Hillary L Copp

University of California, San Francisco, San Francisco, California, United States

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Publications (38)134.51 Total impact

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    ABSTRACT: Introduction: Congenital ventral penile curvature without hypospadias is often treated surgically in childhood. The history of untreated ventral curvature is unknown. Objective: This study's aim was to examine the association of untreated ventral penile curvature with various sexual and psychosexual outcomes. Study design: An electronic survey was advertised to men older than 18 years on Facebook. Men with possible ventral penile curvature identified themselves by choosing sketches that most closely represented their anatomy. Outcomes assessed included: Sexual Health Inventory for Men, difficulty of intercourse because of curvature, International Prostate Symptom Score, Penile Perception Score, psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. Results: Among participants, 81 out of 684 men (11.8%) reported untreated ventral penile curvature. Participants with self-reported curvature noted more difficulty with intercourse because of curvature (4.5 vs 4.9, p<0.001), more unhealthy mental days (8.6 vs 6.2, p=0.02), and increased dissatisfaction with penile self-perception compared with men without reported curvature (8.6 vs 9.5, p<0.001). Discussion: Men with possible untreated ventral curvature reported worse penile perception scores, more mentally unhealthy days, and increased difficulty with intercourse secondary to curvature compared with men without curvature. A limitation to this study is selection bias; responses collected were self-reported from survey volunteers. Additionally, the question identifying ventral penile curvature is not validated but performed well in pretesting. Most questions were from validated surveys, but some were modeled after validated surveys and/or contained high face validity types of questions. Conclusion: Men with possible untreated ventral penile curvature reported more dissatisfaction with penile appearance, increased difficulty with intercourse, and more unhealthy mental days. Given high success rates, low complications, and improved outcomes after surgical correction of penile curvature reported in the literature, our results support correction of congenital penile curvature in childhood.TableAssociation of outcomes with possible untreated ventral curvature.No ventral curvature (N=598)Self-reported ventral curvature (N=81) p-Value a Penile perception overall score9.5 (2.0)8.6 (2.3)<0.001CDC HRQOL-46.2 (9.3)8.6 (10.6)0.02 Mean number of mentally unhealthy daysPenile curvature b 1.6 (0.5)3.2 (0.6)<0.001Difficulty of intercourse secondary to penile curvature c 4.9 (0.6)4.5 (0.7)<0.001Data presented as mean (standard deviation).aContinuous outcomes compared by Student's t test, ordinal by Wilcoxon rank sum test, dichotomous by chi-square or Fisher's Exact test.bHigher number corresponds to more ventral curvature.c1=did not attempt intercourse; 2=extremely difficult; 3=very difficult; 4=difficult; 5=slightly difficult; 6=not difficult. .
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    Rachel Sharon Selekman · Daniel J. Shapiro · Hillary L. Copp ·

    The Journal of Urology 04/2015; 193(4):e668. DOI:10.1016/j.juro.2015.02.2032 · 4.47 Impact Factor
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    Rachel Sharon Selekman · Hillary L Copp ·

    The Journal of Urology 04/2015; 193(4):e669. DOI:10.1016/j.juro.2015.02.2035 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e670. DOI:10.1016/j.juro.2015.02.2036 · 4.47 Impact Factor
  • Sisir Botta · Hillary L. Copp ·

    The Journal of Urology 06/2014; 192(3). DOI:10.1016/j.juro.2014.06.062 · 4.47 Impact Factor
  • Kara N. Saperston · Daniel J. Shapiro · Adam L. Hersh · Hillary L. Copp ·
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    ABSTRACT: Purpose Prior single center studies showed that antibiotic resistance patterns differ between outpatients and inpatients. We compared antibiotic resistance patterns for urinary tract infection between outpatients and inpatients on a national level. Materials and Methods We examined outpatient and inpatient urinary isolates from children younger than 18 years using The Surveillance Network (Eurofins Scientific, Luxembourg, Luxembourg), a database of antibiotic susceptibility results, as well as patient demographic data from 195 American hospitals. We determined the prevalence and antibiotic resistance patterns of the 6 most common uropathogens, including Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence and resistance patterns for outpatient and inpatient isolates using chi-square analysis. Results We identified 25,418 outpatient (86% female) and 5,560 inpatient (63% female) urinary isolates. Escherichia coli was the most common uropathogen overall but its prevalence varied by gender and visit setting, that is 79% of uropathogens overall for outpatient isolates, including 83% of females and 50% of males, compared to 54% for overall inpatient isolates, including 64% of females and 37% of males (p <0.001). Uropathogen resistance to many antibiotics was lower in the outpatient vs inpatient setting, including trimethoprim/sulfamethoxazole 24% vs 30% and cephalothin 16% vs 22% for E. coli (each p <0.001), cephalothin 7% vs 14% for Klebsiella (p = 0.03), ceftriaxone 12% vs 24% and ceftazidime 15% vs 33% for Enterobacter (each p <0.001), and ampicillin 3% vs 13% and ciprofloxacin 5% vs 12% for Enterococcus (each p <0.001). Conclusions Uropathogen resistance rates of several antibiotics are higher for urinary specimens obtained from inpatients vs outpatients. Separate outpatient vs inpatient based antibiograms can aid in empirical prescribing for pediatric urinary tract infections.
    The Journal of urology 05/2014; 189(4). DOI:10.1016/j.juro.2013.10.064 · 4.47 Impact Factor

