Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are common in older patients assigned male sex at birth, regardless of gender identity, and treatment of these symptoms is therefore common in primary care practice. In 2021, the American Urological Association published guidelines for management of BPH. They recommend using a standardized scoring system such as the International Prostate Symptom Score to help establish a diagnosis and to monitor the efficacy of interventions, α-blockers as the first-choice pharmacotherapy option, and 5α-reductase inhibitors for patients with prostate size estimated to be at least 30 cc. Tadalafil is another option regardless of erectile dysfunction. Combination therapies with α-blockers and 5α-reductase inhibitors, anticholinergic agents, or β3-agonists are effective options. A surgical referral is warranted if the BPH results in chronic kidney disease, refractory urinary retention, or recurrent urinary tract infections; if there is concern for bladder or prostate cancer; or if symptoms do not respond to medical therapy. In this article, a general internal medicine physician and a urologist discuss the treatment options and how they would apply their recommendations to a patient who wishes to learn more about his options.

INTRODUCTION:In the development of terminology of the lower urinary tract, due to its increasing complexity, the terminology for male lower urinary tract and pelvic floor symptoms and dysfunction needs to be updated using a male-specific approach and via a clinically-based consensus report.METHODS:This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 22 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).RESULTS:A Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction, encompassing around 390 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in male lower urinary tract and pelvic floor dysfunction. Male-specific imaging (ultrasound, radiology, CT, and MRI) has been a major addition whilst appropriate figures have been included to supplement and help clarify the text.CONCLUSIONS:A consensus-based Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

Underactive bladder (UAB) is defined by the International Continence Society as a symptom complex characterized by a slow urinary stream, hesitancy, and straining to void, with or without a feeling of incomplete bladder emptying sometimes with storage symptoms. Until recently, the topic has received little attention in the literature probably due to a lack of consistent definitions and diagnostic criteria. We performed a literature review to identify articles related to the diagnosis and management of UAB, specifically in female patients. UAB is a common clinical entity, occurring in up to 45% of females depending on definitions used. Prevalence increases significantly in elderly women and women who live in long-term care facilities. The exact etiology and pathophysiology for developing UAB is unknown, though it is likely a multifactorial process with contributory neurogenic, cardiovascular, and idiopathic causes. There are currently no validated questionnaires for diagnosing or monitoring treatment for patients with UAB. Management options for females with UAB remain limited, with clean intermittent catheterization, the most commonly used. No pharmacotherapies have consistently been proven to be beneficial. Neuromodulation has had the most promising results in terms of symptom improvement, with newer technologies such as stem-cell therapy and gene therapy requiring more evidence before widespread use. Although UAB has received increased recognition and has been a focus of research in recent years, there remains a lack of diagnostic and therapeutic tools. Future research goals should include the development of targeted therapeutic interventions based on pathophysiologic mechanisms and validated diagnostic questionnaires.

There are many options available in the surgical treatment of outlet obstruction secondary to benign prostatic hyperplasia (BPH). While most patients exhibit improvement in their lower urinary tract symptoms (LUTS) following intervention, up to 35 % of patients may exhibit persistent or recurrent LUTS. In the present review, we discuss the pathophysiology of LUTS after bladder outlet surgery and discuss considerations in evaluating and managing such patients. We highlight the crucial role of thorough evaluation with complete urodynamics testing, as pure obstruction only accounts for a minority of post-operative LUTS. Hence, detrusor contractility, detrusor overactivity, urethral sphincter function, and urinary incontinence must be assessed to appropriately guide subsequent therapy and improve patients' quality of life.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making IV1 Apr 2016MP37-12 UROLOGY APPLICANTS′ CRITERIA FOR EVALUATING AND MATCHING INTO RESIDENCY Amir H Lebastchi, Ian D McLaren, Gary J Faerber, Kate H Kraft, Khaled S Hafez, Casey A Dauw, Vincent G Bird, Thomas F Stringer, Ajay Singla, Mathew D Sorensen, Hunter Wessells, and Sapan N Ambani Amir H LebastchiAmir H Lebastchi More articles by this author , Ian D McLarenIan D McLaren More articles by this author , Gary J FaerberGary J Faerber More articles by this author , Kate H KraftKate H Kraft More articles by this author , Khaled S HafezKhaled S Hafez More articles by this author , Casey A DauwCasey A Dauw More articles by this author , Vincent G BirdVincent G Bird More articles by this author , Thomas F StringerThomas F Stringer More articles by this author , Ajay SinglaAjay Singla More articles by this author , Mathew D SorensenMathew D Sorensen More articles by this author , Hunter WessellsHunter Wessells More articles by this author , and Sapan N AmbaniSapan N Ambani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1689AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is unclear whether urology residency applicants understand how they are ranked. Furthermore, we do not know how applicants evaluate training programs. We conducted a national survey to better understand how future urology residents evaluate residency programs, and how they feel they are evaluated. METHODS A survey was sent to all 2016 urology residency match applicants who applied to the urology training program at one of 4 participating institutions. Participants were asked to rank criteria they used to evaluate training programs, as well as rank what they felt programs used in the selection of potential trainees. Analysis of variance with post-hoc testing was used to compare and evaluate differences in mean ranks. RESULTS 322 applicants with baseline demographics similar to historical data responded. Applicants ranked operative experience, followed by interaction with residents, as most important when evaluating potential training programs (Table 1). 46% of respondents felt geography played at least a strong role in determining their future training program. Applicants felt that training programs considered United States Medical Licensing Examination scores, followed by urology references, as most important when selecting future residents (Table 2, Figure). CONCLUSIONS Urology applicants have significant insight into what factors influence their ranking by training programs. Additionally, the results of our survey provide data on what today′s applicants value in a training program, which programs may find useful when marketing their program to future applicants. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e501-e502 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Amir H Lebastchi More articles by this author Ian D McLaren More articles by this author Gary J Faerber More articles by this author Kate H Kraft More articles by this author Khaled S Hafez More articles by this author Casey A Dauw More articles by this author Vincent G Bird More articles by this author Thomas F Stringer More articles by this author Ajay Singla More articles by this author Mathew D Sorensen More articles by this author Hunter Wessells More articles by this author Sapan N Ambani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

