Publications by authors named "Patrick Shenot"

28 Publications

  • Page 1 of 1

Management of urinary incontinence following treatment of prostate disease.

Can J Urol 2021 Aug;28(S2):38-43

Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

INTRODUCTION Men who undergo treatment for prostate disease are at increased risk of urinary incontinence (UI). UI has a known negative impact on patient quality of life. Once a thorough evaluation has been performed, there are effective modalities for treatment that can be tailored to the patient.

Materials And Methods: This review article provides the most recent evidence-based work up and management for men with incontinence after prostate treatment (IPT). Etiology, prophylactic measures, work up, surgical treatments, and patient considerations will be covered. The more recent adjustable balloon device is included in this publication as well as more traditional treatments like the artificial urinary sphincter (AUS) and male urethral sling.

Results: IPT can result from treatment of either benign or malignant prostate disease whether surgery or radiotherapy are utilized. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI) are all possibilities. SUI after radical prostatectomy (RP) is the most common form of IPT. Patient education and implementation of pelvic therapy as well as modern surgical techniques have greatly improved continence results. AUS remains the gold standard of SUI treatment with the broadest category of patient eligibility. Patients experiencing UUI should be treated according to the overactive bladder guidelines.

Conclusions: For men with IPT, it is crucial to first take a thorough patient history and delineate the exact nature of UI symptoms which will determine the options for management. Patient factors and preferences must also be taken into consideration when ultimately choosing the appropriate intervention.
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August 2021

Management of neurogenic detrusor overactivity.

Can J Urol 2021 Aug;28(S2):33-37

Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

INTRODUCTION Neurogenic lower urinary tract dysfunction (NLUTD) refers to altered function of the urinary bladder, bladder outlet, and external urinary sphincter related to a confirmed neurologic disorder. Neurogenic detrusor overactivity (NDO) is a subset of NLUTD that frequently results in incontinence and may be associated with elevated bladder storage and voiding pressures resulting in upper urinary tract damage.

Materials And Methods: This article provides an update on the evaluation and management of patients with NDO. Basic bladder physiology as well as classification of NLUTD, initial urologic evaluation, and management options ranging from the most conservative to surgical interventions will be covered.

Results: NDO may be managed by conservative, pharmacologic, and surgical methods. Untreated or inadequately managed NDO may result in significant urologic morbidity and mortality, making careful evaluation and lifelong management necessary to optimize quality of life and prevent secondary complications.

Conclusions: Patients with NDO should have life-long urologic surveillance and follow up. The extent of regular evaluation and testing should be based on the principal of risk stratification. Treatment for NDO should be considered not only for clinical symptoms such as incontinence, but also aimed at preserving renal function.
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August 2021

Holmium Laser Enucleation of the Prostate Following Previous Prostatic Urethral Lift.

J Endourol 2021 Jul 8. Epub 2021 Jul 8.

Thomas Jefferson University Sidney Kimmel Medical College, 12313, Urology, Philadelphia, Pennsylvania, United States.

Purpose: To determine the feasibility and operative challenges of holmium laser enucleation of the prostate (HoLEP) in patients with a previous prostatic urethral lift (PUL) procedure.

Materials And Methods: A retrospective review was performed on files of all patients that underwent HoLEP at our institution between 2013 and 2021. 793 consecutive HoLEP cases were identified. Data collected included demographics, the time elapsed since previous PUL, number of PUL implants, pre-operative prostate size, intra-operative complications/challenges, and post-operative follow-up.

Results: 22 men with a mean pre-operative prostate size of 90 grams (range 32-180 g) underwent HoLEP at a median of 14.4 months (range 2.8-48) after PUL. 63.6% (14/22) of cases involved prostates with pre-operative sizes ≥ 80 grams. Three cases involved PUL implant jamming of morcellator blades which required replacing the blades. 15 cases (68.2%) required using a grasper or a basket device to remove free PUL implants or adenoma parts with PUL implants embedded in them. One patient needed a second procedure to remove a relatively large piece of calcified adenoma. non-post-PUL HoLEP was more time efficient than post-PUL HoLEP (0.77 ml/min versus 0.55 ml/min respectively). There was no difference in functional outcome between post-PUL and non-post-PUL HoLEP cases.

