OBJECTIVE:Rezūm vapor ablation is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for tissue ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30 and ≤80 ml, it is unclear how effective Rezūm is for men in urinary retention. We sought to determine whether Rezūm is effective in the treatment of catheter-dependent urinary retention secondary to BPH. METHODS:A retrospective chart review was conducted on consecutive patients who presented for urinary retention and subsequently treated with Rezūm. We evaluated procedural details and examined variables pre- and post-Rezūm (at 6 months) including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Qmax ), post void residual volume (PVR), prostate specific antigen, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). RESULTS:Of the 49 patients included in this study, median age of was 73 years, median prostate volume was 73cc (Interquartile range [IQR]: 50, 103) and a median lobe was present in 80% of patients. All patients were in urinary retention before treatment with a median PVR of 900 ml (IQR: 566, 1146). Following Rezum, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved at 6 months (p < 0.01). Qmax increased from 3 to 6 ml/s (p = 0.03) and PVR decreased from 900 to 78 ml (p < 0.01). Only 17/38 patients taking alpha-blockers and 7/15 patients on 5ARIs continued therapy at 6 months following Rezūm (p < 0.01). Of the 49 patients treated, 10 (20.4%) remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months (12.2%) even after further surgical therapies for BPH (p < 0.01). CONCLUSION:Rezūm is a safe and effective therapy for treating catheter dependent urinary retention in patients with BPH, including those with median lobes. As a minimally invasive therapy, it is a promising option in patient, particularly those who are not suitable for prolonged anesthesia.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-09 REZŪM FOR RETENTION - A RETROSPECTIVE ANALYSIS OF REZŪM FOR BENIGN PROSTATIC HYPERPLASIA IN MEN WHO PRESENT WITH CATHETER-DEPENDENT URINARY RETENTION Daniel Bassily, Vincent Wong, John Phillips, Mitchell Fraiman, Ross Bauer, Christopher Dixon, and Nathan Wong Daniel BassilyDaniel Bassily More articles by this author , Vincent WongVincent Wong More articles by this author , John PhillipsJohn Phillips More articles by this author , Mitchell FraimanMitchell Fraiman More articles by this author , Ross BauerRoss Bauer More articles by this author , Christopher DixonChristopher Dixon More articles by this author , and Nathan WongNathan Wong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rezūm is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30mL and ≤80mL, it is unclear how effective Rezūm is for men in acute or chronic urinary retention. Our objective is to determine whether Rezūm vapor ablation is effective in the treatment of acute/chronic catheter-dependent urinary retention. METHODS: A retrospective chart review was conducted on 49 consecutive patients who presented for acute/chronic urinary retention and were treated with Rezūm. We evaluated procedural details including type of anesthesia, operating room time, treatment time, number of steam treatments, length of hospital stay and catheter duration. We examined details pre- and post-Rezūm including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Q max), post void residual volume (PVR), PSA, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). RESULTS: The median age of treated patients was 73 years with a median prostate volume of 73cc (Interquartile range (IQR) 50, 103). All patients were in urinary retention prior to treatment with a median PVR of 900mL (IQR 566, 1146). Following treatment, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved (p <0.01). Qmax increased from 3mL/s to 6mL/s (p=0.03) and PVR decreased from 900mL to 78mL (p <0.01). Only 17/38 patients taking alpha-blockers required continued alpha blocker therapy and 7/15 patients on 5ARIs required continued 5ARI therapy (p <0.01). Of the 49 patients treated, 10 remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months even after further, more invasive surgical therapies for BPH (p <0.01). CONCLUSIONS: Rezūm is an effective therapy for treating acute/chronic urinary retention in patients with BPH. As a minimally invasive therapy, it can be used in patient who cannot tolerate general anesthesia. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e3-e4 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Bassily More articles by this author Vincent Wong More articles by this author John Phillips More articles by this author Mitchell Fraiman More articles by this author Ross Bauer More articles by this author Christopher Dixon More articles by this author Nathan Wong More articles by this author Expand All Advertisement Loading ...

