PURPOSE:Transgender individuals experience significant disparities in healthcare access and quality, often owing to limited provider training and awareness. This study aimed to assess the knowledge, attitudes, and clinical exposure of Mexican urologists and urology residents in relation to transgender patient care and to identify potential gaps that may affect treatment quality and access. METHODS:An anonymous survey was distributed to board-certified urologists and urology residents between April and May 2025. The questionnaire included a 5-point Likert scale to evaluate participants' knowledge, confidence, and comfort when treating transgender patients. The questions also assessed clinical experience, familiarity with gender identity and appropriate pronouns, ability to provide endocrine and surgical care, and awareness of healthcare disparities. A total of 322 responses were analyzed using descriptive statistics and t-tests to identify significant trends. RESULTS:Among the respondents, 53.7% had never attended to a transgender patient, and 71.1% were not currently caring for any. Only 15.5% reported a strong knowledge base in transgender health and only 7.4% felt confident in performing gender-affirming surgery. While 62.1% felt comfortable discussing gender identity, only 58.3% could clearly distinguish it from their sexual orientation. Urology residents reported greater comfort and awareness than certified urologists did. Less than half (48.4%) strongly supported transgender care in residency programs. CONCLUSION:There is a marked gap in transgender-related knowledge and clinical exposure between Mexican urologists and residents. These findings underscore the urgent need to integrate structured transgender health education into urological training and continuing medical education to promote equitable, competent, and inclusive care.
INTRODUCTION:Urinary bladder stones cause significant morbidity and are increasingly treated by transurethral holmium laser cystolithotripsy (TULC), a minimally invasive procedure. While spinal anesthesia is commonly used, local anesthesia is gaining interest, especially for high-risk or elderly patients. This study compares the safety, efficacy, and outcomes of TULC under local versus spinal anesthesia. METHODS:A retrospective observational study at AIIMS, Jodhpur, India (March 2023-March 2025) included 81 bladder stone patients undergoing TULC. 43 received local anesthesia and 38 spinal anesthesia. Data on demographics, stone size and number, operative time, pain scores (Visual Analogue Scale), complications, and stone clearance were analyzed. RESULTS:Both groups were comparable in age and sex. Mean stone size was smaller in the local anesthesia group (22 mm) compared to spinal anesthesia (30 mm); multiple stones were more common with spinal (26.3% vs 9.3%). Complete stone clearance was achieved in all patients. Operative time was shorter under local anesthesia (45.3 vs 55 min). Pain scores were similar (VAS 3.69 vs 3.70). Minor complications, such as hematuria and fever, occurred but resolved conservatively. No major complications or mortality were reported. Patient satisfaction was slightly lower with local anesthesia (Likert 4.05 vs 4.13). CONCLUSIONS:Holmium laser cystolithotripsy is safe and effective under both local and spinal anesthesia. Local anesthesia is a well-tolerated alternative for smaller stones, offering a quicker procedure with similar pain outcomes. Spinal anesthesia remains preferred for larger or multiple stones. Further randomized studies are needed to optimize anesthesia selection criteria.
