Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can ...Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can be overlooked or confused with other pathologies. Treatment remains controversial. The aim of this work is to study the epidemiological, clinical and therapeutic data of urethral mucosal prolapse in young girls in our department. Materials and methods: Retrospective and descriptive study on urethral mucosal prolapse in little girls identified from the hospitalization records of the Sino-Guinean Friendship Hospital in Conakry. The study period was 5 years. Patients were selected randomly. Outcome assessment focused on the occurrence of recurrences and urinary incontinence. The mean follow-up duration was 24 months. The parameters studied were: Age, clinical and histological findings, therapeutic data and patient outcomes. Results: The incidence of urethral mucosal prolapse in girls in the urology department was 2.2 cases/year. The mean age of the patients was 6.7 years (with extremes of 5 months and 10 years). The age group of 7 to 10 years was the most represented, observed in 63.63% of patients. The most frequent reason for consultation was vulvar bleeding in 7 patients, or 63.63%. Malpighian hyperplasia with a congested chorion was the most observed histological type, in 4 patients. Surgical treatment consisting of complete excision of the prolapsed part had given excellent results. Conclusion: Urethral prolapse is a rare pathology, observed mainly in young black girls. Its diagnosis is based mainly on clinical examination. Surgical treatment gives satisfactory results, both clinically and aesthetically.展开更多
Purpose: To study the epidemiology and treatment modalities of urolithiasis at Urology Department of University Hospital of Cotonou. Materials and Methods: It was a retrospective and descriptive study over a 10 years ...Purpose: To study the epidemiology and treatment modalities of urolithiasis at Urology Department of University Hospital of Cotonou. Materials and Methods: It was a retrospective and descriptive study over a 10 years period ranging from January 1st, 2004 to December 31st, 2013. One hundred and two patients who were hospitalized for symptomatic urolithiasis at the Urology Department of University Hospital of Cotonou were enrolled. Results: Hospital incidence of urolithiasis was 3.7%. Patients mean age was 39.6 years (extremes: 10 years to 73 years). Male to female ratio was 2.2. The main reason for consultation was renal colic for 81 patients (79.4%). Average duration of symptoms at presentation was 5 months (range: 1 day to 10 years). A total of 173 stones were identified with an average size of 12 mm (range: 1 mm to 95 mm). Calyceal stones were seen in 32.9% of cases, renal pelvis stones in 21.4% of cases, ureteral stones in 34.1% and bladder stones in 11.5% of cases. Open surgery was the main treatment for stones that could not be managed medically. 50.8% of patients underwent surgery with extraction of 116 stones. This represented 67.1% of all stones. 9 patients (8.8%) had expelled their stone during urination. The postoperative course was uneventful in 77.5% of cases. Conclusion: Modern treatment options for urolithiasis remain rudimentary in our health facilities. Open surgery is still the main stay of treatment in our countries with limited resources.展开更多
Objective: The objectives of this study, was to analyze epidemiological diagnosis, therapeutic option and evolutionary aspects. Materials and methods: This is a retrospective study regarding clinical data of nine peni...Objective: The objectives of this study, was to analyze epidemiological diagnosis, therapeutic option and evolutionary aspects. Materials and methods: This is a retrospective study regarding clinical data of nine penile fracture patients who have been admitted in the department of urology (university hospital, Brazzaville) from January 2006 to December 2018. The study parameters were: epidemiological, diagnosis, operative details, outcomes after treatment, and sexual disorders. Results: The mean age was 46.3 ± 14 years, ranged from 25 to 73 years. The etiology of penile fracture was coitus in 5 cases, masturbation in 3 cases and rolling of the penis on the bed in one case. 8 patients were managed surgically. The complications noticed in the postoperative period and during the follow-up visits were penile curvature in 2 cases, and erectyl dysfunction in 2 cases. Conclusion: The diagnosis of penile fracture remains clinic. Immediate surgical management is necessary for good functional result.展开更多
Introduction: Transurethral Resection of the Prostate (TURP) is a multi-invasive technique in the management of Benign Prostatic Hyperplasia. It constitutes a reference in developed countries;however in sub-Saharan Af...Introduction: Transurethral Resection of the Prostate (TURP) is a multi-invasive technique in the management of Benign Prostatic Hyperplasia. It constitutes a reference in developed countries;however in sub-Saharan Africa, it is prostatic adenomectomy which is mostly used. The aim was to analyze the results of the TURP carried out at the General National Reference University Hospital in N’Djamena (Chad). Patients and Methods: This is a retro-prospective study which extended over a period of 2 years, from June 2014 to May 2016. The records of all patients who had undergone TURP during this period were listed and analyzed. We did frequencies and average calculations. Results: 59 patients’ results that were treated with TURP were collected. TURP represented 33.4% of all interventions performed for prostate pathologies. The average age of our patients was 66 ± 8.06 years (50 to 92). Urinary retention was the main reason for consultation (45.7%;n = 27) followed by dysuria (27.1%;n = 16). TURP was associated with another procedure in 28.8% (n = 17). The average duration of hospitalization of our patients was 4.15 days with extremes of 2 to 9 days. Perioperative complications represented 13.6% of cases, early complications represented 15.3% of cases and late complications represented 6.8% of cases. The postoperative voiding status with an average follow-up of 6 months was judged to be good in 72.8% of cases (n = 43). Conclusion: TURP occupies an important place in the management of prostate pathologies with precise indications. It offers many advantages. It must be popularized in our countries;this will make it possible to limit morbidity and mortality rates and slow down medical evacuations abroad.展开更多
