A laparoscopic approach to parastomal hernia repair with re-siting of urinary stoma Parastomal and ventral hernias are common complications in patients with continent catheterizable channels or incontinent urinary diversions. Patients with neurogenic bladder are at particularly high risk due to weak abdominal wall musculature, and hernia repair often requires re-siting of their stoma. While parastomal hernia repair with urinary stoma re-siting has acceptable long-term success rates, it often necessitates a laparotomy which is associated with significant morbidity.
Technique and outcomes of hand-assist laparoscopic continent cutaneous ileocecocystoplasty Continent cutaneous ileocecocystoplasty (CCIC) involves reconfiguring the ileocecal segment for use as a bladder augment and continent catheterizable channel. CCIC requires release of the hepatic flexure of the colon, which necessitates a longer midline laparotomy than would be required for a standard bladder augmentation. This is associated with high rates of ventral and parastomal hernias.
Implications of Calcification in Peyronie's Disease, A Review of the Literature A common characteristic of Peyronie's Disease (PD) is plaque calcification, which is associated with decreased response to treatments and higher rates of surgical intervention. Despite its prevalence in the PD population, the literature on plaque calcification is limited. While the diagnosis of PD is mostly clinical, imaging modalities such as ultrasound can be used to identify plaque calcification. The proper identification of plaque calcification is crucial for guiding management and setting therapeutic expectations for patients with PD.
Single-Stage Reconstruction of Fossa Navicularis Strictures Using A “Sliding-T” Dorsal Inlay Urethroplasty With Buccal Mucosal Graft To describe a single-stage urethroplasty for fossa navicularis strictures using a “sliding-T” dorsal inlay technique with buccal mucosa. Strictures of the fossa navicularis are challenging. Endoscopic treatments typically offer only temporary relief and necessitate lifelong instrumentation. Reconstruction should provide an unobstructed urethra, slit-like meatus, preserve sexual function and create a cosmetically appealing glans. The ideal urethroplasty technique has not yet been elucidated despite various described single-stage and multi-staged approaches.
Congenital Bladder Prolapse Through a Patent Urachus: Two Institutions’ Experience We describe our experience in 2 institutions handling bladder prolapse through a patent urachus (PU), together with a brief review of published literature. Case 1: A term neonate with congenital prolapsed bladder via PU. Ultrasound at 21 weeks gestation revealed a male fetus with a large midline pelvic cyst communicating with the bladder which disappeared on subsequent 27 weeks ultrasound. Case 2: A term female neonate with congenital prolapsed bladder via PU with no prenatal diagnosis. In both cases the bladder closure was undertaken during the newborns’ first days of life.
An Update on Evaluation and Management in Cystinuria Cystinuria is the most common cause of inherited stone disease and is caused by the failure of absorption of filtered dibasic amino acids including cystine in the proximal tubules. It is associated with a very high recurrence rate in affected patients, with the potential for significant morbidity in such patients due to the need for repeated surgical interventions. A multimodal and multispecialty approach in a dedicated centre is the key to improving treatment outcomes and patient adherence to the treatment.
The Evolution of Colonic Mucosa Use in Urethral Reconstruction While oral mucosa remains the preferred graft tissue for urethral reconstruction, rectal mucosa is a viable alternative enteric mucosal graft with the advantage of a less limited supply. Though it has re-emerged in more recent medical literature, the documented use of rectal mucosal grafts for urethral reconstruction dates to the same era as that for oral mucosal grafts in the 1890s. The Russian surgeon Kirill Sapezhko first published his experience with urethroplasty using oral mucosal grafts in 1894, and it was his protégé, Igor Thyrmos, who first published the use of rectal mucosal grafts for urethral reconstruction in 1902.
Prostate Cancer Foundation Hormone-Sensitive Prostate Cancer Biomarker Working Group Meeting Summary Androgen deprivation therapy remains the backbone therapy for the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). In recent years, several treatments, including docetaxel, abiraterone + prednisone, enzalutamide, and apalutamide, have each been shown to demonstrate survival benefit when used upfront along with androgen deprivation therapy. However, treatment selection for an individual patient remains a challenge. There is no high level clinical evidence for treatment selection among these choices based on biological drivers of clinical disease.
Antibiotic Stewardship and Postoperative Infections in Urethroplasties To determine surgical site infection and UTI rates in the setting of urethroplasty. Given significant variation in the utilization of antibiotics, there is an opportunity to improve antibiotic stewardship. This study aims to elucidate the rate of both UTI and surgical site infection after urethroplasty on a standardized peri-operative antibiotic regimen, and to obtain patient and operative characteristics that may predict infection.
Preserving Well-being in Patients With Advanced and Late Prostate Cancer Androgen deprivation therapy, alone or in combination with androgen signaling inhibitors, is a treatment option for patients with advanced prostate cancer (PC). When making treatment decisions, health care providers must consider the long-term effects of treatment on the patient's overall health and well-being. Herein, we review the effects of these treatments on the musculoskeletal and cardiovascular systems, cognition, and fall risk, and provide management approaches for each. We also include an algorithm to help health care providers implement best clinical practices and interdisciplinary care for preserving the overall well-being of PC patients.
Renal Urothelial Carcinoma Complicated by Inferior Vena Cava Tumor Thrombus and Acute Pyelonephritis Renal urothelial carcinoma (UC) with inferior vena cava tumor thrombus is rare, especially when it is concomitant with acute pyelonephritis. In this report, a 70-year-old diabetic man with right flank pain, intermittent painless gross hematuria, and recurrent high fever was described. On the basis of the symptoms, physical examination, cytology and imaging results, renal UC with extension into inferior vena cava, and acute pyelonephritis was established. The patient was unresponsive to antimicrobial chemotherapy.
