Urology Clinic Research Articles

Investigating the effect of SARS-CoV-2 on the sperm parameters

Background: COVID-19, caused by SARS-CoV-2, may impact male reproduction by affecting spermatogenesis and testicular function. This study analyzes semen parameters, including volume, total count, motility, viability, morphology, and concentration, before and after the pandemic over a 3- to 12-month period postinfection. Methods: This cross-sectional study was conducted at infertility and urology clinics. Demographic and medical history data, including age, BMI, number of children, underlying diseases, smoking, and alcohol consumption, were extracted from medical records. Parameters analyzed include semen volume, total sperm count, progressive motility, vitality, sperm morphology, and sperm concentration. The timeframe for sperm analysis ranges from three months to one-year postinfection. Results: A study of 150 men (mean age: 36.4 ± 6.6) compared semen parameters before and after the COVID-19 pandemic. Semen volume showed no significant change (P = 0.73). Sperm concentration and total sperm count significantly decreased (P < 0.000). Sperm morphology also declined significantly (P = 0.043). However, sperm motility and motility percentage showed no significant changes (P = 0.427 and P = 0.306, respectively). Conclusion: SARS-CoV-2 infection can adversely affect male reproductive health, emphasizing the need for targeted treatment strategies to mitigate these effects. Understanding the virus’s impact on semen parameters will help in developing effective therapies, thereby reducing disease-related costs and improving fertility rates.

Academician Nikolai Alekseevich Lopatkin (1924–2013) (on the 100th anniversary of his birth)

An outstanding urological surgeon and nephrologist, a talented scientist and teacher, a major healthcare organizer, the founder of the largest domestic school of urologists and nephrologists, Hero of Socialist Labor (1978), Academician of the USSR Academy of Medical Sciences (1974) and the Russian Academy of Medical Sciences (1992), Honored Scientist of the Russian Federation (1998), three-time laureate of the USSR State Prize (1971, 1984, 1990), laureate of the USSR Council of Ministers Prize (1981), chief urologist of the USSR and Russian Ministry of Health, Chairman of the All-Union and Russian Societies of Urologists (1972–2012), Professor Nikolai Alekseevich Lopatkin was born on February 18, 1924 in Moscow into a doctor’s family. In 1941, he entered the 1st Moscow Medical Institute named after I. M. Sechenov, from which in 1943 he was transferred to the 2nd Moscow Medical Institute named after N. I. Pirogov. In 1947, he graduated from the Faculty of Medicine and was enrolled in residency at the Department of Faculty Surgery of the 2nd Moscow Medical Institute, which he successfully completed in 1950 and was elected to the position of assistant of the Department. In 1953, he defended his candidate’s dissertation and in the same year was transferred to the Department of Urology of the 2nd MMI, where under the supervision of the Professor A. Ya. Pytel, he worked as the assistant, Associate Professor and Professor of the Department, and in 1967, he was elected the head of the Department of Urology and Surgical Nephrology. In 1959, he defended his doctoral dissertation “Renal Angiography”. He introduced general anesthesia with tracheal intubation and artificial ventilation into urological practice, as well as numerous cutting-edge methods of diagnosing and treating urological diseases. In 1958, together with A. Ya. Pytel, he was the first in our country to use the “artificial kidney” apparatus, and later took direct part in organizing hemodialysis departments in urological clinics in the USSR. In 1972, Nikolai Alekseevich organized the All-Union Society of Urologists of the USSR, which he headed until 1991, and was the chairman of the Russian Society of Urologists until 2012. For many years, he served as the chief urologist of the USSR Ministry of Health. On the initiative of N. A. Lopatkin, the Research Institute of Urology of the USSR Ministry of Health was created in Moscow, which he headed from 1979 to 2007. Nikolai Alekseevich was the author and co-author of more than 800 scientific and scientific-practical works, including 40 monographs, manuals and textbooks. Under his supervision, 25 doctoral and about 50 candidate dissertations were defended. Academician N.A. Lopatkin died on September 16, 2013 and was buried at the Vagankovo Cemetery in Moscow.

Enhanced patient recovery with early extensive surgical deb-ridement in Fournier's Gangrene: evaluation of perioperative outcomes in a multicentric experience.

Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis primarily affecting the perineal, genital, and perianal regions. This rapidly progressing bacterial infection predominantly affects middleaged and elderly men. This multicenter study aims to describe the management in a wide cohort of Fournier's gangrene cases that presented to three tertiary centers with early extensive surgical debridement. We retrospectively collect data from patients with FG who were referred to the Urology Clinic of the Department of Medicine and Surgery (Perugia), the Urological Andrological Surgery and Minimally Invasive Techniques Unit (Terni) of the University of Perugia, and the Urology Unit of the Surgery Department of the Macerata Civic Hospital between January 2019 and March 2024 for onset of classic signs and symptoms of FG. Extensive surgical debridement was immediately performed under general anesthesia to reach normochromic and vascularized tissue in wide and depth extension, assuring vital and healthy margins. For all patients, intravenous daptomycin plus piperacillin/tazobactam were administered. 28 male patients with FG underwent early surgical debridement. In two cases, orchidectomy and partial penectomy were required during surgical debridement due to extensive necrosis. Colon diversion and urinary diversion were not necessary for any of the patients. 32.1% complications were recorded according to the Clavien Dindo classification; 6 patients died in the perioperative. Excluding death data, the average duration of antibiotic therapy was 22.0±9.1 days, and the average length of stay was 17.6±11.8 days. Fournier's gangrene has high mortality rates. It requires timely surgical debridement and antibiotic therapy to achieve positive outcomes. This study shows that a primary extensive debridement can help reduce the need for further intervention and shorten the hospital stay.

P-1562. Epidemiology, Management, and Outcomes of a Novel Complex Urologic Infections Interdisciplinary Clinic

Abstract Background Urinary tract infections (UTIs) are the most common bacterial infections, yet patients with recurrent infection are often not offered effective preventative therapies, patients with bacterial persistence may have a urologic nidus of infection, and patients with non-infectious syndromes are often over-treated with antibiotics. Methods We developed a Complex Urologic Infections Interdisciplinary Clinic comprised of infectious diseases and urology physicians as well as antimicrobial stewardship pharmacists. We categorized patients as complicated (defined as abnormal urinary tract predisposing to infection) or uncomplicated and describe the first 237 patients seen 16 months after clinic initiation. Results Most of our patients were female (69%) and white (67%) with a mean age of 61 and a mean Charlson score of 3.3 (Table 1). Most (58%) had complicated urologic tracts with overall higher Charlson comorbidity scores. Based on a standardized clinical classification system, most presented with recurrent/reinfection (38%), but we also identified patients with isolated and intermittent infection, bacterial persistence, and non-infectious syndromes (Table 2). We started 75/89 (84%) patients with recurrent infections on prevention therapy, and 14 declined. Vaginal estrogen or methenamine monotherapy had an efficacy of 57% and 70% at a mean follow up of 4.2 and 4.6 months, respectively (Figure 1). All five patients on vaginal estrogen plus continuous prophylaxis were UTI free at a mean follow up of 5 months. We identified 20 patients with urinary bacterial persistence, ordered imaging of the urologic tract, and identified an infected urologic nidus and cured or suppressed the infection in 95%. Thirty-two percent of patients referred for UTI were found to have non-infectious syndromes, including asymptomatic bacteriuria (19%) and lower urinary tract symptoms (10%) (Figure 2). Multi-drug resistant organisms were found in 25%, 30% of which were in patients with non-infectious syndromes. Conclusion Complex Urologic Infections Interdisciplinary Clinics can provide expertise to prevent recurrent UTIs, identify a urologic nidus of infection in patients with persistence, and potentially reduce antimicrobial burden and resistance in patients without true infection. Disclosures All Authors: No reported disclosures

P-1547. Real-World Patient Insights Inform an Action-Oriented Healthcare Professional (HCP) Educational Initiative to Address Gaps in Uncomplicated Urinary Tract Infection (uUTI) Management

