Urology Annals最新文献

Background: Kidney stones can significantly impact individuals, but existing literature often overlooks the comprehensive effects by not considering the various factors such as stone size, presence of obstruction, and treatment methods, among those with and without diabetes. This study seeks to explore the relationship between diabetes and kidney stone formation, addressing these gaps in research.

Methodology: This cross-sectional study assesses the diverse impacts of kidney stones on adults diagnosed with type 2 diabetes mellitus and nondiabetic adults from 2019 to 2022 in Jeddah, Saudi Arabia. Institutional review board approval was secured for this research. Data collection occurred from December 1, 2022, to March 1, 2023, and the analysis was performed using SPSS software.

Results: The study included 254 adults diagnosed with kidney stones, 127 with type 2 diabetes, and 127 nondiabetics. Our study showed that the individuals with diabetes were more likely to have larger kidney stones than those without diabetes (13.12 mm vs. 10.53 mm, P = 0.03). Moreover, individuals with hypertension and dyslipidemia also had significantly larger stones. However, no significant difference was found between the two groups regarding the presence of obstruction and the treatment modality.

Conclusion: This study revealed that in Saudi Arabia, individuals with diabetes who also suffer from kidney stones tend to develop larger stones. In addition, these individuals frequently exhibit other comorbid conditions, including hypertension, dyslipidemia, obesity, and renal disease. The significance of these findings may inform future strategies for both primary and secondary prevention of kidney stones in diabetic patients.

Introduction: Treatment of upper ureteric calculi has always remained a challenge for urologists. Treating the juxta-UPJ stones has been even more challenging. Difficulties in access, the possibility of up migration of stones, higher chances of leaving behind residual fragments, and the need for ancillary procedures like ESWL or relook URS have been a few inherent limitations in treating such stones. Offering PCNL for smaller stones was considered an overkill by many urologists. However, with the advent of miniaturized PCNL and improvisations in RIRS techniques, more and more of such stones are tackled with ease.

Objective: To compare the safety and efficacy of mini-percutaneous nephrolithotomy (Miniperc PCNL) and retrograde intrarenal surgery (RIRS) in the management of juxta pelvi-ureteric junction (PUJ) calculi, located between 1 and 2 cm from PUJ.

Materials and methods: A prospective, randomized study was done on 100 patients with upper ureteric stones up to 2 cm in size and within 2 cm from PUJ. Patients with odd numbers were assigned Group A (Miniperc PCNL, n = 50) and even numbers were assigned to Group B (RIRS, n = 50).

Results: Stone-free rates were 92% for Group A and 72% for Group B (P < 0.0174). Mean operative time was significantly shorter in Group A than Group B (53.2 min vs. 68.52 min, P < 0.001). Hospital stay was longer for Group A (47.42 h) compared to Group B (29.36 h, P < 0.001). Lasing time was more with RIRS than with PCNL (10.18 min vs. 3.24 min, P < 0.001). The complications were more in Group A than Group B, but not significant (P = 0.160). Postoperative pain and time to return to normal activities were significantly better in Group B RIRS (P < 0.001).

Conclusions: Both Miniperc PCNL and RIRS are the effective treatments for upper ureteric stones. Miniperc PCNL has advantages in terms of shorter operative time, lesser lasing time, and better stone free rates. RIRS demonstrated reduced hospital stay, reduced postoperative pain, and quicker recovery. Miniperc PCNL showed a higher stone-free rate for treating upper ureteric stones up to 2 cm. RIRS is effective for treating stones up to 2 cm in upper ureter reducing the complications associated with Miniperc PCNL.

Background: Gender inequality has been prevalent in the history of medicine, specifically within surgical specialties. Although there have been advances, urology has remained overwhelmingly male-dominant, with slow growth in female recruitment.

Objectives: The study aimed to assess whether the gender influences selection of medical specialty, especially gender bias in urology.

Materials and methods: A cross-sectional study was conducted among undergraduate medical students in Saudi Arabian medical schools to explore the influence of gender on urology specialty selection. Data were collected from November 2023 to June 2024 using a structured questionnaire administered electronically. A pilot study was conducted to evaluate the questionnaire's reliability and clarity. Data were analyzed using descriptive and inferential statistics. The questionnaire demonstrated acceptable reliability.

Results: The total study participants were 602 medical students. The dataset reveals a balanced gender representation, with males constituting 55.6% and females 44.4%. A substantial majority, 94.5%, expressed a definitive willingness to pursue further residency training following graduation, indicating a robust commitment to advancing their medical careers. However, while evaluating interest in urology, the statistics revealed a potential disparity, with only 43.2% affirmatively considering urology as a specialty, contrasted against 56.8% who would not. The study shows that the participants' considering urology as a specialty has a statistically significant relation to gender (P = 0.0001) as 72.3% of those who would consider the specialty were males compared to only 27.7% for females. The data also show a concerning trend where 21.8% of those uninterested in urology reported insufficient exposure during medical school as a deterrent, while others found the specialty to be embarrassing or simply uninteresting, accounting for 70.8% of the negative responses.

