Faculty Bibliography

Introduction & Objective: The Internet has become the weathervane for social attitudes and increasingly, healthcare topics are at the forefront of online discussion. The main three (Figure presented) search engines (Google, Microsoft's Bing, and Yahoo!) account for over 95% of all search queries in the US and over 95% of all website traffic from these engines originate on the first search results page. Essentially, search results on any topic from the first page of each engine dominate the information distributed to the American general public. With the 2012 US Preventive Services Task Force (USPSTF) recommendation against prostate cancer screening, we wanted to evaluate whether the online community agrees with this decision and determine what evidence was used in its formation. We also wanted to see the trend of online recommendations for the past three years to gauge public opinion. Materials and Methods: Using the query "prostate cancer screening" (as well as "PSA screening") on the three main search engines yielded a total of 28.59 million, 17.46 million, and 27.72 million results in November 2013, 2014, and 2015, respectively (Google 21m/7.3m/19.7m, Bing 3.82m/5.06m/4.01m, (Figure presented) Yahoo3.77m/5.07m/4.01m). We analyzed the first page of nonad results produced by each search engine looking at the source and type of website, its recommendations on screening, the number of references provided, and the level of evidence presented to determine information quality. Specifically we evaluated whether each website used the ERSPC and PLCO data (used by the USPSTF) in their recommendation. We excluded duplicate primary domain names on the same search results page but included them on different engines. Results: Our search queries provided a total of 29 distinct primary websites 2013, and 27 websites in 2014 and 2015. Most of the websites that appeared in the 2013 search also displayed prominently in subsequent years. The source and type of website and their recommendations can be seen in Figures 1 and 2. In general, the number of websites advocating discussion of the risks and benefits of screening with a physician and making an informed decision by the patient decreased slightly while sites that did not offer a definitive conclusion rose from over the past three years. Conclusions: Three years after the USPSTF presented its findings and recommendations against routine prostate cancer screening, the online community does not share the same disposition. However, the general consensus toward informed decision has slightly decreased suggesting the topic is still controversial andmost online sources will not point patients towards one way or the other

BACKGROUND AND PURPOSE: Early studies describing robot-assisted radical prostatectomy (RARP) reported the use of pneumoperitoneum at a pressure of 15 mm Hg. While higher insufflation pressures (20 mm Hg) may reduce venous oozing and improve visualization, the safety of this method has not been confirmed. This study evaluates the short-term perioperative outcomes of patients undergoing RARP with insufflation pressures of 20 mm Hg. PATIENTS AND METHODS: A single-surgeon, prospectively maintained database of patients undergoing RARP was retrospectively analyzed. Patients who underwent RARP with a pneumoperitoneum pressure of 15 and 20 mm Hg for the entire procedure were analyzed. Preoperative and postoperative hemoglobin levels and estimated glomerular filtration rate (eGFR) were compared. Complications, operative time, and estimated blood loss were also examined. RESULTS: The number of patients in the experimental (20 mm Hg) and control (15 mm Hg) groups were 550 and 201, respectively. The groups were well matched with respect to age and operative time. The experimental group had a significantly smaller decrease in mean hemoglobin levels after surgery (-1.18 vs-2.13 mg/dL, P<0.0001). There was no significant difference in the eGFR on the first day after surgery (postoperative day [POD]1) (88.4 vs 85.0 mL/min/1.73m(2), P=0.11) or in the change in eGFR from preoperative to POD1 levels (-0.49 vs 1.54 mL/min/1.73m(2), P=0.18). The complication rate in the experimental group was 8.55% vs 8.46% in the control group. CONCLUSION: Pneumoperitoneum using a pressure of 20 mm Hg for RARP is safe and has no significant short-term effects on renal function and hemoglobin. Increased insufflation pressure was not associated with a higher complication rate.

Bilateral cryptorchidism is a rare occurrence and seminoma is the most common germ cell tumor found in undescended testes when they occur. We present the case of a patient with bilateral cryptorchidism who presented to our trauma center after a motor vehicle collision and was found incidentally to have a 17-cm intra-abdominal mass. The mass was subsequently biopsied and proven to be seminoma. The patient completed three cycles of bleomycin/etoposide/cisplatin chemotherapy and successfully underwent a postchemo retroperitoneal lymph node dissection with no viable residual tumor or positive lymph nodes found in the surgical specimen. He also had an orchiopexy of the contralateral testicle. The patient recovered fully and has been found to be recurrence-free four months postoperatively. We highlight the importance of cisplatin-based chemotherapy and extensive tumor resection as the mainstay of initial cancer control.

PURPOSE: National statistics estimate that a quarter of American school children are regularly bullied, making this issue the main parental concern and the leading form of school violence. To our knowledge no study in the literature has examined the association of bullying with lower urinary tract symptoms. We evaluated the relationship between being bullied and lower urinary tract symptoms in the pediatric population. MATERIALS AND METHODS: We accrued 100 patients from a pediatric urology practice in prospective case-control fashion. The degree of lower urinary tract symptoms was determined by the voiding severity score obtained by a single pediatric urologist. Using the Peer Relations Questionnaire and a thermometer scale we surveyed participants for evidence of victimization from bullying and school related anxiety. We then correlated voiding symptom severity with the degree of bullying. RESULTS: After applying our study exclusion criteria we examined and analyzed data on 38 control children without lower urinary tract symptoms and on 38 children with lower urinary tract symptoms. Mean age was similar in the 2 groups. There were more females in the group with lower urinary tract symptoms (22 vs 13). Mean case voiding severity score was 3.82 (range 2 to 5). As measured by Bullied Index Score the degree of being bullied was significantly higher in the case group (4.76 vs 1.95, p <0.001), as was the anxiety level estimated by the thermometer score (3.68 vs 0.97, p <0.001). We also found that physical forms of bullying accounted for worse voiding severity scores (4.56 vs 3.67, p <0.01). CONCLUSIONS: To our knowledge our study is the first to show that 1) bullying is significantly associated with pediatric lower urinary tract symptoms and 2) physical forms of bullying accompany worsened symptoms.

OBJECTIVE: To determine the association between preoperative serum albumin and mortality and postoperative complications after radical cystectomy (RC) and urinary diversion. PATIENTS AND METHODS: We conducted a retrospective review of 1097 RCs performed for the treatment of bladder cancer between 1992 and 2005. All data were entered prospectively into a hospital-based complications database. We used multivariable logistic regression to assess the association between preoperative serum albumin and complications and mortality