Molecular Biophysics
We Must Stop Misusing the Term Prostatitis
Chief complaints and referrals continue to include the word “prostatitis.” A recent PubMed search revealed the persistence of “CP/CPPS” (Chronic Prostatitis/Chronic Pelvic Pain), whether mood, semen quality, weather or brain functional connectivity were being correlated, and whether the interventions employed acupuncture, psychotherapy or low intensity shockwave therapy.Bladder Cancer in a Long-term Survivor of the Prune Belly Syndrome
Prune belly syndrome (PBS) is a rare but morbid complexity of congenital anomalies that consists of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. With the recent advances in perinatal care, the life expectancy of patients with PBS has improved. Although renal and sexual outcomes are frequently discussed in the literature, little is known about urinary tract malignancies in adulthood. Herein, we present a case of advanced bladder cancer in a 38-year-old man with PBS.Ovotesticular Disorder Mimicking Acute Spermatic Cord Torsion
Ovotesticular disorder is a rare form of sexual development in which a patient may have one ovary and one testis, or more commonly a gonad or gonads containing both ovarian and testicular tissue. Patients with this condition typically present in infancy with ambiguous genitalia. Delayed presentations of clinically symptomatic, older patients with normal external genitalia are extremely rare. We present a case of a 14-year-old male with normal external genitalia who presented with symptoms and signs consistent with spermatic cord torsion but found to have ovotesticular disorder on evaluation.Author Reply
It seems that their comments are generally in agreement with our viewpoints. “However, these two papers failed to report the incorrect diagnosis of SUI, and urine accumulates in the diverticulum and flows out after pressurization, which is mistaken for SUI.” The authors insist here on the challenge of diagnosing true SUI when a diverticulum is present, a condition called pseudo-incontinence, which corresponds to the emptying of the fluid content of the diverticulum pocket during stress efforts. This was discussed in several sections of our manuscript and is the main reason why we generally omit urodynamic testing in these women.Persistent Anhydramnios and Lower Urinary Tract Obstruction in a Patient With a Vesicoamniotic Shunt
Persistent anhydramnios after placement of a vesicoamniotic shunt is a rare but potentially serious concern in a patient in utero. We present the case a male fetus who at 32-week gestation had bilateral hydroureteronephrosis, a distended bladder, and anhydramnios. A vesicoamniotic shunt was placed, but the anhydramnios persisted. Postnatally, the child was found to have a migrated shunt, left grade V vesicoureteral reflux and posterior urethral valves. He underwent a posterior urethral valves ablation and removal of the migrated shunt.Bedside Intervention for Neonatal Hydrometrocolpos and Imperforate Hymen
Low complexity cases of neonatal hydrometrocolpos from imperforate hymen are typically treated with hymenotomy or hymenectomy. Although this is commonly performed in the operating room, bedside management is also safe and effective. We present a case of prenatally diagnosed, simple hydrometrocolpos treated via bedside hymenotomy on the first day of life. The patient received periprocedural antibiotics prior to the procedure and had full resolution of hydrometrocolpos without any complication or need for further intervention.Stress Urinary Incontinence After Urethral Diverticulum Repair Without Concomitant Anti-Incontinence Procedure
Recently, we read the report of Chavez et al1 who demonstrated that post-urethral diverticulum (UD) repair, the rate of persistent stress urinary incontinence (SUI) was present in 14 of 31 (45%) cases, and de novo SUI occurred in 4 of 30 (13%) cases. It is controversial to perform SUI and UD surgeries simultaneously, and this paper provides new evidence about this topic. At the same time, Greiman et al demonstrated that the resolution of SUI in simultaneous surgery is 83% and the resolution is 53% in UD surgery alone.Author Reply
Thank you for your response to our article “Erectile Dysfunction and Treatment: An Analysis of Associated Chronic Health Conditions.” Your letter-to-the-editor makes thoughtful additions regarding the complexities many young men encounter in seeking healthcare. Your point on the cultural implications that impact young men when seeking preventative measures is especially noteworthy. As medicine begins to utilize telemedicine more often, it may provide a unique opportunity for young men to establish meaningful long-term rapport with providers.Nephron-Sparing Approach For Familial Bilateral Synchronous Wilms Tumors
Wilms tumors are the most common renal malignancy of childhood, often presenting as asymptomatic abdominal masses. These tumors can occur either in a unilateral or bilateral fashion, with bilateral tumors more commonly associated with various genetic syndromes and familial inheritance with some known loci. Bilateral tumors present challenges with regards to balancing oncologic control with renal function. Here, we present an unusual case of a young female patient diagnosed with bilateral Wilms tumors on the background of a strong family history and unknown genetic loci.“Erectile Dysfunction and Treatment: An Analysis of Associated Chronic Health Conditions”
The article entitled “Erectile Dysfunction and Treatment: An Analysis of Associated Chronic Health Conditions” by Lindsey Wright et al. recently published online ahead of print in Urology 2021 Aug 21; S0090-4295(21)00782-2. highlights one of the many reasons why “Men's Health” is in need of a reformation.Author Reply to Letter to the Editor
