Common Urological Problem Research Articles

Role of Computed Tomography in Differentiation of Radio-Lucent Stones from Radio-Opaque Stones in The Renal System Depending on Attenuation Measurements (Hounsfield Unit)

Renal calculus remains to be a common problem in the hospital. It is the third most common urological problem after urinary tract infection and prostate disease
 Computed tomography (CT) has a superior sensitivity and specificity over all other modalities in
 Diagnosis of renal stones in determining the size and number of kidney stones, no matter how small it is, also it helps in the identification of Hounsfield unit (HU) and thus determines the composition of gravel.
 Aim:
 The aim of this study is to differentiate between radio-opaque from radio lucent stones depending on attenuation measurements of the Hounsfield unit (HU) and to find the cutoff value depending on the Hounsfield unit in computed tomography (CT).
 PATIENT AND METHOD:
 This was a cross-sectional study of 100 patients (65 male and 35 female) aged between 18 and 80, having kidney stones of size more than or equal (l0 mm). The study was done between September 2014 and June 2015 in Al-Emammain Al-Kadhymain Medical City, Baghdad, Iraq. In all patients, an X-ray of the Kidney, ureter, and bladder (KUB) was done after preparation, and then nou contrast Computed Tomography (CT) was performed to all patients. Two parameters were studied, which are the appearance of stone on KUB and Hounsfield unit for each stone was measured in Computed Tomography (CT).
 RESULTS:
 We classified the stones according to their appearance on KUB to Radio-Opaque stone (71 stones) and Radio-Lucent stone (29 stones).
 By statistical analysis, we found that the cut-off value of HU was 573, with a sensitivity of 97.2% and specificity of 93.1%.
 CONCLUSION
 Find the cut-off value of the Hounsfield unit (HU), which is a value in the classification of gravel according to their appearance.

Indications for Intervention in Patients Undergoing Ureteroscopic Therapy for Ureteric Calculus: A Cross-sectional Study

Introduction: Urolithiasis is one of the most common urological problems worldwide. The fastest treatment modality to achieve stone clearance of ureteral stones is Ureteroscopic Lithotripsy (URSL). However, it is negated by both the cost burden and potential risk to the patient. Medical Expulsive Therapy (MET) is a treatment option for upto 10 mm stones but has failure rates of 40-60% in the literature. Aim: To analyse the various indications for surgery, whether MET was used or not, if used-its details, operative findings at ureteroscopy including the reason for the failure of MET. Materials and Methods: A cross-sectional study consisting of 72 patients with ureteric calculi undergoing URSL was analysed from June 2017 to December 2018 at Mazumdar Shaw Medical Centre, Bangalore , Karnataka, India. Indications were assessed at the time of admission. During ureteroscopy, factors like impaction, distal obstruction, and unusual findings were studied, which could have contributed to the failure of MET. The Chi-square test was used as a test of significance for categorical data. The Analysis of Variance (ANOVA) test was used as a test of significance to identify the mean difference between continuous variables. The p-value of <0.05 was considered statistically significant. Results: The mean age in the study was 41.65±13.4 years (range 20-69 years), and the mean stone size was 10.03±3.34 mm. Large stone was the most common indication (41, 56.9%, p=0.004), followed by failed MET (35, 48.6%). Even though MET could have been continued for four weeks in 17 patients (23.6%), they were taken up for surgery. The impaction rate was 70.8% (51), with 48.6% (35) being large impacted stones and 22.2% (16) being small impacted stones. The overall stone clearance rate was 68 out of 72 (94.4%). Conclusion: Large stone size (≥10 mm) and failed MET were the main indications for surgery. One reason for the failure of MET was not waiting for a duration of four weeks. During ureteroscopy, impaction of the stone, irrespective of size, was the most common finding and was the reason for the failure of MET. Ureteric stones on MET should not be neglected as there are reasons for the failure of MET, and they will require URSL after four weeks

Retrograde Intrarenal Surgery versus Mini-Percutaneous Nephrolithotomy for Lower Calyceal Stones of ≤ 2 cm

