Association between YouTube® videos and health literacy with postoperative healthcare utilization following pediatric urologic surgery: A randomized trial.

INTRODUCTION: Limited caregiver health literacy has been associated with poorer health outcomes in pediatric patients and may limit caregiver understanding of printed education resources. Postoperative healthcare utilization may be related to confusion about instructions or complications. OBJECTIVE: To correlate caregiver health literacy and educational video intervention with postoperative healthcare utilization following ambulatory pediatric urologic surgery. STUDY DESIGN: From July through December 2021, a randomized double-blinded trial assessed postoperative healthcare utilization following pediatric urologic surgery. Caregivers were randomized to receive standardized postoperative counseling and printed instructions (control) or access to English-language educational YouTube® videos with standardized postoperative counseling and printed instructions (intervention). Medical record abstraction was completed 30 days following surgery to identify postoperative healthcare utilization with calls, messages, add-on clinic visits, or presentation for urgent or emergent care, and postoperative complications. RESULTS: Target enrollment was achieved with 400 caregivers with 204 in the intervention and 196 in the control groups. There was a 32.5 % overall rate of postoperative healthcare utilization. Health literacy was inversely associated with total postoperative healthcare utilization (p < 0.001). There was no difference in the incidence of postoperative healthcare utilization between the control and intervention groups (p = 0.623). However, on sub-analysis of caregivers with postoperative healthcare utilization (Summary Figure), there were fewer total occurrences in the intervention group (intervention median 1, IQR 1,2.3; control median 2, IQR 1,3; p < 0.001). For caregivers with limited health literacy, there was a greater associated reduction in median calls from 2 (IQR 0,2) to 0 (IQR 0,0.5) with video intervention (p = 0.016). On multivariate analysis, total postoperative healthcare utilization was significantly associated with limited caregiver health literacy (OR 1.08; p = 0.004), English as preferred language (OR 0.68; p = 0.018), and older patient age (OR 0.95; p = 0.001). DISCUSSION: Current resources for postoperative education are limited as resources can be written above recommended reading levels and families can have difficulty recalling information discussed during postoperative counseling. Video intervention is an underutilized resource that can provide an additional resource to families with visual and auditory aids and be accessed as needed. CONCLUSION: Caregiver health literacy was inversely associated with postoperative healthcare utilization. There was no difference in the incidence of postoperative healthcare utilization with video intervention. However, on subgroup analysis, supplemental videos were associated with fewer occurrences of postoperative healthcare utilization, especially in caregivers with limited health literacy. On multivariate regression, health literacy, preferred language, and patient age were significantly associated with total postoperative healthcare utilization.

Contrast-enhanced voiding urosonography (CEVUS) as a safe alternate means of assessing vesicoureteral reflux in pediatric kidney transplant patients.

BACKGROUND: Although voiding cystourethrogram (VCUG) is currently the gold standard in VUR evaluation, there is ionizing radiation exposure. Contrast-enhanced voiding urosonography (CEVUS) uses ultrasound contrast agents to visualize the urinary tract and has been reported to be safe and effective in VUR evaluation in children. CEVUS application has yet to be specifically described in VUR evaluation in the pediatric kidney transplant population. The purpose of this study was to report the use of CEVUS and VCUG in evaluating and managing VUR in pediatric renal transplant patients. METHODS: Retrospective review was conducted for pediatric kidney transplant patients (18 years and younger) who underwent VCUG or CEVUS to assess for transplant VUR from July 2019 through June 2021. Demographic information, reason for VUR evaluation, fluoroscopy time, and postimaging complications were evaluated. Costs of imaging modalities were also considered. RESULTS: Eight patients were evaluated for transplant VUR during the study period. Of the 3 patients who underwent VCUG, all 3 had VUR (median grade 3). Median fluoroscopy time was 18 s and dose-area product was 18.7 uGy*m2 . Of the 5 patients who underwent CEVUS, 4 had VUR (median grade 4). There were no complications for either modality. Based on clinical and radiographic findings, patients were recommended no intervention, behavioral modification, or ureteral reimplantation. The total cost of CEVUS was $800 less than that of VCUG. CONCLUSION: CEVUS can provide an alternate means of safely evaluating VUR in kidney transplant patients with similar outcomes, potentially lower costs, and no exposure to ionizing radiation.

Integration of child life services in the delivery of multi-disciplinary differences in Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) care.

