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Introduction: The effect of the continuous forced expiration action of players of wind instruments to produce sound, on the eustachian tube functions and the middle-ear resonance frequency (RF), has not been investigated in the literature to date. The aim of this study is to evaluate eustachian tube functions and the middle-ear RF of players of wind instruments. Methods: In this prospective case-control clinical study, a study group of 28 players of wind instruments in the orchestra (28 participants, 56 ears) and a control group of 34 volunteers (34 participants, 68 ears) were included. The eustachian function of wind instrument players in a symphony orchestra was measured using an automatic eustachian tube function test in acoustic tympanometry and the RF of the middle ear was determined in multifrequency tympanometry. Results: There was a statistically significant difference among the musicians, especially in players of woodwind instruments, in terms of dysfunction of the eustachian tubes (p = 0.048). In the musicians, the pre- and postperformance RF mean values for all ears were 925 and 1,020 Hz, respectively, and these were significantly different (p = 0.004). Conclusion: This is the first study to uses multifrequency tympanometry to examine the middle-ear RF and eustachian tube function of wind instrument musicians in an orchestra. Eustachian tube dysfunction was found to be more prominent and a higher RF of the middle ear was seen after a performance, especially in players of wood wind instruments. However, the effect of these on the professional performance of players of wind instruments should be investigated in future work. [ABSTRACT FROM AUTHOR]

Purpose: To examine the efficacy of ureteral jet flow measured by Doppler ultrasonography (USG) together with radiological parameters obtained by noncontrast enhanced CT in predicting whether a ureteral stone is impacted. Materials and Methods: A total of 178 patients that met the criteria were included in the study. Stone size, location, grade of hydronephrosis, HU values of the stone and the proximal and distal parts of the stone, and ureteral wall thickness (UWT) were obtained from noncontrast enhanced abdominal CT images. Ureteral jet flows (Vmax) were measured and recorded by Doppler USG. Thirty-eight cases in whom the guidewire or opaque contrast material could not pass beyond the stone were included in the impacted ureteral stone (IUS) group, whereas the remaining 140 patients constituted the non-IUS (non-IUS) group. Results: Significant independent predictors of IUS were determined as stone size (odds ratio [OR]: 2.23, p = 0.020), ureteral HU value under the stone (OR: 1.11, p = 0.014), UWT (OR: 5.66, p = 0.009), anteroposterior diameter (OR: 1.23, p = 0.033), and the Vmax value of the stone side (OR: 0.76, p = 0.011). The proposed scoring system predicted IUS with 89% sensitivity and 91% specificity at a cutoff value of 11.5. Conclusion: Determining whether a ureteral stone is impacted is important in deciding on the optimal treatment modality. The nomogram and scoring system that we created based on the data that were obtained with noninvasive methods can predict IUS with high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Background: To develop and validate a practical nomogram for predicting the probability of patients with impacted ureteral stone.Methods: Between June 2020 to March 2021, 214 single ureteral stones received ureteroscopy lithotripsy (URSL) were selected in development group. While 82 single ureteral stones received URSL between April 2021 to May 2021 were included in validation group. Independent factors for predicting impacted ureteral stone were screened by univariate and multivariate logistic regression analysis. The relationship between preoperative factors and stone impaction was modeled according to the regression coefficients. Discrimination and calibration were estimated by area under the receiver operating characteristic (AUROC) curve and calibration curve respectively. Clinical usefulness of the nomogram was evaluated by decision curve analysis.Results: Age, ipsilateral stone treatment history, hydronephrosis and maximum ureteral wall thickness (UWTmax) at the portion of stone were identified as independent predictors for impacted stone. The AUROC curve of development and validation group were 0.915 and 0.882 respectively. Calibration curve of two groups showed strong concordance between the predicted and actual probabilities. Decision curve analysis showed that the predictive nomogram had a superior net benefit than UWTmax for all examined probabilities.Conclusions: We developed and validated an individualized model to predict impacted ureteral stone prior to surgery. Through this prediction model, urologists can select an optimal treatment method and decrease intraoperative and postoperative complications for patients with impacted ureteral calculus. [ABSTRACT FROM AUTHOR]

Benign prostatic obstruction (BPO) is a prevalent condition that affects men, primarily toward their old age. The condition is often accompanied by lower urinary tract symptoms (LUTS), which can significantly impair a patient's quality of life and lead to other medical complications. Accurate diagnosis of BPO is essential for effective management of complications secondary to BPO, and treatment plans should be tailored patients, and occasionally according to surgeon experience. As such, this literature review aims to analyze the current available data on male LUTS secondary to BPO by providing a comprehensive overview of relevant studies, as well as the surgical and medical management guidelines from the Canadian Urological Association (CUA), American Urological Association (AUA), and European Association of Urology (EAU). By synthesizing the existing literature, this review purports to summarize the current body of knowledge surrounding BPO and male LUTS, and support healthcare providers in making informed decisions about the management of male LUTS secondary to BPO, ultimately improving patient outcomes and quality of life., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: To compare the initial perioperative outcomes of single-port transvesical simple prostatectomy (SP RASP) patients to those of open simple prostatectomy (OSP)., Patients and Methods: Perioperative data from 42 consecutive patients with BPH who underwent SP RASP were prospectively reviewed. Similarly, data from forty-three consecutive patients who underwent the standard OSP, were retrospectively collected. Through direct suprapubic bladder access, prostatic enucleation was performed using the prostatic capsule as a landmark. Then a complete vesicourethral mucosal advancement flap was accomplished. OSP was performed according to the standard approach. Demographics, Intra- and perioperative data were analyzed and assessed with a descriptive analysis., Results and Limitations: Baseline characteristics were comparable between the two groups, except for the preoperative median post-void residual volume, which was higher in the OSP group (p = 0.004). The SP RASP group had less intraoperative estimated blood loss (p < 0.001), no need for continuous bladder irrigation (p < 0.001), and less in-hospital opioid use (p < 0.001). Patients in the SP RASP group were discharged on postoperative day zero, compared to a median of 2 days for OSP (p < 0.001). The median Foley catheter duration was 7 days for SP RASP, compared to a median of 10 days for OSP (p < 0.001). SP RASP group had fewer postoperative complications, however, this did not reach statistical significance., Conclusion: SP RASP is an alternative approach in treating surgical BPH. It may offer patients less morbidity in comparison to OSP., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Renal fusion anomalies are common congenital anomalies of the urogenital tract and have their genesis in the early embryonic period. They are classified into partial fusion anomalies (e.g., crossed fused ectopia, and horseshoe kidney) and complete fusion anomalies (e.g., fused pelvic kidney). Horseshoe kidney is the most common renal fusion anomaly and is characterized by the presence of two distinct functioning kidneys on either side of the vertebral column, with fusion occurring at the inferior poles in majority of the cases. Crossed fused ectopia is characterized by the presence of an ectopic kidney that crosses the midline and fuses with the orthotopic contralateral kidney, whereas fused pelvic (pancake) kidney is a complete fusion anomaly characterized by extensive medial fusion of both kidneys in the pelvis. Fusion anomalies are often associated with abnormalities of renal rotation, migration, and vascular supply, which predispose the kidneys to a number of complications and create difficulty during retroperitoneal surgeries and interventions. They are also associated with other congenital abnormalities of the urogenital tract, gastrointestinal tract, cardiovascular system, and skeletal system. Hence, a thorough understanding of the etiopathogenesis and radiological features of fusion anomalies is important for directing patient management. This review summarizes the embryological basis, clinical presentation and imaging approach to renal fusion anomalies, followed by detailed anatomical and radiological description of the morphological types, and the complications associated with these anomalies. [ABSTRACT FROM AUTHOR]

