Urology Annals最新文献

Objectives: As iatrogenic ureteral injury carries a high burden and is associated with increased postoperative morbidity and mortality, the purpose of this study is to determine the incidence and potential risk factors of iatrogenic ureteral injury following common obstetric and gynecological surgeries in King Abdulaziz Medical City.

Methods: This was a single-center retrospective cohort study based on data extracted from an electronic hospital information system conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Three thousand four hundred and sixty-four cases of cesarean section (C-section) and hysterectomy from January 1, 2021, to December 31, 2022, were reviewed. All cases of C-section and hysterectomy in which the urology department was consulted for suspected iatrogenic ureteric injuries were included in the study. All cases other than C-sections and hysterectomy in which the urology department was consulted for suspected iatrogenic ureteric injuries were excluded from the study.

Results: A total of 45 patients for whom urology was consulted for suspected ureteral injury were included in this study. Approximately (35.6%) one-third of the patients had positive findings of ureteral injury following common obstetric and gynecological surgeries. About 41.2% of these patients had previous gynecological surgeries. Other potential risk factors were tested such as age and body mass index. Older patients were slightly at higher risk of iatrogenic ureteral injury (P < 0.05).

Conclusion: Ureteral injury in obstetric and gynecological surgeries is rare yet serious complication. The findings of this study suggest that the incidence of iatrogenic ureteral injury was relatively associated with older age.

Urolithiasis is a common urological disease that can have a negative impact on health and quality of life in people worldwide. Multiple studies have investigated the prevalence of urolithiasis worldwide. However, research on this disease in Saudi Arabia is very limited. This review was conducted to investigate the prevalence of urolithiasis and its associations in Saudi Arabia. A standardized, systematic search strategy was conducted to identify observational studies that reported the prevalence of urolithiasis in Saudi Arabia. The search included published studies between January 2000 and October 2023. A variation in prevalence between regions was found and was reported to range from 6% to 19%. A significant association between urolithiasis and two factors, increasing age and family history, was found. Studies on urolithiasis are limited in Saudi Arabia. Despite this, it is evident that the prevalence of urolithiasis is comparable in other parts of the world. Public awareness and lifestyle modification efforts may help reduce this disease's impact on our population.

Background: Inguinal lymph node dissection (ILND) is the standard of care for palpable, biopsy-proven lymph node metastases or high-risk groups for nonpalpable lymph nodes in the treatment of penile cancer. ILND is associated with a significant incidence of complications and adverse events, specifically wound complications. Few studies have identified risk factors related to postoperative ILND complications.

Objective: The objective of this study was to assess the prevalence of 30-day postoperative complications and to identify risk factors associated with postoperative complications of ILND for penile cancer.

Materials and methods: This was a retrospective review of medical records for all patients who had ILND for penile cancer between January 2012 and December 2022. According to the modified Clavien-Dindo classification, the 30-day postoperative complications were collected. Using an ordinal univariate logistic regression model and multivariate analysis, potential risk variables for complications were determined.

Results: A total of 60 patients were performed ILND. Sixty percent of the patients had a postoperative complication including wound infection 50%, wound dehiscence 36.7%, skin necrosis 26.6%, lymphocele 33.3%, leg edema 46.7%, and scrotal edema 16.7%. Higher grade of modified Clavien-Dindo classification was associated with body mass index (BMI) (odds ratio [OR] = 1.15; P = 0.03), diabetes mellitus (OR = 3.13; P = 0.04), American Society of Anesthesiologist classification ≥3 (OR = 1.14; P = 0.03), radical ILND (OR = 1.57; P = 0.01), and bilateral ILND (OR = 1.60; P = 0.02). In multivariate analysis, a higher grade of modified Clavien-Dindo classification was correlated with BMI (OR = 1.48; P = 0.01) and bilateral ILND (OR = 4.56; P = 0.01).

Conclusion: ILND is associated with high rates of complication. The severity of the modified Clavien-Dindo classification was associated with BMI and bilateral ILND.

Objective: The purpose of the study was to compare the outcome of microscopic testicular sperm extraction (micro-TESE) between superficial and deep dissection on the same testicle in terms of sperm retrieval rate (SRR).

Patients and methods: In a retrospective study from June 2019 to October 2021, 44 patients with nonobstructive azoospermia who underwent micro-TESE with positive results (mature sperm identified) were included. Eight patients were excluded from the study due to deficient documentation on superficial and deep dissection. A total of 36 patients were included; 60 testicles were examined for superficial and deep biopsies. Testicular histopathology was performed in all patients, and a hormonal evaluation was obtained before the micro-TESE attempt.

