Bicentric retrospective study comparing the postoperative outcomes of patients treated surgically for bladder stones with or without concomitant surgery for BPH.

PURPOSE: To compare the postoperative outcomes of male patients who underwent bladder stone (BS) removal, with or without concomitant benign prostatic hyperplasia (BPH) surgery. PATIENTS AND METHODS: All men aged > 50 years who underwent BS removal at two French university hospitals between 2009 and 2018 were retrospectively reviewed. Four binary outcome criteria were identified during the follow-up: early postoperative complications, stone recurrence, subsequent surgery for BS or BPH, and late surgical complications. A composite score ranging from 0 to 4 was calculated by combining the four criteria. RESULTS: A median follow-up period of 42 months was observed in 179 patients. Of these, 107 patients were in the "concomitant surgical treatment" (CST) group and 72 in the bladder "stone removal alone" (SRA) group. The CST group presented higher baseline post-void residual volume (105 vs. 30 ml, p = 0.005). Patients who underwent CST had a significantly lower rate of BS recurrence (12% vs. 39%; p = 0,001) and underwent fewer subsequent surgeries (14% vs. 44%; p < 0.001). There was no significant difference in the early (51% vs. 35%, p = 0,168) and late (26% vs. 17%, p = 0,229) complications rates between the two groups. A better composite score was observed in the CST than in the SRA, but the difference was not significant (3.07 vs. 2.72, p = 0.078). CONCLUSION: As CST increases morbidity and decreases the risk of reoperation, each situation should be considered, taking into account patient choice and comorbidities.

Predictors of clinical and surgical characteristics of giant stones of the urinary bladder: a retrospective study.

BACKGROUND: Giant stones of the urinary bladder (GSBs) are rare and usually presented as case reports. We aimed to assess the clinical and surgical characteristics of GSBs and identify their predictors. METHODS: A retrospective study of 74 patients with GSBs who presented between July, 2005 and June, 2020 was performed. Patients' demographics, clinical presentations, and surgical peculiarities were studied. RESULTS: Older age and male gender were risk factors for the occurrence of GSBs. The irritative lower urinary tract symptoms (iLUTS) were the main presenting symptoms (97.3%). Most patients were treated with cystolithotomy (90.1%). Univariate analyses showed that solitary (p < 0.001) and rough surface (P = 0.009) stones were significant factors for occurrence of iLUTS as the presenting symptoms. Also, the severity of symptoms (p = 0.021), rough surface (p = 0.010) and size (p < 0.001) of stones, and farmer occupation (p = 0.009) were significantly associated with adherence of the stone to the bladder mucosa at surgery. In multivariate analysis, the rough surface (p = 0.014) and solitary (p = 0.006) stones, and concomitant ureteral stones (p = 0.020) were independently associated with iLUTS as the main presentation. However, the stone size and severity of iLUTS were the independently associated factors for adherence of GSBs to the bladder mucosa. CONCLUSIONS: Solitary GSB, rough surface and the association with ureteral stones are independent risk factors for the occurrence of long-standing iLUTS. The stone size and severity of iLUTS were the independent predictors of adherence of GSBs to the bladder mucosa. Cystolithotomy is the main treatment, but it may be more difficult when there is bladder mucosa adherence.

Comparison of two different minimally invasive techniques used in bladder stone surgery for preschool-aged children.

