Predictors of stone-free rate after a single-session extracorporeal shockwave lithotripsy for a single kidney stone measuring 10 to 20 mm: A private center experience.

Background: Despite the continuous update of guidelines for the management of kidney stones, the ability to predict a successful response to extracorporeal shockwave lithotripsy (SWL) remains a topic of research. This is due to the need to refine the decision making in the context of technological advancements and current pandemics. This study aimed to determine the predictors of stone-free rate (SFR) after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter. Materials and methods: A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021. Univariate and multivariate analyses were performed for stone- and patient-related factors, using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables. Results: A total of 138 patients were eligible for this study, including 92 men and 46 women. The mean age was 38.6 ± 12.4 years, and the mean body mass index (BMI) was 25.9 ± 3.4 kg/m2. Four weeks after SWL, 120 patients (87%) were free of stones, and 18 (13%) needed further treatment. Univariate analyses showed that SFR was negatively correlated with increased BMI (p = 0.0001), maximum stone length (p = 0.0001), transverse diameter of the stone (p = 0.0001), number of shocks per session (p = 0.052), and Hounsfield unit (HU) (p = 0.0001). Multivariate analysis revealed that HU (p = 0.009), maximum stone length (p = 0.01), BMI (p = 0.000), and presence of double-J stent (p = 0.034) were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter. The estimated average cost per case was USD 450.5. Conclusions: Increased HU, maximum stone length, BMI, and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter. The cost of SWL remains an advantage in the private sector.

Isolated ventral congenital penile curvature treated by incisionless plication of tunica albuginea in adults: A prospective case series.

Background: Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature (IVCPC). This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication technique. Materials and methods: This prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea (Essed-Schroeder technique) with a covering pair of absorbable sutures. The primary outcomes were successful correction (defined as a residual curvature ≤15 degrees) and patient satisfaction. Postoperative follow-ups were performed at 3, 6, and 12 months. Results: A total of 23 patients were treated for IVCPC with a mean (range) age of 25.3 (18-31) years. Eighteen patients (78.3%) were single with cosmetic complaints, whereas the other 5 patients (21.7%) were married and presented with a difficult vaginal intromission. The mean (range) curvature, length, and operative time were 40 (30-50) degrees, 15 (10-19) cm, and 82 (65-100) minutes, respectively. Postoperative penile pain and numbness occurred in 13 patients (56.5 %) and 7 patients (30.4%) only within the first month, respectively. Palpable suture knots were reported in 15 patients (65.5%) without being bothersome up to 12 months. The postoperative means (ranges) of penile curvature and length were significantly different from that of the preoperative values at 3 (5 [0-20] degrees and 14.5 [9-18.5] cm), 6 (5 [0-20] degrees and 14.5 [9-18.5] cm), and 12 months (5 [0-30] degrees and 14.5 [9-18.5] cm; all p < 0.001). Age, preoperative penile curvature, penile length, postoperative pain, wound infections, and knot palpation insignificantly affected curvature recurrence. Seventeen patients (73.9%) were very satisfied with their surgical outcomes. Conclusions: Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.

Functional evaluation of a spiral neobladder with an angled chimney; A prospective randomized comparative study.

OBJECTIVES: to assess the functional outcome of performing ureteric re-implantation to an angled short chimney in a modified spiral orthotopic ileal neobladder. PATIENTS AND METHODS: From January 2018 to December 2020, 90 male patients with bladder cancer underwent radical cystectomy and spiral ileal neobladder reconstruction with a chimney. Patients were randomly divided in two groups according to the position of the chimney [straight and angled] to which the ureters will be implanted. Postoperative evaluation included clinical, laboratory, radiographic and urodynamic studies. RESULTS: There were no perioperative deaths. The mean operative time for the procedure was 4.7 ± 1.2 h in group I and 4.9 ± 1.3 h in group II (p 0.456). No intraoperative complications occurred. Early postoperative complications occurred in 8 patients. In group I, according to the modified Clavien system, GII complication occurred in 2 (5%) patients in the form of DVT in 1 (2.5%) and surgical site infection in 1 (2.5%). GIIIa occurred in 3 (7.5%) patients in the form of wound dehiscence. In group II, GII occurred in 2 (4.8%) patients in the form of prolonged urinary leakage and myocardial infarction, each occurred in one patient. GIIIb occurred in 1 (2.4%) patient in the form of intestinal leak. Poucho-ureteral reflux occurred in 10 patients [3 (7.5%) in group I and 7 (16.8%) in group II (p 0.001)]. CONCLUSIONS: The preliminary results of the right sided angled chimney during neobladder reconstruction are safe, acceptable, without an extra time to develop an anti-reflux technique and without an increased incidence of reflux.

