Complete Blood Count Markers and C-Reactive Protein as Predictors of Testicular Viability in the Event of Testicular Torsion in Adults.

INTRODUCTION: The association between blood markers and testicular viability after testicular torsion (TT) is not well known. We evaluated the role of complete blood count markers and C-reactive protein (CRP) in predicting testicular viability after TT. METHODS: Fifty men, ≥18 years of age, operated for TT between the years 2015-2020 were enrolled. Blood markers including neutrophil-, lymphocyte-, and platelet count, and CRP were obtained. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were calculated. The study outcome was testicular salvage. RESULTS: Median age was 23 years (interquartile range [IQR]: 21, 31). Median duration of torsion was 10 h (IQR: 6, 42). Sonographic texture of the testis was homogenous in 27 (56%) patients and heterogenous in 21 (44%). During scrotal exploration, 36 patients (72%) underwent orchiopexy and 14 (28%) underwent orchiectomy. Patients who underwent orchiopexy were younger (22 years vs. 31 years, p = 0.009), had a shorter duration of torsion (median 8 h vs. 48 h, p < 0.001), and a homogenous texture on scrotal ultrasound (76.5 vs. 7.1%, p < 0.001). Median NLR, PLR, and CRP were higher among patients who underwent orchiectomy; however, these differences did not reach statistical significance. Patients with heterogenous echotexture were significantly more likely to undergo orchiectomy (odds ratio = 42, 95% confidence interval: 7, 831, adjusted p value = 0.009). CONCLUSIONS: We found no association between blood-based biomarkers and testicular viability after TT; however, testicular echotexture significantly predicted outcome.

Effect of gender on presentation and outcome of renal colic.

OBJECTIVES: To examine gender-related differences in the presentation, management, and outcomes of patients admitted to the emergency department ED with ureteral stones. METHODS: Retrospective analysis of all patients admitted to the ED at our institution, found to have a ureteral stone on CT. Clinical, laboratory, imaging parameters, and outcomes were collected. RESULTS: 778 patients were admitted with ureteral stones between January 2018 and December 2020. 78% (n = 609) were males and 22% (n = 169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively (p = 0.08). Female patients presented with a higher body temperature (p = 0.01), pulse rate (p < 0.0001), nausea and vomiting (p < 0.0001), elevated serum C-reactive protein (CRP) (p = 0.002) compared to males. The prevalence of elevated serum creatinine was higher in males (p < 0.0001). Alpha-blockers were recommended on discharge in 54.8% (334) of males, compared to only 29.6% (50) of females (p < 0.0001). Spontaneous stone expulsion was significantly higher in males compared to females (p = 0.01). CONCLUSIONS: Our results demonstrate that gender does effect presentation and outcome of patients presenting with renal colic. Females were found to have elevated infectious parameters, more nausea and vomiting and a higher incidence of positive urine cultures. Males admitted to the ED were found to have significantly higher serum creatinine levels. Medical expulsive therapy (MET) with alpha-blockers was prescribed significantly less in female patients, which may have resulted in a lower spontaneous stone expulsion rate.

Spontaneous stone expulsion in patients with history of urolithiasis.

OBJECTIVES: To examine differences in the presentation, management, and outcomes of patients admitted to the emergency department (ED) with ureteral stones, with prior history of urolithiasis compared to patients with a first stone event. PATIENTS AND METHODS: Retrospective analysis of patients who visited the ED that were found to have a ureteral stone on CT. Patients were stratified into two groups: without history of urolithiasis (Group 1) and with history of urolithiasis (Group 2). RESULTS: Between 2018 and 2020, 778 patients were admitted with ureteral stones. Patients in group 1 presented with a higher mean serum creatinine (p = 0.02), larger mean stone size (p < 0.0001), and a higher proportion of proximal ureteral stones (p < 0.0001) than patients in group 2. The 30 day readmission rate was significantly higher in group 1 (p = 0.02). Spontaneous stone expulsion was higher in group 2 (p < 0.0001), whereas the need for endourological procedures was higher in group 1 (p < 0.0001). On multivariable analysis serum creatinine (OR 0.264, 95% CI 0.091-0.769, p = 0.01) and stone size (OR 0.623, 95% CI 0.503-0.771, p < 0.0001) were associated with a lower spontaneous stone expulsion rate. History of prior endourological procedures (OR 0.225, OR 0.066-0.765, p = 0.01) was associated with a higher spontaneous stone expulsion rate. CONCLUSIONS: Our data suggests that patients who are first time stone formers present with larger and more proximal ureteral stones, with a lower likelihood of spontaneous stone expulsion and a subsequent need for surgical intervention. Previous stone surgery and not previous stone expulsion was found to be a predictor for spontaneous stone passage.

Effect of age on presentation and outcome in renal colic.

