A functional vesicostomy for six decades: A case report.

Vesicostomy is a temporary solution for patients with bladder outlet challenger who are not eligible for catheterization. A 73 year-old man who has successfully managed his bladder using a vesicostomy for 59 years. Complications of prolapse and dermatitis led to vesicostomy closure and cystostomy placement at age 73. Vesicostomy can be safely used to preserve bladder and upper urinary tract health for a lifetime.

Urology HEIRS: A Feasibility and Acceptability Study for Video-Based Research on Physician-Family Communication in Pediatric Urology Visits.

PURPOSE: Patient- and family-centered communication is essential to health care equity. However, less is known about how urologists implement evidence-based communication and dynamics involved in caring for diverse pediatric patients and caregivers. We sought to evaluate the feasibility and acceptability using video-based research to characterize physician-family communication in pediatric urology. MATERIALS AND METHODS: We assembled a multidisciplinary team to conduct a multiphase learning health systems project to establish the Urology HEIRS (Health Experiences and Interactions in Real-time Studies) corpus for research and interventions. This paper reports the first phase, evaluating feasibility and acceptability based on consent rate, patient diversity, and qualitative identification of verbal and paraverbal features of physician-family communication. We used applied conversation analysis methodology to identify salient practices across 8 pediatric urologists. RESULTS: We recruited 111 families at 2 clinic sites; of these 82 families (N = 85 patients, ages 0-20 years) participated in the study with a consent rate of 73.9%. The racial/ethnic composition of the sample was 45.9% non-Hispanic White, 30.6% any race of Hispanic origin, 16.5% non-Hispanic Black/African American, 4.7% any ethnicity of Asian/Asian American, and 2.3% some other race/ethnicity; 24.7% of families used interpreters. We identified 11 verbal and paraverbal communication practices that impacted physician-family dynamics, including unique challenges with technology-mediated interpreters. CONCLUSIONS: Video-based research is feasible and acceptable with diverse families in pediatric urology settings. The Urology HEIRS corpus will enable future systematic studies of physician-family communication in pediatric urology and provides an empirical basis for specialty-specific training in patient- and family-centered communication.

The role of alternative medicine and complimentary therapies in urologic disease: New horizons.

The world of complementary and alternative medicine (CAM) encompasses a wide range of practices, treatments, and products that fall outside the realm of conventional (mainstream) medicine. The use of complementary and CAM has become increasingly popular in Western nations. People are turning to CAM for a variety of reasons, including managing chronic diseases, relieving symptoms of various conditions, and improving their overall health and well-being. There's a growing trend of people using and showing interest in complementary and alternative medicine therapies, especially in Western countries. CAM encompasses a wide range of treatments, some offering complete alternatives to conventional medicine, while others aim to complement existing medical approaches. Urologists should stay informed about CAM to guide their patients effectively to treat patients in a modern and personalized way. The aim of review is to analyze the scenario of complimentary and alternative medicine with a specific focus in the urological field.

[Large language models in science]. / Large Language Models in der Wissenschaft.

OBJECTIVE: Large language models (LLMs) are gaining popularity due to their ability to communicate in a human-like manner. Their potential for science, including urology, is increasingly recognized. However, unresolved concerns regarding transparency, accountability, and the accuracy of LLM results still exist. RESEARCH QUESTION: This review examines the ethical, technical, and practical challenges as well as the potential applications of LLMs in urology and science. MATERIALS AND METHODS: A selective literature review was conducted to analyze current findings and developments in the field of LLMs. The review considered studies on technical aspects, ethical considerations, and practical applications in research and practice. RESULTS: LLMs, such as GPT from OpenAI and Gemini from Google, show great potential for processing and analyzing text data. Applications in urology include creating patient information and supporting administrative tasks. However, for purely clinical and scientific questions, the methods do not yet seem mature. Currently, concerns about ethical issues and the accuracy of results persist. CONCLUSION: LLMs have the potential to support research and practice through efficient data processing and information provision. Despite their advantages, ethical concerns and technical challenges must be addressed to ensure responsible and trustworthy use. Increased implementation could reduce the workload of urologists and improve communication with patients.

Long-Term Adherence to Onabotulinum Toxin-A Intradetrusor Injections for Neurogenic Dysfunction in Children-A Retrospective Single-Center Evaluation.

