Background: Septic shock combined with septic cardiomyopathy greatly increases the risk of mortality in elderly patients. Patients with a rapid deteriorating state unresponsive to standard resuscitation may benefit from extra‐corporeal membrane oxygenation (ECMO). In cases where obstructive uropathies lead to urosepsis, emergent decompression with double‐J (D‐J) stenting may be necessitated.

Case Presentation: We report the case of a 72‐year‐old woman who arrived at the emergency department and rapidly deteriorated into a state of shock. During the process of resuscitation, emergent biochemical and ultrasound results suggested septicemia and septic cardiomyopathy due to urinary tract infection caused by ureteric stone obstruction. She was transferred to the intensive care unit to be put on venoarterial ECMO after failed resuscitation. Given the suspected diagnosis, it was decided that an emergent bedside digital disposable flexible ureteroscopy (ddFURS) and D‐J catheterization to be performed as rescue decompression procedure. The patient was successfully stabilized with received antibiotic and continuous renal replacement therapy (CRRT) before being transferred to the cardiology department to correct her arrhythmia. She was weaned off CRRT and was able to walk without the need of aids upon discharge.

Conclusion: Uroseptic cardiomyopathy can rapidly progress to renal and cardiac failure. Emergent decompression with ddFURS and D‐J stenting can be performed effectively even in a patient with venoarterial ECMO for rescuing uroseptic cardiomyopathy‐induced arrest secondary to obstructive uropathy. Short‐term outcomes were favorable. However, long‐term prognosis remains to be elucidated.

Background: Pelvic lymph node dissection (PLND) in radical cystectomy (RC) is of great significance, but the method and scope of PLND remain controversial. Based on the principle of indirect lymphadenography, we designed a method to localize the whole pelvic lymph nodes by intradermal injection of indocyanine green (ICG) through the lower limbs and perineum, and to evaluate the effectiveness of this method.

Methods: In a single center, 54 bladder cancer patients who underwent RC and PLND participated in a prospective clinical trial, which began on February 28, 2022 and ended on December 30, 2022. ICG solution was injected subcutaneously at the medial malleolus of both lower extremities and at both sides of the midline of the perineum. The fluorescent laparoscopy was used to trace, locate, and remove the targeted areas under the image fusion mode. The consistency of lymph node resection was determined by histopathological diagnosis. The impact of ICG guidance on the surgical time of PLND was compared with that of 11 bladder cancer patients who underwent RC and PLND without ICG injection, serving as the control group.

Results: Perineal lower limb combined injection can provide comprehensive visualization of pelvic lymph nodes. This technique reduces PLND surgical time and increases the accuracy of PLND.

Conclusion: Intracutaneous injection of ICG into the lower limbs and perineum can specifically mark pelvic lymph nodes. Intraoperative fluorescence imaging can accurately identify, locate, and resect lymph nodes in the pelvic region, reducing PLND surgical time and increasing the accuracy of PLND.

Posterior urethral stenosis (PUS) is a known complication following prostate cancer treatment as well as other benign endoscopic treatments. Patients with PUS often fail initial endoscopic treatments and have persistent symptoms negatively affecting quality of life. In the past decade, a variety of different surgical techniques and approaches have changed the landscape of PUS management. The goal of this review is to provide details on the historical, current, and future direction of the surgical management for PUS.

Prostate cancer is one of the most common solid tumors in men, and its incidence continues to rise in China. Several guidelines have been developed and published to facilitate the standardization of diagnosis and treatment of prostate cancer. However, there are still many challenges and issues in clinical practice that lack high-level evidence. A panel of recognized domestic experts including urologists, medical oncologists, and radiologists was organized and invited to discuss and vote on the key issues of lacking high-level evidence and unified guideline recommendations questions. Following careful selection and voting processes, 19 questions were identified, leading to the establishment of a consensus based on collective agreement regarding these hot issues. The aim of this consensus is to provide a reference for managing the whole patient journey of prostate cancer for Chinese clinicians.

Evidence suggests that robot‐assisted ureteroplasty is a safe and feasible management option of ureteral strictures. The retroperitoneal approach to ureteral reconstruction using single‐port (SP) robot can be beneficial in challenging cases of patients with prior history of abdominopelvic surgery or radiation. Herein, we present a standardized approach to retroperitoneal SP robot‐assisted ureteral reconstruction, highlighting the advantages of this technique in selected clinical scenarios.

Introduction: Though urinary incontinence (UI) after prostate treatment often contributes to emotional distress and significantly impacts quality of life, many patients do not discuss this condition with their physicians. We analyzed the patient perspective by examining online support group posts to gain insight into specific challenges associated with different UI management methods.

