Urology Annals最新文献

Large testicular tumor is not a commonly seen entity in the modern era. While treatment of large testicular tumors is via inguinal radical orchiectomy, large testicular tumors carry the dilemma of delivering these large masses via the inguinal or scrotal approach. Here, we present a case of a 53-year-old male patient with a testicular tumor weighing 2.170 kg, measuring 22 cm × 16 cm × 12 cm, who was treated via inguinal orchiectomy with the extension of the surgical wound to the neck of the scrotum, with pathological report showing seminoma with no spermatic cord invasion. We review some case reports of such large tumors to illustrate this treatment dilemma.

Carcinoma prostate is the second most common malignancy in males. It starts with a relatively indolent course and maybe asymptomatic during the initial stages. However, metastasis is highly common in Carcinoma prostate. The sites of metastases include bone, lung, liver, pleura and adrenals with cutaneous metastasis being one of the rarest sites being less than 1%. In our case report we present one such rare finding of Carcinoma prostate with cutaneous metastasis.

Uterine prolapse is a condition where some or all parts of uterus descended into the introitus vagina. Patients usually present with lump, feeling of discomfort, pain, urinary, and defecating disorders. Uterine prolapse happen to almost half of the women population. Almost half of the women who had given birth suffer from pelvic organ prolapse that is diagnosed through physical examination; however, only 5%-20% of patients present with symptoms. Uterine prolapse with vesicolithiasis is a rare case. Uterine prolapse can cause bladder obstruction, urine stasis, and chronic infection, which become the risk factors to the increase of urine saturation that can lead to vesicolithiasis. We present a case of multiple vesicolithiasis on cystocele and uterine prolapse in a 79-year-old female who has difficulty of urinating, feeling of burning in the end of urinating, and a mass that protrudes from the vagina for 33 years ago. The patient underwent pervaginam hysterectomy, anterior and posterior colporrhaphy, open vesicolithotomy, and cystoscopy biopsy of the bladder mucosa. She evolved with good postoperative condition and was then discharged.

Background: Hypospadias is among the common congenital anomalies in boys. Snodgrass urethroplasty is one of the most popular techniques for correcting distal and mid hypospadias. Although there is consensus among pediatric surgeons on using absorbable sutures for urethroplasty, there are no established guidelines about the suturing techniques (interrupted suturing [IS] or continuous suturing [CS]) for neourethra creation in Snodgrass urethroplasty. This analysis aims to compare the reported outcomes of both the urethroplasty suturing techniques.

Materials and methods: This systematic review and meta-analysis was conducted as per the preferred reporting items for systematic review and meta-analyses guidelines. A systematic, detailed search was carried out by the authors in the electronic databases - MEDLINE, PubMed Central, Scopus, Google Scholar, and Clinical Trial Registry. Studies were selected and compared based on primary outcomes - development of urethrocutaneous fistula (UCF), meatal stenosis, and secondary outcomes - wound infection, urethral stricture, and operative time. Statistical analysis was performed using a fixed-effect model, pooled risk ratio, and I2 heterogeneity.

Results: Five randomized studies with a total of 521 patients met our inclusion criteria. Pooled analysis for total complications, UCF, meatal stenosis, and wound infection showed no significant difference between the CS and IS groups. Subgroup analysis of patients with the use of polyglactin sutures showed a decrease in total complications and UCF in the IS group.

Conclusion: There is no difference in total complication rates among the CS and the IS group with the use of absorbable sutures in Snodgrass urethroplasty; however, there is a decrease in the incidence of total complications and UCF in the IS group when polyglactin was preferred over polydioxanone suture for urethroplasty.

Objective: A worldwide increased incidence of urolithiasis has been observed over the past few decades. Insight into the composition of these stones can lead to enhanced medical treatment and outcomes. The objective of this study was to examine the distribution and chemical composition of urinary calculi in Southern Thailand over the past decade.