Conclusions: While HoLEP can be performed safely and effectively in the PUL failure population, unique challenges arise. PUL implants may distort prostate anatomy, jam morcellator blades, and may be encountered in aberrant locations. Patients with borderline indications for PUL, should be aware of the possibility of performing HoLEP in case of PUL failure.
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http://dx.doi.org/10.1089/end.2021.0351DOI Listing
July 2021

Rethinking the approach to evaluation and management of overactive bladder.

Authors:
Patrick J Shenot

Can J Urol 2021 Jun;28(3):10705

Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

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June 2021

How I Do It: PureWick female external catheter: a non-invasive urine management system for incontinent women.

Can J Urol 2021 Jun;28(3):10669-10672

Department of Urology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Catheter associated urinary tract infections (CAUTIs) are common hospital-acquired infections and remain a significant medical and financial challenge to the healthcare system. Despite this risk, incontinent women may require prolonged catheterization to accurately monitor urine output and prevent skin breakdown. The PureWick Female External Urinary Catheter is a promising non-invasive urine collection system for use in incontinent women that may help reduce CAUTI rates, maintain skin integrity, accurately quantify urine output, and avoid extra healthcare costs.
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June 2021

Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study.

BJU Int 2021 May 7. Epub 2021 May 7.

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.

Objectives: To develop and validate on a simulator a learnable technique to decrease deviation of biopsied cores from the template schema during freehand, side-fire systematic prostate biopsy (sPBx) with the goal of reducing prostate biopsy (PBx) false-negatives, thereby facilitating earlier sampling, diagnosis and treatment of clinically significant prostate cancer.

Participants And Methods: Using a PBx simulator with real-time three-dimensional visualization, we devised a freehand, pitch-neutral (0°, horizontal plane), side-fire, transrectal ultrasonography (TRUS)-guided sPBx technique in the left lateral decubitus position. Thirty-four trainees on four Canadian and US urology programmes learned the technique on the same simulator, which recorded deviation from the intended template location in a double-sextant template as well as the TRUS probe pitch at the time of sampling. We defined deviation as the shortest distance in millimeters between a core centre and its intended template location, template deviation as the mean of all deviations in a template, and mastery as achieving a template deviation ≤5.0 mm.

Results: All results are reported as mean ± sd. The mean absolute pitch and template deviation before learning the technique (baseline) were 8.2 ± 4.1° and 8.0 ± 2.7 mm, respectively, and after mastering the technique decreased to 4.5 ± 2.7° (P = 0.001) and 4.5 ± 0.6 mm (P < 0.001). Template deviation was related to mean absolute pitch (P < 0.001) and increased by 0.5 mm on average with each 1° increase in mean absolute pitch. Participants achieved mastery after practising 3.9 ± 2.9 double-sextant sets. There was no difference in time to perform a double-sextant set at baseline (277 ± 102 s) and mastery (283 ± 101 s; P = 0.39).

Conclusion: A pitch-neutral side-fire technique reduced template deviation during simulated freehand TRUS-guided sPBx, suggesting it may also reduce PBx false-negatives in patients in a future clinical trial. This pitch-neutral technique can be taught and learned; the University of Florida has been teaching it to all Urology residents for the last 2 years.
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http://dx.doi.org/10.1111/bju.15445DOI Listing
May 2021

Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients.

J Spinal Cord Med 2020 Oct 15:1-8. Epub 2020 Oct 15.

Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Spinal cord injury (SCI) patients with neurogenic bladder and the inability to self-catheterize may require incontinent diversion to provide low-pressure drainage while avoiding the use of indwelling catheters. We demonstrate that in patients with significant functional improvement, the ileovesicostomy can be a reversible form of diversion, with simultaneous bladder augmentation using the same segment of ileum utilized for the ileovesicostomy. Multidisciplinary management should be utilized to assure mastery of intermittent catheterization before urinary undiversion. This technique allows for transition to a regimen of intermittent self-catheterization with excellent functional and urodynamic outcomes. Case Series. Tertiary care hospital, Philadelphia, Pennsylvania. Three individuals with an SCI. Conversion of bladder management from an incontinent ileovesicostomy to an augmentation ileocystoplasty, with intermittent catheterization. Ability to regain urinary continence with preservation of renal function as determined by serum creatinine and renal ultrasound. Three SCI patients who had an incontinent ileovesicostomy developed sufficient functional improvement to intermittently self-catheterize reliably and underwent conversion of ileovesicostomy to ileocystoplasty. For each, the ileovesicostomy channel was taken down and detubularized, then used to create an ileal patch for augmentation ileocystoplasty. Intermittent catheterization was then used for periodic bladder drainage. All achieved large capacity, low-pressure bladders with complete continence and stable creatinine. In motivated SCI patients, it is possible to regain continence by converting the ileovesicostomy into augmentation ileocystoplasty, avoiding the disadvantages of a urostomy. A multidisciplinary collaborative approach facilitates the optimal rehabilitation of SCI individuals.
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http://dx.doi.org/10.1080/10790268.2020.1829420DOI Listing
October 2020

