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Purpose of Review: Prostate cancer and benign prostate hyperplasia (BPH) are two ubiquitous pathologies that may coexist. A significant percentage of patients with different stages of prostate cancer suffer lower urinary tract symptoms (LUTS) due to associated BPH. We aimed to review the literature regarding the role of transurethral surgeries in the management of prostate cancer patients and the different available management options. Recent Findings: The evidence in literature for the use of BPH surgeries in prostate cancer patients is based mainly on low-quality retrospective studies. In patients on active surveillance, BPH surgeries are beneficial in relieving LUTS without oncological risk and can eliminate the contribution of adenoma to PSA level. In patients with advanced prostate cancer, palliative BPH surgery can relieve LUTS and urinary retention with unclear oncological impact; however some reports depict that the need for BPH surgery in advanced prostate cancer is associated with poorer prognosis. In patients receiving radiotherapy, various studies showed that transurethral resection of prostate (TURP) is associated with increased radiotoxicity despite some recent reports encouraging the use of Holmium Laser Enucleation of the Prostate (HoLEP) to improve urinary symptom scores before radiotherapy. The most commonly reported techniques utilized are TURP, photoselective vaporization of prostate (PVP) and HoLEP. Summary: The use of BPH surgery is justified for relieving LUTS in selected prostate cancer patients on active surveillance or in advanced stages, however the use in the pre-radiotherapy settings remains controversial. Future prospective and randomized controlled trials are required for validating the benefits and assessing potential hazards. [ABSTRACT FROM AUTHOR]

Introduction: Renal cell carcinoma (RCC) is the dominant primary renal malignant neoplasm, encompassing a significant portion of renal tumors. The presence of synchronous yet histologically distinct ipsilateral RCCs, however, is an exceptionally uncommon phenomenon that is rather under-described in the literature regarding etiology, diagnosis, management, and later outcomes during follow-up. Case presentation: We aim to present the 9th case of a combination chromophobe RCC (ChRCC) and clear cell RCC (ccRCC) in literature, according to our knowledge, for a 69-year-old North African, Caucasian female patient who, after complaining of loin pain and hematuria, was found to have two right renal masses with preoperative computed tomography (CT) and underwent right radical nephrectomy. Pathological examination later revealed the two renal masses to be of different histologic subtypes. Conclusion: The coexistence of dissimilar RCC subtypes can contribute to diverse prognostic implications. Further research should focus on enhancing the complex, yet highly crucial, preoperative detection and pathological examination to differentiate multiple renal lesions. Planning optimal operative techniques (radical or partial nephrectomy), selecting suitable adjuvant regimens, and reporting long-term follow-up outcomes of patients in whom synchronous yet different RCC subtypes were detected are of utmost importance. [ABSTRACT FROM AUTHOR]

Background: Frailty is a recent multidimensional concept of a contemporary growing interest for understanding the complex health status of elderly population. We aimed to assess the impact of frailty scores on the outcome and complication rate of holmium laser enucleation of prostate (HoLEP). Methods: A 7-year data of HoLEP patients in a single tertiary referral center were reviewed. The preoperative, operative, early, and late postoperative outcome data were collected and compared according to the preoperative frailty scores. Frailty was assessed preoperatively using the Modified Hopkins frailty score. Results: The study included 837 patients categorized into two groups: group I included 533 nonfrail patients (frailty score = 0), whereas group II included 304 frail patients (frailty score ≥1). The median (interquartile range) age was 70 (11) and 75 (11) years for groups I and II, respectively (<0.001). The 30-day perioperative complication rate (p = 0.005), blood transfusion (p = 0.013), failed voiding trial (p = 0.0015), and 30-day postoperative readmission (p = 0.0363) rates were significantly higher in frail patients of group II. The two groups were statistically comparable regarding postoperative international prostate symptom score (p = 0.6886, 0.6308, 0.9781), incontinence rate (p = 0.475, 0.592, 0.1546), postvoid residual (p = 0.5801, 0.1819, 0.593) at 6 weeks and 3 months, and 1-year follow-up intervals, respectively. Conclusion: In elderly patients undergoing HoLEP, the preoperative frailty scores strongly correlate with the risk of perioperative complications. Frail patients should be counseled regarding their relative higher risk of early perioperative complications although they gain the same functional profit of HoLEP as nonfrail patients. [ABSTRACT FROM AUTHOR]

