Ross Rames

Migration of polytef paste to the lung and brain following intravesical injection for the correction of reflux

Polytef paste was injected endoscopically into the bladder submucosa of five dogs. Two were sacrificed after two weeks and the lungs and brain dissolved in sodium hypochlorite solution. The centrifuged deposit revealed particles optically and morphologically indistinguishable from polytetrafluoroethylene when examined by polarizing light microscopy. The remaining three dogs were entered into a long-term study and will be the subject of a separate report.

MALIGNANT PERIPHERAL NERVE SHEATH TUMOR OF THE PROSTATE: A RARE MANIFESTATION OF NEUROFIBROMATOSIS TYPE 1

Malignant peripheral nerve sheath tumors of the prostate associated with neurofibromatosis are rare, with only 1 previous case reported in the medical literature. We report a case treated with radical cystoprostatectomy and low anterior resection with ileal conduit diversion.

Simple vs complex urethral diverticulum: presentation and outcomes.

OBJECTIVE To determine whether complex anatomic configurations of urethral diverticula (UD), namely circumferential UD (cUD), present differently or confer a worse prognosis as compared with simple UD (sUD). METHODS After institutional review board approval, a retrospective review of patients who underwent transvaginal urethral diverticulectomy at a single institution over an 8-year period was performed. A total of 43 patients were identified, of which 11 were found to have cUD. These lesions were repaired with complete division of the urethra to access the dorsally located portion of the UD, followed by end-to-end anastomosis for urethral reconstruction with a Martius flap and/or autologous fascial pubovaginal sling performed as needed. Presenting symptoms and surgical outcomes were reviewed. RESULTS Mean age was 50.9 years in the cUD vs 52.7 years in the sUD. Patients with cUD were more likely to present with stress urinary incontinence than those with sUD (90.9% vs 56.3%; P = .04). There was no statistical difference in the rate of preoperative urgency, pelvic pain and/or dyspareunia, postvoid dribbling, and urinary tract infection. Postoperatively, patients with cUD were more likely to have a urinary tract infection (27% vs 3%; P = .2); otherwise, rates of postoperative results were similar. CONCLUSION Urethral transection and end-to-end anastomosis for the repair of complex UD is a feasible approach and results in similar clinical outcomes compared with the repair of sUD.

Pelvic Organ Prolapse Surgery in Academic Female Pelvic Medicine and Reconstructive Surgery Urology Practice in the Setting of the Food and Drug Administration Public Health Notifications

OBJECTIVE To understand the effect of the Food and Drug Administration (FDA) public health notifications regarding transvaginal placement of surgical mesh for pelvic organ prolapsed (POP) on surgeon practice patterns in tertiary care academic medical centers. MATERIALS AND METHODS Surgical volume for procedures performed primarily by fellowship trained Female Pelvic Medicine and Reconstructive Surgery at a sampling of 8 academic institutions across the US were collected using current procedural technology codes for POP repair and revision surgeries from 2007 to 2013. SAS statistical software was used to analyze data for trends and to assess differences in number of procedures across years by performing Spearman correlation analysis and Pearsons chi-squared test. Significance of trend was defined as P <.05 for both analysis methods. RESULTS There has been a substantial reduction in transvaginal mesh-augmented repair of POP since the FDA warning statements of 2008 and 2011. Mesh revision surgery has increased over this same period. However, the total number of interventions for POP has remained stable over the study period. Abdominal sacrocolpopexy has increased as a whole but represents only a small percentage of total cases. CONCLUSION Surgical correction of POP comprises a large portion of Female Pelvic Medicine and Reconstructive Surgery practice that continues to evolve in the aftermath of the FDA public health notifications. The utilization of transvaginal placement of surgical mesh augmented POP repair has decreased among practicing urologists at a sampling of academic institutions across the United States. Indications for surgery, complications, and outcomes were not evaluated during this retrospective study; however, such data may provide alternative insights into the reasons for the observed trends.

