A Disease-Specific Antibiogram to Evaluate Empiric Coverage Patterns in Fournier's Gangrene.

OBJECTIVE: To analyze our local antibiogram and antibiotic resistance patterns given concern for multidrug-resistant and fungal organisms in contemporary series detailing causative organisms in Fournier's Gangrene (FG). METHODS: All patients from 2018 to 2022 were identified from the institutional FG registry. Microorganisms and sensitivities were collected from operative tissue cultures. The primary outcome of this study was the adequacy of our empiric. Secondary outcomes included the rate of bacteremia, the concordance of blood cultures and tissue cultures, and the rate of fungal tissue infections. RESULTS: Escherichia coli and Streptococcus anginosus were most common, identified in 12 patients each (20.0%). Enterococcus faecalis (9, 15.0%), S agalactiae (8, 13.3%) and mixed cultures without a predominant organism (9, 15.0%) were also common. A fungal organism was identified in 9 (15.0%) patients. Patients who were started on Infectious Diseases Society of America guideline adherent antibiotic regimen were not significantly different in terms of bacteremia rate (P = .86), mortality (P = .25), length of stay (P = .27), or final antibiotic duration (P = .43) when compared to those on alternative regimens. Patients with a tissue culture positive for a fungal organism were not significantly different in terms of Fournier's Gangrene Severity Index (P = .25) or length of stay (P = .19). CONCLUSION: Local disease-specific antibiograms can be a powerful tool to guide empiric antibiotic therapy in FG. Although fungal infections are responsible for a majority of the gaps in empiric antimicrobial coverage at our institution they were present in only 15% of patients and their effect on outcomes does not justify addition of empiric antifungal agents.

Sociodemographic index and global trends in prostate cancer: 1990-2017.

BACKGROUND: Considered globally, prostate cancer is a disease of the aging male that increases in prevalence with exposure to screening and diagnostic testing, and which requires a population with the health and longevity to encounter it. The Global Burden of Disease (GBD) dataset is an aggregation of worldwide registries and health data systems that reports global and regional assessment of disease impact. METHODS: Using the GBD database, 1171 worldwide registries and health registration systems from 1990 to 2016 were aggregated for prostate cancer disease codes and outcomes. Disease-Adjusted Life Years (DALYs) were calculated and segregated by sociodemographic index (SDI) quintile, and compared to other urologic diseases and tuberculosis (TB). RESULTS: Prostate cancer exerts a burden of disease that is vastly higher in the top quintile of SDI. The three lowest SDI quintiles represent the majority of global population but are currently less impacted by prostate cancer. Conversely, TB has its highest impact on the lowest SDI levels, although these rates are declining. CONCLUSIONS: As a global disease, prostate cancer predominantly affects high SDI men who enjoy a longer life expectancy in which to suffer from this disease and a greater exposure to screening and diagnosis. As lower SDI men are elevated in health and income, reallocation of DALYs will occur, and a greater burden of prostate cancer can be expected. These epidemiologic trends have great implications for the allocation of resources, as the population of men affected by prostate cancer outpaces urologic workforce growth.

Long-term Follow Up of Ileal Ureteral Replacement for Complex Ureteral Strictures: Single Institution Study.

OBJECTIVE: To report our 16-year experience with ileal ureter interposition for complex ureteral stricture. Ureteral reconstruction continues to evolve to include less invasive techniques to successfully manage ureteral stricture. However, long, complex, obliterative and especially radiated ureteral strictures are not amenable to less invasive techniques and may require Ileal ureter interposition. MATERIALS AND METHODS: Retrospective review of a single institution's ureteral reconstruction database was performed. Demographics, operative details, success rate, complication rate, and length of follow-up were noted. Unilateral replacements utilized ileal ureteral interposition. Success rate was defined as no need for further open intervention. RESULTS: Between 2003 and 2019, 188 ureteral reconstructions were performed, of which 46 required ileal ureter interposition. Of these 46 patients, 10 required bilateral reconstruction. Average age was 53 years, 26 (57%) were female. The average stricture length was 9.1 cm (2-20 cm). Stricture etiology included iatrogenic causes (n = 24, 52%), radiation causes (n = 12; 26%), vascular disease (n = 3; 7%), and idiopathic retroperitoneal fibrosis (n = 3; 7%). Forty-three surgeries were performed by open abdominal approach; 3 were performed robotically. The average length of operation was 412 minutes, blood loss 417 mL and LOS was 10 days. At mean follow up of 4.4 years (1-16 years), overall success rate was 83%, with 17% (n = 8) patients requiring subsequent major surgery (5 successful ureteral revision, 3 nephrectomy) and 11 (24%) patients experiencing a major complication. CONCLUSION: In our long-term follow up of over 4 years, ileal ureteral interposition remains a successful option for complex ureteral strictures in properly selected patients.

The rising worldwide impact of benign prostatic hyperplasia.

OBJECTIVES: To describe the trend in the impact of lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH) on a global scale using the Global Burden of Disease (GBD) database. MATERIALS AND METHODS: Using the GBD database, worldwide data aggregated from registries and health systems from 1990 to 2017 were filtered for LUTS/BPH diagnoses. Calculation of years lived with disability (YLD) were compared with other urological diseases. YLD were calculated by a standardized method using assigned disability weights. The GBD-defined sociodemographic index (SDI) was used to assess impact of LUTS/BPH by global SDI quintile. RESULTS: Global Burden of Disease data over the 1990-2017 study period were summarized and global numbers and trends noted with other urological diseases for comparison. A total of 2 427 334 YLD were attributed to BPH in 2017 alone, almost three times more than those attributed to the next highest urological disease, prostate cancer (843 227 YLD). When stratified by SDI quintile, a much lower impact of BPH was found in the bottom three quintiles, despite this subset representing 66.9% of the 2017 world population. CONCLUSIONS: Lower urinary tract symptoms attributed to benign prostatic hyperplasia exert a rapidly rising human burden far exceeding other urological diseases. As the population ages and men in a lower SDI enjoy increased life expectancy and decreased competing mortalities, a continually accelerating wave of LUTS/BPH can be forecast. These epidemiological trends have serious implications for the future allocation of resources and the global urological workforce.

Denial of a sleep deprivation message: situational and dispositional influences on message rejection.

Two studies investigated situational and dispositional influences on rejection of a sleep deprivation warning message for young adults. The hassle of protection (Study 1) and the self-relevance of the problem (Study 2) were manipulated; the disposition to use denial (threat orientation) for warning messages was measured. In both studies, it was found that both dispositional denial and the situational manipulation (more protection-hassle or self-relevance) showed at least one denial effect by reducing perceived susceptibility, perceived severity, or credibility. Indirect (mediational) effects were tested with the bootstrap method. In Study 1, judgments of credibility and severity mediated the effects of the hassle manipulation and denial orientation on message outcomes. In Study 2, credibility mediated the effects of the self-relevance manipulation and denial orientation on message outcomes of intentions to change and priority given to sleep. These studies show that both situational and dispositional sources of denial work in similar ways by lowering key message judgments and that the lower judgments lead to less priority given to a health risk and lower intentions to protect oneself.