Methods: We examined discussion board threads from multiple patient‐focused forums on experiences of UI due to prostate treatment (threads from January 2016 to January 2022). Principles of grounded theory in thematic analysis were used to analyze the threads.

Results: Three hundred and eighteen posts from 84 unique users were analyzed. Among users, 47 (56%) reported UI following radical prostatectomy (RP), 5 (6%) secondary to radiation therapy (RT), 12 (14%) after a combination of RP and RT, and 20 (24%) were ambiguous. UI management methods included pads/diapers/liners, condom catheters/external clamps, Kegels/pelvic floor physiotherapy, and surgical treatment (artificial urinary sphincter or sling placement). We identified challenges common to all management methods: “requires trial and error,” “physical discomfort,” and “difficult to be in public.” Factors influencing management choices included the ability to “feel normal” and the development of a management routine.

Conclusion: The current study identifies opportunities for improved expectation‐setting and education regarding post‐procedural UI and its management. These findings can serve as a guide for providers to counsel patients on the advantages and disadvantages of UI management devices.

Introduction: Urethral erosion is a known complication of artificial urinary sphincter (AUS) surgery. We performed an in‐situ urethroplasty (ISU) to reduce the healing time and time to reimplantation of the AUS. We sought to assess urethral integrity one month after ISU and to identify factors associated with delayed healing in our high‐volume tertiary referral center experience.

Methods: A retrospective review of our AUS database from 2009 to 2023 was conducted to identify all ISU cases. Patients were stratified as healed or non‐healed based on the absence of extravasation on voiding cystourethrogram (VCUG) obtained 4 weeks postoperatively. Background characteristics were evaluated including age, body mass index, diabetes, hypogonadism and smoking history. Operative variables included degree of erosion, location of defect, and the number of stitches required for repair.

Results: Among 98 patients undergoing an ISU, 61 underwent VCUG at one month. Of these, 34.4% (21/61) had evidence of delayed healing on VCUG requiring prolonged catheterization. Although a higher average number of repair sutures were used in ISU, this was not significant (p = 0.381). The most common complication in both groups was urinary tract infection (UTI). Non‐healed patients had a higher rate of UTI, without significant predilection towards fistula, stricture or diverticulum. No other patient or operative characteristic was significantly different between groups.

Conclusion: Despite an aggressive approach to management via ISU, many patients still require prolonged catheterization after AUS erosion to ensure complete healing of the defect.

Testosterone plays a pivotal role in male health throughout the lifespan. Men generally exhibit higher serum testosterone levels than women, influencing critical aspects of male physiology. It drives normal sexual differentiation during fetal development, promotes the acquisition of pubertal traits, and induces the development of secondary male sex characteristics. While testosterone levels naturally decline with age, this decrease varies greatly between individuals, indicating that aging alone does not account for any specific testosterone level. The interindividual variability highlights the influence of both genetic and environmental factors on testosterone production. Abnormal changes in testosterone levels, whether excessive or deficient, can have significant implications for men's health, contributing to conditions such as hypogonadism, cardiovascular disease, sexual disorders, and metabolic disorders. Precision medicine provides personalized testosterone treatment options for hypogonadism, taking into account genetic, hormonal, and lifestyle aspects to improve outcomes. This tailored approach is also relevant in dealing with broader reproductive and sexual health issues, ensuring effective and individualized care. This review focuses on testosterone's varied involvement in men's health, using biomarkers and precision medicine breakthroughs to inform tailored therapy and future research.

Benign prostatic hyperplasia (BPH) is a common condition among aging men, often leading to lower urinary tract symptoms (LUTS) of varying severity. Both medical and surgical treatments for BPH can negatively impact sexual function, affecting patients' overall quality of life. This has highlighted the need for minimally invasive interventions that minimize sexual side effects. Rezum, a water vapor therapy, has gained popularity in managing BPH and LUTS due to its proposed potential to preserve sexual function. This scoping review examines the impact of Rezum therapy on sexual function in patients treated for BPH. The review was conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search was performed using the PubMed and Scopus databases up to August 2024. Articles were included if they involved patients treated with Rezum for BPH and reported the effect of Rezum on sexual function using validated scoring tools. A total of 15 studies encompassing 2,425 patients, met the inclusion criteria. Erectile function was assessed in all studies using the International Index of Erectile Function (IIEF) scores. Of these, seven studies reported no significant changes in erectile function scores, six demonstrated improvements, and two reported a significant decline. Ejaculatory function was evaluated using the Male Sexual Health Questionnaire (MSHQ). The MSHQ-Bother score was reported in seven studies, with three indicating improvement and none reporting deterioration. The MSHQ-Function score was reported in eight studies, with only one study reporting a decline, while the remaining studies found no significant changes. In conclusion, Rezum therapy for managing BPH shows favorable outcomes for sexual function or, at the very least, does not negatively impact it. These findings can guide patient counseling, especially for those seeking to preserve ejaculation. Further research is needed to compare Rezum with other treatment options regarding sexual function.

