Urological Emergency Research Articles

Protective effects of empagliflozin on testicular injury induced by torsion/detorsion in adult male rats

Testicular torsion is a known urologic emergency condition and one of the common causes of infertility in males. Hence, prompt diagnosis and treatment play a crucial role in prevention of testicular injury. It has been observed that empagliflozin, a drug for management of hyperglycemia, has anti-oxidative properties against different pathologies, the most important of which are ischemia reperfusion related injuries. This study aims to evaluate the protective effects of empagliflozin on a testicular torsion injury in adolescent rats followed by ischemia/reperfusion (I/R) phenomena. Thirty-six rats were randomly assigned into three groups including sham-operated group received all surgical procedures except testicular torsion-detorsion, torsion/detorsion+dimethyl sulfoxide (DMSO) as vehicle, and torsion/detorsion+empagliflozin (10mg/kg). Testicular torsion was performed for 2h through rotating right testis 720° in the clockwise direction. Thirty minutes before detorsion, a single intraperitoneal dose of empagliflozin was injected to treatment group. Four hours later, orchiectomy was conducted for histopathological and biochemical examinations of testicular tissue specimens. The malondialdehyde (MDA) content in the torsion/detorsion animals was markedly greater than in the animals under sham operated procedure. Moreover, the testicular MDA levels in the torsion/detorsion+empagliflozin group were significantly lower than in the torsion/detorsion group. Also, significant decreases observed in catalase, superoxide dismutase, and glutathione peroxidase activities in the torsion/detorsion group in comparison with sham operated group. These values were significantly improved in the empagliflozin group. Furthermore, histopathological examinations also revealed severe testicular injury which were improved by empagliflozin administration. Empagliflozin prevented increases in oxidative stress markers and subsequently reduced the tissue injury induced by torsion/detorsion in the current study. It can be concluded that administration of empagliflozin before prevents I/R related cellular damage in testicular torsion, possibly via oxidative stress inhibition.

Penile Fracture: A Case Report

Rupture of the corpora cavernosa, also called penile fracture, is a rare urological emergency; it is a tear in the tunic albuginea of the corpora cavernosa of variable depth and extent up to the urethra, generally occurs in young adults between 20 and 40 years old, most often following trauma to the erect penis. The diagnosis is essentially clinical, but it is recommended to perform an ultrasound. Ignorance of this urological emergency exposes you to complications that can be disabling. We report the case of a 25-year-old patient with a fracture of the penis following a false step during coitus who was operated on and with simple postoperative consequences.

Efficacy and Safety of Ketamine Versus Opiates in the Treatment of Patients with Renal Colic: A Systematic Review and Meta-analysis.

Renal colic is one of the most common urological emergencies, and is usually caused by ureteral colic spasms. Pain management in renal colic remains the central focus of emergency treatment. The purpose of this meta-analysis is to identify the efficacy and safety of ketamine versus opioids in the treatment of patients with renal colic. We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for published randomized controlled trials (RCTs) that referred to the use of ketamine and opioids for patients with renal colic. The methodology was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The mean difference (MD) or odds ratio (OR) with a 95% confidence interval (CI) was used to analyze the data. The results were pooled using a fixed-effects model or random-effects model. The primary outcome measure was patient-reported pain scores 5, 15, 30, and 60min after drug administration. The secondary outcome measure was side effects. The data analysis revealed that ketamine was similar to opioids in pain intensity at the time of 5min post-dose (MD = - 0.40, 95% CI - 1.82 to 1.01, P = 0.57), 15min post-dose (MD = - 0.15, 95% CI - 0.82 to 0.52, P = 0.67), 30min post-dose (MD = 0.38, 95% CI - 0.25 to 1.01, P = 0.24). Also, the pain score of ketamine was better than that of opioids at 60min after administration (MD = - 0.12, 95% CI - 0.22 to - 0.02, P = 0.02). As for safety, the ketamine group was linked to a significant decrease in the incidence of hypotensive (OR = 0.08, 95% CI 0.01-0.65, P = 0.02). The two groups did not statistically differ in the incidence of nausea, vomiting, and dizziness. Compared with opioids, ketamine showed a longer duration of analgesia in renal colic, with satisfactory safety. The PROSPERO registration number is CRD42022355246.

The presentation and outcomes of penile fracture with associated urethral injury: A systematic literature review.

