BMC Urology最新文献

Background: Managing lower pole renal stones presents clinical challenges influenced by various factors such as stone size, location, and density. This study aims to assess the efficacy, safety, and stone-free rates of Flexible Ureteroscopy (FURS), Extracorporeal Shock Wave Lithotripsy (ESWL), and Mini Percutaneous Nephrolithotomy (Mini PCNL) for treating lower pole renal hard stones (< 2 cm).

Methods: A prospective single-centre comparative study was conducted on 414 adult patients with primary lower pole renal hard stones. Patients were evenly distributed into three groups: Flexible Ureteroscopy (FURS) utilizing holmium laser lithotripsy, Extracorporeal Shock Wave Lithotripsy (ESWL), and Mini PCNL employing holmium laser lithotripsy.

Results: Statistically significant differences with P value < 0.001 were observed among groups in stone-free rates, hospital stay, radiation exposure, operative duration, auxiliary treatments, and overall cost. No statistically significant differences were found in demographic data with P value = 0.245 or complication rates with P value = 0.611 among the groups. At the 2-week follow-up, stone-free rates were 90.2% for Flexible Ureteroscopy which was comparable with mini PCNL and both were significantly higher than ESWL 61.5%.

Conclusions: Mini PCNL and Flexible URS demonstrated comparable stone-free rates for moderate-sized, hard lower pole renal stones, surpassing ESWL. However, Mini PCNL showed longer operative times, increased radiation exposure, and elevated risks of complications and morbidity compared to Flexible URS. Considering these factors, Flexible URS might be recommended in those types of stones.

Trial registration: Our study has been approved by local ethical committee Kafrelsheikh university (KFSIRB20069) on 30/10/2023 and by clinical trials (NCT06120257) on 15/12/2023.

Introduction: Concealed penis is a congenital anomaly that affects not only the appearance but also the function of the external genitalia in the male sex. Different surgical methods have been proposed to correct this disorder, including removal of the previous scar, penile shaft, penile trunk skin reconstruction with flap, penile skin fixation in penopubic and penoscrotal angles, and removal of extra pubic fat. In this study, we will discuss the results of definitive surgery in one stage using autogenous skin grafts and examine the details of this technique.

Methods: This study was conducted as a clinical trial in Hospitals related to the Isfahan University of Medical Sciences. Children over the age of 7 years old. A full-thickness graft with a length of 1.5 times the defect and a width of 1 cm was taken from the non-dominant thigh and defatted. The inguinal skin was chosen because it is hairless and next to the penis, and the resulting scar is easily hidden under clothing. Then, the graft was transferred to the operation site and fixed.

Results and conclusion: We proposed a method of treatment for concealed penis, using a full-thickness inguinal graft. Our technique showed promising results with minimal and negligible complications. To fully highlight each process's benefits and limitations and evaluate them against one another, these procedures should, however, be tested on larger populations and compared comprehensively.

Trial registration: The study was conducted in accordance with the ethical standards of the Isfahan University of Medical Sciences Research Ethics Committee (ethical code: IR.MUI.MED.REC.1402.073) And was registered on 27/05/2023 as a clinical trial in Iranian registry of clinical trials. (IRCT code: IRCT20230513058160N1).

Background: Prostate cancer is the most frequently diagnosed cancer among men in the world. Uganda and Zimbabwe have been reported to have highest incidence rates of prostate cancer in sub-Saharan Africa. There are no urologists and no prostate cancer diagnostic facilities in rural communities in south western Uganda. Men with lower urinary tract symptoms are treated with prostatectomy by midlevel healthcare workers and general surgeons without prior prostate cancer screening. Histological diagnosis relies on the prostate tissue retrieved during surgery and the results may take several months. Prostate cancer care in southwestern Uganda remains uncoordinated and has not been documented before. This study aimed to establish and document the burden of prostate cancer in rural southwestern Uganda as a basis for further research.

