Pub Date : 2023-07-24eCollection Date: 2024-01-01DOI: 10.1080/2090598X.2023.2238933
Mohamed Fakhry, Hamdy Mahfouz, Khalid Abdelazeem, Mohamed AbdelSabour, Nour Shaheen, Ahmed Fathy, Amro M Hassan, Hazem Dief, Mohamed El-Nady, Mustafa A Haridy, Omran Mohamed, Safwat Salama, Emad Abdelrazzak, Walid Saber, Tarek Mohamed, Maha Mohamed, Wael Esmat, Eman Fathy, Muhamed Abdelrahim, Rasha Maree
Background: Erectile dysfunction (ED) is a prevalent complication observed in male patients with liver cirrhosis; however, there is limited understanding of the etiological determinants responsible for its occurrence. The objective of this investigation is to explore potential contributory factors that underlie the development of ED in male patients with liver cirrhosis.
Method: A cross-sectional study was conducted on 200 male patients with liver cirrhosis, who were divided into three groups according to the Child score. ED was studied using the International Index of Erectile Function (IIEF-5) Questionnaire and penile Doppler.
Results: The prevalence of ED among the cirrhotic patients was 80%, and it was more frequent in patients with advanced liver disease (Child C). Penile venous leakage was observed in 20% of cirrhotic patients, which increased to 28.6% in those with advanced liver cirrhosis. Multivariate logistic regression analysis showed that age, low albumin levels, elevated INR, high hemoglobin levels, and Child C were predictors of ED in cirrhotic patients.
Conclusion: Several clinical variables have been identified as potential contributors to the development of erectile dysfunction (ED) in patients with cirrhosis. These variables include advanced age, decreased levels of albumin, elevated INR, increased hemoglobin levels, and Child C classification. Early identification and treatment of these factors could potentially improve the quality of life for cirrhotic patients with ED. Notably, patients with ED in this population were observed to have elevated levels of INR, serum bilirubin, and hemoglobin, as well as reduced levels of serum albumin.
背景:勃起功能障碍(ED)是男性肝硬化患者的一种常见并发症;然而,人们对导致ED发生的病因了解有限。本研究旨在探讨男性肝硬化患者发生 ED 的潜在诱因:方法:对 200 名男性肝硬化患者进行横断面研究,根据 Child 评分将他们分为三组。采用国际勃起功能指数(IIEF-5)问卷和阴茎多普勒对ED进行了研究:结果:ED在肝硬化患者中的发病率为80%,在晚期肝病患者(Child C)中更为常见。20%的肝硬化患者出现阴茎静脉漏,晚期肝硬化患者的这一比例上升至28.6%。多变量逻辑回归分析显示,年龄、低白蛋白水平、INR升高、高血红蛋白水平和Child C是肝硬化患者ED的预测因素:结论:有几个临床变量被认为是肝硬化患者发生勃起功能障碍(ED)的潜在因素。这些变量包括高龄、白蛋白水平下降、INR升高、血红蛋白水平升高和Child C分类。及早识别和治疗这些因素有可能改善肝硬化 ED 患者的生活质量。值得注意的是,在这一人群中,ED 患者的 INR、血清胆红素和血红蛋白水平升高,血清白蛋白水平降低。
{"title":"Prevalence and risk factors of erectile dysfunction in cirrhotic patients: An observational study.","authors":"Mohamed Fakhry, Hamdy Mahfouz, Khalid Abdelazeem, Mohamed AbdelSabour, Nour Shaheen, Ahmed Fathy, Amro M Hassan, Hazem Dief, Mohamed El-Nady, Mustafa A Haridy, Omran Mohamed, Safwat Salama, Emad Abdelrazzak, Walid Saber, Tarek Mohamed, Maha Mohamed, Wael Esmat, Eman Fathy, Muhamed Abdelrahim, Rasha Maree","doi":"10.1080/2090598X.2023.2238933","DOIUrl":"10.1080/2090598X.2023.2238933","url":null,"abstract":"<p><strong>Background: </strong>Erectile dysfunction (ED) is a prevalent complication observed in male patients with liver cirrhosis; however, there is limited understanding of the etiological determinants responsible for its occurrence. The objective of this investigation is to explore potential contributory factors that underlie the development of ED in male patients with liver cirrhosis.</p><p><strong>Method: </strong>A cross-sectional study was conducted on 200 male patients with liver cirrhosis, who were divided into three groups according to the Child score. ED was studied using the International Index of Erectile Function (IIEF-5) Questionnaire and penile Doppler.</p><p><strong>Results: </strong>The prevalence of ED among the cirrhotic patients was 80%, and it was more frequent in patients with advanced liver disease (Child C). Penile venous leakage was observed in 20% of cirrhotic patients, which increased to 28.6% in those with advanced liver cirrhosis. Multivariate logistic regression analysis showed that age, low albumin levels, elevated INR, high hemoglobin levels, and Child C were predictors of ED in cirrhotic patients.</p><p><strong>Conclusion: </strong>Several clinical variables have been identified as potential contributors to the development of erectile dysfunction (ED) in patients with cirrhosis. These variables include advanced age, decreased levels of albumin, elevated INR, increased hemoglobin levels, and Child C classification. Early identification and treatment of these factors could potentially improve the quality of life for cirrhotic patients with ED. Notably, patients with ED in this population were observed to have elevated levels of INR, serum bilirubin, and hemoglobin, as well as reduced levels of serum albumin.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44709606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-23eCollection Date: 2024-01-01DOI: 10.1080/2090598X.2023.2239107
