Urinary Complications Research Articles

URINARY DIVERSION AFTER RADICAL CYSTECTOMY, ORTHOTOPIC NEOBLADDER VS ILEAL CONDUIT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF POSTOPERATIVE COMPLICATION

ABSTRACT
 Objective: The purpose of this study is to compare orthotopic neobladder (ONB) and ileal conduit (IC) formation in terms of surgical outcome and complication. Material & Methods: Computerized bibliographic search on different databases related to this study. The PICO criteria method was applied to define research eligibility, per PRISMA recommendations and conducted a systematic review of the literature with meta-analysis. Weighted mean differences with 95 percent confidence intervals were used to compare continuous outcomes. Results: There were 479 publications were discovered and only 6 studies fulfilled the criteria included. The random-effect model's pooled result for urinary leakage complication revealed a significant difference of 1.62 between ONB and IC with higher incidence in neobladder group (95 percent CI, 1.85, 8.69, P = 0.0004) with non-significant heterogeneity (Chi2 = 0.65, df = 3 (P = 0.89), I2 = 0%). Other complications (ileus complication, anastomosis site stenosis, sepsis, urinary infection) showed non-significant difference. Conclusion: Because of the heterogeneity in several aspects of the analyzed papers, further study comparing Orthotopic Neobladder and Ileal conduit in terms of complication following urinary diversion are needed to confirm superiority of ONB or IC as the urinary diversion of choice.
 Keywords: Orthotopic neobladder, ileal conduit, urinary diversion, radical cystectomy

Long-Term Non-Congenital Cardiac and Renal Complications in Down Syndrome: A Study of 32,936 Patients.

Individuals with Down syndrome are at a higher risk of cardiac, renal, and other health issues due to a complex disease physiology. However, few data exist on long-term disease risks to guide prevention and care. We aimed to determine the 10-year incidence of cardiac, renal, and urinary tract complications in Down syndrome versus matched controls. This retrospective cohort study utilized a large collaborative database. We identified 32,444 patients with Down syndrome and matched controls, excluding those with pre-follow-up target events. Covariates included demographics, lifestyle factors, and comorbidities. Outcomes were ischemic heart disease, hypertension, hypothyroidism, epilepsy, urinary tract infections and chronic kidney disease. We calculated unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox regression and plotted Kaplan-Meier survival curves. Over 10 years, Down syndrome patients showed a 3.7-fold higher ischemic heart disease risk (95% CI: 3.0-4.6) and a 1.6-fold higher hypertension risk (95% CI: 1.4-1.8) versus controls. Hypothyroidism (HR = 2.0; 95% CI: 1.7-2.4), epilepsy (HR = 4.5; 95% CI: 3.5-5.8), and urinary tract infection (HR = 3.9; 95% CI: 3.4-4.6) risks were also higher. Chronic kidney disease risk was 2.7-fold greater (95% CI: 2.1-3.5). Survival analysis confirmed a significantly higher incidence of all outcomes in Down syndrome (p < 0.0001). This large study found major health challenges in Down syndrome, with risks 3- to 5-fold higher for chronic conditions versus matched controls over 10 years. Though survival remains high with proper care, focusing resources on the prevention and management of complications in this high-risk group can optimize well-being across the lifespan. Future research accounting for limitations here would provide definitive estimates of disease risk in Down syndrome to guide targeted health strategies.

Urological procedures performed by gynecologists: Activity profile in a gynecological surgery department, 10-year observation cohort