A New Combined Laparoscopic-Vaginal Lateral Suspension Procedure for the Treatment of Pelvic Organ Prolapse To show an original technique of a new combined vaginal-laparoscopic lateral suspension in Hysteropexy with cistocele and rectocele. In recent years, changes in attitudes toward sexuality, psychological value of reproductive organs and the desire to preserve fertility have led to a growing interest in uterine-preserving surgery for Pelvic Organ prolapse. Minimally invasive procedures derived from sacrocolpopexy are considered the gold standard in the treatment of apical Pelvic Organ prolapse. However, dissection at the level of the promontory may be challenging, particularly in obese women and when an anatomical variation exists.
Providing a Fossa Navicularis in Reconstruction of Hypospadias I read with great interest the article titled “Tubularized Reconstructed Plate Urethroplasty: An Alternative Technique for Distal Hypospadias Repair” by Taneli et al.1 The authors describe their technique as providing the “fossa navicularis” of the male urethra by increasing the surface area of the glanular urethra with removal of a segment of tissue from the base of the ventral glans surface. The presence of the “fossa navicularis” in the glans penis has been overlooked for decades, and almost all repair techniques for hypospadias involve uniform reconstruction of the urethra over a catheter or stent.
A Novel Technique for Management of Simultaneous Fibro-Epithelial Polyp and Blind-Ending Branch in a Duplicated Ureter: A Case Report With 23-year Follow-Up Ureteral duplication with a blind-ending branch (BEB) is rare anomaly. The presence of fibro-epithelial polyps in duplicated ureters is also infrequent. Despite the noticeability of endoscopic polypectomy, further recurrence of polyps and persistence of pain increase the probability of further ureteral resection with surgical procedures. In such cases, BEB of duplicated ureter is an excellent reservoir to save the function of the kidney. This is the first case with concomitant presence of fibro-epithelial polyps and BEB in duplicated ureter managed with novel surgical technique of uretero-pelvic junction and BEB branch anastomosis.
Minimally Invasive Approach for Wilms Tumor Treatment in a Small Child - A Case Report Wilms tumor is the most common malignant primary tumor in children. Open traditional approach is often aggressive and offers a burden on the patient's life, imposing longer hospital stays, scarring, and higher levels of complications. Here, we present a case of a small child with Wilms tumor on the right kidney that was successfully treated with minimally invasive surgery, with no tumor spillage or rupture, hospital discharge in the next day, and good oncological outcome, with 1-year recurrence-free follow-up.
Multicystic Dysplastic Kidney With Mass Effect in a Neonate Treated With Nephrectomy: Case Report Multicystic Dysplastic Kidney is a developmental disease that results in a lobulated kidney of noncommunicating cysts and abnormal parenchymal tissue. Dysplastic kidneys are usually benign and often involute over time with conservative management. The second most common cause of palpable abdominal mass in a neonate, Multicystic Dysplastic Kidney can cause respiratory distress secondary to extrinsic compression. However, such cases are sparse. Here we present the case of an otherwise healthy term newborn with an exceptionally large MCDK requiring CPAP support and intubation.
An Unusual Cause of Female Urinary Incontinence Following Obstetric Trauma Urethral coitus is a rarely reported cause of female urinary incontinence and has been most commonly described in women with vaginal and hymenal anomalies. Herein, we report a 41-year-old woman with a complex obstetric history, who presented with continuous urinary incontinence. On evaluation, she was found to have an abnormally dilated urethral orifice and vaginal stenosis suggestive of chronic urethral coitus. She underwent a reduction urethroplasty with autologous sling insertion and a vaginoplasty using vaginal flaps.
Variant of Bladder Exstrophy With an Intact Penis: Surgical Options and Approach Variants of bladder exstrophy are a rare but diverse spectrum of bladder exstrophy-epispadias complex. This case series describes a group of 4 unique exstrophy variant cases who had an intact phallus, but a completely open bladder plate. These patients underwent exstrophy repair and concomitant umbilicoplasty at the Civil Hospital, Ahmedabad as part of the US-India Multi-institutional Bladder Exstrophy Collaboration and were followed at the same institution. We believe that a detailed assessment of bladder neck prior to reconstructive repair and bladder closure would be beneficial in these cases as the extent of bladder neck involvement would affect reconstructive approach.
Pneumorenum—A Technique to Ease Laparoscopic Nephrectomy in Giant Hydronephrotic Nonfunctioning Kidney Laparoscopic nephrectomy in a giant hydronephrotic nonfunctioning kidney occupying the most of the abdomen is challenging task. To overcome the difficulty in laparoscopic dissection of such kidneys we described a technique “Pneumorenum,” wherein the kidney is decompressed by suction through a 5 mm trocar inserted directly into kidney under vision. Following suction decompression, the kidney is inflated later during dissection with carbon dioxide gas to moderate size to do the dissection in an easy manner.
Jean Wilson and His Legacy, 50 Years and Counting To evaluate the legacy of endocrinologist Jean Wilson, whose discovery in 1969 of 5 alpha-reductase (5AR) and description of dihydrotestosterone (DHT) as the primary hormone associated with prostatic growth ushered in a golden age of collaboration between endocrinologists, oncologists, and urologists that led to some of the critical discoveries in the understanding and treatment of prostatic pathology.
