Genitourinary Procedures Research Articles

Analyzing Antibiotic Usage Trends in Genitourinary Infections and Procedures: Insights from the TriNetX Database

ObjectiveTo analyze antibiotic prescribing trends, particularly the decline in fluoroquinolone use for various GUI and procedures, and the growing preference for alternative treatments. MethodsThe TriNetX database was queried for antibiotic utilization rates from 2016 to 2022. We analyzed cases of cystitis, pyelonephritis, prostatitis, and other GUIs as well as periprocedure utilization for benign prostatic hyperplasia (BPH), urethral stricture disease, pelvic organ prolapse/stress urinary incontinence (POP/SUI), and overactive bladder/interstitial cystitis (OAB/IC). We determined the top four to six antibiotics prescribed within five days of diagnosis or procedure. Statistical analysis included linear regression modeling. ResultsFrom 2016-2022, fluoroquinolone use decreased in cystitis (p<0.001), pyelonephritis (p < 0.001), and prostatitis (p < 0.01). These infections were increasingly treated with beta-lactams (p<0.0001, p<0.01, p<0.01, respectively). Additionally, we found a decrease in fluoroquinolone utilization in procedures for BPH (p<0.001), urethral stricture (p<0.01), POP/SUI (p<0.001), and OAB/IC (p < 0.001). All cohorts except for OAB/IC showed a significant increase in beta-lactam use (p<0.001, p<0.01, p<0.01, respectively). ConclusionsWe noted a significant decline in fluoroquinolone use for GUI and procedures, accompanied by increased beta-lactam use, reflecting changes in prescribing practices. Judicious use is essential to promote antimicrobial stewardship and mitigate severe adverse effects.

Risk factors for mortality in children with hemorrhagic cystitis after hematopoietic transplant

Hemorrhagic cystitis (HC) is a devastating complication of bone marrow (BMT) and stem cell transplant (SCT). Much of the literature has focused on exclusively adult patient populations, with limited evidence regarding risk factors for mortality and morbidity among pediatric HC patients. To examine factors associated with all-cause mortality in children with HC after BMT/SCT. The Pediatric Health Information System database was queried for patients with ICD-9/10 codes for hematopoietic transplant and gross hematuria, hematuria unspecified, or cystitis with hematuria. Multivariable logistic regression examined association of medical and surgical interventions frequently employed for hemorrhagic cystitis with mortality and genitourinary morbidity, defined as having received instillation of any bladder medication or having undergone any genitourinary procedure. A total of 811 patients, mean age of 12.4 years and 62% male, were included. Primary diagnosis included 388 (49%) leukemia/lymphoma, 182 (22%) blood dyscrasia, 99 (12%) solid organ tumor, 27 (3%) metabolic disease, 115 (14%) unknown. Transplant type included 377 (46%) bone marrow, 329 (41%) stem cell, 105, and (13%) unknown. Performing any bladder instillation (p<0.0001) or any type of GU procedure (p<0.0001) was significantly associated with mortality. On multivariate analysis, dialysis (OR=10.7, 95% CI=5.7-20.2), genitourinary morbidity (OR=4, 95% CI=2.2-6.8) and intravenous cidofovir (OR=2.0, 95% CI=1.2-3.3) were significantly associated with all cause mortality. Having an underlying diagnosis of blood dyscrasia was protective against mortality (OR=0.425, CI=0.205-0.88). In this large retrospective study evaluating factors associated with mortality in children with HC, all cause mortality was found to be 11%. This is probably an underrepresentation of true mortality in this population, as many patients discharged from the hospital likely die outside the hospital at home or hospice care. This study supports the current literature that invasive GU procedures are not associated with increased survival in patients with severe HC. This study is limited by retrospective use of a billing database that has the potential for errors in data entry and missing data. Patients who were discharged from the hospital were not captured by the PHIS which only collects data from inpatient stays. Patients with HC who received dialysis, intravenous cidofovir, or underwent GU intervention had significantly higher all-cause mortality. High grade HC is a marker of disease severity and efforts should be made by urologists and oncologists to maximize quality of life and limit futile treatments in this patient population.

