Pub Date : 2026-03-01Epub Date: 2025-09-10DOI: 10.1016/j.urology.2025.09.009
Luciana Lerendegui , Juanita Velasquez , Daniel Tennenbaum , Miguel Castellan
Urethral duplication is a rare urogenital anomaly, especially in females. We present the case of a preterm female with various congenital anomalies, hydrocolpos, and a persistent interlabial cyst, later found to be secondary to urethral duplication. At age 2, cystoscopy and VCUG confirmed a duplicated urethral tract. Surgical resection of the accessory urethra and genitoplasty were performed successfully. Postoperative recovery was uneventful, with excellent cosmetic and functional outcomes at follow-up. This case highlights urethral duplication as a rare but possible differential diagnosis for interlabial cystic lesions in females, particularly when associated with fluctuating size and underlying urogenital anomalies.
{"title":"Urethral Duplication Mimicking an Interlabial Cyst in a Girl: A Diagnostic Challenge","authors":"Luciana Lerendegui , Juanita Velasquez , Daniel Tennenbaum , Miguel Castellan","doi":"10.1016/j.urology.2025.09.009","DOIUrl":"10.1016/j.urology.2025.09.009","url":null,"abstract":"<div><div>Urethral duplication is a rare urogenital anomaly, especially in females. We present the case of a preterm female with various congenital anomalies, hydrocolpos, and a persistent interlabial cyst, later found to be secondary to urethral duplication. At age 2, cystoscopy and VCUG confirmed a duplicated urethral tract. Surgical resection of the accessory urethra and genitoplasty were performed successfully. Postoperative recovery was uneventful, with excellent cosmetic and functional outcomes at follow-up. This case highlights urethral duplication as a rare but possible differential diagnosis for interlabial cystic lesions in females, particularly when associated with fluctuating size and underlying urogenital anomalies.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 90-92"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-08DOI: 10.1016/j.urology.2025.12.038
Cameron J. Britton , Bryn M. Launer , Kamran Idrees , Kelvin A. Moses , Ruchika Talwar
Health literacy (HL) is defined by the National Institute of Health as the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Poor HL is prevalent among the general population of the United States (US), with only 12% of US adults possessing proficient HL to understand and utilize information delivered by healthcare providers. Furthermore, HL is a quantifiable metric that impacts oncologic outcomes in various malignancies. Given widespread deficits in HL, providers must assess patients’ understanding of their health and tailor their discussion of diagnoses, management, and potential complications of management so that patients can make informed decisions. To date, literature examining HL and its impact on urologic oncology outcomes is sparse. Therefore, we conducted a narrative review examining publicly available information on HL in urologic oncology and propose future avenues for research endeavors.
{"title":"Global Examination of Health Literacy in Urologic Malignancies","authors":"Cameron J. Britton , Bryn M. Launer , Kamran Idrees , Kelvin A. Moses , Ruchika Talwar","doi":"10.1016/j.urology.2025.12.038","DOIUrl":"10.1016/j.urology.2025.12.038","url":null,"abstract":"<div><div>Health literacy (HL) is defined by the National Institute of Health as the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Poor HL is prevalent among the general population of the United States (US), with only 12% of US adults possessing proficient HL to understand and utilize information delivered by healthcare providers. Furthermore, HL is a quantifiable metric that impacts oncologic outcomes in various malignancies. Given widespread deficits in HL, providers must assess patients’ understanding of their health and tailor their discussion of diagnoses, management, and potential complications of management so that patients can make informed decisions. To date, literature examining HL and its impact on urologic oncology outcomes is sparse. Therefore, we conducted a narrative review examining publicly available information on HL in urologic oncology and propose future avenues for research endeavors.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 61-65"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-08DOI: 10.1016/j.urology.2025.12.039
Ushasi Naha, Ahmad M. El-Arabi
{"title":"Editorial Comment on “Performance of a Standardized Retrograde Urethrogram to Optimize Length, Segment, Etiology (LSE) Anterior Urethral Stricture Disease Classification and Staging”","authors":"Ushasi Naha, Ahmad M. El-Arabi","doi":"10.1016/j.urology.2025.12.039","DOIUrl":"10.1016/j.urology.2025.12.039","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 15-16"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-09DOI: 10.1016/j.urology.2026.01.001
Abbas Bader, Colby Souders
{"title":"Editorial Comment on “Quality and Reliability of YouTube Videos on Intravesical Botulinum Toxin Injections: A Provider-based Evaluation”","authors":"Abbas Bader, Colby Souders","doi":"10.1016/j.urology.2026.01.001","DOIUrl":"10.1016/j.urology.2026.01.001","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 164-165"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-13DOI: 10.1016/j.urology.2025.12.044
Wilson Sui , Suprita Krishna , Russell Becker , Andrew M. Higgins , Caitlin Seibel , Stephanie Daignault-Newton , Golena Fernandez Moncaleano , Hector Pimentel , Brian D. Seifman , David L. Wenzler , Karla Witzke , Khurshid R. Ghani , Casey Dauw , for the Michigan Urological Surgery Improvement Collaborative
Objective
To evaluate the impact on patient-reported outcomes of the efforts by the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative to reduce postoperative opioid use after ureteroscopy.
