Bearrick, Elizabeth

ABSTRACT Reconstructive urology encompasses a broad spectrum of lower and upper urinary tract diseases. A recent society of genitourinary reconstructive mission statement emphasized the desire to promote and support research in the growing fields of tissue engineering, device design, patient-reported outcomes, and validated measurement tools for urethral stricture disease. The purpose of this article was to identify and highlight the high-impact recent literature published within reconstructive urology during the past year. Original research, systematic reviews, and videos from the Gold Journal, BJUI, World Journal of Urology International, SIU Journal, Neurourology Urodynamics, Journal of Urology, and European Urology were included.

Clinical History: The case is a 17-year-old boy with a history of bilateral grade 4 vesicoureteral reflux and end-stage renal disease who underwent a living-unrelated donor renal transplantation in November 2021. He presented in June 2022 with vague abdominal pain and creatinine 4.3 mg/dL. Physical Examination: Transplant biopsy showed no evidence of acute rejection. Antegrade nephrostogram at the time of nephrostomy tube placement demonstrated hydronephrosis and a focal stricture of the proximal transplant ureter. His anatomy was further complicated because of prior ligation of his native distal right ureter at the time of transplant and intraperitoneal location of his transplant kidney through a peritoneal window. Diagnosis: Focal proximal stricture of transplant ureter. Intervention: Given the complex anatomy, a 3D-printed anatomical model was created to facilitate surgical planning. The 3D model highlighted a complex trajectory of the proximal ureter and strictured segment directly posterior to the transplant hilar vessels. In addition, the transplant kidney was directly overlying the dome of the bladder because of its intraperitoneal location. Given these anatomic considerations, the patient underwent an uncomplicated robot-assisted ureteropelvicostomy between his native left ureter and transplant renal pelvis. Follow-Up/Outcomes: Total robotic operative time was 2 hours 17 minutes. He was dismissed on postoperative day 1 with a creatinine nadir equivalent to his post-transplant baseline at 10-week follow-up. 3D-printed models have utility in select cases with complex anatomy. These models facilitate accurate regional and spatial anatomy of critical structures to enable effective operative planning. No competing financial interests exist. Patient consent statement: Patient consented to the use of nonidentifiable intraoperative photography and video recording for the purpose of medical education and publication in professional journals. Source of 3D model: Mayo clinic 3D Anatomic Modeling Laboratory. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No funding was received for this article. Music: All music was from Pixabay.com, royalty free. Runtime of video: 04 mins 58 secs

ABSTRACT Introduction The COVID-19 pandemic has had a significant impact on global health. During uncertain times, priorities amongst patients shifted as many faced health concerns, economic uncertainty, and isolation. Access to general medical care during 2020 was challenging for many Americans who spent the year in quarantine. Without access to care, we hypothesize that patients were less likely to search for treatment options for a non-emergent condition like erectile dysfunction. Objective Herein, we aim to report on Google search trends observed in the pre COVID and post COVID era. Methods Google Trends was analyzed using search terms related to erectile dysfunction between June 2018 and June 2021. The search volume index (SVI), a relative measure of search volume on Google, was obtained for the following terms: erectile dysfunction, viagra, trimix, penile pump, and penile implant. Student t test was used to compare changes in mean SVI for each month compared to the same month one year prior. Results Compared to one year prior, the search for erectile dysfunction remained relatively stable over time with the exception of three months (9% decline Mar 2020, 38% increase Jan 2021, 8% increase Jun 2021). When compared to the preceding year, searches for Viagra declined during 9/37 (24%) months analyzed including Mar-Jun 2020, which coincided with the early part of the COVID-19 pandemic (p<0.05 for all). The only statistically significant increase occurred Oct 2020, a 16% change compared to Oct 2019 (p<0.05). In contrast, search for trimix did not change significantly over time except for an increase of 62% Mar 2021 and 60% Apr 2021 (p<0.05 for all). Search for the term penile pump did not change over time except for a 16 and 10% decline early during the pandemic, Feb and Mar 2020, respectively (p<0.05 for all). Lastly, search for penile implant declined 37% Mar 2020 and 32% Apr 2020 compared to 2019, and increased by 67% May 2021 compared to May 2020 (p<0.05 for all). Conclusions COVID-19 represented a major global health crisis, raising concerns and uncertainties for many. Erectile dysfunction remained a constant source of online interest. Despite limited access to medical care for elective conditions, only a few isolated increases in Google SVI were noted, most of which occurred during 2021 compared to 2020. This may be a reflection of the general public's lack of familiarity with treatments other than phosphodiesterase-5 inhibitors. Disclosure No

BACKGROUND: Bim (BCL-2-interacting mediator of cell death) is a downstream pro-apoptotic signaling molecule activated by the PD-1 pathway. OBJECTIVE: We sought to determine if Bim expression in peritumoral T-lymphocytes (PTLs) is associated with survival in patients with metastatic clear cell renal cell carcinoma (ccRCC). METHODS: Immunohistochemistry staining for Bim was performed on paraffin-embedded tumor tissue blocks from patients with metastatic ccRCC who underwent nephrectomy between 1990-2004. Associations of Bim expression with cancer-specific survival (CSS) and overall survival (OS) from date of metastasis were evaluated using multivariable Cox regression models, adjusting for age, sex, and metastases-score. RESULTS: 525 patients with metastatic ccRCC, of whom 169 (32%) had metastases at time of nephrectomy were studied. After multivariable adjustment, high Bim expression remained associated with worse CSS (HR = 1.31; 95% CI 1.07–1.59; p = 0.008) and OS (HR = 1.28; 95% CI 1.06–1.55; p = 0.01). The interaction between Bim and PD-L1 was not statistically significant for CSS ( p = 0.68) or OS ( p = 0.57), suggesting that the associations between Bim and survival outcomes were not significantly different based on tumor PD-L1 expression. CONCLUSION: High Bim expression in PTLs at nephrectomy is prognostic of worse CSS and OS in patients with metastatic ccRCC, irrespective of tumor PD-L1 expression. The role of earlier PD-1/PD-L1-directed therapy warrants evaluation in these patients.