Angiotensin II Type 1 receptor blockade attenuates the neuropathological changes in the spinal cords of diabetic rats with modulation of nuclear factor erythroid 2-related factor 2/ heme oxygenase 1 system.

Peripheral and central neuropathies frequently complicate worldwide diabetes. Compared to peripheral neuropathy, central neuropathy didn`t gain a major research interest. Angiotensin II is reported to be involved in diabetic neuropathic pain but its role in the central pathological changes in the spinal cord is not clear. Here, we study the role of Losartan; an Angiotensin II receptor 1 (AT1) antagonist in suppression of the diabetes-induced changes in the spinal cord. Three groups of rats were applied; a negative control group, a streptozotocin (STZ) diabetic group, and a group receiving STZ and Losartan. After two months, the pathological alteration in the spinal cord was investigated, and an immunohistochemical study was performed for neuronal, astrocytic, and microglial markers; nuclear protein (NeuN), Glial fibrillary acidic protein (GFAP), and Ionized calcium-binding adaptor molecule 1 (Iba1), respectively, and for an apoptosis marker; caspase-3, and the inflammatory marker; nuclear factor kappa B (NF-kB) signaling, heme oxygenase-1 (HO-1) and nuclear factor erythroid 2-related factor 2 (Nrf2); physiological antioxidant system. The results showed that Losartan caused recovery of spinal cord changes, by inhibiting the microglial and astrocytic activation, suppressing neuronal apoptosis and NF-kB expression with activation of Nrf2/HO-1 (P<0.0005). It is suggested, herein, that Losartan can suppress diabetes-induced glial activation, inflammation, neuronal apoptosis, and oxidative stress in the spinal cord; the mechanisms that may underlie the role of AT1 antagonism in suppressing diabetic neuropathic pain.

Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study.

Purpose: Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT). Materials and Methods: This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28-57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed. Results: CSAu and CSAu-CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively). Conclusion: The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS.

Combination of pregabalin and Amitriptyline in management of chronic idiopathic pain following penile prosthesis implantation: a pilot study.

BACKGROUND: Chronic post-penile prosthesis pain is de novo pain persisting > 2 months post-operatively. This pain is inadequately reported, poorly understood and undermanaged. The purpose of this current pilot study was to improvise a medical approach to alleviate the condition and assess the combination of Pregabalin and Amitriptyline in its management. RESULTS: The study enrolled 9 patients complaining of idiopathic penile, pelvic, or scrotal pain persisting > 2 months after penile prosthesis implantation. Patients were prescribed pregabalin 75mg/12h (escalated after 1 week to 150mg/12h upon demand) and Amitriptyline 25mg once daily for 3 months. The pain was reassessed after 10, 30 and 100 days. The dose of pregabalin required and the side effects of the medication were noted. Findings revealed a significant decrease in pain duration (p = 0.007), frequency (p < 0.001), and intensity (p < 0.001); in glanular (p = 0.008), shaft pain (p = 0.046) but not scrotal (p = 0.112). Moreover, a significant decrease was found in sharp pain (p = 0.003) and pain aggravated by touch (p = 0.008) but not aching pain (p = 0.277). Additionally, significant improvement was reported in QoL (p < 0.001) and dose escalation of pregabalin to 150mg/12h was required in only 1 case (11%). CONCLUSION: The combination of pregabalin and amitriptyline is very effective in the management of chronic idiopathic pain following penile prosthesis implantation. However, due to the ambiguity and lack of reporting of the condition, we recommend a multicentric contribution to acknowledge the condition, and weigh its prevalence accurately, whilst evaluating the efficacy of our approach. This study received ethical approval from Ain Shams University Research Ethics Committee (REC) FWA 000017585, on 04/13/2023 (REC-FMASU@med.asu.edu.eg). TRIAL REGISTRATION: no FMASU R98/2023.

