Journal of Urology最新文献

Purpose: Combining fascial interposition and mucosal cautery while leaving the testicular end open (open-ended vasectomy) is an effective and recommended vasectomy occlusion technique. We compared the effectiveness and complication risks of this technique to performing fascial interposition alone without any mucosal cautery (double open-ended).

Materials and methods: We conducted a retrospective cohort study with historical and concomitant controls using the electronic records of 5894 vasectomy patients at a private clinic in Vancouver, Canada. Two surgeons performed no-scalpel vasectomies using fascial interposition with a chromic gut suture and needle. The control group received mucosal cautery of the abdominal segment and fascial interposition covering the abdominal end, whereas the intervention group underwent fascial interposition only without any mucosal cautery. Occlusive effectiveness was assessed using the American Urological Association postvasectomy semen analysis criteria. Complications were defined as in-person visits because of vasectomy-related concerns.

Results: Occlusion successes in patients with at least 1 postvasectomy semen analysis were similar: 98.6% (2092/2122) with and 98.7% (1754/1777) without cautery (risk difference 0.1%, 95% confidence interval [CI] -0.7% to 0.9%, P = .8). There was no significant difference in overall occlusive failure between the cautery (0.8%) and no cautery (0.4%) groups (adjusted relative risk [RR_adj] 0.52, 95% CI 0.20-1.22, P = .2). Complication risks were comparable: 5.3% (182/3462) with cautery and 5.2% (127/2432) without cautery (RR_adj 0.95, 95% CI 0.76-1.19, P = .7).

Conclusions: Fascial interposition with sutures and needle covering of the abdominal end without mucosal cautery (double open-ended) is an effective and safe vasectomy occlusion technique.

Purpose: Minimal data exist regarding awake cystoscopic injection of botulinum neurotoxin in pediatric patients with neurogenic bladders. We assess the feasibility and tolerability of awake bladder botulinum toxin injections in children with neurogenic bladders in a pediatric clinic.

Materials and methods: Retrospective chart review was conducted from 01/01/2018 to 09/30/2025 for all pediatric patients with neurogenic bladders who received awake bladder botulinum injections. Baseline characteristics, procedural details, patients' tolerability, and subsequent awake injections were collected.

Results: We identified 48 patients (25 male, 23 female) and a total of 174 awake bladder botulinum injection encounters. The median age at first awake injection was 10.5 years (interquartile range 7.4, range 2-21). Thirteen patients had cognitive delay and 6 had behavioral or mental health conditions. Forty-seven patients (98%) tolerated their first awake injection well and proceeded with subsequent injections. The median time between injections was 5 months (range: 3.1-17), with a median of 3 awake injections per patient (range 1-15). Seventeen patients eventually discontinued awake injections due to: anxiety or pain (n=5; median 3 injections, range: 2-6), lack of therapeutic response (n=4), having undergone urinary diversion (n=5), lost to follow-up (n=2), or unrelated death (n=1). One patient (2%) poorly tolerated the initial injection due to anxiety or pain and did not receive subsequent awake injections.

Conclusions: Children with neurogenic bladder can successfully undergo awake bladder botulinum toxin injections. The procedure is well tolerated and can be efficiently integrated into the workflow of the outpatient clinic setting.