Can We Predict the Grade of Clear Cell Renal Cell Carcinoma from Houns-Field Unit of Renal Lesion on Computerized Tomography Scan, a Retrospective Cross-Sectional Study.

Introduction: Renal cell carcinoma (RCC) is a type of urological malignancy that affects approximately 2% of the global population. Imaging modalities, especially computed tomography (CT) scanning, play a critical role in diagnosing RCC. In this study, we investigated whether there is a relationship between tumour grade of clear cell RCC and HU values of renal lesions on CT scan performed before operation. Materials and Methods: We conducted a retrospective analysis of 123 patients who underwent radical or partial (open or laparoscopic) nephrectomy for clear cell RCC between January 2017 and January 2021. Post-operation histopathological grades were recorded according to World Health Organization (WHO)/International Society of Urological Pathology (ISUP) 2016 grading system and divided into low grade (includes grade 1 and 2) and high grade (grade 3 and 4), and their links to age, sex, smoking habits, tumour size, and HUs of renal lesions were evaluated. Results: The mean age of the patients studied was 63.02 years old. About 56.9% of the patients were low grade (grade 1 or grade 2), while 43.1% were high grade (grade 3 or 4). The mean tumour size was 6.31 cm. There were no significant differences in tumour grade according to age, sex, or smoking habits. We found a significant relation between tumour grade and HU in the pre-contrast and nephrogenic phases, with p values of 0.001 and 0.037, respectively. On the other hand, there was no significant relation linking the tumour grade to the difference in HU between these phases, where there was a p value of 0.641. Conclusion: HU in the pre-contrast and nephrogenic phases in addition to tumour size on CT scan have a significant relation to clear cell RCC grade.

Evaluation of Antimicrobial Stewardship Programs and antibiotic prescribing patterns among physicians in ambulatory care settings in Jordan.

OBJECTIVES: Currently, there is an urgent need to implement an Antimicrobial Stewardship Program (ASP) in outpatient settings since nearly half of the antibiotic prescribing is inappropriate or unnecessary. The implementation of ASP should emphasize educational interventions that are more interactive. This study examines the adoption of outpatient ASP by physicians in Jordan. METHODS: A cross-sectional study was conducted between 2 March 2022 and 20 May 2022 at major hospitals in Jordan. The survey was distributed randomly among (n = 187) Jordanian physicians. RESULTS: It was found that more than half of the physicians were females (51.9%). The participants who reported not including antibiotic stewardship-related duties in position descriptions were (40.1%). While (46.5%) of participants reported writing and displaying public commitments supporting antibiotic stewardship in ambulatory care settings. Physicians' adoption of (action) core elements of ASPs in ambulatory care settings was positive. Almost (24.6%) reported a lack of self-evaluation of their antibiotic-prescribing practices. It was reported that (69.5%) of physicians used effective communication strategies to educate patients about when antibiotics are necessary. CONCLUSION: It was fair adoption of the core elements in the ambulatory care settings among Jordanian physicians. Progress necessitates a comprehensive strategy tailored to the needs of the health system.

Discovery of a novel genetic variant in the N-acetyltransferase2 (NAT2) gene that is associated with bladder cancer risk.

Smoking is a main risk factor for bladder cancer (BC). NAT2 is a drug-metabolizing enzyme that catalyses the detoxification of many xenobiotics and carcinogens. Single nucleotide polymorphism (SNP) in NAT2 results in different acetylation phenotypes (fast, intermediate or slow). Certain NAT2 SNPs were associated with BC and/or modified the association of BC with smoking. However, limited evidence is available among BC patients or smokers from Jordan. This study aimed to discover novel SNPs in NAT2 and to assess the association with BC. This was a case-control study among 120 BC patients and 120 controls. Amplification of a 446 bp fragment of NAT2 encoding the N-catalytic domain was conducted using a polymerase chain reaction. Gene sequencing was done using Sanger-based technology. A total of 40 SNPs were detected. Two variants were significantly associated with BC (p<0.05); namely a novel c.87G>A and the reported c.341T>C. Regarding c.87G>A, genotype distribution was significantly associated with BC and subgroup analysis confirmed that this was significant in both smokers (p=0.007) and non-smokers (p=0.001). Regression subgroup analysis suggested GA as a risk factor among smokers (AOR= 2.356). The frequencies of TC and CC genotypes of c.341T>C were significantly higher in BC (p<0.05). This was statistically significant among smokers only (p=0.044), upon subgroup analysis. Multivariate analysis showed that subjects with TC genotype are 6.15 more likely to develop BC and regression subgroup analysis revealed TC as a risk factor among smokers (AOR=5.47). This is the first study from Jordan to report the association of smoking and two NAT2 variants with BC. The data supports the use of GA and TC genotypes of the novel c.87G>A and the reported c.341T>C SNPs, respectively as potential biomarkers of BC, particularly among smokers. Future investigations with a larger population are required to support our findings.

