The STING in the tale of Teflon®: Delayed ureteric obstruction after subureteric transurethral injection with polytetrafluoroethylene paste for vesicoureteral reflux.

INTRODUCTION: "Subureteric Teflon INGection" (STING) of polytetrafluoroethylene (PTFE/polytef) paste to treat vesicoureteral reflux (VUR) in children was popularised in 1984. It was later abandoned as an implantation material because of the possibility of migration from the injection site. Giant-cell foreign-body granuloma to Polytef in the bladder is a rare cause of ureteric obstruction. Only a handful of cases have been reported in the literature. METHODS: We performed a prospective analysis of a series of 6 adult patients who had childhood STING and presented with foreign-body granuloma to Polytef in the bladder. We report their clinical presentation, findings and treatment. RESULTS: 1 male and 5 females with a history of STING procedure in childhood for VUR presented in later life with foreign-body granuloma to Polytef. The median age at first STING procedure and at presentation to the Urology Department was 3 and 34 years respectively. The most common clinical presentations were flank pain and urinary tract infection (UTI) and all patients had radiological findings of calcified lesions at the vesicoureteric junction(s). 4 patients had histological findings of giant-cell foreign-body granuloma. 4 patients required definitive ureteric reimplantation. CONCLUSION: Polytef granuloma causing distal ureteric obstruction may give rise to significant morbidity and renal damage. Due to the likelihood of progression of the granuloma, excision and ureteric reimplantation is considered the standard approach in the management of patients with viable kidneys. LEVEL OF EVIDENCE: Level 5.

Systematic review of the ophthalmic complications of robotic-assisted laparoscopic prostatectomy.

This study aims to review ophthalmic injuries sustained during of robotic-assisted laparoscopic prostatectomy (RALP). A search of Medline, Embase, Cochrane and grey literature was performed using methods registered a priori. Eligible studies were published 01/01/2010-01/05/2023 in English and reported ophthalmic complications in cohorts of > 100 men undergoing RALP. The primary outcome was injury incidence. Secondary outcomes were type and permanency of ophthalmic complications, treatments, risk factors and preventative measures. Nine eligible studies were identified, representing 100,872 men. Six studies reported rates of corneal abrasion and were adequately homogenous for meta-analysis, with a weighted pooled rate of 5 injuries per 1000 procedures (95% confidence interval 3-7). Three studies each reported different outcomes of xerophthalmia, retinal vascular occlusion, and ophthalmic complications unspecified in 8, 5 and 2 men per 1000 procedures respectively. Amongst identified studies, there were no reports of permanent ophthalmic complications. Injury management was poorly reported. No significant risk factors were reported, while one study found African-American ethnicity protective against corneal abrasion (0.4 vs. 3.9 per 1000). Variables proposed (but not proven) to increase risk for corneal abrasion included steep Trendelenburg position, high pneumoperitoneum pressure, prolonged operative time and surgical inexperience. Compared with standard of care, occlusive eyelid dressings (23 vs. 0 per 1000) and foam goggles (20 vs. 1.3 per 1000) were found to reduce rates of corneal abrasion. RALP carries low rates of ophthalmic injury. Urologists should counsel the patient regarding this potential complication and pro-actively implement preventative strategies.

Treatment of urge incontinence in postmenopausal women: A systematic review.

