Assessing Vasectomy-Related Information on YouTube: An Analysis of the Quality, Understandability, and Actionability of Information.

This study aims to critically appraise the quality of vasectomy-related health information currently available on YouTube to better address patient information needs moving forward. A YouTube search was performed using the keyword "vasectomy." The first 100 videos were assessed, with irrelevant and duplicate videos excluded. Two independent reviewers evaluated the remaining videos using the DISCERN instrument for evaluating the quality of information and the Patient Education Materials Assessment Tool for Audiovisual materials (PEMAT-A/V) for assessing the understandability and actionability of materials. Source characteristics and markers of bias and misinformation were also collected. Seventy-eight videos were included in the study, with a mean duration of 6.6 minutes and mean of 216,672 views. The median DISCERN score was poor at 28 (IQR 22-33) out of a possible 80 with mean PEMAT-AV Understandability and Actionability scores of 67.6% (±16.7%) and 33.8% (±36.2%), respectively. A medical doctor was present in 61 (78.2%) of the videos, of which 53 (86.9%) were urologists and 38 (62.2%) promoted their personal practice or institution. False statements regarding vasectomy were made in 14 (17.9%) videos. Notably, no significant difference was noted in quality, understandability, or actionability of videos created by those with personal promotion to those without. The quality of information regarding vasectomy on YouTube is poor and reaches a wide audience. Continued appraisal and creation of YouTube videos that contain quality, understandable and actionable information by urologists is necessary to ensure patients are well-informed.

An improbable trifecta: Occurrence of xanthogranulomatous prostatitis, prostate cancer, and prostatic abscess in a single patient.

Xanthogranulomatous prostatitis (XGP) is a rare disease that can mimic the clinical and imaging findings of prostate cancer. Differentiation of these diseases is vital in order to offer the correct treatment. Histological examination of prostate tissue is the definitive manner in which XGP is distinguished from prostate cancer. This case demonstrates the rare possibility of concurrent findings of prostate abscess, prostate cancer, and XGP, further clouding diagnostic assessment. Percutaneous aspiration and antibiotic treatment of the abscess reduced lower urinary tract symptoms and eliminated XGP on subsequent prostate biopsy. Careful work up is necessary to prevent unnecessary interventions or missed diagnoses.

Review of Guidelines for the Evaluation and Treatment of Leukocytospermia in Male Infertility.

Leukocytospermia is an ill-defined and poorly understood condition affecting up to 30% of male factor infertility. Current guidelines on leukocytospermia vary significantly, although it has been linked to increased rates of infertility, uncertainty about its clinical significance, diagnosis, and treatment remains. The guidelines are conflicting with sparse data scattered across different specialties and continents. This study aims to compare and contrast available international guidelines and recommendations. In addition to these guidelines, we sought to consolidate the findings of trials over the last several decades. English language articles on human observational studies, retrospective, prospective, clinical trials and randomized control trials were searched for using the following terms: "leukocytospermia, pyospermia, and male infertility." Articles about treatment and management of leukocytospermia that were published between January 2010 and April 2018 were included, as well as four articles referenced in best practice and guideline statements from urological and andrological associations. Disagreements on this topic are highlighted as some guidelines describe no correlation between leukocytospermia and infertility while others show that treatment leads to improvement of sperm quality by many measures including improved pregnancy rate. Various treatments have been suggested including antibiotics, anti-inflammatory medications, and frequent ejaculation. There is a need for definitive characterization of Leukocytospermia as an infectious or inflammatory marker and a re-evaluation of the leukocyte concentration threshold. Additional studies investigating rates of conception as a measure of outcome are needed, to provide greater level of evidence and generalizability of leukocytopsermia management.

Alemtuzumab Induction Reduces Early Rejection in Female Renal Allograft Recipients: A Single Center Study.

OBJECTIVES: Previous research studies have highlighted differences in rejection and graft survival across sexes that favor men. We compared delayed graft function, rejection, graft survival, and overall patient survival between sexes following alemtuzumab induction. MATERIALS AND METHODS: After Internal Review Board approval, a retrospective analysis of kidney transplants completed at the University of Toledo Medical Center between March 2004 and November 2015 was conducted. RESULTS: During the study period, 675 transplants were performed. This included 429 male patients (63.6%) and 246 female patients (36.4%). Recipient sex was not associated with delayed graft function. Acute rejection occurred less frequently in women than in men at 3 months (12.6% vs 20.7%; P = .009) and at 6 months (15.9% vs 24.6%; P = .008). Cumulative patient survival was superior in women (P = .032). Female recipient death-censored graft survival was inferior at 3 years (85.4% vs 91.6%; P = .034) and at 5 years (77.7% vs 86.9%; P = .019) versus male patients. CONCLUSIONS: Compared with men, early female rejection is reduced and overall female survival is longer after alemtuzumab induction. However, intermediate-term female graft survival is less.

Glucocorticoid receptor beta increases migration of human bladder cancer cells.

Bladder cancer is observed worldwide having been associated with a host of environmental and lifestyle risk factors. Recent investigations on anti-inflammatory glucocorticoid signaling point to a pathway that may impact bladder cancer. Here we show an inverse effect on the glucocorticoid receptor (GR) isoform signaling that may lead to bladder cancer. We found similar GRα expression levels in the transitional uroepithelial cancer cell lines T24 and UMUC-3. However, the T24 cells showed a significant (p < 0.05) increased expression of GRß compared to UMUC-3, which also correlated with higher migration rates. Knockdown of GRß in the T24 cells resulted in a decreased migration rate. Mutational analysis of the 3' untranslated region (UTR) of human GRß revealed that miR144 might positively regulate expression. Indeed, overexpression of miR144 increased GRß by 3.8 fold. In addition, miR144 and GRß were upregulated during migration. We used a peptide nucleic acid conjugated to a cell penetrating-peptide (Sweet-P) to block the binding site for miR144 in the 3'UTR of GRß. Sweet-P effectively prevented miR144 actions and decreased GRß expression, as well as the migration of the T24 human bladder cancer cells. Therefore, GRß may have a significant role in bladder cancer, and possibly serve as a therapeutic target for the disease.