Author Interviews, Baylor College of Medicine Houston, Sleep Disorders, Urology / 18.05.2015

MedicalResearch.com Interview with: Alexander W. Pastuszak, MD, PhD Male Reproductive Medicine and Surgery Scott Department of Urology Jason Malcolm Scovell Medical Student, Ofc SA-BCM Students Baylor College of Medicine Houston, TX Medical Research: What is the background for this study? What are the main findings? Response: Sleep quality is an important component of overall health, and can both exacerbate health issues and be impaired by health problems. Shift workers, primarily those who do not work standard daylight shifts, are prone to sleep problems, a significant concern in light of the fact that up to 25% of the U.S. workforce is comprised of shift workers. As men age, the prevalence of Lower Urinary Tract Symptoms (LUTS), which include urgency, frequency, waking up at night to urinate, and difficulties with urination, increases.  Unsurprisingly, men with LUTS report poor sleep in part due to awakening repeatedly during the night. We studied a group of male shift workers, who we believe to be an ‘at-risk’ population, and found that not only do the men who report worse sleep quality have worse Lower Urinary Tract Symptoms, but also men who report difficulty falling asleep have more severe LUTS than those who do not. This latter point is significant, given that most men with LUTS can fall asleep without difficulty, but then awaken repeatedly throughout the night, and suggests that sleep difficulties in this population may be resulting in Lower Urinary Tract Symptoms rather than LUTS exclusively resulting in sleep difficulties. (more…)
Author Interviews, Infections, Microbiome, Urology / 01.04.2015

Alan J. Wolfe PhD, Professor Department of Microbiology and Immunology Stritch School of Medicine, Loyola University Chicago Maywood, ILMedicalResearch.com Interview with: Alan J. Wolfe PhD, Professor Department of Microbiology and Immunology Stritch School of Medicine, Loyola University Chicago Maywood, IL

Medical Research: What is the background for this study? Dr. Wolfe: Several years ago, Dr. Brubaker and I began a conversation. As a urogynecologist, she was concerned about the general lack of improvement in diagnosis and treatment in her urogynecological practice and thus in clinical outcome. As a microbiologist, I was extremely skeptical of the dogma that urine in the bladder was sterile in the absence of a clinical infection. This skepticism was based upon my former work in bacterial motility and biofilm formation and on the knowledge that most bacteria are not cultured by the standard clinical microbiology urine culture method. With the goal of ultimately improving urogynecological practice, and with the help of our colleagues in the Loyola Urinary Education and Research Collaborative (LUEREC), we decided to test the sterile bladder hypothesis by seeking evidence of bacteria in urine taken directly from the bladder to avoid vulva-vaginal contamination. To detect bacterial DNA, we used high-throughput DNA sequencing technology. To detect live bacteria, we developed an Expanded Quantitative Urine Culture (EQUC) protocol. We applied these complementary approaches to women with and without urgency urinary incontinence (UUI) whose standard clinical urine culture was negative. Medical Research: What are the main findings? Dr. Wolfe: First and foremost, the bladder is not sterile. We can detect bacteria and/or bacterial DNA in most women whether they have urgency urinary incontinence (UUI) or not. Thus, the female bladder contains a resident bacterial community, which we call the female urinary microbiome (FUM). We found that bacterial members of the FUM are distinct from the bacteria that typically cause urinary tract infections (UTI). Thus, the bacteria that make up the FUM are not the bacteria that cause typical UTIs. Indeed, detection of the female urinary microbiome was associated with reduced risk of UTIs that often occur after instrumentation or surgery. We therefore hypothesize that the FUM or some members of the FUM could protect against UTI. We also saw that the FUM in women with UUI differs from the FUM in women without UUI and that certain bacterial species were considerably more common in women with urgency urinary incontinence than in women without urgency urinary incontinence . We hypothesize that some of these bacteria could be causative or contributory to UUI or they could be a consequence of urgency urinary incontinence. (more…)
Author Interviews, Prostate, Prostate Cancer, Urology / 16.01.2015

