RAPN was associated with a low rate of conversion. Independent predictors of conversion were BMI and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion.

Intravenous phenobarbital appears to be more effective than intravenous valproate for Chinese adult patients with GCSE. The occurrence of serious respiratory depression and hypotension caused by phenobarbital was reduced by decreasing the intravenous infusion rate; however, even at a lower infusion rate than typically used in other institutions, intravenous phenobarbital resulted in more serious adverse events than intravenous valproate. The better outcomes in the phenobarbital group compared with the valproate group suggest that phenobarbital should be considered for the early successful treatment of GCSE.

Background: Ureter involvement within indirect hernias is a rare phenomenon usually identified incidentally during herniorrhaphy. Even more rare are extraperitoneal ureteral inguinal hernias, which represent about 20% of these cases and are characterized by a substantial amount of extraperitoneal fat in the hernia defect, the absence of a peritoneal sac, and associated with hydroureteronephrosis and nephroptosis. To date, repair of ureteral inguinal hernias has been performed exclusively using open surgical techniques. We report the first case of successful robot-assisted laparoscopic repair of this rare presentation.Case Presentation: A morbidly obese 70-year-old male with an unremarkable surgical and urological history presents with a 15-year history of nonpainful, enlarging right scrotal swelling measuring 25 cm in diameter. CT imaging revealed right nephroptosis and a hernia defect containing a dilated right ureter looping into the scrotum surrounded by significant extraperitoneal fat. Retrograde pyelography and ureteral catheter placement confirmed a >100 cm ureter. The patient underwent a robot-assisted laparoscopic repair. The inferior epigastric artery, spermatic cord vessels, vas deferens, and ureter were identified. The defect was reduced using external scrotal pressure and reinforced with ProGrip™ self-fixating laparoscopic mesh. The patient was discharged 2 days later following an uneventful postoperative course.Conclusion: Although rare and usually incidentally discovered, extraperitoneal ureteral inguinal hernias can be identified preoperatively by the astute clinician. Preoperative identification allows for improved surgical planning, including a minimally invasive approach. Robot-assisted laparoscopic repair with mesh placement is a feasible alternative to traditional open techniques.

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INTRODUCTION AND OBJECTIVE: Varicocele is the most common surgically correctable cause of infertility in adult men; however, >80% are asymptomatic. While believed to cause a progressive decline in semen parameters, treating varicoceles in the pediatric population is controversial because of uncertain pathogenesis. Current recommendations are to correct a varicocele when there is a >20% ipsilateral testicular size discrepancy, but associations with semen parameters are not well studied. We hypothesized that boys with varicoceles and >20% testicle size discrepancy will have lower sperm concentration and motility compared to boys with varicoceles and <20% size discrepancy.METHODS: We retrospectively identified boys <18 years old diagnosed with a varicocele from a large regional pediatric urological practice from 2013 to 2020. We included patients with at least one semen analysis and scrotal ultrasound with measurements of the right and left testicles. We then compared semen sperm concentrations of boys with >20% testis size discrepancy to those with <20% discrepancy, calculated as (right-left)/(total testis volume). Unpaired t test was used to determine significance.RESULTS: We identified 819 boys with a diagnosis of varicocele. Of them 72 had a semen analysis and testicular ultrasound. There were 26 boys with >20% ipsilateral testicular size discrepancy and 46 with <20% ipsilateral testicular size discrepancy. For boys with >20% ipsilateral testicular size discrepancy, the mean semen concentration and motility were 55.7AE65.9 million and 44.8AE23.9% compared to 59.9AE48.7 million (p[0.76) and 52.1AE20.7% (p[0.17) for boys with <20% testis size discrepancy, respectively. We also compared semen parameters for those with >20% testicular discrepancy vs those with <10% discrepancy (28 boys), for which there was no significant difference.CONCLUSIONS: Based on a single institution cohort, it appears that testicular size discrepancy is not associated with semen concentration or motility in boys with varicoceles.