Contributing factors for cancellations of outpatient pediatric urology procedures: single center experience.

PURPOSE: Surgery cancellations in the pediatric population are often due to preventable causes and can lead to decreased operating room efficiency. We hypothesized that clinical and demographic patient factors are associated with preventable cancellations of scheduled outpatient pediatric urology procedures at our institution. MATERIALS AND METHODS: A retrospective review of cancelled outpatient pediatric urology procedures from January 1 to July 31, 2010 was performed. Data regarding demographics, procedure type, time to surgery from preoperative visit, reason for cancellation, potential operating room and surgeon lost revenue, and ultimate patient outcome were extracted from the electronic medical record. RESULTS: We identified 114 cancellations during the study period, comprising 13.3% of scheduled outpatient procedures. Preventable cancellations included insurance/financial related (11.4%), preoperative fasting violation (8.8%) and condition improved the day of surgery (4.4%). Nonpreventable cancellations included patient illness (40.3%), weather/traffic related (1.7%) and other nonspecified reasons (29%). Compared to nonpreventable cancellations, preventable cancellations were more likely associated with circumcision (OR 2.39, CI 1.04-5.46). Preventable cancellations were also associated with a shorter distance to the hospital (p = 0.03). There was no significant association between preventable cancellations and age, race/ethnicity, caregiver type or time to surgery. Potential associated lost revenue averaged $4,802 per cancellation. CONCLUSIONS: While the most common cause of surgical cancellation is patient illness, a significant number of cancellations are preventable. These findings suggest that future targeted hospital interventions, including improved evaluation of insurance status and preoperative parental education regarding preoperative requirements, may improve operating room use.

Erosive bladder perforation as a complication of ventriculoperitoneal shunt with extrusion from the urethral meatus: case report and literature review.

Ventriculoperitoneal (VP) shunt surgery is the most common technique used in the treatment of hydrocephalus. Erosive bladder perforation is an extremely rare complication of VP shunt surgery. Only 2 cases of erosive bladder perforation by a peritoneal catheter have been reported in the English literature. The authors present the case of a 14-year-old male with a history of cerebral palsy, severe developmental delay and hydrocephalus who presented with VP shunt tubing protruding from his urethral meatus. The patient had no evidence of neurological change. The VP shunt had been last revised over 11 years prior to admission. Imaging demonstrated the VP shunt to be intact, but displaced inferiorly, with the ventricular catheter in the extracranial soft tissue of the neck and the peritoneal catheter passing into the abdomen, bladder, and out through the urethra. Shunt removal was achieved through a multidisciplinary approach, involving both neurosurgery and urology teams. The authors discuss other reported cases of perforation by a VP shunt, potential mechanisms, and considerations for management of this rare complication.

Comparative analysis of early perioperative outcomes following radical cystectomy by either the robotic or open method.

OBJECTIVE: We analyzed early perioperative outcomes following radical cystectomy by the robotic method compared with the conventional open method. METHODS: All relevant clinical information was entered in a Microsoft Access Database and queried. P < 0.05 were considered statistically significant. RESULTS: The study cohort comprised 37 consecutive patients undergoing radical cystectomy; 24 (64.9%) cases were performed by the conventional open method and 13 (29.7%) by the robotic method. Body mass index, age, sex, blood transfusion rate, and median decrease in hemoglobin were comparable between the 2 groups. The robotic method resulted in significantly lower median estimated blood loss, shorter hospital stay, and longer operating time compared with the open group (P < 0.05). Four (16.7%) perioperative complications occurred in the open group compared with 2 (15.4%) in the robotic group (P = 1.0). The incidence of organ-confined (< or =T2N0Mx) disease was 9 (37.5%) and 7 (53.8%) in the open and robotic groups, respectively (P = 0.49). CONCLUSIONS: Radical cystectomy by the robotic method produces early perioperative results comparable to those of the open method. Although intraoperative estimated blood loss and hospital stay were significantly lower in the robotic group, operative time was longer which likely reflects our early operative experience with radical cystectomy by the robotic method.

OTK18 expression in brain mononuclear phagocytes parallels the severity of HIV-1 encephalitis.

OTK18 was isolated by mRNA differential display of human monocyte-derived macrophages (MDM) infected with human immunodeficiency virus type one (HIV-1). Northern blot and real-time reverse transcription polymerase chain reaction showed low levels of OTK18 expression in human tissue, which markedly increased during advanced HIV-1 encephalitis (HIVE). Immunocytochemistry, using rabbit polyclonal antisera, showed OTK18 localized to brain mononuclear phagocytes (MP) in moderate to severe HIV-1 encephalitis. OTK18 expression was selective and not found in HIV-1-infected brain tissue with limited neuropathological abnormalities, nor in cytomegalovirus encephalitis, multiple sclerosis, Alzheimer's disease, or uninfected control brains. Thus, OTK18 expression in brain mononuclear phagocytes is a signature for advanced HIV-1 encephalitis.

Simple method of paraphimosis reduction revisited: point of technique and review of the literature.

Paraphimosis is a urologic emergency that has the potential for serious penile injury, including gangrene and tissue necrosis, if left unattended for a period of time. Multiple different techniques for reduction of paraphimosis have been proposed. We present a novel approach to paraphimosis reduction that utilizes CoFlex(®), a flexible self-adhering bandage. We also present a detailed review of the literature of conservative management options for paraphimosis.

Idiopathic scrotal calcinosis: A rare entity and a review of the literature.

Scrotal calcinosis is a rare condition with presentation including intradermal nodules varying in size and number. Differentials include calcification of epidermal or pilar cysts noted by the presence of keratinaceous debris. We present 2 cases of scrotal calcinosis at our institution.

Molecular characterization of a putative antiretroviral transcriptional factor, OTK18.

Elucidation of the factors involved in host defense against human immunodeficiency viral infection remains pivotal if viral control may be achieved. Toward these ends, we investigated the function of a putative antiretroviral factor, OTK18, isolated by differential display of mRNA from HIV type 1-infected primary human monocyte-derived macrophages. Molecular and immunohistochemical analyses showed that the OTK18 nucleotide sequence contains 13 adjacent C(2)H(2)-type zinc finger motifs, a Krüppel-associated box, and is localized to both cytosol and nucleus. Mutational analyses revealed that both the Krüppel-associated box and zinc finger regions of OTK18 are responsible for the transcriptional suppressive activities of this gene. OTK18 was copiously expressed in macrophages following HIV type I infection and diminished progeny virion production. A mechanism for this antiretroviral activity was by suppression of HIV type 1 Tat-induced viral long terminal repeat promoter activity. Our findings suggest that one possible function of OTK18 is as a HIV type 1-inducible transcriptional suppressor.