Soc. Int. Urol. J., Volume 3, Issue 2 (March 2022) – 9 articles , Pages 53-111

In this report, we look at the relationship between prior circumcision and presenting stage of penile cancer. We performed an analysis of an international, multicenter database of 1254 penile cancer patients diagnosed from 1980 to 2019 in the United States, Europe, Brazil, and China, and analyzed the relationship between circumcision and presenting T and N stage. A total of 710 patients met the inclusion criteria and were statistically analyzed. We found that uncircumcised men with locally advanced tumors (T3–T4) had significantly higher risk of lymph node metastasis compared with circumcised men. Full article

Background: The occurrence of postoperative urinary incontinence (UI) remains a problem for patients undergoing robot-assisted radical prostatectomy (RARP). Non-surgical interventions (NSI) in addition to intraoperative techniques and patient behavioral changes have been proposed to improve urinary continence (UC) recovery after RARP. However, to date, the real clinical impact of postoperative NSI remains not well characterized. Materials and Methods: We performed a Systematic Review in April 2021, using Allied and Complementary Medicine (AMED), Embase, and MEDLINE according to the PRISMA recommendations and using the Population, Intervention, Comparator and Outcome (PICO) criteria. Primary outcome of interest was the impact of NSI on UC recovery rate and time to achieve UC after RARP. Secondary outcomes of interest were the assessment of patient adherence to NSI, risk factors associated with UI, and correlation between postoperative NSI and sexual activity recovery. Results: A total of 2758 articles were screened, and 8 full texts including 1146 patients were identified (3 randomized controlled trials, 3 prospective single-arm trials, and 2 retrospective series). Postoperative NSI of interest included pelvic floor muscle training (PFMT) (n = 6 studies) and administration of oral medications (solifenacin) (n = 2 studies). PFMT appeared to increase UC rates and to accelerate time to achieve UC in the early postoperative period. Similarly, solifenacin provided higher rates of UC recovery and contributed to a certain degree of symptomatic relief. There was a great variability regarding NSI features and data reporting among studies. Major limitations were the small sample sizes and the short follow-up. Conclusion: Postoperative NSI to manage UI after RARP include PFMT and solifenacin administration. Both seem to modestly improve early UC recovery. Nonetheless, evidence supporting their routinely use is still weak and lacks appropriate follow-up to evaluate possible benefits on long-term UC recovery. Full article

Background: Pelvic fracture urethral injuries (PFUI) in females are very rare. The available literature on the management of this condition is scarce and not clear, mainly because of limited experience among reconstructive surgeons. We present our experience of management of these complex urethral injuries in female patients. Materials and Methods: We collected data, retrospectively and prospectively for 22 female patients referred to our center for PFUI repair between 1995 and 2021. During the clinical assessment of these complex injuries, following our internal institutional protocol, all patients underwent pelvic MRI (bladder and urethra are filled with saline solution and jelly to enhance the urethral lumen and the level of the distraction) before anastomotic urethroplasty. Results: PFUI compromised the mid urethra in 10 patients (45.5%). A transabdominal approach was used in 8 patients (80%), and urethra-vaginal fistula repair was undertaken in 6 patients (60%). After a median follow-up of 36 months, only 1 patient with proximal PFUI required a surgical revision without compromising urinary continence. Conclusions: The most common site of urethral involvement in pelvic fracture is mid urethral, which is owing to avulsion. Urethra-vaginal fistula should be suspected. Treatment consists in anastomotic urethroplasty, mainly through the abdominal approach. Full article

Objectives: We aimed to describe the epidemiology and clinical characteristics of urogenital tuberculosis (UGTB) in Sabah, Malaysia. Methods: We performed a retrospective, descriptive study based on medical records of UGTB cases identified between January 1, 2014, and November 30, 2020. Results: We identified 131 cases of UGTB in Sabah. Patient gender was balanced except for a mild male predominance in the 35 to 44 age group. No cases were reported in children. The majority of the patients (96%) were diagnosed in the government facility. Among the UGTB cases, 72% of patients were from rural areas, and 29% were illiterate. The commonest presentation was frequency of micturition (28%), followed by abdominal pain (26%) and loss of appetite (26%). The common sites included renal (32%) and scrotal (25%). Diagnosis was achieved via histopathology in 39.7% of patients and smear microscopy in 35.9%. Anti-tubercular treatment duration was 8.6 (±SD 4.0) months, and 81% of patients have completed treatment. A total of 50.4% of patients had received surgical intervention; 10.7% had undergone incision and drainage, 9.9% had cystoscopy, and 6.9% underwent orchidectomy. Conclusion: UGTB has varied non-specific symptoms, which poses a diagnostic challenge, leading to morbidity. Ensuring awareness via widespread education within government and private health care, along with rural outreach programs, will contribute to early recognition and treatment. Full article

Objective: Micro-ultrasound is an imaging modality used to visualize and target prostate cancer during transrectal or transperineal biopsy. We evaluated the effectiveness of a micro-ultrasound training program and estimated the learning curve for prostate biopsy. Methods: A training program registry was assessed for the rate of clinically significant prostate cancer (csPCa, grade group ≥ 2), negative predictive value, and specificity at each stage of the program. Nine metrics of biopsy quality were evaluated in 4 stages for each practitioner. Non-linear fitting and logistic regression models were used to evaluate the time-course of these metrics over training. Results: Thirteen practitioners from 8 institutions completed stages 1 to 3 of the program, and 9 completed all 4 stages. Over 1190 micro-ultrasound biopsy procedures were performed. Detection of csPCa increased from 40% to 57% from stage 1 to stage 4 (P < 0.01). Stage 4 “expert” level was independently associated with higher detection of csPCa when correcting for overall risk factors (OR 1.95; P = 0.03). Limitations include the retrospective analysis and variation in biopsy protocols. Conclusion: The micro-ultrasound training program was effective in improving biopsy quality and rate of csPCa detection. The presented learning curve provides an initial guide for acquiring expertise with real-time microultrasound image-guided biopsy. Full article

Background: Follicle-stimulating hormone (FSH) dysregulation plays a potential role in prostate cancer progression. The objective of this study was to evaluate whether higher FSH levels during androgen deprivation therapy (ADT) for recurrent prostate cancer could predict the development of castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (CSS), and overall survival (OS). Methods: Serum FSH levels were measured in cryopreserved samples of the continuous ADT arm of the PR.7 trial, supplemented with analogous samples from a large contemporaneous biobank. Univariate and multivariate analyses assessed the relationship between FSH tertiles and time to CRPC, as well as CSS, and OS. Results: A total of 172 patients were included in our analysis. Of these, 54 patients (31%) developed CRPC during the 9-year follow-up. Median FSH for the tertiles was 4.35, 6.13, and 11.32 mIU/mL. FSH tertiles were not significantly associated with the time to CRPC, or with CSS or OS. FSH levels were not a significant prognostic factor for these oncologic outcomes. Conclusion: As previously reported, the use of gonadotropin-releasing hormone (GnRH) antagonists for ADT has significantly more suppression of FSH levels than GnRH agonists. Our results do not suggest that differences in circulating FSH 1 year following ADT initiation influence long-term oncologic outcomes or development of CRPC. Full article