Faculty Bibliography

INTRODUCTION AND HYPOTHESIS:Sacral neuromodulation (SNM) is an effective therapy for non-neurogenic overactive bladder, non-obstructive urinary retention, and chronic fecal incontinence. Previous studies have shown SNM revision rates up to 39%, and the factors that predispose to revisions and complications remain incompletely understood. This study is aimed at characterizing reasons for SNM revision over an 18-month period to identify any potential predictors. METHODS:This is a retrospective chart review of patients following SNM implantation from 1 January 2021 to 17 May 2023 at a single academic center with five surgeons. Patient characteristics, procedural specifics, and reasons for revision were examined. Complications were defined as lead migration, infection, pain, or implantable pulse generator (IPG) issues. RESULTS:A total of 127 patients were included for a total of 135 operations. The overall revision rate was 22% (30 out of 135) with a 6.7% explantation rate (9 out of 135). Primary reasons for revision included lead migration (7), infection (3), pain (3), no efficacy (8), IPG malpositioning (3), or desire for an MRI-compatible device (7). Of patients who underwent revisions, patients with complications had a lower BMI at the time of revision (p = 0.05) and were older (p = 0.007) than patients without complications. There were no differences between genders, or with use of an antimicrobial envelope. CONCLUSIONS:The overall revision rates were lower than those in the published literature. Based on changes in BMI between implantation and subsequent revision, weight loss and older age were associated with more complications that necessitated revision. Use of an antimicrobial envelope did not change complication rates. Surgeons should decide whether its use is warranted given the added cost.

INTRODUCTION/UNASSIGNED:The introduction of transvaginal mesh (TVM) in 2002 for pelvic organ prolapse (POP) repair gained initial popularity until official warnings were released about its associated complications. This study compares the changes in practice patterns between Urogynecology and Reconstructive Pelvic Surgery (URPS)-trained and non-URPS-trained urologists following the warnings and eventual ban of TVM for prolapse repair. METHODS/UNASSIGNED:Case logs from 2001 to 2022 were queried from the American Board of Urology. POP repair cases were identified by their Current Procedural Terminology codes and categorized by surgical approach: vaginal with TVM, vaginal without TVM, and abdominal. Urologists were identified as URPS or non-URPS trained. Case log trends were analyzed before and after the initial US Food and Drug Administration (FDA) warning in 2008 and FDA ban in 2019. RESULTS/UNASSIGNED:TVM was rapidly adopted for vaginal POP repair in 2005 as seen by a 9200% increase among URPS urologists and 558% increase among non-URPS urologists. After the 2008 FDA warning against TVM, URPS urologists transitioned from TVM to non-TVM techniques for POP repair sooner than non-URPS urologists. After the TVM ban in 2019, URPS urologists performed significantly more abdominal approach and vaginal approach with TVM for POP repair. CONCLUSIONS/UNASSIGNED:The use of TVM decreased for both URPS and non-URPS urologists in response to the FDA health warnings and eventual ban of TVM for POP. URPS urologists adapted to non-TVM techniques sooner than non-URPS urologists. By 2021, URPS urologists were performing the majority of POP repair cases compared with non-URPS urologists.

In 2024, more than 300,000 women in the United States were diagnosed with invasive breast cancer. Despite significant advances in chemotherapy and radiation, surgery continues to be a central tenet of these patients' care, with most patients requiring surgery for definitive treatment. Postoperative pain control and anxiety surrounding options for pain relief consistently rank as a major concern of patients before surgery. In a nation recovering from an opioid epidemic with more than 100,000 overdose deaths a year, patients and providers alike are looking for nonnarcotic and nonpharmaceutical approaches to mitigate pain. This study is a proof of concept and initial investigation of a novel vibrating device (Relievvr) that is applied directly to the breast to provide sensory input that may modulate patient-perceived discomfort. The study enrolled 22 women undergoing outpatient breast surgery who used the device as part of their postoperative protocol. At 2 weeks postoperatively, 95% of women said they would use the device if they had surgery again, and 95% of women said they would recommend the device to a friend having the same surgery. These findings serve as proof of concept that a vibrating device based on the gate control theory of pain can be a feasible, nonopioid adjunct for managing postoperative breast surgery pain, with high levels of patient satisfaction and ease of use.