  • The Journal of Urology 04/2014; 191(4):e443. DOI:10.1016/j.juro.2014.02.1377 · 4.47 Impact Factor
  • Rachel S Edlin · Hillary L Copp ·
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    ABSTRACT: Antibiotics are a mainstay in the treatment of bacterial infections, though their use is a primary risk factor for the development of antibiotic resistance. Antibiotic resistance is a growing problem in pediatric urology as demonstrated by increased uropathogen resistance. Lack of urine testing, nonselective use of prophylaxis, and poor empiric prescribing practices exacerbate this problem. This article reviews antibiotic utilization in pediatric urology with emphasis on modifiable practice patterns to potentially help mitigate the growing rates of antibiotic resistance. This includes urine testing to only treat when indicated and tailor broad-spectrum therapy as able; selective application of antibiotic prophylaxis to patients with high-grade vesicoureteral reflux and hydronephrosis with counseling regarding the importance of compliance; and using local antiobiograms, particularly pediatric-specific antiobiograms, with inpatient versus outpatient data.
    Therapeutic Advances in Urology 04/2014; 6(2):54-61. DOI:10.1177/1756287213511508
  • Bruce J. Schlomer · Hillary L. Copp ·
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    ABSTRACT: Objective Augmentation cystoplasty (AC) is a major surgery that can be associated with long-term morbidity. This study aimed to describe the cumulative incidence of outcomes and urologic procedures in a large cohort of children who underwent AC, identify significant sources of morbidity, and to evaluate baseline factors associated with outcomes of interest. Methods Children ≤18 years who underwent AC in the Pediatric Health Information System from 1999 to 2010 were included. All follow-up encounters up to June 2012 were included. Cumulative incidences for 15 outcomes and urologic procedures were calculated using non-informative censoring. Sensitivity analyses were performed to determine effect of censoring assumptions and including hospitals without complete datasets. As an exploratory analysis, baseline patient factors were evaluated for associations with outcomes and urologic procedures of interest using multivariable Cox proportional hazards models adjusted for clustering by hospital. Results 2831 AC patients were identified. Based on cumulative incidence calculations and sensitivity analyses; the cumulative incidence ranges of outcomes and procedures at 1, 3, 5, and 10 years were calculated. Examples of 10-year cumulative incidence ranges are given for the following outcomes and procedures: bladder rupture (2.9–6.4%), small bowel obstruction (5.2–10.3%), bladder stones (13.3–36.0%), pyelonephritis (16.1–37.1%), cystolithopaxy (13.3–35.1%), and reaugmentation (5.2–13.4%). The development of chronic kidney disease was strongly associated with a diagnosis of lower urinary tract obstruction (HR 13.7; 95% CI 9.4–19.9). Bladder neck surgery and stoma creation at time of AC were associated with an increased hazard of bladder rupture (HR 1.9; 95% CI 1.1–3.3) and bladder stones (HR 1.4; 95% CI 1.1–1.8) respectively. Conclusions Outcomes of interest and urologic procedures after AC are common. Results from this large cohort can be used to counsel patients and families about expectations after AC. Pyelonephritis, chronic kidney disease, further reconstructive surgery, and calculus disease appear to cause significant morbidity. Collaborative efforts are needed to further reduce morbidity in this patient population.
    Journal of pediatric urology 04/2014; 10(6). DOI:10.1016/j.jpurol.2014.03.007 · 0.90 Impact Factor
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    ABSTRACT: Objective Hypospadias is usually treated in childhood. Therefore, the natural history of untreated mild hypospadias is unknown. We hypothesized that men with untreated hypospadias, especially mild, do not have adverse outcomes. Materials Facebook was used to advertise an electronic survey to men older than 18 years. Men with untreated hypospadias identified themselves and indicated the severity of hypospadias with a series of questions. Outcomes included: Sexual Health Inventory for Men (SHIM), penile curvature and difficulty with intercourse, International Prostate Symptom Score (IPSS), Penile Perception Score (PPS), psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. Results 736 men completed self-anatomy questions and 52 (7.1%) self-identified with untreated hypospadias. Untreated hypospadias participants reported worse SHIM (p<0.001) and IPSS scores (p=0.05), more ventral penile curvature (p=0.003) and resulting difficulty with intercourse (p<0.001), worse satisfaction with meatus (p=0.011) and penile curvature (p=0.048), and more sitting to urinate (p=0.07). When stratified by mild and severe hypospadias, severe hypospadias was associated with more adverse outcomes than mild hypospadias. Conclusion Men with untreated hypospadias reported worse outcomes compared with non-hypospadiac men. Mild untreated hypospadias had fewer adverse outcomes than severe hypospadias. Research is needed to determine if treatment of childhood hypospadias improves outcomes in adults, especially for mild hypospadias.
    Journal of pediatric urology 02/2014; 10(4). DOI:10.1016/j.jpurol.2014.01.024 · 0.90 Impact Factor
  • B. J. Schlomer · H. L. Copp ·
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    ABSTRACT: Antenatal hydronephrosis (ANH) is a common finding on prenatal ultrasound that can be a sign of a variety of urologic conditions.Most cases of ANH are mild to moderate with the most common cause being transient physiologic dilation, which usually is of no clinical significance. However, there are some infants who have a history of ANH (usually severe) who are at increased risk for febrile urinary tract infections, undergo surgical intervention, and develop chronic kidney disease. It is useful to have an understanding of the possible urologic diagnoses that can lead to ANH and it is critical to recognize the patients who have ANH who require urgent or semiurgent evaluation soon after birth by a pediatric urologist and nephrologist. In addition, it is important to select appropriate postnatal imaging studies and to follow-up based on the clinical scenario and to prescribe prophylactic antibiotics to those patients most likely to benefit. © 2013 by the American Academy of Pediatrics. All rights reserved.
