Male Tract Research Articles

Predictive factors for the success of trial without catheter for men with urinary retention.

To investigate the trial of spontaneous urination without catheter (TWOC) outcomes for men with acute urinary retention, determine successful TWOC predictors, and evaluate the impact of add-on medication therapy on TWOC. This retrospective study included men with acute urinary retention and post-void residual (PVR) >250 mL who underwent TWOC between July 2009 and July 2019. Patients were divided into a medicated group who received alpha1 blocker on urinary retention diagnosis and a naïve group who did not. The trial was defined as unsuccessful if the PVR was >150 mL or if the patient experienced difficulty emptying their bladder with abdominal discomfort or pain, and a transurethral catheter was reinserted. Among 576 men with urinary retention, 269 (46.7%) constituted the medicated group and 307 (53.3%) the naïve. The naïve group comprised more elderly patients (P = 0.010) with higher Eastern Cooperative Oncology Group performance status (PS) (P = 0.001) and smaller prostate volume (P = 0.028) than the other. In the medicated group, 153 men received additional oral medication before TWOC to increase the success rate. There were significant age differences (P = 0.041) in the medicated group and significant median PS differences (P = 0.010) in the naïve group between the successful and unsuccessful outcomes of TWOC. The multivariate logistic regression model demonstrated that age <80 years in medicated patients (P = 0.042, odds ratio [OR] 1.701) and PS <2 in naïve patients (P = 0.001, OR 2.710) were significant independent predictors of successful TWOC outcomes. This is the first study classifying patients with urinary retention according to medication status. Both medicated and naïve groups had different patient backgrounds and TWOC outcome predictors, suggesting a discrepant etiology behind urinary retention. Hence, acute urinary retention management in men should vary based on medication status for male lower urinary tract symptoms when urinary retention is diagnosed.

Do the incidence and severity of lower urinary tract symptoms measured by the international consultation on incontinence questionnaires correlate with urodynamic findings in patients with systemic sclerosis?

Background Systemic sclerosis (SSC) affects the urinary bladder and many other body organs. Systemic sclerosis commonly manifests as lower urinary tract symptoms (LUTS), which are usually reported using validated questionnaires. This study aimed to correlate questionnaire-reported LUTS with urodynamic findings in patients with SSC. Materials and methods This cross-sectional study was performed at our center between August 2018 and July 2021. Lower urinary tract symptoms were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) and ICIQ Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS) and urodynamic studies. Univariate analyses were then performed on variables affecting detrusor activity. Results This study included 22 patients (5 men, 17 women). The mean ± standard deviation age, body mass index, and disease duration were 37.2 ± 11.1 years, 25.5 ± 4.2 kg/m2, and 6.2 ± 5.3 years, respectively. Lower urinary tract symptoms occurred in 19 (86.4%) patients, of whom 18 (94.7%) had mild to moderate symptoms. The ICIQ scores for voiding and filling symptoms were higher than those for incontinence. The most frequent organ involvements included Raynaud’s phenomenon in 22 (100%), skin conditions in 20 (90.9%), gastrointestinal tract maladies in 17 (77.3%), joint disorders in 16 (72.7%), and lung diseases in 14 (63.6%) patients. Abnormal detrusor contractions occurred in only 5 patients (22.7%). Univariate analyses showed that disease duration <5 years (p = 0.010), nonobstructive uroflowmetry findings (p = 0.024), absence of incontinence (p = 0.024) and telangiectasia (p = 0.010), and negative rheumatoid factors (p = 0.043) were significantly associated with normal detrusor contractions. Conclusions Mild to moderate severity of ICIQ-measured LUTS affected most patients with SSC but was not correlated with urodynamic findings. Normal detrusor contractions were significantly associated with shorter disease duration, nonobstructive uroflowmetry findings, absence of incontinence and telangiectasia, and negative rheumatoid factors.