Isolated and combined breast augmentation in transgender patients: Multi-institutional insights into early outcomes and risk factors

BackgroundThe increasing demand for gender-affirming surgery (GAS) in transgender and gender diverse healthcare highlights the importance of breast augmentation surgery (BAS) for transfeminine patients. Despite its significance, there is a lack of research on postoperative outcomes of BAS. MethodsWe analyzed the multi-institutional American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2008-2021) database to identify female transgender individuals (TGIs) who underwent BAS surgery, both isolated and combined with concurrent GAS procedures. We evaluated 30-day outcomes, including the incidence of mortality, reoperation, readmission as well as surgical and medical complication occurrence. ResultsOf 1,699 female TGIs, 92% underwent isolated BAS and 7.7% underwent combined BAS. The mean age and BMI were 36±12 years and 27±6.6 kg/m2. Isolated BAS showed a 2.8% complication rate, while combined BAS had a higher rate with 9.1%. Specifically, all complications occurred in patients undergoing BAS with concurrent genitourinary surgery (n=85; 14%), whereas no adverse events were recorded after combined BAS and facial feminization (n=19) or chondrolaryngoplasty (n=19). In patients seeking combined BAS, advanced age (p=0.05) and nicotine abuse (p=0.004) were identified as risk factors predisposing to adverse events, whereas ASA class 1 was found to be protective (p=0.02). ConclusionsIsolated BAS in TGIs demonstrates a positive safety profile. Combined surgeries, particularly with genitourinary procedures, pose higher risks. Identifying risk factors such as smoking and advanced age is crucial for patient selection and surgical planning. These findings can aid in refining patient eligibility and inform surgical decision-making for BAS.

Bladder stone formation due to neglected double J stent: a case report.

Double J (DJ) stents are commonly used in genitourinary procedures, but they can lead to complications including infection, hematuria, encrustation, and stone formation. The longer the duration of encrustation, the greater the risk of complications and renal dysfunction. Forgotten stents pose challenges for patients and can require endourological or open surgical procedures. A 40-year-old man with hypertension and coronary artery disease had a forgotten DJ stent for 3 years, causing suprapubic pain and dysuria. Kidney, ureter, and bladder (KUB) revealed a coiled DJ stent with a large bladder stone and encrustation, and an open cystolithotomy was successfully performed. Recovery was uneventful, and the patient was discharged without complication. Ureteral stents, including the DJ stent, are commonly used for urological conditions but can cause complications if retained beyond the intended timeframe. Optimal timing for stent removal is crucial, and patients' healthcare knowledge and adherence are critical to preventing retention. KUB X-ray can evaluate stent encrustation and bladder stones. Cystoscopy is the typical approach for stent removal, but supplementary interventions may be necessary. Open surgery was recommended for removing a large bladder stone and encrusted stent in this case. Timely removal of DJ stents is crucial to avoid complications. Extended retention can cause problems such as encrustation and stone formation. Patient education and adherence are essential to prevent retention and forgetfulness. This case report highlights the importance of careful management of patients with DJ stents for optimal outcomes and prevention of complications.

Assessment of Required Patient Travel to Receive Interventional Radiology Services in the Resource-Limited Setting of Tanzania

This study aimed to evaluate the geographic patient profile of a country’s first interventional radiology (IR) service in sub-Saharan Africa. From October 2018 to August 2022, travel time (1,339 patients) and home region (1,184 patients) were recorded from 1,434 patients who underwent IR procedures at Tanzania’s largest referral center. Distances traveled by road were calculated from the administrative capital of each region using a web mapping platform (google.com/maps). The effect of various factors on distance and time traveled were assessed. Patients from all 31 regions in Tanzania underwent IR procedures. The mean and maximum calculated distance traveled by patients were 241.6 km and 1,387 km, respectively (Sk2 = 1.66); 25.0% of patients traveled for over 6 hours for their procedure. Patients traveled furthest for genitourinary procedures (mean = 293.4 km) and least for angioplasty and stent placement (mean = 123.9 km) (P < .001). To increase population access and reduce travel times, geographic data should be used to decentralize services.

Assessment of potential peritonitis risk factors in pediatric patients receiving maintenance peritoneal dialysis.

