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For many males, sexual function holds significant value in determining their quality of life. Despite the importance of male erectile function, no quantitative method to measure it accurately is currently available. Standardized assessment methods such as RigiScanTM, International Index of Erectile Function (IIEF-5), and the stamp test are used to evaluate sexual function, but those methods cannot repetitively and quantitatively measure erectile function. Only direct measurement can quantitatively assess the shape of an erect penis. This paper presents the essential requirements for developing an ideal measurement method for penile erection. It also introduces current approaches for diagnosing male sexual function and reviews ongoing research to quantitatively measure erectile function. The paper further summarizes and analyzes the advantages and disadvantages of each method with respect to the essential requirements. Finally, the paper discusses the future direction toward the development of Penile Erection Morphometry.

Background Antimicrobial peptides (AMPs) are key effectors of urinary tract innate immunity. Identifying differences in urinary AMP levels between younger and older adults is important in understanding older adults' susceptibility and response to urinary tract infections (UTI) and AMP use as diagnostic biomarkers. We hypothesized that uninfected older adults have higher urinary human neutrophil peptides 1-3 (HNP 1-3), human alpha-defensin-5 (HD-5), and human beta-defensin-2 (hBD-2), but lower urinary cathelicidin (LL-37) than younger adults. Methods We conducted a cross-sectional study of patients aged ≥18 years completing a family medicine clinic nonacute visit. Enzyme-linked immunosorbent assays were performed for AMPs. We identified associations between age and AMPs using unadjusted and multivariable linear regression models. Results Of the 308 subjects, 144 (46.8%) were ≥65 years of age. Comparing age ≥65 versus < 65 years, there were no significant differences in HNP 1-3 (p  = .371), HD5 (p  = .834), or LL-37 (p  = .348) levels. Values for hBD-2 were lower in older adults versus younger (p  < .001). In multivariable analyses, older males and females had significantly lower hBD-2 levels (p  < .001 and p  = .004). Models also showed urine leukocyte esterase was associated with increased levels of HNP 1-3 and HD5; hematuria with increased hBD-2; and urine cultures with contamination with increased HNP 1-3 and hBD-2. Conclusions Baseline urinary HNP 1-3, HD-5, and LL-37 did not vary with age. Older adults had lower baseline hBD-2. This finding has implications for the potential use of urinary AMPs as diagnostic markers and will facilitate further investigation into the role of innate immunity in UTI susceptibility in older adults. [ABSTRACT FROM AUTHOR]

• Gastrointestinal and urological symptoms are frequent in children with DM1. • These symptoms impact negatively on the child's and their family's daily life. • Gastrointestinal symptoms often respond excellent to pharmacological treatment. • It is key to correctly recognize, diagnose and treat these symptoms. • We recommend screening for these symptoms as standard of care for children with DM1. Gastrointestinal and urological symptoms are frequently reported by people with myotonic dystrophy type 1 (DM1) but have remained understudied. In a cross-sectional study, frequency, nature, treatment and impact of gastrointestinal and urological symptoms in children with DM1 aged 5–18 years were assessed. We included 58 children (30 males, 28 females) with a mean age of 13 years; 74.1 % reported at least one gastrointestinal symptom. Abdominal pain was the most frequently reported symptom (51.7 %), followed by dysphagia (41.8 %), diarrhoea (36.2 %), encopresis (36.0 %), constipation (32.7 %), bloating and flatulence (both 25.9 %). The most frequently reported urological symptoms were difficulty with toilet training (59.3 %), urinary incontinence (22.0 %), enuresis nocturna (10.3 %) and voiding (23.5 % hesitancy, 4.8 % intermittency and 13.8 % dysuria). The majority considered urological and gastrointestinal symptoms to have a negative influence on their daily life; 22.4 % of parents reported severe influence on daily family life (shame, social restrictions, school absence and concerns for their children's future). Considering the high prevalence of urological and gastrointestinal symptoms in children with DM1 and their influence on daily life it is key to correctly recognize, diagnose and treat these symptoms. We recommend screening for gastrointestinal and urological symptoms in the standard of care for children with DM1. [ABSTRACT FROM AUTHOR]

Patients with Down syndrome (DS) are at risk of multiorgan dysfunction; kidney and urological impairment are common. This is due to a likely increased risk of congenital kidney and urological malformations (odds ratio of 4.5 compared to the general population in one study), more frequent associated comorbidities at risk of kidney dysfunction (such as prematurity in 9–24% of children, intrauterine growth retardation or low birth weight in 20%, and congenital heart disease in 44%), and more frequent lower urinary tract dysfunction (reported in 27–77% of children with DS). If present, malformations and comorbidities at risk of kidney dysfunction warrant regular kidney monitoring in addition to their treatment. Serum creatinine in children with DS has been shown to be higher than in the general population and asymptomatic hyperuricemia is reported in 12–33% of children or young adults with DS. Moreover cryptorchidism and testicular cancer are also more common and should be detected by clinical examination. Thus, persons with DS at risk of presenting kidney and urological impairment should be identified by prenatal ultrasonography, comorbidities at risk of kidney sequelae considered, and during regular medical follow-up, clinically examined and questioned to diagnose testicular anomalies and lower urinary tract dysfunction. This is of importance as such kidney and urological impairments are associated with impaired quality of life and mental health, and risk of kidney failure. [ABSTRACT FROM AUTHOR]

Objectives: Contrast enhancement by MRI done early after cryoablation for renal malignancies may suggest residual tumor (RT). However, we have observed MRI enhancement within 48 h of cryoablation in patients who had no contrast enhancement 6 weeks later. Our purpose was to identify features of 48-h contrast enhancement in patients without RT. Methods: This single-center retrospective study included consecutive patients who underwent percutaneous cryoablation of renal malignancies in 2013–2020, exhibited cryoablation-zone MRI contrast enhancement 48 h later, and had available 6-week MRI scans. Persistent or growing CE at 6 weeks vs. 48 h was classified as RT. A washout index was calculated for each 48-h MRI, and its performance for predicting RT was assessed by receiver operating characteristic curve analysis. Results: We included 60 patients with 72 cryoablation procedures and 83 cryoablation zones exhibiting 48-h contrast enhancement; mean age was 66 ± 17 years. Clear-cell renal cell carcinoma accounted for 95% of tumors. Of the 83 48-h enhancement zones, RT was observed in eight while 75 were benign. The 48-h enhancement was consistently visible at the arterial phase. Washout was significantly associated with RT (p < 0.001) and gradually increasing contrast enhancement with benignity (p < 0.009). A washout index below − 1.1 predicted RT with 88% sensitivity and 84% specificity. Conclusion: MRI contrast enhancement 48 h after cryoablation of renal malignancies was usually benign. Washout was associated with residual tumor, with a washout index value below − 1.1 exhibiting good performance in predicting residual tumor. These findings may help to guide decisions about repeat cryoablation. Clinical relevance statement: Magnetic resonance imaging contrast enhancement 48 h after cryoablation of renal malignancies rarely indicates residual tumor, which is characterized by washout with a washout index lower than − 1.1. Key Points: • Contrast enhancement at the arterial phase of magnetic resonance imaging done 48 h after cryoablation of a renal malignancy is usually benign. • Residual tumor manifesting as contrast enhancement at the arterial phase is characterized by subsequent marked washout. • A washout index below − 1.1 has 88% sensitivity and 84% specificity for residual tumor. [ABSTRACT FROM AUTHOR]

