Prostate cancer among Saudis: a registry review.

Background: Policy makers in Saudi Arabia greatly rely on published studies to make major public health decisions. Prostate cancer (PCa) studies in Saudi Arabia are either outdated or limited to local regions. Aim: The authors aim to analyze the Saudi Cancer Registry to determine the incidence of PCa across all regions of the Kingdom and the risk factors of poor prognosis in the population. Methods: Patients diagnosed with primary PCa from 1 January 2008 to 31 December 2017 were included in the study from the Saudi Cancer Registry. Incidence rates and risk factors for poor survival were calculated. Results: A total of 3607 PCa patients were retrieved. PCa incidence rates ranged from 0.2 to 1.4 per 100 000. Most of the patients were aged 60 and older (86.5%; n=3120), married (97%; n=3497) and lived in the central region (38.1%; n=1375). The mean age at diagnosis was 71.1 (10.8) years. Over half of all tumors were poorly differentiated (64.2%; n=2317), and localized (60.4%; n=2180). The all-time metastasis rate reached 31.4% (n=1131). The lowest mean survival was in those with distant metastasis (P=0.039). Age groups, marital status, tumor morphology, place of residency, and grade were not proven to significantly influence survival. Conclusion: The high metastasis rate and evidence of a greater incidence of newly diagnosed metastatic PCa indicate that the idea of select screening for certain high-risk populations is not farfetched. The authors encourage the promotion of awareness regarding PCa risk factors and screening to optimize prognosis and minimize late presentations and high metastasis rates.

Beyond the norm: exploring the uncommon squamous cell carcinoma of the prostate using a Saudi tumor registry.

Background: Squamous cell carcinoma (SCC) of the prostate has limited treatment choices and portends a dismal prognosis with an average survival time of ~14-months. This study provides a descriptive overview of SCC of the prostate in Saudi Arabia. Materials and Methods: A retrospective cohort study of patients diagnosed with prostatic SCC between 1 January 2008 and 31 December 2017. Information on demographic and tumor characteristics and the survival of patients was collected from the Saudi Cancer Registry. Survival was depicted through Kaplan-Meier plots. Fisher's exact test was used to assess the association between categorical variables and death, while a Wilcoxon rank sum test was applied for numerical variables. Results: Out of a larger subset of 3607 patients, 16 patients were diagnosed with prostatic SCC, of which half resided in the Central region (50.0%) and most (81.2%) were aged greater than or equal to 60 years. Most patients (62.6%) had poorly differentiated (grade III, 43.8%) lesions, and 50% of cases were metastatic at diagnosis. 62.5% of patients died, all residing in the Eastern and Central regions. Regional extension (75.0%) and distant metastasis (87.5%) were significantly associated with death compared to localized lesions (0.0%) (P=0.022). The 5-year survival rate in our study was 33%. Conclusion: The present study is the first to describe the characteristics of prostatic SCC in Saudi Arabia. Our results are consistent with prior studies showing that prostatic SCC is often high-grade and metastatic at diagnosis, conferring a poor prognosis.

Exploring Renal Malignancies in Saudi Arabia: Insights from a Tertiary Care Center Study.

This retrospective study aims to describe the characteristics of renal cell carcinoma (RCC) in Saudi Arabia, in terms of epidemiology, clinical presentation, tumor subtype, Fuhrman grade, tumor size and stage, and overall survival. A total of 431 adult patients with a histopathological diagnosis of RCC between 2015 and 2023 were included in the analysis. Most patients (72.4%) had clear cell tumors, followed by chromophobe (15.1%) and papillary (12.5%) subtypes. In males, papillary RCC (85.2%) was more common compared to clear cell (59.8%) and chromophobe (67.7%) subtypes. Significant differences were observed in median body mass index (BMI) across tumor subtypes, and papillary tumor patients exhibited the highest incidence of hematuria (33.3%) compared to other subtypes. The Fuhrman grade also varied significantly among RCC types. Survival times were found to be lower for patients with papillary tumors. No significant difference was observed based on patients' nationality. This study can inform clinical decision-making on patient prognosis and management as well as public health efforts aimed at reducing the alarming rise of RCC incidence.

