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The role of telemedicine (TM) in endourology has expanded significantly over the past decade, demonstrating benefits for both patient satisfaction and healthcare efficiency. We wanted to look at the role and effectiveness of using these technological innovations in endourology. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework and Population, Intervention, Comparison, and Outcome statement. Search was done for all English language articles, over several databases, from inception to Aug 2024. The inclusion criteria focused on studies involving patients with kidney stone disease and reporting outcomes related to healthcare delivery, cost savings, and environmental sustainability (green credentials). A total of 933 articles were initially identified and after screening of titles, abstracts, and full texts, 10 articles were finally included. Of these articles, 8 showed a cost-saving and 9 showed a greener credential of using TM. All included studies showed a positive impact of TM in terms of reduced time to access urology services, enhanced acute and follow-up efficiency, time to decision-making or treatment, patient satisfaction, and safety. Most studies showed more than one clinical and/or organizational benefit in the patient pathway. Our review shows that TM in endourology demonstrates multiple benefits, including cost savings, environmental sustainability, and improved healthcare delivery. The included studies highlight enhanced access to services, faster decision-making, and high patient satisfaction and safety. Given the pressures on the National Health Service and existing waiting times, more should be done to adapt and adopt this technological revolution.

Shockwave lithotripsy (SWL) is a noninvasive method for removing stones, primarily used for small, uncomplicated urinary stones, as the number of kidney stone cases continues to rise. With rising patient numbers, online information must be accurate and easy to understand. We assessed the quality and readability of SWL information available online and compared it with leaflets created by generative artificial intelligence (AI). The top 20 search results for four SWL-related terms on Google, Yahoo, and Bing were collected and duplicates removed. Generative Artificial Intelligence (GAI) platforms such as ChatGPT, Gemini, and DeepSeek generated a patient leaflet. Two authors evaluated quality using DISCERN and JAMA scores and readability using Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). Later, ChatGPT reviewed the AI-generated information with DISCERN. A total of 68 websites were included. The quality assessments showed average websites with AI-leaflet DISCERN scores of 52.4 (±8.91) and 58.7 (±5.03), JAMA Benchmark scores of 2.22 (±1.10) and 0, FRES of 52.1 (±13.8) and 51.5 (±8.05), and FKGL scores of 9.04 (±2.36) and 8.93 (±1.10). No significant differences were seen in DISCERN (P = 0.224), FRES (P = 0.652), and FKGL (P = 0.866), but differences in JAMA scores were significant (P = 0.0010). A difference was also noted in the author-rated and the AI-rated DISCERN scores. There is a deficiency in high-quality SWL information that meets global readability standards. As more individuals use GAI-resources trained on online data, it is crucial to improve their quality for patients and carers. Doing so enables them to make informed decisions and promotes their well-being during treatment, resulting in improved comfort and outcomes.

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Genitourinary fistulas, though rare, are serious complications predominantly following gynecological surgeries. Minimally invasive laparoscopic techniques have emerged as effective alternatives to open repair, offering faster recovery and reduced morbidity. The purpose of this study is to report the surgical outcome of laparoscopic genitourinary fistula repair performed at our institution. Fifty-eight consecutive patients who underwent laparoscopic genitourinary fistula repair at the Department of Urology, Gandhi Medical College, Bhopal, India, from December 2018 to January 2025, were included in this study. The study was conducted retrospectively by analyzing data from a prospectively maintained institutional medical records database. Among those patients, 30 had vesicovaginal fistula (VVF), 26 had ureterovaginal fistula (UVF), and 2 had vesicouterine fistula (VUF). Patients were assessed preoperatively with imaging and cystoscopy and underwent standardized laparoscopic repair based on fistula type. Outcome measures included success rate, recurrence, complications, perioperative parameters, and postoperative recovery parameters. Statistical analysis was descriptive. Laparoscopic repair of 30 supratrigonal VVF, 26 UVF, and 2 VUF was performed. VVF was associated with abdominal hysterectomy in 20 patients, vaginal hysterectomy in 4 patients, and lower segment cesarean section (LSCS) in 6 patients. UVF was associated with abdominal hysterectomy in 22 patients, vaginal hysterectomy in 2 patients, radical hysterectomy in 1 patient, and LSCS in 1 patient. Both cases of VUF were associated with LSCS. The mean size of the VVF was 15 mm. One intraoperative bowel injury occurred during laparoscopic VVF repair and was successfully managed using the Heineke-Mikulicz repair. Two cases of VVF developed recurrence; both the cases were successfully managed with open VVF repair 3 months after the diagnosis. The success rates of VVF, UVF, and VUF were 93.33%, 100%, and 100%, respectively. Laparoscopic genitourinary fistula repair is a reliable and effective treatment modality with high success rates and minimal morbidity. With appropriate patient selection, meticulous preoperative evaluation, and adherence to sound surgical principles, laparoscopic repair is a feasible and effective option in centers with laparoscopic expertise.

Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide. Malnutrition is highly prevalent in GC patients and is linked to poor prognosis and increased disease burden. While nutritional support is known to improve outcomes and reduce complications, a comprehensive analysis of the research landscape is lacking. This study provides a bibliometric assessment of scientific literature regarding GC and nutrition. Publications from the 21st century to the present were retrieved from the Web of Science Core Collection. Bibliometric and visualization analyses were conducted using VOSviewer, Pajek, and the R package "bibliometrix." A total of 1760 articles were analyzed. Publication volume grew steadily after 2016, peaking in 2022. The United States, China, and Japan emerged as the leading research hubs. Key contributing institutions include Wenzhou Medical University, Sun Yat-sen University, and Ohio State University. Annals of Surgical Oncology is the most prolific and cited journal. Research primarily centers on the prognostic impact of nutrition and strategies to enhance patients' nutritional and immunological status. This study is the first bibliometric analysis of the global research landscape concerning GC and nutrition. By identifying current hotspots and emerging trends, it provides a valuable reference for researchers aiming to optimize nutritional interventions and improve patient outcomes.

Vitamin D deficiency is highly prevalent globally and has been linked to lower urinary tract symptoms (LUTS). In Saudi Arabia, this relationship in women has not been fully explored. A cross-sectional study was conducted among 386 Saudi women aged ≥18 years using a self-administered online survey. Data included sociodemographics, LUTS (assessed via the Bristol Female LUTS questionnaire), and self-reported Vitamin D status and supplementation. Associations between Vitamin D deficiency and LUTS were analyzed using Chi-square tests. Physician-diagnosed Vitamin D deficiency was reported in 82.4% of participants. Severe deficiency was observed in 30.2%, moderate in 27.4%, and mild in 19.5%. Significant associations were found between severe deficiency and delayed urination (50.0% never experienced vs. 66.4% in mild/moderate deficiency and 71.2% in normal Vitamin D; P = 0.010) and straining to void (58.3% never experienced vs. 71.1% and 65.8%; P = 0.049). Paradoxically, 28.1% of women with severe deficiency reported ease in stopping urine flow, compared to 13.4% in mild/moderate deficiency and 20.5% in normal levels (P = 0.028). Supplementation effects varied: 49.4% reported no change, 30.2% slight improvement, and 19.2% considerable improvement, often requiring more than 2 months. Most demographic factors were not significantly associated with deficiency. Vitamin D deficiency affects 82.4% of Saudi women, increasing the odds of delayed urination and straining to void by 1.5-1.8 times. Supplementation improved urinary symptoms in 49.4% of women, often requiring more than 2 months, emphasizing the need for routine screening, tailored supplementation, and public health interventions to reduce LUTS.

