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
Urine examination is one of the important armamentarium in the practice of urology and it is a fundamental test that is usually carried out for urology patients, it can be as simple as dipstick analysis to a complex h...Urine examination is one of the important armamentarium in the practice of urology and it is a fundamental test that is usually carried out for urology patients, it can be as simple as dipstick analysis to a complex hormonal assays. Urine examination is done worldwide as an extension of physical examination which provides a lot of information about the pathology, and both physical and chemical analysis of urine are highly informative. There are several types of urine investigations, some of which include urinalysis, urine microscopy culture and sensitivity, urine microscopy for ova or cyst of parasites, urine cytology, urine tumour antigens assays, urine hormonal assays, urine toxicology, urine quantitative measurement and urine acid fast bacilli. Uses of urine examinations in urology could be diagnostic, such as renal function test, evaluation of heamaturia, stone diseases, urinary tract infections, urologic cancers and infertility or monitoring and for prognosis. Uses of urine investigations in practice of urology cannot be over emphasized as it has many revealing information of the physiology and pathology of urologic organs.展开更多
Background: The prevalence of benign prostatic hyperplasia, BPH is increasing in our environment. Besides androgens and age could there be other risk factors? Aim: To investigate the roles of sexually transmitted infe...Background: The prevalence of benign prostatic hyperplasia, BPH is increasing in our environment. Besides androgens and age could there be other risk factors? Aim: To investigate the roles of sexually transmitted infections, STI and frequency of ejaculation as risk factors for BPH. Methods: It was a prospective observational study carried out among predominantly Christian communities near Port Harcourt, a major cosmopolitan city in the oil rich Rivers State, in the Niger Delta region of Nigeria. Adult males above the age of 40 yrs old with no history of prostate cancer were invited to participate. History of marriage, duration of marriage, number of wives/sexual partners, frequency of sex or ejaculation and present or past history of STI were obtained through an interpreter administered questionnaire. Diagnosis of BPH was based on presence of lower urinary tract symptoms, ultrasound determination of increased prostate size and histopathology report to rule out prostate cancer. Linear logistic regression and odds ration were used to establish strength of association between BPH and frequency of ejaculation and history of various causative organisms for STI. Statistical significance was determined at p value of Results: 754 respondents participated. Age ranged from 40 to 81 years. 92.6% were in a single relationship. 58.4% had 1 - 5 ejaculations per week. 8.2% has had syphilis, 32.6% has had gonorrhea and 1.1% has had candida infection. There was an observed positive relationship between history of gonorrhoea and increase in prostate size but the association was not statistically significant;syphilis showed no positive relationship with prostate enlargement;incidence of candidiasis was too low to establish causal relationship. Individuals who had sex once a week or less showed a higher prevalence of moderate/severe enlargement (42.3%) compared to those with more frequent sexual activity (35.7%) a relationship that approached significance (p = 0.071), with an odds ratio of 1.3 and narrow CI (0.9 to 1.7), suggesting a potential association that requires further investigation. Conclusion: There is an observed causal relationship between both previous history of gonorrhea infection and reduced frequency of ejaculation and prostate enlargement but these associations do not attain statistical significance and would need further studies.展开更多
The presentation of a foreign body in the lower urinary tract is a challenging urological emergency with highly variable management approaches.A retrospective cohort study was undertaken to identify the patients who p...The presentation of a foreign body in the lower urinary tract is a challenging urological emergency with highly variable management approaches.A retrospective cohort study was undertaken to identify the patients who presented with selfinserted genitourethral foreign body to adult tertiary centers within our local health network(Southern Adelaide Local Health Network,Adelaide,Australia)from October 2002 to October 2022.Patient demographics,type of foreign body,psychiatric comorbidities,retrieval techniques,complications,and readmission data were extracted.Twenty-seven cases were identified with a median age of 44 years.Twenty-three(85.2%)were male and 4(14.8%)were female.Ten patients(37.0%)had a concurrent psychiatric illness.The most commonly inserted foreign bodies were plastic tubes/wires(29.6%).Twenty cases(74.1%)were retrieved endoscopically.Three patients(11.1%)required open cystotomy and one underwent a transperineal urethrotomy.Four patients(14.8%)represented after discharge.Two patients had repeat presentations for genitourinary foreign body insertion.A significant monotonic positive trend of foreign body presentations was identified(Mann–Kendall tau=0.95,P=0.043).Presentations of genitourethral foreign body insertions have trended upward over the past two decades.However,most cases were successfully managed endoscopically.展开更多
Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was sched...Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).展开更多
Background:immune checkpoint inhibitors(ICIs)have revolutionized the treatment of metastatic urothelial carcinoma(mUC),significantly improving survival outcomes.However,a subset of patients do not respond to ICIs,prom...Background:immune checkpoint inhibitors(ICIs)have revolutionized the treatment of metastatic urothelial carcinoma(mUC),significantly improving survival outcomes.However,a subset of patients do not respond to ICIs,prompting research into potential predictive factors.Commonly prescribed medications such as corticosteroids,proton-pump inhibitors(PPIs),antibiotics(Abs),antihypertensives,and analgesics may influence ICI effectiveness.Methods:we conducted a literature search on PubMed to investigate the impact of concomitant medications on the outcomes of patients with mUC,treated with ICIs.We selected the most relevant studies and performed a narrative review.Results:corticosteroids,PPIs and Abs have been associated with reduced survival in ICI-treated patients,including those with mUC.In contrast,antihypertensive agents like renin-angiotensin system inhibitors and betablockers may enhance ICI efficacy,though evidence remains inconclusive.The impact of other medications,such as statins,metformin,and analgesics,on ICI outcomes is less clear,with some data suggesting a detrimental impact on immune response.Conclusions:this narrative review synthesizes current evidence on how concomitant medications affect outcomes in mUC patients treated with ICIs.展开更多