Introduction: About 10 to 15% of couples in the world and 20 to 30% in Cameroon consult for infertility problems. Infertility is of male origin in 40% of cases. Our objective was to evaluate the epidemiological and cl...Introduction: About 10 to 15% of couples in the world and 20 to 30% in Cameroon consult for infertility problems. Infertility is of male origin in 40% of cases. Our objective was to evaluate the epidemiological and clinical aspects of male infertility in our setting. Methods: This was a cross-sectional and descriptive study, with retrospective data collection from the files of patients received for male infertility, over 5 years and 6 months (from January 1<sup>st</sup>, 2016 to April 30<sup>th</sup>, 2021) at the Urology Department of the Yaounde Central Hospital. Phone calls were made to patients with incomplete records for completion following a verbal consent. Data reported on data collection forms were entered into a data entry form designed on CSPro software version 7.2. The database was later exported for descriptive statistics using the IBM SPSS software version 23. Qualitative variables were summarized in frequencies and percentages while quantitative variables were summarized in means with their standard deviations for normally distributed data, or medians and interquartile ranges otherwise. Results: Out of 110 patients whose records were analyzed, the median age was 37.0 years, with an interquartile range of 8.3, with 55.5% in the age group 30 to 39 years. Of these 95 (86.4%) were married, 58 (52.7%) were from the West region, 76 (69.1%) were employed. Past history was dominated by mumps 40 (36.4%), varicocele surgery 25 (22.7%), alcoholism 87 (79.1%) and smoking 15 (13.6%). A disorder of spermatogenesis was found in all our patients: 37 (33.6%) azoospermia, 27 (24.6%) asthenospermia and 26 (23.7%) oligospermia patients. Paraclinical evidence of chlamydia and gonococcal infections were found respectively in 38 (34.5%) and 14 (12.7%) patients, varicocele and testicular dystrophy respectively in 95 (86.4%) and 38 (34.5%) patients. Infertility was primary in 67 (60.9%) patients. Conclusion: Most patients with infertility were in their thirties, had risky social habits and comorbidities. An early start of health promotion activities, comorbidities prevention and early detection of spermogram abnormalities would make it possible to reduce the frequency of male infertility.展开更多
Globalization has impacted upon every aspect of our lives.The digital revolution sophisticated transportation systems,and cultural understanding,have all facilitated sharing ideas and improving lives.This maturation o...Globalization has impacted upon every aspect of our lives.The digital revolution sophisticated transportation systems,and cultural understanding,have all facilitated sharing ideas and improving lives.This maturation of our world has also caused positive changes in medicine.Initially,dissemination of thoughts and ideas were dominated by a few western focused publications.Over the past decade there has been a rapid evolution that has revealed the plethora of important ideas and practices from around the globe.展开更多
Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we exa...Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we examined the effectiveness of the SHURUI single-port robotic surgical system in urological interventions.The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy,radical prostatectomy,partial adrenalectomy,and pyeloureteroplasty,exclusively by the SHURUI single-port robotic surgical system.The study's primary endpoints focused on the success of surgeries,defined as no deviations from planned procedures,no need for more than one port,and no re-operations within 24 h after surgery.Secondary endpoints encompassed a range of surgical metrics,functional outcomes,and patient demographic data.Clinical assessments were conducted before surgery,before discharge,and 1 month after discharge.Results:The surgical procedures were executed successfully without requiring intraoperative conversions or transfusions.Both estimated blood loss and operation durations were maintained within satisfactory limits.For each type of surgery,the mean console times and estimated blood loss were 179.8(standard deviation[SD]39.4)min and 125.6(SD 126.0)mL for radical prostatectomy,126.7(SD 47.8)min and 39.2(SD 54.4)mL for partial nephrectomy,112.6(SD 37.4)min and 20.0(SD 13.2)mL for partial adrenalectomy,and 148.0(SD 18.2)min and 18.0(SD 17.9)mL for pyeloureteroplasty,respectively.Across the cohort,17 patients experienced a total of 25 adverse events,while 10 postoperative complications,all rated as Clavien-Dindo grade I,were encountered by eight patients.All patients had shown recovery or improvement from these events before the end of this trial.Conclusion:The SHURUI single-port robotic surgical system demonstrated feasibility and safety in the performance of major urological surgeries.These initial findings highlight the system's potential,though further research and longer follow-up are required to assess long-term outcomes.展开更多
Objectives: To study the epidemiological, diagnostic and prognostic aspects of bladder tumours in Segou Hospital. Patients and Methods: We conducted a descriptive cross-sectional study of bladder tumours over the peri...Objectives: To study the epidemiological, diagnostic and prognostic aspects of bladder tumours in Segou Hospital. Patients and Methods: We conducted a descriptive cross-sectional study of bladder tumours over the period from 1 April 2012 to 1 April 2017, in the urology department of the Nianankoro Fomba Hospital in Segou. The first three years were used for patient recruitment, and the last two years for follow-up of the patients in the series. Results: Over a period of three years, we collected 165 cases of bladder tumours hospitalised out of 1308 hospitalisations from 7007 consultations, i.e. 12.6% of hospitalisations and 2.3% of consultations. The sex ratio was 1.2 in favour of men. A history of treated bilharzia was reported in 78.8% of cases and untreated bilharzia in 9.1% of cases. Haematuria was the most common reason for consultation. The majority of our patients were at stage T4 and T3 at the time of diagnosis, i.e. 53.3% and 44.3% respectively. Most patients consulted within 13 to 24 months after the first sign, i.e. 44.8%. Conclusion: The prognosis is still clouded by the delay in management. All the patients diagnosed had a bladder tumour infiltrating the muscle.展开更多