A Rare Neoplasm: Primary Adrenal Leiomyosarcoma Adrenal incidentalomas are common neoplasms and while they are often benign, they have the potential to be malignant. The American Urological Association guidelines state that adrenal incidentalomas should be surgically resected if they are large, metabolically active, or display malignant characteristics. Other groups have suggested that growth kinetics be factored in as well. We present a case of an adult woman with adrenal incidentaloma which was subsequently discovered to be a primary adrenal leiomyosarcoma, a rare subtype of soft tissue tumors.
Prostate Cancer Undetected by mpMRI: Tumour Conspicuity is Reliant Upon Optimal Scan Timing and Quality We thank the authors of this intriguing letter for their significant interest in our work. They raise essential points that we would like to respond to in detail. The authors' first concern was that, contradictory to "guidelines", the magnetic resonance imaging (MRI) studies included in our analysis were done after prostate cancer was diagnosed with a biopsy, causing bleeding and making it harder to visualize the tumor inside the prostate. The patients included in our study were prostate cancer patients receiving MRI for surgical planning.
Prostate Cancer Undetected by mpMRI: Tumor Conspicuity is Reliant Upon Optimal Scan Timing and Quality We commend Alanee et al for their detailed description of prostate cancers not detected by multiparametric magnetic resonance imaging (mpMRI).1 They analyzed radical prostatectomy findings for 33 men lacking mpMRI-conspicuous prostate cancer (defined as Prostate Imaging Reporting and Data System [PI-RADS] scores 1-2) on preoperative mpMRI. They found 27% (9/33) of men with negative mpMRI had Gleason Grade Group (GGG) 3-5 cancer at prostatectomy, including 9 with extraprostatic extension, and 1 with Gleason grade 5 + 5 disease.
In Vivo Evaluation of a Novel Pigtail Suture Stent To compare pressure, dilation, and histology in a porcine model after stenting with a pigtail suture stent (PSS)–where the ureteral and bladder component consists of a suture and a double J (DJ) stent.
More Than Dysuria: Corynebacterial Encrusted Cystitis Corynebacterium species, typically considered contaminants in urine culture, can cause encrusted cystitis (EC), a form of chronic urinary tract infection causing pain, bladder necrosis, renal failure, and death. Delayed diagnosis is common due to its rarity and the fastidious nature of Corynebacterium urealyticum. Reported mostly in elderly and immunocompromised patients, EC is rare in pediatric patients. A female adolescent on high dose steroids developed persistent dysuria after urinary catheterization.
Dr. Andre De Vries: The Father of Israeli Urolithiasis Research The Middle East has become known as the “Stone Belt” region due to its high prevalence of urinary stones.1 This phenomenon is well documented in even the early civilizations of Medieval Persia,2 Egypt, and Mesopotamia.1 In 1917, during World War I, Palestine came under British legal rule until the founding of the Israeli state in 1948. Researchers described urolithiasis in Jerusalem in 19303 and again in 1936.4 However, this subject was hardly investigated until the end of the 1950s, until internal physician Dr.
Bilateral Calculi in a Child With Bilateral Single System Ureteroceles Ureteroceles in children are detected with prenatal sonography and less commonly during the evaluation following a urinary tract infection. Rarely do ureteroceles in the pediatric population present with stones, particularly in a bilateral fashion. We present a case of a 5-year-old boy found to have bilateral intravesical single system ureteroceles harboring multiple large calculi treated successfully with a staged endoscopic approach.
Overlapping Urological Surgeries at a Tertiary Academic Center To evaluate whether the practice of procedure-time overlapping surgery (OS) is associated with inferior outcomes compared to nonoverlapping surgery (NOS) in urology, to address the paucity of data surrounding urologic surgeries to support or refute this practice.
PTEN Hamartoma Tumor Syndrome: A Case of Renal Cell Carcinoma in a Young Female PTEN Hamartoma-Tumor-Syndrome (PHTS) describes a series of conditions characterized by germline-mutation of the PTEN tumor-suppressor gene. PHTS patients have an increased lifetime risk of multiple malignancies, including thyroid, breast, and endometrial cancers. PHTS patients also have 20-30 fold increased risk of renal cell carcinoma (RCC) compared to age-matched controls. As with many hereditary RCC syndromes, tumors present early and multifocally. We present a case of one of the youngest patients diagnosed with RCC in PHTS and review the urologic implications of this syndrome.
Trends for Stage and Grade Group of Prostate Cancer in the US (2010-2016) To quantify the yearly prostate cancer incidence per 100,000 men, comparing consecutive years from 2010 through 2016. In the years immediately following the 2011/2012 U.S. Preventive Services Task Force update to prostate specific antigen (PSA) screening guidelines, PSA screening, biopsy, and subsequent prostate cancer diagnosis and definitive local treatment have declined. We performed an analysis of stage and grade at diagnosis for prostate cancer in the US, in the years following the 2011/2012 update.
Cost Effectiveness of Sacral Neuromodulation and OnabotulinumtoxinA in Managing Refractory Idiopathic Overactive Bladder Little information from clinical and modelled studies are available on cost effectiveness of OnabotulinumtoxinA and SNM for the treatment of idiopathic overactive bladder. We aimed to summarize the evidence in this regard from different healthcare systems. Seven studies from 5 countries were reviewed. Some modelled studies with a 10-year time frame showed that sacral neuromodulation became dominant long-term; others suggested OnabotulinumtoxinA was more cost effective at <5 years. There was considerable heterogeneity in the base case/sensitivity analysis and statistical modelling among the studies.