Congenital anterior urethrocutaneous fistula (CAUF) is an uncommon penile malformation characterized by the urethra's connection to the skin on the ventral aspect of the penis. It can occur alone or with genitourinary or anorectal anomalies. Due to the scarcity of reported cases, treatment strategies vary, prompting a systematic review to evaluate their clinical presentation, surgical outcomes, and recurrence rates. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, ScienceDirect, EBSCO, Cochrane, and Google Scholar for studies published up to December 12, 2024. Eligible studies focused on CAUF, its variants, surgical interventions, complications, and recurrence rates. Data were extracted and analyzed, including fistula location, associated anomalies, surgical techniques, and patient outcomes. Seventy-eight patients from 46 studies were reviewed. The most common fistula sites were subcoronal (42.3%) and mid-penile (39.7%), followed by penoscrotal (8.9%), proximal penile to subcoronal (5.1%), and scrotal/perineal (3.8%). Chordee occurred in 11 cases, while 19.2% had associated genitourinary anomalies and 16.7% systemic anomalies, mainly anorectal malformations. Surgical repair, especially with a ventral dartos flap, showed high success. Recurrence was 8.9%, with 5.4% closing spontaneously. CAUF is a rare anomaly with variable presentations and frequent associations with other anomalies. Surgical repair generally achieves good outcomes with low recurrence, though spontaneous resolution is possible in select cases. Larger multicenter studies are needed to standardize management and clarify genetic and embryologic factors.

To define how reliable the benefits of potassium citrate (KCit) for stone prevention are framing this in terms of the number needed to treat (NNT). A targeted search of PubMed/MEDLINE, Embase, and the Cochrane Library was conducted through January 2025. For studies reporting recurrence rates in treatment and control groups, absolute risk reduction (ARR) and NNT were calculated. Two pivotal randomized trials in recurrent calcium stone formers demonstrated large ARRs with KCit or potassium-magnesium citrate, lowering 3-year recurrence rates from approximately 60%-80% in placebo groups to 10%-30% with therapy. Corresponding ARRs were around 50%, yielding NNTs of approximately 2 over 3 years. Evidence is strongest for calcium oxalate disease; data for calcium phosphate and brushite stones remain limited. In uric acid and cystine stones, alkalinization is first-line therapy, although precise NNT estimates are unavailable. KCit is one of the most effective preventive pharmacotherapies in nephrolithiasis. In recurrent calcium stone formers, treating two to three patients for approximately 3 years prevents one recurrence, representing a highly favorable benefit-risk profile when appropriately monitored and individualized by stone phenotype.

Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, particularly in hospitalised patients requiring prolonged catheterisation. Despite standard protocols, preventable lapses in catheter care and clinical practices contribute to the incidence of these infections. This study aimed to identify significant risk factors and develop a point-based CAUTI Risk Scoring System for early prediction and intervention. A prospective observational study was conducted over six months at a tertiary care hospital, including 100 catheterized adult inpatients. Demographic data, Clinical variables, and catheter practices were documented. CAUTI was confirmed by urine culture. A risk stratification model was developed by assigning weighted scores to statistically significant variables, categorising patients into low, moderate, and high CAUTI risk groups. A domain-wise heatmap visually represented the novelty and interdisciplinary relevance of the study's contributions across ten clinical research domains. Among the 26% of study participants who had CAUTI overall, the important procedural predictors were open-type drainage systems (p < 0.00001), kinking of catheter tubing (p < 0.00001), and raised urobag placement (p < 0.00001). Clinical risk variables included diabetes mellitus (p = 0.00001), catheter duration greater than 7 days (p = 0.0043), female sex (p = 0.0023), and immobility (p = 0.0014). Strong early signals included turbid urine (p = 0.00004) and unexplained fever (p = 0.00001). A cumulative risk rating system placed patients into low (0-3), moderate (4-6), and high-risk (&#x2265;7) categories. This study presents the first validated CAUTI Risk Scoring System, including clinical, procedural, and early bedside indicators. The scoring tool enables proactive intervention and serves as a necessary adjunct to infection prevention plans in hospital environments.

