Abstract Background This study aimed to evaluate the short‐term influence of preoperative educational materials on the quality of life in patients with newly diagnosed urinary cancer before surgery. Methods Patients with urinary cancer were retrospectively enrolled from April 2020 to March 2021. Quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Core 30 version 3.0 on the day of admission and after patients read the education materials. Propensity score matching was applied to match baseline characteristics in subgroup analyses. Results A total of 180 patients were enrolled. Most of them were male with renal cancer. Sleep disturbance ( p = 0.004), appetite loss ( p = 0.013), fatigue ( p = 0.002), constipation ( p = 0.029), and physical function ( p = 0.006) showed statistically significant differences post‐intervention. Subgroup analyses suggested that improvements in sleep disturbance, fatigue, and physical function persisted in the younger group (≤ 60 years old), while bladder cancer patients showed improvements in physical function and cognitive function. Conclusion Preoperative educational materials were associated with short‐term improvements in specific quality of life domains among patients with urinary cancer. Younger age and bladder cancer diagnosis appeared to be potential effect modifiers.
Abstract Background Low‐grade non‐muscle‐invasive bladder cancer (NMIBC) is characterized by high recurrence rates, resulting in repeated interventions and intensive surveillance. Office‐based transurethral laser ablation (TULA) performed under local anesthesia is a minimally invasive alternative to transurethral resection, and narrow band imaging (NBI) may improve tumor visualization and treatment precision. This study aimed to evaluate the efficacy and safety of NBI‐guided office‐based diode laser ablation for recurrent low‐grade NMIBC and to identify factors associated with recurrence. Methods A retrospective review of 71 patients with recurrent Ta low‐grade NMIBC was conducted who underwent diode laser ablation in an outpatient clinic. All patients had negative urine cytology prior to treatment. Demographic, clinical, and tumor‐related variables were recorded. Recurrence was defined as histologically confirmed tumor reappearance on follow‐up cystoscopy. Univariable and multivariable logistic regression analyses were performed to identify predictors of recurrence. Results Recurrence occurred in 44 patients (62%). Patients with recurrence were younger (median 52.5 vs. 65 years, p < 0.001) and had lower rates of comorbidities (47.7% vs. 74.1%, p = 0.029). A higher proportion of patients with more than three original tumors was observed in the recurrent group (40.9% vs. 11.1%, p = 0.013). On multivariable analysis, younger age (OR = 0.79, 95% CI: 0.67–0.93, p = 0.006), higher number of ablated tumors (OR = 2.5, 95% CI: 1.14–5.85, p = 0.02), and presence of comorbidities (OR = 324.8, 95% CI: 2.99–352.0, p = 0.016) were independently associated with recurrence. Conclusion NBI‐guided office‐based diode laser ablation is a safe and effective option for managing recurrent low‐grade NMIBC.
Abstract Background The diagnosis of prostate cancer (PCa) is limited by low specificity and invasiveness. This study aims to establish a highly accurate, noninvasive reverse transcription‐quantitative polymerase chain reaction (RT‐qPCR)‐based urinary prostate cancer antigen 3 ( PCA3 ) assay system and explore the feasibility of using first‐morning urine instead of post‐digital rectal examination (DRE) samples. Methods Three prospective multicenter cohort studies were conducted on 643 Chinese men. Urine PCA3 expression was quantified by RT‐qPCR, using either the novel reference gene microseminoprotein‐beta ( MSMB ) or conventional kallikrein‐related peptidase 3 ( KLK3 , encoding prostate‐specific antigen, PSA). Diagnostic performance was evaluated through receiver operating characteristic (ROC) analysis in Cohort I ( n = 176), with validation in Cohort II ( n = 350). In Cohort III ( n = 117), the diagnostic accuracy of PCA3 / MSMB test was compared between DRE and non‐DRE urine samples. Results The PCA3 / MSMB RT‐qPCR system showed high precision and stability. In Cohort I, the PCA3 / MSMB test demonstrated superior diagnostic performance compared with the PCA3 / KLK3 test, with a significantly higher area under the receiver operating characteristic curve (AUC) (0.869 vs. 0.830, p = 0.0468), higher sensitivity (82.1% vs. 79.0%), and higher specificity (77.8% vs. 74.1%). Cohort II confirmed these results, yielding a sensitivity of 82.63% and a specificity of 77.50%. In Cohort III, no significant difference in diagnostic performance was observed between non‐DRE and DRE urine samples (AUC 0.859 vs. 0.850, p = 0.6262), suggesting the potential for simplified sample collection. Conclusion The PCA3 / MSMB urine test is a promising noninvasive diagnostic tool for PCa; it can reduce unnecessary biopsies and improve detection accuracy using non‐DRE urine samples.