Many recommendations regarding peritonitis prevention in international consensus guidelines are opinion-based rather than evidence-based. The aim of this study was to examine the impact of peritoneal dialysis (PD) catheter insertion technique, timing of gastrostomy placement, and use of prophylactic antibiotics prior to dental, gastrointestinal, and genitourinary procedures on the risk of peritonitis in pediatric patients on PD. We conducted a retrospective cohort study of pediatric patients on maintenance PD using data from the SCOPE collaborative from 2011 to 2022. Data pertaining to laparoscopic PD catheter insertion (vs. open), gastrostomy placement after PD catheter insertion (vs. before/concurrent), and no prophylactic antibiotics (vs. yes) were obtained. Multivariable generalized linear mixed modeling was used to assess the relationship between each exposure and occurrence of peritonitis. There was no significant association between PD catheter insertion technique and development of peritonitis (aOR = 2.50, 95% CI 0.64-9.80, p = 0.19). Patients who had a gastrostomy placed after PD catheter insertion had higher rates of peritonitis, but the difference was not statistically significant (aOR = 3.19, 95% CI 0.90-11.28, p = 0.07). Most patients received prophylactic antibiotics prior to procedures, but there was no significant association between prophylactic antibiotic use and peritonitis (aOR = 1.74, 95% CI 0.23-13.11, p = 0.59). PD catheter insertion technique does not appear to have a significant impact on peritonitis risk. Timing of gastrostomy placement may have some impact on peritonitis risk. Further study must be done to clarify the effect of prophylactic antibiotics on peritonitis risk. A higher resolution version of the Graphical abstract is available as Supplementary information.

MP76-20 TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: DATA FROM THE AUA QUALITY (AQUA) REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP76-20 TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: DATA FROM THE AUA QUALITY (AQUA) REGISTRY Charles Jones, Benjamin Breyer, Rachel Mbassa, William Meeks, Raymond Fang, and Matthew Cooperberg Charles JonesCharles Jones More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Rachel MbassaRachel Mbassa More articles by this author , William MeeksWilliam Meeks More articles by this author , Raymond FangRaymond Fang More articles by this author , and Matthew CooperbergMatthew Cooperberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The list of surgical options for benign prostatic hyperplasia (BPH) has exploded in recent years, but little is known about the uptake of these new procedures in community urology practice. In this study we aimed to examine surgical BPH practices and trends across the country using the American Urological Association Quality Registry (AQUA). METHODS: The AQUA Registry was launched in 2014 to centralize quality reporting and improvement, primarily among community-based urology practices. Data regarding surgical BPH management from 2014-2021 were accessioned directly from electronic health records at 245 practices across the country. Procedures were grouped by CPT code. These included prostatic urethral lift (Urolift), transurethral incision of the prostate (TUIP), transurethral resection of the prostate (TURP), repeat TURP, laser coagulation of the prostate, laser vaporization of the prostate, holmium laser enucleation of the prostate (HoLEP), transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), transurethral destruction of the prostate by water vapor thermal therapy (Rezum), simple prostatectomy, and other genitourinary procedure. Patients were characterized by race and age. Practice location was also examined. RESULTS: The mean age of BPH diagnosis was 66.4 years old. 72% were White, 7% Black, 1% Asian, and 20% unknown. A total of 300,215 BPH procedures were recorded from 2014-2021. TURP had the greatest overall decline from a relative incidence of 40.1% of total BPH procedures in 2016 to 25.6% in 2021. TURP was used for 32% of White patients, 34% of Black patients, and 26% of Asian patients. Urolift use grew from 0.7% of cases in 2014 to 30.1% in 2021. HoLEP comprised approximately 1% of procedures throughout the time period studied. CONCLUSIONS: There has been a large shift in the procedures of choice for surgical management of BPH within community urology practices in the United States, with Urolift having a significant increase in total and relative proportions of procedures performed since its FDA approval in 2013. There has been a concurrent decrease in TURP, while HoLEP has stayed relatively consistently uncommon in community practice. Source of Funding: AQUA Registry is funded by the American Urological Association © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1100 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Jones More articles by this author Benjamin Breyer More articles by this author Rachel Mbassa More articles by this author William Meeks More articles by this author Raymond Fang More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors and outcome due to extended-spectrum β-lactamase-producing uropathogenic Escherichia coli in community-onset bloodstream infections: A ten-year cohort study in Sweden.