Extent of bladder and ureteric involvement and urologic management in patients with enterovesical fistulas

A retrospective review of hospital charts from 1978-1989 identified 21 patients with acquired enterovesical fistulas. Nine patients with fistulas secondary to benign inflammatory processes required extensive bladder resection; 2 of these had ureteric involvement. Of the 9 patients requiring extensive bladder resection, necrotic and severely inflamed bladder was excised and the bladder was closed in a multilayered fashion with absorbable sutures. An omental flap was used when possible. Postoperative bladder drainage was maintained for seven to fourteen days. Ureteral involvement was managed by stenting in 1 case and ureteroureterostomy in another. No postoperative bladder leaks or recurrent fistulas were reported. Extensive inflammatory involvement of the bladder wall may necessitate a large vesical resection. Excision of diseased bladder tissue, multilayered closure, and the use of omental interposition may help reduce postoperative complications and the risk of recurrence. Associated ureteral involvement may be present in these patients and requires urologic management.

Predicting for postoperative incontinence following sling incision

Introduction and hypothesisOur objective was to assess preoperative risk factors for developing recurrent stress urinary incontinence (SUI) following transvaginal sling incision (TVSI) for bladder outlet obstruction (BOO).MethodsWe identified 101 women who underwent TVSI and/or removal of a midurethral sling. Thirty-nine underwent TVSI for clinical and videourodynamic demonstrable BOO. Eighteen of 39 women demonstrated preoperative clinical SUI and urodynamic BOO. A comparative analysis was performed specifically looking at several clinical factors and the risk of the occurrence of postoperative SUI.ResultsMean age, number of prior surgeries, parity, and pre- and postoperative PVRs did not predict for postoperative SUI. Nine of 18 (50%) of women with SUI and BOO preoperatively vs. only 2/21 (10%) of women with BOO alone developed postoperative SUI. This difference in the incidence of postoperative SUI was statistically significant (p < 0.01).ConclusionsIn patients with BOO, the presence of preoperative clinical SUI is a predictor for postoperative SUI following TVSI.

Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications.

To investigate the possible effects of the Food and Drug Administration (FDA) Public Health Notifications in 2008 and 2011 regarding surgical trends in transvaginal mesh (TVM) placement for stress urinary incontinence (SUI) and related mesh revision surgery in Female Pelvic Medicine & Reconstructive Surgery (FPMRS) practice in tertiary care academic medical centers in the United States.

Mixed Germ Cell-Sex Cord Stromal Tumor of Testis: Incidental Finding of Rare Testicular Neoplasm

Mixed germ cell-sex cord stromal tumor of the testis is rare with 2 reported and 15 known cases. We report a case treated at our institution. CASE REPORT A 31-year-old black man referred for renal donor evaluation was found to have a right teaticular mass. a-Fetoprotein. Bhuman chorionic gonadotropin and a chest x-ray were normal. Radical inguinal orchiectomy was performed. The encapsulated solid maas did not involve the tunica albustromal tumor. Two week after surgery abdominal and pelvic amputerized tomography demonstrated no adenopathy or metastases. Yearly physical examinations were recommended. gjnea (fig. 1). Mimpy revealed mixed germ cell-sex cord

Extensive Pelvic Malacoplakia: Diagnosis and Management

CASE REPORT An 80-year-old black woman with chronic renal insufficiency and hypertension was hospitalized elsewhere with the diagnosis of hemorrhagic cystitis. Gross hematuria, urgency, frequency and vaginal bleeding were noted. Relevant laboratory findings included a urine culture with greater than 100,000 colonies Escherichia coli, serum creatinine 4.4 mg./ dl. (normal 0.5 to 1.4), blood urea nitrogen 80 mg./dl. (normal

Outcomes of treatment of stress urinary incontinence associated with female urethral diverticula: A selective approach

To assess surgical outcomes of concomitant treatment of SUI at time of transvaginal urethral diverticulectomy (TVUD) based on a selective approach.