Pub Date : 2023-09-01DOI: 10.1097/ju9.0000000000000045
Ariel T. Cohen, Danae M. Hamouda, Katherine S Jerew, Thomas M. Blomquist, Firas G. Petros
The Birt-Hogg-Dube (BHD) syndrome is an autosomal dominant genodermatosis harboring a mutated gene encoding for a protein known as folliculin. BHD is associated with increased risk of renal cell carcinoma (RCC), especially chromophobe/oncocytic hybrid tumors. The mutations driving clear cell RCC (ccRCC) in BHD remain investigational. We describe a case of BHD syndrome with a metachronous metastatic ccRCC and genomic alterations.
{"title":"Metastatic Clear Cell-Renal Cell Carcinoma in Birt-Hogg-Dube Syndrome","authors":"Ariel T. Cohen, Danae M. Hamouda, Katherine S Jerew, Thomas M. Blomquist, Firas G. Petros","doi":"10.1097/ju9.0000000000000045","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000045","url":null,"abstract":"\u0000 The Birt-Hogg-Dube (BHD) syndrome is an autosomal dominant genodermatosis harboring a mutated gene encoding for a protein known as folliculin. BHD is associated with increased risk of renal cell carcinoma (RCC), especially chromophobe/oncocytic hybrid tumors. The mutations driving clear cell RCC (ccRCC) in BHD remain investigational. We describe a case of BHD syndrome with a metachronous metastatic ccRCC and genomic alterations.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45664323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ju9.0000000000000050
Robert D. Norman, H. Garg, Lanette Rickborn, D. Kaushik, D. Pruthi, Ahmed M. Mansour, Ian M. Thompson, M. Liss
The clinical management of Atypical Small Acinar Proliferation (ASAP) and High-Grade Prostate Intraepithelial Neoplasia (HGPIN) varies significantly. The aim of this study was to characterize the incidence and natural history of ASAP and HGPIN lesions to optimize follow-up strategies. A retrospective analysis of patients at a VA Medical Center who underwent a prostate needle biopsy between 1988 and 2017 was performed. The pathological lesions were grouped as ASAP, HGPIN, and ASAP & HGPIN. The primary outcome was the incidence of clinically significant prostate cancer (csPCa) defined as grade group ≥2 prostate cancer. Of 6104 patients screened, 312 patients included having ASAP (n = 70, 1.1%), HGPIN (n = 222, 3.6%), or ASAP & HGPIN (n = 20, 0.3%). Follow-up biopsy was performed in 99.3% of patients. The incidence of prostate cancer in ASAP, HGPIN, or ASAP & HGPIN groups was 46.3%, 37%, and 68.4%, respectively (P = .03). However, the rate of csPCa was similar across the 3 groups (10.1% in ASAP, 10.3% in HGPIN, and 10.5% in ASAP & HGPIN, P = .6). The median time to cancer diagnosis was significantly shorter for patients with ASAP (2.8 years for ASAP, 4.9 years for HGPIN, and 1.5 years for ASAP & HGPIN, P = .001); however, there was no significant difference in time to diagnosis of csPCa between the various groups (P = .7). Both ASAP and HGPIN have a low risk of progression to csPCa. This, coupled with a prolonged time to any cancer diagnosis, suggests that immediate repeat biopsy might not be necessary among these patients.
