Pub Date : 2024-09-18DOI: 10.1186/s12301-024-00453-y
Sultan Mohamed Sultan, Baher Salman, Eman Abdelrazek, Ammar Alorabi, Mohamed Selim
Since radical cystectomy is associated with relatively high perioperative morbidity and mortality, this study was conducted to evaluate the efficacy of perioperative immune nutrition in radical cystectomy patients on postoperative outcomes including wound healing, postoperative complications, either infectious or non-infectious, and length of hospital stay. This prospective, randomized controlled study was conducted between June 2022 and November 2023. Forty-two patients who had undergone radical cystectomy with ileal conduit were randomized into two groups: the immune nutrition group, which received perioperative immune nutrition, and the conventional group, which did not receive immune nutrition. Patients were followed up for 30 days postoperatively to assess wound healing, infectious and non-infectious complications, and the length of hospital stay. Patients who received immune nutrition had significantly lower postoperative infectious complications (19.0 vs 61.9%; P = 0.004), shorter hospital stay (16.57 ± 3.74 vs 20.38 ± 5.97; P = 0.01) and shorter ICU stay (2.60 ± 1.07 vs 7.09 ± 7.50; P = 0.029). The proper wound healing was significantly higher in the immune nutrition group (90.5 vs 52.4%; P = 0.006). However, there was no significant difference between both groups in the rate of non-infectious complications (28.5% vs. 57.1%, P = 0.061). Perioperative immune nutrition is associated with improved wound healing, reduced infectious complications, and reduced length of hospital stay. Trial registration clinicaltrials.gov, NCT05822518. Registered 1 April 2023—Retrospectively registered, https://clinicaltrials.gov/study/NCT05822518 .
由于根治性膀胱切除术的围手术期发病率和死亡率相对较高，本研究旨在评估根治性膀胱切除术患者围手术期免疫营养对术后结果的影响，包括伤口愈合、术后感染性或非感染性并发症以及住院时间。这项前瞻性随机对照研究于 2022 年 6 月至 2023 年 11 月期间进行。42名接受根治性膀胱切除术和回肠导管的患者被随机分为两组：免疫营养组和常规组，前者接受围手术期免疫营养，后者不接受免疫营养。术后对患者进行了 30 天的随访，以评估伤口愈合情况、感染性和非感染性并发症以及住院时间。接受免疫营养的患者术后感染性并发症明显降低（19.0 vs 61.9%; P = 0.004），住院时间明显缩短（16.57 ± 3.74 vs 20.38 ± 5.97; P = 0.01），重症监护室住院时间明显缩短（2.60 ± 1.07 vs 7.09 ± 7.50; P = 0.029）。免疫营养组的伤口愈合率明显更高（90.5% vs 52.4%；P = 0.006）。然而，两组的非感染性并发症发生率没有明显差异（28.5% vs. 57.1%，P = 0.061）。围手术期免疫营养与改善伤口愈合、减少感染性并发症和缩短住院时间有关。试验注册 clinicaltrials.gov，NCT05822518。2023年4月1日注册-回顾性注册，https://clinicaltrials.gov/study/NCT05822518 。
{"title":"Outcome of perioperative immune enhancing nutrition in patients undergoing radical cystectomy","authors":"Sultan Mohamed Sultan, Baher Salman, Eman Abdelrazek, Ammar Alorabi, Mohamed Selim","doi":"10.1186/s12301-024-00453-y","DOIUrl":"https://doi.org/10.1186/s12301-024-00453-y","url":null,"abstract":"Since radical cystectomy is associated with relatively high perioperative morbidity and mortality, this study was conducted to evaluate the efficacy of perioperative immune nutrition in radical cystectomy patients on postoperative outcomes including wound healing, postoperative complications, either infectious or non-infectious, and length of hospital stay. This prospective, randomized controlled study was conducted between June 2022 and November 2023. Forty-two patients who had undergone radical cystectomy with ileal conduit were randomized into two groups: the immune nutrition group, which received perioperative immune nutrition, and the conventional group, which did not receive immune nutrition. Patients were followed up for 30 days postoperatively to assess wound healing, infectious and non-infectious complications, and the length of hospital stay. Patients who received immune nutrition had significantly lower postoperative infectious complications (19.0 vs 61.9%; P = 0.004), shorter hospital stay (16.57 ± 3.74 vs 20.38 ± 5.97; P = 0.01) and shorter ICU stay (2.60 ± 1.07 vs 7.09 ± 7.50; P = 0.029). The proper wound healing was significantly higher in the immune nutrition group (90.5 vs 52.4%; P = 0.006). However, there was no significant difference between both groups in the rate of non-infectious complications (28.5% vs. 57.1%, P = 0.061). Perioperative immune nutrition is associated with improved wound healing, reduced infectious complications, and reduced length of hospital stay. Trial registration clinicaltrials.gov, NCT05822518. Registered 1 April 2023—Retrospectively registered, https://clinicaltrials.gov/study/NCT05822518 .","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1186/s12301-024-00449-8
Samir Bouras
