Sean Elliott

Results:Of 138 enrolled men (120 tissue/serum; 18 stricture tissue only), 78 had idiopathic strictures, 33 had trauma-related strictures, and 27 had LS-related strictures. BMI, stricture length, and stricture location significantly differed between cohorts (P<. 001 for each). The highest BMIs and the longest strictures were observed in the LS cohort. SRPT exposures did not significantly differ between etiology cohorts, with> 60% of each reporting low/mild risk. Stricture inflammation significantly differed between cohorts, with mild to severe inflammation present in 27% of trauma-related strictures, 54% of idiopathic strictures, and 48% of LS strictures (P= 0.036). Stricture fibrosis did not significantly differ between cohorts (P=. 7). Three serum cytokines were significantly higher in patients with strictures compared to stricture-free controls: IL-9 (P=. 001), PDGF-BB (P= 0.004), and CCL5 (P=. 01). No differences were observed in …

INTRODUCTION AND OBJECTIVESeveral factors influence recurrence after urethral stricture repair. The impact of socioeconomic factors on stricture recurrence after urethroplasty is not well understood. This study aims to assess the impact social deprivation has on urethral stricture recurrence after urethroplasty.METHODSA retrospective review of patients undergoing urethral reconstruction in the TURNS database was performed. Home zip code was used to calculate Social Deprivation Indices (SDI; 0-100), which quantifies level of disadvantage across several sociodemographic domains collected in the American Community Survey. Patients without zip code, functional or anatomic recurrence data were excluded from the analysis. Cox Proportional Hazards model was used to study the association between SDI and hazard of functional recurrence, adjusting for stricture characteristics.RESULTSMedian age was …

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. 1-3 The genitourinary tract is the primary site of 20% to 25% of RMS cases, and RMS arising from the genitourinary tract affects an estimated 60 to 70 children annually in the United States, with 75% of these cases arising in boys. 3, 4 The most common symptoms on presentation include dysuria, hematuria, abdominal distension, constipation, and urinary retention. 4 There are two major histologic classifications of RMS arising from the prostate: alveolar and embryonal. 1, 4 Embryonal RMS is the most common subtype, accounting for approximately 90% of cases arising in the urogenital tract and carries a better prognosis than alveolar RMS. 1, 3, 4 Risk factors for RMS include Li-Fraumeni syndrome, neurofibromatosis, overexpression of the gene encoding for IGF2, parental use of marijuana before conception and maternal history of …

INTRODUCTION AND OBJECTIVETo evaluate the rates of complications and post operative outcomes in men with AABP utilizing data from a multi institutional cohort of patients based upon the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) Penis, Abdomen and Scrotum (PAS) classification and novel staging system.METHODSPatients with AABP within a multi institutional dataset were retrospectively recategorized into their respective PAS stages based upon their PAS classifications, . Descriptive and operative characteristics, 90 day post operative complications, need for revision surgery and treatment success were collected as outcomes.RESULTS129 patients were classified according to their respective PAS stages. Treatment success and need for revision surgery was noted in 91% and 14% of men. Complications were noted in 47/129 (36%) of men, Table 1. The most common …

Objective The aim of this study is to report the updated 2‐year results of the intervention arm of the ROBUST III randomized trial evaluating the safety and efficacy of the Optilume drug‐coated balloon (DCB) versus standard endoscopic management of recurrent male anterior urethral stricture. Materials and Methods Eligible patients included men with recurrent anterior urethral stricture ≤3 cm in length and ≤12Fr in diameter, International Prostate Symptom Score (IPSS) ≥11 and peak flow rate (Qmax) <15 mL/s. Patients were randomized to treatment with the Optilume DCB or standard‐of‐care endoscopic management. Primary efficacy endpoints measured at 2 years included freedom from re‐intervention and changes in IPSS, Qmax and post‐void residual (PVR). Secondary endpoint was impact on sexual function using the International Index of Erectile Function (IIEF). Primary safety endpoint was freedom from …

INTRODUCTION AND OBJECTIVEWomen with chronic urethral Foley catheterization can develop a patulous urethra with severe urinary incontinence. Bulking agents and slings offer little relief in this setting. Women who opt for a suprapubic tube or catheterizable channel can have their urethral incontinence addressed with a bladder neck closure. This can be performed transvaginally with a Martius flap or transabdominally with an omental flap. While these techniques have been previously described, to our knowledge there has been no direct video comparison of the indications and methods of the two approaches. We describe and compare the indications and methods for transvaginal and transabdominal bladder neck closure.METHODSWe define a patulous urethra as one that can accommodate an index finger. Our first case is a 75-year-old woman with neurogenic bladder due to spinal cord injury. She had a …

