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Introduction: Conventionally, confirmation of clinically significant prostate cancer (csPCa) (Gleason grade group ≥ 2) involves an initial multiparametric magnetic resonance imaging (mpMRI) followed by biopsy. Prostate biopsy incurs inherent risks of infection, bleeding, patient discomfort, and a 6-week delay before robot-assisted laparoscopic radical prostatectomy (RALP). We explored the feasibility of immediate RALP in men with PIRADS 5 lesions without preceding biopsy. Methodology: After obtaining institutional review board approval, a prospective analysis was conducted on 235 patients with PIRADS 5 lesions on mpMRI from December 2018 to February 2023. Patients were divided into 2 groups as follows: Group NoBiopsy (biopsy not done before RALP, cases, n = 118) and Group YesBiopsy (biopsy done before RALP, controls, n = 117). Baseline preoperative, intraoperative, and postoperative parameters were analyzed. Functional outcomes were monitored at 1, 3-, 6-, 9-, and 12-months follow-up post-RALP. Statistical analysis was performed using SPSS and STATA. Results: Ninety-five percent of cases and 87.17% controls had csPCa on final pathology post-RALP. Multivariable analysis did not find significant association between biopsy status and csPCa. Abnormal digital rectal examination (DRE), family history, preoperative PSA, and MRI lesion volume predicted csPCa. Significant differences were observed in console time (NoBiopsy vs. YesBiopsy, 60 ± 10 vs. 70 ± 9 minutes, p < 0.001) and estimated blood loss (80 ± 20 vs. 100 ± 30 mL, p < 0.01) between groups. At 6 months post-RALP, 96% of men in Group NoBiopsy were continent, compared with 88% of men in Group YesBiopsy (p < 0.04). All men in the study cohort were continent (0 pads) at 12 months post-RALP. Ninety-eight percent of cases and 92% of controls at 9 months and 12 months, respectively, were able to have penetrative sex with or without PDE-5 inhibitors post-RALP. Conclusion: RALP without antecedent prostate biopsy in men with PIRADS 5 lesions demonstrated substantial csPCa detection rates and superior functional outcomes, warranting further validation. [ABSTRACT FROM AUTHOR]

Information overload is a symptom of the modern world. In medicine the problem can lead to stress and anxiety. Patients need help to navigate the sea of information they face when trying to make decisions about their own health and treatment. [ABSTRACT FROM AUTHOR]

Myths surrounding COVID‐19 can be challenged with well researched scientific arguments. However, conspiracy theorists are difficult people to persuade and the internet is a rich source of misleading material. [ABSTRACT FROM AUTHOR]

Fetal ultrasound can identify babies who are at risk of developing renal failure. However, renal damage before birth is difficult to reverse and end‐stage renal failure may not be preventable. [ABSTRACT FROM AUTHOR]

Loss of public lavatories is having an impact on some of the more vulnerable people in society who, for health reasons, rely on timely access to a toilet to allow them to leave their homes and enjoy some of the freedoms healthy folk may take for granted. [ABSTRACT FROM AUTHOR]

Surgery for urinary tract stones has a long history – from the days of highly risky open surgery to the minimally invasive techniques used today. The author traces the events that have marked the journey. [ABSTRACT FROM AUTHOR]

Improvements in surgical management usually occur slowly so changes are only recognised when, with maturity, surgeons look back at earlier protocols. Prostate cancer management, on the other hand, has undergone radical change since it was first described, but with identifiable milestones, some of which were quite dramatic. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence that maternal obesity is associated with several structural birth defects. Congenital abnormalities of the kidney and urinary tract (CAKUT) account for 30 to 50% of children starting kidney replacement therapy (KRT). We conducted a systematic review, meta-analysis and ecological study to explore the relationship between maternal obesity and CAKUT. Methods: A systematic literature search was conducted in EMBASE, MEDLINE, Global Health, The Cochrane Library, Scopus and Web of Science. Study quality was assessed for bias and confounding. A meta-analysis using a random effect model was carried out to obtain a summary odds ratio (OR) and 95% confidence interval (CI). In the ecological study, country-level data were used to examine the correlation of secular trends in female obesity, CAKUT incidence and incidence of KRT. Results: Eight epidemiological studies were included in the review—4 cohort studies and 4 case-control studies—7 of which were included in the meta-analysis. There was evidence of a positive association between obesity during pregnancy and the risk of CAKUT, with a summary OR = 1.14 (1.02–1.27). No association was seen with overweight, nor a dose response with increasing obesity. There was an increasing trend in countries' proportion of female obesity and an increasing trend in reported CAKUT incidence with specific rises seen in congenital hydronephrosis (CH) and multicystic kidney dysplasia (MCKD). Conclusions: Our findings suggest that pre-pregnancy obesity may be associated with increased risk of CAKUT at population level. [ABSTRACT FROM AUTHOR]

