Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures.

PURPOSE: Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success. MATERIALS AND METHODS: Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction. RESULTS: At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96, 95% CI 2.07-11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (each p <0.02). When controlling for recurrence, multivariate analysis revealed that urethra and bladder pain (OR 1.71, 95% CI 1.05-2.77 and OR 2.74, 95% CI 1.12-6.69, respectively), a postoperative decrease in sexual activity (OR 4.36, 95% CI 2.07-11.90) and persistent lower urinary tract symptoms (eg straining to urinate OR 3.23, 1.74-6.01) were independent predictors of dissatisfaction. CONCLUSIONS: Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independently of the anatomical appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistent lower urinary tract symptoms were predictors of patient dissatisfaction.

Lower urinary tract pain and anterior urethral stricture disease: prevalence and effects of urethral reconstruction.

PURPOSE: Anterior urethral stricture disease most commonly presents as urinary obstruction. Lower urinary tract pain is not commonly reported as a presenting symptom. We prospectively characterized lower urinary tract pain in association with urethral stricture disease and assessed the effects of urethroplasty on this pain. MATERIALS AND METHODS: Men (18 years old or older) with anterior urethral stricture disease were prospectively enrolled in a longitudinal, multi-institutional, urethral reconstruction outcomes study from June 2010 to January 2013 as part of TURNS (Trauma and Urologic Reconstruction Network of Surgeons). Preoperative and postoperative lower urinary tract pain was assessed by the validated CLSS. Voiding and sexual function was assessed using validated patient-reported measures, including I-PSS. RESULTS: Preoperatively 118 of 167 men (71%) reported urethral pain and 68 (41%) reported bladder pain. Age was the only predictor of urethral pain with men 40 years or younger reporting more pain than those 60 years old or older (81% vs 58%, p = 0.0104). Lower urinary tract pain was associated with worse quality of life and overall voiding symptoms on CLSS and I-PSS (each p <0.01). Postoperatively lower urinary tract pain completely resolved in 64% of men with urethral pain and in 73.5% with bladder pain. There were no predictive factors for changes in lower urinary tract pain after urethral reconstruction. CONCLUSIONS: Lower urinary tract pain is common in urethral stricture disease, especially in younger men. It is associated with worse quality of life and voiding function. In most men lower urinary tract pain resolves after urethral reconstruction.

The role of noninvasive testing and questionnaires in urethroplasty follow-up.

Urethroplasty is the preferred surgical approach for the management of urethral stricture disease. To date, no standard has been established to evaluate stricture recurrence after urethral reconstruction, though both invasive and non-invasive methods are used widely. In this article we review the role of noninvasive testing and questionnaires in urethral monitoring after urethroplasty.

Prevention of wrong site surgery during upper tract endoscopy.

OBJECTIVE: To evaluate the use of radiopaque stickers during endoscopic surgical cases to prevent wrong side surgery. METHODS: We used radiopaque markers before planned endoscopic surgery to ensure correct side surgery. These markers are labeled "R" and "L" and are identifiable during fluoroscopy. RESULTS: These markers were a valuable tool to prevent wrong side endoscopic upper tract procedures. They were also well-accepted by patients at their preoperative surgical verification process. CONCLUSION: Radiopaque stickers can assist in the prevention of wrong side surgery during upper tract endoscopic procedures.

Factors associated with positive attitudes toward organ donation in Arab Americans.

BACKGROUND: The demand for transplantable organ continues to exceed supply, particularly in minority patient populations. We explored the factors influencing organ donation attitude within the Arab American community. METHODS: Secondary data analysis from a face-to-face survey administered in late 2003 to 1016 adults from a representative population-based sample on Greater Detroit Arab Americans. RESULTS: Christian Arab Americans were more likely than Muslim Arab Americans, and women more than men, to believe organ donation after death was justifiable. Higher educational attainment and income, as well as greater acculturation into American society, were associated with greater odds of believing organ donation to be justified. Self-reported health status and level of psychological distress and health insurance status were not associated with beliefs about organ donation. CONCLUSIONS: A multifaceted approach toward increasing organ donation rates in this growing population requires targeted community-health care system collaborations involving religious and civic leaders using Arabic language and culturally sensitive media. SUMMARY: Arab Americans represent a growing population about which little is known in regard to organ donation and transplantation. This population is not specifically captured within national and local transplantation databases, and little empiric work has assessed attitudes and barriers toward organ donation and transplantation within this community. Our work represents the first to use a representative population-based sample to explore the modifiable and non-modifiable characteristics of those who believe cadaveric organ donation to be justified.

crinkled leaves 8--a mutation in the large subunit of ribonucleotide reductase--leads to defects in leaf development and chloroplast division in Arabidopsis thaliana.

The crinkled leaves8 (cls8) mutant of Arabidopsis thaliana displays a developmental phenotype of abnormal leaf and flower morphology, reduced root growth and bleached leaf sections. Map-based cloning identified the mutation as being within the gene encoding the large subunit of ribonucleotide reductase (RNR1), the enzyme that catalyses the rate-limiting step in the production of deoxyribonucleoside triphosphates (dNTPs) for DNA synthesis and repair. Levels of dTTP and dATP were significantly reduced in cls8. Two further mutant cls8 alleles and cls8::RNAi plants show similar or more severe phenotypes. The cls8-1 mutant has fewer copies of the chloroplast genome, and fewer, larger chloroplasts than wild-type plants. The ultrastructure of the chloroplast, however, appears normal in cls8-1 leaves. We present evidence that, under conditions of limited dNTP supply, the inhibition of chloroplast DNA replication may be the primary factor in inducing aberrant growth.