Abstract Background Laryngospasm is a serious anesthetic complication that can lead to acute airway obstruction and hypoxemia. Standard management involves deepening anesthesia and administering succinylcholine intravenously (IV) or intramuscularly (IM). However, if IV access is lost or IM drug delivery is too slow, alternative routes are required. We report the first known use of intracavernosal succinylcholine as a rescue intervention for refractory laryngospasm during pediatric hypospadias surgery. Case Presentation A 13‐year‐old obese male undergoing distal hypospadias repair developed persistent laryngospasm with desaturation. Initial IV propofol failed due to a dislodged IV line and IM succinylcholine (4 mg/kg) showed a delayed effect. Consequently, 0.5 mg/kg of succinylcholine was injected directly into the corpus cavernosum to utilize its rich vascular network for rapid absorption. Intracavernosal administration led to near‐immediate relaxation, allowing effective ventilation and oxygenation recovery. The patient was intubated and surgery proceeded uneventfully. No complications occurred at the injection site or systemically, and the patient was discharged without sequelae. Conclusion This case demonstrates intracavernosal succinylcholine as a feasible emergency route when IV access is lost and IM delivery is insufficient. The corpora cavernosa's vascularity enabled rapid drug uptake similar to IV administration. This novel intervention highlights an interdisciplinary approach to airway emergencies and may be considered in extreme scenarios where standard methods fail. Nonetheless, it must be acknowledged that prior IM administration may have contributed to the clinical response, and further investigation is needed to establish the efficacy and safety of this route.
Abstract Background Pediatric urinary bladder paraganglioma is an exceptionally rare neuroendocrine tumor arising from chromaffin cells within the detrusor muscle. Due to its rarity and variable presentation, early diagnosis can be challenging, often requiring a high index of clinical suspicion and multimodal evaluation. Case Presentation We report a 12‐year‐old female who presented with hypogastric pain, urinary frequency, and mild dysuria. Initial imaging revealed a bladder mass associated with left‐sided hydroureteronephrosis. Over time, the patient developed episodic hypertension, palpitations, and flushing, suggestive of catecholamine excess. Further evaluation with magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) demonstrated a locally invasive mass involving the bladder wall, vesicoureteric junction, cervix, and upper vagina, without evidence of distant metastasis. Histopathological examination showed nests of polygonal cells arranged in a characteristic Zellballen pattern. Immunohistochemistry was positive for chromogranin, synaptophysin, and S‐100 protein, confirming the diagnosis of paraganglioma. Conclusion This case underscores the diagnostic challenges associated with pediatric bladder paraganglioma and highlights the importance of early recognition, thorough evaluation, and a multidisciplinary approach to ensure optimal management and outcomes.
