Outcomes of Mini-Percutaneous Nephrolithotomy in Children and Adolescents: A 10-Year Single-Centre Experience From Kuwait.

The current study retrospectively reviewed data for all children and adolescents who underwent mini-percutaneous nephrolithotomy (PCNL) at Ibn Sina Hospital and Sabah Al Ahmad Urology Centre in Kuwait over 10 years. Accordingly, the 40 patients underwent mini-PCNL. Among them, 21 patients (52.5%) had varying degrees of hydronephrosis, with mild to moderate severity accounting for nearly half of them, whereas six (15%) had multiple stones. The median operative time was 54.5 (43.3-64) minutes. Moreover, 11 patients needed flexible ureteroscopy (URS) and double-J (DJ) ureteric stent, and one patient required DJ ureteric stent only. None of the cases developed intraoperative bleeding. The median hospital stay of the included patients was three (2.3-4) days. Residual stone was observed in 11 patients (27.5%), with a median size of 3 (2 to 7) mm. The incidence of postoperative complications was 27.5% (n = 11 patients), with three patients experiencing postoperative bleeding (7.5%) and eight patients developing a fever (20%). All patients had mild postoperative pain. However, no leakage, sepsis, or pelvic injury occurred. None of the patients required revision. In conclusion, mini-PCNL was a safe and effective procedure in children and adolescents with renal stones.

Super-Mini Percutaneous Nephrolithotomy for Nephrolithiasis: A Systematic Review and Meta-Analysis.

We aimed to conduct a systematic review and meta-analysis to summarize the current evidence regarding the role of super-mini percutaneous nephrolithotomy (SMP), which refers to a 7-Fr nephroscope placed through a tract sized 10-14 Fr, in treating renal stones and compare its outcomes with the standard mini-percutaneous nephrolithotomy (PCNL) techniques. A systematic literature search was conducted on the Medline database via PubMed and SCOPUS until May 2022 to retrieve the relevant studies. The titles and abstracts of unique records were screened for eligibility, followed by the full-text screening of potentially eligible abstracts. Data extraction was performed by two independent reviewers. The risk of bias assessment was conducted based on the study design. Open Meta (Analyst) and Review Manager 5.4 were used to perform all analyses. A total of 14 studies (n = 4,323 patients) were included, with two randomized controlled trials, one single-arm trial, and 11 cohort studies. The stone-free rate (SFR) of SMP was 91.4%. The pooled analysis showed no significant difference between SFR in mini-PCNL (mean difference (MD) = 1.03, 95% confidence interval (CI) = (0.99, 1.06), p = 0.12) and flexible ureteroscopy (MD = 0.84, 95% CI = (0.4, 1.76), p = 0.65]. On the other hand, SMP had a better SFR rate when compared with retrograde intrarenal surgery (MD = 1.3, 95% CI = (1.01, 1.66), p = 0.04). The pooled mean operative time of SMP was 49.44 minutes (95% CI = (41, 57.88), p < 0.001), which was longer than mini-PCNL (MD = 1.92, p < 0.001) and shorter than ureteroscopy (MD = -17.17, p < 0.00001). In the SMP group, the postoperative complications included fever (>38°C), pain, and hematuria, with an incidence of 7.6%, 2.3%, and 3.4%, respectively. The mean length of hospital stay after SMP was 2.4 days (95% CI = (2.17, 2.7), p < 0.001). The current evidence suggests that SMP is a safe and effective technique in the management of renal stones in both children and adults.

Detection rate and clinical pattern of prostate cancer in Kuwait: a single-center experience.