Isolation of Bacteriophage against Pseudomonas aureginosa from Male Urinary Tract Infection (UTI) Specimen

Bacteriophages were isolated from raw sewage and selected based on the size and clarity of plaque that were formed. The selected phages were further enriched and purified. The isolated bacteriophages were found to be able to lyse Pseudomonas aeruginosa isolate from raw sewage. The virulent bacterial viruses of Pseudomonas aeruginosa were found to be of widespread occurrence in nature Bacterial viruses were applied to control pathogenic bacteria in different fields and successfully. Therefore, this work aimed to study is to isolate bacteriophages capable of lysing Pseudomonas aeruginosa as a potential therapeutic alternative to antibiotics.

Re: Niraparib and Abiraterone Acetate for Metastatic Castration-resistant Prostate Cancer

Minimally invasive surgical therapies for male lower urinary tract symptoms secondary to benign prostatic obstruction were developed to be safer and more tolerable than standard ablative techniques. These treatments have not been compared with each other in a randomised fashion, and for some treatments, there are no trials against a reference technique.To compare the efficacy, safety, and tolerability of water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device (iTIND), transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP).A systematic search of MEDLINE/PubMed, Embase, Cochrane Library, and grey literature for randomised controlled trials was performed. Trials meeting the selection criteria were assessed for the risk of bias using the Cochrane RoB2 tool. Treatments were compared, using a network meta-analysis, in terms of outcomes including symptom score, quality of life, maximum urinary flow rate, postvoid residual urine, International Index of Erectile Function (IIEF-5), and scales from the Male Sexual Health Questionnaire.The search identified 63 trials. Symptoms and quality of life for PAE, PUL, and WVTT appeared similar to those for TURP, whereas TURP was found to have the most clinically significant improvement in flow rate. TUMT was less efficacious than TURP but provided similar results on quality of life. Comparisons of ejaculatory function favoured WVTT and PUL compared with TURP. The relative efficacy of iTIND was less clear because of the risk of bias in the respective trial.PAE, PUL, and WVTT appear favourable from a risk-benefit perspective despite probably having less efficacy than TURP for objective outcomes. These findings warrant confirmation through long-term randomised controlled trials.This paper has summarised the evidence from 63 clinical trials on minimally invasive surgical therapies for men with symptoms of an enlarged prostate, including water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device, and transurethral microwave thermotherapy (TUMT). Improvement in symptoms for each of PAE, PUL, TUMT, and WVTT in short-term follow-up was similar to that for the standard surgical treatment, although standard surgery appeared to provide the greatest increase in urine flow. Men who had WVTT or PUL were less likely to have problems with sexual function than those who had standard surgery.

Synchronous fluorescence as a green and selective method for the simultaneous determination of finasteride and tadalafil in dosage form and spiked human plasma

Finasteride and tadalafil are combined in a pharmaceutical capsules called Entadfi™, that has received FAD approval. It was indicated for the management of male benign prostatic hyperplasia-related urinary tract issues. In the current study, finasteride and tadalafil concentrations in raw form, laboratory prepared mixtures, pharmaceutical preparation and spiked human plasma were all quantitatively estimated using a sensitive synchronized fluorescence spectroscopic approach united with first derivative. When excited at 260 nm, finasteride display its emission at 320 nm. Yet, when excited at 280 nm, tadalafil displayed its emission at 340 nm. The application of micellar surfactant as sodium dodecyl sulphate (SDS) significantly increased the fluorescence intensity.The overlapping of the fluorescence spectra was entirely eliminated by derivatizing the synchronous spectra to the first derivative, which also made it possible to simultaneously quantify the cited drugs. Without interfering with one another, the first-order synchronous spectra of tadalafil and finasteride at 320 and 330 nm, respectively. The approach revealed linearity alongside an acceptable correlation coefficient for finasteride and tadalafil concentrations over the range of 10 –50 ng/mL. That approach was utilized to estimation of the cited drugs in dosage forms, simultaneously with %recoveries for tadalafil and finasteride of 99.62 ± 0.78 and 100.19 ± 0.60, respectively. Also, four various tools, the national environmental method index, the AGREE evaluation method, the green analytical procedure index and the analytical eco-scale were used to evaluate how environmentally friendly the given approach was. With regard to the metrics of the greenness aspects, the proposed approach appeared to be better than the previously published spectrophotometric methods and HPLC.

Lowering the percent body fat in the obese population might reduce male lower urinary tract symptoms.

