Background/Objectives: Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) affects up to 60% of men by age 90. With Singapore’s aging population, minimally invasive surgical therapies (MIST) have emerged as effective alternatives for patients unsuitable for traditional surgery. We sought to evaluate real-world outcomes of MIST procedures: Water Vapor Thermal Therapy (WVTT) and Prostatic Urethral Lift (PUL) in treating BPH-related LUTS. Methods: This is a retrospective analysis of 62 MIST patients treated at a tertiary hospital in Singapore between August 2021 and February 2025, with a minimum of three-month follow-up. Primary outcomes included improvements in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and Quality of Life (QoL) scores. Secondary outcomes included complications, re-treatment rates, and healthcare utilization metrics. Results: Thirty-six patients underwent WVTT, and 26 underwent PUL. Median age was 67 years, with a mean prostate volume of 61 cm3. At three months, both procedures showed improvements: Qmax increased by 4.28 mL/s (WVTT, p < 0.001) and 3.46 mL/s (PUL, p = 0.06); IPSS decreased by 12.8 (WVTT, p < 0.001) and 12.5 (PUL, p < 0.001); QoL scores improved by 2.53 (WVTT, p < 0.001) and 3.31 (PUL, p < 0.001). The complication rate was 32.3%, with complications being predominantly Clavien–Dindo grades 1–2. Day surgery was achieved in 83.9% of cases, with only 4.8% requiring readmission within 30 days. At three months, 98.4% were catheter-free, and excluding prior catheter-dependent patients, 82.4% were medication-free. At a median follow-up of 5.9 months, the re-treatment rate was 3.2%. Conclusions: MIST procedures are safe and effective for BPH-LUTS, showing comparable outcomes between WVTT and PUL while optimizing healthcare resource utilization.
Hydrocele is among the oldest documented urological conditions in medical history [...]
Background/Objectives: Third-generation cephalosporins are used to treat many infections, including urinary tract infections. Despite the risk of inducing resistance in SPICE-HaM microorganisms (Serratia, Providencia, indole-positive Proteus, Citrobacter freundii complex, Enterobacter cloacae complex, Klebsiella aerogenes, Hafnia alvei and Morganella morganii), a group of microorganisms with inducible beta-lactamase potentials, guidelines still recommend treating uncomplicated cystitis with third-generation cephalosporins. To improve outpatient pediatric antimicrobial practice, this study aimed to develop a five-year pediatric cumulative antimicrobial susceptibility testing report for SPICE-HaM microorganisms in urine and compare the in vitro sensitivity of cefixime/ceftriaxone with sulfamethoxazole/trimethoprim. Methods: Over 300 pediatric SPICE-HaM urine isolates, processed at regional microbiology laboratories of LifeLabs British Columbia between 2020 and 2024, were analyzed. Results: Compared to cefixime, sulfamethoxazole/trimethoprim demonstrated higher sensitivity against Citrobacter freundii complex (65% versus 95%, p < 0.05, n = 57), Enterobacter cloacae complex (49% versus 92%, p < 0.05, n = 89), and Morganella morganii (68% versus 92%, p < 0.05, n = 76). Compared to ceftriaxone, sulfamethoxazole/trimethoprim failed to show significantly different sensitivities for the SPICE-HaM microorganisms. Conclusions: Sulfamethoxazole/trimethoprim is possibly a more favourable oral agent for SPICE-HaM-associated urinary tract infections in the local pediatric community population compared to cefixime, a third-generation cephalosporin. However, compared to ceftriaxone, sulfamethoxazole/trimethoprim appears to have similar efficacy for SPICE-HaM-associated urinary tract infections.
