To determine whether preoperative partner involvement at clinic appointments is associated with deviation from a standardized postoperative care pathway for patients undergoing an inflatable penile ...prosthesis placement.
This is a retrospective study of 170 patients undergoing primary inflatable penile prosthesis placement performed by a single surgeon between 2017 and 2020. A standardized postoperative clinical pathway was used, including planned follow-up visits at 2 weeks (for wound check and device deflation) and 6 weeks (for device teaching). Patient characteristics, including demographics, partner involvement, and the number of follow-up visits were obtained from the medical record. Logistic regression modeling was performed to determine whether partner involvement was associated with unanticipated follow-up visits.
Partners were involved in preoperative visits for 92 patients (54%). Additional unplanned follow-up visits were observed for 58 patients (34%) between 0 and 6 weeks and for 28 patients (16%) after 6 weeks from surgery. Partner involvement was associated with reduced odds of unanticipated follow-up visits, both between 0 and 6 weeks (odds ratios 0.37, 95% CI 0.18-0.75) and after 6 weeks (odds ratios 0.33, 95% CI 0.13-0.81) in adjusted models.
Having a patient’s partner involved during the preoperative period is associated with a significant reduction in unanticipated follow-up. We would recommend that urologists routinely encourage patients considering the insertion of a penile prosthesis to involve their partners in perioperative visits. Further research needed is needed to determine how to best support patients during surgical decision-making and through the postoperative period.
To identify differences in healthcare expenditures and utilization by race in patients treated for common benign urologic conditions.
A retrospective secondary data analysis was conducted of patients ...with common benign urologic conditions using 2016-2018 Medical Expenditure Panel Survey data. Benign conditions included urolithiasis, cystitis, erectile dysfunction (ED), pelvic organ prolapse (POP), urinary incontinence (UI), and benign prostatic hyperplasia (BPH). Generalized linear models were used to evaluate the relationship between total healthcare expenditures and utilization and race for each condition. Adjusted analyses accounted for age, sex, number of chronic conditions, poverty status, self-reported health status, marital status, highest degree of educational attainment, and insurance status.
The weighted analysis sample consisted of 27,110,416 patients, of whom 80.9% were Non-Hispanic white, 6.9% Non-Hispanic black, and 12.2% other minority races. After adjustment, total healthcare expenditures were significantly lower for Non-Hispanic blacks (incidence rate ratio IRR = 0.19, 95% confidence interval CI: 0.06-0.61) and other minority races (IRR = 0.30, 95% CI: 0.10-0.88) compared to Non-Hispanic whites treated for ED. Similarly, compared to Non-Hispanic whites, healthcare expenditures were significantly lower for Non-Hispanic blacks treated for UI (IRR = 0.56, 95% CI: 0.35-0.90).
Healthcare expenditures are significantly lower for Non-Hispanic black patients treated for ED and UI in the US Future research is needed to determine if these differences represent an inequality in the delivery of urologic care for patients with these conditions.
To characterize patients at the greatest risk of morbidity and mortality after benign scrotal surgery.
A secondary data analysis was conducted of adults undergoing elective scrotal surgery for benign ...conditions using 2015-2020 American College of Surgeons National Surgical Quality Improvement data. Patients who experienced a postoperative complication, an unplanned procedure, or who died within 30-days of surgery were identified using the composite outcome “postoperative event”. Multiple logistic regression was used to examine the association between patient characteristics and the odds of experiencing a postoperative event.
The study consisted of 12,917 patients, of which 4.1% experienced a postoperative event. After adjustment, malnourishment (OR 4.1, 95% CI: 1.2 – 14.5) decreased functional status (OR 3.8, 95% CI: 2.0 – 7.1), bleeding disorders (OR 3.4, 95% CI: 2.2 – 5.4), age ≥ 40 years (OR 1.6, 95% CI: 1.2 – 2.0), chronic obstructive pulmonary disease, (COPD, OR 1.8, 95% CI: 1.2 – 2.6), smoking (OR 1.4, 95% CI: 1.2 – 1.8), diabetes (OR 1.3, 95% CI: 1.1 – 1.7) and increased body mass index (BMI, OR 1.1, 95% CI: 1.1-1.1) were identified as risk factors for a postoperative event. The risk of a postoperative event was 2.7%, 4.5%, and 11.2% for patients with none, 1 to 2, and > 2 risk factors, respectively.