Methods: This was a retrospective study conducted in hospitals in rural southwestern Uganda. We used hospital records as primary source of data. Histology results of patients treated with prostatectomy during the five-year period (2019-2023) were retrieved and data extracted for analysis. 1013 patients were included in the study. Univariate data analysis was done with STATA version 17.0. The study received ethics clearance for Kabale university REC and Uganda National council of Science and Technology.

Results: The average age of patients in this study was 70.6 year (range 54-102 years). Prostate cancer was present in 232 (22.9%) patients. Seventeen (7.3%) patients with prostate cancer were below sixty years. Most (75.4%) of the patients with prostate cancer in this study had low to intermediate risk disease. Perineural tumor infiltration was present in 28.9% of prostate cancer patients.

Conclusion: More than 1 in 5 men (22.9%) with lower urinary tract symptoms treated with prostatectomy in the study period in southwestern Uganda had prostate cancer. Majority of patients (75.4%) had low to intermediate risk disease. These findings highlight the urgent need for systematic improvements in prostate cancer care, including sensitization of both health workers and the general population, establishment of early screening and regional diagnostic and treatment facilities to enhance patient outcomes in resource -limited rural communities in Uganda.

Clinical trial number: Not applicable.

Objective: A ureteric stone is a type of urinary tract stone that is found within the ureter. While most cases can be managed with conservative treatment or minimally invasive surgery, these methods often cause significant pain for the patient. Interestingly, a new type of ureteroscope has shown considerable promise in treating patients with ureteric stones, and this study aims to explore its clinical application.

Methods: A total of 120 patients with ureteric stones were recruited from our hospitals between January 1, 2023, and December 31, 2023. These patients were randomly assigned to either the control group, which received the traditional straight ureteroscope, or the experimental group, which was treated with the new type of ureteroscope. Both groups provided general data and blood samples for further analysis. A logistic regression analysis was conducted to examine the factors influencing infection following surgery in patients with ureteric stones, including preoperative CRP greater than 8 mg/L, postoperative CRP greater than 8 mg/L, preoperative white blood cell count (> 10⁹/L), postoperative white blood cell count (> 10⁹/L), preoperative urinalysis count greater than 28 (/ul), postoperative urinalysis count greater than 28 (/ul), and urine routine leukocyte count.

Results: The findings indicated no significant differences between the observation group and the control group regarding preoperative demographic, participants general data (P > 0.05). Postoperative CRP > 8 mg/L, white blood cell count > 10 × 10⁹/L, urinalysis count > 28/µL, and urine leukocyte count significantly decreased in the experimental group compared to the control group (P < 0.05). Binary logistic regression showed that postoperative CRP > 8 mg/L (OR = 7.03), white blood cell count > 109/L (OR = 3.86), urinalysis count > 28/µL (OR = 2.83), and urine leukocyte count (OR = 1.004) were predictive factors for ureteric stones. Preoperative values showed no significant difference (P > 0.05).

Conclusions: The binary logistic regression analysis identified Postoperative CRP > 8 mg/L, white blood cell count > 10 × 10⁹/L, urinalysis count > 28/µL, and urine leukocyte count as significant predictors of postoperative infections. Our research findings indicate that the new ureteroscope has significant advantages over traditional ureteroscopes in terms of ease of entry into the ureteral lumen, stone fragmentation angle during surgery, surgical field of view, surgical operability, and reducing the risk of postoperative potential infections. These characteristics demonstrate that the new ureteroscope has significant potential in clinical applications, warranting further promotion and use.

Objective: This study aims to identify the risk factors for systemic inflammatory response syndrome (SIRS) after minimally invasive percutaneous nephrolithotomy (PCNL) with a controlled irrigation pressure and to find which patients undergoing PCNL are likely to develop SIRS under the pressure-controlled condition.

Methods: A total of 303 consecutive patients who underwent first-stage PCNL in our institute between July 2016 and June 2018 were retrospectively reviewed. All the procedures were performed with an 18 F tract using an irrigation pump setting the irrigation fluid pressure at 110 mmHg and the flow rate of irrigation at 0.4 L/min. SIRS and sepsis were recorded after PCNL. The demographic data, clinical features, and test results were analyzed.

