Best predictive single nephrometry score component to correlate with achievement of trifecta outcome in laparoscopic and robotic surgery.

BACKGROUND: To evaluate the predictive value of individual components of the R.E.N.A.L scoring system for Laparoscopic (LPN) and Robotic Partial Nephrectomy (RPN). METHODS: Patients that had undergone a Laparoscopic (LPN) or Robotic Partial Nephrectomy (RPN) between 2018 and 2023 were reviewed. Our data collection included Race, Ethnicity, Age, BMI, R.E.N.A.L nephrometry score, and complications. Cases that achieved trifecta outcomes were designated as "Group A" and cases that did not achieve trifecta were "Group B". All the data were collected using REDCap database. RESULTS: A total of 111 cases were included, Group A consisted of 82% of all cases, whereas Group B 18%. Radius score demonstrated significant distinction concerning trifecta attainment and was the most predictive component of the 5 scoring metrics of the nephrometry system. In a subgroup analysis, R-score of 3 or a renal mass measuring ≥ 7 cm, was a significant independent negative predictor for trifecta outcomes, as well as tumor size at presentation. CONCLUSION: Renal nephrometry score is predictive of trifecta outcomes for patients undergoing laparoscopic or robotic partial nephrectomy. Radius of mass was the most effective predictive component of the nephrometry score for trifecta prediction.

Differential effects of obesity on perioperative outcomes in renal cell carcinoma patients based on race and ethnicity and neighborhood-level socioeconomic status.

Background: Obesity is a well-established risk factor of renal cell carcinoma (RCC), however the impact of obesity on surgical outcomes for racial and ethnic minority patients with RCC is unclear. This study investigated whether a higher body mass index (BMI) or obesity (BMI ≥30 kg/m2) was associated with worse perioperative outcomes and if there were heterogeneous effects based on race, ethnicity, and neighborhood-level socioeconomic factor. Methods: In this single-center cross-sectional study, medical records of patients who underwent partial or radical nephrectomy between 2010 and 2022 were retrospectively reviewed. Logistic regression analysis was performed to assess associations of BMI and perioperative outcomes [ischemia time, estimated blood loss (EBL), and length of hospital stay]. Results: A total of 432 patients, including 49.8% non-Hispanic White (NHW), 35.0% Hispanic, and 6.9% American Indian (AI) patients, were included. Median [interquartile range (IQR)] BMI was 30.2 (26.3-35.2) kg/m2, and Hispanic (31.5) and AI (32.5) patients had higher median BMI than NHW (29.1) patients (P=0.006). Median ischemia time, EBL, and length of hospital stay were 18.5 (IQR, 15.0-22.4) minutes, 150 (IQR, 75.0-300.0) mL, and 3 (IQR, 2-5) days. BMI ≥35 kg/m2 was associated with a longer ischemia time [>18.5 minutes; odds ratio (OR), 5.17; 95% confidence interval (CI): 1.81-14.76; P=0.002], and the association was stronger in NHW than Hispanic patients (BMI continuous OR, 1.13; 95% CI: 1.04-1.22; P=0.004 in NHW and OR, 1.07; 95% CI: 0.98-1.17; P=0.12 in Hispanics). Class I and II/III obese patients had over two-fold increased odds of a larger EBL (>150 mL) than patients with normal weight (OR, 2.17; 95% CI: 1.03-4.59; P=0.04 for class I and OR, 2.24; 95% CI: 1.04-4.84; P=0.04 for class II/III obese patients). This association was stronger in patients from neighborhoods with high social deprivation index (SDI) and in NHW patients (BMI ≥30 vs. <30 kg/m2, OR, 3.53; 95% CI: 1.57-7.97; P=0.002 in high SDI neighborhoods and OR, 2.38; 95% CI: 1.10-5.14; P=0.03 in NHW). BMI was not associated with a longer hospital stay. Conclusions: In this study, obesity increased likelihood of worse perioperative outcomes, and the associations varied based on race and ethnicity and neighborhood-level socioeconomic factors.

Age and Sex Comparisons in Pediatric Track and Field Hurdle Injuries Seen in Emergency Departments of the US.

There is limited literature analyzing pediatric hurdle injuries based on sex and age. This study compares hurdle-related injury types, injured body parts, and injury mechanisms by age and sex in pediatrics. Hurdle-related injury data from the National Electronic Injury Surveillance System were used to retrospectively review the injuries of hurdlers 18 years and under. Differences in injured body parts, injury types, and mechanisms were analyzed by age (pre-high school vs. high school) and sex (male vs. female). A total of 749 cases were extracted. Fractures were more common in pre-high schoolers (34.1% vs. 21.5%, p = 0.001), while more sprains were identified in high schoolers (29.6%) than pre-high schoolers (22.8%, p = 0.036). Males suffered more fractures than females (35.1% vs. 24.3%, p = 0.001). Females sustained more joint sprains (29.1% vs. 21.0%, p = 0.012) and contusions/hematomas (12.7% vs. 7.5%, p = 0.020). Ankle injuries were more common in females (24.0%) than males (12.0%, p = 0.001), while wrist injuries were more prevalent in males (11.7% vs. 7.2%, p = 0.034). The most common injury mechanism was apparatus-related, with no differences based on age or sex. Injury types and injured body parts differed depending on age and sex in pediatric hurdle injuries seen in emergency departments. These findings may be helpful for injury prevention and medical care for pediatric hurdlers.

