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Introduction Low testosterone (T) is linked with frailty, which predicts poor postoperative recovery across many surgical procedures. Therefore, low T may impact perioperative outcomes for surgical patients. We sought to characterize the association between low T, frailty, and perioperative outcomes in patients undergoing transurethral resection of the prostate (TURP) and laser photovaporization of the prostate (PVP). Materials and methods We retrospectively reviewed men across our integrated healthcare system who underwent TURP or PVP with a recorded T level within one year prior to their procedure date. Low T was defined as a serum T <300 ng/dL. We compared clinical characteristics, lab values, and frailty, determined by the Hospital Frailty Risk Score (HFRS), of patients with low vs. normal T. Univariable and multivariable analyses were used to assess the association between low T and hospital readmission at 30, 90, and 180 days postoperatively. Results Among 175 patients who underwent either TURP or PVP, 86 (49.1%) had low T, and 89 (50.9%) had normal T. Patients with low T were older (68.7 ± 9.3 vs. 64.8 ± 11.8 years old, p = 0.016) and had longer postoperative length of stay (4.2 ± 10.5 vs. 1.4 ± 0.9 days, p = 0.03). Patients with low T had a significantly higher rate of readmission within 180 days (28% vs. 13%, p = 0.02). Low T was not independently associated with frailty. On univariable logistic regression, preoperative T was associated with readmission at 90 and 180 days. On multivariable regression, low preoperative T was no longer associated with 90-day readmission. Conclusions Almost half of the men undergoing transurethral surgery in our cohort had low T. Low T was independently associated with a higher risk of 180-day readmission on multivariable analysis. These findings indicate a possible prognostic role for low T screening in men undergoing transurethral prostatic surgery. Further studies are needed to determine whether preoperative treatment of low T can impact perioperative outcomes.

Introduction Lymphocele is a typical complication of pelvic lymph node dissection (PLND) in robot-assisted radical prostatectomy (RARP). This study aimed to compare postoperative lymphatic leakage between the polymer ligation clip and vessel sealer, and evaluated the costs associated with the former. Methods The study enrolled patients who underwent RARP with PLND at our institution between April 2018 and March 2023 and were treated with a vessel sealer (LigaSure Blunt Tip 44 NC ; Medtronic, Dublin, Ireland) until September 2021, and Hem-o-lok polymer ligation clips (Teleflex, Wayne, PA, USA) thereafter. The drain was removed on the third postoperative day or later, when the daily drainage volume was less than 200 mL. Results A total of 81 patients underwent RARP with PLND, which resulted in a significant increase in the operative (p = 0.016) and lymph node dissection times (p = 0.008) in the clip group. The total drainage volume (p = 0.048) was smaller, and the drain removal time (p = 0.039) and postoperative hospital stay (p < 0.001) were shorter in the clip group. Moreover, the device costs for the clips were lower than those for the vessel sealer. Conclusion Polymer ligation clips are associated with improved postoperative lymphatic leakage, shorter length of hospitalization, and lower costs, compared with vessel sealers.

The seminal vesicles are an accessory structure of the male reproductive system. The most common pathology associated with the seminal vesicles is infective, and patients may present with haematospermia, pain, and subfertility. Patients presenting with unilateral ureteric obstruction secondary to seminal vesiculitis are rare, and there are very few reported cases in the literature. This case report aims to review the presentation and management of such a case. A 59-year-old male presented to the emergency department with right-sided abdominal pain, vomiting, haematuria, and reduced urinary output. Blood tests showed raised inflammatory markers, hyperkalaemia, and a significant acute kidney injury with a creatinine of 695 µmol/L and an estimated glomerular filtration rate (eGFR) of 7 from a normal baseline. Non-contrast computed tomography (NCCT) imaging of the renal tracts identified an atrophic left kidney and a large soft tissue lesion at the level of the distal third of the right ureter, concerning for a primary ureteric malignancy. Notably, urine samples sent for cytology were reported as negative for malignancy. Following drainage and recovery from the acute episode, a timely outpatient ureteroscopy revealed no abnormalities of the ureter, and a subsequent magnetic resonance imaging (MRI) concluded right-sided seminal vesiculitis as the cause of this patient's presentation. This case report demonstrates seminal vesiculitis as a rare cause of ureteric obstruction. It can mimic upper tract urothelial carcinoma (UTUC) and highlights the importance of a definitive diagnosis in patients with suspected upper renal tract transitional cell carcinoma.