Angiogenesis is an essential process in the growth and metastasis of cancer cells, which can be hampered by an anti-angiogenesis mechanism, thereby delaying the progression of tumors. However, the benefit of this treatment modality could be restricted, as most patients tend to develop acquired resistance during treatment. Vasculogenic mimicry (VM) is regarded as a critical alternative mechanism of tumor angiogenesis, where studies have demonstrated that patients with tumors supplemented with VM generally have a shorter survival period and a poorer prognosis. Inhibiting VM may be an effective therapeutic strategy to prevent cancer progression, which could prove helpful in impeding the limitations of lone use of anti-angiogenic therapy when performed concurrently with other anti-tumor therapies. This review summarizes the mechanism of VM signaling pathways in urological tumors, i.e., prostate cancer, clear cell renal cell carcinoma, and bladder cancer. Furthermore, it also summarizes the potential of VM as a therapeutic strategy for urological tumors. [ABSTRACT FROM AUTHOR]

The research aimed the direct correlations between the water composition and feline urological syndrome prognosis. The study was conducted on 60 patients aged between 1 and 10 years divided into two batches of 30 each. The first batch (LOT1) was represented by 30 oliguric patients, with a value of urinary specific gravity (USG) >1.055, an acidic pH and a urinary protein/creatinine ratio (UPC) >0.2, and the second batch (LOT2) was represented by 30 polyuric patients, with a urinary specific gravity (USG) <1.035, a neutral or alkaline pH and a urinary protein/creatinine ratio (UPC) <0.2 or borderline (0.2-0.4). In the first batch (LOT1), alkaline water without sodium and potassium, was administered. The water was based on a salt-free formula with a pH of 8.0 and 10 ppm of potassium. In the second batch (LOT2), a neutral water with potassium was used. The water was based on a formula with salts (magnesium citrate, calcium acetate and sodium bicarbonate), with a pH of 7.0 and 12.5 ppm potassium. In both batches, the evaluation of the USG, the pH and the UPC was carried out for 180 days, at 30, 90 and 180 days. Hydration is an essential component in the management of patients diagnosed with feline urological syndrome. Administering an alkaline hydric diet in patients with aciduria is a solution to counteract the effect of metabolism on urinary pH. Potassium supplementation in polyuric patients is a beneficial solution in hypokalemia therapy. Potassium restriction in oliguric patients is a beneficial solution in the therapy of hyperkalemia. [ABSTRACT FROM AUTHOR]

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Inventions and innovations have the potential to change lives.1 Perioperative nurses strive for improved patient care2 and are well positioned to develop creative and innovative solutions to clinical challenges faced when caring for patients in the perioperative environment. Fluid leakage during percutaneous nephrolithotomy (PCNL) surgery poses risks to both patients3 and staff. The PCNL drape was developed by a collaborative perioperative team to reduce these risks and improve the quality of care provided to patients. [ABSTRACT FROM AUTHOR]

Introduction: Ascending and descending coli normally are located anterolateral to kidneys. Retrorenal position of the colon has a reported prevalence of 10%–20% in the general population. Its occurrence is of significant while performing percutaneous nephrolithotomy (PNL) which is a routine management procedure for patients showing clinical disease associated with renal calculus. PNL in patients with retrorenal colon can lead to colonic perforation which is associated with significant morbidity and mortality related to septicemia, peritonitis, formation of abscess, and nephro-colic and/or colo-cutaneous fistulae. Hence, the preoperative information about the presence of retrorenal colon is essential for the prevention of surgical complications. Materials and Methods: Our retrospective study included patients who underwent computed tomography (CT)/magnetic resonance (MR) abdomen in our department of radiodiagnosis. All the scans were evaluated for the presence of retrorenal colon. The persistence of retrorenal colon was also observed with change in posture among those with prone scans. Results: The retrorenal colon was present in 130 out of 669 patients included in the study, with an occurrence rate of nearly 20%. Alteration in the position of retrorenal colon was noted with prone position in approximately 79%. Conclusion: The occurrence of retrorenal colon is high in the Indian population being approximately 20% without change with prone position in one-fifth. Thus, to reduce the risk of complication related to colonic perforation during PNL, all patients must be subjected to CT/MR abdomen to detect retrorenal colon followed by scan in the prone position, if retrorenal colon is present, to evaluate the alterations in colonic position with prone posture.

Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.

Luo Jindan,&ast; Wang Xiao,&ast; Xie Liping Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xie Liping, Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China, Email xielp@zju.edu.cnAbstract: Use of α-androgenic receptor blockers remains a mainstay therapeutic approach for the treatment of urological diseases. Silodosin is recommended over other α-blockers for the treatment of lower urinary tract symptoms (LUTS) and benign prostate hyperplasia (BPH), due to its high α1A uroselectivity. Current research data suggest that silodosin is efficacious in the management of various urological diseases. Thus, we herein review the current evidence of silodosin related to its efficacy and tolerability and appraise the available literature that might ultimately aid in management of various urological conditions at routine clinical practice. Literature reveals that silodosin is beneficial in improving nocturia events related to LUTS/BPH. Silodosin exerts effect on relaxing muscles involved in detrusor obstruction, therefore prolonging the need for patients undergoing invasive surgery. Silodosin treatment, either as a monotherapy or combination, significantly improves International Prostate Symptom Score (IPSS) including both storage and voiding symptoms in patients with BPH/LUTS. Patients on other treatment therapies such as phosphodiesterase 5 inhibitors or other α-blockers are well managed with this drug. Steadily, silodosin has proved beneficial in the treatment of other urological disorders such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), overactive bladder/acute urinary retention (AUR), premature ejaculation (PE), and prostate cancer post brachytherapy-induced progression. In patients with distal ureteral stones, silodosin treatment is beneficial in decreasing stone expulsion time without affecting stone expulsion rate or analgesic need. Moreover, there were significant improvements in intravaginal ejaculation latency time, quality of life scores, and decrease in PE profile among patients with PE. Silodosin has also demonstrated promising results in increasing the likelihood of successful trial without catheter in patients with AUR and those taking antihypertensive drugs. Reports from Phase II studies have shown promising role of silodosin in the treatment of CP/CPPS as well as facilitating ureteral stone passage. From the robust data in this review, further silodosin treatment strategies in the management of different urological conditions need to be focused on.Keywords: efficacy, benign prostate hyperplasia, ureteral calculi, prostatitis, silodosin, urological

