Inflatable penile prosthesis implantation into scarred corporal bodies: timing may decrease postoperative problems.

OBJECTIVES: To compare the rates of intra- and postoperative complications between early (<4 months) or delayed (>4 months) inflatable penile prosthesis (IPP) re-implantation performed after a fibrosis-inducing event. PATIENTS AND METHODS: Cases of IPP re-implantation were performed by a single, high-volume prosthetic surgeon in hospitals domestically and abroad over a 15-year period (2001-2016). The time interval from the precipitating event to operation, intra-operative complications and postoperative complications for up to 1 year after implantation, were recorded. RESULTS: A total of 72 cases of IPP re-implantation were recorded. There were 16 (53%) intraoperative complications in patients who had surgery at <4 months (Group 1) and 23 (55%) in patients operated at >4 months (Group 2). There were four (13%) postoperative complications in Group 1 and 14 (33%) in Group 2. CONCLUSION: Re-implantation of an IPP into fibrotic corporal bodies is associated with less serious postoperative complications when performed within 4 months of the fibrosis-inducing event.

Complications of Genital Enlargement Surgery.

INTRODUCTION: The objective of genital enlargement surgery is to increase length and/or girth for cosmetic reasons; however, newer techniques have been recently reported to be associated with only minor complications in a small percentage of patients. AIM: We aim to report the severe complications of penile augmentation surgery seen at a referral center and describe their subsequent management. METHODS: Institutional review board approval was obtained. We reviewed our prospectively collected database for all patients who presented with complications of genital enlargement surgery from 2002-2016. MAIN OUTCOME MEASURE: Interventions following complications of genital enlargement surgery. RESULTS: 11 Patients were identified. Mean age was 47 (21-77) years. Prior procedures included subcutaneous injection of silicone outside a medical setting, girth enhancement procedures involving the subcutaneous placement or injection of substances including fat, other substances, or subcutaneous silicone implants. All patients who underwent subcutaneous penile implant underwent removal prior to presentation. Adverse changes included sexually disabling penile deformity and severe shortening, curvature, edema, subcutaneous masses, infection, non-healing wounds, and sexual dysfunction. 10 patients underwent corrective surgery, with 2 requiring multiple procedures and 3 requiring split-thickness skin grafting. All 10 patients had an improved cosmetic appearance and those who had disabling shortening had significantly improved functional length. CLINICAL IMPLICATIONS: Report of such adverse events should assist in appropriate perioperative counseling prior to genital enhancement surgery. STRENGTH & LIMITATIONS: Few reports of debilitating complications of penile enlargement exist in literature. However, without knowing the overall number of procedures performed, the true complication incidence is not known. CONCLUSION: Penile and scrotal enhancement surgery can be associated with major disabling complications, leading to deformity and functional compromise in men with prior normal anatomy and function. Patients should be aware of these risks. Furr J, Hebert K, Wisenbaugh E, et al. Complications of Genital Enlargement Surgery. J Sex Med 2018;15:1811-1817.

A Nurse-Driven Protocol for Foley Catheter Utilization Decreases the Incidence of Traumatic Foley Catheterization.

Background: Traumatic urethral catheterization is a common reason for urologic consultation in hospitalized patients. The purpose of this study was to determine if a protocol designed to decrease Foley catheter use was effective and if implementation of the protocol decreased the incidence of Foley catheter-associated trauma. Methods: In an effort to decrease catheter use, our institution adopted a nurse-driven Foley catheter protocol in May 2015 that allowed nurses to remove Foley catheters that did not meet criteria. We conducted a retrospective medical records review of patients who had Foley catheter-associated trauma occurring between February 2013 and March 2018 and compiled data concerning Foley catheter use. Using t test statistical analysis, we compared rates of Foley catheter use and Foley catheter-associated trauma before and after protocol implementation. Results: During the 62-month study period, we documented 83 cases of Foley catheter-associated trauma. Prior to protocol implementation, our institution had mean of 2,903 patient-catheterization days per month. Following protocol implementation, the mean decreased to 2,604 patient-catheterization days per month (P<0.01). Prior to protocol implementation, the mean incidence of Foley catheter-associated trauma was 1.81 traumas per month. Following protocol implementation, the mean incidence decreased to 0.97 trauma per month (P<0.05). Conclusion: Implementation of the protocol was successful in decreasing Foley catheter use as well as Foley catheter-associated trauma.

Work-Life Integration of Female Urologists.

INTRODUCTION: Women make up less than 8% of practicing urologists, which is the lowest percentage in any specialty of medicine. In this study we characterize the work-life integration of the American female urologist. METHODS: All members of the Society of Women in Urology (SWIU) and female members of the American Urological Association were emailed an electronic survey in January 2015. This study evaluates demographic, clinical and personal information. RESULTS: Of respondents in practice almost 70% work more than 50 hours per week. There was no association between age and part-time or full-time work (p=0.8175). The most common factors determining where practicing female urologists reside include job opportunities (33%), geographic location (26%), proximity to family (23%) and significant other's job opportunities (17%). Half of female urologists live more than 100 miles away from their nearest family member. The majority of respondents indicated that they are currently married, with marriage occurring before training for 35%, during training for 45% and after training for 20%. The majority of significant others (78%) work full-time. Just over half (51%) of female urologists have children, with more than half (51%) of these women delaying childbearing until after training. Virtually all female urologists (95%) rely on others for daytime childcare. CONCLUSIONS: The majority of female urologists are married, in their first marriage, to a spouse who also works full-time, while practicing more than 60 hours per week. Female urologists are responsible for daily parental duties without family in close proximity for assistance.