Adherence to guidelines in the follow-up of non-muscle-invasive bladder cancer among urology trainers and trainees in Jordan: a cross-sectional study.

To assess the clinical practice in the follow-up of non-muscle-invasive bladder cancer (NMIBC) among urology specialists (trainers) and residents (trainees) in Jordan. Methods: An electronic questionnaire containing, in addition to demographic data, four questions regarding the follow-up of NMIBC was sent by e-mail to 115 urologists (53 residents and 62 specialists) selected randomly by stratified random sampling from different clinical institutions, 105 of them were returned complete. Results: In all, 105 out of 115 (91%) questionnaires were returned complete. All of the candidates are male. For low-risk NMIBC follow-up, 46 of the specialists (79%) and 35 of the trainees (74%) decided to do a follow-up cystoscopy at 3 months after diagnosis, followed by a check cystoscopy 9 months later than yearly, while for high-risk patients, all of the specialists and 45 of the trainees (96%) decide to do a check cystoscopy every 3 months in the first 2 years after diagnosis. For upper tract follow-up in high-risk NMIBC, all of the urologists in the survey (specialists and trainees) routinely perform upper tract imaging in the form of a computed tomography scan with contrast in the first year after diagnosis. On the other hand, in the follow-up of the upper urinary tract in low-risk NMIBC, 16 of the trainees (34%) and 19 of the specialists (33%) still perform a yearly scan. Conclusion: Because of the high recurrence rate for NMIBC, this raises the importance of adherence to guidelines in the follow-up for these patients and, at the same time to avoid overdoing unnecessary cystoscopies or upper tract scans.

The Effect of Transurethral Resection of the Prostate on Erectile and Ejaculatory Functions in Patients with Benign Prostatic Hyperplasia.

INTRODUCTION: The aim of this study was to investigate the effect of TURP on erectile function (EF) and ejaculatory function (EJF). METHODS: A total of 91 patients who underwent TURP were retrospectively assessed. Patients were divided into two groups based on International Index of Erectile Function (IIEF-5): group A included 41 patients with normal EF, and group B included 50 patients with erectile dysfunction (ED). All patients were evaluated for EF and EJF at baseline, 1, 3, and 6 months after TURP by using IIEF-5, Ejaculatory Domain-Male Sexual-Health Inventory (Ej-MSHQ). RESULTS: In group A, there were no significant statistical differences in mean IIEF-5 at baseline and after TURP 22.88 ± 0.81 versus 22.63 ± 2.63 (p = 0.065). However, in group B, there was significant improvement in IIEF-5 after TURP all over the follow-up time points in comparison to the baseline (p = <0.001). The loss of EJF was significant among patients in group A. There was significant improvement of IPSS and Qmax in group A after surgery compared to group B. CONCLUSION: The results confirmed that TURP has no significant negative influence on EF, and patients with preexisting ED were improved after TURP. On the contrary, the loss of EJF was significant.

Continuous Saline Bladder Irrigation in Reducing Recurrence and Progression When Compared to Immediate Mitomycin- C Instillation Post- Resection of Bladder Tumor: A Short Communication.

INTRODUCTION: Intravesical chemotherapy instillation by mitomycin - C (MMC) immediately after transurethral resection of bladder tumor (TURBT), although effective in reducing the incidence of non- muscle invasive bladder cancer (NMIBC) recurrence, can result in non desirable effects like bladder irritation and hematuria . Continuous bladder irrigation with saline post resection has been studied as an alternative. In our study we  compare the rates of  NMIBC recurrence and progression in patients who were treated with either MMC or CSBI immediately after tumor resection. METHODS: We retrospectively reviewed the medical records of patients with NMIBC at our institution in Jordan university hospital in the period between 2015-2019. Postoperative instillation of MMC or CSBI for four hours was recorded. Follow up of the patients for recurrence or progression in the first 2 years after diagnosis was recorded and compared for  both groups. RESULTS: One hundred nineteen patients met inclusion criteria. Fifty four patients received MMC and 65 patients received CSBI immediately post TURBT. Kaplan-Meieranalysis for recurrence- free survival and progression- free survival didn't show a significant difference between both groups with P- value 0.88 and 0.14 respectively. CONCLUSION: Postoperative CSBI for four hours following tumor resection is equivalent to immediate postoperative MMC instillation for NMIBC in terms  of recurrence or progression rates with fewer side effects . However further  research is needed in this field .

