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Gender reassignment surgeries are performed not to treat a congenital or anatomical anomaly, but to treat the psychological problems of transsexuals. In fact, there is no definitive evidence showing that psychological problems in transsexuals are cured by hormonal and/or surgical treatments for gender reassignment. On the contrary, there is evidence that these psychological problems persist after medical and surgical interventions, and even increase in some transsexuals, and a new form of body dysphoria occurs in a quarter of cases. Psychological problems in transgender people are not cured by surgery, and additional surgery-related complications develop in three-quarters of the cases. The vast majority of these are urogenital complications, and more than half require reoperations. However, in a significant proportion of cases, the outcome is unsuccessful and these urogenital complications significantly reduce the quality of life of transsexuals. Data also show that the life expectancy of transsexuals who undergo surgery is shortened by an average of 25-28 years due to psychological problems, suicides, surgical complications, reoperations and diseases related to hormone use. These results have led to an increase in the number of detransitioners who regret their medical and surgical transition and want to return in recent years, and have increased ethical debates on this issue. In this article, urogenital complications that develop after transgender surgery, which reduce the quality of life and possibly play a role in regrets are summarized. [ABSTRACT FROM AUTHOR]

Urogenital emergencies demand immediate attention within the field of emergency medicine, encompassing a range of critical conditions from ectopic pregnancies to kidney stones. Timely diagnosis and treatment are vital to prevent potential mortality and morbidity. However, due to the sensitive nature of these disorders and the cultural taboos surrounding them, accessing prompt medical care can be challenging. To bridge this gap, innovative gamification-based learning techniques, such as the Learning Urogenital Diseases in Oddity (LUDO), have been introduced for emergency medicine residents (Chou, What is gamification? Yukai Chou: Gamification and behavioral design, n.d.; Gamification '13: Proceedings of the first international conference on gameful design, research, and applications, 2013). LUDO is a timed, gamified exercise that offers residents an interactive and engaging platform to enhance their clinical knowledge related to urogenital disorders. Adapted from the well-known board game, LUDO fosters learning, collaboration, and cooperation among residents. This format is highly customizable and can be utilized by various learning groups. Participants, emergency medicine residents from different academic years, formed four teams, each distinguished by a unique color. The exercise utilized simple and accessible materials, including a LUDO board, LED stopwatch, laptop, colored hats, and a desk bell. Teams advanced their tokens through the board by correctly answering urogenital disorder-related questions within a specified time frame. LUDO's objectives extended beyond token movement, assessing essential skills such as teamwork, time management, resource utilization, and strategic decision-making. The option to seek external resources, limited to five times per team, added an element of strategy. Facilitators evaluated participants' performance through questionnaires and Likert scales. The results revealed that LUDO effectively promoted teamwork, communication, leadership, and problem-solving among emergency medicine residents. Resident feedback was overwhelmingly positive, with interest in adopting this format for other educational modules. The gamified approach encouraged engagement and motivation, with immediate feedback ensuring continuous learning. In conclusion, the incorporation of the LUDO gamified format provides an enjoyable and interactive learning experience for emergency medicine residents. It enhances engagement, fosters teamwork, and facilitates the rapid assimilation of crucial knowledge related to urogenital diseases. This adaptable approach holds promise for improving resident training in various clinical scenarios. [ABSTRACT FROM AUTHOR]

Background: Urethropreputial fistulas are communicative conduits between the urethra, prepuce, and environment whose origin deviates the urinary flow from its physiological path. The condition has a multifactorial cause and is considered uncommon in dogs. By the scarce occurrence of this malformation, as well as the scarcity of case reports on the subject, the present work aims to report a case of congenital urethropreputial fistula in a mixed breed dog and the surgical procedures performed to correct this genitourinary abnormality. In addition, it seeks to cross information available in the literature with the changes found during the case attendance. Case: An approximately 1-year-old male canine, mixed breed, was attended at the Veterinary Hospital of the Federal Rural University of Pernambuco (HOVET - UFRPE) with a complaint of dysuria, where the urinary flow occurred by dripping through an orifice caudal to the external urethral ostium. According to the tutor, the animal presented the condition since its adoption at 2 months old. The general physical examination did not show any changes in the physiological parameters. The mucous membranes were normal in color, the capillary refill time was 2 s, there was no pain or discomfort on superficial and deep palpation of the abdomen, and the heart and respiratory rates were within the range considered normal for the species. The specific examination found the existence of a fistula on the ventral aspect of the foreskin, whose resolution required a surgical intervention that consisted of obliteration of the fistula communication channel by suturing the defect using an absorbable suture thread. However, this was not effective in solving the problem of the animal, which returned to the hospital complaining of ischuria, leading to the need for 2 other surgical procedures: A scrotal urethrostomy, whose result was also inadequate due to the displacement of the urethral catheter given the postoperative conditions and the animal's temperament, and, to guarantee the proper functioning of the lower urinary tract, avoiding recurrences, a new urethrostomy dorsal to the first, in the perineal region, was performed. The animal did not present episodes of urinary retention after the third procedure and had a significant improvement in the condition in which it was before the initial treatment. Discussion: Urogenital anomalies are rare in dogs and can be acquired or congenital. With an etiology still not fully elucidated, the variety of fistula presentations indicates that the condition probably has multifactorial causes. The affection may be confused with hypospadias. However, in this case, the external urethral ostium is out of its anatomical location, and several other abnormalities are present, like cryptorchidism, intersexuality, and penile underdevelopment. The history obtained through the anamnesis, associated with the absence of traumatic episodes in the region and other associated congenital alterations, leads to the understanding that it is a urethral fistula not associated with hypospadias and has a congenital origin. The failure of the first surgical intervention provides relevant data in search of the probable causes of fistula formation. The impossibility of urethral catheterization associated with ischuria consequent to the obliteration of the defect is indicative that the urethral path was blind-ended or with a significant reduction of the lumen, and the resulting increase in pressure can be considered a factor for the formation of the fistula. [ABSTRACT FROM AUTHOR]

Background: Menopause leads to a dramatic drop in ovarian function which lower the oestrogen in the circulating blood may cause atrophy of vaginal epithelium. Traditionally the atrophy of vaginal epithelium was managed by Kegels exercise but not attempted using reverse Kegels exercise. Purpose: This present study attempted the reverse Kegels exercise and compares the effectiveness with traditional Kegels exercise on vaginal atrophy and vaginal pH among postmenopausal women. Materials and Methods: 32 postmenopausal women in the age group between 40 to 60 years with vaginal atrophy were recruited and randomly assigned to one of the two groups: Traditional Kegels group (n=16) and Reverse Kegels group (n=16). The vulvovaginal symptom questionnaire (VSQ) and vaginal pH test kit were used as outcome measures to assess the vulvovaginal symptoms and vaginal pH level before and after the intervention. Results: The t-test analysis was used to analyse the comparison within and between the groups. The p value of the Vulvovaginal symptom questionnaire in post-test values between the groups was 0.0256 (p value < 0.05) which was statistically significant. Conclusion: Based on the outcome measures the participants in the traditional Kegels exercise found to be better in reliving the vulvovaginal symptoms. However, the vaginal pH level in both the groups after intervention does not show any changes. [ABSTRACT FROM AUTHOR]

Background Telomere length has been linked to various health outcomes. To comprehensively investigate the causal effects of telomere length throughout the human disease spectrum, we conducted a phenome-wide Mendelian randomization study (MR-PheWAS) and a systematic review of MR studies. Methods We conducted a PheWAS to screen for associations between telomere length and 1 035 phenotypes in the UK Biobank (n = 408 354). The exposure of interest was the genetic risk score (GRS) of telomere length. Observed associations passing multiple testing corrections were assessed for causality by 2-sample MR analysis. A systematic review of MR studies on telomere length was performed to harmonize the published evidence and complement our findings. Results Of the 1 035 phenotypes tested, PheWAS identified 29 and 78 associations of telomere length GRS at a Bonferroni- and false discovery rate-corrected threshold; 24 and 66 distinct health outcomes were causal in the following principal MR analysis. The replication MR using data from the FinnGen study provided evidence of causal effects of genetically instrumented telomere length on 28 out of 66 outcomes, including decreased risks of 5 diseases in respiratory diseases, digestive diseases, and myocardial infarction, and increased risks of 23 diseases, mainly comprised neoplasms, diseases of the genitourinary system, and essential hypertension. A systematic review of 53 MR studies found evidence to support 16 out of the 66 outcomes. Conclusions This large-scale MR-PheWAS identified a wide range of health outcomes that were possibly affected by telomere length, and suggested that susceptibility to telomere length may vary across disease categories. [ABSTRACT FROM AUTHOR]