Holmium laser enucleation of the prostate (HoLEP) is a valid treatment option to relieve bladder outlet obstruction in patients with large prostate volumes (PV). Its efficacy, tolerability, and safety are comparable to the ones of other laser treatments of the prostate and resection techniques. However, safety and efficacy of HoLEP have not been compared between patients with and without preoperative urinary retention. We included 350 patients (mean age 71.2 years) who had undergone HoLEP due to lower urinary tract symptoms (LUTS) or urinary retention caused by prostatic hyperplasia. We evaluated the differences in peri- and postoperative outcomes and complications between patients with and patients without preoperative urinary retention. The mean PV was 115 cm3. PV was > 100 cm3 in 61.9% and < 100 cm3 in 38.1% of the patients. Perioperative complications occurred in 23 patients (6.6%), 15 of which (4.3%) required operative revision. We found no significant differences in terms of complication rates between patients with PV > 100 cm3 and patients with PV < 100 cm3. Mean catheterization-duration was 3.3 days. Preoperatively, 140 patients (40%) had a suprapubic or transurethral indwelling catheter; they did not differ from patients without preoperative catheter regarding postoperative catheter removal success rate, early postoperative complications, and functional outcomes. Prostate cancer was diagnosed in 43 patients (12.3%). Median postoperative PSA-decline was 6.1 ug/l (89.8% drop). HoLEP is a safe and effective treatment for patients with LUTS or urinary retention and large PV. PV > 100 cm3 was not associated with higher complication rates or successful catheter-removal. Furthermore, functional outcomes were independent of preoperative catheterization. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of catheterisation and urinary retention in male patients with bladder cancer after radical cystectomy (RC) and orthotopic neobladder (ONB) and to identify potential predictors. Patients and Methods: Using an Institutional Review Board approved, prospectively maintained bladder cancer database, we collected information using a diversion‐related questionnaire from 299 consecutive male patients with bladder cancer upon postoperative clinic visit. Urinary retention was defined as ≥3 catheterisations/day or a self‐reported inability to void without a catheter. Uni‐ and multivariable Cox regression analysis was performed to identify predictors of catheterisation and urinary retention. Results: Self‐catheterisation was reported in 51 patients (17%), of whom, 22 (7.4% of the total patients) were in retention. Freedom from any catheterisation at 3, 5, and 10 years after RC was 85%, 77%, and 62%, respectively. Freedom from retention at 3, 5, and 10 years after RC was 93%, 88%, and 79%, respectively. Multivariable Cox regression showed that higher body mass index (BMI; ≥27 kg/m2) significantly increased the need for catheterisation (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.26–4.32) as well as retention (HR 5.20, 95% CI 1.74–15.51). Greater medical comorbidity (Charlson Comorbidity Index score ≥2) correlated with the need for any catheterisation (HR 1.84, 95% CI 1.02–3.3), but not retention. Pathological stage and type of diversion were not significant predictors of the need to catheterise or urinary retention. Conclusion: In males undergoing RC with ONB, retention requiring catheterisation to void is uncommon. Patients with a BMI of ≥27 kg/m2 are at significantly increased risk of retention and need for self‐catheterisation. [ABSTRACT FROM AUTHOR]

Technological progress is continuously improving medical care. The urological profession is well-known for further development of technical innovations and quick transfer into daily practice. Robot-assisted surgery, for example, has been part of the clinical routine in modern urological clinics for many years. In the endourological field, the implementation and further evolution of laser-based procedures have dominated research in the last decade. Recently, in 2015, the presentation of a new robot-assisted technique of waterjet-based ablation of prostate tissue raised attention in the society--the Aquablation® therapy. Aquablation therapy has been investigated within several randomized and controlled clinical trials, and--with growing experience--the technique has been modified over recent years to improve the safety of the procedure. Due to the clinical outcome, the number of hospitals performing Aquablation therapy is increasing continuously. This article provides an overview of the technique, its modifications, and the current status of evidence. [ABSTRACT FROM AUTHOR]

Background: Horseshoe kidney (HSK) is a common congenital defect of the urinary system. The most common complications are urinary tract infection, urinary stones, and hydronephrosis. HSK can be combined with glomerular diseases, but the diagnosis rate of renal biopsy is low due to structural abnormalities. There are only a few reports on HSK with glomerular disease. Here, we have reported a case of PLA2R-positive membranous nephropathy occurring in a patient with HSK.Case Presentation: After admission to the hospital due to oedema of both the lower extremities, the patient was diagnosed with nephrotic syndrome due to abnormal 24-h urine protein (7540 mg) and blood albumin (25 g/L) levels. Abdominal ultrasonography revealed HSK. The patient's brother had a history of end-stage renal disease due to nephrotic syndrome. Therefore, the patient was diagnosed with PLA2R-positive stage II membranous nephropathy through renal biopsy under abdominal ultrasonography guidance. He was administered adequate prednisone and cyclophosphamide, and after 6 months of treatment, urinary protein excretion levels significantly decreased.Conclusion: The risk and difficulty of renal biopsy in patients with HSK are increased due to structural abnormalities; however, renal biopsy can be accomplished through precise positioning with abdominal ultrasonography. In the literature, 20 cases of HSK with glomerular disease have been reported thus far. Because of the small number of cases, estimating the incidence rate of glomerular diseases in HSK is impossible, and the correlation between HSK and renal pathology cannot be stated. Further studies should be conducted and cases should be accumulated to elucidate this phenomenon. [ABSTRACT FROM AUTHOR]

