Common Urological Emergency Research Articles

Phosphodiesterase inhibitors and testicular torsion: A systematic review and meta-analysis of animal studies.

Testicular torsion is a common urological emergency in children and teenagers that, in most cases, requires surgical exploration and detorsion. However, even after a successful intervention, a high number of patients still develop irreversible damage. To investigate whether the administration of phosphodiesterase inhibitors (PDE) in animal models of testicular torsion can reduce damages caused by the ischemia-reperfusion syndrome. A systematic search of the Medline, Web of Science, Embase, and Ovid databases for studies up to December 2023 was performed using PRISMA guidelines. A detailed search was conducted using the following key terms: "testicles," "ischemia," "reperfusion," and "phosphodiesterase inhibitors." There was no restriction regarding language or year of publication. We investigated spermatogenesis by the Johnsen's biopsy score (JTBS) and histological damage by the Cosentino's biopsy score (CBS). Malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), and glutathione peroxidase (GPx) testicular levels were also analyzed. Initially, 296 articles were identified. However, only 20 studies met the inclusion criteria. PDE inhibitors improved JTBS (MD=2.53, CI=1.94 to 3.13), CBS (MD=-1.11, CI=-1.25 to -0.97) and SOD (SMD=3.27, CI=1.59 to 4.95) outcomes. PDE did not improve MDA (SMD=-0.93, CI=-2.19 to 0.34), NO (SMD=-0.54, CI=-1.56 to 0.48), and GPx (SMD=0.77, CI=-0.38 to 1.92) outcomes. A higher dose of PDE inhibitors only improved CBS outcome. This review indicates that the administration of PDE inhibitors in rats ameliorated the outcomes, representing a promising complementary strategy for spermatogenesis recovery following testicular torsion. Our review suggests that JTBS and CBS could be translated into future human studies, validating and extending these findings within the context of human physiopathology, while providing applicability of interventions in real clinical practice.

Piroxicam and paracetamol in the prevention of early recurrent pain and emergency department readmission after renal colic: Randomized placebo-controlled trial.

Renal colic (RC) is a common urologic emergency often leading to significant pain and recurrent hospital visits. This study aimed to compare the efficacy and safety of piroxicam versus paracetamol in preventing pain recurrence and hospital readmission in patients treated for RC and discharged from the emergency department (ED). A prospective, randomized, single-blind trial was conducted in four EDs. Eligible adults with RC were randomized to receive oral piroxicam, paracetamol, or placebo for 5 days post-ED discharge. Primary outcomes included pain recurrence and ED readmission within 7 days. Secondary outcomes included time to recurrence and treatment-related side effects. Of 1383 enrolled patients, no significant differences were observed among the groups regarding baseline characteristics. Pain recurrence rates within 7 days were 29% (95% confidence interval [CI] 24.9%-33.2%) for piroxicam, 30.3% (95% CI 26.1%-34.5%) for paracetamol, and 30.8% (95% CI 26.6%-35.0%) for placebo, with no significant between-group differences (p = 0.84). Among patients experiencing recurrence, the majority encounter it within the initial 2 days following their discharge (86% in the piroxicam group, 84.1% in the paracetamol group, and 86% in the placebo group, respectively). ED readmission rates were similar across groups: 20.8% (95% CI 17.1%-24.5%) in the piroxicam group, 23.8% (95% CI 19.9%-27.7%) in the paracetamol group, and 22.9% (95% CI 19.1%-26.8%) in the placebo group (p = 0.52). The piroxicam group reported significantly higher adverse effects compared to others. Piroxicam and paracetamol did not demonstrate efficacy in preventing pain recurrence or ED readmission within the first week following RC treatment.

Comparison of post-decompressive haematuria in rapid versus gradual bladder decompression in patients with chronic urinary retention.