The history of prostate cancer screening has evolved from relying on the Digital Rectal Exam to the introduction of PSA test. Initially, DRE was the cornerstone for diagnosing aggressive PCa, but the advent of PSA testing allowed for proactive detection. Distinctions between screening for the general population and early detection for individuals are vital. The French Onco-Urology Recommendations cite the European Randomized Study of Screening for Prostate Cancer (ERSPC), highlighting a 21% reduction in mortality using total PSA for screening, endorsing DRE in combination with PSA for early detection. However, a comprehensive analysis of the ERSPC study raises questions about DRE's role in screening. Studies indicate weak correlations between DRE and PCa diagnosis, especially with low PSA values. DRE's reproducibility is also a concern. As the ERSPC study progressed, DRE's significance diminished, and PSA became the primary screening tool. Other trials omitted DRE from their protocols, emphasizing PSA’s dominance. While some studies advocate for DRE in specific contexts, its overall utility in screening is questionable. It can be uncomfortable, has low sensitivity and specificity, and may lead to unnecessary biopsies. Controversies persist regarding its role in follow-up tests after the initial screening. In summary, the analysis of various publications suggests that DRE has limited value in subsequent PCa screening procedures, particularly in regions where screening has evolved beyond its initial use. PSA's dominance underscores the diminishing role of DRE in modern PCa screening practices.
{"title":"Digital rectal exam in prostate cancer screening: a critical review of the ERSPC Rotterdam study","authors":"Samir Bouras","doi":"10.1186/s12301-024-00449-8","DOIUrl":"https://doi.org/10.1186/s12301-024-00449-8","url":null,"abstract":"The history of prostate cancer screening has evolved from relying on the Digital Rectal Exam to the introduction of PSA test. Initially, DRE was the cornerstone for diagnosing aggressive PCa, but the advent of PSA testing allowed for proactive detection. Distinctions between screening for the general population and early detection for individuals are vital. The French Onco-Urology Recommendations cite the European Randomized Study of Screening for Prostate Cancer (ERSPC), highlighting a 21% reduction in mortality using total PSA for screening, endorsing DRE in combination with PSA for early detection. However, a comprehensive analysis of the ERSPC study raises questions about DRE's role in screening. Studies indicate weak correlations between DRE and PCa diagnosis, especially with low PSA values. DRE's reproducibility is also a concern. As the ERSPC study progressed, DRE's significance diminished, and PSA became the primary screening tool. Other trials omitted DRE from their protocols, emphasizing PSA’s dominance. While some studies advocate for DRE in specific contexts, its overall utility in screening is questionable. It can be uncomfortable, has low sensitivity and specificity, and may lead to unnecessary biopsies. Controversies persist regarding its role in follow-up tests after the initial screening. In summary, the analysis of various publications suggests that DRE has limited value in subsequent PCa screening procedures, particularly in regions where screening has evolved beyond its initial use. PSA's dominance underscores the diminishing role of DRE in modern PCa screening practices.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"6 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Male infertility is a global problem, and varicoceles are a common and treatable cause of male infertility. This study prospectively evaluated the effects of varicoceles on the fertility status and potential among Nigerian men. The consequences of the presence, location, and grades of varicoceles on the fertility status of infertile men with varicoceles were determined using a Doppler scrotal ultrasound scan and their seminal fluid parameters. One hundred infertile males with clinical varicoceles (study group) and 100 infertile males without varicocele (control group) were recruited. Varicoceles were confirmed/excluded and graded with an ultrasound scan in each subject. They also all had a seminal fluid analysis to measure their fertility potential. The findings were compared and correlated in the two groups. Most subjects in the study group (67%) had bilateral varicoceles, 31% had isolated left varicoceles, and only 2% had isolated right varicoceles. The majority of the participants (61%) in the study group had secondary infertility, while the majority (63%) in the control group had primary infertility (p = 0.001). There were significant increases in the prevalence of azoospermia (p = 0.008) and oligospermia (p = 0.030) with the higher grades of left varicoceles. Bilateral varicoceles were significantly present in males with infertility in the study group. Varicoceles were more common in males with secondary infertility, and higher grades of varicoceles were significantly more associated with azoospermia and severe oligospermia. We recommend the routine use of ultrasound scans to diagnose varicoceles for the optimal management of infertile male patients.