Onabotulinum Toxin-A (BTX-A) is a second-line treatment for neurogenic bladder (NB). It requires repeated injections over time, which is a possible limit for long-term adherence, especially in children, as general anesthesia is required. Almost 50% of adults discontinue therapy; few data on pediatric patients are present. The aim of this study is to share our long-term experience of BTX-A adherence in children. This study is a retrospective review of 230 refractory NB patients treated with BTX-A. The inclusion criteria were ≥3 treatments and the first injection performed ≥10 years before the study endpoint. Fifty-four patients were included. Mean follow-up was 10.2 years; mean treatment number was 6.4 for each patient. During follow-up, 7% did not need BTX-A anymore; 76% discontinued therapy, with a prevalence of acquired NB (64% acquired vs. 34% congenital; p = 0.03); sex-based and urodynamic findings did not influence the discontinuation rate (p = 0.6, p = 0.2, respectively). Considering those who withdrew from the therapy, 43% were lost to follow-up/died after a mean of 7.5 years (although 33% still experienced clinical efficacy); 33% changed therapy after a mean of 5.8 years (with reduced efficacy in 22%, persistent efficacy in 11%). BTX-A is a safe and effective therapy for pediatric patients. The treatment abandonment rate is higher for children than for adults; no specific reasons were highlighted. It is necessary to evaluate any age-specific factors to explain these data.

Performance of ChatGPT-3.5 and ChatGPT-4 on the European Board of Urology (EBU) exams: a comparative analysis.

BACKGROUND AND OBJECTIVE: In the transformative era of artificial intelligence, its integration into various spheres, especially healthcare, has been promising. The objective of this study was to analyze the performance of ChatGPT, as open-source Large Language Model (LLM), in its different versions on the recent European Board of Urology (EBU) in-service assessment questions. DESIGN AND SETTING: We asked multiple choice questions of the official EBU test books to ChatGPT-3.5 and ChatGPT-4 for the following exams: exam 1 (2017-2018), exam 2 (2019-2020) and exam 3 (2021-2022). Exams were passed with ≥60% correct answers. RESULTS: ChatGPT-4 provided significantly more correct answers in all exams compared to the prior version 3.5 (exam 1: ChatGPT-3.5 64.3% vs. ChatGPT-4 81.6%; exam 2: 64.5% vs. 80.5%; exam 3: 56% vs. 77%, p < 0.001, respectively). Test exam 3 was the only exam ChatGPT-3.5 did not pass. Within the different subtopics, there were no significant differences of provided correct answers by ChatGPT-3.5. Concerning ChatGPT-4, the percentage in test exam 3 was significantly decreased in the subtopics Incontinence (exam 1: 81.6% vs. exam 3: 53.6%; p = 0.026) and Transplantation (exam 1: 77.8% vs. exam 3: 0%; p = 0.020). CONCLUSION: Our findings indicate that ChatGPT, especially ChatGPT-4, has the general ability to answer complex medical questions and might pass FEBU exams. Nevertheless, there is still the indispensable need for human validation of LLM answers, especially concerning health care issues.

The Role of Semaphorin 6D (Sema6D) in Non-Muscle-Invasive Bladder Cancer-A Preliminary Study on Human Plasma and Urine.

The incidence of bladder cancer worldwide in the last three decades has been increasing in both men and women. So far, there is no established non-invasive bladder cancer biomarker in daily clinical practice. Semaphorin 6D (sema6D) is a transmembrane protein that belongs to the class VI semaphorins. The aim of this study was to evaluate for the first time the potential role of sema6D in bladder cancer. The study group consisted of 40 patients with non-muscle-invasive bladder cancer (NMIBC) and the control group of 20 patients without malignancies. There was a statistically significantly higher urinary sema6D concentration in patients than controls (p < 0.05) but no significant difference in plasma 6D. There were no statistically significant differences in urinary or plasma concentration of sema6D between low- or high-grade cancer and according to the tumor stage in TNM classification. There was a statistically significant negative correlation between plasma sema6D and age of patients (R = -0.6; p = 0.019). Plasma sema6D does not seem to be useful in the clinical practice at this point. However, the urinary sema6D concentration could potentially serve as a marker of NMIBC used for diagnostic purposes, monitoring, and early relapse detection or the assessment of the treatment efficacy. Urinary sema6D is probably not associated with the grading or staging of NMIBC, so it cannot be used for the prediction of disease prognosis.

Lower urinary tract involvement in Ehlers Danlos and Joint Hypermobility Syndromes: Review of the literature.