BACKGROUND: This study was designed to compare the outcomes of mini-percutaneous cystolithotomy (mPCL) and transurethral cystolithotripsy (TUCL) in treating bladder stones in preschool-aged children (≤6 years old). METHODS: Twenty-four patients treated with mPCL and 28 patients treated with TUCL for bladder stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed. RESULTS: The mean age and gender distribution were similar between the groups. The mean stone size was 16.5 ± 0.5 mm for the mPCL group and 14.9 ± 5.7 mm for the TUCL group (p = 0.318). The mean operative time was 41.1 ± 9.9 min for the mPCL group and 39.0 ± 12.3 min for the TUCL group (p = 0.182). Catheterization times and hospitalization times were statistically significantly longer in the mPCL group (p = 0.000). The rate of urinary retention after urethral catheter removal was significantly higher in the TUCL group (p < 0.05). Reintervention was performed for one patient in Group 1 due to urinary leakage and for five patients in Group 2 due to urinary retention. The stone-free rate (SFR) after a single procedure was 100% in the mPCL group and 89.3% in the TUCL group (p = 0.099). After auxiliary procedures performed for three patients, the overall SFR also reached 100% for the TUCL group. DISCUSSION: Both mPCL and TUCL are effective methods in the treatment of bladder stones of <30 mm in the preschool age group. Although TUCL has some advantages over mPCL, such as shorter hospital stays and catheterization times, there is a risk of urinary retention with increased stone sizes. It may be more advantageous to apply mPCL for the reduction of complications and reintervention rates, especially in small children with bladder stones of >20 mm.

Additional Surgeries after Bladder Augmentation in Patients with Spina Bifida in the 21st Century.

PURPOSE: We determined the long-term risks of additional surgery after bladder augmentation in a modern spina bifida cohort accounting for differential followup. MATERIALS AND METHODS: We retrospectively reviewed patients with spina bifida who were born after 1972 and were followed at our institution after augmentation surgery performed between 1979 and 2018. Outcomes included diversion, bladder stones, perforation, reaugmentation, laparotomy for bowel obstruction, and benign and malignant bladder tumors. Survival analysis was used for the entire cohort and the modern cohort (detubularized and reconfigured ileocystoplasty beginning in 2000). RESULTS: A total of 413 patients were included in the study. At a median followup of 11.2 years 80.9% of the patients had undergone ileocystoplasty and 44.1% had undergone 370 additional surgeries. Ten-year risk of any reoperation was 43.9%, with 17.4% of patients undergoing 2 or more and 9.9% undergoing 3 or more additional surgeries. Outcomes included conversion to a diversion (2.7% at 10-year followup) and bladder stones (28.2% with recurrence in 52.4%) irrespective of detubularized reconfigured status (p ≥0.20). Bladder perforation risk was 9.6% for patients undergoing vs 23.7% for those not undergoing detubularized reconfigured ileocystoplasty (p=0.01). Similarly reaugmentation rate was 5.3% for patients undergoing vs 15.2% for those not undergoing detubularized reconfigured ileocystoplasty (p=0.001). Finally, 10-year reperforation risk was 32.1% for patients undergoing vs 73.8% for those not undergoing detubularized reconfigured ileocystoplasty (p=0.053). Other risks included bowel obstruction (4.5% with recurrence in 15.8%), nephrogenic adenoma (2.2% with regrowth in 48.2%) and malignancy (0.0% at 20 years). For 222 patients in the modern cohort (median followup 9.1 years) 10-year risk of any reoperation was 46.0%, which consisted of diversion in 4.0%, stones in 32.9% (recurrence in 44.5%), perforation in 8.8% (recurrence in 42.2%), reaugmentation in 4.3%, obstruction in 4.9% (recurrence in 10.0%), adenoma in 4.7% (regrowth in 40.0%) and cancer in 0.0%. CONCLUSIONS: Bladder augmentation is long-lasting. While benefiting continence and renal outcomes, this operation frequently requires additional surgeries, necessitating close followup. Since survival analysis based risks of alternative management options such as incontinent diversion are unavailable, comparisons with augmentation are unfeasible.

Appearance of ureterorenal stones after gouty arthropathy: a retrospective cohort study for ethnic disparity.

