Background: Erectile dysfunction is a common consequence following radical cystectomy (RC), with inflatable penile prostheses (IPPs) placement considered as the gold standard for refractory cases. Urethral recurrence post‐RC necessitates urethrectomy, which poses challenges for patients with an IPP in place. The thinning of the ventral tunica albuginea during urethrectomy may increase the risk of corporal disruption and IPP cylinder aneurysm, affecting device functionality. This case report introduces a novel surgical technique using Tutoplast, a human‐derived pericardium allograft, for corporal reinforcement during urethrectomy in the presence of an in‐situ IPP.
Methods: A 74‐year‐old male, with a history of robotic‐assisted RC and IPP presented with recurrent bleeding per urethra. Imaging revealed urethral masses. The patient underwent total urethrectomy which resulted in significant thinning of the ventral tunica albuginea. To prevent device aneurysm or mechanical failure, a Tutoplast graft was used intraoperatively to reinforce the thinned tunica. Patient was followed up six months postoperatively.
Results: Final pathology showed urethral high‐grade papillary urothelial carcinoma. Postoperatively, the patient exhibited smooth recovery, with normal IPP functionality up to the 6‐month follow‐up period. While Tutoplast has been used in other settings, its application in preventing IPP malfunction posturethrectomy is a unique contribution.
Conclusion: Corporal reinforcement using Tutoplast during urethrectomy in patients with an existing IPP presents a simple and cost‐effective solution to mitigate the risks of corporal disruption and IPP cylinder aneurysms. The positive outcomes demonstrated in this case report warrant further studies on larger patient populations and longer follow‐up periods to assess the long‐term outcomes of this technique.
Background: Repair of proximal hypospadias remains a challenge with no consensus on the best surgical approach. Several reports have shown recurrence of chordee after plate‐preserving techniques. In this report, we present our experience in managing cases who presented with persistent/recurrence of chordee after tubularized incised plate (TIP) repair for proximal hypospadias.
Methods: Between 2015 and 2023, the study included eight patients who presented with ventral penile curvature after previous hypospadias repair in infancy (TIP urethroplasty). Reoperation to correct persistent ventral curvature was performed several years after the primary TIP repair (3–15 years; mean 7.9 years; median 7.5 years). The reoperation was a two‐stage procedure: the first stage comprised transection of the urethra and grafting (lower lip mucosal graft); the second stage (6 months later) was a Thiersch‐Duplay urethroplasty.
Results: Complications included poor taking of the graft after the first stage in one case (12.5%), which was regrafted using buccal (cheek) mucosa. Complications after second stage included urethro‐cutaneous fistulae in five (62.5%) that were successfully surgically treated at a later stage. Follow‐up after second stage ranged between 6 months and 7 years (mean 2.4 years; median 1 year). Satisfaction with reoperation to correct penile curvature was noted by parents as well as older children (adolescents) who appreciated better cosmesis by increasing ventral penile length and improved curvature.
Conclusion: Preservation of the urethral plate in proximal hypospadias may result in shortened penile length, mostly on the ventral aspect. A two‐stage reoperation to increase the length of the penile urethra can successfully reverse this complication.
Urinary tract infection (UTI) constitutes a pervasive health concern. UTIs are dichotomously classified into upper and lower strata, and further categorized as either complicated or uncomplicated. Upper UTIs predominantly afflict the renal and ureteral domains, typified by conditions exemplified in pyelonephritis, whereas lower UTIs manifest within the confines of the urethra and bladder. The conventional diagnosis of UTIs relies upon clinical manifestations and urine culture. Common symptoms encompass dysuria, frequent micturition, hematuria, and suprapubic discomfort. Urine culture serves to identify the specific pathogens instigating the infection and assess their antibiotic susceptibility. However, this procedural protocol generally necessitates an approximate duration of 24 h, coupled with an additional 24‐h interval for antibiotic susceptibility testing. In contradistinction, the detection of cell‐free DNA (cfDNA) in the circulatory system presents a potential avenue for non‐invasive diagnostic modalities. Notwithstanding, cfDNA emanates from deteriorating cells, affording insights into the extant cellular demise within the organism. Extensive scholarly inquiry has established a positive correlation between cfDNA concentration in the bloodstream and the incidence of cell death in conditions, such as severe traumas, sepsis, aseptic inflammation, myocardial infarction, and stroke. However, limited investigative effort has been devoted to elucidating the diagnostic potential of cfDNA in the context of UTIs. Consequently, the concentration and constitution of plasma cfDNA harbor substantial promise for non‐invasively diagnosing UTIs. In summation, the utilization of cfDNA in UTI diagnosis remains an incipient area of scholarly pursuit, underscoring the imperative for further research to elucidate the prospective role of plasma cfDNA in non‐intrusively discerning UTIs.
