Comparative study between a new screwed Amplatz sheath and the ordinary one in percutaneous nephrolithotomy.

OBJECTIVE: The objective of the article is to compare the results of using new screwed Amplatz sheath with results of the conventional Amplatz sheath regarding success and complications during percutaneous nephrolithotomy. METHODS: 100 patients aged more than 18 years with renal calculi more than 2 cm with guy's score 1 from December 2018 till July 2020 were randomly stratified by closed envelope in group A (50 patients) with using conventional sheath and group B (50 patients) with new screwed sheath. We exclude morbid obese patients and patients with contraindication for PNL. RESULTS: There were no significant differences between both groups regarding patients demographic and stone demographic. Operative time and fluoroscopy time were significantly lower in group B rather than group A. Tract stability was in favor of group B as no tract loss recorded while in group A, 5 cases were recorded. In overall complications there were no significant differences between both groups. Bleeding was higher in group A (14%) than in group B (4%), but it was not statistically significant. Success rates were 78% for group A and 88% for group B but it was not statistically significant. CONCLUSION: The screwed Amplatz sheath had showed less operative and fluoroscopy time. Also it enables urologists to have stable PNL tract. So it may be a promising tool to make PNL easier with higher success rate and lower complications.

Simplified biplanar (0-90°) versus monoplanar renal puncture technique in flank free modified supine percutaneous nephrolithotomy regarding outcomes and learning curve: Randomized clinical trial.

Objective: To evaluate the learning curve and the success rate of the biplanar (0-90°) puncture technique in the flank-free modified supine position in comparison to the monoplanar puncture technique. Methods: Randomized controlled study included 68 patients more than 18 years with renal stones more than 2 cm from August 2021 to August 2022 were randomly classified by closed envelope method into group A (34 patients) scheduled for monoplanar renal puncture technique in flank-free modified supine PCN. Meanwhile, group B (34 patients) was scheduled for the 0-90° simplified fluoroscopic puncture technique. Morbid obese patients and patients with contraindications for PNL were omitted from the study. Results: There was no significant difference between both groups regarding stone distribution and patients' demographic data. There was a significant difference between both groups regarding puncture attempts. In 88.2% of patients in group B (Biplanar group), the success of renal puncture occurred from the 1st puncture attempt while in 11.2% of patients in group A (monoplanar group). There was a statistically significant difference between both groups in fluoroscopy time and total operation time (p-value <0.001 & p-value: 0.001), respectively. The stone-free rate was 85.2% vs. 88.2% in both groups, respectively, without significant difference. In this study puncture, attempt trials and puncture time were used as indicators for the easiness and rapid educability of the biplanar (0-90°) fluoroscopic guided renal puncture technique. In the biplanar (0-90°) group after 24 cases, the learning curve had reached the plateau. Conclusion: Biplanar (0-90°) puncture technique in flank-free modified supine position allows an easy puncture technique with an easy learning curve without affecting the success rate or complication rate.

Dapoxetine versus glans penis injection with hyaluronic acid gel in treatment of premature ejaculation.

Objective: to compare the results of using Dapoxetine and HA (hyaluronic acid) gel injection by Five puncture technique in the treatment of premature ejaculation (PE). Methods: 100 sexually active heterosexuals circumcised males with lifelong PE were included in the study. Group A patients were treated with on-demand Dapoxetine, while group B was treated with HA gel glans penis injection using a five-puncture technique. Both groups were evaluated at 1st,3rd and 6th months post-treatment using IELT. Results: There were no significant differences between both groups regarding patient demographic. Mean pretreatment IELT in groups A and B were 45.82 ± 7.44 and 46.18 ± 7.82 receptively. There was no significant difference between both groups. After treatment, both groups show significant ILET improvement during the 1st,3rd, and 6th months follow-up with a P value < 0.001. However, when comparing the improvement of ILET in group A (Dapoxetine) and group B (HA injection), there were high significance differences in favor of group B in the 1st,3rd, and 6th-month follow-up. Conclusion: Although both treatment modalities have improved IELT and premature ejaculation, but HA injection with five punctures technique was significantly better than oral Dapoxetine with self-limited side effects.

Pediatric Mini-Percutaneous Nephrolithotomy Using Self-Retained Screwed Amplatz Sheath vs Ordinary Sheath.

Objective: To evaluate the use of a new 16F mini-screwed sheath in pediatrics in comparison to a 16F ordinary Amplatz sheath. Methods: Sixty-seven patients <18 years with renal calculi between 1 and 2 cm who was a candidate for mini-percutaneous nephrolithotomy (mini-perc) between January 2019 and September 2021 were randomized by closed envelope in group A (34 patients) using new mini-screwed sheath and group B (33 patients) with ordinary mini-sheath. Patients with contraindications for percutaneous nephrolithotomy were excluded. Results: No significant difference was present between both groups according to patients and stone demographics. There was no significant difference between both groups regarding puncture site and number. The mean operative time was 51.25 ± 2.15 minutes and 52.35 ± 3.45 minutes in groups A and B, respectively. The fluoroscopy time was significantly lower in group A (2.1 ± 0.85 minutes) than in group B (2.9 ± 1.05 minutes). Tract loss was 18.2% in group B while 0% in group A. Although bleeding was less in group A, it was nonsignificant. The stone-free rate was (94.11%) and (90.9%) in group A and group B, respectively. Conclusion: Screwed sheath enables the urologist to have a stable track during pediatric mini-perc surgery despite the thin abdominal wall in the pediatric. The screw sheath provides significantly lower fluoroscopy time and decreases the need for nephrostomy tube insertion when compared with ordinary sheath in mini-perc renal surgery.