INTRODUCTION: This study aimed to investigate the differences in ureterorenal stone appearance after gouty arthropathy between Taiwanese aboriginal and non-aboriginal patients. METHODS: Between 2007 and 2015, patients with first diagnoses of ureterorenal stones after diagnosis of gouty arthropathy at Puli Christian Hospital were enrolled in this study. Characteristics, underlying diseases and laboratory data for aboriginal and non-aboriginal patients were recorded. All categorical variables were analysed by χ2 test and continuous variables were compared by t-test. RESULTS: A total of 201 patients (66 aboriginal and 135 non-aboriginal) were enrolled in the study. Serum uric acid levels did not differ significantly between aboriginal and non-aboriginal groups. There was a significant difference in the time until ureterorenal stone appearance after gouty arthropathy between aboriginal and non-aboriginal patients (38.0 v 29.3 months, p=0.015). Among males, aboriginal patients exhibited gouty arthropathy at a younger age than non-aboriginal patients (46.0 v 50.2 years, p=0.035). Furthermore, male aboriginal patients exhibited a higher rate of alcoholic hepatitis (26.7% v 12.2%, p=0.046). CONCLUSION: Among males, aboriginal Taiwanese patients exhibited gouty arthropathy at younger ages than did non-aboriginal Taiwanese because of a higher rate of alcoholic hepatitis. The longer time until stone appearance after gouty arthropathy was attributed to alcoholic diuresis. Decreasing alcohol consumption may postpone or halt the development of gouty arthropathy.

Risk of ESRD and Mortality in Kidney and Bladder Stone Formers.

RATIONALE & OBJECTIVES: Kidney stones have been associated with increased risk for end-stage renal disease (ESRD). However, it is unclear whether there is also an increased risk for mortality and if these risks are uniform across clinically distinct categories of stone formers. STUDY DESIGN: Historical matched-cohort study. SETTING & PARTICIPANTS: Stone formers in Olmsted County, MN, between 1984 and 2012 identified using International Classification of Diseases, Ninth Revision codes. Age- and sex-matched individuals who had no codes for stones were the comparison group. PREDICTOR: Stone formers were placed into 5 mutually exclusive categories after review of medical charts: incident symptomatic kidney, recurrent symptomatic kidney, asymptomatic kidney, bladder only, and miscoded (no stone). OUTCOMES: ESRD, mortality, cardiovascular mortality, and cancer mortality. ANALYTICAL APPROACH: Cox proportional hazards models with adjustment for baseline comorbid conditions. RESULTS: Overall, 65 of 6,984 (0.93%) stone formers and 102 of 28,044 (0.36%) non-stone formers developed ESRD over a mean follow-up of 12.0 years. After adjusting for baseline hypertension, diabetes mellitus, dyslipidemia, gout, obesity, and chronic kidney disease, risk for ESRD was higher in recurrent symptomatic kidney (HR, 2.34; 95% CI, 1.08-5.07), asymptomatic kidney (HR, 3.94; 95% CI, 1.65-9.43), and miscoded (HR, 6.18; 95% CI, 2.25-16.93) stone formers, but not in incident symptomatic kidney or bladder stone formers. The adjusted risk for all-cause mortality was higher in asymptomatic kidney (HR, 1.40; 95% CI, 1.18-1.67) and bladder (HR, 1.37; 95% CI, 1.12-1.69) stone formers. Chart review of asymptomatic and miscoded stone formers suggested increased risk for adverse outcomes related to diagnoses including urinary tract infection, cancer, and musculoskeletal or gastrointestinal pain. CONCLUSIONS: The higher risk for ESRD in recurrent symptomatic compared with incident symptomatic kidney stone formers suggests that stone events are associated with kidney injury. The clinical indication for imaging in asymptomatic stone formers, the correct diagnosis in miscoded stone formers, and the cause of a bladder outlet obstruction in bladder stone formers may explain the higher risk for ESRD or death in these groups.

Familial risks in urolithiasis in the population of Sweden.

OBJECTIVE: To assess detailed familial risks for medically diagnosed urolithiasis (UL, urinary tract stone disease) based on nationwide hospital and population records. PATIENTS/SUBJECTS AND METHODS: Subjects were identified from the Swedish Multigeneration Register in which there were 211 718 patients with UL. Standardised incidence ratios (SIRs) were calculated by comparison to individuals without a family history of UL. RESULTS: The highest familial SIRs were invariably found for the same (concordant) type of UL: 2.18 for kidney, 2.20 for ureter, and 1.93 for bladder. SIRs increased from 1.84, when one parent was affected, to 3.54 when both parents were affected, which was a multiplicative interaction. The SIR was 1.79 when one sibling was affected but it increased to 24.91 when two siblings were affected. Such excessive risks (5.2% of familial cases) are probably explained by high-penetrant genes. A low SIR of 1.29 between spouses suggested a minor contribution by shared environmental factors on the familial risk. CONCLUSIONS: The results point to underlying genetic causes for the observed familial clustering and establish the genetic landscape of UL. Family histories should be taken in UL diagnostics and prevention could follow guidelines recommended for recurrent UL.