This study aimed to investigate the practicality of percent body fat (PBF), calculated using bioelectrical impedance analysis (BIA), in predicting benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS). This study included 844 men who underwent medical checkups at our institution between 2014 and 2022. Demographic characteristics, serum PSA levels, and prostate volume were collected using TRUS. BPH was defined as a prostate volume ≥ 30cc. Subjects were divided into two groups according to their quartiles of PBF: the normal PBF group (first to third quartile; PBF < 27.9%) and the high PBF group (fourth quartile; PBF ≥ 27.9%). Characteristics between the groups were compared using the chi-square test and Student's t-test. Multivariate logistic regression analysis was performed to evaluate risk factors for BPH and severe LUTS. The prostate volume (25.21 ± 8.4 vs 27.30 ± 9.0, p = 0.005) and percentage of BPH (22.9% vs. 32.1%, p = 0.007) were greater in the high PBF group. After multivariate analysis, old age (OR = 1.066, p < 0.001), higher appendicular skeletal muscle mass index (ASMI) (OR = 1.544, p = 0.001), and PBF ≥ 27.9% (OR = 1.455, p = 0.037) were risk factors for BPH. Larger prostate volume (OR = 1.035, p = 0.002) and PBF ≥ 27.9% (OR = 1.715, p = 0.025) were risk factors for severe LUTS. However, a greater ASMI had a protective effect against severe LUTS (OR = 0.654, p = 0.011). This study shows that PBF and ASMI are useful for predicting BPH/LUTS. We suggest that lowering PBF to the normal range in a population with high PBF might prevent BPH, while lowering PBF and maintaining adequate ASMI could lower LUTS.

MP24-09 MEN WITH AN IMPROVEMENT IN URINARY SYMPTOMS HAVE A LOWER RISK OF MORTALITY

You have accessJournal of UrologyCME1 Apr 2023MP24-09 MEN WITH AN IMPROVEMENT IN URINARY SYMPTOMS HAVE A LOWER RISK OF MORTALITY Blayne Welk and J Andrew McClure Blayne WelkBlayne Welk More articles by this author and J Andrew McClureJ Andrew McClure More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male lower urinary tract symptoms (LUTS) have been correlated with an increased risk of death, and it is unclear if this is a causal association. Our objective was to determine whether a reduction in LUTS is associated with a reduced risk of mortality. METHODS: We conducted a secondary analysis of the pivotal Medical Treatment of Prostate Symptoms (MTOPS) randomised trial. Men age >50 years with moderate to severe LUTS on the AUASS were randomised to placebo, doxazosin, finasteride, or doxazosin and finasteride. Our primary exposure was the change in the AUASS from baseline. This was modelled as a time-varying covariate and recalculated for each of the biyearly protocolized visits. Our primary outcome was death, which was prospectively recorded during the study. We used an extended cox model and adjusted it for age and treatment assignment. We conducted a similarly adjusted sensitivity analysis among those who were assigned active treatment only. Means and standard deviations (SD) and hazard ratios (HR) with 95% confidence intervals are reported. RESULTS: A total of 3046 men were randomised and had a baseline AUASS; 27 baseline variables were similar between the 705 men who did not have any LUTS improvement and the 2341 men who did have improvement. The mean age was 62.6 (SD7.3), and the mean baseline AUASS was 17.2 (SD 6.1). During the mean observation period of 6.1 (SD1.2) years there were 117 (3.8%) deaths. For each 1-point improvement in the AUASS, the HR for death was 0.96 (0.94-0.99, p=0.01); a 5-point improvement in the AUASS resulted in a HR for death of 0.83 (95% CI 0.72-0.96). This relationship was similar among the 2309 men who received some form of active treatment (HR 0.95, 0.92-0.98, p<0.01), independent of treatment group. A comparable significant reduction in death was seen with improvements in the storage and voiding subscales individually. CONCLUSIONS: Improvement in male LUTS was associated with a reduced risk of death. Unmeasured confounding was partly mitigated by using clinical trial data, where randomisation determined the likelihood of LUTS improvement. Further study is warranted to determine if the male LUTS treatment paradigm should shift towards symptom treatment independent of bother. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e321 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blayne Welk More articles by this author J Andrew McClure More articles by this author Expand All Advertisement PDF downloadLoading ...

