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Chow PM, Trump T, Goldman HB. Outcomes of sequential third-line therapies in patients with refractory overactive bladder. Int J Urol 2024. [PMID: 38693892 DOI: 10.1111/iju.15463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) and onabotulinumtoxinA (BoNTA) injection are third-line therapies for overactive bladder (OAB). Although the efficacy of each third-line treatment has been well established in clinical trials, there is far less information about performing one third-line therapy after the other. Our aim is thus to investigate the outcomes of post-SNM BoNTA and post-BoNTA SNM as "second" third-line treatments. METHODS We retrospectively reviewed all OAB patients who had both SNM and BoNTA between 2013 and 2022. The primary endpoint was the response rates (>50% improvements) of the second third-line treatments. Secondary endpoints were the proportion of the patients who achieved total dry, the duration of treatments of patients who had significant responses, and risk factors that are associated with treatment response or duration of treatments. RESULTS A total of 172 patients had two third-line therapies. There were 104 patients who had post-SNM BoNTA and 68 patients who had post-BoNTA SNM. In the post-SNM BoNTA group, 62.5% (65/104) had significant responses after BoNTA treatment. In the post-BoNTA SNM group, 61.8% (44/68) had significant responses after SNM treatment. The proportions of patients who became dry were 21.2% and 23.5%, respectively. In the post-SNM BoNTA group, spinal pathology is associated with a lower probability of a significant response (48.9% vs. 73.7%, p-value = 0.0105). CONCLUSIONS BoNTA or SNM remains a viable option for refractory OAB after patients fail from one another. Spinal pathology is associated with a poorer response of post-SNM BoNTA.
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Affiliation(s)
- Po-Ming Chow
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital Hsin-Chu Branch, Zhubei City, Taiwan
| | - Tyler Trump
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Howard B Goldman
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Trump T, Mitchell K, Werner Z, Duenas-Garcia O, Shapiro R, Zaslau S. Assessing the effectiveness of antimicrobial pouch use for infection prevention in sacral neuromodulation. Int Urogynecol J 2023; 34:2513-2517. [PMID: 37222739 DOI: 10.1007/s00192-023-05570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacral neuromodulation (SNM) is a commonly performed procedure for various conditions. Infection rates range as high as 10% and often require operative explantation with resultant increased cost and morbidity. Pouches impregnated with antibiotic have been utilized in cardiovascular procedures with decreasing infectious complications. TYRX is an antibiotic pouch utilizing minocycline and rifampin manufactured by Medtronic. The objective of this study is to investigate the utility of antimicrobial pouches for patients undergoing SNM. METHODS We retrospectively analyzed our patients undergoing SNM using an antimicrobial pouch and compared them with a historic cohort. Additional variables of interest included post-operative infection, diagnosis of diabetes, weight, and revision case or virgin implant. RESULTS A total of 170 cases were identified, ranging from March 2017 to November 2022. Overall infection rate was 2.9% with 0 in the antimicrobial pouch cohort (0%) versus 5 in the historic cohort (5.5%; p = 0.04). Groups were similar in terms of body habitus. The group receiving an antimicrobial pouch was noted to be older with a higher percentage of female patients. 85 patients received an antimicrobial pouch and 85 did not. Of the infections, 4 occurred in revision cases (6.9%) and 1 in a virgin implant (0.9%; p = 0.03). No difference was noted in infection rate with regard to a diagnosis of diabetes or body habitus. CONCLUSION The use of antimicrobial pouches in SNM is associated with a decreased rate of infectious complications. Revision cases displayed a higher rate of infectious complications.
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Affiliation(s)
- Tyler Trump
- Department of Urology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Katharina Mitchell
- Department of Urology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Zachary Werner
- Department of Urology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Omar Duenas-Garcia
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, WV, USA
| | - Robert Shapiro
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, WV, USA
| | - Stanley Zaslau
- Department of Urology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA
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Zagade T, Trump T, Elbakry AA, Zekan D, Williams HJ, Morley C. Selective angioembolization as a management strategy for angiomyolipoma causing urinary tract obstruction. Urol Case Rep 2022; 45:102240. [PMID: 36199836 PMCID: PMC9529498 DOI: 10.1016/j.eucr.2022.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022] Open
Abstract
Angiomyolipoma (AML) is a benign renal tumor usually found incidentally. Rarely, AML can present with renal colic due to urinary tract obstruction. Prior cases of obstructing AML have been presented and managed successfully with surgical removal. Selective angioembolization has emerged as an alternative management strategy for AML, but no documented cases have been presented for this strategy in the setting of obstruction. Here, we present a case of obstructing AML treated with selective angioembolization with subsequent resolution of obstruction.
