PURPOSE:Computational fluid dynamics have paradigm shifting potential in understanding the physiological flow of fluids in the human body. This translational branch of engineering has already made an important clinical impact on the study of cardiovascular disease. We evaluated the feasibility and applicability of computational fluid dynamics to model urine flow. MATERIALS AND METHODS:We prepared a computational fluid dynamics model using an idealized male genitourinary system. We created 16 hypothetical urethral stricture scenarios as a test bed. Standard parameters of urine such as pressure, temperature and viscosity were applied as well as typical assumptions germane to fluid dynamic modeling. We used ABAQUS/CAE 6.14 (Dassault Systèmes®) with a direct unsymmetrical solver with standard (FC3D8) 3D brick 8Node elements for model generation. RESULTS:The average flow rate in urethral stricture disease as measured by our model was 5.97 ml per second (IQR 2.2-10.9). The model predicted a flow rate of 2.88 ml per second for a single 5Fr stricture in the mid bulbar urethra when assuming all other variables constant. The model demonstrated that increasing stricture diameter and bladder pressure strongly impacted urine flow while stricture location and length, and the sequence of multiple strictures had a weaker impact. CONCLUSIONS:We successfully created a computational fluid dynamics model of an idealized male urethra with varied types of urethral strictures. The resultant flow rates were consistent with the literature. The accuracy of modeling increasing bladder pressure should be improved by future iterations. This technology has vast research and clinical potential.

Skin grafting is a closure technique widely used in plastic surgery. Urologists may encounter patients with diseases that lead to severe tissue loss due to infection, trauma, burns, malignancy, skin maladies, or primary lymphedema. The development and study of skin harvesting techniques to manage tissue coverage of burns has allowed for great advances and the widening application of skin grafting. As such, there is a growing recognition and application of skin grafts within urology. The aim of surgical treatment and skin grafting within urology is to preserve genital function, improve quality of life, and restore cosmetic damage. In addition to basic technique, this article reviews specific surgical methods employed in reconstruction for patients with Fournier gangrene, buried penis, and hidradenitis suppurativa. Urologists must be aware of these techniques in order to provide adequate counseling for patients considering these operations and when encountering complications.

Objectives

To evaluate the landscape of retractions of literature and to determine the prevalence of research misconduct in the field of urology.

Methods

Three databases (PUBMED, Embase, Retraction Watch) were queried for all retracted studies on urological topics in both urological and non-urological journals from April 1999 to March 2018. Two reviewers screened the records and determined the final list of articles to be included in the analysis.

Results

A total of 138 articles met the inclusion criteria. Over 80% of retractions occurred after 2009. Retractions originated from 76 different journals (13 urological journals) and 28 countries. The most common reasons for retraction were plagiarism (28%), fake peer review (20%), error (20%), and falsification of data (13%). Misconduct accounted for two-thirds of the retractions (n = 93). A large watermark, indicating retraction of the article, was present in 75% of the manuscripts. Articles were cited a total of 4454 times, 38% of citations happened after retraction. The majority of retracted articles related to urological oncology (70%). The highest number of retractions for an individual author was five. Rates of retraction among popular urological journals since 2010 have increased but remain a small proportion of all publications: BJUI, 0.189%; World Journal of Urology, 0.132%; European Urology, 0.058%; Urology, 0.047%; and Journal of Urology, 0.024%.

Conclusion

Retractions of urological literature, similarly to retractions of other biomedical literature, have been rising over the last decade. The majority of these retractions stem from research misconduct. Despite retractions, flawed articles continued to be cited.

This study investigates trends of injury and hospital admission associated with electric scooter use.

This cross-sectional study identified characteristics of patients using an online crowdfunding platform for unmet financial obligations associated with cancer care.

Objective

To examine the most cited literature in urethral reconstruction, review types of work published, and observe research trends.

Methods

The Web of Sciences Sci-Expanded Index was used to conduct a search for urethral reconstruction. References were assessed for relevance to urethral reconstruction by 2 independent reviewers and a final list of the top 100 articles ranked by citation count was obtained. For each article, citation count, publication date, corresponding author, origin institution, origin country, topic area, study design, level of evidence, and origin journal were collected.

Results

The mean citation count per publication was 108 (median = 94.5; range = 69-366, SD = 43) with a total of 10,874 citations for all papers since 1970. The top 100 articles were published between 1973 and 2011, came from 19 different countries and 16 different journals. Nearly half were case series and most studies were Level III evidence or lower. The United States was the largest contributor to the top 100 with 56 publications, followed by Italy (14), England (12), and Egypt (7). "Outcomes of surgical treatment for urethral stricture disease" was the most prevalent topic area comprising 55 articles in the top 100, with most articles including descriptions or outcomes of novel surgical techniques.

Conclusion

In this study, we discovered that the most cited literature in the field of urethral reconstruction is singularly focused and lacking in high levels of evidence. The top 100 cited articles originate primarily from the United States, focus on short-term outcomes after surgical treatment for urethral stricture disease, and are predominantly case series.

We present a case of recurrent episodes of foreign body insertion into the urethra, ultimately resulting in urethral defect at the penoscrotal junction. We have decided against treating the urethral defect as it facilitates nonoperative retrieval of the urethral foreign bodies. We present our experience and rationale for the clinical management of this complex patient.

Objective

To describe the use of Lean in urology at Zuckerberg San Francisco General, a community safety-net and trauma hospital that serves as a major teaching site for the University of California San Francisco.

Methods

We examined our process improvement activities from 2016 to 2018. Our Lean Daily Management System (DMS) includes a 15-minute team huddle ("urology Lean work") of service residents, faculty, clinic and operating room nursing staff, and anesthesia liaisons. Our DMS also includes a 5-minute preoperative huddle. Besides team-building, urology Lean work surfaces logistics, safety or equipment improvement ideas, and ensures progress and completion of initiated projects.

Results

Over a 2-year period we developed and completed 67 projects. Projects impacted the outpatient setting (57%), followed by the operating room (22%), the Urology service (12%), and inpatient setting (9%). We completed projects in the following domains: safety (26%), quality (22%), care experience (21%), workforce care and development (13%), equity (11%), and financial stewardship (7%). Urology Lean work reduced new patient clinic access time (119-21 days) and Bacillus Calmette-Guérin in clinic treatment time (180-105 minutes). The average proportion of urology on-time surgeries was better than the overall surgery on-time surgeries (71% v 61%).

Conclusion

Urology Lean work successfully applied DMS in a service specific yet holistic approach. Urology Lean work improved resident engagement in quality and safety endeavors and served as a DMS model throughout perioperative and clinic areas.