Abstract Background Caudal blocks (CB) are a cornerstone of pediatric urologic surgery, providing effective analgesia while mitigating potential neurotoxicity associated with general anesthesia and opioids. However, the optimal timing of CB—preoperative versus postoperative—remains controversial. This study compares total opioid requirements in pediatric patients receiving preoperative versus postoperative CB to determine the timing that best minimizes opioid use. Methods All male patients aged 6–36 months who underwent urologic surgery from January 2019 to January 2023 at a single institution and had anesthesia care delivered by one of two attending pediatric anesthesiologists were retrospectively reviewed. One routinely administers preoperative CB following induction while the other performs postoperative CB immediately prior to emergence. Data collected included patient demographics, CB timing and dosage, opioid dosages, total anesthesia time, and postanesthesia care unit (PACU) time. Statistical analysis used Mann–Whitney U ‐test and chi‐square test, with results considered statistically significant at p < 0.05. Results 41 patients met inclusion criteria; 24 received preoperative CB, 17 received postoperative CB. There were no significant differences in age, weight, CB dose, total anesthesia time, or PACU time between the groups. Compared to the postoperative CB group, the preoperative CB group had significantly lower mean total opioid dose (3.875 vs. 26.470 mcg, p < 0.001), lower mean weight‐based dose (0.360 vs. 2.620 mcg/kg, p < 0.001), and fewer patients requiring opioids at all (37.5% vs. 94.1%, p < 0.001). Conclusion In this study, preoperative CB administration was associated with a significantly reduced cumulative opioid requirement in pediatric urologic surgery compared to postoperative administration.
Abstract Background Azoospermia affects 10%–15% of infertile men, with non‐obstructive azoospermia (NOA) most often managed by microdissection testicular sperm extraction (mTESE). Despite AUA/ASRM guidelines recommending mTESE, some urologists employ testicular fine‐needle aspiration (TFNA) mapping as a diagnostic adjunct. This study assessed current attitudes and utilization of TFNA mapping among fellowship‐trained male reproductive urologists. Methods An eight‐item anonymous Qualtrics survey was distributed to 96 fellowship‐trained male reproductive urologists identified through the Society for the Study of Male Reproduction. Questions addressed experience with TFNA mapping, reasons for use or discontinuation, and perceived clinical value. Results Thirty‐two surveys were completed (33% response rate). Ten respondents (31%) reported experience with TFNA mapping; six currently use it and four had discontinued use. Reported reasons for discontinuation included poor results (50%), lack of laboratory access (25%), and other factors (25%). Urologists who never used mapping primarily proceeded directly to mTESE. Among current users, management decisions following mapping varied: if no sperm were found, 50% referred to donor sperm and 50% proceeded with mTESE; if rare sperm were identified, 75% performed targeted testicular sperm extraction (TESE) and 25% mTESE; if abundant sperm were observed, 75% proceeded with testicular sperm aspiration (TESA). All current users (100%) agreed TFNA mapping provided valuable prognostic information for counseling NOA patients. Conclusion Although underutilized, TFNA mapping is regarded as a useful diagnostic and prognostic tool by current users. Broader adoption may be facilitated through improved laboratory access, training, and cost‐effectiveness analyses.
Abstract Robot‐assisted radical prostatectomy (RARP) has become the standard surgical approach for treating localized prostate cancer. A crucial component of RARP is nerve‐sparing surgery (NSS), which significantly improves postoperative erectile function and urinary continence. The primary aim of NSS is to preserve the neurovascular bundles, but this must be balanced with oncological safety, particularly concerning the risk of positive surgical margins when extracapsular extension is present. This review aims to provide an overview of NSS techniques, based on the authors' clinical experience and perspective, while avoiding unnecessary technical overdetail.
Abstract Background Metastatic prostate cancer tumor seeding within a percutaneous biopsy tract is rare. While reports of tumor seeding following perineal and transrectal prostate biopsies exist, no cases of prostate cancer tumor seeding along a metastatic percutaneous bone biopsy tract detected by prostate specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) have been reported. Case Presentation We describe a rare case of intramuscular and subcutaneous prostate cancer recurrence along and adjacent to the site of a previous percutaneous metastatic rib biopsy tract. The role of PSMA PET/CT in the early detection of such cases is highlighted. In this case, PSMA PET played a crucial role in achieving both early diagnosis and early targeted management, optimizing the oncological outcome for the patient. Conclusion We hope to increase awareness of this rare presentation and emphasize the need for consensus on management approaches when encountering similar cases of prostate cancer tumor seeding in the future.