Next-generation DNA sequencing for infected genitourinary implants: How I do it.

Can J Urol 2020 10;27(5):10418-10423

Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia Pennsylvania, USA.

Infection of artificial urinary sphincters or inflatable penile prostheses is one of the most devastating complications after prosthetic surgery and can have a significant impact on a quality of life. Patients undergoing revision surgery with or without device replacement may have increased risk for infection when compared to initial primary surgery. As such, surgeons may utilize traditional culture results to direct antimicrobial therapy for these patients. Unfortunately, culture results can be inconclusive in up to one-third of the time even in the setting of active device infection. Next-generation sequencing (NGS) of DNA is an emerging technology capable of sequencing entire bacterial genomes and has the potential to identify microbial composition in explanted devices. Herein, we describe our institutional experience on NGS utilization in patients with genitourinary prostheses. We also highlight our methods and techniques to inform readers on the potential practices that can enhance the utility and diagnostic yield of this new and upcoming technology.
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October 2020

Faculty Development: How Do We Encourage Faculty to Become Better Teachers and Mentors?

Curr Urol Rep 2020 Aug 18;21(10):40. Epub 2020 Aug 18.

Department of Urology, Sidney Kimmel Medical College of Thomas Jefferson University, 1025 Walnut Street, suite 1100, Philadelphia, PA, 19107, USA.

Purpose Of Review: A healthy mentor relationship is a mutually beneficial experience and a necessary part of the natural progression of a career in academic medicine. We sought to explore the advantages of and challenges to becoming a mentor in current academic urology.

Recent Findings: Mentorship can promote self-confidence in the ability to choose a career, drive academic productivity, and even inspire a career in academic medicine. It is necessary to help promote advancement in diverse socioeconomic groups within medical trainees. Strong mentors can serve as role models to the next generation of doctors. However, the ability to be an effective mentor is being challenged in today's world of academic medicine. By staying current with the issues surrounding mentorship, an individual can be fulfilled and successful in training and guiding doctors into the new era of medicine.
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http://dx.doi.org/10.1007/s11934-020-00994-zDOI Listing
August 2020

Iatrogenic bladder rupture in individuals with disability related to spinal cord injury and chronic indwelling urethral catheters.

Spinal Cord Ser Cases 2020 06 8;6(1):47. Epub 2020 Jun 8.

Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

Introduction: Bladder rupture in patients with indwelling urethral catheters is rare. Herein, we describe two spinal cord injured (SCI) patients with neurogenic bladder dysfunction managed with chronic indwelling catheters who presented with extraperitoneal bladder rupture related to bladder instillation. One case was during continuous bladder irrigation for hematuria, the other during routine cystography.

Case Presentation: One patient is a tetraplegic male with a C5 ASIA impairment scale (AIS) SCI and a chronic catheter who presented with gross hematuria and autonomic dysreflexia (AD). Continuous irrigation was complicated by ongoing AD and poor catheter drainage. A CT scan revealed an extraperitoneal bladder rupture which was managed with surgical repair and suprapubic catheter. The second patient is a tetraplegic female who underwent gravity cystography to evaluate for vesicoureteric reflux. She experienced AD, followed by a witnessed extraperitoneal rupture. The rupture resolved with continued catheter drainage. No long term complications were noted.

Discussion: We present two cases of extraperitoneal rupture in chronically catheterized SCI patients following bladder instillation. Both patients were undergoing instillation of fluid through balloon catheters which likely occluded the outlet. We believe that rupture in both cases was iatrogenic, from elevated intravesical pressures during gravity instillation of fluid. Both patients experienced AD during these events. A procedure involving bladder instillation in chronically catheterized SCI patients should be performed by providers familiar with management of AD. Risk factors for iatrogenic bladder rupture during instillation procedures likely include chronic catheterization, small bladder capacity, instillation under significant pressure, and occlusion of the bladder outlet by a balloon catheter.
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http://dx.doi.org/10.1038/s41394-020-0296-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280260PMC
June 2020

Female Representation at High-profile Urology Conferences, 2014-2019: A Leadership Metric.

