Comparison of outcomes of holmium laser versus bipolar enucleation of prostates weighing >80 g with bladder outlet obstruction.

Transurethral enucleation of the prostate has been increasingly recognized as an effective minimally invasive technique for management of enlarged prostates. We aimed to compare holmium laser enucleation (HoLEP) and bipolar transurethral enucleation (B-TUEP) of large-volume prostates. A prospectively maintained database in two tertiary referral centers was reviewed for patients with HoLEP and B-TUEP for prostates >80 g. Operative data, perioperative complications, and early postoperative outcomes were compared. The study included 101 patients, 70 who underwent HoLEP and 31 who underwent B-TUEP. The operative enucleation rate (weight of adenoma enucleated in g/min) was higher in HoLEP compared to B-TUEP (P < 0.0001). The operative complication rate, hemoglobin drop, and readmission rate were comparable in both groups (P = 0.13, 0.35, 0.29, 0.59, respectively). The HoLEP arm had a shorter hospital stay and shorter catheterization time (P = 0.001, 0.012). Follow-up data showed a lower International Prostate Symptom Score and serum prostate-specific antigen level in the HoLEP group. The incontinence rate was comparable in both groups. In conclusion, both techniques were effective in managing a high-volume prostate, although HoLEP had a shorter enucleation time, better symptom score, lower postoperative prostate-specific antigen level, shorter catheterization time, and shorter hospital stay compared to B-TUEP.

The incidence of urethral stricture and bladder neck contracture with transurethral resection vs. holmium laser enucleation of prostate: A matched, dual-center study.

INTRODUCTION: Urethral strictures (US) and bladder neck contracture (BNC) are common, long-term complications of transurethral prostate surgery. We aimed to compare transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) regarding incidence of US or BNC and identify possible risk factors. METHODS: A retrospective review of patients who underwent TURP and HoLEP with followup data of at least one year in two separate institutions was performed. The incidence of postoperative US or BNC in both groups was compared. Bivariate and multivariate analysis of risk factors in both cohorts with US or BNC were performed. RESULTS: The study included 208 patients: 101 and 107 patients in the TURP and HoLEP arms, respectively. The two groups were matched for age and prostate size. Eight (7.92%) and five (4.72%) patients in the TURP and HoLEP arms, respectively, developed US (p=0.3423), while two (1.87%) patients in the HoLEP arm had BNC (p=0.2634). Of the eight patients with the US in the TURP arm, six (9.8%) had bipolar TURP, while two (5%) had monopolar TURP. Multivariate analysis showed that larger prostate volume (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.05, 1.41, p=0.0066) and longer operative time (HR 1.84, 95% CI 1.76, 1.93, p=0.0015) were associated with risk of US/BNC. CONCLUSIONS: There is no significant difference between TURP and HoLEP regarding incidence of US or BNC, although there is a tendency towards a higher rate of US associated with bipolar TURP. Increased prostate volume and operative time are possible risk factors.

Prognostic Indicators for Successful Low-intensity Extracorporeal Shock Wave Therapy Treatment of Erectile Dysfunction.

OBJECTIVE: To assess prognostic factors affecting successful low-intensity extracorporeal shockwave therapy (Li-ESWT) treatment of erectile dysfunction (ED) in patients with vasculogenic ED and to report 30-month follow-up. METHODS: This study was conducted upon 425 patients with vasculogenic ED. Assessment of ED was done using Sexual Health Inventory for Men (SHIM) score. Patients were treated by Li-ESWT using PiezoWave2 (Richard Wolf) device. Successful Li-ESWT was defined as 6-month SHIM score of 22-25. Patients with successful treatment were followed for 30 months. RESULTS: Mean Baseline SHIM scores for the total population studied was 11.8 with a range from 5 to 20. After 6 months from treatment, 220 (51.8%) patients reported satisfactory sexual intercourse. Age, diabetes, hypertension, smoking, obesity, hyperlipidemia, pretreatment SHIM score, and the duration of ED were all found to be significant factors affecting the success of Li-ESWT. At 30-month follow-up, 168 (76.3%) patients from those who responded to Li-ESWT still reported satisfactory sexual intercourse with a SHIM score of 22-25 without using PDE5i. CONCLUSION: Li-ESWT is safe and effective treatment of ED with 30 months success in 39.5% of patients treated. Li-ESWT should be offered to patients with mild-to-moderate ED and not to those with severe ED.

Complications of endourological procedures and their treatment.