INTRODUCTION: Ehlers Danlos Syndrome (EDS) and Joint Hypermobility Syndrome (JHS) are still poorly understood, with a prevalence of 1/5000 for EDS and 1/500 for JHS. They are characterized by multi-system involvement. Urological involvement has been little studied. The aim was to carry out a review of the literature on the urological involvement of EDS and JHS. METHOD: A review of the literature was carried out using the following databases: Pubmed, Canadian Hospitals and EMBASE. Search terms were "Ehlers Danlos" or "Joint Hypermobility" associated with "Urology", "Bladder", "Pelvic Organ Prolapse", "Urinary Retention", "Leak", "Leakage", "Urinary Incontinence", "Urinary Tract Infection" and "Urdodynamic", no filters were added. RESULTS: 73 articles were included for a total of 259 found. The prevalence of urinary incontinence in EDS is estimated at 50-60%, and that of pelvic organ prolapse (POP) at 29-75%. Bladder diverticula are also frequently reported. For JHS, the prevalence of urinary incontinence is estimated between 40 and 73%, that of POP increased with 73% of stage greater than 2, g-JHS patients are almost 3 times more affected by prolapses (OR = 2.37 ) which seem more severe. Patients with vesicoureteral reflux, most often severe, are more affected by joint hypermobility (OR = 2.79). Few studies have been carried out on urological assessment and treatment modalities. CONCLUSION: EDS patients often have urinary incontinence, pelvic organ prolapse or bladder diverticula. JHS patients frequently have urinary incontinence, pelvic organ prolapse and vesicoureteral reflux.

Limitations and complications of robotic urological surgery in younger children: debunking old beliefs. / Limitaciones y complicaciones de la cirugía urológica robótica en niños pequeños. Desmontando viejas creencias.

INTRODUCTION: Even though certain technical limitations associated with the small size of the patients were taken for granted in the advent of pediatric robotic surgery, we could now be facing a paradigm shift challenging these old beliefs. MATERIALS AND METHODS: A retrospective study of patients undergoing Da-Vinci-Xi(IS4000)-assisted urological surgery from May 2022 to October 2023 was carried out. Patients were divided into two groups -Group A < 15 kg and Group B ≥ 15 kg. Operating times, hospital stay, and intra- and postoperative complications were compared. RESULTS: 17 patients (9 in Group A, 8 in Group B) underwent surgery. Median age was 29 months (A) and 109 months (B) (p< 0.001). Median weight was 12.0 kg (A) and 31.5 kg (p< 0.001). Operating time was 162 min (A) and 130 min (p= 0.203). Console time was 99 min (A) and 70 min (B) (p= 0.065). Mean hospital stay was 2 days (A) and 3 days (B) (p= 0.41). No differences were found in terms of intraoperative (p= 0.453) or postoperative (p= 0.485) complications. CONCLUSIONS: Even though operating on younger children seemed more complicated than on older ones in the advent of robotic surgery, the results in our series were similar. The fact patients under 12 months of age were not included means larger studies are required to prove this.

INTRODUCCION: Aunque en los inicios de la cirugía robótica pediátrica solíamos asumir la existencia de ciertas limitaciones técnicas asociadas al pequeño tamaño de nuestros pacientes, podríamos encontrarnos ante un cambio de paradigma y cuestionar estas antiguas creencias. MATERIAL Y METODOS: Estudio retrospectivo que incluye los pacientes a los que se les practicó una cirugía urológica asistida por robot Da Vinci Xi (IS4000), entre mayo de 2022 y octubre de 2023. Se dividieron en dos grupos: A < 15 kg, B ≥ 15 kg. Se compararon tiempos quirúrgicos, estancia hospitalaria y complicaciones intra y postoperatorias. RESULTADOS: Intervenimos 17 pacientes (9 A, 8 B). Edad mediana 29 (A) y 109 meses (B) (p < 0,001). Peso mediano A: 12 kg, B 31,5 kg (p < 0,001). Tiempo quirúrgico A 162 min, B 130 min (p= 0,203). Tiempo de consola A 99 min, B 70 min (p= 0,065). Estancia media A 2, B 3 días (p= 0,41). No se encontraron diferencias en la tasa de complicaciones intraoperatorias (p= 0,453) ni postoperatorias (p=0,485). CONCLUSIONES: A pesar de que al comienzo de la cirugía robótica se pensaba que sería más complicado operar a los niños pequeños que a los más mayores, en nuestra serie los resultados son similares. Por no incluir menores de 12 meses, necesitamos estudios más extensos para probar estas afirmaciones.

