Kozar T, Kaylor JM, Hinderscheid C, et al. Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE). J Urol. 2023;210(6):865-873.

Special thanks to Drs Jose Quesada-Olarte and Omer Acar at the University of Illinois at Chicago.

Urinary retention may occur after artificial urinary sphincter placement. A common tradition has been to leave a Foley catheter in after surgery. This over 12-year multi-institutional study with over 400 patients challenged this custom. The authors compared postoperative urinary retention between those who had an indwelling catheter overnight and those who left the operating room without a catheter. Overall the urinary retention rate remained low at around 7% and did not differ significantly between the study groups. No factors by multivariable analysis were identified that predicted urinary retention. Additionally, the presence or absence of a catheter did not impact device longevity. With its large sample size, this study supports the notion that the tradition of leaving a catheter in place after artificial urinary sphincter placement may very well be unnecessary.

Green B, Flores A, Warner J, Kohler T, Helo S, Trost L. Comparison of collagenase Clostridium histolyticum to surgery for the management of Peyronie’s disease: a randomized trial. J Urol. 2023;210(5):791-802.

Special thanks to Drs Halsie Donaldson and Mahmoud Mimas at the University of Illinois at Chicago.

Since the 1920s, surgery has been the established gold standard to treat Peyronie’s disease. A shift began in 2014, when the Food and Drug Administration approved collagenase Clostridium histolyticum for Peyronie’s disease. But is it a serious contender for the treatment throne? These investigators compared collagenase Clostridium histolyticum vs surgery at 3 months after intervention in about 40 randomized men. Following administration of collagenase Clostridium histolyticum, about half of men were satisfied compared to about one-fifth with surgery. Subjective erectile function and subjective penile length were significantly improved after collagenase Clostridium histolyticum, and patients reported lessened changes in sensation compared to surgery. With surgery, measured curvature was significantly improved, but penile length was shortened, and higher rates of adverse events were recorded, such as penile pain, penile lumps, loss of sensation, and needed additional surgical procedures. Where, then, should collagenase Clostridium histolyticum fit in the Peyronie’s treatment algorithm? This study serves as a great guide for the practicing urologist.

Kang C, Punjani N, Kashanian JA, Schlegel PN. Age, sperm retrieval, and testicular histology in Klinefelter syndrome. J Urol. 2024;211(1):163-169.

Special thanks to Drs Gabe van de Walle and Daniel Garvey at the University of Illinois at Chicago.

Men with Klinefelter syndrome lose germ cells over time by exogenous testosterone and advancing age. So is it better to retrieve sperm as early as possible, or can retrieval be delayed for reproductive goals? To answer this question, the authors studied over 200 men with Klinefelter syndrome undergoing microdissection testicular sperm extraction excluding those with mosaicism, prior sperm retrieval, no available histological data, or recent exogenous testosterone.

The authors observed that sperm retrieval rates peaked in men in their twenties before sharply declining at age 40, and that in multivariable analysis, biopsies revealing hypospermatogenesis were associated a higher likelihood of successful sperm retrieval. Baseline hormone levels in adolescent males did not correlate with chance of sperm retrieval.

So can microdissection testicular sperm extraction for men with Klinefelter syndrome be delayed if they are not treated with exogenous testosterone? Certainly the answer appears to be yes for waiting until a man is in his twenties and a bit beyond.