Osama Mahmoud, Ulrich Krafft, Mulham Al-Nader, Jochen Heß, Claudia Kesch, Mostafa AbdelRazek, Ahmad Abolyosr, Gamal A Alsagheer, Omar Mohamed, Atef Fathi, Boris A Hadaschik, Stephan Tschirdewahn
Introduction: Ureteroenteric stricture (UES) is the leading cause of renal function deterioration after radical cystectomy (RC) and urinary diversion (UD). The aim of the present review is to summarize studies that discussed the risk factors associated with UES development. Identifying the responsible factors is of importance to help surgeons to modify their treatment or follow-up strategies to reduce this serious complication.
Materials and methods: A comprehensive search of the literature using the PubMed database was conducted. The target of the search was only studies that primarily aimed to identify risk factors of UES after RC and UD. References of searched papers were also checked for potential inclusion.
Results: The search originally yielded a total of 1357 articles, of which only 15 met our inclusion criteria, comprising 13, 481 patients. All the studies were observational, and retrospective published between 2013 and 2022. The natural history of UES and the reported risk factors varied widely across the studies. In 13 studies, a significant association between some risk factors and UES development was demonstrated. High body mass index (BMI) was the most frequently reported stricture risk factor, followed by perioperative urinary tract infection (UTI), robotic-assisted radical cystectomy (RARC), occurrence of post-operative Clavian grade ≥ 3 complications and urinary leakage. Otherwise, many other risk factors were reported only once.
Conclusion: The literature is still lacking well-designed prospective studies investigating predisposing factors of UES. The available data suggest that the high BMI, RARC and complicated postoperative course are the main risk factors for stricture formation.
{"title":"Risk factors for ureteroenteric stricture after radical cystectomy and urinary diversion: A systematic review.","authors":"Osama Mahmoud, Ulrich Krafft, Mulham Al-Nader, Jochen Heß, Claudia Kesch, Mostafa AbdelRazek, Ahmad Abolyosr, Gamal A Alsagheer, Omar Mohamed, Atef Fathi, Boris A Hadaschik, Stephan Tschirdewahn","doi":"10.1080/2090598X.2023.2239107","DOIUrl":"10.1080/2090598X.2023.2239107","url":null,"abstract":"<p><strong>Introduction: </strong>Ureteroenteric stricture (UES) is the leading cause of renal function deterioration after radical cystectomy (RC) and urinary diversion (UD). The aim of the present review is to summarize studies that discussed the risk factors associated with UES development. Identifying the responsible factors is of importance to help surgeons to modify their treatment or follow-up strategies to reduce this serious complication.</p><p><strong>Materials and methods: </strong>A comprehensive search of the literature using the PubMed database was conducted. The target of the search was only studies that primarily aimed to identify risk factors of UES after RC and UD. References of searched papers were also checked for potential inclusion.</p><p><strong>Results: </strong>The search originally yielded a total of 1357 articles, of which only 15 met our inclusion criteria, comprising 13, 481 patients. All the studies were observational, and retrospective published between 2013 and 2022. The natural history of UES and the reported risk factors varied widely across the studies. In 13 studies, a significant association between some risk factors and UES development was demonstrated. High body mass index (BMI) was the most frequently reported stricture risk factor, followed by perioperative urinary tract infection (UTI), robotic-assisted radical cystectomy (RARC), occurrence of post-operative Clavian grade ≥ 3 complications and urinary leakage. Otherwise, many other risk factors were reported only once.</p><p><strong>Conclusion: </strong>The literature is still lacking well-designed prospective studies investigating predisposing factors of UES. The available data suggest that the high BMI, RARC and complicated postoperative course are the main risk factors for stricture formation.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46437783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-16eCollection Date: 2024-01-01DOI: 10.1080/2090598X.2023.2234254
Morshed Salah, Bela Tallai, Tawiz Gul, Omar Aboumarzouk, Maged Alrayashi, Mohamed Abdelkareem, Hatem Kamkoum, Mohammed Ibrahim, Mohammed Ebrahim, Hossameldin Alnawasra, Salvan Alhabash, Ahmed Ismail, Maged Alghashmi, Abdulla Al-Ansari
Objectives: To report our initial experience of day care percutaneous nephrolithotomy (PCNL) with early hospital discharge within less than 24 hours of the procedure.