OBJECTIVE:This study aimed to quantify the prevalence and severity of indwelling double-J (DJ) ureteral stent-related symptoms, characterize pain perception, and evaluate patient satisfaction among adult patients in a resource-limited healthcare system, while identifying demographic and clinical factors associated with symptom burden and satisfaction. METHODS:A cross-sectional study was conducted between April and December 2025 at two major urology centers. Patients who underwent DJ ureteral stenting for ureteral obstruction, predominantly due to urinary tract stones, were consecutively recruited. Data were collected using a structured, seven-part questionnaire assessing urinary symptoms, pain characteristics, quality of life, and satisfaction, supplemented by clinical information from electronic medical records. Pain intensity was measured using a visual analogue scale (VAS). RESULTS:Among 200 patients analyzed, stent-related symptoms were highly prevalent. The median stent indwelling duration was 30.0 days [IQR: 19.0-41.0]. Flank or abdominal pain was reported by 176 patients (88%), with a median severity of 6.0 on the VAS. Other frequent complaints included fatigue (74%), sleep disturbance (71.5%), urinary frequency (70.5%), dysuria (69%), hematuria (58%), and sensation of a foreign body (65.5%). Despite this substantial symptom burden, overall satisfaction was relatively high: 124 patients (62%) reported being satisfied or very satisfied, and 134 (67%) expressed willingness to undergo stenting again if medically indicated. Longer stent indwelling time was independently associated with increased flank pain (OR 1.05/day, 95% CI 1.01-1.09, p = 0.007) and satisfaction was negatively associated with comorbidities (β = -0.17, p = 0.027). CONCLUSION:DJ ureteral stents cause significant pain, urinary symptoms, and quality-of-life impairment among Palestinian patients, yet overall satisfaction remains high, reflecting recognition of their clinical necessity. These findings highlight the need for better counseling, tailored symptom management, and structured follow-up to strengthen patient-centered care.
BACKGROUND:Non-obstructive azoospermia (NOA) is absent sperm due to defective spermatogenesis from causes like cryptorchidism, genetics, or unknown factors. AIM:to compare surgical sperm retrieval rate in NOA between men with normally positioned scrotal testis/testes and undescended testis/testes. PATIENTS AND METHODS:This retrospective study included 869 men with NOA who underwent m-TESE between October 2016 and October 2023 at Beni-Suef University Hospital and IVF centers in Beni-Suef and Giza. After excluding 41 cases with confounding factors, 777 had scrotal testes and 92 had undescended testes (UDT) and were included in the analysis. RESULTS:The study included 869 men with non-obstructive azoospermia (NOA) undergoing microdissection testicular sperm extraction (m-TESE), 777 (89.9%) had normally positioned scrotal testes, and 92 (10.1%) had undescended testes (UDT) [66 inguinal, 24 abdominal, 2 mixed]. Men with scrotal testes had higher testicular volume and E2 levels, but lower FSH and LH levels than UDT cases. Sperm retrieval rate (SRR) was significantly higher in scrotal testes (36.8%) compared to UDT (23.9%, p = 0.015), with no sperm retrieved from abdominal or mixed testes. Inguinal testes had an SRR of 33.3%. Earlier orchidopexy (12.4 ± 9.4 years) was associated with higher SRR (37.2% vs 12.2%, p = 0.007) compared to later orchidopexy (24.9 ± 13.8 years). Unilateral UDT showed higher SRR (40%) than bilateral (17.9%, p = 0.0517). CONCLUSION:Higher SRR was seen in scrotal and inguinal testes, especially when orchidopexy was done before 16.5 years. Abdominal testes showed no sperm, and genetics had no clear effect.
BACKGROUND:Andrological emergencies (AEs) constitute a critical subset of acute urogenital conditions requiring urgent recognition and intervention to preserve sexual and reproductive function while preventing long-term morbidity. Common AEs include testicular torsion, ischemic priapism, penile fracture, paraphimosis, Fournier's gangrene, penile strangulation, and acute urinary retention. AIM:To provide a comprehensive synthesis of current knowledge on the clinical presentation, diagnostic approaches, therapeutic strategies, psychosocial implications, ethical considerations, and global disparities. METHODS:A narrative review of peer-reviewed literature was conducted across major medical databases. Evidence was integrated thematically to highlight clinical features, diagnostic tools, management strategies, and broader psychosocial and health system impacts. OUTCOMES:Key outcomes included improved understanding of diagnostic accuracy, therapeutic efficacy, psychosocial burden, ethical considerations, and inequities in access to timely care. RESULTS:AEs present across all age groups with distinct clinical signs necessitating rapid recognition. Doppler ultrasound and timely surgical intervention remain central for testicular torsion, while aspiration with intracavernosal sympathomimetics represents first-line management for ischemic priapism. Early surgical repair is essential in penile fracture and paraphimosis. Delayed presentation, often due to stigma and embarrassment, significantly worsens prognosis. Ethical challenges, particularly regarding informed consent in emergencies, are frequently encountered. Global disparities in healthcare access and provider training contribute to heterogeneous outcomes, particularly in low-resource settings. CLINICAL IMPLICATIONS:Optimal management of AEs requires multidisciplinary expertise, incorporation of sensitive psychosocial care, and equitable access to emergency services.Strengths and limitations:This review integrates clinical, psychosocial, ethical, and global health perspectives on AEs, offering a holistic view. However, reliance on heterogeneous data and limited comparative studies constrain definitive conclusions. CONCLUSION:The timely recognition and management of AEs are essential to preserve function and quality of life. Addressing psychosocial barriers, ethical complexities, and healthcare disparities will require patient-centered education, enhanced provider training, and international collaboration to establish standardized, globally adaptable emergency protocols.