OBJECTIVES: To examine the age-related differences in the presentation, management, and outcomes of patients admitted to the emergency department (ED) with ureteral stones. PATIENTS AND METHODS: A retrospective analysis of all patients who visited the ED at a single institution that were found to have a ureteral stone on CT. Clinical, laboratory, and imaging parameters were collected, including outcomes. Patients were subdivided into age groups: 18-30, 31-50, 51-70, and >70 years. RESULTS: Between January 2018 and December 2020, 778 patients were admitted to the ED with a ureteral stone. About 78% (609) were males and 22% (169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively (p = 0.08). Patients in the 36-50 age group, had significantly higher visual analogue scale (VAS) scores (p < 0.0001). Patients older than 70 years old presented with significantly higher serum creatinine levels (p < 0.0001), C-reactive protein (CRP) (p < 0.001) and leukocyte levels (p = 0.002). These patients were also found to have significantly larger stones (mean size of 6.2 mm (SD 4.8) (p < 0.0001)) and underwent percutaneous nephrolithotripsy (PCNL) in significantly higher numbers (56.3% vs 43.8%, (p < 0.0001)). Less than half of the patients older than 50 years were given medical expulsive therapy (MET) with alpha-blockers, compared to more than 50% in the other age groups (p = 0.002). Spontaneous stone expulsion was noted in 70.2% of the 18-35-year group, 62.4% of the 36-50-year-old group, 51.8% of the 51-70-year-old group, and 37% of the >70-year-old group (p < 0.0001). The ED re-admission rates at 7 and 30 days were not significantly different among all age groups. CONCLUSIONS: Our data suggests that older patients presented with larger stones, elevated inflammatory markers and creatinine and were more likely to require surgical intervention. The spontaneous stone expulsion rate was inversely associated with age.

Patient Satisfaction and Surgical Outcome After Oncoplastic Reconstruction following Radical Lumpectomy Versus Standard Lumpectomy: A Retrospective Cohort Study.

Objective: Oncoplastic reconstruction (OR) enables widening of the indications for breast conserving therapy (BCT) and is redefining the limits of breast conservation. We examined the outcome and satisfaction of patients undergoing OR after radical lumpectomy (excision of more than 25% of the breast volume) and compared it to the outcome of women undergoing OR after standard lumpectomy. Materials and Methods: A retrospective, cohort study, including all patients undergoing OR after BCT between 2009 and 2018, was conducted. The ratio of volume of excision to breast volume was calculated using imaging studies. The study group included women that had more than 25% of their breast volume removed. The remainder formed the control group. Demographic characteristics, oncological treatment, and operation properties were collected. We compared post-operative complications, margin status and need for further surgery, as well as patient satisfaction, evaluated using the BREAST-Q Questionnaire. Results: One hundred and fifty women were included, of whom 24 (16%) comprised the study group with a mean breast volume reduction of 39%, while the remainder (mean volume reduction 8%) served as controls. Patient, tumor characteristics and treatment were comparable. There was a non-significant higher proportion of women in the radical group that underwent a second operation due to complications or positive margins [4/24 (16.7%) vs. 14/126 (11%), p = 0.4). Physical well-being was similar but satisfaction with breasts and with outcome was slightly lower for the study group. These differences did not reach statistical significance. Conclusion: Surgical outcome and patient satisfaction in women undergoing very extensive breast resections with OR are comparable to standard resections.

[UROLOGICAL CONSULT FOR PATIENT WITH RENAL COLIC BEFORE DISCHARGE FROM THE EMERGENCY DEPARTMENT (ED): THE OUTCOME EFFECT ON SPONTANEOUS STONE EXPULSION AND RE-VISIT TO ED].

INTRODUCTION: Renal colic due to ureterolithiasis is a frequent reason for visiting the emergency departments (ED). The majority of those patients are managed non-surgically and will experience a spontaneous stone expulsion. The ED at our hospital works as a unified department, which is a well-established practice in Europe and North America. AIMS: Assess the outcome of urological consultation in the ED for patients with urolithiasis. METHODS: A retrospective cohort examined 402 ureterolithiasis patients proven by abdominal CT-scan at the ED. Patients were divided into 3 groups: Group1: patients were discharged after evaluation by ED physician alone. In Group 2: patients were discharged after being evaluated by an ED physician and urologist. In Group 3: patients who were admitted to the Urology Department. Clinical, laboratory and imaging parameters were examined as well as patients' outcomes: spontaneous stone expulsion, re-visit to ED and surgical intervention. RESULTS: There were not significant differences between group 1 and 2 regarding age, stone size, stone location, WBC levels, stone expulsion rate or surgical intervention. Group 1 had a significant higher rate of ED re-visits compared with group 2 (79 (43.3%) vs. 12 (17.9%). p=0.0002). Group 3 had significantly higher stone size, creatinine levels, inflammatory markers, proximal stone location and surgical interventions. CONCLUSIONS: ED working as a unified department provides excellent management to patients with renal colic due to ureterolithiasis, with a high rate of spontaneous stone expulsion and urologist referral to admissions and surgical interventions. Nevertheless, urological consultation significantly decreases re-visits to ED.