Research and Reports in Urology最新文献

Background: Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis in developing countries. Isolated genital TB is rare, but testicular infarction is an unusual complication of delayed management, in which surgical intervention is warranted.

Case presentation: A 29-year-old male non-smoker presents with painful left scrotal pain of 21 days. Initially managed with intravenous antibiotics, the disease progressed and resulted in testicular infarction. Left orchiectomy was performed, and the specimen was sent for histopathological examination, which revealed features consistent with a testicular tuberculous abscess.

Conclusion: Tuberculous epididymo-orchitis (TBEO) with testicular infarction was unusual. It is prudent to consider this in patients presenting with long-standing urinary symptoms, particularly in those unresponsive to the initial antibiotic therapy. It requires a high index of suspicion, especially in TB endemic areas.

Robot-assisted surgery has emerged as a transformative technology, revolutionizing surgical approaches and techniques that decades ago could barely be imagined. The field of urology has taken charge in pioneering a new era of minimally invasive surgery with the ascent of robotic systems which offer enhanced visualization, precision, dexterity, and enabling surgeons to perform intricate maneuvers with improved accuracy. This has led to improved surgical outcomes, including reduced blood loss, lower complication rates, and faster patient recovery. The aim of our review is to present an evidence-based critical analysis on the most pioneering robotic urologic approaches described over the last eight years (2015-2023).

Epithelioid angiomyolipoma (EAML) is a rare variant of AML with malignant potential. It is occasionally difficult to distinguish EAML from renal cell carcinoma (RCC) on imaging. A 72-year-old woman was admitted to our hospital for the treatment of a left renal tumor with relatively high blood flow and a tumor thrombus extending to the inferior vena cava, suggesting RCC. The patient underwent presurgical combination therapy with axitinib and pembrolizumab. This treatment significantly shortened the thrombus, and radical nephrectomy was performed. The pathological findings were compatible with EAML, and the treatment effects were observed. We report a case treated pre-surgically with a combined therapy of pembrolizumab and axitinib, with a favorable response as a treatment option for EAML.

Background: Urinary tract infections (UTIs) bring a significant and serious health-related problem. Repeated infections may lead to the development of renal scarring and end-stage renal dysfunction. Therefore, balancing the choices of UTI diagnostic tools depending on the costs versus accuracy can minimize false results that may subject patients to wrong treatments.

Objective: The objective of the study was to evaluate the diagnostic performance of LINEAR cromatest and Laboquick URS 10-T dipsticks against conventional urine culture at Arsho Advanced Medical Laboratory (AAML), Addis Ababa, Ethiopia.

Methods: A similar cohort of UTI-suspected patients from our previous study, who were prospectively enrolled from Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia, were considered for this analysis. Data analysis was performed using SPSS version 26. The sensitivity, specificity, and predictive value of different dipsticks were calculated using culture as a gold standard. ROC curve analysis was also used to determine diagnostic performance. A test with a P-value of <0.05 was considered statistically significant.

Results: Out of 446 urine samples processed, bacterial growth was observed in 141 (31.6%). Of this figure, 105/141 (74.5%) and 36/141 (25.5%) were from female and male participants, respectively. The sensitivity and specificity of the LINEAR Cromatest dipstick were 83.7% and 67.9%, respectively (P-value <0.001). The Laboquick URS 10-T dipstick showed sensitivity and specificity of 87.9% and 68.5%, respectively (P-value <0.001). The ROC analysis showed an AUC of >0.7 for both dipsticks.

Conclusion: In a setting where there is no access to urine culture, the urine dipstick may be considered an alternative diagnostic tool in the diagnosis of UTIs.

Retrocaval ureter is a rare congenital vascular anomaly described as the passage of the ureter behind the inferior vena cava (IVC) and then turning around the IVC to attain the final lateral position. The condition is usually associated with obstruction in the ipsilateral kidney, causing different degrees of hydronephrosis and complications associated with urinary stasis, such as stone formation. Imaging has a crucial role in the diagnosis and management of retrocaval ureter. CT urography may be the procedure of choice to confirm the diagnosis and avoid retrograde ureteropyelography. Indications for treatment include flank pain, recurrent infection, hydronephrosis, and stone formation due to obstruction. Surgical management is standard and can be done through either an open, laparoscopic, or robotic approach. In this case series, we are going to see two cases of retrocaval ureter in a 56-year-old male and a 14-year-old male child who presented with a right flank of less than a couple of months duration. The first case has an associated horseshoe kidney and a solitary secondary stone. Both cases were surgically managed with open ureteral division, relocation, and ureteroureterostomy. Both have uneventful post-operative follow-ups.

Purpose: The few available reports regarding adults living with distal hypospadias give disparate views of the functional and aesthetic impact of this penile birth defect when it is not corrected. We reviewed symptoms and findings in consecutive men with unrepaired distal hypospadias and report those observations.

