You have accessJournal of UrologyPenile & Testicular Cancer I (MP01)1 May 2024MP01-19 RADIOLOGIC AND CLINICAL PREDICTORS OF CONCURRENT VASCULAR SURGERY IN POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER Farshad Sheybaee Moghaddam, Justin Lee, Sanam Ladi Seyedian, Alireza Ghoreifi, Sina Sobhani, Maria Lizana, Taseen Haque, Madeleine L. Burg, Ryan Lee, Anne Schuckman, Siamak Daneshmand, Nima Momenin, and Hooman Djaladat Farshad Sheybaee MoghaddamFarshad Sheybaee Moghaddam , Justin LeeJustin Lee , Sanam Ladi SeyedianSanam Ladi Seyedian , Alireza GhoreifiAlireza Ghoreifi , Sina SobhaniSina Sobhani , Maria LizanaMaria Lizana , Taseen HaqueTaseen Haque , Madeleine L. BurgMadeleine L. Burg , Ryan LeeRyan Lee , Anne SchuckmanAnne Schuckman , Siamak DaneshmandSiamak Daneshmand , Nima MomeninNima Momenin , and Hooman DjaladatHooman Djaladat View All Author Informationhttps://doi.org/10.1097/01.JU.0001008660.87408.90.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The success of post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for testicular tumors depends on thorough resection of residual tumors, often requiring additional surgeries such as vascular procedures. We aimed to explore the radiologic and clinical parameters linked to vascular resection during PC-RPLND. METHODS: We retrospectively analyzed our IRB-approved testis cancer database, reviewing pre- and post-chemotherapy CT scans of patients who underwent PC-RPLND for testicular germ cell tumors from 2004 to 2022. We used neural network machine learning and multivariable analysis (MVA) to find independent predictors of vascular resection. RESULTS: Of 230 PC-RPLND patients, 48 (21%) had concurrent vascular procedures. Among 35 patients with available imaging, 26 had inferior vena cava (IVC) resection without graft placement. Of 30 patients with great vessel resection, four had aortic (11.4%), and three had both IVC and aortic resection (8.6%). Nine had metastatic mature teratoma; three had viable tumors in the resected vena cava, including a metastatic seminoma and two embryonal carcinomas. The recurrence rate was 16.7% in the great vessel resection group. Tables 1 and 2 show the baseline and the radiologic features, respectively. Figure 1 depicts the normalized significance of variables, emphasizing the impact of the pre-chemotherapy IVC diameter, craniocaudal size, and circumferential contact of the dominant mass with the IVC. On univariate analysis, pure non-seminoma, higher clinical stage, pre-chemotherapy inter-aortocaval mass, and IVC thrombosis in post-chemotherapy CT scan were associated with great vessel resection, but none were significant on MVA. CONCLUSIONS: IVC resection was the main concurrent vascular surgery in PC-RPLND. Machine learning identified potential predictors for additional vascular interventions, such as clinical stage, orchiectomy pathology, and IVC radiologic parameters. Larger studies are needed to validate this correlation. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e10 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Farshad Sheybaee Moghaddam More articles by this author Justin Lee More articles by this author Sanam Ladi Seyedian More articles by this author Alireza Ghoreifi More articles by this author Sina Sobhani More articles by this author Maria Lizana More articles by this author Taseen Haque More articles by this author Madeleine L. Burg More articles by this author Ryan Lee More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Nima Momenin More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinical History: A 60-year-old man with prostate specific antigen (PSA) of 10.8 ng/mL underwent a biopsy that showed grade group (GG) 5 adenocarcinoma of the prostate. The MRI showed organ-confined disease although there was an indeterminate 1 cm node in the left anterolateral perirectal fat. During the robotic radical prostatectomy, bilateral extended node dissection was performed, but the perirectal lymph node was not identifiable. Final pathology report confirmed adenocarcinoma GG5, pT2pN0MxR0, 22 lymph nodes were examined. At 3 months follow-up, PSA was 7.5 ng/mL. Diagnosis: Axumin positron emission tomography and computed tomography showed a solitary