Background: Renal cysts are common in clinical practice, but some may harbor rare pathological entities such as mixed epithelial and stromal tumors (MEST). Imaging studies are crucial for accurate diagnosis. While laparoscopic deroofing is an established approach for symptomatic renal cysts, encountering MEST within a cyst is uncommon.
Case Presentation: We present the case of a 37-year-old female who presented with persistent left flank pain. Imaging revealed a large renal cyst in the lower pole of the left kidney, classified as Bosniak 2. Despite analgesia, the patient’s symptoms persisted, leading to a laparoscopic deroofing procedure. Histopathological examination postprocedure revealed a MEST. The patient reported complete resolution of symptoms at the 3-month follow-up.
Conclusion: This unique case presents the successful identification and surgical management of a MEST masquerading as a lower pole renal cyst through laparoscopic deroofing. It also contributes to the existing literature by highlighting the importance of considering rare pathological entities in the evaluation of renal cysts and the value of laparoscopic techniques in their management.
Background: Some cases of non-obstructive azoospermia (NOA) are characterized by normal clinical parameters, including testicular volume and levels of reproductive hormones, mimicking obstructive azoospermia (OA).
Methods: We performed a retrospective review of a consecutive series of 1417 patients undergoing primary surgical sperm retrieval between 2014 and 2023. Follicle-stimulating hormone (FSH) level below 7.6 IU/l and normal testicular size with a long axis measurement >4.6 cm were used as criteria to suspect OA.
Results: Four hundred and eighteen patients with normal testicular volume and FSH levels had an initial diagnosis of OA. Among them, 243 (58.1%) had histological signs of spermatogenic dysfunction, and 175 (41.9%) had true OA. One hundred eleven patients had long-standing obstruction (median: 16.5 years) with a median Bergmann–Kliesch score (BKS) of 5 (interquartile range [IQR]: 4–6) and 100% sperm retrieval rate (SRR), though some required microdissection testicular sperm extraction (microTESE). Fifty-eight patients with a history of epididymo-orchitis had a median BKS of 4 (IQR: 2–6) and 100% SRR. Twenty patients with a history of unjustified medical treatment for male infertility had a median BKS of 3 (IQR: 1–4) and 80% SRR. Fifty-four patients had uniform maturation arrest with a 5.5% SRR on microTESE.
Conclusion: Men with normal testicular volume and FSH level may have evidence of spermatogenic failure on pathology. Patients with complicated seminal tract obstruction commonly have hypospermatogenesis, but true NOA caused by uniform maturation arrest may also be observed. Patient counseling for suspected OA should not be overly optimistic, and couples should be warned about possibility of conversion to microTESE and risks of negative sperm retrieval.
With increasing age, pelvic organ prolapse (POP), due to its high incidence, has become a common disease that seriously affects patients’ quality of life and places a heavy economic burden on families and society. Transvaginal mesh (TVM) is a minimally invasive and effective treatment for POP, although its use remains controversial due to the potential risk of meshrelated complications. The US Foods and Drugs Administration, along with authorities in England, Australia, New Zealand, and other countries, have banned the sale and distribution of commercial TVM kits designed for POP. The TVM procedure remains an option for POP treatment and still appeals to many surgeons and patients today in Asia and most European countries, which suggests that a considerable number of POP patients can benefit from its continued refinement. Here we introduce the Huaxi protocol of the TVM plant for the treatment of POP.