Although the health benefits of good sleep have been recognized for centuries, many people continue to struggle with sleep disorders triggered by many factors. Despite numerous studies on sleep disorders, a comprehensive understanding of their risk factors and potential mechanisms remains elusive. This review critically examines how circadian desynchrony acts as the primary driver linking sleep disorders and circadian clock dysfunction to dysregulated lipid metabolism and chronic vascular inflammation, ultimately accelerating atherosclerosis, and mainly focuses on the interplay of sleep-induced metabolic issues with the genetic and environmental factors that alter sleep patterns. Maintaining optimal sleep rhythm, quality, and timing is essential to decrease the risk of metabolic and cardiovascular diseases.

INTRODUCTION/BACKGROUND:Most injuries occur in low- and middle-income countries (LMICs), yet the trauma literature largely reflects high-income countries (HICs), and no research-methodology course is tailored to LMIC acute care surgeons or to trauma-specific infrastructure such as injury registries. We surveyed acute care surgeons to inform an American Association for the Surgery of Trauma (AAST) research-methodology curriculum. METHODS:A voluntary 25-item Research Electronic Data Capture survey developed by the AAST International Relations Committee, covering research experience, infrastructure access, and training priorities, was distributed (January-June 2025) by email and social media to AAST members and partner international trauma organizations. Respondents were classified by World Bank income group and compared using chi-square or Fisher exact tests. RESULTS:Of 132 respondents, 72 (55%) practiced in HICs and 60 (45%) in LMICs. versus HIC peers, LMIC respondents reported less research experience (73% versus 90%; P = 0.01), fewer publications (38% versus 74%; P < 0.001), and markedly less access to a trauma registry (20% versus 86%), statistical support, and a research coordinator (all P ≤ 0.006). A higher proportion of LMIC respondents selected registry design (52% versus 26%), scientific writing (67% versus 46%), and literature appraisal (47% versus 28%), while HIC respondents favored statistics and retrospective research (P < 0.05); and more likely to agree a mentor would help their research (93% versus 60%; P < 0.001). Course interest was high in both groups. CONCLUSIONS:Interest in research-methodology training was strong across income settings, but LMIC surgeons reported distinct, infrastructure-linked needs centered on trauma-registry building, scientific writing, foundational skills, and mentorship. Course design should reflect these differences rather than export a high-income model.

BACKGROUND:Adrenal venous sampling is routinely used to lateralize aldosterone hypersecretion but has an unclear role in adrenocorticotropic hormone-independent autonomous hypercortisolism. We define clinical scenarios where adrenal venous sampling provides value for surgical decision-making. METHODS:We performed a single-center retrospective review of patients undergoing adrenal venous sampling for hypercortisolism (January 2012-April 2025). Lateralization was defined by a lateralization ratio >2 using aldosterone as a reference hormone. We also conducted a scoping review of studies describing adrenal venous sampling use in hypercortisolism identified through a comprehensive literature search. RESULTS:Nine patients with isolated hypercortisolism were included, of which 88.9% were female, with a median age of 60 years (range, 41-76). Seven patients presented with mild autonomous cortisol secretion and 2 with overt Cushing's syndrome. Six patients had bilateral adrenal nodules. Mean nodule size was 2.71 ± 0.85 cm. Eight patients underwent a 1-mg dexamethasone suppression test, with all patients meeting the >1.8 μg/dL threshold for elevated serum cortisol (mean dexamethasone suppression test cortisol: 7.13 ± 4.82 μg/dL). Adrenal venous sampling lateralization corresponded to the larger or unilateral nodule in 5 patients, was nonlateralizing in 3, and correctly lateralized to the smaller nodule in 1 patient with similarly sized lesions (1.9 cm versus 2.0 cm), enabling correct-side surgery and resolution of symptoms of overt Cushing's. Seven isolated hypercortisolism patients underwent adrenalectomy, all with benign pathology. Nine studies were included in the scoping review, demonstrating heterogeneous adrenal venous sampling lateralization criteria. CONCLUSION/CONCLUSIONS:Adrenal venous sampling may be useful in select patients with adrenocorticotropic hormone-independent hypercortisolism and similarly sized bilateral adrenal nodules in order to prevent incorrect-side adrenalectomy or unnecessary bilateral adrenalectomy.