Introduction: Renal stones are one of the common urological problems. The optimal management of lower calyceal renal calculi of 1-2 cm is still debatable. The objective of this research is to assess the safety, efficacy, and stone-free rate of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for the management of lower calyceal stones of 1-2 cm. Methods: A prospective comparative study was conducted among 30 patients which were divided in two group (A and B) prospectively with lower calyceal stones of 1-2 cm. Group A were treated with retrograde intra renal surgery while Group B were treated with mini percutaneous nephrolithotomy. Results: The mean age of patient in Group-A was 44.27±17.10 year and in Group-B was 45.27±16.11 year. The hospital stay in Group-A was 3.47±0.62 and in Group-B was 4.50±0.73 days. The stone size in Group-A was 13.30±2.21 mm and in Group-B was 15.60±2.55 with p-value of 0.381. The duration of operation time in Group-A was79.37±13.96 minutes and in Group-B was 62.53±7.41 minutes with p value of 0.091. Conclusions: Both retrograde intrarenal surgery and mini-percutaneous nephrolithotomy procedure are comparable. Mini percutaneous nephrolithotomy has a better stone free rate and haematuria is more common but retrograde intrarenal surgery has less hospital stay and post operative pyrexia is more common.

Informativeness of the doppler twinkling artifact in the diagnosis of urinary tract calculi

The kidney stone disease (nephrolithiasis, urolithiasis) is a common urological problem that affects both adults and children and has a high recurrence rate. Early and reliable imaging diagnosis of urolithiasis is important for early pain relief and the avoidance of complications that require surgical intervention. Non-contrast computed tomography is considered the method of choice in the diagnosis of urolithiasis, however, this method is associated with exposure to ionizing radiation. Ultrasound diagnostics or sonography, in contrast, is considered as the method of early diagnosis of urolithiasis that is widely spread, highly accessible and does not use ionizing radiation. Recently, the attention of sonographers has been attracted by the so-called twinkling artifact or the artifact of the colored comet tail, which occurs in the Doppler color flow mapping behind a calculus in the urinary tract. The twinkling artifact is a phenomenon of a rapid change (twinkle) of red and blue behind the calculus. Among adult patients, the artifact shows high sensitivity in finding urinary stones, but at the same time a high level of false-positive results. However, the sensitivity of the artifact in children is higher than in adults, whereas the rate of false-positive findings is much lower. According to many authors, the sensitivity and specificity of the twinkling artifact as an independent diagnostic sign of urolithiasis are both very heterogeneous, especially compared to non-contrast computed tomography. Nevertheless, the artifact is known to increase the diagnostic efficiency in stone detection to more than 90%. We believe that the twinkling artifact in the Doppler color flow mapping should always be considered as an additional diagnostic tool, which is complementary to B-mode ultrasonography and increases its sensitivity and specificity.

B-308 Focal Adhesion Kinase Activation is Involved in Tension Development During Contractile Stimulation of Mouse Detrusor Smooth Muscle to Modulate Bladder Dysfunction-Related Lower Urinary Tract Symptoms

