Urology Annals最新文献

Objective: Varicocele, the dilation of the pampiniform plexus of the spermatic cord. It is discovered incidentally in most patients. Symptoms vary, but its impact is especially experienced in the field of fertility and reflected in semen parameters. Varicocelectomy is a surgical approach to correct the varicocele, however, reports are conflicting regarding its success. Our aim was to evaluate the efficacy of varicocelectomy on semen parameters and conception rates in patients who underwent surgery and its association with comorbidities such as diabetes, hypertension, and obesity.

Materials and methods: This cross-sectional study included the complete medical records of 86 patients. Data collection form included the patient's age, body mass index (BMI), chronic diseases, smoking, surgical history, medication usage, and the reason for performing surgery. Presurgical and postsurgical semen parameters were evaluated 3 months before surgery and an average of 6 months postoperatively. Data were analyzed with SPSS, Chi-square test, and independent and paired t-test.

Results: No significant difference was found between primary and secondary infertility regarding semen analysis, postoperative semen analysis indicated an improvement in semen motility at 180 min with no effect on other parameters. Using spontaneous intercourse or in vitro fertilization (IVF) after varicocelectomy was significantly associated with increasing conception rates irrespective of the type of infertility. Diabetes, hypertension, BMI, and smoking did not appear to affect semen parameters.

Conclusion: Patients who underwent varicocelectomy had improved sperm motility at 180 min and subsequently had a higher chance of successful conception either through spontaneous intercourse or IVF. Further studies are needed to understand the relationship between conception and sperm motility. Semen parameters were not affected if the patient had comorbidities such as diabetes and hypertension. Furthermore, smoking and BMI did not appear to affect the conception rate.

Background: Tubularized incised plate (TIP) is the most common technique used for distal hypospadias repair with good outcome but with a high rate of urethral stricture. Inner preputial-free graft can be used as an inlay graft in the incised area of the narrow urethral plate, also can be used as an onlay graft for urethroplasty in hypospadias repair to avoid this complication.

Patients and methods: A comparative prospective randomized study was conducted on two groups of hypospadias patients with narrow urethral plate. Group A: dorsal inlay inner preputial graft repair was performed (grafted TIP [G-TIP]) and Group B: ventral onlay preputial graft repair was performed. The assessment of outcome and hypospadias objective scoring evaluation (HOSE) score was done at 2 weeks and 6 months.

Results: Group A included 55 patients for whom dorsal inlay inner preputial graft repair was performed (G-TIP), and Group B which was planned to be conducted on 55 patients using onlay preputial graft (onlay graft) but was terminated after 15 cases due to high failure rate (33%). Group A showed better success rate 96% and better HOSE score (score 16) at 2 months and 6 months 83.6% and 88.2% versus 26.7% and 33.3% in Group B. Postoperative complications showed a statistically significant difference; glans dehiscence (3.6% vs. 40%), wound infection (1.8% vs. 33.3%), and skin sloughing (3.6% vs. 26.7%) in Groups A and B, respectively.

Conclusion: G-TIP is a good technique for the management of distal hypospadias with narrow urethral plate with good success rate, cosmetic outcome, and with less complications compared to onlay graft.

Introduction: Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature is controversial on this topic. Some data showed that pain may persist after the surgery even if the varicocele is not detected postoperatively.

Objectives: The objectives of the study were to identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and postoperative pain resolution, and to identify the need for a secondary procedure after varicocelectomy to control the pain.

Materials and methods: This was a retrospective study of 47 patients who underwent varicocelectomy between March 2016 and December 2018.

Results: Postoperatively, the pain totally resolved after surgery in 64.3% of patients with scrotal pain; it improved in 21.4%, 11.9% have persistent pain, and the pain got worse in only 2.4%. Our study showed 100% complete resolution or improvement with Grade I, 85.7% in Grade II, and 81.3% in Grade III. In addition, all patients who underwent bilateral varicocelectomy had pain that either completely resolved or improved postoperatively. On the other hand, all patients who had persistent pain or pain worsening postoperatively had unilateral varicocelectomy. An additional intervention for postoperative pain control was needed in only 14% of patients, 7% of them underwent embolization, 4.7% had a cord block, and 2.3% were sent to a pain clinic.

Conclusion: Varicocelectomy offers good outcomes in most patients with varicocele-related scrotal pain. The most significant predictor for success was low grade and bilaterality. However, there is a subset of patients whose symptoms will not improve postoperatively. Careful preoperative counseling and expectation management are crucial when discussing surgical options for those patients.

Background: Penile cancer is a rare malignancy which inguinal and pelvic lymph node involvement plays a major role in patients' survival. The prognosis of patients with lymph node metastasis is poorer.

Objective: The objective of the study was to evaluate the prognostic factors for inguinal lymph node and pelvic lymph node involvement.

