Search

Feminizing genital surgery for transgender women is a feasible and fulfilling intervention in alleviating gender dysphoria. Several techniques in neovaginal creation can be offered, including vulvoplasty, penile skin inversion vaginoplasty, peritoneal vaginoplasty, and enteric vaginoplasty. Complication rates are low and often managed conservatively. Favorable sexual function outcomes indicate high satisfaction rates.

Transmasculine genital reconstructive surgery involves the creation of a neourethra by way of metoidioplasty or phalloplasty. We aim to describe approaches in identifying complications associated with these procedures as well as the various reparative techniques that can be utilized to reestablish the neourethral tract.We prepared a guide to diagnostic and procedural interventions for urologic complications following transmasculine genital reconstructive surgery based on our clinical experience as well as those of our colleagues. We reviewed all current peer-reviewed publications based on this topic.These procedures have a considerable revision rate for urologic complications, which include urethrocutaneous fistulae, persistent vaginal remnant, and urethral strictures. These complications often present simultaneously and require appropriate workup and treatment.Several reconstructive techniques can be employed to restore the neourethral tract, as we describe in detail.

Objectives: Receptor-activator of nuclear factor-κB ligand (RANKL) is an essential stimulating factor for inducing osteoclast differentiation, feasibly resulting in osteoporosis. The bioactive extract of Agrocybe chaxingu mushroom, CHX, has been shown to have osteoclastic inhibitory activity. Accordingly, we investigated if CHX would inhibit or disrupt RANKL-induced osteoclast differentiation, implying possible prevention of osteoporosis. Materials and Methods: Monocyte/macrophage RAW264.7 cells (RAW cells) were employed as our experimental model and treated with varying concentrations of RANKL alone or with CHX for 5 days. Formation of osteoclasts was then assessed using tartrateresistant acid phosphatase (TRAP) assay, counting stained cells as osteoclasts under a light microscope. The inhibitory mechanism of CHX was also explored by examining the RANKLmediated signaling pathways, oxidative stress (OXS), antioxidant enzymes, and apoptosis. Results: RANKL (100 ng/mL)-induced osteoclast differentiation in RAW cells was significantly (~20%) inhibited with 10 μg/mL of CHX. This was accompanied by the downregulation of two key signaling pathways and activation of antioxidant enzymes that likely led to the reduction in OXS. Moreover, CHX ultimately induced undifferentiated or RANKLunresponsive cells to apoptosis, indicated by the modulation of apoptotic regulators. These findings may then account for a disruption of osteoclast differentiation with CHX. Conclusion: CHX appears to have the inhibitory effect on RANKL-induced osteoclast differentiation in RAW cells. It is thus plausible that CHX may have potential clinical implications in osteoclast-mediated bone diseases/disorders, including osteoporosis.

Background: To find the better option for cancer treatment and prevention, we have been working on the bioactive extracts of monk fruit, mogrosides, with potential anticancer and antioxidant activities. As oxidative stress (OXS), generation of reactive oxygen species, is believed to play a significant role in carcinogenesis, certain antioxidants may help prevent the development of cancer. Accordingly, we investigated if such mogroside-based products would have such biological activities in vitro. Materials and Methods: Anticancer effect of four selected products, LS, LME, and LLE, and MOG, was tested on five different cancer cells, including bladder, prostate, breast, lung, and liver. Cancer cells were treated with these products for 72 h and cell viability was determined by MTT assay. The anticancer mechanism was also explored, focusing on cell cycle and apoptosis. For antioxidant study, whether any products would protect normal kidney cells from hydrogen peroxide (H2 O2 )-induced OXS was examined. Cell viability and severity of OXS were determined by MTT assay and lipid peroxidation (LPO) assay, respectively. Results: Although any concentrations (0-500 μg/ml) of LS and LME had little effects, LLE (≥2 μg/ml) and MOG (≥1.5 mg/ml) showed a significant cell viability reduction in all five cancer cells. LLE and MOG, not LS and LME, concurrently led to a G1 cell cycle arrest and ultimately apoptosis. Additionally, LLE and MOG also protected normal cells from H2 O2 -induced OXS, and LPO assay further revealed a significant reduction in the severity of OXS with them. Conclusions: In this study, two of four monk fruit products tested, LLE and MOG, demonstrated their anticancer and antioxidant activities. They may stop/reduce cancer cell growth/viability, while they may also protect normal cells from OXS that can lead to the cancer development. Therefore, these two monk fruit products may have clinical implications in the cancer prevention/treatment.

Background: Although bladder cancer is the second-leading urologic cancer next to prostate cancer in the United States, few effective and satisfactory therapeutic options have yet been established. As we have been searching for certain natural remedies with anticancer activity, we came across the two natural products, namely mushroom extract (PL) and grapeseed extract (GSP). Accordingly, we investigated if the combination of these two extracts could further potentiate anticancer effect on bladder cancer cells. Materials and Methods: Human bladder cancer T24 cells were separately treated with PL, GSP, or their combination, and cell viability was determined by MTT assay. To explore the anticancer mechanism, severity of oxidative stress was assessed by lipid peroxidation (LPO) assay, activities of epigenetic regulators were determined by enzymatic assays, and apoptotic regulators were examined by Western blot analysis. Results: PL and GSP alone led to a ~20% and ~25% cell viability reduction at 20 μg/ml and 25 μg/ml, respectively. When the same concentrations of PL and GSP were then combined, cell viability was drastically reduced to merely ~15% ~85% reduction) in a synergistic manner. Concomitantly, the PL/GSP combination led to a ~3-fold increase in oxidative stress, assessed by LPO assay. Activities of DNA methyltransferase and histone deacetylase were significantly lost by ~50% and 55% with the PL/GSP combination, respectively. Moreover, Western blot analysis revealed that bcl-2 (anti-apoptotic regulator) was down-regulated while Bax (pro-apoptotic regulator) was up-regulated with the combination, implying induction of apoptosis. Conclusions: This study shows that the combination of PL and GSP can synergistically induce the significant reduction (~85%) in T24 cell viability, demonstrating an extensive potentiation of anticancer effect. Such a profound effect is accompanied by increased oxidative stress, chromatin modifications, and ultimate apoptosis. Therefore, the PL/GSP combination may offer a more effective and safer regimen for bladder cancer.

A 62-year-old male presented with abdominal pain and hematuria following impalement of the rectum with a wooden foreign object. CT imaging showed air and fluid in the peritoneum prompting the patient to undergo abdominal exploration. An anterior rectal perforation was discovered along with dual bladder lacerations of the posterior wall and dome. The patient underwent a diverting colostomy and primary bladder repair. Post-operative course was uncomplicated and bladder repair was followed via cystograms with catheter removal 2 months post-operatively. Four months after the injury the patient underwent colostomy closure and remains with normal bladder and bowel function at 21-month follow-up.

Most urologists practicing general urology traditionally have taken care of a large number of older adults over the age of 65. As the overall population of the United States age at a rapid pace, the urologists will be entrusted with the care of an increasing number of older adults with comorbidities. Some of the most common urological problems in the elderly which may require surgical intervention include urological cancers such as prostate, bladder and kidney cancer, benign prostatic hyperplasia (BPH) with lower urinary tract symptoms, urinary incontinence, and pelvic floor dysfunction in female. The risks associated with urological surgery in the elderly is not necessarily related with chronological age but rather greatly influenced by the functional capacity and associated comorbidities of the individual patient. The urologist must be familiar with and carefully consider non-surgical or minimally invasive surgical technique when appropriate, perform a thorough pre-operative assessment, and be cognizant of post-operative complications and their management unique to elderly patients. In this chapter we review the surgical management of some of the most common urological problems in the elderly. We have briefly touched on the clinical evaluation of geriatric patients, as this has been discussed in depth in another chapter. Considering the brevity of the space we have limited our discussion of non-surgical treatment options.