An unusually high prevalence of isolated prostatic ductal adenocarcinoma among Saudi patients: A registry-based study.

Objective: We conduct a secondary analysis on the demographics, tumor characteristics, survival, and risk factors for mortality among patients with prostatic ductal adenocarcinoma (PDA) in the Kingdom of Saudi Arabia (KSA). Methods: This is a registry-based retrospective study that included all patients diagnosed with prostate cancer in the KSA. The data were collected from the Saudi Cancer Registry, which collects tumor data from all private, military, and health ministry hospitals in Saudi Arabia through five regional offices. Results: Among 3607 prostate cancer patients detected during the specified period, 209 (5.8%) had ductal adenocarcinoma. The median interquartile range age of patients was 72.0 years (64.0-78.0). Adenocarcinoma lesions were malignant among all the patients. Grade III tumors were most frequently apparent lesions (61.2%), followed by Grade II tumors (26.3%), Grade I tumors (7.2%), and Grade VI tumors (5.3%). A total of 33 patients died, representing 15.8% of the whole sample. The 1-year survival rate was 78.1%. More than a third of patients who were residing in the Western region deceased (38.0%), whereas no deaths were reported in other regions with a statistically significant difference based on regions (P < 0.001). Conclusion: To the best of our knowledge, this is the first registry-based study to investigate PDA in the KSA; these efforts were done to further understand this deadly condition and to further enhance patient care in the KSA.

Prostatic adenocarcinoma with transitional cell features among the Saudi Arabian population: a registry review.

Prostate cancer is the third leading cause of death from cancer among American men. Acinar adenocarcinoma is the most common form of prostate cancer; however, there are several nonacinar adenocarcinoma variants, such as transitional cell carcinoma of the prostate and ductal adenocarcinoma. Materials and Methods: A retrospective cohort study was conducted on all Saudi patients diagnosed with adenocarcinoma of the prostate with transitional cell features. The data was collected from the Saudi Cancer Registry, which collects tumor data from all private, military, and Health Ministry hospitals in Saudi Arabia through five regional offices. Results: Out of 3608 patients, only 16 (0.44%) had adenocarcinoma with transitional cell features. All the tumors under investigation were malignant and constituted. Only 6.2% of the tumors were well-differentiated, 43.8% were moderately differentiated, and 50.0% were poorly differentiated. Among the included patients, 56.3% of the patients (n=9) died. There were no significant factors associated with death among patients, including the demographic and tumor-related variables. Conclusion: To the authors' knowledge, this is the first study describing the prevalence of adenocarcinoma with transitional cell features and its characteristics in Saudi Arabia. The authors have demonstrated that this rare subtype may be more prevalent than what was originally believed. It is necessary for future studies to assess the effectiveness of various treatment modalities to combat it. Furthermore, identifying risk factors - if any - may be crucial in the prevention of its development among men worldwide.

Is routine re-imaging for high-grade renal injury needed? Retrospective analysis of 1500 abdominal trauma patients from a tertiary care trauma center over 11 years.

INTRODUCTION AND AIM: The AUA and EAU guidelines recommend re-imaging in high-grade renal trauma, regardless of the clinical findings. The aim of this study was to assess the impact of re-imaging on the overall management and outcomes in these patients. METHODS: The trauma registry of our tertiary care Level-1 trauma center was reviewed from January 2007 till October 2018. Out of 1536 patients with abdominal trauma, 174 patients with isolated renal injury were identified. Renal injuries were classified based on the AAST classification. Variables retrieved were demographics, renal injury grade, presence of urinoma, repeated imaging findings, and intervention after initial and repeated imaging. RESULTS: Low-grade injury was found in 78.7% (137/174) compared to 21.3% (37/174) with high-grade injury. The majority (n = 136) of low-grade patients were managed conservatively except one patient with Grade III injury required angioembolization after initial imaging. Of the high-grade patients, 31/37 were treated conservatively except 6/37 patients required surgical intervention after initial imaging. Following re-imaging, only one patient required surgical intervention in the form of insertion of a drainage tube for a hematoma, which was possibly infected. The existence of urinoma (5 patients) or hematoma (47 patients) was not associated with significantly higher rate of intervention (p values: 0.717 and 0.138, respectively). No significant association was noted between hematoma size and rate of intervention (p value = 0.055). CONCLUSION: Re-imaging for high-grade renal injuries could be limited to the presence of urinary extravasation in initial imaging or the presence of clinical deterioration such as pain, fever or decrease in hemoglobin level.