Abstract Background uUTIs are among the most common outpatient infections and reasons for antibiotic use. This project aimed to understand the real-world burden of UTIs on patients, uncover HCP challenges in uUTI management, and educate HCPs to improve knowledge of guidelines and align clinical practices with patient priorities.Table 1.Demographics of Women Who Experience UTIs Who Participated in the Patient Survey (N = 413). Methods Patient surveys were distributed nationwide to women who experience UTIs (Table 1). Baseline HCP surveys were administered in 6 clinics that treat UTIs in the southeast US (Table 2). Survey outcomes informed live education sessions with each clinic from 10/2023 – 2/2024, featuring pre-/post-session surveys and team-based action planning.Table 2.HCP Baseline Survey Participant Demographics (N = 94). Results Outcomes from the patient survey revealed the extensive burden of UTIs on quality of life (N = 413, Fig 1). Patients experienced 4 UTIs in the last year on average and reported the most difficult aspect of experiencing UTIs was fear of recurrence (49%), with 79% of patients seen in urology clinics and 66% of patients seen in infectious disease clinics agreeing they were frequently concerned about recurrence versus 58% of patients seen in other clinics (p < .001 and p = .217, respectively). HCPs (N = 94) also reported their top challenge in uUTI care was management of persistent or recurrent infections (54%) and felt they could most improve on antibiotic stewardship (47%) and aligning clinic protocols with the latest guidelines (42%). HCP education sessions led to improvements in knowledge and confidence in uUTI management. After sessions, more HCPs correctly selected 5 days of nitrofurantoin as a first-line uUTI treatment (85% vs 61%, p < .001) and reported high confidence in applying the latest guidelines (72% vs 40%, p < .001) than before. Patient survey data presented to HCPs during sessions showed patients thought their care teams could most improve on counseling about antibiotic side effects (50%) and education about risks of frequent antibiotic use (47%). In response, 93% of HCPs committed to counseling patients about antibiotic use and UTI prevention and clinic action plans included expansion of patient education efforts.Figure 1.Real-World Patient Insights on UTI Burden. Conclusion This initiative offers real-world insights on the burden of UTIs on patients and demonstrates the potential impact of patient-informed education on HCP knowledge and clinical practice in uUTI care. Disclosures Kalpana Gupta, MD MPH, GlaxoSmithKline: Advisor/Consultant|Iterum Therapeutics: Advisor/Consultant|PhenUtest Diagnostics: Advisor/Consultant|Qiagen: Advisor/Consultant|Up to Date: Royalties|Utility Therapeutics: Advisor/Consultant Kara Cossis, MPH, PA-C, Amgen: Honoraria|Astellas: Advisor/Consultant|AstraZeneca: Advisor/Consultant|Bayer: Advisor/Consultant|Janssen: Advisor/Consultant|Myriad: Advisor/Consultant|Tolmar: Advisor/Consultant

P-1067. In Vitro Potency of Ceftibuten-Avibactam (CTB-AVI) and Comparators against Extended-Spectrum Beta-Lactamase (ESBL)-like Enterobacterales from Outpatient Centers and Nursing Homes in the United States

Abstract Background CTB is a currently available oral third-generation cephalosporin that is being developed in combination with the oral prodrug of AVI. In this study, we evaluated the in vitro activity of CTB-AVI against clinical ESBL-like Enterobacterales that were collected from outpatient settings. Methods 156 ESBL-like Enterobacterales isolates were received from 10 US medical centers that processed cultures from affiliated outpatient centers in 2022. Susceptibility tests for CTB-AVI and standard-of-care antibiotics were performed by CLSI broth microdilution method. Isolates were designated ESBL-like based on cefpodoxime MIC ≥2 mg/L for Proteus mirabilis and ceftriaxone MIC ≥2 mg/L for all other Enterobacterales. Fosfomycin disk diffusion was performed on E. coli isolates only and interpreted according to CLSI M100Ed32 guidance. CTB-susceptible breakpoints currently published by CLSI (≤8 mg/L) and EUCAST (≤1 mg/L) were applied to CTB-AVI for comparison. Results Isolates were primarily E. coli (60%) and Klebsiella pneumoniae (16%) and were recovered from patients seen in nursing home/long-term care (38%), urology (21%), and ambulatory care (19%) clinics. Based on CLSI and EUCAST breakpoints, CTB had susceptibility rates of 66% and 32%, respectively. The addition of AVI (fixed concentration of 4 mg/L) to CTB resulted in in vitro potentiation, resulting in 99% (CLSI) and 97% (EUCAST) susceptibility. Susceptibility rates of all isolates against comparator antimicrobials were as follows: cefpodoxime (7%), ceftriaxone (2%), ceftazidime/avibactam (CAZ-AVI) (99.4%), tebipenem (86% at preliminary susceptible breakpoint ≤0.125 mg/L), ertapenem (92.3%), levofloxacin (29%), sulfamethoxazole/trimethoprim (SMX-TMP) (47.4%), and fosfomycin (96%). CTB-AVI had 4-fold lower MIC50/90 values relative to CAZ-AVI (MIC50/90; 0.031/0.25 versus 0.25/1 mg/L). Overall, 100% of levofloxacin and SMX-TMP co-resistant isolates (n=43) were inhibited at CTB-AVI MIC breakpoint concentrations of 8 and 1 mg/L. Conclusion These data demonstrate potent in vitro activity of CTB-AVI against ESBL-like Enterobacterales isolated from patients in US nursing homes and outpatient clinics warranting further studies this oral treatment option. Disclosures April M. Bobenchik, PhD, Becton Dickinson: Grant/Research Support|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|BioMerieux: Honoraria|Q-Linea: Grant/Research Support|QuidelOrtho: Grant/Research Support|TechLab: Grant/Research Support Lars Westblade, PhD, Accelerate Diagnostics, Inc: Grant/Research Support|bioMerieux, Inc: Grant/Research Support|Element Materials Technology: Grant/Research Support|Hardy Diagnostics: Grant/Research Support|Roche Molecular Systems, Inc.: Advisor/Consultant|Roche Molecular Systems, Inc.: Grant/Research Support|Selux Diagnostics, Inc.: Grant/Research Support|Shionogi, Inc: Advisor/Consultant|Talis Biomedical: Advisor/Consultant Erik Munson, PhD, Hologic, Incorporated: Advisor/Consultant|Hologic, Incorporated: Honoraria David P. Nicolau, PharmD, CARB-X: Grant/Research Support|Innoviva: Grant/Research Support|Innoviva: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Shionogi: Honoraria|Venatorx: Grant/Research Support Tomefa E. Asempa, PharmD, FDA/CDER: Grant/Research Support|Paratek: Grant/Research Support|Shionogi: Grant/Research Support|Spero: Grant/Research Support|VenatoRx: Grant/Research Support

