Urinary tract leiomyomas are rare, benign mesenchymal tumors that are traditionally treated with complete surgical excision. We present three cases of urinary tract leiomyoma — two located in the bladder and one in the ureter. Both bladder leiomyomas were treated with transurethral resection of bladder tumor (TURBT) with no evidence of recurrent disease, while the upper tract leiomyoma was managed with surveillance by patient preference, which to our knowledge, has not been previously described. The ureteral leiomyoma has remained stable at five years followup from initial diagnosis. Given the benign nature of leiomyomas and the overall low recurrence rate reported in the literature, bladder-sparing options should be emphasized when feasible, with active surveillance potentially applicable for highly select patients.

Objectives As the originator of the term “sexual revolution”, Wilhelm Reich – an Austrian physician, psychoanalyst, political activist and author – was a significant, albeit controversial, contributor to his field. Throughout his career he extensively studied the human orgasm and developed the theory of “orgone energy” as a driving force present in animate and inanimate beings. While Reich’s theories are now largely seen as pseudoscientific, his views on sex and orgasmic energy have had an enduring impact in popular culture and society. Methods We analyzed primary material including journal entries and personal accounts obtained from the Wilhelm Reich Museum (Rangeley, Maine). We reviewed published secondary sources on Reich, news articles, and biographies obtained through on-line public resources as cited. Results Following a tumultuous childhood, Reich attended medical school in Vienna and started his early career under the tutelage of Sigmund Freud. Freud’s influence was instrumental in the development of Reich’s theories on character analysis and orgastic potency and his ideas were some of the first linking mental and sexual health. Reich also notably combined his interests in politics and sexual health and created “Sex-Pol” clinics, clinics that provided both sexual and Marxist education along with contraceptives, to the working class. Prior to WWII, Reich fled Nazi Germany to the United States, where he studied the relationship between sexual health and cosmic energy, a novel concept he termed “orgone”. To harness this energy, Reich invented “orgone accumulators’’ which, among other claims, were thought to improve physical and mental health. Ultimately, Reich’s notoriety garnered him attention from the American government, which led to the censorship of his works and ideas and eventual downfall and imprisonment. Conclusions Although Reich’s theories were largely discredited later in his life, he was a pioneer in advocating for a deeper curiosity of sexual health and its personal and societal consequences, which continue to impact society today.

PSMA PET-imaging prior to SRT to that of a patient cohort which did not have PSMA PET-imaging before SRT.METHODS: We included 610 patients who underwent SRT, of whom 298 underwent a PSMA-PET/CT prior to SRT, and 312 did not. No additional hormonal therapy was prescribed. To compare both cohorts, case-control matching was performed, using the prostatespecific antigen (PSA)-value at initiation of SRT, pathological Grade Group, pathological T-stage, surgical margin status, and biochemical persistence after RARP as matching variables. Outcome variable was biochemical progression at one year after SRT, defined as either a rise of PSA !0.2 ng/mL above the nadir after SRT, or the start of additional treatment.RESULTS: After case-control matching, 216 patients were matched in both cohorts (108 patients per cohort). In the patient cohort without PSMA-PET/CT prior to SRT, 23/108 patients (21%) had biochemical progression of disease at one year after SRT, compared to 9/108 patients (8%) who underwent restaging PSMA-PET/CT prior to SRT (p[0.007).CONCLUSIONS: Patients who underwent restaging PSMA-PET/CT for BCR after RARP had better short-term oncological outcomes after SRT than those who underwent 'blind' SRT. Thus, PSMA-PET/CT is associated with an improved oncological outcome in a selected series of patients.

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