IntroductionThe proximity of the urinary tract to the female genital tract explains its possible involvement in pelvic gynaecological cancer or deep endometriosis. Surgical treatment is aimed at improving overall survival and recurrence-free survival of patients, as well as restoring normal anatomy and functional integrity depending on the pathology. These operations are accompanied by significant post-operative complications. Thus, the urological procedures performed must be rigorously justified, and the different resection and reconstruction techniques adapted to the pathology and the level of infiltration. ObjectiveTo describe the activity profile, over the last ten years, of a gynaecological surgery department in terms of urological procedures in the management of patients with deep endometriosis and pelvic carcinology. Study designThis is a monocentric retrospective observational study, including all patients who underwent a urological procedure by a gynaecological surgeon only, as part of the management of pelvic gynaecological cancers or deep endometriosis, at the University Hospital Centre (CHU) of Strasbourg, between January 1st 2010 and April 31st 2021. The variables studied were early postoperative complications, the rate of surgical reintervention, operating time, length of hospital stay, the need for peri-operative drainage or transfusion, and post-operative functional disorders. ResultsA total of 86 patients were included, 27 in the pelvic gynaecological cancer group and 59 in the deep endometriosis group. 61.6% of patients received uretero-vesical catheterization, 60.5% partial cystectomy, 10.5% psoic bladder ureteral reimplantation, and 3.5% trans-ileal Bricker skin ureterostomy. The mean operating time was 316 min in the pelvic gynaecological cancer group and 198.9 min in the deep endometriosis group. The average hospital stay was 11.5 days, 22.3 days for patients treated for pelvic cancer and 6.3 days for those treated for endometriosis. The rate of minor post-operative complications was 8.2% of cases, and major post-operative complications 17.4% of cases, the majority of which were in the gynecological cancer group. There were no cases of intra- or early post-operative death. Early postoperative urinary complications affected 14.0% of the total patients, mostly in the gynaecological cancer group with 33.3% of patients, but only 5.1% of patients in the deep endometriosis group. The total reoperation rate within 60 days postoperatively was 15.1%, 40.7% for patients treated for gynaecological cancer and 3.4% for those treated for deep pelvic endometriosis. The rate of reoperations for urinary complications was 11.6% of total patients, or 76.9% of total reoperations. 15 patients received labile blood products intra- or postoperatively, 11 in the pelvic gynaecological cancer group and 4 in the endometriosis group. ConclusionOur overall results appear comparable to those reported in the literature and are particularly satisfactory in terms of post-operative complications after partial cystectomy in the management of deep endometriosis compared to other gynaecological departments. This work encourages us to continue and improve the training of gynaecological surgeons in terms of multidisciplinary surgical procedures, including urological ones, to obtain a global vision of the pathology and to allow an optimal quality of care for the patients.

Health Challenges Encountered by Spouses of the Selected Defense and Security Wing Personnel Experiencing Intimate Partner Violence (IPV) in Lusaka, Zambia: An Interpretive Phenomenological Study

Background: Intimate partner violence (IPV) is a complex and emotionally charged subject that is usually considered a private matter. Apparently, both sexes can perpetrate or be victims of IPV. Globally, more women are murdered by their intimate partners compared to men. IPV is also a widespread phenomenon in Africa where the associated health challenges can be particularly serious due to fragile healthcare systems. On the global ratings, IPV remains the oldest prominent societal challenge in the sub-Saharan region, South Asia, and Latin America. Noticeably, IPV is more prevalent among military than civilian populations. The effects of IPV include physical injuries, sexually transmitted infections, pelvic inflammatory diseases, urinary tract infections, unwanted pregnancies, pregnancy complications and mental health problems. Nevertheless, there is very little understanding of the health challenges encountered by spouses of military personnel in the Zambia National Service (ZNS).

Spinal Cord Stimulators and Intrathecal Pain Pump Removal Versus Retention During Posterior Lumbar Fusion: A Matched Cohort Analysis.

Retrospective cohort study. To determine risks associated with posterior lumbar arthrodesis after spinal cord stimulator (SCS) and intrathecal pain pump (IPP) insertion. SCS and IPPs aid in the management of chronic back and radicular pain. Little is known regarding the risks of subsequent fusion with these devices in place. The PearlDiver Mariner database was queried for spinal fusion between 2010 and 2020. Study groups were created for indwelling SCS or IPP and matched to a separate cohort without SCS or IPP. Subgroups were created for those who had their device removed and those who retained their device at the time of surgery. Complications up to 2 years postoperatively were reviewed and confounding variables were controlled using multivariable logistic regression. Four thousand five hundred three patients had an indwelling SCS/IPP and underwent posterior lumbar fusion. Compared with patients without history of an SCS/IPP, patients undergoing a lumbar fusion with an SCS/IPP which was removed or retained had higher rates of revision surgery at 1 year [7.3% vs. 5.0%, odds ratio (OR) =1.48, P <0.001] and 2 year (10.8% vs. 7.0%, OR =1.59, P <0.001). For all time intervals, there were higher odds of instrumentation failure (2y: OR =1.65, P <0.001), and pulmonary complications (2y: OR =1.18, P <0.001). At 2 years, there were higher odds of surgical site complications (OR 1.15, P =0.02) and urinary complications (OR=1.07, P =0.04). There were no differences in complications up to 2 years postoperatively in patients with an SCS/IPP who had their devices retained or removed ( P >0.05). Patients with a history of spinal cord stimulators and intrathecal pain pumps are at increased risk of mechanical complications and revision fusion compared with patients without these devices. Patients with an SCS or IPP have similar rates of complications during lumbar fusion whether the device is removed or retained.