{"title":"Clinically Significant Prostate Cancer in Men With High-Grade Intraepithelial Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation","authors":"Robert D. Norman, H. Garg, Lanette Rickborn, D. Kaushik, D. Pruthi, Ahmed M. Mansour, Ian M. Thompson, M. Liss","doi":"10.1097/ju9.0000000000000050","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000050","url":null,"abstract":"\u0000 \u0000 The clinical management of Atypical Small Acinar Proliferation (ASAP) and High-Grade Prostate Intraepithelial Neoplasia (HGPIN) varies significantly. The aim of this study was to characterize the incidence and natural history of ASAP and HGPIN lesions to optimize follow-up strategies.\u0000 \u0000 \u0000 \u0000 A retrospective analysis of patients at a VA Medical Center who underwent a prostate needle biopsy between 1988 and 2017 was performed. The pathological lesions were grouped as ASAP, HGPIN, and ASAP & HGPIN. The primary outcome was the incidence of clinically significant prostate cancer (csPCa) defined as grade group ≥2 prostate cancer.\u0000 \u0000 \u0000 \u0000 Of 6104 patients screened, 312 patients included having ASAP (n = 70, 1.1%), HGPIN (n = 222, 3.6%), or ASAP & HGPIN (n = 20, 0.3%). Follow-up biopsy was performed in 99.3% of patients. The incidence of prostate cancer in ASAP, HGPIN, or ASAP & HGPIN groups was 46.3%, 37%, and 68.4%, respectively (P = .03). However, the rate of csPCa was similar across the 3 groups (10.1% in ASAP, 10.3% in HGPIN, and 10.5% in ASAP & HGPIN, P = .6). The median time to cancer diagnosis was significantly shorter for patients with ASAP (2.8 years for ASAP, 4.9 years for HGPIN, and 1.5 years for ASAP & HGPIN, P = .001); however, there was no significant difference in time to diagnosis of csPCa between the various groups (P = .7).\u0000 \u0000 \u0000 \u0000 Both ASAP and HGPIN have a low risk of progression to csPCa. This, coupled with a prolonged time to any cancer diagnosis, suggests that immediate repeat biopsy might not be necessary among these patients.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47239510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ju9.0000000000000053
Kiyoshi Takahara, M. Kusaka, R. Shiroki
Detailed knowledge of the anatomical relationships between renal tumors, vascular structures, and the urinary tract is required to perform robot-assisted partial nephrectomies (RAPNs) successfully. Recent improvements in imaging modalities include computed tomography and magnetic resonance imaging. In addition, 3-dimensional (3D) workstation systems for intraoperative navigation have also been developed. This report introduces a novel 3D workstation system for intraoperative navigation while performing RAPN called “Atrena.” Atrena is equipped with multiple methods for the stereoscopic viewing of 3D images. Furthermore, Atrena operates on a tablet. Therefore, using Atrena in RAPN enables the rotation and enlargement of stereoscopic 3D images through manipulations on the tablet's screen. Atrena was successfully used for intraoperative navigation in initial 15 cases of RAPN with high trifecta achievement ratios. We believe that this novel 3D workstation system, “Atrena,” is beneficial in performing RAPN and enhances its success. We also believe that Atrena may be useful as an educational tool for medical staff.
{"title":"Novel Three-Dimensional Workstation System for Intraoperative Navigation in Robot-Assisted Partial Nephrectomy: A Single-Arm Study","authors":"Kiyoshi Takahara, M. Kusaka, R. Shiroki","doi":"10.1097/ju9.0000000000000053","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000053","url":null,"abstract":"\u0000 Detailed knowledge of the anatomical relationships between renal tumors, vascular structures, and the urinary tract is required to perform robot-assisted partial nephrectomies (RAPNs) successfully. Recent improvements in imaging modalities include computed tomography and magnetic resonance imaging. In addition, 3-dimensional (3D) workstation systems for intraoperative navigation have also been developed. This report introduces a novel 3D workstation system for intraoperative navigation while performing RAPN called “Atrena.” Atrena is equipped with multiple methods for the stereoscopic viewing of 3D images. Furthermore, Atrena operates on a tablet. Therefore, using Atrena in RAPN enables the rotation and enlargement of stereoscopic 3D images through manipulations on the tablet's screen. Atrena was successfully used for intraoperative navigation in initial 15 cases of RAPN with high trifecta achievement ratios. We believe that this novel 3D workstation system, “Atrena,” is beneficial in performing RAPN and enhances its success. We also believe that Atrena may be useful as an educational tool for medical staff.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42679649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ju9.0000000000000049
Husain Abizer Rasheed, Olivia Hazelrigg, Patrick Magnus Rasmussen, Hamza Mustafa Raja, Mary C Blazek, Julia Chen, Chad Ellimoottil
Since March 2020, telehealth has been a major part of health care delivery. Observational studies have shown that seniors, minorities, low-income Americans, and rural Americans have proportionally greater challenges in accessing telehealth compared with their counterparts. However, strategies to overcome these challenges have not been fully addressed. The objective of this study was to understand in greater detail the challenges patients face with video visits and introduce specific strategies to address these problems. We collected data on the technical barriers faced by patients through phone calls from a medical student-run volunteer program that assisted patients with telehealth visits through an electronic health record referral system. Our study identified 4 main issues faced by patients that prevent successful video visits: (1) completion of registration steps, (2) familiarity with accessing and using video conferencing software, (3) attainment of proxy access for parents of a pediatric patient, and (4) resolution of miscellaneous technical queries. We addressed these issues through a structured workflow algorithm, which provided patients with an opportunity to receive a live walk-through of the steps for registering for a video visit, practice with video conferencing software, and guidance to resources and answers to any issues in the process. This study provides practical guidance for overcoming the challenges that patients face with video visits. These strategies can be used in any urology practice to improve video visit adoption and telehealth access in patient populations where challenges may exist.