Prostate cancer remains one of the most frequently diagnosed malignancies in men worldwide, and despite favorable outcomes for localized disease, progression to castration-resistant prostate cancer (CRPC) represents a major clinical challenge associated with poor prognosis. CRPC is characterized by disease progression despite castrate levels of circulating testosterone and is most commonly diagnosed in the metastatic setting. Although the introduction of second-generation androgen receptor-targeted therapies has improved survival, resistance inevitably emerges. This review overviews the most recent findings in the field of CRPC with particular emphasis on the current understanding of the biological mechanisms of hormone-resistant cancer as well as the evidence on treatment strategies. A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, focusing mainly on studies published between 2015 and 2025 that investigated molecular and cellular mechanisms of resistance to androgen deprivation therapy and androgen receptor (AR)-targeted treatments. Seventy-eight relevant articles were included in the final synthesis. The reviewed evidence highlights four major categories of resistance mechanisms. First, AR-dependent alterations remain predominant, including AR gene amplification, activating mutations, dysregulation of co-regulators, and expression of constitutively active AR splice variants such as androgen receptor variant 7 (AR-V7). Second, AR-independent or bypass pathways, most notably phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR), wingless-related integration site (WNT)/β-catenin, mitogen-activated protein kinase (MAPK), and glucocorticoid receptor signaling, enable tumor survival despite AR blockade. Third, lineage plasticity and transdifferentiation to neuroendocrine prostate cancer represent a distinct and increasingly recognized resistance mechanism driven by loss of tumor protein 53 (TP53) and retinoblastoma 1 (RB1) and epigenetic reprogramming. Finally, additional contributors, including intratumoral androgen synthesis, metabolic reprogramming, and tumor microenvironment interactions, further support disease progression. Together, these interconnected mechanisms underscore the biological complexity of CRPC and emphasize the need for biomarker-guided, combination-based therapeutic strategies to overcome resistance and improve patient outcomes.
Background/Objectives: Penile appearance is an important endpoint for hypospadias surgery. It is difficult to achieve good cosmetic results in patients with complications following hypospadias repair. Currently, there is not much data on factors which influence patient-reported outcomes of salvage hypospadias repair. Methods: A retrospective analysis of a prospectively maintained database on salvage hypospadias repair was performed. This cross-sectional study included 112 patients who were treated in our center for complications of previous attempts at hypospadias repair. We used the Penile Perception Score (PPS) questionnaire to evaluate cosmetic outcomes. The difference between the PPS value before salvage hypospadias surgery and the value at follow-up was the primary outcome of this study. The incidence of various cosmetic problems and the impact of patient-related and surgery-related factors on cosmetic outcome were secondary outcomes of this study. Results: Median PPS prior to salvage surgery was 9 (interquartile range (IQR): 6–13); this increased to 13 (IQR: 11–14) after surgery (p < 0.001). Surgical interventions resulted in a statistically significant improvement for most of the cosmetic concerns, with the exception of buried penis, where the change was borderline (p = 0.063). Age group (at presentation), staged repair, and use of a tunica vaginalis flap were all statistically associated with a good cosmetic outcome on univariate analysis. Multivariate logistic regression analysis revealed that age group (>39 years vs. ≤25 years: odds ratio (OR) = 0.193, 95% confidence interval (CI) = 0.06–0.627, p = 0.006) and staged salvage hypospadias repair (OR = 5.919, 95% CI = 1.706–20.54, p = 0.005) were associated with good cosmetic outcomes. Conclusions: Most cosmetic problems associated with failed hypospadias repair are manageable, and these should be properly addressed during salvage surgery. Younger patients may have better cosmetic outcomes of salvage hypospadias surgery. Multiple-stage repair may offer an advantage in terms of the final appearance of external genitalia in this setting.
Background/Objectives: This study aims to assess changes in seminal parameters and sperm DNA fragmentation (SDF) index after empirical oral antibiotic therapy in infertile men with baseline SDF index > 15%. Methods: This retrospective, paired, uncontrolled pre- and post-intervention study included 98 infertile men with elevated baseline SDF index. Semen samples were obtained before treatment and at least two months after simultaneous oral treatment with ciprofloxacin 1000 mg/day for 21 days and doxycycline 100 mg/day for 10 days. Semen volume, sperm concentration, total sperm count, progressive motility, sperm morphology, round cell concentration, and SDF index were assessed before and after treatment. Results: After treatment, conventional semen parameters did not change significantly. Round cell concentration decreased from 0.3 to 0.2 × 106/mL (p = 0.003), and median SDF index decreased from 30% to 20% (p < 0.0001). Conclusions: Empirical oral antibiotic therapy was associated with reductions in the SDF index and round cell concentration in this cohort. Because microbiological confirmation and an untreated control group were lacking, causality cannot be established, and controlled studies are required before routine clinical adoption.