BACKGROUND:Augmentation cystoplasty is a common procedure in managing bladder dysfunction among mixed-age cohort. However, data on its functional results and associated morbidity from specialist centers are scarce. OBJECTIVES:To evaluate surgical outcomes, functional results, and complications of augmented cystoplasty surgery, especially in terms of bladder capacity, stability of renal function, short & complications during available follow-up. METHODS:This was retrospective cohort study where all patients undergoing an augmentation cystoplasty procedure at the Department of Urology, Pakistan Kidney and Liver Institute & Research Center, Lahore, from June 2023 to May-2025 included in study. Baseline demographics to clinical outcomes noted from patients' medical-records and evaluated based on change in bladder capacity, serum creatinine, and postoperative complications following Clavien Dindo Scale. Secondary-outcomes: continence status, reoperative procedures, and hospital-stay. RESULTS:Seventy-six patients were studied with a mean age: 29.44 ± 15.07 years (range: 4-66) with a predominance of males consisting of 58 patients (76.3%) of mixed-age cohort. Predominant indication for undergoing this surgery was neurogenic bladder in 46 patients (60.5%). The majority of patients 74(97.4%), underwent ileal augmentation procedures, and only two (2.6%) underwent autoaugmentation procedures. Bladder capacity increased significantly post-operatively with a median of 500 mL as compared to a preoperative median of 130 mL(IQR: 60-130) (p < 0.001) and a postoperative stable serum creatinine with p > 0.535. Early postoperative complications occurring within 30 days after surgery were observed in seven patients (9.2%). During available postoperative follow-up period (3-4 weeks), complications requiring additional intervention were uncommon, occurring in 3.9% of patients. At available postoperative follow-up assessment, adequate bladder capacity and social continence were achieved in 75 patients (98.7%), while stable serum creatinine levels were observed in 74 patients (97.4%). CONCLUSION:Augmentation cystoplasty was associated with significant improvement in bladder capacity and stable renal parameters during the available follow-up period in this mixed-age cohort. However, longer follow-up with objective urodynamic and renal assessment is required.
OBJECTIVE:To describe the clinical and epidemiological characteristics of patients diagnosed with penile cancer in a hospital-based cohort from southwestern Colombia. METHODS:A retrospective cross-sectional study was conducted using medical records from the Urology Department of a tertiary hospital in Cali, Colombia, between January 2013 and February 2024. Patients with confirmed penile cancer were identified through ICD-10 codes. Sociodemographic, clinical, pathological, and treatment data were extracted and analyzed descriptively. RESULTS:Eighty-nine patients were included. The median age was 61 years (range: 34-95), with most residing in Cali or nearby departments. At diagnosis, 53.2% had cT3-stage tumors, 61.2% had advanced nodal involvement (cN2 or cN3), and 15.1% presented distant metastases. Pathologically, 72.2% had pT3 tumors, while 43% were pN0 after lymphadenectomy. Surgical treatment was performed in 95.2% of patients, mainly partial or radical penectomy. Postoperative complications occurred in 19.5%, primarily Clavien-Dindo grade II. Adjuvant radiotherapy and chemotherapy were administered to 11.6% and 13.5% of patients, respectively. Disease-related mortality was 10.1%. CONCLUSIONS:A high proportion of patients presented with locally advanced or metastatic disease, reflecting delayed diagnosis and access barriers. These findings highlight the need for public health interventions focused on early detection, sexual health education, and improved referral systems to reduce the burden of penile cancer in Colombia.
