A Systematic Review of Partner Satisfaction After Penile Prosthesis with Special Emphasis on LGBTQ + Populations.

PURPOSE OF REVIEW: Despite the current surgical advances and patients' satisfactions after penile prosthesis (PP) implantation, there has been paucity of data on reported partner satisfaction and their quality-of-life (QoL). Our objective was to summarize the current literature on partner satisfaction for both heterosexual and non-heterosexual populations, respectively. We specifically conducted a systematic review according to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, and stratified studies into three tiers by methodological rigor. RECENT FINDINGS: After an initial search of 172 articles, 33 studies met the inclusion criteria for the final review: 30 for heterosexual partner satisfaction, and 3 for LGBTQ patient satisfaction were included due to lack of published literature on partner satisfaction for LGBTQ patients. For heterosexual partner satisfaction, 10 studies were classified as Tier 1, 11 studies were classified as Tier 2, and 9 studies were classified as Tier 3. From an initial search of 13 records, three studies consisting of 272 patients met the inclusion criteria for our LGBTQ review. Across all the tiers, studies noted satisfaction rates between 50 and 90% and improved satisfaction and sexual QoL metrics compared to pre-surgery rates. That said, partner satisfaction rates were also consistently lower than patient satisfaction rates. Although the range of evidence quality varies, the available literature suggests significant improvements in and relatively high rates of partner satisfaction after PP implantation. Given the diversity of study designs and widespread use of non-validated or non-specific questionnaires in the current literature, future research should focus on prospective studies and/or data collection using validated, PP-specific questionnaires.

Engineering of Bacillus subtilis strains to allow rapid characterization of heterologous diguanylate cyclases and phosphodiesterases.

Microbial processes, including biofilm formation, motility, and virulence, are often regulated by changes in the available concentration of cyclic dimeric guanosine monophosphate (c-di-GMP). Generally, high c-di-GMP concentrations are correlated with decreased motility and increased biofilm formation and low c-di-GMP concentrations are correlated with an increase in motility and activation of virulence pathways. The study of c-di-GMP is complicated, however, by the fact that organisms often encode dozens of redundant enzymes that synthesize and hydrolyze c-di-GMP, diguanylate cyclases (DGCs), and c-di-GMP phosphodiesterases (PDEs); thus, determining the contribution of any one particular enzyme is challenging. In an effort to develop a facile system to study c-di-GMP metabolic enzymes, we have engineered a suite of Bacillus subtilis strains to assess the effect of individual heterologously expressed proteins on c-di-GMP levels. As a proof of principle, we characterized all 37 known genes encoding predicted DGCs and PDEs in Clostridium difficile using parallel readouts of swarming motility and fluorescence from green fluorescent protein (GFP) expressed under the control of a c-di-GMP-controlled riboswitch. We found that 27 of the 37 putative C. difficile 630 c-di-GMP metabolic enzymes had either active cyclase or phosphodiesterase activity, with agreement between our motility phenotypes and fluorescence-based c-di-GMP reporter. Finally, we show that there appears to be a threshold level of c-di-GMP needed to inhibit motility in Bacillus subtilis.

Increasing Role of the Advanced Practice Provider in Men's Health Clinics: An Analysis of Medicare and Commercial Claims in the United States.

INTRODUCTION: As urological care delivery in the U.S. continues to evolve to meet patient needs, we aim to clarify the role of advanced practice providers for publicly and privately insured patients in the treatment of male urological conditions commonly encountered in men's health clinics. METHODS: Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and Merative MarketScan Commercial Database were queried for procedures submitted by advanced practice providers between 2010 and 2021. Common urological conditions were identified using Current Procedural Terminology codes and grouped into 4 categories: testicular hypofunction, erectile dysfunction and Peyronie's disease, benign prostatic hyperplasia, and scrotal pain. The proportion of procedures submitted by advanced practice providers was calculated for each year and category. RESULTS: From 2010 to 2021, the proportion of advanced practice provider-submitted service counts for each condition within the MarketScan group increased up to 5-fold, with benign prostatic hyperplasia representing the greatest growth. The proportion of advanced practice provider-submitted service counts within the Medicare group increased up to 8-fold, with erectile dysfunction/Peyronie's disease representing the greatest fold change. The proportion of claims submitted by advanced practice providers treating all 4 conditions was higher in 2021 than 2010 in both publicly and privately insured groups. CONCLUSIONS: The role of advanced practice providers in men's urological health is increasing for both privately and publicly insured patient populations. Advanced practice providers play a critical role in urological care and can help to improve access to men's health.

