Urology Annals最新文献

A 85-year-old female patient underwent nephrostomy tube insertion for a huge hydronephrosis due to a papillary mass involving the right ureteral ostium diagnosed by at computed tomography scan. As soon as the nephrostomy tube was inserted, a pulsatile bleeding was found and a renal angiography was done. A massive bleeding from the main and unique right renal artery was found such as to require prompt endovascular embolization. A transurethral resection of the bladder was performed and the pathology report confirmed high-grade pTa transitional cell carcinoma. An open drainage was then placed to empty the contents of the pyelocalyceal system of the kidney. Once obtained the volumetric reduction of the abdominal mass the patient underwent the right nephroureterectomy.

Objective: The objective of this study is to compare the outcome of percutaneous nephrostomy by ultrasound (US) versus fluoroscopy including access time, volume of anesthesia required, success rate, and complications.

Methods: One hundred patients were enrolled in a prospective randomized study. Patients were divided into two groups, 50 cases each. Comparing the two groups was done regarding the need for dye, radiation effect, time taken, trial number, rate of complication, volume of anesthesia, and success rate.

Results: Patient demographics were comparable between both groups with no statistically significant difference. According to the modified Clavien-Dindo classification, the complications were Grade I (pain and mild hematuria) in each group. Procedural pain was present in 41 (82%) patients in Group I and in 48 (96%) patients in Group II. It was treated in both groups with a simple analgesic. Mild hematuria was present in 5 (10%) patients in the US group and 13 (26%) in the fluoroscopic group and treated by hemostatic drugs only. There was a statistically significant difference between both groups regarding the volume of required local anesthesia, the trial numbers, the puncture numbers, bleeding, extravasation, and change in the hemoglobin level.

Conclusion: US percutaneous renal access is a safe and effective modality with a high success rate, less operative time, and complication rate. However, a minimum of 50 cases with some pelvicalyceal system dilation may be preliminary requisites to achieve good orientation and competence in achieving safe US percutaneous renal access for future endourological procedures.

Purpose: The purpose of this study was to evaluate renal parenchymal trauma of two-step dilation compared to the conventional Amplatz gradual dilation during percutaneous nephrolithotomy on a porcine model.

Materials and methods: A nonpapillary percutaneous access tract was established under fluoroscopic guidance in both kidneys of four female pigs. On the right kidney of each pig, gradual dilation was performed using an Amplatz dilator set with a gradual dilation to 30 Fr, whereas on the left, a two-step dilation was utilized using only 16 Fr and 30 Fr dilators. Two of the animals were euthanized immediately after the procedure and the remaining two 1 month later. The pigs that were kept alive underwent a contrast-enhanced computed tomography immediately, 15, and 30 days postoperatively. A dimercaptosuccinic acid (DMSA) scintigraphy and single-photon emission computed tomography-computed tomography (CT) were also performed after the last CT and afterward, the pigs were sacrificed. All kidneys were harvested for pathohistological examination.

Results: The follow-up radiologic imaging showed similar parenchymal damage caused by the compared dilation techniques and an expected reduction in scar size in the later scans. No scar was identified by DMSA in any kidney. Gross and microscopic examinations conducted both on the kidneys that were harvested immediately after the procedure and the ones from the animals that were left to heal, revealed no significant differences in tissue damage, grade of fibrosis, or inflammation depending on the dilation method.

Conclusions: Our study showed no inferior outcomes caused by two-step dilation compared to gradual dilation regarding renal parenchymal damage following a nonpapillary puncture. In fact, postoperative imaging findings suggested a trend toward better healing and less scar tissue when the two-step method was used.

Background: Benign prostatic hyperplasia is a common benign disease occurs in older men. Some patients can be treated medically but eventually, most of them will need a surgical intervention, and the most commonly applied procedure is transurethral resection of the prostate (TURP).

Objectives: The objective of this study is to assess the feasibility and safety of performing transurethral resection of large prostate (80 g and more).

Methodology: Out of 153 patients reviewed 48 cases included in this study. The main data collected from patients' files and patient interview. The criteria of exclusion were prostate size <80 g and previous history of TURP. The collected data were analyzed by the Statistical Package for the Social Sciences (SPSS).