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Affiliation(s)
- Tarek Zagade
- Eastern Virginia Medical School, Norfolk, VA, United States
| | - Tyler Trump
- West Virginia University Department of Urology, Morgantown, WV, United States
- Corresponding author. West Virginia University Department of Urology, Morgantown, WV, 26506, United States.
| | - Amr A Elbakry
- West Virginia University Department of Urology, Morgantown, WV, United States
| | - David Zekan
- West Virginia University Department of Urology, Morgantown, WV, United States
| | - H James Williams
- West Virginia University Department of Pathology, Morgantown, WV, United States
| | - Chad Morley
- West Virginia University Department of Urology, Morgantown, WV, United States
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Haffar A, Elbakry AA, Trump T, Werner Z, McCluskey K, Salkini MW. Trans-hepatic trans-portal selective angioembolization; a management option for severe acute variceal bleeding of ileal conduit stoma. Urol Case Rep 2022; 45:102222. [PMID: 36147194 PMCID: PMC9485032 DOI: 10.1016/j.eucr.2022.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
We present a case of severe acute variceal bleeding in an ileal conduit stoma successfully managed with trans-hepatic trans-portal selective angioembolization as a lifesaving measure. Despite repeated transfusions, the patient's hemoglobin continued to be unstable. The patient underwent transhepatic embolization of ileal stoma varicose veins. Angioembolization was followed up with excision of ileal conduit stoma and creation of cutaneous ureterostomy for definitive treatment management of hemorrhage. In conclusion, trans-hepatic trans-portal embolization is an effective option for management of severe acute variceal bleeding in an ileal conduit stoma as a lifesaving measure and can be followed by excision of the conduit.
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Affiliation(s)
- Ahmad Haffar
- Johns Hopkins University, Department of Urology, Division of Pediatric Urology, Baltimore, MD, USA
- Corresponding author. Suite 6300, Health Sciences Center, Morgantown, WV, 26505, USA.
| | - Amr A. Elbakry
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Tyler Trump
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Zachary Werner
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Kevin McCluskey
- Division of Interventional Radiology, Department of Radiology, West Virginia University Hospital, Morgantown, WV, USA
| | - Mohamed W. Salkini
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
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Trump T, Knopff K, Morehouse A, Boyce MS. Sustainable elk harvests in Alberta with increasing predator populations. PLoS One 2022; 17:e0269407. [PMID: 36288266 PMCID: PMC9604012 DOI: 10.1371/journal.pone.0269407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/13/2022] [Indexed: 01/24/2023] Open
Abstract
Large predators often are believed to cause declines in hunter harvests of ungulates due to direct competition for prey with hunters. In Alberta, predators of elk (Cervus elaphus), including grizzly bear (Ursus arctos), cougar (Puma concolor), and wolf (Canis lupus), have increased in recent years. We used trend analysis replicated by Wildlife Management Unit (WMU) to examine regional trends in elk harvest and hunter success. Over a 26-yr period, average harvest of elk increased by 5.46% per year for unrestricted bull and by 6.64% per year for limited-quota seasons. Also, over the same time frame, average hunter success increased by 0.2% per year for unrestricted bull and by 0.3% per year for limited-quota seasons, but no trend was detected in hunter effort (P>0.05). Our results show that increasing large-predator populations do not necessarily reduce hunter harvest of elk, and we only found evidence for this in Alberta's mountain WMUs where predation on elk calves has reduced recruitment. Furthermore, data indicate that Alberta's elk harvest management has been sustainable, i.e., hunting has continued while populations of elk have increased throughout most of the province. Wildlife agencies can justify commitments to long-term population monitoring because data allow adaptive management and can inform stakeholders on the status of populations.