Materials and methods: An analysis was conducted on 2611 urinary calculi submitted to the Stone Analysis Laboratory, Songklanagarind Hospital, a single stone analysis laboratory in Southern Thailand. The analysis was performed from 2007 to 2020 using Fourier-transform infrared spectroscopy. The demographic results were described using descriptive statistical analyses, and the Chi-square test for trends was performed to identify changes in urinary calculi composition.

Results: The patients' demographic data revealed a male-to-female ratio of 2.2:1; the most common age group of affected men was 50-69 years, whereas the most common age group of affected women was 40-59 years. The most common components found in the calculi were uric acid (30.6%), mixed calcium oxalate with calcium phosphate (29.2%), and calcium oxalate (26.7%). We noted a trend of increasing uric acid calculi for 14 years (P = 0.00493), whereas the trend for the other major components was decreasing.

Conclusion: The most common component of urinary calculi analyzed in Southern Thailand was uric acid, with a significant rising trend in proportion in the past decade; the trend of other major components, such as mixed calcium oxalate-calcium phosphate and calcium oxalate, decreased.

Introduction: Patients suffering from stricture urethra and deranged renal function have poor quality of life. The incidence of urethral stricture co-existing with renal failure is comparatively small and cause may be multifactorial. There is paucity of literature on management of urethral stricture associated with deranged renal function. We present our experience of managing stricture urethra associated with chronic renal failure.

Materials and methods: This was a retrospective study conducted from 2010 to 2019. Patients with stricture urethra and deranged renal function (serum creatinine >1.5 mg/dl) who underwent urethroplasty or perineal urethrostomy were included in our study. A total of 47 patients met the inclusion criteria and were included in this study. Patients were followed every 3 months in their 1^st year of surgery and 6 monthly thereafter. Statistical analysis was done using SPSS version 16.

Results: There was a significant increase in the mean postopérative maximum and average urinary flow rates when compared to the preoperative values. The overall success rate was 76.59%. Out of 47 patients, 10 had wound infection and delayed wound healing, 2 patients developed ventricular arrhythmias, 6 patients developed fluid and electrolyte imbalance, 2 patients developed seizures, and 1 patient developed septicemia in the postoperative period.

Conclusion: Prevalence of patients with chronic renal failure associated with stricture urethra was 4.58% and features suggestive of deranged renal function at presentation were present in 1.81% patients. In the present study, complications related with chronic renal failure occurred in 17 (36.17%) patients. Multidisciplinary care of the patient along with appropriate surgical management is a viable option in this sub-group of patients.

Introduction: Testicular torsion is a surgical emergency that, with delayed treatment, may be associated with loss of the testis. It commonly presents with sudden onset testicular pain, vague lower abdominal pain, nausea, and vomiting. Management often requires emergent surgical scrotal exploration, detorsion, and fixation or removal of the affected testis.

Materials and methods: Retrospective review of all the patients in a hospital covering the Muharraq district in Bahrain presenting with testicular pain.

Results: During the six-year period from 2015 to 2021, 48 patients with testicular torsion were managed, with a mean age of 18.4 (± 9.2) years. Most patients (54.7%) presented within 6 hours of the onset of symptoms. All 48 patients underwent a doppler ultrasound, which confirmed the presence of testicular torsion in 87.5% of patients, with a sensitivity of 87% and specificity of 98.5%. Fourteen patients had non-viable testis on surgical exploration, with an average age of 16.6 (± 6.8) years and took an average of 13 to 24 hours to present to the emergency department after the start of pain. Most patients underwent scrotal ultrasound 60 minutes from the presentation to the emergency department and surgical exploration within 120 to 179 minutes. The rate of testicular torsion in patients who underwent diagnostic ultrasound at 60 minutes or more from presentation was 40%, compared to an overall rate of 29%. All detected cases of testicular torsion, except for one case, underwent bilateral fixation of the testes. Of those patients who underwent contralateral fixation, none presented with contralateral torsion, supporting the recommendation of contralateral fixation.