Objective:Partial or segmental inferior vena cava(IVC)resection is indicated for tumor control in patients with renal tumors invading the IVC.This study aimed to introduce a virtual vascular endoscope to assist surgeo...Objective:Partial or segmental inferior vena cava(IVC)resection is indicated for tumor control in patients with renal tumors invading the IVC.This study aimed to introduce a virtual vascular endoscope to assist surgeons in locating IVC invasion,formulate a surgical plan for robot-assisted IVC thrombectomy(RA-IVCT),and evaluate its potential value.Methods:The reconstruction involves building the construction of deep learning models to predict IVC invasion,which were evaluated via intraoperative findings and pathological analysis.Thirty-six patients with renal tumors and IVC thrombi who underwent RA-IVCT between June 2016 and March 2022 were included in the study.A virtual vascular endoscopy was performed based on preoperative CT findings to identify IVC invasion.Based on the extent of IVC wall invasion and the collateral situation,surgeons could decide whether to perform partial or segmental IVC resection during RA-IVCT.Results:Twenty patients were retrospectively analysed for training in virtual vascular endoscopy(the training cohort),and 16 patients were prospectively analysed to evaluate the accuracy of this technique(the validation cohort).Sixteen patients with IVC invasion underwent cavectomy,whereas six patients underwent partial IVC resection.In the validation cohort,pathological analysis confirmed the exact location of IVC invasion in eight of the nine patients,as indicated by virtual vascular endoscopy.Patients who underwent partial IVC wall resection had less lower extremity edema than those who underwent cavectomy.Conclusion:Our initial experience showed that the virtual vascular endoscopy could assist surgeons in identifying IVC invasion and creating a surgical plan for RA-IVCT.展开更多
Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associa...Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL(sPCNL).However,despite this growing acceptance and recognition of its benefits,unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks.In response to these challenges,an international panel comprising experts from the International Alliance of Urolithiasis(IAU)took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice.This endeavor involved conducting a systematic literature review to identify research gaps(RGs),which formed the foundation for developing a structured questionnaire survey.Subsequently,a two-round modified Delphi survey was implemented,culminating in a group meeting to generate final evidence-based comments.All 64 experts completed the second-round survey,resulting in a response rate of 100.0%.Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains,including general information(13 questions),preoperative work-up(13 questions),procedural tips and tricks(19 questions),and postoperative evaluation and follow-up(13 questions).Additionally,9 questions evaluated the experts’experience with PCNLs.Consensus was reached on 30 questions after the second-round survey,while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting.mPCNL,characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique,has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics.It offers several advantages over sPCNL including reduced bleeding,fewer requirements for nephrostomy tubes,decreased pain,and shorter hospital stays.The series of detailed techniques presented here serve as a comprehensive guide for urologists,aiming to improve their procedural understanding and optimize patient outcomes.展开更多
Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men＇s sexual health has improved, and interest in sexual health research has recently increased. The e...Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men＇s sexual health has improved, and interest in sexual health research has recently increased. The epidemiology and prevalence of erectile dysfunction, hypogonadism and premature ejaculation in Asia are similar in the West. However, several issues are specific to Asian males, including culture and beliefs, awareness, compliance and the availability of traditional/complementary medicine. In Asia, sexual medicine is still in its infancy, and a concerted effort from the government, relevant societies, physicians and the media is required to propel sexual medicine to the forefront of health care.展开更多
Varicocele repair is mainly indicated in young adult patients with clinical palpable varicocele and abnormal semen parameters. Varicocele treatment is associated with a significant improvement in sperm concentration, ...Varicocele repair is mainly indicated in young adult patients with clinical palpable varicocele and abnormal semen parameters. Varicocele treatment is associated with a significant improvement in sperm concentration, motility, morphology, and pregnancy rate. Antegrade scrotal sclerotherapy （ASS） represented one of the main alternatives to the traditional inguinal or suprainguinal surgical ligation. This article reviews the use of ASS for varicocele treatment. We provide a brief overview of the history of the procedure and present our methods used in ASS. In addition, we review complication and success of ASS, including our own retrospective data of treating 674 patients over the last 17 years. Herein, we analyzed step by step the ASS technique and described our results with an original modified technique with a long follow-up. Between December 1997 and December 2014, we performed 674 ASS. Mean operative time was 14 min （range 9 to 50 min）. No significant intraoperative complications were reported. Within 90 days from the procedure, postoperative complications were recorded in overall 49 （7.2%） patients. No major complications were recorded. A persistent/recurrent varicocele was detected in 40 （5.9%） cases. In 32/40 （80%） cases, patients showed preoperative grade III varicoceles. In patients with a low sperm number before surgery, sperm count improved from 13 x 106 to 21 x 106 m1-1 （P〈 0.001）. The median value of the percentage of progressive motile forms at 1 h improved from 25% to 45% （P 〈 0.001）. Percentage of normal forms increased from 17% before surgery to 35% 1 year after the procedure （P 〈 0.001）. In the subgroup of the 168 infertile patients, 52 （31%） fathered offspring at a 12-month-minimum follow-up. Therefore, ASS is an effective minimal invasive treatment for varicocele with low recurrence/persistence rate.展开更多