Varicoceles, hernias, and hydroceles are three common presenting complaints seen by urologists. Varicoceles are found in about 15% of the adolescent population. Varicoceles are easy to diagnose on physician examination by a primary care provider and are almost always asymptomatic. Treatment is needed only to improve fertility, which is not an issue for most teens. Further, semen analysis is difficult to obtain and of questionable utility in the adolescent population, hence treatment should be approached with caution. At this time, persistent volume discrepancy is the principle indication for surgical intervention. For most, routine annual or biennial physical examination for testicular volume should suffice. Pediatric hernias and hydroceles are also a common occurrence and are evaluated routinely in the urologist's office. The overall incidence of pediatric inguinal hernias ranges from 1 to 4%, with the incidence being 10x greater in males than females. Standard of care is open repair through an inguinal incision with high ligation of the hernia sac. Laparoscopic inspection of the contralateral internal ring through the patent processus vaginalis is a useful adjunct.

Pathologic upgrading to Gleason 7 or higher on radical prostatectomy (RP) specimens occurs in many patients with Gleason 6 prostate cancer on preoperative biopsy. We evaluated whether biopsy characteristics and preoperative factors, including preoperative PSA velocity (PSAV), are predictive of pathologic upgrading.We identified 235 consecutive Gleason 6 prostate cancer patients who underwent biopsies at our institution, had multiple pre-biopsy PSA values, and eventually underwent RP. Preoperative biopsy, clinical characteristics, and PSAV were analyzed to determine the risk of pathologic upgrading or extracapsular extension. These clinical factors were evaluated for association with biochemical recurrence following RP.Overall, 48% of patients were upgraded to Gleason grade 7 or higher following RP. Median PSAV was 0.61 ng/mL/y, and PSAV was similar between upgraded and non-upgraded patients (1.01 vs. 0.78, P = 0.1). PSA velocity level was not associated with extracapsular disease (P = 0.4). PSA velocity > 1 was associated with biochemical recurrence (HR 3.23, P = 0.01) but this was not statistically significant in a multivariable model. Increasing PSA density (HR 2.18, P < 0.001), bilateral cores positive (HR 1.89, P < 0.05), and any biopsy core involvement > 50% (HR 2.52, P < 0.05) were most associated with pathologic upgrading. On multivariate analysis, only bilateral cancer detection at biopsy (HR 1.90, P < 0.05) significantly predicted upgrading.PSAV has a limited role in predicting Gleason 6 upgrading. Patients with bilateral cancer detected on transrectal biopsy should be encouraged to have radical local therapy due to high risk of harboring more aggressive disease.

PURPOSE:Penile torsion is a congenital malformation that results in a rotational defect of the penile shaft. Various techniques have been described for correcting penile torsion, although there is no consensus on the best repair. We describe our experience using a dorsal dartos flap to correct penile torsion.MATERIALS AND METHODS:We retrospectively reviewed the records of all 25 patients who underwent repair of significant penile torsion using a dorsal dartos flap at our institution between 2004 and 2007. A total of 17 repairs were performed in association with chordee repair, 7 with hypospadias and 1 with bilateral inguinal hernias. Patient age at the time of repair ranged from 6 to 19 months (mean 9). Of the patients 15 had torsion of at least 90 degrees, 8 had torsion of 60 to 90 degrees and 2 had torsion that was not recorded in degrees.RESULTS:Mean followup was 4 months (range 1.5 to 19). Of the cases 16 demonstrated complete resolution of penile torsion, 7 had residual torsion less than 10 degrees and 2 had documented improvement that was not reported in degrees. No patient has undergone further repair for torsion.CONCLUSIONS:Penile torsion is a challenging congenital anomaly. The dorsal dartos flap is familiar to pediatric urologists and can be varied for use in repair of penile torsion. The procedure results in successful repair of the torsion, has few complications and can easily be performed concurrently in the setting of other operative repairs. This approach provides excellent short-term results.

Lower urinary tract symptoms in men usually include symptoms of bladder overactivity such as urinary frequency, urgency or nocturia. These are often the initial presenting symptoms for men seeking medical attention for urinary dysfunction. The prevalence of overactive bladder in men is similar to women and increases with advancing age. While women with these symptoms are treated primarily with anticholinergic therapy, there is reluctance to use these agents in men due to concerns regarding worsening obstructive symptoms or urinary retention exacerbated by a large prostate. For men, alpha blocker monotherapy remains the primary therapy for lower urinary tract symptoms despite the fact that a larger fraction of men continue to experience symptoms of overactive bladder. There is emerging body of evidence that the use of anticholinergic agents may be safe and effective in men. We will discuss the rationale for the use of anticholinergic therapy in men with bladder overactivity, either alone, or in combination with alpha blockers. We will review the current literature on the topic and discuss potential future directions in the management of overactive bladder in men.

