Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a ...Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a retrospective study of patients referred with urologic complications following obstetric and gynaecological surgeries. The study took place at the Teaching Clinic of Urology Andrology at CNHU of Cotonou between April 1, 2008 and March 31, 2013. Results: Forty-one patients were studied. They represented 3.5% of people hospitalized at CUUA throughout the study period. The average age was 41 years swith range of 20 and 57 years. Twenty-one (51.2%) of them were married. Thirty patients (73.2%) were referred from a non-academichospital, while 7 patients (17.1%) were referred from academic hospital. Caesarean section was the primary gynecological surgery in 22 cases (53.7%) and hysterectomy in 19 cases (46.3%). Clinically, the pre- dominant symptoms were leakage of urine throughout the vagina and obstructive anuria with or without back pain. We found 31 cases of VVF, 5 cases of bilateral ligation of the ureters, 3 cases of unilateral ligation of the ureter, 1 ureteralinjury and 1 uretero-vaginal fistula. These complications were diagnosed postoperatively in 95.1% of cases. Surgeries done included VVF repair in 31 cases (75.6%), unilateral ureteral reimplantation in 4 cases (9.8%), removal of ligation of the ureters in 3 cases (7.3%), bilateral ureteral reimplantation for 2 cases (4.9%) and end-to-end anastomosisin 1 case (2.4%). The postoperative period was uneventful in 29 cases and we observed 7 cases of surgical site infection. The overall success rate was 87.8%. Conclusion: Urological complications following gynecologic surgeries managed at the urologic department of teaching hospital of Coto-nou had an even higher incidence. Early diagnosis especially during the operative procedure would save the patients’ serious complications and open surgery due to the lack of endo-urological facilities. The most important factor in prevention is good knowledge of pelvicanatomy and good knowledge of the surgical techniques of caesarean operation section and trans-abdominal hysterectomy.展开更多
BACKGROUND The incidence of chronic kidney disease(CKD)has dramatically increased in recent years,with significant impacts on patient mortality rates.Previous studies have identified multiple risk factors for CKD,but ...BACKGROUND The incidence of chronic kidney disease(CKD)has dramatically increased in recent years,with significant impacts on patient mortality rates.Previous studies have identified multiple risk factors for CKD,but they mostly relied on the use of traditional statistical methods such as logistic regression and only focused on a few risk factors.AIM To determine factors that can be used to identify subjects with a low estimated glomerular filtration rate(L-eGFR<60 mL/min per 1.73 m^(2))in a cohort of 1236 Chinese people aged over 65.METHODS Twenty risk factors were divided into three models.Model 1 consisted of demographic and biochemistry data.Model 2 added lifestyle data to Model 1,and Model 3 added inflammatory markers to Model 2.Five machine learning methods were used:Multivariate adaptive regression splines,eXtreme Gradient Boosting,stochastic gradient boosting,Light Gradient Boosting Machine,and Categorical Features+Gradient Boosting.Evaluation criteria included accuracy,sensitivity,specificity,area under the receiver operating characteristic curve(AUC),F-1 score,and balanced accuracy.RESULTS A trend of increasing AUC of each was observed from Model 1 to Model 3 and reached statistical significance.Model 3 selected uric acid as the most important risk factor,followed by age,hemoglobin(Hb),body mass index(BMI),sport hours,and systolic blood pressure(SBP).CONCLUSION Among all the risk factors including demographic,biochemistry,and lifestyle risk factors,along with inflammation markers,UA is the most important risk factor to identify L-eGFR,followed by age,Hb,BMI,sport hours,and SBP in a cohort of elderly Chinese people.展开更多
Objective:To identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia.Methods:A retrospective study of seven tertiary hospitals from January 2019 to April 2019,and from January 2020 to April 20...Objective:To identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia.Methods:A retrospective study of seven tertiary hospitals from January 2019 to April 2019,and from January 2020 to April 2020 was performed.Records of urology outpatient department(OPD)visits and endourology procedures in the first third of 2020 were analyzed and compared with those in the first third of 2019,as well as,during the full curfew time,i.e.April 2020 versus April 2019.Results:Number of OPD visits in the first third of 2020 and 2019 were 19499 and 26594,respectively(p<0.001).Number of OPD visits in April 2020 was 1512,with a 78.6%decrease compared to that in April 2019,and among them 1373(90.8%)were teleclinics.Number of elective procedures in the first third of 2020 has decreased by 34.3%(from 3025 to 1988)compared to that in the first third of 2019(p<0.001).There were 120 elective procedures in April 2020,84.1%lower than that in April 2019.Percutaneous nephrolithotomy,shockwave lithotripsy,and transurethral resection of prostate procedures declined by 94.2%,98.5%,and 93.8%,respectively.Most procedures were performed as day surgery(85.0%).Number of emergency procedures in 2020 have fallen by 9.3%compared to 2019(pZ0.286).Urolithiasis was the commonest pathology(52.6%)presented to the emergency room(52.6%).Conclusion:During COVID-19 pandemic,urology services slashed by>75%,including OPD visits and elective endourology procedures.Most hospitals have changed their strategic preventive measures by increasing the rate of teleclinics and day surgeries.展开更多
Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive sur...Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin(PSM)rates.Methods We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy(RP)at Siriraj Hospital between January 2013 and September 2019.PSM rates were compared between those with and without preoperative MRI.PSM locations were analyzed.Results In total,322(30.1%)patients underwent MRI before RP.PSM most frequently occurred at the apex(33.2%),followed by posterior(13.5%),bladder neck(12.7%),anterior(10.7%),posterolateral(9.9%),and lateral(2.3%)positions.In preoperative MRI,PSM was significantly lowered at the posterior surface(9.0%vs.15.4%,p=0.01)and in the subgroup of urologists with less than 100 RP experiences(32%vs.51%,odds ratio=0.51,p<0.05).Blood loss was also significantly decreased when a preoperative image was obtained(200 mL vs.250 mL,p=0.02).Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex.Neither the surgical approach,the neurovascular bundle sparing technique,nor the perioperative blood loss was associated with PSM.Conclusion MRI is associated with less overall PSM,PSM at apex,and blood loss during RP.Additionally,preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.展开更多
BACKGROUND Taiwan has a high prevalence of tuberculosis and urothelial carcinoma.However,the simultaneous occurrence of both disorders in one patient is uncommon.Tuberculosis and urothelial carcinoma share some common...BACKGROUND Taiwan has a high prevalence of tuberculosis and urothelial carcinoma.However,the simultaneous occurrence of both disorders in one patient is uncommon.Tuberculosis and urothelial carcinoma share some common risk factors and could demonstrate overlapping clinical manifestations.CASE SUMMARY Herein,we report the case of a patient who presented with fever,persistent hematuria,and pyuria.Chest computed tomography scans revealed a bilateral upper lobes cavitary lesion with fibrosis.Severe hydronephrosis of the right kidney and renal stones and cysts in the left kidney were observed.Initial microbiological testing was negative;however,a polymerase chain reaction assay of the urine confirmed a urinary tuberculosis infection.The patient was started on an anti-tuberculosis regimen.Ureteroscopy performed to resolve obstructive nephropathy revealed the incidental finding of a left middle-third ureteral tumor.Examination after biopsy and transurethral resection of the bladder tumor indicated urothelial carcinoma.The patient underwent laparoscopic nephroureterectomy,with bladder cuff excision for the right kidney and ureter,and holmium laser ablation of the ureteral lesion to preserve the left kidney and ureter.He has remained stable after the procedures.CONCLUSION Although establishing a causal relationship between tuberculosis and cancer is difficult,medical personnel should consider their correlation.展开更多
Dear Editor,Prostate cancer is the most common cancer among men[1].Androgen deprivation therapy(ADT)has remained the primary treatment of metastatic-hormone-sensitive prostate cancer(mHSPC),providing a temporary disea...Dear Editor,Prostate cancer is the most common cancer among men[1].Androgen deprivation therapy(ADT)has remained the primary treatment of metastatic-hormone-sensitive prostate cancer(mHSPC),providing a temporary disease control in the majority of patients.Despite initial ADT response,castration-resistance prostate cancer(CRPC)still develops.Previous study have attempted to determine possible biomarkers for poor prognosis in patients with CRPC[2].展开更多
Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensiona...Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy(t-3DLRP)and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia(GA).Methods:A prospective,double-center,double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed.A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA.Results:The two group were similar in all demographic,clinical,and pathological variables.Postoperative blood gas parameters were within physiologic limits in both groups.Muscle relaxation was adequate for surgery during both NA and GA.Median length of stay was 1 day shorter for NA group than GA group(5 days vs.6 days,p=0.05).t-3DLRP under NA had a statistically lower rate of minor complications(4.8%vs.19.0%,p=0.03)and less postoperative pain(median numeric rating scale 3 vs.4,p=0.01)compared to GA.No major complications were observed in both groups.Significantly more patients were willing to undergo a similar intervention under NA than GA(p=0.04).Conclusion:t-3DLRP under NA is a feasible and safe procedure,with less postoperative pain and fewer minor complications than the same procedure under GA.NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.展开更多
BACKGROUND Giant condyloma acuminatum(GCA)is an uncommon condition affecting the anogenital area.CASE SUMMARY Here,we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance ...BACKGROUND Giant condyloma acuminatum(GCA)is an uncommon condition affecting the anogenital area.CASE SUMMARY Here,we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance of multiple cauliflower-like warts over his penile shaft,pubis region,and groin as well as urine leakage along the distal penile shaft.Physical examination revealed an ulcerative skin perforation with pus discharge under the distal prepuce base,which was initially suspected to be a urethral fistula.However,during surgery,it was discovered that the perforation was caused by a giant condyloma lesion that had obliterated the prepuce opening,with infection and high pressure causing subsequent skin perforation.He underwent circumcision and wide excision with electrocauterization of the warts.He was discharged after the surgery,and the residual lesion was treated with imiquimod and low-dose oral tegafur-uracil.CONCLUSION Penile GCA can cause prepuce perforation and can be postoperatively treated with imiquimod and low-dose oral tegafur-uracil.展开更多