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Affiliation(s)
- Tyler Trump
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kyle Knopff
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
- Golder Associates, Calgary, Alberta, Canada
| | - Andrea Morehouse
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
- Winisk Research and Consulting, Pincher Creek, Alberta, Canada
| | - Mark S. Boyce
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Elbakry AA, Trump T, Ferari C, Mattes MD, Luchey A. Survival outcomes in node-positive non-metastatic bladder cancer: An analysis of the national cancer database. Arab J Urol 2022; 20:175-181. [PMID: 36353472 PMCID: PMC9639493 DOI: 10.1080/2090598x.2022.2077001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Clinically node-positive non-metastatic bladder cancer (cN+) has been the target of several studies aiming to establish a standard of care for this population. Limited studies have shown a survival benefit for various multimodal therapy approaches. The role of radiation therapy has not been well established. Our study aims to study the trends of the reported treatment options offered to patients with cN+ bladder cancer in a national database and to evaluate the effect of various treatments, including radiation, on survival. Methods The National Cancer Database (NCDB) was used to identify cN+ bladder cancer patients who received chemotherapy alone or in combination with radical cystectomy (RC) or radiotherapy. 3,481 patients were included and divided into 4 groups: chemotherapy only, chemotherapy and RC, chemotherapy and radiation therapy, and chemotherapy, RC, and radiation therapy. Demographic data was compared using ANOVA for continuous variables, and Chi-square for categorical variables. Multivariable analysis was done to compare groups using a multinomial logistic regression model. Kaplan-Meier test was used for survival analysis and Cox-Regression was used for multivariable survival analysis. Results Patients undergoing RC were significantly younger (P <0.001). There was a significant difference between the groups regarding racial distribution, facility-type and insurance status. There was no difference in gender, Charlson\Deyo score, financial or educational status. Patients who underwent combination therapy with chemotherapy and RC were found to have the longest median survival time at 27 months. Multivariable analysis showed that final treatment, age, sex, Charlson\Deyo comorbidity score, TNM edition and facility-type were significant survival predictors. Race, insurance and financial status failed to maintain significance. There was no survival difference between the chemotherapy group and chemo-radiotherapy group. Conclusions The combination of surgery and chemotherapy achieves statistically significant superior survival in cN+ bladder cancer. Adding radiotherapy to chemotherapy did not improve survival in this group of patients. Abbreviations (cN+): Clinically node-positive non-metastatic, (MIBC): Muscle invasive bladder cancer, (NCDB): National Cancer Database, (NAC): Neoadjuvant chemotherapy, (RC): Radical Cystectomy
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Affiliation(s)
- Amr A Elbakry
- Department of Urology, West Virginia University, Morgantown, WV, USA
| | - Tyler Trump
- Department of Urology, West Virginia University, Morgantown, WV, USA
| | | | - Malcom D Mattes
- Department of Radiation Oncology, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA
| | - Adam Luchey
- Department of Urology, West Virginia University, Morgantown, WV, USA
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Trump T, Elbakry AA, Al-Omar O. Commentary on: Referral patterns for undescended testis: A 7 Year comparative analysis of primary care providers. J Pediatr Urol 2021; 17:884. [PMID: 34702650 DOI: 10.1016/j.jpurol.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Tyler Trump
- West Virginia University, Department of Urology, USA.
| | - Amr A Elbakry
- West Virginia University, Department of Urology, USA
| | - Osama Al-Omar
- West Virginia University, Department of Urology, USA
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Shapiro R, Sunyecz A, Zaslau S, Vallejo MC, Trump T, Dueñas-Garcia O. A Comparative Study of Braided versus Barbed Suture for Cystotomy Repair. Res Rep Urol 2021; 13:793-798. [PMID: 34805012 PMCID: PMC8594900 DOI: 10.2147/rru.s330586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/07/2021] [Indexed: 02/04/2023] Open
Abstract
Background In this study, we aim to compare outcomes after cystotomy repair between standard sutures (910 polyglactin, poliglecaprone) versus barbed (V-LocTM 90) suture. As a secondary outcome, we analyzed factors for suture preference between the two groups. Methods A retrospective chart review was undertaken for surgeries complicated by cystotomy, identified by ICD-9/10 codes from 2016 to 2019 at West Virginia University (WVU) Hospital. Comparisons were made between cystotomy repair using barbed suture versus standard braided suture. Injuries were categorized by procedure, surgical route, type of suture used in repair, and subsequent complications related to repair. Primary endpoints were examined by Pearson's Chi-square test and interval data by t-test. A p < 0.05 was significant. Results Sixty-eight patients were identified with iatrogenic cystotomy at WVU. Barbed suture was used for cystotomy repair in 11/68 (16.2%) patients. No significant difference was seen in postoperative outcomes between patients repaired with barbed suture versus standard braided suture. Barbed suture was significantly more likely to be used for cystotomy repair in minimally invasive surgery (p = 0.001). It was most often utilized in a robotic approach 7/11 (63.6%) followed by laparoscopic 3/11 (27.3%). Body mass index (BMI) was significantly higher in patients receiving a barbed suture repair (p = 0.005). Conclusion Barbed suture may be comparable to standard braided suture for cystotomy repair. Barbed suture may offer a practical alternative to facilitate cystotomy repair in minimally invasive surgery, especially in patients with a high BMI.
