Citations

Abstract Purpose The temporarily implanted nitinol device (TIND) is a minimally invasive surgical technique (MIST) for benign prostatic hyperplasia (BPH) that promises fewer unwanted side effects compared with traditional bladder outlet procedures for small glands with high-riding bladder necks, including transurethral incision of the prostate (TUIP). This study sought to compare the effect of TIND vs. TUIP on ejaculatory function in sexually active males using the Male Sexual Health Questionnaire Ejaculatory Function Short Form (MSHQ-EjD-SF). Methods A retrospective review of a prospectively maintained database of all patients who underwent TIND at our institution between 1/1/2022 and 10/1/2024. Patients were excluded if they reported no postoperative ejaculations. Patients who underwent TUIP during the same period were compared. Age, prostate volume, PSA, and urinary parameters were collected. MSHQ-EjD-SF scores were collected for all patients. Continuous variables were compared using Wilcoxon Rank sum test and categorical variables using Fisher’s exact test. Results A total of 27 patients underwent TIND, of which 17 reported postoperative ejaculations and were compared with 17 patients who underwent TUIP during the same period with similar baseline age, prostate volume, and urinary parameters. Median MSHQ-EjD-SF score was higher after TIND compared with TUIP (15.0 (14.0, 15.0) vs. 13.0 (11.0, 13.0), p < 0.01), while bother score was lower (0.0 (0.0, 0.0) vs. 1.0 (0.0, 2.0), p = 0.02). Conclusions Patients experienced negligible effect on ejaculatory function after TIND compared with TUIP. This may be an effective bladder outlet procedure for patients who prioritize their postoperative ejaculatory function.

Abstract Purpose This study synthesizes and characterizes pregnancy outcomes and complications among US female physician trainees. Method In this systematic review, the PubMed, Embase, Scopus, Web of Science, and Cochrane databases were searched in May 2024 and May 2025 for peer-reviewed, English-language articles published from January 2000 to May 2025 reporting pregnancy outcomes in US female residents or fellows. Medical Subject Headings and keywords for pregnancy complications, pregnancy outcomes, and women or female physicians were used. Cross-sectional, retrospective, prospective, and case-control studies were included. Opinion articles, editorials, systematic or scoping reviews, and other non–peer-reviewed articles were excluded. Abstracts and full-text articles were screened by 3 investigators. Extracted data were documented in standardized forms. Risk of bias was assessed regarding study population and outcome reporting and summarized using standardized quality assessment tools. Results Of 792 titles and abstracts screened, 10 articles involving 4,891 trainees were included. Eight of these 10 studies described pregnancy outcomes specifically in surgical trainees; all were cross-sectional surveys. The numbers of trainees experiencing pregnancy complications ranged from 38.9% to 56.0%. The most frequently described complication was preterm labor (9 of 10 studies), affecting 5.3% to 22.9% of surveyed trainees. The most cited fetal complication was miscarriage (5 of 10 studies), affecting 20.0% to 28.0% of trainee pregnancies. Other commonly reported complications included preeclampsia or eclampsia, hyperemesis gravidarum, and gestational hypertension. Conclusions Although pregnancy complications appear to be common among female physician trainees, current data on obstetric outcomes in this population remain limited. Most studies focus specifically on surgical trainees and rely on self-reported data, limiting generalizability. Residency programs may consider findings from this review to enhance support for childbearing trainees, although prospective studies are needed to better discern the impact of medical training on maternal and fetal outcomes.

Introduction: Ureteroscopy (URS) is the most commonly performed surgery for the management of renal stones. Post-URS sepsis has been reported to be around 5%, but most studies rely on purchased datasets or electronic medical record (EMR) data that pull data based on billing codes of sepsis without clinical verifications. This study aims to evaluate the true incidence of sepsis using the Sepsis-3 criteria at a single tertiary care institution. Methods: A retrospective review was conducted on all URS procedures at a single tertiary care institution from 2021 to 2022, including both Medicare and private insurance patients ≥18 years old. The EMR was queried for URS procedure codes and readmission within 30 days post-procedure with a sepsis diagnosis code. All other procedures, including URS during percutaneous nephrolithotomy, were excluded. Each identified case was evaluated for sepsis using the Sepsis-3 criteria, including sequential organ failure assessment (SOFA) and quick SOFA (qSOFA). Results: A total of 1316 patients underwent URS. Nineteen patients were identified with a sepsis diagnosis, giving an initial post-URS sepsis rate of 1.44%. After EMR verification, 5 patients were excluded, leaving 14 (1.06%) patients with a diagnosis code of sepsis. Using Sepsis-3 criteria, only 6 (0.44%) met the diagnosis. Conclusions: This retrospective review identified only 0.44% of patients with a true post-URS sepsis within 30 days using Sepsis-3 criteria. The difference in our rate from the initial query and current literature highlights the need for accurate clinical diagnosis and documentation of sepsis.