Penile fracture (PF) with associated urethral injury has been described as a rare condition yet a serious urological emergency. We conducted this systematic review to address the current literature concerning the etiology, presentations, intra-operative findings, site of injury, and complications of PF with associated urethral injury, Materials and Methods: The present systematic review was limited to human-based studies published in English language, and reporting clinical data on PF cases with associated urethral injuries. A comprehensive search of the literature was conducted on five electronic databases from their inception to May 2022: Medline via PubMed, Web of Science, Google Scholar, Scopus, and EBSCO host. A total of 15 studies were included encompassing 1671 patients with PF. Out of 1665 patients with PF retrieved from the case series studies, 65 patients had associated urethral injuries giving a point prevalence of 3.9%. The vast majority of the patients had blood on the meatus and hematuria suggestive of urethral injury (57/59; 96.6%). Forty patients had partial urethral disruption and the rest of the patients had a complete rupture. All patients received primary urethroplasty as the main modality of treatment. The median hospital stay was two days and the median duration of transurethral catheterization was 21 days. Five patients (8.5%) developed urethral stricture; other complications included penile curvature (6.7%), palpable fibrosis (6.7%), and erectile dysfunction (3.4%). Urethral injuries are uncommon, but serious findings, in patients with PF. Primary urethroplasty appears to achieve satisfactory outcomes with a low incidence of short and long-term complications.

Emergencies in Oncological Practice

Oncological emergencies are defined as an acute lifethreatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to endstage disease; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. Oncologic emergencies are clinical situations that can lead to death in a short time (24-48 hours) if not quickly faced. In the clinical practice of the medical oncologist, such situations do not infrequently occur. The onset of oncologic emergencies may depend on the presence of cancer itself, the therapies carried out to counteract cancer, or the patient’s predisposition to develop such events. It is essential to recognize the aforementioned situations early in order to treat them promptly, thus avoiding serious consequences. BJM Vol. 34 No. 2(1) Suppliment 2023 Scientific Presentation 186 Therefore, it is critically important that all physicians have a working knowledge of the potential oncological emergencies that may present in their practice and how to provide the most effective care without delay. Nervous system emergencies include spinal cord compression, raised ICP, leptomeningeal disease, seizures and altered mental status whereas superior venacaval syndrome, hyperviscocity syndrome, hyperleukocytosis, venous thromboembolism, Hemorrhage and DIC are the vascular and haematologic emergencies. Several classic metabolic oncologic emergencies include syndrome of inappropriate antidiuretic hormone secretion, tumor lysis syndrome and hypercalcemia of malignancy. Among the pulmonary problems airway obstruction, massive haemoptysis, toxic lung injuries, pneumonitis and pulmonary fibrosis can be caused by cancer and cancer treatment. Urologic emergencies such as hemorrhagic cystitis and obstructive uropathy are also seen. Gastrointestinal bleeding in patients with cancer and typlitis in patients with neutropenic fever are potentially serius complications also. Immune check point inhibitors may cause irAEs in practically any organ system ranging from SJS, TEN, thyroiditis, hypophysitis, adrenilitis, diabetic ketoacidosis to life threatening pneumonitis and myocarditis which may be associated with poor overall survival. Oncologic emergencies can threaten the well-being of almost any patient with a malignancy. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient’s cancer history and its possible complications forms an important part of any clinician’s knowledge base. Prompt identification of and intervention in these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 186-187

(381) Comparing Erectile Dysfunction (ED) Outcomes Following Priapism as an Adverse Effect of Intracavernosal Injectable Medications to Priapism due to Recreational use of Intracavernosal Injectable

Abstract Introduction Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. We previously identified a large portion of ischemic priapism cases presenting to our institution caused by recreational use of intracavernosal injectable medications (ICI) for which patients did not have a prescription. Objective In the present study we identified a nearly equal number of men who presented with ischemic priapism as an adverse effect of ICI for which they did have a prescription. Our goal was to compare erectile function outcomes between these two populations in follow up. Methods Men presenting for ischemic priapism as an adverse effect of prescription ICI from January 2010 to December 2018 were contacted by mail, then via telephone. Standardized questions were asked of all participants on the topic of erectile dysfunction (five-item international index of erectile function (IIEF-5)). IIEF-5 results were compared to our previously described population of men with ischemic priapism caused by recreational use of ICI using the Student’s T-test of means. Results 13 men aged 23 – 68 (mean 51.9) were recruited. Ten men (77%) were white; the remaining three (23%) were black. All men confirmed diagnosis of ED prior to their priapism episodes and all men had their own prescription for ICI from a urologist. Seven men (54%) required phenylephrine irrigation, five (38%) achieved detumescence with cavernosal aspiration and saline irrigation alone, one (8%) required a distal shunt. Mean IIEF-5 for the population at time of phone interview was 12.5 (□ 7.4) signifying mild-moderate ED, which was not significantly different from the mean IIEF-5 of our priapism population due to recreational use of ICI (13.3 □ 4.0; p = 0.87; table 1). Conclusions Men who present with ischemic priapism as an adverse effect of prescription ICI appear to have similar functional outcomes compared to men with ischemic priapism due to recreational use of ICI as assessed by IIEF-5. This could also be interpreted as a better functional outcome considering that this population had pre-existing ED prior to their priapism episode and therefore did not lose erectile function. The adverse effect population also appears to require a shunt in the treatment of their priapism less frequently than the recreational ICI population. Disclosure No