Successful replantation of self-amputated penis using microvascular repair resulting in restoration of voiding and erectile function.

Intentional self-amputation of the penis is rarely encountered and usually occurs in the context of an underlying psychiatric illness. We report the case of a 42-year-old male who intentionally amputated his penis, both testicles, and a large portion of the scrotum en bloc using garden shears. Microscopic and macroscopic replantation of the penis was undertaken, resulting in restoration of normal urinary function and moderate erectile function.

Pediatric hurdle-related acute injuries in track and field presenting to US emergency departments: descriptive epidemiology study.

BACKGROUND: Hurdling is a track event that is unique due to a combination of running and jumping over an apparatus. Since hurdling requires a special skillset with sprinting and jumping, athletes are at risk for various musculoskeletal injuries. However, there has been a paucity of studies describing the epidemiology of pediatric hurdle injuries. PURPOSE: To examine hurdle-related injury types, injured body parts, injury mechanisms, and injury settings in children and adolescents. METHODS: Descriptive epidemiology study. Data from the National Electronic Injury Surveillance System, which represents emergency room visits, was retrospectively reviewed. Injury data involving hurdle injuries was searched during a 10-year period (2008-2017) with hurdlers 18 years old and younger. Injuries were classified based upon injury types, body parts, injury mechanisms, and injury settings. Descriptive statistics were used including mean ± standard deviation, frequency (N), and percentages (%). RESULTS: A total of 749 hurdle-related injuries were found from 333 males (44.5%) and 416 females (55.5%). The top three injury types were fracture (N = 218, 29.1%), joint sprain (N = 191, 25.5%), and contusion/hematoma/bruise (N = 78, 10.4%). The top three injured body parts were ankle (N = 140, 18.7%), knee (N = 120, 16.0%), and wrist (N = 69, 9.2%). The most common injury mechanisms were apparatus-related trips, falls, and landings (N = 594, 79.0%). Finally, injury settings consisted of track and field practices (N = 469, 62.6%), track and field meets (N = 96, 12.8%), and other settings including gym, physical education class, recess, school activities, and camps (N = 49, 6.5%). CONCLUSION: In pediatric hurdle athletes, the most prevalent injury type seen in the emergency room was fracture. Although most hurdle-related injuries occur in the lower extremity, wrist injuries were the third most commonly injured body location. The most common injury mechanism was apparatus-related trip, fall, and landing, and injuries most commonly occurred during track practices. In pediatric hurdle athletes seen in the emergency room, majority of injuries consisted of traumatic fractures and joint sprains at ankle, knee, and wrist, which frequently occurred with apparatus-related trip, fall, and landing mechanisms during track and field practices.

Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients.

Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84-1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.

Characterizing Injuries from Genital Foreign Objects: Analysis from the National Electronic Injury Surveillance System.

INTRODUCTION: Genital foreign body injuries are becoming more common with the growing popularity of genital piercings and devices such as penile rings. We evaluated a nationwide sample of emergency department data to determine trends in demographics, injury locations, disposition and source of injury over time with regard to genital foreign bodies. METHODS: Using NEISS (National Electronic Injury Surveillance System), a representative sample of data collected from hospital emergency department visits associated with consumer product related injuries occurring in the United States, we retrospectively identified cases of genital foreign body injuries in males and females. Means were compared with the independent t-test and proportions with chi-square analysis. RESULTS: We identified 184 genital foreign body injuries in NEISS from 2008 to 2017 consisting of 87 piercing injuries (47.3%) and 97 genital ring injuries (52.7%). The most common body part injured was the penile foreskin (100 cases, 54.3%). Mean age was 35.9 years, and males were more commonly injured than females (127, 69.0% vs 57, 31.0%). Genital foreign body injuries increased over time from 2008 (10, 5.4%) to 2017 (25, 13.6%), and most patients (166, 90.2%) were treated and released from the emergency department. CONCLUSIONS: Although genital foreign body injuries caused by piercings and sex toys are becoming more common, most can be safely managed at the emergency department without hospitalization. Affected patients tend to be younger and male with most injuries occurring on the penile foreskin. More large-scale studies are needed to determine trends according to economic status, education level and location within the United States.

Narcotic Pain Control for Ureterolithiasis Is Associated With Unnecessary Repeat Imaging in the Emergency Department.

A subset of patients with ureteral stones who present to the emergency department (ED) will return with recurring symptoms and will receive unnecessary repeat imaging. We retrospectively identified 112 patients from 2012 to 2016 diagnosed with at least one ureteral stone on computerized tomography (CT) at our institution who returned to the ED within 30 days. Patients were stratified based on the presence or absence of repeat CT scan imaging. Mean values were compared with independent t-test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of repeat imaging. Sixty-eight patients (60.7%) underwent repeat CT scan imaging upon representation to the ED within 30 days of being diagnosed with ureterolithiasis. Ureteral stone position changed in 34 patients (30.4%) who underwent repeat imaging. On univariate analysis, younger age, nondiabetics, narcotics prescribed on discharge from first ED visit, and longer mean time between ED visits were associated with repeat CT scan imaging being performed (p < .05). Only prescription of narcotic pain medications was an independent predictor of repeat CT scan imaging (odds ratio: 3.18, 95% confidence interval: 1.22-8.28; p = .018). Nonsteroidal anti-inflammatory drugs or nonnarcotic pain medications, therefore, should primarily be used for pain control in these patients to avoid unnecessary testing.