RéSUMé: CONTEXTE: La douleur chronique survenant après l'implantation d'une prothèse pénienne est une douleur de novo qui persiste plus de 2 mois après la chirurgie. Cette douleur est mal rapportée, mal comprise et mal gérée. L'objectif de cette étude pilote était d'improviser une approche médicale pour soulager cette douleur, et d'évaluer l'association de la prégabaline et de l'amitriptyline dans sa prise en charge. RéSULTATS: L'étude a inclut 9 patients se plaignant de douleurs idiopathiques au pénis, au bassin ou au scrotum, persistantes depuis plus de 2 mois après l'implantation d'une prothèse pénienne. Les patients se sont vu prescrire 75 mg/12 h de prégabaline (augmenté après 1 semaine à 150 mg/12 h sur demande) et 25 mg d'amitriptyline une fois par jour, pendant 3 mois. La douleur a été réévaluée après 10, 30 et 100 jours. La dose de prégabaline requise et les effets secondaires du médicament ont été notés. Les résultats ont montré une diminution significative de la durée de la douleur (p = 0,007), de sa fréquence (p < 0,001) et de son intensité (p < 0,001), au niveau du gland (p = 0,008), de la verge (p = 0,046) mais pas du scrotum (p = 0,112). De plus, une diminution significative a été observée en ce qui concerne la douleur vive (p = 0,003) et la douleur aggravée par le toucher (p = 0,008), mais pas la douleur aigüe (p = 0,277). Enfin, une amélioration significative de la qualité de vie (p < 0,001) a été rapportée et l'augmentation de la dose de prégabaline à 150 mg/12 h ne s'est avéré nécessaire que dans 1 cas (11 %). CONCLUSION: L'association de la prégabaline et de l'amitriptyline est très efficace dans la prise en charge de la douleur chronique idiopathique suite à l'implantation d'une prothèse pénienne. Cependant, en raison de l'ambiguïté et de l'absence de déclaration de la maladie, nous recommandons la mise en place d'une contribution multicentrique pour reconnaître la maladie et évaluer sa prévalence avec précision, tout en évaluant l'efficacité de notre approche. Cette étude a reçu l'approbation éthique du Comité d'éthique de la recherche (CER) de l'Université Ain Shams 44 FWA 000017585, le 13/04/2023 (REC46 FMASU@med.asu.edu.eg). N° D'ENREGISTREMENT DE L'ESSAI: FMASU R98/2023.

MRI-Based Classification for Tibial Spine Fracture: Detection Efficacy, Classification Accuracy, and Reliability.

RATIONALE AND OBJECTIVES: Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification. MATERIALS AND METHODS: A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard. RESULTS: The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2-95.6%) was significantly higher than that of the MM classification (73.5-76.5%, p = 0.002-0.01). The fracture detection rate of MRI-based classification (94.1-98.5%) was non-significantly higher than that of the MM classification (83.8-89.7%, p = 0.07-0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2-94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ = 0.69) and MRI-based classification (κ = 0.79). CONCLUSION: MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries.

Predictive urinary RNA biomarkers of kidney injury after extracorporeal shock wave lithotripsy.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is considered one of the best choices for the treatment of various kinds of urinary tract calculi, although it might cause acute kidney injury. OBJECTIVE: To measure the urinary long non-coding RNA-messenger RNA (LncRNA-mRNA) panel before and after ESWL to evaluate post-ESWL renal injury in a reliable and non-invasive method. PATIENTS AND METHODS: The study included 60 patients with renal stones treated with ESWL and 30 healthy volunteers. Voided urine samples were obtained before, 2 h, and 1 day after ESWL. We measured the urinary level of LncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) by real-time qPCR and compared the results with serum creatinine and eGFR. RESULTS: LncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) levels were higher in patients with renal stones when compared with healthy volunteers. They showed a statistically significant increase in the level of LncRNA-mRNA panel in baseline and after ESWL treatment. CONCLUSION: LncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) levels were significantly elevated following ESWL treatment, highlighting the usefulness of urinary biomarkers in identifying patients at higher risk of developing renal injury after ESWL treatment.

