Urology Annals最新文献

Foreign body (FB) in the urinary bladder (UB) is uncommon and rarely reported in pediatric patients. FB migration into the UB is an extremely rare and unpredictable condition that needs a high index of suspicion with meticulous history taking and clinical reasoning, so diagnosis may be challenging. In this study, we report two cases of male pediatric patients from Sudan with FB in the UB, with a history of penetrating perineal trauma, both were presented with irritative lower urinary tract symptoms, history of penetrating perineal trauma, and unremarkable clinical examination. Both were diagnosed by abdominal Ultrasound study (USS) and confirmed by cystoscopy. One child was treated by endoscopic extraction, while the other was treated by open surgical extraction. The outcome of treatment of both the cases was satisfactory.

Purpose: The study was performed to examine patient-reported outcomes (PROs) in the 1^st year after surgery and the institutional learning curve after the introduction of robot-assisted radical prostatectomy (RARP).

Materials and methods: The subjects were 320 consecutive patients who underwent RARP from 2014 to 2018. These cases were divided into three groups treated in the early, middle, and late periods, with about 100 cases in each. PROs were recorded using the Expanded Prostate Cancer Index Composite (EPIC).

Results: There were no significant differences among the early, middle, and late periods based on EPIC scores. Urinary function and bother decreased in the 1^st month after surgery, and gradually recovered thereafter. However, urinary function was significantly worse in the 1^st year after surgery than at baseline. Urinary function and bother were better in patients treated with nerve-sparing surgery, and in nerve-sparing cases, urinary function and bother were best in the early period and worst in the late period. These cases also had the best score for sexual function in the early period, but sexual bother was worst in the early period. In contrast, in cases treated without nerve-sparing surgery, urinary function and bother were best in the late period and worst in the early period, although without significant differences.

Conclusion: The functional results of this study based on PROs are useful for providing information for patients. Interestingly, the institutional learning curves for RARP differed in cases that did and did not undergo a nerve-sparing procedure.

Transurethral foreign bodies (FBs) in the urinary tract are rare findings in a clinical setting. The most common cases are reported for FBs in the urinary bladder. The present report similarly aimed to examine a whole pen as a FB with a discussion about symptoms and complexities. Here, we significantly reported the management of pen extraction from the bladder of a female patient using nephroscope and proposed success with possible recommendations for treatment in future operations.

Background: False-positive (FP) multiparametric magnetic resonance imaging (MPMRI) obscures and swift needless biopsies in men with a high prostate-specific antigen.

Materials and methods: This was a retrospective study, in which all patients who had been exposed to consecutive MP-MRI of the prostate combined with transrectal ultrasound-guided-magnetic resonance imaging fusion-guided prostate biopsy between 2017 and 2020 were involved in the study. The FP was measured as the number of biopsies that did not encompass prostate cancer divided by the whole number of biopsies.

Results: The percentage of FP cases was 51.1%, the highest percentage was found in Prostate Imaging-Reporting and Data System (PI-RADs) 3 (37.7%) and the lowest was detected in PI-RAD 5 (14.5%). Those with FP biopsies are younger, and their total prostate antigen (PSA) and PSA density (PSAD) are significantly lesser. The area under the curve PSAD, age, and total PSA are 0.76, 0.74, and 0.69, respectively. An optimum PSAD value of 0.135 was chosen as a cutoff because it showed the highest sum of sensitivity and specificity, 68% and 69%, respectively.

Conclusion: FP results of mpMRI were detected in more than half of our sample, more than one-third were presented in Pi-RAD3, improved imaging techniques to decrease FP rates are highly needed.

Introduction: Simulations are useful and can mirror the situations needed for skills development. They can have significant impacts on patient safety and help physicians gain proficiency in complex procedures with a short learning curve. They have been validated as an assessment tool and can utilize innovative machines or platforms. Here, we evaluate the construct validity and the performance of residents with different levels using UroLift (NeoTract) simulation.

Methods: This was a prospective observational study. Two groups of trainees were distributed according to their training level: junior residents and senior residents. Each had to finish three cases of varying difficulties. The data were first tested with the Shapiro-Wilk normality test. Construct validity used an independent sample t-test; P < 0.05 was considered significant.

Results: Significant differences were seen in performance among junior residents and senior residents in the following skills: proximal centering, mucosal abrasion, and implants in proximal zones. However, insignificant results were seen for number of deployments, successful deployments, lateral suture centering, and implants in the distal zones.

Conclusion: UroLift simulations are useful for training as a practicing tool. Nevertheless, objective performance evaluation using UroLift simulations requires further steps and frameworks as a source of validity before further result interpretation.

Purpose: The purpose of this study is to evaluate and assess the effect of intermittent tamsulosin treatment as a trial to increase the drug safety (in terms of reducing the drug side effects, particularly retrograde ejaculation) while maintaining the effect in reducing the symptoms and assess its impact on the patients' quality of life.

Materials and methods: Patients who enrolled in this study were suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and were using 0.4 mg tamsulosin daily to relieve their symptoms but complained of ejaculatory problems. A baseline assessment involves medical history and evaluation of ejaculatory function abdominopelvic ultrasound, postvoid residual volume (PVR) estimation, the International Prostate Symptom Score (IPSS), quality of life assessed using global satisfaction, vital signs, physical examination including digital rectal examination, and renal function. During the study, patients consented to take 0.4 mg tamsulosin intermittently every other day and to proceed with their sexual activities on the days they did not take the drug in. Baseline assessment was repeated and recorded after 3 months from starting the treatment. The adverse effects and compliance were analyzed in all patients.

Results: Twenty-five patients had a mean baseline IPSS of 6.6 ± 1 and baseline PVR of 87.6 ± 15.1 ml. At the 3^rd month, the mean PVR was 100.4 ± 15.1 ml and the mean IPSS was 7.3 ± 1.1. Moreover, 20 out of the total number of 25 patients (80%) reported improvement in their ejaculation. All our 20 patients who showed improvement in their ejaculatory function are either satisfied or very satisfied (4 or 5), in regard to the global satisfaction rate.

Conclusion: Intermittent tamsulosin therapy (0.4 mg/every other day) is well-tolerated and shows a potential advantage in recovery in patients who suffer from LUTS/BPH and complaining from abnormal ejaculation, especially absent ejaculate. Although there was a significant change in PVR and IPSS after using intermittent tamsulosin therapy. Most patients show a higher overall satisfaction with the treatment compared to the standard dose (0.4 mg/daily). A study on a larger scale is still needed to confirm our results.