One of the strongest risk factors for prostate cancer is a family history of the disease. Germline mutations in the breast cancer predisposition gene 2 （BRCA2） are the genetic events known to date that confer the hi...One of the strongest risk factors for prostate cancer is a family history of the disease. Germline mutations in the breast cancer predisposition gene 2 （BRCA2） are the genetic events known to date that confer the highest risk of prostate cancer （8.6-fold in men ≤ 65 years）. Although the role of BRCA2 and BRCA1 in prostate tumorigenesis remains unrevealed, deleterious mutations in both genes have been associated with more aggressive disease and poor clinical outcomes. The increasing incidence of prostate cancer worldwide supports the need for new methods to predict outcome and identify patients with potentially lethal forms of the disease. As we present here, BRCA germline mutations, mainly in the BRCA2gene, are one of those predictive factors. We will also discuss the implications of these mutations in the management of prostate cancer and hypothesize on the potential for the development of strategies for sooradic cases with similar characteristics.展开更多
The aim of this article is to assess the outcomes of a low-intensity extracorporeal shock wave therapy(LiESWT)protocol for the treatment of Peyronie’s disease(PD).Patients treated for PD were prospectively recorded,a...The aim of this article is to assess the outcomes of a low-intensity extracorporeal shock wave therapy(LiESWT)protocol for the treatment of Peyronie’s disease(PD).Patients treated for PD were prospectively recorded,and data were retrospectively reviewed.Age,characteristics of fibrous plaques,concomitant treatments,International Index of Erectile Function(IIEF-5),Lue score,and pain score on Likert scale were collected.Patients in acute phase of PD and an angulation of<40°were included.The protocol consisted of 6 weekly sessions of 4000 pulses each,applied from different directions,with a maximal power of 20 W and 8 Hz frequency.We included 39 patients(median age:56.8 years,interquartile range[IQR]:35.8–62.2 years).The median number of sessions received per patient was 7.2.After treatment,the median Lue score decreased from 6.8 initially to 3.3(P=0.003),the median Likert pain score dropped from 1.8 to 0.7(P=0.004),the median plaque size was reduced from 2 cm to 1.2 cm(P=0.08),and the median penile curvature diminished from 31°to 17°(P=0.07).On univariate and multivariate analysis,the only predictors of success were younger age(odds ratio[OR]=0.95,P=0.03 and OR=0.91,P=0.04,respectively)and concomitant use of phosphodiesterase-5 inhibitors(PDE5i;OR=0.92,P=0.02 and OR=0.93,P=0.01,respectively).LiESWT had a favorable impact on Lue score and notably penile pain,curvature,plaque size,and erectile function in patients treated for PD during the early inflammatory phase,with no side effects.Younger age and concomitant use of PDE5i were the only success predictors.展开更多
Aim： To identify and define prostate and seminal vesicle abnormalities in patients with chronic male accessory gland infection （MAGI） who failed to respond to antibacterial treatment. Methods： We selected 67 conse...Aim： To identify and define prostate and seminal vesicle abnormalities in patients with chronic male accessory gland infection （MAGI） who failed to respond to antibacterial treatment. Methods： We selected 67 consecutive patients with MAGI and persistently elevated bacteriospermia （≥ 10^6 colony forming units [CFU]/mL） after three antibiotic courses. Fourteen infertile patients with initial chronic microbial （≥ 10^6 CFU/mL） MAGI who responded to antibacterial treatment （〈 10^3 CFU/mL） served as a control group. All patients and controls underwent transrectal ultrasonography （TRUS） scans and semen analysis. Patients with low seminal plasma volume （〈 1.5 mL） underwent both preejaculatory and post-ejaculatory TRUS examination. Results： TRUS revealed multiple abnormalities indicative of： （i） bilaterally extended prostato-vesiculitis （group A： 52 cases, 77.6%） （nine of these patients also had micro-emphysematous prostate abscess）; and （ii） prostato-vesiculitis with unilateral or bilateral sub-obstruction of the ejaculatory ducts （group B： 15 cases, 22.4%）. Mean sperm concentration, total sperm number, ejaculate volume and pH value were significantly higher in group A than in group B. In addition, sperm forward motility and the percentage of normal forms were significantly worse than in controls, whereas leukocyte concentration was significantly higher in group A. Group B patients had all sperm parameters, but their pH values, significantly different from those of controls. Conclusion： Although antibiotic therapy is considered suitable when microbial MAGI is suspected, it is impossible to account for a poor response to antibiotics merely on the basis of conventional criteria （clinical history, physical and ejaculate signs）. Thus, TRUS may be helpful in the follow-up of these patients.展开更多
Penile urethral strictures have been managed by a staged surgical approach.In selected cases,spongiofibrosis can be excised,a neo-urethral plate created using buccal mucosa graft(BMG)and tubularized during the same pr...Penile urethral strictures have been managed by a staged surgical approach.In selected cases,spongiofibrosis can be excised,a neo-urethral plate created using buccal mucosa graft(BMG)and tubularized during the same procedure,performing a“twoin-one”stage approach.We aim to identify stricture factors which indicate suitability for this two-in-one stage approach.We assess surgical outcome and compare with staged reconstruction.We conducted an observational descriptive study.The data were prospectively collected from two-in-one stage and staged penile urethroplasties using BMG in a single center between 2007 and 2017.The minimum follow-up was 6 months.Outcomes were assessed clinically,radiologically,and by flow-rate analysis.Failure was defined as recurrent stricture or any subsequent surgical or endoscopic intervention.Descriptive analysis of stricture characteristics and statistical comparison was made between groups.Of 425 penile urethroplasties,139 met the inclusion criteria:59 two-in-one stage and 80 staged.The mean stricture length was 2.8 cm(single stage)and 4.5 cm(staged).Etiology was lichen sclerosus(LS)52.5%(single stage)and 73.8%hypospadias related(staged).40.7%of patients had previous failed urethroplasties in the single-stage group and 81.2%in the staged.The most common stricture locations were navicular fossa(39.0%)and distal penile urethra(59.3%)in the single-stage group and mid or proximal penile urethra(58.7%)in the staged group.Success rates were 89.8%(single stage)and 81.3%(staged).A trend toward a single-stage approach for select penile urethral strictures was noted.We conclude that a single-stage substitution penile urethroplasty using BMG as a“two-in-one”approach is associated with excellent functional outcomes.The most suitable strictures for this approach are distal,primary,and LS-related strictures.展开更多