Flank-Free Modified Supine vs Prone Ultra-Mini-Percutaneous Nephrolithotomy in Treatment of Medium-Sized Renal Pelvic Stone: A Randomized Clinical Trial.

Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the standard treatment of renal stone >2 cm. Ultra-mini-percutaneous nephrolithotomy (UMP) had emerged in the past decade as a new technique in treating renal stones <2 cm. In this study we compared between the outcome of UMP in prone position with the outcome of UMP in modified flank free supine position (FFSP). Materials and Methods: A prospective randomized study was conducted between January 2016 and April 2020, including 122 patients, divided into two matched groups. Group A included 61 patients who underwent UMP in FFSP, and Group B included 61 patients who underwent UMP in a prone position. All patients had a single renal pelvic stone 1-2 cm. Patients with a single kidney, renal anomalies, body mass index ≥40 kg/m2, history of ipsilateral renal surgery, and age <18 years were excluded. In both groups, the dilatation was done up to 13F; a holmium laser was used through a 9F ureteroscope for fragmentation. Nephrostomy tube and ureteral stent were used only when indicated. Results: In total, 122 patients were divided into two groups. The mean age was 40.09 ± 13.63 and 39.67 ± 13.80 years in both groups, respectively. The operative time was 63.64 ± 9.22 and 78.48 ± 9.55 minutes in Groups A and B, respectively (p = 0.0001). The fluoroscopy time was 3.47 ± 0.56 and 4.45 ± 0.39 minutes in Groups A and B, respectively (p = 0.0001). No significant difference was shown between both groups regarding operative and postoperative complications. Shift to mini-PCNL was needed in one patient in Group A and four patients in Group B because of impaired vision. The hospital stay was 25.36 ± 4.23 and 26.13 ± 4.76 hours in both groups, respectively. The initial stone-free rate was 95.1% and 91.8% in both groups, respectively. Conclusions: UMP in modified supine position shows comparable results with UMP in the prone position regarding stone-free rate, hospital stay, and perioperative complication, with significantly shorter operative and fluoroscopy time.

The Usefulness of 4 Immunoperoxidase Stains Applied to Urinary Cytology Samples in the Pathologic Stage of Urothelial Carcinoma: A Study With Histologic Correlation.

BACKGROUND: Currently, the golden rule for the diagnosis of urothelial carcinoma is biopsy and cystoscopy, unfortionally both are costly, invasive, and uncomfortable. While most urothelial cancers are noninvasive at presentation, it is necessary to find a highly sensitive, noninvasive way to diagnose in its earlier stages, Cytology with immunostaining is a noninvasive, reliable method that might play a role in detecting the earlier stages before its progression and accurate correlation with different stages of these tumors. AIM: This study aimed to reach an accurate level in the staging of urothelial carcinoma using CD44, ProExC, Laminin, and Fascin on urinary cytology. DESIGN: We include a total of 180 urinary cytology specimens with their surgical biopsies' counterparts, the staging of the surgical specimens were done according to AJCC2017TNM classification, while their counterpart urinary samples were centrifuged and the sediment was used for H&E and immunocytochemical staining with CD44, ProExC, Laminin, and Fascin. RESULTS: The diagnosis of Ta-stage tumors was done according to the following immunohistochemical (IHC) profile [positive (+ve) CD44, negative (-ve) proExC, -ve Laminin, and -ve Fascin] with 100% sensitivity, 100% specificity. The diagnosis of Tis stage tumors was done according to IHC profile [-ve CD44, +ve proExC, -ve Laminin, and -ve Fascin] with 100% sensitivity, 93% specificity. The diagnosis of T1 stage tumors according to IHC profile [-ve CD44, +ve proExC, +ve Laminin, and -ve Fascin] with 100% sensitivity, 97% specificity, The diagnosis of T2 and T3 stage tumors was done according to IHC profile [-ve CD44, +ve proExC, +ve Laminin and weak to moderate +ve Fascin] with 100% sensitivity, 92% specificity, while the diagnosis of T4 stage tumors according to the IHC profile [-ve CD44, +ve proExC, +ve Laminin, and intense +ve Fascin] with 100% sensitivity, 100% specificity. CONCLUSION: Using (CD44, ProExC, Laminin, and Fascin) on urinary cytology is a simple, reliable, and noninvasive method for the staging of urothelial carcinoma with 99% total accuracy.