Investigation of gross haematuria is warranted because of the prevalence of cancer. However, opinion varies for non‐visible haematuria and decisions about who should be investigated further or referred depend on a variety of factors. [ABSTRACT FROM AUTHOR]

Aims: To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post‐prostatectomy urinary incontinence. Methods: The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer‐reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. Results: Voiding diary and pad tests are valuable for assessing quantity of leakage. Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI. Much discussion centers on the definition of moderate SUI. Injectable agents have a poor success rate in men with SUI. Options for recurrent SUI due to urethral atrophy after AUS implantation include changing the pressure balloon, downsizing the cuff and increasing the amount of fluid in the system. Infection and/or erosion demand surgical removal or revision of all or part of the prosthesis. Conclusions: Although there are several series reporting the outcomes of different surgical interventions for PPUI, there is still a need for prospective randomized clinical trials. Recommendations for future research include standardized workup and outcome measures, and complete reporting of adverse events at long‐term. [ABSTRACT FROM AUTHOR]

Parents have limited aspirations for children with major congenital anomalies and have difficulty in preparing themselves for their maturity. Many general lessons can be learnt from experience in urology and vice versa. [ABSTRACT FROM AUTHOR]

Background: The incidence of spina bifida (SB) is~1:1000, and risk of stone disease is substantially raised in SB. This is the unique published study of the outcome of patients with SB undergoing percutaneous nephrolithotomy (PCNL) compared to a neurologically intact historically matched control group at the same institution. Patients and Method: A series of 96 PCNLs in 13 SB and 50 non-SB patients was analyzed. The following measurements were recorded: (1) Comorbidities; (2) Preoperative: (renal function, American Society of Anesthesiologists [ASA] score); (3) Intraoperative: (anesthesia time, number of tracks, stone-free rate); and (4) Postoperative: (sepsis, intensive therapy unit and total length of stay, transfusion rate, stone composition, rate of stone disease-related nephrectomy). Results: Retrograde access to the ureter was impossible in all cases of SB. The median ASA grade (OR 10.5, 95% confidence interval [CI] 2.6-42.7) and operative time (median difference 30 minutes, 95% CI 20-40) were both higher in the SB cohort. Surgeon's estimate of stone-free rate was significantly lower in the SB cohort (46% vs 82%). Intensive care requirement (0.29 days/PCNL vs 0.1 days/PCNL); total hospital stay (7 days vs 4 days); postoperative transfusion rate (11.8% vs 1.6%); and sepsis rate (38% vs 1.6%) were all significantly higher in the SB group. Repeat PCNL and nephrectomy for recurrent stone disease were both significantly increased in SB cohort compared to control group. Conclusions: PCNL in patients with SB is associated with multiple parameters of poor outcome. Patients with SB should be counseled about increased peri-operative risk and likelihood of stone recurrence. In an era where hospitals are judged according to comparative outcomes, a case may be made for comparing PCNL in this cohort of patients separately because of the significantly increased peri- and postoperative morbidity. [ABSTRACT FROM AUTHOR]

Cancer following bladder replacement or diversion is a significant issue and can undo even the very best surgical reconstructions. In this article the author describes which procedures carry the highest risk, and what efforts can be made to reduce the risk and catch cancers at an early stage if they do occur. [ABSTRACT FROM AUTHOR]

