Mohs micrographic surgery for male genital tumors: Local recurrence rates and patient-reported outcomes.

BACKGROUND: Local recurrence rates (LRRs) after Mohs micrographic surgery (MMS) for male genital cancers have been reported in only a few small case series, and patient-reported outcomes (PROs) have not been studied. OBJECTIVE: To determine the LRR and PROs after MMS for male genital skin cancers. METHODS: Retrospective review of all male genital skin cancers removed with MMS between 2008 and 2019 at an academic center. LRR was determined by chart review and phone calls. PROs were assessed by survey. RESULTS: A total of 119 skin cancers in 108 patients were removed with MMS. Tumors were located on the penis (90/119) and scrotum (29/119). Diagnoses included squamous cell carcinoma in situ (n = 71), invasive squamous cell carcinoma (n = 32), extramammary Paget disease (n = 13), melanoma (n = 2), and basal cell carcinoma (n = 1). The LRR was 0.84% (1/119), with a mean follow-up time of 3.25 years (median, 2.36 years). The majority of survey respondents reported no changes in urinary (66%) or sexual functioning (57.5%) after surgery. LIMITATIONS: Retrospective single-center experience; short follow-up time; low survey response rate; no baseline functional data. CONCLUSION: MMS for male genital skin cancer has a low LRR and high patient-reported satisfaction with urinary and sexual function.

Historical and Current Practices in the Management of Fossa Navicularis Strictures.

PURPOSE OF REVIEW: Fossa navicularis strictures represent a surgically challenging disease process that requires detailed preoperative planning and an understanding of each patient's goals in order to achieve a satisfactory long-term outcome. This review summarizes the various approaches used in the management of fossa navicularis strictures over the past several decades. RECENT FINDINGS: In addition to existing evidence to support open flap- and graft-based reconstruction, recent studies suggest a potential role for limited open repair via a transurethral approach. Open repair of fossa navicularis strictures has become the standard of care with high success rates using local skin flaps or tissue grafts. There remains a very limited role for minimally invasive techniques in definitive management of this disease.

Advances and Challenges in Transitional Urology: Caring for Adolescents and Young Adults with Lifelong Complex Genitourinary Conditions.

PURPOSE OF REVIEW: As long-term survival with complex congenital and pediatric diseases has improved, more patients with congenital genitourinary conditions are living into adulthood. These patients can continue to face lifelong issues related to their conditions, including urinary incontinence, recurrent urinary tract infections, chronic kidney disease, and difficulties with sexual health and function. RECENT FINDINGS: The practice of transitional urology continues to grow nationwide and abroad, and it will be important to develop evidence-based practices for coordinated transition of these patients into the adult health care setting. This review describes the broader attention to transitions of care in medicine and specifically evaluates spina bifida as a model disease system for implementation of transitional practices in urology.

Tissue Preservation Techniques at the Time of Urethroplasty for Urethral Stricture Disease.

Reconstructive surgery for urethral stricture disease seeks to re-establish long-lasting urethral patency while minimizing associated adverse effects. In recent years, genitourinary reconstructive surgeons have developed and refined a number of techniques that seek to decrease the impact of urethroplasty on local tissues including blood supply and innervation. This review presents an outline of recent advances in urethral reconstructive techniques that seek to minimize surgical impact, including tissue preservation, tissue engineering, and minimally invasive approaches and reviews the current state of the literature related to these techniques.

Erectile Dysfunction is Predictive of Endothelial Dysfunction in a Well Visit Population.

