Arab Journal of Urology最新文献

Introduction: A UPJO is a blockage of the ureter that affects urine flow. UPJO is mainly treated by an open approach, however, in recent years minimally invasive techniques are taking place. These techniques include robotic and laparoscopic pyeloplasty. Some patients require a redo after a primary intervention. A systematic review was conducted through the examinations of the efficacy and safety of a robotic redo pyeloplasty in adult patients from previous literature reviews.

Methods: A literature search was made through PubMed. A selection process was done based on our eligibility criteria. The data were represented numerically, listed on tables and analyzed cumulatively using Microsoft Excel.

Results: Twenty studies were included in this review, of which nine were studies on robotic outcomes () (157 patients), 10 on laparoscopic (210 patients), and one review by Zhang et al., focused on both types of surgeries. Two papers (24 patients) from the robotic studies and one paper (21 patients) from the laparoscopic studies were excluded from the intra and post-operative characteristics because not enough data were available and were only included for the success and complication rates. The success rate for the robotic studies was 88.5% while the laparoscopic studies had a success rate of 91%. However, the robotic studies had a complication rate of (11.8%) while the laparoscopic studies had a complication rate of (15.9%). Conversion surgery was required in one patient undergoing laparoscopic surgery.

Conclusion: The minimally invasive methods are becoming more viable in adult patients with rUPJO, considering its effectiveness and fast recovery. This can lead to a new era of robotic assisted surgeries to becoming the gold standard.Abbreviations: Systematic review: Redo robotic and laparoscopic pyeloplasty in adults; UPJO = Ureteropelvic junction obstruction; rUPJO = redo ureteropelvic junction obstruction.

Objective: To compare outcomes of low-intensity extracorporeal shock wave therapy (LIESWT) versus 20 mg of Tadalafil in Erectile dysfunction (ED) patients.

Materials and methods: We performed a prospective study of 51 men with ED. Twenty-five were in the LIESWT group and 26 in the Tadalafil group. Patients in the LIESWT group received 6 sessions (2 per week) with an average of 6,000 shocks per session with the PiezoWave² unit. Other patients self-administered Tadalafil on demand. The outcomes were assessed using the International Index of Erectile Function (IIEF-5) score, Erection Hardness Score (EHS) and Self-Esteem And Relationship (SEAR) questionnaire before, at 6 and 12 weeks after treatment. Treatment-related side effects and costs were recorded too.

Results: The mean age in the LIESWT group was 43.7 years old, and in the Tadalafil group was 47 years old. After the 6 and 12-week follow-ups, both groups showed significant improvement when comparing the baseline values to the follow-up variables for all IIEF-5, EHS, and SEAR (P < 0.05). There was a notable statistical difference between the two groups regarding the side effects, as the shockwave group was with mild side effects (8%), while the Tadalafil group (44%) of patients had side effects (p < 0.05). This cost difference is statistically significant (p < 0.001). LIESWT is more costly compared to Tadalafil.

Conclusion: LIESWT has a comparable short-term therapeutic efficacy with higher safety outcomes than on-demand 20 mg of Tadalafil for ED patients.

Objective: To evaluate the safety and efficacy of ultrasound (US) as alternative to fluoroscopy for guidance of ureteroscopy (URS) during treatment of distal ureteric stones in adults.

Materials and methods: This study enrolled 80 patients older than 18 years presented with a single distal ureteric radio-opaque stone of ≤15 mm in longest diameter. Patients were randomized and allocated into two groups: the fluoroscopy group and the ultrasound group (n = 40 patients in each group). Patients with bilateral ureteric stones, solitary kidney, ureteric congenital anomalies, history of failed ureteroscopy, history of ureteric surgery, patients with uremia and pregnant women were excluded. Patients' demographics, stone characteristics, operative data, stone-free status, hospital stay and complications were evaluated in both groups.

Results: No statistically significant difference between both groups was found regarding patients' demographics and stone characteristics. Also there was no statistically significant difference in comparing fluoroscopy group versus ultrasound group regarding operative time (29.48 ± 15.3 versus 31.28 ± 18.24 min; P = 0.83), stone-free rate (97.5% versus 95%; P = 1.0), overall complications (15% versus 12.5%; P = 0.75), or hospital stay (1.17 ± 0.6 versus 1.02 ± 0.16 days; P = 0.12). Four patients (10%) in the ultrasound group required the addition of fluoroscopy beside ultrasound.

Conclusion: Ultrasound is effective in guidance during ureteroscopy for distal ureteric stones. It was comparable to fluoroscopy in terms of stone free rate, operative time, overall complications, and hospital stay. However, fluoroscopy must be available to be used when needed.