Preserving Renal Function without Compromising Oncological Outcomes: A Comparative Study of Partial and Total Nephrectomies in T3 Stage Renal Cell Carcinoma.

The utility of partial nephrectomy (PN) in locally advanced, stage T3 renal cell carcinoma (RCC) is controversial. This retrospective study aimed to review the oncological and functional outcomes of patients with T3a RCC who underwent PN. We included all patients with pT3a stage RCC undergoing either open, laparoscopic, or robotic PN at our center between January 2015 and 2023. A Wilcoxon rank sum test was utilized to compare nephrectomy types (radical nephrectomy [RN] vs PN). Survival analysis was conducted using Kaplan-Meier plots and a log-rank test. P-value < 0.05 indicated statistical significance. There were no significant differences in demographic characteristics between the RN and PN groups, except age (53.0 vs 6.5, respectively; P = 0.012) and body mass index (28.7 vs 34.3, respectively; P = 0.020). Furthermore, there were also no significant differences in the rates of local recurrence (P = 0.597), metastatic progression (P = 0.129), and chemotherapy use (P = 0.367) between nephrectomy types. Patient survival did not differ significantly based on the type of nephrectomy (log-rank P-value = 0.852). Together, our findings indicated that PN and RN yield near-equivalent oncological outcomes in terms of local recurrence, metastasis, and overall survival rates among pT3a RCC patients during a nearly 3-year follow-up period.

Saudi Urological Association consensus guidelines on the use of robotic surgery in urology.

Over the past three decades, minimally invasive robotic technology has evolved substantially in urological practice, replacing many open procedures and becoming part of routine clinical practice. The Health Sector Transformation Program for the Kingdom's Vision 2030 aims to restructure the health sector and optimize its status and prospects as an effective and integrated ecosystem centered on the patient's health. Therefore, this consensus seeks to endorse the clinical practice guidelines for robotic surgery (RS) in the KSA, highlighting its effectiveness, safety, and favorable outcomes compared to open and laparoscopic surgeries in certain procedures when used by trained surgeons in well-structured RS programs.

Rare tumours of the bladder: A Saudi registry based descriptive study.

Objective: There is limited literature focusing on the characteristics and behaviours of bladder tumours outside of the common three morphologies, that is, urothelial carcinoma, squamous cell carcinoma, and adenocarcinoma. The presented study provides a descriptive analysis of rare bladder tumours in KSA. Methods: This retrospective cohort study included all patients with a primary rare bladder tumour between 1 January 2008 and 31 December 2017. The data were acquired from the Saudi Tumour Registry. Frequencies and percentages were then generated for the categorical variables, while means and standard deviations were calculated for quantitative variables. Results: The study included 65 patients. The majority (n = 35, 53.8%) were aged 60 years and older. The patients were predominantly male (n = 53, 81.5%) and the majority lived in the Western region (n = 26, 40.?%). The most diagnosed tumour morphologies were small cell carcinoma in adults (n = 11, 16.9%) and embryonal rhabdomyosarcoma in children (n = 14, 21.5%), with the dominant diagnosis method being histology of primary tumour in 98.5% of the patients. Most tumours were localised (n = 30, 46.2%) and multifocal (n = 34, 52.3%). The overall mortality rate was 24.6%, with an overall diagnosis to death interval of 1.14 ± 0.75 years wherein small cell carcinoma was the shortest (0.84 ± 0.24) days. Conclusion: There remains a gap in the literature regarding uncommon urologic tumours. Shedding light on these factors will aid in further understanding the patterns of tumour behaviour in the region. This will facilitate enhanced risk-and response-based screening strategies and more favourable outcomes. Additionally, formulating a global registry for such patients is recommended.

Bladder Embryonal Rhabdomyosarcoma Among Children: A Descriptive Overview From Saudi Arabia.