Challenges and opportunities in NMIBC management across Latin America: insights from healthcare providers and a patient advocacy group.

Non-muscle invasive bladder cancer (NMIBC) is characterised by high rates of recurrence and progression, requiring substantial healthcare resources. In Latin America, the incidence of NMIBC is set to increase due to an aging population and lifestyle changes. To better understand the current challenges for NMIBC treaters and patients, a mixed-methods approach was leveraged combining secondary research with qualitative interviews from healthcare providers in Brazil, Colombia, Mexico and Argentina. Our analysis found that significant challenges persist across the region, particularly due to Bacillus Calmette-Guérin shortages, inconsistent adherence to clinical guidelines and significant socioeconomic disparities for patients accessing healthcare services. Addressing these challenges requires improved patient advocacy, strategic use of clinical trials and better resource distribution to enhance NMIBC management across Latin America.

Genital Burns Are Associated with Worse Psychosocial and Physical Outcomes.

Genital burns are unique and complex injuries that impact patients physically and emotionally. This study investigates the specific impact of genital burns on psychosocial and physical outcomes. A retrospective cohort study was conducted using the TriNetX database, encompassing over 117 million patients from U.S. healthcare institutions. Patients with genital burns were identified and categorized into sub-cohorts based on TBSA and burn degree. Propensity score matching and cohort balancing were performed based on age, gender, race, and ethnicity. Outcomes were analyzed both short-term (1 month) and long-term (5 years), focusing on psychiatric and physical aspects. This study identified 3,496 genital burn patients over a 15-year period. Analyses revealed that genital burns significantly increased short-term risk of death (RR: 2.8), anxiety (RR: 2.656), hospitalization (RR: 2.167), and any anxiety, PTSD, or depression (RR: 2.363), and long-term risk of death (RR: 1.658) and pruritus (RR: 1.58) (all p<0.05). Interestingly, genital burn patients showed a lower risk of chronic joint pain compared to other burn injuries (RR: 0.815) (p<0.05). These results occurred independently of the extent of TBSA. Genital burns have a distinctive impact on patients, leading to higher rates of certain psychiatric morbidities and physical complications. This study highlights the need for tailored care and consideration of the unique challenges faced by patients with genital burns, both in the immediate aftermath and in the long term. Understanding the specific impacts of genital burns is vital for healthcare practitioners to develop care strategies and better support for patients recovering from such injuries.

Urologic prosthetics: an imaging review of short- and long-term complications.

PURPOSE: Urologic prosthetics offer significant quality of life enhancements for patients with stress urinary incontinence and erectile dysfunction. Artificial urinary sphincter and penile prosthesis are the most commonly used prosthetics for these patients. Radiographic imaging offers important insight, guiding treatment when patients present with complications. Herein, we pictorialize normal radiographic findings and complications alike. METHODS: We reviewed our IRB-approved prosthetics database, highlighting patients with prosthetic complications with available imaging. We collected imaging from patients without complications for baseline reference. RESULTS: The radiographic appearance of orthotopic genitourinary prosthetics and a review of short- and long-term complications including hematoma, infection, malpositioning, leak and erosion are pictorialized. CONCLUSION: Radiologic imaging serves as a vital complement to history and physical examination, aiding in the identification of complications and potentially streamlining surgical preparations. It is important for radiologists to familiarize themselves with standard prosthetic nomenclature, normal positioning and appearance, along with imaging findings of common complications.

Adults With Spina Bifida Fare Worse Than Young Adults: A Systemic Vulnerability in Urinary Tract Infection-Related Hospital Care.