Objective: Evaluate pyeloplasty according to Küss-Anderson-Hynes at the urology-andrology department of the Sino-Guinean Friendship Hospital. Patient and Method: This is a 3-year prospective descriptive study fro...Objective: Evaluate pyeloplasty according to Küss-Anderson-Hynes at the urology-andrology department of the Sino-Guinean Friendship Hospital. Patient and Method: This is a 3-year prospective descriptive study from January 1, 2018 to December 31, 2020. It focused on a sample of 21 patients, who had undergone pyeloplasty according to Küss-Anderson-Hynes. Results: The averages age of the patients was 24.24 years. Lumbar pain was the main reason for consultation in 71.43% of cases. pyeloplasty according to Küss-Anderson-Hynes alone was performed in 76.20% of cases. It was associated with lower pole vessel uncrossing in 14.29% of cases and in 9.52% of cases with pyelolithotomy. The main Postoperative complications consisted of surgical site infections (23.81%) and fistula of the pyelo-ureteral junction (9.52%). The result of the pyeloplasty evaluated after three years, was qualified as good in 13 patients (86.67%), conversely the result was declared bad in 2 patients or 13.33%. During the follow-up period, postoperatively, we had lost sight of 6 patients. Conclusion: Pyeloplasty according to Küss-Anderson-Hynes in addition to its excellent results reported by the literature was the only therapeutic alternative performed during this study. However, its indications are considerably reduced with the advancement of laparoscopy.展开更多
Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to stud...Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.展开更多
The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study t...The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis;we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.展开更多
Background: Urethrocystoscopy is a method of endoscopic exploration that allows direct visualization of the urethra and bladder for diagnosis or treatment of diseases of the lower urinary tract. Purpose: To determine ...Background: Urethrocystoscopy is a method of endoscopic exploration that allows direct visualization of the urethra and bladder for diagnosis or treatment of diseases of the lower urinary tract. Purpose: To determine the epidemiological profile of patients who underwent urethrocystoscopy and to present the indications and the results of this endoscopic examination. Patients and Methods: This is a retrospective, descriptive study of all patients who underwent outpatient urethrocystoscopy in the Urology and Andrology department of Grand Mbour hospital. The epidemiological data of the patients, the indications, the results of the endoscopic exploration and the additional procedures performed were entered and analyzed with Excel 2016. We performed descriptive statistics. Results: Of the 216 patients who underwent outpatient urethrocystoscopy, we counted 179 men (82.87%) and 37 women (17.13%). The sex ratio was 4.84. The mean age of the patients was 53.71 ± 18.76 years (age range 17 to 91 years). The main indications were lower urinary tract disorders (60.18%) and hematuria (28.70%). Endoscopic exploration revealed prostatic tumor in 69 patients (31.9%), 29 cases of bladder tumors (13.4%) and 19 cases of bilharzia cystitis (8.8%). The urethrocystoscopy was normal in 32 patients (14.8%). Conclusion: Urethrostoscopy is an endoscopic exploration examination that can be performed on an outpatient basis. Lower tract urinary disorders and hematuria were the main indications.展开更多
Objective:We aimed to study the effect of flexible ureteroscopy(FURS)for renal stones using a flexible and navigable suction ureteral access sheath(FANS)on intraoperative radiation dose and time.Methods:This was a mul...Objective:We aimed to study the effect of flexible ureteroscopy(FURS)for renal stones using a flexible and navigable suction ureteral access sheath(FANS)on intraoperative radiation dose and time.Methods:This was a multicenter study of adults who underwent FURS with FANS.The correlation analysis was done to identify factors affecting radiation dose and time measured by the C-arm fluoroscopy intraoperatively.Results:We analyzed 110 patients,with a median age of 50 years.Of them,72%were pre-stented prior to the procedure.The median stone volume was 1503 mm3 and the median operative time was 39 min.The median radiation dose was 7.4 mSv and median radiation time was 0.6 min.Totally,91%of patients achieved stone-free status(Grade A or B)on the non-contrast CT scan within 30 days postoperatively.There were no cases of postoperative sepsis.Body mass index,stone volume,and total operation time were associated with a higher radiation dose.Procedures performed under general anesthesia had a lower radiation dose and time than those performed under spinal anesthesia.Disposable scopes were associated with higher radiation time than reusable scopes but not dose.A low-power holmium laser had longer radiation time than other laser sources,but only the thulium fiber laser was associated with a significantly lower radiation dose.Conclusion:Our study is the first to highlight the multitude of factors affecting radiation exposure in FURS with FANS.Although not a direct measure of surgeons'actual exposure,it has important implications for the As Low As Reasonably Achievable principle which is commonly used to minimize radiation exposure to patients and operating room staff.展开更多
The biggest influence on my career choice was my father,Peter L.Scardino,a Hopkins-trained urologist who loved his practice more than anything except his family.As a child,I spent time in his office.Later,he broughtme...The biggest influence on my career choice was my father,Peter L.Scardino,a Hopkins-trained urologist who loved his practice more than anything except his family.As a child,I spent time in his office.Later,he broughtme to the OR as an observer,and I was hooked.展开更多
Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision ...Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision of care,outcomes,or patient population.We aimed to elucidate potential differences in demographics,outcomes,and minimally invasive surgery utilization for SCP performed by urology and gynecology.Methods:In our retrospective analysis,sacrocolpopexies were identified using the American College of Surgeons National Surgical Quality Improvement Project database from 2006–2020.Pearson’s chi-square test was performed to test trends in the utilization of MIS in five-year blocks.Frailty was calculated using the NSQIP modified frailty index and the revised surgical Risk Analysis Index.Univariate analysis was performed using Student’s t-test and Pearson’s chi-square to compare operative parameters,frailty,demographics,and outcomes.Results:We identified 8944 sacrocolpopexies.Gynecology performed 81%of cases while urology performed the remaining 19%(p<0.001).Between the specialties,there were no significant differences in outcomes,minor or major complications,or 30-day reoperations/hospital readmissions/mortality.However,urologists tended to care for patients who were older(65 vs.61 years,p<0.001)and frailer by both frailty indices(p<0.001).Conclusion:Case distributions have remained stable,with gynecologists four-fold more sacrocolpopexies,in keeping with the larger number of practicing gynecologists vs.urologists.There was no difference in 30-day outcomes between both specialties.However,urologists operated on older,more frail patients.展开更多
Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU...Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU Section of Uro-Technology and the International Alliance of Urolithiasis members with particular interest in the stone treatment at all levels of expertise.The final version of the questionnaire included 31 questions,evaluated the level of knowledge on X-ray utilization and exposure,and identified correlations between geographic areas,levels of seniority,surgical volumes,and awareness on radiation protection.ResultsIn total,586 respondents were included.Knowledge of fluoroscopy settings appeared low,particularly among trainees(up to 87.5%were uninformed,p=0.008).Precautions to reduce exposure appeared poorly followed as up to 25.4%of respondents used regularly continuous fluoroscopy,and up to 20.5%used regularly high-frequency setting and this trend was more obvious among senior specialists(6.2%of trainees used high-frequency settings vs.21.3%of consultants,p<0.05).Additionally,only 24.9%of respondents would provide X-ray protection to patients too.ConclusionAlthough high and routinary utilization of X-rays,the level of awareness and adhesion to“as low as reasonably achievable”principles among endourologists seems suboptimal in 65.0%of all respondents.Highest volume surgeons,inevitably at higher risk,do not seem to adopt more precautions.More efforts should be addressed to improve these results,reducing the risk related to excessive radiation exposure for both surgical staff and patients in order to minimize health related issues.展开更多
Objective To assess the effect of upper urinary tract(UUT)urolithiasis on urology services in a region with a high prevalence of the condition,and analyze the trends in endourological procedures for treating UUT uroli...Objective To assess the effect of upper urinary tract(UUT)urolithiasis on urology services in a region with a high prevalence of the condition,and analyze the trends in endourological procedures for treating UUT urolithiasis and the cost of treatments in 11 hospitals over the last 6 years.Methods Using the hospital surgery statistics database,data were gathered from the urology departments of 11 hospitals in Saudi Arabia.The analysis focused on the trends,distribution,and annual cost of endourological procedures for UUT urolithiasis from January 2017 to December 2022.Results Out of the total surgery performed(54711),over half(31039,57%)were related to UUT urolithiasis.Extracorporeal shock wave lithotripsy(ESWL)was the most performed procedure among stone-related procedures,accounting for 38%of all procedures.Double-J stent insertion,flexible ureteroscopy(URS),semi-rigid URS,percutaneous nephrolithotomy,and pyelo-and uretero-lithotomy accounted for 25%,19%,14%,3.8%,and 0.35%,respectively.Notably,the number of stone-related UUT procedures in 2022 increased by 35%(from 4671 to 6283)compared to 2017.In the year 2022 compared to 2017,there was a statistically significant increase in the rate of all stone-related UUT procedures(p<0.001),except for ESWL and pyelo-and uretero-lithotomy.The rates of ESWL procedures reduced from 21%in 2017 to 13%in 2022(p<0.001).Overall,the total cost of treatments has been estimated to be about 192.1 million SAR from 2017 to 2022 with an increase by 107%(47.7 million SAR in 2022 vs.23.0 million SAR in 2017).Conclusion Our research findings suggest that urolithiasis poses a significant burden,accounting for over half of all urological surgery performed at the participating centers.Furthermore,there has been a 35%rise in stone-related UUT procedures over the past 6 years.Percutaneous nephrolithotomy,flexible URS,and semi-rigid URS have experienced significant increase in usage.Furthermore,in 2022 the cost of urolithiasis treatments has been more than doubled compared to 2017.展开更多
Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve...Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve trainee success rates.Strategies and techniques to improve catheterization success are often passed down and shared between trainees without formal documentation or dissemination of techniques.Herein,we present a framework for difficult urethral catheterization based on clinical history and patient examination,while also providing additional techniques and troubleshooting to overcome common challenges with urethral catheterization in adult and pediatric patients.展开更多
BACKGROUND Ureteroneocystostomy(UNC)is considered the gold standard for pediatric vesicoureteral reflux(VUR)treatment.While UNC lowers the likelihood of needing additional VUR procedures within 12 months,patients also...BACKGROUND Ureteroneocystostomy(UNC)is considered the gold standard for pediatric vesicoureteral reflux(VUR)treatment.While UNC lowers the likelihood of needing additional VUR procedures within 12 months,patients also have high 30-day and 90-day readmission rates and emergency department(ED)visits.The most common causes of an ED visit following any urologic procedure are urinary tract infections(UTIs)and catheter/drain concerns.Prior studies are limited in identifying predisposing factors to help mitigate complications of UNC and improve patient outcomes.AIM To identify modifiable characteristics at the time of discharge after UNC that predict subsequent unplanned ED visits.METHODS The 2020 American College of Surgeons National Surgical Quality Improvement Program Pediatric data was analyzed for patients undergoing UNC for VUR.A total of 1742 patients were evaluated,with 1495 meeting inclusion criteria.Patients with an ED visit within 30 days following an anti-reflux procedure(n=164)were compared to those who did not return to the ED(n=1331).Basic statistics and logistic regression analysis were performed to find predictive factors associated with postoperative ED visits after UNC.RESULTS Among the 1495 patients,11.0%visited the ED within the 30-day postoperative period.Patients who returned to the ED visit following UNC were more likely to have had a longer mean operative time,surgical site infection,postoperative UTI,postoperative sepsis,history of prior readmission,unplanned reoperation,blood transfusion,or unplanned urinary catheter placement.Multivariate analysis revealed postoperative UTI(P<0.001),superficial surgical site infection(P=0.022),unplanned procedure(P<0.001),unplanned urinary catheter(P<0.001),and prematurity(35-36 weeks gestation)(P=0.004)as independent risk factors for postoperative ED visits.CONCLUSION Utmost caution is needed prior to discharge after UNC to forestall a return to the ED.Postoperative infection remains a primary risk for ED visits in the acute postoperative period.展开更多
BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
文摘Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can be overlooked or confused with other pathologies. Treatment remains controversial. The aim of this work is to study the epidemiological, clinical and therapeutic data of urethral mucosal prolapse in young girls in our department. Materials and methods: Retrospective and descriptive study on urethral mucosal prolapse in little girls identified from the hospitalization records of the Sino-Guinean Friendship Hospital in Conakry. The study period was 5 years. Patients were selected randomly. Outcome assessment focused on the occurrence of recurrences and urinary incontinence. The mean follow-up duration was 24 months. The parameters studied were: Age, clinical and histological findings, therapeutic data and patient outcomes. Results: The incidence of urethral mucosal prolapse in girls in the urology department was 2.2 cases/year. The mean age of the patients was 6.7 years (with extremes of 5 months and 10 years). The age group of 7 to 10 years was the most represented, observed in 63.63% of patients. The most frequent reason for consultation was vulvar bleeding in 7 patients, or 63.63%. Malpighian hyperplasia with a congested chorion was the most observed histological type, in 4 patients. Surgical treatment consisting of complete excision of the prolapsed part had given excellent results. Conclusion: Urethral prolapse is a rare pathology, observed mainly in young black girls. Its diagnosis is based mainly on clinical examination. Surgical treatment gives satisfactory results, both clinically and aesthetically.
文摘Purpose: To study the epidemiology and treatment modalities of urolithiasis at Urology Department of University Hospital of Cotonou. Materials and Methods: It was a retrospective and descriptive study over a 10 years period ranging from January 1st, 2004 to December 31st, 2013. One hundred and two patients who were hospitalized for symptomatic urolithiasis at the Urology Department of University Hospital of Cotonou were enrolled. Results: Hospital incidence of urolithiasis was 3.7%. Patients mean age was 39.6 years (extremes: 10 years to 73 years). Male to female ratio was 2.2. The main reason for consultation was renal colic for 81 patients (79.4%). Average duration of symptoms at presentation was 5 months (range: 1 day to 10 years). A total of 173 stones were identified with an average size of 12 mm (range: 1 mm to 95 mm). Calyceal stones were seen in 32.9% of cases, renal pelvis stones in 21.4% of cases, ureteral stones in 34.1% and bladder stones in 11.5% of cases. Open surgery was the main treatment for stones that could not be managed medically. 50.8% of patients underwent surgery with extraction of 116 stones. This represented 67.1% of all stones. 9 patients (8.8%) had expelled their stone during urination. The postoperative course was uneventful in 77.5% of cases. Conclusion: Modern treatment options for urolithiasis remain rudimentary in our health facilities. Open surgery is still the main stay of treatment in our countries with limited resources.
文摘Objective: The objectives of this study, was to analyze epidemiological diagnosis, therapeutic option and evolutionary aspects. Materials and methods: This is a retrospective study regarding clinical data of nine penile fracture patients who have been admitted in the department of urology (university hospital, Brazzaville) from January 2006 to December 2018. The study parameters were: epidemiological, diagnosis, operative details, outcomes after treatment, and sexual disorders. Results: The mean age was 46.3 ± 14 years, ranged from 25 to 73 years. The etiology of penile fracture was coitus in 5 cases, masturbation in 3 cases and rolling of the penis on the bed in one case. 8 patients were managed surgically. The complications noticed in the postoperative period and during the follow-up visits were penile curvature in 2 cases, and erectyl dysfunction in 2 cases. Conclusion: The diagnosis of penile fracture remains clinic. Immediate surgical management is necessary for good functional result.
文摘Introduction: Transurethral Resection of the Prostate (TURP) is a multi-invasive technique in the management of Benign Prostatic Hyperplasia. It constitutes a reference in developed countries;however in sub-Saharan Africa, it is prostatic adenomectomy which is mostly used. The aim was to analyze the results of the TURP carried out at the General National Reference University Hospital in N’Djamena (Chad). Patients and Methods: This is a retro-prospective study which extended over a period of 2 years, from June 2014 to May 2016. The records of all patients who had undergone TURP during this period were listed and analyzed. We did frequencies and average calculations. Results: 59 patients’ results that were treated with TURP were collected. TURP represented 33.4% of all interventions performed for prostate pathologies. The average age of our patients was 66 ± 8.06 years (50 to 92). Urinary retention was the main reason for consultation (45.7%;n = 27) followed by dysuria (27.1%;n = 16). TURP was associated with another procedure in 28.8% (n = 17). The average duration of hospitalization of our patients was 4.15 days with extremes of 2 to 9 days. Perioperative complications represented 13.6% of cases, early complications represented 15.3% of cases and late complications represented 6.8% of cases. The postoperative voiding status with an average follow-up of 6 months was judged to be good in 72.8% of cases (n = 43). Conclusion: TURP occupies an important place in the management of prostate pathologies with precise indications. It offers many advantages. It must be popularized in our countries;this will make it possible to limit morbidity and mortality rates and slow down medical evacuations abroad.