AIMS AND OBJECTIVES:To evaluate storage safety parameters and patient-reported bladder/bowel outcomes in adults with incomplete SCI using urodynamics and validated PROMs. MATERIALS AND METHODS:Consecutive adults with incomplete SCI (AIS B-E) underwent NBSS, SF-Qualiveen, NBD, SCIM-III, and urodynamics (capacity, compliance in mL/cmH2O, Qmax, pdet@Qmax, PVR; DSD when available). Poor compliance was prespecified as <20 mL/cmH2O. Analyses were stratified by level and management; safety proportions used measured denominators. Categorical outcomes were compared with χ2; continuous outcomes across ⩾3 groups with Kruskal-Wallis; secondary pairwise tests used Mann-Whitney with Benjamini-Hochberg FDR correction. RESULTS:N = 84; median age 35.5 years. PVR ⩾ 100 mL occurred in 71.4% and differed by neurological level (χ2(3) = 20.77, p = 0.00012). Poor compliance < 20 mL/cmH2O occurred in 26.2% overall and clustered in sacral injuries (72.7%) versus cervical 7.1%, thoracic 10.7%, lumbar 10.0% (χ2(3) = 33.46, p = 2.6 × 10⁻7). Severe NBD (⩾14) differed by management (χ2(3) = 14.92, p = 0.0019). NBSS totals differed by management (H = 52.86, p = 1.96 × 10⁻11), while SF-Qualiveen showed a borderline trend (H = 7.45, p ≈ 0.059). In a complete-case logistic model (outcome low compliance; predictors level, age, sex; reference thoracic), sacral level remained independently associated with poor compliance. CONCLUSIONS:Elevated residual urine and impaired bladder compliance remained common despite neurological sparing. Patient-reported burden varied across bladder-management categories, while sacral lesions demonstrated a disproportionate burden of poor compliance. Combined urodynamic assessment and validated PROMs may help identify patients at risk for unsafe storage and significant symptom burden.
The significant rise in stone disease has led to an increased popularity of percutaneous nephrolithotomy for the management of substantial stone burdens. Despite ongoing advancements in technology and surgical methods, overall complication rates of PCNL have gone up. For the best decision-making and well-informed patient counselling, a precise assessment of treatment success is essential. CT scans offer high-resolution spatial imaging that precisely characterizes stone size and distribution, pelvicaliceal anatomy, anomalies, and anatomical relationships. With these measurable stone and patient features, the Guy's Stone Score, S.T.O.N.E. score and CROES nephrolithometric nomograms have been introduced for systematic and quantitative assessment of kidney stones. There is no study evaluating the efficacy of these three scoring systems in patients undergoing supine PCNL. We prospectively analysed 100 patients over a period of 20 months (December 2022-July 2024). Analysis of relationship between residual calculus, Procedure Time (PT), Scope Time (ST), Fluoroscopy Time (FT) and duration of hospital stay and complications with different nephrolithometric scoring was done. ROC curve was drawn comparing all three scores. AUC for GSS is 0.711, STONE score is 0.705, and CROES score is 0.772 for predicting stone clearance. However, CROES score had highest sensitivity 97.3 but specificity and NPV of GSS is highest for predicting stone clearance with accuracy of 71.58%. For predicting complications AUC for GSS is 0.678, STONE score is 0.537, and CROES score is 0.591. Sensitivity of CROES is 95.7% but PPV, NPV, and accuracy is highest for Guy's stone score but data is insignificant. SFR in our study was 63%. SFR corroborated significantly with low Guy's score, low STONE score, and high CROES score. All three nomograms have statistically significant correlation with SFR. Except CROES Score, other two Scores have statistically significantly correlation with complications.