Generalizability of Prostate-Specific Antigen (PSA) Screening Trials in a “Real World” Setting: A Nationwide Survey Analysis The Prostate, Lung, Colorectal and Ovarian cancer (PLCO) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) trials 1,2 have been widely used to inform policy decisions regarding prostate-specific antigen (PSA) screening in the US. However, the generalizability of any trial to its intended population is directly contingent on the study subjects being "representative" of the "universe" (ie, US men without symptoms or known diagnosis of prostate cancer [PCa]). In the context of PSA screening, its efficacy and effectiveness is predicated upon age, ethnicity, and family history of PCa (amongst other factors).
Inflammatory Myofibroblastic Tumor After Treatment of Wilms Tumor in a 6-Year-Old Boy: A Case Report and Literature Review Inflammatory myofibroblastic tumor (IMT) is a rare tumor with an indolent course. It is less often reported as a second tumor that occurs after treatment of malignant tumors in pediatric patients. Here, we report a case of IMT following Wilms tumor (WT), and conduct a literature review concerning IMTs and WT to evaluate the diagnostic possibility of IMT as a second tumor. The coexistence of the 2 tumors may cause confusion as to whether they share genetic links or that IMTs may appear as late effects of the treatment of WT.
Fertility Preservation: A Tale of Two Testicles The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. The purpose of this case study is to call to attention the often-overlooked aspect of transgender care: the importance of fertility preservation prior to undergoing therapy.
Flank Pain as a Symptom of COVID-19 The COVID-19 disease is spreading rapidly worldwide, and no vaccine or very effective drug has been found yet. However, the transmission rate of the disease can be reduced by taking precautions. Therefore, it is essential to detect the patients early to prevent the spread of the disease.1,2 We report a case of 26-year-old male patient who was admitted to our urology outpatient clinic with the complaint of flank pain and had incidental findings of COVID-19 in the lung bases on abdominal CT.
Prenatally Diagnosed Solid Renal Mass Congenital mesoblastic nephroma is the most common renal neoplasm diagnosed in the first month of life of which 15% occur prenatally. We present a prenatal diagnosis of a 5.8 cm solid renal mass identified on the 36-week ultrasound. Labor was induced at 38 weeks and a female infant was delivered vaginally without complications. The postnatal ultrasound demonstrated a 6.3 cm heterogeneous mass nearly replacing the kidney. The infant underwent a radical nephrectomy on the first day of life and pathology confirmed stage II classic CMN with negative margins and nodes.
Resection of Inferior Vena Cava Without Reconstruction for Intravascular Intrusion of Wilms Tumor Persistent inferior vena cava (IVC) tumor thrombus in Wilms tumor patients represents a management challenge. We describe three pediatric cases with preoperative evaluation documenting complete IVC occlusion and well-developed collaterals. They underwent nephrectomy and tumor thrombus removal accomplished with circumferential resection of the retrohepatic IVC without vascular reconstruction. All patients are asymptomatic and disease-free at 9, 2.5, and 2 years after stopping therapy. Cavectomy without reconstruction is safe and well tolerated in Wilms tumor patients with completely occlusive IVC tumor thrombus.
Bladder Duplication - A Case Series To describe 5 cases with complete urinary bladder duplication, their associated conditions, and their respective treatment. Urinary bladder duplication is an extremely rare congenital anomaly of the urinary system. So far about 70 cases have been published in the English literature, most of them as case reports and a few case series.
Removal of a Steel Ring Causing Penile Strangulation Without the Use of Powered Tools or Sharp Blades Penile strangulation is an uncommon urologic emergency that requires prompt evaluation and treatment to avoid disastrous consequences. Strangulation has been reported with objects ranging from hair tourniquets, to plastic rings, to iron rings. Strangulation with these devices can result in vascular congestion of the penis, swelling and eventual gangrene of the penis distal to the constricting device. We present a case report of a 43-year-old male who had a 2-day history of penile pain and swelling secondary to a metal ring constricting the proximal phallus.
Side Effects of Intravesical BCG and Chemotherapy for Bladder Cancer: What They Are and How to Manage Them Intravesical therapy for nonmuscle invasive bladder cancer decreases recurrence and progression but carries a high risk of side effects, which limit patient adherence. Appropriate management of the toxicities from intravesical therapy requires consideration of the agent used, the side effects experienced, and the timing of those side effects. Management strategies for intravesical toxicities ideally improve patient tolerance without sacrificing oncologic outcomes. This review aims to provide a comprehensive overview of the available evidence regarding the side effects of intravesical therapies for nonmuscle invasive bladder cancer and to propose practical strategies for toxicity management.
A 26-Year-old Woman With Dysuria and Hematuria In this case, we present imaging findings characteristic of chronic genitourinary schistosomiasis. Schistosoma haematobium, a blood fluke endemic to Africa and the Middle East, is a prominent cause of hematuria and bladder cancer in regions lacking adequate water sanitation. Luminal calcifications of the genitourinary tract, that is, of the bladder and/or ureters, from deposition of fluke eggs are a classic sign of chronic S. haematobium infection and should raise suspicion for the disease even when urine or serological tests are negative.
Persistent Dysuria in a Young Male A Cowper's Duct syringocele is a rare diagnosis and currently there exists no clinical guidelines for evaluation and management. This clinical challenge illustrates the case presentation, evaluation, diagnosis, and treatment options for of a newly diagnosed Cowper's Duct syringocele.