Background: Genitourinary syndrome is commonly reported in postmenopausal women. Kegel's exercise is a noninvasive therapy that improves pelvic floor muscle parameters. However, the effect of Kegel's exercise on health-related quality of life (HRQoL) in postmenopausal women with genitourinary syndrome has not been synthesized or shown. Purpose: This study was designed to systematically review and analyze the previous literature to determine whether Kegel's exercise enhances HRQoL in postmenopausal women with genitourinary syndrome of menopause. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, and six databases were searched, including Embase, MEDLINE, Cochrane, CINAHL, Web of Science, and Scopus, from their dates of inception to November 2021. Eligible studies evaluated the effects of Kegel's exercise on HRQoL in postmenopausal women with urinary, sexual, or genital symptoms. Review Manager software was used to perform the meta-analysis using a random-effects model. Chi-square and I² tests were used to evaluate heterogeneity among the studies. Meta-analysis was performed based on the symptoms (i.e., urinary, sexual, and genital) identified in the quality-of-life questionnaires. Results: This systematic review covered five studies with 268 participants. The research appraisal found most of these studies had a low risk of bias. The intervention periods ranged from 4 to 12 weeks. Compared with non-Kegel's exercise or regular activity, Kegel's exercise was found to significantly improve HRQoL-related urinary symptoms (three studies, standardized mean difference = −0.95, 95% CI [−1.35, −0.54], I² = 0%). However, the effect of this exercise on HRQoL-related sexual symptoms did not differ from non-Kegel's exercise or regular activity (two studies, standardized mean difference = 1.11, 95% CI [−0.25, 2.47], I²= 94%). None of the covered studies examined the effect of Kegel's exercise on HRQoL-related genital symptoms. Conclusions/Implications for Practice: Kegel's exercise is an effective intervention for improving HRQoL-related urinary symptoms in postmenopausal women. However, there remains insufficient evidence to assess the effectiveness of Kegel's exercise on HRQoL-related genital symptoms in this population. The results support using Kegel's exercise as a useful intervention to manage urinary symptoms in postmenopausal women. [ABSTRACT FROM AUTHOR]

To present the preliminary results on the clinical utilisation of an online daily adaptive magnetic resonance-guided radiation therapy (MRgRT) for various gynaecological cancers. Twelve patients treated between September 2018 and June 2022 were included. Six patients (50%) were treated with pelvic radiation therapy followed by MRgRT boost as brachytherapy boost was ineligible or unavailable, three patients (25%) were treated with pelvic MRgRT followed by high dose rate brachytherapy, two patients (16.7%) were treated with only MRgRT, one patient (8.3%) was treated with linear accelerator-based radiation therapy followed by MRgRT boost for bulky iliac lymph nodes. The median age was 56.5 years (range 31–86 years). Eight patients (66.7%) had a complete response, three patients (25%) had a partial response and one patient (8.3%) died due to acute renal failure. The mean follow-up time was 11.2 months (range 3.1–42.6 months). The estimated 1-year overall survival was 88.9%. The median treatment time was 47 days (range 10–87 days). During external beam radiation therapy, 10 (83.3%) patients had concomitant chemoradiotherapy. Pelvic external beam radiation therapy doses for all cohorts were 45–50.4 Gy with a fraction dose of 1.8 Gy. The median magnetic resonance-guided boost dose was 32 Gy (range 20–50 Gy) and fraction doses ranged between 4 and 10 Gy. Three patients were treated with intracavitary high dose rate brachytherapy (26–28 Gy in four to five fractions). None of the patients had grade >3 late genitourinary toxicities. MRgRT is reliable and clinically feasible for treating patients with gynaecological cancers alone or in combination with brachytherapy with an acceptable toxicity and outcome. MRgRT boost could be an option when brachytherapy is not available or ineligible. • MRgRT represents a new method for delivering radiotherapy for gynaecological cancers. • MRgRT is a markerless method providing online adaptive planning and real-time tracking. • MRgRT boost could be an option when brachytherapy is not available or is ineligible. [ABSTRACT FROM AUTHOR]

Background and Objectives: Genitourinary syndrome of menopause (GSM) affects more than half of postmenopausal women. This study aimed to evaluate the clinical and histological aspects of microablative fractionated CO2 laser (CO2L), microablative fractionated radiofrequency (RF) and intravaginal estrogen (ET) therapy as GSM treatments for the vulvar vestibule. Materials and Methods: This study included postmenopausal women with at least one moderate-to-severe complaint of GSM. Women in the CO2L and RF groups received three monthly sessions of outpatient vulvovaginal therapy. The procedures were performed 30 min after applying 4% lidocaine gel to the vulva and vaginal introitus. Vulvar vestibular pain was assessed after each application using a 10-point VAS. A follow-up evaluation was performed 120 days after beginning each treatment. Digital images of the vulva were obtained and a 5-point Likert scale (1 = much worse, 2 = worse, 3 = neutral, 4 = better, 5 = much better) was used to assess the global post-treatment women's impression of improvement regarding GSM. Results: A significant change in clinical aspects of the vulva was observed after all treatments with a reduction in the atrophic global vulvar aspect and an enhancement of the trophic aspect. High satisfaction was also reported after treatment according to the Likert scale evaluation: CO2L (4.55 ± 0.97), RF (4.54 ± 0.95), CT (4 ± 1.41), p = 0.066. Histological evaluation revealed enhanced dermal papillae before pre-treatment, significantly reducing post-treatment in all groups (p = 0.002). No unintended effects were reported. Conclusions: CO2L, RF, and ET significantly improved GSM concerning the vulvar vestibule at the 4 months follow-up. [ABSTRACT FROM AUTHOR]

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Background: Genitourinary Tuberculosis (GUTB) is a common site of extrapulmonary tuberculosis. The disease involves the kidneys, ureters, bladder, or genital organs. Clinical symptoms develop 10 - 15 years after primary infection. Only one-quarter of patients with GUTB have a known history of TB and about half of these patients have chest radiography findings. The current study aimed to determine the effects of GUTB. Methods: The included patients were successive cases with a diagnosis of genitourinary tuberculosis. A total of 62 cases were reported with the diagnosis of genitourinary tuberculosis. PCR for MTb was done in 37 cases. Radiological evaluation included chest X-ray, KUB in all cases, and intravenous urogram when serum creatinine was normal. FNAC was performed in cases with serosal masses. All patients received antitubercular drug therapy with 4 drugs (Rifampicin, Ethambutol, Isoniazid, and Pyrazinamide) for 2 months followed by 2 drugs (Rifampicin and Isoniazid) for 7 months. Results: Positive AFB staining and positive MTb culture in urine were seen in 31.37% and 41.17% of cases, respectively, confirming the presence of Mycobacterium tuberculosis in some GUTB patients. Positive PCR for MTb in urine is present in 67.56% of cases (in a subset of 37 patients). MTb culture in pus is only observed in 4 out of 7 cases, suggesting its less frequent occurrence compared to other positive findings. Sterile urine is found in 78.95% of cases, and Radiological abnormalities (IVU/NCCT/MUCG) suggestive of GUTB was found in 46/57 (80.7%) cases. Bladder biopsy was positive in 12/25(48%) cases done. A comparison of urinary PCR with urine for AFB staining urine for MTb culture and bladder biopsy was done. Conclusion: The urinary (PCR) stands out as the most sensitive indicator among all microbiological tests. When coupled with radiological abnormalities, it significantly expedites the diagnosis of genitourinary tuberculosis. Optimal treatment involves a combination of multidrug chemotherapy and judicious surgery, as necessary. It is highly advisable to make every effort to reconstruct the urinary tract due to the rewarding outcomes associated with this approach. However, in cases where tissue is infected and irreparably damaged, the most effective course of action is ablating the affected tissue. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is better prevented in younger ages than in older ages. This study aims to identify the differences in comorbidity patterns in middle-aged inpatients from China and the United Kingdom (UK). Methods: We utilized 184,133 and 180,497 baseline hospitalization records in middle-aged populations (40–59 years) from Shaanxi, China, and UK Biobank. Logistic regression was used to calculate odds ratios and P values for 43,110 unique comorbidity patterns in Chinese inpatients and 21,026 unique comorbidity patterns in UK inpatients. We included the statistically significant (P values adjusted by Bonferroni correction) and common comorbidity patterns (the pattern with prevalence > 1/10,000 in each dataset) and employed network analysis to construct multimorbidity networks and compare feature differences in multimorbidity networks for Chinese and UK inpatients, respectively. We defined hub diseases as diseases having the top 10 highest number of unique comorbidity patterns in the multimorbidity network. Results: We reported that 57.12% of Chinese inpatients had multimorbidity, substantially higher than 30.39% of UK inpatients. The complete multimorbidity network for Chinese inpatients consisted of 1367 comorbidities of 341 diseases and was 2.93 × more complex than that of 467 comorbidities of 215 diseases in the UK. In males, the complexity of the multimorbidity network in China was 2.69 × more than their UK counterparts, while the ratio was 2.63 × in females. Comorbidities associated with hub diseases represented 68.26% of comorbidity frequencies in the complete multimorbidity network in Chinese inpatients and 55.61% in UK inpatients. Essential hypertension, dyslipidemia, type 2 diabetes mellitus, and gastritis and duodenitis were the hub diseases in both populations. The Chinese inpatients consistently demonstrated a higher frequency of comorbidities related to circulatory and endocrine/nutritional/metabolic diseases. In the UK, aside from these comorbidities, comorbidities related to digestive and genitourinary diseases were also prevalent, particularly the latter among female inpatients. Conclusions: Chinese inpatients exhibit higher multimorbidity prevalence and more complex networks compared to their UK counterparts. Multimorbidity with circulatory and endocrine/nutritional/metabolic diseases among both Chinese and UK inpatients necessitates tailored surveillance, prevention, and intervention approaches. Targeted interventions for digestive and genitourinary diseases are warranted for the UK. [ABSTRACT FROM AUTHOR]