OBJECTIVE:To describe the clinical characteristics of patients diagnosed with vesico-vaginal fistula in a urology service in Cali, Colombia, between 2016 and 2025. METHODS:A retrospective cross-sectional study was conducted using medical records from the Urology service at a high-complexity public referral hospital in Cali, Colombia, between June 2016 and June 2025. Patients with confirmed vesico-vaginal fistula were identified through ICD-10 codes. Sociodemographic, clinical, and treatment data were extracted and analyzed descriptively. RESULTS:We found 25 patients with vesicovaginal fistula; the median age was 45 years. A history of cervical cancer and prior radiotherapy was present in 32% and 48% of patients, respectively, and 68% had undergone previous pelvic surgery, most commonly hysterectomy (48%). Cystoscopy was the main diagnostic modality (84%), with a mean fistula size of 14.6 mm and predominantly retrotrigonal or trigonal locations. Conservative management was unsuccessful in all cases, while surgical repair-mostly laparoscopic-achieved a success rate of 72.2%, with postoperative complications occurring in 16.7% of patients. CONCLUSION:Vesicovaginal fistula in this cohort was mainly associated with prior pelvic surgery and radiotherapy. Conservative management was ineffective, while surgical repair-especially laparoscopic-achieved acceptable success with low complication rates.
Background: Ureteral calculi are a common cause of acute urologic morbidity, and semirigid ureteroscopy is a standard treatment when spontaneous passage fails. The relative effectiveness and safety of laser lithotripsy (LL) versus pneumatic lithotripsy (PL) remain clinically important questions. Objectives: To compare LL (Holmium:YAG or Thulium fiber) with PL for ureteral stones in adults undergoing semirigid ureteroscopy, focusing on early stone-free rate (SFR) and key perioperative outcomes. Methods: We searched PubMed, Scopus, CENTRAL, and Google Scholar from inception to 4 September 2025 for randomized controlled trials (RCTs). Eligible studies included adults (⩾18 years) undergoing semirigid ureteroscopy comparing LL with PL. The primary outcome was early SFR (1–4 weeks). Secondary outcomes included operative and lithotripsy times, stone migration, complications, hospital stay, DJ stenting, auxiliary procedures, and late SFR (>4 weeks). Meta-analyses used fixed- or random-effects models as appropriate. Trial Sequential Analysis (TSA), Egger’s test, Begg–Mazumdar, and trim-and-fill assessed robustness and publication bias. Certainty of evidence was evaluated using GRADE. The review was registered in PROSPERO (CRD420251207635). Results: Eighteen RCTs ( n = 2791) were included. LL significantly improved early SFR (OR 2.02; 95% CI 1.59–2.58) and late SFR, reduced stone migration, postoperative fever, overall complications, DJ stenting, and auxiliary procedures. Operative time and procedure-related injuries were similar, while lithotripsy time was longer for LL. TSA confirmed conclusive evidence for early SFR. No substantial publication bias was detected. GRADE rated evidence as high for early SFR and stenting. Conclusions: LL provides superior stone clearance and better overall clinical outcomes than PL, with comparable operative safety. It should be considered the preferred intracorporeal modality during semirigid ureteroscopy for ureteral stones.