Abstract Background The function of the bladder is to store and expel urine. Bladder dysfunction-related lower urinary tract symptoms (LUTS) is a common urological problem and negatively affects health-related quality of life. Investigation of detrusor muscle contraction mechanisms is necessary to understand its underlying pathophysiology. Voiding occurs through bladder muscle contraction, which is mediated primarily by the increased intracellular Ca2+ concentration-induced myosin regulatory light chain (MLC) phosphorylation. Recent studies showed that focal adhesion kinase (FAK)-regulated focal adhesion assembly and actin polymerization are involved in vascular and airway smooth muscle contraction. However, the role of FAK activation in visceral smooth muscle contraction is not well documented. This study aims to determine if FAK activation is involved in mouse detrusor smooth muscle contraction. Methods Normal adult male and female mouse bladders were harvested. The trigone and dome areas were cut, and the bladder body was used. The mucosa was carefully removed. Detrusor muscle strips (1.5–2 × 8–10 mm) were prepared and then suspended in a 20 mL tissue bath filled with physiological Krebs solution and bubbled with 95% O2 and 5% CO2 to obtain a pH of 7.4 at 37 °C. The isometric contraction was recorded. After establishing a stable baseline, the strips were stimulated with 120 mM potassium chloride (KCl), which was used to normalize the contractility induced by subsequent stimuli. One of the following specific inhibitors or the same volume of vehicle (DMSO) was applied and incubated for 30 min: PF-573228 (2 µM, a FAK inhibitor) or latrunculin B (1 µM, an inhibitor of actin polymerization). Then, the contractile responses to KCl (90 mM), electrical field stimulation (EFS, 2–32 Hz), or carbachol (CCh, 10−7.5–10−4.5 M ) were measured. In a separate experiment, the detrusor strips were stimulated with CCh (10 µM) after incubation with PF-573228 (2 µM) or vehicle (DMSO) for 30 min. Once the peak contraction was reached, the strips were snap-frozen for immunoblotting analysis of the phosphorylated FAK (p-FAK) and MLC (p-MLC). Statistical analysis was performed (GraphPad Prism 6). The contractile responses to KCl and EFS between vehicle and inhibitor groups were compared using a paired t-test. Nonlinear regression was used to compare CCh-induced dose-response curves. For the expression of phosphorylated proteins, one-way ANOVA, followed by Tukey’s posthoc test, was used for analysis. Results KCl-induced contractile responses decreased significantly after incubation with PF-573228 or latrunculin B compared to the corresponding vehicle group (P < 0.0001). The contractile responses induced by EFS were significantly inhibited by preincubation with PF-573228 at 8, 16, and 32 Hz (P < 0.05) or latrunculin B at 16 and 32 Hz (P < 0.01). Following the application of PF-573228 or latrunculin B, CCh-induced dose-response contractions were significantly lower than those in the corresponding vehicle-treated strips (P = 0.0021 and 0.0003, respectively). Immunoblotting analysis demonstrated that CCh stimulation caused increased expression of p-FAK and p-MLC, whereas preincubation with PF-573228 led to decreased expression of p-FAK but not p-MLC Conclusion FAK activation is involved in tension development induced by contractile stimulation in mouse detrusor muscle, probably through enhancing actin polymerization, but not MLC phosphorylation.

Short Term Outcome of Urethral Meatal Stenosis Surgery in Males

Background: MS is one of the common urological problems that is acquired and is faced by urologists as well as pediatric surgeons. Symptomatic boys are offered meatoplasty or meatotomy as a procedure of daycare under the influence of any anesthesia for the treatment of meatal stenosis. However, there is scarcity of literature on outcome of these surgical procedures in Pakistan. Objective: To determine the short-term Outcome of urethral meatal stenosis surgery in males was the objective of this study. Methodology: this prospective study including 50 male patients with urethral metal stenosis was conducted in department of urology, Aziz Bhatti Shaheed Hospital, Nawaz Sharif Medical College Gujrat, from June 2017 to June 2022. All patients underwent meatotomy. Operative findings and success rate were recorded. Results: Mean age of patients was 8.42±3.91 years. All patients were male. Pre-operatively, 36% patients had Meatal stenosis, 2% Meatal stenosis with incomplete circumcision, 8% Moderate meatal stenosis, 2% Narrowed external urethral meatus, 40% Pinhole meatus, 4% Pinhole sub-coronal meatus, 2% Pinhole external meatus, 4% Severe meatal stenosis and 2% patients had Sub-coronal hypospadiasis Pinhole meatus. The success rate is 100% in our study. Conclusions: Success rate of meatotomy in urethral meatal stenosis is high in male children and younger males. Keywords: meatal stenosis; Outcome; meatotomy

An overview of the history, current strategies, and potential future treatment approaches in erectile dysfunction: a comprehensive review.