Conclusion: This study reveals a significant gender disparity in urology specialty selection among medical students. While the majority of students intend to pursue residency training, male students are significantly more likely to consider urology as a specialty compared to female students. Factors such as limited exposure and negative perceptions contribute to the underrepresentation of women in urology. Addressing these issues is crucial to achieving gender equality within the field.

Introduction: The arterial anastomosis in renal transplantation is done either end-to-end to the internal iliac artery (IIA) or end-to-side to the external iliac artery (EIA). This retrospective study is to compare the vascular complications of these two techniques occurring in the immediate postoperative period.

Materials and methods: The data of 111 patients who underwent renal transplantation (live and deceased) were collected from the hospital records. Fifty-four (48.6%) had live donors, and 57 (51.4%) had deceased donors. Fifty (45%) patients had anastomosis to IIA alone, 57 (51.3%) to EIA alone, and 4 (3.6%) to both vessels. Age and sex of the recipient, cause of chronic kidney disease, side of the donor kidney, and number of donor renal arteries, presence of atherosclerotic changes on the recipient's vessels, and presence of diabetes mellitus were noted. The details of the perioperative and postoperative vascular complications and the management of each one were recorded.

Results: Nine patients had vascular complications, of which 5 (55.5%) patients had main vessel transplant renal artery thrombosis, 1 (11.1%) patient had accessory renal artery thrombosis, and 3 (33.3%) patients had transplant renal artery stenosis (TRAS). Out of the six cases of transplant renal artery thrombosis, 4 (66.6%) were seen in anastomosis with EIA. All 3 (100%) cases of TRAS were seen in anastomosis to the EIA. The vascular complications were not significantly associated with the type of anastomosis.

Conclusion: On short-term follow-up, the incidence of vascular complications was not found to be significantly affected by the type of anastomosis.

Objective: This study aims to present the prevalence of incidental prostate cancer (IPCa) based on pathology reports of prostate tissue chips following transurethral resection of the prostate (TURP), as well as to assess cancer's stage, associated risk factors, and treatment modalities upon diagnosis.

Methods: This cross-sectional retrospective study included patients who underwent TURP between 2015 and 2023. Patients with a preexisting PCa diagnosis were excluded, resulting in the analysis of 418 patients. Data collected encompassed basic characteristics, personal history of malignancies unrelated to IPCa, prostate volume, and prostate-specific antigen (PSA) levels. IPCa cases were identified through the pathology reports of the prostatic chips. In addition, cancer stage, Gleason score, treatment choices, and outcomes were documented for IPCa cases.

Results: Among the 418 patients who underwent TURP, 35 were diagnosed with IPCa, yielding a prevalence rate of 8.4% (95% confidence interval: 5.7%-11.0%). Of these cases, 13 (37.1%) exhibited metastatic disease, and 4 (11.8%) resulted in patient mortality. IPCa patients were found to have significantly higher PSA levels and smaller prostate volumes. Multivariable logistic regression analysis indicated that elevated PSA density, ischemic heart disease, and chronic kidney disease, significantly influenced the likelihood of IPCa (P < 0.05). Mann-Whitney testing revealed that patients with metastatic disease had a median Gleason score of 9, whereas those with localized disease had a median score of 7 (P < 0.001).

Conclusion: Our study disclosed an IPCa prevalence of 8.4%, with IPCa patients exhibiting elevated PSA levels and reduced prostate volumes, suggesting that PSA density is a valuable tool for evaluating patients with borderline PSA levels.

Introduction: Type 2 diabetes mellitus (T2DM) is a well-established risk factor for erectile dysfunction (ED); the precise impact of glycemic control on male sexual function, including hormonal profiles, remains to be fully elucidated. This study aims to investigate the specific relationship between the degree of glycemic control in T2DM patients and the severity of both hormonal imbalances and ED.

Methodology: A comparative study between two arms - relatively controlled and uncontrolled type 2 diabetic men. We considered a relatively controlled diabetes mellitus (DM), patient with glycated hemoglobin (HbA1c) of 7.9 mmol/L or less. Laboratory results for type 2 diabetic men presenting with ED were studied after stratifying them into the two groups - relatively controlled DM (HBA1c of 7.9 mmol/L or less) and uncontrolled DM (HBA1c equal to or more than 8 mmol/L). Retrieved data include patient's demographics, body mass index (BMI), hormonal profile, Complete Blood Count (CBC), lipid profile, prostate-specific antigen (PSA), urate, Vitamin D level, and the severity of ED as assessed by the International Index of Erectile Function (IIEF) scores. Statistical analysis was done to compare between the two groups using SPSS version 20. P < 0.05 was considered statistically significant.