(126) Long-term Functional Outcomes for Men with Priapism Secondary to Recreational Use of Intracavernosal Injectables: A Multi-center Follo- up Study

Abstract Introduction Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. There is a dearth of studies evaluating long term erectile function after episodes or treatment for priapism. Objective We evaluated the functional outcomes of a larger, multi-institutional population of men with priapism due to recreational use of ICIs. Methods Men who presented with ischemic priapism due to recreational use of ICIs to Cedars-Sinai Medical Center (Los Angeles, CA), University of California at San Francisco (San Francisco, CA), and Jackson Memorial Hospital (Miami, FL) from January 2010 to December 2018 were contacted via telephone. All participants completed the five-item international index of erectile function (IIEF-5). Results A total of 19 men aged 24 – 59 (mean 47.9) were recruited from the 3 sites. Mean follow up was 77.2 months (+/− 27.6). 17 men (89%) were white; the one man was Asian (5.5%) and one man was Hispanic (5.5%). Seven men (37%) had been diagnosed with ED prior to their priapism episode however none of the men had a prescription for ICIs. Four men (21%) required no intervention at all, eleven men (58%) required phenylephrine irrigation alone, four men (21%) required distal shunting. No men required proximal shunting. None of the men had no ED, 31.6% had mild ED, 36.8% had mild-moderate ED, 26.3% had moderate ED, and 5.3% had severe ED. Mean IIEF-5 for the population was 13.4 (+/− 3.9). Strengths of our study included the large population size give the relative rarity of this condition as well as the geographic diversity of our population. Limitations include our low overall recruitment rate and lack of objective measures of erectile function prior to priapism. Conclusions Men who suffer ischemic priapism secondary to recreational use of ICIs appear to retain some erectile function following their priapism episode. Nevertheless, 100% report some level of ED. This is likely due a combination of adequate erectile function at baseline and expeditious treatment of priapism in a minimally invasive manner. Disclosure No

(286) Goldmember: A Novel Approach to Remove Entrapped Metal Rings Around a Penis

Abstract Introduction Penile strangulation with metal objects is a rare urologic emergency that can present considerable challenges. The treatment approach can vary depending on the type of constricting device, degree of injury, and available equipment. Prior medical reports document the use of various instruments such as bolt cutters, oscillating saws, and power drills. Our case demonstrates a safe and reproducible means to remove metal rings entrapped around a penis using the Midas Rex® drill. Objective To describe a novel treatment approach in penile strangulation with the use of the Midas Rex® drill. Methods A 70-year-old male with a history of paranoid schizophrenia presented to our institution’s emergency department with urinary retention and penile pain due to the placement of five rings onto the penis two weeks prior. On exam, he had swelling of the glans and skin necrosis underneath the rings (Figure 1). After initial bedside attempts to remove the rings proved unsuccessful, he was promptly taken to the operating room. Further attempts to remove the rings using orthopedic pin cutters were also unsuccessful. Next, the Midas Rex® drill (Figure 2a) was used to cut each ring into two segments. The penis was protected from traumatic and thermal injury with careful retraction and continuous irrigation (Figure 2b). All five rings were successfully removed without sustaining iatrogenic injuries (Figure 2c). The injuries were limited to pre-existing superficial wounds of the penile skin (Figure 3a). A cystoscopy was performed and did not reveal any evidence of urethral injury. A suprapubic catheter (SPC) was placed to allow for urethral rest with 1,200 ml of urine drained. Postoperatively, the patient was stable and was transferred to the inpatient psychiatric unit the next day. After adjustment of his psychiatric medications and six days of observation, he was discharged. At his two-week urology follow-up, he had near-complete healing of the penile skin (Figure 3b). His SPC was also removed with low post-void residual noted. Results We present a case where mechanical methods could not be used to remove entrapped metal rings around a penis. In cases requiring the use of electrical tools, it is of utmost importance to protect the penis from iatrogenic injuries. Although the use of non-medical devices such as electric saws have been described in penile strangulation, they can often be bulky. Also, in several reports these devices have caused thermal injuries, leading to urethral strictures and urethrocutaneous fistulae. We were able to use the Midas Rex® drill, an instrument typically used in neurosurgical and orthopedic procedures, with excellent results. By using the diamond-tipped metal cutter attachment and powering the drill with compressed nitrogen set at 120 psi, all five metal rings were safely removed in under 30 minutes. Conclusions Penile strangulation represents a rare urologic entity requiring prompt removal of constricting devices to avoid ischemic complications. From our experience, we demonstrated that the Midas Rex® drill can be safely and expeditiously used to remove metal rings entrapped around a penis with minimal risk of iatrogenic injury. Disclosure No

Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) : Arare urological emergency

Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) is arare, semi-acute disease in young, healthy men. In addition to an anatomical predisposition, perineal microtrauma is stated as the main risk factor. Acase report and the results of a literature search with descriptive-statistical processing of 57peer-reviewed publications are presented. Atherapy concept was drawn up for clinical practice. Our patient was treated conservatively and was consistent with the 87cases which have been published since 1976. IPTCC is adisease of young men (33.2years, range 18-70), which is associated with pain and perineal swelling in 88%. Sonography and contrast-enhanced magnetic resonance imaging (MRI) proved to be the diagnostic modality of choice, demonstrating the thrombus and in 89% aconnective tissue membrane inside the corpus cavernosum. Treatment included antithrombotic and analgesic (n = 54, 62.1%), surgical (n = 20, 23%), analgesic (n = 8, 9.2%), via injection (n = 2, 2.3%), as well as radiological interventional (n = 1, 1.1%) options. In 12cases, erectile dysfunction, mostly temporary, which required phosphodiesterase (PDE)-5 therapy developed. Recurrence and prolonged courses were rare. IPTCC is arare disease in young men. Conservative therapy with antithrombotic and analgesic treatment has shown good chances of full recovery. If relapse occurs or the patient refuses antithrombotic treatment, operative/alternative therapy management should be considered.

AB002. SOH23ABS_070. Postponement of urology emergency cases in Midwest region in Ireland 2022

Background: The aim of this study was to investigate the rates of postponement of emergency cases in urology in the Mid-West region of Ireland.

Epidemioclinical, Etiological and Therapeutic Study of Paraphimosis at the Centre de Santé de Référence (CSRéf) of Markala, about Five Cases

The aim was to study the epidemiological, clinical and therapeutic aspects of paraphimosis at the CSRéf of Markala. Patients and Methods: We conducted a prospective and descriptive study of five patients who had consulted for paraphimosis in the operating theatre of the Markala referral health centre from 1er January 2019 to 31 December 2021, i.e. a two-year period. Our study included all patients who consulted for paraphimosis at the CSRéf of Markala with a usable medical file. The criteria for non-inclusion were: Phimosis without other pathologies of the penis. The records were not usable, as this was a prospective study. Results: The frequency of paraphimosis was 2.1% out of 235 patients hospitalized and operated on at the CSRéf of Markala during the study period. Four of our patients had no particular medical or surgical history, but the oldest of our patients had already undergone a hernia repair and an appendectomy at the time ; the average age of our patients was 15.3 years, with extremes ranging from 3 years to 53 years . However, we note that there is no specific age of onset of paraphimosis The treatment received by all our patients was posthectomy. No major complication was noted in our patients, however we deplore a loss of sight in two of our patients for a long term follow-up in order to identify other unknown aspects in the management of paraphimosis. Conclusion: Paraphimosis is a true urological emergency that occurs in uncircumcised men when the foreskin is trapped behind the glans crown, which can lead to long-term strangulation of the glans and compromise its vascularity hence their immediate management paraphimosis.

COMPARISON OF RECURRENCE OF URETHRAL STRICTURE AFTER INTERNAL OPTICAL URETHROTOMY WITH AND WITHOUT POST-OPERATIVE ORAL STEROIDS IN DISTRICT DERA ISMAIL KHAN

