Bladder neck contracture (BNC) is one of the most common complications of surgical treatment of prostate diseases. The rate of postoperative BNC varies depending on the type of surgical treatment used. The options for treatment techniques for BNC can vary from endoscopic interventions to complex (abdominal) surgical interventions. This review evaluates various alternative surgical methods of BNC treatment. The search and analysis of publications in the databases PubMed (MEDLINE), Scopus, Cochrane Library, according to the keywords, “bladder neck sclerosis,” “benign prostatic hyperplasia,” “BNC,” “bladder neck stenosis,” “balloon dilation,” “treatment.” As a result, 71 publications were selected and included in this review. In addition to the standard treatment methods in the form of transurethral resection and incision of the bladder neck using electricity and laser energy, the urologist also has alternative methods of treatment, such as balloon dilation, placement of urethral stents, instillation of the bladder or intraoperative injection of cytostatic drugs, hormones, hyaluronic acid derivatives, and biomedical cell products into the bladder neck area. Although transurethral resection is currently the main treatment option for BNC, the recurrence rate after this procedure can reach up to 38%. According to the literature, balloon dilation can be a promising and minimally invasive method of treatment for recurrent BNC. This method can be used as the first stage in the treatment of recurrent contracture deformity. Furthermore, intravesical instillation of various anti-inflammatory drugs and cytostatics can be promising directions in the treatment and prevention of BNC.

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Purpose: Sildenafil is a phosphodiesterase Type 5 inhibitor, which is a powerful and effective therapy for male erectile dysfunction (ED) and enables to restore temporary ED. The aim of this study was to evaluate the effects of sildenafil on seminal parameters in male participants with idiopathic infertility. Materials and Methods: This randomized, double-blind, controlled cross-over clinical trial study was conducted on 79 participants who had been referred to urology clinics in Rasht. Participants were assigned to two Groups A (n = 40), and B (n = 39). In Phase I, participants in Group A received a pill of sildenafil (50 mg) and then received a pill of placebo after the washout period, and participants in Group B received a pill of placebo and then received a pill of sildenafil after the washout period. In Phase II, participants in Group A received a pill of placebo and then received a pill of sildenafil after the washout period; and participants in group B received sildenafil and then received a placebo after the washout period. Results: The mean age of patients was 34 ± 5 years. There was no significant difference in the mean sperm count before receiving the drug in all groups. Sperm count, motility, morphology, pH, viscosity, and liquefaction time of semen did not significantly change after receiving sildenafil in comparison to their corresponding placebo group (P > 0.05). Conclusion: Sildenafil did not change sperm parameters in treating infertile patients; sildenafil also had no positive effect on semen parameters.

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Purpose: Around 75% of all bladder cancers are classified into nonmuscle invasive bladder cancer (NMIBC). The NMIBC's high recurrence and progressivity rate are most commonly found in tumors invading the lamina propria (LP), classified as staged pT1 when it extended to the LP with a heterogeneous recurrence and progression. This study aimed to correlate the measurement of tumor depth and width to lymphovascular invasion (LVI) in NMIBC. Materials and Methods: A 5-year retrospective analytical study (2015–2019) was conducted in a tertiary hospital in Indonesia. We reassessed and analyzed the tumor depth and width of 64 patients with pT1 bladder cancer based on histopathological reports and analyzed the correlation of tumors and LVI. The depth was reassessed by measuring the transitional urothelium with the LP as an initial marking point, up to the tumor's edge in the LP, and tumor's width by measuring the largest width of one tumor focus in the LP, along with the presence of LVI by histopathological exams. Data were analyzed using the Mann − Whitney test. Results: The participants were 64 patients with pT1 bladder cancer. The mean tumor pT1 invasion depth was 2.03 ± 0.918 mm. The non-LVI group's mean tumor invasion depth was 1.72 ± 0.721 mm, whereas the LVI group was 2.21 ± 0.980 mm. The tumor invasion depth was a significant factor for LVI, whereas the tumor maximum diameter was not. Conclusion: The tumor invasion's depth was significantly associated with the LVI. The pT1 tumor invasion depth measurement might serve as a predictive variable of tumor recurrence and progressivity.

