Ureterocele: Review of Presentations, Types, and Coexisting Diseases

Abstract Introduction: Ureterocele is swelling in one of the ureters that carry urine from the kidney to the bladder, which can block urine flow. An ureterocele usually occurs in the lower part of the ureter, where the ureter enters the bladder. Ureteroceles are equally common in both left- and right-side ureters. Some persons with ureteroceles are asymptomatic. Often, the diagnosis is made later in life due to kidney stones. Materials and methods: A systematic review was accomplished using Medline to obtain articles related to ureteroceles in English, Spanish, Italian, and French. Interests were focused on presentations, types and coexisting diseases for ureterocele. Results: Ureterocele can present with urinary tract infection, urinary retention, urinary incontinence, abdominal or loin pain, abdominal or vulvar mass, abdominal distention, hematuria, or vaginal bleeding. We can type the ureteroceles based on its location (ectopic or intravesicle), its association with triplicate system, duplication system, or single system, prenatal or postnatal, pediatric or adult, female or male, and thick or non-thick. The co-existing diseases include ureteral calculus, tumor, and congenital urinary tract abnormalities. Large ureteroceles are usually diagnosed earlier than smaller ones. An ureterocele may be discovered during a pregnancy ultrasound. Children with this condition often have severe urinary tract infections. Conclusions: The review suggests that there are various presentations, types and coexisting diseases for ureteroceles. Findings implicate the importance of considering these variables when making treatment decision in patients with ureteroceles

Aspermia: A Review of Etiology and Treatment

Aspermia is the complete lack of semen with ejaculation, which is associated with infertility. Many different causes were reported such as infection, congenital disorder, medication, retrograde ejaculation, iatrogenic aspemia, and so on. The main treatments based on these etiologies include anti-infection, discontinuing medication, artificial inseminization, intracytoplasmic sperm injection (ICSI), in vitro fertilization, and reconstructive surgery. Some outcomes were promising even though the case number was limited in most studies. For men whose infertility is linked to genetic conditions, it is very difficult to predict the potential effects on their offspring. It is strongly recommended that assisted reproductive techniques should not be started until genetic screening results

The Role of Hyperbaric Oxygen Therapy in Andrology

Hyperbaric oxygen (HBO) therapy is a supplemental treatment, in addition to the converntional approach, for patients with an underlying ischemic process. In Andrology, HBO is a therapeutic approach supplemental to surgical and medical options for some patients, mainly reported in the treatment of perineal necrotizing fasciitis (Fournier’s gangrene). There were also case reports of successful management using the HBO therapy for post-traumatic ischemic injury, infertility caused by varicocele, hydrocele, testicular torsion, and erectile dysfunction

Magnetic Resonance Urography as an Imaging Modality for Urinary Stone Diseases

Magnetic resonance urography (MRU) techniques have matured and have become applicable to the diagnosis of more and more diseases in urinary tract. Modern MRU offers not only increased spatial and temporal resolution, but also provides anatomic and functional information on renal perfusion, excretion and drainage. Patients with renal colic are better examined by non-enhanced computed tomography (CT) scanning because it is highly sensitive in detecting stones. However, one disadvantage of non-enhanced CT is the high radiation dosage. The goal of this review is to briefly discuss MRU indications for patients with suspected acute calculus ureteric obstruction, summarize MRU techniques as applicable in the diagnosis, and compare MRU techniques to other traditional imaging techniques such as unenhanced spiral CT, intravenous urography (IVU), and ultrasonography

Phalloplasty in Transgender Men with and without Urethral Lengthening

Our goal in trans man phalloplasty is to decrease the patient’s level of gender incongruence, obviate the use of an external prosthesis, be able to orgasm, and give the patient the ability to urinate standing (if desired), while also attempting to decrease urinary complications. The decision to undergo urethral lengthening is considered early in this surgical process. However, urethral complications are among the most common problems we see in phalloplasty, and surgical techniques have evolved to decrease these complications. We have developed an advanced two-stage mucosa-only prelaminated neourethra phalloplasty technique to address these issues. Our surgical technique is detailed in addition to providing patient demographics, co-morbidities, flap complications, and urinary sequelae. We also discuss the perineal urethroplasty in patients opting for no urethral lengthening in phalloplasty. All options should be given and risks considered in trans men undergoing soft tissue phalloplasty, and these will be discussed in detail

A Multicenter Prospective Study Evaluating Efficacy and Safety of a Single-incision Sling Procedure for Stress Urinary Incontinence