{"title":"Practical Strategies for Addressing Video Visit Access Barriers in Urology.","authors":"Husain Abizer Rasheed, Olivia Hazelrigg, Patrick Magnus Rasmussen, Hamza Mustafa Raja, Mary C Blazek, Julia Chen, Chad Ellimoottil","doi":"10.1097/ju9.0000000000000049","DOIUrl":"10.1097/ju9.0000000000000049","url":null,"abstract":"Since March 2020, telehealth has been a major part of health care delivery. Observational studies have shown that seniors, minorities, low-income Americans, and rural Americans have proportionally greater challenges in accessing telehealth compared with their counterparts. However, strategies to overcome these challenges have not been fully addressed. The objective of this study was to understand in greater detail the challenges patients face with video visits and introduce specific strategies to address these problems.\u0000 \u0000 \u0000 \u0000 We collected data on the technical barriers faced by patients through phone calls from a medical student-run volunteer program that assisted patients with telehealth visits through an electronic health record referral system.\u0000 \u0000 \u0000 \u0000 Our study identified 4 main issues faced by patients that prevent successful video visits: (1) completion of registration steps, (2) familiarity with accessing and using video conferencing software, (3) attainment of proxy access for parents of a pediatric patient, and (4) resolution of miscellaneous technical queries. We addressed these issues through a structured workflow algorithm, which provided patients with an opportunity to receive a live walk-through of the steps for registering for a video visit, practice with video conferencing software, and guidance to resources and answers to any issues in the process.\u0000 \u0000 \u0000 \u0000 This study provides practical guidance for overcoming the challenges that patients face with video visits. These strategies can be used in any urology practice to improve video visit adoption and telehealth access in patient populations where challenges may exist.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"1 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10558116/pdf/nihms-1930078.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ju9.0000000000000061
John W. Davis
AUGUST 2023 ISSUE REVIEW The case report by Raheem et al1 is our first for our methods section called videos and manuscripts. The contents are primarily video-based surgical footage with related outcomes and a standard index searchable abstract. We hope to have a steady interest in this format of publishing, which is common in many other types of surgical journals, and now a first for our AUA family of journals. In this work, the authors demonstrate several problem-solving tips and tricks for a neophallus that were creating redundant skin, incontinence, and foul-smelling urine. Congrats to the team for getting this section started. In a case report for our rare conditions section, Schwartz et al2 describe a highly rare incidence of a lipoma of the upper urinary tract. The imaging shows a clear filling defect that would be urothelial carcinoma until proven otherwise vs a blood clot. The lesion was successfully biopsied, fulgurated, and removed with a wire basket—all endoscopic and nephron sparing. The lesion did not appear like urothelial nor have an associated positive cytology—2 good clues to avoid nephroureterectomy and consider rare incidence of benign pathology. Holdren et al3 report an in-depth look at the commonly encountered anatomic feature of adipose tissue covering the anterior prostate and bladder neck. This region is often labeled as periprostatic, anterior, or periurethral fat and may or may not contain histological lymph nodes. Surgeons often dissect this tissue to see the bladder neck plane better and may or may not submit the tissue for analysis. In this retrospective review, the cohort for analysis is a familiar flow of events: 1177 radical prostatectomy cases, with 786 containing lymph nodes, 340 with periurethral tissue submitted, and a final group of 58 that had periurethral lymph nodes on histological examination. Of the 58, 15.5% were positive for cancer, and only 1 patient had concomitant positive pelvic lymph nodes. They observed statistically significant higher average PSA, Gleason score, and staging. Personally, I would advise 2 scenarios: (1) if the patient has typical indications for a pelvic lymph node dissection, then add the periurethral to the submission and (2) if the patient will not have a pelvic lymph node dissection, it may be better to submit periurethral tissue if it is being dissected away and otherwise discarded. Some thin patients have only scant tissue in this plane, and I understand this step being omitted, as you can see from the flow of this cohort from overall population to the group studied with lymph node tissue submitted and demonstrated on histological examination. The study by Chughtai et al4 is essentially a pharmaceutical laboratory investigation into the highly practical question as to whether supplements, such as saw Palmetto, contain standardized active ingredients. It has been my longstanding impression that these categories of supplements that are not approved by the Food and Drug Adminis