To assess clinical outcomes in terms of first to second-stage conversion rates, revision rates, and complications for all patients undergoing sacral neuromodulation of the lower urinary tract for the past five years at the Queen Elizabeth Hospital Birmingham. This is a retrospective observational study. Only patients with the first stage of sacral neuromodulation between January 2017 and January 2023 were included in the study. The data collected included age, type of first-stage trial, that is, percutaneous nerve evaluation (PNE) vs. tined lead, response after the first stage, whether a second trial was carried out, response after the second trial, indication for sacral nerve stimulation (SNS), complications, revisions, etc. Results: 94% of the total (198) patients had PNE at the first trial, while 11 (6%) had tined lead. 129 (65%) patients had a positive response after the first trial, 49 (24%) had a negative response, and 20 (10%) had an equivocal response. 15 (8%) patients from the equivocal and negative response group had a second trial with a tined lead, with 53.3% (104) receiving a positive response, making our total conversion rate 69% (136). 100 (50%) patients had permanent implants fitted, 25 (13%) had complications, and 15 (7.5%) required revision. The indications for the revisions were lead migration (66, 33.33%), pain around the battery site (66, 33.33%), connection failure (40, 20%), battery charging problem (13, 6.67%), and device infection (13, 6.67%). The conversion and complication rates are comparable to national standards and documentation in the literature, while the infection rates were lower. Higher conversion rates may be attained when tined lead is used at the first trial.

Injection of various substances into the penis for augmentation is an uncommon and concerning practice that can have serious consequences, such as skin necrosis, ulcers, suboptimal cosmetic results, and persistent edema, often requiring extensive surgical repair. In this article, we present a rare case of penile self-injection with Kanamycin ointment. We describe the clinical course of the disease and the management framework that was followed. Initially managed conservatively, the patient later developed voiding difficulties and skin ulcers at the injection site. Further evaluation revealed discharging sinuses and secondary ulcers. Despite initial improvement, the wounds failed to heal adequately and required specialist referral for consideration of reconstructive surgery. The injection of foreign substances into the penis, though attempted for sexual benefits, often results in dissatisfaction and requires surgical reconstruction. Close follow-up and regular physical examination are crucial to monitor disease progression and ensure appropriate, timely management. Awareness of the harms associated with the injection of foreign substances into the penis can help reduce this practice.

Stress urinary incontinence (SUI) significantly affects the quality of life in women, causing social, psychological, and physical distress. While artificial urinary sphincter (AUS) implantation is a well-established treatment for male incontinence, it is less commonly used in female patients and is typically considered for cases where other treatments have failed. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of AUS implantation in treating SUI in female patients, focusing on continence rates, revision rates, explant rates, and perioperative complications. A comprehensive literature search was conducted across PubMed, Scopus, Google Scholar, and the Cochrane Library in September 2024. Studies published in English over the past 15 years were included if they reported outcomes such as continence, revision, explant, and complication rates in female patients who underwent AUS implantation. Data were analyzed using Review Manager 5.4, applying a fixed-effects model where appropriate, based on heterogeneity (I > 50%). Publication bias was assessed using funnel plots and Egger's test. Eight studies, comprising a total of 300 female patients, were included in the analysis. AUS implantation significantly improved continence rates, achieving an overall continence rate of 72% (OR = 0.01, 95% CI: 0.00 to 0.02; p < 0.00001). Revision rates were 22.5%, explant rates were 17.6%, and overall postoperative complications were 26.3%. No significant bias was detected. AUS implantation is an effective and safe treatment option for a specific group of women with SUI, particularly in cases where other standard treatments have failed. It shows satisfactory continence rates with considerable revision and explant rates. However, further large-scale, long-term studies are needed to optimize outcomes and confirm these findings.

