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Objectives: To identify and review the most up‐to‐date guidelines pertaining to bladder trauma in a unifying document as an updated primer in the management of all aspects relating to bladder injury. Methods: In accordance with the PRISMA statement, the most recent guidelines pertaining to bladder injury were identified and subsequently critically appraised. An electronic search of PubMed and Scopus databases was carried out in September 2023. Results: A total of six guidelines were included: European Association of Urology (EAU) guidelines on urological trauma (2023), EAU guidelines on paediatric urology (2022), Urotrauma: American Urological Association (AUA) (2020), Kidney and Uro‐trauma: World Society of Emergency Surgery and the American Association for the Surgery of Trauma (WSES‐AAST) guidelines (2019), Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST) (2019), and EAU guidelines on iatrogenic trauma (2012). Recommendations were summarised with the associated supporting level of evidence and strength of recommendation where available. Conclusion: Several widely recognised professional organisations have published guidelines relating to the diagnosis, investigation, classification, management, and follow‐up related to bladder injury. There is consensus amongst all major guidelines in terms of diagnosis and management but there is some discrepancy and lack of recommendation with regards to the follow‐up of bladder injuries, iatrogenic bladder injury, paediatric bladder trauma, and spontaneous bladder rupture. The role of increasing minimally invasive techniques seem to be gaining traction in the select haemodynamically stable patient. Further research is required to better delineate this treatment option. [ABSTRACT FROM AUTHOR]

Objectives To perform a systematic review of all cases of spontaneous rupture of the urinary bladder (SRUB) and to describe the demographic data, associated comorbidities, clinical presentation, diagnosis, relevant laboratory findings, associated factors, management, morbidity and mortality associated with the presentation of SRUB. Methods The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A search was carried out across the following electronic databases: PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews. Full texts of selected studies were analysed, and data extracted. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results A total of 278 articles comprising 240 case reports and 38 case series, with a total of 351 patients were included. The median (interquartile range [IQR]) age of all included patients was 47.5 (33-65) years. The median (IQR) time to presentation was 48 (24-96) h, with the major presenting symptom being abdominal pain (76%). In patients in whom the diagnosis was made prior to any intervention, the condition was misdiagnosed in 64% of cases. The diagnosis was confirmed during explorative open surgery in 42% of cases. Pelvic radiation (13%) and alcohol intoxication (11%) were the most common associated factors. Intraperitoneal rupture (89%) was much more common, with the dome of the bladder being most frequently involved (55%). The overall mortality was 15%. Conclusion This review identified a number of key factors that appear to be associated with an increased incidence of SRUB. It also emphasized the high rate of misdiagnosis and challenge in confirming the diagnosis. Overall, it highlighted the importance of the need for increased awareness and maintaining a high index of suspicion for this condition. [ABSTRACT FROM AUTHOR]

Background: Recurrent Testicular Torsion (RTT) is a rarely reported event after previous testicular torsion (TT) repair. Both conditions have similar signs and symptoms. Various techniques have been attempted to reduce the incidence of retorsion. This review assesses the presentation, diagnosis, risk factors, management and outcomes associated with RTT. Methods: After PROSPERO Registration (CRD42021258997), a systematic search of PubMed, Google Scholar, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, Global Index Medicus and Cumulative Index to Nursing and Allied Health Literature (CIANHL) was performed using specific search terms. Study metadata including patient demographics, orchidopexy techniques, RTT rates and RTT timing were extracted. Results: Twenty‐six articles, comprising 12 case series and 14 case reports, with a total of 46 patients were included. Overall, the median (IQR) age of the pooled cohort was 18 (15–26) years, the median (IQR) time to presentation was 6 (3–36) hours from the onset of testicular pain. The most common presenting features were testicular pain (100%), testicular swelling (60.9%) and a high riding testicle (34.8%). The left testicle was most commonly affected (63.0%), RTT was on the ipsilateral side in relation to the primary episode of TT in 52.2% of cases, the median (IQR) interval between torsion and retorsion events was 4 (1.3–10.0) years, non‐absorbable sutures were the most common suture material used during orchidopexy after RTT (88.9%). Conclusion: RTT is a rare presentation to the Emergency Department. Even with a prior history of TT, RTT should be considered in patients presenting with classic symptoms. [ABSTRACT FROM AUTHOR]