Chronic urinary retention (CUR) is a common urological emergency. Initial management involves the drainage of the bladder by urethral catheterisation. Relief of CUR may be associated with post-decompressive haematuria. The two primary methods of emptying the obstructed bladder are rapid and gradual emptying. The method of relief of CUR to reduce this complication has been debated for decades. To compare the risk of post-decompressive haematuria following rapid versus gradual urinary bladder decompression in patients with CUR. This was a prospective, randomised study in which patients with CUR were randomised into two groups: group A and group B. Group A had rapid urinary decompression with an 18 Fr urethral catheter attached to a urine bag, whereas group B had gradual decompression using a urethral catheter attached to an intravenous fluid-giving set, which was then attached to the urine bag. Post-decompressive haematuria in each group was assessed at designated times and documented based on a research protocol. Data were analysed using the Statistical Package for Social Sciences (IBM) SPSS version 21. Data were summarised by descriptive statistics. The two arms were compared for similarities in demographic variables. Continuous and categorical variables were compared using the Student's t test and Pearson's chi-square test, respectively. The results of the analysis were presented with the aid of bar charts and tables for clarity. Significant P value was ≤0.05. Sixty patients were recruited into the study and randomised into groups A (rapid urinary decompression) and B (gradual urinary decompression) with 30 patients in each arm of the study. The mean age was 70.92 ± 13.98 years (range 20-96 years). The mean age of the patients recruited into group A was 68.50 ± 14.77 years, whereas that of group B was 73.33 ± 13.19 years. The P value was 0.187. Fifteen patients (50%) developed gross haematuria in group A compared with 7 patients (23.3%) in group B with a statistically significant p value of 0.032. Four (26.7%) of the patients with gross haematuria had blood transfusions in group A, whereas only 1 (16.7%) of the patients with gross haematuria in group B had a blood transfusion. The P value was 0.920. The rate of haematuria is significantly higher in group A with a higher rate of blood transfusion than that of group B. Though gradual urinary decompression is cumbersome, it is recommended to reduce the rate of haematuria and blood transfusion with its associated complications.

Protective effect of ligustrazine on oxidative stress and apoptosis following testicular torsion in rats

Testicular torsion is a common urologic emergency and one of the causes of infertility in males. It has been reported that ligustrazine may decrease oxidative stress and reduce ischemia–reperfusion injury. This study aims to investigate the protective effect of ligustrazine in ischemia–reperfusion injury after testicular torsion-detorsion. First, 40 rats were randomly and equally divided into TMP (Ligustrazine) group, the Testicular torsion (T/D) group, the Sham (Sham operation) group, and Control group. The left testis of rats in the TMP and T/D group was rotated for 2 h. The TMP group was intraperitoneally injected with ligustrazine solution and the T/D and the Sham groups were injected with normal saline. The left testes of four groups were obtained for assay on the 4th day after the operation. Average level of superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase (CAT) were higher in Sham and Control groups than T/D group and TMP group. Conversely, average level of malondialdehyde (MDA) and reactive oxygen species (ROS) was lower in Sham and Control groups than T/D group and TMP group. In contrast with the T/D group, SOD, GPX, and CAT enzymatic activities increased, whereas MDA and ROS content decreased in the TMP group (P < 0.05). Microscopic observation showed that the testicular tissue of the Sham and Control groups were basically normal. The TMP and T/D groups had significant testicular tissue damage, whereas the TMP group had less damage and apoptosis than the T/D group. The apoptotic index of germ cells in the TMP group (13.05 ± 4.41) was lower than the T/D group (30.23 ± 11.31) (P < 0.05) and higher (P < 0.05) than the Sham group (0.56 ± 0.29). So we found that Ligustrazine lowered ischemia–reperfusion injury after testicular torsion-detorsion by decreasing the reactive oxygen species and suppressing apoptosis.

140 Five Year Single-Unit Experience and Outcomes of Renal Decompression for Ureteral Obstruction: A Retrospective Analysis of 102 Kidney Units

Abstract Aim Renal decompression following ureteral obstruction is a common urological emergency. Malignant obstruction patients often have poor life-expectancy, and the impact of decompression on survival is questionable [1]. We herein review outcomes of ureteral obstruction management in a single unit. Method Records of nephrostomy requests in Ysbyty Gwynedd between January 2017 and December 2021 were retrospectively reviewed. Information on patient demographics, primary pathology, performance status (PS), change in renal function and outcomes were recorded. Results Over 60 months, 102 nephrostomies were performed. Benign obstructions constituted 30.4% (n = 31) of cases. Of 71 cancer cases, 9 were re-insertions due to complications. Cancer group was associated with high and early deaths (11.3%, 64.5% and 85.5% at 3, 12 and 60 months, respectively) with only 1 in 5 kidney units illustrating improvement in renal function following decompression. All cancer patients were frail, with performance status of 2 (63%) and 3 (37%). Following nephrostomy insertion, 69.3% of kidney units developed urinary infection and/or sepsis requiring treatment. Only about 1 in 2 (53%) cancer patients received further oncological treatment (chemo- and /or radiotherapy). Though ante grade ureteric stenting was attempted in 23 kidney units following nephrostomy insertion for cancer, only 21 were successful and 2 of those blocked within 14 days. Conclusions Decompression of malignant ureteral obstruction may not improve survival and can involve multiple interventions with quality-of-life implication. Hence, the decision to decompress should not be the default and would therefore need to be individualized, adopting a multidisciplinary approach.