Effect of perioperative selective alpha-1 blockers in non-stented ureteroscopic laser lithotripsy for ureteric stones: a randomized controlled trial.

INTRODUCTION: The aim of this studywas to assess the efficacy of perioperative alpha-1 blockers on improving the success rate and decreasing complications of non-stented ureteroscopic laser lithotripsy for ureteric stones. MATERIAL AND METHODS: A randomized control trial was conducted at two high volume urological centers from September 2017 to December 2018. We enrolled 150 patients with lower ureteric stones. They were randomly divided into two groups. Patients in group A, underwent non-stented ureteroscopy using Ho-YAG laser for stone disintegration and received alpha-1 blockers for one week preoperatively and another two weeks postoperatively. Patients in group B, underwent non-stented ureteroscopy and laser and received a placebo. RESULTS: One hundred and twenty patients were available for analysis at the end of our study. There was no statistically significant difference found between both groups regarding demographic data and stone parameters. The need for intraoperative ureteric dilatation was 32.7% and 51.6% for both groups A and B respectively with a statistically significant difference. The incidence of lower urinary tract symptoms (LUTS) and the need for analgesics were higher in group B with a statistically significant difference. CONCLUSIONS: Administration of perioperative tamsulosin seems to not only to significantly decrease the need for intra-operative dilatation and hence operative time, but also leads to a significant decrease in the development of postoperative LUTs, postoperative pain and the need for analgesia and hospital stay.

Fibrin glue as a sealant in stentless laparoscopic pyeloplasty: A randomised controlled trial.

Objective: To evaluate the value of adding fibrin glue, as a sealant material, to the anastomotic line during stentless laparoscopic pyeloplasty (LPP). Patients and methods: In all, 92 patients with pelvi-ureteric junction obstruction (PUJO), scheduled for LPP, were randomised into two groups (46 in each group). Group A, underwent transperitoneal stentless LLP sealed with fibrin glue, whilst Group B underwent the same procedure without fibrin glue. Results: Both groups were similar for patient demographics and presentation. Despite that, we found a significant statistical difference between the groups for operative time and blood loss. The total number of patients that had a urinary leak was 10 and 24 patients, in groups A and B respectively (P = 0.002). A prolonged leak lasting for >5 days, which stopped spontaneously occurred in three patients (7.14%) in Group A and six (14.3%) in Group B (P = 0.265). A persistent 14-day leak that needed intervention developed in two patients (4.3%) in Group A and five (10.9%) in Group B (P = 0.434). One patient in Group B developed urinoma 1 week after discharge, and another patient in the same group developed deep venous thrombosis. There was no significant difference between the groups for postoperative complications in the early 3-month period. The success rate was 39 (92.86%) and 36 patients (85.7%), in groups A and B respectively (P = 0.265). Conclusion: Adding fibrin glue to seal the anastomosis decreased urinary leakage but did not have a significant impact on outcomes. Abbreviations: CONSORT: Consolidated Standards of Reporting Trials; DTPA: diethylene-triamine-penta-acetic acid; LPP: laparoscopic pyeloplasty; PUJO: PUJ obstruction; T½: clearance halftime (renogram).

Case Report: Laparoscopic Approach for Orchiopexy in a 26-Year-Old Man with Accidentally Discovered Persistent Müllerian Duct Syndrome and Bilateral Undescended Testis.

