Where do urologists stand in the era of novel coronavirus-2019 disease.

PURPOSE OF REVIEW: The novel coronavirus-2019 disease (COVID-19) pandemic has had devastating consequences on healthcare systems globally. The effect this has on urologists and the patients they care for is not fully understood and presents the challenge of prioritizing the most urgent cases. We aim to review the impact on urology services and evaluate strategies to minimize disruption. RECENT FINDINGS: Various healthcare systems have been forced to postpone treatment for many urological conditions as resources are dedicated to the treatment of COVID-19. Training has been postponed as staff are reallocated to areas of need. Face-to-face contact is largely minimized and innovative, virtual communication methods are used in the outpatient setting and multidisciplinary team meetings. Surgical practice is changing because of the risks posed by COVID-19 and procedures can be prioritized in a nonurgent, low priority, high priority or emergency category. SUMMARY: Although the COVID-19 pandemic will inevitably affect urological services, steps can be taken to mitigate the impact and prioritize the patients most in need of urgent care. Similarly, in future; simulation, e-learning and webinars will allow interaction to share, discuss and debate focused training and education.

The impact of tissue glue in wound healing of head and neck patients undergoing neck dissection.

We investigated the impact of fibrin glue on postoperative drainage amount and duration in head and neck cancer patients who underwent neck dissection. This study was a prospective randomized controlled trial. Patients who were scheduled to undergo neck dissection due to head and neck cancer were eligible for this study. After receiving a detailed explanation, all patients signed an informed consent form before enrollment. Patients were then randomly assigned to the study group (fibrin glue) or control group. In the study group, 2 ml of fibrin glue (Tissucol(®); Duploject, Baxter AG) was applied on the surface of the surgical wound before closure. Basic demographic data along with tumor-related features, operation-related variables, postoperative drainage amount/duration, postoperative pain, and analgesic usage were collected and analyzed. A total of 15 patients were included in the final analyses, with eight patients in the study group and seven patients in the control group. No significant differences were found between the two groups in age, gender, primary site, clinical N stage, neck dissection levels, perioperative bleeding, postoperative drainage amount/duration, hospitalization duration, and postoperative pain status. The application of 2 ml fibrin glue by the method described herein did not reduce the postoperative drainage amount/duration nor the postoperative pain status in patients who underwent neck dissection.

Guideline of guidelines for kidney and bladder stones.

Urological organizations publish detailed evidence-based guidelines to support the urologists in the management of urolithiasis. Our objective was to provide clear guidance on the management of urolithiasis, compare the American Urological Association (AUA) and European Association of Urologists (EAU) guidelines, and present an algorithm for different clinical scenarios. The latest AUA and EAU guidelines on urolithiasis were evaluated for the level of evidence and grade of recommendation. All recommendations on management of urolithiasis (surgical and medical management) were reviewed and included. Both the organizations provide guidance for initial patient assessment, imaging requirements, and therapeutic options, including surgical intervention and medical therapy. In addition, these guidelines provide advice for managing specific patient groups, including pediatric patients and pregnant patients. Although there is a general concordance between both the groups, differences exist particularly for recommended modality of surgical intervention depending on stone location and size. Although both the guidelines were broadly similar, we also highlighted the variations in the level of evidence and grade of recommendation. Although these guidelines provide a valuable evidence-based framework to support the management of urinary tract stones, their implementation must be tailored to individual patient needs and available resources.

What do urologists need to know: Diagnosis, treatment, and follow-up during COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) is an infectious disease which is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It has had unprecedented effect on healthcare systems globally with severe impact on every specialist service within the hospital including urology. While it affects the respiratory system causing symptoms ranging from fever, cough, dyspnea, diarrhea, nausea, myalgia and fatigue, it eventually causes pneumonia and respiratory distress needing oxygenation and ventilation. Laboratory diagnosis is required to confirm the diagnosis of COVID-19. Radiological changes are seen on chest XR or CT scan of patients. The surge in patients affected by the disease has led to extreme pressures on healthcare systems by the overwhelming number of critically unwell patients. This scenario has presented challenges to maintain other emergency and essential services. Reallocation of staff, wards and equipment has resulted in cancellations of many surgical procedures, requiring urologists to select only the most essential or critical procedures. The outpatient face-to-face clinics are also cancelled or changed to telephone or video consultations. In some hospitals, urologists are required to work outside of their usual scope of practice helping their respiratory and intensive care unit colleagues. The pandemic is disrupting training and education opportunities for junior medical staff. In this review we provide guidance on the diagnosis and management of COVID-19, the influence it has on urological practice and consider the long-term implications that may be of consequence for years to come.

Apnoea is not necessary for flexible ureteroscopy and lasertripsy of renal stones: a prospective study over 6 years.

INTRODUCTION: Temporary apnoea is often practiced during flexible ureteroscopy and lasertripsy (FURSL) for renal stones to reduce the potential movement of kidney secondary to respiratory excursions. While apnoea can help, it can also lead to respiratory complications, longer operative duration and ultimately prolong the length of hospital stay (LOS). The aim of this study was to look at the outcomes of FURSL without the use of apnoea. MATERIAL AND METHODS: Over a 6-year period from March 2012-June 2018, consecutive cases of adult FURSL were prospectively evaluated. Patients underwent surgical and anaesthetic counselling, pre-operative assessment and protocol-based general anaesthetic without using apnoea. Data on patient and stone demographics, operative details, LOS, stone-free rate (SFR) and complication rates were collected and analysed. RESULTS: A total of 292 patients underwent FURSL, with a mean age of 57 years and male:female ratio of 1.6:1. Pre and post-operative stents were inserted in 28.8% and 81.2%, a ureteral access sheath (UAS) was used in 61.6%. The mean single and cumulative stone sizes were 10.2 ±5.9 mm and 14.3 ±10.4 mm respectively. For a mean operative time of 48.8 ±25.5 minutes, the SFR was 88.7%.The median length of stay was 0 days with 216 (74.0%) patients discharged the same day and a further 48 (16.4%) discharged within 24 hours. There were 11 complications, of which 10 were Clavien I/II, and 1 was Clavien IV. CONCLUSIONS: Ureteroscopy can be safely performed without respiratory apnoea, using anaesthetic and surgical protocols. It improves day-case rates for FURSL and minimizes complications.

