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Objectives The aim of this study was to assess the efficacy of laparoscopic transperitoneal pudendal decompression in the improvement of refractory lower urinary tract symptoms (LUTS) in young males presenting with clinical features of pudendal nerve entrapment with no known comorbidities that could explain their LUTS. Methods This is a prospective pilot study involving patients suffering from LUTS refractory to standard treatment and clinical features of pudendal nerve entrapment on physical examination. They underwent laparoscopic transperitoneal pudendal decompression. International Prostate Symptom Score (IPSS) and maximal flow (Qmax) on uroflowmetry were evaluated before and 3 months after the procedure. Results Five male patients aged 34 ± 4 years were recruited. The median IPSS differed significantly before and 3 months after the procedure (18 vs 8, P = .042); likewise, median Qmax differed significantly before and 3 months after the procedure (12 vs 18 mL/s, P = .042). Conclusion Pudendal nerve entrapment syndrome should be considered as a main differential diagnosis for refractory LUTS in young males with no other comorbidities. When clinical features of pudendal nerve entrapment are present, laparoscopic transperitoneal pudendal decompression relieves LUTS in these young males.

Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported. A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval. The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (p

Summary Introduction There are no clear recommendations on how patients with testicular microlithiasis should be followed up. The aim of our systematic review is to give clinical guidelines based on the evidence in the literature. Methods A web search was conducted during February 2018 based on Pubmed data, Embase and Cochrane database. The eligibility of articles was defined using the PICOS method, in concordance with the PRISMA recommendations. Results Fifty three articles were selected for our final synthesis. Our review highlighted an association between testicular microlithiasis and the already known risk factors of testicular germ cell tumor. The presence of testicular microlithiasis in patients with such risk factors increases more the risk of cancer. In the absence of risk factors, the risk to develop testicular cancer is similar to the risk in general population. Conclusion In patients at risk to develop testicular cancer, observation versus testicular biopsy is debatable. We recommend an individualized approach based on the age of the patient, the presence of concurrent features of testicular dysgenesis syndrome, the fertility of the couple, the desire of paternity and the ultrasound pattern (bilateral and clustered vs. unilateral and limited).

Erectile dysfunction (ED) is increasingly becoming more common in young healthy males and is attributed mainly to psychogenic causes in these patients. Recent studies have reported that ED could be secondary to pudendal nerve or artery entrapment. This perspective assessed the efficacy of laparoscopic pudendal nerve and artery decompression in young patients suffering from refractory ED, associated to a pudendal nerve entrapment syndrome. After excluding patients with psychological ED and venous leakage, five young male patients with a history of both ED and pudendal nerve entrapment syndrome diagnosed based on the Nantes criteria were recruited. Pudendal nerve and artery release was performed using a laparoscopic transperitoneal approach. International Index for Erectile Function (IIEF-5) and erectile hardness score (EHS) improved significantly in all patients, 3 months after surgery. Pudendal nerve and artery entrapment could be therefore a reversible cause of ED in young healthy males, and its treatment by laparoscopic pudendal nerve and artery decompression seems to be safe and effective.

Introduction: The interest in laparoscopy in the treatment of ureteropelvic junction obstruction (UPJO) in children under 12 months of age remains controversial. The aim of this study is to evaluate feasibility and benefits of retroperitoneal laparoscopy (RL) compared to open surgery in this age group. Materials and Methods: Between January 2012 and May 2017, we performed 222 pyeloplasties: 144 by laparoscopy and 78 by open surgery. From 2012, the choice of operative technique was decided according to the laparoscopic experience of the surgeon; two surgeons operated laparoscopically on all children