Introduction: Kidney transplantation is an established surgical method for the treatment of end-stage chronic renal failure with good long-term results. Despite the continuous progress and development of transplantology, a number of postoperative surgical and urological complications still occur today, which could compromise the success of this operative method. Purpose: All possible surgical and urological complications in the first 60 days after kidney transplantation were followed up. Materials and Methods: This study is based on a retrospective analysis of the disease history of 35 patients who underwent kidney transplantation at the Clinic of Urology at the UMHAT "Alexandrovska" for the period from 02.2018 to 12.2019. Results: Early postoperative complications were found in 46% of the observed transplant patients. Urological complications were found in 26% of them. Discussion: The incidence of urinary tract infections in transplanted patients was 26%. During the follow-up period, there were no cases of urinary retention, stricture of the ureter and urinoma in the group of patients. The incidence of surgical complications in the transplanted patients was 29%. The incidence of postoperative hematomas was 23%. Postoperative lymphocele was diagnosed in one patient, which shows a complication rate of 3% for this diagnosis. The incidence of surgical wound infection in transplanted patients during the follow-up period was 3%. Conclusions: Our results show that the frequency of the different early postoperative urological and surgical complications correspond to the literature data from other transplant centers. They show that the transplantation activities in the Clinic of Urology in UMHAT "Alexandrovska" correspond to the world standards.

Abstract Introduction Pelvic floor exercises are effective in the treatment of urinary incontinence (UI) and are routinely prescribed, along with bladder training, by primary healthcare providers as first line conservative management. Mobile phone applications are increasingly popular within the healthcare setting and can provide opportunities for patients to complete treatments at home. To date, there has not been a systematic review examining outcomes from randomised controlled trials on the effectiveness of mobile applications to improve UI. Methods A systematic review of randomized controlled trials evaluating the effectiveness of mobile applications to improve UI was carried out according to the PRISMA reporting guidelines. The online databases MEDLINE, Embase, PsychINFO, CINAHL, Web of Science, Scopus, The Cochrane Library, Joanna Briggs Institute (JBI), Google Scholar were searched for papers published between 2007 to 2020. Keywords and MeSH terms were used to identify relevant English language studies. The quality and risk of bias within included studies was assessed by two independent reviewers, RCT JBI critical appraisal tool. Due to heterogeneity in the outcome of studies, a meta-analysis of the data could not be conducted. Findings Four studies reported an improvement in the outcome assessed post-intervention, suggesting that using mobile phone applications for pelvic floor muscle training (PFMT) was an acceptable and valid intervention to improve UI. Conclusion Mobile applications for PFMT indicated that increase adherence to treatment and decrease UI. The integration of this treatment modality into current practice is recommended. Mobile phone applications for PFMT show promise in the conservative management of UI. Further research is required to support the use of this technology in the conservative management of UI.

Background: Robotic surgeries have improved perioperative outcomes. We have combined ultrasound (USG) guided bilateral rectus sheath (RS) block along with transverse abdominis plane (TAP) block to assess perioperative opioid requirement, visual analog scale (VAS) score, and modified Post Anesthetic Discharge Scoring System (PADSS) criteria for robotic urological surgeries. Ultrasound (USG)-guided blocks were given bilaterally after induction of general anesthesia. Methods: A total of ten patients scheduled for robotic urological surgeries were administered 30 ml of 0.25% bupivacaine (2.5 mg kg-1) with 0.75 mcg kg-1 of clonidine (10 ml of drug was given for TAP block and 5 ml of drug for RS block on each side) after negative aspiration. Results: Supplemental opioid was not required perioperatively, and 9 out of 10 patients were pain free (VAS score

OBJECTIVE:To compare the measured stone burden recorded between urologists and radiologists, and examine how these differences could potentially impact stone management. As current urologic stone surgery guideline recommendations are based on stone size, accurate stone measurements are crucial to direct appropriate treatment. This study investigated the discrepant interpretation that often exists between urologic surgeons and radiologists' estimation of patient urinary stone burden. MATERIALS AND METHODS:From November 2015 through August 2016, new patients prospectively enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU) were included if they had computed tomography images available and an accompanying official radiologic report at the time of their urologist provider visit. Stone number and aggregate stone size were compared between the urologic interpretation and the corresponding radiologic reports. RESULTS:Of 219 patients who met the inclusion criteria, concordance between urologic and radiologic assessment of aggregate stone size was higher for single stone sizing (63%) compared with multiple stones (32%). Statistical significance was found in comparing the mean difference in aggregate stone size for single and multiple stones (P

The result of a kidney transplantation may be affected by certain congenital or acquired urological diseases that need to be addressed before, during or after the kidney transplant. Complications accompanying kidney transplantation are not fundamentally different from the events that accompany other difficult surgical procedures. However, their course is usually modified by adverse circumstances in the recipient - uremia, dialysis treatment, immunosuppression. The incidence of urological complications is reported in the range of 1 to 30 % of the transplants, and they represent up to one half of all surgical complications. They can cause a significant morbidity and mortality and can lead to a delayed onset of the function and even to a loss of the transplanted kidney. Urological complications that need to be addressed before kidney transplantation include anomalies or pathological changes in the lower urinary tract, pelvic involvement in atherosclerosis or previous kidney transplants, infectious foci in lithiasis or pyonephrosis, large polycystic kidneys and malignancies. During the kidney transplantation itself, vascular complications, and complications connected with the reconstruction of the lower urinary tract can occur. Other complications are bacterial and viral infections and malignancies. All these complications require a rapid and accurate diagnosis and subsequent targeted treatment with intention to maintain a functional kidney transplant. [ABSTRACT FROM AUTHOR]