Background/Objectives: On 1 November 2023, the Medicare Benefits Schedule (MBS) introduced major reforms to prostate-specific antigen (PSA) testing in Australia, extending the minimum re-test interval for average-risk men (item 66655) from 12 to 23 months and introducing a new annual high-risk item (66654). These changes were aimed at reducing overscreening, aligning practice with national guidelines, and improving cost efficiency; however, their real-world impact on PSA utilisation, downstream diagnostic activity, and health-system costs has not been evaluated. Methods: We performed a national, population-level analysis of all reimbursed PSA tests (items 66655 and 66654) and prostate magnetic resonance imaging (MRI) scans (item 63541) from November 2021 to October 2025 using MBS claims data. Monthly utilisation trends were examined descriptively and modelled using interrupted time-series segmented regression with Newey–West heteroscedasticity- and autocorrelation-consistent standard errors. Economic impacts were estimated using schedule fees. MRI trends were assessed to explore early signals of downstream diagnostic change. Results: Prior to the reform, average-risk PSA testing (item 66655) averaged 61,704 claims per month (median 62,526). After November 2023, utilisation fell immediately to 49,620 and stabilised at a lower mean of 44,702 claims per month (median 43,495), representing a sustained 27.6 percent reduction. High-risk PSA testing (item 66654) accounted for 130,739 claims post-reform (10.9 percent of monthly post-reform PSA activity), but the increase in high-risk testing did not offset the reduction in average-risk claims; total PSA claims fell from 61,704 to 50,149 per month (−18.7 percent). Interrupted time-series modelling confirmed a large, significant step decrease for item 66655 (−23,191 claims, 95% confidence interval (CI) −31,215 to −15,167; p < 0.001) and for total PSA testing (−16,876 claims, 95% CI −25,899 to −7853; p < 0.001). In contrast, prostate MRI utilisation increased from 3854 to 4454 monthly scans (+15.6 percent) with no significant step-change at the time of the reform (p = 0.74) but a significant acceleration in post-reform growth (+49 scans/month, p = 0.0095). The reform resulted in an estimated net saving of $2.8 million in annual PSA expenditure. Conclusions: The November 2023 MBS reforms led to a large, immediate, and durable reduction in reimbursed PSA screening among average-risk men, while high-risk testing increased modestly but remained proportionally small. Total PSA testing declined meaningfully, producing substantial cost savings for Medicare. Rising MRI utilisation indicates that downstream diagnostic activity did not fall in parallel with reimbursed PSA claims, though this trend may reflect independent drivers of MRI growth rather than preserved screening vigilance. Reductions varied by jurisdiction, with two smaller jurisdictions showing net increases over the study window, underscoring that the national pattern was not uniform.
Background/Objectives: Urinary incontinence after radical prostatectomy remains a significant concern affecting postoperative quality of life. This study aimed to investigate whether the early postoperative International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score is associated with mid-term urinary continence outcomes, using a patient-reported outcome approach. Methods: We retrospectively analyzed patients who underwent robot-assisted radical prostatectomy between May 2020 and July 2023 at the International University of Health and Welfare Narita Hospital and completed follow-up at one and six months postoperatively. Urinary incontinence severity was assessed using the ICIQ-SF (range 0–21, with higher scores indicating more severe symptoms). The primary outcome was incontinence at 6 months, defined as any pad use. Multivariable logistic regression and exploratory receiver operating characteristic (ROC) analyses were performed. Results: A total of 74 patients with complete follow-up data at both time points were included in the analysis. The ICIQ-SF score at one month was significantly associated with urinary incontinence at six months in both univariable and multivariable analyses. In the adjusted model, a higher one-month ICIQ-SF score independently predicted urinary incontinence at six months (odds ratio 1.15; 95% confidence interval 1.04–1.27; p = 0.005). Age, body mass index, and nerve-sparing status were not significantly associated with incontinence at six months. Exploratory ROC analysis demonstrated acceptable discriminative ability (area under the curve (AUC) 0.74, 95% confidence interval (CI) 0.61–0.87). A cut-off value of 13 yielded a sensitivity of 76.9% and a specificity of 59.1%. Conclusions: The ICIQ-SF score assessed one month after radical prostatectomy significantly predicts persistent urinary incontinence at six months. Early postoperative ICIQ-SF assessment may help identify patients at higher risk of persistent urinary incontinence. Further prospective studies are warranted to determine whether risk-stratified postoperative management based on early ICIQ-SF assessment improves clinical outcomes.
An article in this issue on infant male circumcision argues that public healthcare funding should be directed to requests for infant male circumcision in Australia to address an inequity as a consequence of religious practice [...]