Efficacy and Safety of Ketamine Versus Opiates in the Treatment of Patients with Renal Colic: A Systematic Review and Meta-analysis.

Renal colic is one of the most common urological emergencies, and is usually caused by ureteral colic spasms. Pain management in renal colic remains the central focus of emergency treatment. The purpose of this meta-analysis is to identify the efficacy and safety of ketamine versus opioids in the treatment of patients with renal colic. We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for published randomized controlled trials (RCTs) that referred to the use of ketamine and opioids for patients with renal colic. The methodology was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The mean difference (MD) or odds ratio (OR) with a 95% confidence interval (CI) was used to analyze the data. The results were pooled using a fixed-effects model or random-effects model. The primary outcome measure was patient-reported pain scores 5, 15, 30, and 60min after drug administration. The secondary outcome measure was side effects. The data analysis revealed that ketamine was similar to opioids in pain intensity at the time of 5min post-dose (MD = - 0.40, 95% CI - 1.82 to 1.01, P = 0.57), 15min post-dose (MD = - 0.15, 95% CI - 0.82 to 0.52, P = 0.67), 30min post-dose (MD = 0.38, 95% CI - 0.25 to 1.01, P = 0.24). Also, the pain score of ketamine was better than that of opioids at 60min after administration (MD = - 0.12, 95% CI - 0.22 to - 0.02, P = 0.02). As for safety, the ketamine group was linked to a significant decrease in the incidence of hypotensive (OR = 0.08, 95% CI 0.01-0.65, P = 0.02). The two groups did not statistically differ in the incidence of nausea, vomiting, and dizziness. Compared with opioids, ketamine showed a longer duration of analgesia in renal colic, with satisfactory safety. The PROSPERO registration number is CRD42022355246.

Parents' Awareness and Knowledge of Testicular Torsion in the Western Region of Saudi Arabia.

Introduction Testicular torsion (TT) is the most common urological emergency in children that requires immediate intervention. The prognosis of testicular torsion depends on the patient's time of presentation to the emergency department (ED), as well as on the time at which the diagnosis is established and treatment is initiated. Raising public awareness of testicular torsion, particularly among parents, plays a crucial role in preventing delay in presentation and reducing the frequency of orchiectomy. To this end, the study is designed to assess the level of awareness and knowledge of testicular torsion, as well as the response of parents to the scrotal pain of their children. Methods A descriptive cross-sectional study was conducted among parents in the western region of Saudi Arabia. Data was collected between the 23rd of November and the 22nd of December 2022. A simple random sampling technique was implemented. The data was collected and analyzed using SPSS software (IBM Corp., Armonk, NY). Results A total of 394 parents participated in this study. It showed that 13.5% of parents reported having a child with a previous experience of pain in the scrotum. Of them, only 25.4% previously heard about torsion of the testicles. Only 68.8% and 76.6% correctly reported that if the child complains of pain in the scrotum during working hours or over the weekend, they will drive him to the hospital immediately. Good knowledge about TT was significantly higher among children's fathers compared to mothers (66.7% vs. 33.3%) (p≤0.05). Conclusion Testicular torsion (TT) represents significant morbidity among male patients and early identification is crucial to avoid the need for orchiectomy and all its prominent physical and psychological consequences. To improve children's well-being, we need to raise parents' awareness of TT and the potential future implications of this critical condition as it is not widely known in our community. Further studies evaluating the knowledge regarding testicular torsion among preadolescent and adolescent boys are warranted.

