Arab Journal of Urology最新文献

Urodynamic study (UDS) is a valuable diagnostic procedure for assessing lower urinary tract symptoms but often induces pain and anxiety due to its invasive nature. This systematic review and meta-analysis aimed to evaluate the effectiveness of various interventions to reduce pain and anxiety in patients undergoing UDS. A comprehensive search was conducted in PubMed, ScienceDirect, EMBASE, and EBSCO up to October 2024. Twenty-two studies, including randomized controlled trials and observational studies, were included. Risk of bias was assessed using RoB 2, ROBINS-I, and the Newcastle-Ottawa Scale. Meta-analysis using Review Manager 5.3 showed that providing detailed information to patients significantly reduced pain (SMD: 0.84; 95% CI: 0.20-1.48; p = 0.01), while music therapy and anesthetic agents did not yield significant effects. The overall pooled effect on pain was not statistically significant. For anxiety, the pooled analysis indicated a modest but significant reduction (SMD: 0.57; 95% CI: 0.11-1.02; p = 0.04), despite high heterogeneity. Interventions such as mindfulness, aromatherapy, and heating pads showed potential in individual studies but were not included in meta-analysis due to limited data. The findings highlight that while certain interventions may alleviate discomfort during UDS, evidence remains inconsistent. Well-designed, large-scale trials are needed to establish standardized approaches for enhancing patient comfort during UDS.

Introduction: Flexible ureteroscopy (fURS) remains the gold standard for managing ureteral and renal calculi. The integration of vacuum suction ureteral access sheaths has demonstrated improved stone clearance rates. Through an in vitro fURS model, this study systematically validates the sheath's efficacy in regulating intraluminal pressure across diverse operational parameters, providing mechanical insights for clinical optimization.

Methods: An 8.6Fr disposable flexible ureteroscope was utilized to measure intraluminal pressure within a silicone urinary tract model fabricated using 3D printing technology. The experiment was conducted under three configurations of ureteral access sheaths (UAS): (1) conventional UAS, (2) negative pressure suction sheath with an open vent, and (3) negative pressure suction sheath with a fully closed vent. Intraluminal pressure and irrigation flow rate were recorded for various UAS sizes under irrigation pressures ranging from 10 to 240 mmHg.

Results: Under varying infusion pressure conditions, the negative pressure sheath with an open vent exhibited slightly lower intraluminal ureteral pressure compared to the traditional sheath; however, this difference was not statistically significant (p = 0.56). In contrast, when using the closed vent method, the negative pressure aspiration sheath demonstrated a significantly distinct change in intraluminal pressure compared to both the traditional sheath and its open vent mode (p < 0.01). Additionally, the choice of ureteral sheath size had a profound impact on intraluminal pressure, with larger sheath sizes associated with lower pressure levels under the same infusion pressure (p < 0.01).

Conclusions: During ureteroscopy procedures, intraluminal pressure within the ureter increases proportionally with irrigation pressure. However, the application of negative pressure using a closed vent can effectively mitigate this rise in intraluminal pressure.

Purpose: Diabetic patients had erectile dysfunction at an earlier age and with greater frequency than nondiabetic males, with prevalence rates ranging from 20% to 75%. The aim of the work is to study the efficacy and safety of different doses of vardenafil in patients with long-standing type II DM on Erectile Dysfunction (ED), testosterone level, and partner satisfaction.

Methods: A randomized clinical investigation was undertaken spanning the period from October 2021 to October 2022 on patients with long-standing type II DM who were diagnosed with ED and were randomized into 4 groups to receive vardenafil, 5 mg once, 5 mg twice, 10 mg once, and 10 mg twice, respectively. The International Index of Erectile Function (IIEF) self-completed questionnaire was used to measure erectile dysfunction, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used to measure partner satisfaction, and testosterone levels were taken both before and after vardenafil was administered.

Results: Of 102 patients, 26 patients received 5 mg once daily, 25 patients received 5 mg twice daily, 27 patients received 10 mg once daily and 24 patients received 10 mg twice daily. The mean age was 55.45 ± 8.142 years, ranging from 40 to 65 years, HbA1c mean was 8.8%  ± 1.5. There was a statistically significant difference regarding EDITS and IIEF-15 scores among patients who received 10 mg once and 5 mg twice, p = 0.001. Testosterone levels were elevated in all doses, especially for higher doses of vardenafil.

Conclusion: Vardenafil with doses of 10 mg once or 5 mg twice is an effective and valid option for long-standing type II diabetic patients with ED.

