Tariq Faisal Al-Shaiji

Male patients with congenital urogenital anomalies and neuro-urological conditions represent a unique and underrecognized population at risk for infertility and sexual dysfunction. This chapter aims to review the embryological and developmental basis of these conditions and to clarify their direct effects on spermatogenesis, hormonal regulation, and sperm transport. We provide a detailed discussion of common anomalies—including bladder exstrophy, prune belly syndrome, cryptorchidism, and spinal dysraphism—as well as acquired neuro-urological disorders, such as multiple sclerosis, spinal cord injury, and cerebrovascular accident, highlighting their impact on reproductive health and quality of life. Key findings demonstrate that both congenital and neurogenic conditions disrupt male fertility through structural anomalies, impaired testicular development, endocrine dysfunction, and ejaculatory disorders. Contemporary management strategies—ranging from early orchiopexy, reconstructive and substitution phalloplasty, penile prostheses, and urinary tract reconstruction, to assisted reproductive technologies (ART) and sperm retrieval—can mitigate these challenges. Multidisciplinary care, involving functional and reproductive urology, endocrinology, neurology, and psychology, is shown to optimize fertility outcomes. Additionally, models of transitional urology illustrate how proactive fertility counseling and early intervention improve long-term reproductive prospects. In conclusion, congenitalism and neuro-urological disease exert profound effects on male reproductive health that extend beyond childhood survival into adulthood and family planning. Advances in surgical reconstruction, ART, and multidisciplinary care are improving outcomes; yet, long-term follow-up and fertility-preservation strategies remain critical. Future directions—including stem-cell therapy, neuromodulation, and AI-supported management—offer promise in addressing the unmet needs of this vulnerable population.

Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder with primary effects on reproductive health, but its systemic impact extends beyond the ovaries. Emerging evidence highlights significant urological associations of PCOS, linking it to various lower urinary tract and renal conditions. This chapter explores the interplay between hormonal imbalances, insulin resistance, metabolic syndrome, and chronic inflammation in shaping the urological sequelae of PCOS. Key topics covered include the increased prevalence of lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary tract infections (UTIs), and nephrolithiasis in women with PCOS. Insulin resistance and obesity contribute to urinary stone formation, urinary frequency, and pelvic floor dysfunction, which may exacerbate stress urinary incontinence (SUI). Additionally, evidence suggests that chronic inflammation and hormonal dysregulation may predispose PCOS patients to bladder pain syndrome/interstitial cystitis (BPS/IC) and even early kidney dysfunction. A dedicated section in this chapter will also explore Fowler’s syndrome, a rare but important cause of urinary retention in young women, which has been linked to PCOS. Fowler’s syndrome is characterized by detrusor underactivity and abnormal sphincter electromyographic activity, often presenting in women with hormonal disturbances. Understanding this relationship is crucial for improving the diagnosis and management of PCOS-related urological dysfunction. This chapter aims to bridge the gap between endocrinology, urogynecology, and functional urology, offering a comprehensive perspective on how PCOS affects urinary health. By highlighting these associations, we hope to improve awareness, promote early identification, and guide targeted management strategies for affected women.

Background: The bladder represents one of the genitourinary organs most vulnerable to iatrogenic injuries. Ideal repair can be challenging and may require augmentation to fully preserve bladder structure and function. The omentum has been employed as a flap or graft to close bladder defects. Objective: This study presented a novel approach involving a complete omental wrap for repairing a small-capacity, irreparably damaged bladder following cystotomy in a complex transvesical vesicouterine fistula repair. Methods: Salvage repair was performed on a severely damaged bladder that had resulted from a chronic vesicouterine fistula, using an omental wrap for augmentation. The omental wrap fully enclosed the bladder to enhance its recovery. The patient had an uneventful post-operative recovery, and follow-up cystography showed a small-capacity bladder with no leakage. Extended follow-up demonstrated resolution of the patient’s symptoms and an improvement in bladder capacity. Results: This was the first documented application of the omentum as a complete wrap to support an irreparable bladder. The omentum’s mechanical and anti-inflammatory properties provided significant support, leading to a rapid and complete healing of a bladder that initially appeared to have an unfavorable outcome due to extensive inflammation. Conclusion: The use of omental wrap for bladder repair leverages the omentum’s unique properties to support and augment challenging repairs, resulting in outstanding outcomes and expedited restoration in what would be considered a poor outcome procedure.

The aims To evaluate the exact role of alpha blocker use for treatment of persistent LUTS after TURP. Methods This is a narrative review of existing manuscripts regarding the alpha blockers use after TURP. The search was done through PubMed in June 2021. The search was conducted using the following key words” alpha blocker” AND “after transurethral prostatectomy”. Results Publications between 2000 and 2020 were reviewed using PubMed database search. 111 studies were found. Seven records were considered for this review. Surgery for BPH is successful in eliminating the need for medical therapy in 75% in patients who use medications before surgery. However, number of patients still have persistent LUTS after TURP. There are no guidelines to direct the management of LUTS after TURP. A little research regarding the outcomes of alpha blockers use for treatment of persistent LUTS after TURP are detected. Based on the studies, theoretical basis exists for using of alpha blockers to treat post TURP urinary symptoms. Conclusion Alpha blockers can be used for treatment of post TURP urinary symptoms whether they are a continuation or de novo. Further large studies are needed.

Erectile dysfunction is a common yet complex problem facing men and their partners worldwide. It continues to be an under reported issue despites its high prevalence and negative impact as well as the availability of successful treatment. One of the main reasons for such a problem is the stigma surrounding it as a complaint and the deep-seated fear to discuss it. This paper aims to highlight the reasons behind the taboo and dilemma behind erectile dysfunction reporting and discusses means to overcome this stigma focusing on clinician–patient communication.

Commentary: Lower Urinary Tract Symptoms and Sexual Dysfunction: A Systematic Review and Meta-Analysis