Results: 52 patients (17.2%) developed SIRS and only 3 patients (0.99%) further progressed to severe sepsis. The results of univariate analysis showed that the stone size, operative time, history of DM, the value of glycosylated hemoglobin, history of ipsilateral surgery, preoperative urine culture, Staghorn calculi, pelvic urine culture, stone culture, number of tracts, blood transfusion, and residual stones were found to have a significant correlation with post-PCNL SIRS (p < 0.05). In multivariate analysis, the stone size (OR = 3.743, p = 0.012), preoperative urine culture (OR = 2.526, p = 0.042), pelvic urine culture (OR = 13.523, p < 0.001), the number of access tracts (OR = 8.945, p = 0.002), blood transfusion (OR = 26.308, p < 0.001) were identified as the independent risk factors for post-PCNL SIRS.

Conclusion: The stone size (>4cm²), positive preoperative urine culture, positive pelvic urine culture, multiple tracts, receipt of a blood transfusion are the independent risk factors for SIRS under the pressure-controlled condition. More attention should be paid when the PCNL patients have these risk factors.

Background: Vaginal pessaries are a common method of managing pelvic organ prolapse (POP), as well as different types of urinary incontinence, allowing patients to successfully improve overall quality of life. Yet despite their positive attributes, there are several reasons why patients may choose to discontinue using pessaries and proceed with surgery to treat their condition instead. This study aimed to explore patients' experiences of pessary use in treating POP.

Methods: Participants completed an online survey regarding pessary use and ideal characteristics of a pessary. Participants were recruited from social media advertisements, online support groups for women's health-related conditions, and pelvic floor clinics.

Results: A total of 100 participants were recruited, of which 77 fully completed the survey. The biggest age group of participants was above 65 years, with 48.1% of participants falling into this category, followed by 35-44 years accounting for 20.8% of respondents. Respondents cited pelvic pain (35.2%), excess vaginal discharge and odor (32.4%), as well as difficulty with pessary placement as the most common issues related to pessary use (41.9%). Easy insertion, removal (81.8%), and relief from side effects (81.8%) were the most commonly reported ideal characteristics for pessary use.

Conclusion: Patients had important concerns with pessary use and a high number either stopped or were considering stopping even when it improved their POP. Whilst pessaries can help in the management of POP, further improvement is warranted to increase pessary use, such as through the development of user-friendly designs, or applicators to aid with fitting.

In calcium stone formers, most stones grow attached to Randall's plaque, which can be identified by measuring the computed tomography (CT) attenuation value of renal papilla. We hypothesized that the CT attenuation value of renal papilla can predict the severity (recurrent or multiple stone former) and recurrence of the stone disease. We retrospectively reviewed the charts of 180 calcium oxalate stone formers who underwent non-contrast CT and 24-hour urine chemistry in our hospital between September 2012 and November 2021. Two observers independently measured the Hounsfield unit (HU) of the renal papilla and classified the patients into the low-HU and the high-HU value groups according to the median value (38.9 HU). The proportion of recurrent and multiple stone formers were similar between the low-HU group and the high-HU group (70.0% vs. 65.6%, 71.1% vs. 74.2%, respectively). There were also no significant differences in urinary volume, urinary excretions of each constituent, or AP(CaOx) index between the two groups. On the other hand, the recurrence rate in the high-HU value group (0.10 events/person/year) was significantly higher than that in the low-HU value group (0 events/person/year, p = 0.03). Multivariate analysis revealed that high-HU value was an independent predictor of stone recurrence (OR 1.90, 95% CI 1.00-3.64, p = 0.04) as well as medical prophylaxis. The results of this study suggest that HU value of renal papilla is a useful predictor of recurrence of stone disease.