MedicalResearch.com Interview with: Mufaddal Mamawala, MBBS, MPH, CPH Biostatistician Johns Hopkins School of Medicine Brady Urological Institute Medical Research: What is the background for this study? What are the main findings? Dr. Mamawala: Twenty years after prostate-specific antigen (PSA) was FDA approved for the diagnosis of prostate cancer, its use remains highly controversial. There has been an ‘over- diagnosis’ and ‘over-treatment’ of low-risk prostate cancers that would have never progressed to a more lethal form of the disease during one’s life. Active surveillance (AS) is an alternative to immediate treatment, which allows for monitoring of favorable risk patients with selective delayed intervention among those with disease progression. However  ‘misclassification’ is a cause of concern for patients in the initial years of been in AS. The initial biopsy may have missed an area of prostate with an aggressive cancer, due to under-sampling of cores or due to randomness, such that this patient could get misclassified as having a low-risk disease and by the time the follow-up biopsy shows an aggressive cancer the window of curability is lost. However with more sampling of the prostate there is more likelihood to find an aggressive cancer. As such if the patient is compliant with their biopsies, and more prostate is sampled under the microscope, better are the chances of finding a higher risk cancer. Conversely if the patient has more biopsies that show no high-risk cancer then they are less likely to have a high-risk cancer on future biopsies. Thus we wanted to evaluate the risk of reclassification, from a low-risk disease to a high-risk disease (higher Gleason score, or increase in extent of the disease), over a period of time in compliant active surveillance patients.  The length of time under Active surveillance without reclassification has not been evaluated as a predictor of future reclassification. Biopsies are invasive procedures, and the fact that patient has to undergo this invasive procedure regularly is a deterrent from been in Active surveillance. This study would help to make informed decisions about the need for doing frequent biopsies in light with other clinical factors especially in older patients who had many non-reclassifying biopsies before. We found that the risk of reclassification was not equally distributed across time. As a result of ‘under sampling’ of prostate at diagnostic biopsy we had highest rates of reclassification in the first two years of been in Active surveillance with more than 50% of total reclassifications happening during those two years. The ‘low-risk’ and the ‘very-low-risk’ groups, determined by the Epstein criteria, had similar rates of reclassification in the first two years. After first two years the ‘low-risk’ group were 2.4 times as likely to have a higher risk of reclassification than the ‘very-low-risk’ group. In both the groups the risk of reclassification declined over time significantly by at least 30% with each biopsy that did not show reclassification. (more…)
Author Interviews, Urinary Tract Infections, Urology / 23.08.2014

Steve J. Hodges MD Associate Professor, Department of Urology Wake Forest University School of Medicine Medical Center Blvd, Winston-Salem, NCMedicalResearch.com Interview with: Steve J. Hodges MD Associate Professor, Department of Urology Wake Forest University School of Medicine Medical Center Blvd, Winston-Salem, NC Medical Research: What are the main findings of this study? Dr. Hodges: The main findings of this study were that skin irritants (typically urine) may cause vulvitis in prepubertal girls, which leads to an alteration of their perineal microbiome, with increased colonization by uropathogenic bacteria, increasing the risk of UTI. (more…)
Author Interviews, Urology / 29.07.2014

MedicDavid C. Johnson, MD, MPH Department of Urology University of North Carolina School of MedicinealResearch.com Interview with: David C. Johnson, MD, MPH Department of Urology University of North Carolina School of Medicine   Medical Research: What are the main findings of the study? Dr. Johnson: The first main finding from this study is that the likelihood of benign pathology after surgical removal of a renal mass suspected to be malignant based on pre-operative is inversely proportionate to size. This concept is well-established, however we systematically reviewed the literature for surgical series that published rates of benign pathology stratified by size and combined these rates to determine a single pooled estimate of benign pathology of pre-operatively suspicious renal masses for each size strata. Using benign pathology rates from US studies only, we found that 40.4% of masses < 1 cm, 20.9% of masses 1-2 cm, 19.6% of masses 2-3 cm, 17.2% of masses 3-4 cm, 9.2% of masses 4-7 cm, and 6.4% of masses >7 cm are benign. The more novel finding from this study was the quantification of a previously unmeasured burden of over treatment in kidney cancer. By combining the above mentioned rates of benign pathology with epidemiological data, we estimated that the overall burden of benign renal masses surgically removed in the US to approach 6,000 per year in 2009. This represented an 82% increase over the course of a decade. Most importantly, we found an overwhelmingly disproportionate rise in the surgical treatment of renal masses in the smallest size categories – those which were most likely to be benign. We found a 233%, 189% and 128% increase in surgically removed benign renal lesions < 1 cm, 1-2 cm, and 2-3 cm, respectively from 2000 – 2009 in the US. (more…)
Author Interviews, Kidney Stones, Urology / 12.07.2014

