The Impact of Body Contouring Procedures on Urologic Outcomes in Massive Weight Loss Patients.

BACKGROUND: Post-massive weight loss body contouring is a growing area of plastic surgery. Studies have shown preexisting urinary incontinence amelioration in patients undergoing abdominal body-contouring procedures. These studies are small, focus on cosmetic abdominoplasties, and lack use of standardized surveys. The purpose of this study was to evaluate urinary incontinence endpoints in massive weight loss patients undergoing body-contouring procedures. METHODS: A retrospective review was conducted over a 6-year period. Patients excluded had previous body-contouring procedures or previously treated urinary incontinence. Participants completed validated surveys to catalogue preoperative and postoperative urinary habits. Patients were then subdivided based on presence of preoperative incontinence. Outcomes were compared within and between cohorts using the t test and chi-square test. RESULTS: A total of 102 patients completed the survey. Of those, 44 had preoperative urinary incontinence. Patients with incontinence were found to be significantly older than those who did not. Postoperatively, patients with preoperative incontinence had significant decreases in incidence and severity of symptoms (p < 0.01, respectively), and significantly improved their quality of life (p < 0.02). Over 20 percent noted symptom resolution, and 67 percent were mostly or completely satisfied with the outcome. CONCLUSIONS: This study is the first to document amelioration of urinary incontinence symptoms in massive weight loss patients undergoing body-contouring procedures. It adds to the literature suggesting that abdominoplasties in select patients may improve incontinence symptoms. Future work will focus on evaluating the mechanism of this outcome and documenting improvement in an objective, prospective manner. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Risk Factors for Readmission after Shock Wave Lithotripsy for Urinary Stones.

INTRODUCTION: Cost saving measures have put an increased emphasis on reducing complications and rehospitalization. We analyzed the rate of readmission and presentation to emergency departments within 90 days of shock wave lithotripsy to identify prognostic risk factors for this outcome. METHODS: We retrospectively reviewed patients who underwent shock wave lithotripsy at our institution from January 2011 to May 2013 using the Modulith® SLX-F2 lithotripter for solitary ureteral or renal stones 2.0 cm or smaller. The primary outcome was readmission or presentation to the emergency department within 90 days. Secondary end points included stone-free rates at 30 and 90 days. Univariate and multivariate logistic regression analyses were performed to identify risk factors for primary and secondary outcomes. RESULTS: The study population consisted of 307 patients with renal and 270 with ureteral stones. Mean stone size was 9.2 mm. The 90-day readmission rate was 11.6%. Of analyzed metrics only urgency of procedure predicted readmission. Among patients who were readmitted renal colic was the most common chief complaint (67%), followed by infection (10%) and postoperative hematoma or hematuria (7.5%). Stone-free rates were 57% and 78% at 30 and 90 days, respectively. Stone size and nonurgent shock wave lithotripsy status predicted stone-free status. CONCLUSIONS: The 90-day readmission rate following shock wave lithotripsy was 11.6%. Urgency of shock wave lithotripsy was predictive of this outcome. Stone centers should monitor their readmission rates following shock wave lithotripsy to establish national standards and guide decision making when considering other endourological methods if these outcomes are considered unacceptable.

Methodology to study the three-dimensional spatial distribution of prostate cancer and their dependence on clinical parameters.

A methodology to study the relationship between clinical variables [e.g., prostate specific antigen (PSA) or Gleason score] and cancer spatial distribution is described. Three-dimensional (3-D) models of 216 glands are reconstructed from digital images of whole mount histopathological slices. The models are deformed into one prostate model selected as an atlas using a combination of rigid, affine, and B-spline deformable registration techniques. Spatial cancer distribution is assessed by counting the number of tumor occurrences among all glands in a given position of the 3-D registered atlas. Finally, a difference between proportions is used to compare different spatial distributions. As a proof of concept, we compare spatial distributions from patients with PSA greater and less than [Formula: see text] and from patients older and younger than 60 years. Results suggest that prostate cancer has a significant difference in the right zone of the prostate between populations with PSA greater and less than [Formula: see text]. Age does not have any impact in the spatial distribution of the disease. The proposed methodology can help to comprehend prostate cancer by understanding its spatial distribution and how it changes according to clinical parameters. Finally, this methodology can be easily adapted to other organs and pathologies.

Augmented-reality-based skills training for robot-assisted urethrovesical anastomosis: a multi-institutional randomised controlled trial.

OBJECTIVE: To validate robot-assisted surgery skills acquisition using an augmented reality (AR)-based module for urethrovesical anastomosis (UVA). METHODS: Participants at three institutions were randomised to a Hands-on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure-based training for UVA within the haptic-enabled AR-based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross-over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank-sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross-over group). RESULTS: A total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention. CONCLUSION: Training in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand.