ObjectiveTo evaluate urinary outcomes following cystoscopic external urinary sphincter onabotulinumtoxinA (BTX) injections in patients with CP. Adults with cerebral palsy (CP) can suffer from bladder outlet obstruction and urinary retention due to a spastic external urethral sphincter (“pseudodysynergia”). We have used BTX injections into the sphincter to relieve the obstruction and allow patients to maintain spontaneous voiding rather than intermittent catheterization.MethodsPatients were included in this retrospective cohort study if they had a diagnosis of CP, were at least 18 years of age, and underwent a urethral external sphincter BTX injection between 2016-2023. The procedure included 100u or 200u of BTX mixed in 4cc of saline. Primary outcomes were subjective, patient or caregiver reported changes in retention, lower urinary tract symptoms (LUTS), frequency of recurrent urinary tract infections (UTIs), and …

INTRODUCTION AND OBJECTIVESmoking cessation prior to surgery is encouraged to minimize cardiac and pulmonary anesthetic risk, but also to improve wound healing, as the nicotine in cigarette smoke decreases microvascular blood supply. Still, many patients will not heed this advice and will smoke up to and throughout surgery. The focus in this study was to determine how active smoking affects urethroplasty outcomes.METHODSA large multi-institutional database was used to identify patients that underwent anterior urethroplasty for bulbar urethral stricture disease (bUSD). Patients with bUSD in prior hypospadias repair sites or from lichen sclerosus were excluded. A generalized linear mixed model was created to predict surgical functional failure (need for secondary procedure for recurrence) after single-stage orthotopic urethroplasty. The following variables were included: bUSD length (cm), location …

Introduction The Optilume® Drug Coated Balloon (DCB) is a dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. Outcomes after 3-year follow-up are presented here. Objective The ROBUST III study is a randomized controlled trial comparing the Optilume® Drug Coated Balloon (DCB) against direct visual internal urethrotomy (DVIU) or dilation. Methods 127 subjects were randomized in a 2:1 fashion at 23 sites. Seventy-nine were treated with the DCB and 48 were treated with DVIU or dilation. Follow-up past 1 year was limited to those treated with the DCB. Eligibility criteria included adult males with anterior strictures with ≥2 prior treatments and stricture length ≤3cm. Long-term endpoints included freedom from repeat treatment, International …

INTRODUCTION AND OBJECTIVETo illustrate the Y-V plasty technique for revising a catheterizable channel.METHODSWe perform a Y-V plasty revision of a colonic Monti channel in a 19-year-old patient with spina bifida found to have a 2.5 cm stenosis of the cutaneous end of his stoma. Although the stoma was shortened almost to the fascia level, we were able to avoid freeing it from the fascia and still mature it the skin.RESULTSNo evidence of stricture recurrence observed at six-month follow-up following channel revision and stricture resection. The patient reports successful catheterization of his stoma using a 14F foley catheter. As we avoided mobilization of the stoma from the fascia, there is no parastomal hernia.CONCLUSIONSThe Y-V plasty technique for stenosis of catheterizable channel allows for maturation of a shortened stoma without the need for deeper mobilization.Source of FundingNone

INTRODUCTION AND OBJECTIVEWe created a staging system based on the Length Segment Etiology (LSE) classification published by the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) where each stage/substage represents a unique subset of anterior urethral stricture disease (aUSD), inferring location, expected repair type, and surgical outcome.METHODSStage development adhered to the aUSD outcomes principles from prior TURNS work on this cohort of 2,396 patients using multivariate logistic regressions and Kaplan Meier curves: 1) penile > (have a higher functional recurrence rate than) bulbar strictures; 2) longer > shorter strictures; 3) adverse pathophysiology etiology (e.g. radiation) > trauma/idiopathic etiology. A novel patient-centered surgical outcome (PCSO) score was used for stage validation, which combined functional success (defined as no secondary repair; 2=success …

Introduction and Objective Individuals with spinal cord injury (SCI) commonly experience secondary complications though it is not known how they prioritize these different health domains. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to identify the top health concerns of individuals with SCI and identify factors that may be associated with these choices with particular focus on urologic issues that participants face. Methods Participants in the NBRG registry were asked: “What are the top 3 problems that affect you on a daily basis?” Urinary symptoms and QoL were assessed with the Neurogenic Bladder Symptom Score (NBSS). Multivariate regression was used to identify factors related to selecting a top ranked health issue. Results Among our 1461 participants, 882 (60.4%) were men and the median age was 45.1 years (IQR 25.3−64.9). Bladder management was the …