Hyperactive Bladder in Men: Modern Recommendations and Practical Approaches to Diagnosis and Treatment

An analysis of modern recommendations of the European Association of Urologists (EAU) regarding diagnosis and treatment options for overactive bladder (OAB) in men was carried out, taking into account real practice. The article discusses the general principles of diagnosis and treatment of non-neurogenic male lower urinary tract symptoms (LUTS) in the case where the predominant clinical features are urgency, pollakiuria, nocturia, which can be combined with urinary incontinence – complaints typical of GSM. Approaches to the treatment of such patients are still not clearly defined, and the effectiveness of treatment does not always satisfy both doctors and patients. It is indicated that in recent years, doctors have received completely new treatment options for this disease in men. In addition to adrenoblockers (AB) and cholinolytics (HL), phosphodiesterase-5 inhibitors (IPDE) and beta-3 adrenomimetics (BAM) were added, which showed their effectiveness and safety not only in women, but also in men. In addition, new options for combined treatment appeared in the recommendations – in addition to AB+HL, a combination of AB+IPDE and HL+BAM is possible. The article discusses various groups of drugs and their combinations recommended for the treatment of LUTS, the specifics of their use and possible side effects, especially the risks of urinary retention in men with infravesical obstruction. It is emphasized that the EAU currently recommends the use of HL in men with moderate and severe LUTS, who mainly have symptoms of accumulation with a residual urine of no more than 150 ml. It is recommended to determine the patient’s residual urine after a week of taking HL. The practical aspects of choosing the category of patients to be treated with certain drugs (or their combinations) are discussed, taking into account the possible side effects of each of the treatment options.

A Velocity-Based Approach to Noninvasive Methodology for Urodynamic Analysis.

To date, invasive urodynamic investigations have been used to define most terms and conditions relating to lower urinary tract symptoms. This invasiveness is almost totally due to the urethral catheter. In order to remove this source of discomfort for patients, the present study investigated a noninvasive methodology able to provide diagnostic information on bladder outlet obstruction or detrusor underactivity without any contact with the human body. The proposed approach is based on simultaneous measurements of flow rate and jet exit velocity. In particular, the jet exit kinetic energy appears to be strongly related to bladder pressure, providing useful information on the lower urinary tract functionality. We developed a new experimental apparatus to simulate the male lower urinary tract, thus allowing extensive laboratory activities. A large amount of data was collected regarding different functional statuses. Experimental results were compared successfully with data in the literature in terms of peak flow rate and jet exit velocity. A new diagram based on the kinetic energy of the exit jet is proposed herein. Using the same notation as a Schäfer diagram, it is possible to perform noninvasive urodynamic studies. A new noninvasive approach based on the measurement of jet exit kinetic energy has been proposed to replace current invasive urodynamic studies. A preliminary assessment of this approach was carried out in healthy men, with a specificity of 91.5%. An additional comparison using a small sample of available pressure-flow studies also confirmed the validity of the proposed approach.

Interview: Kari Tikkinen

Interview: Kari Tikkinen

Prevalence of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum detection in urine and respiratory tract samples in Hiroshima, Japan

BackgroundMycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum are commensal bacteria that are associated with colonization and infection of the urogenital tract. However, colonization of the respiratory tract by these microorganisms in adults has not been fully investigated. MethodsUrine and respiratory tract samples (sputum, tracheal aspirates, and bronchoalveolar lavage) of patients aged 20−80 years were analyzed to detect the presence of M. hominis, U. parvum, and U. urealyticum using a conventional PCR method. The samples were submitted to the microbiological clinical laboratory of Hiroshima University Hospital from December 1, 2021 to May 31, 2022. ResultsIn total, 334 urine and 238 respiratory tract samples were analyzed. The overall detection rates of M. hominis, U. parvum, and U. urealyticum were 2.9%, 1.7%, and 2.3% in male urine; 7.0%, 13.8%, and 1.9% in female urine; 2.2%, 0%, and 2.2% in male respiratory tract; and 0%, 2.0%, and 0% in female respiratory tract, respectively. In urine samples, the detection rates of M. hominis, U. parvum, and U. urealyticum were significantly higher (p < 0.001) for women (29/159; 18.2%) than for men (10/175; 5.7%); however, in respiratory tract samples, the detection rates were not significantly different (p = 0.70) between women (2/101; 2.0%) and men (5/137; 3.7%). Further, both the urine and respiratory samples of 83 patients were analyzed. Three male samples were positive for M. hominis or U. urealyticum, and M. hominis and U. urealyticum were matched in both the urine and respiratory tract samples: M. hominis (n = 1), U. urealyticum (n = 1), M. hominis + U. urealyticum (n = 1). ConclusionM. hominis, U. parvum, and U. urealyticum were detected in the respiratory tract of not only the young patients, but also of patients aged 50−60 years. Further studies are required to understand the relationship of these microorganisms in urogenital and respiratory tract samples with extra-genital infections.