Complications after benign scrotal surgery are not infrequent. Risk factors include malnourishment, decreased functional status, bleeding disorders, age, COPD, smoking, diabetes, and increased BMI. Our results can be used to counsel patients on their risk of negative outcomes following these procedures.
To analyze the accuracy of the 4 most commonly used online symptom checkers (OSCs) in diagnosing erectile dysfunction (ED), scrotal pain (SP), Peyronie's disease (PD), and low testosterone (LT).
...One-hundred and sixty artificial vignettes were created by de-identifying recent initial outpatient consults presenting to discuss ED (40), SP (40), PD (40), and LT (40). The vignettes were entered into the 4 most frequently used OSCs (WebMD, MedicineNet, EverydayHealth, and SutterHealth) as determined by web traffic analysis tools. The top 5 conditions listed in the OSC differential diagnosis were recorded and scored.
WebMD's accuracy for ED, SP, PD, and LT vignettes was 0%, 22.5%, 0%, and 95%, respectively.
EverydayHealth was only able to diagnose SP 20% of the time, and failed to diagnose ED, PD, or LT on all occasions.
MedicineNet diagnosed ED, PD, SP, and LT in 100%, 98%, 27.5%, and 0% of vignettes, respectively.
SutterHealth correctly diagnosed ED, SP, and LT in 100%, 20%, and 80% of patients, respectively.
Cumulatively, the OSCs were most accurate in diagnosing ED and least accurate in diagnosing SP when using the Top 1 (37.5% vs 6.9%) and Top 5 (50% vs 24.5%) of the suggested conditions.
No OSC could accurately diagnose all the conditions tested. The OSCs, on average, were poor at suggesting precise diagnoses for ED, PD, LT, SP. Patients and practitioners should be cautioned regarding the accuracy of OSCs.
Ectopic placement of penile prosthesis reservoirs has become more common in patients whose space of Retzius has been compromised.
To describe techniques and instruments used to place penile ...prosthesis reservoirs ectopically.
We present our method of placing ectopic reservoirs and review the literature for other techniques. We also catalog the instruments used for this purpose.
Similar to traditional reservoir placement, successful ectopic reservoir implantation requires good cosmetic and functional success and low complication rates.
Ectopic reservoir placement has been shown to be effective, to safely avoid bowel, bladder, and vascular injury, and to maintain excellent function and cosmesis. Multiple tools for ectopic placement have been described, but no data exist comparing their effectiveness and complications. Examples include dissection of the space anterior to the transversalis muscle using the surgeon's finger, a pediatric Yankauer suction tip, or a Foerster lung clamp. Instruments described to grasp and advance the reservoir include a sponge stick, a Foerster lung clamp, and the ectopic reservoir insertion tool (Sontec, Centennial, CO, USA). The effect of different instruments on the integrity of reservoir has not been extensively studied.
Attention to technique and the instruments used to dissect the ectopic space and grasp the reservoir are crucial to successful ectopic reservoir placement.
Reports of vascular, bowel, or bladder injuries during ectopic placement are exceedingly rare, as are reports of injury to reservoirs caused by traumatic grasping. However, no methods or tools have been compared in head-to-head trials.
Ectopic placement is safe and effective, but differences between methods and instruments have not been delineated. Thirumavalavan N, Gross MS, Munarriz R. Techniques of Ectopic Reservoir Placement and Their Pitfalls. J Sex Med 2017;14:1451-1454.
We report on a novel dynamical phenomenon in electron spin resonance experiments of phosphorus donors. When strongly coupling the paramagnetic ensemble to a superconducting lumped element resonator, ...the coherent exchange between these two subsystems leads to a train of periodic, self-stimulated echoes after a conventional Hahn echo pulse sequence. The presence of these multiecho signatures is explained using a simple model based on spins rotating on the Bloch sphere, backed up by numerical calculations using the inhomogeneous Tavis-Cummings Hamiltonian.
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