Results: The main results showed that 93.7% of patients did not experience major bleeding postoperatively, neither major drop in hemoglobin level. Moreover, the patient's distribution according to the presence of TUR syndrome was only 2.1% with mild symptoms. No patient had an episode of retention during the hospital stay or in the follow-up.

Conclusion: Surgeon experience, systematic resection approach, and strict time of resection are important factors to assure the safety of TURP in large prostate. In cases of huge prostate size >100 g, staged TURP can be offered safely or if patients' obstructive symptoms do not resolve after the first procedure.

Objective: The present retrospective study evaluates the effectiveness and tolerability of alpha-blockers as monotherapy in patients with benign prostatic hyperplasia associated with lower urinary tract symptoms (LUTS).

Materials and methods: A total of 335 male patients >50 years were categorized into four groups (Alfuzosin: 166, Silodosin: 67, Tamsulosin: 70, Prazosin: 32). The efficacy evaluated as a change in International Prostate Symptom Score (IPSS), peak flow rate (Qmax), residual urine volume, and relief from LUTS, and tolerability of the various alpha-blockers was assessed across the study group.

Results: At baseline, most of the patients in alfuzosin (60%), silodosin (77%), and tamsulosin (90%) groups presented with severe IPSS (20-35), whereas patients in the prazosin group (69%) presented with a moderate score. At the end of the study, the mean IPSS gradually improved to moderate (41%, 62%, 66%, and 28%) and mild (59%, 38%, 28%, and 72%) in the alfuzosin, silodosin, tamsulosin, and prazosin groups, respectively (P = 0.004), with improvement in mean change in residual urine volume and complete relief from LUTS symptoms with no surgical or radiological interventions. Overall, 194 adverse events (AEs) were observed in 38.8% of patients. Of the total AEs, patients in the alfuzosin, silodosin, tamsulosin, and prazosin groups experienced 21%, 22%, 39%, and 18% of AEs, respectively.

Conclusion: The nonselective alpha-adrenergic receptor antagonist, alfuzosin, emerged as noninferior in effectiveness and superior in tolerability than other selective alpha-blockers, silodosin, tamsulosin, and prazosin.

Introduction: Gaining access to the kidney is crucial step in percutaneous nephrolithotomy (PCNL); it has a steep learning curve.

Objective: Describe the mathematical method to predict renal puncture angle and distance based on preoperative computed tomography (CT) measurements. Then evaluating how it correlates with measured values.

Patients and methods: The study was prospectively designed. After ethical committee approval, the study uses data from preoperative CT to construct a triangle so we can estimate puncture depth and angle. A triangle of three points, the first is point of entry to the pelvicalyceal system (PCS), the second is point on the skin perpendicular to it, and the third where the needle punctures the skin. The needle travel is estimated using the Pythagorean theorem and puncture angle using the inverse sine function. We evaluated 40 punctures in 36 PCNL procedures. After PCS puncture using fluoroscopy-guided triangulation, we measured the needle travel distance and angle to the horizontal plane. Then compared the results with mathematically estimated values.

Results: We targeted posterior lower calyx in 21 (70%) case. The correlation between measured and estimated needle travel distance with Rho coefficient of 0.76 with P < 0.001. The mean difference between the estimated and the measured needle travel was - 0.37 ± 1.2 cm (-2.6-1.6). Measured and estimated angle correlate with Rho coefficient of 0.77 and P < 0.001. The mean difference between the estimated and the measured angle was 2° ± 8° (-21°-16°).

Conclusion: Mathematical estimation of needle depth and angle for gaining access to the kidney correlates well with measured values.

We presented two rare cases of secondary seminal vesicle (SV) metastasis from hepatocellular carcinoma of the liver and renal cell carcinoma from the right kidney. Diagnosis of secondary SV metastasis should be made based on clinical history, radiological examination, histopathological examination, and, more importantly, the directed panel of immunohistochemistry. Via our experience in the investigation and diagnostic process, a better understanding of this unusual disease can be achieved.

Objectives: Over the past 20 years, the utility of partial nephrectomy (PN), compared to radical nephrectomy (RN), for the management of localized renal cell carcinoma (RCC) has progressively increased, particularly for larger and more complex masses. We sought to compare the recurrence-free survival (RFS) outcomes of PN versus RN in a single-institution cohort.