Background: We aimed to define the published impact, efficacy, cost‐effectiveness and precise role of the Isiris‐α device: the world's first sterile, single‐use grasper integrated flexible cystoscope (SUGIFC) for ureteral stent removal. Methods: After PROSPERO registration (CRD42021228755), the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines were utilized. The search terms "Grasper Integrated Flexible Cystoscope," and "Isiris," within the following databases: PubMed, Scopus, Cochrane Library, Web of Science and EMBASE were searched. Results: In this review, a cumulative total experience (10 publications) included 970 "SUGIFC" procedures (755 patients). However, only 366/970 procedures were actually used for "ureteral stent removal," with the remainder being surveillance cystoscopy only (603/970) or foreign body retrieval (1/970). Procedure‐related and device failures in planned "removal of ureteral stents," was reported in 8/366 (346 patients) and 1/366 (346 patients), respectively. The cost–benefit utilizing the SUGIFC device is advantageous compared to "in‐theatre" stent removals and favours less busy centres where maintenance, repair and replacement costs are more relevant. Other listed benefits include shorter stent indwelling times, shorter procedure duration, lower rates of bacteriuria and urinary tract infections, fewer emergency department visits and lower readmission rates. Technical limitations include the absence of an independent working channel, a narrower visual field and the lack of image universality since the monitor is device‐specific. Conclusion: The SUGIFC device needs to be outweighed against local costs and individual health systems. Its application in ambulatory ureteral stent removal may become significant due to the accessibility and convenience that it offers the attending urologist. [ABSTRACT FROM AUTHOR]

Background: Ureteral stent insertion and subsequent removal remains one of the most common procedures performed in endourology. We aimed to evaluate a novel, one‐step method, permitting simultaneous stent removal and guidewire passage using a self‐constructed suture snare via standard cystoscopy. This method should be used prior to ureteroscopy, in cases of minimal stent encrustation and peri‐ureteral mucosal oedema, where identification and subsequent cannulation of the ureteral orifice may be a challenge. Methods: A self‐constructed suture snare is constructed using an open‐ended ureteral catheter to facilitate this novel 'Switch' technique. Operative duration, cost feasibility and potential complications with this novel method were assessed in patients with an indwelling stent duration above 100 days. Results: Age inclusion in this study ranged from 21 to 35 years, with kidney, ureter and bladder scores below 6, in the five patients assessed. Previous ureteral stent indwelling time ranged from 106 to 315 days. Reasons for (pre‐stented) ureteroscopy were mostly stone related. The overall recorded procedure time for the Switch technique was successfully performed in less than 96 s (range 68–95 s) in all cases within this series. No procedure‐related complications were reported. Conclusion: Utilizing the suture snare, the novel Switch technique was successfully performed in all cases assessed. This method is both time and cost feasible and could be easily utilized in resource‐limited areas, regional centres or in cases where a stent grasper is not available, may have malfunctioned or cannot adequately approximate due to distal ureteral stent encrustation. [ABSTRACT FROM AUTHOR]

Background: Testicular torsion (TT) is a urological emergency that affects one in 4000 males younger than 25 years. Delays in the management of TT may result in testicular ischaemia, testicular necrosis, orchidectomy and infertility. This review assesses the validity of near‐infrared spectroscopy (NIRS) as a diagnostic tool in the assessment and diagnosis of TT. Methods: A systematic search of Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed in January 2019 using specific search terms. Selected studies were ranked and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Results: A total of nine studies that included 253 subjects (88 animals and 165 humans) with a mean sample size of 28.1 (standard deviation 40.8) subjects were included. The mean difference in testicular tissue oxygen saturation between torsed and non‐torsed testes (Δ%StO2) were 45%, 42% (±5%), 26% and 5–18% in four animal studies and 2.0%, 3.0%, 6.7%, 6.8% and 23.0% in five human studies. The tissue oxygen saturation difference between contralateral healthy testes (controls) ranged from 1% to 10% in the five studies that alluded to this. Conclusion: The current body of evidence does not support the use of NIRS in the work‐up of TT. Well‐designed clinical trials with large patient samples are required to determine whether NIRS may have some future role as a diagnostic modality in TT. [ABSTRACT FROM AUTHOR]