Urology 2021 Apr 5;150:72-76. Epub 2020 Jun 5.

Department of Urology, Thomas Jefferson University, Philadelphia, PA.

Objective: To measure female leadership through speakership at urology conferences and compare involvement to the overall representation of women in the urologic workforce.

Methods: A cross-sectional analysis was conducted to identify the gender of conference speakers from 2014 to 2019. Six high-profile urology conferences were selected: AUA; SUFU; SPU; SUO; GURS; WCE. Using programming published by each society, the number of invited female speakers at each conference was recorded. Comparisons were made to the proportion of practicing female urologists based on AUA census data.

Results: A total of 34 conferences were reviewed. From 2014 to 2019, the percentage of female representation increased from 13.7% to 19.3% (P < .05). The proportion of female speakers at all conferences ranged from 0% to 35.6%. The average absolute increase was 1.3% each year. Female representation at urology conferences in 2019 was significantly greater than female representation in the field (19.3% vs 9.9%, P < .05).

Conclusion: There is a slight trend of increasing proportion of invited female speakers at academic urology conferences from 2014 to 2019. Although the proportion of women in urology remains low, the trend indicates that the mean proportion of female speakers is higher than the proportion of women in the field. Inclusion of female conference speakers presents an opportunity for increased gender parity within urology leadership.
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http://dx.doi.org/10.1016/j.urology.2020.05.049DOI Listing
April 2021

Stress Urinary Incontinence post-Holmium Laser Enucleation of the Prostate: a Single-Surgeon Experience.

Int Braz J Urol 2020 Jul-Aug;46(4):624-631

Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.

Purpose: To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP).

Materials And Methods: We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI.

Results: 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p < 0.0001). On univariate analysis, laser energy used (p < 0.0001), laser "on" time (p=0.0204), resected prostate weight (p < 0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI.

Conclusion: Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2019.0411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239278PMC
December 2020

Hospital-specific antibiograms and antibiotic prophylaxis for prostate biopsies: a reexamination of AUA recommendations.

Can J Urol 2020 02;27(1):10099-10104

Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Introduction: To assess whether standard American Urological Association (AUA) and other recommendations for prostate biopsy prophylaxis provide sufficient coverage of common urinary organisms responsible for post biopsy infections by comparing local antibiograms in Philadelphia-area hospitals.

Materials And Methods: De-identified culture results derived from antibiograms were collected from six academic and community hospitals in the Philadelphia region. Analysis specifically focused on four major bacterial causes of urinary tract infection following prostate biopsy (Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis) along with commonly recommended antibiotics including fluoroquinolones (FQ's), trimethoprim/sulfamethoxazole, ceftriaxone, and gentamicin.

Results: Bacterial sensitivities to each antibiotic across institutions showed variation in E.coli sensitivities to FQs (p < 0.001), trimethoprim/sulfamethoxazole (p < 0.001), ceftriaxone (p < 0.001) and gentamicin (p < 0.001). Klebsiella pneumoniae and Proteus mirabilis exhibited similar variations. Sensitivity comparisons for Enterococcus faecalis was unable to be performed due to absent or incomplete data across institutions.

Conclusion: Institutional antibiograms vary within our regional hospitals. Standardized recommendations for commonly used antibiotic prophylaxis such as fluoroquinolones may be inadequate for peri-procedural prostate biopsy prophylaxis based on local resistance patterns. Valuable information about the potential effectiveness of antibiotic prophylaxis for prostate biopsies can be found in local institutional antibiograms, and should be consulted when considering antibiotic prophylaxis for prostate biopsy procedures.
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February 2020

The Balance between Open and Robotic Training among Graduating Urology Residents-Does Surgical Technique Need Monitoring?

J Urol 2020 05 11;203(5):996-1002. Epub 2019 Dec 11.

Department of Surgery, Division of Urology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.

Purpose: A minimum number of index procedures is required for graduation. Without thresholds for surgical technique, it is unclear if robotic and open learning is balanced. We assessed the distribution of robotic and open surgeries performed by residents upon graduation.