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Purpose: Prostate biopsy induced prostate hemorrhage and periprostate tissue inflammation which raised the concerns of increasing difficulty even in the era of robot-assisted radical prostatectomy (RARP). To evaluate the correlation between postoperative outcomes and the interval after biopsy, we compared surgical outcomes in different time interval (≤4 weeks, 4–8 weeks, and ≥8 weeks). Materials and Methods: We collected patients with localized prostate cancer who underwent RARP by a single experienced surgeon at our institute between April 2016 and February 2019. The complicated statuses such as previously transurethral resection of prostate, grossly nodal positive disease, or locally advanced disease were excluded. A total of 83 patients were enrolled retrospectively according to the regulation of the institutional review board in the institute. The patients were divided into three groups according to the time interval between prostate biopsy and RARP (≤4 weeks, 4-8 weeks and ≥ 8 weeks). The demographic information and perioperative and postoperative outcomes were collected and analyzed. Results: Regarding preoperative characteristics, there were similarities in the three groups. Concerning intraoperative outcomes, statistical difference was observed in mean estimated blood loss (253.1 vs. 158.9 vs. 170.9 ml, P = 0.047). In addition, operative time was similar among three groups (221.9 vs. 248.5 vs. 226.7, P = 0.199). There was no difference in positive surgical margin rate among three groups. The time interval groups did not correlate to prolonged days either urinary catheter indwelling or hospitalization (P > 0.05). There was no difference in decreased erection hardness scores at 12 months between 3 groups (−0.75 vs. −0.77 vs. −0.57, P = 0.556). Conclusion: In our experience, RARP can be effectively and safely performed in different time intervals after prostate biopsy without increasing total operative time or adversely compromising postoperative functionally and oncologic outcomes. However, performing RARP < 4 weeks after prostate biopsy did probably have the risk of increase estimated blood loss.

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Purpose: Socioeconomic inequality may contribute to different risk factors for cancers. This study aims to analyze the socioeconomic patterns of urological cancer incidence and mortality in Taiwan. Materials and Methods: Using data from the National Health Insurance, we designed a retrospective longitudinal cohort study of 3686 subjects who were newly diagnosed with bladder cancer (BC), kidney cancer (KC), and upper urinary tract cancer (UTUC) between 2000 and 2010. We analyzed patients' characteristics and mortality among the three cancers. Results: The average age of KC diagnosis was the youngest among the cancers. Moreover, KC tends to occur in patients with higher-income occupations who reside in urban areas. Both BC and UTUC were much more prevalent in patients with less socioeconomic means and those living in rural areas. Varied comorbidities showed different distributions among urological cancers. Although the extent was most prominent in KC, both overall mortality and cancer-specific mortality of the three cancers increased every year during the follow-up period. Conclusion: Our results demonstrate different patient characteristics and mortality among BC, KC, and UTUC in Taiwan.

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Purpose: The surgical treatment for severe benign prostatic hyperplasia is challenging. The aim of our study was to compare the safety and efficacy of monopolar transurethral resection of the prostate (M-TURP) and holmium laser enucleation of the prostate (HOLEP) for prostate size >100 ml. Materials and Methods: We retrospectively evaluated our database of two groups of patients. Thirteen patients underwent M-TURP (group 1), and 27 underwent HOLEP (group 2). Results: The mean prostate size was 163.1 ± 49.0 ml in group 1 and 143.4 ± 40.9 ml in group 2 (P = 0.19). There was no significant difference in resected tissue volume, days of catheter removal, admission days, and postoperative serum hemoglobin between treatment groups. However, in group 1, mean postoperative serum sodium dropped from 137.1 mmol/L to 131.4 mmol/L, which was significantly lower than postoperative serum sodium in group 2 (P < 0.0001). There were more complications in group 1 than group 2, especially for patients undergoing transfusion (76.9% in group 1 and 22.2% in group 2) and with hyponatremia (15.4% in group 1 and 0% in group 2). At 3-month follow-up, the international prostate symptom score, quality of life score, and residual urine volume revealed no significant differences between groups. Conclusion: M-TURP and HOLEP in men with prostate volume greater 100 ml had similar operative time, admission days and postoperative functional outcomes. However, higher transfusion rates and postoperative hyponatremia were noted in the M-TURP group comparing to the HOLEP group.