Management of Urological Emergencies at the Reference Health Centre of Markala

Context and Objective: Urological emergencies correspond to pathological situations of the urinary tract of both sexes and/or the male genital tract, with a functional and/or vital prognosis at stake in the absence of appropriate and effective treatment as soon as possible. The objective of this study was to evaluate the management of urological emergencies at the Markala health centre. Method: Our work is a prospective descriptive study of 12 months from May 2021 to April 2022 during which we recorded 107 cases of urological emergencies. The average age of occurrence of these pathologies was 47.6 years. The extremes were 04 months and 92 years. The most represented age group was 61 to 80 years with 30.8%. The male sex was the most affected with a sex ratio of 4.94. The most frequent reason for consultation was total inability to urinate with 42.1%. Acute urinary retention (AUR) was the most common urological emergency with 42.1% of cases. The main etiologies of AUR included BPH (57.7%) and urinary lithiasis (17.7%). Non- surgical procedures accounted for 78.5% of the therapeutic procedures performed. Bladder catheterisation accounted for 63.6% of non-surgical emergency procedures. Debridement accounted for 21.7% of emergency surgical procedures. Prostatic adenomectomy was the most performed etiological treatment with 23.4%. We recorded one case of death (0.93%) due to sepsis from Fournier's gangrene. Conclusion: Urological emergencies occupy an important place in our daily activity. The most frequent urological emergency was acute retention of urine, the predominance of which was linked to the frequencies of benign prostatic hyperplasia, urinary lithiasis and urethral stricture. The target population, dominated by adult males in their 50s, implied an etiological role for prostate adenoma. The emergence of these emergencies was mainly related to the delay in consultation and the lack of health education in the general population. Urethral catheterisation, .........

Clinical characteristics and identification of risk factors of testicular torsion in children: Aretrospective study in a singleinstitution.

Testicular torsion (TT) is a common urological emergency posing serious health problem in children. Prompt diagnosis and treatment of TT are very important for children to protect the affected testis. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. We conducted a retrospective record of clinical findings, laboratory data, ultrasound findings, operating results, and the results of follow-up in hospitalized children with TT from November 2004 to December 2021. A multivariable logistic regression model was used to identify predictors of testicular salvage. A total 102 hospitalized children who presented with TT were included. Patients were aged from 1 month to 16 years, with a median age of 7.71 years. TT is significantly more common in the winter. Of these patients, 77 torsions were left-sided, 24 were on the right side, and only 1 was on bilateral sides. Meanwhile, we detected that 88 children suffering from TT had intravaginal torsion of the spermatic cord, and the rest were outside. Anticlockwise torsion was found in 65 cases (63.73%) and clockwise torsion in 37 (36.27%). As a result, 60 underwent orchidectomy, while 42 had a scrotal exploration with fixation of the testis. Multivariate analysis showed that cause of TT, time to intervention, white blood cell (WBC), and mean platelet volume (MPV) were correlated with the risk of a surgical outcome. Only a small proportion of TT children received timely surgical management. Testicular salvage can be predicted by cause of TT, time to intervention, WBC, and MPV. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with scrotal trauma or epididymo-orchitis should have their testicles checked to make sure that they do not have torsion, especially those who visit in the cold season.

Urological Emergencies at Kara Teaching Hospital (Togo): Epidemiological, Clinical and Therapeutic Profile

Background: The urology department of the teaching hospital of Kara is the second urology department in Togo, after that of the teaching hospital Sylvanus Olympio, in Lomé the capital. It is a very young service, created less than 5 years ago. Urological emergencies were previously managed by general surgeons, for lack of urologists. The influx of patients with urological pathologies has increased with the arrival of urologists. The update on urological emergencies having been made in Lomé, we therefore wanted to take stock of urological emergencies at the teaching hospital of Kara. Objective: To describe the epidemiological, clinical, and therapeutic aspects of urological emergencies received at the teaching hospital of Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department, and in the surgical emergency department of the teaching hospital of Kara, over a period of 18 months, from January 2021 to June 2022. The on-call medical team consisted of the intern in on-call medicine, and an on-call urologist, whom the intern called upon when he received a urological emergency. Pediatric urological emergencies were managed by the pediatric surgeon and were not considered in our study. The operating room register, the surgical emergency consultation register, the urology department consultation register, and the records of patients hospitalized in the urology department were used for data collection. The following parameters were studied: age, sex, type of urological emergency, and therapeutic management; epi info 7 software was used for data processing. Results: The average age of the patients was 52.5 ± 19.6 years with extremes ranging from 16 years to 102 years. Note that 57.7% of the patients were over 50 years old. The sex ratio was 8.9. Urinary retention was the most common urological emergency in 47.7% (52) of cases; follow-up of infectious pathologies in 30.2% (33) of cases. Among the patients who had been seen for urinary retention, 84.6% (44) of the cases had presented with acute urinary retention. Urethral catheterization was the type of care most received by patients, in 30.2% (33) of cases; follow-up of medical treatment in 27.5% (30) of cases. The most common etiology of urinary retention was prostate tumours, in 71.1% (37) of cases, followed by urethral stricture in 15.3% (8) of cases. We also found in our series, traumatic emergencies in 10% of cases; these were traumatic urethral injuries, traumatic injuries of external genitalia, traumatic injury of bladder, and traumatic injury of kidney in respectively: 4.5% (5); 2.7% (3); 1.8% (2); and 0.9% (1) of cases. Torsion of the spermatic cord was found in 2.7% (3) of cases. Conclusion: Urine retention is the most common urological emergency at Kara University Hospital. They are most often found in elderly males. Urethral catheterization was the most common type of care.

