Inter-rater reliability of retrograde urethrograms.

PURPOSE: Reliability of pre-operative testing is important for adequate surgical planning. For urethral stricture disease, preoperative planning frequently includes retrograde urethrogram (RUG). The radiographic interpretation of RUGs is often done by urologists themselves. We aimed to evaluate the reliability of RUG interpretation by urologists at our institution. METHODS: We examined the RUGs of 193 patients. These were deidentified and interpreted by three urologists, two general urologists and one reconstructive urologist. These interpretations were compared in 2 ways. Each of the general urologists was compared to the "gold standard" reconstructive urologist interpretation, and the general urologists were additionally compared to each other. We used intraclass correlation coefficient (ICC) for numerical variables and Fleiss' Kappa or Cohen's Kappa statistic (κ) for categorical variables to rate inter-interpreter reliability and agreement among interpretations with regards to the quantitative variables of stricture length and caliber. RESULTS: Level of agreement ranged from poor to moderate across all variables interpreted. Comparing general urologists to the gold standard yielded no better than moderate agreement, with the majority being poor to fair. Similarly, agreement amongst the general urologists did not reach above moderate, with the majority being poor to slight. CONCLUSION: To our knowledge, this is the first analysis of inter-rater reliability of RUGs among practicing urologists. Our analysis showed clinically unacceptable reliability with regards to stricture length, location, caliber, and indicated procedures. This study suggests a need for standardized interpretation of RUGs and poses an opportunity for actionable improvement in management of strictures.

Asymptomatic aggressive angiomyxoma with a two-year follow up in a middle-aged healthy male: A case report and brief review of literature.

A 48-year old male found to have an asymptomatic perineal mass during hospital evaluation for urolithiasis presented two years later for follow up. He underwent imaging which showed slow growth. He subsequently underwent surgical excision of the mass. Histopathology showed it to be an aggressive angiomyxoma. He is currently being followed up on and will continue to do so due to the recurrent nature of the tumor. This case highlights the asymptomatic presentation of aggressive angiomyxomas, consideration for the differential diagnosis in males with a pelvic mass, need for research to potentially prevent recurrence, and importance of follow-up.

Selective angioembolization as a management strategy for angiomyolipoma causing urinary tract obstruction.

Angiomyolipoma (AML) is a benign renal tumor usually found incidentally. Rarely, AML can present with renal colic due to urinary tract obstruction. Prior cases of obstructing AML have been presented and managed successfully with surgical removal. Selective angioembolization has emerged as an alternative management strategy for AML, but no documented cases have been presented for this strategy in the setting of obstruction. Here, we present a case of obstructing AML treated with selective angioembolization with subsequent resolution of obstruction.

Cultural Considerations in Fahr's Syndrome: A Case Report.

OBJECTIVES: Many psychiatrists, and other providers alike, find difficulty integrating a culture-centered approach to clinical practice and navigating the challenges when they arise. We call attention to the ongoing challenges of addressing the cultural barriers between patient and physician. METHODS: We present a case of an African patient with a rare case of Fahr's syndrome whose clinical diagnostic course was complicated by culture and language barriers. RESULTS: The patient's hospital course was challenged by cultural and language barriers that were difficult to integrate into her care, likely contributing to a prolonged diagnostic course and hospitalization. CONCLUSIONS: Cultural considerations in medicine can enhance patient-physician relationships and ultimately strengthen clinical outcomes.