Urology Annals最新文献

High-flow priapism (HFP) is a rare disorder that causes prolonged, painless erections. Because it has the potential to permanently damage erectile function, HFP should be promptly treated to regain potency. The suggested therapies for nonischemic priapism include surgical ligation of the arteriocavernous fistulae or selective arterial embolization. However, extensive studies regarding angioembolization in priapismus patients are still lacking, while most of them were case reports, this article aimed to compile and reviewed the available studies regarding therapeutic angioembolization as the management modality of priapism. This systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists. We included 16 studies involving 52 patients in this review. Our review found that angioembolization had favorable rates of clinical symptom alleviation and favorable rates of erectile function improvement.

Introduction: Chronic kidney disease is a global health challenge, often progressing to end-stage renal disease requiring renal replacement therapies such as dialysis or transplantation. Kidney transplantation is the preferred treatment due to its superior effectiveness in improving survival and quality of life compared to dialysis. In addition, living kidney donation, while generally safe, may impact the donor's psychological and social well-being. The present study investigates the quality of life and social outcomes of living kidney donors, offering important insights into donor experiences in Saudi Arabia.

Methodology: This cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, and Jeddah, Saudi Arabia, between 2022 and 2024. A total of 224 kidney donors participated, with data collected through telephone interviews using the validated Perceived Donation Consequences Scale to assess psychosocial outcomes, including physical health, quality of life, and social relationships. Demographic data were extracted from electronic medical records.

Results: A total of 224 kidney donors participated in the study. The majority of donors were male (72.8%) and married (66.1%), with 79.9% donating to immediate family members. The study showed that 48.2% reported improved quality of life. Moreover, 90.2% of donors would choose to donate again, and 86.6% would recommend donation to others. While 75.4% of donors reported that the surgery met their expectations, 29% experienced ongoing physical symptoms such as pain and fatigue. Psychosocial outcomes were generally positive, with 78.6% reporting no negative impact on family relationships and 70.1% indicating that their job prospects were unaffected.

Conclusion: This study demonstrates that kidney donation generally leads to high levels of satisfaction and positive psychosocial outcomes for donors. While most donors reported improved quality of life and strong motivation to donate again, a subset experienced ongoing physical symptoms such as pain and fatigue.

Background: Transurethral resection of the prostate (TURP) remains the gold standard surgical approach for benign prostatic obstruction. Our aim in this study was to assess factors affecting failure of the first trial of void (TOV) post-TURP.

Methods: This was a retrospective study that included all patients who underwent TURP from January 2016 to January 2020 at our tertiary care endourology center. Patients and prostate characteristics were collected. Patients who developed complications intraoperatively were excluded. Multivariable analysis was performed to identify factors which predict the failure of the first TOV. Furthermore, predictors of acute urinary retention within 30 days from TURP were assessed.

Results: A total of 263 patients who underwent TURP were collected. The mean age was 72.76 ± 8.65 years. Patients with diabetes mellitus (DM) were 50.2% and hypertension were 64.6%. The majority of patients, 78%, had a history of retention before TURP and the most commonly used medication before the operation was alpha-blocker. On univariate analysis, patients who were on Foley's catheter and patients who had type II DM were associated with significantly higher failure of first TOV (15.2% vs. 5.9%; P = 0.031) and (18.2% vs. 6.1%; P = 0.003). However, the multivariable analysis revealed that only patients with type II DM had six times (odds ratios: 5.837; P = 0.006) higher chance to fail the first TOV.

Conclusion: Type II DM was associated with six times increase in the incidence of failure of the first TOV following TURP.

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.

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.

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.