: Posterior urethral stenoses, more specifically, bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS), are a troublesome and dreaded complication after treatment for localized prostate cancer. Patients can develop bothersome and recurrent lower urinary tract symptoms (LUTS) and other urinary complications that diminish their quality of life. The diagnosis and management of these patients can be cumbersome and overwhelming to physicians as many require multiple interventions. We reviewed the current literature to better define the incidence of BNC/VUAS after different treatment modalities for localized prostate cancer and to determine the best management strategies. In general, the incidence is higher in radiated patients and takes significantly longer to present, compared to those that are treated with surgery alone. The risk is highest in patients who undergo salvage prostatectomy with an incidence of up to forty percent. A graded approach should be taken to management, as repeated attempts of minimally invasive methods are relatively successful. More aggressive treatment, either endoscopic or surgical, can result in severe de novo stress urinary incontinence (SUI) and require staged placement of an artificial urinary sphincter (AUS) and requires an educated and motivated patient. Robotic assisted laparoscopic (RAL) techniques are increasing in popularity and show promising results with lower rates of incontinence. Urinary diversion should also be considered in the treatment algorithm for these patients as it is sometimes the best option. However, larger, less heterogeneous studies are needed.

Abstract: Pelvic radiotherapy for the treatment of malignancy is known to cause unintended urinary toxicity including urinary retention and urethral stricture disease (USD). In the treatment of prostate cancer with radiotherapy, the reported rate of USD is between 1.7–5.2% while urinary toxicity has been reported in as high as 16% of patients that undergo radiotherapy for the treatment of rectal cancer. The purpose of this review article is to evaluate literature regarding the role of pelvic radiotherapy in causing urinary retention and to discuss the unique treatment considerations for urinary retention in the irradiated man ranging from urinary catheter placement to transurethral dilation (UD) to open surgical repair.

Background: Studies have evaluated the adherence of published case reports to the Case Report (CARE) guidelines. However, it is unknown how well case report manuscripts initially submitted to journals adhered to CARE guidelines before editorial and reviewer involvement. This study could provide more specific proposals for more transparent reporting of case reports by answering this research gap.

: Prostate cancer remains a common diagnosis and cause of death for men in the US that will affect more than one in ten men at some point in their lives. At presentation, some men will have locally advanced or metastatic disease. Of those men with localized disease who elect treatment with curative intent including radical prostatectomy, radiation therapy (RT), or novel local therapies approximately one third of men will suffer recurrence of their disease which is most often diagnosed via biochemical recurrence (BCR) of prostate specific antigen (PSA). Salvage treatment can potentially lead to long-term cure in certain properly selected patients. Patients should be evaluated for possible salvage radical prostatectomy (SRP) with estimation of life expectancy and evaluation for distant disease via a variety of advanced imaging options including CT, bone scan, or MRI. Once patients are diagnosed with local disease recurrence confirmed via prostate biopsy, salvage therapies including SRP may be offered. Patients should be referred to surgeons with adequate experience performing salvage radical prostatectomies and counselling should include discussions about surgical approach and oncologic outcomes as well as functional outcomes. Salvage prostatectomy is associated with significant quality of life impact and adverse events including incontinence, erectile dysfunction, anastomotic strictures, fistulas, and rectal injury.

: Transurethral resection of bladder tumour (TURBT) is the current gold standard in managing non-muscle invasive bladder cancer (NMIBC), but it is associated with suboptimal pathological and oncological outcomes. There are two main problems with TURBT. First, it is difficult to ascertain complete tumour removal upon piecemeal resection. Second, tumour fragmentation upon resection may lead to increased risk of tumour re-implantation. En bloc resection of bladder tumour (ERBT) has been proposed to tackle these problems. First, it allows full resection of the tumour in one piece including the underlying detrusor muscle, hence providing better evaluation of the resection margins and local staging. As tumours can be completely resected with clear margins, residual disease is less likely with this technique. Second, ERBT avoids manipulation and fragmentation of the bladder tumour, hence minimizing the amount of floating cells and reducing the risk of tumour re-implantation after the surgery. By upholding oncological principles as much as possible, oncological outcomes of NMIBC may be optimised. The future of ERBT is promising in providing better pathological and oncological outcomes, but larger randomised controlled trials are crucial in establishing solid evidence in clinically important outcomes and answering some technical uncertainties regarding ERBT.

Abstract: Millions of patients worldwide undergo cardiac surgery via median sternotomy. Many of those patients suffer from chronic pain. Late pain after median sternotomy usually considered insignificant; however recently chronic postoperative pain has been considered as an annoying problem and gaining more attention in order to understand the nature and management of it. In this review we will shed some lights on the incidence, etiology and management of chronic postoperative pain after cardiac surgery with a focus on the role of sternal wires removal as a management option for chronic post sternotomy pain.

Background: Current understanding of the etiology and epidemiology of priapism includes idiopathic causes, certain medications and hematologic dyscrasias. In this study, we compare existing literature to more common etiologies of priapism at our institution. We aimed to assess the similarities and differences between the etiologies of priapism at our institution compared to the current literature and determine if the cause of priapism could be community specific.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous surgery and reconstruction of gastrointestinal tract is often challenging. Numerous reports of ERCP with short type double balloon enteroscope (DBE) in patients with surgically altered anatomy have been published since 2009 and reported overall ERCP success rates varying widely. The aim of this study was to evaluate the efficacy and safety of ERCP with short type DBE in patients with surgically altered anatomy in a systematic review and meta-analysis. Methods: A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 2001 to December 2018. The following end points were analyzed: enteroscopy success rate, diagnostic ERCP success rate, therapeutic ERCP success rate, overall ERCP success rate, and complications. Data were selected and abstracted from eligible studies and were pooled using a random-effects model. Heterogeneity was assessed using the I2 test. Results: Nine studies involving a total of 1,054 procedures in 890 patients were included in the analysis. The pooled enteroscopy, diagnostic, therapeutic, and overall ERCP success rates were 94.3% [95% confidence interval (CI): 88.9–98.0%], 94.3% (95% CI: 90.8–97.1%), 98.3% (95% CI: 95.5–99.7%) and 85.6% (95% CI: 78.7–91.3%), respectively. Among patients who underwent Roux-en-Y reconstruction, the overall ERCP success rate was 83.8% (95% CI: 75.3–90.8%). In patients who had undergone a pancreatoduodenectomy (PD), the overall ERCP success rate was 92.2% (95% CI: 79.8–99.0%). In patients with Billroth II gastrectomy, the overall ERCP success rate was 92.9% (95% CI: 84.0–98.4%). ERCP with short type DBE-related complications occurred in 38 patients including pancreatitis, perforation, cholangitis, bleeding, and liver graft ischemia. The incidence of ERCP with short type DBE -related complication was 3.8% (95% CI: 2.4–5.5%). Conclusions: Diagnostic and therapeutic ERCP with short type DBE are feasible in patients with altered gastrointestinal anatomy with satisfactory success rate and acceptable complication rate. ERCP with short type DBE may be considered when pancreaticobiliary diseases occur in patients undergoing reconstruction of gastrointestinal tract.