BACKGROUND: Urinary incontinence and other urinary symptoms tend to be frequent at menopause because of hormonal modifications and aging. Urinary symptoms are associated with the genitourinary syndrome of menopause which is characterized by physical changes of the vulva, vagina and lower urinary tract. The treatment strategies for postmenopausal urinary incontinence are various and may include estrogens, anticholinergics, and pelvic floor muscle training. A comparison of these treatments is difficult due to the heterogeneity of adopted protocols. We systematically reviewed the evidence from randomized controlled trials (RCTs) focusing on treatment of postmenopausal women with urge incontinence. METHODS: We conducted a systematic review and meta-analysis by searching PubMed and EMBASE databases for randomized controlled trials (RCTs) reporting results of treatments for postmenopausal urinary urge incontinence. Odds ratios for improvement of urinary incontinence were calculated using random effect Mantel-Haenszel statistics. RESULTS: Out of 248 records retrieved, 35 eligible RCTs were assessed for risk of bias and included in the meta-analysis. Compared with placebo, systemic estrogens were associated with decreased odds of improving urinary incontinence in postmenopausal women (OR = 0.74, 95% CI: 0.61-0.91, 7 series, 17132 participants, Z = 2.89, P = 0.004, I2 = 72%). In most studies, no significant improvement in urinary symptoms was observed in patients treated with local estrogens, although they showed to be helpful in improving vaginal symptoms. Vitamin D, phytoestrogens and estrogen modulators were not effective in improving symptoms of incontinence and other symptoms of genitourinary menopause syndrome or yielded contradictory results. A randomized controlled trial demonstrated that oxybutynin was significantly better than placebo at improving postmenopausal urgency and urge incontinence. The combination of anticholinergics with local estrogens has not been shown to be more effective than anticholinergics alone in improving urinary incontinence symptoms in postmenopausal women. Physical therapy showed an overall positive outcome on postmenopausal urinary incontinence symptoms, although such evidence should be further validated in the frame of quality RCTs. CONCLUSIONS: The evidence for effective treatment of postmenopausal urinary incontinence is still lacking. Welldesigned large studies having subjective and objective improvement primary endpoints in postmenopausal urinary incontinence are needed. At present, a combination of different treatments tailored to the characteristics of the individual patient can be suggested.

Massive inguinal herniation of the bladder with bilateral hydronephrosis, complicated by psychosis.

Massive inguinal herniation of the bladder is rare. This case was made more dramatic by the late presentation and simultaneous psychiatric condition. A man in his 70s was found in his burning house and admitted for smoke inhalation. Initially refusing examination or investigation, on the third day, he was found to have massive inguinal bladder herniation, bilateral hydronephrosis and acute renal failure. After urethral catheterisation, bilateral ureteric stent insertion and resolution of postobstructive diuresis, the patient underwent open right inguinal hernia repair and return of the bladder to its orthotopic position. He also diagnosed with schizotypal personality disorder with psychosis, malnutrition, iron deficiency anaemia, heart failure and chronic lower limb ulcers. Four months later and after multiple failed trial of voids, the patient underwent transurethral resection of prostate with successful resumption of spontaneous voiding.

The decline in transurethral resection of the prostate gland in Irish public hospitals between 2005 and 2021.

BACKGROUND: Lower urinary tract symptoms due to an enlarged prostate is a common condition. Transurethral resection of the prostate gland (TURP) has been the gold standard treatment. The objective of this study was to assess the trends in the prevalence of TURP procedures in Irish public hospitals within the period of 2005-2021. In addition, we explore the attitudes and practices of urologist in Ireland on this topic. METHODS: An analysis using the Hospital In-Patient Enquiry (HIPE) system using code 37203-00 was undertaken. 16,176 discharges contained the code of interest and had undergone a TURP procedure. The data from this cohort was further analysed. In addition, members of the Irish Society of Urology undertook a bespoke questionnaire to understand the TURP surgery practices. RESULTS: There has been a substantial decline in the prevalence of TURP procedures in Irish public hospitals from 2005 to 2021. The number of patients discharged from Irish hospitals with a TURP procedure was 66% less in 2021 compared to 2005. 75% (n = 36) of urologist surveyed felt that the declining TURP numbers were due to lack of resources, access to theatre/inpatient beds and outsourcing. 91.5% (n = 43) felt that the declining TURP numbers would result in a lack of training opportunities for trainees, 83% (39) felt this has increased morbidity for patients. CONCLUSIONS: TURP procedures in Irish public hospitals has declined over the 16-year period studied. This decline is a concern for patient morbidity and urology training.

Risk of urogenital infections in non-diabetic patients treated with sodium glucose transporter 2 (SGLT2) inhibitors. Systematic review and meta-analysis.

