Song S, Amasyali AS, Jhang D, et al. Radiating for two: quantifying radiation exposure to pregnant urologists during percutaneous nephrolithotomy. J Urol. 2025;213(3):370-377. doi:10.1097/JU.0000000000004309

Special thanks to Dr Grace Chen at the University of Illinois at Chicago.

With increasing numbers of women entering the urology field, consideration must be extended to enhancing safety practices for occupational hazards unique to female providers such as radiation exposure to a growing fetus during pregnancy. Endourologic procedures such as percutaneous nephrolithotomy are notorious for higher levels of radiation exposure for the surgeon with estimated radiation amounts as high as 0.5 mSv. Given that the International Commission of Radiologic Protection recommends fetal radiation exposure be kept under 1 mSv to prevent congenital malformation, it becomes a vital task for pregnant urologists to minimize their radiation exposure without compromising their training or care.

In this cadaveric study, colleagues from the Loma Linda Department of Urology sought to determine estimated radiation doses to the gravid uterus during percutaneous nephrolithotomy with various radiation reduction strategies such as lead shielding, decreasing the number of fluoroscopy pulses per second, and activating the low-dose setting. Another objective was to determine a safe nephrolithotomy case volume a pregnant surgeon could complete before reaching the maximum exposure limit. Their results are encouraging; assuming all radiation reduction methods are maximally utilized, a pregnant surgeon would be able to perform over 6000 cases before reaching the maximum recommended limit. Should these strategies be consistently implemented, pregnant urologists either in training or in practice would have no problem safely performing these necessary procedures without harm to their fetus.

Yahyavi SK, Wall-Gremstrup G, Probst-Drejer B, et al. Hypophosphatemia is a frequent finding in infertile men and is associated with low motile sperm count. Hum Reprod. 2025;40(2):226-235. doi:10.1093/humrep/deae293

Special thanks to Dr Mohamad Abou Chakra at the University of Illinois at Chicago.

Despite our growing understanding of the interplay between hormonal factors and spermatogenesis, we still grapple with cases of infertility in patients without overt endocrine disorders. It’s clear that several intricate processes can go awry and cause male infertility in the genome, epigenome, proteome, and microbiome. But how exactly do metabolic elements like phosphate in the serum and seminal plasma impact sperm maturation and motility? The answer remains largely unknown.

This study of over 1200 men evaluated for infertility at a single center aimed to explore the association between serum phosphate, semen parameters, and reproductive hormones. The investigators observed that a significant proportion of infertile men had hypophosphatemia despite their young age. While sperm concentration was similar between patients with hypophosphatemia and those with normophosphatemia, the total number of motile spermatozoa was lower in men with moderate hypophosphatemia. Infertile men with hypophosphatemia also had higher serum estradiol levels compared with their normophosphatemic counterparts.

It’s logical to think that phosphate plays a role in sperm motility because it’s crucial for adenosine triphosphate production and flagellar movement in the epididymal fluid. The big question from this study is whether normalizing phosphate levels could actually improve semen parameters and what specific mechanisms are at play when hypophosphatemia affects sperm function. While the study’s findings don’t prove causation, it’s definitely worth exploring further.

Heesakkers JPFA, Toozs-Hobson P, Sutherland SE, et al. Two-year efficacy and safety outcomes of the pivotal OASIS study using the Revi System for treatment of urgency urinary incontinence. J Urol. 2025;213(3):323-332. doi:10.1097/JU.0000000000004328

Special thanks to Drs Graham Hale and Omer Acar at the University of Illinois at Chicago.

Patients and urologists know well how debilitating the spectra of overactive bladder and urge urinary incontinence are. As the burden of chronic conditions such as these continues to strain our health care system, the need for effective, durable, safe, and ideally at-home solutions grows. The Revi System is an implantable tibial neuromodulation device comprised of a battery-free implant placed under local anesthesia and a wearable stimulator with adjustable parameters designed for noncontinuous use intended to address these needs.

This prospective, multicenter, single-arm clinical study reported the safety and efficacy results of tibial neuromodulation using the Revi System in nearly 100 women with urge urinary incontinence at a 2-year follow up. Over 3 in 4 patients reported a more than 50% decrease, and over half reported a more than 75% decrease in episodes of urge urinary incontinence. Around 2 in 3 patients reported a more than 50% reduction in episodes with moderate to severe urgency. Nearly all patients reported being satisfied with treatment and feeling “better” to “very much better” on patient-reported outcome measures. Only 1 adverse event directly related to the device was reported, and it was managed with antibiotics. While none were related to device adverse events, 3 devices were explanted, and none migrated or required revision.

At a time of increased emphasis on earlier consideration of minimally invasive therapies directed at overactive bladder and urge urinary incontinence, this battery-free, home-centered, tibial neuromodulation system provides a durable, efficacious, and safe addition to our existing treatment armamentarium.