Testis sparing management of tuberculous epididymitis - Case report.

Tuberculous epididymitis is uncommonly encountered and is a very rare complication of Bacillus Calmette-Guérin (BCG) intravesical therapy for the treatment of bladder urothelial cancer. With the increased use of BCG, it is conceivable that practicing urologists will see more patients presenting with this infection. Herein, we describe an unusual presentation of tuberculous epididymitis treated successfully in a conservative fashion with anti-tuberculotic medications and describe current diagnostic, as well as medical and surgical management strategies.

Effect of gender on presentation and outcome of renal colic.

OBJECTIVES: To examine gender-related differences in the presentation, management, and outcomes of patients admitted to the emergency department ED with ureteral stones. METHODS: Retrospective analysis of all patients admitted to the ED at our institution, found to have a ureteral stone on CT. Clinical, laboratory, imaging parameters, and outcomes were collected. RESULTS: 778 patients were admitted with ureteral stones between January 2018 and December 2020. 78% (n = 609) were males and 22% (n = 169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively (p = 0.08). Female patients presented with a higher body temperature (p = 0.01), pulse rate (p < 0.0001), nausea and vomiting (p < 0.0001), elevated serum C-reactive protein (CRP) (p = 0.002) compared to males. The prevalence of elevated serum creatinine was higher in males (p < 0.0001). Alpha-blockers were recommended on discharge in 54.8% (334) of males, compared to only 29.6% (50) of females (p < 0.0001). Spontaneous stone expulsion was significantly higher in males compared to females (p = 0.01). CONCLUSIONS: Our results demonstrate that gender does effect presentation and outcome of patients presenting with renal colic. Females were found to have elevated infectious parameters, more nausea and vomiting and a higher incidence of positive urine cultures. Males admitted to the ED were found to have significantly higher serum creatinine levels. Medical expulsive therapy (MET) with alpha-blockers was prescribed significantly less in female patients, which may have resulted in a lower spontaneous stone expulsion rate.

Spontaneous stone expulsion in patients with history of urolithiasis.

OBJECTIVES: To examine differences in the presentation, management, and outcomes of patients admitted to the emergency department (ED) with ureteral stones, with prior history of urolithiasis compared to patients with a first stone event. PATIENTS AND METHODS: Retrospective analysis of patients who visited the ED that were found to have a ureteral stone on CT. Patients were stratified into two groups: without history of urolithiasis (Group 1) and with history of urolithiasis (Group 2). RESULTS: Between 2018 and 2020, 778 patients were admitted with ureteral stones. Patients in group 1 presented with a higher mean serum creatinine (p = 0.02), larger mean stone size (p < 0.0001), and a higher proportion of proximal ureteral stones (p < 0.0001) than patients in group 2. The 30 day readmission rate was significantly higher in group 1 (p = 0.02). Spontaneous stone expulsion was higher in group 2 (p < 0.0001), whereas the need for endourological procedures was higher in group 1 (p < 0.0001). On multivariable analysis serum creatinine (OR 0.264, 95% CI 0.091-0.769, p = 0.01) and stone size (OR 0.623, 95% CI 0.503-0.771, p < 0.0001) were associated with a lower spontaneous stone expulsion rate. History of prior endourological procedures (OR 0.225, OR 0.066-0.765, p = 0.01) was associated with a higher spontaneous stone expulsion rate. CONCLUSIONS: Our data suggests that patients who are first time stone formers present with larger and more proximal ureteral stones, with a lower likelihood of spontaneous stone expulsion and a subsequent need for surgical intervention. Previous stone surgery and not previous stone expulsion was found to be a predictor for spontaneous stone passage.

Effect of age on presentation and outcome in renal colic.

OBJECTIVES: To examine the age-related differences in the presentation, management, and outcomes of patients admitted to the emergency department (ED) with ureteral stones. PATIENTS AND METHODS: A retrospective analysis of all patients who visited the ED at a single institution that were found to have a ureteral stone on CT. Clinical, laboratory, and imaging parameters were collected, including outcomes. Patients were subdivided into age groups: 18-30, 31-50, 51-70, and >70 years. RESULTS: Between January 2018 and December 2020, 778 patients were admitted to the ED with a ureteral stone. About 78% (609) were males and 22% (169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively (p = 0.08). Patients in the 36-50 age group, had significantly higher visual analogue scale (VAS) scores (p < 0.0001). Patients older than 70 years old presented with significantly higher serum creatinine levels (p < 0.0001), C-reactive protein (CRP) (p < 0.001) and leukocyte levels (p = 0.002). These patients were also found to have significantly larger stones (mean size of 6.2 mm (SD 4.8) (p < 0.0001)) and underwent percutaneous nephrolithotripsy (PCNL) in significantly higher numbers (56.3% vs 43.8%, (p < 0.0001)). Less than half of the patients older than 50 years were given medical expulsive therapy (MET) with alpha-blockers, compared to more than 50% in the other age groups (p = 0.002). Spontaneous stone expulsion was noted in 70.2% of the 18-35-year group, 62.4% of the 36-50-year-old group, 51.8% of the 51-70-year-old group, and 37% of the >70-year-old group (p < 0.0001). The ED re-admission rates at 7 and 30 days were not significantly different among all age groups. CONCLUSIONS: Our data suggests that older patients presented with larger stones, elevated inflammatory markers and creatinine and were more likely to require surgical intervention. The spontaneous stone expulsion rate was inversely associated with age.

[UROLOGICAL CONSULT FOR PATIENT WITH RENAL COLIC BEFORE DISCHARGE FROM THE EMERGENCY DEPARTMENT (ED): THE OUTCOME EFFECT ON SPONTANEOUS STONE EXPULSION AND RE-VISIT TO ED].

INTRODUCTION: Renal colic due to ureterolithiasis is a frequent reason for visiting the emergency departments (ED). The majority of those patients are managed non-surgically and will experience a spontaneous stone expulsion. The ED at our hospital works as a unified department, which is a well-established practice in Europe and North America. AIMS: Assess the outcome of urological consultation in the ED for patients with urolithiasis. METHODS: A retrospective cohort examined 402 ureterolithiasis patients proven by abdominal CT-scan at the ED. Patients were divided into 3 groups: Group1: patients were discharged after evaluation by ED physician alone. In Group 2: patients were discharged after being evaluated by an ED physician and urologist. In Group 3: patients who were admitted to the Urology Department. Clinical, laboratory and imaging parameters were examined as well as patients' outcomes: spontaneous stone expulsion, re-visit to ED and surgical intervention. RESULTS: There were not significant differences between group 1 and 2 regarding age, stone size, stone location, WBC levels, stone expulsion rate or surgical intervention. Group 1 had a significant higher rate of ED re-visits compared with group 2 (79 (43.3%) vs. 12 (17.9%). p=0.0002). Group 3 had significantly higher stone size, creatinine levels, inflammatory markers, proximal stone location and surgical interventions. CONCLUSIONS: ED working as a unified department provides excellent management to patients with renal colic due to ureterolithiasis, with a high rate of spontaneous stone expulsion and urologist referral to admissions and surgical interventions. Nevertheless, urological consultation significantly decreases re-visits to ED.