{"title":"A prospective study of the association between varicoceles and semen quality in men with infertility","authors":"Moses Adebisi Ogunjimi, Olalekan Abdul-Rafiu Abudu, Emmanuel Ajibola Jeje, Rufus Wale Ojewola, Rasheed Ajani Arogundade","doi":"10.1186/s12301-024-00452-z","DOIUrl":"https://doi.org/10.1186/s12301-024-00452-z","url":null,"abstract":"Male infertility is a global problem, and varicoceles are a common and treatable cause of male infertility. This study prospectively evaluated the effects of varicoceles on the fertility status and potential among Nigerian men. The consequences of the presence, location, and grades of varicoceles on the fertility status of infertile men with varicoceles were determined using a Doppler scrotal ultrasound scan and their seminal fluid parameters. One hundred infertile males with clinical varicoceles (study group) and 100 infertile males without varicocele (control group) were recruited. Varicoceles were confirmed/excluded and graded with an ultrasound scan in each subject. They also all had a seminal fluid analysis to measure their fertility potential. The findings were compared and correlated in the two groups. Most subjects in the study group (67%) had bilateral varicoceles, 31% had isolated left varicoceles, and only 2% had isolated right varicoceles. The majority of the participants (61%) in the study group had secondary infertility, while the majority (63%) in the control group had primary infertility (p = 0.001). There were significant increases in the prevalence of azoospermia (p = 0.008) and oligospermia (p = 0.030) with the higher grades of left varicoceles. Bilateral varicoceles were significantly present in males with infertility in the study group. Varicoceles were more common in males with secondary infertility, and higher grades of varicoceles were significantly more associated with azoospermia and severe oligospermia. We recommend the routine use of ultrasound scans to diagnose varicoceles for the optimal management of infertile male patients.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"209 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1186/s12301-024-00451-0
Abbas Basiri, Rasool Zare, Mazyar Zahir, Amir Hossein Kashi, Mahsa Zobeiry, Nasrin Borumandnia, Amir Reza Abedi, Shabnam Golshan
Based on our observations at the largest outpatient urology clinic in Iran, patients for whom finasteride is prescribed as a secondary drug to tamsulosin tend to experience earlier and more severe sexual side effects without any difference in the amelioration of symptoms. This study aimed to compare the time lag, efficacy, and side effects of combination therapy with varying doses of dutasteride or finasteride added to tamsulosin for benign prostatic hyperplasia (BPH) treatment. In this study 165 were randomized into 5 groups (each N = 33); receiving tamsulosin 0.4mg plus either of A: finasteride 3mg, B: placebo, C: dutasteride 0.25mg, D: finasteride 5mg or E: dutasteride 0.5mg. During the 6-month period of the study, International Prostate Symptom Score (IPSS), post-void residual urine (PVR), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate specific antigen (PSA) and maximum urinary flow rate (Qmax) were evaluated at baseline and at the 1st, 3rd and 6th month. The differences between each time point and baseline were then compared between groups. At 3-month follow-up, group E exhibited a higher decrease in PSA but a greater increase in Qmax compared to group A (p = 0.047 and 0.006, respectively). Group C showed higher Qmax increase compared to group A at 3 and 6 months (p = 0.003 and 0.014) and concurrently a more pronounced PV decrease at 1 and 3 months (p = 0.047 and 0.003, respectively). Group D had a significantly more decrease in their IIEF-5 compared to group A at one-month visit (p = 0.006). In summary, at the sixth-month follow-up, dutasteride demonstrated superiority over finasteride solely in enhancing Qmax. Therefore, dutasteride may be marginally more beneficial as a secondary component of combination therapy in BPH. Trial registration IRCT, IRCT20120516009772N2. Registered 18 January 2021 Retrospectively registered, https://irct.behdasht.gov.ir/search/result?query=IRCT20120516009772N2 .