文摘Introduction: About 10 to 15% of couples in the world and 20 to 30% in Cameroon consult for infertility problems. Infertility is of male origin in 40% of cases. Our objective was to evaluate the epidemiological and clinical aspects of male infertility in our setting. Methods: This was a cross-sectional and descriptive study, with retrospective data collection from the files of patients received for male infertility, over 5 years and 6 months (from January 1<sup>st</sup>, 2016 to April 30<sup>th</sup>, 2021) at the Urology Department of the Yaounde Central Hospital. Phone calls were made to patients with incomplete records for completion following a verbal consent. Data reported on data collection forms were entered into a data entry form designed on CSPro software version 7.2. The database was later exported for descriptive statistics using the IBM SPSS software version 23. Qualitative variables were summarized in frequencies and percentages while quantitative variables were summarized in means with their standard deviations for normally distributed data, or medians and interquartile ranges otherwise. Results: Out of 110 patients whose records were analyzed, the median age was 37.0 years, with an interquartile range of 8.3, with 55.5% in the age group 30 to 39 years. Of these 95 (86.4%) were married, 58 (52.7%) were from the West region, 76 (69.1%) were employed. Past history was dominated by mumps 40 (36.4%), varicocele surgery 25 (22.7%), alcoholism 87 (79.1%) and smoking 15 (13.6%). A disorder of spermatogenesis was found in all our patients: 37 (33.6%) azoospermia, 27 (24.6%) asthenospermia and 26 (23.7%) oligospermia patients. Paraclinical evidence of chlamydia and gonococcal infections were found respectively in 38 (34.5%) and 14 (12.7%) patients, varicocele and testicular dystrophy respectively in 95 (86.4%) and 38 (34.5%) patients. Infertility was primary in 67 (60.9%) patients. Conclusion: Most patients with infertility were in their thirties, had risky social habits and comorbidities. An early start of health promotion activities, comorbidities prevention and early detection of spermogram abnormalities would make it possible to reduce the frequency of male infertility.
文摘Globalization has impacted upon every aspect of our lives.The digital revolution sophisticated transportation systems,and cultural understanding,have all facilitated sharing ideas and improving lives.This maturation of our world has also caused positive changes in medicine.Initially,dissemination of thoughts and ideas were dominated by a few western focused publications.Over the past decade there has been a rapid evolution that has revealed the plethora of important ideas and practices from around the globe.
基金funded by the National Key Research and Development Program of China(Grant No.2022YFB4700904 to Wang L)the Shanghai Shenkang Hospital Development Center's project for the Promotion of Clinical Skills and Clinical Innovation Three-Year Action Plan(Project No.SHDC2022CRT006 to Wang L and SHDC2022CRS010B to Tang S).
文摘Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we examined the effectiveness of the SHURUI single-port robotic surgical system in urological interventions.The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy,radical prostatectomy,partial adrenalectomy,and pyeloureteroplasty,exclusively by the SHURUI single-port robotic surgical system.The study's primary endpoints focused on the success of surgeries,defined as no deviations from planned procedures,no need for more than one port,and no re-operations within 24 h after surgery.Secondary endpoints encompassed a range of surgical metrics,functional outcomes,and patient demographic data.Clinical assessments were conducted before surgery,before discharge,and 1 month after discharge.Results:The surgical procedures were executed successfully without requiring intraoperative conversions or transfusions.Both estimated blood loss and operation durations were maintained within satisfactory limits.For each type of surgery,the mean console times and estimated blood loss were 179.8(standard deviation[SD]39.4)min and 125.6(SD 126.0)mL for radical prostatectomy,126.7(SD 47.8)min and 39.2(SD 54.4)mL for partial nephrectomy,112.6(SD 37.4)min and 20.0(SD 13.2)mL for partial adrenalectomy,and 148.0(SD 18.2)min and 18.0(SD 17.9)mL for pyeloureteroplasty,respectively.Across the cohort,17 patients experienced a total of 25 adverse events,while 10 postoperative complications,all rated as Clavien-Dindo grade I,were encountered by eight patients.All patients had shown recovery or improvement from these events before the end of this trial.Conclusion:The SHURUI single-port robotic surgical system demonstrated feasibility and safety in the performance of major urological surgeries.These initial findings highlight the system's potential,though further research and longer follow-up are required to assess long-term outcomes.
文摘Objectives: To study the epidemiological, diagnostic and prognostic aspects of bladder tumours in Segou Hospital. Patients and Methods: We conducted a descriptive cross-sectional study of bladder tumours over the period from 1 April 2012 to 1 April 2017, in the urology department of the Nianankoro Fomba Hospital in Segou. The first three years were used for patient recruitment, and the last two years for follow-up of the patients in the series. Results: Over a period of three years, we collected 165 cases of bladder tumours hospitalised out of 1308 hospitalisations from 7007 consultations, i.e. 12.6% of hospitalisations and 2.3% of consultations. The sex ratio was 1.2 in favour of men. A history of treated bilharzia was reported in 78.8% of cases and untreated bilharzia in 9.1% of cases. Haematuria was the most common reason for consultation. The majority of our patients were at stage T4 and T3 at the time of diagnosis, i.e. 53.3% and 44.3% respectively. Most patients consulted within 13 to 24 months after the first sign, i.e. 44.8%. Conclusion: The prognosis is still clouded by the delay in management. All the patients diagnosed had a bladder tumour infiltrating the muscle.