Introduction Children with urinary tract disorders managed by teams, or individual pediatricians, urologists, nephrologists, gastroenterologists, neurologists, psychologists, and nurses at some point move from child-centered to adult-centered health systems. The actual physical change is referred to as the transfer whilst the process preceding this move constitutes transition of care. Our aims are twofold: to identify management and health-service problems related to children with congenital or acquired urological conditions who advance into adulthood and the clinical implications this has for long-term health and specialist care; and, to understand the issues facing both pediatric and adult-care clinicians and to develop a systems-approach model that meets the needs of young adults, their families and the clinicians working within adult services. Methods Information was gleaned from presentations at an International Children's Continence Society meeting with collaboration from the International Continence Society, that discussed problems of transfer and transitioning such children. Several specialists attending this conference finalized this document identifying issues and highlighting ways to ease this transition and transfer of care for both patients and practitioners. Results The consensus was, urological patients with congenital or other lifelong care needs, are now entering adulthood in larger numbers than previously, necessitating new planning processes for tailored transfer of management. Adult teams must become familiar with new clinical problems in multiple organ systems and anticipate issues provoked by adolescence and physical growth. During this period of transitional care the clinician or team assists young patients to build attitudes, skills and understanding of processes needed to maximize function of their urinary tract-thus taking responsibility for their own healthcare needs. Preparation must also address, negotiating adult health care systems, psychosocial, educational or vocational issues, and mental wellbeing. Conclusions Transitioning and transfer of children with major congenital anomalies to clinicians potentially unfamiliar with their conditions requires improved education both for receiving doctors and children's families. Early initiation of the transition process should allow the transference to take place at appropriate times based on the child's development, and environmental and financial factors. Neurourol. Urodynam. 36:811-819, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Congenital pelvic anomalies are relatively rare in males. Little is known about their impact on sexual function and activity as these boys grow into men. In this article the author looks at the data available and encourages health professionals who look after such patients not to be afraid to discuss sex. [ABSTRACT FROM AUTHOR]

Recreational use of drugs may be viewed by those who indulge as a relatively victimless pursuit. However, as the author discusses in this article, that is far from the truth and those who engage in such activity should be made aware of the potential harms of their action, not least to the genitourinary system. [ABSTRACT FROM AUTHOR]

Urinary catheters are widely used and complications with them are common. In this article the author considers the common problems encountered when using urinary catheters and suggests what can be done about them. [ABSTRACT FROM AUTHOR]

Objective To investigate sexual function and quality of life in adolescent and adult women with classic bladder exstrophy ( BE). Materials and Methods A two-part observational cross-sectional study with a questionnaire arm and a retrospective case review arm was performed. The study was undertaken in a centre providing a tertiary referral gynaecology and urology service. Outcomes were sexual function and quality-of-life scores. Results A total of 44 patients with BE were identified from departmental databases and included in the study, of whom 28 (64%) completed postal questionnaires. Sexual function scores and quality-of-life visual analogue scales were significantly poorer compared with normative data. Conclusions Bladder exstrophy has a detrimental psychological impact on women. In future, methodical multidisciplinary paediatric follow-up research will help to identify predictors of better and worse adolescent and adult outcomes. Development and evaluation of cost-effective psychological interventions to target specific problems is also warranted. [ABSTRACT FROM AUTHOR]

With improved treatments, increasing numbers of boys with chronic illnesses are living into adulthood. The transition between paediatric management and adult services needs to be handled carefully. Christopher Woodhouse discusses some of the issues. [ABSTRACT FROM AUTHOR]

Objectives To identify a cohort of patients under our care who have had significant and in some cases irreparable damage to their bladders after Mitomycin C ( MMC) instillation., To highlight the importance of avoidance and recognition of bladder perforations during transurethral resection of bladder tumour ( TURBT) and explore the issue of consent regarding MMC given the serious complications that may occur after its instillation., Patients and Methods Patients referred to our tertiary centre for a second opinion to manage their complications after a suspected MMC leak was identified from the departmental database between January 2000 and December 2010., After collection of all the records, we established a cohort of six patients., All patients had their initial tumour resection elsewhere and were referred for specialist management thereafter. Details of the operating surgeon and cystoscopic findings were known only in half of the cases., Retrospective analysis of their notes including documentation from the referring centre was undertaken. This included a review of all the histology and imaging., Results All patients had immediate severe pelvic pain on instillation of the MMC. Four of the six continue to have chronic pelvic pain., Two patients had urinary retention and three had severe lower urinary tract symptoms. One patient developed a frozen pelvis., Initial treatment was with an indwelling catheter for a period of 2-52 weeks to aid healing., Two patients had reconstructive surgery, one with success and the other with failure, as an intestinal patch failed to close the fistula and he continues with a catheter. One patient had an ileal conduit., No patient was warned of such complications., Conclusions Although rare, prophylactic MMC can have devastating consequences., Patients should be aware of such major risks., Strong emphasis should be placed on the quality of the initial TURBT coupled with the judgement of an experienced surgeon before to MMC instillation. The real clinical benefit could be reviewed and intravesical MMC offered only to patients who have a good chance of benefit. [ABSTRACT FROM AUTHOR]