Materials And Methods: Voluntary Accreditation Council for Graduate Medical Education resident case logs from 11 institutions were de-identified and trends in robotic and open major surgeries were compared using Wilcoxon rank sum and 2-sample t-tests.

Results: A total of 89,199 major cases were recorded by 209 graduates from 2011 to 2017. The median proportion of robotic cases increased from 2011 to 2017 in reconstruction (4.7% to 15.2%), oncology (27.5% to 54.2%) and pediatrics (0% to 10.9%) (all values p <0.001). Robotic and open cases remained most divergent in reconstruction, with a median of 12 robotic (IQR 9-19) to 70 open cases (IQR 55-106) being performed by residents in 2017. Similar observations occurred in pediatrics. In oncology the number of robotic procedures superseded that of open in 2016 and rose to a median of 148 robotic (IQR 108-214) to 121 open cases (IQR 90-169) in 2017, with the driver being robotic prostatectomy. Substantial differences in surgical technique were observed between institutions and among graduates from the same institution.

Conclusions: Although robotic volume is increasing, the balance of surgical technique and the pace of change differ in reconstruction, oncology and pediatrics, as well as among individual institutions and graduates themselves. This raises questions about whether more specific guidelines are needed to ensure equity and standardization in training.
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http://dx.doi.org/10.1097/JU.0000000000000689DOI Listing
May 2020

Industry payments to female pelvic medicine and reconstructive surgeons: an analysis of Sunshine Act open payments from 2014-2017.

Int Urogynecol J 2020 04 31;31(4):799-807. Epub 2019 Oct 31.

Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA.

Introduction And Hypothesis: We aim to examine the financial relationship between industry and female pelvic medicine and reconstructive surgeons (FPMRS) during the first four full calendar years since the implementation of the Sunshine Act.

Methods: All board-certified FPMRS specialists were identified using the American Board of Medical Specialties directory. Program directors (PDs) were identified using an Accreditation Council for Graduate Medical Education (ACGME) database. All identified physicians were categorized by gender, specialty, and American Urological Association (AUA) region. Payment data for each individual from 2014 to 2017 were accessed using the Centers for Medicare and Medicaid Services (CMS) Open Payments website. Statistical analyses were performed to elucidate payment trends.

Results: Of the 1,307 FPMRS physicians identified, 25.1% (n = 328) are urology-trained and 74.9% (n = 979) are obstetrics/gynecology (OB/GYN)-trained. Of all physicians analyzed, 6.8% had no reported payments over the 4-year period. 90.1%, 86.5%, 85.3%, and 84.4% received some sort of payment in 2014 to 2017 respectively. Median total payments for all physicians decreased yearly, whereas mean payments decreased from 2014 to 2015 before increasing in all subsequent years. Median general payments were higher for men versus women, urology-trained versus OB/GYN-trained, and PDs versus non-PDs in all years analyzed. The largest contributor to overall payments was the "others" compensation category, which includes gifts, royalties, honoraria, and non-continuing medical education speaking engagements.

Conclusions: Since institution of the Sunshine Act, the percentage of physicians receiving payments has decreased each year. Additionally, there has been a decrease in median total payments and an increase in yearly research payments in all years analyzed.
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http://dx.doi.org/10.1007/s00192-019-04098-2DOI Listing
April 2020

A retrospective comparison of diode to holmium for laser enucleation of the prostate.

Can J Urol 2019 08;26(4):9836-9842

Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Introduction: Holmium endoscopic laser enucleation of the prostate (HoLEP) is a well-established alternative to traditional transurethral resection and open prostatectomy for the treatment of benign prostatic hyperplasia (BPH). We investigate the 1470 nm diode laser for enucleation as an alternative to HoLEP. The safety, efficacy, and initial outcomes of diode enucleation of the prostate (DiLEP), when compared to HoLEP, were examined.

Materials And Methods: We reviewed records of 50 patients who underwent DiLEP between 2012 and 2015 and matched them with 50 HoLEP patients during the same time period. Objective evaluation of efficacy was determined by comparing preoperative post-void residual volume (PVR) and peak flow (Qmax) to postoperative values at 4-16 weeks and 1 year following surgery. Subjective evaluation was measured using the International Prostate Symptom Score (IPSS) before and after the operation. Safety was evaluated by the development of persistent Clavien-Dindo grade 1, or 2 or higher postoperative complications. Statistical analyses were conducted using chi-squared and paired Student's t-tests.