We thank Kokayi et al for their interest in our study on the feasibility and outcomes of active surveillance (AS) in renal oncocytoma recently published in Urology.1 We also read with great interest their results on the growth and renal function dynamics of renal oncocytomas in patients on AS.2 It is a great satisfaction to see that our institutions share common research topics in addition to similar conclusions.Congenital Giant Megaureter in a 16-Year-Old Female Presenting With Abdominal Pain: A Case Report and Review of Literature
We describe a case of congenital giant megaureter in a 16-year-old female. She presented with a 5-day history of abdominal distention, right flank pain and tenderness. Right pyelonephritis was suspected. Computerized tomography showed a large cystic abdominal mass with no appreciably functioning left kidney causing secondary compression of the contralateral right ureter. A left upper nephroureterectomy was performed, draining over 3.5 L of fluid. Our experience suggests that congenital giant megaureter should be considered in the differential for pediatric patients presenting with a cystic abdominal mass.Letter to the Editor-Active Surveillance for Biopsy Proven Renal Oncocytomas: Outcomes and Feasibility
We welcome this contribution to the growing body of evidence demonstrating the safety of active surveillance (AS) for biopsy-proven renal oncocytomas. The low median growth rate of 2.4 mm/y reported in this work is in keeping with our own series1 and that of others,2,3 in which no patient has developed metastases or disease-related mortality during median follow up of 29-34 months.Whole Exome Sequencing Identifies a Rare Mutation in NACAD as a Possible Cause of COVID Orchitis in Brothers
COVID orchitis (testicular pain) is reported in 10-15% of men with long COVID. We identified 2 siblings with COVID orchitis and hypothesized that genetic mutations are associated with susceptibility. Blood samples from 5 COVID-19 (+) men, three of whom had orchitis were evaluated by whole-exome-sequencing. A rare deletion on chromosome 7 was found in NACAD among the 3 men with orchitis. Interestingly, circulating ACE2 levels was decreased in men with COVID orchitis. This pilot study generated the hypothesis that men who develop COVID orchitis could have underlying genetic variants and altered levels in circulating ACE2 that may increase their risk.Pediatric Penile Non-Involuting Congenital Hemangioma With an Associated Pyogenic Granuloma: Surgical Management of a Rare Vascular Anomaly
Vascular anomalies include both tumors and malformations. Infantile hemangiomas are the most common benign vascular tumor of infancy that proliferate after birth and eventually involute. By contrast, congenital hemangiomas are formed at birth and are categorized into three groups: rapidly involuting, partially-involuting, and non-involuting congenital hemangiomas (NICH). NICH do not regress and grow with age. Pyogenic granulomas, another acquired vascular tumor, develop over vascular lesions and cause bleeding.Misdiagnosis of Congenital Posterior Urethroperineal Fistula and Comparison With Urethral Duplications and Rectourethral Fistula
Congenital posterior urethroperineal fistula (CUPF) is a urothelium-lined tract between the posterior urethra and perineum. This condition is rare and has been proposed to be a urethral duplication variant. A case of CUPF that was misdiagnosed and surgically treated as a rectourethral fistula is presented. The clinical presentation, diagnosis, and treatment of CUPF are discussed and compared with those of Y-type urethral duplications and H-type rectourethral fistulas.Fluorescent Guided Lymph Node Harvest in Laparoscopic Wilms Nephroureterectomy
Lymph node harvest is an integral part of Wilms tumor surgery with both SIOP and COG protocols asking for more than 6 lymph nodes to best evaluate for nodal spread and a subsequent need for intensification of treatment. The majority of studies show that in both open and minimally invasive resections the median number of nodes removed is 4. Indocyanine green and near infrared fluorescence may be the key to solving this problem. In adult gynaecology, colorectal and breast cancers, ICG is used to identify sentinel nodes and facilitate nodal retrieval.Re: Dudith Pierre-Victor, Howard L. Parnes, Gerald L. Andriole, et al. Prostate Cancer Incidence and Mortality Following a Negative Biopsy in a Population Undergoing PSA Screening. Urology 2021 Jun 26;S0090-4295(21)00539-2
We read with great interest the recent work of Pierre-Victor et al on prostate cancer incidence and mortality in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.1 We previously reported, in 2017, on a similar cohort from this trial.2 We studied men in the screening arm who screened positive (via prostate-specific antigen or digital rectal exam) during the first year of the trial, and whose linked biopsy was negative. We found a similar mortality rate after a median follow-up of 12.9 years of 1.1% (vs 1.2% in the present study).Letter to the Editor re: Gender Differences in Authorship in Urology: A Five-year Review of Publications in Five High-impact Journals
Appreciate the contribution by Whitley et al. 1 which provides valuable perspective on female authorship in urology journals. However, there is a significant error in Table 1 listing the impact factor for the journals evaluated. The impact factor for The Journal of Urology is listed as 2.114 while the correct number for 2019 is 5.925.Letter-to-the-Editor ReplyReply to letter ‘Re: ‘Is Stone-Free Status After Surgical Intervention for Kidney Stones Associated with Better Health-Related Quality of Life? - A Multicenter Study from the North American Stone Quality of Life Consortium’ by Senol Tonyali (10.1016/j.urology.2020.12.044)
We thank you for your interest in our recent article evaluating patients’ HRQOL and stone-free status following kidney stone surgery. We are pleased with the dialogue our findings are generating and hope this propels the emphasis of HRQOL as an important measurement of treatment success. We acknowledge the limitations of retrospective cross-sectional studies, such as ours. Despite this, we hope our study serves as a guide for future studies.