Clinical and Penile Dermoscopy Evaluation of a Reticulated Pattern on the Penile Glans A 32-year-old man visited our clinic for evaluation of a mildly pruritic lesion on the glans. He complained of a recurrent red patch, which had been slowly enlarging over the previous three months. Clinical examination revealed a slightly raised plaque with a reticulated lacy net pattern and white threads on the glans. There was no evidence of skin, nail or other mucosal involvement on physical examination. Laboratory tests, including hepatitis and syphilis serologies, were normal or negative. Penile dermoscopy revealed white reticular and circular lines [Wickham striae] on a red background.
“Bilateral Single System Ectopic Ureters With Vaginal Insertion in a Female Child, A Rare Variant” In most cases an ectopic ureter is associated with a duplicated renal collecting system while in only a few single systems is found. Bilateral single system ureteral ectopia is even rarer. A 9-year-old girl presented with urinary incontinence. Investigations pointed towards bilateral single system ectopic ureters with ectopic openings into vagina with a hypoplastic bladder. The left ureteric system was tortuous with malrotated and hypoplastic left kidney. A 4 × 2 cm hard calculus was found in the vagina.
Cannabinoids in Urology. Which Benign Conditions Might They Be Appropriate to Treat: A Systematic Review There is growing evidence suggesting cannabinoids may provide suitable alternatives to conventional treatments in an increasing number of clinical settings. This review evaluates how cannabinoids are used to treat certain benign urological pathologies and to clarify the clinical value of this data. This review includes 62 papers and was undertaken per PRISMA's guidelines, it evidences the therapeutic potential of cannabinoids in the management of specific benign urological diseases, most notably neurogenic bladder dysfunction (clinical studies), renal disease (animal studies), and interstitial cystitis (animal studies).
Unusual Presentation, Relapse, and Metastasis of a Pediatric Testicular Yolk Sac Tumor: Case Report Testicular tumors are not uncommon in children and represent 1%-2% of all pediatric malignancies. Prepubertal testicular yolk sac tumor is the most common childhood testicular cancer, accounting for 70%-80% of all cases. The clinical presentation varies from one patient to another; most common presentation is painless scrotal mass. Herein, we present a case of pediatric patient with a testicular yolk sac tumor who had unusual presentation followed by a local relapse and metastasis and continued to have high markers while he was on chemotherapy, then underwent retroperitoneal lymph node dissection and local recurrence excision.
Women Leaders in Academic Urology: The Views of Department Chairs Women now comprise the majority of matriculants to medical school (51.6% in 2018),1 yet continue to be underrepresented in academic leadership. Across specialties, women comprise 14% of department chairs, 22% of vice chairs, 22% of division directors, and 17% of decanal positions.2 The lack of women who hold these leadership positions in the field of urology is more pronounced. In a 2017 study, women comprised 3.3% (4 of 122) of department chairs, 4.5% (2 of 44) vice chairs, and 7.9% (20 of 253) division directors.
Current Status and Role of Patient-reported Outcome Measures (PROMs) in Endourology Kidney stone disease can have a number of adverse effects on patients including quality of life. Studies assessing outcome measures in this area have largely been focused on objective assessments such as stone free rate. However, as part of the evolution to shift healthcare to a more patient centered position, patient-reported outcome measures have emerged as an improved tool to address this deficit. Key patient-reported outcome measures in Urology now include Ureteral Stent Symptom Questionnaire, Wisconsin Stone QoL Questionnaire, Cambridge Ureteric Stone PROM, Cambridge Renal Stone PROM, and Urinary Stones and Intervention Quality of Life.
Seminal Vesicle Cysts With Upper Urinary Tract Abnormalities: A Single-center Case Series of Pediatric Zinner Syndrome Seminal vesicle cysts are usually congenital and frequently accompanied by upper urinary tract abnormalities due to mesonephric duct maldevelopment. Zinner syndrome, first described in 1914, refers to a triad of features consisting of seminal vesicle cysts, ejaculatory duct obstruction, and unilateral (mostly ipsilateral) renal agenesis. We herein present four pediatric patients with Zinner syndrome diagnosed at a children's medical center. A remnant ureteral structure was observed in three (75%) patients.
Statewide Price Variation for Generic Benign Prostatic Hyperplasia Medications To examine the geographic and pharmacy-type variation in costs for generic benign prostatic hyperplasia (BPH) medications in order to improve drug price transparency and reduce health disparities. Medical therapy for BPH can be expensive, having significant implications for uninsured and underinsured patients.
Women in Leadership in Urology: The Case for Increasing Diversity and Equity There is a persistent male gender predominance in urology, especially with respect to female representation in leadership. We review the current status of women in urology leadership, discuss challenges women face in leadership positions, present the case for adopting inclusive practices that increase diversity and gender equity in urology leadership, and review the potential benefits of such an expansion. We discuss practical strategies to grow the role of women in urologic leadership, including increasing mentorship, modifying academic promotion criteria, and addressing implicit bias, while presenting a roadmap toward achieving equity and diversity at the highest ranks of urologic leadership.
Hyperbaric Oxygen as Salvage Therapy for Neonates Suffering From Critical Ischemia of the Glans Penis After Circumcision Ischemic complications of glans penis following circumcision are rare, and if occurs can culminate in irreversible necrosis with severe long-term consequences. Here we present 2 challenging cases of neonates suffering from acute severe glans penis ischemia after circumcision that were treated by hyperbaric oxygen treatment (HBOT). In addition to case presentations, the literature related to complications of circumcision and the physiological effects of HBOT are being reviewed. Based on the review and the case presented, we conclude that HBOT can be used as salvage treatment for circumcision induced glans ischemia as early as possible before full necrosis develops.