CLINICAL CASE OF CAVERNITIS-COMPLICATED MONKEYPOX INFECTION

Abstract The article presents a clinical case of monkeypox (MPOX) infection, a rare acute viral zoonosis until 2022, previously endemic in Africa, but currently recorded worldwide, including Europe and Bulgaria. The clinical case describes a 35-year-old man, healthy before the current disease, hospitalized to urology clinic with a diagnosis of cavernitis-complicated acute balanoposthitis. In the department, surgical treatment of liberatio cordi periglandularis penis was performed. The combination of intoxication syndrome with characteristic elements of pustular rash, initially treated as staphyloderma, served as the basis for infectious disease specialist to assume that the patient had MPOX, which was subsequently confirmed by using polymerase chain reaction (PCR) method, after which the patient was transferred to the infectious disease clinic for isolation and treatment, which included detoxication, antibiotic and analgesic therapy. Upon discharge, the patient observed the quarantine regime until all elements of the rash had completely healed, and one-month follow-up observation after discharge showed no deviations from the norm. Due to the presence of a urogenital complication, cavernitis, a rare for this infection, a multidisciplinary approach was required, including urologists, dermatologists and infectious disease specialists. The surgical, pathogenetic and symptomatic treatment led to the patient complete recovery. Although monkeypox-related urogenital complications are rare, they can occur, which requires increased attention to such atypical disease manifestations. MPOX is a rare viral disease that has attracted the attention of health professionals due to its increasing incidence in countries where it is not typically endemic. The key finding of the current study is the necessity for increased vigilance by professionals of various specialties to rare and emerging infectious diseases such as MPOX to control their spread.

Does hypertension develop in children patients who underwent pyeloplasty due to unilateral ureteropelvic junction stenosis

Aims: Hypertension may develop in children with renal and cardiovascular pathologies. In our study, we aimed to investigate the prevalence of hypertension in children who underwent pyeloplasty. Methods: We retrospectively evaluated the blood pressure values measured in the postoperative period in children who were diagnosed with ureteropelvic junction stenosis and underwent pyeloplasty in the pediatric urology clinic of Ankara City Hospital between 2007 and 2020. Results: In our study, 167 patients (48 women, 123 men; mean age 3.6; 58 right, 109 left) who underwent pyeloplasty due to UPJO were evaluated. In the postoperative follow-up, hypertension was detect-ed in 5 patients (2.9%). Bilateral patients were excluded from the study. Of the 5 patients who developed hypertension, one had a pelvic ectopic kidney and one had a contralateral multicystic dysplastic kidney. All of the patients who developed hypertension had intrinsic UPJO; 3 of them were catheterized with a percutaneous nephrostomy catheter preoperatively. The mean MAG3 function was 43.3%. While the mean follow-up period of the patients was 5.6 years, it was ob-served that hypertension developed in an average of 3.5 years. In the postoperative period, there was an average increase of 1.2% in the functions of these five patients in the control scintigraphy. No patient who developed hypertension underwent a second surgical intervention. Conclusion: In cases where pyeloplasty was performed due to UPJO, blood pressure should be monitored in the postoperative period. Blood pressure should be checked, especially in advanced hydronephrotic patients with a history of percutaneous nephrostomy in the preoperative period.