We conceptualized a modified care pathway for renal colic management with the intention of expediting their treatment. This proof-of-concept study aimed at assessment of walk-in ureteroscopy outcomes in comparison to conservative treatment of urolithiasis with renal colic. Forty-two patients (32 in walk-in ureteroscopy group and 10 in the conservative group) with a mean age of 37 &#xb1; 10.2 years were confirmed to have ureteric/renal stones as the cause of renal colic using non-contrast computed tomography (CT) scan. Walk-in ureteroscopy and laser fragmentation procedures were offered to all. Those opting for the procedure underwent ureteroscopy and laser fragmentation. They were discharged immediately after the procedures and followed up in the clinic, including removal of stents. Patients with sepsis were excluded. Stone, free rate, and re-admission, including complications, were assessed and analyzed. The mean time from CT detection to ureteroscopic laser fragmentation was 6 &#xb1; 3.4 h. All patients resumed work in 2-3 weeks and reported no further admission to hospital for stone-related events. 30 patients were stone free at a follow-up imaging at 6 weeks. One patient had a small residual stone fragment (<2 mm) located in the inferior calyx and required no further intervention. In contrast, 4 patients in the control group required at least two admissions each in emergency departments and continued to be off work for more than 3 weeks. Overall, 8 patients in the control group eventually required interventions in other hospitals, and two continued to have stones and managed pain conservatively with analgesics. In a modified pathway for renal colic management, walk-in ureteroscopy is feasible and safe. The procedure is associated with a very high stone-free rate and with early return to work and reduced re-admissions in comparison to the conservative management option. The study and its conclusions are limited by sample size and generalizability, as the procedures were carried out by experienced staff. Lack of randomization raises the possibility of selection bias as patients self-selected their treatment groups. Finally, the brief follow-up duration might not adequately reflect long-term results like recurrence or late complications.

Indwelling urethral catheters (IUCs) are indispensable in modern urology; however, prolonged dwell times increase the risk of infection and patient-reported morbidity. Evidence-based stewardship, therefore, requires risk estimates by catheter material and dwell duration. We conducted a prospective, single-center cohort study from July to December 2023. Consecutive adults who received an IUC were followed until its removal. Dwell was stratified as &#x2264;5, 6-14, 15-30, and >30 days. A baseline urine culture was collected within 24 h of insertion. Follow-up cultures were planned for day 7 or at removal, and symptom-triggered thereafter, with additional sampling for catheters kept for more than 14 days. Culture-confirmed catheter-associated urinary tract infection (CAUTI) and noninfectious events were prospectively recorded. Among 670 eligible participants, 20 refused; 592 were analyzed (median age 51.7 years, 41% of women). Latex, silicone, and Bactiguard Infection Protection (BIP)-coated silicone catheters were used in 451, 120, and 21 insertions, respectively. Culture-confirmed CAUTI occurred in 50% of Latex, 22% of silicone, and 5% of BIP-coated silicone catheterizations (P < 0.0001). The overall incidence of the Centers for Disease Control and Prevention-defined symptomatic CAUTI in the study cohort was 16.7%. Versus &#x2264;5 days, dwell >30 days markedly raised pain/discomfort (RR: 7.1, 95% confidence interval, 2.1-24), hematuria (RR: 10.6, 2.2-51) and sexual issues (RR: 21.2, 2.0-228). Regression identified dwell length (OR: 1.07 per day) and latex material (OR: 3.8) as independent CAUTI drivers. Prolonged catheterization was also associated with marked psychosocial morbidity, including social restriction and sexual dysfunction, which increased exponentially beyond 14 days. Complications escalate sharply after day 5 and are amplified by Latex. Replacing Latex with silicone and limiting dwell time could potentially halve the incidence of culture-confirmed CAUTI. BIP catheters appear highly protective, but demand confirmation in future, robust, multicenter trials.

Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021-30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). In 2023, there were 50&#xb7;9 million (95% UI 46&#xb7;1-56&#xb7;1) road injury incident cases, 1&#xb7;34 million (1&#xb7;04-1&#xb7;58) deaths, and 75&#xb7;3 million (59&#xb7;8-89&#xb7;2) DALYs globally. Road injuries were the leading global cause of death among males aged 10-39 years. Between 1990 and 2023, age-standardised incidence decreased by 38&#xb7;3% (95% UI 36&#xb7;9-39&#xb7;7) and mortality decreased by 32&#xb7;3% (6&#xb7;1-49&#xb7;0), but progress varied widely by World Bank income group. Mortality in low-income countries (43&#xb7;8 [95% UI 31&#xb7;7-56&#xb7;0] deaths per 100&#x2008;000 population) was approximately six times higher than in high-income countries (7&#xb7;5 [7&#xb7;1-7&#xb7;9] deaths per 100&#x2008;000), despite the high-income countries showing the highest age-standardised incidence rates (858&#xb7;1 [95% UI 781&#xb7;9-947&#xb7;1] cases per 100&#x2008;000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Gates Foundation.

Urethroplasty is considered the gold standard treatment for urethral stricture. Occasionally perineal urethrostomy can be offered to patients who cannot or are unwilling to undergo complex reconstruction. In this study, we explore the factors that have influenced urologists to offer perineal urethrostomy over urethroplasty for urethral strictures on the national level. The American College of Surgeons National Surgical Quality Improvement Program database 2006-2021 was used to identify patients undergoing surgical procedures for urethral strictures using current procedural terminology (CPT) codes. The CPT codes for urethroplasty (53410) and perineal urethrostomy (53010) were used to analyze the data appropriately. Cases were excluded if they were missing any demographic data. Patient characteristics of interest were race, age, smoking status, obesity, hypertension (HTN), chronic obstructive pulmonary disease COPD, American Society of Anesthesiologists classification, use of glucocorticoids, history of cancer, and diabetes mellitus. The Chi-square and multivariate logistic regressions were used to identify significant predictors of outcomes. Significance was defined as P < 0.05. In total, 2941 patients received urethroplasty, and 154 patients received perineal urethrostomy for urethral stricture. Patients with significant comorbidities such as diabetes mellitus, HTN, and COPD are significantly more likely to undergo perineal urethrostomy [Table 1]. Patients younger than 70 were more likely to undergo urethroplasty. History of cancer, congestive heart failure, race, and dialysis had no impact on the choice of repair here. Male patients with urethral stricture who are less healthy and had increased comorbidities such as history of diabetes, HTN, and COPD were more likely to receive perineal urethrostomy over urethroplasty, while younger patients were less likely to be offered perineal urethrostomy.

Psychological distress, including depression and anxiety, is a significant yet often overlooked issue among bladder cancer patients. Despite its negative impact on treatment adherence, hospital stays, and overall survival, psychiatric distress remains underrepresented in clinical guidelines. This systematic review aims to assess the prevalence of psychiatric distress and its impact on bladder cancer patients while evaluating the role of psychiatric interventions in improving patient outcomes. A systematic search was conducted across PubMed, Embase, ProQuest, Scopus, and Wiley Online Library following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies assessing psychiatric distress in bladder cancer patients and reporting the effects of psychiatric interventions were included. Data were extracted and analyzed qualitatively. Sixteen studies encompassing 96,175 participants were included. Anxiety prevalence ranged from 7% to 38.3%, while depression ranged from 6.9% to 42.8%, with both increasing posttreatment. These studies collectively revealed heightened rates of depression and anxiety among bladder cancer patients, along with compromised sleep quality and increased incidence of psychiatric disorders posttreatment. Despite the challenges posed by psychological distress, our review identified several studies highlighting the efficacy of psychiatric interventions, including counseling and support services, in ameliorating mental health challenges among bladder cancer patients. However, our study encountered limitations such as language restrictions and heterogeneity among included studies, precluding meta-analysis. Bladder cancer imposes a significant psychological burden, yet mental health support remains underprioritized in clinical practice. Routine psychiatric screening and targeted interventions should be integrated into bladder cancer management to enhance patient well-being, treatment adherence, and overall outcomes.

