Julie W. Cheng

Role of reactive oxygen species in male infertility: An updated review of literature

Abstract Objectives To review the literature and provide an updated summary on the role of reactive oxygen species (ROS) in male infertility. Methods A review of PubMed, Cochrane review, and Web of Science databases for full-text English-language articles published between 1943 and 2017 was performed, focusing on the aetiology of ROS, physiological role of ROS on spermatic function, pathological role of ROS in infertility, evaluation of ROS, and role of antioxidants in oxidative stress. Results ROS play a role in spermatic function and fertilisation. The literature describes both a physiological and a pathological role of ROS in fertility. A delicate balance between ROS necessary for physiological activity and antioxidants to protect from cellular oxidative injury is essential for fertility. Conclusion Although elevated levels of ROS are implicated as a cause of infertility, there is no consensus on selecting patients to test for ROS, which test to perform, or if treatment for ROS can have a positive impact on infertility rates and pregnancy.

Dextrose instillation as an alternative agent to observe ureteral efflux during pelvic reconstructive surgery

OBJECTIVEnTo evaluate the use, cost, postoperative urinary tract infection (UTI) rates, and complications of dextrose instillation during cystoscopy.nnnMETHODSnThe medical records of patients who underwent cystoscopy during pelvic reconstructive surgery between June 2016 and June 2017 were reviewed. Patients were divided into two groups: patients who had one ampule of dextrose 50% (D50) directly instilled and patients who did not have D50 instilled during cystoscopy. Preoperative demographics, UTI rates, and postoperative complications were compared. Pharmaceutical cost and availability were reported by the pharmacy at our institution.nnnRESULTSnOut of 63 patients identified, dextrose instillation was used in 20 patients and no dextrose was used in 43 patients. Each ampule of D50 cost

Translabial ultrasound evaluation of pelvic floor structures and mesh in the urology office and intraoperative setting

2.18 and there were no problems with supply shortage. As D50 was directly instilled into the bladder, there was immediate visualization of ureteral efflux at the time of surgery. Three patients (15%) in the dextrose group and 10 patients (23%) in the nondextrose group developed postoperative UTIs. There was no statistically significant difference in postoperative UTI rates between the two groups (p = 0.43) and there were no differences in postoperative complications.nnnCONCLUSIONnDextrose is a safe, cost-effective, readily available agent that provides instantaneous visualization of ureteral efflux without an increased risk of postoperative UTI.

Erosion of Polytetrafluoroethylene (Gore-Tex®) Sling Over 20 Years after Placement for Stress Urinary Incontinence

BACKGROUNDnTranslabial ultrasound (TUS) can provide an inexpensive alternative imaging modality for evaluating pelvic floor structures and synthetic slings as mesh can be difficult to identify on pelvic exam or cystoscopy, patients may be unable to provide an accurate history of previous pelvic surgery, and cross-sectional imaging with computed tomography and magnetic resonance imaging can be inadequate for evaluating synthetic slings.nnnOBJECTIVEnTo demonstrate the use of TUS in the evaluation of female pelvic floor structures and mesh.nnnMETHODSnTranslabial ultrasound can be used in the Urology clinic or intraoperative setting using a curvilinear transducer. Following identification of anatomic landmarks in the various planes of the pelvic floor, TUS can evaluate for pelvic floor disorders and the type and location of synthetic mesh material. Artifacts, such as air pockets in the vagina or rectum and the hypoechoic pubic symphysis, are also considered.nnnRESULTSnReal-time imaging allows for dynamic examination of pelvic organ prolapse and urethral hypermobility that can contribute to pelvic exam findings. Bladder ultrasound can help evaluate for lesions, calculi, and even mesh erosion. Translabial ultrasound can also be used to differentiate hyperechoic retropubic and transobturator slings by identifying the position of sling arms and the appearance of the sling at different planes. Evaluation with TUS can demonstrate sling disruption, folding, urethral impingement, and erosion into pelvic floor structures. This can be particularly useful in patients presenting with pain, recurrent infections, or voiding dysfunction in which problems with mesh may not be easily identified on pelvic exam or cystoscopy. This imaging modality can complement a patients history, aid in preoperative planning, and enable intraoperative identification of mesh slings.nnnCONCLUSIONnTranslabial ultrasound provides a quick, readily available, and easy-to-learn imaging modality for evaluating pelvic floor structures and mesh in the office or intraoperative setting.