Introduction Urinary incontinence, sexual dysfunction, and bowel dysfunction are well-recognized cancer survivorship outcomes affected by radical prostatectomy (RP) in the treatment of prostate cancer (PCa).The aim of this study was to audit the thoroughness of outpatient discussions and documentation of survivorship outcomes for patients who have undergone RP. Methods This was a retrospective audit of all 253 radical prostatectomies conducted at two tertiary-level Australian institutions (Monash Medical Centre and Alfred Hospital), over a five-year period between 2014 and 2018. Electronic medical records were reviewed across five time points: preoperative and then six weeks, three months, six months, and 12 months post-RP.The main outcomes measured were rates of documented discussions of urinary incontinence, sexual dysfunction, and bowel dysfunction. Results At the initial six-week postoperative review, there was an 86%, 47%, and 27% probability that urinary, sexual, and bowel functions were discussed and documented. When averaging across the four postoperative time points, from six weeks to 12 months, there was a 73%, 45%, and 14% respective rate of documented discussion for each survivorship outcome. Sexual and bowel function discussions were less frequently documented in men over 65 years of age compared with those under 65 years of age by 16% (p < 0.001) and 8% (p = 0.003), respectively. Conclusion Sexual and bowel dysfunction were less frequently discussed and documented in the follow-up of our cohort of RP patients compared with urinary continence outcomes.

Renal cell carcinoma (RCC) is an aggressive malignant neoplasm that accounts for 90% of renal cancers with rising incidence worldwide. This study aimed to analyze the demographics and clinical profiles, histopathological presentations, and treatment outcomes of 73 RCC patients at a hospital in Qassim region, Saudi Arabia. This retrospective observational study was conducted at King Fahad Specialist Hospital, Buraidah, from October 2017 to July 2024. Census sampling included all patients diagnosed with RCC. Data on demographics, clinical, and histopathological characteristics were analyzed using SPSS version 26 (Armonk, NY: IBM Corp.). RCC was found to be more prevalent in males and older patients with common comorbidities such as diabetes and hypertension. Among the histopathological types of RCC, clear cell RCC (ccRCC) is most frequently reported in 60.3% of patients, followed by chromophobe RCC (chRCC) and papillary RCC (pRCC), in 16.4% and 11% of patients, respectively. Fuhrman grade 2 stage was seen in 65.8% of the tumors, indicating its moderately aggressive form. Incidental diagnoses accounted for 45.2% of patients, with 93.2% demonstrating no evidence of metastasis at diagnosis. The primary mode of treatment of RCC was the surgical procedure with laparoscopy, which was undergone in 52.1% of cases. ccRCC exhibits the highest prevalence among the various forms of renal cancer, with the majority of cases being diagnosed incidentally. Despite the rising incidence, early diagnosis and improved screening strategies are yet to be elucidated to address the growing burden of RCC and its incidental finding rate in the Qassim region.

Foreign bodies in the lower urinary system are relatively uncommon. The foreign body can cause significant discomfort, hematuria, or infection of the urinary system. Diagnosis is usually made by clinical examination and pelvic X-ray. The case we present is interesting in that the foreign body, that is the wire, coiled and made a knot within the bladder. We report a case of a 25-year-old male who presented with a history of dysuria after the insertion of a foreign body into the urethra. Examination showed a wire protruding from the urethra with no bleeding or discharge. X-ray showed a wire from the meatus, coiled and tied in the bladder. Open cystostomy and extraction of the wire were done successfully. Foreign bodies are usually a result of psychological illness. Thereby, psychiatric evaluation is needed in such a presentation. Management should be started by a trial of retrieval or, if failed, endoscopically or by open cystostomy.

Urolithiasis is extremely prevalent in Pakistan, with percutaneous nephrolithotomy (PCNL) emerging as the primary treatment modality over traditional open surgery. Despite its effectiveness, PCNL is associated with a risk of complications and residual stones. There is limited data on PCNL outcomes from Southern Punjab, necessitating an evaluation of its efficacy and safety in this region. We conducted a retrospective analysis of 399 patients who underwent PCNL at a tertiary care hospital in Muzaffargarh, Pakistan, between October 2016 and September 2022. Detailed preoperative assessments, surgical procedures, and postoperative outcomes were reviewed. Stone clearance and complication rates were assessed, and factors influencing these outcomes were analyzed. The median age of the study population was 39 years, with a male predominance. Stone clearance was achieved in 80.45% (321) of cases, with higher success rates observed in lower pole punctures. Complications occurred in 2% (13) of patients, predominantly hydrothorax following upper pole puncture. Patients with comorbidities had a higher risk of complications (P = 0.097). Residual stones were more common in staghorn stones and larger stone sizes (>3-4 cm). The median operative time was 60 minutes, shorter than reported in the literature, reflecting surgical expertise. PCNL is an effective and safe treatment option for urolithiasis in Southern Punjab, Pakistan, with favorable stone clearance rates and low complication rates. Tailoring treatment strategies based on patient characteristics and optimizing surgical techniques are essential for improving outcomes in this population.