Recurrent urogenital infections such as bacterial vaginosis, vulvovaginal candidiasis, and urinary tract infections have a high prevalence and pronounced psychosocial impact. However, no review has compared the psychosocial impacts across infection types. This narrative review discusses the impact of common recurrent urogenital infections on psychosocial aspects, including quality of life, stress, mental health, sexual health, work productivity, race and ethnicity, and satisfaction of medical care. Validated questionnaires show that women with recurrent vulvovaginal candidiasis and urinary tract infections have decreased scores on all aspects of quality of life. Those with recurrent vulvovaginal candidiasis and urinary tract infections show lower mental health scores compared to the general population, with increased risk of anxiety and depression. Recurrent urogenital infections affect sexual relationships and intimacy, including avoidance due to symptoms or as a method of prevention. Recurrent infections also increase medical cost and negatively affect work productivity, leading to a combined estimated cost of over US$13 billion per year. There are clear effects of racial inequality involving minority populations that affect diagnosis, treatment, prevalence, and reporting of recurrent urogenital infections. Satisfactory medical treatment improves quality of life and mental health in those suffering from these conditions. Research evaluating psychosocial aspects of recurrent urogenital infections is variable and is not comparable across vulvovaginal conditions. Even so, psychosocial factors are important in understanding contribution and consequence of urogenital infections. Education, awareness, normalization, community support, and access to care can help to alleviate the negative implications of recurrent urogenital infections. Plain language summary: A narrative review discussing the psychosocial impact of common recurrent urogenital infections and highlights areas where further research is needed to improve clinical care. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Stress urinary incontinence (SUI) is treated with transobturator tape (TOT) sling procedures, but problems arise with artificial mesh in certain instances. Hence, non-invasive laser therapy may be useful under such circumstances. The current study was aimed at comparing the effects of these two treatments and at checking their applicability in various body mass index (BMI) groups. Methods: Seventy-nine patients, who were clinically diagnosed with SUI, were divided into two groups, those who preferred TOT and those who preferred the transvaginal fractional micro-ablative CO2 laser system. The SUI symptoms and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores of the patients were determined before and at the 12th month after the treatment. General linear model, Stuart–Maxwell, and Bonferroni correction for pairwise comparison analyses were performed to compare the efficacy of the treatment type. Results: The ICIQ-SF score decreased by 56.8% for laser therapy and 43.5% for TOT therapy (mean ± SE = 5.97 ± 0.16 and 5.09 ± 0.14 respectively). Laser therapy had a better effect on ICIQ-SF than TOT therapy (η2p: 0.176, ptime*group < 0.001). Regardless of the types of treatment, the ICIQ-SF scores of healthy-weight participants decreased more than those of overweight participants (η2p:0.050, ptime*group = 0.045). In the TOT group, healthy-weight participants were more than twice as likely to recover fully from SUI symptoms as overweight participants, 1 year after the treatment. In the laser group, the majority of healthy-weight participants (88.8%) did not report any SUI symptoms after the treatment. Conclusions: The efficacy of laser therapy for urinary incontinence was confirmed. Furthermore, it was observed that being overweight may be a risk factor for the failure of laser therapy. [ABSTRACT FROM AUTHOR]

In the context of the menopausal transition, genitourinary syndrome of menopause (GSM) refers to a range of genitourinary symptoms, from vaginal dryness to dysuria and urinary urgency. While hormonal treatments are standard, their associated side effects have driven the exploration of alternatives like vaginal CO2 laser. We aimed to evaluate the randomized controlled trials (RCTs) comparing vaginal CO2 laser treatment for GSM to sham controls. This systematic review sourced four electronic databases until June 2023. The analysis incorporated seven RCTs with 407 women. The CO2 laser and sham control were comparable for most parameters, including the female sexual function index (FSFI) and visual analogue scale (VAS) for dyspareunia, vaginal health index, pH, and patient satisfaction. However, the CO2 laser group showed significant improvement in the vaginal assessment scale for GSM symptoms. Sensitivity analyses revealed that parameters like FSFI showed significant differences in favor of CO2 laser group upon the exclusion of specific studies. In conclusion, vaginal CO2 laser therapy emerges as a promising alternative for GSM management, especially for most bothersome GSM symptoms; however, the need for further well-designed RCTs remains to validate its broad safety and efficacy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate histological modifications of the vaginal mucosa after repeated microablative fractional CO2 laser treatments. As secondary objectives we evaluated the clinical effects associated with repeated microablative fractional CO2 laser treatments using validated questionnaires. Methods: A prospective intervention study was performed in the Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute with 15 postmenopausal women complaining of genitourinary syndrome of menopause symptoms. The cohort of patients was submitted to at least two previous laser treatment cycles in the past years. The Vaginal Health Index (VHI), visual analog scale (VAS), Female Sexual Function Index (FSFI), Urinary Distress Inventory-6 (UDI-6), International Consultation on Incontinence Questionnaire – Urinary Incontinence (ICIQ-UI) and 5-point Likert scale were used. Moreover, histological examinations were carried out on all samples. Results: At 4weeks after the last treatment, the VHI score and all FSFI items were significantly increased compared with baseline. We observed a statistically significant decrease in both frequency and severity for all urinary symptoms after the follow-up. We observed a statistically significant increase in the number of epithelial cell layers with a consequent increase in epithelial thickness, in the number of glycogen-filled cells and in the number of papillae after the laser treatment. No signs of fibrosis were observed as neovascularization was observed in each woman. Conclusions: This is the first study demonstrating the histological persistency of efficacy in repeated annually laser treatment cycles, with tissue changes always leading to regenerative results without any sign of fibrosis. [ABSTRACT FROM AUTHOR]

Objective: This pilot study intended to assess the feasibility of a large-scale randomized clinical trial designed to analyze the effectiveness of microablative fractional CO2 laser (CO2L) and microablative fractional radiofrequency (RF) compared with vaginal estriol (VE) as treatments for women with moderate-to-severe Genitourinary Syndrome of Menopause (GSM). Methods: Participants were randomized into VE, CO2L, or RF groups. In the VE group, women were required to use vaginal estriol cream for 14 days and then twice a week for 4 months. In the CO2L and RF groups, three energy therapies were administered at monthly intervals. Visual Analog Scale (VAS) for GSM symptoms, Female Sexual Function Index (FSF-I), Vaginal Health Index (VHI), and Nugent Score (NS) were analyzed before and 120 days after the beginning of the treatments. Pain scores were verified after each CO2L and RF session. Results: Thirty-four participants completed the study: 11 in the VE group, 11 in the CO2L group, and 12 in the RF group. No unexpected or serious adverse events were observed. We also verified that GSM symptoms, sexual function, and VHI significantly improved (p < 0.05) with no difference among the groups. NS did not show statistically significant difference before and after the treatments. Pain during RF application was associated with higher scores. Conclusions: The study is feasible and does not seem to have safety implications. Preliminary results suggest that CO2L and RF are good alternatives to VE for ameliorating clinical symptoms, FSF-I, and VHI in patients with GSM. [ABSTRACT FROM AUTHOR]