{"title":"Comparison of combination therapy with tamsulosin and dutasteride or finasteride in patients with benign prostatic hyperplasia: a randomized clinical trial","authors":"Abbas Basiri, Rasool Zare, Mazyar Zahir, Amir Hossein Kashi, Mahsa Zobeiry, Nasrin Borumandnia, Amir Reza Abedi, Shabnam Golshan","doi":"10.1186/s12301-024-00451-0","DOIUrl":"https://doi.org/10.1186/s12301-024-00451-0","url":null,"abstract":"Based on our observations at the largest outpatient urology clinic in Iran, patients for whom finasteride is prescribed as a secondary drug to tamsulosin tend to experience earlier and more severe sexual side effects without any difference in the amelioration of symptoms. This study aimed to compare the time lag, efficacy, and side effects of combination therapy with varying doses of dutasteride or finasteride added to tamsulosin for benign prostatic hyperplasia (BPH) treatment. In this study 165 were randomized into 5 groups (each N = 33); receiving tamsulosin 0.4mg plus either of A: finasteride 3mg, B: placebo, C: dutasteride 0.25mg, D: finasteride 5mg or E: dutasteride 0.5mg. During the 6-month period of the study, International Prostate Symptom Score (IPSS), post-void residual urine (PVR), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate specific antigen (PSA) and maximum urinary flow rate (Qmax) were evaluated at baseline and at the 1st, 3rd and 6th month. The differences between each time point and baseline were then compared between groups. At 3-month follow-up, group E exhibited a higher decrease in PSA but a greater increase in Qmax compared to group A (p = 0.047 and 0.006, respectively). Group C showed higher Qmax increase compared to group A at 3 and 6 months (p = 0.003 and 0.014) and concurrently a more pronounced PV decrease at 1 and 3 months (p = 0.047 and 0.003, respectively). Group D had a significantly more decrease in their IIEF-5 compared to group A at one-month visit (p = 0.006). In summary, at the sixth-month follow-up, dutasteride demonstrated superiority over finasteride solely in enhancing Qmax. Therefore, dutasteride may be marginally more beneficial as a secondary component of combination therapy in BPH. Trial registration IRCT, IRCT20120516009772N2. Registered 18 January 2021 Retrospectively registered, https://irct.behdasht.gov.ir/search/result?query=IRCT20120516009772N2 .","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"23 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1186/s12301-024-00455-w
T K Aravind, Siddharth Yadav, Harshdeep Singh
A blind ending ureteric remnant in a duplicated urinary system is extremely rare, and most of these anomalies go unrecognized as they are asymptomatic. We describe a unique case of a blind ending ureteric remnant presenting with neurological claudication in the lower limb secondary to sacral nerve root radiculopathy which was managed by robotic excision. A 61-year-old male presented with radiating pain in the left gluteal region for the past 2 years, which persisted despite multiple conservative treatments. Extensive evaluation for the pain revealed a blind ending ureteric remnant in a partially duplicated system, which contained multiple calculi and caused the compression of the adjacent sacral nerve roots. The patient was subsequently taken up for excision of the remnant, which was performed robotically, after which the symptoms resolved completely. Blind ending ureteric duplications are rare anomalies that mostly go unrecognized as they are asymptomatic. Rarely, these anomalies may produce clinically relevant symptoms and result in diagnostic dilemmas, meriting intervention.
{"title":"“Urological Claudication”: Blind ending ureteric remnant in a bifid ureteric system causing neurological claudication—Case report with brief review of the literature","authors":"T K Aravind, Siddharth Yadav, Harshdeep Singh","doi":"10.1186/s12301-024-00455-w","DOIUrl":"https://doi.org/10.1186/s12301-024-00455-w","url":null,"abstract":"A blind ending ureteric remnant in a duplicated urinary system is extremely rare, and most of these anomalies go unrecognized as they are asymptomatic. We describe a unique case of a blind ending ureteric remnant presenting with neurological claudication in the lower limb secondary to sacral nerve root radiculopathy which was managed by robotic excision. A 61-year-old male presented with radiating pain in the left gluteal region for the past 2 years, which persisted despite multiple conservative treatments. Extensive evaluation for the pain revealed a blind ending ureteric remnant in a partially duplicated system, which contained multiple calculi and caused the compression of the adjacent sacral nerve roots. The patient was subsequently taken up for excision of the remnant, which was performed robotically, after which the symptoms resolved completely. Blind ending ureteric duplications are rare anomalies that mostly go unrecognized as they are asymptomatic. Rarely, these anomalies may produce clinically relevant symptoms and result in diagnostic dilemmas, meriting intervention.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"17 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1186/s12301-024-00456-9
Waleed Ghoneima, Ahmed M. Rammah, Mohamed Aboulfotouh El gharably, Samih Zamel, Moamen Mohamed, Hesham Torad
This work aimed to study the role of penile duplex in predicting the outcome of anastomotic urethroplasty. Between March 2022 and February 2023, all patients presented with posterior urethral distraction defect (PUDD) underwent anastomotic end to end urethroplasty. Preoperative evaluation of sexual function was performed using international index of erectile function (IIEF-5) and penile doppler parameters (the response E1 to E5, peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI)). Each patient was, routinely, evaluated through 12 month-follow up using IIEF-5, penile doppler parameters, uroflowmetry for Qmax and pelvic ultrasound for postvoid residual urine (PVR). The procedure was considered successful if Qmax > 15 ml/s and PVR < 50 cc at the end of follow up. The correlation between the success rate of anastomotic urethroplasty and pre-operative penile Doppler parameters was the primary outcome. Thirty patients with a mean age of 29.47 ± 9.79 years were evaluated. Twenty patients (66.7%) had previous orthopedic surgery. The stricture site was membranous in 6 patients (20.0%) and bubo-membranous in 24 (80.0%). The mean stricture length was 2.52 ± 0.98 cm. There was a statistically significant increase in mean end-diastolic velocity (P < 0.001) with a subsequent significant decrease in mean resistance index (P < 0.001). 14.3% of pre-operatively potent patients developed venous leakage (P < 0.001), while there was no change of arteriogenic or venogenic erectile dysfunction. In addition, of the patients who have arteriogenic erectile dysfunction, 37.5% did not require surgery, 25% had a urethrocystoscopy, and 37.5% required a repeat end to end urethroplasty. There is a significant association between pre-operative peak systolic velocity and the need for re-operation (P = 0.005). Penile duplex may anticipate anastomotic urethroplasty efficacy in the case of PUDD.
