Is Holmium Laser Enucleation of Prostate equally effective in management of benign prostatic hyperplasia patients with either voiding or storage lower urinary tract symptoms? A comparative study.

OBJECTIVE: To evaluate and compare the effectiveness and safety of holmium laser enucleation of prostate (HoLEP) in relieving either voiding or storage lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH) patients. MATERIALS AND METHODS: The charts of patients with BPH who underwent HoLEP for either predominant voiding or predominant storage LUTS at University of Cincinnati hospitals in the period between February 2015 and December 2020 were retrospectively reviewed and analyzed for changes in voiding symptomatology, storage symptomatology, hematuria, International Prostate Symptom Score (IPSS), peak flow rates (Qmax), presence of detrusor overactivity (DO), and post-voiding residual urine (PVR) from baseline to up to 6 months postoperatively. RESULTS: A total of 132 patients were included in the analysis. Patients were divided into two groups: Group 1 included BPH patients with predominant voiding LUTS (68 Patients) while group 2 involved those with predominant storage LUTS (64 Patients). HoLEP was equally effective in management of both groups with significant improvement in urodynamics study (UDS) parameters, patient voiding and storage symptomatology, and IPSS from preoperatively to up to 6 months postoperatively with relatively low procedure complication rate and postoperative need for medication or procedure. CONCLUSIONS: HoLEP is a safe, effective, and reliable minimally invasive surgical modality that can be relied on for BPH patients with either predominant voiding or predominant storage symptoms with relatively low procedure complicat.

Validating the Martini Staging System for Rectourethral Fistula: A Meta-Analysis of Postoperative Outcomes.

OBJECTIVE: To validate the Martini staging system for postoperative rectourethral fistula (RUF) utilizing data from previous studies to determine whether it can accurately predict postoperative success rate. METHODS: A systematic search of peer-reviewed studies was conducted through January, 2020. The primary inclusion criteria for the studies were studies that evaluated outcomes based on the etiology of the fistula (ie, radiotherapy/ablation [RA] vs nonradiotherapy/ablation [NRA]). Martini RUF classification was utilized for the subgroup analysis. RESULTS: Out of 1948 papers, 7 studies with a total of 490 patients (251 in RA vs 239 NRA) were included in this study. Receiving RA increased the risk of permanent bowel diversion by 11.1 folds, eventual fistula recurrence by 9.1 folds, and post-op urinary incontinence (UI) by 2.6 folds. Similarly, compared to a Grade 0 fistula, a Grade I fistula increased the risk of permanent bowel diversion by 9.1 folds, fistula recurrence by 20 folds, and post-op UI by 2.7 folds. There were some valuable variables that were not captured by the Martini classification. CONCLUSION: Overall, the Martini classification system is efficacious in stratifying post-op complications from RUF repair based on the grade and etiology; however, it is limited in application. There is an opportunity for the development of more comprehensive staging systems in this domain.

Pediatric Microsurgery in the Reconstruction of Complex Posttraumatic Foot and Ankle Defects: A Long-Term Follow-Up with a Comprehensive Review of the Literature.

BACKGROUND: Lower limb reconstruction is a well-recognized challenge to the trauma or plastic surgeon. Although techniques and outcomes in the adult population are well documented, they are less so in the pediatric population. Here, we present our experience in the management of posttraumatic foot and ankle defects with free tissue transfer in children. METHODS: We performed a retrospective analysis of 40 pediatric patients between the ages of 3 and 16 from 2008 to 2016 who underwent foot and ankle soft tissue reconstruction. Any patient who underwent reconstruction for any reason other than trauma was excluded. Data were collected on operative time, free tissue transfer type, use of vein grafts, length of hospital stay, and postoperative morbidity. Also, a comprehensive systematic literature review was completed according to the PRISMA protocol for all previous reports of foot and ankle reconstruction in the young age group with free tissue transfer. RESULTS: Of our 40 patients, 23 were males and 12 females, free tissue transfer was used to reconstruct primarily the dorsum (71%), heel (11%), medial (9%), and lateral (3%) aspect of the foot. The anterior tibial artery was the predominant recipient vessel for anastomosis (77%). Mean inpatient stay was 9 days and our complication rate was 20%, primarily of superficial infection treated with antibiotic therapy. The review of the literature articles is completely analyzed in detail. CONCLUSION: The need for durable coverage of exposed joints, tendons, fractures, or hardware makes the free flap particularly well suited to trauma reconstruction of the foot and ankle. The lack of underlying vascular disease in this patient group allows for low complication rates. Our study evidences the safety and positive long-term outcomes of free tissue transfer for the reconstruction of huge sized-soft tissue defects of the foot and ankle in children.

Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy.

The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.

Down-regulated claudin-7 immunoexpression in urothelial carcinoma of the urinary bladder.