Endourological treatment for urinary stones and other obstructive urinary tract diseases is minimally invasive but in some cases it involves serious complications. This collection of cases describes some complications of endourological procedures and how they were treated. Case 1: A case of right ultrasound-guided percutaneous nephrostomy found to be misplaced in the inferior vena cava. The case was safely managed, but it showed that ultrasound guidance alone may be insufficient so it is recommended that percutaneous nephrostomy should be always placed under fluoroscopic control, either alone or in combination with ultrasound guidance. Case 2: A case of renal subcapsular hematoma occurring on retrograde intrarenal surgery at high perfusion pressure. The hematoma was drained under combined ultrasonic and radiological guidance. Post treatment recovery was uneventful. Large stone size, severe ipsilateral hydronephrosis, long operation time, higher hydrostatic pressure of the irrigating solution and low ureteral wall compliance are supposed to be risks factors associated with renal subcapsular formation. Management strategy should be tailored to patient's clinical conditions. In hemodynamically stable patients, large hematoma drainage is recommended to prevent further complications and favours early recovery. Case 3: A case of double J stent fracture discovered one month after the insertion to relieve obstruction from a 1 cm stone in the right proximal ureter. The distal fragment of the stent was removed by cystoscopy while the proximal fragment was removed by semirigid ureteroscopy in two sessions due to fever and extensive calcification. Case 4: A mini-invasive technique for transurethral replacement of completely encrusted urinary stents in female patients. This technique allows the interventional radiologist to replace obstructed urinary stents by avoiding more invasive and traumatic urological procedures with sedation.

LocSpeck: A Collaborative and Distributed Positioning System for Asymmetric Nodes Based on UWB Ad-Hoc Network and Wi-Fi Fingerprinting.

This paper presents LocSpeck, a collaborative and distributed indoor positioning system for dynamic nodes connected using an ad-hoc network, based on inter-node relative range measurements and Wi-Fi fingerprinting. The proposed system operates using peer-to-peer range measurements and does not need ultra-wideband (UWB) fixed anchor, nor it needs a predefined network topology. The nodes could be asymmetric in terms of the available sensors onboard, the computational resources, and the power capacity. This asymmetry adversely affects the positioning performance of the weaker nodes. Collaboration between different nodes is achieved through a distributed estimator without the need of a single centralized computing element. The ranging measurement component of the system is based on the DW1000 UWB transceiver chip from Decawave, which is attached to a set of smartphones equipped with asymmetric sensors. The distributed positioning filter fuses, locally on each node, the relative range measurements, the reading from the internal sensors, and the Wi-Fi received signal strength indicator (RSSI) readings to obtain an estimate of the position of each node. The described system does not depend on fixed UWB anchors and supports online addition and removal of nodes and dynamic node role assignment, either as an anchor or as a rover. The performance of the system is evaluated by real-world test scenarios using a set of four smartphones navigating an indoor environment on foot. The performance is compared to that of a commercial UWB-based system. The results presented in this paper show that weak mobile nodes, in terms of available positioning sensors, can benefit from collaboration with other nearby nodes.

Optimizing the Diagnostic Role of Alpha-Fetoprotein and Abdominal Ultrasound by Adding Overexpressed Blood mRNA Matrix Metalloproteinase-12 for Diagnosis of HCV-Related Hepatocellular Carcinoma.

BACKGROUND AND AIMS: Matrix metalloproteinase-12 (MMP-12) is involved in tumor invasiveness and metastasis and significantly overexpressed in hepatocellular carcinoma (HCC) tissues. We aimed to investigate the diagnostic and prognostic value of blood mRNA MMP-12 overexpression in patients with HCC. PATIENTS AND METHODS: From January 2017 to June 2017, 100 patients with HCC (HCV-related cirrhosis) and 100 patients with HCV-related cirrhosis (without HCC) were included in this study. All patients were subjected to triphasic CT abdomen when indicated, liver profile, alpha-fetoprotein (AFP), and molecular characterization of metalloproteinase-12 expression. RESULTS: There were no statistically significant differences between both groups regarding CBC parameters and liver profile (p value > 0.05). There was a statistically significant difference between patients with and without HCC regarding blood mRNA MMP-12 overexpression (p value < 0.01), blood mRNA MMP-12, and/or AFP (sensitivity 84.0%, specificity 60.0%, PPV 51.2%, and NPP 88.2%). The accuracy of mRNA MMP-12 and/or AFP in detection of HCC was 68.0%. CONCLUSION: Blood mRNA MMP-12 has a good sensitivity and a bad specificity but is accurate in HCC diagnosis. Adding blood mRNA MMP-12 to AFP optimizes the current screening program to improve early diagnosis of HCC and hence better prognosis.

Direct percutaneous embolization of renal pseudoaneurysm.