Conclusion: Patients underwent comprehensive assessment of their complaint and emergent surgical intervention, including an ultrasound that did not delay the surgical intervention. We agree that clinical judgment is the primary tool for assessment of patients with acute scrotum and an adjunct emergent ultrasound does not significantly cause delays. We concur with the current recommendations for contralateral fixation and prompt surgical management as the anatomical anomaly is present bilaterally.

Introduction and objectives: Urinary bladder tamponade is a common urological emergency, but it has so far been insufficiently researched. The aim of our study was to show the association between the characteristics of bladder cancer (grade and invasiveness) and disease course severity based on blood hemoglobin (Hgb) count at admission, the need for red blood cell transfusion (RBCT), and the length of hospitalization in patients suffering from bladder tamponade.

Materials and methods: A retrospective, cross-sectional study was conducted, namely, including 25 adult patients surgically treated for bladder tamponade resulting from a bleeding bladder cancer.

Results: Patients with low-grade cancer had statistically significantly higher mean Hgb values at admission (101.14 ± 8.26 vs. 87.22 g/L ± 10.64 g/L, P = 0.005), as well as a lower mean number of received units of RBCT (0.71 ± 0.76 vs. 2.39 ± 1.46, P < 0.001) and a shorter hospitalization (2.43 ± 0.55 vs. 4.36 ± 1.04 days, P = 0.009) than those with high-grade cancer. Patients suffering from nonmuscle-invasive bladder cancer (NMIBC) had statistically significantly higher mean Hgb values at admission (96.69 ± 9.86 g/L vs. 81.22 ± 7.23 g/L, P = 0.001), as well as a lower mean number of received units of RBCT (1.31 ± 1.2 vs. 3 ± 1.41, P = 0.004) and a shorter hospitalization (3.31 ± 1.14 vs. 4.78 ± 0.97 days, P = 0.004) than those with muscle-invasive bladder cancer.

Conclusion: Low-grade bladder cancer and NMIBC are associated with a milder clinical course of bladder tamponade.

Purpose: Prostate cryoablation has been proposed as an alternative to radical prostatectomy for men with localized prostate cancer (PCa); however, it is limited by the lack of data regarding oncological outcomes and the impossibility of performing a lymph node dissection. The aim of this study was to assess if whole-gland cryoablation is oncologically safe, especially for patients in whom pelvic lymph node dissection would be necessary.

Materials and methods: After institutional review board approval, we identified 102 patients who underwent whole-gland prostate cryoablation between 2013 and April 2019. Lymph node invasion (LNI) probability was computed using Briganti nomogram, and a 5% cutoff probability was used to stratify the population in two groups. Biochemical recurrence after procedure was assessed using Phoenix criteria. Multiparametric magnetic resonance imaging, (CT), and bone scan or choline positron-emission tomography/CT were performed for the detection of distant metastases.

Results: Seventeen (17%) patients were treated for a low-risk PCa, 48 (47%) patients were at intermediate-risk PCa, and 37 (36%) patients were at high-risk PCa. Patients with a probability of LNI >5% (n = 46) exhibited higher prostate-specific antigen (PSA), PSA density, ISUP Grade Group, CT stage, and european association of urology (EAU) risk. Recurrence-free survival rates at 3 years' follow-up were 93%, 82%, and 72%, respectively for low-, intermediate-, and high-risk patients. At a median follow-up of 37 months (17-62), additional treatment and metastasis-free survival were 84% and 97%, respectively. No differences in oncological outcomes were found in patients with a probability of LNI above and below 5%.

Conclusions: Prostate whole-gland cryoablation can be considered a safe procedure with acceptable outcomes in low- and intermediate-risk patients. A high preoperative risk of nodal involvement could not be considered an exclusion criterion to perform cryoablation. Further studies are required.