Purpose: To compare long-term outcomes between photoselective vaporization (PVP) and Open simple prostatectomy (OSP) for prostates > 80 cc. Methods: Men operated either by PVP or OSP for BPH > 80 cc were included in two expert centres. Functional and uroflowmetric outcomes were assessed pre- and postoperatively. Data were collected prospectively in the PVP group and retrospectively in the OSP group and compared at long-term follow-up. Complications and re-intervention rates were used as main outcomes. Results: 332 men underwent surgery: 132 PVP were performed in a fist expert-centre and 200 OSP were performed in a second one with a median follow-up of 54 and 48 months, respectively. Mean Prostate volume was similar between OSP and PVP group (119 vs 116 cc). Major complications were more common in the OSP group (12.5 vs 1.5%, p < 0.001). At long-term follow-up, Qmax was higher and PVR was lower (p < 0.05) in the OSP group. IPSS score was similar between groups (p = 0.45) but the Qol was better in the OSP group (0.9 vs. 1.6; p < 0.05). There were more re-interventions in the PVP group compared to OSP (15.2 vs. 0%, p < 0.005). Conclusion: PVP is a good alternative for prostates > 80 cc particularly for fragile patients as it is associated with a lower complication rate. At long-term follow-up, IPSS was similar between groups, but Qol was better in the OSP group. Patients treated by PVP should be informed that they could require reoperation in 15% of the cases. [ABSTRACT FROM AUTHOR]

Purpose: Ileal orthotopic neobladder (IONB) reconstruction is the preferred urinary diversion among selected patients who have undergone radical cystectomy (RC) for bladder cancer (BCa). There is insufficient data regarding patients' quality of life (QoL), sexual and urinary outcomes. Our objectives were to assess QoL in a multicentre cohort study, and to identify related clinical, oncological and functional factors. Methods: Patients who underwent RC with IONB reconstruction for BCa from 2010 to 2017 at one of the three French hospitals completed the following self-reported questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Univariate and multivariate analyses were computed to identify clinical, pathological, and functional predictors of global QoL score. Results: Seventy-three patients completed questionnaires. The median age was 64 years and 86.3% were men. The median interval between surgery and responses to questionnaires was 36 months (range 12–96). Fifty-five percent of patients presented a high global QoL (EORTC-QLQC30, median score 75). A pre-RC American Society of Anesthesiologists score > 2, active neoplasia, sexual inactivity, and stress urinary incontinence were associated with a worse QoL. After a multivariate analysis, sexual inactivity was the only independent factor related to an altered QoL. Conclusion: Patients with IONB reconstruction after RC have a high global QoL. Sexual activity could independently impact the global QoL, and it should be assessed pre- and post-operatively by urologists. [ABSTRACT FROM AUTHOR]

Background: Post-prostatectomy incontinence (PPI) is a major complication that can significantly decrease quality of life. Approximately 20% of patients experience consistent PPI as long as 1 year after radical prostatectomy (RP). This study develops a preoperative predictive model and compares its diagnostic performance with conventional tools. Methods: A total of 166 prostate cancer patients who underwent magnetic resonance imaging (MRI) and RP were evaluated. According to the date of the RP, patients were divided into a development cohort (n = 109) and a test cohort (n = 57). Patients were classified as PPI early-recovery or consistent on the basis of pad usage for incontinence at 3 months after RP. Uni- and multi-variable logistic regression analyses were performed to identify associates of PPI early recovery. Four well-known machine learning algorithms (k-nearest neighbor, decision tree, support-vector machine (SVM), and random forest) and a logistic regression model were used to build prediction models for recovery from PPI using preoperative clinical and imaging data. The performances of the prediction models were assessed internally and externally using sensitivity, specificity, accuracy, and area-under-the-curve values and estimated probabilities and the actual proportion of cases of recovery from PPI within 3 months were compared using a chi-squared test. Results: Clinical and imaging findings revealed that age (70.1 years old for the PPI early-recovery group vs. 72.8 years old for the PPI consistent group), membranous urethral length (MUL; 15.7 mm for the PPI early-recovery group vs. 13.9 mm for the PPI consistent group), and obturator internal muscle (18.2 mm for the PPI early-recovery group vs. 17.5 mm for the PPI consistent group) were significantly different between the PPI early-recovery and consistent groups (all p-values < 0.05). Multivariate analysis confirmed that age (odds ratio = 1.07, 95% confidence interval = 1.02–1.14, p-value = 0.007) and MUL (odds ratio = 0.87, 95% confidence interval = 0.80–0.95, p-value = 0.002) were significant independent factors for early recovery. The prediction model using machine learning algorithms showed superior diagnostic performance compared with conventional logistic regression (AUC = 0.59 ± 0.07), especially SVM (AUC = 0.65 ± 0.07). Moreover, all models showed good calibration between the estimated probability and actual observed proportion of cases of recovery from PPI within 3 months. Conclusions: Preoperative clinical data and anatomic features on preoperative MRI can be used to predict early recovery from PPI after RP, and machine learning algorithms provide greater diagnostic accuracy compared with conventional statistical approaches. [ABSTRACT FROM AUTHOR]

Background: To investigate the relationship between ureteral wall thickness (UWT) and other variables of patients who underwent extracorporeal shock wave lithotripsy (SWL) in the primary treatment of the ureteral stone above the iliac crest level. Material and Methods: A total of 147 patients aged 18 years and older, who underwent SWL in our clinic between December 2016 and December 2019 for the treatment of ureteral stones above the iliac crest level and had non‐contrast enhanced abdominal computed tomography scans before the procedure were included in the clinical study. The results were evaluated at 3 months after SWL. The absence of residual fragments was considered as stone‐free status, and the existence of any size residual fragment was considered as treatment failure. Results: In our study, the mean age of the patients was 42.4 ± 12.8 years, and the stone‐free rate was 92.5%. The median transverse stone size was 7.5 mm (min 2.8‐max 15), and the median UWT was 4.2 mm (1‐8.7). In the multivariate analysis, UWT (P =.002) and multiple stone presence (P =.027) were found to be independent factors affecting stone‐free status. In the receiver operating characteristic curve analysis, the optimal threshold value for UWT was determined as 5.25 mm. Conclusions: We found that UWT was the most important independent variable associated with increased failure in SWL treatment. The presence of multiple stones was another independent factor that increased the failure rates. Using SWL technology through experience accumulated with the mechanical hardware of the machine, we can select patients who are more suitable for this treatment and improve treatment outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND፡ BPH is the major cause of bladder outlet obstruction over the age of 40 years. Multiple surgical management options have been described of which STVP and TURP are the oldest and widely available procedures. The objective of this study is to describe and compare the intraoperative and early outcome situations of STVP and TURP. METHODS: This is a hospital-based retrospective descriptive study that compares intraoperative and early outcomes of STVP and TURP in Menilik II Hospital from January 2017 to December 2019. The study samples were 72 STVP and 72 TURP patients. RESULTS: The mean duration of surgery in the STVP group was 97.8 minutes which is significantly longer than TURP group (66.15 minutes). Duration of post-op catheterization and hospital stay are significantly longer in STVP than TURP. CONCLUSION: The duration of surgery, length of hospital stays and post op catheterization are longer in STVP. There was no significant difference in intra-op and early complications from STVP and TURP. [ABSTRACT FROM AUTHOR]

