INTRODUCTION

Vasectomy is a simple and reliable method of permanent contraception in men causing obstructive azoospermia. As many as 50 million men worldwide have relied on vasectomy for family planning. However, it is estimated that around 6% of these men who underwent vasectomy will ultimately seek vasectomy reversal for various reasons. Vasectomy reversal is the most cost effective option for couples desiring children after vasectomy and is the most challenging microsurgical procedures. This study presents local experience, outcomes and complications of microsurgical reconstruction of the male ductal system in the Philippines setting.

This is a retrospective study of 157 post-vasectomy patients who underwent microsurgical vasectomy reversal by a single surgeon from January 2001 to March 2024. Outcomes such as patency and pregnancy rates were documented and analyzed.

One hundred and fifty seven (157) underwent microsurgical vasectomy reversal. One hundred five (105) patients underwent bilateral microsurgical vasovasostomy. Forty eight (48) patients underwent combined microsurgical vasovasostomy and vasoepididymostomy. Three patients underwent bilateral vasoepididymostomy and one crossed microsurgical vasoepididymostomy (left to right). Four patients had no child, 87 patients had 1 child, 34 patients had 2 children, 29 had 3 children and 3 patients had 4 children prior to vasectomy. Age of wife was between 20 to 32 years old. Mean interval from vasectomy was 9 years. Vas deferens was patent in 120 (76%) of patients. Clinical pregnancy with successful delivery was achieved in 99 (63%) patients. There were only three who had postoperative hematoma (0.02%) and one developed surgical site infection (0.001%).

Microsurgical vasectomy reversal is an excellent option in men post vasectomy to achieve natural clinical pregnancy with minimal complications. The study confirms the effectiveness of male infertility microsurgery for vasectomized men who wish to father children.

Augmentation intestinal cystoplasty is usually the preferred method. However, this is complicated by mucus production, recurrent infection and cystolithiasis. In this report, the authors present a unique case of laparoscopically-assisted ureterocystoplasty and describe the operative technique and its advantages.

A 68-year-old female with a contracted urinary bladder and a solitary functioning kidney was diverted with a percutaneous nephrostomy tube for the past ten years. She consulted for a possible reconstructive procedure.

After a comprehensive preoperative evaluation, she underwent laparoscopically-assisted ureterocystoplasty. The operative time was 265 minutes with minimal blood loss. She had an unremarkable postoperative course. On follow-up, a voiding diary revealed urine volume of around 300 milliliters at 3 hour intervals, preservation of renal function, and no evidence of urinary infection.

Ureterocystoplasty was done using a combination of minimally invasive and open techniques. This procedure spared the patient a lifelong diversion with a nephrostomy tube and provided a better quality of life.

BACKGROUND: At present, biopsy is essential for the diagnosis of prostate cancer (PCa) before radical prostatectomy (RP). However, with the development of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and multiparametric magnetic resonance imaging (mpMRI), it might be feasible to avoid biopsy before RP. Herein, we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI. METHODS: Between December 2017 and April 2022, 56 patients with maximum standardized uptake value (SUVmax) of ≥4 and Prostate Imaging Reporting and Data System (PI-RADS) ≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals. The consistency between clinical and pathological diagnoses was evaluated. Preoperative characteristics were compared among patients with different pathological types, T stages, International Society of Urological Pathology (ISUP) grades, and European Association of Urology (EAU) risk groups. RESULTS: Fifty-five (98%) patients were confirmed with PCa by pathology, including 49 (89%) with clinically significant prostate cancer (csPCa, defined as ISUP grade ≥2 malignancy). One patient was diagnosed with high-grade prostatic intraepithelial neoplasia (HGPIN). CsPCa patients, compared with clinically insignificant prostate cancer (cisPCa) and HGPIN patients, were associated with a higher level of prostate-specific antigen (22.9 ng/mL vs . 10.0 ng/mL, P = 0.032), a lower median prostate volume (32.2 mL vs . 65.0 mL, P = 0.001), and a higher median SUVmax (13.3 vs . 5.6, P <0.001). CONCLUSIONS It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI. However, the diagnostic efficacy of csPCa with PI-RADS ≥4 and SUVmax of ≥4 is inadequate for performing a procedure such as RP. Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.
Humans ; Male ; Prostatectomy/methods* ; Prostatic Neoplasms/diagnosis* ; Middle Aged ; Aged ; Positron Emission Tomography Computed Tomography/methods* ; Biopsy ; Multiparametric Magnetic Resonance Imaging ; Prostate-Specific Antigen/metabolism*

INTRODUCTION AND OBJECTIVE

The increasing demand for cost-effective surgical techniques has driven innovations in robotic-assisted radical prostatectomy (RARP). While single-port robotic surgery reduces invasiveness and improves cosmesis, its widespread use is limited by high costs and technical constraints. This study evaluates the safety, feasibility and cost-effectiveness of extraperitoneal single-port robotic-assisted radical prostatectomy (espRARP) using a modified Da Vinci Si HD system, employing a wound protector and surgical glove as a low-cost multi-channel laparoscopic port.