hot spot at the location of the perirectal node. We discussed treatment options androgen deprivation therapy, radiotherapy, and surgery. The patient elected for perirectal lymph node dissection (LND). In office contrast-enhanced transrectal ultrasound (TRUS) was performed. This confirmed location and visibility for planned intraoperative TRUS-guided excision. Intervention: Robotic LND started between the rectovesical pouch and the anterolateral aspect of the distal rectum. The node was identified with intraoperative TRUS and then a 17F Chiba needle was placed transrectally through the node into the surgical field. Transfixing the node gave direct vision and guided the robotic LND off the rectal wall and surrounding fat. There were no intraoperative complications, operative time was 214 minutes, estimated blood loss minimum, and length of stay 1 day. Follow-Up: Pathology report confirmed two distinct lymph nodes with metastatic prostatic carcinoma with 14- and 3-mm tumor deposit, respectively. PSA has remained undetectable at last follow-up, 40 weeks after LND. Authors do not have any commercial associations during the past 3 years that might create a conflict of interest in connection with the video. Authors have received and archived patient consent for video recording and publication in advance of video recording of procedure. Runtime of video: 5 mins

Objective: The aim of this study is to report our experience in minimally invasive management of rectovesical fistulae (RVFs). Materials and Methods: Between 2004 and 2021, 24 patients who underwent minimally invasive RVF repair by a single surgeon at 3 international institutions were retrospectively reviewed. Baseline demographic characteristics and perioperative and postoperative variables were collected. Complications were reported using the modified Clavien-Dindo Classification System and the European Association of Urology Complication Guidelines Panel Assessment and Recommendations. Fistula repair was defined as confirmation of fistula closure by imaging and complete resolution of fistula-related symptoms at the 12-month follow-up. Continuous variables are reported as medians and quartiles, whereas categorical variables are reported as frequencies and percentages. Results: Twenty-four patients with RVFs were treated: 22 males (91.7%) and 2 females with a median age of 66 (64.2-68) years. Twenty cases (83.3%) occurred postsurgery, three cases (12.5%) after surgery with combined radiotherapy, and one case (4.1%) after a combination of energy treatments. A robotic approach was performed in 19 patients (79%) and laparoscopic approach in 5 patients (21%). Ninety-six percent of patients had previous fecal diversions. No intraoperative complications were recorded. The median operative time was 180 (140-282) minutes, estimated blood loss was 50 (40-125) mL, and length of hospital stay was 2 (2-3) days. There were two Grade II complications and one Grade IIIb complication. All patients met criteria for repair. Conclusions: Minimally invasive management of RVFs is feasible. More studies are needed to assess the role of this approach among all RVF management options.

You have accessJournal of UrologyCME1 Apr 2023V08-04 UROLOGIC COMPLICATIONS DURING HARTMANN REVERSAL PROCEDURE: ROBOTIC-ASSISTED MANAGEMENT OF TWO CASES OF ENTEROVESICAL FISTULAE Jaime Poncel, Aref S. Sayegh, Alexandre K. Hidaka, Maria A. Lizana, Sij Hemal, Luis G. Medina, and Rene Sotelo Jaime PoncelJaime Poncel More articles by this author , Aref S. SayeghAref S. Sayegh More articles by this author , Alexandre K. HidakaAlexandre K. Hidaka More articles by this author , Maria A. LizanaMaria A. Lizana More articles by this author , Sij HemalSij Hemal More articles by this author , Luis G. MedinaLuis G. Medina More articles by this author , and Rene SoteloRene Sotelo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hartmann procedure is the resection of the rectosigmoid colon, closure of the rectal stump, and creation of an end colostomy. Unfortunately, a Hartmann reversal to re-establish intestinal continuity carries high morbidity with a complication rate of up to 58%. Urological complications during Hartmann’s reversal procedure are rare however low rates