A contemporary review of the treatments and challenges associated with penile rehabilitation after radical prostatectomy including a proposed optimal approach.

Prostate cancer is one of the most prevalent malignancies affecting men worldwide. Despite advancements in understanding prostate anatomy and minimally invasive approaches to surgical treatment, surgery can have significant adverse effects on sexual function. Penile rehabilitation strategies have emerged as a promising approach to mitigate the impact of prostate cancer treatments on erectile function and improve quality of life. Several methods have been employed for penile rehabilitation, including pharmacotherapy, vacuum erection devices, intracavernous injections, and emerging novel techniques. Yet, there is no consensus on the exact programs or timing of initiation that should be utilized for optimal recovery after surgery. This review discusses various rehabilitation protocols and long-term outcomes and explores the cost-effectiveness of different interventions. Additionally, this review discusses the importance of a multidisciplinary approach to penile rehabilitation which includes patient education, counseling, and the selection of an appropriate rehabilitation strategy tailored to each individual's needs and preferences. Continued research and collaboration among healthcare professionals are essential to refine rehabilitation approaches and ensure optimal outcomes for patients with prostate cancer.

Prevalence of LUTS and urodynamics results in obese women.

INTRODUCTION: Obesity is a well-known risk factor for lower urinary tract disorders. Lifestyle plays an essential role in the etiology of the symptoms, negatively affecting self-esteem and quality of social, professional, and sexual life. OBJECTIVES: To assess the prevalence of lower urinary tract symptoms and urodynamic patterns in obese women and to compare to nonobese volunteers. METHODS: Overactive bladder (OAB) questionaries (International Consultation on Incontinence Questionnaire [ICIQ]-OAB) and stress urinary incontinence (SUI) (ICIQ-short form) were applied to the participants. They underwent a physical exam and urodynamics except for the control group. RESULTS: A total of 109 women completed the protocol and 20 were in the control group. The average age was 43.0 years, and the average body mass index was 45.12 ± 7.64 kg/m2 and control was 44.5 years, and 29.95 ± 5.08 kg/m2 . The OAB symptoms in the obese group were 31.20%, 55.95% higher than the control group (20.0%). The prevalence of SUI in the obese group was 20.20%, an increase of 34.53% compared with the control group (15.00%). The urodynamic study (UDS) showed that the morbidly obese women have a first sensation earlier than the obese or severely obese, as well as the first desire to void. The Valsalva leak point pressure of morbidly obese women was significantly higher than the others. CONCLUSION: Among obese women, either the prevalence of SUI or OAB is significantly higher than the nonobese female population. Regarding UDS, the pattern is similar to the clinic diagnostic. The grade of obesity is directly associated with an impairment of the patient's cystometric capacity.

Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: summary of current literature.

PURPOSE: Nonobstructive azoospermia (NOA) is associated with intrinsic testicular defects that severely impair sperm production. Although NOA invariably leads to infertility, focal sperm production may exist in the testicles of affected patients, which can be retrieved and used for intracytoplasmic sperm injection (ICSI) to generate healthy offspring. However, geographic locations of testicular sperm producing-areas are uncertain, making microsurgical-guided sperm retrieval (microdissection testicular sperm extraction; micro-TESE) an attractive method to identify and retrieve sperm in patients with NOA due to spermatogenic failure. Given the widespread use of micro-TESE, its effectiveness in harvesting sperm and related potential complications need to be clarified. METHODS: We queried PubMed/MEDLINE for studies published in English, from inception to May 2021, concerning the effect of micro-TESE on sperm retrieval rate (SRR), complication rate and ICSI pregnancy rate-using retrieved testicular sperm in subfertile couples where the male had NOA. RESULTS: We found 116 articles, including 70 original papers, 32 review articles, and 14 systematic reviews. The evidence accounted for 4895 patients. Micro-TESE retrieved sperm in 46.6% of men with NOA, but SRRs varied considerably (18.4-70.8%) and were mainly related to the treated population characteristics. Concerning the general population of NOA patients who have not undergone previous sperm retrieval (naïve population), the SRR by micro-TESE was 46.8% (1833 of 3914 patients; range 20-70.8%; 28 studies). In studies reporting SR by micro-TESE for men who had failed percutaneous testicular sperm aspiration or non-microsurgical testicular sperm extraction, the SRR was 39.1% (127 of 325 patients; range 18.4-57.1%; 4 studies). Data on adverse events indicated that micro-TESE was associated with low (~ 3%) short-term postoperative complication rates. The fertilizing ability of testicular sperm retrieved by micro-TESE and used for ICSI was adequate (~ 57%), whereas clinical pregnancy and live birth were obtained in 39% and 24% of couples who had an embryo transfer, respectively. The health of the resulting children seems reassuring, but the evidence is limited. The procedure increases sperm retrieval success compared to non-microsurgical retrieval methods, particularly in men with Sertoli cell-only testicular histopathology. CONCLUSION: We concluded that micro-TESE is an effective and safe method to retrieve sperm from men with NOA-related infertility, with potential advantages over non-microsurgical methods. Nevertheless, high-quality, head-to-head comparative randomized controlled trials by sperm retrieval method, focusing on SRR, live birth rate and assessing long-term adverse events and health of children conceived using testicular sperm from NOA patients are lacking. Therefore, further research is required to determine the full clinical implications of micro-TESE in male infertility treatment.