Burnout is a growing concern across numerous professions and industries worldwide. It has increased for many people since the onset of COVID-19 due to the stress, uncertainty, and changes brought on by the pandemic. Burnout is also a significant issue in the field of medicine, particularly urology, where residents face long working hours and high workloads, leading to physical and mental health problems, as well as limited opportunities for rest and rejuvenation. This alarming trend highlights the need for more effective measures to address burnout and promote employee well-being and job satisfaction. A thorough search of electronic databases such as PubMed, Scopus, and Google Scholar was conducted to obtain pertinent articles using relevant keywords. Retrieved articles were screened for relevance, with duplicates and irrelevant articles excluded. Thematic and critical review analysis was conducted on chosen articles, identifying key themes and contributing factors related to burnout in urology residents. The hidden struggle of overworked urology residents and their overlooked burnout represents a complex issue that requires systemic change and individual-level interventions. Organizations must prioritize employee well-being by providing adequate support and resources for managing burnout. Additionally, promoting effective leadership practices that prioritize resident well-being over any personal or institution recognitions or gains is crucial. These steps will improve the quality of care while mitigating negative outcomes for residents.
Erectile dysfunction (ED) is increasing in prevalence, with estimates that 50% of men between 40 and 70 years of age suffer from the disease. Due to a wide array of available medical interventions, significant focus has been put on combination therapies that can treat ED refractory to first-line treatments such as phosphodiesterase 5 inhibitors (PDE5is). However, reviews evaluating monotherapy noninferiority and patient satisfaction of monotherapy versus combination therapy are lacking. A thorough PubMed search was performed to evaluate combination therapy in ED treatment. Articles published between January 2008 and June 2023 were reviewed, including randomized control trials, retrospective analyses, and cohort studies. Combination therapies included PDE5i plus another PDE5i, testosterone supplementation, α-blockers, vacuum erectile devices, intracavernosal injections, and low-intensity shockwave therapy. Based on this review, PDE5i monotherapy is not inferior to combination therapy and has increased satisfaction, convenience, and ease of use for patients with ED. Limitations of current literature on combination therapy include small sample size, limited data on patient satisfaction, possible biases, and limited follow-up time. Further studies will need larger randomized control trials with follow-up times greater than 1 year.
Artificial intelligence (AI) is a complex combination of multidisciplinary machines and systems that can replicate human-like cognitive tasks to execute capabilities such as pattern recognition, decision-making, and problem-solving. Dating back to the 2000s, AI has been utilized in the medical field, however the interest in this subject has sharply increased over the past several years. Erectile dysfunction (ED) is an increasingly pervasive issue as men age, affecting up to 150 million men worldwide. In the field of men’s health, AI has been employed to assist physicians in the evaluation and management of ED. This article aims to summarize the ways in which AI has been utilized in the management of ED, as well as the considerations that must be made when implementing this technology. AI can be utilized for virtual health assistance to protect patient privacy and increase access to care. Augmented reality can aid surgeons in real-time during operations, as well as be utilized to prepare physicians for situations that they may encounter in the operating room. Pharmaceutical companies can benefit from AI in the interpretation of data, analysis of chemical compounds and in drug development. Additionally, AI can be used to assist patients in post-procedure recovery in the form of rehabilitation and post-treatment monitoring. While the utilization of AI in men’s health is an exciting venture, there are tremendous ethical and practical considerations that have limited its use in the management of ED.
Background: Radical prostatectomy (RP) and radical cystectomy (RC) with concurrent pelvic lymph node dissection (PLND) are considered as the curative surgical treatment options for localized prostate cancer (PC) or muscle-invasive bladder cancer (BC). Regarding lymphatic leakage management after PLND, there is no standard of care, with different therapeutic approaches having been reported with varying success rates.
Methods: Seventy patients underwent pelvic lymphadenectomy during robotic RP and RC with postoperative pelvic drainage volume more than 50 mL/day before the removal of drainage tube, were retrospectively evaluated in this study between August 2015 and June 2023. If the pelvic drainage volume on postoperative Day 2 was more than 50 mL/day, a drainage fluid creatinine was routinely tested to rule out urine leakage. We removed the drainage if the patient had no significant abdominal free fluid collection, no abdominal distension or pain, no fever, and no abdominal tenderness. After 1-day observation of the vital signs and abdominal symptoms, the patient was discharged and followed-up in clinic for 2 weeks after surgery.