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Introduction: transvesical (open) prostatectomy (OP), an invasive surgical procedure, is a common form of treatment offered to patients with benign prostatic enlargement in emerging economies. Recently, there has been an increase in the use of electrosurgical means in treating benign prostate hyperplasia in our environment, especially transurethral resection of the prostate (TURP). This study compares the perioperative, short-term outcomes and complications of open prostatectomy and TURP. Methods: the records of men who had prostatectomies (OP and TURP) from Jan 2016 to Dec 2019 for prostate gland less than 80g were reviewed. The patients´ age, size of the prostate gland, duration of surgery (mins), blood transfusion, clot retention, length of catheterisation (days), hospital stay (days), postoperative infection, postoperative incontinence, reoperation, bladder neck stenosis and urethral stricture were analysed. Results: fifty-nine patients were studied. Twentynine patients had OP, while 30 had TURP. Mean age for OP was 63.8 (SD 7.2) years, while for TURP is 68.5 (SD 8.0) years (p=0.019). The mean for length of catheterisation for OP vs TURP was 9.1 (SD 3.7) vs 3.3 (SD 1.03) days (p=0.001), mean hospital stay was 9.6 (SD 4.1) and 4.7 (SD 2.2) days (p=0.001) for OP and TURP while duration of surgery (mins) for OP and TURP was 106.7 (SD 15.2) vs 53.8 (SD 14.0) minutes (p=0.001). The blood transfusion rate was 13.8% and postoperative incontinence 13.8% in OP, while in the TURP group, the reoperation rate was 3.3% and urethral stricture at a rate of 3.3%. Overall complications showed no statistical difference (p=0.462) between the two groups. Conclusion: the patients who underwent TURP had shorter hospital stay, shorter duration of surgery and catheterisation, and less frequently required blood transfusion compared to those who had open prostatectomy. However, reoperation rate was higher compared to open prostatectomy. The overall complication was fewer with TURP, but this is not statistically significant; hence both forms of surgical therapy remain relevant in a poor resource setting. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to report a multi-institutional retrospective case series of outcomes after robot-assisted laparoscopic pyeloplasty (RALP) in pediatric patients with complex pelvi-ureteric junction obstruction (PUJO). Methods: All patients undergoing complex RALP over the last 5 years were included. RALP was defined complex in the following cases of PUJO: anatomic variations including ectopic, malrotated, horseshoe, or duplex kidney and recurrent PUJO after failed open pyeloplasty. Results: Forty-eight patients underwent complex RALP in four European centers in the study period and included 18 girls and 30 boys with a median age of 8 years (range 5–12). The PUJO was associated with anatomic variations in 35/48 (72.9%), whereas a recurrent PUJO was present in 13/48 (27.1%). A dismembered Anderson–Hynes pyeloplasty was performed in all patients. The median operative time including docking was 178.5 min (range 117–255) and the median anastomotic time was 64.8 min (range 50–76). All patients were discharged on 2nd postoperative day (POD). The median follow-up was 18.2 months (range 14–43). The overall success rate was 95.8% (46/48). Early postoperative complications (< 30th POD) included urinary tract infections (UTIs) and stent-related irritative symptoms in 4/48 (8.3%) [II Clavien], whereas late complications (> 30th POD) included recurrence of PUJO in 2/48 (4.2%), who needed re-operation [IIIb Clavien]. Conclusions: RALP was safe, feasible, and with good mid-term outcome in complex PUJO. An accurate pre-operative planning, a standardized technique, and an experienced surgical robotic team represented key points to manage successfully such complex cases. [ABSTRACT FROM AUTHOR]

Wilms' tumor is the most common malignant kidney tumor found in children. The Horseshoe kidney is the most common renal fusion malformation. However, Wilms' tumor is rarely identified in horseshoe kidney patients. Multimodal treatments in Wilms' tumor can play important roles in increasing the survival rate. In this study, we report the case of a 6-year-old boy in whom a Wilms' tumor was identified in a horseshoe kidney. The tumor was successfully treated with preoperative chemotherapy, followed by surgical resection. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated the efficacy and safety of laparoscopic ureterolithotomy (LPU) for the treatment of large proximal ureteric stone. Methods: A retrospective multicenter analysis for patients with solitary impacted proximal ureteric stone ≥15 mm who underwent LPU from 2016 to 2019 was performed. Primary outcome was to estimate the stone‐free rate (SFR). SFR was defined as absence of residual stones on postoperative computed tomography scan. Secondary outcome was to assess the perioperative outcomes, as well as to review literature data of randomized controlled trials and meta‐analyses comparing LPU to other treatment options. Results: Forty‐four patients were included in our study. Mean stone size was 22.9 ± 5.8 mm and median follow‐up was 14 months. Three patients had previous abdominal surgery, one patient had severe degree of scoliosis and six patients failed primary therapy. All stones were extracted successfully (SFR = 100%) without need of auxiliary treatments. Mean operative time and estimated blood loss were 86.6 ± 14.1 minutes. and 11.9 ± 14.7 mL, respectively. No intraoperative complications or conversion to open surgery were reported. No major postoperative complications (≥grade 3) were reported. Mean length of hospital stay was 2 ± 0.8 days. Conclusions: For treatment of large ureteric stones, our study showed that LPU achieves 100% stone‐free status. When performed by well‐trained laparoscopic surgeons, it is safe and has no major perioperative complications. According to our results and literature data, when counseling patients with large impacted proximal ureteral stones, LPU should be advised as the procedure that has the higher SFR, lower auxiliary treatments, and comparable complication rates to other treatments. [ABSTRACT FROM AUTHOR]

