Comparative outcomes of partial versus total penectomy for penile carcinoma: A retrospective cohort study on demographics and postoperative complications.

When feasible from an oncologic standpoint, partial penectomy (PP) is often preferred to total penectomy (TP) for penile cancer treatment, for the preservation of functional urinary outcomes. However, to date, there has not been a direct comparison of perioperative outcomes between PP and TP. Comparing treatments for penile cancer has proven difficult due to the rarity of penile cancer in the United States. We aimed to report differences in pre-operative risk factors, intra-operative outcomes, and postoperative outcomes between TP and PP for penile cancer. Using the National Surgical Quality Improvement Program database, we conducted a retrospective cohort review of penile cancer patients enlisted in the database between the years 2006-2016 using the International Classification of Diseases clinical modification 9th revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. PP patients were less likely to be transferred patients (p = 0.002), diabetic (p = 0.026), and were more likely to have preoperative laboratory values within normal limits. PP patients also had shorter lengths of stay in the hospital (p < 0.001) and operating time (p < 0.001). Significant differences were also found for inpatient stay (p < 0.001), 30-day post-surgery complications (p < 0.001), deep incisional surgical site infection (SSI) (p = 0.017), wound disruption (p = 0.017), intraoperative or postoperative transfusion (p = 0.029), and sepsis (p < 0.005). Finally, PP patients required fewer concurrent surgical procedures (p < 0.001). Demographic differences between PP and TP patients may reflect patients presenting with more advanced oncologic disease. PP is associated with fewer postoperative complications, shorter surgeries, shorter hospital stays, fewer concurrent surgical procedures, and comorbid conditions compared to TP. A gap remains in the reported data pertaining to postoperative sexual function and erectile outcomes for PP at a national level.

Interobserver Agreement and Accuracy in Interpreting mpMRI of the Prostate: a Systematic Review.

PURPOSE OF REVIEW: To present the latest evidence related to interobserver agreement and accuracy; evaluate the strengths, weaknesses, and implications of use; and outline opportunities for improvement and future development of the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) for detection of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI). RECENT FINDINGS: Our review of currently available evidence suggests that recent improvements to the PI-RADS system with PI-RADS v2.1 slightly improved interobserver agreement, with generally high sensitivity and moderate specificity for the detection of clinically significant PCa. Recent evidence additionally demonstrates substantial improvement in diagnostic specificity with PI-RADS v2.1 compared with PI-RADS v2. However, results of studies examining the comparative performance of v2.1 are limited by small sample sizes and retrospective cohorts, potentially introducing selection bias. Some studies suggest a substantial improvement between v2.1 and v2, while others report no statistically significant difference. Additionally, in PI-RADS v2.1, the interpretation and reporting of certain findings remain subjective, particularly for category 2 lesions, and reader experience continues to vary significantly. These factors further contribute to a remaining degree of interobserver variability and findings of improved performance among more experienced readers. PI-RADS v2.1 appears to show at least minimal improvement in interobserver agreement, diagnostic performance, and both sensitivity and specificity, with greater improvements seen among more experienced readers. However, given the decrescent nature of these improvements and the limited power of all studies examined, the clinical impact of this progress may be marginal. Despite improvements in PI-RADS v2.1, practitioner experience in interpreting mpMRI of the prostate remains the most important factor in prostate cancer detection.

Evaluation of the impact of marijuana use on semen quality: a prospective analysis.

AIMS: To assess if marijuana consumption - prevalent among men of reproductive age and becoming widespread due to decriminalization - is associated with changes in semen parameters. Marijuana's active metabolite, tetrahydrocannabinol, can alter signaling pathways within spermatozoa, affecting spermatogenesis and fertility. METHODS: We prospectively evaluated semen analyses (SA) from men presenting for infertility evaluation at one institution from July 2017 to April 2018. Participants completed a reproductive health questionnaire including items regarding marijuana consumption. SA was performed in accordance with World Health Organization (WHO) 5th Edition criteria. SA parameters included volume (ml), concentration (million/ml), motility (%), progressive motility (%), and Tygerberg strict morphology (%). RESULTS: A total of 409 patients completed the questionnaire; 174 (43%) men reported marijuana use (ever-users). Current and past users comprised 71 (17%) and 103 (25%), respectively. Compared with never-users, current and past users had a significantly higher likelihood of abnormal sperm strict morphology (33.1% versus 50.7% and 53.4%, respectively; p < 0.001). However, sperm motility was more likely to be less than WHO reference values in never-users than current and past-users (38.3% versus 21.1% and 27.2%, respectively; p = 0.01). In multivariate logistic regression analyses, current use was associated with increased odds of abnormal strict morphology [odds ratio (OR) 2.15, 95% confidence interval (CI): 1.21-3.79] and semen volume less than WHO reference value (OR 2.76, 95%CI: 1.19-6.42), while odds of less than WHO reference value sperm motility were reduced (OR 0.47, 95%CI: 0.25-0.91). CONCLUSION: Marijuana use is common among men presenting for fertility evaluation, and may have a detrimental effect on semen quality, particularly morphology and volume, but may be protective against abnormal sperm motility. Large, prospective studies of both semen quality and fertility in this growing, at-risk population are warranted.