of bladder injury (8.16-16%) and fistula formation (0.6-4.08%) have been reported in the literature. This video presents a step-by-step robotic surgical technique for the repair of two entero-vesical fistulae likely caused due to the incorrect use of the circular surgical stapler during a Hartmann’s reversal. METHODS: Two consecutive cases of entero-vesical fistulae were treated through a novel robotic transabdominal approach by a single surgeon. Surgical steps were performed as illustrated in the video. Perioperative and functional outcomes were evaluated and reported. Continuous variables were reported as median and quartiles, whereas categorical variables were presented as frequencies and percentages. RESULTS: Two cases are reported with a median age of 71 (59-83). Both surgeries were uneventful with no intraoperative complications reported. Median operative time estimated blood loss, and length of stay were 557 (454-660) minutes, 150 (100-200) cc, and 3 (2-4) days, respectively. Median Jackson-Pratt drain removal time was 6.5 (4-9) days. Median catheter removal time was 18 (14-22) days. One case of urinary tract infection occurred during the postoperative period, which was successfully treated. No fistula recurrence was reported. CONCLUSIONS: Hartmann reversal is a morbid procedure that carries a small risk of urological complications, which may have a significant impact on patient's quality of life. Herein, we present the robotic-assisted management of enterovesical fistula formation following two Hartmann reversals and demonstrate the feasibility and safety of utilizing a minimally invasive approach. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e749 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jaime Poncel More articles by this author Aref S. Sayegh More articles by this author Alexandre K. Hidaka More articles by this author Maria A. Lizana More articles by this author Sij Hemal More articles by this author Luis G. Medina More articles by this author Rene Sotelo More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023PD41-12 PERIOPERATIVE COMPLICATIONS AND OUTCOMES OF PATIENTS UNDERGOING AQUABLATION FOR BENIGN PROSTATIC HYPERPLASIA: A SINGLE TERTIARY REFERRAL CENTER EXPERIENCE IN 146 PATIENTS Alireza Ghoreifi, David Ortega Herrera, Michael Eppler, Randall Lee, Maria Lizana, Abhisek Venkat, Marissa Maas, Andre Abreu, Rene Sotelo, Mike Nguyen, Inderbir Gill, Leo Doumanian, Giovanni E. Cacciamani, and Mihir Desai Alireza GhoreifiAlireza Ghoreifi More articles by this author , David Ortega HerreraDavid Ortega Herrera More articles by this author , Michael EpplerMichael Eppler More articles by this author , Randall LeeRandall Lee More articles by this author , Maria LizanaMaria Lizana More articles by this author , Abhisek VenkatAbhisek Venkat More articles by this author , Marissa MaasMarissa Maas More articles by this author , Andre AbreuAndre Abreu More articles by this author , Rene SoteloRene Sotelo More articles by this author , Mike NguyenMike Nguyen More articles by this author , Inderbir GillInderbir Gill More articles by this author , Leo DoumanianLeo Doumanian More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most published data with Aquablation, a recently introduced minimally-invasive technology for management of patients with benign prostatic hyperplasia (BPH), is from 2 large multicenter trials. The aim of this study is to report post-commercialization perioperative complications and outcomes of Aquablation from a single institution. METHODS: Using our IRB-approved database, we retrospectively reviewed the records of consecutive patients who underwent Aquablation for BPH in our institution between August 2020 and June 2022. Those with no available 90-day data were excluded. Primary and secondary outcomes were 90-day complications (graded by Clavien-Dindo classification) and 90-day readmission, respectively. Specific focus was placed on hemorrhagic complications. Univariate and multivariable logistic regression were performed to assess the factors affecting the 90-day complications. RESULTS: Among 146 patients who received Aquablation during the study timeframe, 133 patients with a median (IQR) age of 69 (64 – 73) years and median (IQR) prostate size of 85 (65 – 109) mL were included in the analysis. Baseline and clinical features of the patients are presented in Table 1. Median operative time was 64 minutes, and no intraoperative complication/blood transfusion was recorded. Median length of hospital stay and catheter time were 1 and 3 days, respectively. 