{"title":"Can the parameters of penile duplex assessment predict the success of urethroplasty?","authors":"Waleed Ghoneima, Ahmed M. Rammah, Mohamed Aboulfotouh El gharably, Samih Zamel, Moamen Mohamed, Hesham Torad","doi":"10.1186/s12301-024-00456-9","DOIUrl":"https://doi.org/10.1186/s12301-024-00456-9","url":null,"abstract":"This work aimed to study the role of penile duplex in predicting the outcome of anastomotic urethroplasty. Between March 2022 and February 2023, all patients presented with posterior urethral distraction defect (PUDD) underwent anastomotic end to end urethroplasty. Preoperative evaluation of sexual function was performed using international index of erectile function (IIEF-5) and penile doppler parameters (the response E1 to E5, peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI)). Each patient was, routinely, evaluated through 12 month-follow up using IIEF-5, penile doppler parameters, uroflowmetry for Qmax and pelvic ultrasound for postvoid residual urine (PVR). The procedure was considered successful if Qmax > 15 ml/s and PVR < 50 cc at the end of follow up. The correlation between the success rate of anastomotic urethroplasty and pre-operative penile Doppler parameters was the primary outcome. Thirty patients with a mean age of 29.47 ± 9.79 years were evaluated. Twenty patients (66.7%) had previous orthopedic surgery. The stricture site was membranous in 6 patients (20.0%) and bubo-membranous in 24 (80.0%). The mean stricture length was 2.52 ± 0.98 cm. There was a statistically significant increase in mean end-diastolic velocity (P < 0.001) with a subsequent significant decrease in mean resistance index (P < 0.001). 14.3% of pre-operatively potent patients developed venous leakage (P < 0.001), while there was no change of arteriogenic or venogenic erectile dysfunction. In addition, of the patients who have arteriogenic erectile dysfunction, 37.5% did not require surgery, 25% had a urethrocystoscopy, and 37.5% required a repeat end to end urethroplasty. There is a significant association between pre-operative peak systolic velocity and the need for re-operation (P = 0.005). Penile duplex may anticipate anastomotic urethroplasty efficacy in the case of PUDD.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"65 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is a known fact that endourological procedures frequently require placement of double J (DJ) ureteral stent. These patients can have stent-related symptoms (SRS) after DJ stent placement which can be distressing with increased morbidity. Though intraoperative and postoperative factors for SRS have been studied, research work is deficient in preoperative prediction of these symptoms which is the need of the hour. Thus, we aim to find out the factors which can lead to SRS after ureteroscopic lithotripsy (URSL) surgeries. Further, we aim to establish a scoring system which will help us predict the possibility of SRS and take necessary actions to minimise them. Our study includes 150 URSL cases with DJ stenting where we correlated various factors with the presence of SRS. Information regarding preoperative, intraoperative and postoperative factors which may lead to SRS were noted down. All patients completed Ureteral Stent Symptom Questionnaire (USSQ) to evaluate the symptoms at 1 and 3 weeks after stent placement and 1 week after removal of the stent. The statistical data were evaluated using SPSS 24 Statistics. In our study, we found that SRS correlated statistically with factors namely body mass index (BMI) > 25 kg/m2, loin pain, stone size > 1 cm, haematuria, bilateral stone disease, incomplete distal curl, distal end crossing midline and these could predict the occurrence of SRS. Based on the significant preoperative factors, we constructed the Stanley Stent Symptom Status Score (S5 Score) which predicts the possibility of developing SRS. Thorough understanding of factors which can lead to SRS can help us take steps to reduce the morbidity related with this frequent procedure. Stanley Stent Symptom Status Score (S5 Score) predicts the occurrence of these symptoms preoperatively. This score is first of its kind which will pave the way for deeper understanding and prediction of these symptoms preoperatively.