Diagnostic evaluation and management of recurrent urinary tract infections in the spinal cord injury population - a retrospective evaluation at a tertiary care center.

Retrospective review. While most individuals with spinal cord injury (SCI) are expected to have 1-2 urinary tract infections (UTIs) per year, there is a subset with higher incidence. We evaluate our practice to characterize common causes of recurrent UTIs, hypothesizing that more frequent infections typically have addressable risk factors. Tertiary urology clinic, San Jose, CA. We reviewed patients with SCI referred to a tertiary urology clinic for evaluation and management of "recurrent UTIs" during the years 2015-2020. Following workup, the suspected cause of recurrent UTIs and number of post-specialty evaluation UTIs (patient reported) were noted. Forty persons with SCI with a mean of 4.8 UTI treatments in the prior year comprised our cohort with most performing CIC (80%). After workup, 37/40 (92.5%) had a likely cause for their reported recurrent UTIs. In 16/40 (40%), careful questioning determined that the patient was not having UTIs based on guideline definitions. In those with confirmed recurrent UTIs, a bladder diary (62.5%) or urodynamic study (64%) was more likely to identify a cause compared to imaging (2.6%) or cystoscopy (8%). With a minimum 1-year follow-up, 90% of our population had a 50% or more reduction in UTI incidence, mostly using non-antibiotic strategies. In a referral SCI population with a chief complaint of "recurrent UTIs", over a third were not having UTIs. In addition to detailed history, a bladder diary +/- urodynamics are most useful in finding the cause and improving UTI.

Diagnosis of stone-related pyelonephritis activity by monitoring urine electrochemical properties and dynamics of urinary inflammatory mediator IL–8

Introduction. Percutaneous nephrolithotripsy is an important minimally invasive method for treating kidney stones. It is appreciated for its low injury rate and quick recovery. However, one of the most serious complications that can occur after this procedure is calculous pyelonephritis. The timing and safe removal of nephrostomy drainage in the postoperative period remain a significant concern for urologists. Objective. To determine the possibility of using joulemetry and monitoring urinary IL-8 levels to diagnose stone-related pyelonephritis activity following percutaneous nephrolithotripsy. Materials & methods. The study involved 220 patients with kidney stones who had percutaneous nephrolithotripsy at the SSMU Urology Clinic in 2022 – 2023. The patients were aged between 25 and 65 years, including 135 women (61.3 %) and 85 men (38.7 %). The control group consisted of 30 healthy people aged 24 to 67 years: 18 women (60 %) and 12 men (40 %). After surgery, electrochemical urine examination using the joulemetric method according to a patented technique was performed for patients with stone-related pyelonephritis and for those in the control group. Results. When analysing the urine IL-8 level, leukocyturia in the urine test, and the current operation based on joulemetry data, we observe a significant increase in all studied parameters on day 1 compared to the control group (p > 0.05). The values of the studied indicators reach their peak range by day 3 and return to those of the control group by day 5. At the same time, even if there is no leukocyturia on day three, the values of the current parameter and the urine IL-8 level remain elevated in most patients. Conclusion. Joulemetry helps to diagnose the activity of stone-related pyelonephritis in the postoperative period. This is confirmed by general clinical examinations and the determination of urine IL-8 as a marker of inflammation. Using this method allows optimising the timing of drainage removal after surgery.

Diagnostic Accuracy of a Nocturia Single Question Scale as a Predictor of Severity of Lower Urinary Tract Symptoms in Men.