Ten patients with localized prostate cancer underwent espRARP using a three-arm Da Vinci Si system and side docking to enhance instrument access. A homemade multi-channel port was constructed using an Alexis® wound protector and surgical gloves. Perioperative outcomes—including operative time, blood loss, complications and oncologic results were analyzed descriptively.

All cases were completed without conversion to open surgery. The mean operative time was 215.8 minutes with an estimated blood loss of 200 mL. No positive surgical margins were recorded, and 20% of patients exhibited pathological upgrading. The average hospital stay was 3.4 days. One patient developed a Clavien–Dindo II complication; no major complications occurred

This pilot study is limited by its small sample size (n = 10), single-surgeon, single institution design, short follow-up period, and absence of functional outcome assessment. Only descriptive analysis was performed without statistical comparison.

The modified espRARP technique using a low-cost glove-port and three-arm Da Vinci Si system is safe, feasible and cost-efficient. Comparable perioperative and oncologic outcomes to conventional multi-port and proprietary single-port systems were achieved at a fraction of the cost. This approach provides a practical and accessible alternative for robotic prostatectomy in resource-limited healthcare settings.

Synovial sarcoma is an extremely rare soft tissue cancer that predominantly affects young adults, typically occurring at the para-articular region of the extremities. Primary synovial sarcoma of the prostate is exceptionally uncommon in clinical practice.

Presented here is a case of a 29-year-old male with prostatic synovial sarcoma. He experienced lower urinary tract symptoms and eventually had urine retention. The imaging findings, treatment plan, and differential diagnosis, were also discussed.

The patient experienced urinary frequency, dysuria, and acute urinary retention, which led to the insertion of a Foley catheter. Subsequent ultrasound scans revealed a large lobulated solid prostate gland. A prostate biopsy confirmed the presence of a malignant spindle cell neoplasm, indicating a prostatic stromal sarcoma. Immunohistomorphologic findings (TLE-1+, STAT6-, S100-, CD34-, ER-, PR-) were consistent with a diagnosis of Monophasic Synovial Sarcoma. The patient underwent six cycles of neoadjuvant chemotherapy before a Radical Prostatectomy was performed. The postoperative course was uneventful, and the patient was discharged in a significantly improved condition.

Given the rarity of this condition, the authors report a case of prostatic synovial sarcoma and how they managed it. They performed a radical prostatectomy with neoadjuvant chemotherapy, which had a positive effect. Subsequent postoperative monitoring and imaging showed no further symptoms.

We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011. During follow-up, he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence. In February 2023, he presented with a painless cystic mass in the scrotum. Upon pressing the mass with hand, fluid drained from the external urethral orifice, causing the mass to shrink in size, although it returned to its original size a few hours later. Urography and cystoscopy showed a globular urethral diverticulum located anteriorly. The patient underwent surgical excision of the diverticulum along with urethroplasty. Postoperatively, the urinary stress incontinence persisted, but he declined any further surgical intervention. An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence. However, devices such as penile clamps can serve as an alternative when considering surgical suitability or cost. It is important to note that these devices can lead to serious complications such as urethral erosion, stricture, or diverticulum. Therefore, caution is advised when using such devices, and they should be removed periodically at short intervals.
Humans ; Male ; Diverticulum/surgery* ; Prostatectomy/adverse effects* ; Aged, 80 and over ; Urethral Diseases/surgery* ; Urinary Incontinence/surgery* ; Urinary Incontinence, Stress/surgery*

Various techniques have been described for reconstructing the skin of the penile shaft; however, no universally accepted standard exists for correcting buried penis in adults. We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction. We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Forty-two adult males with buried penises, with a mean (±standard deviation [s.d.]) age of 26.6 (±6.6) years, underwent surgery. All patients were obese, with an average (±s.d.) body mass index of 35.56 (±3.23) kg m -2 . In addition to phalloplasty, 32 patients concurrently underwent circumcision, and 28 underwent suprapubic liposuction. The mean (±s.d.) duration of the operation was 98.02 (±13.28) min. The mean (±s.d.) duration of follow-up was 6.71 (±3.43) months. The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively (mean ± s.d: 5.55±1.19 cm vs 1.94±0.59 cm, P < 0.01). Only minor complications, such as wound disruption (7.1%) and infection (4.8%), were observed. The mean (±s.d.) score of patient satisfaction was 4.02 (±0.84) on a scale of 5. This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications. However, additional clinical studies are needed to evaluate the long-term effects of this procedure.
Humans ; Male ; Patient Satisfaction ; Adult ; Lipectomy/methods* ; Penis/surgery* ; Retrospective Studies ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Young Adult ; Penile Diseases/surgery* ; Urologic Surgical Procedures, Male/methods*