Influence of the grade and invasiveness of bladder cancer on disease course severity in patients with bladder tamponade resulting from a bleeding bladder cancer

Urinary bladder tamponade is a common urological emergency, but it has so far been insufficiently researched. The aim of our study was to show the association between the characteristics of bladder cancer (grade and invasiveness) and disease course severity based on blood hemoglobin (Hgb) count at admission, the need for red blood cell transfusion (RBCT), and the length of hospitalization in patients suffering from bladder tamponade. A retrospective, cross-sectional study was conducted, namely, including 25 adult patients surgically treated for bladder tamponade resulting from a bleeding bladder cancer. Patients with low-grade cancer had statistically significantly higher mean Hgb values at admission (101.14 ± 8.26 vs. 87.22 g/L ± 10.64 g/L, P = 0.005), as well as a lower mean number of received units of RBCT (0.71 ± 0.76 vs. 2.39 ± 1.46, P < 0.001) and a shorter hospitalization (2.43 ± 0.55 vs. 4.36 ± 1.04 days, P = 0.009) than those with high-grade cancer. Patients suffering from nonmuscle-invasive bladder cancer (NMIBC) had statistically significantly higher mean Hgb values at admission (96.69 ± 9.86 g/L vs. 81.22 ± 7.23 g/L, P = 0.001), as well as a lower mean number of received units of RBCT (1.31 ± 1.2 vs. 3 ± 1.41, P = 0.004) and a shorter hospitalization (3.31 ± 1.14 vs. 4.78 ± 0.97 days, P = 0.004) than those with muscle-invasive bladder cancer. Low-grade bladder cancer and NMIBC are associated with a milder clinical course of bladder tamponade.

Methodology and findings of randomized clinical trials on pharmacologic and non-pharmacologic interventions to treat renal colic pain - a review.

Renal colic pain is considered one of the most excruciating pains ever experienced and ranks as one of the most common urological emergencies. Despite existing established recommendations, new therapies and their combinations are continuously being tested. The aim of this systematic review is to analyze and compare studies involving pharmacologic and non-pharmacologic interventions used in the treatment of renal colic pain. This systematic review was conducted following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Medline, Scopus, Cochrane Library, and Google Scholar were searched for relevant randomized controlled trials (RCTs) involving adult patients. The quality and results of the included studies were assessed and discussed. This review provides an extensive analysis of 71 identified RCTs. Opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and dipyrone/metamizole have demonstrated effectiveness as single medications. Some evidence points to opioids having a potential disadvantage compared to others when used as a first-line single medication. Among the 63 studies exploring pharmacological therapy, 51 reported opioids utilization for rescue therapy in significant proportion of patients. Promising combination therapies involve the administration of an NSAID alongside opioids, ketamine, desmopressin, steroids, or nitric oxide. Conversely, spasmolytics, magnesium, and lidocaine exhibited limited or no additional effect. Noteworthy methodological shortcomings encompass a low pain threshold during participant recruitment and the reliance on pain reduction rather than complete pain elimination as an endpoint. Frequent use of opioids as rescue medications in RCTs undermine their conclusions on effectiness of other therapeutics. Combination therapies should be considered as first choice in renal colic pain management. RCTs should define success of therapy as achieving complete or near-complete pain relief rather than pain reduction.

