Clinical Outcomes of Holmium Laser Enucleation of the Prostate in Patients With Diminished Bladder Contractility.

Introduction: Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) is common in aging men and can be treated with holmium laser enucleation of the prostate (HoLEP). However, diminished bladder contractility (DC) is also highly prevalent (9%-48%) and can be clinically indistinguishable from BOO without urodynamics (UDS). While HoLEP effectively treats BPH/BOO, clinical outcomes data for patients with DC are limited and mixed.

MRI-Derived Transition Zone Index Is Highly Predictive of Urodynamic Bladder Outlet Obstruction Prior to Holmium Laser Enucleation of the Prostate.

Introduction And Objective: Urodynamic study (UDS) is required to diagnose bladder outlet obstruction (BOO) during evaluation of benign prostatic hyperplasia (BPH) but is seldom performed due to cost and invasiveness. Therefore, anatomic and clinical parameters to predict BOO have been proposed, including the prostate transition zone index (TZI) which is the ratio of prostate transition zone volume (TZV) to whole gland volume (WGV). Historically computed with ellipsoid volume estimation of prostate WGV and TZV from transrectal ultrasound measurements, controversy exists regarding the utility of TZI to predict likelihood of BOO on UDS and clinical outcomes following BPH surgery.

Modified Frailty Index predicts postoperative complications following adult-acquired buried penis surgery: A retrospective cohort study.

Background: Given that patients with morbid obesity are predisposed to frailty, we sought to determine whether the 5-Factor Modified Frailty Index (mFI-5) predicts postoperative complications following surgery for adult-acquired buried penis, and secondarily, to compare the mFI-5 to body mass index (BMI) and American Society of Anesthesiologists (ASA) status as preoperative risk stratification measures.

Methods: We included all patients who underwent surgical management for adult-acquired buried penis at an academic Level I trauma center between 2015 and 2023. A manual chart review was performed to collect data on patient demographics, modified frailty index variables, intraoperative data, postoperative outcomes, and complications.

Postoperative Outcomes following Buried Penis Reconstruction: A Single-Institution Experience Using the Wisconsin Classification System.

Background: Adult acquired buried penis (AABP) is a complex condition often necessitating surgical intervention. This study sought to examine the validity of the Wisconsin Classification System (WCS) in guiding the surgical management of AABP. In addition, the authors aimed to identify which factors contribute to postoperative complications and persistent symptoms following AABP repair.

Collagen is More Abundant and Structurally Altered in Lichen Sclerosus.

Objective: To test the hypothesis that genital skin and male urethra affected by lichen sclerosus (LS) has increased collagen content and altered collagen structure.

Methods: We used picrosirius red to stain and image collagen in human urethral, vulvar, and foreskin specimens with and without LS. Using Image J software, we quantified and compared (1) collagen content (using 2o metrics: collagen proportionate area [CPA] and collagen fiber count), (2) collagen fiber length and width, and (3) collagen structure using the texture analysis technique gray level co-localization matrix (GLCM) with respect to LS status and tissue type.

A systematic approach for successful repair of radiated and non-radiated ureteral injuries.

Background: Successful ureteral reconstruction is challenging, particularly in radiated fields. We characterize and directly compare surgical outcomes in modern cohorts of radiated and non-radiated patients undergoing ureteral reconstruction utilizing a systematic approach to pre-operative assessment. We hypothesize that radiated patients will undergo more complex ureteral reconstructions and experience higher rates of surgical failure and complications compared to nonradiated patients.

Effect of Metabolic Syndrome on Anatomy and Function of the Lower Urinary Tract Assessed on MRI.

Objective: To investigate the relationship between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) with functional and anatomic changes of the lower urinary tract with MRI.

Materials And Methods: The bladder and prostate of 95 subjects (56M, 39F) were segmented on T2-weighted pelvic MRI using Materialize Mimics 3D software. Bladder wall volume (BWV), post-void residual (PVR) and prostate volume (PV) were quantified from the 3D renderings.

A mechanism linking perinatal 2,3,7,8 tetrachlorodibenzo-p-dioxin exposure to lower urinary tract dysfunction in adulthood.

Benign prostatic hyperplasia/lower urinary tract dysfunction (LUTD) affects nearly all men. Symptoms typically present in the fifth or sixth decade and progressively worsen over the remainder of life. Here, we identify a surprising origin of this disease that traces back to the intrauterine environment of the developing male, challenging paradigms about when this disease process begins.

The influence of intermittent hypoxia, obesity, and diabetes on male genitourinary anatomy and voiding physiology.

We used male BTBR mice carrying the mutation, which are subject to severe and progressive obesity and diabetes beginning at 6 wk of age, to examine the influence of one specific manifestation of sleep apnea, intermittent hypoxia (IH), on male urinary voiding physiology and genitourinary anatomy. A custom device was used to deliver continuous normoxia (control) or IH to wild-type and (mutant) mice for 2 wk. IH was delivered during the 12-h inactive (light) period in the form of 90 s of 6% O followed by 90 s of room air.

Histopathology of Anterior Urethral Strictures: Toward a Better Understanding of Stricture Pathophysiology.

Purpose: Histopathology can provide insights into disease mechanisms but to date it has been poorly described for urethral stricture. The purpose of this study was to comprehensively describe histopathological findings of stricture specimens obtained at the time of anterior urethroplasty.

Materials And Methods: All pathological specimens of men who underwent anterior urethroplasty of urethral stricture disease from 2010 to 2017 at a single institution were rereviewed by a single blinded pathologist directed to rule out lichen sclerosus and then describe inflammatory cell type and severity when present.

A Critical Analysis of Perioperative Outcomes in Morbidly Obese Patients Following Renal Mass Surgery.

Objective: To evaluate if body mass index (BMI) ≥ 40 is associated with risk of postoperative complications, receipt of perioperative blood transfusion (PBT), length of hospital stay (LOS), perioperative death, or hospital readmission rate following renal mass surgery.

Materials And Methods: After Institutional Review Board approval, comprehensive information was collected for patients treated with surgery for renal mass from 2000 to 2015 at one institution. Univariable and multivariable analyses were used to evaluate the association of BMI ≥ 40 among other putative risk factors for perioperative outcomes.