Introduction Although rhabdomyosarcoma (RMS) is the most common type of soft-tissue sarcoma seen in the pediatric population, it is rarely located in the bladder. This study aims to provide a descriptive overview of bladder rhabdomyosarcoma among children in Saudi Arabia. Methods This retrospective cohort study included all children diagnosed with embryonal rhabdomyosarcoma from January 1, 2008, to December 31, 2017. Frequency and percentage were used to display the categorical variables and a mean and standard deviation for the continuous variables. Data were collected from the Saudi Cancer Registry (SCR). Results A total of 16 patients were detected. Most of the patients (43.8%) were toddlers (1-3 years) and males (87.5%). Most of the tumors were multifocal (100%), well-differentiated (43.75%), and localized (43.75%). The mortality rate was 12.5% with a diagnosis to death interval of 1.26 + 0.46 years. The incidence pattern of bladder rhabdomyosarcoma fluctuated across the years. The highest incidence of bladder rhabdomyosarcoma (0.17) per 1 million was observed in 2012 while the lowest incidence (0.03) per 1 million was observed in 2015. Conclusion We concluded that tumor presentation in early childhood is associated with a better prognosis. Moreover, males are predominantly affected by this tumor. Through our study, we tried to fill the knowledge gap regarding the descriptive statistics of bladder RMS in Saudi children. We believe that it would add significant value to the existing literature and help in better understanding the disease.

Characteristics and Types of Urolithiasis in the Eastern Region of Saudi Arabia: A Single-Center Retrospective Study.

Introduction Urolithiasis is one of the most common conditions encountered in clinical practice with the prevalence increasing globally in the last few decades. Urolithiasis has been found to be more common in areas with a hot climate, such as Saudi Arabia. The aim of this study was to determine the characteristics and the types of urolithiasis most frequently found in the Eastern Region of Saudi Arabia. Methods This was a single-center retrospective cohort study based on data extracted from an electronic hospital information system (BESTCare) of all patients diagnosed with urolithiasis at King Abdulaziz Hospital, a tertiary care center in Saudi Arabia's Eastern Region. From January 2013 to December 2016, all adult patients aged 18 and up who presented with urinary calculi (renal and ureter) were included in the study. Results A total of 235 patients were reviewed, with a mean age of 48.52 years. Renal calculi were more prevalent in males (74.5%). Calcium oxalate was the predominant type (76%), followed by uric acid calculi (18%) and cystine calculi (4.8%). A small proportion (1.2%) was calcium phosphate calculi. The most frequently associated comorbidity was hypertension (17.9%). The majority (78.5%) had a stone removal through a ureteroscopy and 8.2% by percutaneous nephrolithotomy (PCNL). The mean stone size was 12.2 ± 9.91 mm, with a mean stone Hounsfield unit (HU) of 789.9. The mean urinary PH at stone incident was 6.77, and the mean creatinine level was 92.4mmol. Conclusion This study showed that males were more affected by urolithiasis, compared to females in the Eastern Region. Furthermore, calcium oxalate was the predominant type. These findings are consistent with the literature and they highlighted the necessity for further studies in this area, to provide insight into the pathophysiology and incidence of renal calculi for improving patient care.

A 10-Year Tertiary Care Center Experience With Adrenalectomies for Adrenal Tumors.

