Purpose

We aim to describe the relationship between sexual orientation identity and medical morbidities in a large sample of male-to-female (MTF) transgender patients.

Methods

We reviewed medical records of patients presenting for MTF sex reassignment surgery (SRS) by a single, high-volume surgeon from 2011 to 2015. Sexual attraction to men (heterosexual), women (lesbian), or both (bisexual) was asked of each patient. We examined 16 medical morbidities for this analysis.

Results

During the study period, 330 MTF transgender patients presented for SRS. The average age at the time of surgery was 38.9 (range 18-76). One hundred and one patients (32%) reported being heterosexual, 110 patients (34%) reported being lesbian, and 108 patients (34%) reported being bisexual. Lesbian patients presented for SRS at older ages (mean = 43 years old) compared with heterosexual patients (mean = 36 years old) and bisexual patients (mean = 37), P < 0.01. No differences were found in the majority of coexisting medical morbidities by sexual orientation identity. Lesbian patients had greater odds of having a history of depression, age-adjusted odds ratio (aOR) = 2.36, 95% confidence interval (CI) 1.26-4.40, compared with heterosexual patients. Lesbian patients had higher odds of being married or partnered, aOR = 2.31, 95% CI (1.27-4.19), compared with heterosexual patients. Heterosexual patients had higher odds of having human immunodeficiency virus (HIV), aOR = 9.07, 95% CI (1.08-76.5) compared with lesbian patients.

Conclusions

Sexual orientation identity in MTF transgender patients is variable. The majority of medical morbidities are not associated with sexual orientation identity. Although HIV and depression are common morbidities among MTF patients seeking SRS, the prevalence of these morbidities differs by sexual orientation identity, but these findings need replication. Counseling and future research initiatives in transgender care should incorporate sexual orientation identity and associated risk behavior.

Purpose

Male stress urinary incontinence (SUI) can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male SUI. Our objective is to evaluate 30-day complications in patients undergoing male slings and AUS placement from a national multicenter database.

Methods

Data from the American College of Surgeons National Surgical Quality of Improvement Program for 2008-2013 were used to identify patients who underwent male slings and AUS implantation. Trained coders abstracted complication data from the patient record independent of the surgical team. We compared 30-day postoperative complications for male slings and AUS. We examined the relationship between patient factors and complication rates for each procedure type.

Results

Overall, 1205 incontinence surgeries in men were identified: 597 male sling placements and 608 AUS implantations. Male sling placement had a lower 30-day postoperative complication rate compared to AUS (2.8 vs. 5.1 %, p = 0.046). Compared to AUS, male sling was associated with fewer urinary tract infections (0.3 vs. 2.0 %, p = 0.020) and return trips to the operating room (1.0 vs. 3.0 %, p < 0.001). Patients with higher BMI were more likely to have a complication, while age, race and Charlson comorbidity index were not associated with higher or lower complication rates.

Conclusions

Complications rates for both male sling and AUS are low. Male sling is associated with a lower rate of complications than AUS. These findings allow for better patient perioperative counseling regarding 30-day perioperative complications.

Purpose of Review: Urinary diversion (UD) remains the last option for improving quality of life in patients with treatment-refractory urinary incontinence (UI) or voiding dysfunction after cancer treatment. We aim to critically review the utility of UD for UI and voiding dysfunction in patients previously treated for malignancy. Recent Findings: UD patients are at high risk given their oncologic treatment and multiple procedures prior to UD. The severe impact of UI and voiding dysfunction on quality of life is significant. Despite the risk of complications after UD, men reported significant improvement of their urinary symptoms and were confident that they would have sought UD sooner. Summary: UD remains a last option for some men dealing with severe urinary symptoms after treatment of pelvic malignancy in both men and women. Further investigation is needed to better characterize the burden of disease and potential gains surrounding management of these men.

Background

We performed a systematic review and meta-analysis to determine the prevalence and predictors of urethral stricture development post radiation therapy (RT) for prostate cancer (PCa).

Methods

Published articles in PubMed/Medline, Cochrane, and Embase databases from January 2000 to April 2016 were queried. Inclusion criteria were any study that reported the prevalence of urethral strictures following external beam radiation therapy (EBRT), brachytherapy (BT), or both as a primary treatment for PCa. Forty-six articles met our inclusion criteria. A summary estimate of the proportion of patients who developed a urethral stricture was derived via a random effects meta-analysis.