Peyronie's disease (PD) is an inflammatory and fibrotic disease which results in disfiguring and often distressing penile curvature deformity, affecting up to one in nine men in the United States, and between 0.3% and 13.1% of men globally. It progresses through an acute phase, associated with pain, as the fibrosis develops. In the quiescent phase, penile pain ceases and deformity stabilizes. The precise etiology remains unknown despite ongoing work to elucidate the biological underpinning. The diagnosis is guided by history and physical examination. Except for ultrasonography, imaging is not routinely recommended. Current management is predicated on symptomatic control and slowing progression in the acute phase, and correction of bothersome curvature in the stable phase. Most nonsurgical treatment options are poorly supported by available evidence, with the exceptions of traction therapy and certain intralesional injections. Surgical treatment, considered only after stabilization, is guided by severity and the presence or absence of erectile function and is highly individualized. Investigations are ongoing into several areas, including the exact biological mechanisms leading to plaque formation and failure of resolution; the effects of co-existing systemic disease; the role of imaging in diagnosis and surgical planning; combination and regenerative nonsurgical therapies; and improvements in surgical techniques. As diagnostic accuracy improves and targeted treatments become available, management of PD will become progressively tailored to an individual's particular disease. In this review, we summarize the current knowledge regarding PD, including etiology and epidemiology, diagnosis, management, cutting-edge research, and future directions in care of this condition.

Background: Tubular ectasia of rete testis (TERT) is a benign condition due to dilatation of the rete testis as a consequence of multiple etiologies, including postinfectious, trauma, prior inguinal or scrotal surgeries, mechanical compression of extratesticular excretory ducts, and congenital malformation. TERT is a rare and underreported condition in the medical literature. Its association with infertility is lacking in the literature.

Case Presentation: We present a rare case of primary infertility and obstructive azoospermia associated with TERT. We performed extensive literature regarding the possible etiologies, associations, clinical diagnosis, and different management options of this entity. Our patient is a 33-year-old man presented with primary infertility. He was found to have obstructive azoospermia. During scrotal exploration, the diagnosis of intratesticular obstruction due to TERT was made. The couple was advised to undergo intracytoplasmic sperm injection using testicular sperms. This is the third report of TERT associated with azoospermia.

Conclusion: TERT is usually asymptomatic but can occasionally be associated with pain or abnormal semen analysis, but further studies are required to confirm its effect on fertility. Fortunately, it has a benign course and typically does not require surgical intervention. It is vital to differentiate it from neoplastic conditions.

Background: Pheochromocytomas are tumors originating from chromaffin cells and producing catecholamines. In 10%-20% of cases, these tumors act outside of the adrenal medulla, defining conglomerates named paragangliomas. Bladder paraganglioma is a rare tumor and accounts for less than 0.06% of all bladder neoplasms and less than 1% of all pheochromocytomas, with the first case described in 1953. The clinical procedure given by 47%-77% of the overall number of cases, consists of headache 48.1%, tachycardia 43.4%, hypertension 54.7%, hematuria 47.2%, and visual alterations.

Case Presentation: The article reports a case of a patient whose lesion was identified in the lateral wall of the bladder during a prostate ultrasonography exam, and was subsequently treated surgically with a partial cystectomy. The aim of this study is to detail the diagnosis and treatment of a patient with bladder paraganglioma.

Conclusion: From the overall study conducted in this article, it is possible to conclude that paraganglioma requires adequate diagnostic and therapeutic methods. These methods include ultrasounds and computed tomography scans, followed by cystoscopy with visualization and biopsy of the lesion, and resection of the lesion.

Background: Ureteral stents are used as temporary or permanent drainage measures for intrinsic or extrinsic occlusions of the upper urinary tract. Their use can cause complications such as urinary symptoms, which consequently impact the quality of life. Therefore, the aim of this study was to analyze the symptoms and level of satisfaction of patients who used the double-J ureteral stent.

Methods: This article is a cross-sectional study involving 40 volunteers who had previously undergone a urological procedure that required the insertion of a double-J ureteral stent. Subsequently, they consulted the urology outpatient clinic and answered a questionnaire designed by the authors.