Introduction: One of the main adverse outcomes following Holmium laser enucleation of the prostate (HoLEP) is the development of transient de novo urinary incontinence (UI). We aimed to evaluate the correlation of multiple risk factors to UI rates post‐HoLEP. Methods: A review of prospectively maintained 7 year database for HoLEP patients in a single center was performed. UI data at 6 week, 3 month, and 1 year follow‐up intervals were assessed with bivariate and multivariate analysis of multiple potential risk factors. Results: The study included 666 patients with median (IQR) age of 72 (66–78) years old and median (IQR) preoperative prostate volume of 89 (68–126) gm. UI was seen in 287 (43%), 100 (15%) and 26 (5.8%) at 6 week, 3 month, and 1 year follow up occasions respectively. At 6 weeks follow up, UI type was stress, urge and mixed in 121 (18.16%), 118 (17.72) and 48 (7.21%) patients respectively. Using a multivariate regression analysis, obesity and pre‐operative UI were associated with postoperative UI rate at both 6 week (p =.0065,.031) and 3 month (p =.0261,.044) follow up encounters respectively. Also, larger specimen weight was another predictor for 6 week UI (p =.0399) while higher frailty score was a predictor for UI at 3 month occasion (p =.041). Conclusion: Patients with preoperative UI, obesity, frailty, and large prostate volume are at higher risk of short‐term UI post‐HoLEP up to 3 months. Patients with one or more of these risk factors should be counseled regarding the higher risk of UI. [ABSTRACT FROM AUTHOR]

The widespread use of computed tomography (CT) has increased the incidence of small renal cell masses. We aimed to evaluate the usefulness of the angular interface sign (ice cream cone sign) to differentiate a broad spectrum of small renal masses using CT. The prospective study included CT images of patients with exophytic renal masses ≤ 4 cm in maximal dimension. The presence or absence of an angular interface of the renal parenchyma with the deep part of the renal mass was assessed. Correlation with the final pathological diagnosis was performed. The study included 116 patients with renal parenchymal masses of a mean (± SD) diameter of 28 (± 8.8) mm and a mean age of 47.7 (±12.8) years. The final diagnosis showed 101 neoplastic masses [66 renal cell carcinomas (RCC), 29 angiomyolipomas (AML), 3 lymphomas, and 3 oncocytomas] and 15 non-neoplastic masses [11 small abscesses, 2 complicated renal cysts, and 2 granulomas]. Angular interface sign was statistically comparable in neoplastic versus non-neoplastic lesions (37.6% versus 13.3%, respectively, P = 0.065). There was a statistically higher incidence of the sign when comparing benign versus malignant neoplastic masses (56.25 vs. 29%, respectively, P = 0.009). Also, comparing the sign in AML versus RCC was statistically significant (52% of AML versus 29% of RCC, P = 0.032). The angular interface sign seems beneficial in predicting the nature of small renal masses. The sign suggests benign rather than malignant small renal masses. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate and compare the functional characteristics, safety profile and effectiveness of two commonly used ureteral access sheaths (UAS) during flexible ureteroscopy. Methods: After institutional review board approval, patients with proximal ureteral or kidney stones requiring flexible ureteroscopy and UAS were prospectively randomized to group I or group II according to the type of access sheath used. Primary outcome was incidence of intraoperative complications. Results: Eighty-eight patients were enrolled in the study, 44 patients in each group. Sheath size 12/14 FR was used in both cohorts. Median (IQR) stone size was 10 mm (7-13.5) and 10.5 mm (7.37-14) in group I and II respectively (p = 0.915). Nineteen and twenty patients, in group I and II respectively, were pre-stented. Subjective resistance with insertion of the UAS was observed in 9 and 11 patients in group I and II respectively (p = 0.61) while failed insertion was encountered in one patient in group I. Traxer grade 1 ureteral injury was noted in 5 and 6 patients in group I and II respectively while grade 3 injury was seen in 1 patient for both cohorts (p = 0.338). There was less resistance for UAS placement in pre-stented patients (p = 0.0202) but without significant difference in ureteric injury incidence (p = 0.175). Emergency department visits were encountered in 7 (group I) and 5 patients (group II) (p = 0.534). Conclusions: The studied UASs were comparable regarding safety and efficacy in the current study. Pre-stented and dilated ureters had less resistance to insertion although this was not reflected on incidence of ureteric injury. [ABSTRACT FROM AUTHOR]