Material and methods: Men with uncorrected hypospadias were queried regarding urinary symptoms, sexual dysfunction, and aesthetic concerns. Glans fusion around the meatus was measured. Penile curvature was confirmed by photographs of erections, and its degree objectively measured in those undergoing surgery.

Results: There were 51 men with a mean age of 42 years (18-63). None had glans fusion around the meatus, and the main symptom was urine spraying in 81%. Penile curvature was present in 33%. Painful sexual activity was reported by 34% due to penile curvature, exposed urethral mucosa, or a scrotal web. All but one man experienced functional problems. In addition, 60% were bothered by their abnormal appearance.

Conclusion: All but one of these men with uncorrected distal hypospadias had penile dysfunction, and 60% were additionally concerned about the atypical appearance of their penis. These results offer a different perspective than earlier reports which said that most men with uncorrected distal hypospadias were not bothered by their condition, and many were not aware of it.

Background: Traumatic kidney injuries are the most common urinary tract injuries. Pediatric patients are more susceptible to renal injury from blunt trauma than adults because of anatomic factors. The aim of this publication was to provide a reference for traumatic kidney injury in the pediatric group based on the study in our center.

Methods: A retrospective study was conducted from January 2014 to December 2019 to review medical records of children admitted with renal trauma. Relevant findings including demographics, mechanisms and grades of injury, clinical parameters, interventions, and outcomes were recorded.

Results: Thirty-three pediatric patients were investigated. Males experienced traumatic kidney injury more often than the females with a ratio of 10:1. Most cases occurred during the adolescent (12-18) years (81.82%). Left-side kidney injury (63.64%) was more frequent than right side (36.36%). Most cases (96.97%) were caused by blunt trauma, mainly traffic accidents (81.82%). Most patients (90.91%) had stable hemodynamics. Grade IV kidney injury was the most frequently found injury (39.39%). The cause of renal function disturbance was based on the blood urea nitrogen/creatinine (BUN/Cr) ratio with 21.87% of patients suffering from intra-renal causes and 12.5% from pre-renal causes. No significant association between different grades and BUN/creatinine ratio was found. Isolated renal injuries were found in 54.54% of patients. Most patients were treated conservatively (87.88%), and survival was 96.97%.

Conclusion: Non-operative management is safe and yields good outcomes in kidney trauma patients with stable hemodynamics. Renal trauma severity is not associated with the BUN/Cr ratio.

Purpose: Haemorrhagic cystitis may be due to different etiologies with infectious diseases representing an insidious cause to diagnose. The aim of this narrative review is to provide a comprehensive overview of less common but difficult-to-diagnose causes of infectious haemorrhagic cystitis of bacterial, mycobacterial, and parasitic origin, Moreover, we highlight possible diagnostic tools and currently available treatment options in order to give an updated tool for urologists to use in daily practice.

Patients and methods: The search engine PubMed was used to select peer-reviewed articles published from 1/Jan/2010 to 31/Aug/2022.

Results: Bacteria, fungal, TB and schistosomiasis are uncommon causes of haemorrhagic cystitis burdened by high morbidity, especially if not promptly diagnosed.

Conclusion: Because haemorrhagic cystitis ranges in severity from mild dysuria associated with pelvic discomfort to severe life-threatening haemorrhage, punctual diagnosis, and immediate treatment are essential to avoid further complications.

Muscle-invasive bladder cancer has poor prognosis. If organ confined, it is potentially curable; however, across all prognostic groups, approximately half of patients will relapse. For patients with advanced disease, the median overall survival remains under two years. Systemic treatment options are centered on the use of platinum-based combination chemotherapy, with the choice of cisplatin- or carboplatin-based regimens determined on the basis of criteria including performance status and renal function. PD-1/PD-L1 checkpoint-directed immunotherapy has been established for use in advanced disease with modest overall improvements in survival outcomes. Based on current data, optimal utilization appears to be a switch maintenance strategy on completion of chemotherapy. In the curative setting, cisplatin-based chemotherapy provides modest improvements in cure rates in those fit to receive it. Data on the use of adjuvant immunotherapy are currently contradictory, with disease-free survival demonstrated for adjuvant nivolumab, but not atezolizumab, and no overall survival benefit has yet been confirmed. The Nectin-4 directed antibody drug conjugate enfortumab vedotin is an established treatment option for patients previously treated with both chemotherapy and immunotherapy. The emerging therapeutic targets under evaluation include Trop-2 with sacituzumab govitecan, fibroblast growth factor receptors, HER2, and DNA repair deficiency in biomarker-selected patients. The development of properly validated predictive biomarkers has proven challenging for this disease and should be a central priority in the future development of treatment options. This review summarizes the available systemic treatment options in both palliative and curative disease settings, and highlights the available evidence and current limitations for making treatment recommendations.