You have accessJournal of Urology1 Apr 2008THERAPY-INDUCED SENESCENCE RESPONSE AND DIFFERENTIAL GENE EXPRESSION IN PROSTATE CANCER CELLS WITH VARIABLE METASTATIC POTENTIAL Badar M Mian, Ross Bauer, Eugenia Broude, Olga Berezovska, Gennady Glinsky, and Igor Roninson Badar M MianBadar M Mian More articles by this author , Ross BauerRoss Bauer More articles by this author , Eugenia BroudeEugenia Broude More articles by this author , Olga BerezovskaOlga Berezovska More articles by this author , Gennady GlinskyGennady Glinsky More articles by this author , and Igor RoninsonIgor Roninson More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60556-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "THERAPY-INDUCED SENESCENCE RESPONSE AND DIFFERENTIAL GENE EXPRESSION IN PROSTATE CANCER CELLS WITH VARIABLE METASTATIC POTENTIAL." The Journal of Urology, 179(4S), pp. 191–192 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 191-192 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetrics Author Information Badar M Mian More articles by this author Ross Bauer More articles by this author Eugenia Broude More articles by this author Olga Berezovska More articles by this author Gennady Glinsky More articles by this author Igor Roninson More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Drugs and their metabolites are known factors in 1% to 2% of all kidney stones. Certain antiepileptic drugs are known to cause stone formation. Phenytoin is used as a first line antiepileptic therapy for many seizure disorders. We present what we believe to be the first report of a phenytoin metabolite urinary stone.Methods: A 79-year-old woman with a fever and seizure disorder was found to have a right pelvic kidney with hydronephrosis and multiple large calcifications. She had been taking the antiepileptic medication phenytoin for the past 10 years. Average total serum phenytoin level from the year prior was in the normal range. Free phenytoin levels were not routinely monitored, but the one value available was elevated at 5.1 ng/dL. The patient underwent a percutaneous nephrolitomy, ultimately expiring from medical complications after the procedure. Final stone analysis revealed a composition of 35% phenytoin metabolite (5-(para-hydroxyphenyl)-5-phenylhydantoin) and 65% proteinaceous material. An extensive review of literature including PubMed, MedLine, and various internet search engines was performed, searching for any prior reports of urinary calculi formed from phenytoin or its metabolite.Results: No previous reports of phenytoin or phenytoin metabolite urinary stones were found in the medical literature. Phenytoin has many known ill effects on the genitourinary system including acute interstitial nephritis, nephrotic syndrome, acute renal failure, and priapism. Now we can add urinary lithiasis to the list of its potential adverse effects. This article represents the first report of a phenytoin metabolite urinary stone.Conclusion: A metabolite of the commonly used antiepileptic medication phenytoin can cause clinically relevant urolithiasis leading to significant morbidity and even mortality. Clinicians should have an increased level of suspicion for metabolite stone formation in symptomatic patients taking antiepileptic medications. Further studies on phenytoin metabolism and its potential for inducing urinary lithiasis should be performed.

Las infecciones del tracto urinario (ITU) son frecuentes en los ninos y suponen una causa importante de morbilidad. Su incidencia no se conoce con exactitud, ya que no se trata de una enfermedad de declaracion obligatoria y, en muchos casos, especialmente en lactantes, las ITU son infradiagnosticadas. Este articulo revisa el diagnostico y el estudio de las ITU en los ninos, y presenta los ultimos datos sobre la funcion de las tecnicas de imagen radiologicas, la correccion quirurgica y la profilaxis antibiotica en estos pacientes.

Urinary tract infections (UTIs) in children are common and a major source of morbidity. The incidence of UTIs in childhood is not precisely known because it is not a reportable disease, and in many cases, especially in infants, UTIs are underdiagnosed. Furthermore, the definitions and criteria for diagnosis vary considerably. This article reviews the diagnosis and work-up of UTIs in children, and presents current data reviewing the roles of radiologic imaging, surgical correction, and antibiotic prophylaxis in the setting of pediatric UTIs.