Adult Hypospadias Outcomes for the Pediatric Urologist.

PURPOSE OF REVIEW: This review article will examine the current literature on hypospadias-related complications in adult patients. RECENT FINDINGS: In this article, we will review the most recent studies evaluating hypospadias-related stricture disease, erectile function, fertility, and psychosexual outcomes in adult men with history of hypospadias repair in childhood. Managing hypospadias-related complications in adult patients is challenging to reconstructive urologists due to the compounded complexity of innate tissue deficiency and history of prior surgical repairs. In this review, we explore overall functional outcomes of adults with history of hypospadias repair as well as repair strategies of hypospadias-related urethral stricture disease. We will review erectile function, fertility and psychosexual outcomes as well as potential complications, which often do not surface until late adolescence and adulthood. Although it is challenging to characterize and quantify hypospadias-related complications, further longitudinal study is needed to better care for this complex patient population.

Impact of Preoperative Platelet Count on Bleeding Risk and Allogeneic Transfusion in Multilevel Spine Surgery.

STUDY DESIGN: This was an observational cohort study of patients receiving multilevel thoracic and lumbar spine surgery. OBJECTIVE: The aim of this study was to identify which patients are at high risk for allogeneic transfusion which may allow for better preoperative planning and employment of specific blood management strategies. SUMMARY OF BACKGROUND DATA: Multilevel posterior spine surgery is associated with a significant risk for major blood loss, and allogeneic blood transfusion is common in spine surgery. METHODS: A univariate logistic regression model was used to identify variables that were significantly associated with intraoperative allogeneic transfusion. A multivariate forward stepwise logistic regression model was then used to measure the adjusted association of these variables with intraoperative transfusion. RESULTS: Multilevel thoracic and lumbar spine surgery was performed in 921 patients. When stratifying patients by preoperative platelet count, patients with pre-operative thrombocytopenia and severe thrombocytopenia had a significantly higher rate of transfusion than those who were not thrombocytopenic. Furthermore, those with severe thrombocytopenia had a higher rate of red blood cells, fresh frozen plasma, and platelet transfusion than those with higher platelet counts. Multivariate logistic regression found that preoperative platelet count was the most significant contributor to transfusion, with a platelet count ≤100 having an adjusted odds ratio (OR) of transfusion of 4.88 (95% confidence interval [CI] 1.58-15.02, P = 0.006). Similarly, a platelet count between 101and 150 also doubled the risk of transfusion with an adjusted OR of 2.02 (95% CI 1.01-4.04, P = 0.047). The American Society of Anesthesiologists classification score increased the OR of transfusion by 2.5 times (OR = 2.52, 95% CI 1.54-4.13), whereas preoperative prothrombin time and age minimally increased the risk. CONCLUSION: Preoperative thrombocytopenia significantly contributes to intraoperative transfusion in multilevel thoracic lumbar spine surgery. Identifying factors that may increase the risk for transfusion could be of great benefit in better preoperative counseling of patients and in reducing overall cost and postoperative complications by implementing strategies and techniques to reduce blood loss and blood transfusions. LEVEL OF EVIDENCE: 2.

Menopause symptoms delineated by HIV clinical characteristics in African American women with HIV.

OBJECTIVE: To obtain data on prevalence and severity of climacteric symptoms in women with HIV (WWH) during the menopausal transition and early menopause and to evaluate for any differences in symptoms by CD4 count and viral load. METHODS: We conducted an in-person survey of female patients attending the Johns Hopkins HIV clinic, ages 40 to 50 years with at least one menstrual period within 6 months before the survey. Interviews utilized the Greene Climacteric scale, a validated menopause questionnaire. We also queried patients, (1) if they were informing their primary care physician of menopause symptoms and (2) if their menopause symptoms were being treated. The study used nonparametric Mann-Whitney rank sum tests with significance defined as P < 0.05 to perform symptom severity comparisons of distributions and Fischer exact tests for comparisons of categorical variables such as comparing prevalence of anxiety and depression in the population. RESULTS: Twenty-three women aged 40 to 50 years were interviewed with a median age of 47 years [25 percentile = 46, 75 percentile = 49]. All were African American with median length of HIV diagnosis of 12 years [25 percentile = 7, 75 percentile = 20.5]. Most of the patients, 87% (n = 20), reported experiencing at least one menopause symptom with intense frequency and extreme detrimental effects on quality of life. All women interviewed, 100% (n = 23), reported hot flashes, ranging from infrequent to persistent. Sleeping difficulty was reported by 78% (n = 18) of women. Most women, 78% (n = 18), reported feeling tired or lacking energy with moderate frequency. The majority of the women, 87% (n = 20), said they reported menopause symptoms to their primary care provider. Of these, only 20% received treatment for menopause symptoms. CONCLUSIONS: These findings suggest that WWH undergoing the menopausal transition experience intense symptoms severely impacting quality of life. Although the majority of women reported experiencing menopause symptoms to medical providers, most remained untreated. An opportunity exists to educate providers caring for WWH on menopause medicine.

Readability of pelvic floor dysfunction questionnaires.

BACKGROUND: The National Institutes of Health and Center for Disease Control recommend the readability of self-administered patient questionnaires to be written at or below a sixth to eight grade reading level. The aim of this study is to evaluate the readability of commonly used urinary incontinence (UI), pelvic organ prolapse (POP), overactive bladder (OAB), and benign prostate hyperplasia (BPH) questionnaires. METHODS: Eighteen validated urologic questionnaires were analyzed using four readability assessment tools. A mean grade-level needed to comprehend each questionnaire was calculated. RESULTS: For UI questionnaires, three out of five questionnaires required a reading level of 10th grade or higher, two grade levels above recommendations. Only one POP questionnaire met recommendations with a mean readability score of 5.9, whereas the other questionnaires required a ninth-grade reading level or higher. For the OAB questionnaires, three out of five questionnaires met reading recommendations. Readability scores for BPH questionnaires ranged from 6.4 to 11.2, with only the International Prostate Symptom Score questionnaire in compliance with recommendations. CONCLUSIONS: The majority of currently available pelvic floor dysfunction questionnaires do not comply with recommended reading levels, suggesting that these questionnaires are written at a level too advanced for a large proportion of the population. This limits their effectiveness in accurately assessing symptom severity and impact on quality of life.

Current policies and practicing surgeon perspectives on parental leave.

BACKGROUND: The aim of this study is to evaluate the components of current parental leave policies in surgical practice and evaluate surgeon perceptions of parental leave. METHODS: Practicing surgeons were recruited to complete a survey via social media outlets and e-mail. Participants were asked questions regarding existing policies and their perspectives towards parental leave. RESULTS: The survey was completed by 431 surgeons, of which 90% were female and 45% in academics. The majority (84%) of women took <12 weeks leave, and 24% were fully funded. All male respondents took <4 weeks, of which 55% was fully paid. Discrimination was experienced by 31%. The majority support paid parental leave (94%) without impact on time to promotion (87%) or partnership (85%). CONCLUSIONS: There is variance in current parental leave policies regarding length and compensation. Most respondents support paid parental leave and are in favor of policies that support new parents during and after pregnancy.