Marketing yourself in social media as a global health organization: lessons to be learned.

PURPOSE: To evaluate whether X, formerly known as Twitter, is being used effectively to advance the goals of International Volunteers in Urology (IVUmed). How is X activity associated with end-user engagement? METHODS: Monthly analytics of the X account @IVUmed were reviewed between September 2014 and November 2022 using https://analytics.twitter.com/ . Outcomes included tweets, mentions, impressions, engagements, interactions, followers, and profile visits. Statistical analysis using Mann-Whitney U test and Spearman's rank-order correlation was performed. Top tweet content between December 2020 and November 2022 was also analyzed and assigned one of seven different categories: research, workshops, mission statement, educational materials, fundraising, individual spotlight, and other. RESULTS: Of @IVUmed's 1668 followers, 1334 (80.0%) were individuals. One thousand one hundred twenty-six (84.4%) individuals listed their locations with the majority (79.8%) residing in high-income countries. Tweet impressions have increased over time; they were significantly higher (p < 0.01) on average after the onset of COVID-19 in March 2020. From December 2020 to November 2022, new followers were positively correlated with tweet impressions (p < 0.01), total mentions (p < 0.01), and profile visits (p < 0.01). Profile visits were positively correlated with total tweets (p < 0.01). The content categories for monthly top tweets that proportionally garnered the most engagements were workshops (50%) and individual spotlight (29%), despite not being the most tweeted about content categories. CONCLUSION: Non-profit organizations wishing to increase their web-based outreach can benefit from increased primary X activity. While not evaluated in this study, it may also improve fundraising capabilities. Nevertheless, periodic review of account activity is important to ensure engagement of the targeted audience.

Orchiopexy after prior inguinal surgery: a distal approach.

PURPOSE: Undescended testicle after groin surgery is a condition traditionally approached through an inguinal incision with en bloc mobilization of the spermatic cord and external oblique fascia, and extensive dissection of the proximal spermatic vessels. We report on a single surgeon series of orchiopexies after prior inguinal surgery approached through a single scrotal incision. MATERIALS AND METHODS: From November 2001 to February 2007, 24 patients with a mean age of 6.4 years (range 1.3 to 16.2) presented with 27 undescended testicles. All patients had undergone previous groin surgery including 13 inguinal hernia repairs, 3 orchiopexies and 3 hernia repairs with orchiopexy. Of the 27 testicles 24 (21 patients) were successfully approached through a single scrotal incision (89%). If the scrotum could not be manipulated over or near the relatively fixed testicle, an inguinal incision was made (11%). Charts were retrospectively reviewed for technique and operative outcomes. RESULTS: A mean followup of 12 months was available for 20 of 21 patients. A patent processus vaginalis was found in 3 (12.5%) patients and hernia repair was performed through the scrotal incision in these patients. There were no intraoperative complications. In 1 (4.2%) patient the testicular position was unacceptable and subsequently successful repeat scrotal orchiopexy was performed. At last followup all testes were in a satisfactory scrotal position without hydrocele, hernia or testicular atrophy. CONCLUSIONS: The majority of orchiopexies after prior inguinal surgery can be approached through a single scrotal incision. Retrograde serial dissection of adhesions to the distal cord usually reveals adequate vessel length, thus avoiding extensive inguinal and/or retroperitoneal dissection.

Effect of carbohydrate-electrolyte sports beverages on urinary stone risk factors.

PURPOSE: We evaluated the effects of consuming carbohydrate-electrolyte sports beverages (Gatorade((R))) on urinary stone risk factors. MATERIALS AND METHODS: Twelve normal subjects (5 men, 7 women) and 12 hypercalciuric stone formers (2 men, 10 women) participated in a 4-week prospective, crossover study consisting of 3 study phases. In phase 1 subjects were placed on a monitored stone prevention diet that was continued throughout the study. In phase 2 subjects ingested 2 l Gatorade daily followed by a 7-day washout period. In phase 3 subjects ingested 2 l water daily. On the final day of phases 1, 2 and 3 a 24-hour urine collection and blood sample were analyzed for stone risk factors. Effects of group and phase were tested using repeated measures ANOVA and paired t tests. RESULTS: Changes in urinary risk factors after Gatorade consumption revealed no statistically significant difference between normal subjects and stone formers. However, intrasubject variation occurred in both groups. Gatorade consumption in both groups increased urinary pH (p = 0.006), urinary chloride (p = 0.044) and urinary sodium (p = 0.008), and decreased urinary potassium (p = 0.035) and urinary uric acid (p = 0.019) in a statistically significant manner. In response to Gatorade consumption urinary volume, calcium and citrate were unchanged compared to water consumption and baseline. CONCLUSIONS: Gatorade increased mean urinary sodium and chloride levels compared to water and baseline. However, the results were within normal urinary parameters. The change did not appear to be clinically significant as urinary calcium was unchanged. Overall consumption of Gatorade does not increase or decrease urinary stone risk factors.

