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.

Prostate cancer (PCa) is one of the most prevalent malignant tumors in men, accompanied by high incidence and mortality rates. Novel hormonal therapy (NHT) has emerged as the primary treatment for advanced PCa, providing noticeable clinical benefits. However, the diverse range of adverse events (AEs) associated with NHT may influence both treatment efficacy and patients’ quality of life. In light of the latest international clinical research evidence and recommendations from domestic and foreign guidelines, this consensus aims to provide a comprehensive overview of the common AEs experienced during NHT for advanced PCa patients. Additionally, it seeks to develop a hierarchical approach to more efficiently manage AEs, presenting valuable insights for clinical medication and adverse reaction management.

Background: Although urethral trauma may lead to serious consequences if mismanaged, treatment concepts are inconsistent. We designed a survey to investigate the current diagnosis and management of emergency blunt urethral trauma to aid future dissemination of relevant concepts.

Methods: A 15-item anonymous questionnaire was distributed via an online platform. It addressed items such as the cognition of how to diagnose of urethral trauma, optimal emergency management of a urethral trauma patient, and attitude towards early realignment for pelvic fracture urethral injuries.

Results: Of 538 respondents, 94.2% and 84.9% had received patients with straddle trauma urethral injuries or pelvic fracture urethral injuries, respectively, within the past year. In the emergency room, attempted urethral catheterization was the most selected examination method by respondents for diagnosis of both straddle injury (500/538) and pelvic fracture urethral injury (469/538). For patients with straddle injury, 41.3% of respondents performed endoscopic realignment and 31.6% preferred suprapubic cystostomy. For hemodynamically stable patients with PFUI, 42.2% of respondents preferred suprapubic cystostomy and 34.9% preferred endoscopic realignment. Most respondents felt favorably toward early realignment for pelvic fracture urethral injuries. After realignment, 61.3%, 24.5%, and 13.8% of respondents performed catheterization for 4, 8, and 12 weeks, respectively. Further, 54.6% of respondents believed catheter traction should be applied after realignment.

Conclusion: Although the number of yearly emergency urethral trauma cases was small, the opinions and practices of most urologists were consistent with guidelines. However, the significance of retrograde urethrography was not fully understood, and some respondents had incorrect views on catheter traction after realignment.

Bladder cancer (BC) is an increasingly common malignancy in China, with an incidence rate of 5.80 per 100 000 in 2015, making it the thirteenth most common cancer in the country. This trend underscores the urgent need for standardized diagnosis and treatment protocols. In terms of treatment, approaches for bladder cancer vary based on the cancer’s stage and pathology, as well as the patient’s overall health. Notably, non-muscle-invasive BC (NMIBC) confined to the mucosa (Ta) and lamina propria (T1) without invading the muscle represents about 75% of all BC cases. Succeeding the first part of the guideline, this part of the clinical practice guideline focuses on NMIBC. It details risk classifications and treatment options, including both surgical procedures and posttransurethral resection of the bladder tumor intravesical instillations. Special attention is given to the treatment strategies for carcinoma in situ. The guideline also covers the recommended follow-up procedures for patients with NMIBC, underscoring the need for thorough and continuous care management.

Background: Patients with inflatable penile prostheses (IPP) may experience erosions after years of use or after indwelling Foley catheter placement. IPP erosions should be managed as an infection with the entire IPP removed. Replacing IPPs in erosion patients can be challenging due to extensive scarring development. Using proper graft materials may be necessary to close and reinforce the corporal defect after difficult corporal dilation or significant scar removal for the long-term success of IPP reimplantation.

Case Presentation: Herein we report a patient with a history of IPP placement in 2007 for erectile dysfunction and Peyronie’s disease, presenting in 2018 with dysuria and a feeling of IPP displacement following Foley catheter placement for coronary artery bypass graft surgery. The left cylinder of the IPP was observed by physical examination and a defect near the fossa navicularis was discovered during office cystoscopy. A complete explantation of IPP was then performed. Reimplantation of the IPP was performed in 2021 which required excision of corporal scar tissue and repair of a left distal corporal defect using a Tutoplast^® pericardium allograft. The procedure was successful with proper IPP position and good function without any penile deformity.

