Objective: This study aimed to evaluate reproductive outcomes according to the timing of testicular sperm retrieval. Methods: The study included 282 infertile couples divided into three groups: group A (freeze-thawed testicular sperm extraction [TESE] sperm, n=233), group B (fresh TESE sperm collected 1 day before ovum pickup, n=22), and group C (fresh TESE sperm collected on the same day as ovum pickup, n=27). The indications for TESE were surgically uncorrectable azoospermia or ejaculation failure, often accompanied by medical comorbidities such as diabetes mellitus and spinal cord injury. The outcome parameters assessed were fertilization rates, embryo quality, and clinical pregnancy rates. Results: The mean paternal age was 36.8±5.7 years, and the mean maternal age was 32.6±3.5 years. The mean duration of infertility was 2.9±1.8 years. The fertilization rates were 70.7%, 78.9%, and 73.0% for groups A, B, and C, respectively (p=0.047). The percentages of good-quality embryos were 68.2%, 65.3%, and 48.4%, respectively (p=0.007); specifically, the percentage of good-quality embryos was significantly lower in group C compared with the other two groups. Clinical pregnancy rates per transfer were similar at 51.1%, 50.0%, and 48.1% (p=0.958), with no differences observed in miscarriage rates. Conclusion Testicular sperm retrieval can be safely performed 1 day before ovum pickup, resulting in favorable fertility outcomes.

Iatrogenic colonic perforation is a rare but serious complication of colonoscopy, particularly during therapeutic procedures. Prompt recognition and individualized management are essential to prevent adverse outcomes. This review summarizes current treatment strategies based on major international guidelines. Endoscopic closure is recommended for selected cases involving minor defects, early detection, and adequate bowel preparation. Techniques such as clipping, endoloop application, and suturing have demonstrated favorable success rates. Surgical intervention is crucial for larger, delayed, or complicated perforations, particularly those associated with significant contamination or clinical deterioration. Recognizing risk factors such as age, diverticulosis, and inadequate bowel preparation can help prevent this complication.

Background: Arthroscopic repair of bucket-handle meniscal tears (BHMTs) is technically challenging owing to the complexity of the tear patterns. Compared to simpler meniscal tears, BHMTs are associated with a higher failure rate and often require subsequent meniscectomy. This study aimed to assess clinical outcomes, failure rates, and risk factors for failure following primary arthroscopic repair of BHMTs. Methods: Seventy-four patients (mean age, 27.2 ± 11.2 years) who underwent arthroscopic BHMT repair were included (mean follow-up period, 60.2 ± 36.0 months). Analyzed risk factors included age, sex, body mass index, chronicity, laterality, tear zone, and concomitant anterior cruciate ligament reconstruction. Clinical failure was defined as the presence of clinical symptoms consistent with a meniscus tear and the need for subsequent surgery. The Kaplan-Meier method and log-rank test were performed to compare groups classified by postoperative meniscal healing status on magnetic resonance imaging (MRI) at a mean follow-up period of 7.30 ± 1.80 months. Clinical outcomes were assessed using the Tegner activity score, Lysholm knee score, and Hospital for Special Surgery (HSS) knee score. Results: The clinical failure rate was 14.9% (11 / 74). Six patients underwent subtotal meniscectomy, and 5 patients underwent partial meniscectomy. Red-white zone involvement was a significant risk factor for clinical failure (odds ratio, 6.182; 95% CI, 1.093–34.950; p = 0.039). Survival analysis based on postoperative MRI findings revealed a significant difference among 3 groups (p = 0.008): the completely healed group showed a 100% survival rate (20 / 20); the partially healed group, 80% (32 / 40); and the unhealed group, 0% (0 / 5). Patients with lateral BHMTs had a significantly higher rate of complete healing than those with medial BHMTs (46.4% vs. 18.9%; p = 0.014). At the final follow-up, the non-failure group demonstrated significantly higher Tegner activity (5.1 ± 1.2 vs. 4.4 ± 0.5; p = 0.038), Lysholm knee (87.7 ± 6.2 vs. 83.2 ± 3.1; p = 0.029), and HSS knee (93.9 ± 4.7 vs. 89.6 ± 3.0; p = 0.007) scores than the failure group. Conclusions BHMTs involving the red-white zone or located in the medial meniscus—particularly those showing inferior early postoperative MRI healing—should be closely monitored after surgery.