{"title":"Novel Stanley Stent Symptom Status Score (s5 score) for predicting ureteral stent-related symptoms","authors":"Javangula Venkatasurya Rao Prakash, Palanisamy Venkatachalam Thiruvarul, Arun Kumar Paranjothi, Sattanathan Vetrichandar, Krishnan Vembu Arasi, Vetrivel Natarajan, Girish Sharma","doi":"10.1186/s12301-024-00444-z","DOIUrl":"https://doi.org/10.1186/s12301-024-00444-z","url":null,"abstract":"It is a known fact that endourological procedures frequently require placement of double J (DJ) ureteral stent. These patients can have stent-related symptoms (SRS) after DJ stent placement which can be distressing with increased morbidity. Though intraoperative and postoperative factors for SRS have been studied, research work is deficient in preoperative prediction of these symptoms which is the need of the hour. Thus, we aim to find out the factors which can lead to SRS after ureteroscopic lithotripsy (URSL) surgeries. Further, we aim to establish a scoring system which will help us predict the possibility of SRS and take necessary actions to minimise them. Our study includes 150 URSL cases with DJ stenting where we correlated various factors with the presence of SRS. Information regarding preoperative, intraoperative and postoperative factors which may lead to SRS were noted down. All patients completed Ureteral Stent Symptom Questionnaire (USSQ) to evaluate the symptoms at 1 and 3 weeks after stent placement and 1 week after removal of the stent. The statistical data were evaluated using SPSS 24 Statistics. In our study, we found that SRS correlated statistically with factors namely body mass index (BMI) > 25 kg/m2, loin pain, stone size > 1 cm, haematuria, bilateral stone disease, incomplete distal curl, distal end crossing midline and these could predict the occurrence of SRS. Based on the significant preoperative factors, we constructed the Stanley Stent Symptom Status Score (S5 Score) which predicts the possibility of developing SRS. Thorough understanding of factors which can lead to SRS can help us take steps to reduce the morbidity related with this frequent procedure. Stanley Stent Symptom Status Score (S5 Score) predicts the occurrence of these symptoms preoperatively. This score is first of its kind which will pave the way for deeper understanding and prediction of these symptoms preoperatively.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"19 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1186/s12301-024-00447-w
S. E. Omebe, A. O. Ademuyiwa, O. A. Elebute, A. A. Obasi, A. O. Ulebe, E. N. Afogu, S. O. Ekenze
Previous studies have shown an association between anogenital distance (AGD) and types of hypospadias. This study aims to determine whether AGD can be used to predict the severity of hypospadias in male children. We used a cross-sectional study design to evaluate (43) children with hypospadias. The severity of hypospadias based on the meatal position before surgery was classified using the meatal score of the glans-urethral meatal-shaft (GMS) classification into four groups of M1–M4. Three AGD parameters viz: ano-scrotal distance (ASD), the ano-penal distance 1 (APD1) and the ano-penal distance 2 (APD2) were measured using a digital calliper. The glanulomeatal distance 1 (GMD1) before and the glanulomeatal distance 2 (GMD2) after chordee correction were calculated for any change in the position of the meatus. Data were collected over 18 months and analysed using Statistical Package for Social Sciences (IBM SPSS) version 25 software. A P-value of < 0.05 was considered to be statistically significant. The mean ano-scrotal distance (ASD), ano-penile distance 1 (APD1) and ano-penile distance 2 (APD2) were 35.0 ± 7.11 mm, 66.0 ± 13.0 mm and 82.05 ± 14.0 mm, respectively. The parameters of AGD and AGD index progressively decreased with increasing meatal score but these decreases were not statistically significant across the four categories of meatal score. Statistically significant, moderately negative correlations were observed between GMD2 and mean ASD (R = − 0.394, P ≤ 0.009), APD1 (R = − 0.308, P ≤ 0.045) and APD2 (R = − 0.391, P ≤ 0.010). There were also statistically significant predictive relationships between GMD2 (intra-operative meatal position) with ASD (R2 = 0.155, P ≤ 0.009), APD1 (R2 = 0.095, P ≤ 0.045) and APD2 (R2 = 0.153, P ≤ 0.010). The study demonstrated a significant relationship between the AGD and meatal position. Therefore, AGD may be used to predict the intra-operative meatal position and hence, the severity of hypospadias before surgery.