A Historical and Contemporary Review of Questionnaires Used in the Management of Post-Radical Prostatectomy Patients.

INTRODUCTION: Patients undergoing radical prostatectomy (RP) face obstacles to recovery spanning the domains of erectile and sexual function; urinary function; and health-related quality of life (HRQoL). Numerous patient-directed questionnaires exist that serve to assist in the care of these men. AIM: To describe patient-directed questionnaires of historical and contemporary relevance involving the evaluation and treatment of men after radical prostatectomy. METHODS: A comprehensive review of peer-reviewed publications on the topic was performed. Using PubMed, the search terms used were: "radical prostatectomy; erectile function; lower urinary tract symptoms; sexual dysfunction; urinary incontinence; and health-related quality of life. MAIN OUTCOME MEASURE: We aimed to summarize questionnaires and survey devices of historical and contemporary importance for the care of men after RP. RESULTS: Many questionnaires have been developed specifically for, or conscripted for use in, the care of men after RP. Some of the oldest questionnaires relating to sexual function, urinary function, and general and cancer-specific QoL are important and still utilized in the routine clinical care of post-RP patients. However, recent devices that may offer clinicians a more comprehensive understanding to aid in the evaluation and care of these men. CONCLUSIONS: Post-RP patients face numerous challenges that require a thoughtful approach, one that is broad enough to identify a variety of potential physical and emotional disturbances, yet granular enough to identify appropriate areas for intervention. While there is not a "best" questionnaire for this population, having an appropriate understanding of the current available instruments and what information they provide may help clinicians more thoroughly assess and treat these men. Castillo O, Chen IK, Amini E, et al. Male Sexual Health Related Complications Among Combat Veterans. Sex Med Rev 2022;10:681-690.

A Historical and Contemporary Review of Questionnaires Used in the Management of Post-Radical Prostatectomy Patients.

INTRODUCTION: Patients undergoing radical prostatectomy (RP) face obstacles to recovery spanning the domains of erectile and sexual function; urinary function; and health-related quality of life (HRQoL). Numerous patient-directed questionnaires exist that serve to assist in the care of these men. AIM: To describe patient-directed questionnaires of historical and contemporary relevance involving the evaluation and treatment of men after radical prostatectomy. METHODS: A comprehensive review of peer-reviewed publications on the topic was performed. Using PubMed, the search terms used were: "radical prostatectomy; erectile function; lower urinary tract symptoms; sexual dysfunction; urinary incontinence; and health-related quality of life. Main Outcome Measure: We aimed to summarize questionnaires and survey devices of historical and contemporary importance for the care of men after RP. RESULTS: Many questionnaires have been developed specifically for, or conscripted for use in, the care of men after RP. Some of the oldest questionnaires relating to sexual function, urinary function, and general and cancer-specific QoL are important and still utilized in the routine clinical care of post-RP patients. However, recent devices that may offer clinicians a more comprehensive understanding to aid in the evaluation and care of these men. CONCLUSIONS: Post-RP patients face numerous challenges that require a thoughtful approach, one that is broad enough to identify a variety of potential physical and emotional disturbances, yet granular enough to identify appropriate areas for intervention. While there is not a "best" questionnaire for this population, having an appropriate understanding of the current available instruments and what information they provide may help clinicians more thoroughly assess and treat these men.

Transurethral resection and surveillance of a well-differentiated neuroendocrine tumor in a ileal neobladder.

Our patient presented with a small, well-differentiated neuroendocrine tumor (NET) of the ileal neobladder 21-years after radical cystectomy for urothelial cell carcinoma. Given the rarity of NETs in urinary diversions, there are no established guidelines regarding management in this unique population. We propose that transurethral resection and close cystoscopic surveillance of the neobladder is a feasible, low morbidity approach to management of a well-differentiated, solitary ileal NET tumor.

The Combination of Low Skeletal Muscle Mass and High Tumor Interleukin-6 Associates with Decreased Survival in Clear Cell Renal Cell Carcinoma.

