Prostatic abscess Metastasis: A case report of an unusual complication.

Endogenous endophthalmitis, a rare and severe ocular infection, is typically associated with endogenous infections that reach the eye, while prostatic abscesses pose clinical challenges and are more common in immunocompromised patients. We present a case of a 50-year-old male with endophthalmitis resulting from a prostatic abscess. The patient's journey underscores the need for heightened awareness of prostatic abscess in patients with perineal symptoms, especially those with immunosuppression, and the consideration of endophthalmitis as a potential complication in urologic disease. The case highlights the urgent need for standardized guidelines in managing prostatic abscesses, given their complexity and potential for severe complications.

Recreational use of oral erectile dysfunction medications among male physicians - A cross-sectional study.

Introduction: Erectile dysfunction (ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Bypassing health-care providers and obtaining ED medications (EDM) without a prescription are an issue that is faced globally. Aim: We attempt to assess erectile function (EF) among a local sample of physicians, the psychological effects of recreational EDM use, and compare EF among different user groups. Methods: This is a cross-sectional study done solely on physicians in Saudi Arabia. A self-designed questionnaire including demographics, sexual characteristics, use of ED medication, sexual satisfaction, and the validated international index of EF (IIEF). Outcome: Physicians misused EDM. Results: A total of 503 physicians completed the questionnaire. Among participants reporting sexual problems, only 23% received counseling and 3.4% were professionally diagnosed with ED. Among users, 71.2% were using EDM recreationally, 14.4% prophylactically, and 14.4% were prescribed. Participants aged 20-29 IIEF-5 score was significantly lower than participants aged 30-39 years. Prescribed users had a lower IIEF-5 score compared to both recreational users and nonusers. Clinical Implications: Many healthy sexually active men use EDMs recreationally to increase sexual performance. Strengths and Limitations: One of the limitations of our study is that we did not use standardized tools to determine the diagnosis of some important disorders like premature ejaculation. Our study strengths include the very high response rate, with our results truly showing a nationwide self-assessment of sexual dysfunction. Conclusion: Recreational use of oral EDMs may adversely impact the psychological aspects of sexual function. In our study, physicians misused EDM. We recommend labeling EDMs as restricted medication that requires a prescription to use by a licensed physician.

Enhanced fluid drainage using a novel multi-pod drainage catheter: An in vitro evaluation.

BACKGROUND: A multi-pod catheter (MPC) is a large drainage catheter that can house multiple smaller retractable (MPC-R) and deployable catheters (MPC-D) within the body. OBJECTIVE: The drainage capabilities and resistance to clogging of a novel MPC have been assessed. METHODS: The drainage capabilities are evaluated by placing the MPC in a bag of either a non-clogging (H2O) or clogging medium. The results are then compared to matched-size single-lumen catheters with either a close (CTC) or open tip (OTC). The means of five test runs were used to measure drainage rate, maximum drained volume (MaxDV), and time to drain the first 200 mL (TTD200). RESULTS: In the non-clogging medium, MPC-D had a slightly higher MaxDV than MPC-R, and higher flow rate than CTC and MPC-R. Moreover, MPC-D needed less TTD200 than MPC-R. In the clogging medium, MPC-D had a higher MaxDV than CTC and OTC, higher flow rate, and faster TTD200 than CTC. However, comparison with MPC-R showed no significant difference. CONCLUSION: The novel catheter may offer superior drainage compared to the single-lumen catheter in a clogging medium, implying various clinical applications, particularly when clogging is a potential risk. Further testing may be required to simulate various clinical scenarios.

Evaluation of the urology residency training program in Saudi Arabia: A cross-sectional study.

PURPOSE: This study evaluates the satisfaction of urology residents with the Saudi Board of Urology (SBU) Training Program and identifies areas of weakness and strength to improve the educational environment, surgical competency, and overall satisfaction of urology residents with the program. METHODS: We administered an electronic self-made questionnaire that included two sections. One comprised demographic data (age, gender, weight, height, marital status, level of training, city of training, and center of training), while the other concerned SBU evaluation (satisfaction with different aspects of training, such as ways of assessment, mentors' feedback, surgical competency, research, and strengths and weaknesses of SBU). RESULTS: The overall satisfaction of urology residency program was 28.8% while 44.2% of residents had a neutral response. The highest level of satisfaction with clinical and surgical practice was among graduates (56.9%) and Riyadh residents (45.1%). Furthermore, good work/life balance received the lowest level of satisfaction (5.2%) among senior residents, while good clinical experience received the highest level (62.7%) among the graduates. Residents reported a high exposure in endourology and pediatric urology, while transplant, reconstructive, and neurourology had the lowest exposure. Forty-two percent of respondents undertook research during their residency training, but most respondents (54%) did not publish any research papers during their training. Sixty-two percent of graduates felt that their training program did not prepare them adequately to perform well on the board examinations. CONCLUSION: Our results confirmed that satisfaction of residents with the urology program process is variable according to the city of training. Having high satisfaction level in some cities reflects the improvement of urology training program after restructuring. We identified new areas in need of improvement, namely lack of mentorship, clear and formal assessment process, and variation of training process between central and peripheral programs.