Patients and methods: The files of patients treated with PCNL between 1st January 2020 till 31st December 2022 were retrospectively reviewed. Day care PCNL was defined as the discharge of patients either on the same day or within 24 hours after surgery. Patient age, ASA score, body mass index, stone diameter, laterality, stone burden, Hounsfield unit, and Guy's score were analyzed. Operative time, size of the access tract, method of lithotripsy, estimated blood loss, and length of hospital stay were also recorded. Postoperative complications were stratified according to the Dindo-Clavien classification. The primary outcome was to evaluate the feasibility and safety of early discharge within 24 hours after PCNL compared to the in-patients who were kept in hospital for at least 2 days after surgery.
Results: A total of 85 patients underwent PCNL at our center of whom 36 patients were discharged within 24 hours (day care PCNL) of the procedure and 49 patients were kept for at least 2 days (in-patient PCNL). In the day care group, median stone burden was 465 mm2 (360-980) and 18 patients (50%) had Guy's stone score ≥ III. The median tract size was 24 (13-30) and endoscopic combined intrarenal surgery (ECIRS) was performed in 7 cases in the day care group. Tubeless PCNL was carried out in 88.8% of the day care surgery group compared to 37.5% in the in-patient group (p < 0.0001). The postoperative complication rate was comparable between both groups (13.8% vs 22.4% for day care vs in-patient group, respectively, p = 0.08).
Conclusions: Day care PCNL is feasible and safe for selected patients including those having large stone burden without increasing the risk of complications or readmission rate.
{"title":"Percutaneous nephrolithotomy in supine position with less than 24-hour hospital stay; a single-center experience.","authors":"Morshed Salah, Bela Tallai, Tawiz Gul, Omar Aboumarzouk, Maged Alrayashi, Mohamed Abdelkareem, Hatem Kamkoum, Mohammed Ibrahim, Mohammed Ebrahim, Hossameldin Alnawasra, Salvan Alhabash, Ahmed Ismail, Maged Alghashmi, Abdulla Al-Ansari","doi":"10.1080/2090598X.2023.2234254","DOIUrl":"10.1080/2090598X.2023.2234254","url":null,"abstract":"<p><strong>Objectives: </strong>To report our initial experience of day care percutaneous nephrolithotomy (PCNL) with early hospital discharge within less than 24 hours of the procedure.</p><p><strong>Patients and methods: </strong>The files of patients treated with PCNL between 1st January 2020 till 31st December 2022 were retrospectively reviewed. Day care PCNL was defined as the discharge of patients either on the same day or within 24 hours after surgery. Patient age, ASA score, body mass index, stone diameter, laterality, stone burden, Hounsfield unit, and Guy's score were analyzed. Operative time, size of the access tract, method of lithotripsy, estimated blood loss, and length of hospital stay were also recorded. Postoperative complications were stratified according to the Dindo-Clavien classification. The primary outcome was to evaluate the feasibility and safety of early discharge within 24 hours after PCNL compared to the in-patients who were kept in hospital for at least 2 days after surgery.</p><p><strong>Results: </strong>A total of 85 patients underwent PCNL at our center of whom 36 patients were discharged within 24 hours (day care PCNL) of the procedure and 49 patients were kept for at least 2 days (in-patient PCNL). In the day care group, median stone burden was 465 mm2 (360-980) and 18 patients (50%) had Guy's stone score ≥ III. The median tract size was 24 (13-30) and endoscopic combined intrarenal surgery (ECIRS) was performed in 7 cases in the day care group. Tubeless PCNL was carried out in 88.8% of the day care surgery group compared to 37.5% in the in-patient group (p < 0.0001). The postoperative complication rate was comparable between both groups (13.8% vs 22.4% for day care vs in-patient group, respectively, p = 0.08).</p><p><strong>Conclusions: </strong>Day care PCNL is feasible and safe for selected patients including those having large stone burden without increasing the risk of complications or readmission rate.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41941772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-05eCollection Date: 2023-01-01DOI: 10.1080/2090598X.2023.2218566
Kareim Khalafalla, Walid El Ansari, Pallav Sengupta, Ahmad Majzoub, Haitham Elbardisi, Onder Canguven, Kareem El-Ansari, Mohamed Arafa
Purpose: To systematically review the evidence on the association between sexually transmitted infections (STIs) and male infertility. We sought to answer two questions: Are STIs significantly associated with detrimental changes in semen parameters?; and, is the prevalence of STIs significantly higher in infertile than fertile men?