Results: Thirty-six patients and 60 testicles were included in the study. Of them, 47 (78.3%) testicles had positive results. Superficial TESE was positive in 38 (63.3%) testicles, and deep TESE was successful in 45 (75.0%) testicles. An improvement of 13.9% in the SRR was observed, following deep dissection. However, there was no statistically significant difference (P = 0.166). Rates of positive sperm retrieval (from any side) did not differ significantly based on patients' age, microdissection testicular sperm extraction sides, and hormonal concentrations; these differences were not apparent after superficial or deep TESE.

Conclusion: The presented findings suggest that although successful SRRs of deep TESE were higher than that of its superficial counterpart, there was no significant statistical difference. A larger body of evidence is needed to provide a higher grade of recommendation.

Introduction: Nocturnal enuresis (NE) in children is a very common problem managed in pediatric urology. In this study, we present the prevalence of NE in children in Aseer region in Saudi Arabia.

Methodology: This study was conducted as a descriptive cross-sectional survey to estimate the prevalence of NE among 555 Saudi children aged 5-15 years in Aseer region in Saudi Arabia. Data collection was done through a questionnaire, which included questions on sociodemographic data, personal knowledge, enuresis-related characteristics, risk factors, and management modalities.

Results: This study identified a prevalence of enuresis of 24% of the study population, most of whom were boys. The majority of the parents had a high educational level. Clinical characteristics of the study population showed: 9% have a family history of NE, 2.2% have a history of neurological disorder, 10.0% have a history of urinary tract infections, 66.8% have associated daytime urgency, 67% have urine-holding behavior, and 19.5% have associated daytime enuresis of the study population.

Conclusion: Our study found that 24% of children in the Aseer region in Saudi Arabia have NE. Our study finding helps us to understand the prevalence of NE in Aseer region in Saudi Arabia, and this can be applied to other regions in the kingdom. Furthermore, this finding helps us to understand the need to raise awareness in the community about NE and the need to educate the nonpediatric urologist health-care provider about the best management practice for NE.

Aims: The Saudi Urolithiasis Guidelines are a set of recommendations for diagnosing, evaluating, and treating urolithiasis in the Saudi population. These guidelines are based on the latest evidence and expert consensus to improve patient outcomes and optimize care delivery. They cover the various aspects of urolithiasis, including risk factors, diagnosis, medical and surgical treatments, and prevention strategies. By following these guidelines, health-care professionals can improve care quality for individuals with urolithiasis in Saudi Arabia.

Panel: The Saudi Urolithiasis Guidelines Panel consists of urologists specialized in endourology with expertise in urolithiasis and consultation with a guideline methodologist. All panelists involved in this document have submitted statements disclosing any potential conflicts of interest.

Methods: The Saudi Guidelines on Urolithiasis were developed by relying primarily on established international guidelines to adopt or adapt the most appropriate guidance for the Saudi context. When necessary, the panel modified the phrasing of recommendations from different sources to ensure consistency within the document. To address areas less well covered in existing guidelines, the panel conducted a directed literature search for high quality evidence published in English, including meta analyses, randomized controlled trials, and prospective nonrandomized comparative studies. The panel also searched for locally relevant studies containing information unique to the Saudi Arabian population. The recommendations are formulated with a direction and strength of recommendation based on GRADE terminology and interpretation while relying on existing summaries of evidence from the existing guidelines.

Objective: The objective of the study y was to evaluate factors which can improve shock wave lithotripsy (SWL) results to keep up with COVID-19 pandemic.

Methods: Between June 2020 and June 2021, patients with radio-opaque or faint radio-opaque upper urinary tract stones, stone attenuation value ≤1200 HU, and stones size <2.5 cm were treated by electrohydraulic SWL. Patients with respiratory tract symptoms elevated temperature, contact with COVID-19 patients, or positive COVID-19 swab 2 weeks preoperatively, skin-to-stone distance >11 cm, and body mass index >30 kg/m² were excluded from the study. Patients were prospectively enrolled in SWL done at a rate of 40-50 SWs/min under combined ultrasound and fluoroscopy-guided, ramped into high power in the 1^st 300 shocks. Success rate and complications were recorded.