Horseshoe kidney is the most prevalent congenital kidney fusion anomaly, affecting 0.25% of the general population and occurring in 1 in 400–1600 births. Approximately 40 percent of patients develop kidney stones due to anomalies. In our case, we aimed to perform combined laparoscopic pyelolithotomy with retrograde intrarenal surgery (RIRS) instead of percutaneous nephrolithotomy (PNL) in a patient with a horseshoe anomaly. This procedure enabled us to detect the location of the mobile stone with RIRS and then successfully extract it with laparoscopic pyelolithotomy. Laparoscopic pyelolithotomy combined with RIRS is a reasonable additional treatment option for complicated stone surgery due to horseshoe kidney anomalies. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the literature in order to investigate the efficacy and safety of surgical and non‐invasive penile enhancement procedures for aesthetic and therapeutic purposes. Methods: A systematic search for papers investigating penile enhancement procedures was performed using the MEDLINE database. Articles published from January 2010 to December 2019, written in English, including >10 cases, and reporting objective length and/or girth outcomes, were included. Studies without primary data and conference abstracts were excluded. The main outcome measure was objective length and/or girth improvement. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Results: Out of 220 unique records, a total of 57 were reviewed. Eighteen studies assessed interventions for penile enhancement in 1764 healthy men complaining of small penis. Thirty‐nine studies investigated 2587 men with concomitant pathologies consisting mostly of Peyronie's disease and erectile dysfunction. Twenty‐five studies evaluated non‐invasive interventions and 32 studies assessed surgical interventions, for a total of 2192 and 2159 men, respectively. Non‐invasive interventions, including traction therapies and injection of fillers, were safe and mostly efficacious, whereas surgical interventions were associated with minor complications and mostly increased penile dimensions and/or corrected penile curvature. Overall, the quality of studies was low, and standardized criteria to evaluate and report efficacy and safety of procedures, as well as patient satisfaction, were missing. Conclusion: The quality of the studies on penile enhancement procedures published in the last decade is still low. This prevents us from establishing recommendations based on scientific evidence regarding the efficacy and safety of interventions that are performed to increase the penis size for aesthetic or therapeutic indications. [ABSTRACT FROM AUTHOR]

Purpose of Review: To highlight and review encouraging preliminary studies behind several alternative products and interventions for erectile dysfunction (ED). Recent Findings: Alternative treatments for ED are becoming more prevalent with increased consumer interest. "Natural" products are sold online, and numerous clinics offer various off-label and investigational interventions. These alternative treatments have demonstrated varying degrees of efficacy in randomized trials and meta-analyses, but none of these interventions has robust enough evidence to be considered first-line therapy. These treatments may find a role in combination with guideline treatments or may be used in novel penile rehabilitation research protocols. Summary: With growing interest in alternative treatment for men's health, an awareness of the literature is imperative for patient counsel. Alternative treatments, like l-arginine, have a growing body of evidence for efficacy in combination with PDE5i, and low-intensity shock wave therapy and stem cell therapy continue to demonstrate encouraging outcomes in ED trials. [ABSTRACT FROM AUTHOR]

Purpose: Open simple prostatectomy (OSP) is a standard surgical technique for patients with benign prostatic hyperplasia with prostate size larger than 80 ml. As a minimally invasive approach, robot-assisted simple prostatectomy (RASP) emerged as a feasible surgical alternative. Currently, there are no definite recommendations for the standard use of RASP. Therefore, we aimed at investigating various clinical outcomes comparing RASP with OSP. Methods: In this retrospective single-center study, we evaluated clinical data from 103 RASP and 31 OSP patients. Both cohorts were compared regarding different clinical characteristics with and without propensity score matching. To detect independent predictive factors for clinical outcomes, multivariate logistic regression analysis was performed. Results: Robot-assisted simple prostatectomy patients demonstrated a lower estimated blood loss and need for postoperative blood transfusions as well as less postoperative complications. OSP had a shorter operative time (125 min vs. 182 min) longer hospital stay (11 days vs. 9 days) and longer time to catheter removal (8 days vs. 6 days). In the multivariate analysis, RASP was identified as an independent predictor for longer operative time, lower estimated blood loss, shorter length of hospital stay, shorter time to catheter removal, less postoperative complications and blood transfusions. Conclusion: Robot-assisted simple prostatectomy is a safe alternative to OSP with less perioperative and postoperative morbidity. Whether OSP (shorter operative time) or RASP (shorter length of hospital stay) has a more favorable economic impact depends on the particular conditions of different health care systems. Further prospective comparative research is warranted to define the value of RASP in the current surgical management of benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

Introduction: Erectile dysfunction (ED) following prostate cancer treatment is not uncommon and penile rehabilitation is considered the standard of care in prostate cancer survivorship (PCS), where both patient and his partner desire to maintain and/or recover pre-treatment erectile function (EF). There is a clinical interest in the role of regenerative therapy to restore EF, since existing ED treatments do not always achieve adequate results. Aim: To review regenerative therapies for the treatment of ED in the context of PCS. Materials and Methods: A review of the existing PubMed literature on low-intensity extracorporeal shockwave therapy (LIESWT), stem cell therapy (SCT), platelet-rich plasma (PRP), gene therapy, and nerve graft/neurorrhaphy in the treatment of ED and penile rehabilitation, was undertaken. Results: IESWT promotes neovascularization and neuroprotection in men with ED. While several systematic reviews and meta-analyses showed positive benefits, there is limited published clinical data in men following radical prostatectomy. Cellular-based technology such as SCT and PRP promotes cellular proliferation and the secretion of various growth factors to repair damaged tissues, especially in preclinical studies. However, longer-term clinical outcomes and concerns regarding bioethical and regulatory frameworks need to be addressed. Data on gene therapy in post-prostatectomy ED men are lacking; further clinical studies are required to investigate the optimal use of growth factors and the safest vector delivery system. Conceptually interpositional cavernous nerve grafting and penile re-innervation technique using a somatic-to-autonomic neurorrhaphy are attractive, but issues relating to surgical technique and potential for neural 'regeneration' are questionable. Conclusion: In contrast to the existing treatment regime, regenerative ED technology aspires to promote endothelial revascularization and neuro-regeneration. Nevertheless, there remain considerable issues related to these regenerative technologies and techniques, with limited data on longer-term efficacy and safety records. Further research is necessary to define the role of these alternative therapies in the treatment of ED in the context of penile rehabilitation and PCS. [ABSTRACT FROM AUTHOR]

A 76-year-old gentleman with a background of benign prostatic hyperplasia, hiatus hernia and anxiety was referred to the rapid access haematuria service following an episode of painless visible haematuria. Flexible cystoscopy did not reveal any concerning bladder lesions. CT Urogram demonstrated a horseshoe kidney with a filling defect in the left upper pole moiety suspicious for an urothelial carcinoma. The patient was subsequently referred to the urology services in a tertiary centre. Flexible ureterorenoscopy was performed, with findings of a likely urothelial carcinoma corresponding to the suspicious area on imaging. Biopsy of this lesion revealed a low grade urothelial cancer. The patient proceeded to have a laparoscopic left heminephroureterectomy with an open bladder cuff. The patient recovered well and urinary catheter was removed Day 12 post procedure after the performance of a cystogram. Histology revealed a favourable pTa low grade malignancy, and the patient will require ongoing follow-up moving forward. This case report highlights the operative intricacies in managing patients with horseshoe kidney due to anatomic variations associated with this condition. [ABSTRACT FROM AUTHOR]