Chemically Defined Conditions Mediate an Efficient Induction of Dental Pulp Pluripotent-Like Stem Cells into Hepatocyte-Like Cells.

Liver diseases are major causes of morbidity and mortality. Dental pulp pluripotent-like stem cells (DPPSCs) are of a considerable promise in tissue engineering and regenerative medicine as a new source of tissue-specific cells; therefore, this study is aimed at demonstrating their ability to generate functional hepatocyte-like cells in vitro. Cells were differentiated on a collagen scaffold in serum-free media supplemented with growth factors and cytokines to recapitulate liver development. At day 5, the differentiated DPPSC cells expressed the endodermal markers FOXA1 and FOXA2. Then, the cells were derived into the hepatic lineage generating hepatocyte-like cells. In addition to the associated morphological changes, the cells expressed the hepatic genes HNF6 and AFP. The terminally differentiated hepatocyte-like cells expressed the liver functional proteins albumin and CYP3A4. In this study, we report an efficient serum-free protocol to differentiate DPPSCs into functional hepatocyte-like cells. Our approach promotes the use of DPPSCs as a new source of adult stem cells for prospective use in liver regenerative medicine.

Histologic and Histomorphometric Evaluation of a New Bioactive Liquid BBL on Implant Surface: A Preclinical Study in Foxhound Dogs.

BACKGROUND: Bioactive chemical surface modifications improve the wettability and osseointegration properties of titanium implants in both animals and humans. The objective of this animal study was to investigate and compare the bioreactivity characteristics of titanium implants (BLT) pre-treated with a novel bone bioactive liquid (BBL) and the commercially available BLT-SLA active. METHODS: Forty BLT-SLA titanium implants were placed in in four foxhound dogs. Animals were divided into two groups (n = 20): test (BLT-SLA pre-treated with BBL) and control (BLT-SLA active) implants. The implants were inserted in the post extraction sockets. After 8 and 12 weeks, the animals were sacrificed, and mandibles were extracted, containing the implants and the surrounding soft and hard tissues. Bone-to-implant contact (BIC), inter-thread bone area percentage (ITBA), soft tissue, and crestal bone loss were evaluated by histology and histomorphometry. RESULTS: All animals were healthy with no implant loss or inflammation symptoms. All implants were clinically and histologically osseo-integrated. Relative to control groups, test implants demonstrated a significant 1.5- and 1.7-fold increase in BIC and ITBA values, respectively, at both assessment intervals. Crestal bone loss was also significantly reduced in the test group, as compared with controls, at week 8 in both the buccal crests (0.47 ± 0.32 vs 0.98 ± 0.51 mm, p < 0.05) and lingual crests (0.39* ± 0.3 vs. 0.89 ± 0.41 mm, p < 0.05). At week 12, a pronounced crestal bone loss improvement was observed in the test group (buccal, 0.41 ± 0.29 mm and lingual, 0.54 ± 0.23 mm). Tissue thickness showed comparable values at both the buccal and lingual regions and was significantly improved in the studied groups (0.82-0.92 mm vs. 33-48 mm in the control group). CONCLUSIONS: Relative to the commercially available BLT-SLA active implants, BLT-SLA pre-treated with BBL showed improved histological and histomorphometric characteristics indicating a reduced titanium surface roughness and improved wettability, promoting healing and soft and hard tissue regeneration at the implant site.

Safety and Efficacy of 2 Intracavernous Injections of Allogeneic Wharton's Jelly-Derived Mesenchymal Stem Cells in Diabetic Patients with Erectile Dysfunction: Phase 1/2 Clinical Trial.