Objective:It has been reported that intrinsic apoptosis is associated with the progression of bladder cancer(BC).Recent evidence suggests that polyribonucleotide nucleotidyltransferase 1(PNPT1)is a pivotal mediator in...Objective:It has been reported that intrinsic apoptosis is associated with the progression of bladder cancer(BC).Recent evidence suggests that polyribonucleotide nucleotidyltransferase 1(PNPT1)is a pivotal mediator involved in RNA decay and cell apoptosis.However,the regulation and roles of PNPT1 in bladder cancer remain largely unclear.Methods:The upstream miRNA regulators were predicted by in silico analysis.The expression levels of PNPT1 were evaluated by real-time PCR,Western blotting,and immunohistochemistry(IHC),while miR-183-5p levels were evaluated by qPCR in BC cell lines and tissues.In vitro and in vivo assays were performed to investigate the function of miR-183-5p and PNPT1 in apoptotic RNA decay and the tumorigenic capability of bladder cancer cells.Results:PNPT1 expression was decreased in BC tissues and cell lines.Overexpression of PNPT1 significantly promoted cisplatin-induced intrinsic apoptosis of BC cells,whereas depletion of PNPT1 potently alleviated these effects.Moreover,oncogenic miR183-5p directly targeted the 3′UTR of PNPT1 and reversed the tumor suppressive role of PNPT1.Intriguingly,miR-183-5p modulated not only PNPT1 but also Bcl2 modifying factor(BMF)to inhibit the mitochondrial outer membrane permeabilization(MOMP)in BC cells.Conclusion:Our results provide new insight into the mechanisms underlying intrinsic apoptosis in BC,suggesting that the miR-183-5p-PNPT1 regulatory axis regulates the apoptosis of BC cells and might represent a potential therapeutic avenue for the treatment of BC.展开更多
In this nonsystematic review of the literature,we explored the changing landscape of detection and treatment of low-and intermediate-risk prostate cancer(PCa).Through emphasizing improved cancer assessment with histol...In this nonsystematic review of the literature,we explored the changing landscape of detection and treatment of low-and intermediate-risk prostate cancer(PCa).Through emphasizing improved cancer assessment with histology classification and genomics,we investigated key developments in PCa detection and risk stratification.The pivotal role of prostate magnetic resonance imaging(MRI)in the novel diagnostic pathway is examined,alongside the benefits and drawbacks of MRI-targeted biopsies for detection and tumor characterization.We also delved into treatment options,particularly active surveillance for intermediate-risk PCa.Outcomes are compared between intermediate-and low-risk patients,offering insights into tailored management.Surgical techniques,including Retzius-sparing surgery,precision prostatectomy,and partial prostatectomy for anterior cancer,are appraised.Each technique has the potential to enhance outcomes and minimize complications.Advancements in technology and radiobiology,including computed tomography(CT)/MRI imaging and positron emission tomography(PET)fusion,allow for precise dose adjustment and daily target monitoring with imaging-guided radiotherapy,opening new ways of tailoring patients’treatments.Finally,experimental therapeutic approaches such as focal therapy open new treatment frontiers,although they create new needs in tumor identification and tracking during and after the procedure.展开更多
<strong>Background:</strong> Bladder cancer is a common cause of morbidity and mortality in our institution due to the late presentation. Morbidity is defined as a development of complications that may lea...<strong>Background:</strong> Bladder cancer is a common cause of morbidity and mortality in our institution due to the late presentation. Morbidity is defined as a development of complications that may lead to mortality. Uraemia is a common presentation that constitutes a management challenge in our patients. We study the spectrum of morbidity and mortality in bladder cancer patients in our institution. <strong>Materials and Methods:</strong> This is a retrospective study of patients with clinical, radiological, cytological and or histological features of bladder cancer that had a morbidity and or mortality managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from January 2011 to December, 2017. Data were retrieved from patients’ case notes via a proforma and analyzed using SPSS 20.0 version for windows. The results were presented in number percent, tables and chart. <strong>Results:</strong> There were morbidity and or mortality in 234 bladder cancer patients within the study period with a mean age of 48.4 ± 14.1 years and a range of 3 - 106 years. There were 219 males (91.5%) and 20 females (8.5%) with a male to female ratio of 11:1. There were haematuria and lower urinary tract symptoms (LUTS) in 230 patients (98.3%). There were necroturia ± weight loss and anorexia in 126 patients (53.8%). There was urinary tract infection (UTI) in 75 patients (32.1%), anaemia in 131 patients (56.0%) and uraemia in 161 patients (68.8%). Mortality was recorded in 84 patients (35.9%) which was due to uraemia in 52 patients (22.2%), urosepsis in 22 patients (9.4%) and anaemia in 8 patients (3.4%), intestinal obstruction and blood transfusion reaction in 1 patient each (0.4%). <strong>Conclusion:</strong> Anaemia, urosepsis and uraemia are the most common causes of morbidity and or mortality in bladder tumour patients in Sokoto. This poses great diagnostic and therapeutic dilemma to the urologist, patients and their relatives.展开更多
We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of pat...We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.展开更多
Herein we report a patient with a prostatic hyperplasia weighing exactly 700 g which was successfully removed at the Brong Ahafo Regional Hospital theatre in Ghana by Pfannesteil Transvesical Simple Prostatectomy. A p...Herein we report a patient with a prostatic hyperplasia weighing exactly 700 g which was successfully removed at the Brong Ahafo Regional Hospital theatre in Ghana by Pfannesteil Transvesical Simple Prostatectomy. A prostatic hyperplasia of enormous size is very uncommon and to the best of our knowledge, only ten of such cases have been previously reported. The case report presented here constitutes the eleventh heaviest prostate reported in medical literature and also forms the first case report of giant prostatic hyperplasia from Ghana.展开更多
Object:To determine the extent and impact of upgrading and downgrading among men who underwent radical prostatectomy(RP)according to new grade groupings and to identify predictors of upgrading from biopsy grade Group ...Object:To determine the extent and impact of upgrading and downgrading among men who underwent radical prostatectomy(RP)according to new grade groupings and to identify predictors of upgrading from biopsy grade Group Ⅰ and Ⅱ,and downgrading to grade Group I,in a community setting.Methods:Study participants included 2279 men with non-metastatic prostate cancer diagnosed 2006-2015 who underwent prostatectomy,from the multi-institutional South Australia Prostate Cancer Clinical Outcomes Collaborative registry.Extent of up-or down-grading was assessed by comparing biopsy and prostatectomy grade groupings.Risk of biochemical recurrence(BCR)with upgrading was assessed using multivariable competing risk regression.Binomial logistic regression was used to identify pre-treatment predictors of upgrading from grade Groups Ⅰ and Ⅱ,and risk group reclassification among men with low risk disease.Results:Upgrading occurred in 35%of cases,while downgrading occurred in 13%of cases.Sixty percent with grade Group I disease were upgraded following prostatectomy.Upgrading from grade Group I was associated with greater risk of BCR compared with concordant grading(Hazard ratio:3.1,95%confidence interval:1.7-6.0).Older age,higher prostate-specific antigen levels(PSA),fewer biopsy cores,higher number of positive cores and more recent diagnosis predicted upgrading from grade Group Ⅰ,while higher PSA and clinical stage predicted upgrading from grade Group Ⅱ.No clinical risk factors for reclassification were identified.Conclusion:Biopsy sampling errors may play an important role in upgrading from grade Group I.Improved clinical assessment of grade is needed to encourage greater uptake of active surveillance.展开更多