Methods
We evaluated MUSIC ROCKS patients with complete prescription and PRO data. PROMIS pain intensity and interference scores were compared between opioid and non-opioid users using multivariable regression models. A sub-analysis compared opioid users discharged with multimodal therapy and then required rescue opioids versus those given opioid at discharge.
Results
Opioid prescription rates after ureteroscopy declined from 83% in 2016 to 13% in 2023. Of the 405 opioid-naïve ureteroscopy cases; 23% reported opioid use within 7-10 days post-op. At 7-10 days after surgery, patients taking opioids had worse pain intensity and pain interference than those who had not. However, there were no statistically significant differences in PROs between those prescribed opioid at discharge versus those who required rescue opioid. Multivariable predictors of both pain intensity and interference included postoperative opioid use at 7-10 days, postoperative stent placement and preoperative stent use.
Conclusion
Opioid use after ureteroscopy has declined sharply in Michigan. We did not see evidence that PROs differed between patients discharged opioid-free who later required rescue opioids and those discharged with opioids, supporting the use of multimodal regimens. Postoperative stent use, however, was a key predictor of pain, highlighting its modifiable impact on outcomes.
{"title":"Reducing Opioid Utilization After Ureteroscopy Without Compromising Patient Outcomes in a Statewide Quality Improvement Collaborative","authors":"Wilson Sui , Suprita Krishna , Russell Becker , Andrew M. Higgins , Caitlin Seibel , Stephanie Daignault-Newton , Golena Fernandez Moncaleano , Hector Pimentel , Brian D. Seifman , David L. Wenzler , Karla Witzke , Khurshid R. Ghani , Casey Dauw , for the Michigan Urological Surgery Improvement Collaborative","doi":"10.1016/j.urology.2025.12.044","DOIUrl":"10.1016/j.urology.2025.12.044","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact on patient-reported outcomes of the efforts by the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative to reduce postoperative opioid use after ureteroscopy.</div></div><div><h3>Methods</h3><div>We evaluated MUSIC ROCKS patients with complete prescription and PRO data. PROMIS pain intensity and interference scores were compared between opioid and non-opioid users using multivariable regression models. A sub-analysis compared opioid users discharged with multimodal therapy and then required rescue opioids versus those given opioid at discharge.</div></div><div><h3>Results</h3><div>Opioid prescription rates after ureteroscopy declined from 83% in 2016 to 13% in 2023. Of the 405 opioid-naïve ureteroscopy cases; 23% reported opioid use within 7-10 days post-op. At 7-10 days after surgery, patients taking opioids had worse pain intensity and pain interference than those who had not. However, there were no statistically significant differences in PROs between those prescribed opioid at discharge versus those who required rescue opioid. Multivariable predictors of both pain intensity and interference included postoperative opioid use at 7-10 days, postoperative stent placement and preoperative stent use.</div></div><div><h3>Conclusion</h3><div>Opioid use after ureteroscopy has declined sharply in Michigan. We did not see evidence that PROs differed between patients discharged opioid-free who later required rescue opioids and those discharged with opioids, supporting the use of multimodal regimens. Postoperative stent use, however, was a key predictor of pain, highlighting its modifiable impact on outcomes.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 42-47"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145990875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-13DOI: 10.1016/j.urology.2026.01.015
Yuming Zheng , Philip Dundee , Paul Manohar , Sarah Sneddon, Paul Anderson
Objective
To summarize findings of clinical trials from the past 10 years regarding the safety and efficacy of extracorporeal shock wave therapy (ESWT) for the management of chronic pelvic pain syndrome (CPPS) in male patients, and highlight any current knowledge gap.
Methods
We performed a systematic review (CRD420251164315) of MEDLINE and EMBASE, for clinical trials investigating ESWT in men with CPPS published between 2015 and October 2025. Main outcomes assessed were National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score and domains. Additional measures include visual analog scale (VAS); International Prostate Symptom Score (IPSS); International Index of Erectile Function (IIEF); UPOINT phenotype system.