Myrica nagi is a celebrity medicinal plant that is distributed in sub-Himalayan regions and holds several pharmacological actions and therapeutic effects along with their economic usage. In Unani System of Medicine (USM), it is well known, as Kaiphal and used in the prevention and the management of several common disorders viz. Amraz-i-Riya (Respiratory disease), Amraz-i-Hazam (Gastrointestinal disease), Amraz-i-Aasab (Nervine disease), and Amraz-i-Bawl (genitourinary disease). Recent clinical studies evaluate that the Kaiphal consist of numerous phytoconstituents viz. tannins, flavonoids, phenolic acids, terpenes, glycosides, amino acids, steroids, and volatile oils. These phytoconstituents are responsible for varieties of pharmacological actions viz. Anti-inflammatory, Anti-Oxidant, Anti-Allergic, Anti-helminthic, Neuroprotective, Nephroprotective, Anti-hypertensive, Anticancer, and Anxiolytic. Conventionally, different parts of Kaiphal are used in asthma, allergic disorder, inflammatory diseases, neurological disorders, renal disease, and cancer. The physicians of USM described properties and therapeutics uses of Kaiphal but data on safety and efficacy are limited and also lack of attraction of researcher toward a preclinical and clinical trial. Therefore, this review updated the knowledge about pharmacological and therapeutic effects, ethnomedicinal uses, adverse effects, prevention and treatment of common disorders and also focused on future research in the prospective era. [ABSTRACT FROM AUTHOR]

Spondylo-ocular syndrome is a novel Mendelian genetic disorder characterised by ocular manifestations and bone fragility. To date, only 24 cases have been reported worldwide.1 The syndrome varies in presentation and can be associated with cardiac defects, facial deformities, intellectual disability, hearing impairment, genitourinary manifestations as well as osteoporosis with platyspondyly.1 The anaesthetic considerations for children affected with spondylo-ocular syndrome have not yet been described. We report on the clinical manifestations and anaesthetic concerns surrounding the syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Understanding and addressing sexual dysfunction is of paramount importance to enhance the overall well-being and quality of life of individuals worldwide. While significant progress has been made in the field of sexual medicine, variability in practice patterns among healthcare professionals remains a potential barrier to optimal patient care. To bridge this knowledge gap and identify the prevailing trends in sexual dysfunction management, we conducted an international survey targeting urologists specializing in Andrology, Sexual Medicine, and related fields. Objective: This international survey aimed to assess male and female sexual dysfunction management practices among sexual medicine physicians across to globe to identify variability in practice patterns. Methods: A survey was distributed globally to urologists specializing in Andrology, Sexual Medicine, and related fields who are members of International Society for Sexual Medicine (ISSM) or affiliated regional societies (SMSNA, ESSM, MESSM, APSSM, SASSM, SLAMS, ISSWSH, SIU). Demographic information (age, gender, specialty, and practice setting) and treatment approaches for male and female sexual dysfunction were collected. Respondents also reported the percentage of their practice dedicated to sexual dysfunction and whether treatments were covered by health insurance. Results: A total of 200/3000 practitioners participated, with 101 (50.7%) identifying as urologists. The majority were male (72.9%) and worked in private practice or community hospitals (32.7%) or a mixture of both (34.2%). Male sexual dysfunction was treated by 71.4% of respondents, with 25.7% dedicating 75–100% of their practice to it. Female sexual dysfunction was treated by 36.9% of respondents, with 64% dedicating 0–25% of their practice to it. Health insurance covered 25–49% of their care for 41.2% of respondents, predominantly provided by private companies (45.9%). The most common treatments for erectile dysfunction were oral medications (86.5%), injections (61.7%), and inflatable penile prostheses (45.1). For Peyronie's disease, oral therapies (59.1%) and penile traction therapy (34.4%) were most frequently offered, while surgical treatment for Peyronie's disease was offered by 58.2% of respondents, with penile prostheses being the primary choice (79.7%). Regarding female sexual dysfunction, 58.4% of respondents offered treatments for genitourinary syndrome of menopause/atrophic vaginitis, with vaginal estrogen being the most common choice (50%). For dyspareunia due to vaginismus/hypertonic pelvic floor dysfunction, 50.3% of respondents offered treatment, with pelvic floor exercise/physiotherapy being the most recommended (66%). Conclusions: This study provides valuable insights for healthcare professionals, policymakers, and researchers regarding the current landscape of sexual dysfunction management. The results underscore the importance of continuous efforts to develop comprehensive and individualized approaches, ensuring that both male and female patients receive effective and accessible care for their sexual health concerns. By addressing issues related to insurance coverage and fostering interdisciplinary collaboration, the medical community can collectively work towards improving sexual well-being and quality of life for patients worldwide. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla. [ABSTRACT FROM AUTHOR]

The article informs about the prevalence and impact of bothersome genitourinary (GU) symptoms related to hypoestrogenism at menopause, known as the Genitourinary Syndrome of Menopause (GSM). Topic includeWhile these symptoms significantly affect quality of life for many women, there's controversy surrounding the inclusion of urinary symptoms in the GSM definition, highlighting the need for further research and improved treatment options.

Background: Vaginal CO2 laser therapy is a new treatment option for genitourinary syndrome of menopause. Its potential is particularly interesting in breast cancer survivors, where existing treatment options often are insufficient as hormonal treatment is problematic in these women. The objective of this study is to investigate the effectiveness of vaginal laser treatment for alleviation of genitourinary syndrome of menopause in breast cancer survivors treated with adjuvant endocrine therapy. The secondary objective is to explore the importance of repeated vaginal laser treatment and the long-term effects in this patient population. Methods: VagLaser consist of three sub-studies; a dose response study, a randomized, participant blinded, placebo-controlled study and a follow-up study. All studies include breast cancer survivors in adjuvant endocrine therapy, and are conducted at the Department of Obstetrics and Gynecology, Randers Regional Hospital, Denmark. The first participant was recruited on 16th of February 2023. Primary outcome is vaginal dryness. Secondary subjective outcomes are vaginal pain, itching, soreness, urinary symptoms and sexual function. Secondary objective outcomes are change in vaginal histology (punch biopsy), change in vaginal and urine microbiota, and change in vaginal pH. Discussion: More randomized controlled trials, with longer follow-up to explore the optimal treatment regimen and the number of repeat vaginal laser treatments for alleviation the symptoms of genitourinary syndrome of menopause in breast cancer survivors treated with endocrine adjuvant therapy, are needed. This study will be the first to investigate change in vaginal and urine microbiota during vaginal laser therapy in breast cancer survivors. Trial registration: ClinicalTrials.gov: NCT06007027 (registered 22 August, 2023). Protocol version: Version 1, Date 13.11.2023. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the prevalence of Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) among HPV-positive women undergoing colposcopy at the Second Xiangya Hospital of Central South University, Hunan, China. Additionally, we aimed to assess the impact of C. trachomatis or M. genitalium co-infection with HPV on the severity of cervical lesions. Methods: We collected HPV data, cervical cytology results, and demographic information from 439 women attending colposcopy. Cervical swabs were obtained for simultaneous amplification testing (SAT) of C. trachomatis and M. genitalium. Multivariate logistic regression analyses were performed to examine the association between sexually transmitted pathogens and cervical lesions. Results: Among the participants, C. trachomatis was detected in 17 (3.87%) individuals, and M. genitalium in 16 (3.64%) individuals. There was no co-infection of C. trachomatis and M. genitalium. The highest prevalence of M. genitalium was observed in women aged 19–30 years (10.20%; 95% CI, 1.41-18.99%), with a subsequent decline in prevalence with increasing age (Ptrend = 0.014). The most common HPV subtype in our study was HPV52 (30.79%), followed by HPV16 (18.62%), HPV58 (16.95%), and HPV53 (10.02%). Infection with HPV16 (OR = 3.43, 95% CI, 2.13–5.53), HPV31 (OR = 3.70, 95% CI, 1.44–9.50), and HPV33 (OR = 3.71, 95% CI, 1.43–9.67) was associated with an increased severity of cervical lesions, while HPV53 infection was not likely to lead to advanced cervical lesions (OR = 0.45, 95% CI, 0.23–0.89). The leukocyte level in vaginal secretions (P = 0.042) and cervical cytology results (P < 0.001) showed associations with the degree of cervical lesions. However, there was no significant association between C. trachomatis or M. genitalium infection and the severity of cervical lesions, nor with their co-infection with HPV16. Conclusions: There was no correlation between co-infection of Chlamydia trachomatis or Mycoplasma genitalium and the degree of cervical lesions in HPV-positive population in Hunan, China. Our findings emphasized the need to pay more attention to M. genitalium infection among young women. Increased levels of leukocytes in vaginal secretions may be linked to cervical lesions. HPV16, HPV31, and HPV33 in Hunan province, China, may exhibit higher cervical pathogenicity. [ABSTRACT FROM AUTHOR]