Background: Persistent Müllerian duct syndrome (PMDS) is not a common form of disorder of sex development in which Müllerian duct derivatives (fallopian tubes, uterus, and the proximal vagina) are present in an otherwise normally differentiated 46 XY male. In most of cases, the challenge comes in the procedure of orchiopexy. Case Presentation: We report a case of a 26-year-old man with PMDS. It was accidentally discovered when the patient presented to our outpatient clinic concerning about his empty scrotum as a premarital check. Diagnostic laparoscopy discovered Mullerian remnants in the form of uterus, cervix, and fallopian tubes with two attached testes to the fallopian tubes. Staged laparoscopic orchiopexy was done. We discuss the presentation, the management of this case in the literature, and our intervention. Conclusion: PMDS is not a common condition. Several concerns present in the management of these cases. Malignant transformation of the testis is the main risk facing those patients. Few literature studies discussed the risk of changing of these remnants into malignant tissue. Thus discussion with the patient, tissue histopathology, expert opinions, and literature review are the main clues in management of such cases.

Use of fibrin glue as a sealant at the anastomotic line in laparoscopic pyeloplasty: A randomised controlled trial.

OBJECTIVE: To assess the effectiveness of fibrin glue as a sealant at the anastomotic line of a stentless laparoscopic pyeloplasty (LPP) repair instead of JJ stent insertion. PATIENTS AND METHODS: In all, 46 patients with pelvi-ureteric junction obstruction scheduled for LPP were randomised into two groups each containing 23 patients. Group A underwent stented repair, while group B had a stentless repair together with sealing of the anastomotic line with fibrin glue. RESULTS: There was no statistically significant difference between the groups for the postoperative improvement in the renal scan and intravenous urography. However, there was a statistically significant decrease in early postoperative adverse events in group B. In group A, all the patients had irritative lower urinary tract symptoms (LUTS) and 16 (72.7%) had postoperative urinary tract infections (UTIs). In group B, no patient had a UTI or irritative LUTS. In all, 21 patients (95.4%) in group A had minimal terminal painful haematuria; while in group B, only one patient (4.3%) had minimal total painless haematuria. Also, patients in group B were spared the need for a second anaesthesia exposure for stent removal. CONCLUSION: The use of fibrin glue is a valid alternative to stenting in LPP with the same excellent outcome but with markedly lower short-term postoperative adverse events.

Value of Computed Tomography for Predicting the Outcome After Percutaneous Nephrolithotomy.

INTRODUCTION: Computerized tomography of the urinary tract (CT-UT) has been established as the diagnostic procedure of choice for urinary stones. This study aimed to evaluate its role in predicting the outcome of percutaneous nephrolithotomy (PCNL) in terms of stone free rate and residual fragments. METHOD: This prospective cohort study was conducted on 34 patients in the Urology Department of Theodor Bilharz Research Institute from January 2013 to March 2014. The patients who had large and/or multiple renal stones, including staghorn stones, in 19 renal units scheduled for PCNL were included in this study. All had a pre-operative CT-UT to determine the stones' characteristics and renal anatomy. CT-UT, together with a kidney-Ureter-Bladder (KUB) film, was taken on the first post-operative day. The data were analyzed by SPSS version 17 using independent-samples t-test and the chi-squared test. RESULTS: CT-UT showed a statistical significant sensitivity in detecting residual fragments over standard KUB, yet this significance was lost when corrected to significant residual. Stone size and density were independent factors for the presence of residual stones. CONCLUSION: CT-UT post PCNL was sensitive to detect residual fragments, yet it showed no superiority over standard KUB in detecting significant residual.

Safety and efficacy of quartz head contact laser ablation for large prostates using 980-nm laser: a comparative prospective study against that for small- and medium-sized prostates.