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Urine examination is one of the important armamentarium in the practice of urology and it is a fundamental test that is usually carried out for urology patients, it can be as simple as dipstick analysis to a complex hormonal assays. Urine examination is done worldwide as an extension of physical examination which provides a lot of information about the pathology, and both physical and chemical analysis of urine are highly informative. There are several types of urine investigations, some of which include urinalysis, urine microscopy culture and sensitivity, urine microscopy for ova or cyst of parasites, urine cytology, urine tumour antigens assays, urine hormonal assays, urine toxicology, urine quantitative measurement and urine acid fast bacilli. Uses of urine examinations in urology could be diagnostic, such as renal function test, evaluation of heamaturia, stone diseases, urinary tract infections, urologic cancers and infertility or monitoring and for prognosis. Uses of urine investigations in practice of urology cannot be over emphasized as it has many revealing information of the physiology and pathology of urologic organs.
文摘Background: The prevalence of benign prostatic hyperplasia, BPH is increasing in our environment. Besides androgens and age could there be other risk factors? Aim: To investigate the roles of sexually transmitted infections, STI and frequency of ejaculation as risk factors for BPH. Methods: It was a prospective observational study carried out among predominantly Christian communities near Port Harcourt, a major cosmopolitan city in the oil rich Rivers State, in the Niger Delta region of Nigeria. Adult males above the age of 40 yrs old with no history of prostate cancer were invited to participate. History of marriage, duration of marriage, number of wives/sexual partners, frequency of sex or ejaculation and present or past history of STI were obtained through an interpreter administered questionnaire. Diagnosis of BPH was based on presence of lower urinary tract symptoms, ultrasound determination of increased prostate size and histopathology report to rule out prostate cancer. Linear logistic regression and odds ration were used to establish strength of association between BPH and frequency of ejaculation and history of various causative organisms for STI. Statistical significance was determined at p value of Results: 754 respondents participated. Age ranged from 40 to 81 years. 92.6% were in a single relationship. 58.4% had 1 - 5 ejaculations per week. 8.2% has had syphilis, 32.6% has had gonorrhea and 1.1% has had candida infection. There was an observed positive relationship between history of gonorrhoea and increase in prostate size but the association was not statistically significant;syphilis showed no positive relationship with prostate enlargement;incidence of candidiasis was too low to establish causal relationship. Individuals who had sex once a week or less showed a higher prevalence of moderate/severe enlargement (42.3%) compared to those with more frequent sexual activity (35.7%) a relationship that approached significance (p = 0.071), with an odds ratio of 1.3 and narrow CI (0.9 to 1.7), suggesting a potential association that requires further investigation. Conclusion: There is an observed causal relationship between both previous history of gonorrhea infection and reduced frequency of ejaculation and prostate enlargement but these associations do not attain statistical significance and would need further studies.
文摘The presentation of a foreign body in the lower urinary tract is a challenging urological emergency with highly variable management approaches.A retrospective cohort study was undertaken to identify the patients who presented with selfinserted genitourethral foreign body to adult tertiary centers within our local health network(Southern Adelaide Local Health Network,Adelaide,Australia)from October 2002 to October 2022.Patient demographics,type of foreign body,psychiatric comorbidities,retrieval techniques,complications,and readmission data were extracted.Twenty-seven cases were identified with a median age of 44 years.Twenty-three(85.2%)were male and 4(14.8%)were female.Ten patients(37.0%)had a concurrent psychiatric illness.The most commonly inserted foreign bodies were plastic tubes/wires(29.6%).Twenty cases(74.1%)were retrieved endoscopically.Three patients(11.1%)required open cystotomy and one underwent a transperineal urethrotomy.Four patients(14.8%)represented after discharge.Two patients had repeat presentations for genitourinary foreign body insertion.A significant monotonic positive trend of foreign body presentations was identified(Mann–Kendall tau=0.95,P=0.043).Presentations of genitourethral foreign body insertions have trended upward over the past two decades.However,most cases were successfully managed endoscopically.
文摘Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).
文摘Background:immune checkpoint inhibitors(ICIs)have revolutionized the treatment of metastatic urothelial carcinoma(mUC),significantly improving survival outcomes.However,a subset of patients do not respond to ICIs,prompting research into potential predictive factors.Commonly prescribed medications such as corticosteroids,proton-pump inhibitors(PPIs),antibiotics(Abs),antihypertensives,and analgesics may influence ICI effectiveness.Methods:we conducted a literature search on PubMed to investigate the impact of concomitant medications on the outcomes of patients with mUC,treated with ICIs.We selected the most relevant studies and performed a narrative review.Results:corticosteroids,PPIs and Abs have been associated with reduced survival in ICI-treated patients,including those with mUC.In contrast,antihypertensive agents like renin-angiotensin system inhibitors and betablockers may enhance ICI efficacy,though evidence remains inconclusive.The impact of other medications,such as statins,metformin,and analgesics,on ICI outcomes is less clear,with some data suggesting a detrimental impact on immune response.Conclusions:this narrative review synthesizes current evidence on how concomitant medications affect outcomes in mUC patients treated with ICIs.