Although SGLT2 inhibitors have been initially employed in the treatment of type 2 diabetes, their clinical use was later extended to the treatment of other conditions such as heart failure, chronic kidney disease and obesity. In patients with type 2 diabetes, the administration of SGLT2 inhibitors has been associated with an increased incidence of urogenital infections, which may be linked to high glucose levels in the urine. The rate of urogenital side effects may be different in non-diabetic patients. The aim of this study was to review the risk of urogenital infections in non-diabetic patients taking SGLT2 inhibitors. MATERIALS AND METHODS: We conducted a systematic review and meta-analysis by searching PubMed and EMBASE for randomized controlled trials (RCTs) reporting urogenital adverse effects in non-diabetic patients treated with SGLT2 inhibitors. Odds ratios for urogenital infections were calculated using random effect Mantel-Haenszel statistics. RESULTS: Out of 387 citations retrieved, 12 eligible RCTs were assessed for risk of bias and included in the meta-analysis. Compared to placebo, SGLT2 inhibitors were associated with increased odds of genital infections (OR 3.01, 95% CI: 1.93- 4.68, 9 series, 7326 participants, Z = 5.74, p < 0.0001, I2 = 0%) as well as urinary tract infections (OR 1.33, 95% CI: 1.13-1.57, 9 series, 7326 participants, Z = 4.05, p < 0.0001, I2 = 0%). When four trials investigating the effects of SGLT2 inhibitors in populations including both diabetic and non-diabetic patients were considered, administration of SGLT2 inhibitors in diabetic patients was associated with significantly higher odds of genital infections but not urinary tract infections compared to patients without type 2 diabetes. In patients taking placebo, the odds for urinary tract infections were significantly increased in diabetic patients compared to non-diabetic patients. CONCLUSIONS: The risk of genital infections is increased also in non-diabetic patients taking SGLT2 inhibitors although at a lesser extent that in diabetics. A careful assessment of the local anatomical conditions and of the history of previous urogenital infections is desirable to select those patients who need more intense follow-up, possibly combined with prophylactic measures of infections during treatment with SGLT2 inhibitors.

The impact of a novel surgical forum, 'Virtual Surgical Speed Dating', on career perception for medical students: a pilot study.

BACKGROUND: The SARS-CoV-2 pandemic limited medical student's exposure to surgical specialities, potentially affecting their understanding of specialties and limiting access to mentorship. AIMS: To develop a novel online 'round table' session to increase medical student's exposure to surgical careers, and to assess the value of the event as an educational tool. METHOD: A virtual education session was held, with questionnaires being completed before and after the virtual event. The event began with an introduction to surgical training. Participants rotated every 10 min in groups, with two specialties represented by a specialist registrar at each station. Data were analysed using a 5-point Likert scale, and a Student Evaluation of Educational Quality (SEEQ) questionnaire was completed. RESULTS: Of the 19 students involved, 14 (73.7%) were female, and 16 (84.2%) were undergraduate. The specialty attendees were most interested in before and after the event were neurosurgery (21.1%, n = 4) and cardiothoracic surgery (26.3%, n = 5), respectively. Five (26.3%) students changed the subspecialty they were most interested in after the event. Attendees' knowledge of surgical training in Ireland improved from 52.6% prior to the educational session to 69.5% after (p < 0.001). The session resulted in an increase in the perceived importance of research (4 [IQR 2-4] versus 4 [IQR 4-5], p = 0.0021). CONCLUSIONS: This 'Virtual Surgical Speed Dating' event offered medical students an opportunity to interact with various surgical specialties despite the SARS-CoV-2 pandemic. The novel approach increased medical students' exposure to surgical trainees, improved knowledge of training pathways and altered student values influencing career decision-making.

'Like a ticking time bomb': A qualitative study exploring the illness experiences of adults with kidney stone disease.