Results
Eleven studies were included. All demonstrated significant improvement in NIH-CPSI total and pain measures (NIH-CPSI pain domain and/or VAS) following ESWT, compared with baseline and/or control. Eight studies evaluated the NIH-CPSI quality-of-life domain, all reported significant improvement. Eleven studies evaluated urinary symptoms (NIH-CPSI urinary domain and/or IPSS), 9 reported significant improvement. No major adverse events occurred, minor events included 1 first-degree burn and 4 cases of transient hematuria and haematospermia.
Conclusion
ESWT appears to be a safe and effective treatment for CPPS, improving pain and quality-of-life outcomes across trials. Larger randomized trials with longer follow-up are warranted to confirm findings and define optimal protocols.
{"title":"Safety and Efficacy of Extracorporeal Shock Wave Therapy for the Management of Chronic Pelvic Pain Syndrome: A Systematic Review","authors":"Yuming Zheng , Philip Dundee , Paul Manohar , Sarah Sneddon, Paul Anderson","doi":"10.1016/j.urology.2026.01.015","DOIUrl":"10.1016/j.urology.2026.01.015","url":null,"abstract":"<div><h3>Objective</h3><div>To summarize findings of clinical trials from the past 10 years regarding the safety and efficacy of extracorporeal shock wave therapy (ESWT) for the management of chronic pelvic pain syndrome (CPPS) in male patients, and highlight any current knowledge gap.</div></div><div><h3>Methods</h3><div>We performed a systematic review (CRD420251164315) of MEDLINE and EMBASE, for clinical trials investigating ESWT in men with CPPS published between 2015 and October 2025. Main outcomes assessed were National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score and domains. Additional measures include visual analog scale (VAS); International Prostate Symptom Score (IPSS); International Index of Erectile Function (IIEF); UPOINT phenotype system.</div></div><div><h3>Results</h3><div>Eleven studies were included. All demonstrated significant improvement in NIH-CPSI total and pain measures (NIH-CPSI pain domain and/or VAS) following ESWT, compared with baseline and/or control. Eight studies evaluated the NIH-CPSI quality-of-life domain, all reported significant improvement. Eleven studies evaluated urinary symptoms (NIH-CPSI urinary domain and/or IPSS), 9 reported significant improvement. No major adverse events occurred, minor events included 1 first-degree burn and 4 cases of transient hematuria and haematospermia.</div></div><div><h3>Conclusion</h3><div>ESWT appears to be a safe and effective treatment for CPPS, improving pain and quality-of-life outcomes across trials. Larger randomized trials with longer follow-up are warranted to confirm findings and define optimal protocols.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 136-143"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145990866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-19DOI: 10.1016/j.urology.2026.01.007
Philippe Zimmern , Samuel Kusin , Ethan Fan , Alana L. Christie , Richard Ratevosyan , Larry Reitzer
Objective
To evaluate urinary pH, methenamine (uME), and formaldehyde (uFA) levels from women with documented recurrent urinary tract infections (rUTIs) taking Hiprex and monitored these levels with rUTI incidence over time.
Methods
Following IRB-approval, non-neurogenic women, ages 50-85 years old, with a history of rUTIs, low urinary pH trends (<6), and interested in being monitored for UTI symptoms while taking Hiprex for 1 year were enrolled at a tertiary care center specializing in rUTI management. At the initial and six subsequent office visits, a urine sample was obtained prior to, and 1 hour after, taking 1 gm Hiprex. Urine pH, uME, and uFA levels were measured using commercially available kits, normalized to urinary creatinine.
Results
Of 29 patients (mean age 71.4 years) screened, seven met study criteria and completed the 1-year study, with an additional year of follow-up. Methenamine was identified in the urine of each participant after Hiprex administration. Median uFA levels increased between 14% and 130% 1-hour following Hiprex administration. Most individuals (71%) consistently had a urine pH below 6. The majority remained UTI-free.
Conclusion
This study confirmed the durable presence of uME and uFA from those on Hiprex in a low urinary pH environment with clinical efficacy. A sustained increase in uFA was observed 1-hour following office-administered Hiprex. The uFA concentration was lower than deemed bactericidal in vitro; so, additional research is needed on the mechanism of Hiprex to better define its role in UTI prevention.