Biomechanical study of the male lower urinary tract: Simulation of internal and external sphincters dyssynergia

Urethral sphincter dysfunction is an important cause of stress urinary incontinence (SUI). The most effective treatment is the insertion of an artificial urethral sphincter (AUS), which relies to a large extent on the surgeon’s experience. However, there is no quantitative standard for cuff tightness, resulting in frequent postoperative complications. This study aimed to investigate the effect of internal and external sphincter dyssynergia on urodynamic parameters in the lower urinary tract. A geometric model of male lower urinary tract tissue was constructed from collodion slices, accounting for the active behavior of the internal and external sphincters. Normal and dyssynergic internal and external sphincters (active sphincter behavior was individually injured by 25%, 50%, 75%, or 100%) were simulated with fluid–structure interactions and changes in urethral stress, displacement, and urine flow rate were detected. We found that when the internal sphincter was injured by 25%, 50%, 75%, and 100%, urethral stress near the internal sphincter decreased by 8.3%, 15.6%, 24.3%, and 35.7%, respectively. Additionally, when the external sphincter was injured by 25%, 50%, 75%, and 100%, urethral stress near the external sphincter was reduced by 13.3%, 24.3%, 38.6%, and 46.6%, respectively. Internal sphincter injury primarily affects positions near the internal sphincter and prostate, while external sphincter injury affects the area between the prostate and urethral outlet. These data could facilitate the standardized evaluation of internal and external sphincter dysfunction and lead to novel methods of preoperative assessment for AUS surgery.

Prostatic hyperplasia: Evaluation of practices in general practice, dissemination, and impact of recommendations

In 2015, the French Association of Urology, by the male lower urinary tract symptoms Committee, published a practices guideline for the management of prostatic hyperplasia in general practice. Five years after the publication of these recommendation, our objective is to assess their dissemination and their impact in general practice. A specially designed questionnaire was distributed online via the departmental councils of the order and to all regional unions of liberal doctors. The distribution to general practitioners was at the discretion of each organisation depending on local policies. Two hundred and eighty responses were collected. Fifty-five percent of the population was female. 83% of the general practitioners did not report having knowledge of the practice guideline. 77% of doctors stated that they had not received training or information on prostatic hyperplasia in the past 5years. Among the notable results, 51% of general practitioners declared performing a digital rectal examination. 44% prescribed an endorectal ultrasound. Only 7% of doctors were aware of the existence of minimally invasive surgical techniques. The practices guideline for the management of prostatic hyperplasia in general practice proposed in 2015by the male lower urinary tract symptoms Committee seems to be little known by general practitioners. Dissemination of these recommendations solely through publication in Progrès en Urologie seems ill-suited to consideration by general practitioners, and it seems necessary to consider other modes of dissemination. 4, grade C.

Addressing Gender-Related Inequality in Continence Care

Addressing Gender-Related Inequality in Continence Care

Correlation of Doppler ultrasound resistive index in the prostatic gland with severity of male lower urinary tract symptoms, prostate volume, and concomitant diabetes mellitus.