基金supported by the National Natural Science Foundation of China(No.82273412 to Huang Q).
文摘Objective:Partial or segmental inferior vena cava(IVC)resection is indicated for tumor control in patients with renal tumors invading the IVC.This study aimed to introduce a virtual vascular endoscope to assist surgeons in locating IVC invasion,formulate a surgical plan for robot-assisted IVC thrombectomy(RA-IVCT),and evaluate its potential value.Methods:The reconstruction involves building the construction of deep learning models to predict IVC invasion,which were evaluated via intraoperative findings and pathological analysis.Thirty-six patients with renal tumors and IVC thrombi who underwent RA-IVCT between June 2016 and March 2022 were included in the study.A virtual vascular endoscopy was performed based on preoperative CT findings to identify IVC invasion.Based on the extent of IVC wall invasion and the collateral situation,surgeons could decide whether to perform partial or segmental IVC resection during RA-IVCT.Results:Twenty patients were retrospectively analysed for training in virtual vascular endoscopy(the training cohort),and 16 patients were prospectively analysed to evaluate the accuracy of this technique(the validation cohort).Sixteen patients with IVC invasion underwent cavectomy,whereas six patients underwent partial IVC resection.In the validation cohort,pathological analysis confirmed the exact location of IVC invasion in eight of the nine patients,as indicated by virtual vascular endoscopy.Patients who underwent partial IVC wall resection had less lower extremity edema than those who underwent cavectomy.Conclusion:Our initial experience showed that the virtual vascular endoscopy could assist surgeons in identifying IVC invasion and creating a surgical plan for RA-IVCT.
文摘Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL(sPCNL).However,despite this growing acceptance and recognition of its benefits,unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks.In response to these challenges,an international panel comprising experts from the International Alliance of Urolithiasis(IAU)took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice.This endeavor involved conducting a systematic literature review to identify research gaps(RGs),which formed the foundation for developing a structured questionnaire survey.Subsequently,a two-round modified Delphi survey was implemented,culminating in a group meeting to generate final evidence-based comments.All 64 experts completed the second-round survey,resulting in a response rate of 100.0%.Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains,including general information(13 questions),preoperative work-up(13 questions),procedural tips and tricks(19 questions),and postoperative evaluation and follow-up(13 questions).Additionally,9 questions evaluated the experts’experience with PCNLs.Consensus was reached on 30 questions after the second-round survey,while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting.mPCNL,characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique,has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics.It offers several advantages over sPCNL including reduced bleeding,fewer requirements for nephrostomy tubes,decreased pain,and shorter hospital stays.The series of detailed techniques presented here serve as a comprehensive guide for urologists,aiming to improve their procedural understanding and optimize patient outcomes.
文摘Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men＇s sexual health has improved, and interest in sexual health research has recently increased. The epidemiology and prevalence of erectile dysfunction, hypogonadism and premature ejaculation in Asia are similar in the West. However, several issues are specific to Asian males, including culture and beliefs, awareness, compliance and the availability of traditional/complementary medicine. In Asia, sexual medicine is still in its infancy, and a concerted effort from the government, relevant societies, physicians and the media is required to propel sexual medicine to the forefront of health care.
文摘Varicocele repair is mainly indicated in young adult patients with clinical palpable varicocele and abnormal semen parameters. Varicocele treatment is associated with a significant improvement in sperm concentration, motility, morphology, and pregnancy rate. Antegrade scrotal sclerotherapy （ASS） represented one of the main alternatives to the traditional inguinal or suprainguinal surgical ligation. This article reviews the use of ASS for varicocele treatment. We provide a brief overview of the history of the procedure and present our methods used in ASS. In addition, we review complication and success of ASS, including our own retrospective data of treating 674 patients over the last 17 years. Herein, we analyzed step by step the ASS technique and described our results with an original modified technique with a long follow-up. Between December 1997 and December 2014, we performed 674 ASS. Mean operative time was 14 min （range 9 to 50 min）. No significant intraoperative complications were reported. Within 90 days from the procedure, postoperative complications were recorded in overall 49 （7.2%） patients. No major complications were recorded. A persistent/recurrent varicocele was detected in 40 （5.9%） cases. In 32/40 （80%） cases, patients showed preoperative grade III varicoceles. In patients with a low sperm number before surgery, sperm count improved from 13 x 106 to 21 x 106 m1-1 （P〈 0.001）. The median value of the percentage of progressive motile forms at 1 h improved from 25% to 45% （P 〈 0.001）. Percentage of normal forms increased from 17% before surgery to 35% 1 year after the procedure （P 〈 0.001）. In the subgroup of the 168 infertile patients, 52 （31%） fathered offspring at a 12-month-minimum follow-up. Therefore, ASS is an effective minimal invasive treatment for varicocele with low recurrence/persistence rate.
文摘One of the strongest risk factors for prostate cancer is a family history of the disease. Germline mutations in the breast cancer predisposition gene 2 （BRCA2） are the genetic events known to date that confer the highest risk of prostate cancer （8.6-fold in men ≤ 65 years）. Although the role of BRCA2 and BRCA1 in prostate tumorigenesis remains unrevealed, deleterious mutations in both genes have been associated with more aggressive disease and poor clinical outcomes. The increasing incidence of prostate cancer worldwide supports the need for new methods to predict outcome and identify patients with potentially lethal forms of the disease. As we present here, BRCA germline mutations, mainly in the BRCA2gene, are one of those predictive factors. We will also discuss the implications of these mutations in the management of prostate cancer and hypothesize on the potential for the development of strategies for sooradic cases with similar characteristics.