Results: Forty-one cases underwent the early drainage removal even if the pelvic drainage volume was more than 50mL/day. Among these forty-one cases, twenty-five drainage tubes were removed when drainage volume was more than 100 mL/day. All the forty-one cases with pelvic drainage volume greater than 50mL/day were successfully managed with the early drainage removal. No paracentesis or drainage placement was required. No readmission occured during the follow-up period.
Conclusion: It is safe to manage the high-volume pelvic lymphatic leakage by early clamping of the drainage tube, ultrasonography assessment of no significant residual fluid in the abdominal and pelvic cavity, and then the early removal of the drainage tube.
Backgound: Given the overall aging of the population, erectile dysfunction (ED) has become an increasingly relevant issue. When elective surgery is offered, the patient’s age is often noted as a potential limiting factor. The aim of this study is to investigate the safety of implanting penile prostheses (PPs) in men 90 years and older, and report the potential complications associated with this population.
Methods: The database was screened between the years 2003 and 2023 to identify patients at least 90 years and older who underwent implantation of PP by a single surgeon at MD Anderson Cancer Center and Memorial Hermann Texas Medical Center. We collected demographic information, their anesthesia perioperative assessment, surgical procedure details, and postoperative pathway.
Results: Between 2003 and 2023, 2000 men underwent PP surgery. Three patients were 90 years or older at the time of PP surgeries. All surgeries were performed without intraoperative or postoperative complications. Following the surgery, patients were monitored, and the patients with implantations demonstrated the ability to use the device and reported satisfaction.
Conclusion: This case series demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining a satisfactory sexual life in this age group is vital and achievable through inflatable PP insertion. There are several factors that must be considered prior to operating on an older patient. However, with proper patient selection and preoperative optimization, this operation can be effectively performed in these patients.
Background: As one of the most common diseases in urology, a large number of preclinical studies have been accumulated to explore the etiological mechanism and potential intervention of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Methods: In this study, we systematically evaluated the current status of preclinical research on CP/CPPS through bibliometrics analysis using VOSviewer and Citespace. Characteristics of publication such as year, country/region, institution, author, journal, citation, and keywords were analyzed. Based on the bibliometrics analysis results of keywords, we summarized the possible mechanisms and promising treatments for CP/CPPS narratively.
Results: According to the results of this study, the most common mechanisms involved in CP/CPPS were as follows: Disturbed immune and inflammation mediators, immune cell dysfunction, oxidative stress, dysregulated signaling pathways, apoptosis, gut microbiota, and testosterone metabolism. Traditional Chinese Medicine and extracorporeal shock wave therapy have important potential in the treatment of CP/CPPS.
Conclusion: Further translational studies targeting the above mechanisms and validating the objective efficacy of potential treatments indicated by preclinical studies in clinical patients are needed in the future.
Bladder cancer (BC) has become a significantly prevalent disease in China, with an incidence rate of 5.80 per 100 000 in 2015, ranking it as the thirteenth most common type of cancer within the nation. This illness presents a serious public health concern, highlighting the imperative need to unify the standards for diagnosis and treatment to improve patient outcomes. The section of the clinical practice guideline in question is dedicated to addressing muscle-invasive bladder cancer (MIBC) and metastatic BC. The primary treatment strategies for MIBC are well-defined: preoperative (neoadjuvant) chemotherapy combined with radical cystectomy stands as the conventional treatment protocol. For patients with locally advanced MIBC, integrating systemic and local therapies is advocated to enhance treatment effectiveness. In cases of metastatic BC, the focus shifts to systemic treatment supplemented by supportive care measures. The guideline also succinctly presents the pros and cons of various urinary diversion surgeries, which are critical considerations following radical cystectomy. It provides an in-depth exploration of the treatment modalities for metastatic urothelial carcinoma of the bladder. Additionally, this part delves into the integrated approach to treatment and the use of radiotherapy in bladder preservation for localized disease. Moreover, it offers a concise overview of the classification, diagnosis, and therapeutic approaches for nonurothelial carcinoma of the bladder. Lastly, this part emphasizes the importance of recommended posttreatment follow-up for MIBC patients to ensure comprehensive and ongoing care management.