Priapism a status of continues erected penis more than four hours without erotic stimulus, which is referred to as a persistent erection. There are three recognised types of priapism at this time: ischemic or low-flow priapism, nonischemic or high-flow priapism, and stuttering priapism. These are all based on the history and pathophysiology of the individual episodes. It is characterised by a long-lasting, painful, and rigid erection produced by an abnormality in venous blood outflow from the corpora cavernosa, which is similar to penile compartment syndrome. Patients of ischemic priapism with sickle cell syndrome are more susceptible to stuttering priapism, which is characterised by self-limiting, recurring, and intermittent erections. When arterial blood drains excessively into the corporus cavernosus, a condition known as nonischemic priapism results in an erection that is neither painful nor rigid. Because the emergency status and treatment choices for ischemia and non-ischemic priapism differ, it is necessary to make an accurate distinction between the two in order to begin appropriate therapeutic therapy. An important part of treating and managing priapism is ensuring that patients retain their ability to perform sexual functions even after the symptoms of priapism have disappeared. Medical and surgical advances in treating and preventing priapism are reviewed in this article, as well as scientific studies in this rapidly evolving subject. [ABSTRACT FROM AUTHOR]

Background: Robotic surgeries have improved perioperative outcomes. We have combined ultrasound (USG) guided bilateral rectus sheath (RS) block along with transverse abdominis plane (TAP) block to assess perioperative opioid requirement, visual analog scale (VAS) score, and modified Post Anesthetic Discharge Scoring System (PADSS) criteria for robotic urological surgeries. Ultrasound (USG)-guided blocks were given bilaterally after induction of general anesthesia. Methods: A total of ten patients scheduled for robotic urological surgeries were administered 30 ml of 0.25% bupivacaine (2.5 mg kg-1) with 0.75 mcg kg-1 of clonidine (10 ml of drug was given for TAP block and 5 ml of drug for RS block on each side) after negative aspiration. Results: Supplemental opioid was not required perioperatively, and 9 out of 10 patients were pain free (VAS score <3) for at least 6 h. Ten patients had a modified PADSS score ≥10 after 6 h of surgery. Conclusion: USG combined TAP and RS blocks is a promising technique with low learning curve, excellent analgesia, reduced opioid consumption, and higher PADSS score in the perioperative period. [ABSTRACT FROM AUTHOR]

Clinical phenotyping of urological chronic pelvic pain syndromes (UCPPSs) in men and women have focused on end organ abnormalities to identify putative clinical subtypes. Initial evidence of abnormal brain function and structure in male pelvic pain has necessitated large-scale, multisite investigations into potential UCPPS brain biomarkers. We present the first evidence of regional white matter (axonal) abnormalities in men and women with UCPPS, compared with positive (irritable bowel syndrome, IBS) and healthy controls. Epidemiological and neuroimaging data were collected from participants with UCPPS (n = 52), IBS (n = 39), and healthy sex- and age-matched controls (n = 61). White matter microstructure, measured as fractional anisotropy (FA), was examined by diffusion tensor imaging. Group differences in regional FA positively correlated with pain severity, including segments of the right corticospinal tract and right anterior thalamic radiation. Increased corticospinal FA was specific and sensitive to UCPPS, positively correlated with pain severity, and reflected sensory (not affective) features of pain. Reduced anterior thalamic radiation FA distinguished patients with IBS from those with UCPPS and controls, suggesting greater microstructural divergence from normal tract organization. Findings confirm that regional white matter abnormalities characterize UCPPS and can distinguish between visceral diagnoses, suggesting that regional axonal microstructure is either altered with ongoing pain or predisposes its development.

Introduction: Pelvic floor exercises are effective in the treatment of urinary incontinence (UI) and are routinely prescribed, along with bladder training, by primary healthcare providers as first line conservative management. Mobile phone applications are increasingly popular within the healthcare setting and can provide opportunities for patients to complete treatments at home. To date, there has not been a systematic review examining outcomes from randomised controlled trials on the effectiveness of mobile applications to improve UI. Methods: A systematic review of randomized controlled trials evaluating the effectiveness of mobile applications to improve UI was carried out according to the PRISMA reporting guidelines. The online databases MEDLINE, Embase, PsychINFO, CINAHL, Web of Science, Scopus, The Cochrane Library, Joanna Briggs Institute (JBI), Google Scholar were searched for papers published between 2007 to 2020. Keywords and MeSH terms were used to identify relevant English language studies. The quality and risk of bias within included studies was assessed by two independent reviewers, RCT JBI critical appraisal tool. Due to heterogeneity in the outcome of studies, a meta-analysis of the data could not be conducted. Findings: Four studies reported an improvement in the outcome assessed post-intervention, suggesting that using mobile phone applications for pelvic floor muscle training (PFMT) was an acceptable and valid intervention to improve UI. Conclusion: Mobile applications for PFMT indicated that increase adherence to treatment and decrease UI. The integration of this treatment modality into current practice is recommended. Mobile phone applications for PFMT show promise in the conservative management of UI. Further research is required to support the use of this technology in the conservative management of UI. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to establish the urologic complications of radical type C2 hysterectomy in cervical cancer patients with or without ureteral stenting. Methods: This prospective randomized study included 76 (100%) patients with clinically and pathologically established cervical cancer stages I and II treated with radical type C2 hysterectomy with pelvic lymph node dissection for the last 5 years (2014–2019). Patients were randomized into two groups (2:1 ratio): group II received perioperative ureteral stenting (n = 24, 31.6%) and group I did not (n = 52, 68.4%). Urologic complications observed during follow-up include intraoperative ureter and urinary bladder lesions and postoperative ureterovaginal and vesicovaginal fistulas. Results: Of the 52 patients in group I who underwent surgery for cervical cancer, urologic complications were observed in 8 (10.5%) patients, 2 (2.6%) of whom underwent preoperative radiation therapy. In group II, urologic complications were observed in 2 (2.6%) patients, of which 1 (1.3%) received preoperative radiation therapy. Intraoperative urologic complications in group I (6.6%) included 3 (3.9%) ureteral lesions cases and 2 (2.6%) cases of urinary bladder lesions, wherein 1 patient received preoperative radiation therapy. One case of (1.3%) urinary bladder lesion was observed in group II. Postoperative complications were observed in 3 patients (3.9%) in group I, including 2 (2.6%) ureterovaginal fistula cases, wherein 1 (1.3%) patient received preoperative radiation therapy, and 1 (1.3%) case of vesicovaginal fistula. In group II, 1 (1.3%) patient who received perioperative radiotherapy developed postoperative vesicovaginal fistula. Discussion: Urologic complications are extremely common during and after radical surgery (hysterectomy type C2) for cervical cancer. The cervical cancer stage had a significant effect on intra- and postoperative urologic complication rates in this study; however, no such effect was observed for preoperative radiation therapy and ureteral stenting, and significant differences were observed between the two study groups. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine predictors of physical and emotional discomfort associated with urodynamic testing in men and women both with and without neurologic conditions.MethodsAn anonymous questionnaire-based study was completed by patients immediately after undergoing fluoroscopic urodynamic testing. Participants were asked questions pertaining to their perceptions of physical and emotional discomfort related to the study, their urologic and general health history, and demographics. Logistic regression was performed to determine predictors of physical and emotional discomfort.ResultsA total of 314 patients completed the questionnaire representing a response rate of 60%. Half of the respondents (50.7%) felt that the examination was neither physically nor emotionally uncomfortable, whereas 29.0% and 12.4% of respondents felt that the physical and emotional components of the examination were most uncomfortable, respectively. Placement of the urethral catheter was the most commonly reported component of physical discomfort (42.9%), whereas anxiety (27.7%) was the most commonly reported component of emotional discomfort. Presence of a neurologic problem (odds ratio, 0.273; 95% confidence interval, 0.121-0.617) and older age (odds ratio, 0.585; 95% confidence interval, 0.405-0.847) were factors associated with less physical discomfort. There were no significant predictors of emotional discomfort based on our model.ConclusionUrodynamic studies were well tolerated regardless of gender. Presence of a neurologic condition and older age were predictors of less physical discomfort. These findings are useful in counseling patients regarding what to expect when having urodynamic procedures.