OBJECTIVE: To determine the detection rate and clinical pattern of prostate cancer in Kuwait. SUBJECTS AND METHODS: One hundred and fifty-three males suspected of having prostate cancer based on elevation of prostate-specific antigen (PSA) of more than 4 ng/ml underwent transrectal-ultrasound (TRUS)-guided needle biopsy of the prostate between January 2003 and January 2008; these formed the study group. Analysis of prostate cancer was based on age, prostate volume, PSA level and on finding any abnormality based on a combination of the diagnostic tools. RESULTS: A diagnosis of prostate cancer was histologically confirmed in 42 (27.4%) patients. In those aged <55, 56-65, 66-75 and >76 years, the detection rates were 16.7, 17.6, 33.3 and 40.7%, respectively. In those with prostate volumes of >71, 51-70, 31-50 and <30 g, the detection rates were 18.2, 23.8, 30.8 and 42.9%, respectively. When the PSA levels were divided into groups of 4-10, 10-20, 20-100 and >100 ng/ml, the cancer detection rate was 11.8, 20.5, 47.1 and 83.3%, respectively. When 1, 2 and 3 of the 3 diagnostic tools (digital rectal examination, PSA, TRUS) were abnormal, the detection rate was 15.6, 27.9 and 80%, respectively. CONCLUSIONS: Our data showed that the prostate cancer rate differs according to the region and that the rate was low in our center. Higher PSA and higher number of diagnostic tools with abnormal findings were associated with a higher incidence of prostate cancer.

Transrectal ultrasound guided biopsy for detecting prostate cancer: can random biopsies be reduced using the 4-dimensional technique?

We present our experience with a new technique of real time 3-dimensional sonography -- "4-dimensional Transrectal ultrasound (TRUS)" guided prostate biopsy. A total of 64 patients suspected of having prostate cancer based on an elevated prostate-specific antigen (greater than 4 ng/ml) formed the study group. A voluson (General Electric Vivid 3) ultrasound machine equipped with a transrectal 5-8 MHz curvilinear transducer was used. Sonography-guided prostate biopsy was performed following prostate imaging and volume calculation using 3D and 4D imaging. Biopsies of tumor suspicious areas, if present, as well as random biopsies were done. Histopathology showed prostate cancer in 15 (23.4%) and benign prostatic conditions in 49 (76.6%). TRUS examination in the 15 detected prostatic cancers showed that 6(40%) were hypoechoic, 4 (26.7%) were of mixed hypo and hyper echogenicity, 1 (6.7%) was hyperechoic, and 4 (26.7%) were isoechoic. TRUS finding of a hypoechoic lesion was significantly associated with malignancy. Other TRUS findings such as texture, calcification, and cysts did not show any association with malignancy. Mortality was zero after ultrasound-guided prostate biopsy. TRUS is the diagnostic test of choice in detection of prostate cancer. With advances in the technique of TRUS, effort is being made to identify more subtle lesions in order to reduce random biopsies. 4-Dimensional TRUS does improve the diagnostic accuracy but there is still a group of patients with "invisible" cancers. Therefore, the policy of random biopsies has to be continued till this incidence can be eliminated.

Antioxidant enzyme level in the testes of cirrhotic rats.

OBJECTIVES: An understanding of the tissue and organ level of antioxidant enzymes that scavenge reactive oxygen species may provide an indication of their susceptibility to free radical-related cytotoxic damage. A direct association between testicular production of excessive reactive oxygen species and male infertility has been noted. We measured the activities of superoxide dismutase and glutathione peroxidase in the testes of thioacetamide-induced cirrhotic rats. METHODS: Antioxidant enzyme activities and trace element levels (copper, zinc, manganese, and selenium) in the testes of thioacetamide-induced cirrhotic and control rats were measured. The statistical difference between the experimental and control groups with regard to the activities of superoxide dismutase and glutathione peroxidase and levels of trace elements was analyzed with Student's t test. RESULTS: Our results showed a significant decrease in the activity of these enzymes in the testes of cirrhotic rats. The testicular levels of copper, zinc, and manganese, which are associated with these antioxidant enzymes, increased, whereas selenium decreased slightly in cirrhotic rats; that decrease was not statistically significant. CONCLUSIONS: Our studies showed a drastic decrease in the level of antioxidant enzymes in the testes of cirrhotic rats that could have deleterious effects on sperm function in these animals. Further studies are necessary to understand the exact pathways of trace element metabolism in the testes of cirrhotic rats.

Bilateral emphysematous pyelonephritis and emphysematous cystitis with autosomal-dominant polycystic kidney disease: is conservative management justified?