Symptomatic Benign Prostatic Hyperplasia Is Not Associated With a Higher Risk of Periprosthetic Joint Infections and Periprosthetic Joint Infection-related Revisions After Primary THA.

Symptomatic benign prostatic hyperplasia (sBPH) is a potential risk factor for periprosthetic joint infection (PJI), a leading cause of implant failure and revision THA. However, the available evidence is mixed on whether this is the case. (1) What is the prevalence of sBPH in male recipients of primary THA by age group? (2) Do patients with sBPH compared with those without sBPH have higher 30-day, 90-day, and 2-year odds of PJI and higher 30-day and 90-day odds of urinary catheterization, urinary tract infection (UTI), and sepsis after primary THA? (3) Do patients with sBPH compared with those without sBPH have lower survivorship free from PJI-related revision at 5 years after THA? The PearlDiver database was used as it provided the largest sample of patients across all payer types to perform longitudinal research. Between January 2010 and April 2021, 1,056,119 patients who underwent primary THA were identified. After applying the inclusion criteria (that is, male sex, minimum age of 18, and diagnosis of hip osteoarthritis) and exclusion criteria (that is, history of asymptomatic BPH or any other joint arthroplasty), 16% (172,866) of patients remained. A further 6% (59,500) of patients were excluded as they did not meet the minimum study follow-up of 2 years, leaving 11% (113,366) for analysis. Of those, patients with sBPH were matched to those without in a 1:4 ratio by age and comorbidities, including alcohol abuse, anemia, cardiovascular disorders, chronic pulmonary disease, diabetes mellitus, depression, obesity, peripheral vascular disorders, renal failure, and rheumatoid arthritis. Age and comorbidities of the two groups postmatch were balanced. Logistic regression was performed to analyze the odds for 30-day, 90-day, and 2-year postoperative complications. Survivorship free from PJI-related revision at 5 years after THA was estimated using the Kaplan-Meier method and compared with the log-rank test. Among male recipients of primary THA ages 65 or older, 24% (11,319 of 47,426) had a medical history of sBPH. We found no difference in the odds of PJI at 30 days, 90 days, and 2 years after primary THA between the two groups. PJI occurred in 0.5% (62 of 11,819), 0.8% (97 of 11,819), and 1.3% (150 of 11,819) of patients with sBPH versus in 0.5% (227 of 47,103), 0.8% (360 of 47,103), and 1.2% (570 of 47,103) of those without sBPH within 30 days (OR 1.09 [95% CI 0.82 to 1.43]), 90 days (OR 1.07 [95% CI 0.85 to 1.34]), and 2 years (OR 1.05 [95% CI 0.87 to 1.25]) after THA, respectively. Patients with sBPH compared with those without had higher odds of 30-day and 90-day urinary catheterization (OR 5.00 [95% CI 3.64 to 6.88] and OR 5.36 [95% CI 4.04 to 7.13], respectively), 30-day and 90-day UTI (OR 2.18 [95% CI 1.88 to 2.54] and OR 2.55 [95% CI 2.26 to 2.87], respectively), and 30-day and 90-day sepsis (OR 1.55 [95% CI 1.11 to 2.13] and OR 1.43 [95% CI 1.10 to 1.83], respectively). We found no difference in survival free from PJI-related revision at 5 years after THA between patients with and without sBPH (98.3% [95% CI 98.1% to 98.6%] versus 98.1% [95% CI 98.1% to 98.2%]; p = 0.10). sBPH is common among THA recipients, and surgeons should be aware of the added risk of postoperative urinary complications and sepsis in this subset that could lead to additional postoperative care requirements. Surgeons may consider perioperative measures such as preoperative use of short-form questionnaires to assess urinary symptoms, urology clearance or referral, and closer follow-up to improve care of sBPH patients undergoing THA. As currently available tools for assessing sBPH are limited and lack sensitivity as well as specificity, future studies may develop validated tools that can be used to quickly assess risk in sBPH patients before surgery. Level III, therapeutic study.

