Evaluation of bipolar Transurethral Enucleation and Resection of the Prostate in terms of efficiency and patient satisfaction compared to retropubic open prostatectomy in prostates larger than 80 cc. A prospective randomized study.

OBJECTIVES: To compare the outcomes of bipolar Transurethral Enucleation Resection of the Prostate (TUERP) and simple retropubic prostatectomy in patients with prostate volumes larger than 80 cc. PATIENTS AND METHODS: A prospective randomized study included all patients amenable to surgeries for benign prostate hyperplasia (BPH) with prostate size over 80 cc at a tertiary care hospital between January 2020 to February 2022. Bipolar TUERP and Retropubic open prostatectomy techniques were compared regarding patients' demographics, intraoperative parameters, outcomes, and peri-operative complications. RESULTS: Ninety patients were included in our study and randomly assigned to bipolar TUERP (Group 1 = 45 patients) and retropubic open prostatectomy (Group 2 = 45 patients). The TUERP group demonstrated significantly lower operative time (77 ± 11 minutes vs. 99 ± 14 minutes, p < 0.001), hemoglobin drop (median = 1.1 vs. 2.5, p < 0.001), and resected tissue weight (71 ± 6.6 cc vs. 84.5 ± 10.6 cc, p < 0.001). Postoperatively, the TUERP group demonstrated significantly lower catheter time (median = 2 vs. 7 days, p < 0.001) and less hospital stay. IPSS, Qmax, and patient satisfaction were better in the TUERP group within six months of surgery. We reported 90-day complications after TUERP in 13.3% of patients compared to 17.8% after retropubic prostatectomy, with a statistically insignificant difference. Urethral stricture predominated after TUERP, while blood transfusion dominated in retropubic prostatectomy. CONCLUSIONS: The present study found that TUERP had equivalent efficacy and safety to open retropubic prostatectomy for patients with BPH and prostate volumes > 80 ml.

Value of preoperative ureteral wall thickness in prediction of impaction of ureteric stones stratified by size in laser ureteroscopic lithotripsy.

OBJECTIVES: To evaluate the role of preoperative UWT in the prediction of impaction of ureteral stones stratified according to stone size in ureteroscopic laser lithotripsy. PATIENT AND METHODS: This study included 154 patients submitted to URSL for ureteral stones. Radiological data comprised the presence of hydronephrosis, anteroposterior pelvic diameter (PAPD), proximal ureteric diameter (PUD), and maximum UWT at the stone site. Collected stone characteristics were stone size, side, number, site, and density. RESULTS: The study included 154 patients subjected to URSL. They comprised 74 patients (48.1%) with impacted stones and 80 (51.9%) with non-impacted stones. Patients were stratified into those with stone size ≤ 10 mm and others with stone size > 10 mm. In the former group, we found that stone impaction was significantly associated with higher PAPD, PUD, and UWT. In patients with stone size > 10 mm, stone impaction was related to higher UWT, more stone number, and higher frequency of stones located in the lower ureter. ROC curve analysis revealed good power of UWT in discrimination of stone impaction in all patients [AUC (95% CI) 0.65 (0.55-0.74)] at a cut-off of 3.8 mm, in patients with stone size ≤ 10 mm [AUC (95% CI) 0.76 (0.61-0.91)] at a cut-off of 4.1 mm and in patients with stone size > 10 mm [AUC (95% CI) 0.72 (0.62-0.83)] at a cut-off of 3.0 mm. CONCLUSIONS: Stratifying ureteric stones according to size would render UWT a more practical and clinically-oriented approach for the preoperative prediction of stone impaction.

Evaluation of Rezum therapy as a minimally invasive modality for management of Benign Prostatic Hyperplasia: A prospective observational study.