AimsTo review available evidence regarding evaluation and treatment of stress urinary incontinence (SUI) and provide recommendations for management of urinary incontinence under specific conditions determined by the International Federation of Gynecology and Obstetrics (FIGO) Working Group.MethodsThe FIGO Working Group discussed the management of SUI during meetings and assessed the evidence. The search of evidence was performed using MEDLINE® and Cochrane databases as well as additional searches from societies and major organizations for additional guidelines and recommendations and hand searches from bibliographies. Initial searches from 1985 to December 31, 2012 extended until July 15, 2015. After review, recommendations are made based on levels of evidence according to the recommendations from Oxford EBM Center.ResultsInitial evaluation of SUI consists of history and physical examination; cough stress test, evaluation for urinary tract infections (UTI), assessment of urethral mobility, and post‐void residual volumes (LOE 5). Urodynamic studies are not necessary to evaluate patients with uncomplicated SUI (LOE 1a). Conservative treatment should be tried prior to surgery and more importantly in areas of low resources (LOE 5). Midurethral slings (MUS), pubovaginal (traditional suburethral) slings (PVS), and Burch colposuspension are effective in treating SUI (LOE 1a). Patients with SUI with ISD or UUI appear to have lower cure rates than patients without (LOE 2‐4). There are limited data on surgical outcomes under limited resources (LOE 5).ConclusionsMUS, PVS, and Burch colposuspension are effective treatments for SUI. Evidence for recommendations to treat patients in underserved low resource areas is lacking. Neurourol. Urodynam. 36:518–528, 2017. © 2016 Wiley Periodicals, Inc.

The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point.

High-flow priapism secondary to posttraumatic arteriovenous fistula (AVF) formation is a condition that can be easily diagnosed via penile color Doppler ultrasonography. In order to make the diagnosis, however, adequate coverage of the shaft and perineum is required when performing the scan. This case highlights failure to properly cover these areas, resulting in missed diagnosis of penile AVF.

Urethral compression provided by a male sling is not a new concept.A variety of urethral compression procedures have been applied in an attempt to control urinary incontinence over the years.Most notable were the Kaufman procedures which used silicone gel prosthesis to compress the ventral urethra.In the last decade various slings have emerged as popular alternative to the gold standard artificial urinary sphincter (AUS).The modern sling evolved from the bulbo-urethral sling of Schaeffer et al. to slings being used currently. New Developments in Male Sling in the Last Decade

Over the last 25 years, the field of urology has seen the advent and evolution of minimally invasive surgical techniques. The robot in particular has been shown to be safe and efficacious in managing malignancies. More recently its application has been expanded to benign urological conditions. While some robotic applications have been well established, others remain at varying stages of evolution. Relative to open approaches, the robot has been shown to enhance intraoperative visualization and precision, mitigate surgeon tremor, hasten post-operative recovery, and shorten length of hospital stay for certain indications; however, it has also been associated with higher costs, longer operative times, and limited outcomes data. We review the evolution of robotic applications within urology and speculate on the future directions and implications within the field.

Urinary incontinence after prostatectomy or radiation is a devastating problem in men and remains the most feared complication following the treatment of localized prostate cancer. With an increasing number of radical prostatectomies performed globally for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. With the advent of male sling procedures, more men are now seeking treatment for incontinence. Since the introduction of the artificial urinary sphincter almost four decades ago, several surgical procedures have emerged to manage post-prostatectomy incontinence, including the male sling for milder forms of incontinence. Several of the newer procedures have shown promise in the United States; many others have been developed and utilized in other parts of the world, though they have not yet gained FDA approval in the United States. The present review seeks to illuminate the etiology, evaluation, and management of post-prostatectomy incontinence. An effort has been made to provide an algorithm to clinicians for appropriate surgical management. The surgical techniques of commonly performed procedures and their outcomes are described.