Urethral stricture is one of the most common diseases in urology. The urethral structure is the narrowing of the urethral lumen due to spongiofibrosis. It is notorious for its recurrence and accounts for the major burden on the Urology department. Internal optical urethrotomy is considered the first line of treatment for urethral stricture. When combined with clean intermittent self-catheterization, and Intralesional injections, better results could be obtained. This study compares the recurrence of urethral stricture after internal optical urethrotomy with and without post-operative oral steroids in the population of Dera Ismail Khan. The study was a non-randomized control trial done in the Urology Department, DHQ/MTI-TH, Dera Ismail Khan, Pakistan, from January 2021 to June 2021. The patients from the urology outdoor and emergency of DHQ Teaching Hospital were included in the study. A total of 152 patients were divided by lottery method into two groups’ an experimental group and Control group, each containing 76 patients. After losing follow-up, the remaining patients who completed the study were 128. The patients in both groups underwent internal optical urethrotomy with a cold knife. The experimental group of patients received oral steroids for 4 weeks. The control group didn’t receive steroids after the procedure. The mean age in the experimental group was 41 ± 09 years, while in the control group, it was 36 ± 13 years. After 6 months, the recurrence was observed in 12 patients (18.75%) in the experimental group and 25 in the control group (39.06%). These results showed a statistically significant difference in recurrence rate between these two groups with a p-value of 0.0123. Based on the results, it can be concluded that the use of oral steroids after internal optical urethrotomy decreases the risk of recurrence of urethral stricture significantly.

Strangulation of the Penis by Metal Ring on a Right Inguino-Scrotal Hernia: About a Case at Sikasso Hospital

Strangulation of the penis by a metal ring is a rare situation in urology. It requires emergency care because it can jeopardize the functional prognosis of the penis. We report the case of strangulation of the penis by a metal steel ring associated with a right inguino-scrotal hernia from which we will present the non-surgical management of this urological emergency.

Remote limb ischemic postconditioning attenuates myocardial dysfunction induced by testicular torsion/detorsion in rats.

Torsion of the spermatic cord is a urological emergency that must be treated immediately with surgery, yet detorsion of the testis can cause testicular tissue damage because of ischemia‒reperfusion (I/R) injury. I/R injury is a complex pathophysiological process that may affect the functions of distant organs. Here, we examined whether testicular torsion/detorsion causes myocardial dysfunction. We next investigated the potential beneficial effect and underlying mechanisms of remote ischemic postconditioning (RIPost) on cardiac function after testicular torsion/detorsion. Male Sprague Dawley rats were assigned to three different sets of experimental groups. Testicular I/R was induced by rotating the right testis to 1080 degrees clockwise for 3 hours followed by 3 h of detorsion. RIPost was induced at the onset of testicular detorsion by four cycles of 5-min bilateral femoral artery occlusion with 5-min reperfusion. Cardiac function was determined postdetorsion, and the cardioprotective effect of RIPost was examined. Testicular torsion/detorsion-treated rats had reduced serum testosterone levels, impaired systemic hemodynamics, elevated systemic inflammatory responses and increased serum levels of LDH, CK-MB, α-HBDH and cTnI. Healthy rats transfused with testicular torsion/detorsion-treated plasma presented impaired cardiac function. However, RIPost attenuated remote heart dysfunction induced by testicular torsion/detorsion. Furthermore, RIPost enhanced the phosphorylation of ventricular STAT-3, which is a key component of the SAFE signaling pathways. Inhibition of STAT-3 with Ag490 abolished the RIPost-induced cardioprotection and STAT-3 phosphorylation. Testicular torsion followed by detorsion resulted in impairment of cardiac function. RIPost effectively attenuates this remote cardiac dysfunction. RIPost-induced protective effects may be mediated by the STAT-3 signaling pathway.

