Anees Fazili

Short-term quality-of-life assessed after robot-assisted radical cystectomy : a prospective analysis

To prospectively determine the effect of robot‐assisted radical cystectomy (RARC) on quality of life (QoL) after surgery.

Does the presence of significant risk factors affect perioperative outcomes after robot-assisted radical cystectomy?

To evaluate the effect of preoperative risk factors on perioperative outcomes up to 3 months after robot‐assisted radical cystectomy (RARC), as RC continues to be associated with a high rate of morbidity and mortality.

Putative Health Risks Associated with Vasectomy

Vasectomy is widely regarded as a safe method of contraception, but over the years there have been many reports suggesting putative health risks associated with the procedure. Concerns over the possible association of vasectomy with a number of medical conditions, including cardiovascular disease, testicular cancer, prostate cancer, psychologic distress, and a variety of immune complex-mediated disease processes have been reported. Most recently, a manuscript from the neurology literature has described an association between vasectomy and primary progressive aphasia, a rare variety of frontotemporal dementia. This article reviews the literature surrounding each of these purported health concerns. Because the ultimate findings have important ramifications for both informed consent of vasectomy patients and for public health, the reported health risks in question should be critically evaluated.

A critical analysis of the reported association between vasectomy and frontotemporal dementia.

those men of lower socioeconomic status; these men may thus be less likely to receive specialized medical care. Men of higher socioeconomic status may be more likely to receive a correct diagnosis of PPA in a specialized center. This population is also more likely to undergo a vasectomy. Furthermore, men with vasectomies generally have several children, and therefore may be more likely to be brought in by family for early signs or symptoms of dementia, thus facilitating the correct diagnosis of a rare disorder such as PPA. THE ROLE OF MISCLASSIFICATION BIAS Misclassification bias is a common challenge for retrospective epidemiological studies. In this study, the PPA subjects are more likely to have been placed in the incorrect classification of occurrence of vasectomy than are the control subjects. It would seem likely that the control group of mentally intact individuals, who are generally well educated and motivated to volunteer for a study would more accurately recount vasectomy occurrence in comparison to a patient with dementia. The PPA group had a similar educational level, but education level of the corroborating partners was not controlled. Due to the small sample size of the study, misclassification of even a small numberofsubjectscouldsignificantlyimpacttheapparentassociation of PPA with vasectomy. Although in this study the possibility of misclassification was reduced by partner verification, it may still play a role due to the mental impairment of the subjects and retrospective nature of determining vasectomy status performed several decades earlier.