    NeoReviews 11/2013; 14(11):e551-e561. DOI:10.1542/neo.14-11-e551
  • Bruce J Schlomer · Hillary L Copp ·
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    ABSTRACT: Secondary data analysis is the use of data collected by someone other than the investigator for research. In the last several years there has been a dramatic increase in the number of these studies being published in urologic journals and presented at urologic meetings, especially of secondary data analysis of large administrative datasets. Along with this expansion, skepticism for secondary data analysis studies has increased for many urologists. In this narrative review we discuss the types of large datasets that are commonly used for secondary data analysis in urology and discuss the advantages and disadvantages of secondary data analysis. A literature search was performed to identify urologic secondary data analysis studies published since 2008 using commonly used large datasets and examples of high quality studies published in high impact journals are given. We outline an approach for performing a successful hypothesis or goal driven secondary data analysis study and highlight common errors to avoid. Over 350 secondary data analysis studies using large datasets have been published on urologic topics since 2008 with likely many more studies presented at meetings but never published. Non-hypothesis or goal driven studies have likely constituted some of these studies and have probably contributed to increased skepticism of this type of research. However, many high quality hypothesis driven studies addressing research questions that would have been difficult to study with other methods have been performed in the last few years. Secondary data analysis is a very powerful tool that can address questions which could not be adequately studied by another method. Knowledge of limitations of secondary data analysis and of the datasets used is critical for a successful study. There are also important errors to avoid when planning and performing a secondary data analysis study. Investigators and the urologic community need to strive to use secondary data analysis of large datasets appropriately to produce high quality studies that hopefully lead to improved patient outcomes.
    The Journal of urology 10/2013; 191(3). DOI:10.1016/j.juro.2013.09.091 · 4.47 Impact Factor
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    ABSTRACT: Objective: To characterize urine test use in ambulatory, antibiotic-treated pediatric urinary tract infection (UTI). Methods: We studied children <18 years who had an outpatient UTI and a temporally associated antibiotic prescription from 2002 through 2007 by using a large claims database, Innovus i3. We evaluated urine-testing trends and performed multivariable logistic regression to assess for factors associated with urine culture use. Results: Of 40 603 treated UTI episodes in 28 678 children, urinalysis was performed in 76%, and urine culture in 57%; 32% of children <2 years had no urinalysis or culture performed for an antibiotic-treated UTI episode. Urine culture use decreased during the study period from 60% to 54% (P < .001). We observed variation in urine culture use with age (<2 years: odds ratio [OR] 1.0, 95% confidence interval [CI] 0.9-1.1; 2-5 years: OR 1.3, 95% CI 1.2-1.4; 6-12 years: OR 1.3, 95% CI 1.2-1.4, compared with 13-17 years); gender (boys: OR 0.8, 95% CI 0.8-0.9); and specialty (pediatrics: OR 2.6, 95% CI 2.5-2.8; emergency medicine, OR 1.2, 95% CI 1.1-1.3; urology: OR 0.5, 95% CI 0.4-0.6, compared with family/internal medicine). Recent antibiotic exposure (OR 1.1, 95% CI 1.1-1.2) and empirical broad-spectrum prescription (OR 1.2, 95% CI 1.1-1.2) were associated with urine culture use, whereas previous UTI and urologic anomalies were not. Conclusions: Providers often do not obtain urine tests when prescribing antibiotics for outpatient pediatric UTI. Variation in urine culture use was observed based on age, gender, and physician specialty. Additional research is necessary to determine the implications of empirical antibiotic prescription for pediatric UTI without confirmatory urine testing.
    Pediatrics 09/2013; 132(3):437-444. DOI:10.1542/peds.2012-3135 · 5.47 Impact Factor
  • Bruce Schlomer · Esequiel Rodriguez · Dana Weiss · Hillary Copp ·
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    ABSTRACT: Objective: To better understand parental beliefs regarding the etiology and treatment of nocturnal enuresis (NE). Methods: A self-administered survey queried parental NE beliefs including perceived etiologies and home behavioral treatments. We assessed for associations between demographic characteristics and propensity to seek medical care for NE. Results: Of 216 respondents, 78% were female. The most common causes for NE reported were: deep sleeper (56%), unknown (39%), and laziness (26%). Popular home behavioral therapies included: void prior to sleep (77%) and limiting fluid intake at night (71%). Few reported they would use a bedwetting alarm (6%). Fifty-five percent reported they would seek medical care for NE and 28% reported awareness of effective treatments. On multivariable analysis, females (OR 2.3, 95% CI 1.04-5.0) and those with graduate level education (OR 4.8, 95% CI 1.5-15.7) were more likely to seek medical care for their child with NE. Conclusions: General parental knowledge of the causes and effective treatments for NE is lacking. Only 55% reported they would seek medical care for their child with NE and only 28% reported awareness of effective treatments. Counseling should focus on dispelling common misconceptions about causes and treatments of NE and focus on proven effective treatments.
    Journal of pediatric urology 04/2013; 9(6). DOI:10.1016/j.jpurol.2013.02.013 · 0.90 Impact Factor
  • Bruce Schlomer · Kara Saperston · Hillary Copp ·