BACKGROUND AND OBJECTIVES: Stem cell therapy is a novel treatment with regenerative ability that can treat erectile dysfunction (ED). This phase 1/2 clinical trial (NCT02945449) using 2 consecutive intracavernous (IC) injections of allogeneic Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) was studied for the first time in the treatment of diabetic patients with ED. The primary outcome was to assess the safety and tolerability, and the secondary outcome was to assess the efficacy of 2 consecutive IC injections of allogeneic WJ-MSCs in diabetic ED. PATIENTS AND METHODS: Twenty-two diabetic patients with refractory ED were included. Two consecutive IC injections of allogeneic WJ-MSCs were performed. Tolerability was assessed immediately, and at 24 h, safety was evaluated for 12 months. Efficacy was assessed using International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS), and Color Duplex Doppler Ultrasound for 12 months. RESULTS: The procedure was well-tolerated. Minimal and transient adverse events were redness and bruising at the site of injections. There were no patient-reported serious adverse effects. There were significant improvements in IIEF-5, EHS, peak systolic velocity (PSV) basal, and 20-min PSV, all over the follow-up time points in comparison to the baseline. CONCLUSION: This is the first human study with proven tolerability, safety, and efficacy of IC injections of allogeneic WJ-MSCs for the treatment of diabetic patients with ED.

The combinatorial use of propofol-fentanyl-ketamine for sedoanalgesia in patients undergoing urological procedures.

OBJECTIVES: To compare sedoanalgesia achieved using propofol-fentanyl-ketamine (PFK) combination with general anesthesia (GA) in terms of safety, hemodynamic stability, and perioperative complications. METHODS: Patients in the GA group were anesthetized using fentanyl (2 µg kg-1) and propofol (2 mg kg-1). The PFK group was anesthetized using a mixture of which each one ml contains 0.005 mg of fentanyl, 5 mg of propofol, 5 mg of ketamine, and 2 mg of lidocaine. Patients received an initial dose of 0.05 ml kg-1, followed by 0.05 mg kg-1 60 seconds later. Maintenance boluses of 0.025 ml kg-1 were administered every 3-5 minutes. Respiration occurred spontaneously through a simple face mask with 3 L min-1 O2. RESULTS: The GA group had 37 (37%) patients develop hypotensive episodes, compared to one (1%) episode in the PFK group (p<0.001). Five (5%) patients in the PFK group had an episode of transient O2 desaturation, compared to one (1%) patient in the GA group (p=0.212). The duration of induction and termination of anesthesia were significantly shorter in the PFK group (p<0.001). CONCLUSION: The PFK combination herein described is safe, effective, and provides intraoperative hemodynamic stability in patients with multiple comorbidities undergoing urological procedures.

Use of conditioned media (CM) and xeno-free serum substitute on human adipose-derived stem cells (ADSCs) differentiation into urothelial-like cells.

BACKGROUND: Congenital abnormalities, cancers as well as injuries can cause irreversible damage to the urinary tract, which eventually requires tissue reconstruction. Smooth muscle cells, endothelial cells, and urothelial cells are the major cell types required for the reconstruction of lower urinary tract. Adult stem cells represent an accessible source of unlimited repertoire of untransformed cells. AIM: Fetal bovine serum (FBS) is the most vital supplement in the culture media used for cellular proliferation and differentiation. However, due to the increasing interest in manufacturing xeno-free stem cell-based cellular products, optimizing the composition of the culture media and the serum-type used is of paramount importance. In this study, the effects of FBS and pooled human platelet (pHPL) lysate were assessed on the capacity of human adipose-derived stem cells (ADSCs) to differentiate into urothelial-like cells. Also, we aimed to compare the ability of both conditioned media (CM) and unconditioned urothelial cell media (UCM) to induce urothelial differentiation of ADCS in vitro. METHODS: ADSCs were isolated from human lipoaspirates and characterized by flow cytometry for their ability to express the most common mesenchymal stem cell (MSCs) markers. The differentiation potential was also assessed by differentiating them into osteogenic and adipogenic cell lineages. To evaluate the capacity of ADSCs to differentiate towards the urothelial-like lineage, cells were cultured with either CM or UCM, supplemented with either 5% pHPL, 2.5% pHPL or 10% FBS. After 14 days of induction, cells were utilized for gene expression and immunofluorescence analysis. RESULTS: ADSCs cultured in CM and supplemented with FBS exhibited the highest upregulation levels of the urothelial cell markers; cytokeratin-18 (CK-18), cytokeratin-19 (CK-19), and Uroplakin-2 (UPK-2), with a 6.7, 4.2- and a 2-folds increase in gene expression, respectively. Meanwhile, the use of CM supplemented with either 5% pHPL or 2.5% pHPL, and UCM supplemented with either 5% pHPL or 2.5% pHPL showed low expression levels of CK-18 and CK-19 and no upregulation of UPK-2 level was observed. In contrast, the use of UCM with FBS has increased the levels of CK-18 and CK-19, however to a lesser extent compared to CM. At the cellular level, CK-18 and UPK-2 were only detected in CM/FBS supplemented group. Growth factor analysis revealed an increase in the expression levels of EGF, VEGF and PDGF in all of the differentiated groups. CONCLUSION: Efficient ADSCs urothelial differentiation is dependent on the use of conditioned media. The presence of high concentrations of proliferation-inducing growth factors present in the pHPL reduces the efficiency of ADSCs differentiation towards the urothelial lineage. Additionally, the increase in EGF, VEGF and PDGF during the differentiation implicates them in the mechanism of urothelial cell differentiation.