Materials and methods: This was a retrospective analytic study of medical records between January 2010 and December 2020.

Results: Thirty-nine patients were diagnosed with penile cancer, median age of 59 ± 14.898 (range: 32-86 years) were included in the analysis. Twenty-eight patients underwent inguinal lymph node dissection, 13 patients had inguinal lymph node metastasis (46.4%), 8 patients underwent pelvic lymph node dissection, and 5 patients had pelvic lymph node metastasis (62.5%). Inguinal lymph node metastasis was associated with tumor grading (odds ratio [OR]: 2.92, confidence interval [CI]: 0.123-0.704), lymphovascular invasion (LVI) (OR: 5.182, CI: 0.430-0.996), perineural invasion (PNI) (OR: 3.687, CI: 0.277-0.975), and fixation of inguinal node (OR: 2.463, CI: 0.078-1.195). Pelvic lymph node metastasis was associated with tumor grading (OR: 2.619, CI: 0.033-0.967).

Conclusion: Grading, LVI and PNI of primary tumor, and fixation of inguinal node are significantly associated with inguinal lymph node metastasis. While primary tumor grading is significantly associated with pelvic lymph node metastasis. These factors are associated with poorer prognosis.

Purpose: Myriad operative factors and characteristics of patients may influence the risk of infection in a patient undergoing stone surgery. We prospectively determined the risk factors for systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) in patients undergoing percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS).

Materials and methods: Patients who underwent PCNL and RIRS from March 2018 to January 2020 satisfying our selection criteria were enrolled. Samples of urine from the renal pelvis, bladder, and retrieved stones were sent for culture testing. Postoperatively patients were keenly supervised for any indications of SIRS and qSOFA. The association between stone and urine cultures across various sites was examined. Regression analysis was performed to ascertain clinical variables affiliated with SIRS and qSOFA.

Results: The study included a total of 150 patients including both PCNL and RIRS, of which 23% post-PCNL and 20% post-RIRS met the criteria of SIRS and qSOFA. On univariate analysis in PCNL-Dilated pelvicalyceal system (PCS), renal pelvic urine culture (RPUC), stone culture (SC), and operative time >124 min among others were identified as risk factors whereas, in RIRS-residual calculus, RPUC, SC and operative time >62 min were risk factors. Multivariate analysis identified dilated PCS and SC for PCNL and only intraoperative RPUC for RIRS as independent risk factors. Only a significantly strong correlation among culture analysis was found between RPUC and SC in both the procedures.

Conclusion: Intraoperative RPUC and SCs are better predictors of post-PCNL SIRS while Intraoperative RPUC and duration of surgery are better predictors of post-RIRS sepsis. We, therefore, recommend that both these cultures must routinely be obtained in the above procedures to identify the offending organisms and amend antibiotic therapy during treatment and surgical duration should be kept <62 min in RIRS. SIRS serves as a sensitive review tool which is specifically useful for initial care and on the contrary qSOFA is well suited for patients at greater risk of demise, thereby guiding clinicians to decide future care and course of treatment of patients.

Objective: Laser lithotripsy has been the standard of care for lower and mid-ureteric calculi. Thulium fiber laser (TFL) is a new introduction to this field, which has been extensively studied for retrograde intrarenal surgery. We have done a prospective randomized study of ureteroscopic lithotripsy between TFL and holmium: Yttrium-aluminum-garnet (HO: YAG) laser to know the efficacy of stone fragmentation, stone-free rate, and complications.

Methodology: A prospective randomized study was done in our hospital from March 2021 to May 2022 on patients planned for ureteroscopic laser lithotripsy. Patients with distal and mid-ureteral stones from 4 mm to 15 mm were included. The laser was used to fragment the stone. All the stones were fragmented from the center to periphery. The setting used was up to 10 W (6-10 Hz, 1J) for TFL and up to 10 W for HO: YAG (5-10 Hz, 0.5-1J). Once the stones were fragmented, they were retrieved until complete visual clearance. Demographic data and stone parameters such as stone size, volume, density, laterality, laser usage time, total operative time, and total energy used were recorded. Operative time, lasering time, retropulsion rate, ablation speed, and visibility score were recorded.

Results: Each group had 90 randomized patients. Both the groups had similar kinds of patient and stone profiles. The mean operating time was 18.5 ± 1.5 min (95% confidence interval [CI] 16.2-25.6) in the TFL group, which was shorter than the holmium group 31.6 ± 1.2 min (95% CI 18.4-38.5), and it was statistically significant (P = 0.024,). Lasering time was also statistically significant with less lasering time with TFL group 7.4 ± 1.8 min (95% CI 5.2-10.3) versus holmium group 14.8 ± 1.5 min (95% CI 12.3-18.4) (P = 0.011). Laser efficacy and ablation speed were better in the TFL group compared to the HO: YAG group and were statistically significant. The visual score was better in HO: YAG group compared to the TFL group.