Objective: To determine the effectiveness and safety of surgery, chemotherapy, or radiotherapy for treating post-chemotherapy residual mass in advanced testicular seminoma in terms of overall survival and progression-free survival. Methods: We conducted a search strategy in MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to nowadays. We assessed the risk of bias and performed this review according to the recommendations of the Cochrane Collaboration and following the PRISMA Statement. Results: Within the included studies, there are 239 patients with germ cell carcinoma, all in an advanced stage of the disease (IIa,IIb, IIc, or III) and where 100% are pure seminomas. The interventions were radiation therapy, immediate resection after the first positive PET, other salvage therapy as second or third chemotherapy for residual masses, and a high dose of chemotherapy and autologous stem cell transplantation. The median progression-free survival in the observation arm was 39.4 months in the very high-risk group and 40 months in the high-risk group, whereas it was not reached for the radiotherapy arm. Also, a new chemotherapy scheme had progression-free survival in a 10-year follow-up of 94.2%. The overall survival for the high-risk group radiotherapy versus observation was not significant ( p = 0.47), similar to the very high-risk subgroup ( p = 0.42). The reported complications are due to surgical management and chemotherapy toxicity. Conclusion: Evidence on the management of post-chemotherapy residual retroperitoneal masses in advanced seminoma is limited and of low certainty. Available studies are few and heterogeneous, precluding definitive conclusions regarding progression-free or overall survival. Current findings support individualized treatment decisions, while further prospective studies are needed to better define optimal management strategies and long-term outcomes.
Introduction an objective:Urinary tract infections (UTIs) are a significant health concern with high costs and poor quality of life (QoL) impact. Managing recurrent UTIs (rUTI) in women requires effective treatments that relieve symptoms and reduce recurrence, while also sparing antibiotics due to rising resistance. This study evaluates the efficacy of a nutritional supplement in reducing UTI recurrences and improving QoL compared to antibiotic therapy.Materials and methods:The study compared the effectiveness of a dietary supplement (containing D-mannose, Palmitoylethanolamide, N-acetylcysteine, Lactobacillus rhamnosus, and Hibiscus extract) with a low dose of Fosfomycin in treating recurrent urinary tract infections (rUTI) in women. Both treatments were administered for 6 months, with clinical and microbiological evaluations at 3 and 6 months. Quality of life and patient satisfaction were assessed using specific questionnaires. Fosfomycin was given every 10 days, while the supplement was taken for 14 days each month.Results:The study involved 55 patients in the nutritional supplement group (NGroup) and 34 in the Fosfomycin group (FGroup). In the NGroup, the average age was 62.2 years, with a BMI of 27.2. UTIs significantly decreased from 1.87 at baseline to 0.51 at 3 months and 0.28 at 6 months (p < 0.001). Few mild gastrointestinal side effects were reported. Quality of life (QoL) and satisfaction both improved significantly. In the FGroup, the average age was 62.9 years, with a lower BMI of 23.5. UTIs also decreased from 2.68 at baseline to 0.87 at 3 months and 0.67 at 6 months (p < 0.001). No side effects were reported. QoL improved, but satisfaction declined significantly. Both groups showed similar improvements in UTI frequency and QoL, but the Fosfomycin group had lower satisfaction overall.
BACKGROUND:Robotic-assisted pyeloplasty is a well-established minimally invasive technique for the management of pelvi-ureteric junction obstruction (PUJO). The Versius Robotic System (CMR) is a state-of-the-art robotic technology that is increasingly being used in urologic surgery. The aim of this study was to evaluate the outcomes of primary and redo robotic pyeloplasty with the Versius robotic system in patients undergoing surgery at the Pakistan Kidney and Liver Institute & Research Center (PKLI & RC), Lahore. METHODS:This is a retrospective study carried out on 74 patients who underwent robotic pyeloplasty between May 2023 and July 2025. Data on demographics, intraoperative parameters, and postoperative outcomes were analyzed. RESULTS:Seventy-four patients underwent robotic pyeloplasty with the Versius robotic system. Of these, 65 (87.8%) were primary cases and 9 (12.2%) were redo procedures. The mean age of these patients was 32.5 ± 10.7 years. There were 44 (59.5%) males in our study. The mean operative time was 157.1 ± 35.8 min, and the console time was 80.3 ± 12.9 min. The median blood loss was 50 mL (IQR: 54). Conversion to open surgery occurred in four patients (5.4%). Early postoperative complications occurred in six patients (8.1%), while late complications were observed in eight patients (10.8%). Median hospital stay was 1 day (IQR: 0). Symptomatic improvement occurred in all patients (74, 100%), while radiological improvement was observed in 61 patients (82.4%) at a mean follow-up of 10.1 ± 1.5 weeks. CONCLUSION:Robotic pyeloplasty using the Versius system is a safe, feasible, and effective option for both primary and redo PUJO, providing favorable perioperative outcomes and rapid recovery.
