Video-Assisted Telescope Operating Monitor 3D System in Microsurgical Varicocelectomy: A Preliminary Report.

INTRODUCTION: Video-assisted telescope operating monitor (VITOM®) with 3D Visualization technology was developed and has been used with favorable results by several surgical specialties. Our study aims to be a preliminary report for initial experience using the VITOM® 3D system for microsurgical varicocelectomy on varicocele patients. METHODS: We performed 35 microsurgical varicocelectomy procedures using the VITOM® 3D system on varying types and grades of varicoceles. The surgeon had the option of using either a 2.5 or 3.5 magnifying loupe in addition to the exoscope for each operation evaluated. The exoscope is a standalone camera head with an integrated 3D telescope and remote control with zoom and focus functions. It is connected to the 3D monitor via a mechanical holding arm. During the procedure, surgeons, assistants, and observers were able to view the 3D high-definition stream displayed on a 26-inch 3D monitor at a convenient viewing angle and distance. The varicocele ligation was performed using a Carl Zeiss Meditec AG microscope. RESULTS: There were 35 patients with varicocele aged 31.51 years old on average, which were included in this report. Most patients had grade 3 bilateral varicocele (n = 13, 37.1%). All procedures were performed without any intraoperative complications. After the procedures, only a few patients suffered from postoperative complications. Three patients suffered scrotal edema (8.6%), while another had hydrocele (2.9%). The postoperative pain results were also very minimal from .89 1 day after the operation to .26 3 days after the operation. CONCLUSION: The VITOM® 3D system showed promise in microsurgical varicocelectomy.

The role of interferential current electrical stimulation in pediatric urology: A systematic review of randomized controlled trials.

Background: In recent years, interferential current (IFC) electrical stimulation has been studied as a novel treatment for various lower urinary tract dysfunctions in children. As the findings of multiple studies may vary, we aimed to evaluate the current view on IFC in pediatric urology problems based on the findings of randomized clinical trials (RCTs). Methods: We performed a systematic search in the Embase, Medline, and SCOPUS databases in accordance with the latest Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies comprised studies evaluating IFC for lower urinary tract problems in children. The studies' quality was assessed using the Cochrane risk of bias (RoB) tool 2. Results: A total of 125 articles were initially obtained, among which 40 articles were duplicates. There were six eligible RCTs with an overall low RoB. All subjects underwent 10-18 sessions of treatment. The outcomes measured consisted of the alleviation of symptoms and urodynamic parameters. The trials reported that 61-90% of patients responded positively to the treatment. Both IFC and transcutaneous electrical nerve stimulation generated improvements in the subjects. However, overall the IFC group showed better immediate and short-term improvement. Conclusion: IFC is a promising therapy for bladder dysfunction and enuresis in children. More comparative RCTs are required in the future to quantitatively determine the superiority of IFC to other alternatives. The safety aspects of the treatment should also be studied further before it can be used in a clinical setting as the standard and protocol for children are still unclear.

Giant bladder calculi due to four years neglected cystostomy.

Giant bladder calculi are rare and long-term usage of cystostomy could cause stone formation. Due to the lack of evidence on giant bladder calculi and the long-term usage of cystostomy can cause bladder calculi formation, we provide a case study of a man with a neglected cystostomy with giant bladder calculi for 4 years. A fixed mass was discovered in the suprapubic region. Ultrasound examination revealed 4.1 × 5.5 cm bladder calculi and contracted left kidney. Bipolar voiding cystourethrography portrayed stricture in pars pendular and membranacea, uneven bladder wall, and 4.5 × 4.5 cm bladder calculi. The stone was extracted, and the bladder filling test revealed a small bladder capacity. Since the patient refused urethral reconstruction and bladder augmentation, he was discharged with another cystostomy catheter. Six-month follow-up revealed no forming stones. Neglected cystostomy catheter can cause giant bladder calculi. Prompt diagnosis and treatment should be made to manage this condition to reduce the likelihood of bladder cancer.

Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis.

Introduction: Tamsulosin is the most commonly used medical expulsive therapy (MET). However, it does not alleviate ureteral colic. It is important to develop MET that can reduce ureteral colic while maintaining a high stone clearance rate. Silodosin is an α1A adrenoceptor with high affinity and selectivity for the distal ureter, which may reduce ureteral colic and enable stone expulsion for distal ureteral stones. Therefore, we performed this systematic review and meta-analysis to evaluate the efficacy of silodosin as MET and its role in reducing ureteral colic among patients with distal ureteral stones. Materials and Methods: This research was conducted in accordance with the Cochrane Handbook for Systematic Review and Intervention, in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42021249003). A comprehensive literature search was performed in several databases including Medline, EMBASE, and Scopus up to July 2021 for randomized trials comparing silodosin with placebo for MET. RevMan 5.4 was used for data analysis. Results: A total of six randomized controlled trials were included in this analysis with a total of 907 patients. Our analysis revealed that the patients who received silodosin had significantly higher stone expulsion rate (SER) (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.34, 4.76, P < 0.01), significantly shorter stone expulsion time (SET) (mean difference -3.79, 95% CI -4.51, -3.06, P < 0.01), and lower analgesic use (OR 0.4, 95% CI 0.23, 0.69, P < 0.01) compared to the group receiving placebo. Conclusion: Silodosin showed significantly higher SER, lower SET and lower analgesic use in patients with distal ureteral stones as compared to a placebo.

Male Reproductive Tract Involvement and Sperm Parameters in SARS-CoV-2 Patients: A Systematic Review and Meta-Analysis.

PURPOSE: There is a growing concern regarding the impact of SARS-CoV-2 infection on the male reproductive tract due to ACE2 receptor expression, however, its impact remains unclear. We performed this review to evaluate whether SARS-CoV-2 infection affects the male reproductive system. MATERIALS AND METHODS: We conducted a search in the Embase, Scopus, and MEDLINE databases, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Eligible studies comprised articles reporting viral RNA presence in semen, sperm parameters, and orchitis or orchiepididymitis occurrence in SARS-CoV-2 patients. Observational studies' quality was determined using the Newcastle-Ottawa Scale (NOS). Case reports were assessed using the Joanna Briggs Institute (JBI)'s checklist. RESULTS: A total of 32 relevant articles were included. Viral RNA was found in 7% of infected patients' semen (95% CI, -0.01 to 0.15) from 3 studies. There were also only 7% of patients with orchitis or orchiepididymitis clinical manifestations (95% CI, 0.05-0.10). The semen volume and concentration were 2.34 mL (95% CI, 1.87-2.81) and 51.73 million/mL (95% CI, 31.60-71.85). The progressive and total motility percentages were 36.11% (95% CI, 28.87-43.35) and 43.07% (95% CI, 28.57-57.57), respectively. The morphology was 6.03% (95% CI, -1.05 to 13.10). There is a difference in semen volume between moderate and severe infections (MD, 0.52; 95% CI, 0.27-0.76; p<0.0001) and concentration between mild and moderate (MD, 18.74; 95% CI, 1.02-36.46; p=0.04), mild and severe (MD, 43.50; 95% CI, 13.86-73.14; p=0.004), as well as moderate and severe (MD, 22.25; 95% CI, 9.33-35.17; p=0.0007). CONCLUSIONS: SARS-CoV-2 infection may result in decreased sperm concentration in severe cases and the mechanism relates to potential reproductive tract inflammation. The absence of large viral RNA detection in the semen indicates a systemic effect, although this is largely unproven.

The role of tranexamic acid in reducing bleeding during transurethral resection of the prostate: An updated systematic review and meta-analysis of randomized controlled trials.