INTRODUCTION: Multiple studies have demonstrated the benefit of incorporating certified child life specialist (CCLS) services in various aspects of pediatric care. Although the significance of psychosocial support of patients with Disorders of Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) is increasingly recognized, the involvement of CCLS services into the DSD and CAH multidisciplinary care model has yet to be described. OBJECTIVE: To evaluate the feasibility, acceptability, and patient and family experience of routinely incorporating CCLS services into the multidisciplinary DSD and CAH care model. STUDY DESIGN: As part of a quality improvement initiative, CCLS services were routinely incorporated in the multidisciplinary DSD and CAH clinics at our institution. Encounters for patients seen in clinic between July 2018 through October 2019 were reviewed for demographic information, DSD diagnosis classification, CCLS documentation, and whether an exam under anesthesia (EUA) was required due to an incomplete clinical exam. CCLS documentation was reviewed for assessments, interventions, whether patients tolerated their physical exams, time of CCLS services, and additional CCLS support beyond the physical exam. All patients were limited to one physical exam per clinic visit. RESULTS: Out of the 45 encounters with CCLS involvement, 42 (93.3%) exams were well-tolerated. CCLS assessments considered patient development, communication considerations, temperament, medical stressors, coping preferences, and patient preferences for activities and distractions. Interventions included preparing patients for their physical exams, encouragement before and during exams, addressing patient stressors, distractions and coping mechanisms, and advocating for the patient. No patients required an EUA. DISCUSSION: The CCLS aimed to provide families with a sense of control during clinic visits and teach them to advocate for themselves. The CCLS helped prepare and distract patients for their clinic visit and addressed the sensitive nature of the physical exam by focusing on the emotional and development needs of patients. CCLS contributions to a positive patient experience are consistent with multiple studies demonstrating the benefit of CCLS services for pediatric care. This quality improvement initiative ultimately helped to create a positive experience for patients and families. CONCLUSION: This study demonstrates the feasibility, acceptability, and positive impact of CCLS services in the delivery of patient and family-centered care for patients with DSD and CAH as part of the multidisciplinary team model.

Primary Ewing Sarcoma of the Testicle in an Adolescent Patient.

Extraosseous Ewing sarcoma with genitourinary tract involvement is rare. We present a case of primary Ewing sarcoma of the testis with review of the literature. While primary Ewing sarcoma of the testis is unusual, it is important to appropriately diagnose. This case emphasizes the benefits of prompt and appropriate evaluation, pathologic work-up, and treatment of testicular tumors.

Digital photography in the evaluation and management of female patients with congenital adrenal hyperplasia: A standardized protocol for quality improvement.

INTRODUCTION: Digital photography can be securely stored in the medical record and enhance documentation of physical exam findings and monitor wound healing. A standardized protocol that respects the dignity of the patient and maintains the fidelity of objective documentation is needed for patients with differences in sexual development (DSD) and congenital adrenal hyperplasia (CAH). OBJECTIVE: The purpose of this study was to evaluate the feasibility, acceptability, and applications of a HIPAA-compliant digital photography protocol in the care of female patients with CAH. STUDY DESIGN: A protocol for standardized digital imaging including consent, permission, data capture, and storage in the electronic medical record (EMR) was implemented. Patients undergoing physical examination during multidisciplinary CAH clinic visits, preoperative evaluation, and postoperative follow-up from October 2020 through May 2021 were included. Male patients with CAH, patients with clitoromegaly or urogenital sinus not from CAH, and patients seen through telehealth were excluded. Consent was obtained from caregivers and permission from patients. Images of the exam were taken during clinic visits or at the time of surgery with no identifying features included. Images were directly uploaded into the patient's chart in the HIPAA-protected EMR separate from other clinical documentation and not stored on personal devices. RESULTS: There were 17 patients with CAH seen with median age 6 years (range 2 weeks-18 years). There was a median of 3 photos per patient during the study period with cooperation from both the patient and their caregiver. Amongst the patients seen, 6 patients underwent reconstruction with a median of 10 photos per patient. Images were available and used for preoperative planning and counseling. Patients with previous images did not require repeat examinations and were subjected to fewer genital examinations. Fewer providers were present during exams. Images taken by providers and caregivers during the postoperative period were used to monitor wound healing and surgical outcomes. DISCUSSION: Protocol implementation improved patient care by reducing the number of exams and number of providers present, enhancing clinical documentation, and providing a means of tracking the physical exam over time. This was in concordance with guidelines for limiting exams for patients with DSD and CAH. Implementation of best practices for medical photography was important in respecting patient dignity and confidentiality. CONCLUSION: Implementation of standardized digital photography was feasible and acceptable to patients and caregivers. Digital images reduced the need for repeat physical examination and provided a visual means of enhancing clinical documentation.