V11-04 ORTHOPEDIC DRILL FOR REMOVAL OF A STEEL PENILE CONSTRICTION RING AFTER PROLONGED ENTRAPMENT

You have accessJournal of UrologyCME1 Apr 2023V11-04 ORTHOPEDIC DRILL FOR REMOVAL OF A STEEL PENILE CONSTRICTION RING AFTER PROLONGED ENTRAPMENT Stephen Harrington, Hershey, Pa Ashley Matthew, Susan Macdonald, Hershey Pa, and Tyler Roseman Stephen HarringtonStephen Harrington More articles by this author , Hershey, Pa Ashley MatthewHershey, Pa Ashley Matthew More articles by this author , Susan MacdonaldSusan Macdonald More articles by this author , Hershey PaHershey Pa More articles by this author , and Tyler RosemanTyler Roseman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile incarceration or strangulation due to an external device is a rare urologic emergency. There are many different types of constriction rings that vary in composition and form. Metal constriction rings are particularly challenging to remove once the penis becomes entrapped as they are not only a harder material, but often are of increased thickness compared to typical constriction rings. We detail a case of prolonged penoscrotal incarceration due to a steel constriction ring and the method utilized for the ring’s removal. We aim to describe a specific and actionable technique for removing metal constriction rings. METHODS: We report the technique used to remove a stainless steel ring that cause penoscrotal entrapment and subsequent edema after being in place for 12 hours. RESULTS: The patient was prepped in an operating room and a combination of saline soaked gauze and blue towels were used to protect the surrounding skin. The skin below and surrounding the ring was coated in lubricating jelly to prevent scatter of heated metal fragments. An army navy retractor was placed between the ring and the skin to protect the genitals from injury. An Ortho Core Metal Cutting Pneumatic Drill with a 3.2 mm x 18.3 mm metal cutting helicoidal rasp was used to cut the ring at the 3 and 9 ‘o clock positions. Cooled saline irrigation was applied throughout removal to prevent thermal injury. The patient was seen 6-weeks post-operatively. There were no visible external injuries, palpable penoscrotal pathology or voiding complaints. All swelling had resolved. The patient did endorse worsened erectile dysfunction, but no other complications were noted. CONCLUSIONS: Penile incarceration due to a constriction ring is a urologic emergency that necessitates timely evaluation and management. The Stryker Ortho Core Metal Cutting Drill with a metal cutting helicoidal rasp is a reliable tool for the removal of metal constriction rings. Measures to protect the genitals and surrounding skin from both direct mechanical injury and indirect thermal injury are critical. Lastly, staff should wear appropriate protective gear. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1000 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Harrington More articles by this author Hershey, Pa Ashley Matthew More articles by this author Susan Macdonald More articles by this author Hershey Pa More articles by this author Tyler Roseman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP25-06 DEVELOPMENT OF A MULTI-INSTITUTIONAL, SIMULATION-BASED SURGICAL SKILLS BOOTCAMP FOR JUNIOR UROLOGY RESIDENTS

You have accessJournal of UrologyCME1 Apr 2023MP25-06 DEVELOPMENT OF A MULTI-INSTITUTIONAL, SIMULATION-BASED SURGICAL SKILLS BOOTCAMP FOR JUNIOR UROLOGY RESIDENTS Justin Lee, Miyad Movassaghi, Nitya Abraham, William Atallah, Jamie Kanofsky, Evan Kovac, Michael Maren, Gregory Mullen, Allison Polland, Courtney Phillips, John Phillips, Rollin Say, Michael Smigelski, Jeffrey Weiss, Andrew Winer, Alexander Small, Christopher Anderson, and Gina Badalato Justin LeeJustin Lee More articles by this author , Miyad MovassaghiMiyad Movassaghi More articles by this author , Nitya AbrahamNitya Abraham More articles by this author , William AtallahWilliam Atallah More articles by this author , Jamie KanofskyJamie Kanofsky More articles by this author , Evan KovacEvan Kovac More articles by this author , Michael MarenMichael Maren More articles by this author , Gregory MullenGregory Mullen More articles by this author , Allison PollandAllison Polland More articles by this author , Courtney PhillipsCourtney Phillips More articles by this author , John PhillipsJohn Phillips More articles by this author , Rollin SayRollin Say More articles by this author , Michael SmigelskiMichael Smigelski More articles by this author , Jeffrey WeissJeffrey Weiss More articles by this author , Andrew WinerAndrew Winer More articles by this author , Alexander SmallAlexander Small More articles by this author , Christopher AndersonChristopher Anderson More articles by this author , and Gina BadalatoGina Badalato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In order to increase junior resident proficiency and improve patient safety, simulation-based procedural trainings, or bootcamps, have become an emerging educational tool. Our goal was to assess the viability and efficacy of a multi-institutional, predominantly skills-based bootcamp for junior urology residents. METHODS: First and second year urology residents from the New York Section of the American Urologic Association (AUA) attended a live, procedurally-focused EMPIRE (Educational Multi-Institutional Program for Instructing REsidents) Boot Camp. The curriculum included simulation-based trainings including urethral catheterization, cystoscopy, renal and bladder ultrasound, and robotic simulation (Figure 1). Faculty from 10 institutions helped lead the various exercises. The seminar also included a didactic on urologic emergencies. A questionnaire assessing the experience was distributed to all faculty and resident participants immediately following the course. RESULTS: Twenty-nine junior residents and 16 faculty members participated in this course. Following completion, 11 faculty (69%; 11/16) and 23 trainees (79%; 23/29) submitted an evaluation. On a 5-point Likert scale of relative efficacy, with a higher number being more favorable, the score for each activity ranged from a mean of 4.39 ± 0.64 for the renal bladder ultrasound station to 4.83 ± 0.38 for the urethral catheterization workshop. The majority of trainees “strongly agreed” the event was fun and engaging (20/23; 4.83 ± 0.48) and felt better prepared for upcoming residency rotations (20/23; 4.78 ± 0.59) after the boot camp. Over 90% (21/23; mean 4.91 ± 0.28) strongly agreed the course provided a high-yield overview of urologic emergencies. 73% (8/11) of faculty rated the event as “excellent” for skills training. When asked about skills sessions for interns at their institutions in prior years, 45% (5/11) faculty noted no prior advanced skills sessions were offered. CONCLUSIONS: A skills-based collaborative urology boot camp is feasible and is perceived to be effective in preparing junior trainees for residency in a multi-institutional environment. Multi-institutional efforts such as these can help ensure trainees have equitable access to fundamental training experiences. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e344 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Lee More articles by this author Miyad Movassaghi More articles by this author Nitya Abraham More articles by this author William Atallah More articles by this author Jamie Kanofsky More articles by this author Evan Kovac More articles by this author Michael Maren More articles by this author Gregory Mullen More articles by this author Allison Polland More articles by this author Courtney Phillips More articles by this author John Phillips More articles by this author Rollin Say More articles by this author Michael Smigelski More articles by this author Jeffrey Weiss More articles by this author Andrew Winer More articles by this author Alexander Small More articles by this author Christopher Anderson More articles by this author Gina Badalato More articles by this author Expand All Advertisement PDF downloadLoading ...