B Materials and Methods: b We present a laparoscopic urethra-sparing simple prostatectomy performed in a patient with a 50 g prostate (transrectal ultrasound) willing to undergo BPH-related surgery and wishing maintaining anterograde ejaculatory function. When the patient is anesthetized, the surgical team uses the abdominal binders to strap the bolsters across the patient, in the location where they best position the patient for PCNL. Http://online.liebertpub.com/doi/full/10.1089/vid.2022.0003 Efficient Method for Percutaneous Nephrolithotomy Positioning Using Abdominal Binders Kenneth A. Softness, MD, Suprita Krishna, MD, and Peter L. Steinberg, MD Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. The patient is then proned and the binders are cut off of the patient before beginning the procedure. [Extracted from the article]

Superselective intra-arterial chemotherapy (SSIAC) for oral cancer can deliver a higher concentration of anticancer agent into a tumor-feeding artery than intravenous systemic chemotherapy. However, the agent distribution between the lingual artery and facial artery (FA) is not clear in SSIAC for patients with the linguofacial trunk. The agent distribution in the SSIAC method was investigated using computational fluid dynamics (CFD). Ten three-dimensional vessel models were created from CT images of two patients with oral cancer (patients A and B) with the linguofacial trunk. Catheter models were combined with vessel models to mimic intra-arterial infusion, and the agent flow was analyzed. In patient A models, the agent distribution varied depending on the catheter tip position in the linguofacial trunk, while all anticancer agents flowed into the FA only in patient B models. This study revealed that the behavior of the agent in the common trunk is determined by the blood flow field which depends on the topography of the vessels in each patient. Therefore, the catheter tip position should be changed according to the vessel topography to deliver anticancer agents into the tumor-feeding artery. Moreover, CFD can be a useful method to predict the agent flow for each patient before SSIAC. [ABSTRACT FROM AUTHOR]

Background: To identify risk factors for anastomotic strictures in patients after radical prostatectomy. Methods: In all, 140 prostate cancer patients with one or more postoperative anastomotic strictures after radical prostatectomy were included. All patients underwent transurethral anastomotic resection at the University Hospital of Munich between January 2009 and May 2016. Clinical data and follow-up information were retrieved from patients' records. Statistical analysis was done using Kaplan-Meier curves and log rank-test with time to first transurethral anastomotic resection as endpoint, Chi-square-test, and Mann–Whitney-U test. Results: In all, 140 patients with a median age of 67 years (IQR: 61–71 years) underwent radical prostatectomy. Median age at time of transurethral anastomotic resection was 68 years (IQR: 62–72). Patients needed 2 surgical interventions in median (range: 1–15). Median time from radical prostatectomy to transurethral anastomotic resection was 6 months (IQR: 3.9–17.4). Median duration of catheterization after radical prostatectomy was 10 days (IQR: 8–13). In all, 26% (36/140) received additional radiotherapy. Regarding time to first transurethral anastomotic resection, age and longer duration of catheterization after radical prostatectomy with a cutoff of 7 days showed no statistically significant differences (p = 0.392 and p = 0.141, respectively). Tumor stage was no predictor for development of anastomotic strictures (p = 0.892), and neither was prior adjuvant radiation (p = 0.162). Potential risk factors were compared between patients with up to 2 strictures (low-risk) and patients developing > 2 strictures (high-risk): high-risk patients had more often injection of cortisone during surgery (14% vs 0%, p < 0.001) and more frequently advanced tumor stage pT > 2 (54% vs 38%, p = 0.055), respectively. Other risk factors did not show any significant difference compared to number of prior transurethral anastomotic strictures. Conclusions: We could not identify a reliable risk factor to predict development of anastomotic strictures following radical prostatectomy. [ABSTRACT FROM AUTHOR]

Objectives: Pubectomy is an ancillary technique used to increase exposure of the disrupted urethra and reduce anastomotic tension, which can be difficult for inexperienced surgeons. The objective of the present study was to illustrate the use of an air drill enabling delicate and precise bone resection in pubectomy for delayed anastomotic urethroplasty for pelvic fracture urethral injury. Methods: Between 2009 and 2019, 88 male patients underwent delayed anastomotic urethroplasty with pubectomy for pelvic fracture urethral injury. A total of 73 procedures used a high-speed surgical air drill (HiLAN HS; Aesculap, Tuttlingen, Germany) equipped with a short-hand piece. Operative time and blood loss in the air drill patient group (group 1) were compared with that of patients who underwent pubectomy using a rongeur and/or gouge (group 2, n = 15). Results: In 65 group 1 patients, urethroplasty was carried out using the perineal approach, with partial inferior pubectomy. Eight group 1 patients, whose proximal urethral end was displaced upward superior to the upper edge of pubis, underwent urethroplasty using the perineal and abdominal approach, with a superior partial pubectomy and supracrural urethral rerouting. No difficulty was encountered using the air drill in any of the cases. There was no significant difference in median operative time between the groups (group 1 256 min vs group 2 228 min; P = 0.31). The median blood loss in group 1 was significantly lower than group 2 (149 mL vs 453 mL; P < 0.0001). Conclusions: Surgical air drills might facilitate pubectomy in patients undergoing delayed anastomotic urethroplasty for pelvic fracture urethral injury. This tool offers the advantage of a delicate bone resection with reduced blood loss. [ABSTRACT FROM AUTHOR]

Sonography can be used to detect horseshoe kidneys. Sonographic findings for horseshoe kidney commonly include an isthmus connection occurring anterior to the aorta and just inferior to the inferior mesenteric artery. This anomaly can occur with or without complications. Each kidney is associated with its separate collecting system, leading to increased risk for complications. This case study describes the importance of identifying a horseshoe kidney, isthmus, and blood supply to ensure prompt intervention if needed. A case report of a horseshoe kidney with a solid mass, in the isthmus, is provided. [ABSTRACT FROM AUTHOR]

Introduction: Horseshoe Shaped (HSK) Kidneys are often asymptomatic and are frequently diagnosed incidentally. The prevalence varies from approximately 1 in 400 to 600 with preponderance in males (male: female ratio of 2:1). This abnormality can affect the drainage of the kidney leading to Pelviureteric Junction Obstruction (PUJO), renal calculi, urinary tract infections and some renal cancers. The superficial location also makes it more vulnerable to injury during trauma or surgical procedures. Aim: To assess the prevalence of HSK and report their morphological features as evidenced following examination with a 64-slice Computed Tomography of the Kidney and Urinary Bladder (CT KUB). Materials and Methods: A retrospective study was conducted in the Department of Radiology, Sri Muthukumaran Medical College and Hospital, Chennai from January 2017 to December 2018. The study included 861 patients who underwent 64 slice CT KUB during that period and review of both plain and contrast enhanced CT KUB examinations were done. For deciding the fusion site, the isthmus, the authors measured a maximum diameter of the outline of the HSK on the axial image and decided the center of the kidneys. The HSK was classified based on fusion site and type of isthmic tissue connecting two kidneys. Results: HSK was found in 4 (3 male and 1 female) out of 861 patients examined. Thus the prevalence of HSK in the study population was 1 in 215 (0.46%). Two patients with a thick isthmus and anteriorly facing pelvises had PUJO and urolithiasis. Variant vascular anatomy was found in all four patients. No crossed fused ectopia was found in this study. Conclusion: This study showed that HSK is the most common congenital fusion anomaly and is more common in males. It also demonstrated that patients with a thick isthmus and associated anteriorly facing renal pelvises were more prone to develop PUJO and renal calculi. [ABSTRACT FROM AUTHOR]