To study clinical outcome and risk factors associated with extended-spectrum β-lactamase (ESBL)-producing uropathogenic Escherichia coli (UPEC) in community-onset bloodstream infections (CO-BSI). This was a population-based cohort study including patients with pheno- and genotype-matched ESBL-producing E. coli and non-ESBL- E. coli in urine and blood samples collected in 2009-2018 in southeast Sweden. Seventy-seven episodes of ESBL-UPEC satisfying the inclusion criteria were matched 1:1 with 77 non-ESBL-UPEC for age, gender, and year of culture. The most common ST-type and ESBL gene was ST131 (55%), and blaCTX-M-15 (47%), respectively. Risk factors for ESBL-UPEC were: previous genitourinary invasive procedure (RR 4.66; p = 0.005) or history of ESBL-producing E. coli (RR 12.14; p = 0.024). There was significant difference between ESBL-UPEC and non-ESBL-UPEC regarding time to microbiologically appropriate antibiotic therapy (27:15 h vs. 02:14 h; p = <0.001) and hospital days (9 vs. 5; p = <0.001), but no difference in 30-day mortality (3% vs. 3%; p = >0.999) or sepsis within 36 hours (51% vs. 62%; p = 0.623) was observed. The predominant risk factors for ESBL-UPEC were history of ESBL-Ec infection and history of genitourinary invasive procedure. The overall mortality was low and the delay in appropriate antibiotic therapy did not increase the risk for 30-day mortality or risk for sepsis within 36 hours among patients infected with ESBL UPEC. However, these results must be regarded with some degree of caution due to the small sample size.

Postpartum urinary incontinence in nulliparous and multiparous women

Background: postpartum urinary incontinence is an area of ​​growing interest at the health level because pelvic floor dysfunction caused by pregnancy and obstetric procedures leads to this condition and impacts women's quality of life. Objective: to evaluate urinary incontinence in postpartum nulliparous and multiparous women. Methodos: this is a quantitative, descriptive and cross-sectional study developed in the Health Center No. 2 of the city of Ambato in the province of Tungurahua, with a population of 120 nulliparous and multiparous women to whom the International Consultation on Incontinence Questionnaire-Urinary Short Form ICIQ-SF. Results: 85 % of postpartum nulliparous and multiparous women presented incontinence and it was mainly due to stress (laughing 26,7 %, physical exercise 20,8 % and coughing or sneezing 14,2 %). The loss of urine was moderate (40 %) and the loss was several times a day (40 %), which significantly impacted the quality of life of those who suffer from it. Conclusion: urinary incontinence is prevalent in postpartum nulliparous and multiparous women and was related to older age and multiparity because it was more frequent in those between 31 to 42 years old and in multiparity due to genitourinary physiological changes, gynecological conditions and procedures -obstetrics affect the functionality of the pelvic floor and lead to this condition

Initial experience with and surgical outcomes of da Vinci single-port system in general thoracic surgery.

BackgroundThe da Vinci single-port system (SPS) (Model SP1098, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been used in genitourinary and general surgical procedures; however, its clinical application in general thoracic surgery has not been attempted. This retrospective study investigated the clinical outcomes of SPS in general thoracic surgery.MethodsAfter approval from the Ministry of Food and Drug Safety in Korea, the surgical details of SPS in simple thoracic surgeries at two independent institutions were collected and retrospectively reviewed.ResultsOverall, 17 surgeries were performed using SPS without conversion to multiport surgery. The patients included six males, and the overall median age was 52 years (range, 28–83 years). The commonest pathological diagnoses were thymoma (8 cases) and benign cystic lesions (6 cases). The approach for SPS was subxiphoid, subcostal, and intercostal in 11, 4, and 2 cases, respectively. All patients underwent the surgeries without complications. The median operation time and peak pain score were 120 minutes (range, 58–250 minutes) and 3 (range, 2–4). The median duration of in situ chest tube and hospital stay was 1 day (range, 1–2 days) and 3 days (range, 2–7 days), respectively. SPS showed a shorter duration of in situ chest tube and hospital stay than robotic single-site surgeries.ConclusionsThe application of SPS in the field of general thoracic surgery is feasible and can be successful. Although this study reported preliminary data and the cases were relatively simple, advanced and complex procedures should be attempted with the SPS in the near future.