This study evaluates the efficacy of the Nocturia Severity Quality Score (NSQS) as a simplified tool for assessing the severity of lower urinary tract symptoms (LUTS) in men, comparing it to the International Prostate Symptom Score (IPSS), the established standard. We conducted a cross-sectional analysis on 697 men aged ≥40 from two urban urology clinics in Brazil. Participants completed both the IPSS and the NSQS, the latter consisting of a single question assessing nocturia frequency on a scale from 0 to 4. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis to compare the NSQS against the IPSS. The NSQS effectively distinguished between moderate/severe and mild/asymptomatic LUTS, achieving an area under the ROC curve of 0.75 (95% CI: 0.72-0.79). NSQS thresholds of ≥2 and ≥3 episodes per night corresponded to increased likelihoods of moderate to severe LUTS, with significant diagnostic value despite varying sensitivities and specificities. The NSQS provides a valid, efficient alternative to the IPSS for the initial assessment of LUTS severity in men.

CHARACTERISTICS OF FEMALE GENITO-PELVIC PAIN-PENETRATION DISORDERS IN UROLOGY PATIENTS

Objective: This study aims to identify the characteristics of GPPPD in urologic patients. Material & Methods: The research design used descriptive cross-sectional study conducted at urology clinic patients of Arifin Achmad Hospital, Pekanbaru, Riau Province in October 2021 to January 2022 The patients were interviewed based on validated questionaire. The data collected were urology diseases and disorders, age, symptoms, risk factors of biology, interpersonal, psychological, socio-cultural, sexual satisfaction. The study had been approved by ethical committee of Medical Faculty, Riau University. Univariate analysis were used. Results: There were 22 patients in the study with most urology disease were urinary tract infection (54.5%), while the most common age group was 41-60 years(77.3%) and the common risk factors were biological (41%), psychological (13.6%) and socio-cultural ones (100%). Conclusion: The characteristics of GPPPD in urologic patients were mostly with UTI, age group of 41-60 years and socio-cultural factors. Keywords: GPPPD, urology, urinary tract infection.

Benign Prostatic Hyperplasia Knowledge Deficits Among Male Urology Patients.

To measure patient knowledge about Benign prostatic hyperplasia (BPH) and identify factors associated with knowledge deficiencies among those newly presenting to our urology clinic. Adult men presenting as new patients to our institution's urology clinic, regardless of chief complaint, were invited to complete a 26-item multiple choice questionnaire to assess basic knowledge about BPH, related symptomatology, and treatment options prior to their initial consultation. Responses were correlated to demographic variables using Analysis of Variance (ANOVA) and multivariable linear modeling. 206 patients completed the questionnaire and had a mean age of 60.8years. The majority were white (85.6%) and 28.9% were medicare/medicaid insured. The mean correct response rate was 62% (standard deviation of 22.9%) with the worst performing domain being BPH complications. Having a graduate or professional degree (P<.001) and self-referral were associated with significantly higher scores (P=.027). There remain significant knowledge gaps about BPH among men seeking urologic care. Education tools for both patients and primary care physicians may help improve health literacy as well as health outcomes for patients with BPH.

Predicting Elevated Postvoid Residual Urine Volume Following OnabotulinumtoxinA Treatment for Overactive Bladder: A Pilot Study.

To evaluate possible predictors of elevated postvoid residual volume (PVR) following onabotulinumtoxinA administration in patients with idiopathic overactive bladder (OAB), a condition that may include urinary urgency, frequency, and nocturia, without any identifiable cause or underlying neurological or metabolic condition. Adults who had been treated with 100-200 U onabotulinumtoxinA for OAB and had previous failure of other OAB treatments were identified by retrospective review of medical chart data from three urology clinics in the United States treating patients with a variety of urological conditions. A total of 211 patients were allocated to cohorts based on posttreatment PVR < 200 mL (n = 173) and ≥ 200 mL (n = 38). Logistic regression analyses were performed to evaluate potential predictors of posttreatment PVR ≥ 200 mL, including pretreatment peak urine flow rate (Qmax), average urine flow rate (Qavg), and Modified Liverpool Qmax and Qavg flow index (FI), and to determine whether patient age and baseline PVR were associated with the likelihood of PVR ≥ 200 mL. Patients were excluded if symptoms of OAB were secondary to a neurological condition, they had a PVR > 200 mL within 2 weeks prior to the index therapy or had been treated with other botulinum toxin formulations for a urinary condition. In the predictor analyses, neither Qmax nor Qavg alone was a likely predictor. Odds ratios of PVR ≥ 200 mL for Modified Liverpool Qmax FI and Qavg were 0.30 (95% CI: 0.08-0.91; p = 0.0488) and 0.07 (95% CI 0.01-0.40; p = 0.0045), respectively. When patient age and baseline PVR were incorporated into the analyses, results suggested that Qmax, Qavg, Qmax FI, and Qavg FI, as well as increased age and baseline PVR, were likely predictors of elevated posttreatment PVR. Patients who are older, have high pretreatment PVR values, and have lower pretreatment urine flow indexes and flows may be at increased risk of developing elevated PVR after receiving onabotulinumtoxinA treatment for OAB.