Delayed Bladder Perforation Related to Immediate Single Dose Intravesical Doxorubicin Instillation After TURBT: A Case Report and Literature Review.

INTRODUCTION: Intravesical chemotherapy instillation immediately after tumor resection is a well-known practice in the management of non-muscle invasive bladder cancer. Despite being largely well tolerated in most cases, it is not devoid of severe and life-threatening complications. CASE PRESENTATION: We present an unusual case of bladder perforation that happened 2 weeks after bladder tumor resection. The patient had received single dose intra-vesical instillation of doxorubicin after TUR-BT. Conservative managements failed to achieve bladder healing; as a result, open surgical repair was performed. To the best of our knowledge, this is the first reported case of bladder perforation after intra-vesical doxorubicin instillation. CONCLUSION: The occurrence of such a rare serious complication in a mostly safe intervention must be taken into consideration. A high index of suspicion, timely management, and proceeding to more invasive surgical treatments when necessary are cornerstones in the management and preserving the bladder.

Knowledge, Practice, and Attitude Toward COVID-19 Among Physicians in Jordan and Palestine: Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Coronavirus disease-2019 (COVID-19) is an emerging disease threatening the world with a rapid increase in cases and deaths since it was first identified in December 2019. Adequate knowledge, practice, and attitudes (KPA) toward COVID-19 among physicians at the frontline defense against the COVID-19 pandemic may enhance their ability to avoid the risk of self-infection, decrease mortality, and provide adequate medical care service in this pandemic. This study aimed to assess KPA toward COVID-19 among physicians in Jordan and Palestine. METHODS: This is a cross-sectional study using an online survey conducted from 10 April to 26 April 2020 among Jordan and Palestine physicians. Invitations were sent to physician groups on Facebook and WhatsApp. This survey contains 36-items, divided into four main sections to assess the participants' socio-demographic characteristics, knowledge, practice, and attitude about COVID-19. RESULTS: A total of 454 physicians participated in this study. The mean score of basic knowledge was 4.4 ± 0.8 (range 2-4). There were significant differences between basic knowledge mean scores among physicians in different professional degrees and physicians in various health sectors (P=0.0315, P=0.0137, respectively). The mean scores of self-protection measures, were 6.1 ± 1.1 (range 3-7) and measures if physician self-suspected of COVID-19 were 9.9± 1.1 (range 5-11). The mean score of attitudes toward COVID-19 was 41.5 ± 3.3 (range 21-45) and significantly related to the age and different experience years (P=0.0022, P=0.0077, respectively). CONCLUSION: As the global threat of COVID-19 continues to emerge, physicians from Jordan and Palestine showed adequate KPA toward COVID-19. There was a significant difference in knowledge level and attitude between physicians. Policymakers and physicians should keep continuous educational activities, training, and follow-up updates during this pandemic.

Ureteric stenting vs not stenting following uncomplicated ureteroscopic lithotripsy: A prospective randomised trial.