Background: Generally, urological emergencies are assumed not to be very common, however, recent reports showed that they constitute an important aspect of the day-to-day urological practice. If not well and promptly ...Background: Generally, urological emergencies are assumed not to be very common, however, recent reports showed that they constitute an important aspect of the day-to-day urological practice. If not well and promptly managed, they may lead to serious morbidity or mortality. Objectives: To study the pattern of presentation, diagnosis and outcome of management of non-traumatic urological emergencies seen at the Emergency Department of Souro Sanou University Hospital in Bobo-Dioulasso. Patients and Methods: This was a retrospective and descriptive study over four years. It included patients of all ages and both sexes, admitted for non-traumatic urological emergencies in the surgical emergency department of Souro Sanou University Hospital. It took place from January 1, 2017 to December 31, 2020. Results: A total of 584 patients were reviewed in our study. Non-traumatic urological emergencies account for 6.3% of all surgical emergencies seen during the study period. The male-to-female ratio was 9.2 to 1. The mean age of the patients was 51.9 ± 23.9 years. Forty-five per cent of the patients presented within 48 hours of symptoms. The vast majority of the patients presented with difficulties with passing urine (41.6%), followed by cases of hematuria (18.4%). On admission, 154 patients (26.4%) presented with severe conditions such as anemia as seen in 40.9% of the cases and deterioration in the general health condition as seen in 34.4% of the patients. Leukocytosis was noted in 18.7% of the patients and anemia in 17.9%. Urine culture was positive in 15.4% of the patients and Escherichia coli was the most common pathogen found (40.6%). Ultrasound was the most requested examination (81.2%), followed by a computerized tomography (CT) scan (22%). The most frequent diagnoses were urine retention (42.9%), hematuria (16.9%) and renal colic (10.1%). Emergency interventions were carried out in 525 patients (89.9%) who include bladder catheterization (46.1%), bladder lavage and/or bladder irrigation (20.9%) and suprapubic cystocatheterization (10.1%). Most of the patients (61.3%) were discharged after a mean stay in the hospital of about 5.1 ± 7.5 days. A mortality rate of 3.8% was also recorded among the patients studied. Conclusion: Non-traumatic urological emergencies are common and are an important aspect of daily urological practice. The majority of the patient presents late with usually a severe form of the disease, which adversely affects the outcome even after treatment.展开更多
Introduction: Male urethral stricture is one of the oldest urological disorders. Many techniques have been proposed to treat them, including endoscopic internal urethrotomy (DVIU). Material and Methods: To evaluate th...Introduction: Male urethral stricture is one of the oldest urological disorders. Many techniques have been proposed to treat them, including endoscopic internal urethrotomy (DVIU). Material and Methods: To evaluate the contribution of this technique in the treatment of urethra narrowing, a retrospective study on the records of patients with urethral stricture treated with endoscopic internal urethrotomy between January 2014 and December 2021 in the urology division of the Souro Sanou University Teaching Hospital. Results: A total of 44 male patients with urethral stricture were treated with this technique and 48 procedures were performed. The average age of the patients was 53.2 ± 18.2 years. The etiology of the stricture was dominated by iatrogenic, infectious, traumatic and idiopathic causes in 43.2% (n = 19), 27.3% (n = 12), 20.4 % (n = 9), and 9.1% (n = 4) respectively. The location of the stricture was bulbar in 72.7%, and the anterior penile urethra in 15.9%. The overall success rate was 72.7% with satisfactory urination without dysuria, evaluated after removal of the urinary catheter, at three months this rate fell to 69.1%, and at 6 months this rate was 67.5%. Five cases (5) of extravasation of blood or irrigation fluid into the scrotum were reported and managed conservatively as well as two (2) cases of false routes with postoperative oedema of the penis were observed. Conclusion: DVIU is a simple technique, free of major morbidity and requiring only short-term hospitalization. It can be proposed as a first-line treatment for urethral stricture.展开更多
Prostate cancer poses a significant health challenge globally,demanding proactive prevention strategies.This editorial explores the emerging role of vitamin D in prostate cancer prevention.While traditionally associat...Prostate cancer poses a significant health challenge globally,demanding proactive prevention strategies.This editorial explores the emerging role of vitamin D in prostate cancer prevention.While traditionally associated with bone health,vitamin D is increasingly recognized for its broader impact on immune function,cellular signaling,and cancer prevention.Epidemiological studies suggest an intriguing link between vitamin D deficiency and elevated prostate cancer risk,particularly in regions with limited sunlight exposure.Mechanistically,vitamin D regulates cellular processes,inhibiting unchecked cancer cell growth and bols-tering immune surveillance.Personalized prevention strategies,considering individual factors,are deemed essential for harnessing the full potential of vitamin D.To unlock this potential,the future calls for robust research,public awareness campaigns,dietary improvements,and vigilant medical guidance.Collaborative efforts are poised to pave the way toward a future where vitamin D stands as a sentinel in prostate cancer prevention,ushering in hope and improved health for men worldwide.展开更多