Results: According to the results, the average age of the patients was 43 years old, 75% were female, and 42.5% reported comorbidities, with hypertension being the most prevalent. The wired double-J ureteral stent was used in 72.5% of patients, and the average length of stay was 6 days. 95% of the patients had complaints related to the use of the double-J ureteral stent, with colicky abdominal pain being the most frequent symptom (77.5%) and hematuria being the most common urinary symptom (65%), followed by dysuria (62.5%) and urgency (52.5%). Analysis of the level of satisfaction showed that 55% of patients were satisfied and 22.5% were dissatisfied. No statistical significance was found between the incidence of symptoms related to the double-J ureteral stent and the groups analyzed.

Conclusion: This study was able to highlight important features of the symptomatology of patients using the double-J ureteral stent and the repercussions on satisfaction with its use. Furthermore, it was possible to concluded that the experience of using the double-J ureteral stent was satisfactory for 55% of the patients.

Telemedicine has rapidly integrated into healthcare, overcoming initial barriers such as regulatory restrictions and technological limitations. Its role in sexual medicine, especially urology, has been accelerated by technological advances and the COVID-19 pandemic. However, as telehealth continues to expand, key ethical challenges emerge, including concerns over privacy, healthcare equity, and informed consent. These challenges are particularly important in sexual medicine, where sensitive patient data and intimate conditions are involved. We aimed to examine the ethical implications of telemedicine in sexual medicine, focusing on data security, consent processes, and healthcare disparities. We further emphasize the importance of maintaining high ethical standards while integrating telemedicine as a complement to traditional care, ensuring that patient outcomes are not compromised.

Nonobstructive azoospermia (NOA) is a serious form of male infertility with therapeutic options limited to trials of endocrine manipulations and repertoire of surgical interventions, also known as surgical sperm retrieval (SSR) procedures. Despite its invasive nature, SSR remains crucial in the management of NOA, offering infertile males the opportunity of fathering their biological children using assisted reproductive technologies. Success rates of SSR are variably governed by several factors including the genetic background, preoperative endocrine optimization, testicular histopathology, surgeon's microsurgical expertise, and laboratory technological and technical team's capability. This paper explores the significant role of artificial intelligence (AI) in the process of sperm retrieval among NOA patients. The role of AI has evolved from basic predictive models used for outcome assessment and patient counseling, to advanced image processing capabilities for assessing sperm parameters, and now to cutting-edge applications in identifying the rare sperm present in the azoospermic microdissection testicular sperm extraction tissue samples.

Background: A ureterocele is a cystic dilation of the distal ureter, most commonly presenting as a congenital abnormality that may be associated with other renal anomalies. Ureteroceles present in a variety of manifestations in both children and adults, from asymptomatic to significant flank pain with urolithiasis or recurrent urinary tract infections (UTIs) that often mimic other more common renal pathologies, owing to its challenging clinical diagnosis.

Case Presentation: We report the case of a 78-year-old female patient who presented with recurrent UTIs and failure to thrive, complicated by a large stone that first presented in the bladder on computed tomography scan and was later found in the distal right ureter.

Conclusion: This case underscores the varied and often deceptive clinical presentation of ureterocele, stressing the importance of timely diagnosis to prevent secondary complications.

Introduction: Percutaneous nephrolithotomy (PCNL) is a standard management for complex renal stone disease. However, the implications of delays in PCNL are under-explored. We hypothesized that increased time prior to intervention in a county hospital system would be associated with higher hospital charges, increased clinic and hospital visits, and increased procedural interventions.

Methods: A single-center retrospective chart review of 132 adult patients undergoing PCNL at a county hospital from April 2019 to December 2022 was performed. Groups were organized based on time from diagnosis to surgery (<4 months, 4–6 months, >6 months). Key outcomes included hospital charges, insurance types, ureteral stent versus nephrostomy decompression, presence of stent encrustation, and number of preoperative computed tomography (CT) scans, emergency department (ED) visits, and interventions. Kruskal–Wallis ANOVA was used for determining group differences between continuous variables, and χ² was used for categorical variables.

Results: A total of 132 PCNLs were analyzed with a median diagnosis-to-operating room (OR) period of 135 days. Compared to patients with diagnosis-to-OR period less than 4 months, those with PCNL performed in 4–6 months and over 6 months had 7% and 36% higher hospital charges respectively ($27 607 vs. $29 416 vs. $37 622, p = 0.018). Delays to PCNL surgery resulted in more CT scans (p = 0.019), clinic visits (p < 0.001), and interventions (p = 0.003).

Conclusion: Our study showed that in a medically underserved population, increased diagnosis-to-OR period led to increased healthcare utilization, additional procedures, and hospital charges. Changes aimed at reducing the time from diagnosis to surgery could reduce the financial burden for both patients and the healthcare system.