Urological emergencies in two university hospitals in Douala: a retrospective study (2016-2020)

urological emergencies are critical situations that require rapid response by a qualified urology health care professional. The purpose of this study was to highlight the profile of urological emergencies in two university hospitals in the city of Douala by assessing emergency management. we conducted a retrospective study of the urological emergencies in two reference hospitals in the city of Douala: the Laquintinie Hospital and the General Hospital. Files were collected over a period of 5 years (January 1st, 2016 to December 31st, 2020). All emergency consultations in the Emergency Unit as well as all clinical and therapeutic data from the on-call list during the study period were included. We excluded all emergencies (consultations during the study period) not recorded in the emergency registry. we conducted a study of 364 patients with an average age of 43 ± 8.34 years; 92.58% (n=337) of patients were male. The most common urological emergencies included: urinary retention (45.05%, n=164), renal colic (15.33%, n=56) and haematuria (13.18%, n=48). The most common cause of urinary retention was prostate tumors, renal colic was mainly due to renal lithiasis (96.45%, n=159) and hematuria was due to tumor in 68.75% (n=33) of patients. Therapeutic management was based on urinary catheterization (39.01%, n=142), medical treatment was associated with monitoring (27.47%, n=100) and suprapubic cystostomy (10.71%, n=39). acute urinary retention due to prostate tumors is the most common urological emergency in the university hospitals in the city of Douala. Early and optimal management of prostate tumors is therefore essential.

931 Timeline in Management of Urinary Retention: Trial Without Catheter (TWOC) Clinic – Single Centre Outcomes of District General Hospital

Abstract Aim Urinary retention is a common urological emergency, but the management is not standardised due to lack of clinical guidelines &amp; various options available to a complex problem. We aim to assess the timeline of patients going into acute urinary retention &amp; their first/second TWOC appointment until clinic appointment and decision for definitive treatment as-well as to reduce waiting time&amp;improve patients’ safety/experience. Method Using retrospectively collected data, all TWOC admissions from June 2019-December 2019 and June 2020-December 2020 were included. Data was extracted from various sections across our e-system. Outpatient letter appointments also checked to complete the timeline. Results Total of 93-TWOC admissions in total, 45 of which were in2019 and 48 in2020. 26%(n=24) of patients have passed their TWOC. 74%(n=69) of patients have failed their TWOC necessitating re-catheterisation/consideration for TURP/re-TWOC. Time from urinary retention/catheterisation to TWOC admission in 2019 had an average of 36.2days, whereas it was 37.9days in 2020. Time from urinary catheterisation to clinic also showed variation with an average of 83.9days in 2019 and 56.3days in 2020, ultimately resulting in long waiting-period for an operation. Conclusions A TWOC-clinic, where patients can be seen once-a-week to reduce clinic waiting time &amp; improve safety by performing DRE &amp; checking PSA in timely-manner, was proposed. It allows effective use of TWOC slots &amp; timely decision of suitable patients for surgery rather than simply-listing patients for unnecessary further TWOC. It also serves as a platform to safety-net patients with possible underlying prostate-cancer by checking PSA &amp; performing DRE early in their journey for early-management.

Efficacy and safety of emergency ureteroscopy as first-line treatment for patients with renal obstruction due to ureteral stones in the COVID-19 pandemic

Introduction and objective: Acute renal colic due to ureteral calculi is a common urological emergency that can be managed conservatively, by providing renal drainage and medical management of the pain syndrome followed by planned treatment, or by emergency surgery. With the onset of the COVID-19 pandemic leading to the temporary suspension of elective surgical activity, emergency ureteroscopy has become a valuable modality for the treatment of acute renal obstruction. The objective of this study is to evaluate the efficacy and safety of emergency ureteroscopy as first-line treatment for patients with acute renal obstruction due to ureteral stones during the COVID-19 pandemic. Material and methods: A prospectively collected database of 120 patients with acute renal obstruction due to ureteral stone who underwent emergency ureteroscopy within 24 hours from hospitalization between March 2020 and December 2021, was reviewed. Data on patients’ preoperative characteristics, stone-free rates and complication rates was analyzed. Results: Patients’ mean age was 51.4±15.2 years. Male-to-female ratio was 73.3%/26.7%. Mean preoperative serum creatinine values were 120.1±64.1 umol/l. 33 patients (2.5%) had a solitary functioning kidney. Stone location was proximal ureter in 3 patients (27.5%), mid-ureter – in 12 (10%), distal ureter – in 73 (60.8%), distal and proximal ureter – in 2 cases (1.6%). Mean stone size was 8.1±3.3 mm. Stone-free rate after a single procedure was 95% and mean operative time – 25.1±11.5 min. Postoperative drainage was stent JJ in 34 (28.3%) and ureteral catheter for 12h – in 22 (18.3%) patients. 21 patients (17.5%) had a narrow ureter, necessitating the use of smaller caliber ureteroscope (6 Fr). In 2 patients (1.7%) the ureter could not be accessed and a stent JJ was inserted. Intraoperative complications were present in 5 cases – 1 ureteral perforation (0.8%) and 4 cases of upward stone migration (3.3%). Postoperative complications were fever in 2 patients (1.7%) and postoperative renal colic pain - in 7 (5.8%). Conclusions: The results of this prospective study suggest that emergency ureteroscopy is a safe and effective first-line treatment for acute renal obstruction due to ureteral stones. It offers a one-stage management, without the potential complications of obstruction and loss of renal function due to delayed treatment during the COVID-19 pandemic. Key words: Ureterorenoscopy, Ureteral obstruction, Ureteral stone, Covid-19