Granulomatosis with Polyangiitis (GPA) is a form of Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. We report a case of a 56-year-old man with GPA who first presented with acute urinary retention, and then developed pulmonarycavitating lesions and subarachnoid hemorrhage (SAH). The SAH was due to a ruptured right vertebral artery aneurysm, whichwas subsequently embolized. The patient initially had a good response to immunosuppressive therapy but later succumbed due to fulminant sepsis. SAH is a rare complication of GPA and usually not associated with a detectable aneurysm. Our patient is thesecond case in the literature where an aneurysm had been detected on angiography and the first case where examination of the culprit aneurysm revealed features of vasculitis.

Context: Urological complications are inevitable in renal transplantation; however, their occurrence and brunt on graft survival can be downsized. The aim of our study was to analyze and review the literature on various urological complications and their management in renal transplant patients. Materials and Methods: We reviewed all cases of urological complications in renal transplantation managed at our institution from January 2010 to March 2017. Results: Urological complications arose in 29 renal transplant patients amidst the study period with median identification time of 24 days (range 0–1500 days). Ten (34.5%) patients developed complications pertaining to ureteric handling and reimplantation followed by significant lymphocele in 9 (31%) patients. Four (13.8%) cases succumbed to vascular anastomosis-related complications. Out of 29 patients, 45% of these complications manifested within a month posttransplant. Complications were tackled individually. Sixteen (55%) cases were treated with either endoscopic or minimally invasive methods, whereas 13 (45%) cases required open surgery. Two grafts were lost as a consequence of vascular complications and a fatality which was directly or indirectly linked with urological complication. Remaining all treated patients improved on follow-up. Conclusion: Comprehensive preoperative recipient evaluation, meticulous organ procurement, and integrated multidisciplinary teamwork are helpful in achieving optimal outcome of transplant. Endourological and minimally invasive procedures are emerging as main modality in the management of these complications; however, many cases still requires contemporary surgical management.

Objects: Approximately, 1% of school children have daytime urinary incontinence. The symptoms may be caused by an overactive bladder (OAB). In the evaluation of boys with OAB complaints, one should consider a possible urethral cause. The aim of the study was to evaluate the value of a diagnostic regime with cystourethroscopy, voiding cystourethrography (VCUG) and urodynamic pressure-flow studies in boys with OAB complaints after unsuccessful urotherapy and pharmacological therapy. Materials and Methods: Seventy-five boys (5–14 years old) were investigated with cystourethroscopy and within 24 h thereafter VCUG followed by urodynamic combined cystometry and pressure-flow study. All boys had daytime incontinence and urgency. Results: Sixty-one boys had no suspected urethral valves at cystoscopy or VCUG, and urodynamics showed no obstructed Pdet-Qmax. All 61 boys had detrusor overactivity. Two boys had late diagnosed urethral valves. In four boys, the initial cystourethroscopy was described as normal. The VCUG indicated presence of posterior urethral valves, but urodynamics showed no obstructed Pdet-Qmax. In eight boys, the initial cystourethroscopy was described as normal whereas urodynamics showed obstructed Pdet-Qmax. In four of these boys, VCUG showed abnormalities in the sphincter area but they were not described as suspected urethral valves. At repeat cystourethroscopy, urethral valves could still not be identified. Patient follow-up regarding achievement of continence after investigation guided treatment was in accordance with the literature. Conclusions: Boys can be safely evaluated by cystourethroscopy followed by urodynamics in search for a possible urethral problem. It is our suggestion, that VCUG can be restricted to those boys where urodynamics indicates obstruction or the findings by cystourethroscopy are uncertain. [ABSTRACT FROM AUTHOR]

Objectives: To review our experience in the management of iatrogenic ureter injuries caused by different urological procedures. Study Design: Descriptive Case series. Setting: Department of Urology, Jinnah Postgraduate Medical Centre Karachi. Period: January 2011 to December 2018. Material & Methods: We included all cases of iatrogenic ureteric injuries induced by urology department only. Gynecological and general surgical iatrogenic injuries were excluded in this study. Results: We managed 56 iatrogenic ureteric injuries in 47 patients during study period. Mean age was 43.14+ 8.86 years. There were 31 males (66%) and 16 females (34%). Right sided injury was observed in 29 patients (61.7%), left sided injury in 16 patients (34.0%) while bilateral injuries were seen in 2 patients (4.3%). Regarding site of injury proximal ureteric injuries were the most common accounting for 32 patients (68.1%). Intraoperative diagnosis was the most common time for diagnosis seen in 30 patients (63.8%). The endoscopic urological surgeries were the most common cause of urological iatrogenic ureteric injury accounts for 71.4% of cases. Open upper tract surgeries were responsible for 8 cases (14.2%). One patient sustained proximal ureteric injury during retro-peritoneal lymph node dissection (RPLND). Laparoscopic urological surgeries were responsible for four cases of injury. One patient developed ureteric avulsion. 13 patients presented with late Ureteric stricture. We have five nephrectomies while three patients needed permanent nephrostomies. Our success rate was 83%. Conclusions: Endo-urological procedures are the commonest causes of ureteric injuries in our study. Prompt diagnosis and early corrective intervention can result in satisfactory outcome in about 83% of cases. [ABSTRACT FROM AUTHOR]