Analysis of outcome of prostatic UroLift placement in benign prostatic hyperplasia in a district hospital

Aims and Objective: To analyse the outcome of prostatic UroLift (PUL) placement done at our hospital for the treatment of benign prostatic hyperplasia (BPH). Materials and Methods: Demographic and perioperative data were collected for all patients who underwent PUL placement for BPH at out hospital from December 2017 to January 2020. International prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Q-max), complications and requirement of auxiliary procedures were noted till date. Mann–Whitney U test was used to compare the pre- and post-operative parameters. Results: A total of 45 patients underwent PUL placement and were followed up for a median period of 26 months (range 14–37 months). The median age of the patients and prostate volume were 76 years (range 54–90 years) and 50 mL (range 30–70 mL), respectively. Five patients had median lobe. An average of 3.2 ± 1.1 clips were placed. The mean IPSS, QoL and Q-max in the pre-operative and latest follow-up period were 19.3 ± 5.9 and 11.1 ± 5.6 ( p &lt; 0.001), 4.3 ± 1.1 and 2.5 ± 1.4 ( p &lt; 0.001), 9.8 ± 5.0 mL/s and 12.8 ± 6.2 mL/s ( p = 0.004), respectively. Complications were dysuria (one patient, 2.2%), urinary tract infection (one patient, 2.2%), haematuria (one patient, 2.2%), transient urinary retention (two patients, 4.4%), post-void dribbling (two patients, 4.4%), bladder stone (one patient, 2.2%) and clip migration (one patient 2.2%). Six patients (13.3%) required auxiliary treatment in follow-up. Conclusion: PUL placement improved the IPSS, QoL and Q-max significantly over a median follow-up of 26 months with retreatment rate of 13.3%. It is a safe procedure with few easily manageable complications. Level of evidence: Not applicable

P-338 Preliminary results of the DINE Study (Dienogest vs. Norethindrone Acetate in Endometriosis Treatment)

Abstract Study question How do the two-progestin type NETA and dienogest affect on pain and recurrence in patients with endometriosis? Summary answer NETA and dienogest are progestin derivatives that have similar effects on pain and recurrence in treating endometriosis and canbe safely preferred for treatment. What is known already Although surgical treatment significantly improves pain symptoms in endometriosis, it may be associated with significant urinary, intestinal and vascular complications; In addition, postoperative pain and recurrence rates of endometriotic lesions are high. Medical treatment gains importance, and progestins are mainly used in treatment. NETA is one of the most researched progestins for the treatment. It has a good safety profile and efficacy in curing endometriosis-related pain, making NETA a viable medical option among first-line treatments. Study design, size, duration The study was designed as a single-center, prospective, randomized study. Patients were randomly assigned to one of the two treatment protocols, with the single digit 'NETA' and double 'dienogest' according to the last digit of their protocol number. Patient recruitment started in February 2022. The patients were evaluated at 6-month visits for one year. Participants/materials, setting, methods Seventy patients aged 18-40 years were included. Patients with contraindicated progestins and pelvic inflammatory disease were excluded from the study. Demographic data, medical and surgical treatment histories were recorded. Patients were evaluated with detailed physical examination, ultrasound, and laboratory tests. They were questioned because of their chronic pain symptoms, they were asked to give a score between 1 and 10 with the numerical scoring system and recorded. They were re-evaluated at 6 and 12 months. Main results and the role of chance 40 dienogest and 30 NETA patients were included in the study. There were eight patients (one headache, one orthostatic hypotension, five metrorrhagia, one pregnancy request) in the NETA group and 11 patients (1 headache, one decreased sexual desire, one surgery, eight metrorrhagia) in the dienogest group. In the final analysis, 48 patients were included in the study. There was no significant difference between the two groups regarding initial laboratory, ultrasonographic and demographic parameters. (p &amp;gt; 0.5) There was no significant difference between the two groups in dropout rates at six months. (p = 0.65) Dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain scores were similar both at the beginning of treatment and at the 6th-month follow-up, and no significant difference was observed in both group. (p &amp;gt; 0.5) Significant improvement was observed in all scores in both groups.(p &amp;lt; 0.001) In the 6th month, the most common side effects in the dienogest group were emotional lability (26%), and metrorrhagia (15%), while the NETA group were metrorrhagia (40%) and weight gain (20%). No significant effect was observed on the lipid profile and bone mineral density at the 6th-month control. Limitations, reasons for caution Our study is the first study in the literature to compare NETA and dienogest in the medical treatment of endometriosis. The strongest aspect is that it is a randomized control study. The small number of study population and the high dropout rates are the limitations. Wider implications of the findings NETA and dienogest are two progestin derivatives that are effective on pain and recurrence in the medical treatment of endometriosis and can be safely preferred for treatment. An analysis of our long-term data and further studies are needed to evaluate which progestin preparation is more effective and safe in treatment. Trial registration number NCT05476172