文摘The aim of this article is to assess the outcomes of a low-intensity extracorporeal shock wave therapy(LiESWT)protocol for the treatment of Peyronie’s disease(PD).Patients treated for PD were prospectively recorded,and data were retrospectively reviewed.Age,characteristics of fibrous plaques,concomitant treatments,International Index of Erectile Function(IIEF-5),Lue score,and pain score on Likert scale were collected.Patients in acute phase of PD and an angulation of<40°were included.The protocol consisted of 6 weekly sessions of 4000 pulses each,applied from different directions,with a maximal power of 20 W and 8 Hz frequency.We included 39 patients(median age:56.8 years,interquartile range[IQR]:35.8–62.2 years).The median number of sessions received per patient was 7.2.After treatment,the median Lue score decreased from 6.8 initially to 3.3(P=0.003),the median Likert pain score dropped from 1.8 to 0.7(P=0.004),the median plaque size was reduced from 2 cm to 1.2 cm(P=0.08),and the median penile curvature diminished from 31°to 17°(P=0.07).On univariate and multivariate analysis,the only predictors of success were younger age(odds ratio[OR]=0.95,P=0.03 and OR=0.91,P=0.04,respectively)and concomitant use of phosphodiesterase-5 inhibitors(PDE5i;OR=0.92,P=0.02 and OR=0.93,P=0.01,respectively).LiESWT had a favorable impact on Lue score and notably penile pain,curvature,plaque size,and erectile function in patients treated for PD during the early inflammatory phase,with no side effects.Younger age and concomitant use of PDE5i were the only success predictors.
文摘Aim： To identify and define prostate and seminal vesicle abnormalities in patients with chronic male accessory gland infection （MAGI） who failed to respond to antibacterial treatment. Methods： We selected 67 consecutive patients with MAGI and persistently elevated bacteriospermia （≥ 10^6 colony forming units [CFU]/mL） after three antibiotic courses. Fourteen infertile patients with initial chronic microbial （≥ 10^6 CFU/mL） MAGI who responded to antibacterial treatment （〈 10^3 CFU/mL） served as a control group. All patients and controls underwent transrectal ultrasonography （TRUS） scans and semen analysis. Patients with low seminal plasma volume （〈 1.5 mL） underwent both preejaculatory and post-ejaculatory TRUS examination. Results： TRUS revealed multiple abnormalities indicative of： （i） bilaterally extended prostato-vesiculitis （group A： 52 cases, 77.6%） （nine of these patients also had micro-emphysematous prostate abscess）; and （ii） prostato-vesiculitis with unilateral or bilateral sub-obstruction of the ejaculatory ducts （group B： 15 cases, 22.4%）. Mean sperm concentration, total sperm number, ejaculate volume and pH value were significantly higher in group A than in group B. In addition, sperm forward motility and the percentage of normal forms were significantly worse than in controls, whereas leukocyte concentration was significantly higher in group A. Group B patients had all sperm parameters, but their pH values, significantly different from those of controls. Conclusion： Although antibiotic therapy is considered suitable when microbial MAGI is suspected, it is impossible to account for a poor response to antibiotics merely on the basis of conventional criteria （clinical history, physical and ejaculate signs）. Thus, TRUS may be helpful in the follow-up of these patients.
文摘Penile urethral strictures have been managed by a staged surgical approach.In selected cases,spongiofibrosis can be excised,a neo-urethral plate created using buccal mucosa graft(BMG)and tubularized during the same procedure,performing a“twoin-one”stage approach.We aim to identify stricture factors which indicate suitability for this two-in-one stage approach.We assess surgical outcome and compare with staged reconstruction.We conducted an observational descriptive study.The data were prospectively collected from two-in-one stage and staged penile urethroplasties using BMG in a single center between 2007 and 2017.The minimum follow-up was 6 months.Outcomes were assessed clinically,radiologically,and by flow-rate analysis.Failure was defined as recurrent stricture or any subsequent surgical or endoscopic intervention.Descriptive analysis of stricture characteristics and statistical comparison was made between groups.Of 425 penile urethroplasties,139 met the inclusion criteria:59 two-in-one stage and 80 staged.The mean stricture length was 2.8 cm(single stage)and 4.5 cm(staged).Etiology was lichen sclerosus(LS)52.5%(single stage)and 73.8%hypospadias related(staged).40.7%of patients had previous failed urethroplasties in the single-stage group and 81.2%in the staged.The most common stricture locations were navicular fossa(39.0%)and distal penile urethra(59.3%)in the single-stage group and mid or proximal penile urethra(58.7%)in the staged group.Success rates were 89.8%(single stage)and 81.3%(staged).A trend toward a single-stage approach for select penile urethral strictures was noted.We conclude that a single-stage substitution penile urethroplasty using BMG as a“two-in-one”approach is associated with excellent functional outcomes.The most suitable strictures for this approach are distal,primary,and LS-related strictures.
基金supported by the National Natural Science Foundation of China(No.81772714).
文摘Objective:It has been reported that intrinsic apoptosis is associated with the progression of bladder cancer(BC).Recent evidence suggests that polyribonucleotide nucleotidyltransferase 1(PNPT1)is a pivotal mediator involved in RNA decay and cell apoptosis.However,the regulation and roles of PNPT1 in bladder cancer remain largely unclear.Methods:The upstream miRNA regulators were predicted by in silico analysis.The expression levels of PNPT1 were evaluated by real-time PCR,Western blotting,and immunohistochemistry(IHC),while miR-183-5p levels were evaluated by qPCR in BC cell lines and tissues.In vitro and in vivo assays were performed to investigate the function of miR-183-5p and PNPT1 in apoptotic RNA decay and the tumorigenic capability of bladder cancer cells.Results:PNPT1 expression was decreased in BC tissues and cell lines.Overexpression of PNPT1 significantly promoted cisplatin-induced intrinsic apoptosis of BC cells,whereas depletion of PNPT1 potently alleviated these effects.Moreover,oncogenic miR183-5p directly targeted the 3′UTR of PNPT1 and reversed the tumor suppressive role of PNPT1.Intriguingly,miR-183-5p modulated not only PNPT1 but also Bcl2 modifying factor(BMF)to inhibit the mitochondrial outer membrane permeabilization(MOMP)in BC cells.Conclusion:Our results provide new insight into the mechanisms underlying intrinsic apoptosis in BC,suggesting that the miR-183-5p-PNPT1 regulatory axis regulates the apoptosis of BC cells and might represent a potential therapeutic avenue for the treatment of BC.