Engagement of common pediatric urologic conditions on social media.

INTRODUCTION: As social media use continues to increase, parents and caregivers report using social media platforms as a source of health information. However, there are minimal regulations for social media content and health misinformation has been shared for various medical issues and urologic conditions. While internet content related to pediatric urology has been previously described, social media engagement for various pediatric urologic conditions have yet to be described. OBJECTIVE: To evaluate the evidence supporting articles engaged on social media that are related to common pediatric urologic conditions. STUDY DESIGN: A social media analysis tool was used to identify articles engaged through Facebook, Reddit, Twitter, and Pinterest between July 2020-2021. The top 5 articles related to toilet training, circumcision, cryptorchidism, testicular torsion, and hypospadias were identified. Article citations were reviewed and classified by Oxford levels of evidence. The content of each article was then reviewed and compared against supporting evidence on an independent literature search. Statistical analysis was completed with descriptive statistics, Mann-Whitney U, Wilcoxon signed rank, and bivariate correlation. RESULTS: Of the 25 articles reviewed, 8 (32%) were affiliated with medical journals, hospitals, or academic institutions and 17 (68%) were on non-affiliated websites with advertisements. There was greater social media engagement for articles related to toilet training and circumcision than testicular torsion, hypospadias, and cryptorchidism. No articles cited level 1 evidence and 32% of articles cited no evidence. Literature search for article content demonstrated a discrepancy between the level of evidence cited by articles compared to the evidence available in the literature to support article content. There was greater social media engagement for articles with no cited or supporting evidence and those not affiliated with medical journals, hospitals, or academic institutions. DISCUSSION: The findings in this study are consistent with trends reported for other urologic conditions, including genitourinary malignancy, female pelvic medicine and reconstructive surgery, nephrolithiasis, and sexual function. Parents without a medical background may have difficulty identifying whether articles shared on social media can be a reliable resource for health information. It is important to understand how information related to pediatric urologic conditions is engaged on social media so that misinformation can be addressed in clinical, online, and regulatory settings. CONCLUSION: There was greater social media engagement for articles with no cited or supporting evidence and those not affiliated with medical journals, hospitals, or academic institutions.

Bedside Intervention for Neonatal Hydrometrocolpos and Imperforate Hymen.

Low complexity cases of neonatal hydrometrocolpos from imperforate hymen are typically treated with hymenotomy or hymenectomy. Although this is commonly performed in the operating room, bedside management is also safe and effective. We present a case of prenatally diagnosed, simple hydrometrocolpos treated via bedside hymenotomy on the first day of life. The patient received periprocedural antibiotics prior to the procedure and had full resolution of hydrometrocolpos without any complication or need for further intervention. Early intervention and administration of periprocedural antibiotics allowed for safe management of this condition without the risks and resources of treatment in the operating room.

Misdiagnosis of Congenital Posterior Urethroperineal Fistula and Comparison With Urethral Duplications and Rectourethral Fistula.

Congenital posterior urethroperineal fistula (CUPF) is a urothelium-lined tract between the posterior urethra and perineum. This condition is rare and has been proposed to be a urethral duplication variant. A case of CUPF that was misdiagnosed and surgically treated as a rectourethral fistula is presented. The clinical presentation, diagnosis, and treatment of CUPF are discussed and compared with those of Y-type urethral duplications and H-type rectourethral fistulas.

Stressors and Coping Mechanisms Related to Burnout Within Urology.

OBJECTIVE: To identify factors and stress coping mechanisms associated with burnout within the field of urology. METHODS: A survey study was completed using the abbreviated Maslach Burnout Inventory to evaluate emotional exhaustion, depersonalization, and low personal achievement. Demographic information, training status, practice setting, work hours, and mechanisms used to cope with stress were evaluated. Participants were also asked to comment on contributors to burnout in an open-ended question. Univariate analysis and multivariate regression identified factors associated with measures of burnout. RESULTS: A total of 476 survey responses from 377 practicing urologists and 99 residents/fellows were included. Burnout was identified in 49.6% of all participants. Burnout through high emotional exhaustion was seen in 40.7%, high depersonalization in 30.7%, and low personal achievement in 18.3%. Trainees exhibited higher levels of depersonalization and lower levels of personal achievement. Higher levels of emotional exhaustion were identified in urologists in the middle of their careers and those in private practice. Urologists identified documentation, insurance and reimbursement, government regulations, medical practice expectations, and patient expectations as stressors contributing to burnout. Exercising and socializing were consistently associated with lower measures of burnout whereas stress eating and alcohol use were associated with higher measures of burnout on multivariate analysis. CONCLUSION: Burnout in urology was associated with trainee status, years in practice, and practice setting. Exercising and socializing were protective against burnout whereas stress eating and alcohol consumption were associated with higher rates of burnout.