Cystoscopic Management of Prostatic Utricles In this case series (n = 7) on prostatic utricles (PU), retention of urine was seen in 5 of 7, urinary tract infection (4 of 7), recurrent epidydymo-orchitis (3 of 7), and scrotal sinus (1 of 7). Voiding cystourethrogram established diagnosis in 3 of 7 patients while CT/MRI in 4 of 7 patients. Four patients were primarily managed by cystoscopic widening of mouth of PU. Three with large PU underwent initial open (2) or laparoscopic (1) excision but later warranted cystoscopic widening for residual PU.
Mature Ovarian Cystic Teratoma Mimicking a Bladder Diverticulum in a 16-year-old Female A 16-year-old female was incidentally found to have an abnormal pelvic ultrasound while undergoing evaluation for mild scoliosis. A large, thick-walled, lobular, fluid-filled structure was found at midline in the pelvis that initially resembled bladder diverticula due to its anatomical position and sonographic appearance. Voiding cystourethrogram and computed tomography later revealed a large cystic mass originating from the right ovary. This report outlines a case of a mature cystic teratoma convincingly mimicking bladder anomaly on sonography.
Management of Testicular Torsion and a Contralateral Testicular Mass Presenting Synchronously Testicular masses found in prepubertal males are often benign in nature. This has led to an increase in the use of testis-sparing surgery. Testicular torsion is considered a urologic emergency that requires immediate surgical intervention. Based off literature review, it is rare for these unique entities to present synchronously in a single patient. This report demonstrates that in the pediatric population it is possible to safely treat a suspected benign testicular mass with testis sparing mass enucleation if it presents synchronously with testicular torsion in the contralateral testis.
Surgical Treatment of Primary Penile Scrotal Lymphedema: A Case Report Lymphedema is the result of altered lymphatic drainage. Primary lymphedema is a rare condition with a reported incidence of only 0.6%. Most cases in children are caused by congenital factors. We report a 4-year-old child with primary penile scrotal lymphedema combined with bilateral hydrocele, and satisfactory therapeutic and aesthetic results were obtained through surgical resection and genital reconstruction.
Optimizing Women's Sexual Function and Sexual Experience After Radical Cystectomy Survivorship in bladder cancer has improved in terms of lower morbidity, mortality, and improved oncological outcomes. However, there is a dearth of research on women's quality of life, specifically, on the effect of radical cystectomy on women's sexual function and sexual experience. This narrative literature review focuses on the current state of knowledge about women's sexual function after cystectomy, identifies patient and provider-related factors that have contributed to the lack of research and sexual health support in clinical practice, and proposes a model for sexual rehabilitation as well as future areas for research.
Baseline Renal Volumes in Children Born With Cloacal Anomalies To better understand why children born with cloacal anomalies are at a high risk of renal insufficiency, this study aims to determine baseline renal volume in children with cloacal anomalies compared to controls. We hypothesized children with cloacal anomalies would be born with less renal volume.
Segmental Testicular Infarction Associated to Torsion: First Case Report in Childhood Testicular torsion in children is not uncommon emergency problem which occur due to twist in the spermatic cord leading to ischemia or infarction to testicle. Hemorrhagic infarction can occur following testicular torsion is globally; however, in extremely rare situation, such infarction can be segmental.Segmental testicular infarction (STI) was reported in an infant due to epididymitis and a newborn with STI in 1 testicle with complete infarction in the contralateral testicle due to birth trauma.
Supernumerary Kidney Associated With Horseshoe Malformation and Ureteric Stricture With Hydroureteronephrosis – A Rare Case Supernumerary kidney is an accessory kidney with its own vasculature, collecting-system and encapsulated parenchyma with about 100 cases reported in the literature. However, there is no report of supernumerary kidney associated with horseshoe malformation with ureteric stricture. We report a rare case of 20 months old female admitted with left-sided abdomen lump and mild abdominal pain. During surgery, supernumerary kidney with horseshoe component with grossly-dilated left-sided pelvicalyceal system and proximal 1-cm of left-ureter, distal to which whole of left-ureter was noncanalized, was seen.
Urinary Pubic Symphysis Fistula Leads to Histopathologic Osteomyelitis in Prostate Cancer Survivors To assess the histologic findings in the pubic bone resected during extirpative surgery for urinary pubic symphysis fistula (UPF). The concurrent presence of osteomyelitis and the need for bone resection at time of extirpative surgery for UPF has been debated. We hypothesized that UPF results in histopathologically confirmed osteomyelitis, underscoring the importance of bone resection at the time of surgery.
Native Ureter Ventriculo-Ureteral Shunt Placement for Management of Refractory Hydrocephalus in a Child With a History of Renal Transplant: Case Report and Technical Note This report describes the case of a 5-year-old male with intractable hydrocephalus secondary to neonatal intraventricular hemorrhage who was ultimately managed with the placement of a ventriculo-ureteral (VU) shunt. He had previously failed numerous attempts at cerebrospinal fluid shunting, choroid plexus cauterization, and endoscopic third ventriculostomy. The patient had a history of end stage renal disease, and had previously undergone renal transplant. In an operation that involved Neurosurgeons, Pediatric Urologists, and Transplant surgeons, a Gibson incision was used to avoid the patient's multiple intra-abdominal adhesions, and his nonfunctioning renal unit was used to implant a VU shunt without early or late complications.