A Ten-Year Study on Risk Factors of Orchiectomy in Testicular Torsion

Testicular torsion is a common urological emergency among children, peaking in neonates and pubertal age with an incidence rate of 3.8 in 100.000 (0.004%) annually. This study aimed to explore the characteristics of testicular torsion cases and risk factors for orchiectomy in testicular torsion patients. This was a retrospective study on medical records of patients diagnosed with testicular torsion underwent surgery at the urology department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from January 2009 to August 2019. Patient characteristics including age, duration of symptom, location, etiology, and degree of torsion were analyzed. A total of 86 cases of testicular torsion were identified, with most cases (54 cases, 62.8%) occured at the mean age 14.67 ± 2.4 years old. Most patients (69 patients, 80.2 %) arrived more than six hours after the onset, and 65 (75.5%) and 4 (4.6%) of them underwent orchiectomy and orchidopexy, respectively. The remaining patients (17 patients, 19.8%) came less than 6 hours after the onset and only 8 (9.3%) and 9 (10.4%) underwent orchiectomy and orchidopexy, respectively. Both duration of torsion (p = 0.000, P&lt;0.05) and degree of torsion (p = 0.006 , P&lt;0.05) were significantly correlated with orchiectomy. In conclusion, the risk factor for orchiectomy is strongly related to duration and degree of torsion. The chance for testis salvation increases if torsion happens before 4.5 hours and the degree of torsion is below 180 degrees. Prompt diagnosis and treatment is the only key to testicular salvation.

The Causes and Complications of Urinary Retention in Adult Males Managed at Pakistan Institute of Medical Sciences Islamabad Pakistan

Background: urinary retention is characterized as body inability to empty the bladder completely by voluntary micturition. The UR is highly observed in the male adult. But the limited and sufficient knowledge is present about its causes and associated complication. Objective: It is most common urological emergency in hospitals. The study aimed to evaluate the causes and associated complications of urinary retention. Material and Methods: This prospective hospital based study was conducted on 176 patients visited the emergency department of Pakistan Institute of Medical Sciences Islamabad over a period of 06 months. The review board and ethical committee of the hospital approved the study. Informed consent was taken from all patients included in study. A brief history and examination was done to establish the diagnosis. Urinary retention was relived either by per urethral or supra-pubic cathrterization followed by detailed history, examination and investigations. The urine sample of each patient was taken for urinalysis. Baseline investigations were done on every patients. Depending on the clinical impression the investigations were individualized. The results were retrieved from the collected data. The data was statistically analyzed by using SPSS software. Results: 176 patients were recruited during this research time. The patients mean age was 58.81±17.36SD. The maximum number of patients encountered in age group of 55-74years. Most common cause of urinary retention was enlarge prostate 67.04%, followed by urethral stricture 18.75% and impacted urethral/Urinary bladder stone 14.20%. Acute urinary retention was diagnosed in 62.50% while 37.50% were diagnosed as chronic urinary retention. The 65.34% patients were treated with per urethral catheterization and 34.66% were treated with supra-pubic catheterization. In 62.50% patients no complication were observed while in other 19.88% were diagnosed with urinary tract infection and 17.62% with the renal insufficiency. Conclusion: Urinary retention is common in adult patients. Enlarge prostate was the one of the main cause of urinary retention. The most common type of retention was acute urinary retention. Complications were mostly associated with chronic urinary retention. Keywords: Urinary retention, Complications, adult male, Enlarge Prostate and acute urinary retention.