Introduction: The aim is to compare the outcome of open versus laparoscopic Lich-Gregoir technique in patients with vesicoureteral reflux. We report a retrospective multicenter comparative study between open and laparoscopic extra-vesical ureteral reimplantation (EVUR) following Lich-Gregoir (LG) technique for the correction of Vesico-Ureteral Reflux (VUR). Materials and Methods: Between January 2007 and December 2015, 96 patients with VUR (69 females and 27 males) and deterioration of the renal function, underwent EVUR following LG technique. Fifty patients (16 males and 34 females) were operated by open surgery (group A). The mean age was 4.22 years-old, (14-147 months). Laparoscopic approach (group B) was performed in 46 patients (11 males and 35 females). The mean age was 4.19 years-old (15-110 months). We compared the results in relation to degree of VUR, operative time, hospital stay, post-operative pain medications, recovery time, complications, successful rate, recurrence, and follow-up. Statistical analysis was done used Chi square test for categorical variables and the Student t-test for continuous variables. P < 0.05 was considered significant. Results: In both groups no correlation was identified between age or weight and operative time, length of stay or total analgesia used. The mean operative time for group A was 63.2 and 125.4 min for unilateral and bilateral VUR, respectively, and for the group B was 127.90 and 184.5 min, respectively. There was no conversion in the laparoscopic group. Perioperative mucosal perforation of the bladder occurred in 6 patients of group A and 4 patients of group B and was immediately repaired. One patient had to be reoperated for leakage in group B. The mean duration of Morphine, IV and PO analgesia was shorter in group B. The mean hospital stay was 5.46 days for group A and 1.54 days for Group B. The success rate was 98% in group A and 97, 8% in group B. The mean follow-up was 3.67 years for the open and 1.54 years for the laparoscopic group. Transitory voiding dysfunction occurred in bilateral EVUR in one case in each group. Conclusion: Laparoscopic or Open approach for the correction of VUR following Lich-Gregoir technique is effective in unilateral and bilateral VUR with similar results. Laparoscopic approach reduces significantly (p < 0.05 in each item) post-operative pain medication, hospital stay, and allows for a faster return to normal activity., SCOPUS: ar.j, info:eu-repo/semantics/published

Current shortage in organ donors led to the expansion of criteria for organ donation placing organ preservation as one cornerstone for successful transplant, graft function and survival. The historical work of Belzer and Collins paved the way for key descriptions of physiopathology of cell ischemia and protection (cytokines roles, oxidative stress, energy shift to lactic acidosis and perfusion pressure changes). Good preservation means immediate recovery of function and prevention of chronic rejection. Two cooling approaches are available: static (SCS: simple cold storage) suitable for all organs, and dynamic (HMP: hypothermic machines perfusion) designed for kidneys and liver. A thorough discussion of historically manufactured and widely sold preservation solutions e.g. EuroCollins, UW solution (Viaspan®) as well as current used solutions e.g. Custodiol® and the new Celsior is available in this review. Obviously, every single organ exhibits different tolerance to warm and cold ischemia depending on its nature and demands after transplant. Future perspectives of organ preservation may be hidden in hibernators which may hold the enigmas of perfect human organ preservation.

The evidence for the existence of a common pathway for health issues in men is presented in this review. Several epidemiological studies have shown that conditions like cardiovascular diseases (CVD), metabolic syndrome, diabetes, lower urinary tract symptom (LUTS), erectile dysfunction (ED), prostate cancer, hypogonadism, depression and suicide can be associated as risk factors for each other. Thus, the risk of CVD is significantly increased in men with metabolic syndrome, ED, hypogonadism, prostate cancer and/or LUTS. In addition, the above mentioned conditions are more prevalent in atherosclerotic patients. In addition, growing evidence indicates that low androgen levels can cause metabolic syndrome. In addition, obesity, dyslipidaemia and diabetes can further reduce androgen levels potentiating their adverse effect. Low testosterone levels are also associated with a higher incidence of aggressive prostate cancer on biopsy and on definitive pathology, and lower probability of abiraterone response in the metastatic setting. Several recent studies point towards diffuse endothelial dysfunction and dysregulated pro-inflammatory state as the biological link between all these disorders. Our current hypothesis is that oxidative stress caused by these dysfunctions explains the pathogenesis of each of these conditions., SCOPUS: re.j, info:eu-repo/semantics/published

Vesicoureteral reflux (VUR) represents nowadays a controversial issue regarding its diagnosis, screening and treatment for its potential renal damage is not clearly understood. We aim in this mini-review to study the pathogenesis of VUR mechanisms in order to understand its clinical presentation and then be able to evaluate evidence in its screening and diagnosis. Primary VUR is essentially related to short intravesical length of the ureter, while secondary reflux is more related to anatomic or neuro functional anomalies of the bladder. Prevalence of VUR is high in siblings and offspring of index patients making its genetic predisposition quite evident. Recommendations in evaluation of VUR in case of antenatal hydronephrosis or urinary tract infection (UTI) differ among experts and organizations with benefits and inconveniences to each attitude.

The presence of a renal agenesis with an ipsilateral seminal vesicle cyst and an ejaculatory duct obstruction is a rare congenital anomaly initially reported by Zinner in 1914. This anomaly can be responsible of perineal pain, hemospermia, hematuria, post-ejaculatory pain, urinary tract infection, infertility and lower urinary tract symptoms (LUTS).