Purpose: To determine graft and patient survival and adverse events in patients who undergo orthotopic kidney transplantation.

Methods: We performed a systematic review and meta-analysis. We search in Medline, Embase, and Central from inception to nowadays. We included observational studies with patients who undergo orthotopic kidney transplantation. The primary outcomes were overall patient and graft survival. We pooled the information in a frequency meta-analysis with a 95% CI. We analyzed bias with the STROBE statement.

Results: Of the 106 papers initially retrieved, four met the inclusion criteria. Vascular and urinary tract complications were reported in 19% and 15%, respectively. The overall patient survival was 92% 95%CI (88% to 95%), I2 = 0%, and the overall graft survival was 88% 95 CI (83% to 91%), I2 = 0%.

Conclusion: Our analysis showed a high survival rate in patients and kidney grafts after orthotopic kidney transplantation, with a similar complication rate compared to a heterotopic kidney transplant.

Background/objective: Testicular cancer (TC) is one of the most curable solid malignancies affecting young adults. The objective of this study was to identify factors affecting survival of Saudi adults who were diagnosed with testicular cancer over 10 years.

Methods: This was a retrospective study with data extracted from the Saudi Cancer Registry for Saudi Adults diagnosed with TC from 2008 to 2017. We collected demographic information, including age, marital status, region of residency, year of diagnosis, and the survival status. In addition, the tumor factors included the basis of diagnosis, the origin of the tumor, histopathological group and subtype, and tumor behavior, stage, and laterality were collected.

Results: A total of 869 patients were included, with a median age of 30 (IQR: 25-38). The highest percentage of the cases was 37.5% (326) in the Central region, followed by the Western region 24.6% (214). The primary site of the tumor was the testis 96.9% (842), 3.1% (27) in the undescended testis. The histopathological examination revealed seminoma in 44.8% (389), 33.5% (291) mixed germ cell tumor, 8.4% (73) embryonal carcinoma, 6.1% (53) teratoma, 2.6% (23) yolk sac tumor, 1.6% (14) choriocarcinoma, 0.3% (3) Leydig cell tumor, and 2.6% (23) sarcomas. Kaplan-Meier analysis revealed significant association between survival and the age groups (p = 0.001), histopathology group (p 0.04), histopathology subtypes (p = 0.01), and the stage of the tumor (p < 0.001).

Conclusions: A notable increase in the incidence of TC among Saudi adults was seen, with a mortality rate of 5.4% over a period of 10 years. Longer survival was associated with age groups, seminomatous germ cell tumor, and lower tumor stage.

Aim: To determine the advantages and disadvantages of both methods by comparing classic circumcision methods with circumcision methods assisted by ring instruments.

Material-methods: Only studies that compared open procedures and ring devices for male circumcision were included. A total of 6226 patients were examined in 14 studies. The methodological quality of RCT was evaluated using Cochrane collaboration's tools. The Review Manager software statistical package was used to analyze the ORs for dichotomous variables and the mean differences for continuous variables. The proportion of heterogeneity across the studies was tested using the I 2 index. Potential publication bias was assessed by identifying the presence of visual asymmetry/symmetry with funnel plot studies.

Results: There were 1812 patients in the open circumcision group and 4414 patients in the ring groups. In total, there was no difference identified between the groups. The open procedure had an advantage compared to the Plastibell subgroup for hemorrhage, while in the other two subgroups, the ring instrument groups had the advantage. Statistically significant in favor of ring devices was found in operating time.There was no difference between the groups for early (postoperative) pain scores. For late-period pain scores, differences with statistical significance were identified in favor of ring devices both in subgroups and in total. For satisfaction, apart from one study in the PrePex group, statistical significance was obtained in favor of ring devices for the other subgroups and in total.

Conclusion: The main factors in favor of the use of ring instruments for circumcision are the short total surgical duration, not requiring advanced surgical experience, ease of learning and application, and patient relative satisfaction rates. However, it is a condition to know open circumcision methods and to have experience of this surgery for use in situations with hemorrhage complications, mainly, and without ring instruments of appropriate size.

Introduction: Clinically node-positive non-metastatic bladder cancer (cN+) has been the target of several studies aiming to establish a standard of care for this population. Limited studies have shown a survival benefit for various multimodal therapy approaches. The role of radiation therapy has not been well established. Our study aims to study the trends of the reported treatment options offered to patients with cN+ bladder cancer in a national database and to evaluate the effect of various treatments, including radiation, on survival.