{"title":"JU Open Plus: The Train to Seoul","authors":"John W. Davis","doi":"10.1097/ju9.0000000000000061","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000061","url":null,"abstract":"AUGUST 2023 ISSUE REVIEW The case report by Raheem et al1 is our first for our methods section called videos and manuscripts. The contents are primarily video-based surgical footage with related outcomes and a standard index searchable abstract. We hope to have a steady interest in this format of publishing, which is common in many other types of surgical journals, and now a first for our AUA family of journals. In this work, the authors demonstrate several problem-solving tips and tricks for a neophallus that were creating redundant skin, incontinence, and foul-smelling urine. Congrats to the team for getting this section started. In a case report for our rare conditions section, Schwartz et al2 describe a highly rare incidence of a lipoma of the upper urinary tract. The imaging shows a clear filling defect that would be urothelial carcinoma until proven otherwise vs a blood clot. The lesion was successfully biopsied, fulgurated, and removed with a wire basket—all endoscopic and nephron sparing. The lesion did not appear like urothelial nor have an associated positive cytology—2 good clues to avoid nephroureterectomy and consider rare incidence of benign pathology. Holdren et al3 report an in-depth look at the commonly encountered anatomic feature of adipose tissue covering the anterior prostate and bladder neck. This region is often labeled as periprostatic, anterior, or periurethral fat and may or may not contain histological lymph nodes. Surgeons often dissect this tissue to see the bladder neck plane better and may or may not submit the tissue for analysis. In this retrospective review, the cohort for analysis is a familiar flow of events: 1177 radical prostatectomy cases, with 786 containing lymph nodes, 340 with periurethral tissue submitted, and a final group of 58 that had periurethral lymph nodes on histological examination. Of the 58, 15.5% were positive for cancer, and only 1 patient had concomitant positive pelvic lymph nodes. They observed statistically significant higher average PSA, Gleason score, and staging. Personally, I would advise 2 scenarios: (1) if the patient has typical indications for a pelvic lymph node dissection, then add the periurethral to the submission and (2) if the patient will not have a pelvic lymph node dissection, it may be better to submit periurethral tissue if it is being dissected away and otherwise discarded. Some thin patients have only scant tissue in this plane, and I understand this step being omitted, as you can see from the flow of this cohort from overall population to the group studied with lymph node tissue submitted and demonstrated on histological examination. The study by Chughtai et al4 is essentially a pharmaceutical laboratory investigation into the highly practical question as to whether supplements, such as saw Palmetto, contain standardized active ingredients. It has been my longstanding impression that these categories of supplements that are not approved by the Food and Drug Adminis","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135348802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1097/ju9.0000000000000032
Yundong Xuan, Q. Cheng, Kan Liu, Xintao Li, Yang Fan, P. Zhang, Hanfeng Wang, Xupeng Zhao, Shuo Tian, Jichen Wang, Baojun Wang, Yu Gao, Xu Zhang
The purpose of this study was to elucidate the feasibility and safety of the technique of robot-assisted laparoscopic adrenal metastasectomy (RAL-AME) for adrenal metastasis (AM) originating from renal cell carcinoma (RCC) with surgical history. From October 2015 to September 2020, RAL-AME was performed on 13 patients with AM from RCC with surgical history by using a transperitoneal approach. Whether metastasis occurs on the left or right side, adhesiolysis is required in the supine position from the contralateral side to the affected side. Three planes were established sequentially to separate the AM with patients converted into a lateral decubitus position. The first dissection plane was between the inferior side of the liver for right AM or spleen for left AM and the posterior side of the colon. The second dissections plane was established between the anterior renal fascia and the lateral aspect of perirenal fat. Care should be taken to avoid damaging the aorta or inferior vena cava when establishing the left or right plane. The third dissection plane was achieved between the retrorenal fascia and the anterior aspect of the psoas major. The metastasis was identified and en bloc–excised. The median operative time was 127 minutes (range 60-290), and median estimated blood loss was 50 ml (range 20-500). The average time to oral intake and hospital length of stay were 2.5 and 2.8 days, respectively. Perioperative complications and conversion to open surgery were not observed. All surgical margins were negative. RAL-AME for adrenal metastasis is safe and feasible. The therapeutic effect and overall survival rate require further investigation with a larger sample size and longer follow-up.