Results: Five hundred and ninety patients completed the study. The success rate after 1^st session was 408/590 patients (69.15%) which was augmented by 2^nd session to reach 527/590 patients 89.3%. The success rate was 96.2% at 3 months postoperatively. Most complications were mild (Grade 1 or 2).

Conclusions: SWL results improved using slow rate high power from the start of the session under combined fluoroscopy and ultrasound guidance. SWL may be a preferred option during a pandemic.

Objectives: Gastrointestinal stromal tumors (GISTs) can occur synchronously with other neoplasms, including the genitourinary (GU) system. Machine learning (ML) may be a valuable tool in predicting synchronous GU tumors in GIST patients, and thus improving prognosis. This study aims to evaluate the use of ML algorithms to predict synchronous GU tumors among GIST patients in a specialist research center in Saudi Arabia.

Materials and methods: We analyzed data from all patients with histopathologically confirmed GIST at our facility from 2003 to 2020. Patient files were reviewed for the presence of renal cell carcinoma, adrenal tumors, or other GU cancers. Three supervised ML algorithms were used: logistic regression, XGBoost Regressor, and random forests (RFs). A set of variables, including independent attributes, was entered into the models.

Results: A total of 170 patients were included in the study, with 58.8% (n = 100) being male. The median age was 57 (range: 9-91) years. The majority of GISTs were gastric (60%, n = 102) with a spindle cell histology. The most common stage at diagnosis was T2 (27.6%, n = 47) and N0 (20%, n = 34). Six patients (3.5%) had synchronous GU tumors. The RF model achieved the highest accuracy with 97.1%.

Conclusion: Our study suggests that the RF model is an effective tool for predicting synchronous GU tumors in GIST patients. Larger multicenter studies, utilizing more powerful algorithms such as deep learning and other artificial intelligence subsets, are necessary to further refine and improve these predictions.

Purpose: The current study aimed to assess the long-term effect of COVID-19 infection on unexplained male infertility.

Materials and methods: A retrospective comparative study of 134 men attending the infertility outpatient clinic of our institution before exposing to COVID-19 infection in KSA from January 2019 to July 2022. Medical recorded data of these patients who were investigated before COVID-19 infection were retrospectively collected using the hospital's electronic database, including semen analysis, sex hormonal, and ultrasound testicular size, and their data were compared prospectively to collected data after 2-year follow-up.

Results: One hundred and thirty-four infertile males who got COVID-19 infection in KSA (median age, 33 years) were assisted retrospectively preinfection and delayed 2 years postinfection (median of 23 months). Of the 134 men, 44 (32.83%) were asymptomatic positive COVID-19 (Group A), 68 (50.74%) had mild-to-moderate symptomatic positive COVID-19 (Group B), and 22 (16.41%) had severe symptomatic positive COVID-19 (Group C). There was no significant change between pre- and postinfections in sperm parameters, sex hormonal level, and testicular size. Subgroup analyses were performed for patients regarding the severity of infections. None of the evaluated parameters differed significantly after infections up to 2 years. Results of this study demonstrate that COVID-19 infection does not have significant changes in sperm parameters, sex hormonal level, and testicular size.

Conclusion: The long-term impact of COVID-19 infections has no significant effect on normal sperm parameters, sex hormones, and testicular size in male infertility in KSA.

Nephrolithiasis is a prevalent issue around the globe, particularly in hot climates such as Saudi Arabia. This analysis's objectives were to investigate the characteristics of kidney stones in Eastern Saudi Arabia and to provide the following findings: urinary stone composition, gender and age distribution, seasonal variations in stone formation, coexisting diseases linked to stone development, and urinary stone incidence. With comparisons to European and American populations, the primary risk factors for nephrolithiasis in Asian populations are to be determined through this systematic review and meta-analysis. We synthesized data from 13 geographically different studies using a thorough literature search through PubMed, ScienceDirect, and ResearchGate following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses criteria. Potential targets for specialized public health programs were highlighted by the elucidation of differences in health-care-seeking behavior and disparities in health-care access. The results of this systematic analysis give doctors, researchers, and policymakers a thorough understanding of the condition of nephrolithiasis care in Saudi Arabia today. In addition, to maximize the care of nephrolithiasis in this particular group, this review identifies information gaps and highlights the necessity of context-specific guidelines and future research initiatives. All things considered, this systematic review addresses the unique possibilities and problems that exist within the Saudi Arabian health-care sector while also adding to the worldwide conversation on nephrolithiasis.