Study Objective: The aim of the Altis 522 study was to compare the safety and efficacy of the Altis Single-Incision Sling System (SIS) (Coloplast, Minneapolis, MN) with standard midurethral transobturator and/or retropubic slings through 36 months. In this report, we present data through 12 months of follow-up. Design: Postmarket, prospective, multicenter, nonrandomized cohort design. Setting: The study was performed at 23 hospitals in the United States and Canada. Patients: Adult female patients with stress urinary incontinence (SUI) clinically indicated for an incontinence sling were treated (n = 355). Interventions: Altis SIS was compared with any Food and Drug Administration–cleared transobturator or retropubic sling. Measurements and Main Results: Collected measures included device- and/or procedure-related serious adverse events, relevant nonserious and all adverse events, and revision surgery. Objective efficacy measures included 24-hour pad weight, dryness (defined as pad weight ≤4.0 g), and cough stress test. Subjective outcome measures included patient global impression of improvement, urogenital distress inventory, Incontinence Impact Questionnaire–Short Form, Surgical Satisfaction Questionnaire, and visual analog scale for pain. At 12 months, 24-hour pad weight success (≥50% reduction), negative cough stress test, patient global impression of improvement, urogenital distress inventory, and Incontinence Impact Questionnaire–Short Form appeared similar between groups. Through 12 months, 2 subjects in the Altis group and 3 subjects in the comparator group experienced a serious device- and/or procedure-related adverse event. In the Altis group, 1 subject (0.5%) experienced a device revision, and 1 subject (0.5%) had the device explanted. In the comparator group, 7 subjects (4.1%) experienced a device revision, and 1 device (0.6%) was explanted before the 12-month visit. The occurrence of relevant nonserious procedure and/or device-related adverse events was similar between groups. Conclusion: At 12-months follow-up, safety and efficacy appeared similar between Altis SIS and standard transobturator and retropubic midurethral slings

EFFECT OF OPERATIVE LOCAL ANESTHESIA ON POSTOPERATIVE PAIN OUTCOMES OF INFLATABLE PENILE PROSTHESIS: PROSPECTIVE COMPARISON OF TWO MEDICATIONS

Original demographic and outcome data and statistical analyses (2 excel files with original data and one pdf file with statistical analysis) to compare the outcome of two local anesthetics in pain management after penile prosthetic surger

Management of female stress urinary incontinence with single-incision mini-sling (Altis®): 36 month multicenter outcomes.

PURPOSE: To assess noninferiority of the safety and effectiveness of the Altis® Single Incision Sling (SIS) with standard midurethral transobturator and/or retropubic slings through 36 months in a prospective, longitudinal, nonrandomized US Food and Drug Administration (FDA) 522 cohort study. MATERIALS AND METHODS: Adult females with confirmed predominant stress urinary incontinence (UI) through cough stress test (CST) or urodynamics and failed two noninvasive incontinence therapies. Effectiveness endpoints included objective dryness, negative CST, adverse events, and revision/resurgery through 36 months. The primary effectiveness endpoint was reduction from baseline in 24-h pad weight of ≥50% at 6 months, as requested by the FDA, and is included as a study point in this paper. Primary safety endpoint was rate of related serious adverse events (SAE) through 36 months. Noninferiority margins of 15% and 10% were prespecified for the effectiveness and safety endpoints. Due to the observational nature of the cohort study, a propensity methodology was conducted to assess the effect of potential confounding variables on the primary endpoints between groups. RESULTS: Three hundred fifty-five women underwent the sling procedure (n = 184 Altis; n = 171 Comparator). One hundred fourty (76%) Altis subjects and 101 (59%) Comparator subjects completed follow-up through 36 months. At 36 months, for the effectiveness endpoint, the difference in proportions of -0.005 for Altis versus Comparator (95% confidence interval [CI]: -0.102 to 0.092) was statistically significant (p = 0.002), supporting the hypothesis that Altis is noninferior to Comparator. Furthermore, both groups demonstrated high objective efficacy; in the Altis arm n = 99 (81.8%) subjects were a success, and in the Comparator arm, n = 79 (82.3%) subjects were a success. Additionally, regarding the CST, Altis was found to be noninferior to the Comparator at every study visit, and the rate of negative CST remained above 80% for both groups (p \u3c 0.001). At 36 months, Altis (n = 2; 1.1%) and Comparator (n = 4; 2.3%) subjects experienced a device and/or procedure-related SAE. The difference in proportions of 0.013 for Altis versus Comparator (95% CI: -0.023 to 0.048) was statistically significant (p \u3c 0.001), demonstrating that Altis is noninferior to Comparator with respect to the primary safety endpoint throughout the study. There were 62 (36.3%) retropubic midurethral slings (RMUS), 96 (56.1%) transobturator midurethral slings (TMUS), and 13 (7.6%) SIS slings in the Comparator group. For the 36 month effectiveness endpoint, assessing the noninferiority of Altis versus RMUS and Altis versus TMUS, 99 (81.8%) Altis and 37 (90.2%) RMUS were a success, trending toward statistical significance, however, it cannot be determined to be noninferior (p = 0.092). Ninty-nine (81.8%) Altis and 33 (71.7%) TMUS were a success; this was statistically significant (p \u3c 0.001), demonstrating Altis was noninferior to TMUS. Rates of negative CST were 122 (87.1%) Altis, 40 (93.0%) RMUS (p \u3c 0.001), and 44 (91.7%) TMUS (p \u3c 0.001). CST demonstrated that Altis was noninferior to RMUS and Altis was noninferior to TMUS at 36 months. CONCLUSION: Altis single-incision sling was noninferior to standard midurethral sling for treatment of stress UI, throughout the study and at 36 months. Furthermore, adverse event rates were low