A common disorder in men that has been linked to the natural aging process is benign prostatic hyperplasia (BPH). In men aged 70 and older, the frequency is approximately 40%. In this study, we compared the results of bipolar transurethral resection of the prostate (TURP) with our experience using holmium laser enucleation of the prostate (HoLEP). The research was prospective and randomized. It was conducted from April 2024 to January 2025 to treat BPH. Fifty participants in total had taken part in the study. Patients were randomized using the odd-even method into two groups; Group A was administered with HoLEP, and Group B with bipolar TURP. Both groups were distributed equally, with 25 patients in each. For statistical analysis, an independent t-test was employed. Any P value below 0.05 was considered statistically significant. Operative time was 70.74 &#xb1; 16.54 min in Group A, whereas 52.46 &#xb1; 12.24 min in Group B. The operative time and capsular perforation were found to be statistically significant between the groups with a P < 0.001 and 0.04, respectively. The International Prostate Symptom Score scores were 5.65 &#xb1; 2.23 in Group A and 5.43 &#xb1; 2.02 in Group B, respectively. Qmax was found to be 20.32 &#xb1; 8.7 in Group A, while 18.66 &#xb1; 5.45 in Group B. In the study, both HoLEP and TURP tend to be equally effective in terms of symptomatic relief. A steep learning curve has been seen along with less morbidity, which is associated with HoLEP.

Benign prostatic hyperplasia (BPH) is a prevalent urological condition characterized by nonneoplastic enlargement of the prostate gland, leading to lower urinary tract symptoms such as nocturia, urine retention, and secondary urinary infections. This cross-sectional study evaluates BPH awareness, risk factors, and management among males &#x2265;19 years in Riyadh, using a validated questionnaire (n = 398). Data were collected using a structured questionnaire distributed to 398 participants. The results reveal a significant lack of awareness, with 61.3% of participants showing poor knowledge about BPH, its symptoms, and available treatments. Notably, the internet and social media were the primary information sources, overshadowing healthcare providers. Despite the low awareness, 76.6% of participants expressed interest in learning more about BPH, highlighting an opportunity for targeted educational programs. The study shows an urgent need for public health interventions to improve awareness, promote early detection, and address modifiable lifestyle risk factors to enhance the quality of life in affected populations. Targeted interventions leveraging social media and healthcare providers are urgently needed to address gaps in awareness and screening.

Persistent genital arousal disorder (PGAD) is a distressing, often debilitating condition of unwanted genital arousal occurring independent of desire and difficult to relieve, with substantial psychosocial burden. We systematically reviewed peer-reviewed studies (2015-2025) to synthesize the evidence for diagnosis, etiology, and treatment. PubMed, Ovid (MEDLINE/Embase), and CINAHL (English-language, human studies; last searched on August 31, 2025) were searched. Two reviewers independently screened the records and extracted data, with disagreements resolved by the consensus and third-reviewer adjudication. Risk of bias was assessed using ROBINS-I for comparative observational studies and Joanna Briggs Institute tools for case series. The findings were synthesized narratively in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The review protocol was registered prospectively in PROSPERO (CRD420251108714). Of 799 records identified, 56 duplicates were removed; 743 titles/abstracts were screened, 197 full texts were assessed, and 14 studies were included. Eligible designs comprised cross-sectional surveys, case-control/cohort studies, case series &#x2265;3 patients, and one clinical review with embedded cases; no randomized controlled trials (RCTs) were identified. Owing to clinical and methodological heterogeneity, meta-analysis was not performed. Participants were predominantly women. Diagnostic practice was inconsistent: Most used symptom-based criteria aligned to International Society for the Study of Women's Sexual Health or Leiblum-Nathan frameworks, variably combined with targeted imaging, neurophysiology, or small-fiber testing. Etiologic signals most often implicated neuropathic/structural mechanisms - sacral radiculopathy, Tarlov cysts, and pudendal or small-fiber neuropathy - alongside central neurobiological and psychosocial contributors. Interventions included pelvic-floor physiotherapy, cognitive-behavioral approaches, pharmacologic agents (e.g., gabapentinoids and benzodiazepines), neuromodulation, and selected surgical decompressions for defined lesions; outcomes were mixed and follow-up/safety reporting limited. Overall, PGAD appears multifactorial and under-standardized in assessment. It should be prioritized to include a consensus, multimodal diagnostic pathway and prospective, comparative studies using validated patient-reported outcomes to inform individualized, evidence-based care.