{"title":"Correlation between anogenital distance and severity of hypospadias in male children","authors":"S. E. Omebe, A. O. Ademuyiwa, O. A. Elebute, A. A. Obasi, A. O. Ulebe, E. N. Afogu, S. O. Ekenze","doi":"10.1186/s12301-024-00447-w","DOIUrl":"https://doi.org/10.1186/s12301-024-00447-w","url":null,"abstract":"Previous studies have shown an association between anogenital distance (AGD) and types of hypospadias. This study aims to determine whether AGD can be used to predict the severity of hypospadias in male children. We used a cross-sectional study design to evaluate (43) children with hypospadias. The severity of hypospadias based on the meatal position before surgery was classified using the meatal score of the glans-urethral meatal-shaft (GMS) classification into four groups of M1–M4. Three AGD parameters viz: ano-scrotal distance (ASD), the ano-penal distance 1 (APD1) and the ano-penal distance 2 (APD2) were measured using a digital calliper. The glanulomeatal distance 1 (GMD1) before and the glanulomeatal distance 2 (GMD2) after chordee correction were calculated for any change in the position of the meatus. Data were collected over 18 months and analysed using Statistical Package for Social Sciences (IBM SPSS) version 25 software. A P-value of < 0.05 was considered to be statistically significant. The mean ano-scrotal distance (ASD), ano-penile distance 1 (APD1) and ano-penile distance 2 (APD2) were 35.0 ± 7.11 mm, 66.0 ± 13.0 mm and 82.05 ± 14.0 mm, respectively. The parameters of AGD and AGD index progressively decreased with increasing meatal score but these decreases were not statistically significant across the four categories of meatal score. Statistically significant, moderately negative correlations were observed between GMD2 and mean ASD (R = − 0.394, P ≤ 0.009), APD1 (R = − 0.308, P ≤ 0.045) and APD2 (R = − 0.391, P ≤ 0.010). There were also statistically significant predictive relationships between GMD2 (intra-operative meatal position) with ASD (R2 = 0.155, P ≤ 0.009), APD1 (R2 = 0.095, P ≤ 0.045) and APD2 (R2 = 0.153, P ≤ 0.010). The study demonstrated a significant relationship between the AGD and meatal position. Therefore, AGD may be used to predict the intra-operative meatal position and hence, the severity of hypospadias before surgery.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"149 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1186/s12301-024-00446-x
Mohamed Salah Ayyad, Ibrahim Elgaml, Alrawy Ali Mohammad, Amr Mohamed Rizq, Samira Ebrahim
Liposarcoma is considered the most common among spermatic cord sarcomas. It usually presents as a progressively enlarging inguinoscrotal mass. The resemblance between the spermatic cord liposarcoma and the inguinal hernia allows the swelling to be tolerated for a long duration giving time for hematogenous dissemination. In this article, we share the experience of a unique case of metastatic liposarcoma of the spermatic cord that showed a stationary course of the lower abdominal satellite lesions on follow-up following palliative resection. We present a case of a 53-year-old male with progressively enlarging painless scrotal swelling over 1-year duration. A heterogeneous lesion of the right hemiscrotum and spermatic cord with non-specific radiological features was described by imaging. Two lower abdominal skip lesions were also discovered synchronously in addition to the primary one and were designated inoperable as they were adherent to the nearby bowel loops. The patient underwent cytoreductive surgery of the primary tumour which was proven to be an undifferentiated liposarcoma with free safety margins based on histopathology. Finally, the patient was referred for adjuvant chemotherapy and sequential follow-up. Despite being a rare tumour, the radiologist should always consider the liposarcoma of the spermatic cord in the differential diagnosis of inguinoscrotal lesions even in the absence of typical imaging features. The diagnosis and management of spermatic cord liposarcoma remain a challenge with no clear accepted guidelines.
{"title":"Spermatic cord liposarcoma presented as scrotal swelling: a case report","authors":"Mohamed Salah Ayyad, Ibrahim Elgaml, Alrawy Ali Mohammad, Amr Mohamed Rizq, Samira Ebrahim","doi":"10.1186/s12301-024-00446-x","DOIUrl":"https://doi.org/10.1186/s12301-024-00446-x","url":null,"abstract":"Liposarcoma is considered the most common among spermatic cord sarcomas. It usually presents as a progressively enlarging inguinoscrotal mass. The resemblance between the spermatic cord liposarcoma and the inguinal hernia allows the swelling to be tolerated for a long duration giving time for hematogenous dissemination. In this article, we share the experience of a unique case of metastatic liposarcoma of the spermatic cord that showed a stationary course of the lower abdominal satellite lesions on follow-up following palliative resection. We present a case of a 53-year-old male with progressively enlarging painless scrotal swelling over 1-year duration. A heterogeneous lesion of the right hemiscrotum and spermatic cord with non-specific radiological features was described by imaging. Two lower abdominal skip lesions were also discovered synchronously in addition to the primary one and were designated inoperable as they were adherent to the nearby bowel loops. The patient underwent cytoreductive surgery of the primary tumour which was proven to be an undifferentiated liposarcoma with free safety margins based on histopathology. Finally, the patient was referred for adjuvant chemotherapy and sequential follow-up. Despite being a rare tumour, the radiologist should always consider the liposarcoma of the spermatic cord in the differential diagnosis of inguinoscrotal lesions even in the absence of typical imaging features. The diagnosis and management of spermatic cord liposarcoma remain a challenge with no clear accepted guidelines.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"9 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1186/s12301-024-00448-9