Methods: Between 2002 and 2017, 228 patients underwent RN or PN for lcT1a-T2b, N0M0 RCC at a single tertiary referral center, performed by five surgeons. The clinical end point result was (local or distant) RFS. Univariate and multivariate (cox regression) models were used to evaluate the association between type of surgery (PN vs. RN) and RFS, in the overall cohort and in a subgroup of patients with cT1b.

Results: The median age was 59 (interquartile range [IQR] 48-66), and the median tumor size was 4.5 cm (IQR 3-7). There were 128 PN and 100 RN. Over a median follow-up of 4.2 years (IQR 2.2-6.9), the Kaplan-Meier analysis showed no significant RFS difference between PN and RN (logrank P = 0.53). On multivariate analysis, pathologic stage ≥T2a, Fuhrman Grade ≥3, and chromophobe histology were associated with a worse RFS. PN was not significantly associated with diminished RFS (Hazard ratio [HR] 1.78, 95% confidence interval [CI] 0.74-4.3, P = 0.199) in the overall cohort compared to RN. However, in the cT1b subgroup, PN was associated with a significant increase in recurrence compared to RN (HR = 12.4, 95% CI 1.45-133.4, P = 0.038).

Conclusions: Our institutional data highlight the possibility of compromise in RFS for clinically localized RCC treated with PN compared to RN, particularly for larger and more complex masses. These data raise concern, especially in light of the nonproven association of survival benefit of PN over RN, warranting future randomized prospective studies for further evaluation.

Background: One of the leading causes of mortality and morbidity worldwide is cancer; this encompasses a challenging health issue for both health providers and the community. Bladder cancer is the ninth most common cancer worldwide. However, few studies have been conducted to estimate the level of knowledge and awareness of urinary bladder cancer among the general population globally and nationally. Therefore, the following study aims to assess the magnitude and level of awareness of urinary bladder cancer among citizens in western Saudi Arabia.

Methodology: The following survey-based cross-sectional study was conducted in Saudi Arabia's western region from April to May 2019. A structured questionnaire exploring the knowledge of urinary bladder cancer was given to the participants. In addition, participants' demographics, social determinants, and past personal and family histories were gathered. The sum of the awareness responses was graded as positive or negative and correlated to determinants.

Results: A total of 927 participants participated in the study. 74.2% were male, and for most participants, the highest educational level was a university degree (64.7%). The majority of the participants were unmarried (single) (51%) and widowed participants represented the lowest response (3.7%). The majority of the participants were aware of the term "urinary bladder cancer" (78.2%), yet only 24.8% acquainted good knowledge about urinary bladder cancer.

Conclusion: We found that the citizens in Saudi Arabia have insufficient knowledge of urinary bladder cancer and its detriments.

Objective: The objective of this study was to determine risk factors for delayed response in patients with neurogenic and idiopathic overactive bladder (OAB) after intradetrusor onabotulinumtoxin A injection.

Subjects and methods: This is a retrospective study that included 87 patients who underwent onabotulinumtoxin A intradetrusor injection from October 2011 to November 2019. Patients were followed up at 2, 4, and 12 weeks post intervention in the outpatient clinic and over the phone. The data of patients with early response were compared with those with late response using univariate and multivariate analyses.

Results: The study included 87 patients. The mean age was 41 ± 15.3 standard deviation, and 69% of the participants were female. Fifty-one percent were diagnosed with neurogenic OAB. A median response time to onabotulinumtoxin A injection of 7 days was demonstrated, and patients who responded during the first 7 days post procedure were considered early responders. Independent predictors for late response include diabetes (Relative risk: 3.89, P = 0.018, and 95% confidence interval [CI]: 1.26-11.98), >1 BTX-A session (Relative risk: 4, P = 0.011, and 95% CI: 1.38-11.6), and wet OAB (RR: 9.94, P = 0.002, and 95% CI: 2.31-42.17).

Conclusions: The median time of onset post intradetrusor injection of onabotulinumtoxin A was found to be 7 days. Diabetes mellitus, wet OAB, and <1 Botox sessions were independent risk factors for late onset of response.