Impact of COVID-19 pandemic on urology residency training.

CONTEXT: The COVID-19 pandemic has led a lot of countries worldwide to go on lockdown. Potential collateral damage is the impact of residency. AIMS: The aim of this study is to assess the impact of COVID-19 pandemic on urology training aspects, study habits of residents, and their awareness and training regarding COVID-19. SETTINGS AND DESIGN: A questionnaire aiming to assess the impact of COVID-19 pandemic on different urology training aspects. The questionnaire was sent to all urology residents under the Saudi Commission for Health Specialties (SCFHS) programs. SUBJECTS AND METHODS: Urology residents under SCFHS programs, excluding 1st-year residents. The questionnaire included the following sections: demographic data, studying habits during the pandemic, involvement in training before the pandemic, involvement in training during the pandemic, and training related to COVID-19. STATISTICAL ANALYSIS USED: Using the SPSS software, frequencies of all data were calculated, and a Wilcoxon-signed rank test was done to assess the change in ordinal data. RESULTS: A total of 77 residents completed the survey (38% response rate). Most residents (40.5%) reported that they "strongly agree" with the statement that they have more time for reading. There has been a decrease in on-call duties, outpatient visits, diagnostic procedures, endoscopic surgeries urology, minimally-invasive surgeries, and major open surgeries in comparison to before the pandemic, with a decrease in mean scores in all domains, especially in diagnostic procedures. CONCLUSIONS: There has been a decrease in residents' involvement in all training domains, and this has been similar to the results of other studies. E-learning sources, during these times, present themselves as a valuable source to compensate for what has been missed in training.

Survey of Saudi urology program directors: What do you look for in a candidate?

INTRODUCTION: Prospective urology applicants in Saudi Arabia must go through a rigorous matching process. Defining which aspects of an applicant's portfolio or interview will get them matched is difficult. Our objective is to provide information on which aspects of an application are the most important. SUBJECTS AND METHODS: In this cross-sectional study, an electronic survey was sent out to all urology program directors (PD). The survey included 27 items from an application that were rated by the respondent using a 5-point Likert scale. RESULTS: Twenty-three urology PD completed the survey (79.3% response rate). Most of the PD subspecialized in endourology and minimally invasive surgery. The three most important aspects as perceived by all responding PD were as follows: performance during rotation at the respondent's centre, publications in urology, and the total number of electives in urology. The three least important factors were as follows: presentations in fields other than urology, recommendation letters from nonurologists, and quality reference letters from nonurologists. CONCLUSION: Performance during rotations has been shown in our and other studies to be one of the most important factors in an application. Surveying PD on what they value the most in an applicant, provides valuable information and more transparency regarding the match processes. We also recommend that our colleagues from different specialties conduct similar studies.

"Tele-urology": Is the COVID-19 pandemic a wake-up call?

BACKGROUND: The purpose of this research is to measure the current use of telemedicine technologies among urologists, their readiness to adopt the same, and to assess the barriers preventing such usage. METHODS: Two hundred and twenty eight board-certified urologists completed our self-designed survey. An analysis was done to assess the increase in the use of telemedicine and the urologists' telemedicine experience responses. Data analysis was done using SPSS software. RESULTS: There has been a tremendous increase in the use of telemedicine among urologists during the coronavirus disease (COVID-19) pandemic. Most of the respondents of this study performed general urology as part of their daily practice (59.6%). Prior to the pandemic, 53.9% of the participants had never used any means of telemedicine. However, during the pandemic, 72.4% of urologists who had never used telemedicine began using the same. Almost all of the respondents agreed that physical examination is difficult when using telemedicine, which resulted in the highest mean value among the questionnaire items. Urologists below 35-year-old agreed, to a larger extent, that telemedicine saves them more time and is simple to use than urologists from other age groups. CONCLUSION: During the COVID-19 pandemic, most urologists adopted telemedicine technology rapidly. Adopting telemedicine in the future could have multiple advantages. However, the limitations of telemedicine should be respected in order to avoid compromising patient safety.

The status of medical malpractice litigations in Saudi Arabia: Analysis of the annual report.