Background Due to limited data, our understanding of the trends and outcomes of adrenalectomy in the Saudi surgical practice is limited and insufficient. The aim of this study was to review the clinical data regarding the diagnosis and management of patients with adrenal masses and to assess the effect of surgeon specialty on the outcomes. Materials and methods The study included all adult patients who underwent an adrenalectomy for tumors from 2011 to 2021. The patient characteristics, tumor profile, and preoperative, perioperative, and post-operative variables were collected. Frequency and percentage were generated for the categorical variables, and mean and standard deviation were generated for the quantitative variables. Results A total of 55 patients were identified. Most of the patients had a well-defined (58.2%, n = 32), benign (85.5%, n = 47) mass located in the cortex (58.2% n = 32). The majority of the sample were asymptomatic (52.7%, n = 29), and the most frequent diagnosis was adrenal adenoma (47.27%, n = 26). The most frequent indication for surgery was tumor functionality (69.1%, n = 38). Surgeries were mostly laparoscopic (69.1% n = 38) and performed by a urologist (52.7%). The conversion to open surgery was 13%, the intraoperative complication rate was 9.1%, the post-operative complication rate was 7.3%, and the 30-day readmission rate was 3.6%. Intraoperative complications, post-operative complications, and conversion to open surgery were more frequent among general surgeons, while 30-day readmissions were more frequent among urologists. However, a statistically accurate association could not be found due to the small population size. Conclusion Open surgery was replaced by laparoscopic adrenalectomy as the surgery of choice for different adrenal pathologies. The findings reported in this study are substantiated by current literature, adding to our comprehension of adrenal tumor presentation. There are, however, some inconsistencies regarding the influence of gender on tumor development and the association between surgeon specialty and outcome in the literature that merit research. However, evidence regarding the contribution of comorbidities, such as hypertension, diabetes, and hypothyroidism, is lacking.

Characteristics of renal cell carcinoma in Saudi patients below the age of 50 years.

BACKGROUND: The incidence of renal cell carcinoma (RCC) in young adults has started to increase in recent years. OBJECTIVES: The objective of the study was to describe and compare the mode of presentation, incidence, risk factors, histopathological features, nephrectomy modalities used, and outcome in patients diagnosed with RCC below the age of 50. MATERIALS AND METHODS: A total of 139 confirmed RCC patients diagnosed below the age of 50 years who underwent nephrectomy from January 1990 to April 2019 were included in this retrospective review. We compared the characteristics of two age groups (≤40 years and 41-50 years) and evaluated incidentally discovered versus symptomatic tumors in patients below 50 years. RESULTS: Loin pain contributed to most symptomatic presentations in the older group (55%) (P = 0.014). Hypertension and diabetes were present in 24% of patients from 41 to 50 years of age versus 3.8% for hypertension and 5.7% for diabetes in the young group. (P = 0.001 and P = 0.004, respectively). Chromophobe was the second most common pathology (26.5%). Tumor size tended to be larger in the older group (P = 0.006). Fuhrman's grade was significantly lower in incidentally diagnosed patients (88.2%) (P = 0.006). The T stage was significantly lower in the incidental group (P = 0.005), but the mortality rate was higher in symptomatic patients (9.6%) (P = 0.013). CONCLUSION: RCC increases after the age of 40-50 years in the presence of other risk factors. Chromophobe represented almost a quarter percentage of the pathology, while partial nephrectomy yielded a better outcome.

Bladder cancer in Saudi Arabia: a registry-based nationwide descriptive epidemiological and survival analysis.

BACKGROUND: Our understanding of the risk factors, prevalence, incidence rate, and age distribution of bladder cancer (BC) in Saudi Arabia is insufficient due to limited data. OBJECTIVE: Describe the epidemiology and analyze factors associated with survival in patients with BC in Saudi Arabia. DESIGN: Retrospective medical record review. SETTINGS: Registry-based nationwide study. PATIENTS AND METHODS: The study included all records in the Saudi Cancer Registry of patients diagnosed with a primary BC from 1 January 2008 to 31 December 2017. Collected data included year of diagnosis, gender, age, marital status, region and nationality, tumor site of origin, tumor histological subtype, tumor behavior, tumor grade, tumor extent, tumor laterality, the basis of the diagnosis, and survival status. Factors predicting survival were tested by a Kaplan-Meier and Cox proportional hazards regression analysis. MAIN OUTCOME MEASURES: Mortality status on last contact. SAMPLE SIZE: 3750 patients. RESULTS: The overall incidence of BC was 1.4 per 100 000 persons. Significant differences in the distribution of survival were observed by age, gender, nationality, place of residency, tumor morphology, tumor grade and extension. The adjusted predictors of decreased survival were age, squamous cell carcinoma, Grade III and IV bladder tumors, regional direct extension, regional lymph node extension, combined regional lymph node and direct extension, and distant metastasis. Male gender and being widowed were predictors of improved survival in the unadjusted analysis. CONCLUSION: This study provides further understanding of BC in a region with a high prevalence of risk factorsuch as smoking. Highlighting these factors, specifically in Saudi Arabia, improves evidence-based practice in this region and may facilitate appropriate care to optimize outcomes. LIMITATIONS: Retrospective study and underreporting. CONFLICT OF INTEREST: None.