OBJECTIVES: To analyse the gene-expression level of claudin-7 in urothelial carcinoma (UC) of the urinary bladder, and its relationship with clinicopathological variables. MATERIALS AND METHODS: This study included 68 specimens of UC of the bladder, comprising 35 with non-muscle-invasive (NMI), stage Ta-T1, and 33 with muscle-invasive (MI) tumours, T2-T4, and 26 of normal urothelium (NU). Total RNA was extracted and 1 µg was reverse transcribed using a cDNA kit. RT-PCR was conducted using SYBR Green I dye to examine the expression levels of the target gene (claudin-7) and the housekeeping gene glyceraldehyde-3-phosphate dehydrogenase. Using confocal-laser scanning light microscopy, immunohistochemistry (IHC) was used to validate the RT-PCR data. The correlation between claudin-7 and the clinicopathological variables was assessed. RESULTS: Claudin-7 was down-regulated in UC samples compared to NU samples (P < 0.001). NMI (Ta-T1) tumours had significantly higher claudin-7 expression than MI (⩾pT2) tumours (P = 0.012). There was no significant difference between patients with G1-2 tumours and those with G3 tumours (P = 0.19). There was no significant difference between patients with recurrent NMI UC and those with no recurrence (P = 0.61). IHC showed a lower expression of claudin-7 in the UC samples than NU samples, and in MI UC than in NMI UC. CONCLUSIONS: These results indicate that a reduced expression of claudin-7 correlates with the invasiveness and progression of UC of the urinary bladder. Further studies are needed to validate claudin-7 as a marker for UC.

Straddle injuries to the bulbar urethra: management and outcome in 53 patients.

OBJECTIVE: To describe our experience with blunt injuries to the bulbar urethra and their late sequelae to identify factors that may affect patient outcome. MATERIALS AND METHODS: A retrospective study was performed on 53 male patients who presented, between January 2001 and December 2005, with blunt traumatic injury to the bulbar urethra. The definitive diagnosis of urethral rupture was made by retrograde urethrography, where urethral rupture was classified into partial or complete. The minimum follow-up period was 3 years. The initial management was either suprapubic cystostomy or endoscopic urethral realignment over a urethral catheter using a cystoscope to pass a guide-wire over which the catheter was inserted. Stricture formation was managed by visual internal urethrotomy (VIU) for passable strictures and urethroplasty (stricture excision and re-anastomosis) for impassable strictures or recurrence after VIU. The follow-up period was three years. The results were analyzed by SPSS software (chi-square and Student's-t-test). RESULTS: Stricture formation occurred in 19 of 22 patients (86%) with complete urethral rupture and in 10 of 31 (32%) with partial rupture (p < 0.001). Strictures occurred in 11 of 31 (35%) patients treated initially with suprapubic cystostomy and in 18 of 22 (82%) treated with primary urethral realignment (p < 0.001). The success rate after VIU was 15% (4 of 26 patients) and after urethroplasty it was 96% (24 of 25 patients) (p < 0.001). CONCLUSIONS: Suprapubic cystostomy is better than urethral realignment and catheterization as primary management after straddle injury to the bulbar urethra. Stricture excision and re-anastomosis is better than VIU as delayed management for strictures that develop after straddle injury to the bulbar urethra.

Straddle injuries to the bulbar urethra: management and outcome in 53 patients

Objective: To describe our experience with blunt injuries to the bulbar urethra and their late sequelae to identify factors that may affect patient outcome. Materials and Methods: A retrospective study was performed on 53 male patients who presented, between January 2001 and December 2005, with blunt traumatic injury to the bulbar urethra. The definitive diagnosis of urethral rupture was made by retrograde urethrography, where urethral rupture was classified into partial or complete. The minimum follow-up period was 3 years. The initial management was either suprapubic cystostomy or endoscopic urethral realignment over a urethral catheter using a cystoscope to pass a guide-wire over which the catheter was inserted. Stricture formation was managed by visual internal urethrotomy (VIU) for passable strictures and urethroplasty (stricture excision and re-anastomosis) for impassable strictures or recurrence after VIU. The follow-up period was three years. The results were analyzed by SPSS software (chi-square and Student's-t-test). Results: Stricture formation occurred in 19 of 22 patients (86 percent) with complete urethral rupture and in 10 of 31 (32 percent) with partial rupture (p < 0.001). Strictures occurred in 11 of 31 (35 percent) patients treated initially with suprapubic cystostomy and in 18 of 22 (82 percent) treated with primary urethral realignment (p < 0.001). The success rate after VIU was 15 percent (4 of 26 patients) and after urethroplasty it was 96 percent (24 of 25 patients) (p < 0.001). Conclusions: Suprapubic cystostomy is better than urethral realignment and catheterization as primary management after straddle injury to the bulbar urethra. Stricture excision and re-anastomosis is better than VIU as delayed management for strictures that develop after straddle injury to the bulbar urethra.

Management of calculus anuria in children: experience of 54 cases.

OBJECTIVE: To evaluate the outcome of different treatment plans for calculus anuria in children. PATIENTS AND METHODS: Patients were subdivided into three groups, A, B and C. Group A included patients who were critically ill, had serum creatinine> or =3.5mg/dl, blood urea> or =100mg/dl, serum potassium> or =7meq/l and/or blood pH< or =7.1; and they were treated initially by peritoneal dialysis. Patients in groups B and C were stable with serum creatinine<3.5mg/dl, blood urea<100mg/dl, serum potassium level<7meq/l and blood pH>7.1. In group B, the obstructing stone could not be localized, and they were treated either by percutaneous nephrostomy or JJ stent. In group C, stone level was confidently determined and patients were treated by open surgery. RESULTS: Fifty-four patients were included. All patients regained normal serum creatinine levels within 72-120h. Overall complication rate in groups A and C was 26% and 13%, respectively. In group B, overall complication rate was 66% for percutaneous nephrostomy and 50% for internal stent. CONCLUSIONS: Urinary diversion in children is associated with a high complication rate while dialysis is highly effective in children. Formal surgery in compensated children is associated with a low complication rate with good outcome and early recovery.