The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline – consisting 43 clinical questions – and overview its key practical issues.

Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men's sexual health has improved, and interest in sexual health research has recently increased. The epidemiology and prevalence of erectile dysfunction, hypogonadism and premature ejaculation in Asia are similar in the West. However, several issues are specific to Asian males, including culture and beliefs, awareness, compliance and the availability of traditional/complementary medicine. In Asia, sexual medicine is still in its infancy, and a concerted effort from the government, relevant societies, physicians and the media is required to propel sexual medicine to the forefront of health care. Asian Journal of Andrology (2011) 13, 537-542; doi:10.1038/aja.2010.135; published online 6 June 2011Keywords: Asia; erectile dysfunction; health; hypogonadism; male; premature ejaculation; sex INTRODUCTIONUntil recently, men's sexual health has taken a backseat in the planning and implementation of health care. When Viagra (sildanefil) burst onto the scene more than a decade ago, it opened up the floodgates for research and development on men's sexual health. As a result, a previously taboo subject was transformed into a popular topic, even in Asia. Being a conservative society, male sexual health was initially embraced with trepidation in Asia. In contrast, the more open culture of the West has seen significant progress in the field of sexual medicine. The purpose of this review is to examine the burden of men's sexual health in Asia and to identify issues that are unique to Asian men in order to develop strategies for the improvement of men's health care in Asia.

PurposeUrinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases.Materials and MethodsThis was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures.ResultsOf the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures.ConclusionsThis prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones.

IntroductionVentriculoperitoneal (VP) shunt is a common procedure in managing hydrocephalus. Complications associated with VP shunt are numerous and can be disastrous. Among the complications that can occur are migration of the catheter into the abdominal wall, gastrointestinal tract, bladder, vagina, scrotum, mediastinum and infections like peritonitis, ventriculitis, and meningitis (24-47 %) (5, 7). One of the rare complications associated with ventriculoperitoneal shunt is herniation of the peritoneal catheter into the scrotum. Here we describe the migration of a fractured VP shunt catheter into the left scrotum. Case reportA 14-year-old boy with congenital hydrocephalus on VP shunt, presented with a history of left scrotal swelling for three days associated with pain and fever. There was no previous history of epididymitis or orchitis. Examination of the scrotum revealed a 4x3 cm mass, separate from the testis, in the scrotum. Cough impulse and transillumination test was negative. Full blood count and urine test was normal. Ultrasound done showed a foreign body in the scrotum with mild hydrocoele.On further questioning, his mother admitted that his previous VP shunt catheter had fractured a year ago and was replaced with a new one. The shunt had then migrated into the abdominal cavity but since it was not causing any problem, his parents were not keen for any abdominal surgery. An abdominal pelvic x-ray was done and it confirmed the migration of the previously fractured VP shunt into the left scrotum (Fig. 1).Removal of the catheter was attempted via an inguinal incision but failed. A scrotal incision had to be made to remove the catheter (Fig. 2). The hernia sac was then ligated and divided via the inguinal wound. Post operatively, he recovered well and was discharged the next day. Clinic followup at one, three and six months showed that there was no recurrence or complications. Summary: Ventriculoperitoneal shunts are associated with multiple complications. Among them are disconnection and migration of the tubing into the peritoneal cavity. Here we describe a case of a fractured ventriculoperitoneal shunt which migrated and coiled in the scrotum, masquerading as a scrotal swelling. Removal of the shunt via a scrotal incision was performed concomitantly with repair of the hernia sac.

PurposeThis study aimed to determine the urethral stricture (US) rate and identify clinical and surgical risk factors associated with US occurrence after transurethral resection of the prostate using the bipolar Gyrus PlasmaKinetic Tissue Management System (PK-TURP).Materials and MethodsThis was an age-matched case-control study of US occurrence after PK-TURP. Retrospective data were collected from the hospital records of patients who had a minimum of 36 months of follow-up information. Among the data collected for analysis were prostate-specific antigen level, estimated prostate weight, the amount of prostate resected, operative time, history of urinary tract infection, previous transurethral resection of the prostate, and whether the PK-TURP was combined with other endourological procedures. The resection rate was calculated from the collected data. Univariate and multivariate analyses were performed to identify clinical and surgical risk factors related to US formation.ResultsA total of 373 patients underwent PK-TURP between 2003 and 2009. There were 13 cases of US (3.5%), and most of them (10 of 13, 76.9%) presented within 24 months of surgery. Most of the US cases (11 of 13, 84.6%) occurred at the bulbar urethra. Multivariable logistic regression analyses identified slow resection rate as the only risk factor significantly associated with US occurrence.ConclusionsThe US rate of 3.5% after PK-TURP in this study is comparable to contemporary series. A slow resection rate seems to be related to US occurrence. This should be confirmed by further studies; meanwhile, we must be mindful of this possibility when operating with the PK-TURP system.