Results: Subjective and objective postoperative results showed no difference between DiLEP and HoLEP. Average PVR volume following DiLEP was 47.1 mL at 1 year. The mean increase in Qmax was 16.4 mL/s at 1 year. The IPSS improved by a mean of 12.7 points, and by 2.6 points on quality of life questioning at 1 year post operation. Compared to HoLEP patients there was no statistically significant difference. Safety assessments were the same across both procedures.

Conclusions: Diode laser is safe and effective for use in patients with BPH, with no significant difference in outcomes compared to HoLEP.
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August 2019

Making the case for enterocystoplasty in the urologic management of patients with multiple sclerosis.

Authors:
Patrick J Shenot

Can J Urol 2019 06;26(3):9781

Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

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June 2019

Knowledge Gaps in Urologic Care of Female Spinal Cord Injury Patients.

Curr Urol Rep 2019 Mar 23;20(5):21. Epub 2019 Mar 23.

Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Ste 1100, Philadelphia, PA, 19107, USA.

Purpose Of Review: We highlight the substantial gaps in knowledge on urologic care of female spinal cord injury (SCI) patients.

Recent Findings: Males account for approximately 80% of people living with SCI in developed nations. Although there is a robust body of literature in some aspects of urologic care of individuals with SCI, such as treatments for neurogenic detrusor overactivity, there are relatively few studies focusing specifically on females. There are also few studies focusing on other aspects of urologic care of women with SCI such as sexual dysfunction, pelvic organ prolapse, and bladder cancer. Established guidelines for bladder management exist, generally recommending intermittent catheterization, but the fact remains that a substantial number of women with SCI utilize indwelling catheters for bladder management. There remains a paucity of literature using patient-reported measures regarding both outcomes and experiences of urologic management in the SCI population. Bladder management is challenging for many women with SCI. There are few studies on other urologic concerns in women with SCI.
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http://dx.doi.org/10.1007/s11934-019-0884-6DOI Listing
March 2019

Medial Renal Ptosis: First Radiographic Documentation With Computed Tomography.

Urology 2019 04 5;126:e1-e2. Epub 2019 Feb 5.

Department of Urology, Thomas Jefferson University, Philadelphia PA.

Medial renal ptosis is the abnormal mobility of the kidney towards or across the midline of the body. Historically, this phenomenon is evaluated by observing abnormal mobility in the lateral decubitus position during intravenous pyelography. Here, we present the first radiographic documentation of this anomaly on computed tomography on a 34-year-old female who experienced an intermittent abdominal bulge over her right upper quadrant. Nephropexy is the definitive treatment for symptomatic patients. Further studies are required to determine the true prevalence and clinical significance of this phenomenon.
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http://dx.doi.org/10.1016/j.urology.2019.01.024DOI Listing
April 2019

Leaders in Urologic Education and Their Relationship to Industry: An Analysis of Sunshine Act Open Payments From 2014-2016.

Urology 2019 01 2;123:53-58. Epub 2018 Nov 2.

Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

Objective: To examine trends in the financial relationship between biomedical companies and leaders in urologic education during the first 3 full calendar years since implementation of the Sunshine Act.

Methods: All accredited American Urological Association (AUA) residency programs were identified using the AUA website. Urology program directors and department chairs of the affiliated institutions were identified using residency program or urology department websites. Urology journal editors who practice in the United States were identified using the SCImago Journal & Country Rank website. All identified individuals were categorized by urologic subspecialty and AUA region based on information stated on their corresponding websites. Payment data for each individual from 2014 to 2016 was accessed using the Centers for Medicare and Medicaid Services Open Payments website, and statistical analyses were performed to elucidate trends based on leadership position, urologic specialty, AUA region, payment type, and overall payments over time.

Results: Out of the 239 urologists identified, 85%, 78%, and 91% received some sort of payment in 2014, 2015, and 2016, respectively. Department chairs accepted payments more readily than program directors and journal editors in all years. Average total payments for all urologists increased yearly, with mean general payments trending down and mean research payments trending up.