Clear cell renal carcinoma (ccRCC) is frequently associated with cachexia which is itself associated with decreased survival and quality of life. We examined relationships among body phenotype, tumor gene expression, and survival. Demographic, clinical, computed tomography (CT) scans and tumor RNASeq for 217 ccRCC patients were acquired from the Cancer Imaging Archive and The Cancer Genome Atlas (TCGA). Skeletal muscle and fat masses measured from CT scans and tumor cytokine gene expression were compared with survival by univariate and multivariate analysis. Patients in the lowest skeletal muscle mass (SKM) quartile had significantly shorter overall survival versus the top three SKM quartiles. Patients who fell into the lowest quartiles for visceral adipose mass (VAT) and subcutaneous adipose mass (SCAT) also demonstrated significantly shorter overall survival. Multiple tumor cytokines correlated with mortality, most strongly interleukin-6 (IL-6); high IL-6 expression was associated with significantly decreased survival. The combination of low SKM/high IL-6 was associated with significantly lower overall survival compared to high SKM/low IL-6 expression (26.1 months vs. not reached; p < 0.001) and an increased risk of mortality (HR = 5.95; 95% CI = 2.86-12.38). In conclusion, tumor cytokine expression, body composition, and survival are closely related, with low SKM/high IL-6 expression portending worse prognosis in ccRCC.

Robotic Partial Nephrectomy for a Peripheral Renal Tumor.

Partial nephrectomy (PN) is the preferred surgical treatment for T1 renal tumors whenever technically feasible. When properly performed, it allows preservation of nephron mass without compromising oncologic outcomes. This reduces the postoperative risk of renal insufficiency, which translates into better overall survival for the patients. PN can be technically challenging, because it requires the surgeon to complete the tasks of tumor excision, hemostasis and renorrhaphy, all within an ischemic time of preferably below 30 minutes. The surgeon needs to avoid violating the tumor margins while leaving behind the maximal parenchymal volume at the same time. Variations such as zero ischemia, early unclamping, and selective clamping have been developed in an attempt to reduce the negative impact of renal ischemia, but inevitably add to the steep learning curves for any surgeon. Being able to appreciate the fine details of each surgical step in PN is the fundamental basis to the success of this surgery. The use of the robotic assistance allows a good combination of the minimally invasive nature of laparoscopic surgery and the surgical exposure and dexterity of open surgery. It also allows the use of adjuncts such as concurrent ultrasound assessment of the renal mass and intraoperative fluorescence to aid the identification of tumor margins, all with a simple hand switch at the console. Robot-assisted laparoscopic PN is now the most commonly performed type of PN in the United States and is gaining acceptance on the global scale. In this video, we illustrate the steps of robot-assisted laparoscopic PN and highlight the technical key points for success.

Intraoperative Mannitol Not Essential During Partial Nephrectomy.

OBJECTIVE: Intraoperative mannitol is routinely administered for renoprotection in partial nephrectomy (PN). However, there is a paucity of evidence supporting mannitol's renoprotective effect. We performed a retrospective study of mannitol's efficacy in PN. MATERIALS AND METHODS: Using an institutional database, patients undergoing PN from 2006 to 2016 were retrospectively identified and divided into two groups based on mannitol use. Cases with missing serum creatinine measurements were excluded. Mannitol use was dependent on surgeon preference. An independent-samples t-test was used to compare 6-month postoperative estimated glomerular filtration rate (eGFR) between mannitol groups and to compare 6-month eGFR between mannitol dose for patients who received mannitol. Multivariate linear regression was used to estimate 6-month eGFR when adjusting for multiple covariates that were considered clinically relevant to postoperative renal function. RESULTS: Of the patients, 476 patients were eligible for analysis and 286 received mannitol. Preoperative eGFR (7.8 ± 21.4 mL/minute/1.73 m2 vs 75.3 ± 23.1 mL/minute/1.73 m2, p = 0.223) and tumor size (3.5 ± 1.7 cm vs 3.4 ± 1.5 cm, p = 0.532) were matched between the mannitol (M+) and no mannitol (M-) groups, whereas warm ischemic time (22.5 ± 11.2 minutes vs 15.0 ± 10.2 minutes, p < 0.001) was longer in the M+ group. There was no significant difference in 6-month eGFR between mannitol groups (70.6 ± 22.2 mL/minute/1.73 m2 vs 68.0 ± 23.9 mL/minute/1.73 m2, p = 0.225). No significant association between mannitol dose and 6-month eGFR was found. Covariates that significantly predicted 6-month eGFR in our multivariate model were age (ß = 0.052, p = 0.042) and preoperative eGFR (ß = 0.843, p < 0.001). In addition, neither the use of renal cooling nor the surgical approach (open vs minimally invasive) was significantly associated with 6-month eGFR. CONCLUSION: Mannitol did not demonstrate renoprotective effects based on analysis of 6-month postoperative eGFR. In addition, neither the surgical approach nor the use of renal cooling significantly predicted postoperative renal function.