Our objectives were to compare measurements of ureteral wall area, ureteral wall volume and ureteral wall thickness for their use in prediction of shock wave lithotripsy outcomes. We retrospectively identified 218 patients that underwent shock wave lithotripsy for ureteral calculi with pretreatment non-contrast computed tomography. We measured ureteral wall thickness, ureteral wall area and ureteral wall volume by high functional viewer. Ureteral wall thickness was defined as the maximum thickness of ureteral wall, and ureteral wall area as the area of ureteral wall around the stone in the maximal stone diameter on axial computed tomography image. Ureteral wall volume was defined as the volume of ureteral wall from the upper to lower edge of the stone. Treatment success was defined as absence of residual fragments within 3 months after the first session. We compared the outcome predictive power among these parameters and logistic regression analysis to identify factors contributing to treatment failure. The treatment success rate was 47.6%. Ureteral wall thickness, ureteral wall area and ureteral wall volume in successful cases were all significantly smaller than those in unsuccessful cases (all p < 0.01). Area under curve of ureteral wall volume was the largest of these parameters and significantly larger than that of ureteral wall thickness (p < 0.01). On multiple logistic regression analysis, ureteral wall volume was the only significant independent predictor of treatment outcome. Ureteral wall volume is a better predictor of shock wave lithotripsy outcome than ureteral wall thickness or ureteral wall area. [ABSTRACT FROM AUTHOR]

Background: Horseshoe kidney (HSK) is a common renal fusion anomaly, occurring in about 1 in 400-600 individuals. In addition, the incidence of duplicated collecting system is about 0.8%.Case Presentation: This report documents an extremely rare case, which was treated by multiple procedures in the same operative session to accomplish laparoscopic amputation of the HSK isthmus, resection of duplicate kidney and ureteroscopic lithotripsy.Conclusion: Results showed that minimally invasive surgery with use of multiple endoscopes may be a feasible choice for this patient population with complicated comorbid renal conditions. [ABSTRACT FROM AUTHOR]

Background: Bladder cancer (BC) treatment can have a detrimental effect on the sexual organs of patients and yet assessment of sexual health needs has been greatly overlooked for these patients compared to those who have undergone other cancer therapies.Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines in July 2019. Studies were identified by conducting searches for Medline (using the PubMed interface), the Cochrane Central Register of Controlled Trials (CENTRAL) and Ovid Gateway (Embase and Ovid) using a list of defined search terms.Results: 15 out of 37 studies included men only, 10 studies women only and 11 both sexes. Most participants were aged 50 to 65 years. Most studies (n = 34) focused on muscle invasive BC and only three on non-muscle invasive BC. Measurements of sexual dysfunction, including erection, ejaculation, firmness and desire, were the most commonly used measurements to report sexual health in men. In women, lubrification/dryness, desire, orgasm and dyspareunia were the most commonly reported. Twenty-one studies evaluated sexual dysfunction based on validated questionnaires, two with a non-validated questionnaire and through interviewing participants.Conclusion: While recognition of the importance of the inclusion of psychometric measurements to assess sexual health is growing, there is a lack of consistent measures to assess sexual health in BC. With the focus on QoL arising in cancer survivorship, further studies are needed to develop, standardize and implement use of sexual health questionnaires with appropriate psychometrics and social measures to evaluate QoL in BC patients.Trial Registration: "PROSPERO does not currently accept registrations for scoping reviews, literature reviews or mapping reviews. PROSPERO is therefore unable to accept your application or provide a registration number. This decision should not stop you from submitting your project for publication to a journal." [ABSTRACT FROM AUTHOR]

Soft tissue defect of the lateral malleolus and achilles tendon is very challenging for reconstruction due to the bony prominence and limited local tissue availability. The purpose of this study to describe our early experience of 30 patients treated with this flap for reconstruction of posterior heel defects with or without exposure of tendo-achilles. The study was conducted at department of plastic surgery, National Institute of Traumatology and Orthopedic Rehabilitation between 2015 to 2018. Twenty five patients (20 male and 5 females) with soft tissue defects over the posterior heel underwent reconstruction using a lateral calcaneal flap. The etiology is trauma in twelve patients, chronic ulcer in four and surgical wound dehiscence for repair of Tendo-Achilles in nine patients. Patients age range from 15 to 60 years (mean 35yrs) and follow up period ranged from 6 months to 2 years(mean 1 yr). All flaps had good perfusion and survived completely. In 3 cases there was partial loss of skin graft managed conservatively. The lateral calcaneal flap can be used safely to provide sensory skin coverage of posterior heel in single stage. [ABSTRACT FROM AUTHOR]

We evaluated contemporary trends in radical prostatectomy (RP) in men aged >70 years and investigated associations of selected variables with recovery of urinary continence (UC) in two age groups: >70 and ≤ 70 years. A retrospective cohort of 2301 eligible patients attending our institution from 2004 to 2015 was reviewed. Patients were divided into two groups based on age at surgery (>70 years [n = 610] vs 70 years [n = 1691]) and four groups by year of surgery. Over the study period, the proportion of patients aged >70 years gradually increased up to 30.0%, and the rate of robot-assisted RP and neurovascular bundle (NVB) saving increased continually to 80.0% and 67.4% of older patients, respectively. Although the rate of recovery of UC within 12 months (3 months) in patients aged >70 years was lower than that in those aged ≤ 70 years (81.5% [52.6%] vs 88.6% [60.9%], respectively; both P < 0.001), the gap between age groups in the rate of recovery within 12 months narrowed from the second quarter of the study period. Among younger patients, age, robot-assisted RP, prostate volume, membranous urethral length (MUL), and NVB saving were predictors of recovery of UC within 3 or 12 months. In contrast, only age and MUL were predictors of recovery of UC within 3 and 12 months in patients aged >70 years. Therefore, unlike younger patients, only variables (age and MUL), possibly associated with the inherent function of the urinary sphincter, were predictors of recovery of UC in patients aged >70 years. [ABSTRACT FROM AUTHOR]