Background: Tibiotalocalcaneal (TTC) arthrodesis is a viable salvage option for failed total ankle arthroplasty (TAA), but it is typically a complex procedure associated with a high complication rate. This study analyzed outcomes of salvage TTC arthrodesis using a retrograde intramedullary (IM) nail without subtalar joint preparation after failed TAA. Methods: This study included 18 patients (18 ankles) who underwent TTC arthrodesis without subtalar joint preparation for failed TAA from July 2008 to March 2023 and were followed up for at least 2 years. Visual analog scale pain scores and Ankle Osteoarthritis Scale pain and disability scores were used to assess functional outcomes. Radiographic union, time to union, complications, and clinical success—defined as pain improvement without the need for revision surgery or amputation—were also evaluated. Results: The mean follow-up duration after TTC arthrodesis was 79.8 months (range, 26–199 months). Tibiotalar joint union was achieved in 13 ankles (72.2%) at a mean of 7.5 months after TTC arthrodesis. Subtalar joint union was achieved in 7 ankles (38.9%). All functional scores improved significantly from preoperatively to the last follow-up. The overall clinical success rate was 83.3% (15 ankles). Conclusions TTC arthrodesis using a retrograde IM nail without subtalar joint preparation produced favorable outcomes in patients with failed TAA. No complications associated with the subtalar joint were observed in any patient during follow-up. Therefore, TTC arthrodesis using a retrograde IM nail without subtalar joint preparation may be a considerable salvage option for failed TAA.

Background/Aims: Despite numerous global changes in Helicobacter pylori treatment guidelines over the past decade, no comprehensive nationwide trend analysis has been conducted.We aimed to investigate the annual trends in the use of H. pylori treatment regimens on the basis of hospital type and region to identify whether changes in prescription patterns aligned with the Korean guidelines updated in 2013 and 2020. Methods: Using data from Korean Health Insurance Review and Assessment database spanning from January 2010 to December 2022, we extracted the performance code for H. pylori diagnosis along with the drug combination code for H. pylori treatment. Results: We analyzed the annual trends in standard triple therapy (STT; n=664,748), bismuth quadruple therapy (BQT; n=151,828), concomitant therapy (CT; n=3,034), sequential therapy (SEQ; n=1,612), and salvage treatment. Overall, STT use declined, with the use of 7-day STT decreasing but the use of 10- and 14-day STT increasing. The use of BQT as a first-line treatment consistently increased, and non-BQT (i.e., CT and SEQ) use also increased sharply since 2019.The tendency to adhere to the guideline changes was more pronounced in primary care clinics.Salvage treatment with BQT after STT failure exhibited a declining trend from 2010 to 2017, followed by an increase since 2018. Salvage treatment with levofloxacin triple therapy after BQT failure increased over time. Conclusions This long-term nationwide trend analysis revealed that real-world prescriptions for H. pylori treatment generally corresponded to the updated guidelines. Efforts are needed to disseminate the revised guidelines to achieve higher compliance rates.

Janus kinase (JAK) inhibitors are an important treatment option for ulcerative colitis, providing rapid onset of action, oral administration, and efficacy even after biologic failure. The 3 approved agents—tofacitinib, filgotinib, and upadacitinib—differ in JAK isoform selectivity, leading to clinically meaningful differences in efficacy and safety. Evidence from network meta-analyses, clinical trials, and real-world studies consistently shows that upadacitinib provides the highest efficacy for induction and maintenance of remission, whereas filgotinib demonstrates the most favorable safety profile. The strong efficacy of upadacitinib and tofacitinib is particularly relevant in patients with severe disease, including acute severe ulcerative colitis, and upadacitinib maintains high efficacy regardless of prior advanced therapy exposure. JAK inhibitors also benefit extraintestinal manifestations. Although risks such as herpes zoster, serious infection, thromboembolism, and major cardiovascular events differ among agents, long-term data suggest generally acceptable safety when used appropriately. Intraclass JAK-to-JAK cycling is feasible, with about half of patients achieving steroid-free clinical remission in retrospective cohorts. Based on mechanistic, clinical, and real-world evidence, filgotinib may be a first-line option for patients with lower disease activity or when safety is a priority, whereas upadacitinib or tofacitinib may be preferred in higher disease activity. Strategically selecting agents may improve durability and outcomes.