Results

In total, 16,129 PCa patients underwent either EBRT (5681, 35.2%), BT (5849, 36.3%), or both (4599, 28.5%). Overall, 630 strictures were diagnosed at follow-up with a pooled estimate period prevalence of 2.2% (95% confidence interval, CI 1.9-2.6%) in a median follow-up time of 4 years (interquartile range, IQR 2.7-5). Of which, the pooled estimate prevalence was 1.5% (95% CI 0.9-2%) post EBRT, 1.9% (95% CI 1.3-2.4%) post BT, and 4.9% (95% CI 3.8-6%) post both EBRT and BT. Of 20 studies reporting a median time to stricture formation, the overall median time was 2.2 years (IQR 1.8-2.5, range 1.4-9). In a meta-regression analysis, receiving both EBRT and BT increased the estimated difference in proportion of stricture diagnoses by 3% (95% CI 1-6%), p = 0.018 compared to EBRT alone. An increase in median follow-up time was found to significantly increase the risk of developing urethral strictures (p = 0.04).

Conclusions

With a short-term follow-up, urethral strictures occur in 2.2% of men with PCa receiving radiotherapy. Receiving both EBRT and BT increased the risk of stricture formation. Longer follow-up is needed to determine the long-term natural history of stricture formation after RT.

Introduction

Workforce disparities in medicine have been well documented. Early medical school exposures have been shown to highly influence career choice. We hypothesized that gender and racial disparities exist in early medical school exposures to urology.

Methods

We surveyed urology residency applicants who interviewed at our institution from 2016 to 2017. Student demographics were collected in addition to forms of urology exposures (clinical and research). Early urology exposure was defined as occurring before the 3rd year of medical school. Early exposures were compared by gender and racial/ethnic groups underrepresented in medicine.

Results

During the study period 72 interviewees were invited to participate and 71 completed the survey (response rate 98.6%). The majority of participants were male (54, 76%). Thirteen participants (18%) met the criteria for underrepresented in medicine. Fewer female applicants discovered urology (41% vs 75%, p=0.01), first shadowed a urologist (35% vs 68%, p=0.02), first operated with a urologist (29% vs 60%, p=0.03) and began research (0% vs 49%, p <0.001) before the 3rd year of medical school compared to male applicants. Fewer applicants underrepresented in medicine had shadowed a urologist before the 3rd year of medical school (31% vs 67%, p=0.02). We found no other statistical differences between those underrepresented in medicine and those not underrepresented in medicine in terms of other early urology exposures, medical school urology opportunities or personal exposures.

Conclusions

Disparities in early urology exposures, especially research exposure, exist by gender and less so among applicants underrepresented in medicine. Identifying these disparities may uncover systemic bias within career trajectories and provide targets for earlier interventions in medical school training.

Methamphetamine is a central nervous system stimulant and is the second most commonly used illicit drug after cannabis. Methamphetamine use for sexual pleasure is well documented. In this case report, we describe two cases presenting to our urban county hospital associated with complications related to penile injection of methamphetamine. Both patients developed penile abscesses and required urgent surgical incision and drainage. Penile abscesses represent a rare complication associated with IV drug administration into the penile corpora. Resultant penile abscesses require broad-spectrum antibiotics and surgical drainage. Further understanding of methamphetamine abuse along with the role it plays in sexual enhancement would be an invaluable addition to understanding of the rationale behind this self-administered stimulant. Drainage of penile abscesses associated with IV drug users may be hazardous to healthcare providers who are at risk from a needle stick injury.

Background

Urethral catheters (UCs) are commonly used in medicine and are associated with complications such as urinary tract infections (UTIs) and trauma. Given UC complications and their ubiquitous usage in healthcare, there is a potential for liability risk. We aim to explore litigation involving UC-related complications.

Methods

The LexisNexis legal database was queried for all state and federal cases from January 1965 through October 2015 using the terms "urethral catheter" or "Foley catheter" in combination with "medical malpractice", "negligence", "medical error", and "trauma". Each case was reviewed for reported medical characteristics and legal aspects, including the outcome of the case.

Results

Our search yielded 29 cases. Urologists were the most common providers cited as defendants (21%), all of whom were successful in their defense. The most common malpractice claim was for traumatic insertion (48%). Pain was the most common type of damage claimed by plaintiffs (28%), followed by UTI (24%). Nineteen (66%) cases favored defendants, while 10 (34%) cases favored the plaintiffs, of which 2 (7%) were settled out of the court. In settled cases, the mean settlement received by plaintiffs was $55,750 (range, $25,000-$86,500). The mean award to plaintiffs for cases determined by the court was $112,991 (range, $4,000-$325,000).

Conclusions

Despite widespread usage of UC over a 50-year period, lawsuits centered on UC misuse are rare at the state and federal court levels. Of litigated cases, urologists are commonly involved yet have successful defenses.