Remote spinal trauma resulting in dorsal column spinal pathway dysfunction and anejaculation.

Spinal cord injury (SCI) as the cause of anejaculation is a rare entity. We present the case of a 65-year-old male with a five-year history of intractable anejaculation. Two years prior to onset of his anejaculation, the patient fell from height, causing minor spinal trauma, with sequelae of cervical myelopathy and eventual posterior spinal fusion of C1/C2. Biothesiometry and sensory evaluation revealed diminished somatic sensation of his glans penis in a frequency-dependent pattern. The patient's pudendal sensory loss and anejaculation correlate with his spinal trauma, as evidenced by the lack of peripheral nervous system findings upon neurological exam and imaging.

Pelvic osteotomy in cloacal exstrophy: A changing perspective.

BACKGROUND: The type of osteotomy and pelvic fixation in the management of primary cloacal exstrophy (CE) closure is variable. The purpose of this study was to evaluate primary CE closure outcomes with osteotomy, immobilization, and multi-staging procedure trends over time. METHODS: An institutional database was retrospectively reviewed for patients who underwent primary CE closure from 1960 to 2020. Demographics, osteotomy, fixation, and outcomes were noted. Subanalyses by location of primary closure (AH=author's hospital; OH=outside hospital). RESULTS: Out of 122 patients, multi-stage became more common than single-stage procedures (p = 0.019), with multi-stage associated with higher success rates (77.4% v 45.7%; p = 0.001). The use of any osteotomy increased over time (p = 0.007), with a posterior approach falling out of favor and increasing prevalence of a combined osteotomy (p<0.001). The use of any osteotomy compared to no osteotomy was associated with successful closure (77.6% v 41.7%; p = 0.007). The combined, posterior, and anterior approaches were associated with 90%, 76.2%, and 60.9% successful primary closure rates, respectively (p<0.001). Fixation modalities changed over time as Buck's traction (p<0.001) and external fixation (p<0.001) became more prevalent. Spica casting has become less common (p = 0.0002). Immobilization type was associated with success rates with Buck's (92.1%; p<0.001) and external fixation (86.0%; p<0.001) performing best. CONCLUSIONS: The use of osteotomy and fixation in the CE spectrum has changed markedly. In this cohort, a staged approach with combination osteotomy was associated with better outcomes when using a multidisciplinary team approach. LEVEL OF EVIDENCE: This is a retrospective comparative study (Type of Study: Treatment; Evidence Level: III).

Urology case reports: Rapidly growing adrenal ganglioneuroma in a young man.

A 23-year-old man was incidentally diagnosed on CT scan with a 6.4 cm right adrenal mass during workup for acute abdominal pain, with interval growth to 9.4 cm over 3 months. Given the mass size and concern for potential malignancy, a right open adrenalectomy was performed. Pathologic evaluation confirmed a diagnosis of adrenal ganglioneuroma (AG) and the patient exhibited an unremarkable postoperative course. AGs are rare, benign tumors of the adrenal gland. Diagnosis is made by histopathologic assessment, and management of larger AGs is nearly always surgical given radiographic similarities between AG and malignancy. Adrenalectomy is generally curative for AG.

Robotic Excision of Large, Multi-focal Ureteral Fibroepipthelial Polyps.

Ureteral fibroepithelial polyps (UFP) are benign neoplasms of mesodermal origin. In this report, we describe the rare presentation and robotic surgical management of UFP in an adult female. A 25-year-old female with recurrent bilateral UFP s/p multiple ureteroscopic ablations and right partial ureterectomy with ureto-ureteral anastomosis presented with left flank pain. Four-phase CT with delayed images demonstrated a filling defect in the left ureter. Ureteroscopy confirmed the left UFP. The number, size, and multifocality precluded endoscopic management. Creatinine was normal and the split function was 53%/47%. The patient was recommended for robotic repair. After mobilization of the colon, the ureter was identified and traced up to the hilum. There was an inflammatory rind surrounding the ureter through the majority of its length. Care was taken to avoid circumferential dissection of the ureter. Upon longitudinal incision of the ureter, polyps erupted with a release of hydronephrotic urine, despite pre-stenting. Polyps were transected at their base, revealing abnormal underlying urothelium. A ureteroscope was advanced through a robotic port to examine the proximal ureter and renal pelvis. The remaining polyps were removed after which a wire and stent were placed antegrade into the open distal ureter and proximally into the renal pelvis. The anastomosis was performed with 5-0 PDS. ICG and firefly confirmed suitable blood flow to the ureter. Pathology revealed benign fibroepithelial polyps with reactive changes to the urothelium. A retrograde pyelogram 2 months later revealed a patent ureter. This video demonstrates the successful robotic surgical management of large, multifocal UFPs.1-5.

Acquired male urethral diverticulum complicated by calculi: A case report.

We present the case of a 38-year-old male with a past presumed history of traumatic genitourinary injury. Twenty-one years later, he presented with dysuria, urinary frequency, and urinary urgency and was found to have membranous stricture as well as a urethral diverticulum filled with calculi. For this rare case, we elected surgical management via urethroplasty and a urethral diverticulectomy. We present his clinical course and brief review of the diagnosis and management of male urethral diverticula.