Bilateral same session renal stone surgery tolerance and complications.

INTRODUCTION: The prevalence rate of upper urinary tract calculi in Saudi Arabia is one of the highest globally. Bilateral renal stone management is an option but is still controversial. METHODOLOGY: The study was a retrospective study, including 31 patients with bilateral renal or ureteric stones who underwent bilateral same-session ureterorenoscopy (BSS-URS). The data collected included age, gender, body mass index (BMI), stone burden bilaterally, operative time bilaterally, hospital stay, stone location, type of anesthesia, stone history, renal anomaly as well as pre- and postoperative JJ stenting. In addition, data related to complications (ureteric injury, renal failure, urinary tract infection, pain requiring an emergency department visit within 1 week of the procedure), the stone-free rate (defined as £ 3 mm asymptomatic stone fragment identified with computed tomography Kidney, Ureter and Bladder 3 months after surgery was also collected. The data were collected from the electronic patient record system, entered in an Excel spreadsheet, and descriptive analysis was done. RESULTS: In total, 31 patients were included, with the majority (80.6%, n = 25) male. The mean age was 41.6 years, the mean BMI 28.7 ± 5.59, the mean operative time for each renal unit 46.53 ± 25.69 min, and the mean hospital stay 17.87 ± 8.43 h. The majority (96.7%, n = 30) received general anesthesia. Less than half (40.3%, n = 25) of the renal units had stones in multiple calyces and the majority (90.3%, n = 56) of the renal units were stone free at the 3-month follow-up. A small proportion (3.2%, n = 2) of the renal units were polycystic. Prestenting was documented in 40.3% (n = 25) of the renal units and the majority (95.2%, n = 59) were stented postoperatively. CONCLUSION: BSS-URS is a safe and a highly effective management option for bilateral renal stones.

Factors Associated with Varicocele Recurrence After Microscopic Sub-Inguinal Varicocelectomy.

PURPOSE: This study has been conducted to identify the rate of varicocele recurrence in patients who underwent microscopic subinguinal varicocelectomy at our center. We also aimed to determine the contributing factors to varicocele recurrence. PATIENTS AND METHODS: A total of 34 married male patients who underwent microscopic sub-inguinal varicocelectomy were retrospectively included in this study. The medical records of recruited patients were reviewed. The diagnosis of varicocele was based on physical examination, while recurrent varicocele was diagnosed based on both physical examination and colored doppler ultrasound. We investigated contributing factors to varicocele recurrence, including demographic characteristics (such as body mass index), clinical (varicocele grade and size of dilated veins), and laboratory data (semen analysis). Patients were followed up at 3 and 6 months after surgery. RESULTS: The mean age of patients was 32.53 years. The majority of patients had left-sided varicocele (70.6%) and underwent surgery due to scrotal pain (82.4%), with a mean operation duration of 92 minutes. Left-sided varicoceles were grade II in 51.7% of patients, while right-sided varicoceles were grade II in 16.1% of patients. Recurrence occurred in 2.9% after 3 and 6 months. Pain recurred in 8.8% and 10.5% of patients at 3 and 6 months, respectively. Pregnancy rates were 44.1% at 3 months and 11.8% at 6 months after surgery. The grade of varicocele (P = 0.24) and the size of the left dilated vein (P = 0.002) was significantly associated with recurrence. CONCLUSION: There was a significant association of advanced grade on the left side and large vein diameter before and after surgery with an increased rate of recurrence; however, due to the small sample size of our study, more and larger studies are still warranted.

A rare case of Ewing's sarcoma of the kidney.

We report the case of a 15-year-old girl presenting with distended abdomen, left flank pain, and a history of weight loss. Computed tomography showed a large tumor involving the left kidney that was initially diagnosed as renal cell carcinoma. She underwent exploratory open laparotomy and left radical nephrectomy followed by chemotherapy and showed good response. Histology of the resected tumor revealed features of Ewing's sarcoma of the kidney which was confirmed by molecular studies. This disease is rare, particularly in the pediatric population, and this report will help better understand the potential disease course and response to treatment.