Background/Objectives: Cesarean section (C-section) is a common surgical procedure associated with an increased risk of 30-day postpartum hospital readmissions. This study utilized machine learning (ML) to predict readmissions using a nationwide database. Methods: A retrospective analysis of the National Surgical Quality Improvement Project (2012–2022) included 54,593 patients who underwent C-sections. Random Forests (RF) and Extreme Gradient Boosting (XGBoost) models were developed and compared to logistic regression (LR) using demographic, preoperative, and perioperative data. Results: Of the cohort, 1306 (2.39%) patients were readmitted. Readmitted patients had higher rates of being of African American race (17.99% vs. 9.83%), diabetes (11.03% vs. 8.19%), and hypertension (11.49% vs. 4.68%) (p < 0.001). RF achieved the highest performance (AUC = 0.737, sensitivity = 72.03%, specificity: 61.33%), and a preoperative-only RF model achieved a sensitivity of 83.14%. Key predictors included age, BMI, operative time, white blood cell count, and hematocrit. Conclusions: ML effectively predicts C-section readmissions, supporting early identification and interventions to improve patient outcomes and reduce healthcare costs.

e23024 Background: Efforts to address disparities in clinical trial participation have increased over the past 30 years. Strict eligibility criteria in phase III interventional trials may exacerbate these disparities, limiting access and raising concerns about generalizability. Chronic lymphocytic leukemia (CLL), the most common chronic leukemia in adults, primarily affects older individuals and those with comorbidities, emphasizing the need for inclusive research. This study aimed to explore changes in eligibility criteria for phase III interventional CLL trials over 15 years. Methods: Clinical trial data were obtained from ClinicalTrials.gov, focusing on Phase 3 interventional studies related to CLL. The search used "chronic lymphocytic leukemia," filtered for adults aged 18–64 and older adults aged 65+. Trials enrolling patients between January 1, 2004, and December 1, 2019, were included. Trial designs, endpoints, and eligibility criteria were primarily extracted from published protocols when available and supplemented with information from ClinicalTrials.gov. Studies not specific to CLL, those evaluating supplements or vaccines, lacking a control arm, being single-center, or without investigational products were excluded from the data analysis. Data were grouped into three periods (2004–2008, 2009–2013, 2014–2019), and one-way ANOVA was used to assess differences in average eligibility criteria across these periods. Results: A total of 103 clinical trials were identified, with 47 included in the final analysis. Most were industry-funded (37 trials, 81%), while 10 (19%) were non-industry-funded. Regarding treatment settings, 60% targeted untreated patients, 32% focused on relapsed/refractory patients, and 9% included both. Interventions included chemoimmunotherapy (40%), targeted therapies (21%), combined approaches (36%), and other types (2%). The average number of eligibility criteria increased over time: 23.86 (IQR 14; range 12–39) in Period 1, 32.05 (IQR 19; range 18–59) in Period 2, and 46.25 (IQR 26.5; range 13–70) in Period 3. One-way ANOVA confirmed a significant difference across periods (F = 7.35, p < 0.001), showing a significant increase in the average number of criteria over time. Conclusions: Over 15 years, the number of eligibility criteria in phase III interventional CLL trials significantly increased, nearly doubling from 23.86 (2004–2008) to 46.25 (2014–2019). While this may improve internal validity, it risks excluding older patients and those with comorbidities, who are most affected by CLL. These findings highlight the need to balance scientific rigor with equitable access to ensure generalizability.

e17530 Background: Cervical cancer remains a significant public health challenge, especially in low-resource settings such as Vietnam. HPV self-collection offers a promising avenue for improving screening uptake, yet its acceptance depends on addressing knowledge gaps and sociocultural barriers. This study aims to explore the perceptions of Vietnamese women in regard to HPV and HPV self-collection, emphasizing strategies for health promotion and disease prevention. The aims of this study were to summarize responses to a 51-item survey regarding perceptions of HPV self-collection in Vietnamese women between 30 and 65 years old, as well as to compare survey responses according to age, religion, education level, marital status, and frequency of doctor visits in the past year. Methods: A survey of 538 women aged 30–65 assessed cervical cancer knowledge, attitudes toward HPV self-collection, cost concerns, and communication preferences. Associations between demographic factors and perceptions were analyzed using Wilcoxon rank sum, Kruskal-Wallis, and Fisher’s exact tests (p < 0.05). Results: While 84.4% of respondents were aware of cervical cancer, only 59.0% had knowledge of HPV, and 41.3% were familiar with self-collection. Most women (82.5%) recognized the importance of cervical cancer prevention; however, only 45.5% viewed self-collection as equally effective as doctor-administered testing. For negative self-collection recorded results, 64.3% felt reassured, yet 81.1% preferred secondary confirmation by a doctor (p<0.01). Cost concerns were notable, with 56.5% willing to pay 400,000 VND but fewer accepting higher costs. Education significantly influenced responses, with higher-educated women demonstrating greater awareness and confidence in self-collection (p < 0.001) . Importantly, participants identified doctors and healthcare professionals as trusted sources of information, when compared to other sources of information such as television and government officials, underscoring the role of health promotion campaigns. Conclusions: Effective health promotion strategies are critical to increasing HPV self-collection uptake in Vietnam. Public health campaigns should prioritize education to address misconceptions, emphasize the efficacy of self-collection, and reduce stigma. Programs that leverage trusted communication channels, such as healthcare providers, can foster trust and improve participation. Efforts to ensure affordability and accessibility are essential to achieving equitable and widespread cervical cancer prevention.