Erectile dysfunction (ED) is one of the most common urologic problems in men worldwide, with an approximately high incidence rate, significantly affecting patients' quality of life and their sexual partners. Due to the association of this disorder with essential diseases such as cardiovascular disease and diabetes, its prevention and treatment are vital for overall human physiologic and psychological health. Along with reviewing the history of treatment and current methods, we seek new approaches to curb this issue in the future. In this review, investigations were based on the focus of each section's content or conducted on an ad hoc basis. Searches were performed in Scopus and PubMed. In recent years, many treatments for ED have been reported besides oral administration of phosphodiesterase 5 inhibitors such as sildenafil and tadalafil (approved by the Food and Drug Administration). Common oral medications, intracavernous injections, herbal therapies (eg, herbal phosphodiesterase 5 inhibitors), and topical/transdermal medications are routine ED treatment approaches. Moreover, some novel medications are innovative candidates for completing ED's treatment protocols: stem cell injection, low-intensity extracorporeal shock wave therapy, platelet-rich plasma injection, gene therapy, amniotic fluid matrices, rho-kinase inhibitors, melanocortin receptor antagonists, maxi-K channel activators (ie, large-conductance calcium-activated potassium channels), guanylate cyclase activators, and nitric oxide donors. Due to the importance of this complicated problem in men's society, a faster course of treatment trends toward new methods is needed to increase efficiency. Combining the mentioned treatments and attentively examining their efficacy through programmed clinical trials can be a big step toward solving this global problem.

OUTCOMES AND SAFETY OF RETROGRADE INTRA RENAL SURGERY FOR RENAL STONES

Background: Renal stones are one of the most common urological problems requiring surgical interventions. Retrograde intra-renal surgery is a minimally invasive surgical technique with minimal complications and a good stone-free rate. In the present study we aimed to assess the outcomes and safety of retrograde intrarenal surgery. Methods: A retrospective study was performed at Chitwan Medical College Teaching Hospital in the span of two years from Dec 2019 to Nov 2021. Patient demographics; stone burden, stone density, and location were collected from the medical records and evaluated. The data was collected in a proforma which was then entered into SPSS version 20. The data was presented in form of frequency and percentage. Results: One hundred and seventy patients were subjected to retrograde intrarenal surgery, out of which 32 were converted to mini- percutaneous nephrolithotripsy, 12 were presented and total of 126 were subjected to retrograde intrarenal surgery. The major complications were pyrexia in 21(16.67%) patients followed by hematuria in 4(3.17%) patients, and sepsis in 2(1.58%) patients. The stone-free rate was 94.4%. 2 (1.58%) patients underwent mini- percutaneous nephrolithotripsy and5 (3.96%) of them showed stones of varying size 2-6mm, non-obstructive with none of cases planned for staged retrograde intrarenal surgery. Conclusions: Primary Retrograde intrarenal surgery is the safe and effective treatment for the intrarenal stones.

Comparison of early surgical and conservative therapy in children with ureteropelvic junction obstruction

Ureteropelvic junction obstruction is a relatively common urologic problem in children. Most cases present with pelvicaliceal dilatation in antenatal period. Historically most UPJO cases were treated with surgical procedures, but recently many of these children have been treated by nonsurgical observational plans. We compared the outcome of children with UPJO treated in surgical and observational ways. In a retrospective study, we assessed the medical history of patients diagnosed as UPJO, march 2011 to march 2021. The case definition was based on grade 3-4 hydronephrosis and obstructive pattern in dynamic renal isotopescan. Patients were put into two groups; Group 1 children were treated with a surgical procedure, and group 2 patients without any surgical procedure for at least a six months' period after diagnosis. We assessed long-term events and improvement of obstruction. Seventy-eight children (mean age 7.32mo., 80% male) enrolled in the study, 55 patients in group one and 23 as group 2. Severe hydronephrosis was the problem of 96% of all patients significantly led to 20% in group 1 and 9% in group 2 (P < 0.001). Severe kidney involvement was observed at 91% in group 1 and 83% in group 2, decreased to 15% and 6%, respectively (P < 0.001). There were no significant differences in sonographic and functional improvement between the two intervention groups. Long-term prognostic issues; growth, functional impairment, and hypertension were not different between the two groups, but group 1 children experienced more recurrence of UTI than group 2 patients. Conservative management is as effective as early surgical treatment in the management of infants with severe UPJO.