Unilateral Corporal Cavernosum Partial Thrombosis: A Challenging Presentation and Management.

A 29-year-old African American male presented to our emergency department with a 5-day history of perineal pain and tender swelling of the left perineal body with no evidence of trauma. Physical examination revealed a firm left proximal corpus cavernosum body. Laboratory tests were within normal limits. Pelvic MRI confirmed the presence of a large left-sided unilateral corporal cavernosum partial thrombosis filling the proximal third of the left corpus cavernosum. The patient was managed conservatively with anticoagulation, pain control, and pelvic rest. At 3-month follow-up, perineal imaging showed reduction of thrombus size and resolution of pain and swelling. At 6-month follow-up, a penile ultrasound demonstrated almost complete resolution of the thrombus.

Correlation of ride sharing service availability and decreased alcohol-related motor vehicle collision incidence and fatality.

BACKGROUND: Alcohol-related motor vehicle collisions (AR-MVCs) account for ~30% of all US traffic fatalities. Ride-sharing services (RSS) have existed since 2010, but few studies to date have investigated their impact on AR-MVCs. We hypothesized that the availability of RSS would be correlated with a decrease in AR-MVCs at an urban Level I trauma center. METHODS: A retrospective chart review was conducted of all AR-MVC trauma activations at a Level I trauma center from 2012 to 2018. Additional data were gathered from regional governmental traffic and law enforcement databases, including crash incidence, fatalities, and demographics. Data were compared pre- and post-RSS and analyzed using an unpaired t test with p less than 0.05 considered significant. RESULTS: There were 1,474 patients in AR-MVCs during the study period. There was a significant decrease in the annual average proportion of MVCs that were AR-MVCs pre- vs. post-RSS (39% vs. 29%, p = 0.02) as well as a decrease in the average annual incidence of fatal AR-MVCs (11.6 vs. 5, p = 0.02). Subset analysis showed a decrease in AR-MVC incidence in 18- to 29-year-olds (12.7% vs. 7.5%; p = 0.03), which was also demonstrated by data from a local law enforcement database. Availability of RSS was also correlated with a decreased proportion of nighttime AR-MVCs (14.7% vs. 7.6%, p = 0.03) and decreased number of driving while intoxicated (1198.0 ± 78.5 vs. 612.8 ± 137.6, p = <0.01). CONCLUSION: We found that the incidence of both total AR-MVCs and fatal AR-MVCs presenting to our trauma center decreased after the introduction of RSS. Ride-sharing services may play a role in preventing AR-MVCs. Further research is needed to correlate AR-MVC incidence with granular proprietary RSS usage data and to account for any confounding factors. Future studies may identify ways to better utilize RSS availability as a targeted intervention for certain demographic groups to prevent AR-MVCs. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level IV.

Sex differences in object-in-place memory of adult rats.

Male rodents typically display an advantage over female conspecifics in tasks that assess memory for the identity or location of objects. However, the performance of female rodents on object recognition and object location tasks often is enhanced by elevated levels of ovarian steroids. The novel object-in-place task, combines elements of object recognition and object location tasks used to assess rodent object memory. Until now, only male rats have been tested on the object-in-place task, therefore, a study was conducted to compare the performance of males to females under different hormone conditions. Rats were given a sample phase to study the locations of four objects in an open field. After various delays, a test phase was administered with the locations of two objects reversed. Increased investigation of moved objects indicates memory for these objects and their original locations. Rats were able to discriminate moved from unmoved objects after a brief 5-min delay, regardless of biological sex or hormone status. However, gonadally intact males, but not diestrous females, were able to discriminate object locations after a 30-min delay. In contrast, ovariectomized females treated with estradiol and progesterone discriminated moved from unmoved objects after a 60-min delay while ovariectomized vehicle-treated females and gonadally intact males did not. Results indicate that female rats outperform males on a memory task that combines object recognition and location but only when circulating levels of the ovarian steroids, estradiol and progesterone, are elevated and only when memory is challenged by an extended retention interval.