Conclusion: The Sunshine Act was passed in part to promote transparency of the physician-industry relationship. Though the proportion of urologic leaders accepting payments between 2014 and 2016 did not change significantly, increased public scrutiny could have contributed to the decrease in yearly general payments and the increase in yearly research payments.
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http://dx.doi.org/10.1016/j.urology.2018.09.022DOI Listing
January 2019

Ureteroarterial fistula: A review of the literature.

Vascular 2016 Apr 13;24(2):203-7. Epub 2015 May 13.

Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Ureteroarterial fistulas are rare, erosive defects that occur between the distal segments of the ureter and the adjacent blood vessels in individuals with urologic and vascular comorbidities. Characterized by diffuse, pulsatile bleeding into the urinary tract, this condition carries a significant mortality rate in the absence of early recognition. Recent treatment efforts have focused on use of endovascular stenting techniques as an alternative to open surgical closure of the underlying defects in hemodynamically stable patients. We provide a literature review detailing the characteristics, mechanism, and management of ureteroarterial fistulas.
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http://dx.doi.org/10.1177/1708538115585261DOI Listing
April 2016

The effects of fatigue on robotic surgical skill training in Urology residents.

J Robot Surg 2014 Sep 14;8(3):269-75. Epub 2014 May 14.

Department of Urology, Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 1100, Philadelphia, PA, 19107, USA.

This study reports on the effect of fatigue on Urology residents using the daVinci surgical skills simulator (dVSS). Seven Urology residents performed a series of selected exercises on the dVSS while pre-call and post-call. Prior to dVSS performance a survey of subjective fatigue was taken and residents were tested with the Epworth Sleepiness Scale (ESS). Using the metrics available in the dVSS software, the performance of each resident was evaluated. The Urology residents slept an average of 4.07 h (range 2.5-6 h) while on call compared to an average of 5.43 h while not on call (range 3-7 h, p = 0.08). Post-call residents were significantly more likely to be identified as fatigued by the Epworth Sleepiness Score than pre-call residents (p = 0.01). Significant differences were observed in fatigued residents performing the exercises, Tubes and Match Board 2 (p = 0.05, 0.02). Additionally, there were significant differences in the total number of critical errors during the training session (9.29 vs. 3.14, p = 0.04). Fatigue in post-call Urology residents leads to poorer performance on the dVSS simulator. The dVSS may become a useful instrument in the education of fatigued residents and a tool to identify fatigue in trainees.
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http://dx.doi.org/10.1007/s11701-014-0466-zDOI Listing
September 2014

OnabotulinumtoxinA improves quality of life in patients with neurogenic detrusor overactivity.

Neurology 2013 Aug 26;81(9):841-8. Epub 2013 Jul 26.

Oakland University, William Beaumont School of Medicine, Royal Oak, MI, USA.

Objective: To evaluate the effects of onabotulinumtoxinA on patient-reported outcomes including health-related quality of life (HRQOL), treatment satisfaction, and treatment goal attainment in patients with urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO).

Methods: In this multicenter, double-blind, randomized, placebo-controlled, phase III, 52-week study (ClinicalTrials.gov NCT00311376), patients with UI due to NDO who were not adequately managed with anticholinergic therapy were treated with intradetrusor injections of onabotulinumtoxinA (200 or 300 U) or placebo (0.9% saline). HRQOL measures included the Incontinence Quality of Life (I-QOL) Questionnaire total score, and the 3 domain scores (avoidance and limiting behavior, psychosocial, and social embarrassment), the modified Overactive Bladder Patient Satisfaction with Treatment Questionnaire (OAB-PSTQ), and Patient Global Assessment. Assessments were made at baseline, posttreatment week 6 (primary time point), week 12, and at 12-week intervals.

Results: Patients (mean age of 46 years with 30.5 weekly UI episodes at baseline) were randomized to receive placebo (n = 149) or onabotulinumtoxinA (200 U [n = 135] or 300 U [n = 132]). At week 6, improvements from baseline in I-QOL Questionnaire total score were greater (p < 0.001) in both onabotulinumtoxinA-treated groups vs placebo. Responses to the OAB-PSTQ also demonstrated greater mean improvements from baseline (p < 0.001) in both onabotulinumtoxinA-treated groups vs placebo at week 6. Patients who received onabotulinumtoxinA also reported greater improvement in the Patient Global Assessment than those in the placebo group (p ≤ 0.001 vs placebo).

Conclusions: Patients with UI due to NDO reported greater improvement in HRQOL and treatment satisfaction with onabotulinumtoxinA than with placebo consistently across several patient-reported outcome instruments.