The Burden of Comorbidities in Obstructive Sleep Apnea and the Pathophysiologic Mechanisms and Effects of CPAP

Micro-arousals and the repeated desaturation of oxyhemoglobin, which are typical in obstructive sleep apnea syndrome (OSAS), have adverse effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction), cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), and neuropsychiatric complications as well as a wide range of malignancies. These, in turn, have multilateral effects on familial, occupational, and social life, as well as increasing the risks of road traffic accidents and accidents at the workplace. Awareness, timely screening, and the prevention of complications play important roles in diagnosing and treating comorbid conditions. This review focuses on comorbidities in OSAS and the effect of Continuous Positive Airway Pressure (CPAP) therapy on their prognoses.

Outcomes of Kidney Transplantation in Patients That Underwent Bariatric Surgery: A Systematic Review and Meta-analysis.

The impact of bariatric surgery (BS) on kidney transplantation (KT) outcomes in patients with obesity remains controversial. We systematically searched MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials for studies reporting outcomes of KT recipients that underwent prior BS. Common/random effects meta-analyses were performed to obtain summary ratios of the postoperative outcomes. Eighteen eligible studies involving 315 patients were identified. Sleeve gastrectomy was the most common BS type (65.7%) followed by Roux-en-Y gastric bypass (27.6%) and gastric banding (4.4%). Across studies that provided the data, the %excess weight loss from BS to KT was 62.79% (95% confidence interval [CI], 52.01-73.56; range, 46.2%-80.3%). The rates of delayed graft function and acute rejection were 16% (95% CI, 7%-28%) and 16% (95% CI, 11%-23%) in 14 and 11 studies that provided this data, respectively. The rates of wound, urinary, and vascular complications following KT were 5% (95% CI, 0%-13%),19% (95% CI, 2%-42%), and 2% (95% CI, 0%-5%), in 12, 9, and 11 studies that provided this data, respectively. Follow-up time after KT was reported in 11 studies (61.1%) and ranged from 16 mo to >5 y. Graft loss was reported in 14 studies with an average of 3% (95% CI, 1%-6%). Four studies that included a comparator group of patients with obesity who did not undergo BS before KT showed comparable outcomes between the groups. We conclude that currently there is a paucity of robust evidence to suggest that pretransplant BS has a major effect on post-KT outcomes. High-quality studies are needed to fully evaluate the impact of BS on KT outcomes.