K. R. Surag, Kasi Viswanath Gali, Abhijit Shah, A. V. B. Krishnakanth, Anshuman Singh, Abhishek Goli, Arun Chawla, Padmaraj Hegde, Anupam Choudhary
Management of high-grade renal trauma is debatable, with the recent evidence embracing a conservative approach in the management of even grade 5 renal injuries. The study aimed to analyze the clinical profile of patients with high-grade renal trauma, assessing their management strategies, outcomes, complications, and need for ancillary procedures. A retrospective analysis of prospectively maintained data was performed involving blunt abdominal trauma patients with high-grade renal injuries (Grade 4 and 5) presenting to our hospital from January 2018 to December 2022. Patient data analyzed included demographics, clinical presentation, injury characteristics, complications, ancillary procedures, and mortality rates. All patients underwent renal functional assessment using an isotope renogram scan at the 3-month follow-up. Data collected were entered into a database and subjected to descriptive analysis using Jamovi version 2.3.28. The study included 45 patients with a mean age of 29 years and a male-to-female ratio of 41:4. Most patients (n = 42) were managed conservatively. Thirty-eight patients had grade 4 injuries, and seven had grade 5 injuries. Twenty-six patients suffered renal parenchymal injuries alone, three patients had renal vascular injuries alone, and 16 patients had both parenchymal and vascular injuries. Grade 5 renal injury (p < 0.001), vascular high-grade injury (p < 0.001), angioembolization (p < 0.001), and blood transfusions (p = 0.021) were significantly associated with the incidence of poorly functioning kidney in high-grade renal trauma patients managed conservatively. Multinomial logistic regression analysis revealed angioembolization (p < 0.001), poorly functioning kidney post-trauma (p < 0.001), and blood transfusions (p < 0.001) were significantly associated with high-grade renal vascular injuries compared to high-grade renal parenchymal injuries. Conservative management is advisable for high-grade renal trauma in hemodynamically stable patients. High-grade vascular injuries are more severe than parenchymal injuries and correlate with poorer renal functional outcomes. Grade 5 renal injury, predominantly vascular high-grade injury, and the requirement for angioembolization and blood transfusions serve as significant predictors of poorly functioning kidneys post-trauma. Urologists should consider these predictors when counseling patients regarding potential outcomes following conservative management of high-grade renal trauma.
{"title":"Predictors of outcomes in conservative management of high-grade renal trauma","authors":"K. R. Surag, Kasi Viswanath Gali, Abhijit Shah, A. V. B. Krishnakanth, Anshuman Singh, Abhishek Goli, Arun Chawla, Padmaraj Hegde, Anupam Choudhary","doi":"10.1186/s12301-024-00448-9","DOIUrl":"https://doi.org/10.1186/s12301-024-00448-9","url":null,"abstract":"Management of high-grade renal trauma is debatable, with the recent evidence embracing a conservative approach in the management of even grade 5 renal injuries. The study aimed to analyze the clinical profile of patients with high-grade renal trauma, assessing their management strategies, outcomes, complications, and need for ancillary procedures. A retrospective analysis of prospectively maintained data was performed involving blunt abdominal trauma patients with high-grade renal injuries (Grade 4 and 5) presenting to our hospital from January 2018 to December 2022. Patient data analyzed included demographics, clinical presentation, injury characteristics, complications, ancillary procedures, and mortality rates. All patients underwent renal functional assessment using an isotope renogram scan at the 3-month follow-up. Data collected were entered into a database and subjected to descriptive analysis using Jamovi version 2.3.28. The study included 45 patients with a mean age of 29 years and a male-to-female ratio of 41:4. Most patients (n = 42) were managed conservatively. Thirty-eight patients had grade 4 injuries, and seven had grade 5 injuries. Twenty-six patients suffered renal parenchymal injuries alone, three patients had renal vascular injuries alone, and 16 patients had both parenchymal and vascular injuries. Grade 5 renal injury (p < 0.001), vascular high-grade injury (p < 0.001), angioembolization (p < 0.001), and blood transfusions (p = 0.021) were significantly associated with the incidence of poorly functioning kidney in high-grade renal trauma patients managed conservatively. Multinomial logistic regression analysis revealed angioembolization (p < 0.001), poorly functioning kidney post-trauma (p < 0.001), and blood transfusions (p < 0.001) were significantly associated with high-grade renal vascular injuries compared to high-grade renal parenchymal injuries. Conservative management is advisable for high-grade renal trauma in hemodynamically stable patients. High-grade vascular injuries are more severe than parenchymal injuries and correlate with poorer renal functional outcomes. Grade 5 renal injury, predominantly vascular high-grade injury, and the requirement for angioembolization and blood transfusions serve as significant predictors of poorly functioning kidneys post-trauma. Urologists should consider these predictors when counseling patients regarding potential outcomes following conservative management of high-grade renal trauma.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"67 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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