Outcomes and Risk Factors of Revision and Replacement Artificial Urinary Sphincter Implantation in Radiated and Nonradiated Cases.

PURPOSE: Risk factors for complications after artificial urinary sphincter surgery include a history of pelvic radiation and prior artificial urinary sphincter complication. The survival of a second artificial urinary sphincter in the setting of prior device complication and radiation is not well described. We report the survival of redo artificial urinary sphincter surgery and identify risk factors for repeat complications. MATERIALS AND METHODS: A multi-institutional database was queried for redo artificial urinary sphincter surgeries. The primary outcome was median survival of a second and third artificial urinary sphincter in radiated and nonradiated cases. A Cox proportional hazards survival analysis was performed to identify additional patient and surgery risk factors. RESULTS: Median time to explantation of the initial artificial urinary sphincter in radiated (150) and nonradiated (174) cases was 26.4 and 35.6 months, respectively (p=0.043). For a second device median time to explantation was 30.1 and 38.7 months (p=0.034) and for a third device it was 28.5 and 30.6 months (p=0.020), respectively. The 5-year revision-free survival for patients undergoing a second artificial urinary sphincter surgery with no risk factors, history of radiation, history of urethroplasty, and history of radiation and urethroplasty were 83.1%, 72.6%, 63.9% and 46%, respectively. CONCLUSIONS: Patients without additional risk factors undergoing second and third artificial urinary sphincter surgeries experience revision-free rates similar to those of their initial artificial urinary sphincter devices. Patients who have been treated with pelvic radiation have earlier artificial urinary sphincter complications. When multiple risk factors exist, revision-free rates decrease significantly.

Content Analysis of ACGME Accredited Urology Residency Program Webpages.

OBJECTIVE: To provide an update on the web pages of academic Urology departments in the United States and to evaluate for consistency of information available to applicants. MATERIALS AND METHODS: The American Urologic Association accredited listing of US urology residency programs was accessed in January 2018. One hundred and thirty-five urology residency program websites were then accessed and searched for the presence or absence of 44 criteria. Criteria were grouped into 7 categories: program overview and contact information, application information, program curriculum, current residents, alumni, faculty, and resident benefits. Programs were categorized based on US census bureau designated regions, program size, and by program ranking by the Doximity Urology Residency Program Navigator. RESULTS: Out of 135, 134 (99%) of the AUA accredited listing of US urology residency programs had functional websites. The most commonly available information included clinical rotation sites (84%), resident curriculum (78%), number and names of current residents (76% and 77%, respectively), and faculty names and corresponding subspecialties (74% and 72%, respectively). These trends were similar across geographic regions. The top 20 residency programs on Doximity were more likely to list alumni names (70% vs 35%, P = .005), alumni fellowships (75% vs 30% P = .0003) and alumni jobs (75% vs 29%, P = .001) compared to all other residency programs. CONCLUSION: There is high variability regarding comprehensiveness of urology residency websites. An informative and well-constructed website has the potential to improve optics and marketability of a residency program. Top notch residency programs are more likely to display fellowship and faculty information, both desirable prospects after residency.

A Case of Bilateral Atrophy of the Inferior Vestibular Nerves.

: We report a case of a 62-year-old woman who was found to have bilateral atrophy of the inferior vestibular nerves on magnetic resonance imaging (MRI) after presenting to our clinic with 6 years of intermittent vertigo and residual unsteadiness. The nerve atrophy may be associated with an episode of vestibular neuritis, a common cause of vertigo that exclusively involves the inferior vestibular nerve in less than 3% of cases. While MRI may demonstrate vestibular nerve enhancement in cases of acute vestibular neuritis, no single MRI finding has been demonstrated consistently among cases of acute or chronic vestibular neuritis. Physical therapy is likely an effective long-term treatment for this patient to achieve central compensation for symptomatic relief.

Serum Biomarkers May Prognosticate Recurrence in Node-Negative, Non-Small Cell Lung Cancers Less Than 4 Centimeters.

BACKGROUND: A significant proportion of patients who undergo lung resection for less than 4 cm non-small cell lung cancer (NSCLC) will die of disease recurrence within 5 years. The ability to identify patients at greatest risk for recurrence may help individualize treatment and surveillance regimens and improve outcomes. We hypothesized that a serum-based biomarker panel could help risk stratify patients with node-negative NSCLC less than 4 cm for recurrence after lung resection. METHODS: An institutional biorepository of more than 1,800 cases was used to identify patients with resected, node-negative NSCLC less than 4 cm in size. Clinical and radiographic data were collected. Preoperative serum specimens were evaluated in a blinded manner for 47 biomarkers that sampled biological processes associated with metastatic progression, including angiogenesis, energy metabolism, apoptosis, and inflammation. Receiver-operating characteristics curves and log rank tests were used to evaluate individual biomarkers with respect to recurrence, followed by random forest analysis to generate and cross validate a multiple-analyte panel to risk stratify patients for recurrence. RESULTS: The cohort included 123 patients with a median follow-up of 58.2 months; 23 patients had recurrences. A seven-analyte panel consisting of human epididymis protein 4, insulinlike growth factor-binding protein 1, beta-human chorionic gonadotropin, follistatin, prolactin, angiopoietin-2, and hepatocyte growth factor optimally identified patients with disease recurrence with a cross-validated specificity of 91%, sensitivity of 22%, negative predictive value of 83%, positive predictive value of 36%, and accuracy of 78%, providing an area under the receiver-operating characteristics curve of 0.70. CONCLUSIONS: Serum-based biomarkers may be useful for risk stratifying patients with node-negative NSCLC less than 4 cm for recurrence after lung resection.

Unresectable Middle Mediastinal Biphasic Pulmonary Blastoma.

We report a case of a young male who presented with an unresectable, centrally-located classic biphasic pulmonary blastoma (CBPB) involving his bilateral mainstem bronchi and esophagus and a synchronous right testicular seminoma. CBPB is a rare and aggressive tumor that most commonly presents as a solitary mass in the periphery of the lung. Surgical resection is the preferred treatment for CBPB, as chemotherapy and radiation have demonstrated limited effectiveness. In the current case, four cycles of cisplatin, ifosfamide, and etoposide with concurrent radiotherapy resulted in a favorable response at three months. Currently he optimal treatment for unresectable pulmonary blastomas remains undefined.