Purpose As part of the RICE study, we previously developed validated case definitions to identify interstitial cystitis/bladder pain syndrome (IC/BPS) in women and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men. Using population-based screening methods, we applied these case definitions to determine the prevalence of these conditions in men. Materials and Methods A total of 6,072 households were contacted by phone to screen for men who had symptoms of IC/BPS or CP/CPPS. An initial 296 men screened positive, of which 149 met the inclusionary criteria and completed the telephone interview. For IC/BPS, two case definitions were applied (one with high sensitivity and one with high specificity), while for CP/CPPS, a single case definition (with both high sensitivity and specificity) was used. These case definitions were used to classify subjects into groups based on diagnosis. Results The IC/BPS weighted prevalence estimate for the high sensitivity and specificity definition was 4.2% (3.1-5.3%), and 1.9% (1.1-2.7%), respectively. The CP/CPPS weighted prevalence estimate was 1.8% (0.9-2.7%). These values equate to 1,986,972 (95% CI 966,042- 2,996,924) men with CP/CPPS and to 2,107,727 (95% CI 1,240,485 – 2,974,969) men with the high specificity definition of IC/BPS in the U.S.. The overlap between men who met either the high specificity IC/BPS case definition or the CP/CPPS case definition was 17%. Conclusions Symptoms of IC/BPS and CP/CPPS are widespread among men in the US.. The prevalence of IC/BPS symptoms in men approaches that in women, suggesting that this condition may be underdiagnosed and undertreated in the male population.

Objectives To evaluate the association of frailty, a measure of diminished physiologic reserve, with both major and minor surgical complications among patients undergoing urologic surgery. Materials and Methods Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2007 to 2013, we identified all urologic cases that appeared more than 1000 times in the dataset among patients age 40 and older. Frailty was measured using the NSQIP Frailly Index (FI), a validated measure that includes 11 impairments such as decreased functional status and impaired sensorium. We created multivariable logistic regression models using the NSQIP Frailty Index to assess major and minor complications after surgery. Results We identified 95,108 urologic cases representing 21 urologic procedures. The average frequency of complications per individual was 11.7%, with the most common complications being hospital readmission (6.2%), blood transfusion (4.6%), and urinary tract infection (3.1%). Major and minor complications increased with increasing NSQIP-FI. Frailly remained strongly associated with complications after adjustment for year, age, race, smoking status, and method of anesthesia [adjusted OR 1.74 (95% CI 1.64, 1.85) NSQIP-FI 0.18+]. Increasing NSQIP-FI was associated with increasing frequency of complications within age groups (by decade) up to age 81 and across most procedures. Conclusion Frailty strongly correlates with risk of post-operative complications among patients undergoing urologic surgery. This finding is true within most age groups and across most urologic procedures.

Mammary epithelial regeneration implies the existence of cellular progenitors with retained replicative capacity, prolonged lifespan and developmental potency. Evidence exists that DN-p63 isoforms preserve these features by modulating p53 activity in basal epithelia. DN-p63 mRNA levels decline at the onset of differentiation suggesting that its transcriptional regulation may contribute to the initiation of differentiation. To study transcriptional regulation of DN-p63, a 10.3 kbp fragment containing the DN-p63 promoter was isolated. We report here that DN-p63 is a positive and negative transcriptional target of p53 and DN-p63-a, respectively. Disruption of p53 activity or expression abolishes the expression of DN-p63-a. This regulation is mediated by a p53-binding element sufficient to confer these activities to a heterologous promoter. Chromatin immune-precipitation indicates that, in asynchronously growing cells, p53 occupies this element. In response to DNA damage, DN-p63-a is recruited to this element as transcription of DN-p63 declines. Disruption of DN-p63-a expression had differential effects on the transcriptional regulation of several p53-target genes. These findings indicate that p53 contributes to the preservation of basal epithelia by driving the expression of DN-p63 isoforms. These studies also suggest that in response to genotoxic stress, DN-p63-a mediates the silencing of its own promoter thereby altering the pattern of p53-target gene expression.

Defining and categorizing nonneurogenic chronic urinary retention, creating a treatment algorithm and proposing treatment end points will hopefully spur comparative research that will ultimately lead to a better understanding of this challenging condition.

Objective To determine the incidence and characteristics of women with uncomplicated recurrent UTIs and to explore whether the use of culture-driven treatment affects rates of UTI-related complications and resource utilization. Methods Using MarketScan claims from 2003 to 2011, we identified UTI naive women ages 18–64 with incident uncomplicated recurrent UTIs. Recurrent UTIs were defined as 3 UTI visits associated with antibiotics during a 12-month period. Cases were excluded if they had a UTI in the preceding year, or if they had any complicating factors (e.g. abnormality of the urinary tract, neurologic condition, pregnancy, diabetes, or currently taking immunosuppression). We next assessed use of urine cultures, imaging, and cystoscopy and performed propensity score matching with logistic regression to determine whether having a urine culture associated with >50% of UTIs affected rates of complications and downstream resource utilization. Results We identified 48,283 women with incident uncomplicated recurrent UTIs, accounting for an overall incidence of 102 per 100,000 women, highest among women ages 18–34 and 55–64. 61% of these women had at least 1 urine culture, 6.9% had imaging, and 2.8% had cystoscopy. Having a urine culture >50% of the time was associated with fewer UTI-related hospitalizations and lower rates of IV antibiotic use, while demonstrating higher rates of UTI-related office visits and pyelonephritis. Conclusions The incidence of uncomplicated recurrent UTIs increases with age. Urine culture directed care is beneficial in reducing high cost services including UTI related hospitalizations and IV antibiotic use, making them a valuable component to management of these patients.