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available at http://www.ncbi.nlm.nih.gov/pubmed/29786870 Editorial Comment: A host of hypotheses have been put forward to help define the etiological mechanism of prostate growth. While hormonal elements are clearly at work, we have had little clarity on why some prostates grow more than others. We have generally written this off as genetic predisposition or perhaps unknown environmental factors, ie diet, but to date there is no widely accepted mechanism to explain these differences. In this study the authors perform an interesting analysis of the connection between the magnitude of prostatic artery atherosclerosis and size. The results suggest that severe atherosclerosis may be associated with greater degrees of prostatic enlargement. While not correlated with subjective metrics such as the International Prostate Symptom Score, it appears that prostate size was significantly greater in men with severe prostatic artery atherosclerosis. Moreover, a host of factors, including the increased expression of hypoxia-inducible factor, malondialdehyde, transforming growth factor and basic fibroblast growth factor, all associated with oxidative stress pathways, were noted. It should be mentioned that these findings were observed in a limited number of patients and only 12 had severe atherosclerosis. Nevertheless, this represents an interesting linkage to other associated observations made, including the relationship between metabolic syndrome and prostate size. Clearly downstream inflammatory pathways, which may modulate hormonal response, could be driving factors for prostate enlargement and size. Interestingly systemic atherosclerosis as measured by a cardio-ankle vascular index did not correlate with degree of enlargement. It is possible that progression and/or degree of systemic atherosclerosis precedes that of the prostatic arteries. The practical implications and possible preventive strategies remain to be defined. Steven A. Kaplan, MD Suggested Reading Akaihata H, Nomiya M, Hata J et al: Pelvic arterial occlusive disease affects the RhoA/Rho-kinase pathway in bladder smooth muscle. J Urol 2015; 193: 706. Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Retrosigmoid versus Traditional Ileal Conduit for Urinary Diversion after Radical Cystectomy V. Ficarra, G. Giannarini, A. Crestani, V. Palumbo, M. Rossanese, C. Valotto, A. Inferrera and V. Pansadoro Department of Human and Paediatric Pathology “Gaetano Barresi,” Urologic Section, University of Messina, Messina, Urology Unit, Academic Medical Centre “Santa Maria della Misericordia,” Udine and Vincenzo Pansadoro Foundation, Rome, Italy Eur Urol 2019; 75: 294e299. doi: 10.1016/j.eururo.2018.06.023 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/30091420available at http://www.ncbi.nlm.nih.gov/pubmed/30091420 Editorial Comment: Ureterointestinal anastomotic strictures following ileal conduit urinary diversions are difficult to manage. Left-sided ureteral strictures are more common due to more extensive mobilization of the distal segment of ureter as well as the tunneling of the left ureter under the sigmoid mesocolon. In this nonrandomized study the authors describe their experience DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE 7 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.