Experience of a Tertiary-Level Urology Center in Clinical Urological Events of Rare and Very Rare Incidence. V. Urological Tumors: 1. Adrenal Myelolipoma.

OBJECTIVES: To present our center's experience in the management of adrenal myelolipoma in the context of shifting from the open to the laparoscopic adrenalectomy approach. MATERIALS AND METHODS: A retrospective search of our center's records was done for reported cases of adrenal myelolipoma during the period July 2001-June 2016. All the cases with histopathologically-documented adrenal myelolipoma diagnosis were included. Relevant demographic and clinical variables were studied with a comparison between the open and laparoscopic approaches. RESULTS: Of more than 82,000 urological surgeries, 238 adrenalectomies were done with only 22 cases of myelolipoma that had a mean age and body mass index of 52.4 ± 10.3 years and 30.23 kg/m2, respectively. The main clinical presentation was accidental discovery. The largest dimension of tumors varied from 6 to 16 cm. Computed tomography described a characteristic picture of hypodense heterogeneous adrenal tumors in all cases, while magnetic resonance imaging was indicated for malignancy suspicion in only 5 cases. Adrenal tumor markers were normal in all cases. Open and transperitoneal laparoscopic adrenalectomies were used in 14 and 8 cases, respectively. The latter approach was insignificantly advantageous in the need for blood transfusion, postoperative pain degree, need for analgesia, and hospital stay duration (p = 0.22). Histo-pathological examination revealed benign adipose tissue and myeloid cells and confirmed the diagnosis of adrenal myelolipoma in all cases. CONCLUSIONS: Adrenal myelolipoma is a rare non-functioning benign tumor. Laparoscopic excision seems to be a promising alternative approach to the traditional open adrenalectomy, even in the context of large tumors and obesity.

Comments on: Computed tomography evaluation of renal artery morphometry in adults. The impact of age and gender.

[No Abstract Available].

Comment on: Surgical and oncological outcome after laparoscopic versus open nephroureterectomy for non-metastatic, upper-tract urothelial carcinoma. A single-centre experience.

[No Abstract Available].

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. II. Urological Self-Inflicted Harms: 1. Unintentional Patient's Side-Inflictor Urological Injuries.

INTRODUCTION: Unintentional self-inflicted injuries mainly refer to those injuries which are inflicted by the patient himself with benign intentions. In urology, they may vary and result in significant morbidities. PATIENTS AND METHODS: A retrospective search of our patients' data records for the reported cases of patient's side-inflictor urological injuries during the period July 2006 - June 2016 was made. Each case was studied for age, gender, primary diagnosis, injury inflictor, involved organ, motivating factor, mechanism, diagnosis, management, and final outcome. RESULTS: Of more than 55,000 urological procedures, 26 patients (0.047%) were involved in unintentional patient's side-inflictor urological injuries. The age range was 8-76 years and included 23 males and 3 females. Fifteen patients (57.7%) had urological disorders before the injury. They could be differentiated into direct organ involvement injuries (53.8%) and catheter involvement injuries (46.2%). External male urogenital organs were involved in 69.3% of cases which were diagnosed on physical examination. The inflictor of the injury was the patient himself, a relative, and another patient in 73.1, 19.2, and 7.7% of cases, respectively. Motivating factors were relief of painful conditions (34.6%), psychiatric disorders (38.5%), and sexual purposes (27%). Final outcomes were short-term harm, long-term harm, and permanent disability in 50, 11.5, and 38.5% of cases, respectively. CONCLUSION: Unintentional patient's side-inflictor urological injuries are very rare events and mainly involve the external male urogenital organs under different motivating stressors. They could be differen-tiated into direct organ and catheter manipulation injuries with variable final outcomes from mild short-term harms to permanent disabilities.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 3. Urological Electrosurgical Never Events.