Benign prostatic enlargement (BPE) and type 2 diabetes mellitus (T2DM) are common in elderly men. This study aimed to correlate the Doppler resistive indices of prostatic arteries with the severity of lower urinary tract symptoms (LUTS) and prostate volume in men with concomitant BPE and T2DM. Fifty men with T2DM and BPE (BPE-DM) as cases and 50 age-matched men with BPE but no T2DM (BPE-ND) as controls were enrolled. B-mode and power Doppler ultrasonography of the prostate gland were done for both groups. The mean total prostatic volume of the BPE-DM was 79.18 ±8.9 ml, while that of BPE-ND was 60.73 ±10.6 ml (p <0.0001). The mean prostatic resistive index (PRI) was significantly higher among BPE-DM than BPE-ND (0.74 ±0.02 vs 0.68 ±0.09 for right capsular artery; 0.77 ±0.04 vs 0.71 ±0.02 for left capsular artery; and 0.76 ±0.04 vs 0.70 ±0.02 for the urethral artery). BPE-DM with higher glycated haemoglobin, fasting plasma glucose, and longer duration of T2DM experienced more severe lower urinary tract symptoms and had higher PRI. In conclusion, the BPE-DM group presented larger prostate glands and more bothersome LUTS, which correlated with higher PRI. Strict glycaemic control is necessary in men with co-existing BPE and T2DM.

MULLERIAN CYST PRESENTING AS A LARGE ABDOMINOPELVIC CYST CAUSING OBSTRUCTIVE UROPATHY IN MALE: A RARE CASE.

Introduction: Mullerian duct cyst presenting as a large abdominopelvic cyst is a rare entity. A Mullerian duct cyst represents an incomplete focal regression of the embryological Mullerian duct in a male. Case Report: This is a case of a 55 year old gentleman presenting with a pelvic mass of chronic duration with a recent onset of pain abdomen and obstructive urinary symptoms. Radiological imaging revealed a large centrally located cystic pelvic mass and Left Hydroureteronephrosis. The patient underwent Left DJ stenting followed by an Explorative laprotomy and Marsupialization of the cyst. It is prerogative to understand the development of the male urinary tract and the Conclusion: reproductive system to diagnose rare midline pelvic pathologies and decide on surgical options for treatment of the same. In addition, the nal diagnosis being dependent on the histology of such pelvic masses makes it an additional diagnostic challenge for the surgeons.

Nurses leading male lower urinary tract symptom (LUTS) clinics: A scoping review

AbstractNurse‐led clinics are known to positively impact and benefit patients; however, there is little understanding of the role of the nurse in a nurse‐led male Lower Urinary Tract Symptoms (LUTS) clinic. LUTS affect up to 30% of males over 65 in the United Kingdom and can significantly impact the quality of life of the person experiencing them. LUTS can be managed with conservative changes, as well as with medication and surgical intervention. The aim of this scoping review is to map what is known about the role of the nurse in a nurse‐led male LUTS clinic and what research tells us regarding, the barriers and enablers in nurses leading a male LUTS clinic. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐SCR) checklist and the methodological guidelines set out by the Joanna Briggs institute. A literature search was carried out over three databases (CINAHL, Medline Ovid, ProQuest health and medical collection) and systematically searched from 2000 to 2021. Grey literature was also searched, and citation chaining was undertaken. Following a systematic review of the literature, four papers met the inclusion criteria for this scoping review. The emergent themes across the four papers consisted of structure, assessment and resources, and effectiveness of the nurse‐led male LUTS clinic. There was clear agreement across the literature regarding the investigations and assessment the nurse should carry out. Ongoing practical, theoretical, and observational training and education is required to ensure the nurse is competent in running a male LUTS clinic. The papers reviewed showed the nurse provided a supportive role to the consultant. However, there is evidence indicating there is a move towards autonomous practice. There is a dearth of the current research relating to the role of the nurse in nurse‐led male LUTS clinics and the enablers and barriers in nurses leading male LUTS clinics. Further research should be considered to gain a better understanding of where nurse‐led male LUTS clinics currently take place, what the role of the nurse is in leading a LUTS clinic and what enablers and barriers exist.

Host defense functions of the epididymal amyloid matrix.