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Purpose: The purpose of the study is to compare the efficacy of Bacillus Calmette-Guérin (BCG) strains, Connaught (ImmuCyst^®), and TICE (OncoTICE^®) in patients with nonmuscle invasive bladder cancer (nMIBC). Materials and Methods: Patients with nMIBC who underwent transurethral resection between March 1997 and December 2017 were enrolled. TICE was used due to the Connaught strain shortage since 2012; hence, direct comparison of the two strains could not be performed. An intravesical instillation (IVI) regimen of mitomycin-C, doxorubicin, and cisplatin (MDP) was used as the reference for comparison. The MDP group was separated into two cohorts (MDP-1 and MDP-2) that matched the same time period of Connaught and TICE treatment. Patients who did not complete the IVI course before disease recurrence or progression or were not followed up for at least 24 months were excluded. Results: A total of 730 patients were included in the analysis. There were 67 (9.2%), 38 (5.2%), and 625 (85.6%) patients who received the Connaught, TICE, and MDP treatment, respectively. During a median follow-up duration of 59 months, the recurrence rates of the Connaught, MDP-1, TICE, and MDP-2 groups were 10.5%, 22.8%, 28.9%, and 23.0%, respectively. Both BCG groups had higher tumor grades and more instances of carcinoma in situ than their corresponding MDP cohorts. The Connaught and TICE strains had similar effects in preventing tumor recurrence (Connaught vs. MDP, P = 0.876; TICE vs. MDP, P = 0.556). In the multivariable Cox proportional hazard model that included all patients, the Connaught and TICE groups had a similar risk (hazard ratio = 0.784 and 0.850) of recurrence compared to the MDP protocol. Although progression events were more frequently noticed in the Connaught group, the small number of events limited the analysis. Conclusion: The BCG strains, Connaught and TICE, had similar efficacy in reducing bladder tumor recurrence in nMIBC patients. Both strains resulted in similar bladder recurrence-free survival rates to chemotherapeutic agents.

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Purpose: This study aimed to determine the reliability and validity of a new baseline renal function calculator after radical nephrectomy in Malaysian patients. Materials and Methods: This study retrospectively collected data on patients' demographics, tumor characteristics, and baseline estimated glomerular filtration rate (eGFR) during radical nephrectomy from a single urology center from 2015 to 2020. The predicted eGFR was determined using a calculator. Predicted eGFR was validated by performing simple linear regression and Pearson coefficient correlations; reliability was determined by calculating Shrout and Fleiss's intraclass correlation coefficients. Results: Fifty-two patients (mean age, 57.5 years) were enrolled in this study. Thirty-seven (71.2%) patients were men, and 15 (28.8%) had diabetes. Most of the patients (90.2%) had a baseline eGFR of >60 mL/min/1.73 m2. The mean preoperative eGFR was 85.33 mL/min/1.73 m2, whereas the mean postoperative eGFR was 59.88 mL/min/1.73 m2. Simple linear regression analysis resulted in an R2 value of 0.700. The predicted eGFR was significantly correlated with the actual eGFR 6 months after radical nephrectomy (r = 0.837, P < 0.0001). The intraclass correlation coefficient value of 0.83 indicated good reliability of the formula. Conclusion: Our new validated and reliable baseline renal function calculator can provide easy and rapid prediction of renal function in patients scheduled for radical nephrectomy in a sample Malaysian population.

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