Implementing Change Through an Outpatient Antibiotic Stewardship Program.

We sought to implement a multipronged behavioral intervention to reduce and tailor antibiotic use for 2 common urologic outpatient procedures. This study was a nonblinded intervention study that consisted of a preintervention phase (November 2018-January 2019), an intervention phase (January 2020-December 2020) in which a multipronged behavioral intervention was implemented, and a postintervention phase (January 2021-March 2021). We examined antibiotic use for cystoscopy and transrectal prostate biopsy at 3 separate urologic outpatient clinics. A multipronged behavioral intervention consisted of formal physician education, modification of the electronic health order sets, clinic staff education, literature review, development and introduction of patient questionnaires, and individual audit feedback. The primary outcome was 30-day infections. Secondary outcomes were adherence to the recommended antibiotic protocols, questionnaire completion, and Escherichia coli outpatient antibiograms. A total of 2374 patients underwent 3047 cystoscopies, and 547 patients underwent 559 prostate biopsies. The proportions of cystoscopy patients receiving antibiotic prophylaxis and prostate biopsy patients receiving augmented antibiotic prophylaxis decreased 33% and 35%, respectively. The odds of postcystoscopy infection were not different between the preintervention and intervention phases and were lower in the postintervention phase. The odds of postbiopsy infection were not changed between the preintervention and intervention phases or between the preintervention and postintervention phases. Implementing a multipronged behavioral intervention reduced and tailored antibiotic use without an increase in 30-day infections. These findings suggest that outpatient antibiotic stewardship and facilitating rapid adoption of guidelines can be accomplished via this approach.

Are adult males concerned about the appearance of their circumcision that was done as a newborn?

Male circumcision is a common procedure performed in the US, most often during the newborn period. The rate of circumcision revisions has increased over time and are most often performed at a prepubertal age. Requests for circumcision revision are commonly driven by parents' concerns about the penile appearance and how their child will feel about the appearance as an adult. We sought to survey adult men about their feelings regarding their penile appearance in high school and as an adult and to compare this to their penile exam as an adult. Adult males presenting to the urology clinic for vasectomy consultation were provided an anonymous questionnaire on their feelings regarding their penile appearance. Circumcised and uncircumcised males were included. Males with any urologic concern other than request for sterilization were excluded. The provider completed a questionnaire on the objective penile appearance (redundant foreskin, penoscrotal webbing, skin bridges, adhesions). 103 men were surveyed, 87 were circumcised as newborns, 16 were uncircumcised. Most circumcised men had no concerns about their penile appearance at any time point (80%, 70/87) despite 21/70 having an abnormality on exam. The table outlines the penile exam findings based on men's answers to the questionnaire. 14 circumcised men (16%) were concerned about their penile appearance in high school, 6 had abnormal penile exams as an adult. 8 circumcised men (9%) were unhappy with their penile appearance at the time of the survey, but all had a normal exam except for 1 patient who had redundant foreskin. All uncircumcised men (16/16) were happy with their appearance as an adult, none had phimosis, 19% 3/16) had penoscrotal webbing. Most adult circumcised men are happy with their penile appearance, even in the presence of redundant foreskin. Future studies are needed to better understand the factors leading to dissatisfaction of circumcised penile appearance to better counsel families when they are requesting revisions in the prepubertal period.

EHealth, digital information and technology use of men with prostate cancer.