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Affiliation(s)
- Robert Shapiro
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.,Department of Urology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Alec Sunyecz
- West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Stanley Zaslau
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.,Department of Urology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Manuel C Vallejo
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.,Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Tyler Trump
- Department of Urology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Omar Dueñas-Garcia
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
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Mitchell K, Crigger C, Overholt T, Trump T, Barnard J, AL-Omar O, Morley H. Dysfunctional Voiding: Does a validated urine color scale correlate with dysfunctional voiding severity score? Marshall Journal of Medicine 2021. [DOI: 10.33470/2379-9536.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Elbakry AA, Aldabek K, Crigger C, Trump T, Salkini MW. Robot-assisted laparoscopic repair of a huge sliding inguinal hernia of the urinary bladder, left ureter and sigmoid colon. Urology Video Journal 2021. [DOI: 10.1016/j.urolvj.2021.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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McClelland D, O'Connor LP, Barnard J, Hajiran A, Crigger C, Trump T, Bacharach E, Elbakry A, Werner Z, Morley C, Grabo D, Luchey A. The utilization of perfused cadaver simulation in urologic training: a pilot study. BMC Urol 2021; 21:134. [PMID: 34579687 PMCID: PMC8474764 DOI: 10.1186/s12894-021-00895-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background We sought to determine if participating in a surgical training session using perfused fresh human cadavers (PFHC) had a positive effect on urology residents’ confidence in performing open and endoscopic procedures. Methods Urology residents at our institution participated in a surgical training session in the West Virginia University Fresh Tissue Training Program, which utilized fresh cadavers with vascular perfusion. The session consisted of performing different urologic procedures (open and endoscopic) on the perfused fresh human cadavers (PFHC). Residents were given a survey to rate their confidence in different urologic procedures before, after, and 6 months after the session. Each procedure on the survey had 3–6 questions associated with it, with scores ranging from 0 (no confidence) to 4 (great confidence). Scores for each procedure before and after the session were compared.
Results Six residents participated in the session. There was an increase in the score for every procedure performed after the session. Scores at 6 month follow up remained higher than the pre-session scores. Conclusion PFHCs offer an excellent opportunity to teach a wide variety of urologic procedures to residents. Incorporation of PFHCs may be very useful in urologic training, and further studies on its use are warranted.
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Affiliation(s)
- Daniel McClelland
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Luke P O'Connor
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA.
| | - John Barnard
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Ali Hajiran
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Chad Crigger
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Tyler Trump
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Emma Bacharach
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Amr Elbakry
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Zach Werner
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Chad Morley
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
| | - Daniel Grabo
- Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Adam Luchey
- Department of Urology, West Virginia University, 1 Medical Center Drive, PO Box 9251, Morgantown, WV, 26506-9251, USA
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Trump T, Elbakry AA, Haffar A, McClelland D, Morley C, Al-Omar O. The Impact of Targeted Education of American Urological Association Cryptorchidism Guidelines in a Rural State: Improvement Still Needed. Res Rep Urol 2021; 13:437-443. [PMID: 34235100 PMCID: PMC8254607 DOI: 10.2147/rru.s316563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background The American Urological Association published guidelines in 2014 regarding management of undescended testicles (UDT). Despite these guidelines, prior studies have indicated discordance between guidelines and actual practice, especially in rural states. This study aims to identify if educating referring providers improves management of UDT. Methods Patients with UDT referred to our institution were divided into two groups: those referred prior to (Group 1) and after (Group 2) targeted education. A retrospective review was performed to compare the groups in terms of age at time of referral and surgery, laterality, specialty, and practice setting of referring provider, and whether or not ultrasound (US) was performed prior to referral. Results A total of 100 patients were identified in Group 1 and 168 in Group 2. No significant differences were noted between groups regarding age, variability of referring provider, or those receiving US prior to referral. Median age at referral was 20.7 months (range=0-194) and 33 months (range=0-205.1) in Groups 1 and 2, respectively (p=0.26). Sixty-two (37%) patients underwent surgical evaluation within 18 months of age or younger in Group 1 compared to 39 (39%) in Group 2 (p=0.73). Private practice pediatricians comprised the majority of referring providers in both cohorts. US was performed prior to referral in 41% of patients in Group 1 compared to 35.8% in Group 2 (p=0.51). The number of US ordered prior to referral significantly decreased from 10 (50%) to six (19%) following education among academic providers (p=0.02). No significant difference was found following education for private practice physicians (p=0.27). Conclusion Targeted education did not improve age at referral in the short-term, which may reflect suboptimal healthcare access. Additionally, more research is needed to evaluate whether more diverse targeted education provided on a regular basis to both physician and mid-level providers would have a meaningful impact.