Assessment of health literacy in adolescents with spina bifida and their caregivers: a multi-institutional study.

INTRODUCTION: and Objective: Health literacy is defined as the ability to obtain, integrate, and appraise health-related knowledge. It is known to correlate with disparities in clinical outcomes in adults with chronic disease. Patients with spina bifida represent a potentially vulnerable cohort as they often have multiple comorbidities. The authors aimed to characterize health literacy in adolescent patients with spina bifida and their caregivers. STUDY DESIGN: The Newest Vital Sign (NVS), a validated assessment of health literacy and numeracy, was administered to patients (aged ≥10 years) and caregivers in outpatient pediatric urology and multidisciplinary spina bifida clinics. Subjects not fluent in English or Spanish and those with cognitive delay were excluded. Survey responses and demographic information were analyzed and compared between the spina bifida and control groups. RESULTS: Three hundred eleven caregivers (caregivers for patients with spina bifida: 185, caregivers for the controls: 126) and 84 adolescents (those with spina bifida: 46, controls: 38) completed the NVS. Although there was no difference in health literacy between caregivers (p = 0.98), adolescents with spina bifida demonstrated lower NVS scores (spina bifida 1 [0-3] vs. control 2 [2-4]; p = 0.02) (Figure). Health literacy of patients with spina bifida and controls increased with age (p = 0.002). Adjusting for age and gender, the odds of having limited literacy were 5.5 times higher in patients with spina bifida than in the controls (p = 0.004). Inadequate caregiver health literacy was associated with a lower education level (p < 0.001). DISCUSSION: Spina bifida is among the most complex birth defects compatible with life and affects a multitude of systems. Although it is well established that limited health literacy in adults with chronic disease is associated with adverse outcomes, there are considerably fewer data in the pediatric population. The authors found that caregivers of patients with spina bifida exhibited health literacy and numeracy comparable with parents in the control group, despite lower education levels. In contrast, adolescents with spina bifida demonstrated poorer health literacy than the controls. Multidisciplinary care is necessary, given the medical complexity of spina bifida; therefore, impaired understanding of adults' own needs may pose a barrier to successful transition to their care and subsequent outcomes. CONCLUSIONS: The majority of surveyed caregivers for patients with spina bifida exhibited adequate health literacy, especially those with some college education; however inadequate health literacy was more likely among adolescents with spina bifida when compared with the controls. Screening for health literacy may be useful to assess readiness for transition to more independent self-care among patients with spina bifida.

Consistencies and Discrepancies Between the Expectations of Urology Trainees and the Experience of Practicing Urologists.

OBJECTIVE: To compare the expectations of urology trainees with the experience of practicing urologists. METHODS: Residents, fellows, and practicing urologists were surveyed in 2018 regarding weekly work hours, number of hospitals covered, call nights per week, administrative workload relative to residency, annual net income, and time to pursue personal interests and hobbies. Urology trainees, defined as residents and fellows, were also surveyed regarding their expectations for clinical practice. The expectations of trainees were compared with the reported experience of practicing urologists using 1-tailed t test and chi-square analysis. Trainee expectations were also stratified by age, gender, training level, relationship status, and whether trainees had dependent children. RESULTS: The expectations of 99 trainees were compared with the reported experience of 377 practicing urologists. Trainees expect to work more hours but less call nights per week than reported by practicing urologists while annual net income was either consistent or underestimated. Compared to practicing urologists, however, trainees appear to underestimate the administrative workload relative to residency and overestimate time to pursue personal interests and hobbies. Junior residents were more likely to underestimate administrative workload than senior residents and fellows. CONCLUSION: While the expectations of urology trainees for work hours and annual net income were fairly consistent with those reported by practicing urologists, trainees may underestimate administrative workload and overestimate time to pursue personal interests and hobbies.

The effect of high impact crossfit exercises on stress urinary incontinence in physically active women.