Background: Although aspirin is increasingly utilized to reduce the event of severe perioperative complications, the effect of long-term aspirin use (L-AU) on perioperative complications in patients undergoing shoulder arthroplasty (SA) has not been well studied. The goal of the present study is to identify the influence of L-AU on perioperative complications in individuals undergoing SA. Methods: We selected data from the National Inpatient Sample database between 2010 and 2019, to identify adult patients with SA. Patients were subsequently categorized into L-AU and whole non-L-AU cohorts according to the presence of aspirin use. The demographic and comorbidity characteristics were matched using propensity score matching (PSM). The Pearson chi-square test, Wilcoxon rank test and logistic regression were utilized to assess the association of L-AU with perioperative complications. Results: From 2010 to 2019, a total of 162,418 SA patients satisfied the inclusion criteria, with 22,659 (13.95%) using aspirin on a long-term basis. The vast majority of the patients with pre-existing L-AU were aged 65–74 years, female, White and had Medicare insurance. L-AU before surgery was linked to increased risks of perioperative complications, such as blood transfusion (adjusted odds ratio [aOR]: 1.339), genitourinary disease (aOR: 1.349), acute renal failure (aOR: 1.292), acute myocardial infarction (aOR: 1.494), higher total charge (L-AU vs. the whole non-L-AU vs. matched non-L-AU: $66,727.15 vs. $59,697.08 vs. $59,926.32), and prolonged hospitalization stay (LOS) (aOR: 0.837). However, L-AU was considered a protective factor of acute cerebrovascular disease (aOR: 0.722) and stroke (aOR: 0.725). Conclusions: Our study is based on the largest open-access all-payer inpatient database, revealing a noteworthy finding of aspirin's protective and adverse impact on different postoperative complications in the US population, such as acute cardiovascular disease, and stroke, etc. Further studies assessing the optimum preoperative aspirin duration and dosage to meet the best benefit quantity for patients with planned joint arthroplasties are suggested. [ABSTRACT FROM AUTHOR]

Kidney stone disease (KSD) is a complex disorder with high heritability and prevalence. We performed a large genome-wide association study (GWAS) meta-analysis for KSD to date, including 720,199 individuals with 17,969 cases in European population. We identified 44 susceptibility loci, including 28 novel loci. Cell type-specific analysis pinpointed the proximal tubule as the most relevant cells where susceptibility variants might act through a tissue-specific fashion. By integrating kidney-specific omics data, we prioritized 223 genes which strengthened the importance of ion homeostasis, including calcium and magnesium in stone formation, and suggested potential target drugs for the treatment. The genitourinary and digestive diseases showed stronger genetic correlations with KSD. In this study, we generate an atlas of candidate genes, tissue and cell types involved in the formation of KSD. In addition, we provide potential drug targets for KSD treatment and insights into shared regulation with other diseases. Kidney stone disease is a complex disorder with high heritability and prevalence. Here, the authors perform a large genome-wide association study meta-analysis, identifying 28 new loci and genes potentially involved in disease etiology. [ABSTRACT FROM AUTHOR]

Introduction Although women have always served in the U.S. Armed Forces, it has only been in the last half century that systematic examinations have been done on the health issues experienced by military women. Still, little is known about how occupational health risks among Navy divers might vary between men and women. Our objective was to use available data to examine health issues among all separating divers and then determine how prevalence rates varied between men and women for diagnoses made within the diver's last year of active duty service. Materials and Methods For this retrospective observational study, medical records and personnel data were linked with dive logs at the individual level. We calculated sex-specific prevalence rates and relative risks per 1,000 divers by major diagnostic categories and by specific disease diagnoses. Results We identified 47 women among the 4,623 active duty Navy divers (1.0%) who separated between 2008 and 2018. Ages varied between 19 and 54 years (M = 33, SD = 8) for women, compared to men who were 18-65 years (M = 35, SD = 9). When compared to men, women had about six times the rate of diseases of the genitourinary system, twice the rate of respiratory system diseases, and about four times as many diagnoses of disorders of the lacrimal system. Conclusions The findings of much higher relative risks for women for conditions such as genitourinary disease, skin conditions, and acute respiratory infections require follow-up research to look for causes and potential risk reduction interventions. Future research must determine specific and relative risks as a necessary precursor to developing, implementing, and testing potentially sex-specific risk reduction and health improvement interventions. [ABSTRACT FROM AUTHOR]

Cognition and beliefs of women about vaginal penetration can be important in understanding the basic mechanisms of sexual disorders and their treatment process, especially genito-pelvic pain/penetration disorder (GPPPD). Thus, as a systematic review and meta-analysis, the present study aimed to compare the beliefs and cognitions related to vaginal penetration in women with and without GPPPD. In this systematic review and meta-analysis study, articles published in the international databases of PubMed, Scopus, Embase, Web of Science, ProQuest and Cochrane Library were searched using keywords related to vaginal penetration cognition. Inclusion criterion was all case-control studies which used the standard Vaginal Penetration Cognition Questionnaire (VPCQ). There were no language or time limitations. Egger's test was used to investigate the possibility of bias in publishing the results. Data analysis was performed using STATA software version 12 (StataCorp LP, College Station, TX). In this study, five articles were analyzed after assessing their quality by using Newcastle–Ottawa scale. The difference between the mean scores of Control cognition, catastrophic and pain cognitions, self-image cognitions, positive cognitions and genital incompatibility cognitions in the two groups with and without GPPPD was 0.450, 2.312, 1.528, −1.343 and 1.881, respectively, and the two groups were significantly different (p < 0.001). According to the results of the present study, women with GPPPD had higher levels of negative cognition about catastrophic and pain cognition, genital incompatibility, self-image and perceived control during the vaginal penetration than women without GPPPD. They had also lower levels of positive cognition and beliefs associated with vaginal penetration. Therefore, the cognitive dimensions of vaginal penetration should be considered in the treatment and sexual counseling of women with GPPPD, and some plans have to be designed for interventional measures in this regard. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this systematic review was to examine the current literature on the urinary microbiome and its associations with noninfectious, nonmalignant, urologic diseases. Secondarily, we aimed to describe the most common bioinformatics used to analyze the urinary microbiome. Methods: A comprehensive literature search of Ovid MEDLINE using the keywords "microbiota" AND "prostatic hyperplasia," "microbiota" AND "urinary bladder, overactive," "microbiota" AND "pelvic pain," and "microbiota" AND "urolithiasis" OR "nephrolithiasis" OR "urinary calculi" AND "calcium oxalate" was performed to identify relevant clinical microbiome studies associated with noninfectious benign urological conditions published from 2010 to 2022. We included human studies that evaluated the urinary, stone, or semen microbiota, or any combination of the above-mentioned locations. Results: A total of 25 human studies met the inclusion criteria: 4 on benign prostatic hyperplasia (BPH), 9 on overactive bladder (OAB), 8 on calcium oxalate stones, and 4 on chronic pelvic pain syndrome (CPPS). Specific taxonomic profiles in the urine microbiome were associated with each pathology, and evaluation of alpha- and beta-diversity and relative abundance was accounted for most of the studies. Symptom prevalence and severity were also analyzed and showed associations with specific microbes. Conclusion: The study of the urogenital microbiome is rapidly expanding in urology. Noninfectious benign urogenital diseases, such as BPH, calcium oxalate stones, CPPS, and OAB were found to be associated with specific microbial taxonomies. Further research with larger study populations is necessary to solidify the knowledge of the urine microbiome in these conditions and to facilitate the creation of microbiome-based diagnostic and therapeutic approaches. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to assess the overall incidence of genitourinary anomalies in patients with congenital scoliosis by providing the highest level of evidence. The secondary objective was to look for associations and trends influencing the incidence. Methods: A meta-analysis using PubMed, Embase, Scopus, and the Cochrane Collaboration Library database was carried out. We included studies focusing on patients with congenital scoliosis and genitourinary anomalies. The main outcome was the incidence of genitourinary anomalies in congenital scoliosis. We also collected the following data: patient gender, type of deformity (formation, segmentation, or mixed), deformity location, and associated anomalies. We included cohort studies. Data was extracted from published reports and combined using Review Manager 5.4. The quality of the included studies was assessed independently by two authors using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: A total of eight cohort studies were included from a pool of 2781 patients. The incidence of genitourinary anomalies associated with congenital scoliosis was 22.91% (95% CI 13.39–32.43%). The incidence of surgically treated genitourinary anomalies was 13.92% (95% CI 4.54–23.31%). There were no differences related to gender (male 49.3% versus female 50.7%; p > 0.05). There were no differences regarding the type of deformity. The incidences of associated intraspinal, cardiac, musculoskeletal and craniofacial anomalies were 33.30%, 17.60%, 27.77% and 19.83% respectively. The most frequent genitourinary anomalies were: unilateral kidney (111/388); renal ectopia (50/367); obstructive uropathy (30/201), horseshoe kidney (30/313) and undescended testicle (16/180). Conclusions: The incidence of genitourinary anomalies associated with congenital scoliosis was 22.91%, and 13.92% were surgically treated. Unilateral kidney was the most common genitourinary abnormality. There were no differences between genders and deformity types. It is important to consider the association between genitourinary anomalies and intraspinal or musculoskeletal anomalies. [ABSTRACT FROM AUTHOR]