{"title":"Robot-Assisted Laparoscopic Adrenal Metastasectomy With Prior Partial or Radical Nephrectomy: Step-by-Step Technique and 1-Year Outcomes","authors":"Yundong Xuan, Q. Cheng, Kan Liu, Xintao Li, Yang Fan, P. Zhang, Hanfeng Wang, Xupeng Zhao, Shuo Tian, Jichen Wang, Baojun Wang, Yu Gao, Xu Zhang","doi":"10.1097/ju9.0000000000000032","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000032","url":null,"abstract":"\u0000 \u0000 The purpose of this study was to elucidate the feasibility and safety of the technique of robot-assisted laparoscopic adrenal metastasectomy (RAL-AME) for adrenal metastasis (AM) originating from renal cell carcinoma (RCC) with surgical history.\u0000 \u0000 \u0000 \u0000 From October 2015 to September 2020, RAL-AME was performed on 13 patients with AM from RCC with surgical history by using a transperitoneal approach. Whether metastasis occurs on the left or right side, adhesiolysis is required in the supine position from the contralateral side to the affected side. Three planes were established sequentially to separate the AM with patients converted into a lateral decubitus position. The first dissection plane was between the inferior side of the liver for right AM or spleen for left AM and the posterior side of the colon. The second dissections plane was established between the anterior renal fascia and the lateral aspect of perirenal fat. Care should be taken to avoid damaging the aorta or inferior vena cava when establishing the left or right plane. The third dissection plane was achieved between the retrorenal fascia and the anterior aspect of the psoas major. The metastasis was identified and en bloc–excised.\u0000 \u0000 \u0000 \u0000 The median operative time was 127 minutes (range 60-290), and median estimated blood loss was 50 ml (range 20-500). The average time to oral intake and hospital length of stay were 2.5 and 2.8 days, respectively. Perioperative complications and conversion to open surgery were not observed. All surgical margins were negative.\u0000 \u0000 \u0000 \u0000 RAL-AME for adrenal metastasis is safe and feasible. The therapeutic effect and overall survival rate require further investigation with a larger sample size and longer follow-up.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45457086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1097/ju9.0000000000000051
John W. Davis
{"title":"JU Open Plus: A Little Business…Hopefully a Little More Time Off","authors":"John W. Davis","doi":"10.1097/ju9.0000000000000051","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000051","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42738454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1097/ju9.0000000000000031
O. Raheem, Parviz Hajiyev, A. Al-Malki, E. Kocjancic
The aim of this video is to demonstrate step-by-step surgical techniques for neophallus and urethroplasty revisions, emphasizing key reconstructive maneuvers and improving patient outcomes. Neophallus and urethroplasty revisions can be challenging procedures associated with complications. We present a 25-year-old male with a history of ambiguous genitalia and micropenis due to 17-hydroxylase deficiency. The patient presented with bothersome penile skin redundancy at the base of the neophallus and a history of intermittent urinary incontinence, necessitating “milking the base of the neophallus” to completely evacuate his urethra. The patient also reported foul-smelling discharge with urine. Imaging evaluation, including retrograde urethrogram and voiding cystogram, revealed a smooth cystic dilatation of the posterior urethra with a normal bladder contour and capacity. Further evaluation with cystoscopy identified a Mullerian duct remnant in the urethra. We recommend surgical excision of the remnant and neophallus skin revision using intraoperative SPY Indocyanine green to carefully delineate the blood supply to the neophallus and mitigate potential risks and complications. This paper demonstrates step-by-step surgical techniques for neophallus and urethroplasty revisions, highlighting key surgical maneuvers such as using intraoperative SPY Indocyanine green to delineate blood supply, excision of the Mullerian duct cystic lesion, and urethroplasty. These techniques aim to improve patient outcomes by addressing penile skin redundancy and urinary incontinence while minimizing potential complications. As neophallus reconstruction becomes increasingly common, familiarity with surgical anatomy, complications management, and outcomes is essential. This video provides a valuable resource for surgical education and may aid in the improvement of patient outcomes.