INTRODUCTION:Radical cystectomy followed by urinary diversion is the standard of care for patients with muscle-invasive bladder cancer (MIBC). Cutaneous ureterostomy has emerged as an alternative to ileal conduit diversion, particularly in high-risk patients. The present study aimed to evaluate the outcomes and complications of cutaneous ureterostomy versus ileal conduit in patients with MIBC. METHODS:This was a retrospective, descriptive cross-sectional study performed at Shahid Modarres Hospital in Tehran between 2018 and 2021. The study population consisted of patients who underwent radical cystectomy with either ileal conduit or cutaneous ureterostomy. Baseline characteristics, operative data, and postoperative complications were compared between the two groups. RESULTS:The results showed that cutaneous ureterostomy was significantly utilized in patients with high creatinine levels, renal failure, and metastatic disease (p < 0.05). Analysis revealed that 30-day, 90-day, and 6-month survival rates, as well as surgical complications, were not significantly different between the two groups. Multivariable regression analysis was performed to adjust for baseline imbalances, indicating that the choice of diversion was not an independent predictor of early mortality, though it was heavily influenced by preoperative frailty. One-year survival, the number of preoperative transfusions, length of hospitalization, and operation duration were significantly higher in the ileal conduit group. CONCLUSION:Cutaneous ureterostomy appears to be a viable and "hypothesis-generating" alternative for elderly and frail patients. It is associated with shorter surgery duration, less blood loss, lower transfusion rates, and shorter hospital stays. Although early mortality rates are comparable, cutaneous ureterostomy may offer a safer profile for high-risk individuals, though long-term comparative studies with multivariable adjustment are warranted.
INTRODUCTION:If medical treatment and/or interventional methods have failed, and high intravesical pressure and urinary incontinence or recurring urinary tract infections persist combined with present vesicoureteral reflux and impaired renal function, surgical treatment in terms of bladder augmentation is indicated. AIM OF THE STUDY:The main objective of this study was to evaluate whether we have to do ureteral reimplantation in patients with spastic neurogenic bladder during augmentation. PATIENTS AND METHODS:A total of 72 patients with spastic neurogenic bladder with VUR were included in the study. The median age at surgery was 12 years, ranging from 3 to 27 years. All of them underwent augmentation cystoplasty for the period between 2016 and 2023. The changes in VUR grade and urodynamic findings were retrospectively evaluated. RESULTS:The median follow-up after AC surgery was 1.5 years, ranging from 0.3 to 2.3 years. The changes in vesicoureteral reflux (VUR) grade before and after surgery: VUR was detected in 72 patients, involving 89 ureters. Among the 89 ureters, the reflux grade was V in 31, IV in 34, III in 23, I in 11. Postoperative VCUG revealed that the reflux resolved in 74 ureters (83%) and was downgraded in 15 ureters (17%). During urodynamics, it was observed that the bladder capacity at which VUR occurred significantly increased from 50 to 450 mL (p < 0.05). However, there was no significant change in detrusor pressure at the onset of VUR. CONCLUSION:In patients with spastic neurogenic bladder undergoes augmentation cystoplasty: Routine ureteral reimplantation may not be necessary.