文摘Objective: Evaluate pyeloplasty according to Küss-Anderson-Hynes at the urology-andrology department of the Sino-Guinean Friendship Hospital. Patient and Method: This is a 3-year prospective descriptive study from January 1, 2018 to December 31, 2020. It focused on a sample of 21 patients, who had undergone pyeloplasty according to Küss-Anderson-Hynes. Results: The averages age of the patients was 24.24 years. Lumbar pain was the main reason for consultation in 71.43% of cases. pyeloplasty according to Küss-Anderson-Hynes alone was performed in 76.20% of cases. It was associated with lower pole vessel uncrossing in 14.29% of cases and in 9.52% of cases with pyelolithotomy. The main Postoperative complications consisted of surgical site infections (23.81%) and fistula of the pyelo-ureteral junction (9.52%). The result of the pyeloplasty evaluated after three years, was qualified as good in 13 patients (86.67%), conversely the result was declared bad in 2 patients or 13.33%. During the follow-up period, postoperatively, we had lost sight of 6 patients. Conclusion: Pyeloplasty according to Küss-Anderson-Hynes in addition to its excellent results reported by the literature was the only therapeutic alternative performed during this study. However, its indications are considerably reduced with the advancement of laparoscopy.
文摘Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.
文摘The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis;we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.
文摘Background: Urethrocystoscopy is a method of endoscopic exploration that allows direct visualization of the urethra and bladder for diagnosis or treatment of diseases of the lower urinary tract. Purpose: To determine the epidemiological profile of patients who underwent urethrocystoscopy and to present the indications and the results of this endoscopic examination. Patients and Methods: This is a retrospective, descriptive study of all patients who underwent outpatient urethrocystoscopy in the Urology and Andrology department of Grand Mbour hospital. The epidemiological data of the patients, the indications, the results of the endoscopic exploration and the additional procedures performed were entered and analyzed with Excel 2016. We performed descriptive statistics. Results: Of the 216 patients who underwent outpatient urethrocystoscopy, we counted 179 men (82.87%) and 37 women (17.13%). The sex ratio was 4.84. The mean age of the patients was 53.71 ± 18.76 years (age range 17 to 91 years). The main indications were lower urinary tract disorders (60.18%) and hematuria (28.70%). Endoscopic exploration revealed prostatic tumor in 69 patients (31.9%), 29 cases of bladder tumors (13.4%) and 19 cases of bilharzia cystitis (8.8%). The urethrocystoscopy was normal in 32 patients (14.8%). Conclusion: Urethrostoscopy is an endoscopic exploration examination that can be performed on an outpatient basis. Lower tract urinary disorders and hematuria were the main indications.
文摘Objective:We aimed to study the effect of flexible ureteroscopy(FURS)for renal stones using a flexible and navigable suction ureteral access sheath(FANS)on intraoperative radiation dose and time.Methods:This was a multicenter study of adults who underwent FURS with FANS.The correlation analysis was done to identify factors affecting radiation dose and time measured by the C-arm fluoroscopy intraoperatively.Results:We analyzed 110 patients,with a median age of 50 years.Of them,72%were pre-stented prior to the procedure.The median stone volume was 1503 mm3 and the median operative time was 39 min.The median radiation dose was 7.4 mSv and median radiation time was 0.6 min.Totally,91%of patients achieved stone-free status(Grade A or B)on the non-contrast CT scan within 30 days postoperatively.There were no cases of postoperative sepsis.Body mass index,stone volume,and total operation time were associated with a higher radiation dose.Procedures performed under general anesthesia had a lower radiation dose and time than those performed under spinal anesthesia.Disposable scopes were associated with higher radiation time than reusable scopes but not dose.A low-power holmium laser had longer radiation time than other laser sources,but only the thulium fiber laser was associated with a significantly lower radiation dose.Conclusion:Our study is the first to highlight the multitude of factors affecting radiation exposure in FURS with FANS.Although not a direct measure of surgeons'actual exposure,it has important implications for the As Low As Reasonably Achievable principle which is commonly used to minimize radiation exposure to patients and operating room staff.
文摘The biggest influence on my career choice was my father,Peter L.Scardino,a Hopkins-trained urologist who loved his practice more than anything except his family.As a child,I spent time in his office.Later,he broughtme to the OR as an observer,and I was hooked.
文摘Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision of care,outcomes,or patient population.We aimed to elucidate potential differences in demographics,outcomes,and minimally invasive surgery utilization for SCP performed by urology and gynecology.Methods:In our retrospective analysis,sacrocolpopexies were identified using the American College of Surgeons National Surgical Quality Improvement Project database from 2006–2020.Pearson’s chi-square test was performed to test trends in the utilization of MIS in five-year blocks.Frailty was calculated using the NSQIP modified frailty index and the revised surgical Risk Analysis Index.Univariate analysis was performed using Student’s t-test and Pearson’s chi-square to compare operative parameters,frailty,demographics,and outcomes.Results:We identified 8944 sacrocolpopexies.Gynecology performed 81%of cases while urology performed the remaining 19%(p<0.001).Between the specialties,there were no significant differences in outcomes,minor or major complications,or 30-day reoperations/hospital readmissions/mortality.However,urologists tended to care for patients who were older(65 vs.61 years,p<0.001)and frailer by both frailty indices(p<0.001).Conclusion:Case distributions have remained stable,with gynecologists four-fold more sacrocolpopexies,in keeping with the larger number of practicing gynecologists vs.urologists.There was no difference in 30-day outcomes between both specialties.However,urologists operated on older,more frail patients.