OBJECTIVE: To examine the safety and efficacy of quartz head laser ablation of the prostate (QLAP) in the treatment of large and huge prostates as compared with small- and medium-sized ones. MATERIALS AND METHODS: Two hundred forty-two patients with lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH) were included in the study, of which 210 patients were evaluable. Patients were divided into 2 groups: group A: patients with BPH volume of <80 mL (120 patients) and group B patients with gland size ≥80 mL. All patients were subjected to QLAP procedure. They were evaluated perioperatively and 1 week; 1, 3, and 6 months; and every 6 months thereafter postoperatively. RESULTS: Patients' demographics and preoperative data were similar except for the gland size (group A, 54.96 ± 15.49 mL [20-79 mL] and group B, 124.68 ± 40.88 mL [80-233 mL]). Operative time corrected to gland volume was shorter in group B. Only 10% of all patients needed 2 fibers. There was no significant electrolyte change in both groups. Hemoglobin has minimally decreased in both groups but was statistically significant. Group B outcome was significantly better regarding International Prostate Symptom Score, International Prostate Symptom Score quality of life, and uroflowmetry. Prostate size decreased by 47 ± 2% and 62.7 ± 2% at 6 months post operatively for groups A and B, respectively. CONCLUSION: QLAP demonstrated good efficacy and safety in treating large and huge BPH. It possessed no added risk as compared with small prostates. It can be a good alternative to open prostatectomy especially in patients with significant comorbidities.

Quartz head contact laser fiber: a novel fiber for laser ablation of the prostate using the 980 nm high power diode laser.

PURPOSE: High power 980 nm diode laser ablation of the prostate using the side firing fiber has proven its efficiency and safety in treating lower urinary tract symptoms secondary to benign prostatic hyperplasia. Nevertheless, this procedure is associated with some drawbacks such as prolonged irritative symptoms and tissue sloughing. In this study we evaluated the clinical outcome of high power 980 nm diode laser ablation of the prostate using a new quartz head contact fiber, and compared it to the standard side firing fiber in a randomized fashion. MATERIALS AND METHODS: A total of 120 patients with benign prostatic hyperplasia scheduled for high power 980 nm diode laser ablation of the prostate were randomized to receive treatment with the standard side firing fiber or the novel quartz head contact fiber between April 2009 and April 2010. Patients were followed for at least 6 months, although 7 were lost to followup. RESULTS: The side firing fiber and quartz head contact fiber groups demonstrated significant improvement in International Prostate Symptom Score (from 20 to 8.39 vs 21.63 to 9.91), International Prostate Symptom Score-quality of life (from 4.47 to 1.94 vs 4.57 to 1.98) and maximum flow rate (from 7.79 to 22.22 vs 8.93 to 29.63 ml per second), and decreased prostate volume (47.79% vs 55.54%) and prostate specific antigen (59.69% to 60.61%), respectively. Complications, postoperative passage of tissue remnants and irritative symptoms were significantly less in the quartz head contact fiber group, as was the number of fibers per case. CONCLUSIONS: The quartz head contact fiber can produce similarly good outcomes in ablating the prostate using the high power 980 nm diode laser compared to the side firing fiber, and with fewer complications and side effects.

The Twister laser fiber degradation and tissue ablation capability during 980-nm high-power diode laser ablation of the prostate. A randomized study versus the standard side-firing fiber.

The objective of this work is to test the ablation capability and fiber degradation of the novel Twister fibers (TW), in both the large (LTW) and the standard (STW) sizes, against the standard side-firing (SF) fiber in a clinical setting during the treatment of BPH patients using the 980-nm high-power diode laser (HPDL). One hundred and twenty BPH patients treated with HPDL (Ceralase300, Biolitec AG, Jena, Germany) were randomized to receive treatment by one of the three fibers. Operative time corrected to tissue volume, laser treatment time, and laser energy were measured. Ablation rate was calculated as follows: the decrease of the prostate volume after 6 months/laser time. The fibers' resistance to degradation was defined by the laser energy needed to degrade the fiber completely. Preoperative prostate volume of 76 ± 38, 70 ± 39, and 88 ± 49 cc decreased by 49 ± 16, 51 ± 20, and 63 ± 16% for the SF, STW, and LTW fibers, respectively. This difference was highly significant when the LTW was compared to the other two fibers (p < 0.001). Prostate volume reduction post-operatively within each group as compared to the pre-operative volume was highly significant (p < 0.001). The ablation rate was highest in LTW, being 1.31 ± 0.59, 1.09 ± 0.51, and 1.54 ± 0.44 cc/min for the SF, STW, and LTW fibers, respectively. The LTW fiber resisted degradation more than the other fibers and the STW more than the SF fiber (p < 0.001). This study demonstrates the higher ablation efficiency and resistance to degradation of the LTW fiber as compared to the STW and SF fibers. The STW fiber has a similar ablation rate of the SF fiber but resists degradation better.