Aim:To evaluate the long term effect of experimental cryptorchidism on germ cell apoptotic rate and testicular sperm content in adult rats.Methods:Bilateral cryptorchidism was created in 40 adult male Sprague-Dawley r...Aim:To evaluate the long term effect of experimental cryptorchidism on germ cell apoptotic rate and testicular sperm content in adult rats.Methods:Bilateral cryptorchidism was created in 40 adult male Sprague-Dawley rats by surgically manipulating the testes into the abdominal cavity and closing the internal inguinal ring.The rats were sacrificed and the testes removed 6 hours and 2,4,7,21,28 and 56 days after cryptorchidism.Germ cell apoptosis was quantified by means of TUNEL assay and apoptosis was confirmed using transmission electron microscopy.Results:The rate of apoptosis peaked at 4 days of cryptorchidism and then progressively declined to a nadir at 14 days of cryptorchidism.At 56 days of cryptorchidism,the germinal epithelium was largely depleted by the apoptotic process and only a few mature sperm were seen within the testis.At this point,a few tubules were seen to be repopulating with primary spermatocytes and the level of germ cell apoptosis began to increase marginally.Testicular sperm count (TSC) began to decline rapidly at day 7 of cryptorchidism.Only a few mature sperm were found in the testes of rats following 56 days of cryptorchidism.Multinucleated giant cells (MGC) were most numerous within the seminiferous tubules at day 4.At day 7,35% of MGCs were TUNEL positive.At all subsequent time points,however,MGCs fail to stain positive for apoptosis.This resumption of increased apoptosis coincided with the appearance of a population of primary spermatocytes in some seminiferous tubules.Moreover,there was not a corresponding increase in the number of mature sperm after 56 days of cryptorchidism.Conclusion:The decline in germ cell apoptosis after 4 days of cryptorchidism can be attributed to be the result of an overall depletion of germ cells.It appears that after a prolonged cryptorchidism (56 days),there is a limited resumption of spermatogenesis presumably as a result of a decrease in the maturing germ cells undergoing programmed cell death.(Asian JAndrol2004 Mar;6:47-51)展开更多
The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field.Flexible ureteroscopy(fURS)has advanced considerably to be...The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field.Flexible ureteroscopy(fURS)has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies.The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet(YAG)laser lithotripsy.Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones.fURS has proved to be an effective and safe procedure with few contraindications.Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.展开更多
Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal malignancies. They are rarely seen near the urinary tract. In a literature review, only one case of GIST presenting as a left adrenal tumor was reporte...Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal malignancies. They are rarely seen near the urinary tract. In a literature review, only one case of GIST presenting as a left adrenal tumor was reported. We report two documented cases of gastric GISTs mimicking left adrenal tumors which were successfully treated with pure laparoscopic adrenalectomy and wedge resection of the stomach by excising the tumor from the stomach with serial fi ring of endoscopic gastrointestinal staplers. The surgical margins were clear, and the patients recovered smoothly. No adjuvant therapy with imatinib was prescribed. During the surveillance for 9 mo and 44 mo respectively, no tumor recurrence and metastasis were documented. Laparoscopic tumor excision, when adhering to the principles of surgical oncology, seems feasible and the prognosisis favorable for such tumors.展开更多
Aim: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities. Methods: In a prospective, controlled and blind study, nineteen p...Aim: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities. Methods: In a prospective, controlled and blind study, nineteen patients, aged 24 years～42 years and married for 3 years～11 years without children with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause, were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for l0 weeks. Semen analyses were performed before and after the treatment course. Results:The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group (calculated U=16.0, critical U=17.0). Conclusion: The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normalform sperm in infertile patients with oligoastenoteratozoospermia without apparent cause.展开更多
The aim of this study was to determine the correlation of ultrasonographic estimates of testicular volume with true testicular volume and to compare the accuracy and precision of the three most commonly utilized formu...The aim of this study was to determine the correlation of ultrasonographic estimates of testicular volume with true testicular volume and to compare the accuracy and precision of the three most commonly utilized formulas.A total of 15 patients underwent high-resolution ultrasonography(US)analysis for testicular volume before orchiectomy.Testicular volume was calculated using three common formulas:(1)length(L)×width(W)×height(H)×0.52;(2)the empirical formula of Lambert:L×W×H×0.71;and(3)L×W^(2)×0.52.The actual volume of each removed testis was estimated directly by a water displacement method.Thus,four volume measurements were obtained for each of the 30 testes.The obtained data were analyzed by paired t-test and linear regression analysis.All three US formula measurements significantly underestimated the true testicular volume.The largest mean biases were observed with US formula 1,which underestimated the true volume by 3.3 mL(31%).US formula 2 had a smaller mean difference from the true volume,with an underestimation of only 0.6 mL(6%).Regression analysis showed that formulas 1 and 2 had better R^(2) values than formula 3.However,all three US formulas displayed a strong linear relationship with the true volume(R^(2)=0.872−0.977;P<0.001).Among the commonly used US formulas,the empirical formula of Lambert(L×W×H×0.71)provided better accuracy than the other two formulas evaluated,and better precision than formula 3.Therefore,the formula of Lambert is the optimal choice in clinical practice.展开更多