    The Journal of Urology 04/2013; 189(4):e200. DOI:10.1016/j.juro.2013.02.1879 · 4.47 Impact Factor
  • Rachel S Edlin · Daniel J Shapiro · Adam L Hersh · Hillary L Copp ·
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    ABSTRACT: Purpose: We characterize the current national patterns of antibiotic resistance of outpatient pediatric urinary tract infection. Materials and methods: We examined outpatient urinary isolates from patients younger than 18 years in 2009 using The Surveillance Network®, a database with antibiotic susceptibility results and patient demographic data from 195 United States hospitals. We determined the prevalence and antibiotic resistance patterns for the 6 most common uropathogens, ie Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence between males and females using chi-square analysis. Results: We identified 25,418 outpatient urinary isolates. E. coli was the most common uropathogen overall but the prevalence of E. coli was higher among females (83%) than males (50%, p <0.001). Other common species among males were Enterococcus (17%), P. mirabilis (11%) and Klebsiella (10%). However, these uropathogens each accounted for 5% or less of female isolates (p <0.001). Resistance among E. coli was highest for trimethoprim-sulfamethoxazole (24%) but lower for nitrofurantoin (less than 1%) and cephalothin (15%). Compared to 2002 Surveillance Network data, E. coli resistance rates increased for trimethoprim-sulfamethoxazole (from 23% to 31% in males and from 20% to 23% in females) and ciprofloxacin (from 1% to 10% and from 0.6% to 4%, respectively). Conclusions: E. coli remains the most common pediatric uropathogen. Although widely used, trimethoprim-sulfamethoxazole is a poor empirical choice for pediatric urinary tract infections in many areas due to high resistance rates. First-generation cephalosporins and nitrofurantoin are appropriate narrow-spectrum alternatives given their low resistance rates. Local antibiograms should be used to assist with empirical urinary tract infection treatment.
    The Journal of urology 01/2013; 190(1). DOI:10.1016/j.juro.2013.01.069 · 4.47 Impact Factor
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    ABSTRACT: To investigate whether orchiopexies are occurring later than recommended by American Academy of Pediatrics 1996 guidelines (around age 1). Adherence to guidelines is poorly studied. The main cohort consisted of 4103 boys insured from birth (Innovus i3, insurance claims database). The complementary cohort consisted of 17 010 insured and noninsured boys (Pediatric Health Information System, PHIS). The inclusion criteria was age ≤5 years at time of International Classification of Disease, 9th revision-defined cryptorchidism diagnosis. The primary outcome was timely surgery (orchiopexy by age 18 months). In Innovus, 87% of boys who underwent an orchiopexy had a timely orchiopexy. Of those who did not undergo surgery (n = 2738), 90% had at least 1 subsequent well-care visit. Those who underwent timely surgery were referred to a surgeon at a younger age compared with those who underwent late surgery (4.1 vs 16.1 months, P < .00005). Predictors of timely surgery were number of well-care visits (odds ratio 1.5, 95% confidence interval 1.3-1.7), continuity of primary care (odds ratio 1.9, 95% confidence interval 1.3-2.7), and use of laparoscopy (odds ratio 4.5, 95% confidence interval 1.4-14.9). Family/internal medicine as referring provider was predictive of delayed surgery (odds ratio 0.5, 95% confidence interval 0.3-0.8). In the Pediatric Health Information System, 61% of those with private insurance had timely surgery compared with 54% of those without private insurance (P < .0001). We found an unexpectedly high adherence to guidelines in our continuously insured since birth Innovus population. Primary care continuity and well-care visits were associated with timely surgery. Further studies can confirm these findings in nonprivately insured patients with the ultimate goal of instituting quality improvement initiatives.
    Urology 11/2012; 80(5):1121-6. DOI:10.1016/j.urology.2012.08.008 · 2.19 Impact Factor