Conclusion: The use of graft materials in the management of corporeal defects should be considered in the setting of complex IPP revision. The Tutoplast^® pericardium allograft reinforcement can provide long-term durability, flexibility, and a lower risk of infection.

Background: Whether conventional behavioral therapies for premature ejaculation can significantly improve the intravaginal ejaculatory latency time is still controversial. Prone masturbation is rare and observed in some patients with delayed ejaculation. Therefore, we tried to verify whether the regular prone masturbation training method had a therapeutic effect on premature ejaculation.

Methods: From July to December 2018, a total of 21 patients met the enrollment criteria and volunteered to participate. Participants were diagnosed with premature ejaculation with an intravaginal ejaculatory latency time of less than 3min and a Premature Ejaculation Diagnostic Tool score greater than 9. Participants performed 12-week prone masturbation training.

Results: Ten patients completed the entire treatment regimen. The mean age of the 10 participants was 30.4 ± 6.1 years, the mean frequency of sexual intercourse was 1.9 ± 0.83 times a week, and the median duration of premature ejaculation was 1.5 years. After 3 months of prone masturbation training, the median self-reported intravaginal ejaculatory latency time significantly increased from 60 to 105 s (p = 0.011), and the mean Premature Ejaculation Diagnostic Tool scores decreased from15.0 ± 3.7 to 12.7 ± 3.7 points (p = 0.119).

Conclusion: The regular prone masturbation training method, as a novel behavioral therapy, probably has a therapeutic effect on premature ejaculation.

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.

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: 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.

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.

This paper explores the advancement and application of high-power blue diode lasers in treating benign prostatic hyperplasia (BPH). Addressing the challenges posed by existing techniques, the study focuses on optimizing tissue removal methods. Energy platform for BPH should balance a range of factors, such as operative time, patient conditions, urinary functions, complications, durability, accessibility, and cost, all while prioritizing patient care. Blueray Medical’s innovation of high-power blue diode laser systems for BPH surgery is explored, with emphasis on achieving a balance among these considerations. By illustrating the biomedical effects of lasers and their interaction with soft tissues, particularly emphasizing the role of photon absorption by biomolecules and proteins in tissue behavior, this study outlines the advantages of the high-power blue diode laser system. The initial laboratory experiments and clinical results consistently align with our theoretical predictions, especially in terms of tissue vaporization efficiency, tissue coagulation, and bleeding control. In conclusion, blue diode lasers hold potential to enhance surgical outcomes for BPH. Their unique properties offer benefits like improved tissue removal rate and reduced thermal damages. Integrating blue laser technology into BPH protocols could lead to shorter hospital stays, cost savings, and expanded patient eligibility, although rigorous clinical studies are needed to fully understand their benefits and limitations.

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.

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.

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.

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.

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.

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: 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.

Prostate cancer is a heterogeneous disease process with a wide spectrum of clinicopathologic variables that impact diagnosis, risk stratification, and management. To improve diagnostic accuracy and to better inform clinical decision making, the development of molecular biomarkers has undergone considerable discovery and clinical validation in the past decade. Prostate cancer is no longer seen as a single disease entity but one with considerable heterogeneity existing between tumors and between patients. Biomarkers now allow for more personalized and precision-based approaches to management that otherwise would have depended on applying clinical algorithms alone. The aim of this review is to discuss and evaluate prostate cancer tissue-based biomarkers that have been developed to aid diagnosis, improve risk stratification, and management.

Infertility is a pervasive issue affecting a considerable proportion of couples in their reproductive years, with a projected 10%–15% prevalence. It is characterized by the incapability to achieve conception following a year of consistent, unprotected intercourse, and its far-reaching consequences can take a profound emotional, psychological, and social toll on couples, inducing feelings of melancholy, exasperation, and anxiety. The appraisal of infertile couples’ cases is a multifaceted and daunting process, necessitating a holistic understanding of the intricate underlying factors contributing to their infertility. Consequently, an individualized evaluation should be conducted, considering diverse parameters, such as the couple’s medical history, age, infertility duration, and other relevant criteria. This paper will provide an in-depth overview of the current approaches utilized in the evaluation of men with infertility, including the commonly employed diagnostic tools and procedures. Enhancing our comprehension of infertility assessment and management holds the promise of helping couples achieve their ultimate desire of conceiving and enriching their overall quality of life.