A Nurse-Driven Protocol for Foley Catheter Utilization Decreases the Incidence of Traumatic Foley Catheterization.

Background: Traumatic urethral catheterization is a common reason for urologic consultation in hospitalized patients. The purpose of this study was to determine if a protocol designed to decrease Foley catheter use was effective and if implementation of the protocol decreased the incidence of Foley catheter-associated trauma. Methods: In an effort to decrease catheter use, our institution adopted a nurse-driven Foley catheter protocol in May 2015 that allowed nurses to remove Foley catheters that did not meet criteria. We conducted a retrospective medical records review of patients who had Foley catheter-associated trauma occurring between February 2013 and March 2018 and compiled data concerning Foley catheter use. Using t test statistical analysis, we compared rates of Foley catheter use and Foley catheter-associated trauma before and after protocol implementation. Results: During the 62-month study period, we documented 83 cases of Foley catheter-associated trauma. Prior to protocol implementation, our institution had mean of 2,903 patient-catheterization days per month. Following protocol implementation, the mean decreased to 2,604 patient-catheterization days per month (P<0.01). Prior to protocol implementation, the mean incidence of Foley catheter-associated trauma was 1.81 traumas per month. Following protocol implementation, the mean incidence decreased to 0.97 trauma per month (P<0.05). Conclusion: Implementation of the protocol was successful in decreasing Foley catheter use as well as Foley catheter-associated trauma.

Penile Fracture Caused by Straddle Injury to a Nonerect Penis.

We present the case of a 36-year-old male who sustained a straddle injury with classic signs of a urethral injury. He had blood at the meatus, a high-riding prostate, a butterfly hematoma, and he was unable to void. A retrograde urethrogram confirmed a bulbar urethral injury. After attempts at primary realignment with a Foley failed, he underwent suprapubic tube placement. However, when his physical examination worsened, an MRI revealed a concomitant injury to his left corpus cavernosum. This is the first reported case in the literature in which blunt trauma to a nonerect penis caused a penile fracture.

A patient-derived orthotopic xenograft model enabling human high-grade urothelial cell carcinoma of the bladder tumor implantation, growth, angiogenesis, and metastasis.

High-grade urothelial cell carcinoma of the bladder has a poor prognosis when lymph nodes are involved. Despite curative therapy for clinically-localized disease, over half of the muscle-invasive urothelial cell carcinoma patients will develop metastases and die within 5 years. There are currently no described xenograft models that consistently mimic urothelial cell carcinoma metastasis. To develop a patient-derived orthotopic xenograft model to mimic clinical urothelial cell carcinoma progression to metastatic disease, the urothelial cell carcinoma cell line UM-UC-3 and two urothelial cell carcinoma patient specimens were doubly tagged with Luciferase/RFP and were intra-vesically (IB) instilled into NOD/SCID mice with or without lymph node stromal cells (HK cells). Mice were monitored weekly with bioluminescence imaging to assess tumor growth and metastasis. Primary tumors and organs were harvested for bioluminescence imaging, weight, and formalin-fixed for hematoxylin and eosin and immunohistochemistry staining. In this patient-derived orthotopic xenograft model, xenograft tumors showed better implantation rates than currently reported using other models. Xenograft tumors histologically resembled pre-implanted primary specimens from patients, presenting muscle-invasive growth patterns. In the presence of HK cells, tumor formation, tumor angiogenesis, and distant organ metastasis were significantly enhanced in both UM-UC-3 cells and patient-derived specimens. Thus, we established a unique, reproducible patient-derived orthotopic xenograft model using human high-grade urothelial cell carcinoma cells and lymph node stromal cells. It allows for investigating the mechanism involved in tumor formation and metastasis, and therefore it is useful for future testing the optimal sequence of conventional drugs or the efficacy of novel therapeutic drugs.

Erectile Dysfunction: A Review of Historical Treatments With a Focus on the Development of the Inflatable Penile Prosthesis.

Erectile dysfunction has been a concern for men since the beginning of written history. For many men it can lead to severe psychological distress and humiliation. The treatment of erectile dysfunction has advanced significantly over the past 200 years. Men today are presented with many more viable therapy options leading to improved efficacy and more satisfactory sex lives. The objective of this article is to explore historical options for the treatment of erectile dysfunction, with particular emphasis on the development and progression of the inflatable penile prosthesis.

Validation of the Patient Global Impression of Improvement for Penile Prosthesis.

BACKGROUND: No consensus on the preferred means of evaluating patients after surgical placement of an inflatable penile prosthesis (IPP) currently exists. Many self-assessment questionnaires are available, but none specifically targets patients with IPPs. The purpose of this study was to assess the construct validity of the Patient Global Impression of Improvement (PGI-I) for evaluating patient satisfaction after placement of an IPP. METHODS: We conducted a multicenter prospective trial and enrolled patients who elected to have a 3-piece IPP surgically implanted. Postoperatively, patients completed the Sexual Health Inventory for Men (SHIM), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), and PGI-I at 3, 6, and 12 months. The Pearson correlation coefficient (PCC) was used to compare scores over time. RESULTS: Fifty-six patients were enrolled, and complete data were available for 39 patients. At 3 months, the PGI-I correlated with the EDITS (PCC=0.83, P<0.01) and with the SHIM (PCC=0.73, P<0.01). At 6 months, the PGI-I correlated with the EDITS (PCC=0.74, P<0.01). At 6 months, the PCC between the PGI-I and the SHIM was 0.41 (P<0.05). At 12 months, the PCC between the PGI-I and the EDITS was 0.83 (P<0.01), and the PCC between the PGI-I and the SHIM was 0.61 (P<0.01). CONCLUSIONS: Overall, the PGI-I appears to correlate with both the SHIM and EDITS and is a valid evaluation tool for use with patients after IPP placement.