文摘In this nonsystematic review of the literature,we explored the changing landscape of detection and treatment of low-and intermediate-risk prostate cancer(PCa).Through emphasizing improved cancer assessment with histology classification and genomics,we investigated key developments in PCa detection and risk stratification.The pivotal role of prostate magnetic resonance imaging(MRI)in the novel diagnostic pathway is examined,alongside the benefits and drawbacks of MRI-targeted biopsies for detection and tumor characterization.We also delved into treatment options,particularly active surveillance for intermediate-risk PCa.Outcomes are compared between intermediate-and low-risk patients,offering insights into tailored management.Surgical techniques,including Retzius-sparing surgery,precision prostatectomy,and partial prostatectomy for anterior cancer,are appraised.Each technique has the potential to enhance outcomes and minimize complications.Advancements in technology and radiobiology,including computed tomography(CT)/MRI imaging and positron emission tomography(PET)fusion,allow for precise dose adjustment and daily target monitoring with imaging-guided radiotherapy,opening new ways of tailoring patients’treatments.Finally,experimental therapeutic approaches such as focal therapy open new treatment frontiers,although they create new needs in tumor identification and tracking during and after the procedure.
文摘<strong>Background:</strong> Bladder cancer is a common cause of morbidity and mortality in our institution due to the late presentation. Morbidity is defined as a development of complications that may lead to mortality. Uraemia is a common presentation that constitutes a management challenge in our patients. We study the spectrum of morbidity and mortality in bladder cancer patients in our institution. <strong>Materials and Methods:</strong> This is a retrospective study of patients with clinical, radiological, cytological and or histological features of bladder cancer that had a morbidity and or mortality managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from January 2011 to December, 2017. Data were retrieved from patients’ case notes via a proforma and analyzed using SPSS 20.0 version for windows. The results were presented in number percent, tables and chart. <strong>Results:</strong> There were morbidity and or mortality in 234 bladder cancer patients within the study period with a mean age of 48.4 ± 14.1 years and a range of 3 - 106 years. There were 219 males (91.5%) and 20 females (8.5%) with a male to female ratio of 11:1. There were haematuria and lower urinary tract symptoms (LUTS) in 230 patients (98.3%). There were necroturia ± weight loss and anorexia in 126 patients (53.8%). There was urinary tract infection (UTI) in 75 patients (32.1%), anaemia in 131 patients (56.0%) and uraemia in 161 patients (68.8%). Mortality was recorded in 84 patients (35.9%) which was due to uraemia in 52 patients (22.2%), urosepsis in 22 patients (9.4%) and anaemia in 8 patients (3.4%), intestinal obstruction and blood transfusion reaction in 1 patient each (0.4%). <strong>Conclusion:</strong> Anaemia, urosepsis and uraemia are the most common causes of morbidity and or mortality in bladder tumour patients in Sokoto. This poses great diagnostic and therapeutic dilemma to the urologist, patients and their relatives.
文摘We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.
文摘Herein we report a patient with a prostatic hyperplasia weighing exactly 700 g which was successfully removed at the Brong Ahafo Regional Hospital theatre in Ghana by Pfannesteil Transvesical Simple Prostatectomy. A prostatic hyperplasia of enormous size is very uncommon and to the best of our knowledge, only ten of such cases have been previously reported. The case report presented here constitutes the eleventh heaviest prostate reported in medical literature and also forms the first case report of giant prostatic hyperplasia from Ghana.
基金This project was funded by the Movember Foundation as part of their Australian and New Zealand prostate cancer outcomes registry initiative(PCOR-ANZ)which aims to develop a binational clinical registry for outcomes monitoring and research to inform practice and improve outcomes for men with prostate cancer.Dr.Beckmann is supported by an NHMRC Early Career Researcher Fellowship.
文摘Object:To determine the extent and impact of upgrading and downgrading among men who underwent radical prostatectomy(RP)according to new grade groupings and to identify predictors of upgrading from biopsy grade Group Ⅰ and Ⅱ,and downgrading to grade Group I,in a community setting.Methods:Study participants included 2279 men with non-metastatic prostate cancer diagnosed 2006-2015 who underwent prostatectomy,from the multi-institutional South Australia Prostate Cancer Clinical Outcomes Collaborative registry.Extent of up-or down-grading was assessed by comparing biopsy and prostatectomy grade groupings.Risk of biochemical recurrence(BCR)with upgrading was assessed using multivariable competing risk regression.Binomial logistic regression was used to identify pre-treatment predictors of upgrading from grade Groups Ⅰ and Ⅱ,and risk group reclassification among men with low risk disease.Results:Upgrading occurred in 35%of cases,while downgrading occurred in 13%of cases.Sixty percent with grade Group I disease were upgraded following prostatectomy.Upgrading from grade Group I was associated with greater risk of BCR compared with concordant grading(Hazard ratio:3.1,95%confidence interval:1.7-6.0).Older age,higher prostate-specific antigen levels(PSA),fewer biopsy cores,higher number of positive cores and more recent diagnosis predicted upgrading from grade Group Ⅰ,while higher PSA and clinical stage predicted upgrading from grade Group Ⅱ.No clinical risk factors for reclassification were identified.Conclusion:Biopsy sampling errors may play an important role in upgrading from grade Group I.Improved clinical assessment of grade is needed to encourage greater uptake of active surveillance.