PURPOSE: The relationship between erectile dysfunction and endothelial dysfunction has been described and is associated with adverse cardiac events. Endothelial dysfunction is believed to precede erectile dysfunction. Our objective was to characterize the prevalence of subjective erectile dysfunction, endothelial dysfunction and commonly related comorbidities in a population of men undergoing wellness screening. MATERIALS AND METHODS: A total of 205 men presented for wellness screening. They underwent testing for endothelial dysfunction via peripheral arterial tonometry and completed a health screening questionnaire. Reactive hyperemia index scores were generated by peripheral arterial tonometry testing. A reactive hyperemia index score of 1.67 or less defined endothelial dysfunction. The Student t-test and Fisher exact test were performed for continuous and categorical variables, respectively. The association of endothelial dysfunction, erectile dysfunction and various comorbidities was calculated using univariate and multivariable analyses. RESULTS: Of 205 men 47 reported subjective erectile dysfunction. Median age was 44 years old. The mean reactive hyperemia index in patients with erectile dysfunction was significantly lower than in patients without erectile dysfunction (1.63 vs 1.87, p = 0.001). Endothelial dysfunction was more common in men with than without erectile dysfunction (55% vs 36%, p = 0.027). Multivariable analysis revealed that men with erectile dysfunction and obesity were twofold more likely to have concomitant endothelial dysfunction (OR 2.45, 95% CI 1.13-4.24, p = 0.02 and OR 2.08, 95% CI 1.16-3.75, p = 0.01, respectively). CONCLUSIONS: Among middle-aged men presenting for wellness screening erectile dysfunction and obesity independently predicted endothelial dysfunction, a known risk factor for long-term adverse cardiac events.

Management Strategies for Post-Prostatectomy Bladder Neck Contractures.

Patients who develop bladder neck contracture (BNC) after surgical treatment for prostate cancer often present with progressive lower urinary tract symptoms. Multiple risk factors contribute to BNC development including patient-related factors and technical considerations at the time of surgery. Initial management begins with endoscopic therapies, including dilation, transurethral incision (TUIBNC), and injection of adjunctive agents. When BNC remains refractory to these therapies, surgical reconstruction of the vesicourethral anastomosis or urinary diversion can be considered in select cases. This review presents an outline of the management of BNC after radical prostatectomy (RP), highlighting the recent literature related to the subject.

Adapting to the Educational Challenges of a Pandemic: Development of a Novel Virtual Urology Subinternship During the Time of COVID-19.

OBJECTIVE: To design, implement, and evaluate learner attitudes of a virtual urologic surgery clinical rotation for medical students. METHODS: Ten senior medical students at the Perelman School of Medicine at the University of Pennsylvania were enrolled. Students were administered a precourse test on their perceived confidence of their urologic knowledge, confidence in identifying urologic conditions, comfort with performing urologic evaluations, and confidence placing consults for urologic issues. Students participated in a 2-week curriculum that included both asynchronous and synchronous content. Asynchronous content included prerecorded lectures, self-paced problem-based learning modules, directed reading and video content, and an online discussion board. Synchronous content included real-time videoconferences covering case discussions, simulated patient presentations, and critical literature reviews. At the conclusion of the course, students were administered the postcourse survey evaluating changes in their ability to identify and understand urologic conditions. RESULTS: The postcourse survey demonstrated this course significantly increases students' scores in: self-perceived urologic knowledge, confidence in naming urologic conditions, comfort with performing urologic evaluations, and confidence placing consults for urologic conditions (P <.05). CONCLUSION: Virtual medical student rotations are scalable and effective at delivering surgical material and can approximate the interpersonal teaching found in clinical learning environments. They may be a useful tool to supplement or augment clinical learning in select situations.

A Teenager With Recurrent Epididymitis.

A 17-year-old man with a history of imperforate anus presented to clinic with recurrent epididymitis. A fluoroscopic voiding cystourethrogram demonstrated urethra-ejaculatory duct reflux. A narrowing was also noted in the distal prostatic urethra with dilation of the proximal urethra. Subsequent cystoscopy revealed a patent urethra with a hypertrophic external sphincter as the culprit. Pelvic floor physical therapy was undertaken with resolution of urinary symptoms and testicular pain.

Ventral inlay buccal mucosal graft urethroplasty: a novel surgical technique for the management of urethral stricture disease.

To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures.