Search

Tanapoom Limtrakul,1 Ukrit Rompsaithong,1 Anucha Ahooja,2 Pakorn Kiatsopit,1 Supanut Lumbiganon,1 Kachit Pachirat,1 Wichien Sirithanaphol1 1Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Wichien SirithanapholDepartment of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, ThailandTel +66-43-363664Fax +66-43-202491Email wichsir@kku.ac.thBackground: Emergency renal artery embolization (RAE) is a useful method in treating renal trauma and bleeding renal tumors. The aim of this study was to evaluate the clinical efficacy and safety of emergency RAE, and factors associated with RAE failure.Methods: This retrospective study included patients treated with emergency RAE for acute renal hemorrhage between 1 January 2009 and 31 October 2019 in Srinagarind Hospital. The embolization was performed using coils, glues, and/or gel foams. Factors associated with unsuccessful outcomes were analyzed using univariate and multivariate regression analyses.Results: A total of 94 patients were treated at the center during the study period with the clinical success rate of 91.5%. The most common cause of acute renal hemorrhage was iatrogenic injury (76.5%). Factors associated with unsuccessful RAE according to multivariate analyses were hypertension (adjusted odds ratio [AOR] 24.2) and ruptured tumor/aneurysm (AOR 26.8).Conclusion: RAE is an effective procedure for acute renal hemorrhage. Hypertension and ruptured tumor/aneurysm were negative predictors for success.Keywords: renal artery embolization, renal trauma, renal hemorrhage, PCNL, kidney biopsy, renal tumor

Ischemic priapism is a urological emergency which may lead to irreversible erectile dysfunction. One of the accepted treatments is penile prosthesis implantation. Given the scarcity of studies directly comparing timing of penile prosthesis insertion after ischemic priapism, consensus remains elusive. We aim to compare different studies in the literature concerning advantages and disadvantages of early versus delayed inflatable penile prosthesis following ischemic priapism. We analyzed 8 articles that investigated immediate and delayed inflatable penile prosthesis placement after ischemic priapism. Early inflatable penile prosthesis placement is associated with better outcomes, including pain relief, priapism resolution, penile shortening prevention, and quicker sexual activity resumption. However, it still carries a high risk of complications like edema, infection, and distal perforations. Delayed inflatable penile prosthesis insertion poses surgical challenges due to the potential for extensive corporal fibrosis. Comparative analyses have shown elevated complication rates in patients with ischemic priapism who undergo delayed inflatable penile prosthesis insertion, as opposed to those with early insertion. In studies reporting complications rates, the total complication rate in the early group was 3.37%, significantly lower than the delayed group (37.23%). Most studies support the superiority of early inflatable penile prosthesis placement following ischemic priapism over delayed placement. Further research is, however, needed to establish a global consensus on timing of prosthesis insertion., Competing Interests: Competing interests: YAF: Coloplast: Advisory board, speaker; Endo: Advisory board; Haleon: Advisory board; Halozyme: Advisory board, speaker; Masimo: Intellectual property; Softwave: Advisory board; Sprout: Consultant; Vertica: Research investigator; Xialla: Advisory board. DO: Coloplast Porgès: Medical Consultant, Rigicon: Medical Consultant. The remaining Authors have no conflicts of interest to disclose., (© 2024. The Author(s).)

Objective: The impact of obesity on outcomes after adrenalectomy for pheochromocytoma is unclear. This study aims to evaluate outcomes after minimally invasive and open adrenalectomy for pheochromocytoma in patients with obesity and to determine factors that may affect outcomes. Patients undergoing adrenalectomy for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed, analyzing baseline information, length of hospital stay (LOS), and postoperative complications., Patients and Methods: Obese (body mass index (BMI) ≥ 30 kg/m 2 ) and nonobese patients were compared. Multivariable analysis was utilized to evaluate outcomes and risk factors for complications, LOS, and increased comprehensive complication index (CCI)., Results: Of the 2016 patients, 639 (31.7%) had obesity. Operative time (110.0 versus 105.0 min; p = 0.467), conversion to open rate (3.1% versus 4.7%; p = 0.079), estimated blood loss (20.0 versus 20.0 ml, p = 0.088), rate of complications (19.3% versus 20.8%; p = 0.425), and CCI were similar. However, patients with obesity required a median of 1 day longer LOS (4.0 days versus 5.0 days; p < 0.001). On multivariable analysis, obesity was not significantly associated with complications or higher CCI. Analyzing solely obese patients, laparoscopic (OR 0.24; p < 0.001) and robotic (OR 0.22; p = 0.011) approaches were independently associated with less morbidity. Additionally, multivariable modeling demonstrated that a retroperitoneal approach in patients with BMI ≥ 30 kg/m 2 was independently associated with reduced CCI (- 3.74; p = 0.017). Similar results were demonstrated when analyzing severe obesity (BMI ≥ 35)., Conclusions: Obesity does not increase complications or CCI following pheochromocytoma resection, but it does increase LOS. A retroperitoneal approach may uniquely benefit patients with obesity. In view of rising obesity rates, these results warrant further research to validate findings., Competing Interests: Disclosure: The authors declare no conflicts of interest. Ethical approval: The study was approved with registration: CARMS-18769., (© 2024. Society of Surgical Oncology.)

Purpose of Review: In modern healthcare, the integration of artificial intelligence (AI) has revolutionized clinical practices, particularly in data management and patient visit summary creation. Manual creation of patient summary is repetitive, time-consuming, prone to errors, and increases clinicians' workload. AI, through voice recognition and Natural Language Processing (NLP), can automate this task more accurately and efficiently. Erectile dysfunction (ED) clinics, which deal with specific pattern of conditions together with an involvement of broader systemic issues, can greatly benefit from AI-driven patient summary. This scoping review examined the evidence on AI-generated patient summary and evaluated their implementation in ED clinics., Recent Findings: A total of 381 articles were initially identified, 11 studies were included for the analysis. These studies showcased various methodologies, such as AI-assisted clinical notes and NLP algorithms. Most studies have demonstrated the ability of AI to be used in real life clinical scenarios. Major electronic health record platforms are also integrating AI to their system. However, to date, no studies have specifically addressed AI for patient summary creation in ED clinics., Competing Interests: Declarations Ethics Approval and Consent to Participate Not applicable. Consent for Publication Not applicable. Competing Interests FY: Coloplast: Advisory board, speaker; Endo: Advisory board; Haleon: Advisory board; Halozyme: Advisory board, speaker; Masimo: Intellectual property; Softwave: Advisory board; Sprout: Consultant; Vertica: Research investigator; Xialla: Advisory board., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are important etiological factors for several cancers. This study aimed to determine the prevalence of HPV and EBV infection in penile cancer., Methods: Forty-three formalin-fixed paraffin-embedded penile cancer tissue samples were analyzed for the HPV-induced p16INK4A protein by immunohistochemistry and Epstein-Barr encoding region in situ hybridization. Demographic data and overall survival were analyzed., Results: The median age of patients was 59 years, ranging from 23 to 91 years old. Most of the tumors (86%) were located at the tip of the penis. HPV infection was positive in 12/43 (27.9%) patients. EBV infection was observed in 2/43 (4.6%) of cases and there was no co-infection detected in this cohort. Patients who had p16INK4A overexpression had a trend toward longer survival compared to those without; the median survival time of 104.4 vs 89 months, the hazard ratio of 0.48 (95% CI: 0.16-1.42, p = 0.173)., Conclusions: One-third of penile cancer patients were positive for HPV-induced p16INK4A expression and there was a trend toward better survival in HPV-positive patients. EBV infection was infrequent in penile cancer in Thailand.

Background and Objective: Robotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients., Methods: Data for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed. We analyzed baseline characteristics and postoperative complications at discharge, 90 d, and 1 yr. We conducted propensity score matching (PSM; 1:1 ratio) and multivariable analyses to evaluate outcomes and risk factors for the occurrence of complications and higher Comprehensive Complication Index (CCI)., Key Findings and Limitations: Of 1755 patients, 1613 (91.9%) underwent LA and 142 (8.1%) underwent RA. Estimated blood loss, conversion rate, complication rate, and CCI at discharge, 90 d, and 1 yr were similar between the groups. However, RA was associated with a longer operative time in comparison to LA (100 vs 123 min; p < 0.001), but not after PSM (p = 0.120). Multivariable analysis revealed that Charlson comorbidity index (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.07-1.29; p = 0.001), and tumor size per 1-cm increment (OR 1.13, 95% CI 1.07-1.21; p < 0.001) were independently associated with the incidence of complications, but there was no significant difference in complication rates between the LA and RA groups (OR 1.09, 95% CI 0.63-1.87; p = 0.767). After PSM, RA was associated with a lower rate of severe (grade ≥3a) complications in comparison to LA (p = 0.023)., Conclusions and Clinical Implications: RA is a safe alternative to LA and yields similar outcomes for patients with pheochromocytoma. RA may be associated with a lower likelihood of severe complications. Further studies are warranted to determine the role of robotic surgery in pheochromocytoma., Patient Summary: Pheochromocytoma is a rare tumor in the adrenal gland and the gold-standard treatment is surgical removal. We assessed patient outcomes after robot-assisted surgery compared with laparoscopic surgery and found that outcomes are similar, but the rate of severe complications may be lower if a surgical robot is used., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Priapism is a rare condition characterized by prolonged and often painful penile erection unrelated to sexual stimulation. Ischemic priapism, the most common subtype, requires immediate attention to prevent irreversible damage to erectile tissue. This narrative review explores the initial management strategies for ischemic priapism. Intracavernosal phenylephrine injection and aspiration with or without irrigation are recommended as first-line treatments, with alternative options available depending on clinical settings and patient factors. While guidelines offer clear recommendations for priapism lasting more than 4 h, management of shorter-duration cases remains challenging due to limited evidence., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Hard-flaccid syndrome (HFS) is a poorly understood condition of male sexual dysfunction (MSD) that has more recently become a new topic of discussion in online forums and sexual medicine conferences. There has been limited research looking into HFS and consequently there are no evidence-based guidelines for its work-up and management. In order to identify the current level of understanding of HFS in the sexual medicine community, a survey was distributed at a national urologic conference focusing on pertinent management strategies employed by practitioners, and their own thoughts on HFS. This showed that nearly one-third of those surveyed had never seen HFS in their practice. Of those that had, diagnosis was mainly made via clinical history as well as patient self-diagnosis. Additionally, only about half of the respondents who had seen HFS were confident in its legitimacy as a real medical syndrome. This analysis is one of the first of its kind, and highlights the ongoing lack of familiarity of HFS among the sexual medicine community. There were limitations, most notably its survey format as well as low sample size, however, it importantly emphasizes the critical need for continued education and research into HFS to improve diagnostic accuracy, enhance patient care, and develop effective treatment strategies., (© 2024. The Author(s).)

We aimed to determine the impact of the COVID-19 pandemic on search trends for inflatable penile implants in the US. Search trends for inflatable penile implants ranging from 2016 through 2023 were analyzed utilizing Google Trends. Associations between search trends and US Census Bureau data, including average household income and per capita income, were analyzed. Pre- and post- COVID-19, the interest in inflatable penile implants has been steadily increasing on average in the US. The average household income for counties with the highest interest in inflatable penile implants during the pre-COVID era was $53,136, whereas for the counties with the highest interest in inflatable penile implants in the post-COVID era, the average decreased to $50,940. Similarly, the average per capita median decreased from $35,209 to $34,547. Search traffic for inflatable penile prosthesis increased following the pandemic in the US. Nevertheless, post-pandemic, individuals with lower income levels showed no change in interest in penile implant searches compared to the pre-pandemic period. Understanding this steadiness in interest can inform healthcare professionals and policymakers to tailor interventions and educational efforts to reach a broader audience, ensuring equitable access to information and healthcare resources., (© 2024. The Author(s).)

Sleep-related painful erection (SRPE) is a condition characterized by painful nocturnal erections and frequent nighttime awakenings; however, the pathophysiology is not well understood and existing literature consists mainly of case reports. We aimed to investigate the causes, treatments, and impact on quality of life among individuals affected by SRPE. An e-questionnaire comprising of 30 items was administered to a group of men with SRPE identified through social media in October of 2021. The survey collected information on demographics, clinical and social history, symptomatology, interventions and quality of life. 44 patients with SRPE completed surveys (70.9% response rate), with a mean age ± SD of 43.3 ± 12.8 years. Most respondents had no relevant medical history related to erectile function disorders. 43.2% of subjects reported sleep apnea, and 27.1% reported a mental health disorder or psychiatric medication use. Baclofen was the most common medication, but only 25% of patients found it beneficial. Sleep repositioning, oxygen device use and pelvic floor therapy were interventions that provided the most relief. Most patients did not require emergency department visits (93.2%); only a small number needed penile aspiration (n = 2). As reported by most respondents, SRPE significantly impacted patients' quality of life., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Objectives: To report outcomes of surgical treatment in patients with penile foreign body granuloma and compare surgical outcomes between single- and two-stage scrotal flap reconstructions., Methods: Medical records of patients with penile foreign body granuloma who underwent surgical treatment were reviewed. Patients with single- and two-stage scrotal flap reconstructions were compared., Results: Forty-two patients underwent surgical treatment from January 1, 2018 to October 31, 2022. Twenty-three patients underwent single-stage reconstruction with bilateral scrotal flap while 12 patients underwent two-stage repair with 19 operations. Five patients underwent circumcision; one had excision with primary closure. Another patient underwent reconstruction by penile skin preservation technique. There was no statistically significant differences between single- and two-stage groups in wound infection (8.69% vs. 0%, RR 2.71, 95%CI; 0.14-52.29), wound dehiscence (21.74% vs. 8.33%, RR 2.61, 95%CI 0.34-19.87), reoperation rate (26.08% vs. 8.33%, RR 3.13, 95%CI; 0.42-23.10). Postoperative fever was significantly higher in single-stage group (56.52 vs. 8.33%, RR 6.78, 95%CI; 1.01-43.83). Total length of hospital stay was shorter in single-stage group (7.43 ± 3.19 days vs. 10.86 ± 1.57 days, MD -3.42, 95%CI; -5.28 to -1.57). Incidence of patients without Clavien-Dindo surgical complications was significantly lower in single-stage group (43.48% vs. 83.33%, RR 0.53, 95%CI; 0.31-0.89)., Conclusions: Both single- and two-stage techniques may be considered for penile foreign body granuloma reconstruction. Although the hospital stay was longer in two-stage group, the complication rates were lower., (© 2023 The Japanese Urological Association.)