Endemic bladder calculi in children.

Urinary calculi are being recognized more frequently in children and the urinary bladder is the most common site for stone formation in the lower urinary tract. Bladder calculi are grouped into three basic categories: primary idiopathic/endemic, secondary, and migrant. The incidence of vesical calculi has declined significantly in the last 70 years in developed nations owing to improvements in nutrition and socioeconomic conditions, but it is still high in developing nations. Primary idiopathic/endemic bladder calculi typically occur in children, in the absence of urinary tract infection (UTI), urinary stasis, or foreign body, and diet lacking in animal proteins is the major contributor factor. Comprehensive preventive and treatment strategies are critical for improving the quality of life of diseased children, in addition to helping to eradicate, or at least decrease, the incidence of endemic bladder calculi in developing nations.

Healthcare Costs Associated with Hydrophilic-Coated And Non-Coated Urinary Catheters for Intermittent Use In the United States.

This health economic evaluation simulated a cohort to compare hydrophilic-coated to non-coated catheters for intermittent catheterization. By using a Markov model, lifetime costs and catheter-related complications were investigated. Results determined that the use of hydrophilic-coated catheters save money and reduce treatment-related complications.

Morbidity associated with operative management of bladder stones in spinal cord-injured patients.

STUDY DESIGN: Retrospective cohort study of spinal cord-injured (SCI) patients undergoing bladder stone removal operations between 1999 and 2013. OBJECTIVES: To determine the morbidity associated with different operative management of bladder stones in SCI patients. SETTING: National Spinal Injuries Unit, Stoke Mandeville Hospital, UK. METHODS: Data on age, sex, level and Frankel classification of spinal cord injury, method of bladder drainage, method of bladder stone removal, complications and length of stay were collected from patient records. Complication was defined as bladder perforation, sepsis or persistent haematuria. Predictors of complications and length of stay were determined using univariate and multivariate regression analyses. RESULTS: Overall, 112 consecutive bladder stone removal operations were performed, one open cystolithotomy and 111 transurethral procedures utilising simple washout, stone punch or electrohydraulic lithotripsy (EHL). Of these procedures, 17% (19/112) had complications; 0/11 (0%) following washout, 5/44 (11%) after stone punch, 3/12 (25%) following EHL and 10/26 (38%) after combined procedures using stone punch and EHL. In a multivariate model, patients with a cervical-level injury and those undergoing a combined procedure were significantly more likely to have a complication (P=0.032 and P=0.046). Length of stay was longer following a complication, the mean was 4.18 days compared with 1.37 days without a complication (P<0.001). Controlling complications and age, use of a combined procedure was associated with significantly longer stay than use of stone punch alone. CONCLUSION: This study provides important outcome data that should guide operative procedure choice and inform patients about possible risks during consent. It sets a benchmark that other centres can evaluate their outcomes against.

CHILDHOOD BLADDER STONES-AN ENDEMIC DISEASE OF DEVELOPING COUNTRIES.