Introduction: Genitourinary Tuberculosis (GUTB) remains an important cause of infertility in India. The clinical manifestations of GUTB are non specific, resulting in delayed diagnosis and initiation of Anti Tubercular Treatment (ATT). This delay can lead to various complications such as kidney dysfunction, ureteral strictures, and a shrunken bladder. Aim: To evaluate the diagnostic importance of Real Time Polymerase Chain Reaction (RT-PCR) targeting the mpb64 gene for the rapid and accurate diagnosis of GUTB. Materials and Methods: A cross-sectional hospital-based observational study was conducted in the Department of Microbiology at Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital in Meerut, Western Uttar Pradesh, India. The study was conducted over a three-year period, from January 2019 to December 2021. A total of 200 genitourinary samples were collected from female patients with clinical suspicion of Tuberculosis (TB) and subjected to direct microscopy, mycobacterial culture by BacT/Alert 3D (Biomerieux, France), and RT-PCR targeting the mpb64 gene (Qiagen). Demographic details were recorded in a predesigned proforma. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software version 26.0 (IBM Corp., Armonk, NY, USA). The p-value was calculated using the Chi-square test. Results: RT-PCR showed a higher positivity rate of 56 (28.9%) compared to 47 (24.2%) by culture. Acid Fast Bacilli (AFB) microscopy was the least sensitive, detecting only 7 (3.6%) cases. When comparing the results of RT-PCR with conventional methods, RT-PCR had a sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of 91.9%, 99.4%, 85.1%, and 93.8%, respectively. Conclusion: RT-PCR targeting the mpb64 gene is a specific and effective additional test that aids in the early and accurate diagnosis of Extrapulmonary Tuberculosis (EPTB), including GUTB, compared to conventional methods. Early diagnosis facilitates timely initiation of ATT, leading to better clinical outcomes. [ABSTRACT FROM AUTHOR]

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Background: Traditional Polynesian medicine for children has been poorly documented, and few data are available on their efficacy and safety. In this context, the aim of this study was to identify traditional practices used for treating children and then assess the efficacy and safety of the most cited remedies by reviewing the literature. Methods: In 2022, a semi-structured survey was carried out on five islands from the Society archipelago (Bora Bora, Huahine, Moorea, Raiatea, and Tahiti). A total of 86 participants were interviewed including 19 experts in herbalism. A thorough literature review was performed on the most cited plant species to gather the relevant ethnobotanical, pharmacological, and clinical data of each remedy. Results: Participants mentioned using 469 remedies to treat 69 health disorders. The most represented health categories were digestive system, skin disorders, infectious diseases, and respiratory system. A total of 67 plant species (representing 731 use-reports) were mentioned and Annona muricata, Gardenia taitensis, and Hibiscus rosa-sinensis were the main plants reported. Regarding the safety of cited remedies, one plant (Microsorum grossum) showed high risk of toxicity, and its use should be avoided in infants and children. Conclusion: Our survey confirms the importance of traditional medical practices for children in the Society Islands. A lack of data in children for most cited remedies demonstrate the need for more pharmacological and toxicological research on Polynesian medicinal plants. Finally, the potential risk of toxicity for some cited plant species reported calls for a better information of traditional medicine users and healers. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the relationship between air temperature and the risk of hospitalization for genitourinary disorders. Methods: Distributed lag non-linear models (DLNM) were used to estimate the association between air temperature and the risk of hospitalization for genitourinary disorders, with subgroup analysis by gender and age to identify the susceptible population of temperature-sensitive genitourinary system diseases. Results: Low mean temperature (MT) (RR = 2.001, 95% CI: 1.856~2.159), high MT (RR = 2.884, 95% CI: 2.621~3.173) and low diurnal temperature range (DTR) (RR = 1.619, 95% CI: 1.508~1.737) were all associated with the increased risk of hospitalization for genitourinary disorders in the total population analysis, and the high MT effect was stronger than the low MT effect. Subgroup analysis found that high MT was more strongly correlated in male (RR = 2.998, 95% CI: 2.623~3.427) and those <65 years (RR = 3.003, 95% CI: 2.670~3.344), and low DTR was more strongly correlated in female (RR = 1.669, 95% CI: 1.510~1.846) and those <65 years (RR = 1.643, 95% CI: 1.518~1.780). Conclusions: The effect of high MT on the risk of hospitalization for genitourinary disorders is more significant than that of low MT. DTR was independently associated with the risk of hospitalization for genitourinary disorders. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a communicable disease that is a major cause of ill health. Urogenital TB was a frequent urological disease in the pre-antibiotic era: about 20% of patients in urological hospitals had renal TB, mostly in the form of pyonephrosis. We composed a narrative review of the literature with keywords "urogenital tuberculosis', "prostate tuberculosis" "kidney tuberculosis", "treatment of tuberculosis". Urogenital TB (UGTB) includes TB of the kidney and the urinary tract and male and female genital TB. Each clinical presentation requires tailored antibiotic therapy depending on stage and general management. Anti-TB therapy should be multicomponent, continuous, long-lasting and controlled with a follow-up for 2-3 years. Otherwise, the risks of development of drug-resistance and relapse increase. Index of suspicion on UGTB is generally low, causing a delay in diagnosis; consequently, complicated forms of UGTB respond poorly to anti-TB therapy, while timely diagnosed "minor" forms are curable medically without surgery. Even with timely diagnosed UGTB, non-optimal therapy may result in over-fibrosis, scarring and strictures of the urinary tract, making surgical repair inevitable. Nevertheless, we have a wide enough spectrum of anti-TB drugs to cure urogenital TB. [ABSTRACT FROM AUTHOR]

