Citations

Abstract Introduction Sacral neuromodulation (SNM) is an effective third line treatment for overactive bladder (OAB). It is estimated that 10-27% of men suffer from OAB, however, prior studies on SNM have only reported on female-predominant cohorts. OAB in the male patient has gender-specific complexity given the effects of prostatic anatomy and associated therapeutics on voiding function, which may influence treatment outcomes and underutilization of SNM in this population. Objective We sought to assess a dedicated cohort of male patients undergoing SNM for refractory OAB by a single surgeon at our institution. Methods A retrospective cohort study was conducted, analyzing medical records of male patients who underwent SNM implantation for OAB by a single surgeon between February 2023 and September 2024. Data extraction encompassed demographic characteristics, urological history, and micturition parameters. The latter were assessed by using validated bladder diaries completed pre- and post-SNM implantation. Comparative analysis was conducted using independent t-tests and chi-square tests. Results Over the study period, 39 patients underwent either a peripheral nerve evaluation (PNE) or first stage SNM procedure, of which 32 (82.1%) had greater than 50% improvement in symptoms and underwent second stage implantation. 97.4% of the cohort had previously failed OAB medications, 25.6% had previously undergone bladder Botox, and 15.4% had previously undergone percutaneous tibial nerve stimulation. 30.8% had undergone a previous bladder outlet procedure (Table 1). In the cohort that underwent second stage implantation, average total voids in 24 hours improved from a median of 20.9 to 10.3 (Table 2, p<0.001), daily leakage episodes improved from 3.9 to 1.3 (p=0.001) and pad usage improved by >50%. Conclusions In this exploratory cohort, SNM demonstrated safety and efficacy in improving symptoms and quality of life for men with treatment-refractory OAB. Disclosure No

Parkinson's disease (PD) is a progressive neurodegenerative disease with multiple manifestations including both motor and non-motor symptoms. One manifestation of PD that is often overlooked is the sexual dysfunction (SD) that patients may experience. Individuals with PD can experience impairment in sexual desire, arousal or lubrication, orgasm, ejaculation, pain and the physical aspect of intimacy. This article aims to provide an overview of the current practices in the evaluation and treatment of sexual dysfunction in men in the context PD. Note that this article focuses on the male population as it reviews the available American Urology Association practice guidelines many practitioners follow, which focus on the male population. Sexual dysfunction guidelines for the female population are much more limited, and future work should review the existing literature and gaps to provide a more robust understanding of sexual dysfunction in PD. PD represents a particularly vulnerable population for development of sexual dysfunction given the multifactorial nature of its manifestations. Given its profound impact on not only the patient, but their partner, it is important to be aware of the various manifestations of SD when evaluating individuals with PD. Through thorough history taking and targeted psychosexual evaluation, we as practitioners can ensure a more holistic and comprehensive approach to caring for individuals with PD.

ABSTRACT Introduction and Objectives Female urethral strictures remain a challenging clinical entity with limited data on optimal reconstructive techniques. This study presents 12‐month clinical and patient‐reported outcomes following a novel transurethral approach to dorsal inlay buccal graft urethroplasty. Methods We evaluate the outcomes of consecutive female patients with urethral strictures treated via dorsal inlay buccal graft urethroplasty from October 2021 to November 2024. Preoperative evaluation included cystoscopy, uroflowmetry, and/or voiding cystourethrogram. Follow‐up at 4 and 12 months included cystoscopy, uroflowmetry, and patient‐reported outcomes measured via the Global Response Assessment. Success was defined as absence of recurrence on cystourethroscopy. Results Twenty‐one patients were included in the study, with 95% having undergone prior treatments (90% dilation/DVIU and 9% urethroplasty). Stricture locations varied across the distal (33%), mid (19%), proximal (19%), and multifocal/pan urethral (19%). The median operative duration was 60 min (IQR: 56–86) and all were discharged on the day of surgery. Nineteen patients (90%) underwent a dorsal inlay procedure, while two (10%) required combined dorsal and ventral inlay due to obliterative stricture. No complications were observed. The median follow‐up was 13.2 (IQR: 5.1–23.5) months, during which time 1 patient underwent retreatment for recurrent stricture. Clinical success was 95% at 4 months and 92% at 12 months. Median peak urinary flow rate preoperatively versus 4‐month postoperatively was 7.0 cc/s versus 13.0 cc/s ( p = 0.20) and at 12‐month postoperatively was 13.3 cc/s ( p = 0.50). 90% of patients reported improvement on the Global Response Assessment. There were no cases of de novo stress urinary incontinence. Conclusions This novel transurethral dorsal inlay buccal graft urethroplasty offers a safe and efficient treatment for female urethral strictures with durable clinical and patient‐reported outcomes at 12 months. The technique's minimal urethral mobilization translates into shorter operative times and a low risk of stress incontinence, making it a promising alternative to traditional approaches.