BackgroundTesticular torsion is surgical emergency. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. There is scant data regarding the degree of twisting and its association with testis outcomes. The purpose of our study is to explore how the degree of torsion factors into testicular outcome using follow-up data.MethodsWe retrospectively reviewed the records of adolescent males who presented with testicular torsion to our institution, looking at duration of pain symptoms, degree of torsion documented in the operative note, procedure performed (orchiopexy versus orchiectomy), and follow-up clinic data for whether testicular atrophy after orchiopexy was present. A non-salvageable testis was defined as orchiectomy or atrophy. Receiver operator characteristics (ROC), multivariate, and logistic regression analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting.ResultsEighty-one patients met our study criteria, with 55 testes deemed viable and 26 non-salvageable. We found a 25.7% atrophy rate after orchiopexy. Cut-off values of 8.5 h and 495 degrees of torsion would provide sensitivities of 73% and 53%, respectively, with specificity of 80% for both. Only duration and age were correlated with the risk of non-salvage on multivariate analysis. Logistic regression generated linear probability formulas of 4 + (3 ¡Á hours) and 7 + (0.05 ¡Á degrees) in calculating the probability of non-salvage with strong correlation.ConclusionsWe were able to derive separate formulas to determine the viability of the torsed testis based on symptom duration and degrees of twisting. Fifteen h of symptoms and 860 degrees of torsion gives testes a 50% salvage rate. Interestingly, we also found that about 1 out of every 4 testes undergoes atrophy after orchiopexy.

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Introduction: The 24-hour bladder diary is considered to be the gold standard for evaluating maximum voided volume (MVV). However, we observed that patients often have a greater MVV during office uroflowmetry than that seen in the bladder diary. The purpose of this study is to compare these two non-invasive methods by which MVV can be determined - at the time of uroflowmetry (Q-MVV), or by 24hour bladder diary (BD-MVV). Materials and Methods: This was an Institutional Review Board approved retrospective study of patients evaluated for LUTS who completed a 24hour bladder diary and contemporaneous uroflowmetry. For Q-MVV, the patient was instructed to wait to void until their bladder felt full. Sample means were compared, and Pearson's correlations were calculated between the Q-MVV and BD-MVV data across the total sample, women, and men. Results: Seven hundred seventy one patients with LUTS completed bladder diaries. Of these, 400 patients, 205 women and 195 men, had contemporaneous Q-MVV. Mean BD-MVV was greater than mean Q-MVV. However, Q-MVV was larger in a sizable minority of patients. There was a weak correlation between BD-MVV and Q-MVV. Furthermore, there was a difference ≥50% between Q-MVV and BD-MVV in 165 patients (41%). Conclusions: The data suggest that there is a difference between the two measurement tools, and that the BD-MVV was greater than Q-MVV. For a more reliable assessment of MVV, this study suggests that both Q-MVV and BD-MVV should be assessed and that the larger of the two values is a more reliable assessment of MVV.

Aims: Refractory ketamine-induced uropathy (KU) (RKU) has devastating effects on the lower urinary tract leading to ureteral obstruction and even renal failure. The only effective treatment for RKU is major surgical reconstruction or urinary diversion.Nevertheless, there is a paucity of awareness about this destructive condition; the aim of this study is to conduct a narrative systemic review of all surgical outcomes of RKU.Methods: This is an English language literature review of surgical outcomes in KU patients who underwent reconstructive lower urinary tract surgery or urinary diversion through 5 August 2022. Two independent researchers assessed the relevance of each paper and disputes were settled by a third party. In-vitro, animal studies, letters to the editor and papers that did not evaluate surgical outcomes were excluded.Results: Of the 50 763 identified articles, 622 were relevant based on title, 150 based on abstract, but only 23 papers were relevant by content. In all, 875 patients were documented as having KU, of whom 193 (22%) underwent reconstructive surgery.The data were disconcerting, as the apparent rapid progression from the beginning of KU to end-stage bladder was only a 1-year difference of ketamine abuse between those patients who required surgery (4.4 years) and those that did not (3.4 years).Conclusions: The data suggest that the time interval from the beginning of ketamineinduced uropathy to the end-stage bladder may be measured in months, confounding decision making. There is a dearth of literature about KU, and more research is needed to better understand this pathology.