The effect of proton pump inhibitors on the gastric mucosal microenvironment.

BACKGROUND: Proton pump inhibitors (PPIs) are widely applied for acid related disorders, and possess pleiotropic biological functions. The effect of PPIs on the gastric mucosa, neutrophil and Helicobacter pylori (H. pylori) infiltration and glandular atrophy has not been well investigated, particularly the duration of the effects of PPIs. OBJECTIVES: To investigate the effects of PPIs on neutrophil infiltration, H. pylori infiltration and the gastric mucosa. MATERIAL AND METHODS: A total of 76 adult patients with gastrointestinal symptoms who had undergone upper gastrointestinal endoscopy were enrolled in the study. Each patient's history was recorded, including smoking, alcohol consumption and the duration of PPI use prior to gastric biopsy. Endoscopic biopsies of gastric antral mucosa were performed and evaluated by histology. Neutrophil and H. pylori infiltration were graded by H & E staining in accordance with the updated Sydney system. RESULTS: Among the 76 patients, 44 patients had H. pylori infection and 19 patients had taken PPIs for varying durations prior to gastric biopsy. Neutrophil infiltration was significantly inhibited by PPIs (p = 0.005). The duration of PPI use was correlated with inhibition of neutrophil and H. pylori infiltration. A logistical regression analysis demonstrated that PPIs significantly inhibited neutrophil infiltration in the gastric mucosa and were associated with atrophy of the mucosa. CONCLUSIONS: PPIs attenuated neutrophil infiltration of gastric mucosa, and may be related to atrophy of the mucosa.

Determinants of in-hospital mortality after surgery for acute type A aortic dissection.

BACKGROUND AND PURPOSE: Acute type A aortic dissection presents a formidable challenge for the cardiac surgeon, although remarkable improvements have been achieved in diagnosis, surgical techniques and perioperative management. The aim of this study was to identify the most important variables associated with in-hospital mortality in patients undergoing surgery for this condition. METHODS: Between July 1998 and June 2002, 80 patients underwent surgery for acute type A aortic dissection. Univariate and multivariate analyses were performed to identify the variables independently correlated with in-hospital mortality. RESULTS: The overall in-hospital mortality rate was 20% (16/80 patients). Univariate analysis revealed 24 preoperative and operative variables, including type of surgery, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, diabetes mellitus, and postoperative (postoperative 24 hours) bleeding > or = 1500 mL, as factors associated with in-hospital death. Stepwise logistic regression analysis showed the factors independently associated with in-hospital death were CPB time, diabetes mellitus, and postoperative bleeding > or = 1500 mL (p <0.05). CONCLUSIONS: Multiple factors affect in-hospital mortality after surgery for acute type A aortic dissection. This study suggests that CPB time, diabetes mellitus and postoperative bleeding > or = 1500 mL are the main determinants of in-hospital death.

Effect of the herbal drug guilu erxian jiao on muscle strength, articular pain, and disability in elderly men with knee osteoarthritis.

Background. Guilu Erxian Jiao (GEJ) is a widely used Chinese herbal remedy for knee osteoarthritis, but its clinical efficacy is unknown. Methods. We enrolled 42 elderly male patients with knee OA, including 21 patients who received the herbal drug GEJ as the case group and 21 patients who did not receive GEJ as the control group. The effects of 12 weeks of GEJ treatment on muscle strength of lower limbs were measured by a Biodex dynamometer, with disability evaluated on the Lequesne index and articular pain measured on the visual analog scale (VAS) between the two groups on the baseline and after treatment. Results. There were significant increases in the levels of muscle strength of TQ/BW-ext-dominant and TQ/BW-flex-dominant between the two groups after treatment (P < 0.05). There were also significant increases in muscle strength of knee extensor muscles in the GEJ-treated group (n = 21) self-controlled before and after 12 weeks of treatment (all P < 0.01). There were significant decreases in articular pain (P < 0.01) and Lequesne index scores (P < 0.01) in the GEJ-treated group when compared to the non-GEJ-treated group. Conclusions. Our results showed that GEJ is effective and is tolerated well in elderly men with knee OA.

Surgical site infection after preoperative neoadjuvant chemotherapy in patients with locally advanced oral squamous cell carcinoma.

BACKGROUND: We investigated whether preoperative neoadjuvant chemotherapy is associated with increased surgical site infection (SSI) rate in patients with locally advanced oral cancer. METHODS: In this hospital-based study, we retrospectively reviewed over 2000 chart records of patients with oral cavity cancer from March 1994 to December 2007. Those who received neoadjuvant chemotherapy were identified and matched for age, sex, tumor classification, primary site, and reconstruction methods to hospitalized patients who did not receive chemotherapy. Data were analyzed for the relationship between chemotherapy and SSI. RESULTS: A total of 306 patients were enrolled for final analyses. The overall postoperative SSI rate was 31.0%. The SSI rate in patients after neoadjuvant chemotherapy was similar to that in patients who did not receive the chemotherapy (33.3% vs 29.9%, p = .631). CONCLUSIONS: Preoperative neoadjuvant chemotherapy was not associated with increased SSI rate in patients with locally advanced oral cancer.