OBJECTIVE: To compare three groups of patients who underwent uncomplicated ureteroscopic lithotripsy (URSL) and to evaluate whether stenting could be eliminated after the procedure, as there is no consensus about whether a ureteric stent should be placed after uncomplicated ureteroscopy for stone retrieval. PATIENTS AND METHODS: In this randomised clinical trial (NCT04145063) 105 patients underwent uncomplicated URSL for ureteric stones. They were prospectively randomised into three groups: Group 1 (34 patients) with a double pigtail ureteric stent, Group 2 (35 patients) with a double pigtail ureteric stent with extraction string, and Group 3 (36 patients) with no ureteric stent placed after the procedure. The outcomes measured were: postoperative visual analogue scale (VAS) score for flank pain and dysuria score, urgency, frequency, suprapubic pain, haematuria, analgesia requirement, operative time, re-hospitalisation, and return to normal physical activity. RESULTS: The mean (SD) operative time was significantly longer in groups 1 and 2 compared to Group 3, at 22.2 (9.1), 20.2 (6) and 15.1 (7.1) min, respectively (P < 0.001). The results of the VAS for flank pain and dysuria scores, urgency, frequency, haematuria, and suprapubic pain showed a significant difference at all time-points of follow-up, being significantly higher in groups 1 and 2 compared to Group 3 (all P < 0.001). Further analysis showed that measured outcomes, and analgesia need for groups 1 and 2 were similar, at all time-points except at week 1 and 1 month where Group 2 patients' had less symptoms (P < 0.001). CONCLUSION: Double pigtail ureteric stent placement appears to be unnecessary in procedures considered 'uncomplicated' by operating urologists during surgery. The advantages of the double pigtail ureteric stent with extraction string over the double pigtail ureteric stent only include earlier and easier removal with earlier relief of symptoms, and less analgesia requirements. ABBREVIATIONS: KUB: plain abdominal radiograph of the kidneys, ureters and bladder; URSL: ureteroscopic lithotripsy; VAS: visual analogue scale.

A Huge Penile Fibroepithelial Polyp Treated with Partial Penectomy: A Case Report and Review of the Literature.

Fibroepithelial polyps are benign tumors of mesodermal origin that usually arise on the surface of the skin and to a lesser extent in the urinary tract; however, their presence on the penis is extremely unusual. We report the case of a 73-year-old male with an extremely large broad-based penile fibroepithelial polyp (FEP) involving the penile shaft and glans penis associated with chronic condom catheter use and that was treated with partial penectomy. A review of the literature is included to highlight the rarity of this case. To the best of our knowledge, this is the largest mass of its kind to be reported on the penis.

Huge perinephric hematoma after ureteroscopy and pneumatic lithotripsy for ureteral stone; A life-threatening rare complication: Case report and review of literature.

INTRODUCTION: Ureteroscopy with pneumatic lithotripsy is a relatively safe procedure for the management of the ureteral stone disease. However; subcapsular hematoma and even huge perinephric hematoma are potentially serious events that may complicate this procedure and must be kept in mind. CASE PRESENTATION: We present a case of huge perinephric hematoma post ureteroscopy and pneumatic lithotripsy for an impacted ureteral stone. CONCLUSION: The occurrence of such a rare complication in a relatively safe procedure must be taken into consideration especially while dealing with patients with long-standing obstruction and thin renal cortex. Furthermore, the risk of bleeding should be included in risk-benefit counselling before ureteroscopic lithotripsy.

Evaluation of Voiding Position on Uroflowmetry Parameters and Post Void Residual Urine in Patients With Benign Prostatic Hyperplasia and Healthy Men.

Uncertainty remains whether it is best for men to void in a sitting or standing position. The objective of this study is to evaluate the effect of standing and sitting voiding position on uroflowmetry parameters and post void residual urine (PVRU) in patients with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) and healthy men. A total of 116 participants with BPH (Group 1) and 78 healthy men (Group 2) were enrolled in the study. The uroflowmetry parameters were measured in both positions. The PVRU volume was measured using transabdominal ultrasound after each voiding. Uroflowmetry parameters and PVRU were measured and compared between the two different voiding positions using Wilcoxon signed rank test. In Group 1, there were significant statistical differences in uroflowmetry parameters between standing and sitting voiding position. The median of maximum flow rate in Group 1 in standing and sitting position was 14.7 ml/s (IQR; 11.7-17.5) and 11 ml/s (IQR; 8.9-13.3), respectively (p < .0001). The median voided volume at standing position was 340 ml (IQR; 276-455) while it was 267 ml (IQR; 194-390) at sitting position (p < .0001). Median average flow rate in standing position was 5.9 ml/s (IQR; 4.5-7.5) and 5 ml (IQR; 3.2-6.4) in sitting position. There was a statistically significant difference between the median of PVRU in standing and sitting position (p < .0001). In patients with BPH, voiding in standing position showed better uroflowmetry parameters and significant less PVRU volume.