Classification Of Evidence: This study provides Class I evidence that onabotulinumtoxinA intradetrusor injections (200 or 300 U) can improve quality of life measures in patients with NDO not adequately managed with anticholinergic therapy.
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http://dx.doi.org/10.1212/WNL.0b013e3182a2ca4dDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908462PMC
August 2013

Intradetrusor onabotulinumtoxinA injection: how I do it.

Can J Urol 2013 Feb;20(1):6649-55; discussion 6655

Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

Overactive bladder is a highly prevalent condition that may have significant impact on quality of life. This condition may be idiopathic or may have a neurogenic etiology. Antimuscarinics have long been the preferred agents for the treatment of this condition. OnabotulinumtoxinA, an injectible agent that prevents presynaptic release of acetylcholine at the neuromuscular junction, has emerged as an important option in the management of patients with urinary incontinence caused by refractory detrusor overactivity. This manuscript describes our technique for performing utilizing this therapy, describes key equipment needed and provides technical tips for avoiding common pitfalls.
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February 2013

Uropharmacology in primary care: 2010 update.

Can J Urol 2010 Feb;17 Suppl 1:35-51

Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

Many disorders such as erectile dysfunction, overactive bladder, hypogonadism and benign prostatic hypertrophy have traditionally been managed primarily by urologists. The development of newer agents to treat many of these conditions has allowed the primary care provider to manage many of these common conditions. The use of these newer medications has become commonplace in the primary care setting. This article will update some of the most commonly used urologic medications to optimize patient management strategies by the primary care provider or in coordination with the urologist.
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February 2010

Bladder augmentation using an autologous neo-bladder construct.

Kidney Int 2009 Jul;76(2):236

Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

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http://dx.doi.org/10.1038/ki.2009.81DOI Listing
July 2009

Intravesical resiniferatoxin for refractory detrusor hyperreflexia: a multicenter, blinded, randomized, placebo-controlled trial.

J Spinal Cord Med 2003 ;26(4):358-63

Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Objective: Resiniferatoxin (RTX) is an analogue of capsaicin with more than 1,000 times its potency in desensitizing C-fiber bladder afferent neurons. This study investigated the safety and efficacy of intravesical RTX in patients with refractory detrusor hyperreflexia (DH).

Methods: Thirty-six (22 males, 14 females) neurologically impaired patients (20 spinal cord injury, 7 multiple sclerosis, 9 other neurologic diseases) with urodynamically verified DH and intractable urinary symptoms despite previous anticholinergic drug use were treated prospectively with intravesical RTX using dose escalation in a double-blind fashion at 4 centers. Patients received a single instillation of 100 mL of placebo (n = 8 patients) or 0.005, 0.025, 0.05, 0.10, 0.2, 0.5, or 1.0 microM of RTX (n = 4 each group). A visual analog pain scale (VAPS) (0-10; 10 = highest level of pain) was used to quantify discomfort of application. Treatment effect was monitored using a bladder diary and cystometric bladder capacity at weeks 1, 3, 6, and 12 posttreatment.

Results: Mean VAPS scores revealed minimal to mild discomfort with values of 2.85 and 2.28 for the 0.5-microM and 1.0-microM RTX treatment groups, respectively. Due to the small sample size, there were no statistically significant changes in mean cystometric capacity (MCC) or incontinence episodes in each treatment dose group. However, at 3 weeks, MCC increased by 53% and 48% for the 0.5-microM and 1.0-microM RTX treatment groups, respectively. Patients in the 0.5-microM and 1.0-microM groups with MCC < 300 mL at baseline showed greater improvements in MCC at 120.5% and 48%, respectively. In some patients, MCC increased up to 500% over baseline, despite a low RTX dose. Incontinence episodes decreased by 51.9% and 52.7% for the 0.5-microM and 1.0-microM RTX treatment groups, respectively. There were no long-term complications.

Conclusion: Intravesical RTX administration, in general, is a well-tolerated new therapy for DH. This patient group was refractory to all previous oral pharmacologic therapy, yet some patients responded with significant improvement in bladder capacity and continence function shortly after RTX administration. Patients at risk for autonomic dysreflexia require careful monitoring during RTX therapy.
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http://dx.doi.org/10.1080/10790268.2003.11753706DOI Listing
June 2004
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