Temporal Effects of Clomiphene Citrate on Testosterone and Semen Parameters

ABSTRACT Introduction In men with secondary hypogonadism or impaired sperm concentrations, clomiphene citrate (CC) is often prescribed off-label to improve testosterone levels and fertility parameters. Prior studies have largely focused on outcomes in the short term (∼3 months). Longer-term efficacy of CC use is less clear, particularly if and when improvement may reach a plateau. Objective We sought to determine the magnitude of improvement in total testosterone and sperm concentration in men taking CC for fertility optimization 3, 6, 9, and 12-month interval follow-up. Methods With IRB approval, we retrospectively evaluated men presenting to an academic andrology clinic for fertility evaluation who were prescribed CC from January 2016 through May 2021. We identified men with 3, 6, 9, and 12-month follow-up data for total testosterone (TT) and 3, 6, and 9-month follow-up semen analyses. Mean absolute change in TT and sperm concentration are reported, along with 95% confidence intervals. Men with previous genitourinary procedures or hormone therapy were excluded. Paired t-tests were used to compare change in TT and sperm concentration at each time point to baseline, and statistical significance was set at p&amp;lt;0.05. Results CC (25 mg qd or 50 mg qod) was prescribed to 235 men seeking fertility optimization during the 5-year period. Mean age was 37.7 (SD 6.7, range 24-52). Of these 235, data for TT at 3, 6, 9, and 12 months were available for 25 men, and semen analyses at 3, 6, and 9 months were available for 26 men. Baseline TT at time of prescription was 358±145 ng/dL, and baseline sperm concentration was 13±17.2 M/mL. In the subset of 25 men with long-term follow-up data, a statistically significant improvement in TT was identified at 3 months (+62.7 ng/dL, 95% CI: 0.49-125.0 ng/dL, p=0.048), and additional benefit was seen at 6 months (+181.8 ng/dL, 95% CI: 114.1-249.5 ng/dL, p&amp;lt;0.01) followed by plateau at 9 and 12 months (Figure A). Improvement in sperm concentration was first noted at 9 months of treatment with CC (+20.7 M/mL, 95% CI: 10.2-31.2 M/mL, p&amp;lt;0.01) (Figure B). At no point were there improvements of semen volume and % motility at any follow-up. Conclusions In men prescribed CC for fertility optimization, we observed a maximal improvement in TT at 6 months, followed by plateau. Sperm concentrations showed a statistically significant improvement at 9 months. Our results suggest that longer duration of CC therapy may be needed to fully appreciate a benefit from CC treatment. Our study is limited by retrospective analysis, absence of controls, and small sample size. Work is under way to examine long-term follow-up data of CC in men seeking treatment for hypogonadism rather than optimization of fertility. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: JNM: Antares Pharma, Boston Scientific, and Endo Pharmaceuticals

Effectiveness of Transdermal Buprenorphine for Pain Control in the ICU After Major Surgical Procedures.

OBJECTIVES:Transdermal buprenorphine (TBUP) may be useful for postoperative pain after major surgery, when pain is expected to be severe and sustained. The objective of this study was to compare pain control and opioid consumption in critically ill postoperative patients who were treated with TBUP or not during ICU admission.DESIGN:This was a retrospective, parallel, cohort study.SETTING:ICU of a quaternary, urban hospital in Sydney, Australia.PATIENTS:Data were obtained for all patients admitted to the ICU from January 2019 to July 2021 after major gastrointestinal (GI) or genitourinary (GU) surgery.INTERVENTIONS:TBUP or non-TBUP.MEASUREMENTS AND MAIN RESULTS:Pain control was compared between patients who received TBUP and those who did not receive TBUP. The primary outcome was the probability of significant pain. A significant pain score was defined as greater than or equal to 4 on the 0–10 numeric rating scale or greater than or equal to 6 on the behavioral pain scale. Inverse probability of treatment weighting was used to adjust for baseline differences. The cohort included 376 patients, with 224 (60%) in the control group and 152 (40%) in the TBUP group. The mean age was 60 ± 14 years, 202 (54%) were male, mean Acute Physiology and Chronic Health Evaluation III score was 44 ± 13, and 147 (39%) received mechanical ventilation. After adjustment, the median probability of significant pain was 0.25 with control and 0.30 with TBUP (median difference, 0.02; 95% CI, 0.04–0.11; p = 0.44). The median opioid consumption (oral morphine milligram equivalents) per day was 5.7 mg with control and 10.1 mg with TBUP (median difference, 0.4 mg; 95% CI, –0.4 to 3.7 mg; p = 0.31).CONCLUSIONS:In patients who are admitted to the ICU after major GI or GU procedures, the use of TBUP in the ICU was not associated with improved pain control or opioid consumption compared with those who did not receive TBUP.