90-day complications were recorded in 36 patients (27%) with a Clavien 3 in 11 patients (8%). A bleeding event was recorded in 5 patients (4%) of whom 4 required cystoscopic fulguration (Table 2). Average drop in postoperative hemoglobin was 1.5 gm/dL, yet no patient required peri-operative blood transfusions. The readmission rate was 4.5% (6/133). Two patients underwent re-treatment (transurethral resection of the prostate). On multivariable analysis, prostate size was not independently associated with 90-day complications (OR 1.02, 95% CI 0.99 – 1.03, p=0.07). CONCLUSIONS: Aquablation is safe with a 27% overall complication rate that is independent of patient or prostate factors. Bleeding rate with incorporation of selective cautery hemostasis has dropped compared to the Water and Water 2 trial data. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1063 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author David Ortega Herrera More articles by this author Michael Eppler More articles by this author Randall Lee More articles by this author Maria Lizana More articles by this author Abhisek Venkat More articles by this author Marissa Maas More articles by this author Andre Abreu More articles by this author Rene Sotelo More articles by this author Mike Nguyen More articles by this author Inderbir Gill More articles by this author Leo Doumanian More articles by this author Giovanni E. Cacciamani More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To report our experience and outcomes using a novel robotic technique for the simultaneous repair of rectovesical fistula (RVF) with vesicourethral anastomotic stricture (VUAS) after radical prostatectomy (RP).METHODS Between 2019 and 2021, four consecutive patients who underwent robotic-assisted simultaneous repair of RVF with concurrent VUAS after RP were retrospectively reviewed. Baseline character-istics and perioperative outcomes were examined and reported. Complications were graded using the modified Clavien-Dindo classification system and the European Association of Urology Com-plications Panel Assessment and Recommendations. RESULTS Four cases with a median age of 68.5 (63.3-72.3) years were treated. Interposition omentum flaps were used in all our cases. One case had perineal urethral mobilization to reach healthy urethral margins and tension-free vesicourethral anastomosis. Surgeries were uneventful, with no intrao-perative complications reported. Median operative time, estimated blood loss, and length of hospi-tal stay were 370 (291.3-453) minutes, 255 (175-262.5) mL, and 2.5 (2-3) days, respectively. Median Jackson-Pratt drains, Double-J stents and Foley catheter removal days were 6 (6-10), 38 (32-43), and 30 (27-41) days, respectively. No postoperative complications were reported. The median follow-up time was 16.25 (12-26) months, and no fistula recurrence was shown.CONCLUSION Robotic-assisted laparoscopic repair could represent an effective approach for the simultaneous repair of RVF with concomitant VUAS. More studies and management standardization are needed to assess the role of the robotic platform in the simultaneous repair of RVF with VUAS after radical prostatectomy. UROLOGY 175: 107-113, 2023. & COPY; 2023 Elsevier Inc.

You have accessJournal of UrologyCME1 Apr 2023PD41-11 THE IMPACT OF PROSTATE VOLUMES (≤80 CC VS. > 80 CC) ON PERIOPERATIVE OUTCOMES AND RISK OF RETREATMENT IN PATIENTS UNDERGOING AQUABLATION: A SINGLE-CENTER STUDY Michael Eppler, Giovanni E. Cacciamani, Randall A. Lee, Alireza Ghoreifi, David Ortega Herrera, Maria Lizana, Abhisek Venkat, Marissa Maas, Andre Abreu, Rene Sotelo, Mike Nguyen, Leo Doumanian, Inderbir Gill, and Mihir M. Desai Michael EpplerMichael Eppler More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , Randall A. LeeRandall A. Lee More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , David Ortega HerreraDavid Ortega Herrera More articles by this author , Maria LizanaMaria Lizana More articles by this author , Abhisek VenkatAbhisek Venkat More articles by this author , Marissa MaasMarissa Maas More articles by this author , Andre AbreuAndre Abreu More articles by this author , Rene SoteloRene Sotelo More articles by this author , Mike NguyenMike Nguyen More articles by this author , Leo DoumanianLeo Doumanian More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir M. DesaiMihir M. Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aquablation (AA) therapy is a promising alternative for the treatment of lower urinary tract symptoms secondary to an enlarged prostate. Though generally shown to be safe in patients with larger prostates and novel image-guiding software simplifies treatment, prostate volume (PV) could have implications on the perioperative course. The goal of this study was to determine if PV has an impact on perioperative outcomes following AA therapy. METHODS: 133 patients underwent AA therapy at our institution between 2020-2022. Patients were stratified based on small (≤80 cc) and large (>80 cc) PVs. Patient data on baseline characteristics and peri- and postoperative outcomes were retrospectively collected. Outcomes of interest included 90-day complication rate, bleeding requiring retreatment, and 90-day readmission rate and retreatment for bladder outlet obstruction (BOO) within the follow-up (sig. p<0.05). RESULTS: A total of 58 (44%) have a PV ≤80 cc (group 1), while 75 (56%) of patients have a PV >80 cc (group 2). In group 1, the PV was 57.6 ccs while in group 2 the mean was 109.4 ccs. There was no difference in age (68.1 v 69.3, p=0.61), BMI (27.4 v 27, p=0.86), and ASA score (ASA 3, 47% v 49%, p=0.87). A small prostate was associated with any prior prostate surgery, including prior resection (17% v 4%, p=0.02) and a large prostate was associated with prior retention (29% v 45%, p=0.07) and likelihood of having an identifiable median lobe (44% v 63%, p=0.06). A higher number of AA passes (1.8 v 2.0, p=0.001) and operative time (60.2 v 69.1 min., p=0.001) were associated with a large prostate, while there was no difference in EBL (11.6 v 16.5 ml, p=0.25). There was no statistically significant difference in 90-day complications (26% v 39%, p=0.17), postoperative bleeding requiring endoscopic treatment (2% v 7%, p=0.2), and 90-day readmission (0% v 7%, p=0.07) based on prostate size. The risk of retreatment of BOO during the follow-up was comparable between the 2 cohorts (0% v 5%, p=0.14). CONCLUSIONS: Overall, patients undergoing AA therapy experienced low rates of perioperative complications, bleeding, or retreatment and are independent of baseline PV. This provides an attractive transurethral minimally invasive alternative to patients with larger prostate glands and LUTS. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1063 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Eppler More articles by this author Giovanni E. Cacciamani More articles by this author Randall A. Lee More articles by this author Alireza Ghoreifi More articles by this author David Ortega Herrera More articles by this author Maria Lizana More articles by this author Abhisek Venkat More articles by this author Marissa Maas More articles by this author Andre Abreu More articles by this author Rene Sotelo More articles by this author Mike Nguyen More articles by this author Leo Doumanian More articles by this author Inderbir Gill More articles by this author Mihir M. Desai More articles by this author Expand All Advertisement PDF downloadLoading ...

Complete testicular epididymal dissociations are exceedingly rare conditions where the epididymis and the vas deferens are completely dissociated from the testicle. We present the case of a 46-year-old male with a history of chronic, intermittent and severe left testicular pain who was found to have a complete testicular epididymal dissociation at the time of surgical exploration and bilateral orchidopexy. Microsurgical approximation of the tail of the epididymis to the tunica albuginea of the testis with reapproximating the muscularis of the spermatic cord to the epididymal appendage was performed with subsequent relief of symptoms.