Gregory Tasian, MD, MSc, MSCE Attending Urologist The Children’s Hospital of Philadelphia MedicalResearch.com Interview with: Gregory Tasian, MD, MSc, MSCE Attending Urologist The Children’s Hospital of Philadelphia    Medical Research: What are the main findings of the study? Dr. Tasian: The risk of developing kidney stones increased during the study period in all the cities except Los Angeles when mean daily temperatures rose above 50°F (10°C). Mean daily temperatures reaching 86°F (30°C) were associated with risk increases of 38% in Atlanta, 37% in Chicago, 36% in Dallas, and 47% in Philadelphia compared with 50°F (10°C). Kidney stone risk peaked within 3-5 days of exposure to high temperatures but then decreased within 7 to 10 days afterward. (more…)
Author Interviews, JAMA, Kidney Stones, Urology / 21.05.2014

Charles D. Scales, Jr MD MSHS Assistant Professor of Surgery Division of Urologic Surgery Duke University Medical CenterMedicalResearch Interview with: Charles D. Scales, Jr MD MSHS Assistant Professor of Surgery Division of Urologic Surgery Duke University Medical Center   MedicalResearch: What are the main findings of the study? Dr. Scales: When it comes to treating kidney stones, less invasive is not always better. We used the best method short of a randomized trial to balance out patients in terms of factors that might influence the success of treatment.  In other words, we achieved a “statistical toss-up” for factors that could influence the outcome of the procedure. When we balanced out all of the factors that might influence the chance of a repeat procedure, we found that about 11% of patients treated with non-invasive SWL had a repeat procedure, as compared to <1% with minimally invasive URS. (more…)
Mayo Clinic, Urology / 20.05.2014

Daniel S. Elliott, M.D MAYO Clinic, Associate Professor Department of Urology Section of Pelvic and Reconstructive Surgery Rochester, MinnesotaMedicalResearch.com Interview with: Daniel S. Elliott, M.D MAYO Clinic, Associate Professor Department of Urology Section of Pelvic and Reconstructive Surgery Rochester, Minnesota MedicalResearch: What are the main findings of the study?  Dr. Elliott: The biggest issue is that we were able to devise a new procedure that is a simple outpatient anti-incontinence surgery for women that does NOT use any synthetic meshes.  The importance of this is that all traditional (meaning NON-mesh) surgeries for female incontinence have been large surgeries with fairly significant risks such as pain, bleeding and prolonged recovery.  When the meshes came out in the late ‘90’s, their big benefit was that they were outpatient and quick procedures.  But now that we are discovering all the long term complications from meshes such as chronic pain, scarring, painful intercourse, vaginal extrusion of the meshes, and organ injury, patients have become VERY reluctant and fearful to undergo any mesh type surgery.    Therefore, we devised a new procedure that used a very small piece of the patient’s own tissue (from the rectus fascia) and placed this via the “transobturator route.”  In the process, we melded together the “best” of both worlds---a NON-mesh, outpatient anti-incontinence procedure that is safe (no long term problems as seen with meshes) . (more…)
Mayo Clinic, Urology / 20.05.2014

MedicalResearch.com Interview with: Sarah P. Psutka, MD Fellow in Urologic Oncology Department of Urology, Mayo Clinic MedicalResearch: What are the main findings of each study?  Dr. Psutka: In this study, we analyzed 1335 patients who underwent radical cystectomy at the Mayo clinic between 1996 and 2006. We categorized patients who stayed in the hospital longer than 10 days, putting them in the top 25th percentile of the length of stay, as having a prolonged hospital stay. We noted that prolonged hospital stay was associated with adverse postoperative outcomes, including serious complications and early postoperative death. Patients who had a prolonged length of stay had a higher burden of comorbidities, American Society of Anesthesiologist score, and their Eastern Cooperative Oncology Group Score. A multivariable analysis, holding these factors and other clinically relevant potential confounders constant, revealed that only the ECOG performance score independently predicted whether or not a patient had a prolonged hospital course following radical cystectomy. (more…)
General Medicine, Urology / 26.08.2013

MedicalResearch.com Interview with: Kirill Kosilov Far Eastern Federal University Department of Neurourology-Urodynamics, Primorsky Regional Diagnostic Center, Vladivostok, Russian Federation MedicalResearch.com What are the main findings of the study? Answer: Our study in a group of elderly patients showed that the combination of antimuscarinic drugs in a dosage which is higher than the usual recommended one is an effective treatment option for patients with OAB in those cases where treatment with one antimuscarinic drug was poorly effective. Side effects occurred almost equally in patients treated with only one antimuscarinic drug compared to the combined dosage. (more…)