CONTEXT: Medical malpractice is a leading cause of morbidity and mortality worldwide. Analyzing the current number of lawsuits and comparing it to previous years will help assess the status of medical malpractice litigations in Saudi Arabia. SUBJECTS AND METHODS: A review and analysis of the annual statistics book of the Medico-Legal Committees (MLCs) in Saudi Arabia over the years (1437-1439 H) was conducted. RESULTS: Over the 3-year study period, the total number of lawsuits was 3,684. The percentage of increase of malpractice lawsuits from 1437 until 1439 Hijri (2016-2018) was 26% (1,097-1,379 lawsuits). Obstetrics and Gynecology consistently had the highest number lawsuits compared to other specialties (25.6%), followed by dentistry (13.5%). Similarly, the rate of compensation after a lawsuit was highest in Obstetrics and Gynecology claims (62.7%), followed by dentistry (60%). The private healthcare sector consistently showed the highest number of lawsuits when compared to other healthcare providers, with a 73% increase over 3 years. The Ministry of Health showed an overall reduction in the number of lawsuits by 6.6% over the course of the study period. CONCLUSIONS: The number of lawsuits in Saudi Arabia is increasing rapidly. Understanding the reason for this is very important especially given the high rates of lawsuits for certain specialties and healthcare sectors. A root cause analysis cannot be conducted without a detailed reporting system for malpractice lawsuits; the development of which would help in research and the generation of solutions in this field.

Neural Network Analysis of Crystalluria Content to Predict Urinary Stone Type.

PURPOSE: To investigate the relationship between urinary stone type and the type of crystals in the urine. PATIENTS AND METHODS: This retrospective study involved 485 patients with urinary stones treated at King Saud University Medical City from May 2015 to June 2017. Clinical data were obtained from medical records. Different statistical analysis methods were applied, including basic contingency analysis, analysis of variance, logistic regression, discriminant analysis, partition modeling, and neural network evaluations. RESULTS: Of 485 patients, 47 had crystals detected by urinalysis. The most common type of crystal was calcium oxalate (n = 31), which had the highest association with calcium oxalate stones. Uric acid crystals (n = 8) were associated with uric acid stones. The neural network model used for determining the sensitivity and specificity showed an R-square value of 0.88, with an area under the curve of 0.94 for calcium oxalate, 0.94 for carbonate apatite, and 1.0 for uric acid. CONCLUSION: The predictive algorithm developed in the present study may be used with a patient's clinical parameters to predict the stone type. This approach predicts the stone types associated with certain patient characteristics with a high sensitivity and specificity, indicating that the models may be a valuable clinical tool in the diagnosis, management, and monitoring of stone diseases.

Study Habits of Urology Residents in Saudi Arabia: Identifying Defects and Areas for Curricular Development - A Trainee-Based Survey.

PURPOSE: This study evaluated the study habits of Saudi urology residents throughout their residency training. It examines the study time and quality of study materials used by Saudi urology residents and identifies ways to maximize study benefits. PATIENTS AND METHODS: An online questionnaire was distributed to 152 registered residents in regions throughout Saudi Arabia (response rate: 93.4%). The questionnaire addressed study habits throughout training, motivations for studying, preferred study resources, impressions on teaching quality, study preparation methods, and exam preparedness among junior and senior residents. RESULTS: Among all residents, 37.3% read for 2-5 hours weekly. Juniors read significantly more than seniors (P = 0.034). Marital status affects seniors' study habits (P = 0.029). For most seniors, preparation for the final board exam is the greatest motivation for studying (P = 0.006). The AUA/EAU guidelines were useful information source for seniors (P = 0.001). Fifty-four percent (54.4%) of residents felt that their residency program did not provide protected study time prior to the board exams. Moreover, the majority (64.8%) felt that the training program did not adequately prepare them for the board exams. CONCLUSION: We recommend that local program directors implement more effective teaching methods. Structured reading habits and specific study materials were found to be positive predictors of successful performance. Residents should also be educated in balancing working hours, social life, and study.

Mini gastric bypass for the management of gastrobronchial fistula: A case report.

INTRODUCTION: With the high rates of obesity worldwide, laparoscopic sleeve gastrectomy (LSG) has become a very popular procedure. Due to its simple technique, rare complications might be overseen. Gastric leaks and fistula are fairly uncommon complications. In comparison to other types of fistulas, gastrobronchial fistulas are rarer with serious complications. Definitive management is yet to be determined. We intend to explore the literature on the management approach of such patients. PRESENTATION OF CASE: A 46-year-old male, presented with on/off abdominal pain, productive cough, and vomiting. The patient had left sided rhonchi on examination. In addition to a history of laparoscopic sleeve gastrectomy (LSG) 4 years ago. Imaging confirmed the presence of a gastrobronchial fistula. Conservative and endoscopic treatment failed. Consecutively, surgery was indicated. A laparoscopic mini gastric bypass with refashioning of gastric fistula edges and closure with graham patch was done. CONCLUSION: Given the increasing number of such surgeries performed the recognition of acute and chronic complications, and their optimal management is of great importance. Although performing a Roux-en-Y fistulojejunostomy was recommended in the literature, conservative and endoscopic treatment should be considered before.