OBJECTIVE: Kidney stone disease (KSD) is a common, complex and painful urological condition, but how patients make sense of and respond to the challenges of KSD is poorly understood. Using the common-sense model of illness self-regulation (CSM-SR), we aimed to explore the illness experiences of individuals with KSD. DESIGN: A qualitative design using individual semi-structured interviews. METHODS: Thirty-three patients with KSD attending outpatient urology services participated in interviews informed by the CSM-SR. Data were analysed using reflexive thematic analysis. Themes were mapped onto the domains of the CSM-SR. RESULTS: Five main themes were generated, broadly echoing domains within the CSM-SR: (1) making sense of KSD, (2) normality paused, (3) the psychological burden of KSD, (4) the tensions of managing KSD, and (5) improving understanding of KSD. Additionally, findings suggested that partners' perceptions of KSD were an additional contextual factor that informed patients' own perceptions and management of KSD. Participants appraised initial KSD symptoms as indicative of a serious health threat. Diagnosis brought some relief, however, KSD wielded multi-dimensional impacts on patients' perceptions, self-management and well-being. Anxiety, including fear of KSD recurrence, and low mood were common psychological burdens across narratives. CONCLUSION: The majority of the themes identified were commensurate with an extended CSM-SR. This model has utility in informing how patients perceive and manage KSD. Examining patients' KSD representations and routinely assessing for psychological distress may be of benefit to improve health outcomes for this patient group.

Psychological Distress in Patients With Urolithiasis: A Systematic Review and Meta-analysis.

PURPOSE: Urolithiasis can be a painful condition associated with significant individual and health care burdens. Several studies have shown that anxiety and depression, termed psychological distress, may be associated with urolithiasis. However, there is little consensus on this relationship. We performed a systematic review and meta-analysis on the relationship between urolithiasis and psychological distress and examined rates of psychological distress in this population. MATERIALS AND METHODS: We searched online databases including MEDLINE (via PubMed), Embase (via Ovid), Web of Science, and the Cochrane Library with predefined search criteria up to March 2022 utilizing the Preferred Reporting Items for Systematic Review and Meta-analyses. Forty-nine peer-reviewed publications were included in this review. We performed a narrative synthesis on included studies, and a random-effects meta-analysis to obtain a single summary estimate for the relationship between urolithiasis and anxiety. RESULTS: Narrative synthesis found evidence for a relationship between urolithiasis and psychological distress, both anxiety and depression. Meta-analysis of 7 studies found a moderate pooled association between urolithiasis and state anxiety. Additionally, higher proportions of urolithiasis patients experienced psychological distress compared to nonurolithiasis samples across studies. Our findings are limited by the observed heterogeneity in assessment protocols within the data set. CONCLUSIONS: Our findings suggest a moderate but significant association between anxiety and urolithiasis, as well as a greater than expected number of urolithiasis patients experiencing psychological distress. More high-quality research studies are required to better understand factors that may influence the relationship between urolithiasis and psychological distress.

Systematic review of urological injury during caesarean section and hysterectomy.

INTRODUCTION AND HYPOTHESIS: We aim to review iatrogenic bladder and ureteric injuries sustained during caesarean section and hysterectomy. METHODS: A search of Cochrane, Embase, Medline and grey literature was performed using methods pre-published on PROSPERO. Eligible studies described iatrogenic bladder or ureter injury rates during caesarean section or hysterectomy. The 15 largest studies were included for each procedure sub-type and meta-analyses performed. The primary outcome was injury incidence. Secondary outcomes were risk factors and preventative measures. RESULTS: Ninety-six eligible studies were identified, representing 1,741,894 women. Amongst women undergoing caesarean section, weighted pooled rates of bladder or ureteric injury per 100,000 procedures were 267 or 9 events respectively. Injury rates during hysterectomy varied by approach and pathological condition. Weighted pooled mean rates for bladder injury were 212-997 events per 100,000 procedures for all approaches (open, vaginal, laparoscopic, laparoscopically assisted vaginal and robot assisted) and all pathological conditions (benign, malignant, any), except for open peripartum hysterectomy (6,279 events) and laparoscopic hysterectomy for malignancy (1,553 events). Similarly, weighted pooled mean rates for ureteric injury were 9-577 events per 100,000 procedures for all hysterectomy approaches and pathologies, except for open peripartum hysterectomy (666 events) and laparoscopic hysterectomy for malignancy (814 events). Surgeon inexperience was the prime risk factor for injury, and improved anatomical knowledge the leading preventative strategy. CONCLUSIONS: Caesarean section and most types of hysterectomy carry low rates of urological injury. Obstetricians and gynaecologists should counsel the patient for her individual risk of injury, prospectively establish risk factors and implement preventative strategies.

Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases.

OBJECTIVES: To systematically review the current demographics, treatment and mortality rate associated with xanthogranulomatous pyelonephritis (XGP) and to test the hypothesis that the weighted pooled peri-operative mortality rate will be <10%. METHODS: Searches were performed of the Cochrane, Embase and Medline databases and the grey literature for studies published during the period 1 January 2000 to 30 August 2021. Eligible studies reported cohorts of ≥10 predominantly adult patients with XGP and described either average patient age or mortality rate. RESULTS: In total, 40 eligible studies were identified, representing 1139 patients with XGP. There were 18 deaths, with a weighted pooled peri-operative mortality rate of 1436 per 100 000 patients. The mean age was 49 years, 70% of patients were female and 28% had diabetes mellitus. The left kidney was more commonly affected (60%). Four patients had bilateral XGP, and all of whom survived. Renal or ureteric stones were present in 69% of patients, including 48% with staghorn calculi. Urine culture was positive in 59% of cases. Fistulae were present in 8%. Correct preoperative diagnosis occurred in only 45% of patients. Standard treatment continues to comprise a short cause of antibiotics and open radical (total) nephrectomy. Preoperative decompression occurred in 56% of patients. When considered at all, laparoscopic nephrectomy was performed in 34% of patients. Partial nephrectomy was conducted in 2% of patients. CONCLUSIONS: Xanthogranulomatous pyelonephritis has a lower mortality rate than historically reported. A typical patient is a woman in her fifth or sixth decade of life with urolithiasis. While open radical nephrectomy remains the most common treatment method, laparoscopic, and to a lesser degree partial nephrectomy, are feasible in well selected patients.

Systematic Review of Local Anaesthetic Systemic Toxicity in Urology.

OBJECTIVE: To systematically evaluate cases of local anaesthetic systemic toxicity (LAST) in adult urological patients. METHODS: A search of the Cochrane, Embase, and Medline databases as well as grey literature from 1 January 1974 to 1 February 2023 was performed using reported methods. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible studies were published in English, described LAST secondary to local anaesthetic administration by urological medical staff to an adult patient, and reported >1 symptom of LAST. RESULTS: One hundred fifty-seven publications were screened, and six eligible studies (all case reports) were identified, representing six cases of LAST in adult urological patients. Patients were aged 29-54 years and one was female. Cases occurred secondary to penile dorsal nerve block (two cases), scrotal self-injection (two), circumcision (one) or trans-vaginal tape insertion (one). Causative drugs were lidocaine (three patients; median dose 600mg) and bupivacaine (three; 200mg). While one patient was found deceased at home and received no treatment, five experienced LAST as inpatients and were discharged with no deficit. Three patients (50%) experienced a state of reduced consciousness or seizures, one experienced psychosis and one had asymptomatic tachyarrhythmia. Management consisted of supportive management (five patients), intravenous lipid emulsion (three) or intravenous thiopental and diazepam (one). Recommended tools suggested that two of these studies were at moderate or high risk of bias. CONCLUSION: LAST is seen only rarely in adult urology. Most iatrogenic cases occur due to penile dorsal nerve block and most patients have no long-term sequelae. Urologists should be familiar with its presentation and management, and minimise risk by adhering to local anaesthetic maximum safe dose ranges.

Risk of urinary stone formation associated to proton pump inhibitors: A systematic review and metanalysis.