Abstract Introduction Sexually transmitted viruses (STVs), including Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV), Herpes Simplex Virus (HSV), and Hepatitis B Virus (HBV), present major public health challenges due to their high prevelance, chronicity, and transmission rates. Extending beyond immediate health impacts, these viruses affect sexual health and function through mechanisms including chronic inflammation, psychological stress, social stigma, and adverse effects of treatment. While the link between STVs and sexual disorders is acknowledged, it is underexplored in the literature, particularly concerning female sexual health. Current research largely focuses on male sexual dysfunction, especially erectile disorder and its treatment. This review investigates the relationship between STVs and female sexual disorders, examining physiological, psychological, and social factors contributing to sexual health concerns. Enhancing our understanding of this relationship could support clinicians in identifying sexual health concerns in female patients with STVs and providing targeted interventions to optimize sexual health outcomes. Objective This systematic review aims to examine existing literature on the relationship between STVs and female sexual disorders, identifying specific dysfunctions (e.g., pain, desire, arousal, and satisfaction) associated with each virus, underlying mechanisms, and discussing clinical and research implications. Methods A comprehensive literature search was conducted in September 2024 across four databases: Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science. A total of 523 references were identified, with 139 duplicates removed, leaving 384 studies for screening based on inclusion and exclusion criteria. Searches combined MeSH (Medical Subject Headings) terms and keywords to capture relevant studies. MeSH terms included “Sexual Dysfunction, Physiological,” “Sexual Dysfunction, Psychological,” “Papillomavirus Infections,” “Herpesvirus 2, Human,” “Hepatitis B,” and “HIV.” Additional keywords included “sexual dysfunction,” “HSV,” “hepatitis,” “HPV,” “woman,” “women,” and “female.” The search was limited to English-language studies. Results A total of 384 studies met the inclusion criteria, with findings revealing associations between specific STVs and various types of female sexual dysfunction. HSV was notably associated with dyspareunia during outbreaks due to genital ulcers, as well as with psychosexual issues linked to concerns about transmissibility and the stigma of visible lesions, negatively affecting intimate relationships. HIV was associated with multifactorial sexual dysfunction, encompassing psychological impacts such as fear of transmission and health-related anxiety, as well as physiological effects like decreased sexual desire from antiretroviral therapy and lipodystrophy. HPV’s relationship with sexual disorders was variable, with some studies connecting it to heightened depression and anxiety following diagnosis, which diminished sexual desire. For HBV, sexual dysfunction correlated with the severity of liver dysfunction, as chronic liver disease in women impairs hormone metabolism and increases sex hormone-binding globulin (SHBG) levels, leading to suppression of the hypothalamic–pituitary-gonadal axis. Conclusions This review highlights a notable relationship between STVs and female sexual dysfunction, emphasizing the need for comprehensive care that addresses both management of the infection and sexual health concerns. Routine screening for sexual health concerns in women with STVs is recommended, along with interdisciplinary approaches to address these complex impacts. Improved recognition and management of sexual disorders in this context can enhance both sexual health outcomes and overall quality of life in affected individuals. Disclosure No.

Although allogeneic hematopoietic cell transplantation (HCT) offers a potential for cure for many patients with advanced hematologic malignancies and bone marrow failure or immunodeficiency syndromes, it is an intensive treatment and accompanied by short- and long-term physical and psychological symptoms requiring specialized care. With substantial advances in therapeutic approaches for HCT and supportive care, HCT survivors experience less morbidity and mortality. However, disparities in both HCT access and outcomes persist, and HCT survivors and their caregivers often lack access to much-needed psychosocial care. Additionally, more medical and psychosocial resources are needed to holistically care for HCT survivors with chronic graft-versus-host disease (GVHD). Hence, this chapter focuses on three areas pertaining to advances and gaps in HCT care: disparities in access to and outcomes of HCT, psychosocial and physical symptom management with supportive care interventions, and GVHD prevention and management.

Atypical ductal hyperplasia (ADH) is a benign lesion of the breast that is associated with an increased risk of invasive breast cancer. This review explores the pathophysiology, risk factors for progression to breast cancer, and lifetime management for patients diagnosed with ADH on core needle biopsy (CNB). The management plan for patients diagnosed with ADH includes regular clinical surveillance, diagnostic mammography, along with risk-reduction strategies such as lifestyle modifications or the use of adjuvant endocrine therapies. This review aims to delve into the complexities of ADH from diagnosis to management to aid clinicians in finding the best way to approach this high-risk breast lesion.