Miniaturized percutaneous nephrolithotomy(PCNL)procedures have gained increased popularity in recent years.They aim to reduce percutaneous tract size in order to lower complication rates,while maintaining high stone-f...Miniaturized percutaneous nephrolithotomy(PCNL)procedures have gained increased popularity in recent years.They aim to reduce percutaneous tract size in order to lower complication rates,while maintaining high stone-free rates.Recently,miniaturized PCNL techniques have further expanded,and can currently be classified into mini-PCNL,minimally invasive PCNL(MIP),Chinese mini-PCNL(MPCNL),ultra-mini-PCNL(UMP),micro-PCNL,mini-micro-PCNL,and super-mini-PCNL(SMP).However,despite its minimally-invasive nature,its potential superiority in terms of safety and efficacy when compared to conventional PCNL is still under debate.The aim of this review is to summarise different available modalities of miniaturized PCNL,details of instruments involved,and their corresponding safety and efficacy.In particular,this article highlights the role of the SMP and our experience with this novel technique in management of urolithiasis.Overall,miniaturized PCNL techniques appear to be safe and effective alternatives to conventional PCNL for both adult and pediatric patients.Well-designed,randomized studies are required to further investigate and identify specific roles of miniaturized PCNL techniques before considering them as standard rather than alternative procedures to conventional PCNL.展开更多
文摘Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a retrospective study of patients referred with urologic complications following obstetric and gynaecological surgeries. The study took place at the Teaching Clinic of Urology Andrology at CNHU of Cotonou between April 1, 2008 and March 31, 2013. Results: Forty-one patients were studied. They represented 3.5% of people hospitalized at CUUA throughout the study period. The average age was 41 years swith range of 20 and 57 years. Twenty-one (51.2%) of them were married. Thirty patients (73.2%) were referred from a non-academichospital, while 7 patients (17.1%) were referred from academic hospital. Caesarean section was the primary gynecological surgery in 22 cases (53.7%) and hysterectomy in 19 cases (46.3%). Clinically, the pre- dominant symptoms were leakage of urine throughout the vagina and obstructive anuria with or without back pain. We found 31 cases of VVF, 5 cases of bilateral ligation of the ureters, 3 cases of unilateral ligation of the ureter, 1 ureteralinjury and 1 uretero-vaginal fistula. These complications were diagnosed postoperatively in 95.1% of cases. Surgeries done included VVF repair in 31 cases (75.6%), unilateral ureteral reimplantation in 4 cases (9.8%), removal of ligation of the ureters in 3 cases (7.3%), bilateral ureteral reimplantation for 2 cases (4.9%) and end-to-end anastomosisin 1 case (2.4%). The postoperative period was uneventful in 29 cases and we observed 7 cases of surgical site infection. The overall success rate was 87.8%. Conclusion: Urological complications following gynecologic surgeries managed at the urologic department of teaching hospital of Coto-nou had an even higher incidence. Early diagnosis especially during the operative procedure would save the patients’ serious complications and open surgery due to the lack of endo-urological facilities. The most important factor in prevention is good knowledge of pelvicanatomy and good knowledge of the surgical techniques of caesarean operation section and trans-abdominal hysterectomy.
基金Supported by the Kaohsiung Armed Forces General HospitalThe study protocol was approved by the Institutional Review Board of the Tri-Service General Hospital,National Defense Medical Center(IRB No.:KAFGHIRB 109-46).
文摘BACKGROUND The incidence of chronic kidney disease(CKD)has dramatically increased in recent years,with significant impacts on patient mortality rates.Previous studies have identified multiple risk factors for CKD,but they mostly relied on the use of traditional statistical methods such as logistic regression and only focused on a few risk factors.AIM To determine factors that can be used to identify subjects with a low estimated glomerular filtration rate(L-eGFR<60 mL/min per 1.73 m^(2))in a cohort of 1236 Chinese people aged over 65.METHODS Twenty risk factors were divided into three models.Model 1 consisted of demographic and biochemistry data.Model 2 added lifestyle data to Model 1,and Model 3 added inflammatory markers to Model 2.Five machine learning methods were used:Multivariate adaptive regression splines,eXtreme Gradient Boosting,stochastic gradient boosting,Light Gradient Boosting Machine,and Categorical Features+Gradient Boosting.Evaluation criteria included accuracy,sensitivity,specificity,area under the receiver operating characteristic curve(AUC),F-1 score,and balanced accuracy.RESULTS A trend of increasing AUC of each was observed from Model 1 to Model 3 and reached statistical significance.Model 3 selected uric acid as the most important risk factor,followed by age,hemoglobin(Hb),body mass index(BMI),sport hours,and systolic blood pressure(SBP).CONCLUSION Among all the risk factors including demographic,biochemistry,and lifestyle risk factors,along with inflammation markers,UA is the most important risk factor to identify L-eGFR,followed by age,Hb,BMI,sport hours,and SBP in a cohort of elderly Chinese people.