Purpose of Review: Radical cystectomy and urinary diversion remains the gold standard treatment for patients with high risk or muscle invasive bladder cancer. Despite the fact that a majority of patients are eligible for orthotopic neobladder, over 85% of patients receive incontinent urinary diversions, primarily over concerns for complications or postoperative voiding dysfunction. In this review, we explore the incidence, etiology, and treatment of voiding dysfunction after orthotopic neobladder creation in male and female patients. Recent Findings: Voiding dysfunction after orthotopic neobladder consists of urinary incontinence and urinary retention. Both are well-recognized potential sequelae, but occur more commonly in female patients. Recent studies have characterized voiding dysfunction as a dynamic problem that improves with time. While treatment options are limited, several techniques exist to minimize the risks of voiding dysfunction after orthotopic neobladder. Summary: Despite excellent functional outcomes in the majority of patients, concerns over voiding dysfunction after orthotopic neobladder may in part explain the disparity in receipt of incontinent versus continent urinary diversions. More prospective and patient-reported studies of voiding outcomes are required and newer more effective treatment options for voiding dysfunction are needed. [ABSTRACT FROM AUTHOR]

Chronic kidney disease is an important comorbidity of HIV infection causing real problems in the evolution and medical healthcare of HIV-positive patients. In recent years, a significant number of HIV-positive patients develop renal dysfunction, several mechanisms being incriminated: direct effect of the virus, toxic effect secondary to of antiretroviral medication, secondary to associated comorbidities, given that life expectancy has increased significantly in the last decade, thanks to the use of antiretroviral therapies. There are few studies in the literature to evaluate malformative renourinary pathology in patients with HIV infection. We present the case of a patient with HIV infection, horseshoe kidney, chronic kidney disease and incomplete Fanconi syndrome, secondary to the administration of tenofovir fumarate, a nucleoside reverse transcriptase inhibitor. Malformations, abnormalities or dysmorphysms of the renal tract should be considered in the HIV-positive patient with secondary renal dysfunction because they take a wide range of forms, are underdiagnosed and predispose to multiple complications, with varying degrees of severity, such as urinary tract infections, renal stones or progression of chronic kidney disease. Tenofovir fumarate and atazanavir must be avoided in patients with HIV infection and chronic renal dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Surgical management of benign prostatic hyperplasia (BPH) primarily consists of transurethral resection of the prostate (TURP). Due to BPH and after surgical intervention, anatomic variations in the posterior urethra are expected. Due to the paucity of information regarding posterior urethral anatomic variations in these conditions and its aftermath, this study was undertaken to evaluate the anatomic variations in the posterior urethra after TURP. Materials and Methods: This prospective observational study was conducted over 2 years at the Department of Surgery and Radiodiagnosis, University College of Medical Sciences, Delhi. All consenting patients undergoing TURP for BPH were included in the study. We assessed the posterior urethral changes in BPH before and 3 months after the procedure. Diagnostic modalities used were urethrocystoscopy, micturating cystourethrogram, and retrograde urethrogram. Furthermore, the prostate volume and postvoid residual volume of urine were compared before and after its surgery using ultrasonography. Urodynamic studies were used to calculate total voided volume (TVV), peak flow rate (PFR), voiding time (VT), and hesitancy. Results: Mean age of the patients was 68.12 ± 7.83 years. Lengthening in posterior urethra was seen in BPH patients with a mean of 4.24 ± 1.012 cm. Postprocedure, there was a mean reduction of 2.6 ± 1.225 cm in length of the posterior urethra (P < 0.0001). Prostatic urethral angle was increased in patients suffering from BPH, and it decreased after undergoing surgical management (P < 0.679). All patients enrolled in our study had prostatic lobes enlargement, and after surgery, this enlargement was reduced in most of the patients with 21 having no prostatic enlargement, and in four patients, bilateral lateral lobe was not completely reduced (P = 1.000). Stricture in prostatic urethra was observed in 2 out of 25 (8%) patients operated for BPH. Evaluation of various parameters of urodynamic studies revealed the net improvement in the TVV of 157.746 ± 120.999 ml, as before the procedure, this value was 176.715 ± 72.272 ml, and after surgery, it was 334.46 ± 78.588 ml (P < 0.001). VT taken by patients before surgery was 57.377 ± 16.858 s, and postprocedure, this value was 33.31 ± 8.807 s. This net reduction of 24.069 ± 14.88 s was statistically significant (P < 0.0001). PFR before the procedure was 6.177 ± 3.5067, and postprocedure, this value was 26.43 ± 7.112 ml/s with a net improvement of 20.253 ± 9.226 ml/s (P < 0.0001). Hesitancy in BPH patients before the procedure was 23.908 ± 15.521 s. Postprocedure, hesitancy decreased to a value of 6.79 ± 4.435 s with a net reduction of mean 17.115 ± 15.817 s (P < 0.002). Conclusion: By our findings, we conclude that BPH is associated with anatomic variations in posterior urethra such as lengthening of the length of the posterior urethra and increased posterior urethral elevation, which is measured by an increase in posterior urethral angle (PUA). Whereas post-TURP, there is a shortening of posterior urethra, decrease in PUA, decrease in prostatic volume, postvoid residual urine volume, and improvement in uroflowmetric parameters. [ABSTRACT FROM AUTHOR]

Introduction: Erectile dysfunction is associated with diabetes mellitus with an estimated prevalence of 52.5% in the diabetic population. The first-line therapy for erectile dysfunction is phosphodiesterase type 5 inhibitors, but data suggest that diabetic men may be less responsive than non-diabetic men. Thus, other treatments, including intracavernosal injections, intraurethral prostaglandin, vacuum erection devices and penile prosthetic surgery, should be considered in management of diabetic men with erectile dysfunction refractory to phosphodiesterase type 5 inhibitors. Furthermore, combination therapy of phosphodiesterase type 5 inhibitors and other oral treatments such as arginine or l-carnitine may have synergistic effects resulting in better outcomes. In addition, there are novel therapies such as low-intensity shockwave therapy and stem-cell therapy, which may also be effective in targeted treatment modalities. Furthermore, studies suggest that erectile dysfunction can be improved by targeting concurrent comorbidities or metabolic diseases such as depression, hypertension, hypogonadism, and dyslipidaemia. We present an evidence-based narrative review focusing on the management of erectile dysfunction in diabetic men who have not responded to phosphodiesterase type 5 inhibitors., Conclusions: Both clinicians and patients should be aware of the different management options in diabetic patients who have not responded to phosphodiesterase type 5 inhibitors., (© 2022 The Authors. Andrology published by Wiley Periodicals LLC on behalf of American Society of Andrology and European Academy of Andrology.)

Aims: To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). Methods: This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence‐Research Society (ICI‐RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" Results: Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long‐term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long‐term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP. Conclusions: Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer‐term follow‐up. [ABSTRACT FROM AUTHOR]