Background/Objectives: Double-J stents (DJS) cause clinically significant lower urinary tract symptoms (LUTS) in 58–80% of patients following ureteroscopy (URS). The distal vesical coil is regarded as the primary anatomical source of trigonal irritation and detrusor instability. The single-J stent (SJS) eliminates this element while preserving the proximal renal pigtail for anti-migration anchorage. This study aimed to evaluate the safety and patient-reported symptom outcomes of a modified SJS compared with standard DJS following elective URS for ureteric stone disease. Methods: A prospective, single-arm, within-patient feasibility study was conducted in 28 adults undergoing elective URS at Austin Health, Melbourne, Australia (Human Research Ethics Committee (HREC)/25658/Austin-2025; NCT07535580). A modified SJS was fashioned from a commercially available 7Fr Bander™ ureteral diversion stent (Cook Medical, G14780) by trimming the shaft to 28 cm and affixing a 7 cm Prolene retrieval suture (Ethicon NW807) to the blunt distal end. The primary outcome was a cystoscopically confirmed SJS migration rate at removal (pre-specified feasibility threshold ≤5%). Secondary outcomes included change in Ureteral Stent Discomfort Test (USDT) total and domain scores (paired analysis, n = 24), adverse events, and patient preference. Results: The clinically significant migration rate was 0% (0/28); 27/28 stent tips were freely floating within the bladder, with one asymptomatic tip at the ureteric orifice at the scheduled removal visit. Mean total USDT score decreased from 39.92 ± 2.00 (DJS) to 30.42 ± 1.73 (SJS)—a mean absolute reduction of 9.50 points (23.8%; p < 0.001), a magnitude consistent with clinically relevant change, although a USDT-specific minimum clinically important difference has not been independently validated. All six USDT domains improved significantly (all p ≤ 0.014). No adverse events were recorded. All 28 patients (100%) reported they would choose the SJS again. Conclusions: The modified SJS demonstrated a favourable safety profile and was associated with lower patient-reported symptom scores than the preceding DJS across all USDT domains in this uncontrolled within-patient comparison. Because stent design, stone burden, and dwell time differed between the two assessment phases, these differences should be regarded as hypothesis-generating and provide a feasibility basis for a prospective randomised controlled trial evaluating the SJS following URS.
The evolution of ureteroscopy has been characterized by remarkable technological advances, leading to excellent stone-free rates, lower complication rates, and increasingly efficient procedures [...]
Prostate cancer is the most commonly diagnosed malignancy among Australian men and survivorship care represents an increasingly important component of urological practice [...]
Background/Objectives: To evaluate the feasibility, in-hospital mortality, and perioperative morbidity of open radical cystectomy performed entirely under combined spinal-thoracic epidural anesthesia (CSTEA) in patients with a predominantly high anesthetic risk profile. Methods: This retrospective multicenter cohort study included 145 consecutive adults with histologically confirmed bladder cancer who underwent open radical cystectomy with pelvic lymph node dissection and urinary diversion under planned CSTEA at two institutions between 2008 and 2017. The rationale for CSTEA was to preserve spontaneous breathing and avoid planned intubation and neuromuscular blockade in selected patients. The primary endpoint was in-hospital mortality during the index admission. Results: Most patients were classified as American Society of Anesthesiologists (ASA) III (85.5%) or ASA IV (1.4%). Urinary diversion consisted of transureteroureterocutaneostomy in 97 patients (66.9%), ileal conduit in 24 (16.6%), and orthotopic ileal neobladder in 24 (16.6%). No patient required intraoperative conversion to general anesthesia. In-hospital mortality was 0.7% (1/145), and severe complications occurred in 5.5%. Median length of stay was 15 days, and median postoperative pain score was 1. Conclusions: Open radical cystectomy under CSTEA appeared feasible in selected patients and was associated with low in-hospital mortality, low severe complication rates, and favorable early recovery. These findings support CSTEA as a feasibility-based option in experienced centers, while prospective comparative studies using standardized in-hospital, 30-day, and 90-day endpoints are needed.