Erectile Dysfunction: A Review of Historical Treatments With a Focus on the Development of the Inflatable Penile Prosthesis.

Erectile dysfunction has been a concern for men since the beginning of written history. For many men it can lead to severe psychological distress and humiliation. The treatment of erectile dysfunction has advanced significantly over the past 200 years. Men today are presented with many more viable therapy options leading to improved efficacy and more satisfactory sex lives. The objective of this article is to explore historical options for the treatment of erectile dysfunction, with particular emphasis on the development and progression of the inflatable penile prosthesis.

Women Urologists: Trends in Mentoring and Career Choices.

INTRODUCTION: We examined trends in the mentorship and career choices of women urologists. METHODS: An anonymous electronic survey was distributed to 1,563 women urologists in January 2015. Descriptive data are presented as the percent and mean. RESULTS: Of the 1,563 emails sent 365 surveys were completed for a 23% response rate. Practicing women urologists were most likely to be in academic practice (85 of 218 or 39%) or group practice (96 of 218 or 44%). Of 215 women urologists 108 (almost 45%) held a traditional academic rank of professor, associate professor or assistant professor. Of practicing female urologists 52% had completed fellowship training. In the early 1990s a traditional academic rank was held by 22% to 31% of women compared to 44.6% in the current study. Fellowship trained women urologists were more likely to hold a traditional academic rank (p <0.001). Nonfellowship trained women urologists were as likely to work more than 50 hours per week as those who were fellowship trained (p = 1). Compared to practicing urologists current trainees were more likely to have another female urology resident in the program during training as well as a female attending (each p <0.001). There was no difference between trainees and those in practice with respect to being mentored during training (p = 0.6). Most trainees and practicing urologists reported being a mentor to younger women in urology (p = 0.5). CONCLUSIONS: Women urologists have a high rate of fellowship training and more women are attaining academic rank and pursuing academics. Mentoring in urological training is improving. However, there is a continued need for women urologists to ascend to leadership positions in training programs and urological societies to more accurately reflect the changing membership of urologists as a group.

Women Urologists: Changing Trends in the Workforce.

OBJECTIVE: To characterize the current workforce of women urologists in the United States. MATERIALS AND METHODS: An anonymous electronic survey was sent to all members of the Society of Women in Urology and all female non-Society of Women in Urology members of the American Urologic Association. The survey was distributed in January of 2015. Demographic, work, and personal life data were collected. RESULTS: Of 1563 e-mails with a link to our survey sent to women urologists in the United States, 365 surveys were completed for a 23% response rate. The average age of all participants was 39 years (range 25-73 years). Practicing women urologists had an average age of 44 years (range 32-65 years) compared to the average age (53 years) of all practicing urologists reported in the 2014 American Urologic Association Census. The majority of practicing female urologists live and work in a population of >1 million whereas a few live and work in rural areas. Practicing women urologists are most likely to work academic or group practice. Twenty percent of practicing women urologists reported working part-time, but almost 70% report working >50 hours/week. CONCLUSION: Women urologists in the United States are younger than their male counterparts and most work full-time in urban academic centers.

Management of Bladder Diverticula in Menkes Syndrome: A Case Report and Review of the Literature.

Menkes syndrome is a genetic disorder of copper metabolism, often with urologic complications, including bladder diverticula and vesicoureteral reflux. A 1-year-old boy with Menkes syndrome presented with recurrent urinary tract infections and incomplete bladder emptying secondary to 2 large bladder diverticula. He underwent robot-assisted excision of both diverticula with subsequent improved emptying and resolution of urinary tract infections. There is no consensus on management of bladder diverticula in Menkes syndrome. Because the life span of these patients is significantly shortened, one must select an intervention based on their clinical condition, potential morbidities, and informed expectations of the family.

Mobile DNA in Old World monkeys: a glimpse through the rhesus macaque genome.

The completion of the draft sequence of the rhesus macaque genome allowed us to study the genomic composition and evolution of transposable elements in this representative of the Old World monkey lineage, a group of diverse primates closely related to humans. The L1 family of long interspersed elements appears to have evolved as a single lineage, and Alu elements have evolved into four currently active lineages. We also found evidence of elevated horizontal transmissions of retroviruses and the absence of DNA transposon activity in the Old World monkey lineage. In addition, approximately 100 precursors of composite SVA (short interspersed element, variable number of tandem repeat, and Alu) elements were identified, with the majority being shared by the common ancestor of humans and rhesus macaques. Mobile elements compose roughly 50% of primate genomes, and our findings illustrate their diversity and strong influence on genome evolution between closely related species.