Recorded volume in which reflux occurred increased between periods (0.6% vs 2.3%, p < 0.05), while reporting of filling vs voiding reflux decreased in the post-cohort (84.4% pre-vs 77.4% post-protocol, p < 0.008). DISCUSSION: The 2016 VCUG protocol recommended inclusion of various data points, however the volume at which reflux occurs remained vastly underreported. Timing of reflux has been shown to predict likelihood of spontaneous resolution and risk of breakthrough urinary tract infection; thus, its omission may limit the information used to counsel families and provide individualized care. CONCLUSION: Despite consensus on standard VCUG protocol to best perform and record data, reports remain inconsistent. While VUR grade is routinely reported, other important anatomic and functional findings which are known to impact resolution and breakthrough urinary tract infection rates, such as volume at which reflux occurs, are consistently underreported.