MP15-12 VALIDATION OF THE FOURNIER'S GANGRENE SEVERITY INDEX AND OUTCOMES OF A DECADE OF FOURNIER'S GANGRENE EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP15-12 VALIDATION OF THE FOURNIER'S GANGRENE SEVERITY INDEX AND OUTCOMES OF A DECADE OF FOURNIER'S GANGRENE EXPERIENCE Bruce N. Haik, Akhil A. Saji, Muhammad S. Choudhury, and Daniel C. Rosen Bruce N. HaikBruce N. Haik More articles by this author , Akhil A. SajiAkhil A. Saji More articles by this author , Muhammad S. ChoudhuryMuhammad S. Choudhury More articles by this author , and Daniel C. RosenDaniel C. Rosen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fournier’s Gangrene (FG) is a life-threatening but rare urologic emergency. The prognosis depends on several factors, many of which are captured by the Fournier Gangrene Severity Index (FGSI). We aimed to identify predictors of mortality, prolonged length of stay, and home discharge in a patient sample from a single center over a 11-year period. METHODS: Patients treated for FG at a tertiary care facility between 2011-2022 were identified using diagnosis codes and then data from the index hospitalizations were manually extracted. Captured data included demographic and baseline comorbidities, FGSI, operative treatment, and postoperative course and outcomes. Univariate logistic regression analyses were performed for mortality, composite mortality or >6-week length of stay (LOS), and home discharge. RESULTS: Predictors of mortality were FGSI >=14 (β=3.8, p=0.015) and Charlson comorbidity index (CCI) >=8 (β=3.1, p=0.028); predictors of composite mortality or >6-week LOS were FGSI >=10 (β=2.5, p=0.009), delay before presentation >=2 days (β=-2.4, p=0.046), and abdominal involvement (β=2.6, p=0.007); and the predictor of home discharge was CCI <4 (β=3.3, p=0.012). CONCLUSIONS: FGSI was an accurate predictor of mortality in this cohort. Baseline health, rather than disease severity, was the strongest predictor of ability to be discharged directly to home. Presentation within one day of symptom onset may indicate fulminant disease and was associated with poor outcomes. Finally, empiric antimicrobial therapy should include antifungal coverage, as Candida species were found in a quarter of wound cultures. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e196 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruce N. Haik More articles by this author Akhil A. Saji More articles by this author Muhammad S. Choudhury More articles by this author Daniel C. Rosen More articles by this author Expand All Advertisement PDF downloadLoading ...

A contemporaneous narrative review of Fournier's gangrene.