The intrauterine device (IUD) is an important and highly effective means of contraception. Migration of the IUD, post implantation, out of the uterus is an infrequent complication, and its subsequent migration into the urinary bladder with formation of secondary bladder calculi, is even more infrequently reported. The authors report a 51 year old woman who had had her last child delivered via cesarean section 16 years ago. She underwent an IUD insertion in the next few months but was subsequently lost to follow up. Before detection of the ectopic state of the IUD she complained of dysuria and dyspareunia for two weeks. Clinically detected suprapubic discomfort on palpation. After a series of imaging studies and cystoscopy, the presence of an IUD stump with stones attached to it in the patient's bladder were confirmed. Cystoscopy followed by laser lithotripsy of the calculus was performed, as the first step in the treatment. After failure to remove the IUD cystoscopically, further cystotomy was made, however one side end of the cap structure of the IUD could not be located, necessitating abdominal exploration and irrigation till retrieval in totality. The patient made an uneventful recovery.The case report emphasizes the importance of excluding uncommon etiolgies like ectopic IUDs as a cause of immobile adherent bladder calculi in women. Complete removal necessitates good preoperative knowledge of the type of IUD, as structural degradation might lead to separation of its components. An adequate consent for a possible exploration of the abdomen in case of a missing component should also be taken.

Background: Current treatments for penile erectile structures reconstruction are limited and remain a great challenge in clinical practice. Tissue engineering techniques using different seed cells and scaffolds to construct a neo-tissue open promising avenues for penile erectile structures repair and replacement and show great promise in the restoration of: structure, mechanical property, and function which matches the original tissue.

Methods: A comprehensive literature review was conducted by accessing the NCBI PubMed, Cochrane, and Google Scholar databases from January 1, 1990, to January, 1, 2022 using the search terms "Tissue engineering, Corpus cavernosum (CC), Tunica albuginea (TA), Acellular Matrix, Penile Reconstruction". Articles were screened and assessed by two independent reviewers to determine whether those met the inclusion criteria, and a total of 19 articles were being selected and included in the data analysis.

Results: Tissue engineered cell-seeded scaffold can reconstruct a similar structure to native TA and CC and showed good histocompatibility with no immunological rejection. The results of the evaluation of morphological feature, intracavernosal pressure, and erectile-related nitric oxide (NO) expression were strongly proofs that the tissue engineered graft can significantly improve the penile erectile and ejaculatory function. In addition, increasing the purity of seed cells, improving the mechanical properties of the scaffold, providing appropriate induction for stem cells, and optimizing cell delivery systems are potential approaches to improve reconstructive outcomes. Currently, a larger animal model, comparable in size to the human penis, is needed to test the feasibility of the engineered grafts.

Conclusion: Our review summarized the research in tissue engineering of CC and TA. It showed great promise in reconstructing the functional structures and restoring the erection and ejaculatory function. With continuous advancement in the field, tissue-engineered penile erectile structures hold substantial potential to enhance clinical outcomes for patients.

Background: Complications after male circumcision are numerous and may be presented as an adhesion between the glans penis and the preputial remnants, these adhesions may acquire different forms and troublesome the affected children.

Patients and methods: This is a retrospective study of 95 consecutive children of presumed glanular-preputial adhesions referred for correction of circumcision. They were assessed and classified as having either an early preputial adhesion or a well-formed skin bridge into 2 groups; group (A) who have a simple adhesion that was resolved through a conservative preputial adhesiolysis while those in the group (B) had a well-formed skin bridge, which deserves surgical correction. Histopathology done for 30 cases from group B. All cases were followed up till resolution of the adhesion.

Results: A wide diversity of the Glanular-Preputial Adhesions (GPA) was recognized with a different form ranged from a simple fibrinous adhesion which was diagnosed in 55 cases (group A), these adhesions were resolved with medical treatment, and a well-formed single or multiple skin bridges formed 3-4 months after circumcision; which were detected in 40 patients (group B) with a smegma pearls in 15, all required a surgical adhesiolysis. Mean age of patients was 3 years (6 months to 12 years). Three cases were diagnosed with penile scleroatrophic lichen balanitis.

Conclusion: Glanular-Preputial Adhesions is not a rare complication after MC. It could be a simple fibrinous; which resolves with topical corticosteroid or a well-formed skin bridge which needs surgical adhesiolysis.