OBJECTIVE:To report our experience and outcomes in minimally invasive management of rectourethral fistula (RUF).METHODS:From 2004 to 2021, 15 patients who underwent minimally invasive RUF repair by a single surgeon at 2 international institutions were retrospectively reviewed. Baseline demographic characteristics, perioperative, and postoperative data were collected. Complications were reported using the modified Clavien-Dindo Classification System and the European Association of Urology Complication Panel Assesment and Recommendations. Success was defined as complete resolution of fistula-related symptoms at 12-month follow-up along with confirmation of fistula closure by imaging or cystoscopy. Categorical variables were presented as frequencies and percentages whereas continuous variables were reported as median and quartiles.RESULTS:Fifteen male patients with a median age of 71 (64-79.2) years were treated. Four cases (26.6%) occurred postsurgery, 8 cases (53.3%) occurred after energy treatments, and 3 cases (20%) after surgery combined with an energy treatment modality. A robotic and laparoscopic approach was performed in 9 (60%) and 6 (40%) patients, respectively. No intraoperative complications were reported. Median operative time was 264 (217.5-341) minutes, estimated blood loss was 175 (137.5-200) mL, and the length of hospital stay was 4 days. Nine postoperative complications were reported. All patients were followed-up for 12 months with no recurrence reported. All patients reached our criteria for successful RUF repair.CONCLUSIONS:Minimally invasive surgery could represent an efficient way to manage RUF in selected patients. More studies and treatment standardization are needed to assess the role of minimally invasive surgery in the management of RUF.

Abstract The purpose of this study is to report our experience and outcomes using a novel robotic technique for the simultaneous repair of rectovesical fistula (RVF) with bladder neck contracture (BNC) after radical prostatectomy (RP). Between 2019 and 2021, four consecutive patients who underwent robotic-assisted simultaneous repair of RVF with concurrent BNC after RP were retrospectively reviewed. Baseline characteristics and perioperative outcomes were examined and reported. Complications were graded using the modified Clavien-Dindo classification system and the European Association of Urology Complication Panel Assessment and Recommendations. Four cases with a median age of 68.5 (63.3–72.3) years were treated. Interposition omentum flaps were used in all our cases. One case had perineal urethral mobilization to reach healthy urethral margins and tension-free vesicourethral anastomosis. Surgeries were uneventful, with no intraoperative complications reported. Median operative time, estimated blood loss, and length of hospital stay were 370 (291.3–453) minutes, 255 (175–262.5) mL, and 2.5 (2–3) days, respectively. Median Jackson-Pratt drains, Double-J stents and Foley catheter removal days were 6 (6–10), 38 (32–43), and 30 (27–41) days, respectively. No postoperative complications were reported. The median follow-up time was 13 (6–16) months, and no fistula recurrence was shown. Robotic-assisted repair could represent a feasible and effective approach for the simultaneous repair of RVF with concomitant BNC. Larger studies and treatment standardization are needed to assess the role of minimally invasive surgery in the simultaneous management of RVF with BNC after radical prostatectomy.

Cowper's gland syringocele (CGS) is the cystic dilation of its duct. It is an uncommon urological condition and is thought to be more commonly encountered in pediatric urology. However, it is in adults that CGS poses a diagnostic challenge because of its "chameleon-like" clinical presentation that may masquerade multiple urological etiologies. In this population, where urological conditions are more prevalent, CGS may present as bladder outlet obstruction, recurrent urinary tract infections, gross hematuria, urinary retention, perineal pain, or abscess.

Recent advances in ultrasonography (US) technology established modalities, such as Doppler-US, HistoScanning, contrast-enhanced ultrasonography (CEUS), elastography, and micro-ultrasound. The early results of these US modalities have been promising, although there are limitations including the need for specialized equipment, inconsistent results, lack of standardizations, and external validation. In this review, we identified studies evaluating multiparametric ultrasonography (mpUS), the combination of multiple US modalities, for prostate cancer (PCa) diagnosis. In the past 5 years, a growing number of studies have shown that use of mpUS resulted in high PCa and clinically significant prostate cancer (CSPCa) detection performance using radical prostatectomy histology as the reference standard. Recent studies have demonstrated the role mpUS in improving detection of CSPCa and guidance for prostate biopsy and therapy. Furthermore, some aspects including lower costs, real-time imaging, applicability for some patients who have contraindication for magnetic resonance imaging (MRI) and availability in the office setting are clear advantages of mpUS. Interobserver agreement of mpUS was overall low; however, this limitation can be improved using standardized and objective evaluation systems such as the machine learning model. Whether mpUS outperforms MRI is unclear. Multicenter randomized controlled trials directly comparing mpUS and multiparametric MRI are warranted.