Abstract Background In Zinner syndrome (ZS), surgical intervention is recommended for pediatric patients with symptomatic disease. It is generally believed that cyst aspiration alone may lead to symptom recurrence. Although comprehensive surgical excision is often advocated to prevent recurrence, a combined approach of cyst aspiration and maximal cyst wall ablation may also provide lasting symptom relief. Case Presentation A 14‐year‐old boy with a long‐standing history of voiding difficulties presented with acute urinary retention. Pelvic magnetic resonance imaging revealed a 5 cm × 4 cm × 3.5 cm cystic lesion arising from the right posteroinferior prostate and compressing the bladder. Transurethral laser ablation of the ejaculatory duct cyst was performed using a holmium:YAG laser (0.8 J, 10 Hz). The patient recovered uneventfully and was discharged on postoperative Day 1. At the 1‐year follow‐up, he remained asymptomatic with normal uroflowmetry findings and only a small residual cyst visible on ultrasound. Conclusion For the management of large seminal vesicle cysts in ZS, combining cyst aspiration with cyst wall ablation provides an effective, safe, and durable therapeutic approach.
Abstract Background Nephrolithiasis is a common urologic condition, with increasing prevalence in the United States. This can often present with flank pain and hematuria; however, sequelae such as hydroureteronephrosis, forniceal rupture, and pyelonephritis can lead to more severe complications. Case Presentation This case report describes a 43‐year‐old female who presented to the hospital with left upper quadrant pain, fever, nausea, and vomiting. Imaging revealed an obstructive 0.7 cm kidney stone at the right ureterovesical junction with severe hydroureteronephrosis resulting in mass effect on the duodenum and upstream gastric dilation. Percutaneous nephrostomy placement resolved both the hydroureteronephrosis and the secondary gastrointestinal obstruction. Conclusion This case study highlights the rare complication of bowel obstruction caused by obstructive nephrolithiasis, underscoring the diverse clinical presentations of nephrolithiasis and the importance of timely, conservative management to avoid clinical decompensation.
Erectile dysfunction (ED) is one of the most frequent and distressing complications after radical prostatectomy (RP), significantly impairing patients’ quality of life and intimate relationships. Penile rehabilitation (PR) aims to preserve erectile tissue integrity, prevent fibrosis, and facilitate early functional recovery by restoring oxygenation to the corpora cavernosa. Current PR strategies include oral phosphodiesterase type 5 inhibitors (PDE5is), intracavernosal injections, and vacuum erection devices, used alone or in combination. Adjunctive options, such as low-intensity shockwave therapy, stem cell therapy, and platelet-rich plasma, are currently under investigation. Despite widespread use, there is no standardized PR protocol, and evidence remains mixed regarding optimal timing, dosage, and duration. This review summarizes contemporary and emerging PR modalities, highlighting evidence-based principles, patient selection, and integration of preoperative counseling to set realistic expectations. Psychosocial support, partner involvement, and multidisciplinary collaboration are essential to maximize adherence and recovery. Future research should prioritize high-quality randomized controlled trials to define standardized, evidence-based PR protocols tailored to individual risk profiles and preferences, ultimately improving functional recovery and quality of life after RP.
Supersonic transporter (SST) deformity, also known as floppy glans syndrome, represents a persistent source of post-operative dissatisfaction among patients undergoing inflatable penile prosthesis (IPP) implantation. Although infection and mechanical failure rates have declined with advances in device design and surgical technique, SST deformity remains a challenging anatomical complication. It results primarily from inadequate corporal dilation, undersized or malpositioned cylinders, or true glans hypermobility due to disruption or weakness of the corporo-glanular ligament. Diagnosis is largely clinical, supported by adjunctive imaging when needed, while the glans hypermobility scale has emerged as an objective tool for intra-operative grading and decision-making. Conservative approaches such as observation, phosphodiesterase type-5 inhibitors, intraurethral vasoactive agents, and vacuum therapy may offer benefit in mild cases, but durable correction is most consistently achieved through glanulopexy techniques, which now demonstrate success rates exceeding 85%–95% with low morbidity. This review synthesizes historical perspectives, evolving diagnostic approaches, and contemporary surgical management strategies for SST deformity. Future research into minimally invasive fixation and injectable bulking agents may further expand the treatment armamentarium for this complex but correctable cause of dissatisfaction following IPP implantation.