Postoperative urinary retention after pelvic organ prolapse repair: Vaginal versus robotic transabdominal approach

As synthetic material has evolved to improve both the efficacy and biocompatibility of suburethral slings, soft polypropylene slings are currently the gold standard for treatment of stress urinary incontinence. However, reports of complications beyond 10 years are limited and patients can nevertheless present with erosion and other complications from other sling materials that have been used in the past. We present a case of synthetic sling erosion 21 years after placement of a polytetrafluoroethylene sling (Gore-tex).

Do Illuminated Foot Pedals Improve the Speed and Accuracy of Pedal Activation During Endoscopic Procedures

Postoperative urinary retention has been reported in 13–32% of patients that undergo pelvic organ prolapse (POP) repair. The purpose of our study was to compare rates of urinary retention between transvaginal and robotic transabdominal approaches and identify risk factors for postoperative urinary retention following POP repair.

Comparing the vaginal wall sling with autologous rectus fascia and polypropylene sling: Short term outcomes and patient satisfaction

PURPOSEnEndourologic procedures such as percutaneous nephrolithotomy (PCNL) employ the use of foot pedals in low-light operating room (OR) settings. These pedals can be especially difficult to locate or distinguish when several pedals are present during a single operation. Improper instrument activation in the OR has led to serious complications ranging from unintentional electrocautery to patient burns and even an intraoperative explosion. This study evaluates the impact of color-coded illumination on speed and efficiency of foot pedal activation.nnnMATERIALS AND METHODSnDuring a simulated PCNL procedure, the foot pedals for a C-arm, laser, and ultrasonic lithotripter (USL) were placed in random positions. Ten participants performed pedal activation in a randomized sequence. Objective outcomes included time to instrument activation, number of attempted pedal presses, number of incomplete pedal presses, and number of incorrect pedal presses. Subjective preferences for pedal illumination were also determined. Data were analyzed using Mann-Whitney U, Wilcoxon signed-rank, and Chi-square tests with pu2009<u20090.05 indicating statistical significance.nnnRESULTSnIlluminated foot pedals were associated with decreases in the average activation time for all instruments collectively (3.95 seconds vs 6.49 seconds; pu2009=u20090.017) and individually (C-arm: 3.07 seconds vs 4.21 seconds; pu2009=u20090.006; laser: 13.04 seconds vs 15.18 seconds; pu2009<u20090.001; USL: 3.28 seconds vs 4.91 seconds; pu2009<u20090.001) compared with nonilluminated pedals. Illuminated pedals were associated with fewer attempted pedal presses (33.5 vs 39.5; pu2009=u20090.007) and incomplete pedal presses (1.5 vs 8.5; pu2009=u20090.002). The number of incorrect pedal presses decreased with illumination, but this did not reach statistical significance (0 vs 0.5; pu2009=u20090.08). Participants reported that illumination simplified pedal activation and recommended its use (pu2009<u20090.01).nnnCONCLUSIONnColor-coded illumination improved the speed and efficiency of foot pedal activation during simulated PCNL. Participants subjectively preferred using illuminated foot pedals for endourologic procedures and felt that they improved safety and efficiency.

PD35-07 CHRONIC INDWELLING URETERAL STENTS: DOES STENT LENGTH OR STIFFNESS AFFECT ENCRUSTATION?

OBJECTIVESnMany women are affected by stress urinary incontinence (SUI). Due to investigations of the safety of synthetic mesh slings, there has been renewed interest in autologous slings. The aim of this study is to evaluate whether different sling material affects outcomes and patient satisfaction.nnnMETHODSnA retrospective review was performed of patients who underwent sling placement between May 2011 and April 2017 for SUI or stress-predominant mixed urinary incontinence. Patients were divided based on the sling material used: vaginal wall sling (VWS), rectus fascia sling (RFS), and soft polypropylene sling (SPS). Outcomes were compared using a Likert scale, the validated SEAPI score system, Incontinence Impact Questionnaire 7 (IIQ-7), and Incontinence Symptom Severity Index (ISSI).nnnRESULTSnThere were 228 patients that underwent sling placement with 94 receiving VWS, 62 RFS, and 72 SPS. Mean follow-up was 14 months. There was no statistical difference in postoperative pad usage or satisfaction score between the groups. All three groups had a statistically significant postoperative improvement in subjective SEAPI scores and daily pad use. The VWS and RFS groups had significant improvement in their ISSI. The VWS group also had postoperative improvement in IIQ-7 score. Complication rates were rare and similar between all three groups.nnnCONCLUSIONSnPatient satisfaction and outcomes were overall similar between all three sling materials. Based on our outcomes, we continue to use the VWS as a treatment option for patients with SUI and redundant vaginal wall tissue that are opposed to synthetic mesh slings.