Purpose: To develop and validate an artificial intelligence (AI)-based personalized outcome prediction model for upper-urinary tract urothelial carcinoma patients undergoing radical nephroureterectomy. Materials and Methods: Data from patients who underwent radical nephroureterectomy between 2010 and 2020 across three hospitals were retrospectively analyzed. A model was developed using one tertiary center’s data and externally validated with data from two other hospitals. An AI model using XGBoost as risk estimator and bootstrapped Weibull Accelerated Failure Time model for 10-year survival probability was employed. Hyperparameter tuning used Optuna method. Model efficacy was assessed using concordance index, average Brier score, D-calibration, and six-month interval time-dependent area under the curve (AUC). Results: Of 1,039 patients, 627 qualified after excluding 50 with neoadjuvant chemotherapy. Model development used 564 patients (507 training, 57 test) with 9:1 stratified random split, plus 63 for internal validation and 362 for external validation. Significant parameters included preoperative glomerular filtration rate (p<0.001), hydroureteronephrosis (p=0.013), pathological N stage (p<0.001), concurrent carcinoma in situ (p<0.001), disease progression (p<0.001), and survival rate (p<0.001). Disease-free survival (DFS) model’s concordance index: internal validation 0.789, external validations 0.734 and 0.771. Overall survival (OS) model’s concordance index: internal validation 0.819, external validations 0.780 and 0.771. Mean time-dependent AUC was 0.66–0.77 for DFS and 0.67–0.80 for OS during 10-year periods. Conclusions AI-based model effectively predicts disease-free and OS outcomes for upper-urinary tract urothelial carcinoma patients with post-radical nephroureterectomy, showcasing robust performance across multicenter settings.

Purpose: Testicular torsion is a urological emergency necessitating immediate surgical intervention. However, the altered medical environment during the coronavirus disease 2019 (COVID-19) pandemic posed several challenges and the current study aimed to analyze its effects on the treatment of pediatric testicular torsion cases. Materials and Methods: We retrospectively analyzed 47 pediatric patients diagnosed with testicular torsion at Severance Children's Hospital from 2009 to 2022. Patients were categorized into pre–COVID-19 (n=38) and COVID-19 (n=8) groups. Data were collected for each patient, and the differences between the two groups were statistically analyzed. Results: The patients’ median age was from 13 years (range, 1–19 years) to 13 years (range, 1–16 years) between the pre–COVID-19 and COVID-19 period (p=0.309). The analysis revealed a significant difference between the pre–COVID-19 and COVID-19 groups in the time from symptom onset to emergency department arrival (6.4 hours [0.7–120.0] vs. 20.0 hours [1.3–288.0], p=0.031) and the time from symptom onset to surgery start (19.5 hours [4.5–124.3] vs. 28.5 hours [6.1–293.4], p=0.047). The median postoperative size of the affected testis was 9.8 mL (range, 2.0–13.9 mL) during the COVID-19 period, compared to 1.6 mL (range, 0.1–7.3 mL) in pre–COVID-19 period (p=0.012). The testicular volume ratio (affected/unaffected) was used to evaluate outcomes across patients with varying ages and testicular sizes. Conclusions The current study shows that pandemic-related delays in treatment may worsen ischemic injury in testicular torsion, emphasizing the importance of timely intervention even during global crises.

Purpose: To assess long-term outcomes of vesicostomy on bladder capacity (BC) and voiding function in non-neurogenic bladder, and explore the association between kidney ultrasonographic findings and renal function. Materials and Methods: Thirty-four patients under 2 years at the time of vesicostomy formation (2005–2020) with ≥3 years of follow-up were reviewed. Patients were further stratified based on neurogenic bladder status. Twenty-one patients were nonneurogenic. A subgroup analysis of 7 patients under 3 months with primary vesicoureteral reflux (VUR) and compromised renal function was conducted. Results: The median age at vesicostomy formation was 1.0 months (interquartile range [IQR] 0.0–3.5); the median duration of vesicostomy was 16.0 months (IQR 8.0–21.0). At a median age of 93.0 months (IQR 59.5–117.5), all patients achieved spontaneous micturition and continence. Eleven patients (52.4%) showed bell-shaped voiding patterns. Five patients showed interrupted (n=2) or plateau (n=3) patterns. With the exemption one patient, all patients with primary VUR showed bell-shaped curves. None initiated clean intermittent catheterization during follow-up. The median BC-to-estimated BC in patients with non-neurogenic bladder and primary VUR was 0.9 (IQR 0.7–1.1) and 0.9 (IQR 0.8–1.1), respectively. Three patients underwent revision due to prolapse. The glomerular filtration rate (GFR) was improved by 68.9% compared to the baseline (p=0.045). Parenchymal abnormalities on kidney ultrasonography were associated with decrease in GFR. Conclusions Vesicostomy in non-neurogenic bladder patients was associated with recovery of BC, preservation of continence, and improved renal function. Parenchymal abnormalities on ultrasonography predicted lower GFR.