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Apart from less invasiveness, the concomitant use of minimal invasive robotic systems with soft tissue navigation enhances surgical precision. However, at present, abdominal navigation systems are in experimental use and not perfect enough for daily surgical routine.

Despite the limitations of variations of uroflowmetry, this study showed that sildenafil improves Q (max) and Q (avg) in patients suffering from ED with concomitant BPH-LUTS. Long-term studies are needed to evaluate the effects on IPSS, side effects, and drug interactions.

The inheritance of varicoceles and the potential transmission to first-degree relatives has rarely been investigated. In the present study, we examined the first-degree relatives of men with known varicocele to reveal the familial risk for varicocele. decided to participate in this study. Of these 66 men, 21 (33.9%) had a palpable varicocele on physical examination. Compared with a control population (12%), the prevalence of palpable varicocele in the first-degree relatives of patients with known varicocele (33.9%) was approximately 3-fold greater (P , .005). Among the first-degree relatives, 4 (21.1%) of 19 fathers and 17 (36.2%) of 47 brothers had palpable varicocele. As a conclusion, a significant increase in varicocele prevalence is present in the first-degree relatives of men with known varicoceles. Patients should be counseled about this increased risk in male relatives of patients.

Transitional cell carcinoma (TCC) of the bladder is the seventh most frequent cancer of women. The possible mechanisms of local tumor recurrence are seeding and multicentricity. Distant metastases are most frequently as a result of vascular or lymphatic spread and to a lesser extent by seeding of the tumor cells with urine or transurethral instrumentation. We report a clitoral metastasis of a TCC of the bladder, which is a very unexpected and extremely rare site for metatstasis and discuss whether the possible mechanism is vascular spreading or direct seeding. To our knowledge this is the third case in the literature.

Two types of lower urinary tract symptoms are associated with symptomatic benign prostate enlargement: storage symptoms and voiding symptoms. The detrimental effects of storage symptoms on patients' quality of life, which have been recognized as a major burden on healthcare resources, are more significant than voiding symptoms. 1 An association between lower urinary tract symptoms and cardiovascular hyperstimulus based on an overactive sympathetic nervous system has been reported. 2 The filling and voiding cycles of the bladder trigger sympathetic activity and, thus, benign prostate enlargement-related storage and voiding symptoms stimulate autonomic hyperactivity. 3-5 Since blood pressure elevation indicates sympathetic hyperactivity, this subject has become a focus of interest over recent years. 3-5 The presence of hypertension as a component of metabolic syndrome has been recognized to play a role in the development of severe lower urinary tract symptoms. 6 It has been shown that bladder dysfunction may occur in the presence of endothelial dysfunction in the pelvic vascular system. The mechanism is based on increased sympathetic activity, especially α1-adrenoreceptor activity. This pathway is common for hypertension and severe lower urinary tract symptoms. 6,7 Other studies have demonstrated that there is an association between benign prostate hyperplasia and hypertension via activation of insulin-like growth factor and increased sympathetic nervous system activity. 8-10