Gynecologic Considerations for the Urologic Surgeon While gynecologic malignancy is uncommon in women with conditions such as pelvic organ prolapse and bladder cancer, urologists should be acquainted with the relevant gynecologic literature as it pertains to their surgical care of female patients. While taking the patient history, urologists should be aware of prior cervical cancer screening and ask about vaginal bleeding, which can be a sign of uterine cancer. Urologic surgeons should also discuss the role of concomitant prophylactic oophorectomy and/or salpingectomy for ovarian cancer risk reduction at the time of pelvic surgery.
Rising Tides: Challenges and Opportunities for Women in the Urologic Workforce The number of practicing female urologists has increased from < 2% in 1980 to 9.2% in 2018. Despite this increase, urology trails far behind medical fields overall and surgical subspecialties, in achieving gender parity. Barriers, such as pervasive biases and institutional policies, exist at the medical student, resident, and practicing urologist levels. Once recognized as detrimental, action can be taken to combat these forces to allow for advancement of women in the field of urology. This will result in a richer workforce better able to serve its patient population and advance the field.
Let's Talk About Sex: Special Considerations in Reproductive Care and Sexual Education in Young Women With Spina Bifida Medical advances in the last several decades have allowed an increasing number of children with spina bifida to reach adolescence and adulthood. As they reach puberty, girls with spina bifida face unique social and health challenges to their sexuality, such as orthopedic restrictions, continence, and pelvic floor disorders. Recent research efforts have focused on better understanding female sexual desires, dysfunctions, and activity and the role of the physician in educating this vulnerable population.
Congenital Lymphedema of the Foreskin in a 3-Year-Old Boy: A Case Report and Literature Review Congenital lymphedema of the external genitalia is a rare, disfiguring disorder. We describe here a case of a 3-year-old male with primary foreskin lymphedema persisting since birth. A compact, heterogenous swelling of the foreskin's distal third was observed, inhibiting preputial retraction (phimosis). Right lower extremity lymphedema was also observed in this case, while no further abnormalities were found. Surgery was performed, maintaining the foreskin, producing an excellent result with no recurrence at 10-month follow up.
Gastric Adenocarcinoma Arising in Gastrocystoplasty Gastric cancer is a rare long-term complication in gastrocystoplasty. We report 2 cases of gastric adenocarcinoma and review the literature for similar cases. A total of 14 cases are identified. The majority of patients are males, presented with hematuria, and developed cancer at a younger age, more than 10 years after gastrocystoplasty. Long-term follow up information was limited, but 5 patients (36%) died within 5 years of diagnosis. Annual surveillance for malignancy may not be effective due to its rarity.
Incidence of Significant Findings of Microhematuria Workup in Women—What Guidelines Work Best? To apply the American Urogynecological Society (AUGS)/American College of Obstetricians and Gynecologists (ACOG) recommendations of foregoing workup in patients under 50 years of age with less than 25 red cells per high-powered field, to a cohort of asymptomatic microscopic hematuria (AMH) patients, and assess diagnostic accuracy, sensitivity, specificity, positive, and negative predictive value compared to the American Urologic Association (AUA) guidelines.
Characteristics of Genitourinary Fistula in Kigali, Rwanda; 5-Year Trends To assess the characteristics of women presenting with genitourinary fistula over a 5-year period in Kigali, Rwanda. Genitourinary (GU) fistula is a devastating condition that can result from difficult vaginal deliveries or as a surgical complication. Rwanda has seen notable increases in cesarean section rates as a result of a successful universal health care system. It is unclear how the increase in cesarean section rates may influence the types of fistula diagnosed.
Female Sexual Dysfunction – Awareness and Education Among Resident Physicians To develop a better understanding of the strengths and deficiencies of female sexual health education and the attitudes toward female sexual health amongst urology, obstetrics and gynecology, psychiatry, and family medicine trainees. Female sexual dysfunction (FSD) is characterized as distress related to sexual pain, interest/arousal, or orgasm. Despite the high prevalence of FSD there are few clinical resources available for patients and providers in Canada.
Post-cystectomy Enterocele: A Case Series and Review of the Literature To present a case series and literature review on post radical cystectomy (RC) pelvic organ prolapse (POP) to heighten awareness of the symptoms, imaging findings, and risk factors associated with this complication and discuss opportunities for prevention. Women with muscle invasive bladder cancer undergo RC with anterior exenteration, significantly disrupting the pelvic floor. These women are at risk for POP.
Vaginal Estrogen—What a Urologist Should Know The implications of estrogen depletion on the lower urinary tract and vagina are relevant to the urologist treating women with genitourinary symptoms. The main symptoms of vaginal estrogen depletion that affect women are dyspareunia and vaginal dryness, recurrent urinary tract infection, and lower urinary tract symptoms. Vaginal estrogen can be used to effectively treat these conditions. Vaginal estrogen is available in a variety of formulations. Each formulation has different considerations regarding its use and patients should be actively involved in choosing the right product for them.
Nonobstetrical Robotic-Assisted Laparoscopic Surgery in Pregnancy: A Systematic Literature Review Urologic and gynecologic surgeons are the top utilizers of robotic surgery; however, nonobstetrical robotic-assisted laparoscopic surgery (RALS) in pregnant patients is infrequent. A systematic literature review was performed to ascertain the frequency, indication and complications of RALS in pregnancy. Results showed 38 pregnancies from eleven publications between 2008 and 2020. Five cases were for urologic indication and 33 for gynecologic indication. Minimal surgical alterations were required.