PURPOSE: We aim to estimate the odds of UTI-related hospital care in spina bifida (SB) patients aged 18 to 25 years as compared with patients with SB in adolescence (11-17 years) or adulthood (26-35 years). We hypothesize that patients with SB in the typical transitional age, 18 to 25 years, will have higher odds of UTI-related hospital care as compared to adolescent SB patients or adult SB patients. MATERIALS AND METHODS: Using Cerner Real-World Data, we performed a retrospective cohort analysis comparing SB patients to age- and gender-matched controls. SB cases between 2015 and 2021 were identified and compared in 3 cohorts: 11 to 17 years (adolescents), 18 to 25 years (young adults [YA]), and 26 to 35 years (adults). Logistic regression analysis was used to characterize the odds of health care utilization. RESULTS: Of the 5497 patients with SB and 77,466 controls identified, 1839 SB patients (34%) and 3275 controls (4.2%) had at least 1 UTI encounter. UTI-related encounters as a proportion of all encounters significantly increased with age in SB patients (adolescents 8%, YA 12%, adult 15%; P < .0001). Adjusting for race, sex, insurance, and comorbidities, the odds of a UTI-related encounter in YA with SB were significantly higher than for adolescents with SB (adolescent odds ratio = 0.65, 95% CI: 0.57-0.75, P < .001). YA had lower odds of a UTI-related encounter as compared with adults with SB (adult odds ratio = 1.31, 95% CI: 1.16-1.49, P < .001). CONCLUSIONS: YA with SB have higher odds of UTI-related hospital care than adolescents, but lower odds of UTI-related hospital care when compared with adults.

Burning body parts "Guboow" to treat epididymo-orchitis: A traditional Somali healing practice.

In many parts of the world, mainly in rural communities, villages, and some urban areas, traditional healers play a role in primary healthcare. Guboow or body burning is practiced in Africa and Asia to treat various symptoms and conditions. In this article, we present a Somali patient from central Somalia with left epidydimo-orchitis and left inguinal hernia who received body burns to treat the illnesses and the symptoms. The burns caused severe pain and wound infection in the area applied which resulted in increased morbidity and prolonged hospital stay of the patients.

Assessment of the gender gap in urology industry payments: An Open Payments Program data analysis.

PURPOSE: The Open Payments Program (OPP), established in 2013 under the Sunshine Act, mandated medical device and pharmaceutical manufacturers to submit records of financial incentives given to physicians for public availability. The study aims to characterize the gap in real general and real research payments between man and woman urologists. MATERIALS AND METHODS: The study sample included all urologists in the United States who received at least one general or research payment in the OPP database from 2015 to 2021. Recipients were identified using the National Provider Identifier and National Downloadable File datasets. Payments were analyzed by geography, year, payment type, and years since graduation. Multivariable analysis on odds of being in above the median in terms of money received was done with gender as a covariate. This analysis was also completed for all academic urologists. RESULTS: There was a total of 15,980 urologists; 13.6% were woman, and 86.4% were man. Compared to man urologists, woman urologists were less likely to be in the top half of total payments received (odds ratio [OR] 0.62) when adjusted for other variables. When looking at academic urologists, 18.1% were woman and 81.9% were man. However, woman academic urologists were even less likely to be in the top 50% of payments received (OR 0.55). CONCLUSIONS: This study is the first to characterize the difference in industry payments between man and woman urologists. The results should be utilized to educate physicians and industry, in order to achieve equitable engagement and funding for woman urologists.

Urological Challenges during Pregnancy: Current Status and Future Perspective on Ureteric Stent Encrustation.

The management of ureter hydronephrosis and urolithiasis during pregnancy has been changed by the adoption of ureteric stents. Despite their broad use for several other conditions, from emergency to elective settings, their complications cannot be ignored. Being most prevalent during pregnancy, urinary tract infections and stent encrustations are particularly common and can affect either fetal growth or maternal-fetal homeostasis, leading to obstetric complications. The main concern associated with ureteric stents is the indwelling time, which could represent the potential trigger of those complications. However, to ensure the optimal management of a ureteric stent during pregnancy, factors such as the grading of encrustations and the presence, size, and location of stones should be evaluated in pre-operative planning. As a consequence, a multimodal approach, including obstetrics, gynecologists, urologists, and nurses, is essential to ensure a complication-free procedure and successful ureteric stent removal. Finally, future research should focus on utilizing biodegradable and biocompatible materials to reduce and even eliminate the complications related to forgotten stents in order to reduce the financial burden associated with stent replacement and the management of stent-encrustation-related complications.

Machine learning enables automated screening for systematic reviews and meta-analysis in urology.