Temporal Changes of Clomiphene on Testosterone Levels and Semen Parameters in Subfertile Men.

Clomiphene citrate (CC) is prescribed off-label in men to improve testosterone and sperm parameters, but the duration of treatment needed to reach maximal benefit remains unclear. Our objective was to examine temporal effects of CC on total testosterone (TT) and semen analysis (SA) using longitudinal follow-up data in treated men. We analyzed an IRB-approved database of men treated with CC (25 mg q.d. or 50 mg q.o.d.) from January 2016 through May 2021. We identified patients with 3, 6, 9, and 12 month follow-up data for TT and 3, 6, and 9 month follow-up SA. Mean absolute changes in TT and sperm concentration compared to baseline were calculated, along with 95% confidence intervals. Men with prior genitourinary procedures or hormone therapy were excluded. Paired t-tests were used to compare TT and sperm concentration at each time point to baseline (alpha=0.05). One hundered thirty-four men received CC, mean age 37.7 years (SD 6.7, range 24-52). TT at all follow-ups (3, 6, 9, and 12 months) were available for 25 men, and SA at 3, 6, and 9 months for 26 men. Baseline TT was 358±145 ng/dL and sperm concentration was 13±17.2 M/mL. Significant improvement in TT was identified at 3 months (62.7 ng/dL, 95% CI: 0.49-125.0, p=0.048), additional benefit at 6 months (181.8 ng/dL, 95% CI: 114.1-249.5, p<0.01), and plateau at 9 and 12 months. Improvement in sperm concentration was first observed at 9 months (20.7 M/mL, 95% CI: 10.2-31.2, p<0.01). Semen volume and sperm motility did not change. Duration of treatment with clomiphene may impact testosterone and sperm concentration, and the historical 3 month milestone may be insufficient for clinical and research evaluation. Men taking CC may experience plateau in TT at 6 months and first benefit in sperm concentration at 9 months.

Penile inversion vaginoplasty outcomes: Complications and satisfaction

Penile inversion vaginoplasty helps to alleviate gender dysphoria and improve quality of life in many transgender individuals. Overall, the procedure is associated with high post-operative satisfaction, even when complications occur. Adverse events related to vaginoplasty are commensurate with other genitourinary reconstructive procedures performed for other diagnoses (ie, cancer or congenital issues). Here, we explore the incidence of complications following vaginoplasty, emphasizing the challenges in defining and managing these adverse events. In addition, outcome measures to assess patient satisfaction will be reviewed.

Erratum for “Positioning at a Glance: Reverse Trendelenburg”