The investigation of digital information sources and technologies specifically used by men with prostate cancer is scarce. This study seeks to address current gaps in the literature by investigating prostate cancer-specific internet and technology use by men with prostate cancer and factors associated with this use. Cross-sectional surveys were conducted in three Australian urology clinics (local in Sydney, Western Sydney and Murrumbidgee) in 2023. Data analysis included descriptive and bivariate analysis. Chi square tests of independence, Mann-Whitney U tests and Fischer exact tests were used to assess demographic, prostate cancer-specific and psychometric variables with prostate cancer-specific usage of each website, social media and technology type. A total of 349 men responded. Mean age of respondents was 69.6 years (SD 7.8). 74.5% (n = 260) had undergone radical prostatectomy, while 10% (n = 35) reported locally advanced/metastatic disease. Information websites were used by 77.7% (n = 271) of men. Social media was used by 37% (n = 129), and total internet use was 79.1% (n = 276). Younger age, higher education and higher income were commonly associated with a greater extent of use of information source and technology types. High variability in usage and factor association was demonstrated between and within analysed group categories. Men with prostate cancer use a broad variety of digital information sources and technologies to access prostate cancer information at a higher rate than ever before. This work stresses the significant variability in the extent of use which men demonstrate among these resources and the factors which may play a role in this behaviour.

Urogenital Anomalies Identified on Examination of Pediatric Patients Before Circumcision

Objective: Circumcision is included in European urology guidelines as a treatment choice only for severe phimosis, while it is a procedure routinely performed for socio-cultural reasons in many different countries. Parents bring their children to urology clinics requesting circumcision. Before circumcision, it is very important to perform full urogenital examination because many urogenital anomalies that require treatment may be identified so. In this study, we aimed to determine the urogenital anomalies identified in children before circumcision. Material and Method: This study retrospectively investigated findings of 190 pediatric cases attending our urology for circumcision between September 2015 and September 2021. Each child had standard examinations of penis, urethra, testis and scrotum. The presence and laterality of undescended testis, presence and laterality of retractile testis, presence and degree of phimosis, presence and localization of hypospadias, presence and degree of buried penis, presence direction, and angle of penis chordee-curvature, presence of penoscrotal web, presence and laterality of hydrocele, presence of urethral stenosis, and presence of urethral duplication were recorded. Complete phimosis was noted when the foreskin could not be retracted or when less than half of the glans penis could be seen when retracted; partial phimosis was noted when more than half of the glans penis could be seen but not the whole penis; and no phimosis was noted when the foreskin could be easily retracted without difficulty and the glans penis could be seen completely. When grading the buried penis, fully and partially buried penis were recorded. Results: In our study assessing the examination findings of 190 pediatric cases attending our urology clinic for circumcision between September 2015 and September 2021, a total of 127 children had urogenital anomalies (66%). Buried penis (46 cases, 24%) was the most frequently encountered urogenital anomaly. Undescended testis was the second most common (19 cases, 10%), while retractile testis (15 cases, 7%) was the third most common anomaly. Accordingly, phimosis was identified in 11 cases, penile curvature in 6 cases, hypospadias in 3 cases, hydrocele in 3 cases, penoscrotal web in 1 cases and urethral meatus duplication in 1 case. Conclusion: Circumcision is performed for both medical reasons and socio-cultural reasons in many countries. However, these patients may have serious urogenital anomalies. Careful physical examination is very important for patients attending for circumcision.

50 ÉVES A DEBRECENI UROLÓGIAI KLINIKA

A significant milestone in the history of the Urology Clinic in Debrecen was celebrated with a jubilee lecture series held on May 10, 2024. Urological patients were initially treated from 1921 at the Faculty of Medicine of the István Tisza University of Debrecen, within the Surgical Clinic led by Tivadar Hüttl. In 1958, an independent urology department and outpatient clinic began operations within the Surgical Clinic, and in 1972, the urology care system was relocated to the II. Surgical Clinic at its current location. The independent Urology Clinic was officially established on July 1, 1974, under the leadership of Márton Kelenhegyi. In 1979, József Pintér became the clinic’s director, followed by Csaba Tóth in 1995. Professor Tóth introduced numerous open and endoscopic urological surgical procedures, was a founding figure in the field, mentored many renowned urologists both nationally and internationally, and placed strong emphasis on scientific rigor. Since 2006, the clinic has been led by Associate Professor Tibor Flaskó, who has further developed laparoscopic procedures. In 2022, the former Urology Department of Kenézy Gyula Hospital was integrated into the structure of the Urology Clinic

The first 100 years: from the "Urology Clinic of the First City Clinic" to the "University Clinic of Urology and Andrology named after Academician N.A. Lopatkin of N.I. Pirogov Russian National Research Medical University"

The first 100 years: from the "Urology Clinic of the First City Clinic" to the "University Clinic of Urology and Andrology named after Academician N.A. Lopatkin of N.I. Pirogov Russian National Research Medical University"