Abstract Surgical intervention for benign prostatic hyperplasia (BPH) can lead to postoperative stress urinary incontinence. Pelvic floor muscle exercises (PFME) are proposed as a non‐invasive strategy to mitigate symptoms, but their efficacy and optimal timing remain unclear. A systematic review of six studies (five randomized controlled trials and one prospective cohort) was conducted, evaluating PFME in men undergoing BPH surgery. Three studies investigated preoperative PFME, and three evaluated postoperative interventions. Outcomes included incontinence rates, lower urinary tract symptoms (LUTS), pelvic floor muscle strength, and quality of life. Evidence for preoperative PFME was mixed; one trial ( n = 70) demonstrated significantly reduced incontinence at 3 months (3% vs. 26%; p = 0.01), while another ( n = 49) found improved muscle endurance without clinical benefits. In contrast, postoperative PFME showed more consistent improvements. One randomized controlled trial (RCT) ( n = 61) reported significantly better LUTS at 12 weeks (IPSS: 3.32 vs. 6.33; p < 0.001) and better quality of life. Another ( n = 58) noted fewer incontinent episodes at 1–3 weeks ( p < 0.01). However, a large multicenter randomized controlled trial ( n = 442 TURP patients) found no long‐term benefit in incontinence rates at 12 months (65% vs. 62%). In conclusion, PFME may enhance the postoperative recovery of continence and LUTS, particularly when initiated early and performed consistently. Preoperative PFME shows promise but requires further validation. Heterogeneity in study designs highlights the need for standardized, large‐scale trials to define optimal PFME protocols for this population.
Abstract High‐intensity focused ultrasound (HIFU) has emerged as a widely adopted, minimally invasive treatment for localized prostate cancer (PC). Although originally applied for whole‐gland treatment, recent advancements in imaging and technology have facilitated the adoption of HIFU as a focal therapy modality, targeting clinically significant prostate cancer (CSPC) while preserving surrounding functional structures. Recently, transrectal prostate compression during HIFU has been developed to improve treatment precision by reducing intraoperative prostatic swelling and minimizing target displacement. This method improves the ultrasound propagation path, enhances cavitation, and mitigates the heat‐sink effect by reducing blood flow within the prostate. Clinical outcomes using HIFU with compression in 240 patients demonstrated high biochemical and pathological disease‐free survival rates across low‐, intermediate‐, and high‐risk groups (93.7%/92.2%, 88.5%/91.6%, and 84.8%/86.6%, respectively), with radical treatment‐free survival >94% in all groups. Complication rates were low, with no cases of recto‐urethral fistula reported. The rate of CSPC detection in follow‐up biopsies was significantly lower than in previous studies, suggesting improved local control. These findings support the efficacy and safety of focal HIFU therapy with intraoperative compression as a promising treatment for localized PC.
Abstract Backgroud Persistent Müllerian duct syndrome (PMDS) is a rare condition characterized by the persistence of Müllerian duct structures in genotypic and phenotypic males. Case Presentation We present the case of a 4‐month‐old male with PMDS who presented with transverse testicular ectopia. The patient underwent diagnostic laparoscopic orchiopexy with preservation of the Müllerian structures to maintain future fertility options. Due to the abnormal appearance of the testes, a biopsy revealed normal testis tissue without any ovarian tissue. Genetic testing identified a unique mutation in each copy of the AMHR2 gene: c.322A>C and c.658G>C. Neither mutation has been previously reported. Conclusion This case highlights the importance of considering PMDS in male infants presenting with transverse testicular ectopia. Early recognition and fertility‐preserving surgical management are essential, and novel genetic variants continue to expand the mutational spectrum of AMHR2‐related PMDS.