Introduction: Transurethral resection of the prostate (TURP) is regarded as the current gold standard surgical intervention for benign prostatic hyperplasia (BPH). However, this procedure is associated with significant chances of intraoperative and postoperative bleeding. Several studies have reported the role of tranexamic acid in prostatic surgeries, but, its role in TURP is still unclear. This review aims to evaluate the role of tranexamic acid in reducing the blood loss during TURP. Materials and Methods: A systematic search was performed on Medline, Scopus, Embase, and Cochrane, up to December 2021. Relevant randomized controlled trials (RCTs) evaluating the role of tranexamic acid in TURP were screened using our predefined eligibility criteria. Data were expressed as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs). All analyses were performed using RevMan 5.4 (Cochrane Collaboration, UK). Results: Six trials were included in this meta-analysis, comprising of 582 patients with BPH who underwent TURP. The meta-analysis revealed an insignificant difference in the rate of blood transfusion (OR 0.68, 95% CI 0.34, 1.34, P = 0.27) but, a significantly lower amount of blood loss and a lower reduction in the hemoglobin (Hb) levels in the patients receiving tranexamic acid as compared to the control group (MD - 127.03, 95% CI - 233.11, -20.95, P = 0.02; MD - 0.53, 95% CI - 0.84, -0.22, P < 0.01; respectively). Also, the operative time (P = 0.12) and the length of hospitalization (P = 0.59) were similar between the two groups. Conclusion: The administration of tranexamic acid was not found to be effective in reducing the need for blood transfusion, the operative time, and the length of hospitalization during the TURP. However, it could reduce the amount of blood loss and the fall in the Hb levels.

Management of prolonged penile ring entrapment in an Indonesian tertiary hospital: A case report and literature review.

Penile ring entrapment is a rare urological emergency with severe functional consequences if not treated in time. It may be challenging for physicians in limited-resource settings without a standardized intervention method. An lectrical grinder is the most commonly used tool for ring removal. However, in prolonged cases, additional post-removal interventions may be necessary. We report a prolonged penile ring entrapment case in an Indonesian tertiary hospital.

The role of hyperbaric oxygen therapy in Fournier's Gangrene: A systematic review and meta-analysis of observational studies

ABSTRACT Purpose: Management of Fournier's Gangrene (FG) includes broad-spectrum antibiotics with adequate surgical debridement, which should be performed within the first 24 hours of onset. However, this treatment may cause significant loss of tissue and may delay healing with the presence of ischemia. Hyperbaric oxygen therapy (HBOT) has been proposed as adjunctive therapy to assist the healing process. However, its benefit is still debatable. Therefore, this systematic review and meta-analysis aimed to evaluate the effect of HBOT as an adjunct therapy for FG. Materials and Methods: This study complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol to obtain studies investigating the effect of HBOT on patients with FG. The search is systematically carried out on different databases such as MEDLINE, Embase, and Scopus based on population, intervention, control, and outcomes criteria. A total of 10 articles were retrieved for qualitative and quantitative analysis. Results: There was a significant difference in mortality as patients with FG who received HBOT had a lower number of deaths compared to patients who received conventional therapy (Odds Ratio 0.29; 95% CI 0.12 - 0.69; p = 0.005). However, the mean length of stay with Mean Difference (MD) of -0.18 (95% CI: -7.68 - 7.33; p=0.96) and the number of debridement procedures (MD 1.33; 95% CI: -0.58 - 3.23; p=0.17) were not significantly different. Conclusion: HBOT can be used as an adjunct therapy to prevent an increased risk of mortality in patients with FG.

Comparative efficacy and safety between Micro-Percutaneous Nephrolithotomy (Micro-PCNL) and retrograde intrarenal surgery (RIRS) for the management of 10-20 mm kidney stones in children: A systematic review and meta-analysis.