INTRODUCTION: Surgical fires are unique topics that belong to surgical never events and deserve urological attention. MATERIALS AND METHODS: A retrospective search of our hospital records was done for the states of electrosurgical never events in the period from July 2001 to June 2016. The included events were classified according to the site of occurrence in relation to the patient's body and possibilities of human involvement. The events were studied for the type, extent, damages, personnel involvements, complications, and management. RESULTS: Of more than 82,000 urological interventions, 18 cases (0.022%) of electrosurgical never events were detected. Four subcategories were differentiated: electrosurgical theater fires (33.3%), electrosurgical contact skin burns (38.9%), electrosurgical internal injuries (16.7%), and electrocutions (11.1%). Electrosurgical theater fires included 3 ignition fires with fire skin burns and 3 device explosions. Fires only occurred with the use of alcoholic skin disinfectants. Contact skin burns resulted from inadvertent direct electrosurgical contacts, with 2 burns on the back, 3 burns on the lower limbs, 1 burn at the penile shaft, and 1 burn at the suprapubic region. Only 1 case of contact skin burn required plastic surgery. Electrosurgical internal in-juries involved the intestine, spleen, and urethra and were followed by major complications. Electrocutions involved a doctor and a patient with multiple bone fractures in the former. CONCLUSION: Urological electrosurgical never events are very rare incidents and were differentiated into 4 clinical subcategories. Human involvements varied from absence to major devastating complications. Reduction of these events depends on the adjusted use of electricity-based armamentarium.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. VI. Unusual Events in Urolithiasis: 1. Long-Standing Urethral Stones without Underlying Anatomical Abnormalities in Male Children.

OBJECTIVES: The study aimed to present our center's experience with long-standing urethral stones in male children with normal urethra. MATERIALS AND METHODS: Retrospective search of our center data was done for the cases of long-standing urethral stones with normal urethra in male children during the period July 2001 - June 2016. Demographic and clinical data were studied. RESULTS: Of more than 54,000 urolithiasis procedures, 17 male children (0.031%) were operated for long-standing urethral stones with normal urethra. In 14 cases (82.4%), residence was rural and parental education levels were low or none. All children were regularly prompted voiding with a history of difficulty or dysuria. All the stones lodged in the posterior urethra with an approximate mean duration of 2 months. The mean stone size of 11.29 ± 3.88 mm and rough surfaces in 88.2% of cases represented the main predisposing factors. Major complications included rectal prolapse in 1 case and vesicoureteral reflux in 3 cases. Endoscopic push-back was followed by disintegration in 76.5% or cystolithotomy in 17.7%, while it failed in 1 case that was treated by cystolithotomy. CONCLUSIONS: Long-standing urethral stones in male children with normal urethra are very rare misdiagnoses. Stone topography and sociocultural factors predisposed to their lodgments and negligence. Endoscopic treatment is the best approach.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. III. Psychourological Events: 1. Psychic Anuria.

INTRODUCTION: Psychic anuria is an old term, referring to a very rare psycho-urological event that has scarcely been studied so far. MATERIALS AND METHODS: A retrospective study of the patients with psychic anuria presented to Assiut Urology and Nephrology Hospital during the period July 1991-June 2016 was done. Psychic anuria was defined, and the demographic and clinical characteristics including the methods of diagnosis and management were studied. RESULTS: Of more than 3,800 cases of anuria, 9 female patients (0.24%) experienced psychic anuria in the age range of 17-43 years. Cardinal clinical findings included anuria for 36-72 h with absence of organic causes and normal renal function tests. Psychosocial risk factors were reported in the 9 cases. Anuria was documented by reliable history (56%) or observable urine collection (44%). Diagnosis was done by exclusion, where the investigations revealed no organic causes. Seven cases responded to the placebo intervention and 2 cases were self-limiting and resolved spontaneously. CONCLUSIONS: Psychic anuria is an extremely rare urological emergency that presents, mainly, in young adult females with unknown mechanisms. Renal vasoconstriction following psychosocial stressors is suggested. It is diagnosed by exclusion and resolves spontaneously or responds to placebo intervention as a mental distraction technique.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 2. Intracorporeally-Retained Urological Surgical Items.