Identifying Opportunities to Improve Patient Experience With Sacral Neuromodulation: A Human Factors Approach To use a human factors approach to conduct a needs assessment of patient preparedness, education, device usability, and satisfaction regarding all stages of sacral neuromodulation therapy and identify opportunities for improvement. Sacral neuromodulation, though minimally invasive, involves an initial testing phase that requires active patient participation. This process is relatively complex and, if a patient does not receive adequate preprocedure education, can be difficult to conceptualize.
Recurrent UTIs in Girls: What Is the Role of the Microbiome? Urinary tract infections (UTIs) are one of the most common childhood bacterial infections. Recurrent UTIs can lead to renal scarring. Compared to boys, girls are more likely to develop scars as a result of recurrent UTIs. Therefore, there is a need to identify girls at high risk for recurrent UTIs and develop interventions to decrease the risk of recurrent UTIs. In this commentary, we will review the hypothesized pathophysiology of recurrent UTIs, explore the literature on the role of the microbiome in recurrent UTIs, focusing on female pediatric patients when able, and highlight the need for future research in this area.
A Review of Mullerian Anomalies and Their Urologic Associations Structural anomalies of the female reproductive tract, known as Mullerian anomalies, can occur in isolation or in association with anomalies of other organ systems. Due to shared embryology, the most common association in up to 40% of patients is with renal, ureteral, and bladder anomalies. Affected girls can have a wide range of genitourinary symptoms with urologists playing an integral role in their diagnosis and treatment. To facilitate the recognition and management of these conditions, we provide a review of Mullerian anomalies including the embryology, classifications, syndromes, evaluation, and treatments with attention to their urologic applicability.
The Impact of Sex and Gender on Clinical Care and Research Design in Nephrolithiasis Although classically a disease of male preponderance, scrutiny of the available data on nephrolithiasis reveals substantial epidemiological discrepancies between males and females, suggesting sex-based pathophysiology underlying this disease.1 Furthermore, sex-based differences may exist in underlying urinary risk factors, presentation, and treatment response. Recognizing these differences will be essential to further understand the multitude of etiologies of kidney stone disease and aid in developing appropriately designed comparative effectiveness trials.
Robotic Adrenalectomy for Functional Adenoma in Second Trimester Treats Worsening Hypertension A 33-year-old G6P3023 was found to have a 4.2 cm right adrenal incidentaloma during an admission for right pyelonephritis. Computed tomography (CT) was performed to rule out perinephric abscess in the setting of worsening leukocytosis while on antibiotics (Fig. 1). Initial differential diagnosis from endocrinology included pheochromocytoma and primary aldosteronism. Due to the lack of typical physical exam stigmata, Cushing syndrome was initially of low concern. Of note, her past medical history included hypertension treated with amlodipine 10 mg and hydrochlorothiazide 12.5 mg.
Lower Urinary Tract Symptoms: Advances in Women's Urologic Health From MAPP and LURN Urinary tract conditions causing urinary symptoms, including pain and discomfort, are common in women of all ages. Lower urinary tract symptoms (LUTS) are highly prevalent with 59.2% of women exhibiting storage symptoms; 19.5% exhibiting voiding symptoms; and 14.2% exhibiting postmicturition symptoms and the prevalence of symptoms increases with age.1 Lower urinary tract pain, in particular, appears to be a problem more common in women than men.1 Unfortunately, many patients who seek care for LUTS experience neither total nor permanent resolution of their symptoms with current management approaches.
Laying the Foundation for Bladder Health Promotion in Women and Girls Prevention strategies have been effective in many areas of human health, yet have not been utilized for lower urinary tract symptoms (LUTS) or bladder health (BH). This commentary outlines LUTS prevention research initiatives underway within the NIH-sponsored Prevention of Lower Urinary Tract Symptoms Research Consortium (PLUS). Prevention science involves the systematic study of factors associated with health and health problems, termed protective and risk factors, respectively. PLUS is enhancing traditional prevention science approaches through use of: (1) a transdisciplinary team science approach, (2) both qualitative and quantitative research methodology (mixed methodology), and (3) community engagement.
The Prognostic Value of PIK3CA Copy Number Gain in Penile Cancer To determine whether phosphatidylinositol-4,5-bisphosphate 3- kinase, catalytic subunit alpha (PIK3CA) copy number gain in penile cancer has prognostic value and association with histopathological parameters, human papillomavirus (HPV), and clinical outcome.
Dual Pathology Causing Congenital Bladder Outlet Obstruction Anterior urethral syringocele is an uncommon congenital deformity characterised by cystic dilatation of bulbo-urethral gland ducts and is usually asymptomatic. We present a case on 4-day-old male neonate who presented with bilateral antenatal hydroureteronephrosis and renal impairment and found to have urethral syringocele and posterior urethral valves (PUV).
Author Reply The comments of the editor truly reflect the findings of our study on the surgical treatment of giant penoscrotal lymphedema. All the 19 patients described in the study were to be treated by surgery. Eight patients, however, defaulted, possibly because of their belief in alternative traditional herbal medicine and or financial constraint, because health insurance schemes are yet to be fully established in our environment.
WITHDRAWN: Stented or Unstented Distal Hypospadias Repair The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2017.04.057. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
WITHDRAWN: Reply The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2015.08.053. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
WITHDRAWN: Editorial Comment The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2013.02.086.The duplicate article has therefore been withdrawn.
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