Can Silodosin Be Considered a Superior Substitute for Tamsulosin in Medical Expulsion Therapy for Patients with Lower Ureteral Calculi

Introduction: Urinary stones, also known as calculi, are a common urological problem affecting millions of people worldwide. Medical expulsion therapy (MET) is a commonly used treatment for lower ureteral calculi. Objectives: The main objective of the study is to find the role of silodosin as a superior substitute for tamsulosin in medical expulsion therapy for patients with lower ureteral calculi. Material and methods: The study design for this research article would be a randomized controlled trial comparing the efficacy and safety of silodosin and tamsulosin in medical expulsion therapy (MET) for patients with lower ureteral calculi. Patients with lower ureteral calculi who meet the inclusion criteria will be recruited for the study. Inclusion criteria may include age over 18 years, presence of lower ureteral calculus confirmed by imaging, and willingness to participate in the study. Exclusion criteria may include previous history of ureteral surgery, contraindication to alpha-blockers, and pregnancy. Results: A total of 100 participants were randomized to receive either silodosin (n=50) or tamsulosin (n=50) for medical expulsion therapy of lower ureteral calculi. The mean age of the participants was 45 years, and 60% were male. The stone expulsion rate at 4 weeks was 80% in the silodosin group and 75% in the tamsulosin group. There was no statistically significant difference between the two groups (p=0.54). Conclusion: In conclusion, the results of this study indicate that silodosin may not be a superior substitute for tamsulosin in medical expulsion therapy for patients with lower ureteral calculi. Both drugs demonstrated similar rates of stone expulsion and time to stone passage, as well as comparable safety profiles and patient satisfaction rates. Keywords: Silodosin, Tamsulosin, Lower Ureteral Calculi

Effects of Low Dietary Cation and Anion Difference on Blood Gas, Renal Electrolyte, and Acid Excretions in Goats in Tropical Conditions.

Goats can suffer from intermittent heat stress in high ambient temperature (HTa) conditions, which causes sporadic respiratory hypocapnia. Obstructive urolithiasis is a common urological problem in goats. Sandy uroliths can be partially relieved by urine acidification with short-term ammonium chloride (NH4Cl) treatment. However, the outcome of urine acidification and the physiological responses to short-term NH4Cl supplementation under respiratory hypocapnia of HTa have rarely been reported. The present study investigated the effect of NH4Cl supplementation that produced a low dietary cation-anion different (l-DCAD) diet on acid-base balance and renal function under HTa conditions. The first experiment investigated the physiological responses to natural HTa to prove whether the peak HTa during the afternoon could induce HTa responses without a change in the plasma cortisol. The partial pressure of CO2 also tended to decrease during the afternoon. The second experiment examined the short-term effect of l-DCAD under HTa conditions. Although the blood pH was within the normal range, there was a clear acid-base response in the direction of metabolic acidosis. The major responses in renal function were an increase in tubular function and acid excretion. With a comparable level of creatinine clearance, the fractional excretions (FE) of chloride and calcium increased, and the FE of potassium decreased. Acid excretion increased significantly in the l-DCAD group. We conclude that under HTa conditions, the tubular excretion of electrolytes and acids was the major response to acid loading without changing the filtration rate. The l-DCAD formulation can be used to acidify urine effectively.

Outcome of Upper Ureteric Stone Management by in Situ Extracorporeal Shock Wave Lithotripsy and Intracorporeal Pneumatic Lithotripsy

Background: Ureteric stone disease is a common urological problem throughout the world. Treatment of ureteral stones depends on stone size, composition and degree of obstruction, pain, presence of infection, single kidney and abnormal ureteral anatomy. The aim of the present study is to evaluate and compare in situ ESWL and URS with pneumatic lithotripsy in terms of Stone clearance, duration of procedural time, duration of hospital stay and complications (fever, haematuria, ureteral injury, stone migration, stone clearance, steinstrasse, UTI, ureteral perforation). Methods: A total of 80 patients were included in the study. 42 of them enrolled in ESWL group and 38 in pneumatic lithotripsy group. This is a Prospective Observational study. ICPL were done as day case surgery and ESWL were done as outpatient basis. Results: Intracorporeal pneumatic lithotripsy is better than in situ ESWL for the treatment of small non-impacted upper ureteric stone because it has more stone clearance rate and less complication like fever, haematuria, steinstrasse, UTI, ureteral injury and ureteral perforation. Conclusion: At the end of the study, it can be concluded that for the management of upper ureteric stones ICPL is a better option than in situ ESWL considering its greater stone clearance and less complications.