AIMS: The impact of CrossFit (high energy and intensity exercise) on SUI has not been well described. This study evaluates the incidence of SUI in physically active women, and examines specific exercises that can increase SUI. METHODS: A cross-sectional study was conducted in women from four CrossFit centers and one aerobic center for comparison. Participants were surveyed regarding baseline demographics, activity levels, severity, and frequency of leakage during CrossFit exercises as well as preventative strategies against SUI. Participants were stratified based on age, body mass index, types of exercises, parity, delivery, and compared using Mann Whitney-U and Chi square. RESULTS: This study had 105 CrossFit (mean = 36.9 years) and 44 aerobic (mean = 29.0 years) participants. Fifty women reported SUI during exercises, while none of the aerobic women reported SUI during exercise. The top three CrossFit exercises associated to SUI were double-unders (47.7%), jumping rope (41.3%), and box jumps (28.4%). CrossFit women with a history of parity had significantly more episodes of SUI with box jumps, jumping rope, double-unders, thrusters, squats without weights, squats with weights, and trampoline jumping (P < 0.001). The top preventative strategies were emptying the bladder before workouts, wearing dark pants, and performing Kegel exercises during workout. Vaginal delivery (OR 4.94) and total incontinence symptom severity index (OR 1.45) were both significant predictors of SUI during exercise (P < 0.05). CONCLUSION: There is a significantly higher risk of SUI during CrossFit exercises associated with previous pregnancy and vaginal delivery but also in nulliparous women. In general, women participating in CrossFit have been applying preventative measures for protection of SUI during exercises.

The Effect of Lemonade and Diet Lemonade Upon Urinary Parameters Affecting Calcium Urinary Stone Formation.

PURPOSE: To determine the effects of regular and diet lemonade upon urinary parameters affecting kidney stone formation. METHODS: In this prospective blinded crossover study, 12 healthy participants consumed either 2 L of regular or diet lemonade daily while on a standardized low sodium moderate calcium diet. Twenty four-hour urine collections were obtained at baseline on the controlled diet only and on days 4 and 5 of each treatment phase. There was a 1-week washout period between regular and diet lemonade treatments. Primary outcomes were urine citrate, pH, and volume determined by 24-hour urine collections. Secondary outcomes included the supersaturation of calcium oxalate, calcium phosphate, and uric acid. RESULTS: Urine volume was significantly higher with both regular and diet lemonade consumption compared with baseline values. Urinary citrate significantly increased from baseline with diet lemonade only. Urine pH was unchanged with both beverages. The supersaturation of calcium oxalate significantly decreased with diet lemonade only, whereas supersaturation of calcium phosphate decreased with both beverages. Daily consumption of 2 L of regular and diet lemonade resulted in an intake of 168.4 and 170.2 mEq of citrate but a total alkali intake of 12.2 and 16.0 mEq, respectively. Compared with diet lemonade, regular lemonade provided subjects with 805 additional calories and 225 g of sugar per day. CONCLUSIONS: Diet lemonade may provide a low-calorie sugar-free cost-effective option for decreasing the risk of recurrent calcium nephrolithiasis through a significant increase in urine volume, increase in urinary citrate, and reduction in supersaturation of calcium oxalate and calcium phosphate.

Comparing the vaginal wall sling with autologous rectus fascia and polypropylene sling: Short term outcomes and patient satisfaction.

OBJECTIVES: Many women are affected by stress urinary incontinence (SUI). Due to investigations of the safety of synthetic mesh slings, there has been renewed interest in autologous slings. The aim of this study is to evaluate whether different sling material affects outcomes and patient satisfaction. METHODS: A retrospective review was performed of patients who underwent sling placement between May 2011 and April 2017 for SUI or stress-predominant mixed urinary incontinence. Patients were divided based on the sling material used: vaginal wall sling (VWS), rectus fascia sling (RFS), and soft polypropylene sling (SPS). Outcomes were compared using a Likert scale, the validated SEAPI score system, Incontinence Impact Questionnaire 7 (IIQ-7), and Incontinence Symptom Severity Index (ISSI). RESULTS: There were 228 patients that underwent sling placement with 94 receiving VWS, 62 RFS, and 72 SPS. Mean follow-up was 14 months. There was no statistical difference in postoperative pad usage or satisfaction score between the groups. All three groups had a statistically significant postoperative improvement in subjective SEAPI scores and daily pad use. The VWS and RFS groups had significant improvement in their ISSI. The VWS group also had postoperative improvement in IIQ-7 score. Complication rates were rare and similar between all three groups. CONCLUSIONS: Patient satisfaction and outcomes were overall similar between all three sling materials. Based on our outcomes, we continue to use the VWS as a treatment option for patients with SUI and redundant vaginal wall tissue that are opposed to synthetic mesh slings.