AORN JournalVolume 113, Issue 5 p. P17-P17 AORN Periop BriefingFree Access Erratum for “Positioning at a Glance: Reverse Trendelenburg” This article corrects the following: Reverse Trendelenburg Volume 112Issue 6AORN Journal pages: P15-P17 First Published online: November 30, 2020 First published: 30 April 2021 https://doi.org/10.1002/aorn.13408AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In the “Positioning at a Glance: Reverse Trendelenburg” article (December 2020, Vol 112, Issue 6, P15-17), the fourth bullet point under “Preoperative Assessment” incorrectly stated: “Patients may be placed in the reverse Trendelenburg position for abdominal procedures (e.g., laparotomy, abdominal hernia reduction), genitourinary procedures (e.g., prostatectomy), laparoscopic procedures, gynecologic surgery (e.g., hysterectomy, oophorectomy), minimally invasive glaucoma surgery, endoscopic retrograde cholangiopancreatography, or central venous catheter placement.” It should have stated: “Patients may be placed in the reverse Trendelenburg position for laparoscopic procedures involving the stomach, gallbladder, or biliary tract;1 procedures involving the head or neck;2 or other procedures to move the abdominal contents toward the feet,1, 2 decrease blood supply to a surgical site, or facilitate breathing.”1 References 1 Positioning, prepping, and draping the patient. In: N Phillips, A Hornacky. Berry & Kohn’s Operating Room Technique. 14th ed. St. Louis, MO: Elsevier; 2021: 487- 522. Google Scholar 2Fawcett DL. Positioning the patient for surgery. In: JC Rothrock, ed. Alexander’s Care of the Patient in Surgery. 16th ed. St. Louis, MO: Elsevier; 2019: 142- 175. Google Scholar Volume113, Issue5May 2021Pages P17-P17 ReferencesRelatedInformation

A government mandated consent safely reduces opioid utilization for major pediatric genitourinary surgeries

IntroductionWe describe the effect of a state mandated opioid consent on opioid utilization and multimodal pain use for major pediatric genitourinary surgeries. MethodsAll patients who underwent an inpatient pediatric genitourinary surgery at the Children's Hospital of Pittsburgh between August 2015 and February 2020 were identified. Inpatient and outpatient multimodal pain control utilization were assessed. Delayed prescriptions or emergency department visits within 30 days were identified and when applicable referenced against National Surgical Quality Improvement Program data. ResultsAfter accounting for a 6-month transition period following policy implementation, 462 major pediatric genitourinary procedures were identified. The frequency of discharge opiate prescriptions decreased from 68.4% prior to the transition period to 10.7% afterward(p<0.001). Morphine milligram equivalents per prescription decreased from 75(IQR 45–150) to 45(IQR 22.5–75)(p<0.001). The rate of delayed non-opioid analgesic prescriptions (6.6% vs 7.4%), delayed opioid prescriptions (1.5% vs 0.3%), or emergency department visits (11.8% vs 12.6%)(p = 0.809) remained unchanged. Data agreed with National Surgical Quality Improvement Program data in 98.5% of cases. After excluding one surgeon who departed after the transition period, regional block utilization did not change from 61/115(53%) to 147/320(45.9%)(p = 0.425). ConclusionsA state mandated opioid consent safely reduced opioid utilization for most major pediatric genitourinary surgeries. Level of evidenceLevel III

National patterns of injury and outcomes of gunshot wounds to the penis: A Trauma Quality Programs retrospective cohort analysis.

AimGunshot wounds (GSW) to the penis represent a rare type of traumatic injury in the civilian United States population. Although small, single‐center studies have reported results of care for these types of injured patients, no national analyses have examined this group.MethodsA cohort of patients with GSW to the penis was identified using the 2017 American College of Surgeons Trauma Quality Programs database, a comprehensive national database of 753 accredited trauma centers.ResultsGunshot wounds to the penis occurred in 722 patients, which represents 1.7% of all GSW patients (n = 41,017). Gunshot wounds from altercations with law enforcement or accidental discharge of a firearm were rare; the vast majority (n = 655, 90.7%) occurred as a result of assault, intentional self‐harm, attempted suicide, or attempted homicide. Patients with a major concomitant non‐genitourinary injury comprised 119 (16.5%) patients of the cohort. Most patients (n = 499, 69.1%) underwent a genitourinary procedure during their trauma admission. Penile salvage was successful in most cases, with only 13 (1.8%) patients requiring completion penectomy. Most patients (87.8%) required admission with a median length of stay of 49.8 h. Most patients were treated at the initial trauma center without requiring transfer to another center, and complications during admission were rare.ConclusionsThis analysis, the first national examination of care of patients with GSW to the penis, reveals overall favorable outcomes. Admission and surgical intervention were required in most patients, but penectomy was rare and length of stay was generally short. These results will guide resource utilization and quality improvement efforts in this patient cohort.

Asymptomatic Bacteriuria versus Symptom Underreporting in Older Emergency Department Patients with Suspected Urinary Tract Infection

Asymptomatic Bacteriuria versus Symptom Underreporting in Older Emergency Department Patients with Suspected Urinary Tract Infection

Patient-Reported Functional Outcomes After Hypofractionated or Conventionally Fractionated Radiation for Prostate Cancer: A National Cohort Study in England.