{"title":"Neophallus and Urethroplasty Revisions: Step-by-step Surgical Techniques and Key Reconstructive Maneuvers","authors":"O. Raheem, Parviz Hajiyev, A. Al-Malki, E. Kocjancic","doi":"10.1097/ju9.0000000000000031","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000031","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 The aim of this video is to demonstrate step-by-step surgical techniques for neophallus and urethroplasty revisions, emphasizing key reconstructive maneuvers and improving patient outcomes.\u0000 \u0000 \u0000 \u0000 Neophallus and urethroplasty revisions can be challenging procedures associated with complications. We present a 25-year-old male with a history of ambiguous genitalia and micropenis due to 17-hydroxylase deficiency. The patient presented with bothersome penile skin redundancy at the base of the neophallus and a history of intermittent urinary incontinence, necessitating “milking the base of the neophallus” to completely evacuate his urethra. The patient also reported foul-smelling discharge with urine. Imaging evaluation, including retrograde urethrogram and voiding cystogram, revealed a smooth cystic dilatation of the posterior urethra with a normal bladder contour and capacity. Further evaluation with cystoscopy identified a Mullerian duct remnant in the urethra. We recommend surgical excision of the remnant and neophallus skin revision using intraoperative SPY Indocyanine green to carefully delineate the blood supply to the neophallus and mitigate potential risks and complications.\u0000 \u0000 \u0000 \u0000 This paper demonstrates step-by-step surgical techniques for neophallus and urethroplasty revisions, highlighting key surgical maneuvers such as using intraoperative SPY Indocyanine green to delineate blood supply, excision of the Mullerian duct cystic lesion, and urethroplasty. These techniques aim to improve patient outcomes by addressing penile skin redundancy and urinary incontinence while minimizing potential complications.\u0000 \u0000 \u0000 \u0000 As neophallus reconstruction becomes increasingly common, familiarity with surgical anatomy, complications management, and outcomes is essential. This video provides a valuable resource for surgical education and may aid in the improvement of patient outcomes.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49015167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1097/ju9.0000000000000040
B. Chughtai, N. Bhojani, K. Zorn, D. Elterman
Some men with mild-to-moderate benign prostatic hyperplasia/lower urinary tract symptoms use saw palmetto supplements to proactively manage their symptoms as an alternative to watchful waiting and/or to avoid prescription medication side effects. This study assessed the potency and authenticity of commercially available saw palmetto–based supplements in the United States. Twenty-eight saw palmetto berry powders, powdered extracts, berry blends, lipid extracts, and multiactive products (lycopene, pumpkin oil, etc) were purchased from major online retailers and retail stores. Total fatty acid content (% weight/weight) and individual fatty acid profile of each product were determined using validated gas chromatography-fatty acid methyl ester methodology and compared with the US Pharmacopeia monograph standards for lipidosterolic extracts of Serenoa repens. Total fatty acid content ranged from 0.796% for a berry powder product to 89.923% for a lipid extract product. None of the berry powders or powdered extracts, 6 of 9 lipid extracts, and 1 multiactive product met criteria for ≥80% total fatty acid content. Only 1 of the 28 products met the US Pharmacopeia criteria for a standardized lipidosterolic extract, defined as total fatty acid content ≥80% and a fatty acid profile indicative of authentic S. repens based on the ratios of the lauric acid concentration to 9 other individual fatty acid concentrations. There is substantial heterogeneity in fatty acid content and profile in saw palmetto supplements. Lipidosterolic extracts of saw palmetto berries standardized to ≥80% fatty acids are most likely to meet established criteria for quality and identity.