Background: Holmium laser enucleation of the prostate (HoLEP) has been used as an effective minimally invasive technique for management of enlarged prostates. We aimed to report the role of HoLEP in prostate cancer (PCa) patients either on active surveillance with bothersome lower urinary tract symptoms (LUTS) or for prostate debulking before radiation therapy and the impact on PCa management plans. Methods: Prospectively maintained database in two institutions was reviewed for patients with localized PCa managed by HoLEP with at least a follow-up of 1 year. We assessed prostate-specific antigen (PSA) trends, effect on international prostate symptom score (IPSS) and further management of PCa. Results: Out of >2000 HoLEP patients, 117 patients with a median follow-up of 30 months were included. Mean (standard deviation) age was 72.3 (±8.3) years with median (interquartile range, IQR) IPPS of 22 (16–28) and median (IQR) PSA at 7.6 (5.3–14.9) ng/mL. Gleason grade group was 1, 2, 3, and 4 in 47 (73.2%), 32 (27.35%), 7 (5.9%), and 4 (3.4%) patients, respectively. Median (IQR) PSA has significantly dropped to 1.3 (0.6–3.1), 1.4 (0.75–2.9), and 1.7 (0.86–2.75) ng/mL at 6-week, 3-month, and 1-year follow-up, respectively (p < 0.001). IPSS scores post-HoLEP obviously improved with mean (IQR) IPSS of 10 (5–13), 7 (3–12), and 3 (2–5) at 6-week, 3-month, and 1-year, respectively (p < 0.001). Eighty-eight (72%) patients stayed on active surveillance, whereas 27 (23%) patients had radiotherapy ± androgen deprivation therapy for persistently high or relapsing PSA. Within 36 intermediate-risk patients, 15 (41.6%) and patients had radiotherapy, whereas 21 (58.3%) patients continued active surveillance. Conclusions: HoLEP is beneficial in debulking large prostate in PCa patients with bothersome LUTS on active surveillance or before radiotherapy. HoLEP reduces the contribution of large adenoma to PSA level, thus reflecting PSA level better and helping reduce overtreatment. [ABSTRACT FROM AUTHOR]

Background: Urethral strictures (US) and bladder neck contracture (BNC) are troublesome complications of transurethral surgery. We aimed to report the incidence, risk factors, and management of US and BNC post-holmium laser enucleation of the prostate (HoLEP) together with review of literature. Patients and Methods: A retrospective review of prospectively managed HoLEP patients in one institution between 2015 and 2021 was performed. The study included patients with complete follow-up of at least 1-year. Multivariate regression analysis for risk factors of US or BNC was performed. Appropriate statistical analysis methods were used. Results: Out of total 1055 HoLEP patients, 566 patients were included. Eleven (1.94%), 8 (1.41%), and 1 (0.17%) patients developed US, BNC, and both, respectively, while 8 (1.41%) patients had postoperative recurrence of intraoperatively diagnosed US. With multivariate regression analysis, intraoperative US (p = 0.0055, odds ratio [OR] = 15.5, confidence interval [95% CI] = 2.2–37.7), intraoperative need for meatotomy (p = 0.0019, OR = 7.69, 95% CI = 2.12–27.8), and longer operative time (p = 0.0250, OR = 1.043, 95% CI = 1.005–1.083) were predictors of US/BNC. For US patients, urethral dilatation under local anesthesia was sufficient in 14 (70%) patients while 6 (30%) patients had visual urethrotomy. Patients with BNC were managed by endoscopic bladder neck incision. Conclusion: Although the US/BNC are annoying long-term sequalae that may complicate HoLEP, the incidence is still low and can be easily managed. Diagnosed intraoperative stricture, need for meatotomy, and longer operative time are the main predictors of urethral complications post-HoLEP. [ABSTRACT FROM AUTHOR]

Objective: This pilot study aimed to objectively assess the osteoporotic effect caused by androgen deprivation therapy (ADT) in patients with prostate cancer and compare this effect in surgical versus medical castration, specifically with luteinizing hormone-releasing hormone (LHRH) antagonists. Material and methods: The study included 60 patients with metastatic prostate adenocarcinoma treated with either bilateral orchidectomy (group I) or LHRH antagonist (Degarelix) injection (group II). The patients had a baseline bone mineral density (BMD) assessment before the start of ADT using dual energy X-ray absorptiometry (DEXA) scan and then follow-up assessment after 6 months. BMD was measured at the spine (lumbar vertebrae L2-L4), femur (total), and forearm (one-third radius). Results: Group I included 33 patients and group II 27 patients. Both the groups showed significant reduction in BMD at the spine and femur after 6 months, whereas the forearm did not show a significant reduction. Spine BMD showed 5.9%±2.6% and 4.7%±2.6% reduction whereas the femur BMD showed 6%±7.4% and 6%±4.7% reduction in the orchiectomy and the Degarelix groups, respectively. There was no statistically significant difference between the groups at the 3 measured sites. Conclusion: Both surgical castration and LHRH antagonists were associated with significant accelerated osteo-porotic effect at the spine and femur after 6 months without difference between both the methods. Assessment of osteoporotic risk together with preventive or management measures should be started early during ADT. [ABSTRACT FROM AUTHOR]

Hematuria is a critical symptom that should properly be investigated. One of the rare causes is renal papillary hypertrophy. Literature review revealed only few reported cases. Biopsy in reported cases has shown hyperplasia of renal papillae with normal histology. We report a case of bilateral renal papillary hypertrophy in a 32 years old female presented with intermittent gross hematuria. Computed tomgraphy urography, cystoscopy and selective cytology did not show any positive findings. Retrograde flexible uretero-renoscopy showed enlarged renal papillae protruding into upper and middle calyces of both kidneys with clots and active bleeding in some. Holmium:YAG Laser ablation of hypertrophic papillae showed an effective minimally invasive management of the condition. [ABSTRACT FROM AUTHOR]