Loss of structural integrity of a coil based ureteral stent.

We present the first reported complication of the Silhouette, (Applied Medical, Santa Margarita, CA) 4 Fr. soft, nitinol coil-reinforced double-J ureteral stent, that is specifically related to its unique construct and design. These novel ureteral stents were placed in a medically unstable patient with bilateral partially obstructing proximal ureteral calculi. At the time of ureteroscopy, it was noted that a mild to moderate amount of encrustation was present on the distal curl of the ureteral stent. Upon removal of the stent, resistance was encountered and disintegration and fragmentation of the stent was noted. The patient eventually underwent staged ureteroscopy and shock wave lithotripsy (SWL) to remove the remaining portions of the encrusted ureteral stent.

Minimally invasive surgery for urologic disease in children.

This article is a comprehensive review of the current indications and recent literature pertaining to laparoscopic techniques in pediatric urology. Basic concepts such as instrumentation, anesthetic considerations, and complications are reviewed. Specific techniques and indications are also explored. As the field of pediatric urology continues to expand, it still lags behind adult urology. With improvements in technology, however, and with new surgeons entering the field with a basic laparoscopic background, pediatric urologic laparoscopy continues to progress. Currently, procedures such as laparoscopic exploration for undescended testicles and laparoscopic nephrectomy are accepted as the 'gold standard', and are performed at most institutions. Other procedures, such as laparoscopic pyeloplasty and laparoscopic reconstructive surgery, have only recently been introduced and are primarily available at centers with surgeons experienced in laparoscopy. It is our hope that minimally invasive surgical approaches to urologic conditions will become available to all children and become commonplace at most institutions.

Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children.

PURPOSE: To examine our experience of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO) in the pediatric population. METHODS: From November 2001 to June 2009, 112 patients underwent transperitoneal laparoscopic pyeloplasty for the treatment of symptomatic or radiographic UPJO. Data were collected retrospectively. Patients were followed at regular intervals with imaging and symptom assessment. Failure was defined as inability to complete the intended procedure, persistent flank pain, radiographic evidence of obstruction, or the need for definitive adjunctive procedures. RESULTS: Mean patient age was 9.4 years (0.2-20.5 years), and follow-up was available on all 112 patients with a mean duration of 15.3 months (0.6-84.5 months). There was one open conversion in the series. Mean operative time was 254 minutes (102-525 minutes). There was one minor intraoperative complication reported (0.8%). There were 12 (10.8%) postoperative complications; most were relatively minor with complete resolution and without long-term sequelae. Postoperative ultrasonography has been performed in 102 patients, with 99 (97%) patients demonstrating improvement of the UPJO. Three patients (3%) continued to have symptomatic and/or radiographic evidence of obstruction that necessitated the need for adjunctive procedures, which included laser endopyelotomy in 2 patients, and a re-do open pyeloplasty in 1 patient. Of those cases that were completed laparoscopicaly, the overall success rate was 97.2%. CONCLUSIONS: Laparoscopic pyeloplasty for UPJO in the pediatric population is technically challenging; however, with experience, one can expect excellent success rates comparable to open pyeloplasty, with minor complications with reasonable operative times.

Laparoscopic retroperitoneal lymph node dissection for high-risk pediatric patients with paratesticular rhabdomyosarcoma.

BACKGROUND AND PURPOSE: Retroperitoneal lymph node dissection (RPLND) is recommended in children 10 years or older with paratesticular rhabdomyosarcoma (PTRMS). Primary tumors >5 cm are an additional risk factor for disease recurrence in the retroperitoneum. We report our experience with laparoscopic RPLND (LRPLND) in high-risk pediatric patients with PTRMS. PATIENTS AND METHODS: Three patients, mean age 13.6 years (range 10-16 yrs), underwent modified template LRPLND after radical orchiectomy for preoperative rhabdomyosarcoma stage T(1a)N(0)M(0), T(1b)N(0)M(0), and T(2b)N(0)M(0), respectively. Primary paratesticular masses measured a mean 7.5 cm (range 4-10 cm). LRPLND was performed a mean of 8.6 days (range 7-12 d) after radical orchiectomy using four trocars that were placed equidistant in the midline. RESULTS: Average operative time was 382 minutes (range 245-656 minutes). Mean estimated blood loss was 53 mL (range 10-75 mL), and mean postoperative hospital stay was 2.5 days (range 2-3 d). There were no postoperative complications. Retroperitoneal nodes had negative findings for microscopic disease in two patients and positive findings in one patient. All patients received adjuvant chemotherapy with vincristine, actinomycin, and cyclophosphamide. CONCLUSION: LRPLND for high-risk pediatric patients with PTRMS is a safe diagnostic and therapeutic procedure with the benefit of rapid convalescence, enabling early commencement of adjuvant chemotherapy.