OBJECTIVE: To evaluate safety and efficacy of Rezum therapy as a minimally invasive modality for management of benign prostatic hyperplasia in patients with prostate volume < 80cc and those with prostate volume > 80cc. METHODS: Between June 2020 and February 2023, A total of 98 patients diagnosed with BPH and managed by Rezum were included in this study. Patients were divided based on their prostate volume of either less than 80 cc or greater than 80 cc. We evaluated several parameters related to their condition, including prostate volume, post-voiding residual (PVR) before and after surgery, number of treatments received, maximum urine flow rate (Qmax) before and after surgery and mean follow- up periods. RESULTS: The mean age was 68 years (SD 11.2). The median prostatic volume was 62 cc (IQR 41, 17). A maximum of 9 treatments were administered. Six months was determined to be the average post-operative follow-up period (IQR: 3.5-7.2). The mean preoperative total PSA was 2.7 (IQR 1, 2), preoperative mean PVR was 79.8 cm3, preoperative mean Qmax was 8.2 ml/s (IQR 4.7-10.5), and median post-operative days until catheter removal was four days (IQR 3,1). Post-operative PVR was 24.7 cm3 (IQR 18.2, 29.4) and the mean post-operative Qmax was 18.3 ml/s (SD 6.3). Qmax levels significantly increased, by an average of 8.2 ml/s (SD 7.13) (p < 0.001). Similarly, a decrease of average PVR of 97.28 cm3 (SD 95.85) (p < 0.001) was detected, which is a substantial reduction. Between prostates less 80cc and those over 80cc, there were no appreciable differences in Qmax or PVR (p-values: 0.435 and 0.431, respectively). CONCLUSIONS: From our study, we conclude that Rezum water vapor thermal therapy, as a minimally invasive modality, is an effective and safe surgical option for management of benign prostatic hyperplasia of men with moderate to severe lower urinary tract symptoms (LUTS). This procedure has been shown to be effective in patients with varying larger prostate volumes.

The Impact of Cell-free Plasma DNA on Metastatic and Nonmetastatic Prostate Cancer.

Intorductuion: Increased cell-free DNA (cfDNA) is observed in many diseases such as cancer, myocardial infarction, and autoimmune diseases. It has the ability to alter the receptor cell phenotype, triggering events related to malignant transformation. AIMS: Our study aims at assessing the use of cell-free plasma DNA in the diagnosis of metastatic and non-metastatic prostate cancer. METHODS: The study included 180 subjects who were classified into four groups: Group I (GI) included 50 perfect health subjects as the control group, Group II (GII) included 40 patients with prostatitis, group III (GIII) included 40 patients with benign prostatic hyperplasia (BPH) and Group IV (GIV) included 50 patients with pre-operative prostate cancer (PC). Evaluation of the plasma level of circulating cell-free DNA by real-time PCR and measurement of total PSA (tPSA) and free to total PSA percent (f/tPSA%) were carried out for all groups. RESULTS: Our study revealed that the level of tPSA was significantly higher in prostate cancer patients, while levels of f/t PSA were found to be significantly lower. The level of cfDNA was significantly higher in prostate cancer patients (399.9±88.6ng/ul) when compared to that of group I (12.1±1.5ng/ul) (p<0.01), group II (14.7±2.4 ng/ul) (p<0.01), and group III (26.6±45.6 ng/ul) (p<0.01) respectively. CONCLUSION: There was a statistically significant difference in yields of cfDNA between metastatic and non-metastatic groups (P=0.03) with a higher level in the metastatic group.

Mini-percutaneous nephrolithotomy is a safe alternative to extracorporeal shockwave lithotripsy for high-density, renal stones: a prospective, randomised trial.

OBJECTIVES: To compare the outcomes of miniaturised percutaneous nephrolithotomy (mini-PCNL) and extracorporeal shockwave lithotripsy (ESWL) in the management of 10-20 mm, non-lower pole, renal stones. PATIENTS AND METHODS: This prospective randomised double-arm trial was conducted at a tertiary care hospital in Egypt from February to December 2020. Adult patients with single, non-lower pole, high-density (≥1000 HU) renal stones were randomised to receive mini-PCNL or ESWL. The stone-free rate (SFR); operative, fluoroscopy and hospitalisation times; blood loss; auxiliary procedures; retreatment; unscheduled hospital readmission; and complications were compared between the groups. RESULTS: The primary analysis included 34 patients in the mini-PCNL group and 33 in the ESWL group. Overall, the SFR was 97.1% in the mini-PCNL group vs 30.3% in the ESWL group (P < 0.001). All patients in the ESWL group required retreatment, and none of them were stone-free after the first ESWL session. None of the patients in the mini-PCNL group required retreatment. The overall operative time, fluoroscopy time, auxiliary procedure, retreatment, and unscheduled hospital readmission were significantly higher in the ESWL group. The hospital stay and decrease in the haemoglobin level were significantly higher in the mini-PCNL group. The groups were comparable for the overall complication rate. CONCLUSIONS: Mini-PCNL is more effective than ESWL for treating 10-20 mm, high-density, non-lower pole renal stones. Mini-PCNL has the advantages of a high SFR and abolishing the need for retreatment and re-hospitalisation.