Fournier's gangrene is a necrotizing infection of the external genitalia, perineal or perianal regions and is mainly seen in males. Its main risk factors include diabetes, chronic alcoholism, HIV and other immune-compromised states. Fournier's gangrene has an aggressive course associated with a mortality rate of 20%-30%, making early diagnosis and management very important. The Fournier Gangrene Severity Index (FGSI) has been traditionally used to predict the severity and prognosis. More recently, simplified FGSI (sFGSI) has been proposed and is helpful. However, timely diagnosis, supportive medical management and complete surgical debridement are still the cornerstones of treatment. These must be complemented with early and timely re-look debridements and appropriate reconstruction to cover soft tissue defects. This literature review aims to look at recent relevant research regards risk factors and prognostic features of Fournier's gangrene. A search was conducted on Google Scholar and PubMed databases for all articles related to Fournier's Gangrene. These included clinical reviews, case reports, case series and retrospective studies. Reports or studies which were not published in English were not reviewed. Various reconstructive techniques to cover the defects have also been revisited. Broad-spectrum antibiotics and urgent surgical debridement are the core management principles of Fournier's gangrene. Repeat debridement after 24 h is also recommended. Adjunctive therapies such as hyperbaric oxygen and vacuum-assisted closure are supported in most aspects of recent literature. Expectedly, there is a lack of randomised controlled studies in such emergency surgical conditions, which limits the widespread use of newer therapies to patients unresponsive to conventional management. Fournier's gangrene is a urological emergency with a high mortality rate. The aggressive nature of the infection necessitates early recognition and immediate surgical intervention. Negative pressure dressing and occasional hyperbaric oxygen as adjuncts should be used more routinely, especially if there is a delayed response to conventional treatment or in severe infections.

Parents' Awareness and Knowledge of Testicular Torsion in the Western Region of Saudi Arabia.

Introduction Testicular torsion (TT) is the most common urological emergency in children that requires immediate intervention. The prognosis of testicular torsion depends on the patient's time of presentation to the emergency department (ED), as well as on the time at which the diagnosis is established and treatment is initiated. Raising public awareness of testicular torsion, particularly among parents, plays a crucial role in preventing delay in presentation and reducing the frequency of orchiectomy. To this end, the study is designed to assess the level of awareness and knowledge of testicular torsion, as well as the response of parents to the scrotal pain of their children. Methods A descriptive cross-sectional study was conducted among parents in the western region of Saudi Arabia. Data was collected between the 23rd of November and the 22nd of December 2022. A simple random sampling technique was implemented. The data was collected and analyzed using SPSS software (IBM Corp., Armonk, NY). Results A total of 394 parents participated in this study. It showed that 13.5% of parents reported having a child with a previous experience of pain in the scrotum. Of them, only 25.4% previously heard about torsion of the testicles. Only 68.8% and 76.6% correctly reported that if the child complains of pain in the scrotum during working hours or over the weekend, they will drive him to the hospital immediately. Good knowledge about TT was significantly higher among children's fathers compared to mothers (66.7% vs. 33.3%) (p≤0.05). Conclusion Testicular torsion (TT) represents significant morbidity among male patients and early identification is crucial to avoid the need for orchiectomy and all its prominent physical and psychological consequences. To improve children's well-being, we need to raise parents' awareness of TT and the potential future implications of this critical condition as it is not widely known in our community. Further studies evaluating the knowledge regarding testicular torsion among preadolescent and adolescent boys are warranted.

The Antimicrobial Resistance Index and Fournier Gangrene Severity Index of Patients Diagnosed with Fournier's Gangrene in a Tertiary Hospital in North Eastern Romania.

Background: Although rare, Fournier's gangrene is a major urological emergency. We aimed to learn more about the pathogenesis of Fournier's gangrene and assess the antibiotic resistance patterns in individuals with this disease. Methods: We retrospectively evaluated the patients diagnosed with and treated for Fournier's gangrene in a Neamt county hospital and "CI Parhon" Clinical Hospital in Iasi, Romania between 1 January 2016 and 1 June 2022. Results: We included a total of 40 patients, all males; of these, 12.5% died. In our study, in the patients that died, the adverse prognostic factors were a higher body temperature (38.12 ± 0.68 vs. 38.94 ± 0.85 °C; p = 0.009), an elevated WBC (17.4 ± 5.46 vs. 25.23 ± 7.48; p = 0.003), obesity (14.28% vs. 60%; p = 0.04), and a significantly higher FGSI (4.17 ± 2.80 vs. 9.4 ± 3.2; p = 0.0002) as well as MAR index (0.37 ± 0.29 vs. 0.59 ± 0.24; p = 0.036). These patients were more likely to have liver affections than those in the group who survived, but the difference was not significant. The most frequently identified microorganism in the tissue secretions culture was E. coli (40%), followed by Klebsiella pneumoniae (30%) and Enterococcus (10%). The highest MAR index was encountered in Acinetobacter (1), in a patient that did not survive, followed by Pseudomonas (0.85) and Proteus (0.75). Conclusions: Fournier's gangrene remains a fatal condition, a highly resistant causative microorganism that is not always correlated with a poor prognosis.