INTRODUCTION AND OBJECTIVE: Patients with lower urinary tract symptoms (LUTS) may be subcategorized based on urinary output into polyuria, normal or oliguria groups as demonstrated by Blaivas et al (Can J Urol. 2021 Jun) and Clemens et al (Neurourol Urodyn., 2020 Apr). Polyuria may be caused by several pathologic conditions including diabetes mellitus (DM), chronic kidney disease (CKD), diabetes insipidus (DI), or primary polydipsia (PPD). While fluid restriction is appropriate for the majority of patients, doing so in all may result in serious complications. This study investigates the prevalence of these pathologic conditions in LUTS patients with polyuria.METHODS: Two lower urinary tract databases were retrospectively queried to identify men and women presenting with LUTS who filled out the validated Lower Urinary Tract Symptom Score (LUTSS) questionnaire (Blaivas et al, Can J Urol 2015 Oct), a 24-hour bladder diary on a mobile app* or on paper, and met criteria for polyuria (>2.5 L/day). Patients were divided into four groups: poorly controlled DM, DI, CKD grade 3, and PPD. A one-way ANOVA was performed to compare groups and Pearson correlation was run examining the relationship between LUTSS and bother with 24 HVV, MVV and total voids. *weShareÒ by Symptelligence Medical Informatics.com.RESULTS: Among 814 total patients presenting with a chief complaint of LUTS, 146 (18%) men and women completed 24 HBD and LUTSS questionnaires and met criteria for polyuria. 7.8% had poorlycontrolled DM, 3.1% had DI, 4.7% had CKD grade 3 and 84.4% had PPD. Amongst groups, statistically significant differences were seen in measurements of 24 HVV, NUV, MVV, Daytime Voids, NPi, and Ni. A statistically significant relationship was seen between LUTSS and bother score, LUTSS and total voids, and bother and total voids. CONCLUSIONS: 18% of the patients with LUTS in this series were found to have polyuria based on a 24HBD. Within this cohort, four sub-populations were phenotyped demonstrating significant differences in 24HVV, NUV, MVV, daytime voids, NPi and Ni. Identifying the underlying etiology of polyuria should be carried out to safely treat patients with LUTS.

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INTRODUCTION AND OBJECTIVE: To investigate the side effects associated with exposure to overactive bladder medications in the post marketing world.METHODS: The FDA's post marketing safety surveillance program (FAERs) for antimuscarinic and B agonist overactive bladder medications was analyzed from January 2005 to December 2019. Reports identified one or more adverse effects. Cases of monotherapy with the primary antimuscarinic or B agonist were identified. The frequency of adverse reactions was summarized between various drugs and dosages. Reporter type and age of patients with reactions was collected.RESULTS: A total of 19,607 case reports were obtained. 13,328 case reports of antimuscarinics (combined) and 6279 of B agonists. The average age of the patient was 71.8 years (SD-13.6), with 63% of all reports filed by a non-health care professional. On a per drug basis, oxybutynin (n[8,083) followed by mirabegron (n[6,279) had the highest number of adverse events and trospium (n[186) had the lowest. Neuropsychiatric followed by constitutional side effects were reported with the greatest frequency (see Table 1). Oxybutynin had the most side effects reported in 2014 with 2,777 reports, and mirabegron had the most reports submitted in 2018 with 901 reports.CONCLUSIONS: Analysis of FAERS data showed the greatest number of reports for oxybutynin and mirabegron medications. The causality and rate of AEs are not certain based on FAERS data.

The LURN SI-10 correlates strongly with the AUA-SI, a validated and widely used questionnaire for BPH in men. Additionally, the LURN SI-10 can help identify PVD, bladder pain/ discomfort, and UUI in men with BPH, symptoms that are not identified by the AUA-SI. Further prospective study of the LURN SI-10 in men with BPH, including before and after medical and surgical treatment, is warranted.