Purpose: This study aims at assessing the effectiveness of using prophylactic mesh for the prevention of Parastomal hernia (PSH) after cystectomy and ileal conduit.

Methods: PRISMA statement guidelines were followed. A comprehensive literature search was conducted across PubMed, MEDLINE, Cochrane Library, and Embase databases. The primary outcomes analyzed were operation time, clinical hernia, radiological hernia, and complications classified as greater than or less than 3 on the Clavien-Dindo scale.

Results: Three RCTs with a total number of 782 patients were included. The occurrence of clinical hernia significantly favored the mesh group, with a risk ratio (RR) of 0.50 (p < 0.002). However, the occurrence of radiological hernia showed no significant difference between groups, with an RR of 0.72 (p = 0.10). The analysis of operation time significantly favored the no mesh group, with a mean difference (MD) of -28.56 minutes (p < 0.002), indicating shorter operation times compared to the mesh group. Regarding complications, no significant differences were observed between the mesh and no mesh groups. For Clavien-Dindo Grade ≥3 complications, the RR was 1.11 (p = 0.42), and for Clavien-Dindo Grade <3 complications, the RR was 1.15 (p = 0.36).

Conclusion: Prophylactic mesh significantly reduces the incidence of PSH following ileal conduit. However, it does not significantly affect radiological hernia rates or complication rates. Despite longer operation times, its use offers a clear benefit in preventing PSH without substantially increasing complications.

Objective: To evaluate the efficacy and safety of low-intensity shockwave therapy (LiSWT) for non-prostatic storage lower urinary tract symptoms (LUTS), including overactive bladder (OAB), stress urinary incontinence (SUI), and interstitial cystitis/bladder pain syndrome (IC/BPS).

Methods: A systematic search of MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov was conducted up to September 2024. Randomized controlled trials (RCTs), prospective studies, and single-arm studies evaluating LiSWT for non-prostatic LUTS in adults were included. Outcomes assessed included urinary frequency, urgency, nocturia, pain for IC/BPS, pad-test for SUI, uroflowmetry parameters, and questionnaire-based symptom scores. Risk of bias was assessed using Cochrane Risk of Bias 2.0 and ROBINS-I. Random-effects meta-analysis was performed.

Results: Twelve studies (six RCTs, six observational) involving 624 participants were included. LiSWT significantly reduced urinary frequency in OAB and IC/BPS patients, with SUI improvements emerging at 12 weeks. Compared to sham treatment, only the OAB group showed significant reductions at 4 weeks. Urgency symptoms improved in OAB and SUI, but differences from sham were not significant. Nocturia improved in OAB and IC/BPS but was not significantly different from sham. Overall pain reduction was significant for IC/BPS (MD -1.61 (95%CI -2.21 to -1.02)). In SUI, most participants had >50% improvement in pad-test weight, but the mean difference compared to sham was not significant. Significant improvements in uroflowmetry also observed in OAB and SUI groups, while IC/BPS showed non-significant changes. Compared to sham, LiSWT did not significantly improve uroflowmetry parameters at 4 weeks. OAB and IC/BPS questionnaire-symptom scores significantly improved, but quality-of-life data was limited.

Limitations: Heterogeneity in treatment protocols, short follow-ups, and high risk of bias in some studies limited generalizability.

Conclusions: LiSWT may present a novel non-invasive treatment modality for non-prostate LUTS etiology. While it demonstrates some subjective symptom improvements, its overall clinical utility remains uncertain due to methodological limitations, heterogeneity, and high bias risk in current studies. Larger, high-quality RCTs are urgently needed to establish standardized treatment protocols and long-term safety profiles.Registration: PROSPERO (CRD42024590708).

Introduction: Alpha-blockers are widely used in medical expulsive therapy (MET) for ureteral stones; however, the current evidence regarding their comparative effectiveness remains inconsistent. We aimed to evaluate the efficacy and safety of different alpha-blockers in facilitating ureteral stone passage and identify factors influencing treatment outcomes.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2010 and 2025. We searched multiple databases for studies comparing alpha-blockers with control interventions or other alpha-blockers for ureteral stones ≤10 mm. Primary outcome was stone expulsion rate; secondary outcomes included time to expulsion, pain episodes, analgesic use, and adverse events. We performed subgroup analyses by alpha-blocker type, stone size, location, and treatment duration. Network meta-analysis assessed comparative effectiveness between agents.