Whole exome sequencing identifies KIF26B, LIFR and LAMC1 mutations in familial vesicoureteral reflux.

Vesicoureteral reflux (VUR) is a common urological problem in children and its hereditary nature is well recognised. However, despite decades of research, the aetiological factors are poorly understood and the genetic background has been elucidated in only a minority of cases. To explore the molecular aetiology of primary hereditary VUR, we performed whole-exome sequencing in 13 large families with at least three affected cases. A large proportion of our study cohort had congenital renal hypodysplasia in addition to VUR. This high-throughput screening revealed 23 deleterious heterozygous variants in 19 candidate genes associated with VUR or nephrogenesis. Sanger sequencing and segregation analysis in the entire families confirmed the following findings in three genes in three families: frameshift LAMC1 variant and missense variants of KIF26B and LIFR genes. Rare variants were also found in SALL1, ROBO2 and UPK3A. These gene variants were present in individual cases but did not segregate with disease in families. In all, we demonstrate a likely causal gene variant in 23% of the families. Whole-exome sequencing technology in combination with a segregation study of the whole family is a useful tool when it comes to understanding pathogenesis and improving molecular diagnostics of this highly heterogeneous malformation.

Extracorporeal Shock Wave Lithotripsy Success Rate and Prognostic Factors

Background: Urinary tract stones are common urological problems with a considerable burden worldwide. Management strategies mostly rely on the stone’s characteristics and the patient’s clinical conditions. Extracorporeal shock wave lithotripsy (ESWL) is a method of choice for managing small calculus. However, the success rate of ESWL and the prognostic factor of success widely vary among different studies. The aim of the present study was to evaluate these prognostic factors in an Iranian population undergoing ESWL. Methods: The present retrospective study was conducted in Imam Ali Hospital of Bojnurd, Iran. Every patient who was referred for the ESWL of distal urethral calculus (5-20 mm) and failed to respond to medical treatment enrolled in this study. The prevalence and relationship between various individual factors and ESWL outcomes were evaluated among the study patients. Results: Among 49 patients (24 males and 25 females) who had urinary tract stones, the mean (±standard deviation) of age was 42.7 (14.04) years. ESWL could successfully treat urinary tract stones in 43 patients (85%). The kidney stone diameter was not related to having a successful procedure (P=0.447). Moreover, the stroke number and receiving tamsulosin were not significantly associated with favorable ESWL outcomes (P=0.909 and P=0.590, respectively). Twenty-seven patients (45.1%) received pethidine during the procedure. There was a significant relationship between receiving analgesics and favorable ESWL outcomes (P=0.033). Conclusion: The results demonstrated that 85% of the distal urinary tract stones that are smaller than 20 mm can be successfully managed by ESWL, and providing analgesics was significantly related to better outcomes.

Comparison between Lingual Mucosal Graft Urethroplasty and Buccal Mucosal Graft Urethroplasty in The Management of Anterior Urethral Stricture.

Background: Urethral stricture is a chronic and common urological problem in Bangladesh and its management poses a big challenge to urologists. Surgical treatment of urethral stricture diseases is a continuously evolving process, and the superiority of one technique over another has yet to be clearly demonstrated. Urethrotomy is the most commonly used technique but long term results are not satisfactory. Long penile urethral strictures are best treated by substitution urethroplasty. The ideal graft material for substitution urethroplasty is constantly evolving. Buccal mucosa produces excellent result but is associated with many long term donor site complications. Lingual mucosa is an alternative donor site for graft urethroplasty and achieved good functional and aesthetic results. Materials &amp; Methods: A hospital based prospective study was conducted in the department of urology, Dhaka Medical College Hospital from July 2016 to March 2017. Total 40 patients were included in this study. They were divided in two groups, group 1 was treated by lingual mucosal graft and group 2 was treated by buccal mucosal graft. All patients were followed up for six months noting pre and post-operative maximum urine flow rate (Qmax), voiding time and complications at both urethroplasty and donor site. Results: There were no significant differences in overall operative success rate between two groups of patients. But complications at donor site were higher in group 2 patients. Conclusion: Lingual mucosal graft urethroplasty may be preferred to buccal mucosa in anterior urethral stricture as it is easy to harvest and is associated with less short and long term donor site complications without significant difference in operative success rate. KYAMC Journal Vol. 13, No. 02, July 2022: 108-114