BACKGROUND: Bladder calculi are one of the commonest health problems in young children especially in rural and underprivileged areas. METHODS: All children of bladder stones operated at District Headquarter Hospital Mithi from July 2009 to June 2012 were included in this cross-sectional study. Data was collected regarding age, sex, address (rural or urban), body weight, duration of breast feeding, weaning, detailed dietary history regarding milk type, volume, amount of water intake, recurrent diarrhoea, urinary tract infection (UTI), family history, and socioeconomic history. Urine analysis, complete blood count (CBC), renal function, ultra sound abdomen, X-ray kidney, ureter, and bladder (KUB) was done in all patients. All patients had cystolithotomy and were followed up till complete recovery. RESULTS: A total of 113 children (97 males and 16 females) operated at District Headquarter Hospital Mithi Tharparker were included in study. All patients belonged to local desert areas of Tharparker. Age ranged from 18 months to 14 year (mean age 8.6 year). Most frequent symptom was difficulty in micturition in 76 (67.25%) patients, urinary retention in 18 (15.9%) and stone with pyuria and fever in 12 (10.6%) patients. Recurrent episodes of diarrhoea (more than 3 episodes per year) in 73(65%) patients, recurrent UTI in 51 (45.6%), family history of stone disease in 6 (5%) and associated rectal prolapse in 3 (2.6%) patients. On x-ray KUB 111 (98%) patients had single stone in bladder, 2 (2%) had multiple stones and an associated renal and ureteric stone in 5 (4.5%). Mild anaemia (Hb 7-10 gm%) was seen in 35 (39.55%) patients, moderate anaemia (Hb 5-7 gm %) was seen in 21(24%) and severe anaemia (Hb less than 5 gm%) was seen in 14 (16%) patients. All patients had open cystolithotomy for removal of stones under general anaesthesia. CONCLUSION: Bladder stones are public health problem. Majority of affected patients were less than 5 years old. Low protein diet, dehydration, use of goat milk and poor socio-economic conditions were major risk factors identified for development of bladder stones.

Cutting for stone in augmented bladders-what is the risk of recurrence and is it impacted by treatment modality?

PURPOSE: Bladder stones are common after bladder augmentation, often resulting in numerous procedures for recurrence. We sought to determine whether surgical technique and stone fragmentation are significant predictors of bladder stone recurrence after bladder augmentation. MATERIALS AND METHODS: We retrospectively reviewed 107 patients treated for first bladder stones at our institution. Patient demographics, details of surgeries, stone therapy and recurrence were reviewed. Kaplan-Meier survival and Cox proportional hazards analysis were used to determine predictors of time to first stone recurrence. RESULTS: Of 107 patients 55.1% were female and 79.4% had neuropathic bladder. Patients underwent augmentation at a median age of 8.0 years (range 2.4 to 22.8) and were followed for a median of 12.4 years (1.8 to 34). Segments used for augmentation included ileum (72.9% of cases), sigmoid (16.8%), cecum/ileocecum (9.4%) and other (ureter, stomach/ileum, 1.8%). Bladder neck procedures were performed in 63.6% of patients and catheterizable channels in 75.7%. First stone surgery occurred at a median of 3.1 years after augmentation (range 5 months to 21.8 years). Endoscopy was used in 66.4% of cases and open cystolithotomy in 33.6%. Overall 47.7% of stones were fragmented. Bladder stones recurred in 47.7% of patients (median recurrence time 9.5 years, range 3 months to 14.7 years). Recurrence risk was greatest in the first 2 years postoperatively (12.1% per patient per year, p = 0.03). Recurrence risk did not change with technique (endoscopic vs open) or fragmentation, even after controlling for surgical and clinical variables. CONCLUSIONS: Bladder stones recurred in almost half of the patients at 9 years postoperatively independent of treatment technique and patient characteristics. As a high risk group, yearly x-ray of the kidneys, ureters and bladder, and ultrasound of the kidneys and bladder are recommended in these patients.

Bladder stones in patients with spinal cord injury: a long-term study.