文摘Objective:To identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia.Methods:A retrospective study of seven tertiary hospitals from January 2019 to April 2019,and from January 2020 to April 2020 was performed.Records of urology outpatient department(OPD)visits and endourology procedures in the first third of 2020 were analyzed and compared with those in the first third of 2019,as well as,during the full curfew time,i.e.April 2020 versus April 2019.Results:Number of OPD visits in the first third of 2020 and 2019 were 19499 and 26594,respectively(p<0.001).Number of OPD visits in April 2020 was 1512,with a 78.6%decrease compared to that in April 2019,and among them 1373(90.8%)were teleclinics.Number of elective procedures in the first third of 2020 has decreased by 34.3%(from 3025 to 1988)compared to that in the first third of 2019(p<0.001).There were 120 elective procedures in April 2020,84.1%lower than that in April 2019.Percutaneous nephrolithotomy,shockwave lithotripsy,and transurethral resection of prostate procedures declined by 94.2%,98.5%,and 93.8%,respectively.Most procedures were performed as day surgery(85.0%).Number of emergency procedures in 2020 have fallen by 9.3%compared to 2019(pZ0.286).Urolithiasis was the commonest pathology(52.6%)presented to the emergency room(52.6%).Conclusion:During COVID-19 pandemic,urology services slashed by>75%,including OPD visits and elective endourology procedures.Most hospitals have changed their strategic preventive measures by increasing the rate of teleclinics and day surgeries.
文摘Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin(PSM)rates.Methods We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy(RP)at Siriraj Hospital between January 2013 and September 2019.PSM rates were compared between those with and without preoperative MRI.PSM locations were analyzed.Results In total,322(30.1%)patients underwent MRI before RP.PSM most frequently occurred at the apex(33.2%),followed by posterior(13.5%),bladder neck(12.7%),anterior(10.7%),posterolateral(9.9%),and lateral(2.3%)positions.In preoperative MRI,PSM was significantly lowered at the posterior surface(9.0%vs.15.4%,p=0.01)and in the subgroup of urologists with less than 100 RP experiences(32%vs.51%,odds ratio=0.51,p<0.05).Blood loss was also significantly decreased when a preoperative image was obtained(200 mL vs.250 mL,p=0.02).Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex.Neither the surgical approach,the neurovascular bundle sparing technique,nor the perioperative blood loss was associated with PSM.Conclusion MRI is associated with less overall PSM,PSM at apex,and blood loss during RP.Additionally,preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.
文摘BACKGROUND Taiwan has a high prevalence of tuberculosis and urothelial carcinoma.However,the simultaneous occurrence of both disorders in one patient is uncommon.Tuberculosis and urothelial carcinoma share some common risk factors and could demonstrate overlapping clinical manifestations.CASE SUMMARY Herein,we report the case of a patient who presented with fever,persistent hematuria,and pyuria.Chest computed tomography scans revealed a bilateral upper lobes cavitary lesion with fibrosis.Severe hydronephrosis of the right kidney and renal stones and cysts in the left kidney were observed.Initial microbiological testing was negative;however,a polymerase chain reaction assay of the urine confirmed a urinary tuberculosis infection.The patient was started on an anti-tuberculosis regimen.Ureteroscopy performed to resolve obstructive nephropathy revealed the incidental finding of a left middle-third ureteral tumor.Examination after biopsy and transurethral resection of the bladder tumor indicated urothelial carcinoma.The patient underwent laparoscopic nephroureterectomy,with bladder cuff excision for the right kidney and ureter,and holmium laser ablation of the ureteral lesion to preserve the left kidney and ureter.He has remained stable after the procedures.CONCLUSION Although establishing a causal relationship between tuberculosis and cancer is difficult,medical personnel should consider their correlation.
文摘Dear Editor,Prostate cancer is the most common cancer among men[1].Androgen deprivation therapy(ADT)has remained the primary treatment of metastatic-hormone-sensitive prostate cancer(mHSPC),providing a temporary disease control in the majority of patients.Despite initial ADT response,castration-resistance prostate cancer(CRPC)still develops.Previous study have attempted to determine possible biomarkers for poor prognosis in patients with CRPC[2].
文摘Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy(t-3DLRP)and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia(GA).Methods:A prospective,double-center,double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed.A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA.Results:The two group were similar in all demographic,clinical,and pathological variables.Postoperative blood gas parameters were within physiologic limits in both groups.Muscle relaxation was adequate for surgery during both NA and GA.Median length of stay was 1 day shorter for NA group than GA group(5 days vs.6 days,p=0.05).t-3DLRP under NA had a statistically lower rate of minor complications(4.8%vs.19.0%,p=0.03)and less postoperative pain(median numeric rating scale 3 vs.4,p=0.01)compared to GA.No major complications were observed in both groups.Significantly more patients were willing to undergo a similar intervention under NA than GA(p=0.04).Conclusion:t-3DLRP under NA is a feasible and safe procedure,with less postoperative pain and fewer minor complications than the same procedure under GA.NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.
文摘BACKGROUND Giant condyloma acuminatum(GCA)is an uncommon condition affecting the anogenital area.CASE SUMMARY Here,we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance of multiple cauliflower-like warts over his penile shaft,pubis region,and groin as well as urine leakage along the distal penile shaft.Physical examination revealed an ulcerative skin perforation with pus discharge under the distal prepuce base,which was initially suspected to be a urethral fistula.However,during surgery,it was discovered that the perforation was caused by a giant condyloma lesion that had obliterated the prepuce opening,with infection and high pressure causing subsequent skin perforation.He underwent circumcision and wide excision with electrocauterization of the warts.He was discharged after the surgery,and the residual lesion was treated with imiquimod and low-dose oral tegafur-uracil.CONCLUSION Penile GCA can cause prepuce perforation and can be postoperatively treated with imiquimod and low-dose oral tegafur-uracil.