Materials and methods: PubMed, Scopus and Google Scholar databases were searched (inceptionMarch 2023) following the PRISMA guidelines. Identified original studies in English on the association between STIs and male infertility were included. Data was tabulated/described by pathogen, mechanisms of action, number of studies and their level of evidence.
Results: Seventy out of 903 originally retrieved articles were included in this review. For the detrimental changes in semen parameters (first question), the evidence seems equivocal based on the nearly equal number of studies and similar levels of evidence. The only exception was for Ureaplasma, where the number of studies and levels of evidence supported an association with male infertility. Pertaining to a significantly higher prevalence of STI among infertile compared to fertile men (second question), evidence was insufficient to support/deny a significant association. The two exceptions were Ureaplasma and Mycoplasma, where the number of studies and evidence levels were in favour of an association with male infertility.
Conclusions: Generally, the relationship between STIs and male infertility remains to be uncovered. Our appraisal of the overall state of this relationship shows that the evidence base leaves much to be desired. The exceptions are Ureaplasma and Mycoplasma, where the evidence convincingly suggests their associations with infertility in men.
{"title":"Are sexually transmitted infections associated with male infertility? A systematic review and in-depth evaluation of the evidence and mechanisms of action of 11 pathogens.","authors":"Kareim Khalafalla, Walid El Ansari, Pallav Sengupta, Ahmad Majzoub, Haitham Elbardisi, Onder Canguven, Kareem El-Ansari, Mohamed Arafa","doi":"10.1080/2090598X.2023.2218566","DOIUrl":"10.1080/2090598X.2023.2218566","url":null,"abstract":"<p><strong>Purpose: </strong>To systematically review the evidence on the association between sexually transmitted infections (STIs) and male infertility. We sought to answer two questions: Are STIs significantly associated with detrimental changes in semen parameters?; and, is the prevalence of STIs significantly higher in infertile than fertile men?</p><p><strong>Materials and methods: </strong>PubMed, Scopus and Google Scholar databases were searched (inceptionMarch 2023) following the PRISMA guidelines. Identified original studies in English on the association between STIs and male infertility were included. Data was tabulated/described by pathogen, mechanisms of action, number of studies and their level of evidence.</p><p><strong>Results: </strong>Seventy out of 903 originally retrieved articles were included in this review. For the detrimental changes in semen parameters (first question), the evidence seems equivocal based on the nearly equal number of studies and similar levels of evidence. The only exception was for Ureaplasma, where the number of studies and levels of evidence supported an association with male infertility. Pertaining to a significantly higher prevalence of STI among infertile compared to fertile men (second question), evidence was insufficient to support/deny a significant association. The two exceptions were Ureaplasma and Mycoplasma, where the number of studies and evidence levels were in favour of an association with male infertility.</p><p><strong>Conclusions: </strong>Generally, the relationship between STIs and male infertility remains to be uncovered. Our appraisal of the overall state of this relationship shows that the evidence base leaves much to be desired. The exceptions are Ureaplasma and Mycoplasma, where the evidence convincingly suggests their associations with infertility in men.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10763591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47045332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-20eCollection Date: 2023-01-01DOI: 10.1080/2090598X.2023.2225315
Ahmad R Al-Qudimat, Mohamed B Al Darwish, Saif B Altahtamouni, Kalapan Singh, Raed M Al-Zoubi, Omar M Aboumarzouk, Abdulla Al-Ansari
Objective: We conducted this review to offer a comprehensive search and up-to-date overview of the currently available information about the probability risk of colorectal cancer among chronic kidney disease patients.
Method: We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews (PRISMA) and meta-analysis guidelines. We identified, reviewed, and extracted from Scopus, PubMed, EMBASE, and Komaki Databases for research publications on chronic kidney disease and colorectal cancer published between February 2016 and January 2023. We meta-analyzed the prevalence of colorectal cancer with chronic kidney disease. We ran a random effect meta-regression. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. The systematic review was registered with PROSPERO (CRD42023400983).
Results: The risk of CRC in chronic kidney diseases was reported in 50 research studies, which included 4,337,966 people from 16 different countries. SIR of CRC was obtained from 14 studies and showed a significant relationship between CRC with CKD patients, with a pooled SIR of 1.33; 95% CI (1.30-1.36), with higher heterogeneity (Q = 121.82, P < 0.001, and I2 = 86.9%). Metaregression showed that there was no significant correlation between the risk of CRC and the proportion of males or age.
