Kelly Johnson

Laparoendoscopic single site orchiopexy

We report a laparoendoscopic single site orchiopexy in a 2-year-old boy with a right nonpalpable testis. Diagnostic laparoscopy using a 5-mm port revealed a right intraabdominal testis. The 5-mm port site was extended to accommodate the smallest commercially available triport, and orchiopexy was performed. The operative time was 55 minutes, and the estimated blood loss was minimal. There were no complications, and surgical and cosmetic results were excellent. Laparoendoscopic single site surgery is a feasible technique for orchiopexy of the nonpalpable testis.

Pathological findings following radical prostatectomy in patients who are candidates for active surveillance: impact of varying PSA levels

Active surveillance is an acceptable treatment option in men with a low-risk prostate cancer. In the present study, we have retrospectively reviewed the outcomes of 509 men who fit the criteria for active surveillance but selected radical prostatectomy. Then, the impact of varying prostate-specific antigen (PSA) levels on the risk of upstaging and upgrading in these patients was assessed. Pathological characteristics of patients who fulfilled the inclusion criteria under three active surveillance criteria--those of the University of California-San Francisco, the National Cancer Institute and the European Association of Urology--were examined. The proportion of men who were deemed candidates for active surveillance but were subsequently upstaged or upgraded was determined. Of 509 patients, 186 (36.5%), 132 (25.9%) and 88 (17.3%) men fulfilled the active surveillance criteria, respectively. Upgrading (Gleason scores 7-10) ranged from 32.8% to 38.6%, while upstaging (≥pT3) ranged from 10.2% to 12.5%, depending on the three active surveillance criteria. After a median follow-up of 24 months, three patients developed a biochemical recurrence. When the impact of varying PSA levels was examined using a test for trend analysis in the context of PSA for each protocol, rates of upstaging were lower in men with PSA <4 ng ml(-1). However, there was no impact of varying PSA levels on upgrading. In conclusion, commonly used active surveillance protocols carry the risks of upgrading and upstaging. More reliable and accurate markers are needed to better stratify the risks of men who are appropriate candidates for active surveillance.

Impact of robot-assisted radical prostatectomy on health-related quality of life in patients with lower urinary tract symptoms

Objective:  Lower urinary tract symptoms (LUTS) are a common complaint in patients with prostate cancer. We attempted to elucidate the effect of robot‐assisted radical prostatectomy (RARP) on patients having different preoperative LUTS severity through analysis of postoperative health‐related quality of life.

Toilet Training Method Is Not Related to Dysfunctional Voiding

Background. Toilet training is an important marker of physical and psychosocial development, but the best strategy for implementing training is still unknown. The purpose of this study is to compare dysfunctional voiding outcomes for 2 common toilet training strategies: parent-oriented training and child-oriented training. Materials and methods. This study was completed using a case-control design, with participants between the ages of 4 and 12 years. All participants were asked to complete questionnaires related to demographics and toilet training method. Results were then analyzed between cases and controls. Results. In all, 215 patients with a mean age 7.76 years participated in this study. Cases and controls showed no significant difference for demographic measures and socioeconomic status. Furthermore, there was no significant difference in dysfunctional voiding between toilet training methods. Conclusion. Toilet training method does not seem to have any long-term effect on dysfunctional voiding. As such, clinicians should advise parents that both methods are acceptable.

Laparoendoscopic Single-Site Varicocele Repair in Adolescents—Initial Experience at a Single Institution

BACKGROUND AND PURPOSE Laparoendoscopic single-site (LESS) varicocele repair is a modification of standard laparoscopic varicocele repair that uses a single port. We describe our initial experience with LESS varicocele repair. PATIENTS AND METHODS During a 1-year period, all patients who presented for varicocele repair underwent LESS repair. We evaluated our initial experience by determining operative time, operative and postoperative complications, and overall cost of the procedure. RESULTS A total of 11 adolescents underwent LESS varicocele repair. There were no intraoperative complications, and there were no conversions to open surgery or traditional laparoscopy. Estimated blood loss was minimal, and mean operative time was 66.9 minutes (range 48-91 min). The varicocele was corrected in all cases. During the 4 to 14 month follow-up, there was no recurrence, testis atrophy, or hernia in any patient. One subclinical hydrocele developed postoperatively that has not been repaired. CONCLUSION Our experience with LESS varicocele repair in adolescents suggests it to be a safe and effective method for varicocele repair in adolescents.