Objective To examine long-term quality-of-life, urinary continence and sexual function outcomes in patients diagnosed with bladder exstrophy ( BE)., Patients and Methods A total of 65 patients with BE and follow-up of at least 20 years were identified., After informed consent for inclusion in the study, the patients were asked to complete three validated questionnaires, the Short-Form 36 quality-of-life questionnaire ( SF-36), the International Consultation on Incontinence Questionnaire ( ICIQ) and the International Index of Erectile Function ( IIEF), to assess quality of life, perceived urinary continence and sexual function., Results In all, 21 patients responded to the questionnaires, yielding a 32% response rate., High scores in each of the eight dimensions of the SF-36 reflected a positive perception of quality of life by respondents; calculated scores were compared with those of a normal control group. The only significant difference found between the groups was that the study population perceived their general health to be poorer than those in the control group., High scores on the ICIQ indicate high levels of subjective incontinence in patients, with scores ranging from 0 to 21. Reporting scores of 0 (continent), 12/21 patients perceived their continence to be normal, 9/21 patients had scores >2 (mild), with one patient scoring a 16, and 11 (severe incontinence), patients reported no identifiable leakage during normal activities., There was a 29% response rate for the IIEF (15 patients completed this). IIEF scores were broken down into five dimensions and mean scores were calculated. The mean scores showed mild to moderate dysfunction in each category, including overall satisfaction with sexual experience., Conclusions The patient-reported quality of life in patients with BE was normal in all dimensions, with the exception of perception of general health. Half of the patients reported normal continence and had no complaints of urinary leakage., Sexual function in males was significantly affected across all dimensions, with mild to moderate dysfunction. [ABSTRACT FROM AUTHOR]

It is clear that no one urinary diversion suits all patients - a variety of approaches allows in depth counselling of patients and a feeling of 'choice'. Regardless of the decision made any patient undergoing such surgery must be able to accept the surgical and physical changes alongside the psychological impact. There is currently no validated means to measure acceptance. Health Related Quality of life (HRQoL) may be thought of a surrogate measure and is often high following urinary diversion. Thus could be interpreted as a retrospective validation of patient selection - in its simplest form this could create the dangerous misconception that urologists should offer an ileal conduit as the standard. In modern urinary diversion, high patient acceptance develops from comprehensive pre-operative counselling, setting realistic expectations, careful patient-to-method-matching, strict adherence to surgical detail during the procedure and a meticulous lifelong follow-up. Misjudgements in patient or diversion selection may result in harm to a patient's physical or psychological health. This will undermine the factors behind success which include individual coping strategies, disease related social support and confidence in the success of treatment. A reconstructive surgeon must have all appropriate surgical options available and choices need to be tailored to an individual's needs. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this paper is to study the incidence and risk factors for genital prolapse in adult women with bladder exstrophy and to describe the long-term outcome of the Gore-Tex wrap procedure for genital prolapse. Methods: A retrospective observational study on adult women with classical bladder exstrophy in a tertiary referral centre for disorders of sex development, including complex urogenital anomalies. Medical notes were reviewed and a confidential postal questionnaire on urinary continence and symptoms of prolapse was carried out. Results: Fifty-two women with bladder exstrophy and a mean age of 39 years (range 23 to 63) were identified, of whom 27 patients (52%) developed pelvic organ prolapse. Twenty-three out of 27 (85%) were treated surgically while only 4 patients were managed expectantly. Risk factors for prolapse included pregnancy in 10 (37%) patients and introitoplasty in 1 patient (4%). Of the 23 women treated surgically, 16 (70%) were treated using a Gore-Tex wrap, while 7 had other surgical procedures including colposuspension and hysterosacrocolpopexy. In the Gore-Tex wrap group, 12 out of 16 patients (75%) had had a successful result after the first repair compared with 2 out of the 7 patients (28%) in the group treated using other procedures. Mean follow-up was 8 years (range 1-15). One patient developed an infection after the procedure and another patient had Gore-Tex erosion. Conclusions: Prolapse is a common gynaecological complaint in adult women with bladder exstrophy and the majority will require treatment. At present the Gore-Tex wrap offers good results with a low rate of serious complications. [ABSTRACT FROM AUTHOR]