PURPOSE: To investigate and implement semiautomated screening for meta-analyses (MA) in urology under consideration of class imbalance. METHODS: Machine learning algorithms were trained on data from three MA with detailed information of the screening process. Different methods to account for class imbalance (Sampling (up- and downsampling, weighting and cost-sensitive learning), thresholding) were implemented in different machine learning (ML) algorithms (Random Forest, Logistic Regression with Elastic Net Regularization, Support Vector Machines). Models were optimized for sensitivity. Besides metrics such as specificity, receiver operating curves, total missed studies, and work saved over sampling were calculated. RESULTS: During training, models trained after downsampling achieved the best results consistently among all algorithms. Computing time ranged between 251 and 5834 s. However, when evaluated on the final test data set, the weighting approach performed best. In addition, thresholding helped to improve results as compared to the standard of 0.5. However, due to heterogeneity of results no clear recommendation can be made for a universal sample size. Misses of relevant studies were 0 for the optimized models except for one review. CONCLUSION: It will be necessary to design a holistic methodology that implements the presented methods in a practical manner, but also takes into account other algorithms and the most sophisticated methods for text preprocessing. In addition, the different methods of a cost-sensitive learning approach can be the subject of further investigations.

Litigation claims in Urology in the UK National Health Service: an analysis of the trends, costs and causes over a 16-year period.

OBJECTIVE: To analyse the litigation trends and the reasons for claims within the specialty of Urology, within the UK National Health Service (NHS), over a 16-year period. MATERIALS AND METHODS: Data were requested from NHS Resolution under the Freedom of Information Act 2000. This included the total number of claims in Urology, the number of these that were successful (settled or closed), and the costs in damages paid out per financial year between 2006 and 2022. A breakdown of the successful claims by their primary cause was also collected. These were coded into the categories: 'non-operative', 'intraoperative', 'postoperative', and 'other'. RESULTS: A total of 4124 litigation claims were made between 2006 and 2022 and 60.9% (2511/4124) of these claims were successful. In all, £145 million (British pounds) was paid out in damages. The number of successful claims increased 2.9-fold from the start to end of this 16-year period, and the costs in damages paid out increased 10-fold. Regarding primary causes for the successful claims, failure or delay in treatment (20.9%, 525/2511), failure or delay in diagnosis (14.5%, 364/2511), and intraoperative problems (9.1%, 229/2511) accounted for the highest proportion. Overall, non-operative causes for successful claims accounted for 73.3% (1840/2511), intraoperative for 20.1% (504/2511), and postoperative for 3.9% (98/2511). CONCLUSIONS: The number of successful urological litigation claims, and their associated costs is rising. The majority are due to non-operative causes, which may be partially explained by NHS waiting lists alongside the effects of the coronavirus disease 2019 (COVID-19) pandemic.

Receptive Anal Intercourse: Impact on Colorectal and Urologic Diagnoses.

Purpose: We evaluated the relationship between lifetime receptive anal intercourse (RAI) and the risk of common colorectal and urologic diagnoses. Methods: We conducted an internet-based survey on sensations during RAI between July 2022 and March 2023. We used multivariable logistic regression to assess the independent impact of lifetime RAI exposure on the diagnosis of common urologic and colorectal conditions. Participants completed a main survey and were invited to complete randomly assigned patient-reported outcome measures (PROMs), which measured pelvic symptoms, mental health symptoms, and sexual satisfaction. Results: In total, 1100 participants completed the main survey and 416 completed the PROMs. Participants of the main survey ranged from 18 to 78 years old and the median age of the sample was 32 years. There was no significant association between lifetime RAI exposure and any medical diagnosis, except for anal fissures, which increased linearly with additional RAI exposure. Both sexual satisfaction and mental health symptoms improved with RAI exposure. Conclusions: RAI was not associated with most of the colorectal and urologic diagnoses tested and was associated with fewer mental symptoms and increased sexual satisfaction. Development of anal fissures may be directly related to trauma of the anal canal from penetration.

Adrenal cyst presenting with clinical features of a pheochromocytoma.

Benign adrenal cysts are relatively uncommon variants of all adrenal incidentalomas. When identified, most benign adrenal cysts are asymptomatic, which differentiates them from other functional adrenal lesions. There are various types of adrenal cysts, although the most common being an endothelial cyst. Ultimately, evaluation and management approaches are aimed at ruling out a functional adrenal mass and management of symptoms if present. We present a unique presentation of an otherwise healthy male with a large incidental adrenal cyst, later identified as a benign endothelial cyst, who presented with classic symptoms of catecholamine excess. The patient had a negative hormonal evaluation, and his episodic symptoms were resolved with surgical removal of the adrenal mass. This case report and brief review provides valuable insight into the evaluation and management of a unique clinical scenario, where a benign cystic mass led to compression-related symptoms of catecholamine excess that were resolved after removal of the nonfunctional, cystic, mass.