Methods: The National Cancer Database (NCDB) was used to identify cN+ bladder cancer patients who received chemotherapy alone or in combination with radical cystectomy (RC) or radiotherapy. 3,481 patients were included and divided into 4 groups: chemotherapy only, chemotherapy and RC, chemotherapy and radiation therapy, and chemotherapy, RC, and radiation therapy. Demographic data was compared using ANOVA for continuous variables, and Chi-square for categorical variables. Multivariable analysis was done to compare groups using a multinomial logistic regression model. Kaplan-Meier test was used for survival analysis and Cox-Regression was used for multivariable survival analysis.

Results: Patients undergoing RC were significantly younger (P <0.001). There was a significant difference between the groups regarding racial distribution, facility-type and insurance status. There was no difference in gender, CharlsonDeyo score, financial or educational status. Patients who underwent combination therapy with chemotherapy and RC were found to have the longest median survival time at 27 months. Multivariable analysis showed that final treatment, age, sex, CharlsonDeyo comorbidity score, TNM edition and facility-type were significant survival predictors. Race, insurance and financial status failed to maintain significance. There was no survival difference between the chemotherapy group and chemo-radiotherapy group.

Conclusions: The combination of surgery and chemotherapy achieves statistically significant superior survival in cN+ bladder cancer. Adding radiotherapy to chemotherapy did not improve survival in this group of patients.

Abbreviations: (cN+): Clinically node-positive non-metastatic, (MIBC): Muscle invasive bladder cancer, (NCDB): National Cancer Database, (NAC): Neoadjuvant chemotherapy, (RC): Radical Cystectomy.

Arabic medicine, or Arab-Islamic, mainly refers to all developments achieved in the Age of Khalifs, or the Golden Age of the Arab-Islamic civilization (ca 7^th-14^th centuries AD). Arab scholars adopted ancient Greek medicine and soon understood the essence of the fatal disease known as cancer. They introduced various new types of cancer, distinguishing other entities like infection and proposed new methods of treatment, both surgical and non-invasive. Herbal medicine after Dioscurides and Galen bloomed in the Arabic world. Malignancy of the urinary tract was identified and a plethora of herbs were used to slow down its expansion. Moreover, herbal drugs were introduced to alleviate cancerous symptomatology. Avicenna introduced Hindiba, while known scholars like Abulcasis and Rhazes noted the benefits of garlic, onion, black seeds, pomegranate, olive oil as well as leaf and bread wheat. Arabian herbal medicine may still be beneficial in anticancer fight and mainly in the palliative medicine. It should be emphasized that almost 50% of the drugs administered today have their point of origin in the plants used in antiquity.

Purpose: To validate the detection of clinically significant prostate cancer (Gleason's score ≥7) by PI-RADS v2 and to assess the ability of quantitative MRI parameters to detect clinically significant prostate cancer (CSPCa) in Indian men.

Methods: Adult men (n = 95) with serum PSA >4 ng/ml were prospectively evaluated with multiparametric MRI (mpMRI) followed by histopathological evaluation using systematic 12-core prostate biopsy in 69 patients and prostatectomy specimens in 26 patients, performed within six weeks of mpMRI. The imaging and the pathology were divided into 12 sectors per prostate. For the validation of PI-RADS v2, a cut-off of PI-RADS v2 score ≥ 3 and PI-RADS v2 score ≥ 4 were compared to histopathology as a reference standard. Further, quantitative parameters, apparent diffusion coefficient (ADC), K^trans, and K_ep were correlated with the Gleason score and evaluated for their ability to distinguish between sectors with CSPCa and sectors without CSPCa.

Results: PI-RADS score ≥ 4 showed higher specificity (89%) than PI-RADS score ≥ 3 (72.2%) at the cost of mild but not significant reduction of sensitivity (sensitivity-87.6% vs 91.9), (n = 1,140 sectors, 95 patients). PI-RADS v2 and quantitative parameters demonstrated the ability to discriminate sectors positive vs negative for CSPCa: AUC (area under the curve) for ADC was 0.928, PI-RADS v2 was 0.903, K^trans was 0.897 and K_ep was 0.695. Gleason score correlated well with PI-RADS (r = 0.74), ADC (r = -0.73) and K^trans (r = 0.69).

Conclusion: PI-RADS v2 is a reliable method for the detection and localization of clinically significant prostate cancer in Indian men, suggesting applicability beyond European or American demographics. Quantitative mpMRI parameters can detect clinically significant prostate cancer with similar test characteristics as PI-RADS v2.