Research Spotlight

Kelling, J. A., C. R. Erickson, J. Pin and P. G. Pin (2020). “Anatomical Dissection of the Dorsal Nerve of the Clitoris.” Aesthet Surg J 40(5): 541-547.

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BACKGROUND: The clitoris is the primary somatosensory organ of female sexual response. Knowledge of its neural anatomy and related landmarks is essential for safe genital surgery. OBJECTIVES: The aim of this study was to describe the distal course of the dorsal nerves of the clitoris and associated structures. METHODS: Clitorises of 10 fresh cadavers were dissected. Measurements of the dorsal nerves, suspensory ligament, clitoral body, clitoral hood, and clitoral glans were obtained. The course of the dorsal nerves was examined. RESULTS: The dorsal nerves of the clitoris were larger than expected, ranging from 2.0 to 3.2 mm in diameter, on average, along their course in the clitoral body. In 9 of 10 specimens, the dorsal nerves could be traced to within 6 mm of the glans. They traveled deep to a superficial clitoral fascia but superficial to the tunica albuginea, were variably located between 10 and 2 o’clock, and were separated by the deep suspensory ligament (DSL) of the clitoris. The mean length of the descending clitoral body, from the angle to the base of the glans, was 37.0 mm. The mean distance from the pubic rim to the DSL was 37.7 mm. CONCLUSIONS: The clitoral body is substantial in length, mostly lying superficially under the clitoral hood and mons pubis. The dorsal nerves of the clitoris are large and superficial, terminating at or near the base of the clitoral glans. Knowledge of this anatomy is critical prior to performing surgery near the clitoris.

Kazory, A., C. Ronco and P. A. McCullough (2020). “SARS-CoV-2 (COVID-19) and intravascular volume management strategies in the critically ill.” Proc (Bayl Univ Med Cent) 0(0): 1-6.

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread across the globe, and millions of people may be affected. While knowledge regarding epidemiologic features and diagnostic tools of coronavirus disease 2019 (COVID-19) is rapidly evolving, uncertainties surrounding various aspects of its optimal management strategies persist. A subset of these patients develop a more severe form of the disease characterized by expanding pulmonary lesions, sepsis, acute respiratory distress syndrome, and respiratory failure. Due to lack of data on treatment strategies specific to this subset of patients, currently available evidence on management of the critically ill needs to be extrapolated and customized to their clinical needs. The article calls attention to fluid stewardship in the critically ill with COVID-19 by judiciously applying the evidence-based resuscitation principles to their specific clinical features such as high rates of cardiac injury. As we await more data from treating these patients, this strategy is likely to help reduce potential complications.

Holmes, D. R., Jr. and M. Mack (2020). “The Truly Functional Heart Team: The Devil Is in the Details.” J Am Heart Assoc 9(8): e05035.

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The multidisciplinary team concept for the management of patients with cardiovascular diseases is now well ingrained into the culture of most hospitals and healthcare systems.1, 2, 3, 4, 5, 6, 7, 8 Despite the lack of a robust evidence base demonstrating benefit, the heart team for clinical decision making is a Class I Recommendation in both the US and European guidelines albeit Level of Evidence C.7, 9, 10 Too frequently, however, in practice, the heart team is more virtual than real or worse, it is a perfunctory “check box” at some centers. An ever‐increasing variety of publications relating and attesting to the positives of the heart team while describing the potential nuances, fail to serve as a template for its actual implementation.11, 12, 13 So how then does a center put into practice the concepts of a true heart team approach and demonstrate better patient care? (Excerpt from text; no abstract available.)

Hogan, J. J., J. G. Owen, S. J. Blady, S. Almaani, R. S. Avasare, S. Bansal, O. Lenz, R. L. Luciano, S. V. Parikh, M. J. Ross, D. Sharma, H. Szerlip, S. Wadhwani, R. R. Townsend, M. B. Palmer, K. Susztak and A. K. Mottl (2020). “The Feasibility and Safety of Obtaining Research Kidney Biopsy Cores in Patients with Diabetes: An Interim Analysis of the TRIDENT Study.” Clin J Am Soc Nephrol Apr 27. pii: CJN.13061019. [Epub ahead of print].

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Diabetic kidney disease (DKD) accounts for nearly half of all CKD in the United States. The diagnosis of DKD is usually made clinically, on the basis of longstanding (>5 years) diabetes or concurrent microvascular complications, and the presence of albuminuria and/or decreased eGFR. The heterogeneity of DKD and predominant study of blood and urine rather than direct analysis of kidney tissue are both barriers to identifying biomarkers and novel therapeutic targets for progressive disease. Data are lacking regarding the feasibility and safety of obtaining research kidney biopsy cores. To address this issue, we present an interim analysis of the Transforming Research in Diabetic Nephropathy (TRIDENT) study (Clinicaltrials.gov identifier: NCT02986984), a multicenter, longitudinal, observational cohort study of adults with diabetes undergoing clinically indicated kidney biopsies and consenting to an additional research biopsy core (1). (Excerpt from text; no abstract available.)

High, R., Y. Zhang, S. Virani, K. Eggleston, T. J. Kuehl, E. T. Bird and J. M. Danford (2020). “Pilot Trial of Midstream Urine Collection Device Versus Transurethral Catheter in Women With Lower Urinary Tract Symptoms: Practicality of Use in a Clinical Setting, Patient Preferences, and Comparison of Laboratory Findings.” Female Pelvic Med Reconstr Surg Apr 6. [Epub ahead of print].

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OBJECTIVES: This study aimed to evaluate successful use of a midstream urine collection device in women with lower urinary tract symptoms and to assess specimen contamination. METHODS: Nonpregnant women 18 years or older without use of antibiotics in the last 4 weeks were recruited. After using the midstream urine collection device to obtain a specimen in a private restroom, a paired specimen was obtained by transurethral catheterization. Patients completed preference questionnaires. Culture organisms and microscopic urinalysis of paired specimens (device vs catheterized) were compared using the McNemar chi test. Bivariate analysis was performed. RESULTS: Successful use was demonstrated in 54 (77%) of 70. Reasons for failure included inadequate specimen volume and improper device use. Older median age (50 vs 72 years, P = 0.0003) and history of diabetes (7% vs 27%, P = 0.037) were associated with failed use. Organisms were discordant in 21 (41%) of 51 paired urine culture specimens. The device detected 7 (88%) of 8 uropathogens. There were no detectable differences in microscopic urinalysis. CONCLUSIONS: The midstream urine collection device could increase comfort, and many patients prefer it to transurethral catheterization. With proper patient selection and instructions for use, this device could increase satisfaction. Further studies are needed to assess contamination rates with this device.