OBJECTIVE: To report a case of bilateral emphysematous pyelonephritis (EPN) and emphysematous cystitis in a 64-year-old diabetic male with autosomal-dominant polycystic kidney disease (ADPKD). CASE PRESENTATION AND INTERVENTION: A 64-year-old diabetic male presented with worsening of renal function and fluid overload. Diagnosis was confirmed by computerized tomography (CT scan) and conservative management with broad-spectrum antibiotics was instituted. There was good clinical response and repeated CT scan showed complete resolution. CONCLUSION: This case shows that conservative management is an acceptable alternative to surgery in EPN occurring with ADPKD. However, it is recommended that patients should be closely monitored, both clinically and radiologically, and percutaneous catheter drainage or surgical intervention carried out whenever deemed necessary.

Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia: a preliminary assessment of the Prostalund feedback treatment machine.

OBJECTIVE: The aim of this preliminary study was to evaluate the efficacy of Prostalund feedback treatment (PLFT) using microwave thermotherapy equipment for benign prostate hyperplasia (BPH) in patients with urinary retention and an indwelling urethral catheter. SUBJECTS AND METHODS: Four unselected patients, 51-68 years old (mean age 60 years), with urinary retention and an indwelling catheter were treated with PLFT under local anaesthesia and sedation. They were considered high-risk patients for treatment by transurethral resection of the prostate (TURP) under spinal or general anaesthesia. Initial assessment included prostate-specific antigen, determination of prostate volume and exclusion of prostate cancer using transrectal ultrasound (TRUS). The patients had the indwelling catheter for 1-2 weeks prior to treatment, the urethral catheters were removed 10-12 days after PLFT. Two patients who failed to void after transurethral microwave thermotherapy underwent urodynamic study to determine the reason for failure. RESULT: The mean volume of the treated prostate gland was 75.50 cm3 (range 51-150 cm3). Two of the 4 patients were successfully relieved of their indwelling catheter with satisfactory peak flow, residual urine and symptom score, while treatment failed in the remaining 2. The reasons for the failure were identified as a small bladder capacity and neurogenic bladder in a diabetic patient and the presence of a middle lobe with large protruding lateral lobes into the bladder of the other patient. The latter patient had a prostate volume of 150 cm3. 'Salvage' TURP in both patients revealed that PLFT caused extensive necrosis of prostatic tissue and the TURP was then accomplished with minimal blood loss (<200 ml) even in the patient with 150-gram prostate. There were no serious complications such as bleeding, sepsis, rectoprostatic fistula or urine incontinence. CONCLUSION: The result of this preliminary investigation appears to be satisfactory and indicates that PLFT could be a good, minimally invasive alternative to surgery for BPH patients with retention of urine and an indwelling catheter.

The acute scrotum: a review of 40 cases.

OBJECTIVE: To determine the relative importance of clinical presentation, laboratory studies, and ultrasonography in the diagnosis of acute scrotum, and to suggest an effective method of management. SUBJECTS AND METHODS: Forty patients who were hospitalized between January 2002 and December 2002 for acute scrotum were studied with respect to history, physical examination, blood tests, urine analysis including culture, and scrotal ultrasonography with color Doppler study. RESULTS: Epididymitis (n = 24) was the commonest cause of acute scrotum followed by testicular torsion (n = 11), torsion of testicular appendages (n = 4), and idiopathic scrotal edema (n = 1). Both mean age (40.7 vs. 13.8 years), and average duration of pain at presentation (4.5 days vs. 19.1 h) were higher in patients with epididymitis than in torsion. Onset was usually insidious in epididymitis, sudden in testicular torsion, and variable in torsion of testicular appendages. The majority (87.5%) of patients with epididymitis were managed conservatively. The testis was salvaged in 81.8% of patients with testicular torsion. The accuracy of ultrasonography was only 72.7% in testicular torsion, but was good in epididymitis. CONCLUSION: Our results show that a careful clinical evaluation, by an experienced examiner, provides the correct diagnosis in acute scrotum rather than ultrasonography. It is of utmost importance to exclude testicular torsion in those who are younger than 16 years and whose pain duration is less than 24 h.