文摘Background: Generally, urological emergencies are assumed not to be very common, however, recent reports showed that they constitute an important aspect of the day-to-day urological practice. If not well and promptly managed, they may lead to serious morbidity or mortality. Objectives: To study the pattern of presentation, diagnosis and outcome of management of non-traumatic urological emergencies seen at the Emergency Department of Souro Sanou University Hospital in Bobo-Dioulasso. Patients and Methods: This was a retrospective and descriptive study over four years. It included patients of all ages and both sexes, admitted for non-traumatic urological emergencies in the surgical emergency department of Souro Sanou University Hospital. It took place from January 1, 2017 to December 31, 2020. Results: A total of 584 patients were reviewed in our study. Non-traumatic urological emergencies account for 6.3% of all surgical emergencies seen during the study period. The male-to-female ratio was 9.2 to 1. The mean age of the patients was 51.9 ± 23.9 years. Forty-five per cent of the patients presented within 48 hours of symptoms. The vast majority of the patients presented with difficulties with passing urine (41.6%), followed by cases of hematuria (18.4%). On admission, 154 patients (26.4%) presented with severe conditions such as anemia as seen in 40.9% of the cases and deterioration in the general health condition as seen in 34.4% of the patients. Leukocytosis was noted in 18.7% of the patients and anemia in 17.9%. Urine culture was positive in 15.4% of the patients and Escherichia coli was the most common pathogen found (40.6%). Ultrasound was the most requested examination (81.2%), followed by a computerized tomography (CT) scan (22%). The most frequent diagnoses were urine retention (42.9%), hematuria (16.9%) and renal colic (10.1%). Emergency interventions were carried out in 525 patients (89.9%) who include bladder catheterization (46.1%), bladder lavage and/or bladder irrigation (20.9%) and suprapubic cystocatheterization (10.1%). Most of the patients (61.3%) were discharged after a mean stay in the hospital of about 5.1 ± 7.5 days. A mortality rate of 3.8% was also recorded among the patients studied. Conclusion: Non-traumatic urological emergencies are common and are an important aspect of daily urological practice. The majority of the patient presents late with usually a severe form of the disease, which adversely affects the outcome even after treatment.
文摘Introduction: Male urethral stricture is one of the oldest urological disorders. Many techniques have been proposed to treat them, including endoscopic internal urethrotomy (DVIU). Material and Methods: To evaluate the contribution of this technique in the treatment of urethra narrowing, a retrospective study on the records of patients with urethral stricture treated with endoscopic internal urethrotomy between January 2014 and December 2021 in the urology division of the Souro Sanou University Teaching Hospital. Results: A total of 44 male patients with urethral stricture were treated with this technique and 48 procedures were performed. The average age of the patients was 53.2 ± 18.2 years. The etiology of the stricture was dominated by iatrogenic, infectious, traumatic and idiopathic causes in 43.2% (n = 19), 27.3% (n = 12), 20.4 % (n = 9), and 9.1% (n = 4) respectively. The location of the stricture was bulbar in 72.7%, and the anterior penile urethra in 15.9%. The overall success rate was 72.7% with satisfactory urination without dysuria, evaluated after removal of the urinary catheter, at three months this rate fell to 69.1%, and at 6 months this rate was 67.5%. Five cases (5) of extravasation of blood or irrigation fluid into the scrotum were reported and managed conservatively as well as two (2) cases of false routes with postoperative oedema of the penis were observed. Conclusion: DVIU is a simple technique, free of major morbidity and requiring only short-term hospitalization. It can be proposed as a first-line treatment for urethral stricture.
文摘Prostate cancer poses a significant health challenge globally,demanding proactive prevention strategies.This editorial explores the emerging role of vitamin D in prostate cancer prevention.While traditionally associated with bone health,vitamin D is increasingly recognized for its broader impact on immune function,cellular signaling,and cancer prevention.Epidemiological studies suggest an intriguing link between vitamin D deficiency and elevated prostate cancer risk,particularly in regions with limited sunlight exposure.Mechanistically,vitamin D regulates cellular processes,inhibiting unchecked cancer cell growth and bols-tering immune surveillance.Personalized prevention strategies,considering individual factors,are deemed essential for harnessing the full potential of vitamin D.To unlock this potential,the future calls for robust research,public awareness campaigns,dietary improvements,and vigilant medical guidance.Collaborative efforts are poised to pave the way toward a future where vitamin D stands as a sentinel in prostate cancer prevention,ushering in hope and improved health for men worldwide.
