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Introduction: Extrusion of transvaginal mesh into the urethra is a rare but potentially serious complication. Our objective is to evaluate the efficacy and long‐term outcomes of women who underwent an endoscopic laser procedure to treat intraurethral mesh. Materials and Methods: A retrospective chart review identified women who underwent an endoscopic Holmium:YAG laser procedure to treat intraurethral mesh between September 2011‐October 2021. Information about the procedure, symptoms, and level of incontinence was gathered from the medical records. Primary outcomes were the need for further procedures, and the Urinary Distress Index‐6 score at last follow‐up. Results: We identified a total of 29 women; mesh sling procedure included tension‐free vaginal sling (19), transobturator sling (6), or other transvaginal mesh sling (4). Presentation of intraurethral mesh was a median of 6 (interquartile range [IQR]: 1–7) years after placement. After the endoscopic procedure, 18/29 (62%) women had no visible urinary mesh and complete resolution of their presenting symptoms. Retreatment was necessary in 3/29 women, and 6/29 (21%) reported new or worsening stress incontinence. The UDI‐6 was completed by all patients at a median of 3.7 (IQR: 2.0–5.8) years after their endoscopic procedure. The median score was 22 (IQR: 11–44), and 18/29 (62%) women had scores in the asymptomatic range. UDI‐6 scores were similar for the six women who had further mesh procedures and the ones who did not. Conclusions: Endoscopic laser treatment of an eroded transvaginal mesh sling is an acceptable treatment with minimal morbidity and satisfactory UDI‐6 scores after a median follow‐up of 3.7 years. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of testicular microlithiasis and its association with sperm retrieval rates and histopathology in men with non‐obstructive azoospermia. Methods: A total of 120 men underwent scrotal ultrasonography prior to microsurgical testicular sperm extraction. Sperm retrieval rate, testicular histopathology, testicular size, reproductive hormones, karyotyping, Y chromosome microdeletion analyses, and presence of varicoceles and hydroceles were compared between men with and without testicular microlithiasis. Results: The total sperm retrieval rate was 40%. Ten men with normal spermatogenesis were excluded. The remaining 110 men with non‐obstructive azoospermia were analyzed and testicular microlithiasis was detected in 16 of them (14.5%). The sperm retrieval rate in that subgroup was only 6.2% (1/16) as opposed to 39.4% (37/94) in men with non‐obstructive azoospermia and no evidence of microlithiasis (P = 0.009). The mean right and left testicular diameters were significantly lower in the microlithiasis group (P = 0.04). On multivariate logistic regression analysis, the presence of mictolithiasis (odds ratio 7.4, 95% confidence interval 2.3, 12.2; P = 0.01) was the only independent predictor of unsuccessful sperm retrieval. The 15 patients with microlithiasis and without successful sperm extraction were diagnosed by histopathology as having Sertoli cells only. The 16th patient with successful sperm retrieval had a histopathology of mixed atrophy and was diagnosed with Klinefelter syndrome. Conclusion: The presence of testicular microlithiasis is associated with low sperm retrieval rates among our cohort of men with non‐obstructive azoospermia undergoing scrotal ultrasonography prior to microsurgical testicular sperm extraction. Larger, prospective studies should be conducted to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Data on who among the infertile male population may benefit from round spermatid injections (ROSI) are lacking. Objective: To determine the probability of finding round spermatids suitable for ROSI in men with non‐obstructive azoospermia (NOA) in whom no spermatozoa were retrieved at testicular sperm extraction. Materials and methods: Four‐hundred fifty‐seven consecutive men with azoospermia underwent testicular sperm extraction. Clinical examination included age, secondary sexual characteristics, testicular size, reproductive hormone estimation, karyotyping, and Y chromosome microdeletion analyses. Histologic examination was performed, and histologic classification was determined by the most advanced spermatogenetic cell identified in the combined histologic and cytologic examination. Results: Of the 457 azoospermic men, 342 were diagnosed with NOA, and 148 (148/342, 43%) had mixed atrophy on histopathology and retrievable spermatozoa. No spermatozoa were found in 194/342 men with NOA (57%). Histopathology diagnosed 145/194 (75%) of them with Sertoli cell only, 45/194 (23%) with spermatocyte maturation arrest, and 4/194 (2%) with spermatid maturation arrest. Conclusions: Histopathologically identified round spermatids without spermatozoa were rare in men with NOA. Only very few of them are likely to reap the benefits of ROSI, thus presenting the need to reconsider its actual clinical value. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions The value of post‐operative pelvic drain placement after robot‐assisted radical prostatectomy (RARP) for the purpose of diagnosing post‐operative complications is undetermined. The aim of this study was to assess the yield of pelvic drain outputs in predicting post‐operative early‐onset urinary leaks from a vesicourethral anastomosis.We conducted a retrospective analysis of 204 consecutive patients who underwent RARP in our institution between 2018 and 2022. The daily outputs of the drain and the urinary catheter were measured, and patients with early‐onset anastomotic urinary leak were compared with those who were free of any leak. The association between post‐operative drain output and the presence of urinary leak was investigated by regression analyses.Post‐operative early‐onset leak was present in six patients (3.4%) whose baseline characteristics were not different from those of patients with no leak. The median pelvic drain output on post‐operative day 1 (D‐POD1) was 80 mL (interquartile range [IQR] 51–150 mL) and 122 mL (IQR 62–200 mL) on D‐POD2. The median D‐POD1 of patients with a leak was significantly higher than those without one (250 mL vs 80 mL, respectively; P < .001). The threshold to predict an anastomotic urinary leak was 227 mL on D‐POD1 (area under the curve 0.88; P < .001), and an association between D‐POD1 >227 mL and the presence of urinary leak (odds ratio 35; P < .001) was found.Pelvic drain output on POD1 can predict early‐onset urinary leak. Given the relatively low rate of this complication via a robotic approach, however, we consider that, unless otherwise indicated, the routine placement of a pelvic drain may be safely avoided. [ABSTRACT FROM AUTHOR]