Benign prostatic hyperplasia (BPH) is the most common disease of the lower urinary tract in men. The prevalence increases continuously with increasing age and a chronic progressive course is to be expected. In order to reduce the morbidity of affected patients and to improve their quality of life, the expert panel Benign Prostatic Hyperplasia (BPH) of the German Society of Urology (DGU) has written a new version of the evidence-based \"S2e guideline on the diagnosis and treatment of BPH\". Using a current patient case, the contents of the new S2e guideline are illustrated, from diagnosis to the decision-making process for a suitable treatment choice. The case presented here shows the possible complexity and difficulty that can arise in the diagnosis of BPH, the need for further diagnostic steps and the finding of a suitable therapy in order to fulfill the patient\'s wishes, if possible.
UNASSIGNED: Das benigne Prostatasyndrom (BPS) ist die häufigste Erkrankung des unteren Harntraktes beim Mann. Die Prävalenz steigt kontinuierlich mit zunehmendem Lebensalter an und ein chronisch progredienter Verlauf ist zu erwarten. Um die Morbidität betroffener Patienten zu senken und die Lebensqualität zu verbessern, hat der Arbeitskreis Benignes Prostatasyndrom (BPS) der Deutschen Gesellschaft für Urologie e. V. (DGU) eine Neufassung der evidenzbasierten „S2e-Leitlinie Diagnostik und Therapie des BPS“ verfasst. Anhand eines aktuellen Patientenfalls werden hier die Inhalte der neuen S2e-Leitlinie von der Diagnostik bis zur Entscheidungsfindung einer passenden Therapiewahl anschaulich dargestellt. Im hier vorgestellten Fall zeigen sich die mögliche Komplexität und Schwierigkeit, die bei der Diagnose eines BPS auftreten können, die Notwendigkeit weiterführender Diagnostik und die Findung einer passenden Therapie, um auch vorliegende Patientenwünsche, wenn möglich, zu erfüllen.

Lower urinary tract foreign bodies are often reported but the underlying causes remain intriguing, ranging from unconventional practices to medical interventions. This condition predominantly affects young males and presentations are varied from asymptomatic, lower urinary tract symptoms to acute obstructive renal failure. We report a case of a 48-year-old male presented with lower urinary tract symptoms and obstructive renal failure. Imaging revealed multiple foreign bodies in the pelvic cavity, suggestive of vesical, and urethral lithiasis. Urethrocystoscopy removed an 8-cm needle with rubber band and a 10-cm encrusted cable, forming a urethral stone. Vesicolithotomy removed a 5 × 3 cm bladder stone with a SIM card inserter as its core. The patient\'s condition improved after surgery. Notably, the patient\'s history prompted a psychiatric evaluation, leading to the diagnosis of and treatment for an adjustment disorder. While endourology procedure is effective in most cases, some cases necessitate open surgery. Identification and treatment of underlying psychiatric disorders is needed to for long term care.

UNASSIGNED: Children with foreign bodies (FBs) in the lower urinary tract have rarely been reported, and their management remains challenging. This study aimed to describe the characteristics and treatment of FBs in children\'s lower urinary tract.
UNASSIGNED: We retrospectively analyzed the clinical data on lower urinary tract FBs that were removed in our hospital from August 2017 to August 2022, including demographics, location, symptoms, imaging examinations, and treatment.
UNASSIGNED: Four male patients were enrolled, whose ages ranged from 9 to 13 years, with a mean age of 11 years. The course of the disease ranged from 3 h to 2 weeks. Their imaging characteristics were reviewed and analyzed, and two FBs were located in the bladder and two in the urethra. Mosquito forceps were used to remove an acne needle through the urethra in one case. Cystoscopy was first attempted in three cases, in only one of which was the FB removed successfully under endoscopic minimally invasive surgery. In the remaining two cases, removal via transurethral cystoscopy failed, whereby leading to cystotomy being performed. The FBs comprise a skipping rope, hairpin, magnetic bead, and acne needle. The postoperative recovery was uneventful, and no complications occurred during the follow-up period of 3 to 6 months.
UNASSIGNED: It is rare for children to have FBs in the lower urinary tract. An early diagnosis, as well as appropriate management of lower urinary tract FBs, can significantly reduce complications. Surgical removal of lower urinary tract FBs can be safe and effective, and relatively better outcomes can be achieved.

Migration and embedding of an intrauterine contraceptive device (IUCD) in the urinary bladder wall is rare. We present such a case of a 30-year-old woman with complaints of persistent lower urinary tract symptoms and a history of IUCD placement 8 years earlier. The IUCD was successfully removed with cystoscopy alone. The patient recovered well and had her second baby after the surgery without complaints of new urinary symptoms.

Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment.

Penetrating penile injuries occur mostly in industrial/work accidents, automobile accidents, or as a result of sexual curiosity and attempts at self-expression/mutilation. In this case report, the authors describe an accidental nailgun injury to the penis of a 46-year-old man. We discuss the management of such injuries in the emergency department, including the utility of a dorsal penile block for regional anesthesia. Although exceptionally rare, familiarity with penetrating lower urinary tract injuries may reduce their long-term repercussions on genitourinary and sexual health.

A 62-year-old male was admitted after being struck by a bus. He sustained a severe pelvic fracture, sigmoid colon injury, and both intraperitoneal and extraperitoneal bladder injury. He underwent initial successful bladder repair. However, at 7 days post-operatively he manifested a leak from the repair and urine was evident coming from the pins of his pelvic external fixator. A repeat cystogram showed massive extravasation, which was managed by operative ligation of the lower ureters and placement of percutaneous nephrostomy tubes. He underwent ureteral reconstruction and colostomy reversal at 9 months. He has both bladder and bowel control.

Clear cell carcinoma is an uncommon but distinct variant of urinary bladder carcinoma histologically resembling the neoplasm in the female genital tract. The histogenesis of this neoplasm is uncertain. The clinicopathologic and histologic features are suggestive of a mullerian origin in some tumors, while some believe it to be glandular differentiation of urothelium or a unique vesicular adenocarcinoma of non-mullerian origin.[1] We present a case of clear cell adenocarcinoma in a 74-year-old woman with review of literature along with its differential diagnosis.