OBJECTIVE: Proton pump inhibitors are widely used as treatment of acid-related disorders. They are considered safe although their long-term use has been associated with some adverse effects including an increased propensity for urinary calculi formation. The aim of this study was to systematically review available data from studies evaluating the association of PPIs and nephrolithiasis. MATERIALS AND METHODS: We searched two electronic databases (PubMed and EMBASE) for cohort studies or case-control studies evaluating the relationship between treatment with proton pump inhibitors and the risk of stone formation published up to 31 October 2022. The overall association of PPIs and urinary calculi was analyzed using a random effects model (RevMan5). The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. RESULTS: A total of 550 studies were retrieved; 7 were selected by title and abstract screening; after removal of duplicates, 4 records were evaluated by full-text examination. An additional study was retrieved by handsearching the references included in screened studies. In the unadjusted analysis, the odds of urinary calculi were greater in subjects taking PPIs compared to controls (unadjusted OR = 2.10, 95% CI 1.74-2.52, p < 0.00001). The pooled odds ratio of two case-control studies confirmed that use of PPIs increased the odds of urinary calculi compared with non-use (OR 2.44, 95% CI 2.29 to 2.61). Pooled analysis of three cohort studies evaluating incident nephrolithiasis showed an overall hazard ratio estimate of 1.34 (95% CI = 1.28-1.40). One study found lower urinary citrate and urinary magnesium levels in subjects exposed to PPIs. The Newcastle-Ottawa Quality Assessment Scale scores ranged between 6 and 8. CONCLUSIONS: PPIs showed an association with urinary calculi in patients included in the studies included in this review. If these data will be confirmed in adequately powered randomized trials, clinicians may consider limiting the long-term use of PPIs, to avoid unnecessary prolongation of treatment. Urinary magnesium and citrate should be evaluated in renal stone forming patients taking PPIs to supplement their intake when requested.

Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials.

BACKGROUND: Overactive bladder (OAB) symptoms of frequency, urgency and urge incontinence are frequently associated with known neurological diseases like multiple sclerosis (MS), spinal cord injury (SCI), Parkinson's disease (PD), stroke. OBJECTIVE: The aim of our study was to review the efficacy of pharmacological and non-pharmacological treatments for neurogenic overactive bladder. MATERIALS AND METHODS: We searched two electronic databases (PubMed and EMBASE) for randomized controlled trials focusing on pharmacological and non-pharmacological medical treatments for overactive bladder symptoms associated with neurological diseases published up to 30 April 2022. RESULTS: A total of 157 articles were retrieved; 94 were selected by title and abstract screening; after removal of 17 duplicates, 77 records were evaluated by full-text examination. Sixty-two studies were finally selected. The articles selected for review focused on the following interventions: anticholinergics (n = 9), mirabegron (n = 5), comparison of different drugs (n = 3), cannabinoids (n = 2), intravesical instillations (n = 3), botulinum toxin (n = 16), transcutaneous tibial nerve stimulation (TTNS) (n = 6), acupuncture (n = 2), transcutaneous electrical nerve stimulation TENS (n = 4), pelvic floor muscle training (PFMT) (n = 10), others (n = 2). Anticholinergics were more effective than placebo in decreasing the number of daily voids in patients with PD (mean difference [MD]- 1.16, 95 % CI - 1.80 to - 0.52, 2 trials, 86 patients, p < 0.004), but no significant difference from baseline was found for incontinence episodes and nocturia. Mirabegron was more effective than placebo in increasing the cystometric capacity in patients with MS (mean difference [MD] 89.89 mL, 95 % CI 29.76 to 150.01, 2 trials, 98 patients, p < 0.003) but no significant difference was observed for symptom scores and bladder diary parameters. TTNS was more effective than its sham-control in decreasing the number of nocturia episodes (MD -1.40, 95 % CI -2.39 to -0.42, 2 trials, 53 patients, p < 0.005) but no significant changes of OAB symptom scores were reported. PFMT was more effective than conservative advice in decreasing the ICIQ symptom score (MD, -1.12, 95 % CI -2.13 to -0.11, 2 trials, 91 patients, p = 0.03), although the number of incontinence episodes was not significantly different between groups. CONCLUSIONS: The results of the meta-analysis demonstrate a moderate efficacy of all considered treatments without proving the superiority of one therapy over the others. Combination treatment using different pharmacological and non-pharmacological therapies could achieve the best clinical efficacy due to the favorable combination of the different mechanisms of action. This could be associated with fewer side effects due to drug dosage reduction. These data are only provisional and should be considered with caution, due to the few studies included in metaanalysis and to the small number of patients.