Update on the sexual impact of treatment for benign prostatic hyperplasia.

There is an established link between lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). The medical and surgical management of LUTS can affect erectile function (EF), cause ejaculatory dysfunction (EjD) or affect libido. This article will review the effects of these therapies on sexual function.

Male urethral diverticulum after placement of an artificial urinary sphincter.

Urethral diverticula are sac-like dilatations of the urethra that communicate with the true urethral lumen. Because the condition is rare in men, no consensus exists regarding the management of male diverticula. Excision with primary repair of the urethra, urethroplasty (both one- and two-stage), and even endoscopic techniques have been used. We report a case of an acquired urethral diverticulum in a male following placement of an artificial urinary sphincter (AUS). Urethral diverticula arising after placement of an AUS have been described in the literature, but those cases occurred after erosion of the AUS. To our knowledge, our case is the first reported in a patient with a functioning AUS.

A review of surgical techniques for impending distal erosion and intraoperative penile implant complications: part 2 of a three-part review series on penile prosthetic surgery.

INTRODUCTION: More than half of intraoperative complications occur during dilatation of the corpora cavernosa, a critical step in the placement of any type of penile prosthesis, which can be especially difficult in a patient with corporal fibrosis. A late manifestation of cylinder placement can be impending erosion with lateral extrusion or medial deviation (into the urethra) of the distal tips. There are many different approaches to try and fix these surgical issues. AIM: The review article evaluates the many different surgical techniques prosthetic surgeons use in the management of intraoperative complications and lateral extrusion. METHODS: A review of the literature was preformed with published results being evaluated to try to help guide the management of intraoperative complications and impending distal erosion. There is a special focus on dilation of the corpora cavernosa. MAIN OUTCOMES MEASURES: The article reviews and evaluates the outcomes of the landmark papers in the management of intraoperative complications and impending distal erosion. RESULTS: Intraoperative complications of penile implant placement can be distressing for the prosthetic surgeon, but with proper recognition, most of these complications can be navigated with excellent postoperative results. CONCLUSIONS: This review article summarizes many of the techniques, outcomes, and new developments in the complicated field of penile prosthetic surgery to help guide the implanting surgeon.

Preservation of sexual function with the prostatic urethral lift: a novel treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia.

INTRODUCTION: We investigated the prostatic urethral lift, a novel, minimally invasive treatment for symptomatic lower urinary tract complaints presumed to be from benign prostatic hyperplasia (BPH), which aims to mechanically open the prostatic urethra without ablation or resection. We hypothesized that this novel approach would not degrade erectile or ejaculatory function. AIMS: We sought to determine the effect of the prostatic urethral lift procedure on erectile and ejaculatory function. METHODS: The procedure was performed on 64 men in Australia with an average age of 66.9 years and an average duration of lower urinary tract symptom (LUTS) of 4.7 years. Primary inclusion criteria included International Prostate Symptom Score (IPSS) > 13, Qmax of 5-12 mL/second, and prostate specific antigen (PSA) < 10 ng/mL. Baseline IPSS was 22.9 ± 5.4 (N = 64). There were no inclusion criteria for sexual function. Baseline Sexual Health Inventory for Men (SHIM) was 11.7 ± 8.6 (N = 58); baseline Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) function score was 9.0 ± 3.7 (N = 46); and lack of sexual activity or unwillingness to answer sexual function questionnaires accounted for the reduced sample size in the sexual function instruments. Implants were placed to separate encroaching lateral prostatic lobes. MAIN OUTCOME MEASURES: Patients were evaluated at 6 weeks and 3, 6, and 12 months postprocedure via the SHIM and MSHQ-EjD instruments. RESULTS: There was no evidence of degradation in sexual function after treatment for LUTS with the prostatic urethral lift procedure. Erectile function, as measured by SHIM, was slightly increased at all time points as compared with baseline. No patient reported retrograde ejaculation at any follow-up visit. CONCLUSIONS: We demonstrated significant improvement in LUTS with no evidence of degradation in erectile or ejaculatory function after treatment with the prostatic urethral lift procedure. This procedure warrants further study as a new option for patients underserved by current treatments for LUTS/BPH.

Medical management of lower urinary tract symptoms.

Lower urinary tract symptoms (LUTS) are a common complaint among aging men and are often caused by benign prostatic hyperplasia (BPH). A number of medical treatments for LUTS/BPH exist, such as alpha-blockers, 5alpha-reductase inhibitors, anticholinergics, phosphodiesterase type 5 (PDE5) inhibitors, and combination therapies. Agonist binding of the alpha(1A)-adrenergic receptor (AR), causing prostatic smooth muscle contraction, has been attributed to cause some LUTS. Therefore, medical therapy has aimed to block the alpha(1A)-AR and improve LUTS. Determining which therapy to choose must take into account individual patient factors as well as cost and patient choice.