{"title":"Urinary pH, Methenamine, and Formaldehyde Levels in the Management of Postmenopausal Women With Recurrent Urinary Tract Infections: A 1-Year Prospective Pilot Study With Extended Follow-up","authors":"Philippe Zimmern , Samuel Kusin , Ethan Fan , Alana L. Christie , Richard Ratevosyan , Larry Reitzer","doi":"10.1016/j.urology.2026.01.007","DOIUrl":"10.1016/j.urology.2026.01.007","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate urinary pH, methenamine (uME), and formaldehyde (uFA) levels from women with documented recurrent urinary tract infections (rUTIs) taking Hiprex and monitored these levels with rUTI incidence over time.</div></div><div><h3>Methods</h3><div>Following IRB-approval, non-neurogenic women, ages 50-85 years old, with a history of rUTIs, low urinary pH trends (<6), and interested in being monitored for UTI symptoms while taking Hiprex for 1 year were enrolled at a tertiary care center specializing in rUTI management. At the initial and six subsequent office visits, a urine sample was obtained prior to, and 1 hour after, taking 1 gm Hiprex. Urine pH, uME, and uFA levels were measured using commercially available kits, normalized to urinary creatinine.</div></div><div><h3>Results</h3><div>Of 29 patients (mean age 71.4 years) screened, seven met study criteria and completed the 1-year study, with an additional year of follow-up. Methenamine was identified in the urine of each participant after Hiprex administration. Median uFA levels increased between 14% and 130% 1-hour following Hiprex administration. Most individuals (71%) consistently had a urine pH below 6. The majority remained UTI-free.</div></div><div><h3>Conclusion</h3><div>This study confirmed the durable presence of uME and uFA from those on Hiprex in a low urinary pH environment with clinical efficacy. A sustained increase in uFA was observed 1-hour following office-administered Hiprex. The uFA concentration was lower than deemed bactericidal in vitro; so, additional research is needed on the mechanism of Hiprex to better define its role in UTI prevention.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 48-53"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-11DOI: 10.1016/j.urology.2025.12.006
Tanisha Martheswaran , Zoë Cohen , Jeremy B. Myers , Jane T. Kurtzman
Objective
To examine low- and middle-income country (LMIC) representation within urology research and highlight disparities that limit equitable, inclusive, and context-specific investigation.
Methods
A systematic review was performed using Scopus to identify all urology articles published from 2013-2023 across 117 urology journals. Country affiliations were based on abstract, title, or author institution. Publications were categorized by country income level based on World Bank classifications. Trends in first authorship across income settings were analyzed using separate linear regression models and compared using multiple linear regression analysis with interaction terms. Population-adjusted Poisson regression models assessed for associations between income category and first author research output.
Results
A total of 128,949 articles were included. 0.99% were affiliated with low-income (LIC), 7% with middle-income (MIC), 23% with upper-middle-income (UMIC), and 79% with a high-income country (HIC). The top country from each income-category was Niger, India, China, and USA, respectively. LICs first-authored 0.4% of all publications. HICs produced 95-times more first-authored articles than LICs, while UMICs and MICs produced 13- and 3-times more, respectively (IRR = 94.8, IRR = 12.7, IRR = 3.1, all P-values <.001). Over the 10-year, the proportion of first-authored articles from LIC, MIC and UMICs increased significantly, but variably. On average, HIC publications increased at a rate of 145 more articles/year than LICs and UMICs increased at a rate of 189 more articles/year (both P < .001).
Conclusion
Major disparities exist in urology research output and authorship across income settings. Addressing these inequities will require deliberate efforts to strengthen research infrastructure, expand international collaborations, and create more inclusive opportunities for publication.