Results: Twenty-nine RCTs with a total of 4,256 patients were included. Alpha-blockers significantly increased stone expulsion rates compared to controls (70.9% vs. 56.5%; RR 1.25, 95% CI 1.20-1.32; Number Needed to Treat (NNT) = 7) and reduced expulsion time by approximately three-days. Efficacy was greatest for distal ureteral stones (RR 1.52; Number Needed to Treat (NNT) = 4) and stones 5-10 mm (RR 1.35; NNT = 6). Network meta-analysis revealed efficacy ranking favoring at first terazosin, followed by doxazosin then, silodosin then, tamsulosin then, alfuzosin and last the least effective was naftopidil. Alpha-blockers significantly reduced pain episodes and analgesic requirements. Adverse events were infrequent (Number Needed to Harm (NNH) = 38), with retrograde ejaculation being most common with silodosin.

Conclusion: Alpha-blockers significantly improve the stone expulsion rates and reduce expulsion time, especially for distal ureteral stones 5-10 mm in size. While tamsulosin remains the most studied agent, our network meta-analysis suggests terazosin and doxazosin may offer superior efficacy. The favorable risk-benefit profile supports routine use of alpha-blockers for appropriately selected patients with ureteral stones.

Background: Despite the high efficacy of percutaneous nephrolithotomy (PNL), it has more morbidity and a difficult learning curve. Retrograde intra renal surgery (RIRS) was introduced as a minimally invasive procedure for treatment of renal stones.

Objective: To compare RIRS versus PNL in the management of renal stones sized 2-3 cm.

Patient and methods: In this prospective randomized controlled trial, 122 patients with renal stones 2-3 cm were included and divided into two equal groups. Group A underwent RIRS. Group B underwent PNL. Patients with bleeding disorders, pregnancy, active UTI were excluded. Laboratory investigations, Ultrasound, CTUT were done preoperatively. Perioperative outcome (operative time, complications, hospital stay and pain score) was recorded. SFR (stone free rate) was assessed by CTUT after one month.

Results: The mean stone size for group A and B were 2.11 ± 0.21 and 2.12 ± 0.23, respectively. The Stone free rate was 70.5% in RIRS and 73.8% in PNL (p = 0.840). lithotripsy time was significantly longer in the RIRS group (84.75 vs 72.95 minutes) (p = 0.019). PNL group showed significant post-operative hemoglobin drop but with no need for blood transfusion. High-grade fever was slightly higher in the RIRS group (8.2% vs 6.5%) (p = 0.557). Sepsis developed in 4.9% of RIRS group and 1.6% of the PNL group (p = 0.362). One case of mortality was reported in the PNL group. The hospital stay was significantly longer in the PNL group. The mean pain score was significantly lower in the RIRS.

Conclusion: RIRS can be used as an alternative to PNL for the management of renal stones sized 2-3 cm, with comparable stone free rates, less hospital stays, less pain score, less hemoglobin drops. but longer lithotripsy time.

Introduction: Prostate cancer is the most diagnosed cancer in men, with transrectal ultrasound-guided (TRUS) biopsy being the most frequently used method of tissue diagnosis in the past. With the introduction of the new modality of trans-perineal (TP) ultrasound-guided prostate biopsy, urologists and radiologists adopted this new technique for the decreased rate of complications such as urinary tract infections, bacteremia, sepsis and the avoidance of antimicrobial prophylaxis. We aim to compare the infectious rates of TRUS versus TP biopsy from our Middle Eastern tertiary care center.

Methods: Retrospective data was collected on patients from our medical records from May 2019 till December 2023 at our institution. The data included adult male patients aged 18 years and above undergoing TP or TRUS prostate biopsy. Patients with positive urine culture before biopsy were excluded. Electronic medical records, pathology and laboratory reports were reviewed to collect patient-related data including age, BMI, smoking, alcohol consumption, medical history and comorbidities. In addition, variables related to the procedure type, the target lesion location, antibiotic prophylaxis, bowl preparation, number of cores taken, and laterality of the tumor were included.

Results: A total of 745 patients underwent an ultrasound guided prostate biopsy performed by 6 attending urologists at our institution. Among them, 157 (21.1%) patients underwent TRUS biopsy, while 588 (78.9%) underwent TP biopsy. Within one month of the biopsy, 13 patients (1.7%) developed UTI. 6 of them had TRUS (4.1%), and 7 had TP (1.2%) with p = 0.03. Four patients required hospital admission for fever and bacteremia, all of which had undergone TRUS biopsy with hospital stay from 2-5 days receiving meropenem, ciprofloxacin, cefixime or Bactrim.

Conclusion: TP prostate biopsy carries a lower risk of infectious complications and requires no antibiotic prophylaxis compared to TRUS biopsy of the prostate. These results advocate the superiority of the use of TP biopsy over TRUS biopsy.