Background: Menopause is a natural stage in a woman's life marked by the cessation of menstrual periods. Common symptoms include hot flashes, mood swings, and vaginal discomfort, among others. These climacteric symptoms lead to a compromised quality of life affecting physical, biological, psychological, and social well-being. There are concerns with long-term clinical use of Hormone replacement therapy (HRT) and alternative therapies that are devoid of adverse risks are required. This study aimed to evaluate the safety and efficacy of EstroG-100®, containing a mixture of standardized extracts of Cynanchum wilfordii, Phlomis umbrosa, and Angelica gigas, on menopausal symptoms and its impact on quality of life. Methodology: This was a prospective, single-center, single-arm, interventional study. Sixty female subjects, with confirmed menopause and moderate-to-severe symptoms, were enrolled and treated with EstroG-100® twice daily, for 12 weeks. Improvement in the climacteric symptoms was evaluated using the Menopause Rating Scale-11 and Menopause Symptoms Treatment Satisfaction Questionnaire (MS-TSQ). All the results were evaluated by the SPSS software version 23.0. Results: A significant improvement was noticed in the somatic, urogenital, and psychological climacteric symptoms from baseline to 6 weeks (P = 0.001) and a highly significant improvement after 12 weeks (P = 0.0001) of treatment. 96.5% of patients were satisfied with the treatment outcome evaluated by the MS-TSQ. No changes in blood pressure and body mass index were reported. No side effects were reported during the study. Conclusion: The first study of EstroG-100® in Indian menopausal women demonstrated a statistically significant improvement in climacteric symptoms. A 12-week treatment proved safe and effective in enhancing postmenopausal women's quality of life. The remedy was well-tolerated and effectively alleviated menopausal symptoms. [ABSTRACT FROM AUTHOR]

Background: Middle age is a link between adulthood and old age, which requires special attention. During middle age among females, changes like menopause occur, which is responsible for causing various physical, vasomotor, psychological, and social changes, which may affect overall well-being and positive mental health status. Hence, the present study has been planned to assess the prevalence of menopausal symptoms among middle-aged females. Materials and Methods: The present study was a cross-sectional study carried out in rural and urban areas of district Dehradun among 400 females. A stratified systematic random sampling technique method was used. All the females fulfilling the inclusion criteria and aged 40–60 years were included in the study. The Menopause-Specific Quality of Life (MENQOL) questionnaire was used to assess the prevalence of menopausal symptoms. Results: A total of 400 women were recruited in the study, 200 from rural and urban areas each. The mean age of the total study participants was 50.00 ± 0.32 years. Among 400 middle-aged women, 189 were premenopausal and 211 were postmenopausal. The frequencies of occurrence of menopausal symptoms were explored in 189 premenopausal and 211 postmenopausal women. The mean age of premenopausal women was 44.21 ± 2.35 and postmenopausal was 54.39 ± 4.21. Females experienced varying grades of MENQOL symptoms. Conclusions: It was found that majority of the females' quality of life were found to be affected with different grades of menopausal symptoms. With increasing age, symptoms also increase and are significantly high among postmenopausal women. [ABSTRACT FROM AUTHOR]

This study aimed to compare the efficacy of concomitant application of an intraurethral (IU) + intravaginal (IV) non-ablative Erbium (Er):YAG laser with IV application in improving the symptoms of stress urinary incontinence (SUI) in women. This observational retrospective cohort study included 122 patients with SUI, 60 women in the IU + IV laser arm and 62 in the IV laser arm. The primary outcome was the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form score at entry and at 3, 6 and 12 months from baseline. Demographic characteristics were comparable in both arms. Significant improvement in SUI symptoms was seen 3 months after the intervention and was sustained until the end of month 12 in both arms. The women who had severe SUI symptoms initially showed greater improvement. A higher number of women who initially had mild to moderate SUI symptoms were dry after treatment. Patients treated with IU + IV Er:YAG laser showed significant improvement in SUI symptoms compared to IV laser only, especially at postmenopausal state (p = 0.003). The Er:YAG laser appears to be an efficient treatment method for SUI. Concomitant application of an IU + IV Er:YAG laser is more effective in relieving SUI symptoms at postmenopausal state. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the safety and acceptability of two fixed-dose 28-day vaginal ring formulations of 17β-estradiol (E2) and progesterone (P4) to treat vasomotor symptoms (VMS) and the genitourinary syndrome of menopause. DARE HRT1-001 was the first-in-woman study of 28-day exposure to two 28-day intravaginal rings (IVRs) designed to release 80 µg/day E2 + 4 mg/day P4 (IVR1) or 160 µg/day E2 + 8 mg/day P4 (IVR2) compared with oral E2 1 mg/day + oral P4 100 mg/day. To assess safety, participants completed a daily diary to record treatment emergent adverse events (TEAEs). To determine acceptability, at the end of treatment IVR users completed a questionnaire assessing tolerability and usability. Enrolled women (n = 34) were randomized to use IVR1 (n = 10), IVR2 (n = 12) or oral (n = 12). Thirty-one participants (IVR1 = 10, IVR2 = 10, oral = 11) completed the study. The TEAE profile of those in the IVR groups were similar to the referent oral regimen. TEAEs related to the study product were more common with IVR2 use. Endometrial biopsies were not performed unless endometrial thickness was >4 mm or for clinically significant postmenopausal bleeding. One IVR1 participant had an endometrial stripe increase from 4 mm at screening to 8 mm at the end of treatment. The biopsy indicated no evidence of plasma cells or endometritis and no evidence of atypia, hyperplasia or malignancy. Two other endometrial biopsies were performed for postmenopausal bleeding with similar findings. There were no clinically meaningful laboratory or vital sign abnormalities or trends identified in observed values or changes from baseline. Pelvic speculum examination identified no clinically significant abnormalities in any participant at any visit. Tolerability and usability data demonstrated that both IVRs were generally highly acceptable. Both IVR1 and IVR2 were safe and well tolerated in healthy postmenopausal women. TEAE profiles were comparable to the referent oral regimen. [ABSTRACT FROM AUTHOR]

Our aim to conduct the descriptive study was to determine the maternal and neonatal outcomes of frequent vaginal examinations during labor. Data were collected in the first 24 hours, between days 2-5, in week 2 and in week 6 after the birth. No statistically significant correlation was observed between the frequency of vaginal examinations and the development of genitourinary or neonatal infections. On the other hand, it was seen that being a primipara were risk factors for a woman's developing a genitourinary infection while an increase in the number of personnel performing the vaginal examination was a risk factor for a neonatal infection. [ABSTRACT FROM AUTHOR]

Key Clinical Message: A female in her thirties inserted an Asian traditional hair stick, kanzashi, into her urinary bladder for sexual gratification. We need to know that everyday objects can become bladder foreign bodies and how to manage them properly. [ABSTRACT FROM AUTHOR]

Introduction: Genitourinary syndrome of menopause (GSM) is one of the pathological symptoms of menopause, which causes significant physical, psycho-emotional, and sexual discomfort to a woman. Material and methods: The study describes an examination of 65 middle-aged women, who were divided into 2 groups. Group I included 39 patients with GSM, who, depending on the duration of symptoms (3–5 years, more than 7 years), were divided into subgroups Ia and Ib. Group II included 26 patients who did not have clinical manifestations of GSM. All patients underwent general clinical studies. Bacteriological examination of faeces was used to assess the state of the intestinal microbiota. Results: It was found that menopause occurred in women with GSM earlier, compared with patients without manifestations of urogenital disorders. Also, the women with GSM were more likely to be diagnosed with type 2 diabetes mellitus, metabolic syndrome, overweight, and iron deficiency anaemia. When analysing the results of a bacteriological study in this group of patients, a statistically significant decrease in the colonization of Bifidobacterium and Lactobacillus, as well as excessive bacterial growth of such conditionally pathogenic bacteria as Escherichia coli with reduced enzymatic activity, and Klebsiella and Streptococcus was revealed. Conclusions: Conducting a fundamental study on the characteristics of the intestinal microbiota in menopausal disorders will be an important step towards understanding the pathogenetic mechanisms of their formation, and correction of intestinal metabolism can become an important condition for effective prevention and treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: This retrospective study presents the clinical outcomes of the largest cohort of patients (853 patients) with low-, favorable intermediate-, and unfavorable intermediate-risk prostate cancer treated with ultra-hypofractionated proton beam radiotherapy (36.25 GyE/five fractions). The median follow-up time was 62.7 months. Ultra-hypofractionated proton beam radiotherapy is an effective treatment for low- and favorable intermediate-risk prostate cancer, with long-term bDFS rates comparable to other techniques. It is promising for unfavorable intermediate-risk prostate cancer and has acceptable long-term GI and favorable GU toxicity. Background: We retrospectively analyzed the 5-year biochemical disease-free survival (bDFS) and occurrence of late toxicity in prostate cancer patients treated with pencil beam scanning (PBS) proton radiotherapy. Methodology: In the period from January 2013 to June 2018, 853 patients with prostate cancer were treated with an ultra-hypofractionated schedule (36.25 GyE/five fractions). The mean PSA value was 6.7 (0.7–19.7) µg/L. There were 318 (37.3%), 314 (36.8%), and 221 (25.9%) patients at low (LR), favorable intermediate (F-IR), and unfavorable intermediate risk (U-IR), respectively. Neoadjuvant hormonal therapy was administered to 197 (23.1%) patients, and 7 (0.8%) patients had adjuvant hormonal therapy. The whole group of patients reached median follow-up time at 62.7 months, and their mean age was 64.8 (40.0–85.7) years. The bDFS rates and late toxicity profile were evaluated. Results: Median treatment time was 10 (7–38) days. Estimated 5-year bDFS rates were 96.5%, 93.7%, and 91.2% for low-, favorable intermediate-, and unfavorable intermediate-risk groups, respectively. Cumulative late toxicity (CTCAE v4.0) of G2+ was as follows: gastrointestinal (GI)—G2: 9.1%; G3: 0.5%; genitourinary (GU)—G2: 4.3%, and no G3 toxicity was observed. PSA relapse was observed in 58 (6.8%) patients: 16 local, 22 lymph node, 4 bone recurrences, and 10 combined sites of relapse were detected. Throughout the follow-up period, 40 patients (4.7%) died, though none due to prostate cancer. Conclusion: Ultra-hypofractionated proton beam radiotherapy is an effective treatment for low- and favorable intermediate-risk prostate cancer, with long-term bDFS rates comparable to other techniques. It is promising for unfavorable intermediate-risk prostate cancer and has acceptable long-term GI and favorable GU toxicity. [ABSTRACT FROM AUTHOR]

