Several types of contraception methods exist, and among these are hormonal and non-hormonal intrauterine devices (IUDs). Cases have been reported of fractured IUD pieces and retention of copper fragments upon attempted removal in office. These findings suggest the importance of careful removal of an IUD by providers. A 38-year-old Caucasian woman, gravida 2, para 2, presented for a colposcopy and endometrial biopsy (EMB). She had had a copper IUD (ParaGard) placed 10 years prior. She now requested to have it removed. After completion of the colposcopy and EMB, the provider located the IUD strings for removal. During careful removal of the IUD, a piece was broken off and remained in the uterine cavity. Upon visual inspection of the removed IUD, the right wing was missing and presumed to be still in the patient. Transabdominal and transvaginal ultrasound (TVUS) confirmed presence of a portion of the IUD in the uterine wall near the cervix. The patient was scheduled for surgical removal of the IUD by robot-assisted total laparoscopic hysterectomy with bilateral salpingectomy. This case highlights the importance of thorough evaluation of an IUD upon removal. Practitioners who work with IUD insertion and removal should remain informed about this rare complication. Risk of fracture during IUD removal should be better communicated between physicians and patients. This case study underlines the importance of careful IUD planning, from insertion to removal. Further research considering improved stepwise removal should be considered.

Mpox is a zoonotic viral disease transmitted by close contact with infected individuals, contacting or eating infected animals, and now, sexual contact. The main treatment option for infected individuals is supportive care as no FDA-approved treatment exists. A 33-year-old male with HIV who contracted Mpox who developed a large painful genital ulcer with overlying eschar. He required surgical debridement of the penile ulcer followed by scrotoplasty. While local wound care plus antibiotics may be effective at managing some genital lesions, Urologists should consider surgical debridement with delayed reconstruction for progressive, non-healing wounds in these individuals.

An estimated one third of American adults have prediabetes; over 30 million have type 2 diabetes mellitus. Health and wellness coaching is an emerging tool for preventing and treating chronic disease. Mastering Diabetes (MD) promotes a low-fat, plant-based, whole-food diet, utilizing online education, day-to-day accountability and support, and video conferencing. This pilot study provides a retrospective view of the effectiveness of MD to treat diabetes. Current and former clients of MD were invited to participate in a survey. On completion of the online consent, subjects were asked a series of questions in a REDCap-based survey: age, gender, enrollment date in MD, changes in weight, HbA1c, medication use, overall health, and current level of adherence to achieved changes. Overall, 253 (8.9%) participants responded to the survey; 80.6% were females, mean age was 56 years. Most of those responding (78.4%, P < .001) reported weight loss; 68.8% (P < .001) reported decreased HbA1c; 52.4% reported decreased medication use; 86.8% reported continued health improvement since having participated in MD; and 83.5% found the online program very helpful. This study demonstrated improvement in HbA1c and weight in participants in an online health and wellness coaching. Study limitations prevent drawing generalizable conclusions; further prospective evaluation is needed.

Urothelial carcinoma is the fourth most common solid organ malignancy. Rare cases arise from the upper urinary tract. A 78-year-old male presents with a chief complaint of hematuria, burning, urinary incontinence, and passing clots. The patient appeared to have a partial duplication of the left ureter. During the ureteroscopy, a mass was seen at the bifurcation of the partially duplicated left ureter. The mass in the ureter was classified as a T1 upper tract urothelial carcinoma. Minimally invasive endoscopic approaches were chosen to manage the patient and he presented to the operating room for laser ablation of the UTUC.

BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations. Complications surrounding Foley catheterizations represent a significant burden to the healthcare system. AIM To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals. METHODS This is a single-institution, multi-hospital, 263 patient, retrospective chart review from Jan 2020–December 2023. RESULTS The majority of consultations (80.2%) did not require heroic measures by the urology service. A Foley catheter placement was determined not difficult in the majority 191 (72.6%) of patients. Sub-group analysis of “difficult by urology” vs “not difficult by urology”, showed a significant difference between those with zero attempts, one attempt, and greater than one attempts (P = 0.004). Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment (60.6%) compared to not difficult (38.6%). Likewise, those patients with a history of difficult urethral catheter (DUC)/traumatic urethral catheterization (TUC) (25.8%) were more likely to be difficult compared to those without a history of DUC/TUC (14.2%) (P = 0.038). CONCLUSION The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter. Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment. At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs. For example, this protocol would ideally address complications of multiple catheter attempts such as urethral trauma, development of urethral strictures, and infection risk. Additionally, future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.

Bladder cancer is the fourth most common malignancy in men and ninth most in woman. Most bladder cancers are urothelial, and the neuroendocrine sub-types make up 0.5–1.0% of cases. Here we present a 70-year-old female with poorly differentiated small cell carcinoma of the bladder who complains of an extensive history of gross hematuria. She was started on a neoadjuvant chemotherapy regimen of 21-day Etoposide with Carboplatin and radical cystectomy. More work needs to be done when it comes to the best treatment method for this rare cohort of patients.