Laparoscopy in paediatric urology: present status.

The spectrum of laparoscopic surgery in children has developed dramatically; what was initially used as a diagnostic method to identify an impalpable testis is now commonly used for complex reconstructive procedures such as pyeloplasty. Laparoscopic orchidopexy and nephrectomy are well established and are used at many centres. Laparoscopic partial nephrectomy, adrenalectomy and dismembered pyeloplasty series have reported shorter hospital stays and operative times that are comparable with that of open techniques, and/or decreasing with experience. The initial experiences with laparoscopic ureteric re-implantation and laparoscopically assisted bladder reconstructive surgery are reported, with encouraging results for feasibility, hospital stay, and cosmetic outcome.

Dysfunctional elimination syndrome is a negative predictor for vesicoureteral reflux.

PURPOSE: We investigated the likelihood of finding vesicoureteral reflux (VUR) in patients with urinary tract infections (UTIs), accompanied by fever or dysfunctional elimination syndrome (DES). MATERIALS AND METHODS: Two hundred consecutive voiding cystourethrograms performed in 1997-2002 for a diagnosis of UTI were reviewed. Fever, DES, and the grade and laterality of VUR were recorded. Patients were stratified into two groups by age to allow for assessment of DES symptoms in the older patient population: <2 years (n=68) and > or =2 years (n=132). Ratios were compared using a two-tailed Fisher's exact test. RESULTS: Of the children> or =2 years old, 64/132 (48%) had VUR. Patients who were non-febrile with DES were less likely than patients who were febrile without DES to have VUR [12/34 (35%) vs 23/34 (68%), P=0.02], whereas the risk of dilating VUR [5/34 (15%) vs 11/34 (32%), P=0.15] and bilateral VUR [4/34 (12%) vs 11/34 (32%), P=0.08] was not statistically different. In febrile patients, the presence of DES was associated with a lower risk of VUR [22/51 (43%) vs 23/34 (68%), P=0.03] and dilating VUR [5/51 (10%) vs 11/34 (32%), P=0.01], but not bilateral VUR [8/51 (16%) vs 11/34 (32%), P=0.11]. CONCLUSIONS: Children with non-febrile UTI and DES have a significantly lower risk of having VUR compared to children with febrile UTI and no DES. Among children with a history of UTI, DES is a negative predictor for VUR.

Treatment of stress urinary incontinence with duloxetine hydrochloride.

Currently, there are no approved medications for the treatment of stress urinary incontinence (SUI) in the United States. The effectiveness of duloxetine in the treatment of SUI is linked to its inhibition of presynaptic neuronal reuptake of serotonin and norepinephrine in the central nervous system, resulting in elevated levels of serotonin and norepinephrine in the synaptic cleft. In animal studies, this agent leads to an increase in nerve stimulation to the urethral striated sphincter muscle. A similar mechanism in women is believed to result in stronger urethral contractions, with improved sphincter tone during urine storage and physical stress. In 3 randomized, placebo-controlled clinical trials, patients receiving duloxetine had a statistically significant and clinically relevant reduction in the number of incontinence episodes and a corresponding improvement in quality of life. If this use of duloxetine is approved by the U.S. Food and Drug Administration, as it has been by the European regulatory agencies, it will be the first drug indicated for the treatment of SUI. This pharmacologic therapy is an additional option for women and is likely to become an integral component of patient management.

Treatment of postoperative voiding dysfunction following incontinence surgery.

