Every urologist and oncologist should know about treating sexual and gender minority prostate cancer patients: translating research findings into clinical practice

In 2016, the NIH designated sexual and gender minorities (SGM) a health disparity population. The next year, the American Society of Clinical Oncology highlighted the need to improve the suboptimal cancer and survivorship care received by SGM populations. There are currently no evidence-based training programs in culturally competent care of prostate cancer patients who are gay, bisexual and/or transgender. In this selective review, we summarize findings from the largest quantitative studies focused on sexual minority prostate cancer survivors and from 65 interviews with NIH staff, clinicians, and cancer clinics in 11 US cities. The report is divided into three parts and uses a question and answer format to address 21 questions relevant to clinicians providing care to SGM prostate cancer patients. First, we identify population-specific issues that are culturally relevant in the care of SGM patients with prostate cancer. While a body of research has emerged on sexual minority prostate cancer patients, the literature on gender minorities is limited to single case reports and inadequate to inform practice. This review covers definitions, population size, cultural and historical context, sexual behavior, population invisibility, sexual orientation and gender identity (SOGI) in the electronic medical record, disparities and evidence of discrimination in treatment provision. The second part focuses on promoting evidence-informed, patient-centered care. This includes current practices in assessing sexual orientation, management of disclosure of sexual orientation, how to address common problems sexual minority men experience post-treatment, common questions sexual minority patients have, management of urinary incontinence, HIV and STI risk during and post-treatment, and sub-groups of sexual minority patients with worse outcomes. It then identifies how male partners differ in prostate cancer support, current research on rehabilitation for sexual minority men, issues in advanced prostate cancer, and things to avoid with minority patients. Finally, we examine the cultural divide between provider and patient, advocating for cultural humility when working with minority patients. Training programs and continuing education can help providers both to become more aware of their own cultural assumptions, informed about health disparities, and able to provide quality care, and to make clinics more welcoming to SGM patients.     

Child sexual abuse: what the urologist needs to know.

PURPOSE: We define what the urologist needs to know regarding child sexual abuse. MATERIALS AND METHODS: Based on our experience in treating numerous child victims of sexual assault and a review of the contemporary literature, the data concerning child sexual abuse incidence, risk factors, clinical presentation, child interview, physical examination and management were analyzed. RESULTS: It is estimated that at least 1 in 4 girls and 1 in 10 boys will suffer victimization by age 18 years. There are no predicting socioeconomic factors. In legally proved cases of child sexual abuse the majority of victims have no diagnostic physical findings. Examination findings change depending on the position of the child, degree of relaxation, amount of labial traction and time to perform the evaluation. Findings that are consistent but not independently diagnostic of abuse include chafing, abrasions or bruising of inner thighs or genitalia, scarring, tears or distortion of the hymen, a decreased amount of or absent hymenal tissue, scarring of the fossa navicularis, injury to or scarring of the posterior fourchette/posterior commissure and scarring or tears of the labia minora. In all 50 states physicians are mandated by law to report to child protection services whenever they suspect that a child has been sexually abused. CONCLUSIONS: The urologist must routinely examine the anogenital area of children during routine urethral evaluation and include child sexual abuse as part of the routine urological history.     

Smallpox: what the dermatologist should know

Despite the eradication of naturally occurring smallpox in 1977, stores of the virus have been maintained in laboratories in the United States and Russia. It is feared that certain rogue states and terrorist organizations may have illicitly acquired the virus with the intent of unleashing it as an agent of bioterrorism. The United States and other nations have begun vaccinating individuals in the military and health care workers who might become exposed. Primary care providers and dermatologists will be called upon to evaluate potential index cases and vaccination reactions. In this report, the authors review the essential clinical aspects of smallpox and potential reactions to smallpox vaccination. Special attention is given to eczema vaccinatum, which can occur in vaccinees and their family contacts with active or quiescent atopic dermatitis or a personal history of eczema.     