Failure of ureteral access sheath insertion in virgin ureters: A retrospective tertiary care center study.

OBJECTIVE: The objective of the study was to identify the failure rate of insertion of ureteral access sheath (UAS) during primary flexible ureteroscopy (FURS). MATERIALS AND METHODS: This was a single-surgeon, single-tertiary care center retrospective study. All patients who underwent primary FURS for proximal ureteric or renal stones from November 2014 to May 2018 were included in the study. Patients with a stone burden of more than 20 mm were excluded from the study. A 10/12-Fr coaxial UAS (Bi-Flex, Rocamed) was used. Data collection included age, sex, body mass index (BMI), stone burden and location, previous spontaneous passage of stones, type of anesthesia, and preexisting congenital anomalies. The Chi-square test and t-test were used for the statistical analyses. RESULTS: One hundred and twelve patients were included in the study. All patients underwent primary FURS. The failure rate of primary UAS insertion was 10.7% (n = 12). No statistically significant difference was found in age, BMI, type of anesthesia, previous history of spontaneous stone passage, and stone burden between the success and failure groups (P > 0.05). CONCLUSIONS: We believe that our study opens the door for a multicentric prospective trial. Identifying factors leading to a failed primary FURS and UAS insertion is crucial to properly counsel patients preoperatively about the number of procedures that they might need and to prevent the financial loss associated with failed UAS insertion.

Sloughing Prostatic Tissue, a Rare Complication Post Rezum Therapy: A Case Report.

Benign prostatic hyperplasia (BPH) is the most prevalent urological disease in men that leads to lower urinary tract symptoms (LUTS). The clinical presentation is, most likely, obstructive symptoms such as intermittency, hesitancy and poor stream, due to the obstructive nature of the pathology. BPH treatment approach varies. However, they can be divided into two main approaches which are non-surgical and surgical. Non-surgical methods usually started first, such as lifestyle modifications, watchful waiting, and medications. Hence, surgical intervention remains the mainstay of treatment to relieve clinical symptoms. Although transurethral resection of the prostate (TURP) is the gold standard, management is shifting towards minimally invasive surgeries such as Rezum due to its good outcome and fewer adverse effects. We present a case of prostatic tissue sloughing, a rare complication post Rezum system therapy in a 50-year-old male.

Simultaneous and synchronous bilateral endoscopic treatment of urolithiasis: a multicentric study.

INTRODUCTION: The general prevalence of bilateral urolithiasis has risen to 15% and bilateral non-simultaneous treatment has been reported to have good outcomes. The objective of this study was to evaluate the effectiveness and safety of simultaneous bilateral endoscopic surgery (SBES). MATERIAL AND METHODS: An international multicenter analysis was performed between May 2015 and December 2017. All patients with bilateral stone disease that underwent SBES were included. Patients were treated under general anesthesia in either the supine or lithotomy position. Demographic, clinical, intraoperative and postoperative data were analyzed. RESULTS: A total of 47 patients were included. Mean age was 53.8 years and 70% of the patients were males. The mean American Society of Anesthesiology (ASA) score was 2. The mean diameter of right- and left-sided stones was 29.43 mm (2-83 mm) and 31.15 (4-102 mm), respectively. Staghorn stones were treated in 18 cases (8 right-sided and 10 left-sided), four of them were defined as complete staghorn. The procedures performed were 42 cases of bilateral URS and PCNL and ureteroscopy. Additionally, 5 bilateral flexible ureteroscopy (fURS) cases were described. Intraoperative complications occurred in five patients: four of them were classified as Clavien-Dindo (CD) I and one as CD II. Postoperatively, there were two cases with CD I, 6 with CD II and one CD IIIa.The stone-free status was 70%. Residual stones (30%) were detected only on the side treated for high-volume (complete) staghorn calculi. CONCLUSIONS: SBES is a feasible, effective and safe procedure. It may potentially avoid repeated anesthetic sessions as needed for staged procedures and reduce the length of patients' hospital stay.