Post-orgasmic illness syndrome (POIS) is a rare condition characterized by debilitating symptoms following ejaculation. We present a case of a 25-year-old male with flu-like symptoms post-ejaculation since age 17. Despite minimal relief from conventional treatments, a comprehensive evaluation led to the diagnosis of POIS and successful management with niacinamide therapy. The presentation of flu-like symptoms following ejaculation in this case raises several questions regarding the underlying pathophysiology. While the exact cause of his symptoms remains elusive, the resolution achieved with niacinamide therapy underscores the importance of considering alternative treatment modalities in complex cases. The role of varicocele in symptom manifestation, if any, also warrants consideration, as varicocele has been associated with male infertility and testicular dysfunction.

OBJECTIVE: Urogynecology and Reconstructive Pelvic Surgery (URPS) fellowship can be pursued after completion of either a urology (URO) or obstetrics and gynecology (GYN) residency. Our aim is to determine differences in graduating fellow cohort (GFC) case logs between URO- and GYN-based URPS programs.
METHODS: Accreditation Council for Graduate Medical Education case logs for URPS GFCs in both GYN- and URO-based programs were analyzed for the 2019-2023 academic years (AY). Unpaired t-tests with Welch\'s correction were used to compare annual mean logged cases between URO- versus GYN-based GFCs for select surgical categories and the top 11 most logged index cases.
RESULTS: GYN-based GFCs logged more cases for all pelvic organ prolapse (POP) categories including surgery on apical POP, anterior wall POP, and posterior wall POP (all p < 0.01), while URO-based GFCs logged more cases for surgery on the urinary system (p = 0.03). For the top 11 logged procedures, URO-based GFCs logged more sacral neuromodulation cases (p = 0.02), whereas GYN-based GFCs logged more slings, vaginal hysterectomies, minimally-invasive hysterectomies, vaginal apical POP, vaginal posterior POP, vaginal anterior POP, and minimally-invasive apical POP cases (all p < 0.01). There was no difference between URO- and GYN-based GFCs for complex urodynamics, cystoscopy with botox injection, or periurethral injection cases.
CONCLUSIONS: URO-based URPS fellows tend to graduate with more surgery on the urinary system and sacral neuromodulation cases, while GYN-based fellows perform more slings, hysterectomies, and POP surgery. These findings may help fellowships better understand potential differences in training among graduates from URO- and GYN-based programs and encourage collaboration to lessen these discrepancies.

Emphysematous pyelonephritis (EPN) represents a severe and acute infection localized in the renal parenchyma and surrounding perirenal area, typically observed in individuals with predisposing factors such as urinary tract obstruction, diabetes mellitus, or compromised immune function. Here, we present a unique case involving a 23-year-old female patient presenting to the emergency department with complaints of discomfort localized to the right side of her abdomen. Despite the absence of diabetes mellitus, the patient was diagnosed with EPN based on clinical presentation and imaging findings. Prompt and effective management was initiated under the care of the urology department, highlighting the importance of early recognition and intervention in mitigating the potential complications associated with this severe infectious process.

UNASSIGNED: Primary adenocarcinoma of the renal pelvis is a rare and unique malignancy, representing a small fraction of renal cancers and posing significant diagnostic challenges due to its unusual presentation and similarity in symptoms to more common excretory tract disorders. This case emphasizes the importance of distinguishing this pathology from other renal neoplasms and metastatic adenocarcinomas that originate in the digestive tract.
METHODS: We report the case of a 34-year-old man with no significant medical history who presented persistent lower back pain but no hematuria, which is atypical for renal pathologies. Initial imaging identified a 30 × 14 mm enhancement mass in the right renal pelvis. Surgical intervention was performed through right nephroureterectomy, including excision of the bladder cuff. Histopathological examination confirmed the diagnosis of primary intestinal-type adenocarcinoma of the renal pelvis, characterized by necrotic carcinomatous proliferation with varying architectural patterns and occasional signet ring cells.
UNASSIGNED: The diagnosis of primary renal pelvis adenocarcinoma is complicated by its nonspecific symptomatology and the potential for misdiagnosis as a more common urothelial carcinoma or a metastatic digestive-origin adenocarcinoma. Immunohistochemical staining supported a primary rather than metastatic digestive tract origin. This case underscores the need for a comprehensive diagnostic approach, including advanced imaging and meticulous histopathological analysis, to effectively differentiate this rare entity from other neoplasms.
CONCLUSIONS: This case highlights the diagnostic complexities and the critical need to be aware among clinicians about rare renal cancers such as primary adenocarcinoma of the renal pelvis. It also stresses the importance of interdisciplinary collaboration in the diagnosis and management of such rare cases, improving our understanding and requiring timely and accurate treatment.