Translabial Ultrasound Evaluation of Pelvic Floor Structures and Mesh in the Urology Office and Intraoperative Setting.

BACKGROUND: Translabial ultrasound (TUS) can provide an inexpensive alternative imaging modality for evaluating pelvic floor structures and synthetic slings as mesh can be difficult to identify on pelvic exam or cystoscopy, patients may be unable to provide an accurate history of previous pelvic surgery, and cross-sectional imaging with computed tomography and magnetic resonance imaging can be inadequate for evaluating synthetic slings. OBJECTIVE: To demonstrate the use of TUS in the evaluation of female pelvic floor structures and mesh. METHODS: Translabial ultrasound can be used in the Urology clinic or intraoperative setting using a curvilinear transducer. Following identification of anatomic landmarks in the various planes of the pelvic floor, TUS can evaluate for pelvic floor disorders and the type and location of synthetic mesh material. Artifacts, such as air pockets in the vagina or rectum and the hypoechoic pubic symphysis, are also considered. RESULTS: Real-time imaging allows for dynamic examination of pelvic organ prolapse and urethral hypermobility that can contribute to pelvic exam findings. Bladder ultrasound can help evaluate for lesions, calculi, and even mesh erosion. Translabial ultrasound can also be used to differentiate hyperechoic retropubic and transobturator slings by identifying the position of sling arms and the appearance of the sling at different planes. Evaluation with TUS can demonstrate sling disruption, folding, urethral impingement, and erosion into pelvic floor structures. This can be particularly useful in patients presenting with pain, recurrent infections, or voiding dysfunction in which problems with mesh may not be easily identified on pelvic exam or cystoscopy. This imaging modality can complement a patient's history, aid in preoperative planning, and enable intraoperative identification of mesh slings. CONCLUSION: Translabial ultrasound provides a quick, readily available, and easy-to-learn imaging modality for evaluating pelvic floor structures and mesh in the office or intraoperative setting.

Dextrose Instillation as an Alternative Agent to Observe Ureteral Efflux During Pelvic Reconstructive Surgery.

OBJECTIVE: To evaluate the use, cost, postoperative urinary tract infection (UTI) rates, and complications of dextrose instillation during cystoscopy. METHODS: The medical records of patients who underwent cystoscopy during pelvic reconstructive surgery between June 2016 and June 2017 were reviewed. Patients were divided into two groups: patients who had one ampule of dextrose 50% (D50) directly instilled and patients who did not have D50 instilled during cystoscopy. Preoperative demographics, UTI rates, and postoperative complications were compared. Pharmaceutical cost and availability were reported by the pharmacy at our institution. RESULTS: Out of 63 patients identified, dextrose instillation was used in 20 patients and no dextrose was used in 43 patients. Each ampule of D50 cost $2.18 and there were no problems with supply shortage. As D50 was directly instilled into the bladder, there was immediate visualization of ureteral efflux at the time of surgery. Three patients (15%) in the dextrose group and 10 patients (23%) in the nondextrose group developed postoperative UTIs. There was no statistically significant difference in postoperative UTI rates between the two groups (p = 0.43) and there were no differences in postoperative complications. CONCLUSION: Dextrose is a safe, cost-effective, readily available agent that provides instantaneous visualization of ureteral efflux without an increased risk of postoperative UTI.

Role of reactive oxygen species in male infertility: An updated review of literature.

OBJECTIVES: To review the literature and provide an updated summary on the role of reactive oxygen species (ROS) in male infertility. METHODS: A review of PubMed, Cochrane review, and Web of Science databases for full-text English-language articles published between 1943 and 2017 was performed, focusing on the aetiology of ROS, physiological role of ROS on spermatic function, pathological role of ROS in infertility, evaluation of ROS, and role of antioxidants in oxidative stress. RESULTS: ROS play a role in spermatic function and fertilisation. The literature describes both a physiological and a pathological role of ROS in fertility. A delicate balance between ROS necessary for physiological activity and antioxidants to protect from cellular oxidative injury is essential for fertility. CONCLUSION: Although elevated levels of ROS are implicated as a cause of infertility, there is no consensus on selecting patients to test for ROS, which test to perform, or if treatment for ROS can have a positive impact on infertility rates and pregnancy.