Time-related Complications in Patients with Traumatic Spinal Cord Injury according to the AIS Impairment Scale Grade: A Retrospective Review

Purpose: The aim of this study was to analyze time-dependent complications in patients with traumatic spinal cord injury (SCI) as a function of their initial neurological status determined by the ASIA Impairment Scale (AIS) grade.Methods: Consecutive patients with SCI who visited the emergency department at Asan Medical Center from 2005 to 2019 were included, and their electronic medical records were analyzed according to four time periods from initial visit to hospital discharge. Time-dependent SCI-related complications, including medical, urinary, musculoskeletal, and neurological complications and pain, were analyzed as well as the association between SCI complications and AIS grade. In-hospital recovery from neurological damage and long-term outcomes were also evaluated.Results: Of the 632 SCI patients who visited the emergency department during the study period, 110 patients were included in the study. The complication rates in patients initially assessed as AIS grades A, B, C, D, and E were 53.6%, 16.4%, 14.6%, 13.6%, and 1.8%, respectively. The most common complications after SCI were UTIs (n=37; 33.6%), pressure ulcers (n=36; 32.7%), neuropathic pain (n=34; 30.9%), and pneumonia (n=33; 30.0%). Patients with a poor neurological status (AIS grade A) had more medical complications and lower neurological resilience than did those with better neurological status (AIS grades B-E).Conclusion: Post-SCI complications differed by time after SCI and neurological status. Nurses should be aware that complications can occur at any time in patients with traumatic SCI. Patients with poorer AIS grades should be particularly closely observed and receive preventive care for complications.

Impact of Two Urethral Stent Types on Complications after One-Stage Hypospadias Repair Using the Duckett Procedure.

The authors evaluated whether the new nickel-titanium alloy stent (NTAS) is superior to the traditional silicone stent used in hypospadias repair surgery in preventing complications such as urinary fistula. This retrospective cohort study included 576 patients with hypospadias who underwent NTAS or traditional silicone stent placement after hypospadias surgery between March of 2002 and August of 2019. The primary outcome was the rate of urinary fistula occurrence at 4 weeks (stent removal time), and the secondary outcomes were the rate of other complications, such as urethral stricture, urethral diverticulum, infection, and so on. The occurrence of complications in both groups was compared, and the important contributing factors of urinary fistula and urethral stricture were determined. Among 576 patients, 398 were assigned to the NTAS group, and 178 were assigned to the silicone group. Thirty-five patients in the NTAS group and 30 in the silicone group developed urinary fistula, with a rate of 8.8% and 16.9%, respectively ( P = 0.005). Subgroup analysis showed that the differences were mainly in preschool patients (6 years or younger) ( P = 0.004) and those with the penile type of hypospadias ( P = 0.008). In addition, urethral stricture complicated five patients in the NTAS group and two in the silicone group, with a rate of 1.3% and 1.1%, respectively ( P = 1.000). Logistic regression showed that hypospadias type ( P = 0.001) and stent type ( P = 0.001) are the important risk factors for urethral fistula. The NTAS reduced the occurrence of urinary fistula complications after hypospadias repair in preschool patients, and can be presented as a better choice for hypospadias surgery. Therapeutic, III.

Risk of multiple lower and upper urinary tract problems among male older adults with type-2 diabetes: a population-based study

Aim This study explores the risk of diabetes-associated lower and upper urinary tract diseases among male older adults aged 45 and above in India. Methods Longitudinal Ageing Study in India (LASI), 2017–2018 data was used in this study. The prevalence of various urinary tract problems and diabetes among male older adults was estimated by background characteristics using bivariate cross-tabulation. In addition, multivariate logistic regression was applied to examine the likelihood of urological disorders associated with diabetes. Result The prevalence of incontinence was highest among male older adults with diabetes, followed by kidney stones, benign prostatic hyperplasia, and chronic renal failure. Multivariate logistic regression estimation showed that men diagnosed with diabetes were 80% more likely to experience chronic renal failure, 78% more likely to suffer from incontinence, and 37% more likely to suffer from kidney stones than those without diabetes when controlling for various socio-demographic, behavioral, and co-morbidity status of the older adults. Conclusions The study findings suggest that diabetes is associated with multiple urinary complications among male older adults in India and needs more careful investigation of the phenomenon. Independent risk factors such as changes in lifestyle with regular monitoring and diagnosis may help to prevent the progression of diabetes and reduce the risk of diabetes-associated lower and upper urinary tract diseases among male older adults.