Social determinants of health (SDOH) impact whether a patient will report lower urinary tract symptoms (LUTS). Since management of benign prostatic hyperplasia is guided by symptoms, it is important to understand the drivers of symptom severity. This study investigated the relationship between neighborhood-level SDOH and the severity of LUTS in men. Men who completed the International Prostate Symptom Score (IPSS) at a single institution from October 25, 2018, to July 31, 2024, were retrospectively analyzed. High social vulnerability index (SVI) neighborhoods were defined as those in the 75th percentile or above. IPSS scores were compared between high and low SVI groups. Results were stratified into storage, voiding, or quality of life (QOL) domains. Adjustment for confounding was achieved with linear regression models adjusting for age, race, ethnicity, and number of medical comorbidities. The study included 20,795 patients, with 1351 (6.5%) from high SVI communities. The high SVI group reported worse overall (10.5 vs. 9.6; P < 0.001), storage (5.4 vs. 5.0; P < 0.001), voiding (5.1 vs. 4.6; P < 0.001), and QOL (2.8 vs. 2.5; P < 0.001) scores. Age and number of comorbidities were independently associated with worse AUA-SI scores, while nonwhite race and Latinx ethnicity showed no association on multivariable analysis. High SVI patients report more severe LUTS at initial urologic referral. Delayed access to primary and urologic care in high SVI patients may lead to worse symptoms. Our findings highlight the importance of lowering barriers to urologic care for underserved groups.

To assess the feasibility, safety, and efficacy of supine minitubeless percutaneous nephrolithotomy (PCNL) for managing renal stones in paediatric patients. A prospective, observational, single-surgeon study was conducted at Ford Hospital and Research Centre over 2 years, including paediatric patients (<14 years) presenting with renal stones. Patient demographics, stone characteristics, intraoperative parameters, postoperative outcomes, stone-free rates (SFRs), complications, and hospital stay were recorded. Statistical analysis was performed using XLSTAT 2021. Double-J stents were placed in all cases without a nephrostomy tube. SFR was defined as complete clearance or residual fragments <2 mm in the computed tomography scan. The Clavien-Dindo system was used for grading the complications. Fifty paediatric patients were analyzed. The mean age was 6.45 years. Mean stone size was 15.24 mm, with a mean Hounsfield Unit of 829.54 &#xb1; 161.94. Mean operative time was 38.38 min. Stone-free status was achieved in 96% of patients at 3 months, with two patients requiring retrograde intrarenal surgery for residual stones. The mean haemoglobin drop was 0.51 g/dL and the mean hospital stay was 1.4 days. Minor Clavien-Dindo Grade I/II complications occurred in 12% of cases (fever 4%, pain 6%, and mild ascites 2%), all resolving spontaneously. No major complications or blood transfusions occurred. Supine mini-tubeless PCNL appears to be a safe and effective surgical management of paediatric renal stones, offering high SFRs with minimal complications, and short hospital stays. This technique may represent a useful minimally invasive treatment option, particularly when flexible ureteroscopy is limited.