Conclusion: TFL is more efficacious and faster than Holmium: Yag laser. Complications were similar between the groups. Stone-free rate was also similar between both the groups.

Penile cancer is a rare malignancy of the male genital system. Approximately 98% of penile cancer corresponds to squamous cell carcinoma (SCC), with further morphological and molecular classification into human papillomavirus (HPV) dependent and non-HPV SCC. Compared to HPV-induced SCC, non-HPV SCC appeared to have a worse prognosis. Here, we present a case of an uncircumcised male with an unusual coral-like polymorphic lesion, and confirmed histopathology of well-differentiated non-HPV penile SCC with rapid growth progression.

Objectives: Patients with urolithiasis receive a significant amount of radiation during diagnosis, treatment, and follow-up of their pathology, with nearly 20% receiving more than the annual recommended, creating a growing concern regarding radiation exposure faced by patients and health personnel. The objectives of the study were to describe a standardized fluoroscopy-free (FF) semirigid (SR) ureteroscopy (URS) technique for ureteral stone treatment and to determine the feasibility, efficacy, and safety of this technique for the treatment of ureteral stones comparing it to a historical cohort of fluoroscopy-guided (FG) SR-URS.

Materials and methods: A prospective single-arm study of patients submitted to FF SR-URS was conducted. Visual and tactile cues were employed to avoid the use of ionizing radiation. The success (feasibility), stone-free (efficacy), and complication (safety) rates of each procedure were registered. The results were compared to a historical cohort of patients that underwent FG SR-URS at our center.

Results: One hundred and five patients subjected to FF SR-URS were included in the study and compared to a historical cohort of 87 patients subjected to FG SR-URS. The main characteristics were comparable among groups. Ninety-seven patients (92.38%) were completed without any use of ionizing radiation. The stone-free rate was 92.45%, similar to the historical cohort. Only Clavien I and II complications were found without statistical difference between the study groups. The average dose of radiation exposure for the historical cohort was approximately 0.5 mSv.

Conclusions: FF SR-URS is a feasible, efficacious, and safe technique for treating the ureteral stones for urologists with good practice of the traditional technique. Implementing this procedure allows a decrease in radiation exposure to both patients and health personnel.

Background: Although testicular cancer (TC) is the most common malignancy in males between the ages of 18 and 50 years, little effort has been made to increase public awareness about TC and testicular self-examinations (TSEs). Therefore, the aim of this study was to assess the level of awareness of TC and TSEs in the Saudi population.

Materials and methods: This study was conducted using a structured questionnaire distributed online through social media platforms. The questionnaire consisted of 11 questions related to TC and TSE. All relevant data were moved into an Excel sheet, and data analyses were carried out using SPSS.

Results: A total of 849 responses were received. The proportion of respondents who knew any information about TC was 26.5%, with media or the Internet being the most common sources of information (16.3%). In addition, 5.5% of respondents knew how to perform a TSE, although only 4% actually performed TSEs. The patient age group was an independent significant predictor of this knowledge, with a P = 0.031.

Conclusions: These findings suggest that there is a low level of public awareness and knowledge of TC and TSE in Saudi Arabia, and further efforts should be focused on raising public awareness.

Objective: The objective is to compare supine and prone positions in terms of arterial blood gas during lithotripsy endourology procedures in different stages.

Material and methods: Cases of during lithotripsy endourology procedures in our department from March to September 2020 were included prospectively. The variables registered were body mass index, age, the American Society of Anesthesiologists (ASA) score, diabetes mellitus, positive end-expiratory pressure (PEEP), FiO₂, stone size, stone location, procedural type, position, procedure duration, PaO₂, SaO₂, PaCO₂, pH, and dynamic compliance. PaO₂, SaO₂, PaCO_2, pH, and dynamic compliance were recorded at the beginning of the procedure, 5 min later, 15 min later, and at the end of the procedure.

Results: Thirty patients in prone position and 30 in lithotomy position were included in this study. Patients in prone position underwent percutaneous nephrolithotomy, and patients in supine/lithotomy underwent retrograde intrarenal surgery or ureteroscopy. Statistically significant differences were found in PEEP, duration, PaO₂ at the beginning, SaO₂ at the beginning and at the end of the procedure, PaCO₂ at the beginning and at minute 5 and pH at the beginning of the surgery. The saturation PaO2 increased significantly on prone position and was statistically significantly better at the end of the surgery.

Conclusions: Both prone and supine positions were safe regarding anesthesiologic risk and had no clinically relevant differences in terms of individual comparisons in arterial blood gas parameters in static moments of the procedure. Prone position was related to an increase in PaO₂ and a drop in PaCO₂ gradually from the beginning to the end of the surgery.