Take home messages by Joseph Y. Clark
2022 Kimbrough at Rancho Mirage:
Many thanks to Dr. Clark for taking the time to make this contribution.
- Despite COVID, one military hospital system in San Antonio was able to be flexible and make adjustments so that there was no significant decrease in operative case numbers for residents.
- Use of SelectMDx in evaluating patients with elevated PSA can help stratify risk and select patients to go on to have MRI and targeted biopsy.
- Results of MRI-fusion biopsies shows that the most benefit was gained in patients who were biopsy naïve.
- When comparing outcomes of artificial urinary sphincter placement in patients with and without prior sling surgery, there was no difference in incidence or time interval until revision or explantation.
- In a pilot study using 12 rabbits undergoing lower pole partial nephrectomy, depth of the renorrhaphy sutures was not associated with depth of necrosis, but the lower suture tension (0.04 lbs) had a higher depth of necrosis than the higher suture tension (0.08 lbs) closure.
- In a small study, drinking apple cider vinegar and lemon drink did not increase urinary citrate levels, although drinking orange soda and coconut water did.
- In the pediatric population, the renal pelvic diameter change before and after furosemide administration on functional MR urogram can predict obstruction (decreased % change in renal pelvic diameter compared with the normal contralateral kidney can predict obstruction).
- Based on a retrospective analysis of MTFs in the San Diego region, there was an association between a diagnosis of several neuropsychiatric diseases with elimination dysfunction and voiding dysfunction.
- A systematic review of the literature showed that nephrectomy for pediatric unilateral nephrogenic hypertension may offer an alternative to long-term antihypertensive medication with modest success.
- In pediatric patients with duplex systems, circumcision and antibiotic prophylaxis after the first year of life can decrease UTIs, and grade of hydronephrosis and UTI events predict surgical intervention.
- There was a trend towards decreased recurrence when TURBT was performed by loop resection instead of cold cup biopsy, with patients with multifocal or high-grade disease having the most benefit from loop resection.
- In male Akita mice with diabetes, there was progression to underactive bladder, manifested by increase in voided volume and decreased urinary frequency (without first having overactive bladder), and seems to be independent of NLRP3 mediated inflammation.
- Patients who have had a negative microhematuria workup with a CT urogram and cystoscopy may not need additional evaluation unless they develop gross hematuria.
- Based on receiver operating characteristics, lowering the threshold for chromosome analysis to patients with a sperm count of <1 million/mL maintains acceptable performance and would result in cost savings.
- Though rare, malignant priapism should be considered in patients with apparently idiopathic priapism.
- Peripheral sacral neuromodulation may be effective in children with refractory bowel and bladder dysfunction.
- A prospective observational study of 63 patients who had lower extremity duplex ultrasound before and after urologic surgeries show low incidence (0%) of DVTs.
- It is possible to perform robotic-assisted repair of benign distal uretero-enteric stricture following radical cystectomy.
- The incidence of testicular cancer in the MHS is significantly higher than that of the general population and these patients have low levels of recurrence and mortality and a high level of adjuvant therapy for low stage disease.
- A database of microwave ablation of renal masses between 3-4 cm shows non-inferiority to renal masses <3 cm, although the median follow-up was <2 years.
- Urethral strictures and stenosis from HIFU are complex, usually involve the prostatic urethra, and difficult to treat, resulting in a significant treatment burden, often managed with repeated endoscopic procedures or extirpative surgery, to include urinary diversion.
- Despite the standardized VCUG protocol published in 2016 by the American Academy of Pediatrics Sections on Urology and Radiology, VCUG reports remain inconsistent.
- In patients with genitourinary involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis, Foley catheters do not seem to be necessary to prevent urethral strictures.
- With increasing PI-RADS score, there was good correlation with detecting clinically significant prostate cancer on cognitive fusion biopsies.