An ex-vivo assessment of a new single probe triple modality (Trilogy) lithotripter.

INTRODUCTION AND OBJECTIVES: This Swiss LithoClast® Trilogy lithotrite is a new lithotrite for percutaneous nephrolithotomy (PCNL). It has four modifiable settings; impact, frequency, ultrasound and suction. We aim to determine the optimal device settings for the fastest stone clearance. MATERIALS AND METHODS: Kidney stone phantoms were made with Begostone in a powder to water ratio (15:3-15:6). Complete stone clearance (seconds) was calculated and impact and frequency were adjusted and repeated N = 3. Intra renal pressure (IRP) was then measured in a porcine kidney model. RESULTS: Stone phantoms with physical properties similar to struvite were cleared best with 100% impact and frequency of 12 Hz. Both uric acid stone phantoms and calcium phosphate stone phantoms were cleared most efficiently with an impact of 30% and a frequency of 4 Hz. The mean time to clear uric acid stone phantoms was 83 s versus 217 s for calcium phosphate stone phantoms. Similarly, for calcium oxalate stone phantoms, an impact of 30% and a frequency of 4 Hz was associated with the fastest clearance time, mean 204 s. However, the differences between 4, 8 and 12 Hz were not statistically significant. At a suction level of 60% or higher, IRP became negative. CONCLUSION: These results indicate that stone phantoms of hard kidney stones are cleared more efficiently at lower impact and frequency settings. With regard to suction, a setting of ≤ 50% appears to be the optimal setting.

Bilateral staghorn kidney stones in Megacalycosis: Non operative management of complex kidney stone disease.

What happens when kidney stone clearance is not feasible? We report the case of a 46-year-old male who presented for review with bilateral congenital non-obstructive calyceal dilatation (megacalycosis) and high volume bilateral renal calculi in the setting of stage four chronic kidney disease. Since complete stone clearance was deemed futile, thus a consensus was made between Urology and Nephrology, and treatment goals were focused on addressing symptoms, preserving renal function and preventing urinary tract infections until renal transplantation is needed. This case highlights that for some patients with severe complex kidney stone disease, an alternative management plan is needed.

Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis.

BACKGROUND: Alpha-adrenoreceptor antagonists or alpha-blockers are used in the treatment of hypertension, in the therapy of benign prostatic hyperplasia and in medical expulsive treatment of ureteral stones. These agents may affect the sexual function, with differences between drugs within the same class, depending on their selectivity for receptor subtypes. The aim of this review was to analyze the effects of alpha-blockers on sexual function. MATERIALS AND METHODS: We conducted a systematic review and meta-analysis by searching PubMed, EMBASE and other databases for randomized controlled trials (RCTs) reporting sexual adverse effects in patients treated with alpha-blockers. Odds ratios for sexual dysfunction were calculated using random effects Mantel-Haenszel statistics. RESULTS: Out of 608 records retrieved, 75 eligible RCTs were included in the meta-analysis. Compared with placebo, alphablockers were associated with increased odds of ejaculatory disorders both in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH) (OR: 7.53, 95% CI: 3.77-15.02, Z = 5.73, p < 0.00001, I2 = 55%) and in patients with ureteral stones (OR: 2.88, 95% CI: 1.50-5.44, Z = 3.19, p < 0.001, I2 = 31%). Uroselective alpha-blockers showed higher odds of ejaculatory disorders. Conversely, nonselective alpha-blockers were not associated with higher odds of ejaculatory dysfunction. Silodosin was associated with increased odds of ejaculatory dysfunction compared with tamsulosin (OR: 3.52, 95% CI: 2.18-5.68, 15 series, 1512 participants, Z = 5.15, p < 0.00001, I2 = 0%). Naftopidil and alfuzosin showed lower odds of ejaculatory dysfunction compared to uroselective alpha-blockers.No statistically significant differences in the odds of erectile dysfunction were observed when alpha-blockers were compared to placebo.