STUDY DESIGN: Retrospective follow-up study. OBJECTIVES: To assess the occurrence of bladder stones in patients with spinal cord injury (SCI). SETTING: Single SCI rehabilitation center in Switzerland. METHODS: We searched our database for SCI patients who had undergone surgery due to bladder stones between 2004 and 2012. In all patients retrieved, personal characteristics, bladder management, bladder stone occurrence and time to stone formation/recurrence were recorded. RESULTS: We identified 93 (3.3%) of 2825 patients with bladder stones, 24 women and 69 men, with a mean age 50 years (17-83) years. We observed bladder stones in patients with suprapubic catheter (SPC) in 11% (50/453), transurethral catheter (TC) in 6.6% (5/75), with intermittent catheterization (IC) in 2% (27/1315) and with reflex micturition (RM) in 1.1% (11/982), respectively. The mean time period to stone development was 95 months. The TC group had the shortest time interval (31 months), followed by the SPC group (59 months), individuals performing IC (116 months) and RM (211 months), respectively. Bladder stone recurrence rate was 23%. Recurrences were most frequent in the TC group (40%), followed by SPC (28%) and IC (22%), whereas no recurrences occurred in the RM group. Time to recurrence was shortest in the SPC group (14 months), followed by the IC (26 months) and the TC group (31 months), respectively. CONCLUSION: In SCI patients, bladder management has an important role in the development of bladder stones. Indwelling catheters (TC/SPC) are associated with the highest risk to develop bladder stones and therefore should be avoided if possible. If unavoidable, SPC are superior to TC.

Epidemiology of upper urinary tract stone disease in a Taiwanese population: a nationwide, population based study.

PURPOSE: We investigated the epidemiology of upper urinary tract stone disease in Taiwan using a nationwide, population based database. MATERIALS AND METHODS: This study was based on the National Health Insurance Research Database of Taiwan, which contains data on all medical beneficiary claims from 22.72 million enrollees, accounting for almost 99% of the Taiwanese population. The Longitudinal Health Insurance Database 2005, a subset of the National Health Insurance Research Database, contains data on all medical benefit claims from 1997 through 2010 for a subset of 1 million beneficiaries randomly sampled from the 2005 enrollment file. For epidemiological analysis we selected subjects whose claims records included the diagnosis of upper urinary tract urolithiasis. RESULTS: The age adjusted rate of medical care visits for upper urinary tract urolithiasis decreased by 6.5% from 1,367/100,000 subjects in 1998 to 1,278/100,000 in 2010. There was a significantly decreasing trend during the 13-year period in visits from female and all subjects (r(2) = 0.86, p = 0.001 and r(2) = 0.52, p = 0.005, respectively). In contrast, an increasing trend was noted for male subjects (r(2) = 0.45, p = 0.012). The age adjusted prevalence in 2010 was 9.01%, 5.79% and 7.38% in male, female and all subjects, respectively. The overall recurrence rate at 1 and 5 years was 6.12% and 34.71%, respectively. Male subjects had a higher recurrence rate than female subjects. CONCLUSIONS: Our study provides important information on the epidemiology of upper urinary tract stone disease in Taiwan, helping to quantify the burden of urolithiasis and establish strategies to decrease the risk of urolithiasis.

A case-control study on the association between bladder cancer and prior bladder calculus.

BACKGROUND: Bladder calculus is associated with chronic irritation and inflammation. As there is substantial documentation that inflammation can play a direct role in carcinogenesis, to date the relationship between stone formation and bladder cancer (BC) remains unclear. This study aimed to examine the association between BC and prior bladder calculus using a population-based dataset. METHODS: This case-control study included 2,086 cases who had received their first-time diagnosis of BC between 2001 and 2009 and 10,430 randomly selected controls without BC. Conditional logistic regressions were employed to explore the association between BC and having been previously diagnosed with bladder calculus. RESULTS: Of the sampled subjects, bladder calculus was found in 71 (3.4%) cases and 105 (1.1%) controls. Conditional logistic regression analysis revealed that the odds ratio (OR) of having been diagnosed with bladder calculus before the index date for cases was 3.42 (95% CI = 2.48-4.72) when compared with controls after adjusting for monthly income, geographic region, hypertension, diabetes, coronary heart disease, and renal disease, tobacco use disorder, obesity, alcohol abuse, and schistosomiasis, bladder outlet obstruction, and urinary tract infection. We further analyzed according to sex and found that among males, the OR of having been previously diagnosed with bladder calculus for cases was 3.45 (95% CI = 2.39-4.99) that of controls. Among females, the OR was 3.05 (95% CI = 1.53-6.08) that of controls. CONCLUSIONS: These results add to the evidence surrounding the conflicting reports regarding the association between BC and prior bladder calculus and highlight a potential target population for bladder cancer screening.