The aim of the current study was to determine patient-reported functional outcomes in men with prostate cancer (PCa) undergoing moderately hypofractionated (H-RT) or conventionally fractionated radiation therapy (C-RT) in a national cohort study. All men diagnosed with PCa between April 2014 and September 2016 in the English National Health Service undergoing C-RT or H-RT were identified in the National Prostate Cancer Audit and mailed a questionnaire at least 18 months after diagnosis. We estimated differences in patient-reported urinary, bowel, sexual, and hormonal function-Expanded Prostate Cancer Index Composite short-form 26 domain scores on a 0 to 100 scale-and health-related quality of life-EQ-5D-5L on a 0 to 1 scale-using linear regression with adjustment for patient, tumor, and treatment-related factors in addition to GI and genitourinary baseline function, with higher scores representing better outcomes. Of the 17,058 men in the cohort, 77% responded: 8,432 men received C-RT (64.2%) and 4,699 H-RT (35.8%). Men in the H-RT group were older (age ≥ 70 years: 67.5% v 60.9%), fewer men had locally advanced disease (56.5% v 71.3%), were less likely to receive androgen-deprivation therapy (79.5% v 87.8%), and slightly more men had pretreatment genitourinary procedures (24.2% v 21.2%). H-RT was associated with small increases in adjusted mean Expanded Prostate Cancer Index Composite short-form 26 sexual (3.3 points; 95% CI, 2.1 to 4.5; P < .001) and hormonal function scores (3.2 points; 95% CI, 1.8 to 4.6; P < .001). These differences failed to meet established thresholds for a clinically meaningful change. There were no statistically significant differences in urinary or bowel function and quality of life. This is the first national cohort study comparing functional outcomes after H-RT and C-RT reported by patients. These real-world results further support the use of H-RT as the standard for radiation therapy in men with nonmetastatic PCa.

Risk factors and reasons for reoperation after radical cystectomy

PurposeReoperation after radical cystectomy (RC) is common but the types of reoperation after RC and associated risk factors have not been fully characterized. Here, we provide a detailed, contemporary account of the factors that drive surgical reoperation within the first 30-days after surgery, identify at risk patient populations, and describe common reoperations. Materials and methodsThe American College of Surgeons National Surgical Quality Improvement Program database (2012–2017) was analyzed to identify 30-day reoperation rates after RC. Captured variables included demographic, preoperative, operative, and postoperative characteristics. Postoperative characteristics included complications, including types of reoperation, length of stay, unplanned readmissions, and discharge destination. Pearson chi-squared and multivariable logistic regression models were used for analysis. ResultsA total of 10,848 patients underwent RC and there were 633 (5.84%) unplanned reoperations. On multivariable logistic regression, patient factors associated with increased risk of reoperation included longer operative times at index procedure (>90th percentile operative time) (OR1.41 [1.08–1.83], P = 0.02), smoking (OR1.34 [1.11–1.63], P < 0.01), obesity (BMI≥30) (OR 1.29 [1.04–1.60], P = 0.02) and chronic obstructive pulmonary disease (OR1.74 [1.36–2.3], P < 0.01). Other significant factors included clinically significant hypertension, perioperative blood transfusion, and male sex. The most common reoperation procedures were those performed on the gastrointestinal tract, accounting for 60.59% (349) of all reoperations, followed by skin/subcutaneous procedures 14.76% (85), followed by Genitourinary procedures at 8.16% (47). Patients who underwent reoperation were at higher risk for readmission, discharge to a facility, and death (P < 0.01). ConclusionReoperation after RC is associated with approximately 5% rate of reoperation within 30 days of surgery. The most common reason for reoperation was related to the gastrointestinal tract, accounting for more than 60% of all reoperations. Risk factors for reoperation included longer surgical times, smoking, obesity, chronic obstructive pulmonary disease, perioperative blood transfusion, and clinically significant hypertension. Knowledge of these factors can aid in operative planning and counseling and lead to possible strategies to reduce reoperations in the early perioperative setting.