Objectives: The aim of this study was to evaluate the level of hematuria and the presence of clots during retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) to predict surgical outcomes. Materials and Methods: The data of patients who underwent RIRS and mPCNL were analyzed separately. A hematuria grading (HG) system was classified into five grades based on the presence of blood clots and any visible stones according to the irrigation settings. Inter-observer reliability of the grading system was assessed using intra-class correlation and Spearman’s rho. Results: The HG system showed high agreement among examiners, with high intra-class reliability and a strong correlation between RIRS and mPCNL groups. The stone density of the Houns-field unit was the most important factor in determining the hematuria across the development and validation groups of RIRS and mPCNL patients. Multivariate logistic regression analysis showed that the HG system was a significant predictor for remnant stones in the PCNL group and the probability of acute pyelonephritis or sepsis in the RIRS group. The high hematuria group showed lower basketing difficulty with the basket with a blue marker instrument than with others. Conclusions: The new HG system shows excellent inter-observer reliability and a correlation with a gradual increase in stone density and surgical difficulty.

Introduction Sexual activity can be broadly defined to include not only sexual intercourse but also physical intimacy. However, most studies of sexual activity in older adults have a limited focus on sexual intercourse only. Aim The aim was to investigate sexual activities including sexual intercourse and physical intimacy in community-dwelling older Korean adults. Methods This study was based on cross-sectional data to measure sexual activities (sexual intercourse and physical intimacy) in 209 participants (100 men and 109 women) aged 65 years or older. Sexual intercourse and physical intimacy were defined as vaginal penetration and as any sexual behavior with sexual arousing (eg, kissing, caressing), respectively. Erectile dysfunction was evaluated by the use of the International Index of Erectile Function questionnaire, and female sexual dysfunction was evaluated by Female Sexual Function Index scores. Main Outcome Measure Trained interviewers collected the survey information on sexual activities in the last 6 months at the senior welfare center. Results The participants’ mean age was 73.4 ± 4.8 years (men, 74.2 ± 5.0 years; women, 71.6 ± 5.3 years). The prevalence of erectile dysfunction was 91.0% (91/100), and the prevalence of female sexual dysfunction was 96.3% (105/109). In the previous 6 months, 122 participants (58.4%) reported sexual activities, and men reported more sexual activities than women ( P = .001). A total of 69.6% of men and 41.9% of women engaged in sexual activity with intercourse, whereas 30.4% of men and 58.1% of women engaged in physical intimacy only. The physical intimacy–only group was more likely to have erectile dysfunction or female sexual dysfunction than the sexual intercourse group ( P = .035 and P = .012, respectively). Conclusions Although sexual intercourse is an important part of sexual activity, our study results suggest that physical intimacy is also a considerable component of sexual activity that should not be neglected in older adults, especially in women. Our findings imply that health-care professionals need to consider physical intimacy as part of sexual activity in the assessment of geriatric patients with sexual dysfunction. Chung HS, Kim GH, Shin M-H, et al. Physical Intimacy Is an Important Part of Sexual Activities: Korean Older Adults Study. Sex Med 2020;8:643–649.

Purpose To compare renal function change by urinary diversion (UD) type (ileal conduit [IC] vs. neobladder [NB]) in patients with a single kidney who underwent radical cystectomy (RC) due to bladder cancer. Materials and Methods We evaluated the renal function change in 86 patients with a single kidney who underwent RC between January 1999 and August 2022. Renal function was assessed using serum creatinine, serum estimated glomerular filtration rate (eGFR), eGFR difference value (preoperative and follow-up values), and eGFR difference proportion (eGFR difference value/preoperative eGFR) at 1, 3, 6, 12, 24, 36, 48, and 60 months. In addition, multiple definitions of eGFR decline were evaluated: 10 points, 10%, and 20% decline in eGFR. Cox regression models were used to identify risk factors of eGFR decline-free, recurrence-free, overall, and cancer-specific survival rates. Results A total of 54 patients (62.8%) underwent IC, whereas 32 (37.2%) underwent NB. Baseline characteristics were similar between the two groups except for age and body mass index. Renal functions over time by various methods did not differ significantly between the IC and NB groups. Furthermore, eGFR decline-free survival rate using different definitions was similar between the IC and NB groups. Overall survival, recurrence-free survival, and cancer-specific-free survival rates were not different between the IC and NB groups. Conclusions UD type (IC vs. NB) did not impact the renal function change of patients with a single kidney who underwent RC. Therefore, patients with a single kidney might be considered to be an indication of NB.