Jeffrey D. Redshaw

Intralesional Injection of Mitomycin C at Transurethral Incision of Bladder Neck Contracture May Offer Limited Benefit: TURNS Study Group

PURPOSE Injection of mitomycin C may increase the success of transurethral incision of the bladder neck for the treatment of bladder neck contracture. We evaluated the efficacy of mitomycin C injection across multiple institutions. MATERIALS AND METHODS Data on all patients who underwent transurethral incision of the bladder neck with mitomycin C from 2009 to 2014 were retrospectively reviewed from 6 centers in the TURNS. Patients with at least 3 months of cystoscopic followup were included in the analysis. RESULTS A total of 66 patients underwent transurethral incision of the bladder neck with mitomycin C and 55 meeting the study inclusion criteria were analyzed. Mean ± SD patient age was 64 ± 7.6 years. Dilation or prior transurethral incision of the bladder neck failed in 80% (44 of 55) of patients. Overall 58% (32 of 55) of patients achieved resolution of bladder neck contracture after 1 transurethral incision of the bladder neck with mitomycin C at a median followup of 9.2 months (IQR 11.7). There were 23 patients who had recurrence at a median of 3.7 months (IQR 4.2), 15 who underwent repeat transurethral incision of the bladder neck with mitomycin C and 9 of 15 (60%) who were free of another recurrence at a median of 8.6 months (IQR 8.8), for an overall success rate of 75% (41 of 55). Incision with electrocautery (Collins knife) was predictive of success compared with cold knife incision (63% vs 50%, p=0.03). Four patients experienced serious adverse events related to mitomycin C and 3 needed or are planning cystectomy. CONCLUSIONS The efficacy of intralesional injection of mitomycin C at transurethral incision of the bladder neck was lower than previously reported and was associated with a 7% rate of serious adverse events.

Childhood Cancer Risk in the Siblings and Cousins of Men with Poor Semen Quality

Purpose: Poor semen quality is associated with reduced somatic health and increased cancer risk. Infertility and cancer are increasingly being linked by epidemiologists and basic scientists. We sought to identify semen parameters associated with an increased childhood cancer risk in the family members of subfertile men. Materials and Methods: We performed a retrospective cohort study in men from the SHARE (Subfertility Heath and Assisted Reproduction) study who underwent semen analysis between 1994 and 2011. We used fertile population controls from the Utah Population Data Base. Our primary outcome was the risk of any childhood (18 years or younger) cancer in the siblings and cousins of men who underwent semen analysis compared to fertile, age matched controls. Cox proportional hazard regression models were used to test the association between semen quality and childhood cancer incidence. Results: We selected 10,511 men with complete semen analysis and an equal number of fertile controls. These men had a total of 63,891 siblings and 327,753 cousins. A total of 170 and 958 childhood cancers were identified in siblings and cousins, respectively. The 3 most common cancers diagnosed in siblings were acute lymphoblastic leukemia in 37, brain cancer in 35 and Hodgkin lymphoma in 15. Oligozoospermia was associated with a twofold increased risk of any childhood cancer and a threefold increased risk of acute lymphoblastic leukemia in the siblings of subfertile men compared to fertile controls (HR 2.09, 95% CI 1.18–3.69 vs HR 3.07, 95% CI 1.11–8.46). Conclusions: Siblings of men with oligozoospermia are at increased risk for any‐site cancer and acute lymphoblastic leukemia. This suggests a shared genetic/epigenetic insult or an environmental exposure that merits further investigation.

Use of a polytetrafluoroethylene (GORE-TEX) bolster to close the renal parenchymal defect during open partial nephrectomy.

INTRODUCTION Numerous surgical techniques have been described to facilitate closure of the renal parenchymal defect. We sought to describe the operative technique and define the safety and efficacy of using an expanded polytetrafluoroethylene (GORE-TEX; WL Gore and Associates, Flagstaff, AZ) bolster to aid in closure of the renal parenchymal defect at the time of open partial nephrectomy (OPN). TECHNICAL CONSIDERATIONS A retrospective review of 175 patients who underwent an OPN using an expanded polytetrafluoroethylene (ePTFE) bolster at the Huntsman Cancer Hospital, University of Utah and Salt Lake City Veterans Affairs Medical Center from March 2005 to February 2013 was conducted. Postoperative complications occurring within 90 days were graded using the Clavien grading system. CONCLUSION Overall, 57 patients (32.6%) experienced a postoperative complication. Fifteen patients (8.5%) had a Clavien ≥ grade-III complication. Ten patients (5.7%) received blood transfusions. Urine leak requiring intervention occurred in 2 patients (1.1%). Delayed hemorrhage requiring nephrectomy and pseudoaneurysm formation were rare, occurring in 1 patient each (0.6%). Infection of the ePTFE material occurred in 2 patients (1.1%). In both cases, it was explanted without requiring nephrectomy. The use of an ePTFE bolster is an effective and safe method of closing the renal parenchymal defect after OPN with an acceptable 90-day postoperative complication rate and a low risk of infection.

Clinical, radiologic, and pathologic analysis of penile epithelioid hemangioendothelioma: A diagnostic and management dilemma

Epithelioid hemangioendotheliomas (EHE) are rare soft tissue tumors and only 17 cases involving the penis have been reported in the literature. These tumors are often incorrectly diagnosed as Peyronies disease or superficial penile thrombosis. We present the case of a 59-year-old male referred to our institution with EHE after being incorrectly diagnosed with Peyronies disease. A color Doppler ultrasound of the penis showed a highly vascular mass superficial to the tunica albuginea and a subsequent biopsy demonstrated EHE with low-grade features. Complete local excision was performed and given the patients low-risk pathological features, he has been followed with only close surveillance. Early recognition of epithelioid vascular tumors is important and using adequate imaging modalities is critical to avoid prolonged periods of misdiagnosis.

Improved compliance with prophylactic antibiotic guidelines in urologic prosthetic surgery using a simple protocol: Should antimicrobial prophylaxis be administered exclusively in the operating room?

Context: Established guidelines advocate for the administration of antimicrobial prophylaxis (AMP) within 60 min of the surgical incision. An internal audit of genitourinary prosthetics at our institution revealed, we were compliant in only 25% of cases and led to the development of a standardized protocol emphasizing administration of AMP in the OR by the anesthesia provider and specific duties for each member of the surgical team (anesthesia, surgery, and nursing). Aims: The aim was to describe the system factors that we recognized as responsible and determine our protocols effect on compliance. Settings and Design: A retrospective review of urologic prosthetics cases performed by a single surgeon at our institution from October 2009 to January 2011 was conducted. Sixty consecutive cases occurring: Prior to the protocol, immediately after, and 18 months after it went into effect were reviewed. Statistical Analysis: Categorical data were compared using the Fishers exact test and continuous variables using the Students t -test at the P > 0.05 significance level. Results: System factors associated with noncompliance included: Location of antibiotic administration (OR vs. preoperative area) and timing of the case (first case vs. not). Ninety-six percent of noncompliance was the result of AMP being administered too early. Compliance increased from 25% to >91% and the proportion of AMP administered in the OR increased from 20% to >88%. No drop-off in compliance occurred 18 months after initiation of the protocol. Conclusion: A defined protocol in conjunction with shifting administration of AMP to the OR and into the hands of the anesthesia provider can achieve a durable increase in compliance with established guidelines.