Results: This study found a significant association between poor glycemic control (HbA1c ≥8%) and ED in diabetic men (P < 0.0001). Longer diabetes duration correlated with both ED and poor glycemic control, suggesting a potential causal link. Well-controlled diabetics had lower BMI (P = 0.001), higher free testosterone (FT) (P = 0.0002), lower sex hormone-binding globulin (SHBG) (P = 0.0001), and higher IIEF scores (P < 0.0001) compared to the poorly controlled group, indicating better erectile function and potential benefits of weight management and improved testosterone availability. While follicle-stimulating hormone and luteinizing hormone levels were not significantly affected, Vitamin D levels were higher in the well-controlled group (P = 0.0002), suggesting a potential role for Vitamin D in ED, although further investigation is needed. Cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, PSA, thyroid-stimulating hormone, and T4 levels did not show significant differences but might warrant further exploration.

Conclusion: This study demonstrates an association between poor glycemic control and impaired erectile function in diabetic men. Lower FT levels, elevated SHBG, and increased BMI were observed in the poorly controlled group, potentially contributing to ED. Conversely, good glycemic control correlated with improved erectile function, potentially due to higher FT availability and Vitamin D levels.

Introduction: Calculous formation is a well-known complication of lower urinary tract reconstruction using an intestinal segment. Special considerations are required as access to the reconstructed bladder is complicated. To date, a standard strategy is yet to be accepted.

Objective: This study aims to investigate the efficiency and safety of percutaneous cystolitholapaxy (PCCL) access.

Materials and methods: This was a retrospective analysis of patients with reconstructed lower urinary tract who developed bladder stones and were treated with PCCL.

Results: Seven patients underwent a total of nine PCCLs between 2019 and 2023. Sone burden ranged from 4 to 10 cm. No intraoperative complications were faced. Three patients had residual stone fragments < 7 mm in size. Suprapubic catheter was removed between days 0 and 3 postoperative. Cystostomy was left to close spontaneously, none of the patients developed peritoneal leak after removal. Patients with Mitrofanoff channel reported no leak or compromise to the continued mechanism. Predominant stone composition was magnesium ammonium phosphate (struvite) in seven cases.

Conclusion: In our experience, PCCL accessing through bowel segment without tract closure in reconstructed bladder is a reliable and safe approach. When it comes to our patient selection, no limitations to this approach have been identified.

Overactive bladder (OAB) is a chronic disease with the symptoms of urgency with or without incontinence. Solifenacin is an antimuscarinic drug that Excels in OAB treatment due to its specific bladder receptor targeting. While previous research had positive outcomes, reports of adverse events (AEs) highlight the need for regular updates on the safety and efficacy of solifenacin for OAB management. This study followed PRISMA 2020 guidelines and was registered to PROSPERO CRD42023445318. A comprehensive search of PubMed, ScienceDirect, and Scopus databases was conducted until July 2023. Data were analyzed using Review Manager version 5.4 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). Solifenacin had a significantly better effect in decreasing urgency episode (mean difference (MD) = -1.09, 95% confidence interval [CI]: -1.29--0.89, P < 0.00001), incontinence episode (MD = -0.56, 95% CI: -0.80--0.32, P < 0.00001), micturition frequency (MD = -1.01, 95% CI: -1.16--0.85, P < 0.00001), nocturia episode (MD = -0.13, 95% CI: -0.25--0.01, P = 0.04), and had a higher urine volume (MD = 26.88, 95% CI: 24.17-29.59, P < 0.00001) per 24 h compared to placebo. Solifenacin had a significant number of AEs compared to placebo (MD = 1.75, 95% CI: 1.25-2.45, P = 0.001). Solifenacin significantly decreased urgency episode, incontinence episodes, micturition frequency, and nocturia episode, and had a higher urine volume per 24 h. There was a significant number of AEs in patients receiving solifenacin.

Background: Male infertility is a major health problem that can have a tremendous negative impact on the affected individuals and couples. The use of folk medicine is common practice in the Middle Eastern region, especially before seeking conventional medical treatment. Unfortunately, some of these remedies might be potentially harmful. This study aims to assess the use of folk medicine before formal medical evaluation by a male infertility specialist among men in couples with subfertility in Saudi Arabia.

Materials and methods: A retrospective study of prospectively documented data was conducted among male patients who presented for evaluation of their infertility at one center in Jeddah, Saudi Arabia, from May 1, 2020, to April 30, 2021, to assess the prevalence of the use of traditional medicine among these patients.

Results: The total number of patients who visited the center for infertility assessment during the specified period was of 427. Most patients had primary infertility (64.4%). Table 1 summarizes the demographic data of the patient population. About 55.3% of the patients were 40 years old or less. Patients who consumed some form of alternative medicine are 38.9%. A clinical varicocele was detected in 57.8% of these men. Patients who use alternative medicine had significantly lower semen concentration and estradiol levels (P = 0.02 similarly).

Conclusion: About 38.9% of patients who attended our clinic were using some alternative medicine. Furthermore, patients who use alternative medicine had significantly less sperm motility and progressive motility.