Purpose: Transurethral resection of prostate (TURP) with postoperative catheter traction can lead to significant catheter-related bladder discomfort (CRBD). This condition causes many postoperative complications and low patient satisfaction. This study aimed to evaluate the effectiveness of preoperative single-dose intravenous nefopam on the incidence and severity of CRBD and its adverse effects., Methods: This randomized, controlled, double-blind study included patients who underwent TURP under spinal anesthesia with postoperative urinary catheter traction. Patients were allocated into nefopam (NF) and normal saline (NS) groups. Twenty mg of nefopam in normal saline solution (NSS) 100 mL or NSS 100 mL were given intravenously before TURP. The primary outcome was the incidence of CRBD., Results: Seventy-three patients were randomized into NF (n = 37) and NS (n = 36) groups. There were 35 and 33 patients in the NF and NS groups, respectively, in the final analysis. The incidences of CRBD were 45.71% and 84.85% in the NF and NS groups at 6 h after operation, respectively, OR 0.54 (95% CI 0.36, 0.73), while before the end of catheter traction, the corresponding incidences were 37.14% and 75.76%, respectively, OR 0.49 (95% CI 0.28, 0.84). The CRBD scores were statistically significantly lower in the NF group at both time points. Morphine consumptions and adverse effects were not different between groups. Patient satisfaction was higher in the NF group., Conclusions: Single-dose nefopam significantly reduced the incidence and severity of CRBD in patients undergoing TURP with urinary catheter traction at 6 h after the procedure and before the end of catheter traction without increasing the adverse effects., (© 2022. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Background: Smart lens is a magnifying device that turns the smartphone into a microscopic exploring instrument. It is a convenient and inexpensive tool as an on-site evaluation device for the kidney biopsy specimen. We demonstrate the benefit of using a handheld smartphone microscope compared to the standard procedure in allograft kidney specimens., Material and Methods: This was a cohort study of allograft kidney biopsies performed between June 2015 and November 2017 in Srinagarind Hospital, Khon Kaen University, Thailand. The clinical utility of the "Chula smart lens" applied to the smartphone as an on-site evaluation device was studied. Clinical data, diagnostic quality, and complications were retrospectively reviewed and compared between the smart lens group and the standard group., Results: The study cohort consisted of 93 allograft kidney biopsies (standard:47, smart lens:46). The mean age was 40.6 (18-48) years, and 63 patients (67.7%) were male. By using the smart lens device, the number of obtained tissue cores was higher (3.5 vs 2.9, p = 0.019) and the inadequacy rate for diagnosis was significantly lower (7% vs 21.3%, p = 0.05)., Conclusion: Using a handheld smartphone microscope as an on-site evaluation device resulted in more positive glomeruli and diagnostic yield compared to the standard procedure., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Published by Elsevier Ltd.)

Radical prostatectomy is one of the treatment of choices for localized prostate cancer. Published data show that radical prostatectomy is associated with both an increase and decrease in testosterone levels. This study aimed to document the changes in pre- and postoperative serum testosterone levels after radical prostatectomy along with the associations between serum testosterone levels and prostate cancer profiles in Thai population. Localized and locally advanced prostate cancer patients who elected to have radical prostatectomy without prior androgen deprivation therapy were included in the study. Patients' demographic data, pre- and postoperative serum testosterone levels, sex hormone binding globulin, albumin, prostate-specific antigen, and final pathologic reports were collected. Eighty-five prostate cancer patients were included in this study. Mean age was 67.32 years. Mean pre- and postoperative serum testosterone levels were 424.95 ng/dL and 371.94 ng/dL, respectively (p-value < 0.001). There was a greater testosterone reduction in patients with a final pathologic report of Gleason 4 + 3 and above compared with those with a Gleason 3 + 3 and 3 + 4 (p-value = 0.001). No significant association between preoperative testosterone levels and final Gleason scores was observed. This study documented significant postoperative testosterone reductions in prostate cancer patients after a radical prostatectomy. Patients with high Gleason grades had greater testosterone reductions. These findings may have clinical implications for the prediction of postoperative hypogonadal states in prostate cancer patients.