文摘Aim:To evaluate the long term effect of experimental cryptorchidism on germ cell apoptotic rate and testicular sperm content in adult rats.Methods:Bilateral cryptorchidism was created in 40 adult male Sprague-Dawley rats by surgically manipulating the testes into the abdominal cavity and closing the internal inguinal ring.The rats were sacrificed and the testes removed 6 hours and 2,4,7,21,28 and 56 days after cryptorchidism.Germ cell apoptosis was quantified by means of TUNEL assay and apoptosis was confirmed using transmission electron microscopy.Results:The rate of apoptosis peaked at 4 days of cryptorchidism and then progressively declined to a nadir at 14 days of cryptorchidism.At 56 days of cryptorchidism,the germinal epithelium was largely depleted by the apoptotic process and only a few mature sperm were seen within the testis.At this point,a few tubules were seen to be repopulating with primary spermatocytes and the level of germ cell apoptosis began to increase marginally.Testicular sperm count (TSC) began to decline rapidly at day 7 of cryptorchidism.Only a few mature sperm were found in the testes of rats following 56 days of cryptorchidism.Multinucleated giant cells (MGC) were most numerous within the seminiferous tubules at day 4.At day 7,35% of MGCs were TUNEL positive.At all subsequent time points,however,MGCs fail to stain positive for apoptosis.This resumption of increased apoptosis coincided with the appearance of a population of primary spermatocytes in some seminiferous tubules.Moreover,there was not a corresponding increase in the number of mature sperm after 56 days of cryptorchidism.Conclusion:The decline in germ cell apoptosis after 4 days of cryptorchidism can be attributed to be the result of an overall depletion of germ cells.It appears that after a prolonged cryptorchidism (56 days),there is a limited resumption of spermatogenesis presumably as a result of a decrease in the maturing germ cells undergoing programmed cell death.(Asian JAndrol2004 Mar;6:47-51)
文摘The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field.Flexible ureteroscopy(fURS)has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies.The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet(YAG)laser lithotripsy.Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones.fURS has proved to be an effective and safe procedure with few contraindications.Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.
文摘Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal malignancies. They are rarely seen near the urinary tract. In a literature review, only one case of GIST presenting as a left adrenal tumor was reported. We report two documented cases of gastric GISTs mimicking left adrenal tumors which were successfully treated with pure laparoscopic adrenalectomy and wedge resection of the stomach by excising the tumor from the stomach with serial fi ring of endoscopic gastrointestinal staplers. The surgical margins were clear, and the patients recovered smoothly. No adjuvant therapy with imatinib was prescribed. During the surveillance for 9 mo and 44 mo respectively, no tumor recurrence and metastasis were documented. Laparoscopic tumor excision, when adhering to the principles of surgical oncology, seems feasible and the prognosisis favorable for such tumors.
文摘Aim: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities. Methods: In a prospective, controlled and blind study, nineteen patients, aged 24 years～42 years and married for 3 years～11 years without children with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause, were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for l0 weeks. Semen analyses were performed before and after the treatment course. Results:The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group (calculated U=16.0, critical U=17.0). Conclusion: The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normalform sperm in infertile patients with oligoastenoteratozoospermia without apparent cause.
基金We are grateful to Ms Shu-Fang Huang,a statistical specialist at our institute,for her valuable assistance in statistical analysis and review of the statistical section.
文摘The aim of this study was to determine the correlation of ultrasonographic estimates of testicular volume with true testicular volume and to compare the accuracy and precision of the three most commonly utilized formulas.A total of 15 patients underwent high-resolution ultrasonography(US)analysis for testicular volume before orchiectomy.Testicular volume was calculated using three common formulas:(1)length(L)×width(W)×height(H)×0.52;(2)the empirical formula of Lambert:L×W×H×0.71;and(3)L×W^(2)×0.52.The actual volume of each removed testis was estimated directly by a water displacement method.Thus,four volume measurements were obtained for each of the 30 testes.The obtained data were analyzed by paired t-test and linear regression analysis.All three US formula measurements significantly underestimated the true testicular volume.The largest mean biases were observed with US formula 1,which underestimated the true volume by 3.3 mL(31%).US formula 2 had a smaller mean difference from the true volume,with an underestimation of only 0.6 mL(6%).Regression analysis showed that formulas 1 and 2 had better R^(2) values than formula 3.However,all three US formulas displayed a strong linear relationship with the true volume(R^(2)=0.872−0.977;P<0.001).Among the commonly used US formulas,the empirical formula of Lambert(L×W×H×0.71)provided better accuracy than the other two formulas evaluated,and better precision than formula 3.Therefore,the formula of Lambert is the optimal choice in clinical practice.
基金financed by a grant from the National Natural Science Foundation of China(Nos.81670643 and 81370804)the Science and Technology Program of Guangzhou,China(No.201604020001).
文摘Miniaturized percutaneous nephrolithotomy(PCNL)procedures have gained increased popularity in recent years.They aim to reduce percutaneous tract size in order to lower complication rates,while maintaining high stone-free rates.Recently,miniaturized PCNL techniques have further expanded,and can currently be classified into mini-PCNL,minimally invasive PCNL(MIP),Chinese mini-PCNL(MPCNL),ultra-mini-PCNL(UMP),micro-PCNL,mini-micro-PCNL,and super-mini-PCNL(SMP).However,despite its minimally-invasive nature,its potential superiority in terms of safety and efficacy when compared to conventional PCNL is still under debate.The aim of this review is to summarise different available modalities of miniaturized PCNL,details of instruments involved,and their corresponding safety and efficacy.In particular,this article highlights the role of the SMP and our experience with this novel technique in management of urolithiasis.Overall,miniaturized PCNL techniques appear to be safe and effective alternatives to conventional PCNL for both adult and pediatric patients.Well-designed,randomized studies are required to further investigate and identify specific roles of miniaturized PCNL techniques before considering them as standard rather than alternative procedures to conventional PCNL.