Conclusion: Overall, this study shows that patients with chronic kidney disease have a significantly increased risk of colorectal cancer. More studies with larger sample sizes, and robust surveillance are needed.
{"title":"Chronic kidney diseases and the risk of colorectal cancer: A systematic review and meta-analysis.","authors":"Ahmad R Al-Qudimat, Mohamed B Al Darwish, Saif B Altahtamouni, Kalapan Singh, Raed M Al-Zoubi, Omar M Aboumarzouk, Abdulla Al-Ansari","doi":"10.1080/2090598X.2023.2225315","DOIUrl":"10.1080/2090598X.2023.2225315","url":null,"abstract":"<p><strong>Objective: </strong>We conducted this review to offer a comprehensive search and up-to-date overview of the currently available information about the probability risk of colorectal cancer among chronic kidney disease patients.</p><p><strong>Method: </strong>We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews (PRISMA) and meta-analysis guidelines. We identified, reviewed, and extracted from Scopus, PubMed, EMBASE, and Komaki Databases for research publications on chronic kidney disease and colorectal cancer published between February 2016 and January 2023. We meta-analyzed the prevalence of colorectal cancer with chronic kidney disease. We ran a random effect meta-regression. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. The systematic review was registered with PROSPERO (CRD42023400983).</p><p><strong>Results: </strong>The risk of CRC in chronic kidney diseases was reported in 50 research studies, which included 4,337,966 people from 16 different countries. SIR of CRC was obtained from 14 studies and showed a significant relationship between CRC with CKD patients, with a pooled SIR of 1.33; 95% CI (1.30-1.36), with higher heterogeneity (Q = 121.82, <i>P</i> < 0.001, and I<sup>2</sup> = 86.9%). Metaregression showed that there was no significant correlation between the risk of CRC and the proportion of males or age.</p><p><strong>Conclusion: </strong>Overall, this study shows that patients with chronic kidney disease have a significantly increased risk of colorectal cancer. More studies with larger sample sizes, and robust surveillance are needed.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10763595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45574390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-13eCollection Date: 2024-01-01DOI: 10.1080/2090598X.2023.2220627
Elizabeth M Jackson, Prajit Khooblall, Scott D Lundy, Petar Bajic
Guidelines from the American Urological Association (AUA) and the European Association of Urology (EAU) present conflicting recommendations regarding combination therapy of phosphodiesterase 5 inhibitors (PDE5is) with α-blockers to treat benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Use of PDE5is is widespread in the population of patients with LUTS/BPH. In this scoping review, we examine the evidence regarding the safety and efficacy of combined PDE5is and α-blockers compared to PDE5i medications alone. A search was conducted using PubMed, Cochrane, and Web of Science to identify manuscripts discussing the safety of PDE5i and α-blockers in combination or comparing this combination to PDE5is alone in the treatment of LUTS/BPH. Study designs, data, and conclusions were qualitatively analyzed. Combination therapy was found to be safe across all studies; importantly, no evidence documents increased risk of hypotension. Most studies reported added improvement in symptom and quality of life scores compared to PDE5i alone, with additional International Prostate Symptom Score (IPSS) change ranging from -1.30 to -8.50 and IPSS quality of life score change ranging from -0.15 to -1.50. Objective metrics such as postvoid residual volumes and maximum flow rate were inconsistently reported. Taken together, the current body of data suggests that combining PDE5i α-blocker therapy is safe and that there are opportunities for additional symptomatic improvement, though it should be utilized for select patients. Situations with particular utility could include patients with comorbid erectile dysfunction or without sufficient improvement on monotherapy.