Background: Intestinal volvulus is a potentially life‐threatening condition that occurs when loops of bowel twist around its supporting mesentery and associated vasculature. Clinicians often rely on various radiological investigations for prompt diagnosis to avoid complications such as bowel infarction. This review assesses the clinical reliability of the ultrasonographic whirlpool sign (WS) in the diagnosis of intestinal volvulus. Methods: In adherence with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta‐analyses) statement, a systematic search of BMJ Best Practice, Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed (August 2017), using relevant search terms. Selected studies were ranked for quality and relevance using the CASP (Critical Appraisal Skills Program) tool. Results: Sixteen articles (1640 participants) were assessed. The mean and median sample size was 102.5 (SD ± 192.23) and 28 (range 7–770), respectively. The WS was positive in 212 of 255 (83.1%) patients with intestinal volvulus. Meta‐analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of 87.42% (95% confidence interval (CI): 81.05–92.25) and 98.63% (95% CI: 97.88–99.18), respectively, with an estimated summary effect of 5.28 (95% CI: 4.47–6.08, P < 0.001). There was negligible inter‐study heterogeneity, which was suggested by an I2 statistic of 0% (95% CI: 0.00–76.34) and a τ2 parameter of 0 (95% CI: 0.00–5.35). Conclusion: Though the pooled sensitivity was less than ideal (87.42%), this review and meta‐analysis nevertheless supports the reliability of the ultrasonographic WS as an acceptable indicator of intestinal volvulus. [ABSTRACT FROM AUTHOR]

Background The Anderson- Hynes pyeloplasty ( AHP) is a surgical technique used in the management of pelvi-ureteric junction obstruction. This operation has been performed for over six decades and has etched its name in the annals of urology. But are we all really referring to the same procedure? Methods A systematic review of the Ovid MEDLINE( R) and Ovid OLDMEDLINE( R) database from 1946 to 20 June 2014 was performed for the terms ' Anderson and Hynes' and ' Anderson- Hynes', with later restriction to the title of journal article. Each respective author's descriptive images (figures/photographic) of technique performed was compared with the original procedure. Non-English figure legends were translated using online translational tools. Results In total, 242 articles were retrieved. Streamlining this search to articles with the above search terms restricted to article title revealed 58 (34 English/24 non-English) articles. Only 29/58 papers had referenced the original procedure. Operative images were present in 17/58 of the articles claiming to have performed the AHP. Within these papers, only 7/17 articles depicted both the L-shaped cut and pelvic flap. Diverse variations were observed in the remainder 10/17 articles. This was a worldwide phenomenon, observed more commonly in recent decades and when minimally invasive techniques were used. Conclusion The AHP is often not performed as was originally described. Over the decades, surgeons have unknowingly attributed variations to this procedure. Based on this review, a novel 'geometric classification' system has been proposed to better define the dismembered pyeloplasty. [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The PCA3 assay has shown significant potential amongst the initial studies carried out in Western countries. This assay performed in line with previous studies. We have shown this marker to perform independent of prostatic volume and have identified potential indications for its use in our setting. However, we have not observed the PCA3 assay to outperform the PSA level across the risk spectrum. OBJECTIVES [ABSTRACT FROM AUTHOR]

The article presents a case study of a 3‐month‐old male infant with a history of antenatal hydronephrosis. Topics discussed include the endoscopic incision revealing arterial bleeding originating from the ureterocele, the patient undergoing a relook procedure to prevent all bleeding, and Doppler flow revealing an underlying left iliac arteriovenous malformation.

A letter to the editor is presented in response to the article "Prostate cancer gene 3 urine assay for prostate cancer in Japanese men undergoing prostate biopsy," by A. Ochiai and colleagues in the 2011 issue.