This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias. We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between October 2012 and October 2022. In total, 31 patients underwent the conventional Byars procedure (conventional group), and 45 patients underwent the modified Byars staged procedure (modified group). Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage. Notably, there were no statistically significant differences in the preoperative baseline characteristics, duration of surgery, amount of blood loss, or occurrence of postoperative complications, including urethral fistula, stricture and diverticulum, or penile curvature, between the conventional and modified groups. However, there was a significantly lower incidence of coronal sulcus fistula (0 vs 16.1%, P = 0.02) and glans dehiscence (0 vs 12.9%, P = 0.02) in the surgical group than that in the conventional group. In addition, the modified group exhibited a notably greater rate of normotopic urethral opening (100.0% vs 83.9%, P = 0.01) and a higher mean score on the Hypospadias Objective Penile Evaluation (HOPE; mean ± standard error of mean: 8.6 ± 0.2 vs 7.9 ± 0.3, P = 0.02) than did the conventional group. In conclusion, the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula. Consequently, it offers a promising approach for achieving favorable penile esthetics, thereby providing a reliable therapeutic option for severe hypospadias.
Humans ; Hypospadias/surgery* ; Male ; Retrospective Studies ; Urologic Surgical Procedures, Male/methods* ; Child, Preschool ; Child ; Postoperative Complications/etiology* ; Urethra/surgery* ; Plastic Surgery Procedures/methods* ; Surgical Flaps ; Penis/surgery* ; Treatment Outcome ; Infant

Urinary incontinence is a common complication following robot-assisted radical prostatectomy (RARP). Urethral length has been identified as a factor affecting postoperative continence recovery. In this meta-analysis, we examined the association between use of the maximal urethral length preservation (MULP) technique and postoperative urinary continence in patients undergoing RARP. We conducted a comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library up to December 31, 2023. The quality of the literature was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio (OR) from eligible studies on continence and MULP. Six studies involving 1869 patients met the eligibility criteria. MULP was positively associated with both early continence (1 month after RARP; Z = 3.62, P = 0.003, OR = 3.10, 95% confidence interval [CI]: 1.68-5.73) and late continence (12 months after RARP; Z = 2.34, P = 0.019, OR = 2.10, 95% CI: 1.13-3.90). Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex (both P > 0.05). In conclusion, the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.
Humans ; Prostatectomy/adverse effects* ; Robotic Surgical Procedures/methods* ; Male ; Urethra/surgery* ; Urinary Incontinence/prevention & control* ; Postoperative Complications/etiology* ; Prostatic Neoplasms/surgery* ; Organ Sparing Treatments/methods*

Isolated male epispadias typically presents with preputial defects and dorsal urethral dehiscence. A less common subtype, known as concealed epispadias, is distinguished by an intact prepuce. Despite its clinical relevance, there is limited literature on this variant. In this study, we retrospectively analyzed the clinical data of 86 pediatric patients with isolated male epispadias treated in Beijing Children's Hospital (Beijing, China) from May 2004 to July 2023, including 19 cases of concealed epispadias and 67 of nonconcealed epispadias. We compared clinical characteristics, preoperative diagnostics, surgical techniques, postoperative outcomes, and sexual function during follow-up between the concealed and nonconcealed groups. No significant differences were observed between the two groups regarding surgical methods, postoperative complications, or rates of urinary incontinence. However, notable distinctions were found in the age at initial diagnosis, timing of surgery, frequency of incontinence, location of the urethral meatus, and postoperative urinary incontinence scores (all P < 0.05). Given the absence of penopubic epispadias in concealed cases, we categorized glans and penile epispadias within nonconcealed epispadias as distal epispadias ( n = 40) and subsequently compared them with concealed epispadias cases. The postoperative urinary incontinence scores did not differ significantly between the concealed and distal epispadias groups. These findings suggest that concealed epispadias represents a relatively milder form of the condition, characterized by the absence of penopubic involvement, lower rates of urinary incontinence, and favorable surgical outcomes. However, the intact prepuce in concealed cases underscores the need for careful identification and early diagnosis.
Humans ; Male ; Retrospective Studies ; Epispadias/classification* ; China ; Tertiary Care Centers ; Child, Preschool ; Child ; Postoperative Complications/epidemiology* ; Urinary Incontinence/epidemiology* ; Urethra/surgery* ; Infant ; Penis/surgery* ; Adolescent ; Urologic Surgical Procedures, Male/methods* ; East Asian People