Preservation of left colic artery in laparoscopic colorectal operation: The benefit challenge

During laparoscopic resection for colorectal cancer, there is controversy regarding whether the left colic artery (LCA) should be preserved at its origin.To investigate the prognostic significance of preservation of the LCA in colorectal cancer surgery.Patients were divided into two groups. The high ligation (H-L) technique (refers to ligation performed 1 cm from the beginning of the inferior mesenteric artery) group consisted of 46 patients, and the low ligation (L-L) technique (refers to ligation performed below the initiation of the LCA) group consisted of 148 patients. Operative time, blood loss, lymph nodes with tumor invasion, postoperative complications and recovery time, recurrence rate, and 5-year survival rate were compared between the two groups.The average number of lymph nodes detected in postoperative pathological specimens was 17.4/person in the H-L group and 15.9/person in the L-L group. There were 20 patients (43%) with positive lymph nodes (lymph node metastasis) in the H-L group and 60 patients (41%) in the L-L group. No statistical differences were found between the groups. Complications occurred in 12 cases (26%) in the H-L group and in 26 cases (18%) in the L-L group. The incidences of postoperative anastomotic complications and functional urinary complications were significantly lower in the L-L group. The 5-year survival rates in H-L and L-L groups were 81.7% and 81.6%, respectively, and relapse-free survival rates were 74.3% and 77.1%, respectively. The two groups were similar statistically.Complete mesenteric resection combined with lymph node dissection around the inferior mesenteric artery root while preserving the LCA is a beneficial surgical approach during laparoscopic resection for colorectal cancer.

Rectosigmoid resection morbidity in ovarian cancer cytoreductive surgery.

This case series evaluated morbidity following rectosigmoid resection during cytoreductive surgery for advanced ovarian cancer at the Shaukat Khanum Memorial Cancer Hospital, Lahore. The data of 20 female patients with complications corresponding to the Clavien-Dindo classification was included; the patients received treatment between January 2016 and January 2021. The mean age was 45.05± 13.11 years. Complications were observed in 3 (15.0%) cases, i.e., urinary complications in 2 (66.7%), and intra-abdominal abscess in 1 (33.3%) case. Clavien-Dindo classification grade II was noted in 2 (66.7%), while grade III-B in 1 (33.3%) case. Surgical risk factors were noted as appendectomy in 6 (66.7%) cases, bowel resection in 1 (11.1%), left colectomy in 1 (11.1%), sigmoid colectomy in 1 (11.1%), and stoma formation in 11 (55.0%) cases. In this reported case series, significant complications were observed in women undergoing rectosigmoid resection as cytoreductive surgery for advanced ovarian cancer.

Symptomatic Benign Prostatic Hyperplasia: An Optimizable Risk Factor for Periprosthetic Joint Infection After Elective Primary Total Knee Arthroplasty

BackgroundWhether symptomatic benign prostatic hyperplasia (sBPH), which is common among middle-aged and older men, affects the risk of periprosthetic joint infection (PJI) remains controversial. The present study explored this question among men undergoing total knee arthroplasty and total hip arthroplasty (TKA and THA). MethodsWe retrospectively analyzed medical data from 948 men who underwent primary TKA or THA at our institution between 2010 and 2021. We compared the incidence of postoperative complications such as PJI, urinary tract infection (UTI), and postoperative urinary retention (POUR) between 316 patients (193 hips and 123 knees) who did and 632 patients who did not have sBPH; the 2 groups of patients were matched to each other in a 1:2 ratio based on numerous clinical demographic variables. In the subgroup analyses, we stratified sBPH patients according to whether they began anti-sBPH medical therapy prior to arthroplasty. ResultsPJI following primary TKA was significantly more common among sBPH patients than among patients who did not have sBPH (4.1 vs 0.4%; P = .029), as were UTI (P = .029), and POUR (P < .001). Patients who had sBPH also had an increased incidence of UTI (P = .006) and POUR (P < .001) following THA. Among sBPH patients, those who started anti-sBPH medical therapy before TKA suffered significantly lower incidence of PJI than those who did not. ConclusionSymptomatic benign prostatic hyperplasia is a risk factor for PJI after primary TKA among men, and starting appropriate medical therapy before surgery can reduce the risk of PJI following TKA and postoperative urinary complications following TKA and THA.

