Over the past two decades our understanding of ejaculatory dysfunction has evolved from the initial premise that these conditions were almost exclusively due psychological factors to a new understanding. We now understand that men with lifelong premature ejaculation may have an underlying genetic predisposition to rapid ejaculation and that men with acquired premature ejaculation may have, in addition to a variety of psychorelational factors including global anxiety, sexual performance anxiety and depression, be also suffering comorbid erectile dysfunction, chronic prostatitis and a variety of less common conditions including hyperthyroidism. Interested parties have observed a paradigm shift in the way we classify, define, evaluate, diagnose and treat ejaculatory disorders. Our understanding of these disorders is not as advanced as is our understanding of other sexual dysfunctions particularly erectile dysfunction. However there is a growing awareness and an increased level of interest from clinicians, scientists and industry parties which promises future major advances in the management of these important disorders.

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Nephrogenic diabetes insipidus (NDI), a rare cause of polyuria and polydipsia in children, is usually managed with medications and careful monitoring of water intake. We present a child who was incidentally found to have right hydronephrosis secondary to ureteropelvic junction obstruction, and was subsequently also diagnosed with NDI. After being medically managed, he underwent open right pyeloplasty. His polydipsia abated within 1 month of surgery, and he has done well off of medications since that time. NDI resolution after correction of obstructive uropathy in adults has been reported, but this represents a novel case in pediatrics.

The number of patients requiring kidney transplantation in the USA has steadily risen over time, by 3000-4000 patients each year, 1 with the gap between allograft supply and demand continuing to grow. As of the year 2019, nearly 103 039 end-stage kidney disease (ESKD) patients were listed on the transplant waiting list at the United Network for Organ Sharing (UNOS) in the USA. An increase in the number of living donor allograft supply is needed to decrease this trend. [2][3][4] Recently, more deceased donor grafts are also being considered for pediatrics to also expand the donor pool. 5 Kidney transplantation is the most effective form of kidney replacement therapy for children. 6 Transplantation is associated with increased survival as well as improvement in neurocognitive development and growth. 7 Medullary Sponge Kidney (MSK) disease is a rare congenital malformation of the distal nephron where cystic dilatation is appreciable in the collecting ducts and kidney papillae. It normally affects the medulla, and cortical structures are almost always spared.Presentation is usually indolent and can include urinary tract infections (UTI), kidney stones, nephrocalcinosis, distal kidney tubular acidosis, and hypocitraturia. 8 Deciding whether to accept a living donor with MSK is a multifaceted task because of the potential challenge of managing pediatric recipients post-transplant given risk of UTI and recurrent nephrolithiasis with progression to chronic kidney disease. 6,9,10 Recently, it was reported that donors with history of MSK had lower kidney stone-related events after nephrectomy compared with non-donors with MSK. 1 Also, the incidence of kidney stone-related

To describe a multicenter experience with management of ureteral obstruction after injection of Dx/HA for VUR in pediatric renal transplant patients. The records of all pediatric renal transplant patients who underwent Dx/HA injection for VUR and had subsequent obstruction were identified, and the management and outcomes were reviewed. Follow-up ranged from 1 to 10 years. There were four patients identified, all of whom had a history of rising creatinine, recurrent UTI, and increasing hydronephrosis which led to the diagnosis of high-grade VUR. Obstruction was diagnosed within 24-72 hours after injection in three patients. One patient was asymptomatic, and rising creatinine and hydronephrosis were noted 1 month after injection. One patient was managed expectantly, while three patients underwent ureteral stent placement. After the stent was removed, one patient went on to open reimplant due to delayed obstruction, the second patient with voiding dysfunction is currently managed with an indwelling ureteral stent and may require further definitive surgery, the third patient recovered, and the fourth is being observed. Our cases illustrate that despite initial successful management of the obstruction in some, delayed obstruction is possible and may necessitate open reimplant. It is imperative that these patients have close follow-up after Dx/HA.

Patients born with spina bifida, bladder exstrophy, posterior urethral valves, and other severe congenital genitourinary conditions now reach adolescence and adulthood at greater rates than ever before. 1 This trend has given rise to the field of transitional urology (TU), a relatively new subspecialty dedicated to caring for these patients as they approach adulthood.The boom in transitional patients across fields demands a proportionate increase in dedicated transitional providers and resources. 2 For young patients with chronic nonurological conditions like cystic fibrosis, type 1 diabetes, congenital heart disease, and organ transplantation, providers have demonstrated impressive rates of follow-up and disease control in dedicated transitional clinics. 3 Urologists are following suit, establishing dedicated TU clinics throughout the US and internationally. We sought to evaluate dedicated TU clinics in the US, hypothesizing that they are mostly new and disproportionately in larger, well-equipped and -staffed centers with training programs in relevant urological subspecialties. Methods