Objectives: Kidney stone in children is a recurring problem that requires multiple interventions over time. Minimally-invasive approach, such as Extracorporeal Shockwave Lithotripsy (ESWL) is recommended for moderately-sized stones. However, since ESWL is associated with multiple interventions, Micro-Percutaneous Nephrolithotomy (Micro-PCNL) and Retrograde Intrarenal Surgery (RIRS) can also be considered to treat kidney stones in pediatric patients. Both approaches have their respective advantages and disadvantages. In this study, we aimed to compare the efficacy and safety of Micro-PCNL and RIRS in pediatric patients with kidney stones. Methods: This systematic review and meta-analysis adhered to the PRISMA guideline and Cochrane Handbook of intervention. The included studies were obtained from the PubMed and ScienceDirect databases. The protocol of this review has been registered in PROSPERO (CRD42021265894). The quality of the studies was assessed using the Newcastle-Ottawa Scale, outcomes were analyzed using STATA®16, and certainty of evidence was evaluated using GRADE. Results: A total of 239 participants were included in this study, divided into the Micro-PCNL (n = 112) and RIRS (n = 127) procedure groups. Statistical analysis revealed a significantly lower requirement of postoperative stenting procedure in Micro-PCNL compared to RIRS (OR 0.09; 95%CI 0.02, 0.47; p < 0.01). However, no significant difference was found in stone-free rate (p = 0.86), operative time (p = 0.09), UTI incidence (p = 0.67), blood transfusion requirement (p = 0.95), and length of stay (p = 0.77). Conclusion: Micro-PCNL is superior to RIRS in managing pediatric kidney stones,10-20 mm in size based on their comparable SFR and fewer requirements of additional stenting procedures.

Comparative efficacy and safety of holmium laser enucleation of the prostate (HoLEP) using moses technology and standard HoLEP: A systematic review, meta-analysis, and meta-regression.

Purpose: The use of HoLEP was associated with steep learning curve thus prolonging operative procedure. The problem of learning curve could be solved with the invention of Moses HoLEP. This study aimed to evaluate the comparison of efficacy and safety between Moses HoLEP and standard HoLEP in BPH patient. Materials and methods: Systematic search was carried out using PRISMA guideline. Pubmed, Scopus and Embase were searched to collect randomized controlled trials and observational studies. Quantitative analysis was performed to evaluate the comparison in intraoperative, postoperative and complications characteristics. RevMan 5.4 and STATA were used in data analysis. Results: Total of 7 studies (1226 patients) were included. Regarding intraoperative characteristics, Moses HoLEP provided significantly shorter enucleation time (MD: 3.00, 95% CI: 5.57 to -0.43, p = 0.02), shorter hemostasis time (MD: 3.79, 95% CI: 5.23 to -2.34, p < 0.00001), and shorter laser use time (MD: 2.79, 95% CI: 5.03 to -0.55, p = 0.01). For postoperative characteristics, Moses HoLEP possessed significantly lower PVR (MD -34.57, 95% CI -56.85 to -12.30, p = 0.002). Overall complication was higher in standard HoLEP although the result was not significant (MD 0.68, 95%CI: 0.38 to 1.21, p = 0.19). Moses HoLEP possessed more superiority over standard HoLEP regarding shorter hemostasis time with the increasing of prostate size (coefficient -0.894, p = 0.044). Conclusion: Moses HoLEP demonstrated shorter enucleation time, shorter hemostasis time and shorter laser use time. Moses HoLEP also possessed lower PVR. There were no safety issues in Moses HoLEP compared with standard HoLEP.

Prognostic value of neutrophil-to-lymphocyte ratio (NLR) in penile cancer: A systematic review and meta-analysis.