Urologic disease in a resource-poor country.

BACKGROUND: Understanding the role that urologic disease plays within central Haiti could lead to the development of sustainable and regionally appropriate urologic care. We aim to document the prevalence of urologic surgical disease presenting for treatment in central Haiti. METHODS: The present study is based on a retrospective review of surgical case logs at five Partners in Health and Zanmi Lasante hospitals in central Haiti. Data were collected from June 30, 2009, through July 29, 2010, and included patient demographics, disease processes, interventions required, surgeon name, and surgeon training (urologic trained versus non-urologic trained). RESULTS: Urologic surgical disease comprised 498/5,539 (9.0 %) of all surgical cases in central Haiti from July 2009-July 2010. A total of 492 diagnoses and 498 urologic procedures on 469 patients were recorded. Most common diagnoses included hydrocele (33.3 %), phimosis (23.0 %), benign prostatic hyperplasia (10.8 %), and cryptorchidism (7.3 %). Hydrocelectomy was the most commonly performed procedure (160/498, 32.1 %), followed by circumcision (117/498, 23.4 %) and open prostatectomy (38/498, 7.6 %). Surgeon training (urologic versus non-urologic) was determined for 360/498 (72.3 %) of surgical cases. Urologic trained surgeons performed 55/360 (15.3 %) of all surgical procedures. Among patients who underwent prostatectomy, urology surgeons performed 14/31 (45.2 %) of open prostatectomies, and non-urology surgeons performed 17/31 (54.8 %). Urologists performed all transurethral resections of the prostate (9 vs. 0; p = 0.0051). CONCLUSIONS: Urologic surgical diseases comprise a substantial source of morbidity for patients in central Haiti. Understanding the scale and scope of urologic disease is important in developing health systems to adequately address the regional burden of surgical disease in limited-resource settings.

Age, Benign Prostatic Hyperplasia, Geography of Residence, and Occupation are Predictors of Bladder Calculi in Men: A Three-Year Data Analysis.

BACKGROUND: The formation of bladder calculi is a complex multifactorial process. Our objective was to identify predictors of bladder calculi in men. METHODS: This cross-sectional study was conducted at a regional public hospital. We used medical records from 2017 to 2019 for men diagnosed with urinary calculi or benign prostatic hyperplasia (BPH). The diagnosis of urinary calculi was based on urinalysis, plain x-ray, and ultrasonography (USG). The diagnosis of BPH was based on digital rectal examination (DRE), USG, and American Urological Association (AUA) Symptom Index to assess the severity of BPH. The data were analyzed using Kruskal-Wallis, Mann-Whitney U, Chi-square tests, and binary logistic regression. RESULTS: Of 2010 study participants, 66.0% were men with urinary calculi, 39.7% had BPH, 21.0% were aged 70 years or more, 12.5% lived in limestone mountain areas, and 24.6% had occupations that were mainly outdoors. Urinary calculi in men with BPH were found in the urethra (3.0%), bladder (27.6%), ureter (2.2%), and kidney (1.1%). Of all men with urinary calculi, the odds of having bladder calculi in men aged 70 years or more was 13.484, 95% confidence interval (95% CI): 8.336-21.811; In men with BPH was 11.182, 95% CI: 6.440-19.416; In men who lived in limestone mountain area was 1.894, 95% CI: 1.242-2.887; In men whose occupation is mainly outdoor was 3.240, 95% CI: 1.954-5.375, compared to reference groups. CONCLUSIONS: Age, BPH, geography of residence, and occupation were predictors of bladder calculi in men.

Population based assessment of enterocystoplasty complications in adults.