文摘Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU Section of Uro-Technology and the International Alliance of Urolithiasis members with particular interest in the stone treatment at all levels of expertise.The final version of the questionnaire included 31 questions,evaluated the level of knowledge on X-ray utilization and exposure,and identified correlations between geographic areas,levels of seniority,surgical volumes,and awareness on radiation protection.ResultsIn total,586 respondents were included.Knowledge of fluoroscopy settings appeared low,particularly among trainees(up to 87.5%were uninformed,p=0.008).Precautions to reduce exposure appeared poorly followed as up to 25.4%of respondents used regularly continuous fluoroscopy,and up to 20.5%used regularly high-frequency setting and this trend was more obvious among senior specialists(6.2%of trainees used high-frequency settings vs.21.3%of consultants,p<0.05).Additionally,only 24.9%of respondents would provide X-ray protection to patients too.ConclusionAlthough high and routinary utilization of X-rays,the level of awareness and adhesion to“as low as reasonably achievable”principles among endourologists seems suboptimal in 65.0%of all respondents.Highest volume surgeons,inevitably at higher risk,do not seem to adopt more precautions.More efforts should be addressed to improve these results,reducing the risk related to excessive radiation exposure for both surgical staff and patients in order to minimize health related issues.
文摘Objective To assess the effect of upper urinary tract(UUT)urolithiasis on urology services in a region with a high prevalence of the condition,and analyze the trends in endourological procedures for treating UUT urolithiasis and the cost of treatments in 11 hospitals over the last 6 years.Methods Using the hospital surgery statistics database,data were gathered from the urology departments of 11 hospitals in Saudi Arabia.The analysis focused on the trends,distribution,and annual cost of endourological procedures for UUT urolithiasis from January 2017 to December 2022.Results Out of the total surgery performed(54711),over half(31039,57%)were related to UUT urolithiasis.Extracorporeal shock wave lithotripsy(ESWL)was the most performed procedure among stone-related procedures,accounting for 38%of all procedures.Double-J stent insertion,flexible ureteroscopy(URS),semi-rigid URS,percutaneous nephrolithotomy,and pyelo-and uretero-lithotomy accounted for 25%,19%,14%,3.8%,and 0.35%,respectively.Notably,the number of stone-related UUT procedures in 2022 increased by 35%(from 4671 to 6283)compared to 2017.In the year 2022 compared to 2017,there was a statistically significant increase in the rate of all stone-related UUT procedures(p<0.001),except for ESWL and pyelo-and uretero-lithotomy.The rates of ESWL procedures reduced from 21%in 2017 to 13%in 2022(p<0.001).Overall,the total cost of treatments has been estimated to be about 192.1 million SAR from 2017 to 2022 with an increase by 107%(47.7 million SAR in 2022 vs.23.0 million SAR in 2017).Conclusion Our research findings suggest that urolithiasis poses a significant burden,accounting for over half of all urological surgery performed at the participating centers.Furthermore,there has been a 35%rise in stone-related UUT procedures over the past 6 years.Percutaneous nephrolithotomy,flexible URS,and semi-rigid URS have experienced significant increase in usage.Furthermore,in 2022 the cost of urolithiasis treatments has been more than doubled compared to 2017.
文摘Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve trainee success rates.Strategies and techniques to improve catheterization success are often passed down and shared between trainees without formal documentation or dissemination of techniques.Herein,we present a framework for difficult urethral catheterization based on clinical history and patient examination,while also providing additional techniques and troubleshooting to overcome common challenges with urethral catheterization in adult and pediatric patients.
文摘BACKGROUND Ureteroneocystostomy(UNC)is considered the gold standard for pediatric vesicoureteral reflux(VUR)treatment.While UNC lowers the likelihood of needing additional VUR procedures within 12 months,patients also have high 30-day and 90-day readmission rates and emergency department(ED)visits.The most common causes of an ED visit following any urologic procedure are urinary tract infections(UTIs)and catheter/drain concerns.Prior studies are limited in identifying predisposing factors to help mitigate complications of UNC and improve patient outcomes.AIM To identify modifiable characteristics at the time of discharge after UNC that predict subsequent unplanned ED visits.METHODS The 2020 American College of Surgeons National Surgical Quality Improvement Program Pediatric data was analyzed for patients undergoing UNC for VUR.A total of 1742 patients were evaluated,with 1495 meeting inclusion criteria.Patients with an ED visit within 30 days following an anti-reflux procedure(n=164)were compared to those who did not return to the ED(n=1331).Basic statistics and logistic regression analysis were performed to find predictive factors associated with postoperative ED visits after UNC.RESULTS Among the 1495 patients,11.0%visited the ED within the 30-day postoperative period.Patients who returned to the ED visit following UNC were more likely to have had a longer mean operative time,surgical site infection,postoperative UTI,postoperative sepsis,history of prior readmission,unplanned reoperation,blood transfusion,or unplanned urinary catheter placement.Multivariate analysis revealed postoperative UTI(P<0.001),superficial surgical site infection(P=0.022),unplanned procedure(P<0.001),unplanned urinary catheter(P<0.001),and prematurity(35-36 weeks gestation)(P=0.004)as independent risk factors for postoperative ED visits.CONCLUSION Utmost caution is needed prior to discharge after UNC to forestall a return to the ED.Postoperative infection remains a primary risk for ED visits in the acute postoperative period.
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