The Efficacy of Flexible Ureterorenoscopy Compared with Extracorporeal Shock Wave Lithotripsy for &lt;20 mm Renal Stone: A Systematic Review and Meta-Analysis

ABSTRACT Introduction: Renal stone is a common urological problem that has increased over the years. Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive treatment for patients with &lt;20 mm renal stones, but it also has a lower stone-free rate (SFR) and a higher re-treatment rate (RR) compared to other modalities. On the other hand, flexible ureterorenoscopy (F-URS) can be used to manage larger renal stones and is associated with higher SFR. Thus, we created this study to assess the efficacy and safety of F-URS versus ESWL for patients with &lt;20 mm renal stones. Methods: This systematic review and meta-analysis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and used PICO analysis to systematically search the included studies from several databases, such as PubMed and ScienceDirect. Sixteen relevant studies were included for qualitative and quantitative analysis. Cochrane risk-of-bias tool for randomized trials (RoB) 2.0 was used as bias analysis for RCT studies and the Newcastle-Ottawa Scale for observational studies. Results: A total of 2487 patients were included in this study. The SFR was significantly higher in the F-URS group (P &lt; 0.00001), while the auxiliary procedure was significantly higher in the ESWL group (P &lt; 0.00001). However, neither significant difference was observed in the mean operative time, RR Clavien–Dindo classification, and complication rate-based symptom outcomes in both the groups. Conclusion: F-URS and ESWL are safe and effective in treating &lt;20 mm renal stones. In terms of SFR, F-URS is superior compared to ESWL. However, a lower complication rate was observed in ESWL.

Open Ureteric Exploration in Aminu Kano Teaching Hospital: Indications and Outcome.

Open ureteric exploration is an important procedure in urology employed in the management of ureteric obstruction from various causes. Ureteric obstruction is a common urological problem leading to significant morbidity and may lead to obstructive nephropathy in patient with bilateral obstruction or obstruction in a solitary kidney. The study aims to determine the demographics of patients who underwent open ureteric exploration, indications, and complications associated with open ureteric exploration. This is a retrospective review of all patients who had open ureteric exploration between January 2012 and September 2015. A total of 41 patients had the procedure within this period. Their case notes were retrieved; relevant information was collected with a structured proforma and analyzed with SPSS version 17. In the 41 patients reviewed, the age range was 3 to 70 years with mean age of 33.1 ± 12.14. The commonest age group was 21 - 30years accounting for about 32% (n = 13). Male patients account for 68% (n = 28) while females 32% (n = 13). The indications were ureteric stone 58%, ureteric stricture 23% and external compression 19%. The commonest site of obstruction was the distal ureter 84% (n = 36). Ureterolithotomy was the predominant definitive procedure performed in 58% (n = 24). About 24% (n = 9) of patients developed complications, which includes urinary tract infections (UTI), post-operative intestinal obstruction and surgical site infections. The distal ureter was the commonest site of obstruction while the commonest procedure was ureterolithotomy. Open ureteric exploration is still an important option in the management of ureteric obstruction especially in resource constrain areas.