PURPOSE: Enterocystoplasty can be used to treat several types of bladder dysfunction. We conducted a population based study to identify the rate and significant predictors of urological surgery after adult enterocystoplasty. MATERIALS AND METHODS: A retrospective, population based cohort was assembled using administrative data records, and adults who underwent enterocystoplasty between 1993 and 2009 were included in the analysis. Administrative data sources were used to measure primary exposure (neurogenic bladder and concurrent catheterizable channel or anti-incontinence procedure) and primary outcome (urological surgical procedures after enterocystoplasty). Multivariable Cox proportional hazards models were used (covariates of age, gender, Charlson score and socioeconomic status). RESULTS: We identified 243 patients, of whom 61% had a neurogenic bladder, 20% had a simultaneous incontinence procedure and 18% underwent creation of a catheterizable channel. Median followup was 7.8 years (IQR 4.0-12.2). The proportion of patients who required a subsequent urological procedure was 40% (0.098 procedures per person-year of followup). A simultaneous incontinence procedure at enterocystoplasty was a significant predictor of future surgical procedures (HR 1.47, 95% CI 1.02-2.12, p = 0.0414). Cystolitholapaxy was the most common subsequent procedure (25% of patients) and a catheterizable channel conferred a significant risk of cystolitholapaxy (HR 2.92, 95% CI 1.461-5.85, p = 0.0024). CONCLUSIONS: Repeat urological surgery is common after enterocystoplasty. Patients who require a simultaneous incontinence procedure at enterocystoplasty are more likely to require future surgery. Patients with catheterizable channels are at significant risk for future cystolitholapaxy.

Bladder stones in Afghan children.

OBJECTIVES: Military surgeons have been providing humanitarian care in Afghanistan since 2002. There are scant published reports on the details of that care. We report here the experience of deployed U.S. Army general surgeons in the management of an endemic problem, bladder stones in Afghan children. METHODS: A retrospective review was performed of pediatric patients presenting to an International Security Assistance Force humanitarian clinic over a 12-month period from October 2010 to November 2011. Symptoms at presentation, diagnostic modalities, and treatment provided were analyzed. The general surgeons of the 126th Forward Surgical Team (FST) provided surgical consultations for this military humanitarian clinic on a remote base in western Afghanistan. RESULTS: Eight male pediatric patients of an average age of 4 years presented with dysuria and underwent further evaluation. In five patients, the use of a portable ultrasound machine led to the diagnosis of bladder stones. Three other patients presented with ultrasound exams from an Afghan clinic. Four patients underwent surgical removal of their bladder stones by the FST and 4 four patients, including one with a recurrent bladder stone, were referred to a distant Afghan Regional Hospital. No short-term complications occurred in the five patients available for follow-up. CONCLUSIONS: Military surgeons providing humanitarian care in rural areas of Afghanistan, and humanitarian surgeons serving in endemic areas, can expect to encounter multiple cases of bladder stones in pediatric patients. Dysuria is a typical presenting symptom. The FST has the resources to diagnose and treat this disorder. If accessible, Afghan regional hospitals can provide curative surgery.

Improving lower urinary tract symptoms in BPH.

Benign prostatic hyperplasia (BPH) is one of the most common diseases to affect older men. Histological disease is present in more than 60% of men beyond their sixties, and more than 40% of men in this age group have lower urinary tract symptoms (LUTS). The prevalence increases with age. About one-fifth of patients with symptomatic disease who present to a doctor will eventually be treated surgically. The remainder will often be managed initially by active surveillance. The majority of these men suffer gradual progression of symptoms and increasingly require treatment. BPH is characterised by a spectrum of obstructive and irritative symptoms, known collectively as LUTS. Poor urinary flow and the sensation of incomplete bladder emptying are the two symptoms that correlate most closely with the eventual need for prostate surgery. Untreated, a significant number of men with BPH will eventually develop acute urinary retention. In addition tosymptom assessment, digital rectal examination can provide an estimate of prostate volume and exclude a palpable nodule suggestive of prostate cancer. PSA testing provides additional information about the risk of prostate cancer being present. Medical management of BPH is suitable for most patients with moderate symptoms. The two main evidence-based approaches are treatment with alpha1-blockers and 5alpha-reductase inhibitors (5-ARLs). Severely symptomatic patients may also respond to these drugs. Mild symptoms should usually be managed by active surveillance. Combination therapy with an alpha1-blocker and a 5-ARI is more effective than monotherapy in terms of symptom relief and prevention of progression.