Sacrospinous hysteropexy with an autologous rectus fascia sling for treatment of advanced apical pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: There is a great interest in avoiding mesh usage in vaginal surgeries. We propose using the autologous rectus fascia to repair apical vaginal prolapse in a similar way it has been successfully used in urinary stress incontinence surgery. This study aims to demonstrate the technique of sacrospinous hysteropexy using autologous rectus fascia for apical pelvic organ prolapse (POP) treatment. METHODS: We present a video of a 63-year-old female with stage IV pelvic organ prolapse and urinary obstruction. A rectus fascia sling of approximately 90 × 10 mm was harvested through a Pfannenstiel incision. It was used in vaginal surgery to suspend the cervix and fix the apical POP. RESULTS: The patient resumed her usual activities after 1 week and waited 2 months to resume physical activities and sexual intercourse. She is satisfied at 6 months follow-up, without complications or prolapse recurrence. CONCLUSION: The sacrospinous hysteropexy using autologous rectus fascia is a feasible technique with excellent results and low risk of complication. Further studies are required to compare POP repair using autologous rectus fascia and polypropylene meshes.

A novel histologic finding in male patients with bladder outlet obstruction: a possible etiopathogenesis of Marion's disease?

PURPOSE: George Marion first described primary bladder neck obstruction in 1933. Even today, the etiopathogenesis of this condition is unknown. The objective of this study is to associate a novel histologic finding with Marion's disease to contribute to its etiopathogenesis, and to seek the reason why the lower urinary tract symptoms of some patients was not relieved after pharmacological treatment. METHODS: The retrospective study was carried out with patients who underwent transurethral resection of the prostate from 2009 to 2019. Patients with histological diagnosis did not present hyperplastic nodules, and the presence of skeletal muscle fibers were included in the study. The frequency of cases with presence of skeletal muscle fibers was assessed as well as the area occupied by these fibers in each resected fragment. As a control group, fragments of bladder neck of surgical specimens from 50 radical prostatectomies were analyzed. RESULTS: In 14 patients with skeletal muscle fibers in the resected fragments the extent of each positive fragment was < 25%, > 25-50%, > 50-75%, and > 75% in 28.6%, 28.6%, 21.4%, and 21.4% fragments, respectively. In the control group, 20% (10/50) of the patients had skeletal muscle fibers and, in all cases, they occupied < 25%. CONCLUSION: In these 14 cases, the presence of skeletal muscle fibers is frequent and predominant in TURP fragments, which stands in striking contrast to the control group. We consider that presence of skeletal muscle fibers may be related to Marion's disease, thus contributing to explain its etiopathogenesis and the unsuccessful alpha-blocker treatment in these patients.

Lower Urinary Tract Symptoms Due to Xanthoma of the Prostate After Kidney Transplantation: A Case Report.

BACKGROUND: Prostatic xanthoma is a lesion of unknown cause that is often an incidental finding in patients undergoing needle biopsy or transurethral resection. To the best of our knowledge, we report on a unique case of a pure xanthoma without benign prostatic hyperplasia of the prostate in a patient with lower urinary tract symptoms manifested after kidney transplantation. METHODS: A 62-year-old man was submitted for a kidney transplant in April 2018. He had no urinary complaints previous to the transplant. Since July 2019, he had complained of lower urinary tract symptoms. In October 2019, he had acute urinary retention being submitted to a transurethral resection of an estimated 47 g prostate. All measures of cholesterol, high-density lipoproteins (HDL), and low-density lipoproteins (LDL) were within the normal range-except triglycerides, which were mildly elevated in 2 measures. RESULTS: The pathologic examination of the resected prostate showed pure xanthoma without benign prostatic hyperplasia. A similar lesion with a xanthomatous cell component is verruciform xanthoma. It is a rare benign lesion of unknown etiology not associated with underlying disorders of lipid metabolism that has been reported in patients with bone marrow, kidney, and liver transplant. CONCLUSIONS: We report a unique case of prostate enlargement caused by pure xanthoma in a patient with renal transplant. In absence of any apparent infection, normal cholesterol measures, and appearance of symptoms after the transplant and considering the morphologic similarity with verruciform xanthoma, a lesion also reported in transplanted patients, we speculate that the pathogenesis of the lesion in this particular patient may be related to immunosuppression.

Do rapid emotional thermometers correlate with multidimensional validated structured questionnaires in low-risk prostate cancer?

PURPOSE: To promptly identify mental suffering in low-risk prostate cancer (LRPC) patients, vulnerable to over- and undertreatment, we evaluated the correlation of rapid emotional thermometers (ET) with multidimensional validated structured questionnaires. METHODS: At diagnosis, consecutive LRPC patients underwent five ET domains: emotional suffering, anxiety, depression (DT), revolt and need for help and multidimensional questionnaires: beck anxiety inventory (BAI), beck depression inventory (BDI), beck hopelessness scale, SF36 (physical functioning PF, role limitations due to physical health RP, bodily pain BP, general health perceptions GH, vitality VT, social functioning SF, role limitations due to emotional problems RE and general mental health MH), international index of erectile function and international prostate symptom score (IPSS). RESULTS: Among 30 included patients, mean age 67.4 y (52-74), 20 days after the diagnosis (15-30), mean time to obtain ET 27 s (15-57) and all questionnaires 36.7 min (31-49), ETs showed moderate/strong Spearman correlation among themselves. DT domain displayed the best correlation to most of the multidimensional validated structured questionnaires: moderate to BDI, SF-36 (PF, GH, VT, SF, RE, MH) and IPSS and strong to BAI. CONCLUSION: DT revealed the best correlation to validated structured questionnaires of diverse dimensions with clear potential for quick screening of patients with psychological suffering and in need of further evaluation and support.