Pathologic features the urologist should expect on a prostate biopsy

In recent years, the pathological evaluation of prostate biopsy specimens has made great improvements in diagnostic accuracy and comprehensiveness. In this article, we review major pathological findings on prostate biopsy, their interpretation and reporting, as well as their clinical significance and utility. We discuss especially the clinically relevant histological features in either a positive or negative biopsy. We emphasize that both Gleason score and extent of cancer involvement in a needle core biopsy are important predictors of clinical outcome after either radical prostatectomy or radiation. Special issues regarding diagnosis and grading of minimal cancer on needle core biopsies are discussed. We also highlight the current standards on high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on needle core biopsies. In summary, the pathology reports on needle biopsies are far beyond the simple presence or absence of cancer; they contain invaluable information to clinicians on patient management and counseling.     

Smallpox: what every otolaryngologist should know.

OBJECTIVE: In light of recent terrorist events and the potential threat of smallpox as a biological agent, we present information concerning smallpox to better inform the otolaryngologist concerning this disease and its prevention. STUDY DESIGN: We performed a review of the smallpox and smallpox vaccination literature over the past 200 years using MEDLINE, PREMEDLINE, Centers for Disease Control and Prevention Internet site, World Health Organization Internet site, and references found in previous publications not found in MEDLINE or PREMEDLINE. Our search focused on the pathogenesis, clinical presentation, course, unique manifestations in the head and neck, diagnosis, and treatment of smallpox, as well as the method of smallpox vaccination, vaccination contraindications, and complications. RESULTS: Smallpox is a viral disease with a high mortality rate. Its clinical course, manifestations, and methods of prevention are carefully analyzed in light of otolaryngology practice. CONCLUSION: Smallpox manifestations in the head and neck often presented as acute airway obstruction and also as long-term sequelae such as ectropion, nasal vestibular stenosis, conductive hearing loss, and blindness. Most chronic sequelae involve the head and neck. Smallpox vaccination is effective but not without potential serious risks.     

Contemporary outcomes of focal therapy in prostate cancer: what do we know so far…

Introduction  

Despite the enthusiasm for an organ preserving approach to prostate cancer treatment, studies that support the supposition that this approach will offer patients the “Trifecta” of prostate cancer therapy are lacking.     

What the urologist should know about the female infertility evaluation

As childbirth is delayed and divorce rates remain high, urologists will continue to see more and more infertile couples. It is imperative that urologists understand at least the basic aspects of the female evaluation. Fundamental information can be obtained from a simple, directed history. Risk factors for female infertility can be identified in a matter of minutes, and the reproductive endocrinologist can then carry out a complete female evaluation simultaneously with the male evaluation. Most female infertility problems can be classified as ovulatory, anatomic, or cervical. Signs of decreasing ovarian reserve with age can be ascertained easily with a history and perhaps the determination of a day-3 serum FSH level. Finally, a basic understanding of the female evaluation allows meaningful discourse between the urologist and the reproductive endocrinologist, leading to a more effective treatment plan for the infertile couple.     

Chronic prostatitis: what we know,what we do not know,and what we should do!

Chronic prostatitis is a major health problem in men. This review details the various types of prostatitis, discusses the possible aetiologies and potential pathogens. In addition, the symptoms and therapies are outlined. Those individuals affected by prostatitis suffer from a markedly reduced quality of life with, in many cases, only a limited benefit from treatment. Many questions remain unanswered, and more research is required in this significant disease.     

Pay for performance: what the urogynecologist should know

As urogynecologists, we should educate ourselves about pay for performance and be proactive in the development of outcome measures.     

Errors in laparoscopic surgery: what surgeons should know

Some two decades after its introduction, minimal access surgery (MAS) is still evolving. Undoubtedly, its significant uptake world wide is due to its clinical benefits to patient outcome. These benefits include reduced traumatic insult, reduction of pain, earlier return to bowel function, decrease disability, shorter hospitalization and better cosmetic results. Nonetheless complications due to the laparoscopic approach are not rare as documented by several studies on task specific or procedure related MAS morbidity. In all these instances, error analysis research has demonstrated that an understanding of the underlying causes of these complications requires a comprehensive approach addressing the entire system related to the procedure for identification and characterization of the errors ultimately responsible for the morbidity. The present review covers definition, taxonomy and incidence of errors in medicine with special reference to MAS. In addition, possible root causes of adverse events in laparoscopy are explored and existing methods to study errors are reviewed. Finally specific areas requiring further human factors research to enhance safety of patients undergoing laparoscopic operations are identified. The hope is that awareness of causes and mechanisms of errors may reduce incidence of errors in clinical practice for the final benefit of the patients.