Divergent adaptive and innate immunological responses are observed in humans following blunt trauma.

BACKGROUND: The immune response to trauma has traditionally been modeled to consist of the systemic inflammatory response syndrome (SIRS) followed by the compensatory anti-inflammatory response syndrome (CARS). We investigated these responses in a homogenous cohort of male, severe blunt trauma patients admitted to a University Hospital surgical intensive care unit (SICU). After obtaining consent, peripheral blood was drawn up to 96 hours following injury. The enumeration and functionality of both myeloid and lymphocyte cell populations were determined. RESULTS: Neutrophil numbers were observed to be elevated in trauma patients as compared to healthy controls. Further, neutrophils isolated from trauma patients had increased raft formation and phospho-Akt. Consistent with this, the neutrophils had increased oxidative burst compared to healthy controls. In direct contrast, blood from trauma patients contained decreased naïve T cell numbers. Upon activation with a T cell specific mitogen, trauma patient T cells produced less IFN-gamma as compared to those from healthy controls. Consistent with these results, upon activation, trauma patient T cells were observed to have decreased T cell receptor mediated signaling. CONCLUSIONS: These results suggest that following trauma, there are concurrent and divergent immunological responses. These consist of a hyper-inflammatory response by the innate arm of the immune system concurrent with a hypo-inflammatory response by the adaptive arm.

Unplanned In-Global Clinic Visits, Emergency Department Encounters and Hospital Readmissions following Urological Prosthetic Surgery: Data for Quality Improvement.

INTRODUCTION: Unplanned and potentially avoidable clinic encounters, emergency department visits and readmissions burden the health care system. We identified and characterized unplanned health care utilization during the 90-day global period following urological prosthetic surgery. METHODS: Records of patients undergoing penile prosthesis implantation and/or artificial urinary sphincter placement by a single surgeon between January 2011 and November 2016 were retrospectively reviewed. Unplanned visits to the urology clinic, emergency department and/or hospital for each patient within 90 days of surgery were identified and characterized. RESULTS: Of the 288 surgeries performed during the designated study period 214 were for inflatable penile prosthesis, 59 for artificial urinary sphincter and 15 for a combination. There were 58 unplanned in-global clinic encounters, 13 emergency department visits and 7 hospital readmissions. Unplanned clinic visits were most common for additional teaching, voiding issues and incision concerns, presenting an average of 39 days postoperatively. Emergency department visits were most commonly due to voiding issues and incision concerns, presenting an average of 25 days postoperatively. Hospital readmissions were most common for complications and incision concerns, presenting an average of 23 days postoperatively. CONCLUSIONS: Most unplanned visits during the 90-day global period following urological prosthetic surgery do not require hospital readmission. Improved preoperative counseling, instruction before hospital discharge and/or scheduled phone contact with patients during recovery may reduce unnecessary resource use.

Ushering in the era of penile transplantation.

Penile transplantation is a novel approach to management of penile loss in the developing field of composite tissue allotransplantation (CTA). Prior management for significant penile loss has been free flap phalloplasty with issues related to function, cosmesis, and functional loss from the location of flap harvest. Transplantation has been an evolving field with advancement in CTA over the past several decades leading to the option of penile transplant. Management of penile injury with replantation provided some preliminary groundwork on the technical aspects for penile transplantation. Additionally, penile transplantation raises many ethical, emotional, and psychological considerations with need for patience amidst ongoing advancement within the field.

Prostate cancer survivorship: Implementation of survivorship care plans to meet the mandate and enhance urologic practice through collaborative care.

Prostate cancer is the most common malignancy among the male survivorship population in the United States, representing 44% of approximately 7 million survivors. In the era of modern medicine and value-based care, successfully treating only the cancer is not sufficient. The cancer survivor represents an individual in need of restoration and protection against future events. A well-designed and well-supported survivorship program not only meets a mandate for accreditation, it logically translates into better patient care. This review summarizes the history of the survivorship movement, outlines some key elements of a survivorship program, and highlights the opportunity to apply these principles to improve cancer-related care, develop relationships with colleagues that may allow increased identification of men at risk, and expand both the experience and outcomes of individual specialists within men's health.