Background: Penile cancer is rare among male malignancies. Various biomarkers have been used to predict the prognosis of cancer, one of which is the neutrophil to lymphocyte ratio (NLR). Therefore, we conducted this systematic review and meta-analysis to evaluate the prognostic value of NLR in penile cancer. Methods: This review was conducted following the PRISMA guideline. Several databases, including Scopus, Science-direct, and PubMed, were systematically searched. The primary outcomes were lymph node metastasis (LNM), cancer-specific survival (CSS), and overall survival (OS). All statistical analyses were processed using Review Manager (RevMan) version 5.4. Results: A total of six retrospective studies were included in the analysis. The cut-off values of NLR in the included studies ranged from 2.6 to 3.59. Meta-analysis showed that penile cancer patients with high NLR had worse LNM and CSS based on the univariate analysis (OR 3.56, 95% CI 2.38, 5.32, p < 0.01; HR 4.19, 95% CI 2.19, 8.01, p = 0.0; respectively). Furthermore, the meta-analysis revealed that NLR is an independent predictor of LNM and CSS (OR 6.67, 95% CI 2.44, 18.22, p < 0.01; HR 2.15, 95% CI 1.23, 3.73, p < 0.01; respectively). However, NLR failed to show as independent predictor for OS (HR 1.69,95% CI 0.95,3.00, p = 0.07). Conclusion: NLR is an independent predictor of LNM and CSS. However, NLR is not proven to be an independent predictor of OS in this study.

A rare case report of tricorpora penile fracture associated with urethral disruption.

Penile fracture is defined as a tear of tunica albuginea that covers the corpus cavernosum during an erection. It is a rare finding that both the corpora cavernosum and corpora spongiosum are involved in penile fracture. Herewith, we reported a rare case of 44 years old presented with penile fracture during woman on top sex position with both corpora cavernosum and corpus spongiosum rupture with urethral disruption. On clinical examination, the penis was swollen, and there was a sudden loss of erection and ecchymosis. Cystoscopy examination revealed urethral rupture. Emergent surgical repair was then performed. During emergency surgery, we found a defect of 3 cm in bicorporal cavernosa with urethral and corpus spongiosum disruption. The penis was degloved, and debridement with water-tight suturing of tunica albuginea was performed to repair the tear in corpora cavernosa. End-to-end anastomosis urethroplasty with spatulation was also performed to repair the urethra. After 21 days following surgery, erectile function was good and no difficulties in voiding function as shown in uroflowmetry result with Qmax >15 mL/s. The patient had a favorable recovery. This was a rare case report, and with early and prompt surgical intervention, this case could result in a good outcome in preserving erectile function and voiding function.

The use of tissue sealant in reducing urethrocutaneous fistula event following hypospadias repair: A systematic review and meta-analysis.

Background: One of the most frequent complications following hypospadias repair is urethrocutaneous fistula (UCF) event. Tissue sealant has been introduced as a means to reduce UCF. However, reports regarding its benefits are varied. Thus, we initiated a systematic review and meta-analysis to investigate its role in reducing UCF following hypospadias repair. Methods: We completed a systematic search through the Embase, MEDLINE, and Scopus databases for studies assessing postoperative complications in hypospadias patients undergoing urethroplasty with and without tissue sealant. Cochrane risk of bias 2 (RoB 2) tool was used to assess the quality of randomized clinical trials (RCTs), while the observational studies were assessed with Newcastle-Ottawa Scale. The primary outcome analyzed in this study was UCF, while secondary outcomes consisted of postoperative complications such as edema, infection, and wound dehiscence that increases the risk of UCF formation, measured using odds ratio (OR) with a 95% confidence interval (CI). Results: Six eligible studies comprising three RCTs and three non-randomized studies were included. Patients undergoing hypospadias repair with tissue sealant had lower UCF events (OR = 3.27; 95% CI 1.92-5.58; p < 0.0001). Likewise other post-operative complications, tissue sealant group had a lower rate of edema (OR = 2.29; 95% CI 1.38-3.78; p = 0.001) and infection (OR = 3.87; 95% CI 1.55-9.70; p = 0.004). The difference in wound dehiscence was insignificant between the groups (OR = 2.08; 95% CI 0.21-20.55; p = 0.53). Conclusion: Tissue sealant can reduce UCF events following hypospadias repair as well as edema and infection that increases the risk of UCF formation.

The efficacy and safety of mitomycin C intra urethral injection to prevent recurrent urethral stricture: A systematic review and meta-analysis.