Liquid biopsy has emerged as a transformative approach in oncology, providing minimally invasive access to tumor‐derived biomarkers with applications across diagnosis, prognosis, therapeutic guidance, and disease monitoring. This literature review synthesizes evidence from 125 studies evaluating circulating tumor DNA, circulating tumor cells, extracellular vesicles, RNA species, and proteomic or metabolomic signatures in prostate, bladder, and renal cancers. The findings demonstrate that liquid biopsy technologies have shown substantial promise in early detection, risk stratification, and longitudinal surveillance, while also offering novel insights into therapeutic resistance and clonal evolution. However, clinical translation remains constrained by pre‐analytical variability, assay standardization challenges, limited sensitivity in low‐tumor‐burden settings, and the need for prospective validation in large, diverse populations. Despite these barriers, ongoing technological advances and integration with multi‐omics approaches are likely to accelerate the adoption of liquid biopsy as a complement to conventional tissue‐based diagnostics and imaging in genitourinary oncology.
ABSTRACT Holmium laser enucleation of the prostate (HoLEP) has emerged as a widely adopted surgical technique for the management of benign prostatic hyperplasia (BPH), regardless of prostate size; however, its impact on male sexual function—particularly in terms of erectile and ejaculatory outcomes—remains a subject of ongoing debate. The aim of this study is to critically evaluate the effects of HoLEP on male sexual function (SF), with emphasis on erectile and ejaculatory outcomes, intraoperative considerations, and comparative effectiveness versus other surgical treatments for BPH. The narrative review was conducted using PubMed, Web of Science, and Google Scholar to identify English‐language clinical studies, cohort trials, randomized controlled trials, and meta‐analyses published between January 2000 and May 2025. Included studies evaluated SF before and after HoLEP using validated tools such as the International Index of Erectile Function (IIEF) and the Male Sexual Health Questionnaire‐Ejaculatory Dysfunction (MSHQ‐EjD). The literature indicates that HoLEP has a neutral to modestly favorable effect on erectile function (EF). Transient declines may occur in the early postoperative period, with most patients returning to baseline by three to six months. In contrast, retrograde ejaculation is a frequent and expected outcome, with incidence rates typically ranging from 74% to 78%. While various surgical modifications—such as modified enucleation techniques and partial apical preservation—have demonstrated potential in preserving ejaculatory function, outcomes remain inconsistent and poorly standardized. HoLEP is an effective and durable treatment for BPH with a stable EF profile but a high likelihood of ejaculatory dysfunction. Although promising ejaculation‐sparing techniques exist, robust evidence supporting their routine use is lacking. Future research should focus on standardized intraoperative strategies, validated patient‐reported outcome measures, and personalized approaches to optimize both urinary and sexual outcomes.
Abstract Background Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, with common metastatic sites including the lungs, bones, liver, and brain. Omental metastasis is exceedingly rare and usually occurs postoperatively. Fumarate hydratase‐deficient (FH‐deficient) RCC, a recently classified and highly aggressive subtype of RCC, is known to show early metastatic potential but remains poorly understood. We present a rare case of synchronous FH‐deficient RCC with isolated omental metastasis identified at diagnosis. Case Presentation We report the case of a 48‐year‐old man who first presented with abdominal pain, early satiety, and a 25‐pound weight loss. Imaging revealed an 11.8 cm right renal mass with a separate 15.4 cm left upper quadrant mesenteric mass with no definitive evidence of lung, bone, or liver involvement. Biopsies of both renal and mesenteric masses confirmed non‐clear‐cell FH‐deficient RCC with papillary architecture and diffuse overexpression of 2‐succinyl cysteine. Conclusion Omental metastasis of RCC is rare, especially in the absence of prior surgery. This case is distinguished by its synchronous presentation of the primary RCC and omental metastasis with a rare histologic subtype. Unlike most documented reports of RCC with omental spread, which typically involve clear cell histology and often present years after nephrectomy, this case involves a rare, aggressive subtype with atypical metastatic behavior. This case underscores the importance of considering atypical metastatic patterns in non‐clear‐cell subtypes and the need for further research to inform evidence‐based therapy.