MP75-19 STRESS URINARY INCONTINENCE OUTCOMES FOLLOWING TRANSVAGINAL SLING INCISION

INTRODUCTION AND OBJECTIVES: Mid-urethral slings (MUS) have been commonly used in the operative management of stress urinary incontinence (SUI). Unfortunately, many women suffer from complications following MUS surgery that may necessitate a subsequent surgery such as a transvaginal sling incision (TVSI). The objective of this study is to assess the SUI outcomes following TVSI. METHODS: A retrospective review of patients who underwent TVSI from 2007 to 2013 was conducted. Indications for the surgery included bladder outlet obstruction (BOO), pelvic pain, dyspareunia, transvaginal exposure of mesh and erosion of mesh into the urinary tract. SUI at baseline and at 3 months follow-up was assessed. SUI was defined as any patient-reported symptoms of SUI, or demonstration of SUI on physical exam, or urodynamic examination. RESULTS: A total of 167 patients underwent TVSI with the most common indication being BOO (67.7%). Of the entire cohort, 88/167 (52.7%) had no SUI at baseline and following TVSI 26.1% of these patients had SUI at 3 months follow-up. Of the 113 patients with BOO at presentation, 67 (59.3%) patients had no SUI at baseline and 16/67 (23.9%) patients had SUI at 3 months follow-up. 17/39 (43.6%) patients with transvaginal mesh exposure had no SUI at baseline and 23.5% of these patients had SUI following TVSI. Of the 23 patients with mesh erosion into the urinary tract, 11 (47.8%) patients had no SUI at baseline and 6/11 (54.5%) patients had SUI at 3 months. Of the 66 patients with pelvic pain, 10/30 (33.3%) patients had SUI following TVSI who did not have SUI at baseline. Of the 78 patients with dyspareunia, 10/34 (29.4%) who did not have SUI at baseline had SUI following TVSI. There were 46 patients with SUI and BOO at baseline and following TVSI, 21 patients (45.7%) continued to have SUI at 3 months. Of the 33 patients with SUI and no BOO at baseline, concomitant slings were done on 5 patients at the time of TVSI (2 MUS and 3 autologous pubovaginal slings (aPVS). One patient with concomitant MUS had SUI at 3 months and no patient with a concomitant aPVS had SUI at 3 months. 19 patients have undergone subsequent SUI surgery or bulking injection (11 aPVS, 3 MUS, 2 bladder neck closures, and 3 bulking agents). CONCLUSIONS: For patients who do not have SUI at baseline, recurrent SUI following TVSI is not commonly seen. However, for those patients with mesh erosion into the urinary tract or SUI at presentation, recurrent/persistent SUI is seen in over 50% of patients. This knowledge can be used in counseling patients who undergo TVSI.

1658 CAN DEEP BRAIN STIMULATION WORSEN VOIDING FUNCTION IN PATIENTS WITH PARKINSON'S DISEASE?

Methods Deep brain stimulation (DBS) of the subthalamic nucleus has been shown to improve urinary sensory deficits in Parkinson’s Disease (PD) patients by normalizing the perception of bladder filling. Most PD patients experience lower urinary tract symptoms (LUTS) such as urgency or frequency due to detrusor overactivity, and some studies have shown DBS to alleviate these symptoms and improve bladder functioning. However, the exact mechanism of this improvement is unknown and the benefits can vary substantially. In this study, we documented new manifestations or worsening of pre-existing voiding dysfunction (VD) in patients following DBS.