Vasectomy histology: Is it still useful?

OBJECTIVES: To determine if histological evaluation of the vasa is useful when post-vasectomy semen analysis (PVSA) compliance is low and to determine whether compliance could be predicted. METHODS: A retrospective evaluation of patients undergoing vasectomy between 2018 and 2022 was undertaken. A comparison of the PVSA between three vasa histological categorisations was made: complete divisions, incomplete division(s), absent vas(a). A multivariate model was constructed to predict PVSA compliance. RESULTS: From 388 patients, 191 (49.2%) undertook PVSA. Four patients had a revision of vasectomy. On 3 occasions this was due to the histology findings and once from semen analysis with normal histology. There was no significant difference in the number of azoospermic samples (95.4% vs 91.2%, ns), of samples with presence of Rare Non-Motile Sperm (RNMS) (2.6% vs 8.8%, ns) and those with sperm present (2.0 vs 0%, ns), between patients with complete division of the vasa on both sides and those with incomplete division on one side respectively. There was no difference in patient characteristics between those who complied with PVSA and those who did not. CONCLUSIONS: This paper suggests that there is a role for histological evaluation of the vasa when PVSA compliance is poor. Incompletely divided vasa on histology are not associated with an adverse PVSA.

Robotic pyeloplasty: Technological global panacea or geo-surgical nightmare?

To the Editor, Pelvi-ureteric junction obstruction (PUJO) is a well-recognised clinical entity characterised by functionally significant impairment of drainage of urine at the level of the pelvi-ureteric junction due to extrinsic or intrinsic obstruction and is encountered both by adult and paediatric urologists alike. Management of PUJO has been surgical historically, and the gold standard has been an open Anderson-Hynes dismembered pyeloplasty [...].

Comparison of outcomes of open, laparoscopic and robot-assisted laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: protocol for a systematic review and meta-analysis.

INTRODUCTION: The treatment of children with pelviureteric junction obstruction (PUJO) has naturally progressed from open, to minimally invasive approaches, including laparoscopic pyeloplasty and robot-assisted laparoscopic pyeloplasty (RALP). The RALP is now considered to be the gold standard for paediatric patients with PUJO, except for smaller infants due to size limitations. Our systematic review aims to synthesise all the available evidence regarding key postoperative outcomes for the three surgical approaches to pyeloplasties in children. Our outcomes of interest include, but are not limited to, the reoperation rate, length of hospital stay and postoperative complications as classified by the Clavien-Dindo grading system. A comprehensive assessment of all three methods in paediatric patients has yet to be conducted in the literature to date. METHODS AND ANALYSIS: A systematic search of the MEDLINE, PubMed, EMBASE and Cochrane databases will be conducted. Screening, data extraction, statistical analysis and reporting will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included papers will be full-text manuscripts written between 1947 and March 2024, comparing the outcomes and complications of open, laparoscopic and RALP. Quality and study bias will be assessed using the Newcastle-Ottawa score and, if relevant, the Cochrane risk of bias tool for randomised trials. This present protocol is written in accordance with the PRISMA Protocol 2015 checklist, ensuring that the highest methodological standards are adhered to. ETHICS AND DISSEMINATION: No ethical approval shall be required, as this is a review of already published literature. Findings will be disseminated through publications in peer-reviewed journals and presentations at international and national conferences. PROSPERO REGISTRATION NUMBER: CRD42023456779.

Case of duplication of the urethra in an adult male, presenting with symptoms of bladder outlet obstruction.

Duplication of the urethra is a rare congenital anomaly, usually found in children and adolescents. The authors present a rare case of urethral duplication, presenting in a 58-yr-old man, with symptoms of bladder outlet obstruction.

Dorsal onlay augmentation urethroplasty with small intestinal submucosa: modified Barbagli technique for strictures of the bulbar urethra.

AIM: To present the results from one clinic's experience of using small intestinal submucosa (SIS) in augmentation urethroplasty for management of strictures of the bulbar urethra. METHODS: Urethral surgery was performed in nine men with strictures 4-6 cm. All of the patients were evaluated by history, physical examination, retrograde urethrogram, and uroflowmetry. Four layers of SIS were soaked in saline or Ringer's solution for 15 minutes at 37 degrees C, and the inner surface of the patch was gently fenestrated with a thin scalpel. The patch was spread-fixed onto the tunica albuginea. The mucosa was sutured to the submucosal graft first at 2-3 mm inwards from the SIS margins, then the spongiosum tissue was attached to the margins with interrupted absorbable sutures. RESULTS: Of the nine patients who underwent augmentation urethroplasty using SIS, only one had re-stricture at 6 months due to urethral infection. At 18 months after the surgery the uroflowmetry of the other eight patients was 20-21 mL/s. In terms of complications, six patients reported having post-micturition dribbling, and seven patients reported lack of morning erections for 35-69 days after surgery. CONCLUSIONS: Using SIS is a safe procedure; however, long-term follow-up is needed to substantiate the good short-term results.