Schistosoma haematobium urinary tract complications in African migrants attending primary care facilities in Paris, France: A retrospective cohort study (2004–2018)

ObjectivesLittle is known about the burden of urogenital schistosomiasis (UGS) outside endemic areas. This study was aimed at describing urinary complications of UGS detected among African migrants in French primary care facilities. Patients and methodsA retrospective cohort study included patients with UGS diagnosed from 2004 to 2018 in 5 primary health centers in Paris. Cases were defined by the presence of typical Schistosoma haematobium eggs at urine microscopy. Demographic, clinical, biological and imaging data were collected. Ultrasonography (U-S) findings were classified in accordance with the WHO guidelines. ResultsU-S was prescribed for all patients and performed in 100/118. Sex ratio (F/M) was 2/98, and mean age 24.4 years. Patients were from West Africa (73% from Mali) and consulted 8 months (median) after their arrival. Among the 95 patients with interpretable findings, 32 (33.7%) had abnormalities related to UGS, considered as major in 6 cases (6.3%), and mostly localized at the bladder (31/32) without detection of cancer. No sociodemographic, clinical, or biological factors were found to be associated with U-S abnormalities. All 100 patients were treated by praziquantel (PZQ). Among those with abnormalities, 20/32 received two to four doses at various time intervals. Post-cure imaging control performed in 19/32 showed persistent abnormalities in 6 patients, on average 5 months after the last PZQ uptake. ConclusionUrinary tract abnormalities associated with UGS were common and predominated at the bladder. U-S should be prescribed to any patient with positive urine microscopy. Schedules for PZQ uptake and U-S monitoring for patients with complications remain to be determined.

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy.

Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications-i.e., urethrocutaneous fistulae and urinary stricture-are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15-70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment.

Kindler syndrome: a rare case report from Syria.

Kindler syndrome is a rare autosomal recessive inherited disease. The authors report a case with unique presentation that has never reported before in the medical Literatur" lanugo hair". This is a case of a 13-year-old Syrian child, who presented with difuse fine face hair, and serious urinary complications. Kindler syndrome is characterized by acral skin blistering beginning at birth, diffuse cutaneous atrophy, photosensitivity, poikiloderma, and various mucosal findings. Highlighting a set of clinical diagnostic criteria; which is used only if a genetic test is not available.

Use of prophylactic ureteral stents in gynecologic surgery.

The aim of this study was to evaluate rate of complications with the use of prophylactic ureteral localization stents (PULSe) in gynecologic surgery. To compare the occurrence of complications according to the indication of surgery. This retrospective study included 1248 women who underwent 1275 different gynecologic surgeries with PULSe between 2007 and 2020. Data was collected regarding patient characteristics (age, sex, race, ethnicity, parity, previous pelvic surgery, creatinine), operative characteristics (trainee, guidewire use, indication) and complications in the first 30 days (ureteral injury, urinary tract complication, re-stenting, hydronephrosis, urinary tract infection (UTI), pyelonephritis, emergency room visit, re-admission). Median age was 57 years (range: 18-96 years), most women were Caucasian (88.9%), and had previous pelvic surgery (77.7%). Indication of surgery was benign for 459 (36.0%), female pelvic medicine and reconstructive surgery (FPMRS) for 545 (42.7%), and gynecologic oncology (gyn-onc) for 271 (21.3%). Disabling complications occurred rarely with 8 patients (0.6%) having a ≥III Clavien Dindo Grade (CDG), and only 1 (0.08%) ≥IV CDG. Statistically significant differences between benign, FPMRS, and gyn-onc groups were noted for re-stenting (0.9% vs. 0.0% vs. 1.1%, P=0.020), hydronephrosis (0.9% vs. 0.2% vs. 2.2%, P=0.014), UTI (4.6% vs. 9.4% vs. 7.0%, P=0.016), and re-admission (2.4% vs. 1.1% vs. 4.4%, P=0.014). The incidence of 30-day CDG III and IV complications after PULSe placement is low. FPMRS patients had a higher rate of complicated UTI, however gyn- onc patients appear to be at overall higher risk of stent related complications when compared to surgeries for FPMRS or benign indications.