Obstetric vesico-vaginal fistula repair: should we trim the fistula edges? A randomized prospective study.

OBJECTIVE: To test the hypothesis that not trimming the edges of the vesico-vaginal fistula (VVF) during its surgical repair has an advantage in the outcome as compared to the classical teaching of trimming the fistula. METHODOLOGY: Sixty-four females with obstetric VVF were randomized into two groups. Both groups were treated with vaginal anatomical closure in three layers with Martius flap inter-positioning. Fistulae of the first group were closed without trimming the edges of the bladder while the second group was subject to trimming of the bladder edges. RESULTS: There were no statistically significant differences between both groups regarding pre-operative patient demographics and fistula characteristics. Cure rates were 75% and 67.6% in the non-trimming and the trimming groups, respectively. This was not statistically different. When patients were stratified according to the number of previous repairs, 100% patients in both groups were cured in cases of primary repair of the fistula. Lower cure rates were shown with increasing number of previous repairs. Recurrent fistulae after our repair were not statistically different in site and number in both groups. Nevertheless, fistulae after trimming tends to get larger than the original ones as compared to the non-trimming group which tends to get smaller. This is statistically different. CONCLUSION: Although there is no statistically significant difference between both groups regarding the cure rate in both fresh cases or recurrent ones, there is an advantage of not trimming the fistula since trimmed fistula tends to get larger, should recurrence occur after trimming.

Functional and quality of life outcome of transobturator tape for treatment of female stress urinary.

INTRODUCTION AND HYPOTHESIS: this study aims to evaluate the functional outcome of transobturator tape (TOT) in treatment of female stress urinary incontinence (SUI) and its impact on patient quality of life (QoL). METHODS: sixty female patients with SUI underwent TOT operation, outside-in technique. Forty-eight patients completed the study. Clinical evaluation, urodynamics, and QoL using validated Arabic translation of the International Consultation on Incontinence Questionnaire-Short Form were done both preoperatively and 3, 6, and 12 months postoperatively. RESULTS: the mean follow-up was 16 months. The objective cure rate was 95.83%. There were no cases of urethral injury, bladder perforation, or thigh pain. De novo urgency and urge incontinence was observed in four patients (8.3%). No early or late outflow obstructive symptoms were noted. No difference was observed between pre- and postoperative filling cystometrogram and pressure flow studies. There was significant improvement in the postoperative QoL assessment. CONCLUSIONS: TOT (outside-in) appears to have no deleterious effect on storage and voiding functions.

The twister fiber: a comparative study of tissue interaction between this novel fiber and the side-firing fiber using the 980 nm laser in bovine kidneys.

Twister fiber has been recently introduced to convey the 980 nm laser. It is an end-firing fiber with terminal angulation. Theoretically, this fiber has many advantages over the standard side-firing fiber. Tissue characterization for such fiber has not been performed until now. It is important to carry out such a task to better understand the performance of this type of laser using this new fiber. Ablation capacity, fiber degradation, and maximum coagulation depth were tested for both the side-firing and the Twister fibers using a 980 nm diode laser system with a maximum output of 300 watts (Ceralas 300 system). The fibers have been tested on bovine kidneys. Laser powers used were 50, 100, 150, and 200 watts. The application time was 3 minutes for each experiment. Each experiment was repeated six times. Ablation rate was directly proportional to laser power reaching 2.4 ± 0.24 g/minute for the side-firing fiber and 1.83 ± 0.23 g/minute for the Twister fiber when the 200 watts power was reached. There was no statistical significant difference between the two fibers except at the 200 watts power. The side-firing fiber seems to resist degradation better at high power. The maximum coagulation depth was equivalent and did not significantly increase with power increase beyond the 100 watts. At 50 watts, the coagulation depth was significantly lower in the side-firing fiber. Both fibers produced significantly smaller coagulation at the 50 watts power setting compared with higher powers. In conclusion, both fibers performed well with regard to the ablation rate and produced a reasonable coagulation zone beyond the ablation area. The side-firing fiber seems to resist degradation more than the Twister fiber.