Background/Objectives: Prostate biopsy is essential for diagnosing prostate cancer. Social determinants of health (SDOH), including socioeconomic status, race, occupation, education, and environment, affect access, outcomes, and quality of life. Recognizing disparities from technology access to complications is crucial for equitable care. A systematic review examined how SDOH impacts biopsy access, technology, and complications. Methods: A systematic search of PubMed, Web of Science, and Scopus was performed to identify eligible studies published through February 2026. We included studies that evaluated the association between one or more SDOHs and prostate biopsy. Relevant outcomes included biopsy utilization, use of specific biopsy technologies (e.g., magnetic resonance imaging (MRI)-guided, transperineal), and post-procedural complications. Results: Nine observational studies met the inclusion criteria. The findings revealed disparities across three key domains. First, access to advanced biopsy technology was uneven. Four studies showed that Black men were significantly less likely than White men to receive MRI-guided biopsies. Additionally, post-biopsy outcomes showed that Black and Hispanic men faced significantly higher rates of post-biopsy infection and hospitalization compared to White men. Lastly, patients in rural areas, those in public hospitals, and individuals with lower socioeconomic status demonstrated reduced access to modern techniques, including MRI-guided or transperineal biopsy. Conclusions: Social and economic factors influence who receives a prostate biopsy and who has access to advanced technologies. Minority and low-income patients face diagnosis barriers and higher complication rates, highlighting systemic inequities. The healthcare system often rewards access over need, and without bold policy changes, gaps in technology and resources will worsen, moving us further from truly equitable prostate cancer care.
In the current issue of Société Internationale d’Urologie Journal, Peich et al [...]
Background/Objectives: Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive intervention for overactive bladder (OAB) typically utilized in patients for whom behavioural and pharmacological therapies do not work. The aim of this study is to identify predictors of progression to alternate minimally invasive treatment options following PTNS in patients with OAB refractory to medical and behavioural therapy. In addition, the aim of this study is to determine predictors of maintenance therapy after completing PTNS induction. Methods: This study is a retrospective cohort analysis of patients that underwent PTNS between March 2018 and June 2023 for management of overactive bladder. The primary outcome of this study is progression to alternate minimally invasive treatment options following PTNS, such as sacral neuromodulation or intradetrusor onabotulinum toxin injections. The secondary outcome of this study is the continuation of maintenance therapy following the initial 12-week PTNS treatment course. Results: A total of 49 patients were included for analysis. Overall, 33% (16/49) of patients had further alternate minimally invasive treatment. Multivariate logistic regression analysis identified only age (odds ratio (OR) = 1.06; p = 0.05) as a significant predictor of progression to alternate minimally invasive OAB treatment following PTNS. Overall, 27 (55%) patients continued with ongoing monthly maintenance PTNS after completing initial weekly treatment for OAB. Multivariate logistic regression only identified sex as a predictor of ongoing maintenance PTNS (OR = 13.2; p = 0.017). Conclusions: The present study identifies younger age as a significant predictor of progression to further minimally invasive OAB treatments after PTNS. Furthermore, female sex was found to be a significant predictor of ongoing maintenance PTNS.
Background/Objectives: Variations in urinary symptom improvement after benign prostatic hyperplasia (BPH) surgery remain incompletely characterized. Preoperative factors, including bowel dysfunction, may influence postoperative recovery. We evaluated the association between baseline bowel function and urinary outcomes after holmium laser enucleation of the prostate (HoLEP), hypothesizing that worse baseline constipation would be associated with poorer outcomes. Methods: A prospective cohort study of patients undergoing HoLEP by a single surgeon at a high-volume center (December 2023–September 2024) was performed. Patients with neurogenic bladders, bowel disorders, or diabetes mellitus were excluded. Baseline bowel function was assessed using the Constipation Scoring System (CSS) and Vaizey Incontinence Score (VIS). The primary outcomes were 3-month changes in International Prostate Symptom Score (IPSS) and Michigan Incontinence Severity Index (MISI). Associations were evaluated using Spearman correlation and multivariable linear regression. Results: Among 102 patients (median age of 71.6 years), 81 (79.4%) completed follow-up. The median prostate size was 90.5 cc, and 50% had prior urinary retention. The baseline CSS and VIS were low. IPSS, quality of life, and MISI bother improved postoperatively, while MISI severity showed minimal change. Higher CSS correlated with higher VIS (p < 0.001). Baseline CSS and VIS were not associated with changes in IPSS, quality-of-life (QoL), or MISI bother. Baseline VIS was associated with modest improvement in MISI severity (β −1.14, p = 0.01). Conclusions: Baseline bowel function was not associated with urinary symptom improvement after HoLEP. However, preoperative fecal incontinence was associated with improvement in urinary incontinence severity.