Prune belly syndrome is a rare disorder that occurs mainly in men. It is characterized by the triad of deficient abdominal wall muscles, the dilated urinary collecting system, bilateral cryptorchidism, and infertility. It mainly affects the genitourinary system, which involves the prognosis. We present the case of a preterm neonate male whose diagnosis of a prune belly was suspected in antenatal ultrasound. He had a urinary tract abnormality starting at 22 weeks of gestation. At birth, a clinical examination revealed a distended abdomen within a wrinkled and flaccid abdominal wall, a macropenis, and bilateral cryptorchidism. A urinary tract ultrasound revealed a right pyelocaliciel dilatation and a right megaureter with a megacystis. The neonate ultimately died due to severe renal failures. Prune Belly syndrome is a complex disease with a high mortality rate. Early antenatal ultrasound may ameliorate the prognosis.

UNASSIGNED: Penile fractures, though rare, demand urgent surgical attention due to their potentially severe consequences. This case report illustrates the significance of prompt and comprehensive imaging with surgical exploration in managing a delayed presentation of a double penile fracture.
METHODS: A 27-year-old male sustained a penile injury during sleep, presenting to our department 36 h post-trauma. His clinical symptoms included significant penile swelling, deviation, and the characteristic \'eggplant\' deformity. Ultrasonography revealed extensive subcutaneous edema and a substantial hematoma at the penile base, with a disruption in the tunica albuginea. Surgical exploration identified two distinct fractures in the corpora cavernosa, which were successfully repaired. The patient experienced a rapid and complication-free recovery, regaining full erectile function within four days.
UNASSIGNED: This case underlines the anatomical complexity of penile fractures. Despite the delay in seeking medical attention, the outcome was favorable, challenging the notion that immediate surgery is crucial for avoiding long-term complications. The literature suggests that delayed surgery might not significantly impact long-term outcomes, especially in the absence of urethral involvement, a perspective supported by our case findings.
CONCLUSIONS: Penile fracture requires a nuanced approach to diagnosis and treatment. The case demonstrates that while immediate surgical intervention is ideal, delayed repair can also result in positive outcomes under certain conditions. This report contributes to the growing body of evidence suggesting the potential for re-evaluating current clinical guidelines for penile fracture management.

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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.

Tri-tubular penile fracture (PF) is a rare urological subdivision of PFs commonly caused by a blow to the erect penis during sexual intercourse or aggressive manipulation. PF associated with complete urethral injury and bleeding is an extremely rare presentation. This is a case report of a healthy 20-year-old male who presented to the emergency room after a motorcycle accident, experiencing rapid penile swelling and urethral bleeding. The accident happened while he was riding his motorcycle with a full erection. The patient reported a tearing sensation, immediate detumescence, and excruciating penile pain. A clinical diagnosis of PF was made, and the patient was immediately taken to the operating room for surgical intervention. At the three-month follow-up, the patient reported satisfactory erections and good voiding function. This case highlights the importance of immediate surgical intervention and urethral evaluation to avoid PF complications.

UNASSIGNED: The United States Medical Licensing Examination (USMLE) Step 1 test evolved into a key metric utilized by program directors (PDs) in assessing candidates for residency. The transition to a USMLE Step 1 binary pass/fail scoring system has resulted in a loss of an important objective assessment. With national movements toward pass/fail systems for clerkship grading and trends toward abandonment of class ranking, assessing residency applications has become increasingly challenging.
UNASSIGNED: The Society of Academic Urologists convened a task force to, in part, assess the perspectives of urology PDs regarding the importance of various aspects of a residency application for predicting clinical performance. An anonymous survey was disseminated to all urology PDs in the US. Perspectives on 11 potential application predictors of clinical performance and demographics were recorded. Descriptive statistics characterized PD responses. Friedman test and pairwise Wilcoxon tests were used to evaluate the relative ranks assigned to application elements by PDs.
UNASSIGNED: There was a 60.5% response rate (89/147). Letters of recommendation (LORs) were ranked as the most important predictor, with a mean rank of 2.39, median of 2 (IQR 1-3). Clerkship grades and USMLE Step 1 were comparable and ranked second. Medical school reputation ranked the lowest. There was significant subjective heterogeneity among categories; however, this was less so for LORs, which predominated as the most important factor among application elements (P < .001).
UNASSIGNED: To our knowledge, this is the largest sample size assessing PD perspectives on application factors that predict clinical performance. The second (clerkship grades) and third (USLME Step 1) most important factors moving toward binary pass/fail systems create an opportunity for actionable change to improve assessment objectivity. Our data demonstrate LORs to be the most important factor of residency applications, making a compelling argument for moving toward a standardized LOR to maximize this tool, mitigate bias, and improve interreviewer reliability.