Fibrin glue versus martius flap interpositioning in the repair of complicated obstetric vesicovaginal fistula. A prospective multi-institution randomized trial.

AIMS: To examine the efficacy of using fibrin glue (FG) as an interpositioning layer in the repair of complicated vesioovaginal fistulae (VVFe) as compared to the classical repair using martius flaps (Ml'). METHODS: The study was conducted in 3 African institutions. Forty female patients with complicated VVFs were randomized into 2 groups. Group A were repaired anatomically using FG as interpositioning layer. Group B were repaired anatomically using MF as an interpositioning layer. FG used in this study was prepared from patients own blood. Complicating factors were recurrence, local moderate to severe fibrosis, fistula location involving the bladder neck, and or size of the fistola being more than 1.5 cm in its largest diameter. Patients were evaluated after 2 weeks, one month and 3 months postoperatively. RESULTS: Thirty eight patients were evaluable as 2 patients, one from each group, lost to follow-up. Patient demographics were not different between the two study groups. The frequency of occurrence of complicating factors was not different between the 2 groups. Thirteen of group A and eleven from group B were rendered dry and that was maintained for as long as they were followed-up. The difference in the outcome was not statistically significant. CONCLUSION: The use of FG as an interpositioning layer during the vaginal anatomical repair of complicated VVF appears to be of great value as an alternative to the use of MF interpositioning. Decreasing the operative time and adding simplicity to the already complicated procedure are additional values of using this procedure. Neurourol. Urodynam. 28:438-441, 2009. (c) 2009 Wiley-Liss, Inc.

Nocturnal polyuria and nocturnal arginine vasopressin (AVP): a key factor in the pathophysiology of monosymptomatic nocturnal enuresis.

AIMS: To identify the relationship between nocturnal AVP deficiency, nocturnal polyuria (NP), and low urinary osmolality in children suffering of primary monosymptomatic nocturnal enuresis (NE). PATIENTS AND METHODS: The study included 50 children (28 males and 22 females) with primary monosymptomatic NE and 30 non enuretic children of the same age group (controls). Night samples of blood and urine were obtained for AVP, blood osmolality, and urine osmolality. In addition, volume frequency charts, arousal threshold, and urodynamics were performed for these children. RESULTS: Twenty eight (56%) of the enuretic children were considered to have NP. Mean AVP level was 44.80 +/- 8.19 and 32.49 +/- 18.25 pg/ml while mean urine osmolality was 865.07 +/- 158.66 mOsm/kg and 700.06 +/- 84.42 mOsm/kg in controls and enuretic group respectively. These differences were highly significant. No significant difference was found between the controls and enuretics without NP. On the other hand, nocturnal AVP and urine osmolality were significantly lower in enuretics with NP when compared to both controls and enuretics without NP. Blood osmolality did not reach statistically significant difference between subgroups. Arousal threshold was significantly higher in enuretic children irrespective to NP. The timing for NE episodes were predominantly late in the night in NE children without NP while patients suffering of NE with NP typically experienced multiple incidents each night. CONCLUSION: We have shown that low nocturnal AVP and urine osmolality may play a role in the pathophysiology of enuretics with NP. This abnormality doesn't occur as an isolated disease as these children suffer from arousal defect as well.