Purpose: The perioperative management of patients who are receiving antithrombotic (antiplatelet or anticoagulant) therapy and require urologic surgery is challenging due to the inherent risk for surgical bleeding and the need to minimize thromboembolic risk. The aim of this review is to assess the quality and consistency of clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on this topic, and to summarize the evidence and associated strength of recommendations relating to perioperative antithrombotic management. Methods: A pragmatic search of electronic databases and guidelines websites was performed to identify relevant CPGs/CPRs. The AGREE II (Appraisal of Guidelines for REsearch and Evaluation) instrument was used to assess the methodological quality and integrity of the CPGs. Results: The CPGs provided by the European Association of Urology (EAU), the American College of Chest Physicians (ACCP) and the European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and the CPRs provided by the International Consultation on Urological Disease (ICUD)/American Urologic Association (AUA) were retrieved and reviewed. The 3 CPGs were critically assessed using the AGREE II instrument. Inconsistent recommendations were provided based on the indication for antithrombotic medication, the antiplatelet/anticoagulant agent and the type of urological procedure. Based on the AGREE II tool for CPG assessment, the EAU CPGs scored higher (83.3 points) compared to the ESC/ESA (75 points) and ACCP CPG (66.7 points). Conclusion: The perioperative management of antithrombotic therapy in urological patients is potentially challenging but inconsistent CPG of varying quality may create uncertainty as to best practices to minimize thromboembolic and bleeding risk. [ABSTRACT FROM AUTHOR]

Background: Aim of the study was to present the surgical techniques and the postoperative outcomes in women treated with robotic excision for deep endometriosis involving the urinary tract.Materials and Methods: We retrospectively reviewed the prospectively recorded clinical data of women consecutively undergoing minimally invasive treatment for complex endometriosis involving urinary tract in our center between January 2012 and June 2018. All the patients received a preoperative multidisciplinary evaluation with the general surgeon, the gynecologist and the urologist due to the frequent concomitant involvement of bowel and genital system. Patients undergoing robotic surgery were treated with the Si or Xi da Vinci surgical system.Results: A total of 74 consecutive patients were enrolled. Twenty-eight (37.8%) patients underwent conventional laparoscopy and 46 (62.2%) robotic surgery. Only patients treated with robotic approach were considered for the final analyses. Overall, 17 (36.9%) patients were treated with partial cystectomy, 13 (28.3%) with ureteral reimplantation, 10 (21.7%) patients were treated with ureteral lysis, 4 (8.7%) with removal of bladder endometrial node without opening the mucosa layer and 2 (4.3%) with ureteral end-to-end anastomosis. Concomitant involvement of bowel and genital system was registered in 14 (30.4%) and 32 (69.5%) patients, respectively. No conversions to laparotomy were recorded. Overall, 5 (10.9%) patients experienced postoperative complications, of which only one was a major complication (Clavien 3b). At a median follow-up of 31.3 (IQR 17.6-43.3) months, 4 (8.7%) patients experienced disease recurrence at the level of urinary tract.Conclusions: Robotic excision of urological endometriosis represents a safe and effective treatment option, since a limited rate of surgical complications was recorded even in cases of multi-organ disease. [ABSTRACT FROM AUTHOR]

Background this study compares diuresis rate, sodium clearance and free water clearance (FWC) by age and time of day (nighttime vs. daytime) in subjects with and without nocturnal polyuria (NP) to determine whether these variables affect the phenotype of NP. Methods post hoc analysis of two prospective observational studies. Eight urine samples collected at 3-h intervals and a single blood sample were used to calculate daytime (10a/1p/4p/7p/10p) and nighttime (1a/4a/7a) diuresis rates, sodium clearance and FWC. Three mixed linear models were constructed for diuresis rate, sodium clearance and FWC using four predictor variables: NP status (present [nocturnal urine production >90 ml/h] vs. absent [≤90 ml/h]), time of day, age and study identification. Results subjects with NP experienced higher nighttime versus daytime diuresis rates, sodium clearance and FWC. Regardless of NP status, increased age was accompanied by an increase in the ratio of nighttime/daytime diuresis rate, nighttime sodium clearance and daytime sodium clearance. FWC showed a complex age effect, which was independent of time of day or NP status. Conclusions age-related increases in nighttime/daytime diuresis rate, 24-h sodium clearance and 24-h FWC are not specific to subjects with NP. The age-related surge in either nocturnal sodium clearance or nocturnal FWC may represent the relevant substrate for behavioural or pharmacologic interventions targeting sodium diuresis or free water diuresis, respectively. Increases in FWC in older age groups may reflect impaired circadian rhythmicity of endogenous AVP or changes in responsiveness of the aged nephron to water clearance. [ABSTRACT FROM AUTHOR]

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Purpose: We aimed to investigate the current management status of urologic diseases in geriatric hospitals in South Korea. Materials and Methods: Questionnaire surveys and in-depth person-to-person interviews were conducted at 13 hospitals within the Seoul and Incheon areas. Results: The study was carried out from July to December 2014; 75.6% of patients (1,858/2,458) and 77.5% (779/1,031) of medical personnel responded to our survey. All surveys and interviews were performed by urology specialists, fellows, residents, or nurses. The hospitals included in the study had an average of 215.2 beds (range, 110–367), 189.1 patients (range, 90–345), and 40.2 nurses (range, 10–83). The average number of physicians was 6.2 (range, 3–11), but none of these were certified urologists. Only 4 hospitals provided consultation services for urological disorders. In total, 64% of patients had urological disorders, although only 20.7% of patients were receiving medication. Most patients were being treated using urological interventions; diapers (49.7%), indwelling catheters (19.5%), clean intermittent catheters (12.2%), and external collection urinary drainage (7.9%). However, most interventions were inadequately implemented, and only 17% of the patients had been examined by a certified urologist. Urological complications were found in 20.2% of patients, and secondary complications occurred in 18.8%. Excluding redundant cases, the total prevalence of urological complications was 39.0%. Conclusions: Urologic diseases are poorly managed, and no certified urologists work in geriatric hospitals. Therefore, more designated urologists are needed in geriatric hospitals.

