Faculty Bibliography

Introduction: Social media networks and websites are an important source of healthcare information exchange. Despite the quantity of information, there is growing evidence for poor quality medical information that may be misleading and biased. Some studies suggest information available online on controversial topics may disperse inaccurate information and contribute to public confusion. Objective: The goal of this study is to examine information available in YouTube videos on a controversial urologic topic, pelvic organ prolapse (POP) repairs with mesh. Methods: A keyword search of ''vaginal POP repair with mesh'' was performed and the first 100 search results examined on 7/29/13. Videos not in English, lacking spoken words, or duration 910 minutes were excluded. Video characteristics including source (legal, medical, other), number of views, time online and duration were recorded. The content of each video was assessed in the following domains: description of POP, management of POP, explanation of the 2011 FDA Safety Communication, and balanced presentation of information. Scores were assigned based on whether the video made a series of objective statements pertaining to each domain, The proportion of statements made in the video per domain was calculated and videos of different sources were compared. Significance was assessed by t test. Results: 51 videos were excluded, and the remaining 49 were viewed. The sources were 69% legal firm, 24% medical institution, and 7% other. The former 2 groups were compared. Videos from medical institutions were older (online for 31.6 vs. 14.2 months, p lt; 0.01), longer (249 vs 99 seconds, p lt; 0.01), and had more views per month (784 vs. 140 , p lt; 0.01) when compared to legal videos. Legal videos explained more aspects of the 2011 FDA Safety Communication (0.22 vs. 0.07; p<0.01). Medical videos did not show a significant difference in addressing aspects of other domains including description of POP (0.25 vs. 0.12, p=0.087, management of POP (0.2 vs. 0.14, p=0.086), or presentation of balanced information (0.10 vs. 0.06; p=.528). Conclusions: The majority of information available in YouTube videos on the topic of vaginal POP repair with mesh is recent, short, and published through legal services that outline the 2011 FDA Safety communication but contain less comprehensive descriptions of POP compared to other videos. However, low overall scores in all domains studied, regardless of source, demonstrate lack of content. This raises questions about the utility of YouTube as a source of information for patients

Benign multicystic mesothelioma (BMM) is a benign intra-abdominal lesion that generally occurs in women in their reproductive years. A urachal cyst occurs when the epithelial-lined urachal canal fails to completely obliterate. We report a case of a 38-year-old female presenting with abdominal pain found to have a lesion highly suspicious for a urachal cyst. On pathologic evaluation the lesion was identified as a BMM. This is the first report of BMM presenting as a lesion suspected to be a urachal cyst.

OBJECTIVE: To explain what role urinary urgency has on urinary frequency in patients with overactive bladder (OAB). MATERIALS AND METHODS: We prospectively enrolled 102 patients with OAB over a 6-week period. Patients were assessed with the OAB-q and a pilot questionnaire to identify which urinary symptoms were most bothersome and what underlying cause subjects attributed urinary frequency to. Associations between epidemiologic characteristics, OAB-q scores, and subject responses to the pilot questionnaire, were examined for statistical significance with the Pearson chi square test. RESULTS: The study population comprised 85% women and 15% men, with mean age 67.4 years and mean OAB-q score 54. Subjects reported their most bothersome symptom was: frequency 24.5%, urgency or urgency incontinence 48.0%, nocturia 27.5%. Of the patients most bothered by frequency, 64% identified the International Continence Society definition of urgency or "fear of leakage" as the underlying reason for their frequency. Overall, 82.4% and 48.0% of patients reported urgency or urgency incontinence as a symptom and most bothersome symptom respectively. However, when patients were specifically asked what drives their urinary frequency, these percentages increased to 89.2% and 63.7%. CONCLUSION: This pilot study confirms that urgency is a large factor underlying the drive to void frequently in OAB, even when patients do not admit to urgency as the most bothersome symptom.

Although the male sling is a popular and effective option to treat stress urinary incontinence, the reported success rates are highly variable. Detailed knowledge of the factors affecting male sling outcome can improve clinical efficacy and provide realistic expectations for patients. The objective of this article is to review the current literature that identifies factors associated with surgical outcome, with the goal of optimizing pre-operative selection criteria. Since most practitioners prefer the transobturator approach, the retrourethral transobturator sling (i.e., AdVanceâ„¢ sling) is the focus of this review.

PURPOSE: Many investigators have used number of pads to determine severity of post prostatectomy incontinence (PPI), yet the accuracy of this tool remains unproven. The aim of this study was to determine if patient's perception of pad use and urine loss reflects actual urine loss. We also sought to identify a quality of life (QoL) measure that distinguishes patients by severity of incontinence. MATERIALS AND METHODS: We prospectively enrolled 235 men from 18 sites >6 months after radical prostatectomy, with incontinence requiring protection. Patients completed a questionnaire about perception of number, size and wetness of pads and a QoL question, several standardized incontinence questionnaires, and a 24-hour pad test that assessed number, size, and weight of pads. SPSS was used for statistical analysis. RESULTS: Perception of number of pads used was in close agreement with number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p<0.001). Patients with "wet" and "soaked" pads had statistically, and clinically, significantly different pad weights uniquely different from each other, and from the "almost dry" and "slightly wet". The response to the QoL question separated men in to 4 statistically significantly different groups based on mean 24-hour pad weight. CONCLUSIONS: Patients accurately describe the number, size and the degree of wetness of pads collected during a 24-hour pad test. These correlate well with actual urine loss. The single question of "To what extent does urine loss affect your quality of life?" separated men into distinct categories.