Persistent postoperative voiding dysfunction is a known complication following female stress incontinence surgery. Although many variations on surgical technique exist, the most common cause remains attributable to hypersuspension of the urethra. The diagnosis of postoperative voiding dysfunction in this setting can be challenging due to the lack of standardized criteria and varied clinical presentation. Furthermore, patients can present with a wide spectrum of symptomatology, not merely incomplete bladder emptying or outright retention. The symptoms of urethral hypersuspension can range from purely bladder storage symptoms on one hand (frequency, urgency, or urge incontinence), to the more commonly recognized bladder emptying dysfunction on the other hand (incomplete emptying or frank urinary retention). Although most cases of mild postoperative voiding dysfunction appear to resolve with expectant management, a subset of patients clearly benefit from a sling incision or formal urethrolysis. This leads to prompt improvement or resolution of their postoperative bladder symptoms. The timing of surgery must be determined by the clinician's judgment. However, experience would suggest that postoperative bladder symptoms that persist beyond 4 weeks rarely resolve spontaneously. Within the literature, there has been a paradigm shift toward earlier intervention. Indeed, there are some data to suggest that delayed time to urethrolysis can lead to irreversible bladder dysfunction.

A tissue-engineered suburethral sling in an animal model of stress urinary incontinence.

OBJECTIVE: To create and evaluate the functional effects of a tissue-engineered sling in an animal model of stress urinary incontinence (SUI). MATERIALS AND METHODS: Twenty female Sprague-Dawley rats were divided into four equal groups: a control group (C) had no intervention before the leak-point pressure (LPP) was measured; a denervated group (D) had bilateral proximal sciatic nerve transection (PSNT) and periurethral dissection with no sling placed; group S had concomitant bilateral PSNT and a suburethral sling of small intestinal submucosa (SIS) placed; and group (M) had concomitant bilateral PSNT with implantation of a tissue-engineered sling. The suburethral sling was placed via a transabdominal approach with the sling sutured to the pubic bone. Tissue-engineered slings were prepared with muscle-derived cells obtained via the pre-plate technique and subsequently seeded for 2 weeks on a SIS scaffold. Suburethral slings were implanted 2 weeks before LPP testing, using the vertical-tilt method. RESULTS: Surgically placing a suburethral sling is feasible in the female rat, with few complications. LPPs from both sling groups (S and M) were not significantly different from untreated controls (C). The S, M and C groups all had significantly higher LPPs than group D. Importantly, no rat from either sling group (S and M) had signs of urinary retention. CONCLUSIONS: Placing tissue-engineered slings in an animal model of SUI resulted in LPP values that were not significantly different from those in untreated control or SIS (S) groups. These data show that incorporating muscle stem cells into SIS slings does not adversely alter the advantageous mechanical properties of the SIS sling in a model of SUI, and provide the basis for future functional studies of tissue-engineered sling materials with long-term retention.

Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction.

PURPOSE: Our urethrolysis cohort demonstrated an unusual delay time to surgical treatment of bladder outlet obstruction. We determined whether urethrolysis outcomes, ie persistent bladder symptoms, were associated with time between sling and urethrolysis surgeries. MATERIALS AND METHODS: Retrospective analysis of all patients who underwent urethrolysis for post-sling voiding dysfunction between June 1997 and June 2002 was performed. We excluded from study 6 patients with a known history of overactive bladder symptoms, neurogenic bladder dysfunction and use of anticholinergic pharmacotherapy before stress incontinence surgery. The remaining 15 patients were stratified into 2 outcomes groups based upon the absence or presence of post-urethrolysis bladder storage symptoms. Patients (7) in group 1 have no current bladder symptoms. Patients (8) in group 2 still require anticholinergic drug therapy for significant bladder symptoms of frequency and urgency. Data collected for the 2 groups included mean age, existence of urinary retention before urethrolysis, mean time to urethrolysis in months, urethrolysis outcome based upon subjective bladder symptoms and followup duration. For comparison of mean age between groups the standard t test was used. Fisher's exact test was used to compare frequency of urinary retention before urethrolysis between groups. Lastly the Mann-Whitney U test was conducted to compare time to urethrolysis between groups. All statistical analyses were conducted using the SPSS software package (SPSS, Inc., Chicago, Illinois). RESULTS: There was no statistically significant difference between the groups with respect to age or frequency of urinary retention before urethrolysis. Time to urethrolysis for the whole cohort ranged from 2 to 66 months. Mean followup after urethrolysis was 17.3 +/- 22.9 months. Comparison of mean time between incontinence and urethrolysis surgeries between group 1 (9.0 +/- 10.1 months) and group 2 (31.25 +/- 21.9 months) demonstrated a statistically significant difference (p = 0.01). CONCLUSIONS: This urethrolysis population demonstrated an unusual delay time to surgical treatment of bladder outlet obstruction. We categorized the cohort according to absence or presence of persistent bladder storage symptoms, and found a strong association between persistent bladder symptoms and greater delay to urethrolysis.