{"title":"A Review of Combined Phosphodiesterase-5-Inhibitors and α-Blockers versus Phosphodiesterase-5-Inhibitors Alone for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia.","authors":"Elizabeth M Jackson, Prajit Khooblall, Scott D Lundy, Petar Bajic","doi":"10.1080/2090598X.2023.2220627","DOIUrl":"10.1080/2090598X.2023.2220627","url":null,"abstract":"<p><p>Guidelines from the American Urological Association (AUA) and the European Association of Urology (EAU) present conflicting recommendations regarding combination therapy of phosphodiesterase 5 inhibitors (PDE5is) with α-blockers to treat benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Use of PDE5is is widespread in the population of patients with LUTS/BPH. In this scoping review, we examine the evidence regarding the safety and efficacy of combined PDE5is and α-blockers compared to PDE5i medications alone. A search was conducted using PubMed, Cochrane, and Web of Science to identify manuscripts discussing the safety of PDE5i and α-blockers in combination or comparing this combination to PDE5is alone in the treatment of LUTS/BPH. Study designs, data, and conclusions were qualitatively analyzed. Combination therapy was found to be safe across all studies; importantly, no evidence documents increased risk of hypotension. Most studies reported added improvement in symptom and quality of life scores compared to PDE5i alone, with additional International Prostate Symptom Score (IPSS) change ranging from -1.30 to -8.50 and IPSS quality of life score change ranging from -0.15 to -1.50. Objective metrics such as postvoid residual volumes and maximum flow rate were inconsistently reported. Taken together, the current body of data suggests that combining PDE5i α-blocker therapy is safe and that there are opportunities for additional symptomatic improvement, though it should be utilized for select patients. Situations with particular utility could include patients with comorbid erectile dysfunction or without sufficient improvement on monotherapy.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42468209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-10eCollection Date: 2024-01-01DOI: 10.1080/2090598X.2023.2221403
Shrouq Qudah, Mohammad Abufaraj, Randa Farah, Abdulrahman Almazeedi, Ali Ababneh, Mazen Alnabulsi, Ayman Qatawneh, Dana Hyassat, Kamel Ajlouni
Objective: Overactive bladder (OAB) is a common condition affecting both men and women and has been shown to affect the quality of life. We conducted this study to estimate the prevalence of OAB, and to incorporate symptom severity, symptom bother and health-related quality of life (HRQL) in the assessment of OAB and evaluate associated factors.
Methodology: A total of 940 participants were categorized into non-OAB and OAB using the Overactive Bladder Symptom Score (OABSS). HRQL and symptom bother were measured using the Overactive Bladder Questionnaire - Short Form (OAB-q SF). Descriptive analyses and multivariable regression analyses were performed.
Results: The prevalence of OAB among our population was 27.4%. Patients with older age (Odd ratio [OR] = 2.26, 95% confidence interval [CI]: 1.6-3), higher body mass index (BMI) (OR = 2.6, 95% CI: 1.8-3.8), comorbidities (OR = 2.6, 95% CI: 1.9-3.5) and history of recurrent urinary tract infection (UTI) s (OR = 1.9, 95% CI: 1.4-2.6) were significantly associated with increased risk of OAB (p < 0.001). The mean OAB symptom bothers score was 35.7 + 22.9 and increased significantly across OAB severity groups (p < 0.001). The mean HRQL score was 73.3 + 22 and a significant decreased across OAB severity groups (p < 0.001). All OAB symptoms showed significant positive correlation with increased symptom bother (p < 0.001) in addition to significant inverse correlation with HRQL (p < 0.001).
Conclusion: OAB is a prevalent condition in our population and the associated symptoms negatively affect HRQL. In this study, the detrimental effect is not exclusive to UUI and can be attributed to the other elements in the symptom spectrum of OAB. Screening for OAB should be considered during routine clinical visits using validated and reliable measures for early detection of symptoms and possible modification of risk factors to improve the outcome.
{"title":"The prevalence of overactive bladder and its impact on the quality of life: A cross-sectional study.","authors":"Shrouq Qudah, Mohammad Abufaraj, Randa Farah, Abdulrahman Almazeedi, Ali Ababneh, Mazen Alnabulsi, Ayman Qatawneh, Dana Hyassat, Kamel Ajlouni","doi":"10.1080/2090598X.2023.2221403","DOIUrl":"10.1080/2090598X.2023.2221403","url":null,"abstract":"<p><strong>Objective: </strong>Overactive bladder (OAB) is a common condition affecting both men and women and has been shown to affect the quality of life. We conducted this study to estimate the prevalence of OAB, and to incorporate symptom severity, symptom bother and health-related quality of life (HRQL) in the assessment of OAB and evaluate associated factors.</p><p><strong>Methodology: </strong>A total of 940 participants were categorized into non-OAB and OAB using the Overactive Bladder Symptom Score (OABSS). HRQL and symptom bother were measured using the Overactive Bladder Questionnaire - Short Form (OAB-q SF). Descriptive analyses and multivariable regression analyses were performed.</p><p><strong>Results: </strong>The prevalence of OAB among our population was 27.4%. Patients with older age (Odd ratio [OR] = 2.26, 95% confidence interval [CI]: 1.6-3), higher body mass index (BMI) (OR = 2.6, 95% CI: 1.8-3.8), comorbidities (OR = 2.6, 95% CI: 1.9-3.5) and history of recurrent urinary tract infection (UTI) s (OR = 1.9, 95% CI: 1.4-2.6) were significantly associated with increased risk of OAB (<i>p</i> < 0.001). The mean OAB symptom bothers score was 35.7 + 22.9 and increased significantly across OAB severity groups (<i>p</i> < 0.001). The mean HRQL score was 73.3 + 22 and a significant decreased across OAB severity groups (<i>p</i> < 0.001). All OAB symptoms showed significant positive correlation with increased symptom bother (<i>p</i> < 0.001) in addition to significant inverse correlation with HRQL (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>OAB is a prevalent condition in our population and the associated symptoms negatively affect HRQL. In this study, the detrimental effect is not exclusive to UUI and can be attributed to the other elements in the symptom spectrum of OAB. Screening for OAB should be considered during routine clinical visits using validated and reliable measures for early detection of symptoms and possible modification of risk factors to improve the outcome.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43702974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-10eCollection Date: 2024-01-01DOI: 10.1080/2090598X.2023.2222262
Bora Özveren, Nejdet Karşıyakalı, Levent Türkeri
Objective: To assess the incidence, risk factors, and timing of specific causes of reoperations following PVP.