Objectives: Direct Vision Internal Urethrotomy (DVIU) is regarded as the most popular and frequently used minimal invasive approach for treating urethral stricture. However, the application of this procedure is limited due to the high recurrence rate. Recent trials have the benefit of mitomycin C as adjuvant therapy to reduce the stricture recurrence in DVIU procedures. In this meta-analysis, we aim to determine the efficacy of mitomycin C as adjuvant therapy for DVIU. Methods: A systematic literature search was carried out from Embase, ScienceDirect, and PubMed published up to September 2021. Relevant Randomized Controlled Trials (RCTs) were screened using our eligibility criteria. The quality assessment of the RCT was assessed using Cochrane RoB 2. The outcome was measured as an Odds Ratio (OR) with 95% Confidence Intervals (CIs). Statistical analyses were performed using RevMan 5.4. Results: We included four RCTs in the meta-analysis, with a total of 392 patients with urethral strictures undergoing DVIU. The pooled analysis showed a significantly lower recurrence rate in patients undergoing DVIU with additional treatment of mitomycin C compared to the control group (OR 0.27, 95% CI 0.16-0.45, p < 0.0001). Conclusion: Our findings highlight the benefit of adjuvant treatment with mitomycin C to reduce the incidence of urethral stricture recurrence after DVIU procedures.

The role of hyperbaric oxygen therapy in Fournier's Gangrene: A systematic review and meta-analysis of observational studies.

PURPOSE: Management of Fournier's Gangrene (FG) includes broad-spectrum antibiotics with adequate surgical debridement, which should be performed within the first 24 hours of onset. However, this treatment may cause significant loss of tissue and may delay healing with the presence of ischemia. Hyperbaric oxygen therapy (HBOT) has been proposed as adjunctive therapy to assist the healing process. However, its benefit is still debatable. Therefore, this systematic review and meta-analysis aimed to evaluate the effect of HBOT as an adjunct therapy for FG. MATERIALS AND METHODS: This study complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol to obtain studies investigating the effect of HBOT on patients with FG. The search is systematically carried out on different databases such as MEDLINE, Embase, and Scopus based on population, intervention, control, and outcomes criteria. A total of 10 articles were retrieved for qualitative and quantitative analysis. RESULTS: There was a significant difference in mortality as patients with FG who received HBOT had a lower number of deaths compared to patients who received conventional therapy (Odds Ratio 0.29; 95% CI 0.12 - 0.69; p = 0.005). However, the mean length of stay with Mean Difference (MD) of -0.18 (95% CI: -7.68 - 7.33; p=0.96) and the number of debridement procedures (MD 1.33; 95% CI: -0.58 - 3.23; p=0.17) were not significantly different. CONCLUSION: HBOT can be used as an adjunct therapy to prevent an increased risk of mortality in patients with FG.

An earphone wire inside the urinary bladder: A case report and comprehensive literature review of genitourinary polyembolokoilamania.

Self-inserted urinary bladder foreign bodies for sexual gratification generate a significant challenge for physicians due to its difficult diagnosis and management. Most patients were late to be admitted due to embarrassment leading to serious short-term and long-term complications. We report a 34-year-old male with an earphone wire as a urinary bladder foreign body. The findings in the patient were compared with the currently published reports through a comprehensive literature review to evaluate the current strategy for diagnosis and management for self-inserted genitourinary foreign bodies to achieve sexual pleasure.

Imaging modalities and management of pediatric high-grade renal trauma in an Indonesian tertiary hospital: a report of two cases and literature review.

As one of the most commonly injured organs in the genitourinary system during trauma, a thorough understanding of pediatric renal trauma's diagnosis and management is essential for physicians. The improvement of imaging modalities in recent years has shifted most treatments to a conservative approach. Non-operative management could reduce the risk of nephrectomy while increasing renal salvage rate. However, high-grade pediatric renal injury management remains controversial. We aimed to report two children with high-grade renal trauma, diagnosed using computed tomography and retrograde pyelography studies, undergoing different approaches. The first patient underwent a nephrectomy, whereas the second patient underwent non-operative management.