  • The Journal of Urology 04/2012; 187(4):e245. DOI:10.1016/j.juro.2012.02.679 · 4.47 Impact Factor

  • The Journal of Urology 04/2012; 187(4):e253-e254. DOI:10.1016/j.juro.2012.02.702 · 4.47 Impact Factor
  • Gregory E Tasian · Hillary L Copp · Laurence S Baskin ·
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    ABSTRACT: Cryptorchidism (undescended testis) is the most common genitourinary anomaly in male infants. We reviewed the available literature on the diagnostic performance of ultrasound, computed tomography, and magnetic resonance imaging (MRI) in localizing undescended testes. Ultrasound is the most heavily used imaging modality to evaluate undescended testes. Ultrasound has variable ability to detect palpable testes and has an estimated sensitivity and specificity of 45% and 78%, respectively, to accurately localize nonpalpable testes. Given the poor ability to localize nonpalpable testes, ultrasound has no role in the routine evaluation of boys with cryptorchidism. Magnetic resonance imaging has greater sensitivity and specificity but is expensive, not universally available, and often requires sedation for effective studies of pediatric patients. Diagnostic laparoscopy has nearly 100% sensitivity and specificity for localizing nonpalpable testes and allows for concurrent surgical correction. Although diagnostic imaging does not have a role in the routine evaluation of boys with cryptorchidism, there are clinical scenarios in which imaging is necessary. Children with ambiguous genitalia or hypospadias and undescended testes should have ultrasound evaluation to detect the presence of müllerian structures.
    Journal of Pediatric Surgery 12/2011; 46(12):2406-13. DOI:10.1016/j.jpedsurg.2011.08.008 · 1.39 Impact Factor

Publication Stats

449 Citations
134.51 Total Impact Points


  • 2011-2014
    • University of California, San Francisco
      • Department of Urology
      San Francisco, California, United States
    • CSU Mentor
      Long Beach, California, United States
  • 2010
    • American Urological Association
      Linthicum, Maryland, United States
  • 2009
    • Stanford University
      Palo Alto, California, United States