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Affiliation(s)
- Tyler Trump
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Amr A Elbakry
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Ahmad Haffar
- West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Chad Morley
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Osama Al-Omar
- West Virginia University Department of Urology, Morgantown, WV, USA
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Shapiro R, Dueñas-Garcia OF, Vallejo M, Trump T, Sufficool M, Zaslau S. Recurrent Incontinence After Transvaginal Partial Sling Excision in Patients with Prior Mid-Urethral Sling. Res Rep Urol 2021; 13:9-15. [PMID: 33469519 PMCID: PMC7811473 DOI: 10.2147/rru.s281697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients may develop recurrent urinary tract infections, pain syndromes, dyspareunia, and voiding difficulty after mid-urethral sling placement that can be treated by partial sling excision. Objective The primary objective of this study was to evaluate the incidence of de novo incontinence and voiding difficulty after partial sling excision. A secondary objective was to assess risk factors associated with future incontinence surgery in this subset of patients. Methods From 2009 to 2017, 95 female patients with subjective complaints of pelvic pain, dyspareunia, or voiding difficulty following synthetic mid-urethral sling placement for stress urinary incontinence underwent partial sling excision at a single institution. The incidence of urinary incontinence was assessed 6 months after partial sling excision. Patients were also assessed for resolution of voiding difficulty and future incontinence surgery. Primary endpoints were examined by Pearson's Chi-square test and interval data by t-test. A p < 0.05 was significant. Results About 72% of patients were more likely to be continent after partial sling excision irrespective of initial symptoms prior to surgery. No difference was seen in voiding difficulty between the continent and incontinent patients after partial sling excision (p=0.09). Patients with a retropubic mid-urethral sling were more likely to be continent after partial sling excision (p=0.03). Preoperative maximum flow rate >16 mL/sec was associated as an independent variable to develop incontinence surgery after partial sling excision (p=0.009). Conclusion In conclusion, partial sling excision poses a low risk for de novo urinary incontinence regardless of preoperative symptoms. Stress urinary incontinence may be less likely to reoccur in those patients having a retropubic approach. A preoperative maximum flow rate of >16 mL/sec is a risk factor for future incontinence surgery after partial sling excision and should be taken into consideration when formulating a treatment plan.
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Affiliation(s)
- Robert Shapiro
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.,Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Omar Felipe Dueñas-Garcia
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Manuel Vallejo
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Tyler Trump
- Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Makenzy Sufficool
- West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Stanley Zaslau
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.,Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
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14
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Trump T, Luchey AM, Hogg J, Mattes MD. Intramedullary Reactive Fibrosis as Mimic of Prostate Cancer Bone Metastasis on 11C-Choline Positron Emission and Computed Tomography. Pract Radiat Oncol 2019; 9:e1-e3. [PMID: 30611465 DOI: 10.1016/j.prro.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/19/2018] [Accepted: 05/23/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Tyler Trump
- Department of Urology, West Virginia University, Morgantown, West Virginia
| | - Adam M Luchey
- Department of Urology, West Virginia University, Morgantown, West Virginia
| | - Jeffery Hogg
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Malcolm D Mattes
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia.
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15
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Robinson J, Trump T, Cagna R, Carter WH. Observations of Beta Blocker Doses for Systolic Heart Failure Without Chronic Obstructive Pulmonary Disease. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Trump T. Detection of the consistency of two speech signals using pitch periods. Proc Estonian Acad Sci 2013. [DOI: 10.3176/proc.2013.2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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17
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