{"title":"Global Disparities in Urological Research: A Systematic Bibliometric Analysis of Low- and Middle-income Country Representation in Urology Journals From 2013-2023","authors":"Tanisha Martheswaran , Zoë Cohen , Jeremy B. Myers , Jane T. Kurtzman","doi":"10.1016/j.urology.2025.12.006","DOIUrl":"10.1016/j.urology.2025.12.006","url":null,"abstract":"<div><h3>Objective</h3><div>To examine low- and middle-income country (LMIC) representation within urology research and highlight disparities that limit equitable, inclusive, and context-specific investigation.</div></div><div><h3>Methods</h3><div>A systematic review was performed using Scopus to identify all urology articles published from 2013-2023 across 117 urology journals. Country affiliations were based on abstract, title, or author institution. Publications were categorized by country income level based on World Bank classifications. Trends in first authorship across income settings were analyzed using separate linear regression models and compared using multiple linear regression analysis with interaction terms. Population-adjusted Poisson regression models assessed for associations between income category and first author research output.</div></div><div><h3>Results</h3><div>A total of 128,949 articles were included. 0.99% were affiliated with low-income (LIC), 7% with middle-income (MIC), 23% with upper-middle-income (UMIC), and 79% with a high-income country (HIC). The top country from each income-category was Niger, India, China, and USA, respectively. LICs first-authored 0.4% of all publications. HICs produced 95-times more first-authored articles than LICs, while UMICs and MICs produced 13- and 3-times more, respectively (IRR = 94.8, IRR = 12.7, IRR = 3.1, all <em>P</em>-values <.001). Over the 10-year, the proportion of first-authored articles from LIC, MIC and UMICs increased significantly, but variably. On average, HIC publications increased at a rate of 145 more articles/year than LICs and UMICs increased at a rate of 189 more articles/year (both <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>Major disparities exist in urology research output and authorship across income settings. Addressing these inequities will require deliberate efforts to strengthen research infrastructure, expand international collaborations, and create more inclusive opportunities for publication.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 54-58"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-19DOI: 10.1016/j.urology.2025.12.031
Matthew J. Salvino, Thomas E. Schroeder, Logan W. Grimaud, Andrew C. Peterson
Objective
To assesses the influence of artificial urinary sphincter (AUS) device age on pressure-regulating balloon (PRB) mechanical and microscopic properties. The AUS is a fluid-filled hydraulic system comprised of a urethral cuff, mechanical pump, and PRB. Material fatigue prior to terminal failure of the PRB can reduce its ability to pressurize the urethral cuff, leading to recurrent urinary incontinence.
Methods
Tensile testing was performed on PRBs from 32 previously implanted and 1 new AUS. Stress softening and relaxation testing, as well as scanning electron microscopy (SEM), were conducted on a subset of 7 PRBs evenly distributed in age. Data were analyzed using linear regression, Pearson correlation, and repeated measures ANOVA.
Results
AUS device age ranged from 2 months to 17.6 years (median 7.2 years). There was a moderate positive linear correlation between PRB age and stiffness (r = 0.68, P <.01). PRB wall thickness displayed a weak negative correlation with PRB age (r = −0.38,P = .03). There was no noticeable weakening of the PRB with repeated use over the course of a day, regardless of the time of testing or device age. After SEM, 4 of the 7 PRB specimens revealed fine surface cracks present in their microstructure, which were evident in the 4 oldest specimens.
Conclusion
PRBs exhibit progressive material degradation with age prior to terminal failure, including increased stiffness, decreased wall thickness, and formation of microstructural defects. These findings underscore considering age-related PRB fatigue as a potential cause of declining device performance and support earlier evaluation of PRB replacement in symptomatic patients with recurrent stress urinary incontinence.
{"title":"Time Dependent Material Fatigue of the Artificial Urinary Sphincter Pressure-regulating Balloon: A Mechanical and Microscopic Analysis","authors":"Matthew J. Salvino, Thomas E. Schroeder, Logan W. Grimaud, Andrew C. Peterson","doi":"10.1016/j.urology.2025.12.031","DOIUrl":"10.1016/j.urology.2025.12.031","url":null,"abstract":"<div><h3>Objective</h3><div>To assesses the influence of artificial urinary sphincter (AUS) device age on pressure-regulating balloon (PRB) mechanical and microscopic properties. The AUS is a fluid-filled hydraulic system comprised of a urethral cuff, mechanical pump, and PRB. Material fatigue prior to terminal failure of the PRB can reduce its ability to pressurize the urethral cuff, leading to recurrent urinary incontinence.</div></div><div><h3>Methods</h3><div>Tensile testing was performed on PRBs from 32 previously implanted and 1 new AUS. Stress softening and relaxation testing, as well as scanning electron microscopy (SEM), were conducted on a subset of 7 PRBs evenly distributed in age. Data were analyzed using linear regression, Pearson correlation, and repeated measures ANOVA.</div></div><div><h3>Results</h3><div>AUS device age ranged from 2 months to 17.6 years (median 7.2 years). There was a moderate positive linear correlation between PRB age and stiffness (<em>r</em> = 0.68, <em>P</em> <.01). PRB wall thickness displayed a weak negative correlation with PRB age (<em>r</em> = −0.38,<em>P</em> = .03). There was no noticeable weakening of the PRB with repeated use over the course of a day, regardless of the time of testing or device age. After SEM, 4 of the 7 PRB specimens revealed fine surface cracks present in their microstructure, which were evident in the 4 oldest specimens.</div></div><div><h3>Conclusion</h3><div>PRBs exhibit progressive material degradation with age prior to terminal failure, including increased stiffness, decreased wall thickness, and formation of microstructural defects. These findings underscore considering age-related PRB fatigue as a potential cause of declining device performance and support earlier evaluation of PRB replacement in symptomatic patients with recurrent stress urinary incontinence.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 128-133"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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