Evaluation of the clinical pharmacist role in improving clinical outcomes in patients with lower urinary tract symptoms due to benign prostatic hyperplasia.

Background Lower urinary tract symptoms due to benign prostatic hyperplasia set restriction to patients' daily life activities and decrease their quality of life. Adherence to medications is considered a core element to improve patients' clinical outcomes. Objective To evaluate the role of clinical pharmacist in improving adherence to medication, reducing severity of symptoms, and improving quality of life in this group of patients. Setting The study was conducted in urology outpatients' clinics in Amman, Jordan. Methods This was a prospective randomized controlled trial, patients were randomly allocated into intervention group or control group. Patients in the intervention group were offered a pharmaceutical care service and patients in the control group received regular healthcare provided by urologist and then followed for 1 month. Main outcome measures Morisky Medication Adherence Score and International Prostate Symptom Score. Results Among 209 patients completed the study, 105 were in the intervention group and 104 in the control group. By the end of the study, 91.4% of the intervention group patients became adherent to their medication compared to 72.1% in the control group (p < 0.0001). At follow up, the severity of the symptoms to calculated score was lower in the intervention group (mean 15.6 ± 5.69) compared to control group (mean 13.9 ± 5.43) (p < 0.0001). The quality of life score were better in the intervention group compared to the control group at follow-up (p < 0.0001). Conclusion The current findings indicate that implementing clinical pharmacy services can positively increase the level of adherence to medications. This was accompanied by modest improvement in the severity of urinary symptoms in benign prostatic hyperplasia and in quality of life for patients. Hence, clinical pharmacy services could provide beneficence in outpatient setting.

Knowledge, awareness, and attitudes about research ethics committees and informed consent among resident doctors.

Background: Medical research involving humans is now common all over the world. Medical doctors and residents are increasingly involved in such research. As part of their training requirements, medical residents in many institutions have to be involved, to different degrees, in human research projects. Methods: In this study, knowledge, awareness, and attitudes of resident doctors toward research ethics committees (REC) and informed consent (IC) processes were evaluated. For that purpose, a sample of 209 medical residents of different years from a major teaching hospital was surveyed. Results: Results showed that resident doctors had minimal knowledge of major ethical guidelines such as the Declaration of Helsinki and Belmont Report. However, more than half of respondents in this study had general knowledge of REC. Additionally, the majority of participants believed that there is a need for REC in each research conducting institution, and that training is also needed for REC members. Moreover, 82.7% of participants thought that investigators should have some training in research ethics. Finally, the current study showed that 60.3%-88.7% of participants were aware of IC requirements in clinical research. Conclusion: Although many residents showed good knowledge and positive attitudes regarding certain aspects related to REC and IC, others need improvement.

Safety and Potential Therapeutic Effect of Two Intracavernous Autologous Bone Marrow Derived Mesenchymal Stem Cells injections in Diabetic Patients with Erectile Dysfunction: An Open Label Phase I Clinical Trial.

OBJECTIVES: This open label, phase I clinical trial (NCT02945462) using 2 consecutive intracavernous autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) for the first time in the treatment of diabetic patients with erectile dysfunction (ED). The primary outcome is to assess the safety and tolerability of intracavernous autologous BM-MSCs, the secondary outcome is to assess efficacy of the procedure. PATIENTS AND METHODS: Four diabetic patients with refractory ED were included. Two consecutive intracavernous autologous BM-MSC injections were performed. Tolerability was assessed immediately and at 24 h, safety was evaluated for 2 years. Efficacy was assessed using International Index of Erectile Function-15 (IIEF-15) and Erection Hardness Score (EHS) for 12 months. RESULTS: procedure was well tolerated and no patients reported significant adverse effects. There was significant improvement of IIEF-15 and EHS; IIEF-15 (p = 0.04), Erectile Function (p = 0.03), Sexual Desire (p = 0.04), Intercourse Satisfaction (p = 0.04), and Overall Satisfaction (p = 0.04). CONCLUSION: This is the first human study with proven tolerability, safety and efficacy of intracavernous autologous BM-MSC injections for treatment of diabetic patients with ED.