Surgical management of National Institutes of Health category II chronic bacterial prostatitis: a case series and scoping review of the literature.

Background: National Institutes of Health (NIH) category II prostatitis refractory to antibiotic therapy can be challenging to treat. We present the outcomes from a case series of men who have undergone various surgical therapies to treat this condition. Additionally, we performed a scoping review of studies describing the characteristics and outcomes of patients surgically treated for chronic bacterial prostatitis (CBP). Methods: This is a single-center retrospective case series of adult patients at Cleveland Clinic Glickman Urological and Kidney Institute with refractory NIH category II prostatitis managed with surgical intervention. PubMed was queried and all resulting articles were analyzed for relevance and parallel study designs. Results: Twelve subjects underwent endoscopic procedures. Two of 12 (16.7%) subjects had CBP recurrence with E. Coli at 12 and 60 months; both patients initially had prostatic stones. One patient with CBP recurrence developed a urethral stricture. Seven subjects were treated with nerve-sparing robotic radical prostatectomy of whom two had concomitant prostate cancer. Three subjects had prostate stones, two of which extended beyond the surgical capsule. E. coli was the isolated pathogen for six patients with two of these being multi-drug resistant (MDR) E. coli. One patient in this group experienced recurrent urinary tract infections (UTIs) despite the surgery. Scoping review of available articles consistently failed to mention definitive diagnosis of CBP with prostatic secretion cultures or even urine cultures prior to surgical intervention and no studies were found on the curative outcomes of surgical intervention. Conclusions: Our study provides one of the first single-center retrospective case series of patients with antibiotic refractory NIH category II CBP managed with surgical intervention. Overall, rate of cure between all surgical modalities was 84% (n=16). When disease is confined to the surgical capsule, endoscopic management is likely sufficient. Radical prostatectomy expectedly increased rates of postoperative erectile dysfunction and stress urinary incontinence compared to endoscopic intervention. However, in patients with disease beyond the capsule and/or concomitant prostate cancer, prior endoscopic treatment, or life-threatening UTI, radical prostatectomy may be justified.

Female sexual function evaluation and intraoperative vaginal reconstruction in bladder cancer.

RC significantly negatively impacts sexual function (SF) in both men and women. While significant research resources have been allocated to examine the deleterious effects of post prostatectomy erectile dysfunction, little attention has been directed towards female sexual function and organ preservation post cystectomy. These academic shortcomings often result in poor provider awareness and inadequate preoperative assessment. As such, it is crucial for all providers involved in female RC care to understand the necessary and available tools for preoperative evaluation, in addition to the anatomic and reconstructive techniques. This review aims to summarize the current preoperative evaluation and available tools of SF assessment and describe in detail the varying operative techniques in the preservation or restoration of SF in women after RC. The review explores the intricacies of preoperative evaluation tools, and intraoperative techniques for organ- and nerve-sparing during radical cystectomy in females. Particular emphasis on vaginal reconstruction after partial or complete resection is provided, including split-thickness skin (STF) graft vaginoplasy, pedicled flaps, myocutaneous flaps and use of bowel segments. In conclusion, this narrative review highlights the importance of understanding anatomic considerations and nerve-sparing strategies in promoting postoperative SF and quality of life. Furthermore, the review describes the advantages and limitations of each organ- and nerve-sparing technique and their impact on sexual function and overall well-being.

Development of a Clinical-scholar Index Score for Measuring Academic Contributions in Urology.

OBJECTIVE: To develop an academic index that would permit annual measurement of faculty non-clinical activities. METHODS: Academic activities were extracted from curriculum vitae (CV) and sorted into pre-determined categories. Categories were weighted based on discussion with department leadership. Weights were scaled 0-1 with 0 being defined as an activity that was non-essential to the mission, brought little to no external recognition or was beneath the appropriate milestone for the individual (middle author publications for a senior career staff member). 1 was defined as an activity that was essential to the department's mission, a significant time commitment for the individual, and provided external recognition. Annual scholarly index scores were determined for all participants based on their weighted contributions for the year. RESULTS: Early career staff primarily make contributions through peer-reviewed publications and presentation. Velocity of scholarly contributions was greatest during the Mid-career (MC) stage. Senior career (SC) urologists had the most diverse array of contributions of any group. Like many of the MC faculty, SC faculty demonstrated a decrease in nonclinical productivity beginning in 2018 following a shift in organizational priorities to increased clinical productivity. CONCLUSIONS: Nonclinical contributions of academic urologists can be quantified and tracked annually using this academic index. By doing so, leadership can more easily identify ways to support career development, which is especially important in mid-career, where individuals likely have the greatest opportunity for growth or stagnation. Finally, shifts in organization-wide priorities affect academic contributions and can be quantified by the model.