Doxorubicin and ifosfamide for recurrent renal synovial sarcoma: The first case report in Indonesia.

INTRODUCTION AND IMPORTANCE: Synovial sarcoma (SS) is the fourth most common soft tissue sarcoma. The primary treatment for renal SS is radical surgical resection of the tumor. However, there are several stages of SS that need systemic treatment. The consensus regarding systemic treatment remains unclear. Therefore, we reported a case of an 18-year-old male with recurrent renal SS treated with doxorubicin and ifosfamide as systemic chemotherapy. CASE PRESENTATION: An 18-year-old male was admitted with a chief complaint of right flank pain for three months. He had a history of radical nephrectomy due to a suspicion of Wilms tumor. The histopathological and immunohistochemistry results showed a SS of the kidney. One year after the surgery, the patient came with a sign of a residual tumor. The diagnosis of recurrent renal SS was established after the physical examination, and Second-line chemotherapy was not administered because the patient refused any further treatment. However, the patient showed a partial response after the first chemotherapy session, indicating the benefit of the treatment. CLINICAL DISCUSSION: The chemotherapy regimen is generally considered safe and can be widely used in clinical practice. Partial response was shown after six courses of treatment. Ifosfamide-based chemotherapy was also used in some reported cases. Most of the cases reported in the current literature were only managed by surgery without using chemotherapy. These cases had various RFS, ranging from 5 to 25 months. CONCLUSION: Doxorubicin and ifosfamide are useful as first-line chemotherapy for recurrent renal synovial sarcoma.

The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Bleeding is one of the most common complications of transurethral resection of the prostate (TURP). Several previous studies reported that administering dutasteride before surgery could reduce perioperative bleeding. We aimed to evaluate the efficacy of preoperative dutasteride treatment in benign prostatic hyperplasia patients undergoing TURP by performing a meta-analysis of relevant randomized controlled trials (RCTs). METHODS: A comprehensive literature search was performed through the electronic databases including Medline, Cochrane Library, Google Scholar, and ClinicalTrial.gov in October 2020. RCTs evaluating the role of dutasteride for TURP were screened using the eligibility criteria and the quality of RCTs was assessed using the Cochrane Risk of Bias Tool. The heterogeneity was assessed using I 2 statistic. The measured outcomes were hemoglobin (Hb) levels, perioperative blood loss, blood transfusion, microvessel density (MVD), and operation time. Data were pooled as mean difference (MD) and odds ratio (OR). RESULTS: A total of 11 RCTs consisting of 627 samples from the treatment group and 615 samples from the placebo group were analyzed. Patients that received dutasteride had less reduction in Hb levels (MD -1.10, 95% confidence interval [CI] -1.39 to -0.81, p<0.00001). Dutasteride also significantly reduced the operation time (MD -1.79, 95% CI -2.97 to -0.61, p=0.003) and transfusion rate after surgery (OR 0.34, 95% CI 0.15 to 0.77, p=0.009) compared to the control group. However, the MVD (MD -3.60, 95% CI -8.04 to 0.84, p=0.11) and perioperative blood loss in dutasteride administration for less than 4 weeks (MD 46.90, 95% CI -144.60 to 238.41, p=0.63) and more than 4 weeks (MD -190.13, 95% CI -378.05 to -2.21, p=0.05) differences were insignificant. CONCLUSION: Preoperative administration of dutasteride is able to reduce bleeding during TURP, as indicated by less reduction in Hb level, lower transfusion rate, and less operation time.

Self-introduction of a two-meter nylon string into the urinary bladder: A case report.

A foreign body of the urinary bladder can be caused by several factors. Several patients deliberately insert foreign bodies via the urethra due to psychiatric issues to achieve sexual pleasure. Self-inserted urinary bladder foreign bodies remain a significant challenge in the urology field regarding diagnosis and management as patients may be late in seeking medical assistance due to guilt and embarrassment. We aimed to report a 37-year-old man who inserted a two-meter nylon string into his urethra for sexual gratification.