Estrogen receptors in prostate development and cancer.

Prostate cancer (PCa) is an androgen-sensitive disease, which can be pharmacologically controlled by androgen blockade. To date, a growing body of evidence showed that estrogen and estrogen receptors (ERs) could regulate prostate development, as well as cancer initiation and progression. This review will address the expression levels and function of ERs in different stages of PCa progression. The functions of ERs in different types of prostate cells, the ligand effect, and the potential applications of selective estrogen modulators (SERMs) will also be discussed. To further dissect ERs' roles in prostate development, cell type specific ER knockout mouse models were generated. Results collected from the prostate cell type-specific ERαKO mouse models provided new insights about the cell type specific ERα roles in prostate development prenatally and postnatally. The results of ERs' roles in mouse PCa mode and the correlation of ERs expression and biomedical outcome will also be discussed.

Putative health risks associated with vasectomy.

Vasectomy is widely regarded as a safe method of contraception, but over the years there have been many reports suggesting putative health risks associated with the procedure. Concerns over the possible association of vasectomy with a number of medical conditions, including cardiovascular disease, testicular cancer, prostate cancer, psychologic distress, and a variety of immune complex-mediated disease processes have been reported. Most recently, a manuscript from the neurology literature has described an association between vasectomy and primary progressive aphasia, a rare variety of frontotemporal dementia. This article reviews the literature surrounding each of these purported health concerns. Because the ultimate findings have important ramifications for both informed consent of vasectomy patients and for public health, the reported health risks in question should be critically evaluated.

Does the presence of significant risk factors affect perioperative outcomes after robot-assisted radical cystectomy?

OBJECTIVE: To evaluate the effect of preoperative risk factors on perioperative outcomes up to 3 months after robot-assisted radical cystectomy (RARC), as RC continues to be associated with a high rate of morbidity and mortality. PATIENTS AND METHODS: From 2005 to 2007, 66 consecutive patients had RARC at Roswell Park Cancer Institute. Patient demographics, preoperative risk factors and complications up to 3 months after RARC were reviewed from a prospective quality-assurance database. Patients were stratified into high- and low risk groups based on age, previous abdominal surgery, chronic obstructive pulmonary disease (COPD), body mass index (BMI), Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiologists (ASA) score. RESULTS: Age, previous abdominal surgery, COPD, BMI, RCRI score and ASA score did not significantly influence complications during or up to 3 months following RARC (P > 0.05). Advanced age was associated with a higher RCRI score (P = 0.014) and an increased likelihood of admission to the Intensive Care Unit (P = 0.007). A higher ASA score was associated with an increased overall hospital stay (P = 0.039). Previous abdominal surgery was associated with more frequent unscheduled postoperative clinic visits (P = 0.014). Operative duration did not significantly influence complication rates (P > 0.05). Fifteen of 62 patients (24%) had a major complication, while 15 (24%) had minor complications within 3 months of surgery. The reoperation rate was 11% and the overall mortality rate was 1.6%. CONCLUSIONS: RARC appears to be well tolerated, independent of comorbid risk factors such as age, BMI, RCRI and ASA score.

Short-term quality-of-life assessed after robot-assisted radical cystectomy: a prospective analysis.

OBJECTIVE: To prospectively determine the effect of robot-assisted radical cystectomy (RARC) on quality of life (QoL) after surgery. PATIENTS AND METHODS: In all, 34 patients who had RARC for bladder cancer between January 2006 and December 2007 at one institution were prospectively enrolled in a study of QoL. All patients had RARC with extracorporeal urinary diversion by one surgeon. As part of the routine follow-up, QoL was assessed at intervals. Functional Assessment of Cancer Therapy-Bladder (FACT-BL) questionnaires were administered before and then over a 6-month period after RARC. Patients undergoing chemotherapy were not excluded. Follow-up FACT-BL and individual domain scores for physical, social, emotional and functional well-being were compared with those obtained before RARC. RESULTS: The mean age of all patients was 65 years, 88% were men, and 13 (38%) had adjuvant chemotherapy. The mean time after RARC for the 1-, 3- and 6-month assessments was 29, 90 and 193 days, respectively; 19 patients completed three follow-up questionnaires. Initially, there were significant decreases in the physical and functional domains, with improvements in the emotional domain (P < 0.001). Total FACT-General and FACT-BL scores decreased in the initial period after RARC and then progressively improved. There was no statistically significant difference in total scores at 3 months after surgery; at the 6-month follow-up the total FACT-BL scores exceeded those before RARC (P = 0.048). CONCLUSIONS: QoL appears to return promptly to, or exceed, baseline levels by 6 months after RARC. The improvement in the short term might allow for more contented patients and quicker initiation of adjuvant chemotherapy.