Objective: To determine the rate of incidental urological findings in patients undergoing computed tomography (CT) colonography/CT colonoscopy (CTC) for investigation of suspected colorectal cancer. Methods: Retrospective analysis of patients undergoing CTC between January 2011 and December 2013. All patients with new incidental urological findings were included with their type and number of urological findings. These were stratified as per the colonography reporting and data system (C-RADS) criteria, and a note made of any further imaging, intervention and histology where appropriate. Results: Within the time period, n = 1891 CTCs were undertaken. Of these, n = 333 (17.6%) had an incidental urological finding and n = 41 of these patients had dual incidental urological pathologies. In total, n = 49 had significant pathology which required monitoring, further imaging, and medical or surgical intervention; n = 12 required further imaging. In n = 1, the imaging result led to a decision to operate and in n = 9 the results excluded the need for surgical intervention; n = 24 underwent operative intervention. The rates of incidental urological findings were similar to those quoted in literature. Conclusion: Our study demonstrates a 17.6% rate of incidental urological findings. Of all findings, 13.1% were deemed significant to warrant further investigation or intervention, and 7.2% of patients with urological findings required intervention. CTCs can adequately image renal masses and further imaging of renal masses did not change management. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

Aim: To understand the different roles and aspects of the Surgical Care Practitioner (SCP) in delivering urology care to patients. To identify the different activities and various settings that SCP's are active in. Method: Data collection was via online survey, distributed to 12 Urology SCP's from around the United Kingdom. Results: 83% response rate was recorded. The Majority of SCP's time is spent in the Operating Theatre setting with 90% stating they spent at least half or more of their time there, 80% stated less than quarter of their time in clinic and even less time spent involved with ward based activity. The type of surgery SCP's were involved with most being Urology Oncology Open/Laparoscopic 80% and Robotic 80%. In comparison, Benign or Core urology surgery accounts for only 30%. None theatre activity was found to consist of assessment of new patients 40%, follow ups 60% and investigations 40%. Conclusion: The SCP has become a recognized role in the theatre setting, assisting with and in some circumstances, under indirect supervision, carrying out surgical procedures. What this small survey has highlighted is the other facets to the role, demonstrating their input in Outpatient clinic assessment, follow up reviews and in some cases conducting investigations (Flexible Cystoscope and Urodynamic) on urology patients. [ABSTRACT FROM AUTHOR]

Background: Pelvic radiotherapy causes tissue atrophy and fibrosis, leading to urinary tract dysfunction. Tissue ischaemia poses a significant surgical challenge. This study examined the urological sequelae of radiotherapy, types of reconstructive urological surgery (RUS) required and functional outcomes. Methods: A retrospective review was performed of all radiotherapy patients who underwent RUS at a tertiary centre between 2007–2017. Details including time from radiotherapy, pre-operative assessments, type of surgery performed and functional outcome were analysed. Results: Fifty-four patients were identified. The primary malignancy was cervical (32), colorectal (9) and other urogenital/metastatic origins in the remaining cases. Mean time between radiation and RUS was 13 years. Sixty-nine reconstructive surgeries were performed. Twenty-two patients had fistulae, but only 27% were closed and 73% ended with urinary diversion. Eighteen had ureteric strictures, with 56% having associated bladder dysfunction. Twelve (67%) patients had RUS, of whom 83% required bowel interposition, and 33% primary diversion. Nine of 24 patients with contracted bladders were reconstructed and eight remain functionally continent. Renal function stabilised or improved in 87%. Nine patients (17%) had Clavien 3 or 4 complications. Conclusions: A variety of complex, major RUS were required. In 61%, urinary diversion was necessary, with radiotherapy fistulae being a particular challenge and closed in only a third. In total, 37% of patients were reconstructed achieving functional continence and restoration of upper-tract drainage with renal function preservation. This surgery was at a cost of a re-intervention rate of 28% and significant morbidity in 17%. RUS in the radiotherapy field should be performed in centres with experience. [ABSTRACT FROM AUTHOR]

Context: Urological complications are inevitable in renal transplantation; however, their occurrence and brunt on graft survival can be downsized. The aim of our study was to analyze and review the literature on various urological complications and their management in renal transplant patients. Materials and Methods: We reviewed all cases of urological complications in renal transplantation managed at our institution from January 2010 to March 2017. Results: Urological complications arose in 29 renal transplant patients amidst the study period with median identification time of 24 days (range 0–1500 days). Ten (34.5%) patients developed complications pertaining to ureteric handling and reimplantation followed by significant lymphocele in 9 (31%) patients. Four (13.8%) cases succumbed to vascular anastomosis-related complications. Out of 29 patients, 45% of these complications manifested within a month posttransplant. Complications were tackled individually. Sixteen (55%) cases were treated with either endoscopic or minimally invasive methods, whereas 13 (45%) cases required open surgery. Two grafts were lost as a consequence of vascular complications and a fatality which was directly or indirectly linked with urological complication. Remaining all treated patients improved on follow-up. Conclusion: Comprehensive preoperative recipient evaluation, meticulous organ procurement, and integrated multidisciplinary teamwork are helpful in achieving optimal outcome of transplant. Endourological and minimally invasive procedures are emerging as main modality in the management of these complications; however, many cases still requires contemporary surgical management. [ABSTRACT FROM AUTHOR]

Priapism is an uncommon urological emergency that can lead to permanent impotence if prompt presentation and medical intervention is not performed. It is a breakdown of the usual physiological mechanisms controlling penile tumescence and detumescence, leading to a prolonged penile erection (>4 hours) that is unrelated to sexual stimulation. Currently, there are three accepted subtypes: ischaemic, non-ischaemic, and stuttering priapism, which is also known as recurrent ischemic priapism. The aim of treatment is the immediate resolution of the painful erection and the preservation of cavernosal smooth muscle function in order to prevent cavernosal fibrosis, which can lead to penile shortening and permanent erectile dysfunction.

Positron emission tomography/computed tomography (PET/CT) technology has been a significant, but expensive addition to the oncologist′s armamentarium. The aim of this review was to determine the clinical utility of PET/CT in urological oncology, its impact on disease outcome and cost-effectiveness. We searched MedLine and peer reviewed journals for all relevant literature available online from the year 2000 until January 2014 regarding the use of PET/CT in the management of urological malignancies. 11 C-choline PET/CT has emerged as a powerful tool for assessment of biochemical relapse in prostate cancer. Use of novel radiotracers like 124 I-girentuximab has shown promise in the diagnosis of clear cell renal carcinoma. Fluorodeoxyglucose PET has a proven role in seminoma for the evaluation of postchemotherapy residual masses and has shown encouraging results when used for detection of metastasis in renal, bladder, and penile cancer. Introduction of novel radiotracers and advanced technology has led to a wider application of PET/CT in urological oncology. However, testicular seminoma aside, its impact on disease outcome and cost-effectiveness still needs to be established.