Descriptive Profile of Urolithiasis Cases in a Tertiary Hospital in Sabah

Urolithiasis is a common urological problem in Malaysia. Stones can be formed by precipitation or crystallization of minerals and urinary constituents. It is a multifactorial, recurrent disease distributed worldwide with a trend of increasing incidence. This study aims to describe the characteristics of patients with urolithiasis in a tertiary centre in Sabah. Patients seen in the urology clinic or inpatient ward in the Department of Urology, Hospital Queen Elizabeth, Sabah, who had urolithiasis confirmed on plain CT KUB were reviewed. Demographic data regarding age, gender, race, address, and BMI were recorded. Details regarding fluid intake and family history of urolithiasis associated with medical conditions like diabetes, hypertension, and gout were collected during the interview with the patient. Routine urine and blood investigations for urolithiasis were performed, and results with CT scan findings were recorded in a data collection sheet. A total of 300 patients with urolithiasis were reviewed. The median age was 54 years, with similar gender distribution. BMI above normal was found in 69% of participants, and 55% had underlying hypertension. The highest incidence was seen in the Kadazan-Dusun population. Those who consume &lt; 2 L/day of fluid also had a higher frequency of urolithiasis. 60.6% of stones were unilateral, whereas 43.7% were found to be renal. There were 39.7% of patients who had CKD stage 2. The mean Hounsfield unit of stones was 1,091. In conclusion, urolithiasis is a common problem worldwide, and it is apparent that its burden on the healthcare system is increasing. These findings will help better understand local clinical characteristics to prevent and reduce morbidity and mortality by urolithiasis.

Evaluation of Awareness about Hematuria among Non-Urologist Doctors

Objective: To evaluate the attitude, general level of knowledge and practices regarding the common urological problems in non urological doctors Methodology: A cross-sectional study was carried out in multiple tertiary care hospitals and private clinics between August 2018 to December 2019. All the general physicians having their private practice or those working in Agha Khan University Hospital, Civil Hospital Karachi, Liaquat National Hospital, Jinnah postgraduate hospital, and Ziauddin Hospital were included in the study. General physicians belonging to the urology department were excluded from the study. Results: Most of the doctors could easily diagnose gross hematuria (55.17%) but microscopic hematuria was missed by many(34.96%). Risk assessment of bladder carcinoma like smoking , any chemical exposure , previous history of hematuria etc was not addressed by the majority of gynecologists (69.03%), physicians(52.54%) as well as internists (32.72%). While most physicians assess gross hematuria by ultrasound, microscopic hematuria is not further investigated by a significant percentage of physicians. During survey it was revealed that most of the physicians use antibiotics as the the mainstay of treatment for hematuria without considering the urine c/s and cytology. Conclusion: A trend of overuse of antibiotics and reluctance of primary care doctors in referring the patient to the specified doctor was seen. It was noted that there is a lack of understanding and knowledge among non urological doctors regarding a common sign. Keywords: awareness, hematuria, general physician, urology

Systematic review and meta-analysis of candidate gene association studies of benign prostate hyperplasia

BackgroundBenign prostate hyperplasia (BPH) is the most common urological problem in elderly males. Recent studies have reported polymorphism in various metabolic genes in BPH. However, their association with the susceptibility of BPH is still inconsistent. Here, we systematically reviewed and performed a meta-analysis of CYP17, VDR, and ACE genes to determine their precise association with the risk of BPH.MethodsA comprehensive literature search for published studies on candidate gene associations involving vitamin D receptor (VDR), angiotensin-converting enzyme (ACE), and CYP17 genes with the risk of BPH was done up to April 2020 in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases. Fixed/random effects models were used to estimate the odd’s ratio (OR) and 95% confidence intervals (CIs). Begg’s funnel plot was used to assess the potential for publication bias.ResultsWe found a total of 23 studies containing 3461 cases and 3833 controls for these gene polymorphisms. A significant association of ACE gene polymorphism was observed under the recessive (II vs. ID + DD) model for BPH susceptibility compared to control subjects (overall OR = 1.67, 95% CI = 1.03–2.73). Similar trends were observed for ACE gene polymorphism in Caucasian (OR = 6.18, 95% CI = 1.38–27.68) and Asian (OR = 1.42, 95% CI = 0.99–2.03) populations under study. No significant association was observed in VDR and CYP17 gene polymorphisms in any dominant or recessive models.ConclusionSignificant OR demonstrated the implication of ACE gene polymorphism in the proliferation of prostate tissue, which in turn is associated with BPH susceptibility. However, prospective studies at large scale and sample size are needed to confirm the current findings.