Factors Predicting Urethral Stricture Recurrence after Dorsal Onlay Augmented, Buccal Mucosal Graft Urethroplasty.

INTRODUCTION: This study was carried out to identify the predictors of urethral stricture recurrence after dorsal onlay buccal mucosal graft (BMG) urethroplasty. MATERIALS AND METHODS: The medical records of patients with anterior urethral stricture who underwent dorsal onlay BMG urethroplasty at a single tertiary medical center during the period from March 2010 to January 2018 were reviewed. Only patients with ≥2-year follow-up were included. Data regarding patient demographics, clinical characteristics, stricture characteristics, postoperative course, and adverse events were recorded. Kaplan-Meier analysis was used to assess the recurrence-free survival and likelihood of stricture recurrence. Cox regression analysis was used to identify potential independent predictors of stricture recurrence. RESULTS: This study included 266 patients with a mean age of 37.71 years and a mean follow-up period of 49.77 months. From the overall study cohort, 34 (12.8%) reported stricture recurrence and 232 (87.2%) were not. The mean recurrence-free time was 79.93 months and mean time to recurrence was 21.59 months. On multivariate analysis, obesity (hazard ratio (HR): 6.02; 95% conference interval (CI): 1.91, 19.03: p = 0.002), inflammatory aetiology (HR: 9.13; 95% CI: 3.50, 23.81; p < 0.001), prior urethroplasty (HR: 8.81; 95% CI: 3.26, 23.86; p < 0.001), penile stricture location (HR: 3.09; 95% CI: 1.10, 8.71; p = 0.033), and stricture length >4.5 cm (HR: 6.83; 95% CI: 1.69, 27.62; p = 0.007) were the significant independent predictors of stricture recurrence. CONCLUSIONS: Dorsal onlay BMG urethroplasty has a reasonable recurrence-free rate with acceptable postoperative complications. Obesity, inflammatory etiology, prior urethroplasty, penile stricture location, and longer stricture were the factors associated with urethral stricture recurrence.

Concomitant transobturator tape and anterior colporrhaphy versus transobturator subvesical mesh for cystocele-associated stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) and cystocele often occur concomitantly and thus may potentially be treated via a single surgical procedure. This study evaluated the efficacy and safety of concomitant transobturator tape (TOT) with anterior colporrhaphy versus subvesical transobturator mesh (TOM) for cystocele-associated SUI. METHODS: This prospective, clinical trial included women with cystocele-associated SUI. Patients were randomly allocated into either group I (anterior colporrhaphy with concomitant TOT "in-out" fixation) or group II (implantation of a subvesical four-armed TOM). All patients were followed up at 1, 3, 6, 9, and 12 months postoperatively. Statistical tests were performed to compare the group outcomes based on objective, subjective, and anatomical variables. RESULTS: There were 81 patients in group I and 83 in group II. Median follow-up duration was 12 months. The demographic data and baseline clinical characteristics of both groups were comparable. There were no significant differences between groups regarding the success rates of SUI and cystocele repair. Groups I and II had similar cure rates of SUI (82.9 and 88.4%, respectively; p = 0.369) and incidences of successful cystocele repair (85.4 and 97.7%, respectively; p = 0.055). No urethral or bladder injuries or mesh erosions were reported. Both groups had comparable postoperative complications, except the greater incidence of micturition difficulty in group I than group II, during the early follow-up (12.2% vs. 0.0%; p = 0.024). CONCLUSIONS: Transvaginal mesh was not superior to native tissue repair. Anterior colporrhaphy and TOT may be an appropriate alternative to four-armed TOM application for concomitant correction of SUI and cystocele.