Male Sexual Dysfunction-Related Medical Comorbidities in a Tertiary Care Center, Western Region, Saudi Arabia.

INTRODUCTION: Sexual functionality is considered a vital component of human life and quality of life. Issues with sexual functionality can be a source of distress, lower self-esteem, and lower quality of life. Early detection of medical comorbidities can significantly lower the effect on sexual function. In Saudi Arabia, studies investigating the association between medical comorbidities and male sexual dysfunction (MSD) are limited. Therefore, our goal was to fill this knowledge gap. AIM: This study aimed to analyze and elaborate on all cases of MSD at a tertiary hospital, in Jeddah, Saudi Arabia from 2016 to 2021. METHOD: This is a cross-sectional retrospective study. The medical records of 321 patients diagnosed with MSD from 2016 to 2021 were reviewed retrospectively. The age, sex, type of sexual dysfunction, comorbidities, and lipids profile were some of the factors obtained from the patient's computerized medical records. RESULTS: The study population included 321 men with MSD and a mean age of approximately 53 years (SD=11.5). Among the sexual dysfunction pattern, only erectile dysfunction (ED) was found in 279 (86.9%) patients. ED duration lasted one to five years in 169 (52.8%) patients. Most of the patients (196, 61.1%) had mild ED severity. Medical causes were seen in 278 (80.4%) patients. The most frequent comorbidities were diabetes mellitus (DM) in 179 (55.8%) patients, hypertension (HTN) in 155 (48.2%) patients, and dyslipidemia in 113 (35.2%) patients. Smoking was not a risk factor for ED. The risk of having a severe form of ED was associated with idiopathic causes, HTN, DM, and ischemic heart disease (IHD). The risk of having a long duration of ED was related to idiopathic causes of ED and high serum creatinine levels. CONCLUSION:  In conclusion, patients diagnosed with DM, HTN, and IHD are at greater risk to experience a severe form of ED. It is crucial to keep erection function in mind for patients with DM, HTN, and IHD as this is associated with severe ED.

Upper Urinary Tract Urothelial Carcinoma With Squamous, Glandular, and Sarcomatoid Variants in a Horseshoe Kidney: A Novel Case Report and Literature Review.

Horseshoe kidney is a congenital anomaly, which consists of fusion of the lower poles of the kidneys. Cancer in a horseshoe kidney is common, possibly because of the increased risk of chronic obstruction, renal calculi, and recurrent urinary infection. We report a case of a 64-year-old male with a horseshoe kidney who presented to our hospital with gross hematuria and flank pain, which was highly suggestive of pyelonephritis. Comprehensive workup and imaging were performed and showed an extremely rare form of tumor consisting of three histological variants: squamous, glandular, and sarcomatoid. To the best of our knowledge, this is the first case reported with these three histological variants in a horseshoe kidney.

Comparison of a magnetic retrieval device vs. flexible cystoscopy for removal of ureteral stents in renal transplant patients: A randomized controlled trial.

INTRODUCTION: Placement of a ureteral stent at the time of renal transplantation can reduce complications when compared to non-stented anastomoses. Removal by flexible cystoscopy can be associated with discomfort, risk for infection, and high costs. New magnetic stents offer a means of bypassing cystoscopy by use of a magnetic retrieval device. Our objective was to compare clinical and cost-related outcomes of conventional and magnetic stents in patients undergoing deceased donor renal transplantation. METHODS: Patients were randomized to receive either a conventional or a Black-Star® magnetic stent. Clinical, procedural, and cost outcomes were assessed, and the Ureteral Stent Symptom Questionnaire (USSQ) was administered with the stent in situ and after stent removal. All variables were compared between groups. RESULTS: Forty-one patients were randomized to conventional (n=19) or Black-Star (n=22) stent. The total time for stent removal under cystoscopy was significantly longer compared to Black-Star removal (6.67±2.47 and 4.80±2.21 minutes, respectively, p=0.019). No differences were found in the USSQ domains between groups. Rates of urinary tract infections and surgical complications between groups were similar. Stent removal was well-tolerated in both groups. Black-Star stent use resulted in a cost savings of $304.02 Canadian dollars (CAD) per case. CONCLUSIONS: USSQ scores suggest that stent removal with the Black-Star magnetic stent is as equally well-tolerated as flexible cystoscopy by renal transplant patients. Black-Star stent removal was significantly faster than conventional stents. No differences in discomfort, infection rate, or complication rate were found. Use of the Black-Star stent resulted in an estimated annual savings of $27 360 CAD at our centre.

A prospective, randomized, pilot trial of a polyethylene glycol (PEG)-coated collagen patch (Hemopatch®) for intraoperative hemostasis during deceased donor renal transplant.

INTRODUCTION: The objective of this study was to evaluate the safety and feasibility of using a polyethylene glycol (PEG)-coated collagen patch (Hemopatch®) in patients undergoing deceased donor renal transplant. The primary outcome was the amount of intraoperative estimated blood loss in those patients receiving the patch compared to without. Secondary outcomes were the subjective achievement of hemostasis, perigraft collection, and drop in hemoglobin 48 hours postoperatively. METHODS: We performed a single-center, prospective, randomized trial. Patients scheduled to undergo deceased donor renal transplant surgery were randomized to receive the PEG-coated patch or standard hemostasis (i.e., electrocautery and clips). RESULTS: A total of 30 patients were enrolled over 15 months and randomized to receive the PEG-coated patch (n=15) or standard hemostasis (n=15). The mean age was 62.5 years. As determined by the operating surgeon, hemostasis was successfully achieved in all 15 cases using the PEG-coated patch. In the PEG-coated patch group, there was a trend towards less estimated blood loss (237 cc vs. 327 cc; p=0.11) and a lower drop in hemoglobin 48 hours postoperatively (22.27 g/L vs. 29.53 g/L; p=0.09) compared to the standard hemostasis group. Perigraft collection was similar between groups (27% vs. 40%; p=0.43). Subgroup analysis on patients who received anticoagulation therapy revealed no significant difference in blood loss between groups. CONCLUSIONS: Based on our single-center experience, the PEG-coated patch (Hemopatch®) is a safe and feasible option to aid hemostasis during deceased donor renal transplant surgery. Hemostasis was successfully achieved in all cases using the PEG-coated patch.