Background: The development of single‐cell sequencing technology has expanded the understanding of cell heterogeneity and disease progression in the male genitourinary system. However, complex processing and unprofessional analytical annotations limit the daily use and widely sharing of published datasets. Objectives: Single‐cell sequencing data of male‐specific tissues and organs. Materials and methods: The data were downloaded from published studies and were processed based on the Seurat R package, including quality control, cell clustering, reduction and graph generation, and cell type annotation were differentiated by referring to the related paper or recognized cell markers. Input and visual results output through the Shiny package, which was loaded into the remote server. Results: The current version of the Male Health Atlas database includes two species (human and mouse), five male‐specific tissues and organs (testis, epididymis, vas deferens, corpus cavernosum, and prostate), and eight major cell types, with a total of 57 samples and 258,428 single‐cell profiles. The results were divided into two main parts: Cell Clustering and Gene Display. In Cell Clustering section, visitors are free to change cell dimensionality reduction (t‐distributed stochastic neighbor embedding, or uniform manifold approximation and projection), color palette, and annotation (cell type or sample type). The Gene Display section includes a reduced dimension scatter plot, violin plot, and bubble plot. Visitors can easily view the expression characteristics of single or multiple genes, and compare the expression differences between different cell types or groups. Discussion and conclusion: Male Health Atlas is the first single‐cell database website in the field of andrology and male reproduction, providing researchers with single‐cell sequencing resources and an accessible tool. Male Health Atlas is freely available at http://malehealthatlas.cn/. [ABSTRACT FROM AUTHOR]

The present century faces developmental fallout as vulnerability and risk mount on the global systems due to climate change, urbanisation, and population ageing. Moreover, population ageing is gaining a stronger hold in urban areas, and so are climate change and related shocks and stresses. Consequently, repercussions for the weakest sections of society – including the elderly – remain under academic consideration. In this context, the paper aims to understand the perilous predicament of older people due to the occurrence and interaction between climate change, urbanisation, and population ageing. This review investigates the underpinnings of the nature of the interaction among the three phenomena; and discerns how as a result of the interaction, various climate change related shocks and stresses affect older people in urban settings. It emerges that these three phenomena exhibit: concurrence; a positive trend of growth; and a cyclic pattern of interaction with four linkages, implying (i) rapid urbanisation is fuelling climate change, (ii) climate change is impacting urban areas, (iii) older people are increasing in urban areas, and (iv) urbanisation provides opportunities and barriers for older people. This interplay further discloses that older people stand vulnerable and at heightened risk from climate change related stressors in urban areas. These understandings highlight the need to ensure that urban environments remain age-friendly even in the face of climate change. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of iatrogenic menopause on the physiology of the vagina of the ewe and to evaluate if vaginal changes in ewes can be translated to women with genitourinary syndrome of menopause (GSM). Methods: Preclinical research with Dohne Merino ewes. Iatrogenic menopause was induced by bilateral ovariectomy (OVX). Animals were randomized for surgery, blinded for allocation and outcome assessment. Differences between groups were determined by linear regression analyses at 5 months after OVX. Outcome measures were vaginal epithelial thickness, pH, vaginal maturation value, vaginal maturation index, epithelial glycogen accumulation, content of elastin fibers, collagen, and vascularity. Results: OVX ewes (n = 20) showed epithelial thinning of the vaginal wall from 146 μm to 47 μm (mean, P < 0.001). Furthermore, epithelial glycogen accumulation and vascularity of the vaginal wall significantly decreased (43% and 23%, respectively) as compared with the control group (no intervention; n = 5). No significant differences were found for other outcome measures. Conclusion: This study established the ewe as a suitable large animal model for GSM. Furthermore, the similar relevant outcomes in humans and ewes hold great value for future translational research for the evaluation and optimization of different treatment modalities for GSM. Synopsis: Iatrogenic menopause in ewes mimics physiologic vaginal changes in women encountering GSM. This animal model is vital to improve treatment for GSM. [ABSTRACT FROM AUTHOR]

Hailey-Hailey disease (HHD), or familial benign pemphigus, is a rare genetic condition characterized by recurrent blisters and erosions with a predilection for intertriginous areas. There is no specific treatment for HHD. Topical and systemic treatments tend to provide temporary remission. Alternative treatment (surgical interventions such as dermabrasion, excision, and laser) has been shown to prolong remission. Considering the risk of complications associated with surgical modalities, laser is often preferred as an alternative for patients failing to respond to first-line therapies. We report a case of recalcitrant HHD successfully treated with a fractional ablative CO2 laser procedure (wavelength of 10600 nm, power of 7-10 W, 2-3 passes) on a 35-year-old female. The patient has a 7-year history of therapy-resistant HHD. A 2-month followup showed substantially resolved lesions, with mild erythema and post-inflammatory hyperpigmentation in treated areas. [ABSTRACT FROM AUTHOR]

Aims: To describe and synthesize non‐pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature. Methods: A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three‐step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA‐ScR Checklist was used to report. Results: A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence. Conclusion: The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods. Relevance to clinical practice: Physicians and nurses need to be up to date on the latest evidence‐based non‐pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences. [ABSTRACT FROM AUTHOR]

Estrogen withdrawal, which occurs with the cessation of ovulation, causes genitourinary syndrome of menopause in up to 50–85% of women. Symptoms may profoundly impact quality of life and sexual function, interfering with enjoyment of sex in up to three out of four individuals. Topical estrogens have been found to provide symptom relief with minimal systemic absorption and appear to be superior to systemic therapy as what regards genitourinary symptoms. However, conclusive data on their appropriateness in postmenopausal women with a history of endometriosis is not available and the hypothesis that exogenous estrogen stimulation may reactivate endometriotic foci or even promote their malignant transformation is still open. On the other hand, endometriosis affects around 10% of premenopausal women, many of which may be exposed to an acute hypoestrogenic depletion even before spontaneous menopause occurs. This considered, excluding on principle patients with a history of endometriosis from first-line treatment for vulvovaginal atrophy would mean excluding a considerable percentage of the population from adequate care. More robust evidence is urgently needed in these regards. Meanwhile, it would appear reasonable to tailor the prescription of topical hormones in these patients, taking into account the entity of symptoms and the impact such symptoms have on patients' quality of life, as well as the form of endometriosis and the possible risks hormonal may entail. Moreover, the application of estrogens on the vulva instead of the vagina could be efficacious, while outweighing the possible biological cost of hormonal treatment in women with a history of endometriosis. [ABSTRACT FROM AUTHOR]

The article focuses on nonsurgical body contouring technologies, such as cryolipolysis, microfocused ultrasound (MFU), laser therapy, radiofrequency (RF) technology, and electromagnetic muscle stimulation (EMMS), highlighting their mechanisms of action, indications, and potential adverse effects. Topics include the importance of patient selection, precautions, and the emergence of energy-based vaginal rejuvenation procedures with associated concerns about safety and efficacy.