Material and methods: A retrospective analysis of data on men who underwent GreenLight PVP between 2004 and 2019 in a single center and required surgical intervention for bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma.
Results: The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter. None of the risk factors had any relevance to US. In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor. In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations (p < 0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis.
Conclusions: An unselective utilization of PVP may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons.
摘要评估PVP术后再次手术的具体原因的发生率、风险因素和时间:回顾性分析2004年至2019年期间在一个中心接受GreenLight PVP手术的男性患者的数据,这些患者因膀胱颈挛缩(BNC)、尿道狭窄(US)或持续/复发性前列腺腺瘤而需要手术治疗:在为期61个月的中位随访中,377名患者的再次手术率为13.8%。因BNC、US和腺瘤而再次手术的比例分别为7.7%、5.6%和4.8%。因 US 而再次手术的中位间隔时间(11 个月)明显较短。所有风险因素均与 US 无关。在因 BNC 而再次手术的患者中,激光时间和能量明显较低,前列腺体积也较小;但是,多变量分析仅发现较短的激光时间是一个预测因素。在因腺瘤持续/复发而再次手术的患者中,PSA 升高,而前列腺体积却无明显增大,由经验较少的外科医生进行手术与较高的再次手术率有关(P 结论:在因腺瘤持续/复发而再次手术的患者中,PSA 升高,而前列腺体积却无明显增大,由经验较少的外科医生进行手术与较高的再次手术率有关:不加选择地使用 PVP 可能会导致较高的再手术率。BNC 与较短激光时间的相关性可能意味着较小前列腺的 PVP 术后风险较高。较长的穿刺时间预示着因腺瘤持续/复发而再次手术的风险增加,这可能与前列腺体积较大以及经验较少的外科医生的 PVP 效率较低有关。
{"title":"Surgical reintervention requirements following GreenLight PVP: A single-center experience using three different laser device models.","authors":"Bora Özveren, Nejdet Karşıyakalı, Levent Türkeri","doi":"10.1080/2090598X.2023.2222262","DOIUrl":"10.1080/2090598X.2023.2222262","url":null,"abstract":"<p><strong>Objective: </strong>To assess the incidence, risk factors, and timing of specific causes of reoperations following PVP.</p><p><strong>Material and methods: </strong>A retrospective analysis of data on men who underwent GreenLight PVP between 2004 and 2019 in a single center and required surgical intervention for bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma.</p><p><strong>Results: </strong>The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter. None of the risk factors had any relevance to US. In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor. In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations (<i>p</i> < 0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis.</p><p><strong>Conclusions: </strong>An unselective utilization of PVP may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46307690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-09eCollection Date: 2024-01-01DOI: 10.1080/2090598X.2023.2220631
Fady K Ghobrial, Mahmoud Laymon, Nasr El-Tabey, Ahmed M Elshal
Objectives: To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPSTM system are still pending.
Patients and methods: Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported.
Results: Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, P = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (P = 0.03). In retreatment group, more intraoperative bleeding (P = 0.02), early postoperative hematuria (P = 0.03), higher median preoperative PSA (P = 0.02) and less postoperative one-year percent PSA reduction (P = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76).Median (range in months) time to event was 20 (1-60) for all cases and 13.5 (1-42) and 30 (18-60), P = 0.7, for GL.PVP and GL.PVEP groups, respectively.
Conclusion: Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.