Validation of TWIST (Testicular Workup for Ischemia and Suspected Torsion) Score System for Differential Diagnosis in Acute Scrotum in Tertiary Teaching Hospital

The acute scrotum is a common urological emergency and has a broad differential diagnosis. There is no clear consensus on a particular algorithm to follow in the diagnosis of testicular torsion. Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score, a risk scoring system based on signs and symptoms, can be invaluable in managing patients with the acute scrotum, specifically testicular torsion. This study aimed to evaluate the effectiveness of the TWIST scoring system for differential diagnosis of acute scrotal patients. The study was conducted using secondary data, medical records from 111 male patients diagnosed with acute scrotum in Saiful Anwar General Hospital Malang between January 2015 and December 2018. Data about the onset of pain, first contact, history, physical examination findings, any adjunct test performed, and intra-operative findings were collected. The effectiveness of the TWIST score in diagnosing testicular torsion was determined by calculating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Of the 111 patients, 43 patients (38.7%) had testicular torsion. The mean age was 17.49 (6.69) years. A total of 39 patients were classified as high risk as per the TWIST Score with cut point 5 had 83.7% sensitivity, 95.6% specificity, 92.3% positive predictive value (PPV), and 90.3% negative predictive value (NPV). The area under the curve was 0.93. The use of the TWIST Score in clinical practice can accurately determine high-risk patients who can proceed straight to the operating theatre without the need for an ultrasound.

Urological emergencies in a regional hospital in Senegal: a 20-month retrospective study

urological emergencies are diverse and varied, and are frequently encountered in urological practices. The purpose of this work was to study the epidemiological features and management of urological emergencies at the regional hospital of Kolda, Senegal. we conducted a retrospective and descriptive study collecting data from the medical records of all patients admitted as a urological emergency for 20 months (January 2020 and August 31, 2021). urological emergencies accounted for 3.6% of admissions to the Emergency Department and for 20.4% of urological consultations. The average age of patients was 51.9 ± 21.5 years, ranging from 1 to 98 years. Urinary retention was the most common urological emergency, observed in 249 cases (57.3%), followed by urogenital infections 89 (20.5%). Renal colic affected 48 (11%) of patients. Emergency management was based on urinary catheterization, which was performed in 193 patients (44.3%). The most common surgical procedures were suprapubic catheterization (42 patients; 51.9%) and emergency scrotal exploration (15 patients; 18.6%). in our context, urological emergencies are dominated by urinary retention due to prostatic disorders and urethral stenosis. Traumatic emergencies are uncommon.

Extra Burden on Urology Outdoor Due to Non Urology Flank Pain

Background: Flank pain is one of common urological emergency. It can be result of various causes. Most commonly results from one of three causes: urinary tract infection (UTI), kidney stones, and musculoskeletal problems like a muscle strain or pinched nerve. Objective: Determine frequency of none urological flank pain burden in urology outdoors. Methods: This was prospective descriptive case study conducted at department of urology and transplantation at Jinnah Postgraduate Medical Center Karachi from September 2020 to December 2020. All patients with flank pain, who visited in urology outdoor, were included in study. All patients had detailed history and physical examination. Urinalysis and ultrasound abdomen were done in all patients. CT KUB was also done in patients who had abnormal ultrasound finding of kidney ureter and bladder. Results: Total 100 patients were included in this study, 41 (41%) male while 59 (59%) patients were females. 45 patients had right sided pain, 34 had left sided while remaining 21 patients had bilateral flank pain and six patients had also lower urinary tract symptoms along with pain. 13 patients had positive renal punch on examination, 23 patients had positive straight leg rising sign and rest of the 64 patients’ examination was unremarkable. 55 patients had urology related pathology on ultrasound, in 9 patients had non urological pathology and rest 36 patients it was unremarkable. CT KUB was done in all 55 patients who had positive findings on ultrasound showing pathology in kidney and ureter in which 47 patients CT scan had confirmed the diagnosis while in 8 patients it was in remarkable. Conclusion: flank pain is not always secondary to renal origin. It has wide spectrum of alternative significant causes also. Keywords: Flank pain, none urological, CT KUB