PURPOSE: To describe and evaluate a novel method of direct ultrasonography (US)-guided percutaneous embolization of renal pseudoaneurysm. PATIENTS AND METHODS: Fourteen patients with severe hematuria were included in this study from February 2005 to February 2006. They included five patients with penetrating renal trauma, two patients after renal biopsy, and seven patients after percutaneous nephrolithotripsy. Diagnostic duplex US of the pseudoaneurysm was performed. The size of the pseudoaneurysm and its neck were determined. A solution of Gelfoam particles was prepared in sterile saline and under US guidance, the tip of the needle was inserted into the aneurysm, and the solution with Gelfoam particles was injected slowly. During injection of Gelfoam, the pseudoaneurysm initially filled with an echogenic thrombus, thereby decreasing the color flow detected by US. The needle was removed when no flow in the pseudoaneurysm was detectable. The patient was kept for 30 minutes in the department and then discharged home. Follow-up by color Doppler US was performed every 2 weeks for 3 months and then every 3 months for 1 year. RESULTS: In 13 patients, bleeding was effectively controlled with direct embolization in a single session and did not need any further intervention, while one patient needed endovascular embolization because of recurrent severe hematuria after 24 hours. The amount of the injected Gelfoam particles (1-2 mm diameter) was 1 to 3 mL, according to the size of the pseudoaneurysm. No complication was observed secondary to the embolization procedure. Rebleeding did not occur in any patient during the follow-up period that ranged from 3 to 12 months. CONCLUSION: Direct US-guided percutaneous embolization is a new method for managing renal pseudoaneurysm. It avoids the side effects of contrast media, hazards of irradiation, and complications of angiographic catheterization. Moreover, it saves the risk of surgical interference to control bleeding either by partial or total nephrectomy, especially in patients with a solitary kidney. It is rapid, effective, feasible, and tissue preserving, and likely to reduce morbidity and mortality. Therefore, it is recommended as a first-line treatment of actively bleeding renal pseudoaneurysms.

Radiolucent renal stones in children: combined use of shock wave lithotripsy and dissolution therapy.

OBJECTIVES: To provide a noninvasive efficient modality for the treatment of radiolucent renal stones in children. Uric acid calculi comprise a significant proportion of urinary stones. METHODS: This study included 24 children (10 girls and 14 boys) with radiolucent renal stones. Of the 24 patients, 5 presented with bilateral renal stones, 8 with multiple stones, 4 with staghorn stones, and 7 with a solitary renal stone. Their age range was 2-12 years (mean 6.3 +/- 2.8). The stone size range was 12-65 mm in the largest diameter. All patients were treated with combined extracorporeal shock wave lithotripsy (ESWL) and medical therapy in the form of urinary alkalization using potassium sodium hydrogen citrate and allopurinol for the treatment of hyperuricosuria. Before ESWL, 3 patients had a percutaneous nephrostomy tube inserted and 2 patients had a ureteral stent placed to relieve obstruction. ESWL was performed with a Siemens Lithostar using either general anesthesia or intravenous sedation. The follow-up period after stone clearance was 12-36 months (mean 26 +/- 7.2). RESULTS: The stone-free rate of 100% was achieved in all 24 patients after 3 months of combined use of extracorporeal shock wave lithotripsy and dissolution therapy. CONCLUSIONS: Combined ESWL and dissolution therapy accelerated stone clearance and delayed stone recurrence. The use of ESWL and medical therapy as a combined modality is a safe and effective treatment of radiolucent renal stones in children.

Transurethral ethanol injection therapy of benign prostatic hyperplasia: four-year follow-up.

OBJECTIVE: Evaluating long-term (50 months) efficacy of transurethral intraprostatic injection of absolute ethanol to treat benign prostatic hyperplasia (BPH). METHODS: A prospective study was conducted to evaluate 35 patients with BPH treated by transurethral injection of dehydrated ethanol. Mean age was 66.3 years. Endoscopic injection of 6-12 mL ethanol was carried out at 5-10 sites in the prostate. International Prostate Symptom Score (IPSS), maximum flow rate, prostate volume, postvoid residual and side effects or complications incidence were logged. RESULTS: Mean IPSS +/- standard deviation improved significantly from 22.0 +/- 3.89 preoperatively to 9.85 +/- 2.23 at 50 months follow-up. Mean peak urinary flow rate increased from 5.87 +/- 3.69 mL/s to 16.89 +/- 4.12 after 4 years. Mean residual urine volume had decreased from 68.6 +/- 49.98 mL to 36.02 +/- 20.87 after 4 years (P < 0.05). The prostate volume decreased from 52.67 +/- 20.43 g preoperatively to 49.94 +/- 21.28 g after 4 years (statistically significant). There were no intra-operative complications but post-operative urine retention occurred in all patients requiring catheterization for a mean 6.7 days. Acute epididymitis and chronic prostatitis occurred in two patients. Urethral stricture occurred in one patient. CONCLUSIONS: This technique appears to be safe and cost effective. No occurrence of retrograde ejaculation was detected. The long-term effects of ethanol injection of the prostate were satisfactory and acceptable as a minimally invasive therapeutic modality of selected patients.