{"title":"Variability of Commercial Saw Palmetto–Based Supplements for the Management of Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms","authors":"B. Chughtai, N. Bhojani, K. Zorn, D. Elterman","doi":"10.1097/ju9.0000000000000040","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000040","url":null,"abstract":"\u0000 \u0000 \u0000 Some men with mild-to-moderate benign prostatic hyperplasia/lower urinary tract symptoms use saw palmetto supplements to proactively manage their symptoms as an alternative to watchful waiting and/or to avoid prescription medication side effects. This study assessed the potency and authenticity of commercially available saw palmetto–based supplements in the United States.\u0000 \u0000 \u0000 \u0000 Twenty-eight saw palmetto berry powders, powdered extracts, berry blends, lipid extracts, and multiactive products (lycopene, pumpkin oil, etc) were purchased from major online retailers and retail stores. Total fatty acid content (% weight/weight) and individual fatty acid profile of each product were determined using validated gas chromatography-fatty acid methyl ester methodology and compared with the US Pharmacopeia monograph standards for lipidosterolic extracts of Serenoa repens.\u0000 \u0000 \u0000 \u0000 \u0000 Total fatty acid content ranged from 0.796% for a berry powder product to 89.923% for a lipid extract product. None of the berry powders or powdered extracts, 6 of 9 lipid extracts, and 1 multiactive product met criteria for ≥80% total fatty acid content. Only 1 of the 28 products met the US Pharmacopeia criteria for a standardized lipidosterolic extract, defined as total fatty acid content ≥80% and a fatty acid profile indicative of authentic S. repens based on the ratios of the lauric acid concentration to 9 other individual fatty acid concentrations.\u0000 \u0000 \u0000 \u0000 There is substantial heterogeneity in fatty acid content and profile in saw palmetto supplements. Lipidosterolic extracts of saw palmetto berries standardized to ≥80% fatty acids are most likely to meet established criteria for quality and identity.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45951875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1097/ju9.0000000000000044
A. Schwartz, Eric E. Santos, Metin Aksu
We report an exceptionally rare case, documenting the diagnosis and treatment of a lipoma of the renal pelvis in a 66-year-old White woman. This case represents the second reported lipoma in the upper urinary tract. An incidentally found filling defect in the right renal pelvis identified on CT scan in a 66-year-old woman resulted in referral to urology. Ureteroscopy was used to visualize, biopsy, and remove the tumor, with complete sparing of the kidney and associated structures. Histological analysis of the lesion revealed a benign tumor of mature adipocytes. The patient has been monitored for over 15 months postoperatively with no evidence of recurrence. This case serves as a reminder that many different nonmalignant lesions may be found throughout the upper urinary tract. It also highlights the kidney-sparing benefits of using ureteroscopic approaches whenever feasible in the timely diagnosis and treatment of upper urinary tract lesions.
{"title":"Lipoma of Renal Pelvis, Case Report of a Rare Upper Urinary Tract Tumor","authors":"A. Schwartz, Eric E. Santos, Metin Aksu","doi":"10.1097/ju9.0000000000000044","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000044","url":null,"abstract":"\u0000 \u0000 \u0000 We report an exceptionally rare case, documenting the diagnosis and treatment of a lipoma of the renal pelvis in a 66-year-old White woman. This case represents the second reported lipoma in the upper urinary tract.\u0000 \u0000 \u0000 \u0000 An incidentally found filling defect in the right renal pelvis identified on CT scan in a 66-year-old woman resulted in referral to urology. Ureteroscopy was used to visualize, biopsy, and remove the tumor, with complete sparing of the kidney and associated structures. Histological analysis of the lesion revealed a benign tumor of mature adipocytes. The patient has been monitored for over 15 months postoperatively with no evidence of recurrence.\u0000 \u0000 \u0000 \u0000 This case serves as a reminder that many different nonmalignant lesions may be found throughout the upper urinary tract. It also highlights the kidney-sparing benefits of using ureteroscopic approaches whenever feasible in the timely diagnosis and treatment of upper urinary tract lesions.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47927123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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