Introduction: Nonmuscle invasive bladder cancer (NMIBC) is the most common presentation of bladder cancer and is often treatable with endoscopic resection and intravesical therapies. Cystoscopy and urine cytology are the gold standard in diagnosis and surveillance but are limited by their sensitivity in some situations. We seek to provide an overview of recent additions to the diagnostic armamentarium for urologists treating this disease. Methods: Articles were identified through a literature review of articles obtained through PubMed searches including the terms “bladder cancer”and various diagnostic techniques described in the article. Results: A variety of urinary biomarkers are available to assist the diagnosis and management of patients with NMIBC. Many have improved sensitivity over urine cytology, but less specificity. There are certain situations in which this has proved valuable, but as yet these are not part of the standard guidelines for NMIBC. Fluorescence cystoscopy has level 1 evidence demonstrating increased rates of tumor detection and prolonged recurrence-free survival when utilized for transurethral resection. Other technologies seeking to enhance cystoscopy, such as narrow band imaging, confocal laser endomicroscopy, and optical coherence tomography are still under evaluation. Conclusions: A variety of urine biomarker and adjunctive endoscopic technologies have been developed to assist the management of NMIBC. While some, such as fluorescence cystoscopy, have demonstrated a definite benefit in this disease, others are still finding their place in the diagnosis and treatment of this disease. Future studies should shed light on how these can be incorporated to improve outcomes in NMIBC.

Objectives: To quantify public and academic interest in the urological field using a novel new media‐based methodology. Methods: We systematically measured public and academic interest in 56 urological keywords and combined in nine subspecialties. Public interest was quantified as video views on YouTube. Academic interest was quantified as article citations using Microsoft Academic Search. The public‐to‐academic interest ratio was calculated for a comparison of subspecialties as well as for diseases and treatments. Results: For the selected 56 urological keywords, we found 226 617 591 video views on YouTube and 2 146 287 citations in the academic literature. The public‐to‐academic interest ratio was highest for the subspecialties robotic urology (ratio 6.3) and andrological urology (ratio 4.6). Prostate cancer was the central urological disease combining both a high public (20% of all video views) and academic interest (26% of all citations, ratio 0.8). Further diseases/treatments of high public interest were premature ejaculation (ratio 54.4), testicular cancer (ratio 11.4), erectile dysfunction (ratio 5.5) and kidney transplant (ratio 3.7). Urological treatments had a higher public‐to‐academic interest ratio (median ratio 0.25) than diseases (median ratio 0.05; P = 0.029). Conclusions: A quantification of academic and public interest in the urological field is feasible using a novel new media‐based methodology. We found several mismatches in public versus academic interest in urological diseases and treatments, which has implications for research strategies, conference planning and patient information projects. Regular re‐assessments of the public and academic interest landscape can contribute to detecting and proving trends in the field of urology. [ABSTRACT FROM AUTHOR]

The technique of whole genome amplification is advancing rapidly and generating attention on detecting genomic lesions in individual cancer cells. Also, single-cell genome could label the uniqueness of each cell, its individual mutations and structural variations especially in cancer studies. In this Review, we provide the insight into the current state of single-cell genome in urological tumor mainly including kidney cancer, bladder cancer and prostate cancer. We put more forward on the new progress of the technique used by single-cell genomes and different results of the genes transform on random tumor tissue from single cell isolated on account of tumor heterogeneity. With the advent of more complete and accurate genome information, single-cell sequencing will become a standard tool in early diagnosis and targeted therapy and prognosis judgement. [ABSTRACT FROM AUTHOR]

Purpose Urothelial carcinoma is associated with a high rate of recurrence. Guidelines recommend rigorous, regular surveillance programs that are invasive and expensive. This study describes a noninvasive urine test with sufficient sensitivity to rule out recurrent urothelial carcinoma, thereby reducing invasive diagnostic evaluations without compromising patient care. Methods and Materials A total of 1,036 urine samples were prospectively collected from 763 patients undergoing routine surveillance for recurrent urothelial carcinoma of the bladder. The purpose was to develop and validate a test with combined high sensitivity and high negative predictive value. Cxbladder Monitor combines gene expression, clinical and patient data, and it is designed to rule out the presence of recurrent urothelial carcinoma. Results Cxbladder Monitor showed an internally validated sensitivity of 0.93 with a negative predictive value of 0.97 and a test negative rate of 0.34. Sensitivity was 0.95 for recurrent disease with a high risk of progression (all high grade disease and low grade, stage T1 or greater disease) compared with 0.86 for low grade Ta disease. Subgroup analyses indicated that diagnostic performance was not significantly different in different age groups, or by gender or tumor stage. Sensitivity was not affected by adjuvant bacillus Calmette-Guérin treatment within the last 6 months. False-negative findings were reported in fewer than 1.5% of all samples collected. Conclusions The Cxbladder Monitor test offers combined high sensitivity and high negative predictive value to rule out urothelial carcinoma. This test has clinical utility as a confirmatory negative adjunct to cystoscopy, potentially justifying the postponement/avoidance of cystoscopic investigations to monitor recurrence in patients. [ABSTRACT FROM AUTHOR]

Angiogenesis is an essential process in the growth and metastasis of cancer cells, which can be hampered by an anti-angiogenesis mechanism, thereby delaying the progression of tumors. However, the benefit of this treatment modality could be restricted, as most patients tend to develop acquired resistance during treatment. Vasculogenic mimicry (VM) is regarded as a critical alternative mechanism of tumor angiogenesis, where studies have demonstrated that patients with tumors supplemented with VM generally have a shorter survival period and a poorer prognosis. Inhibiting VM may be an effective therapeutic strategy to prevent cancer progression, which could prove helpful in impeding the limitations of lone use of anti-angiogenic therapy when performed concurrently with other anti-tumor therapies. This review summarizes the mechanism of VM signaling pathways in urological tumors, i.e., prostate cancer, clear cell renal cell carcinoma, and bladder cancer. Furthermore, it also summarizes the potential of VM as a therapeutic strategy for urological tumors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lin, Long, Yan, Zou, Zhang, Zou and Wu.)

Neurogenic lower urinary tract dysfunction (NLUTD) remains a formidable challenge to pediatric urologists to achieve the goals of renal preservation and the reduction of urinary tract infections as well as the attainment of continence and independence as children grow toward adulthood. Tremendous progress has occurred over the past 50 years which have witnessed an evolution in focus from mere survival to optimal quality of life. This review presents four separate guidelines for the medical and surgical care of pediatric NLUTD, most commonly related to spina bifida, to highlight the change in approach from expectant to more proactive management., (Copyright © 2023 Elsevier Inc. All rights reserved.)