INTRODUCTION AND OBJECTIVEOperative planning for catheterizable channel with bladder augmentation in patients with neurogenic bladder can be difficult, as different etiologies of neurogenic bladder each come with unique intra-operative challenges as well as widely varying patient preferences and considerations. Further, there are many different channel types. So, it can be confusing to decide on the right channel for the right patient. Broadly grouping these patients into phenotypes and understanding the benefits of each channel type can help guide operative planning and aid surgeons in selecting the most appropriate catheterizable channel for the unique needs of each patient type.METHODSWe describe an intra-operative decision-making algorithm for catheterizable channel creation and bladder augmentation in patients with spinal cord injury, spina bifida and cerebral palsy.RESULTSWe rank …

INTRODUCTION AND OBJECTIVEThe ROBUST III study is a randomized controlled trial comparing the Optilume® Drug Coated Balloon (DCB) against direct visual internal urethrotomy (DVIU) or dilation. The Optilume® DCB is a dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. Outcomes after 4-year follow-up are presented here.METHODS127 subjects were randomized in a 2:1 fashion at 23 sites. Seventy-nine were treated with the DCB and 48 were treated with DVIU or dilation. Follow-up past 1 year was limited to those treated with the DCB. Eligibility criteria included adult males with anterior strictures with≥2 prior treatments and stricture length ≤3cm. Long-term endpoints included freedom from repeat treatment, International Prostate Symptom Score (IPSS), and peak urinary flow rate (Qmax …

Objective To characterize the difference in uptake of virtual care for urinary tract infections (UTIs) by demographic

INTRODUCTION AND OBJECTIVENearly 50% of anterior urethral strictures are of idiopathic etiology. To investigate the underlying biology of idiopathic strictures, we compared inflammatory profiles of idiopathic strictures with those of known etiology, specifically trauma/iatrogenic strictures and lichen sclerosus strictures. We hypothesized that each group would contain distinct inflammatory features.METHODSFive centers prospectively enrolled patients into an NIDDK-funded study evaluating inflammation in anterior urethral stricture disease. Subjects underwent standard urethroplasty per surgeon routine and tissue was sent to a centralized repository. H&E-stained sections of stricture tissue and stricture-adjacent urethral tissue (1 cm from stricture when available) were examined by a single, blinded pathologist and evaluated for degree of inflammation and primary inflammatory cell type.RESULTS133 strictures …

INTRODUCTION AND OBJECTIVEPaclitaxel Drug Coated Balloons (PDCBs) have proven efficacious in the treatment of urethral stricture disease. Application of PDCBs for ureteral strictures holds promise but safety and efficacy of their use have yet to be evaluated. This study was designed to gather data concerning; pharmacokinetics, histology, safety and healing potential for the ureter after ureteral dilation with a PDCB in a porcine model.METHODSUreteral dilation with PDCBs was performed on three anesthetized female pigs. In all cases one ureter was treated with PDCB dilation alone while the contralateral ureter was treated first with holmium laser endoureterotomy followed by PDCB dilation. Treatments were delivered in the proximal and distal ureter on each side using either an 8mm x 50 mm or 10 mm x 50 mm PDCB. Retrograde pyelograms (RPG) were performed to assess for extravasation after dilation …

PurposeWe sought to characterize sex-stratified differences in bladder management and bladder symptoms and satisfaction after spinal cord injury.Materials and MethodsThis study was a prospective, cross-sectional, observational study; eligibility included: age ≥18 years and acquired spinal cord injury. Bladder management was grouped as (1) clean intermittent catheterization, (2) indwelling catheter, (3) surgery, and (4) voiding. Primary outcome was Neurogenic Bladder Symptom Score. Secondary outcomes were subdomains of the Neurogenic Bladder Symptom Score and bladder-related satisfaction. Multivariable regression was used in sex-stratified models to establish associations between participant characteristics and outcomes.ResultsA total of 1,479 participants enrolled in the study. Of the patients 843 (57%) were paraplegic and 585 (40%) were women. Median age and time from injury were 44.9 (IQR …

Re: Outcomes of a noninferiority randomised controlled trial of surgery for men with urodynamic stress incontinence after prostate surgery (MASTER). - Abstract - Europe PMC Sign in | Create an account https://orcid.org Europe PMC Menu About Tools Developers Help Contact us Helpdesk Feedback Twitter Blog Tech blog Developer Forum Europe PMC plus Search life-sciences literature (43,385,428 articles, preprints and more) Search Advanced search Feedback This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Abstract Full text Re: Outcomes of a noninferiority randomised controlled trial of surgery for men with urodynamic stress incontinence after prostate surgery (MASTER). Lei G 1 Author information Affiliations 1. Urology Department, Jianyang People Hospital, Jianyang, …

BackgroundThis study updates the American Association for Surgery of Trauma (AAST) Organ Injury Scale (OIS) for renal trauma using evidence-based criteria for bleeding control intervention.Methods