{"title":"Greenlight laser (XPS-180watt) prostatectomy for treatment of benign prostate obstruction, Pursuit of durability.","authors":"Fady K Ghobrial, Mahmoud Laymon, Nasr El-Tabey, Ahmed M Elshal","doi":"10.1080/2090598X.2023.2220631","DOIUrl":"10.1080/2090598X.2023.2220631","url":null,"abstract":"<p><strong>Objectives: </strong>To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPS<sup>TM</sup> system are still pending.</p><p><strong>Patients and methods: </strong>Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported.</p><p><strong>Results: </strong>Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, <i>P</i> = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (<i>P</i> = 0.03). In retreatment group, more intraoperative bleeding (<i>P</i> = 0.02), early postoperative hematuria (<i>P</i> = 0.03), higher median preoperative PSA (<i>P</i> = 0.02) and less postoperative one-year percent PSA reduction (<i>P</i> = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76).Median (range in months) time to event was 20 (1-60) for all cases and 13.5 (1-42) and 30 (18-60), <i>P</i> = 0.7, for GL.PVP and GL.PVEP groups, respectively.</p><p><strong>Conclusion: </strong>Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46235389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-16eCollection Date: 2023-01-01DOI: 10.1080/2090598X.2023.2211897
Ahmed Ibrahim Radwan, Ahmed Mohsen Ibrahim Saif, Younan Ramsis Samir, Wael Ali Maged, Mohamed A Gamal
Objectives: The purpose of this study is to compare results, safety and outcome of ultra-mini-percutaneous nephrolithotomy (PCNL) versus stented shock wave lithotripsy (SWL) for the management of renal calculi sized 10-20 mm.
Methods: This study was conducted at Urology Department, Faculty of Medicine, Ain Shams University. After meeting inclusion and exclusion criteria, 90 patients were randomized to either ultra-mini-PCNL group or stented SWL group through the closed-envelope technique, with 45 patients in each group. Patient data were collected preoperatively, immediately postoperatively and 2 and 4 weeks postoperatively assessing operative time, hospital stay, complications including haematuria, fever, the need for blood transfusion, residual stones and the need for retreatment.
Results: Stone-free rate (SFR) was higher in the ultra-mini-PCNL group compared to the stented SWL group, with no statistically significant difference with P-value = 0.316. As for the need for retreatment, it was slightly higher in the stented SWL group compared to the ultra-mini-PCNL group, yet this difference was statistically insignificant with P-value = 0.681.We found no statistically significant difference between both groups regarding post-operative complications including fever, haematuria and need for blood transfusion, respectively.Operative time and hospital stay were significantly higher in the ultra-mini-PCNL group compared to the stented SWL group with P-value < 0.001 for both.
Conclusion: Both stented SWL and ultra-mini-PCNL are good treatment choices for renal stones sized less than 2 cm with low complication rates. Stone size indices were significant predictor for the need for retreatment. Further studies to compare SFR based on stone size in both interventions are needed.
{"title":"Comparative study between ultra-mini-percutaneous nephrolithotomy versus stented extracorporeal shock wave lithotripsy for treatment of renal stones in Egypt.","authors":"Ahmed Ibrahim Radwan, Ahmed Mohsen Ibrahim Saif, Younan Ramsis Samir, Wael Ali Maged, Mohamed A Gamal","doi":"10.1080/2090598X.2023.2211897","DOIUrl":"10.1080/2090598X.2023.2211897","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study is to compare results, safety and outcome of ultra-mini-percutaneous nephrolithotomy (PCNL) versus stented shock wave lithotripsy (SWL) for the management of renal calculi sized 10-20 mm.</p><p><strong>Methods: </strong>This study was conducted at Urology Department, Faculty of Medicine, Ain Shams University. After meeting inclusion and exclusion criteria, 90 patients were randomized to either ultra-mini-PCNL group or stented SWL group through the closed-envelope technique, with 45 patients in each group. Patient data were collected preoperatively, immediately postoperatively and 2 and 4 weeks postoperatively assessing operative time, hospital stay, complications including haematuria, fever, the need for blood transfusion, residual stones and the need for retreatment.</p><p><strong>Results: </strong>Stone-free rate (SFR) was higher in the ultra-mini-PCNL group compared to the stented SWL group, with no statistically significant difference with <i>P</i>-value = 0.316. As for the need for retreatment, it was slightly higher in the stented SWL group compared to the ultra-mini-PCNL group, yet this difference was statistically insignificant with <i>P</i>-value = 0.681.We found no statistically significant difference between both groups regarding post-operative complications including fever, haematuria and need for blood transfusion, respectively.Operative time and hospital stay were significantly higher in the ultra-mini-PCNL group compared to the stented SWL group with <i>P</i>-value < 0.001 for both.</p><p><strong>Conclusion: </strong>Both stented SWL and ultra-mini-PCNL are good treatment choices for renal stones sized less than 2 cm with low complication rates. Stone size indices were significant predictor for the need for retreatment. Further studies to compare SFR based on stone size in both interventions are needed.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10763587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42718040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}