PurposeUrological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery.MethodsUrological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum of 6 months after surgery, and patients were asked to report their urogenital function pre- and post-operatively, allowing changes in urogenital function to be identified. Questionnaires were sent to 158 patients (89 laparoscopy, 69 robotic) of whom 126 (80 %) responded. Seventy-eight (49 male, 29 female) of the responders underwent laparoscopic and 48 (35 male, 13 female) robotic surgery.ResultsMale patients in the robotic group deteriorated less across all components of sexual function and in five components of urological function. Composite male urological and sexual function score changes from baseline were better in the robotic cohort (p < 0.001). In females, there was no difference between the two groups in any of the components of urological or sexual function. However, composite female urological function score change from baseline was better in the robotic group (p = 0.003).ConclusionRobotic rectal cancer surgery might offer better post-operative urological and sexual outcomes compared to laparoscopic surgery in male patients and better urological outcomes in females. Larger scale, prospective randomised control studies including urodynamic assessment of urogenital function are required to validate these results.

Ureteric stents have played a vital role in relieving urinary obstruction in many urological conditions. Although they are extremely successful, stents have been associated with complications and reduced patients' health-related quality of life (HRQoL). There are many factors that may affect the quality and longevity of stents. In this review, we have highlighted the journey and innovation of ureteric stents through the modern day. A literature review was conducted to identify relevant articles over the last 20 years. There is a plethora of evidence with various indications for the use of ureteral stents and how they affect QoL. There is still ongoing research to develop the ideal stent with reduced encrustation, one that resists infection and is also comfortable for the patients. Stents made from metal alloys, polymers and biodegradable materials have unique properties in their own right but also have certain deficiencies. These have been discussed along with an overview of newly developed stents. Certain pharmacological adjuncts have also been highlighted that may be useful to improve patient's tolerance to stents. In summary, this paper describes the features of the different types of stents and the problems that are frequently encountered, including effect on patients' HRQoL and financial burden to healthcare providers.

Introduction:Retrograde ureteroscopy (URS) can be safely and successfully performed in patients who have had previous urinary diversion (UD). With broadening indications and advances in technology, URS can be used in complex cases. In this review article, we have summarized the relevant published literature regarding the outcomes and challenges encountered during retrograde URS in patients with UD. Materials and Methods: We conducted a systematic review of literature according to Cochrane and preferred reporting items for systematic reviews and meta-analysis guidelines for all studies reporting on retrograde URS from inception to September 2017. A literature search was conducted through MEDLINE, EMBASE, CINAHL, and Cochrane library for all English language articles. Results: Our literature search identified 6 retrospective studies. In total, 125 patients with a mean age of 67 years (range 28-90 years) underwent retrograde URS (190 procedures) after UD for diagnostic and therapeutic purposes. The main indications included upper urinary tract filling defects (due to either intrinsic pathology or extrinsic compression), strictures due to ureteral thickening, stone disease, and surveillance for suspected malignancy. The success rate and complications across the studies varied from 56 to 80% and 0 to 44% respectively, with most complications being Clavien I in nature. Conclusion: Retrograde URS can be technically challenging due to ureteric cannulation, strictures, and anatomical variations. However, there is very little evidence currently available on this topic with data based on retrospective case series. In experienced hands, it seems to be relatively successful with a low risk of major complications.

Objective: To conduct a systematic review of the literature to assess whether music reduces the use of analgesics and anxiolytics during flexible cystoscopy. Methods: The systematic review was performed in line with the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The databases searched included the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, the Excerpta Medica dataBASE (EMBASE), Cochrane library, Google Scholar, and Web of Science from inception of the databases to February 2020. The primary outcome measure was the effect of music on pain and anxiety, and secondary outcome measures were patient heart rate and blood pressure. Results: The initial search yielded 234 articles and after going through titles and abstracts, four studies (399 patients, 199 in the music group and 200 in no music group) were included for the final review. There were three randomised controlled trials and one prospective study published between 2014 and 2017. These studies were done in China, the USA and Italy, with the study duration between 9 and 24 months. All patients had 2% topical lignocaine jelly given per-urethra before the procedure. The choice of music was classical in three studies and a mixture of different music types in one study. Three of the four studies showed significantly reduced pain and anxiety with the use of music for flexible cystoscopy procedures. Heart rate was noted to be higher for the no music group, reflecting a higher pain perceived by these patients. Conclusion: The present review showed that listening to music was associated with reduced anxiety and pain during flexible cystoscopy. Listening to music is therefore likely to increase procedural satisfaction and willingness to undergo the procedure again, considering repeated flexible cystoscopy is often needed for surveillance. As music is simple, inexpensive and easily accessible, it should be routinely offered to patients for outpatient and officebased urological procedures.

I n d e x e d i n P u b M e d , W e b o f S c i e n c e a n d S c o p u s Pankaj M. Joshi and Sanjay B. Kulkarni. A new technique of double-face buccal graft urethroplasty for female urethral strictures.