The epididymal lumen is an immunologically distinct environment. It maintains tolerance for the naturally antigenic spermatozoa to allow their maturation into functional cells while simultaneously defending against pathogens that can ascend the male tract and cause infertility. We previously demonstrated that a nonpathological amyloid matrix that includes several cystatin-related epididymal spermatogenic (CRES) subgroup family members is distributed throughout the mouse epididymal lumen but its function was unknown. Here, we reveal a role for the epididymal amyloid matrix in host defense and demonstrate that the CRES amyloids and CD-1 mouse epididymal amyloid matrix exhibit potent antimicrobial activity against bacterial strains that commonly cause epididymal infections in men. We show the CRES and epididymal amyloids use several defense mechanisms including bacterial trapping, disruption of bacterial membranes and promotion of unique bacterial ghost-like structures. Remarkably, these antimicrobial actions varied depending on the bacterial strain indicating CRES amyloids and the epididymal amyloids elicit strain-specific host defense responses. We also demonstrate that the CRES monomer and immature assemblies of the epididymal amyloid transitioned into advanced structures in the presence of bacteria, suggesting their amyloid-forming/shape-shifting properties allows for a rapid reaction to a pathogen and provides an inherent plasticity in their host defense response. Together, our studies reveal new mechanistic insight into how the male reproductive tract defends against pathogens. Future studies using a mouse model for human epididymitis are needed to establish the epididymal amyloid responses to pathogens in vivo. Broadly, our studies provide an example of why nature has maintained the amyloid fold throughout evolution.

Pitfalls in Pathology-Fibroepithelial Stromal Polyp of the Bladder

Abstract Introduction/Objective The fibroepithelial stromal polyp is a benign polypoid proliferation of the stroma with overlying, usually squamous epithelium. It was originally reported in 1966 and is a generally recognized lesion of the female genital tract. Because the lesion contains atypical stromal cells, it can be mistaken for a sarcoma, particularly if it shows hypercellularity, pleomorphism, and atypical mitoses. It is often found in the female lower genital tract, urethra, and rarely extragenital sites, such as the breast. Other unusual locations such as the anus and nasal cavity have also been reported. The lesion is hormonally related and affects mostly reproductive-age women. Rare cases were reported in the male urinary tract and genital area. Because it is not well known in the bladder, overinterpretation as a sarcoma is possible. Methods/Case Report We report a ~60-year-old patient with a history of lower urinary tract symptoms due to prostatic hypertrophy on maximal medical therapy. He had been experiencing hematuria. On office cystoscopy, he was found to have a 3 cm prostate mildly obstructing the urethra, and 2 small velvety, erythematous patches on the posterior bladder wall. At cystoscopy, he was seen to have a small posterior bladder lesion, which was resected without difficulty. The pathology laboratory received two fragments of pink/tan soft tissue measuring 0.1 and 0.2 cm in the greatest dimension. On histology, the overlying urothelium was benign. The stroma was collagenous and hypocellular, containing scattered atypical and multinucleated cells, similar to the fibroepithelial stromal polyp well recognized in the female lower genital tract. Results (if a Case Study enter NA) N/A. Conclusion Benign fibroepithelial stromal polyp is an uncommon lesion usually seen in the lower genital tract of reproductive aged women. The presence in the bladder of a male is exceptionally rare. Recognition of the lesion will prevent overdiagnosis as a malignancy.

Transurethral water vapor ablation of the prostate with the Rezūm system: Urodynamic findings.

The efficacy of the transurethral convective interstitial radiofrequency water vapor thermal ablation of the prostate with the Rezūm system for the treatment of male lower urinary tract symptom due to benign prostatic hyperplasia is well proven. The improvement of urodynamic parameters obtained from a simple uroflowmetry cannot measure the effect of water vapor injection on the bladder outlet obstruction. This monocentric retrospective pilot study analyzes the data of pressure-flow studies performed before and after 17 Rezūm procedures to answer the question whether thus obtained ablation of prostate tissue has a disobstructive effect on the bladder outlet. All the functional outcomes were consistently improved after the procedure, with a median flowrate increase of 5.1 ml/s (p = 0.0022) and a median postvoid residual urine (PVR) reduction of 100 ml (p = 0.0042). The prostate volume was reduced by 40% (p < 0.0001) and the median Bladder Outlet Obstruction Index (BOOI) reduction was 53.8 (p < 0.0001). These data show that the possibility to significantly reduce the obstruction grade with even a single Rezūm procedure is concrete and seems to be independent from the degree of the obstruction grade.