Prostate cancer (PCa) remains a leading cause of cancer-related morbidity and mortality among men worldwide, with advanced stages often exhibiting resistance to standard therapies. Drug resistance in advanced prostate cancer is a multifactorial process influenced by genetic mutations, hereditary factors, epigenetic alterations, lifestyle choices, and dietary habits. Understanding this complex interplay is crucial for developing effective predictive and therapeutic strategies. In this context, a multiomics approach integrating genomics, transcriptomics, proteomics, metabolomics, and epigenomics offers a comprehensive framework to dissect the molecular mechanisms driving drug resistance.Current challenges include tumor heterogeneity, limited access to longitudinal patient data, and insufficient representation of diverse populations in omics datasets. This study highlights the novel application of multiomics integration to stratify patient subgroups based on molecular signatures, enabling early prediction of therapy resistance. We also emphasize key biomarkers and signaling pathways associated with treatment failure, including alterations in androgen receptor signaling, PI3K-AKT-motor pathways, and metabolic rewiring. The integration of these datasets not only enhances diagnostic precision but also aids in identifying actionable therapeutic targets. It also opens up new avenues for developing targeted therapies by integrative profiling and quantifying a broad spectrum of biomolecular features across distinct subtypes of malignant cells.
OBJECTIVES:Achieving both relief of urinary obstruction and preservation of ejaculatory function is a key goal of modern surgical management for benign prostatic hyperplasia (BPH). However, standardized definitions of success that integrate multiple clinical domains remain limited. This study introduces a composite definition of clinical success and explores its predictors using a multicenter dataset of minimally invasive, ejaculation-preserving procedures. METHODS:Multi-institutional data were combined, including patients who underwent urethral-sparing robot-assisted simple prostatectomy (usRASP; n = 94), Aquablation (n = 95), or Rezum (n = 308). Complete clinical success (CSS) was defined as: (1) ⩾30% International Prostatic Symptoms Score (IPSS) reduction at 12-months; (2) preserved ejaculation, based on a positive response to the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD Q3); and (3) absence of ⩾Grade III Clavien-Dindo complications. Partial clinical success (PCS) was defined as the achievement of any two of the three criteria. A multivariable logistic regression analysis identified independent predictors of CCS. RESULTS:The final cohort included 497 patients. CCS rates were 66.0% (usRASP), 73.6% (Aquablation), and 68.8% (Rezum); PCS rates were 28.7%, 14.7%, and 20.1%, respectively. No significant differences were observed among groups for IPSS (p = 0.455), ejaculation rates (p = 0.07), or complication rates (p = 0.445). On multivariable analysis, prostate volume < 110 mL (OR 0.52; p = 0.034), higher MSHQ-EjD Q3 (OR 1.07; p < 0.001), and shorter catheterization time (OR 0.91; p = 0.02) independently predicted CCS at 1 year. CONCLUSIONS:This composite endpoint offers a pragmatic and clinically relevant framework for evaluating success in minimally invasive BPH surgery. Its adoption may enhance cross-technique comparisons and inform individualized treatment strategies.
Premature ejaculation (PE), acquired or lifelong, is a ubiquitous male sexual dysfunction with profound psychosexual morbidity. Accurate diagnosis requires integration of symptom timing, perceived ejaculatory control, partner perspective, and comorbidities, notably erectile dysfunction, alongside validated patient-reported outcomes; IELT, while a useful objective metric for severity grading, is insufficient as a standalone diagnostic criterion. Initial therapy is on-demand topical anesthetics and dapoxetine, with enhanced durability when combined with psychosexual therapy. Off-label SSRIs produce a modest but clinically meaningful delay in ejaculatory latency, limited by side effects and poor long-term adherence. PDE5 inhibitors demonstrate increasing efficacy particularly in combination with co-existing erectile dysfunction and combination treatment regimens optimize overall outcomes. No surgical intervention is currently endorsed by international guidelines, though frenulectomy may increase IELT in selected cases and selective dorsal neurectomy remains investigational. Device-based approaches including perineal transcutaneous electrical stimulation and pelvic floor rehabilitation show early promise in peer-reviewed trials, but remain investigational pending larger controlled studies. The literature was systematically searched across PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science (January 2005 to October 2025). Harmonized definitions, inclusive diagnostic criteria, and standardized outcome measures remain high priorities for future research.
