Holmium laser endourethrotomy and litholapaxy of an occult prostatic utricle calculus.

Prostatic utricle (PU) stones are rare and the surgical treatment of such PU anomalies has proved challenging given their location adjacent to the posterior urethra and proximity to important fertility and continence structures. We report the case of a 58-year-old male with hypospadias, microphallus, and irritative lower urinary tract symptoms (LUTS) found to have a large PU stone. He underwent successful complete endoscopic removal of the stone via transurethral unroofing and holmium laser litholapaxy. We conclude that it is an effective alternative to other surgical techniques once size of the stone and the patient's individual anatomy are considered.

Pediatric hemorrhagic cystitis.

PURPOSE: To review the current literature as it pertains to hemorrhagic cystitis (HC) in the pediatric bone-marrow transplant (BMT) population. By reviewing the pathophysiology of the disease, preventive methods, and therapeutic options, urologists may be better equipped to manage this challenging clinical scenario. MATERIALS AND METHODS: The HC literature was reviewed using a MEDLINE/PubMed literature search, specifically focusing on the pediatric BMT population as it pertains to the incidence, pathophysiology, prevention, and treatment of HC. RESULTS: Conservative estimates of HC incidence in recent retrospective studies of pediatric BMT populations still approach 10-20%. Several high-volume pediatric BMT centers have reported contemporary data on their experience with HC providing increased insight into incidence and pathophysiology. Accumulating evidence linking BK virus to HC is a significant development warranting further investigation. Other contributing agents/risk factors need identification in the likely multifactorial etiology of HC. Preventive and therapeutic strategies have made modest advances, but certainly need further validation with prospective randomized studies. CONCLUSIONS: Pediatric BMT patients are susceptible for HC development despite preventive measures and improved insight into the pathophysiology. Unfortunately, there are no evidence-based treatment guidelines for this difficult clinical issue that frequently requires prolonged care and multiple treatment modalities necessitating judicious patience in the application of more aggressive interventions.