OBJECTIVE: Presentation of our center's experience in the management of intracorporeally-retained urological surgical items. MATERIALS AND METHODS: Retrospective search of our center's data for cases of retained surgical items during the period July 2006 to June 2016. Each case was studied for the demographic and clinical variables including types, presentation, and management. RESULTS: Out of more than 55,000 different urological interventions, only 39 cases (28 males and 11 females) had retained surgical items. Urolithiasis-related urological subspecialties were more involved than others. Forgotten items and technically-retained items occurred in 38.5 and 61.5% of cases, respectively, and were immediately discovered or discovered up to 10 years later. Material types were textiles, biosynthetics, and metallics in 31, 51, and 18%, respectively. Possible predisposing factors included complex surgeries, emergent intraoperative events, and extra approaches. Occurrences of retained surgical items before and after implemented corrective actions were 74.6 and 25.4%, respectively. All the final outcomes were either short- or long-term harm without deaths, organ losses, or permanent disabilities. CONCLUSION: Retained urological surgical items are surgical never events that result from forgetfulness or technical surgical human errors. Their sequels can be potentially fatal, but they are preventable and can be significantly reduced.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 1. Urological Wrong-Surgery Catastrophes and Disabling Complications.

INTRODUCTION: Surgical never events are preventable harmful non-intentional human errors. Urology is a common surgical specialty for their occurrence. PATIENTS AND METHODS: A retrospective search of our center's data was done during the period 2006-2016 for surgical never events. Each included case was studied for the primary diagnosis, procedure, and subspecialty, never event type and timing, needed extra-interventions, urologist/procedure proportioning, outcomes, and possible underlying causes of the event. RESULTS: Of more than 55,000 different urological interventions, 61 patients were involved in never events. Wrong procedures represented 75% of the never events, and endourology and urolithiasis subspecialties were more often involved. The main detectable underlying factor was the disproportion between the levels of the procedure class and the qualification of the urologist (41%). Thirty-four cases had extra-procedures. The short-term harm effect represented the final outcome in 42% of all events. Death, permanent organ loss, and long-term harm represented 20, 15, and 23%, respectively. CONCLUSION: Urological surgical never events are rare, but their final outcomes could be catastrophic, even leading to death.

Isolated Renal Hydatid Cyst Misdiagnosed and Operated as a Cystic Renal Tumor.

OBJECTIVE: The aim of this work is the presentation of a case of isolated renal hydatid cyst with novel findings and an unusual surgical scenario. CLINICAL PRESENTATION AND INTERVENTION: A 54-year-old female patient presented with left loin pain and a palpable left renal mass. Imaging described a well-demarcated left renal cystic lesion with a double-layer wall. Radical nephrectomy was performed due to the possibility of malignancy. On retrograde revision, the double-layer wall represented the detached germinative membrane of a hydatid cyst that was confirmed by histopathology. CONCLUSION: Isolated renal hydatid cyst could be misinterpreted as a renal tumor. It should be considered in the differential diagnosis of renal cystic lesions.

Does the site of the orthotopic neobladder outlet matter? A prospective randomized comparative study.

BACKGROUND: To compare the results of urethral anastomosis to a button hole and to the lowest part of the anterior suture line during orthotopic neobladder substitution. METHODS: From January 2012 to December 2015, 87 consecutive male patients with invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder. Patients were randomly divided into two groups; group I (44 patients), the outlet was created as a button-hole at the most dependent part of the pouch, group II (43 patients), the lowest 1 cm of the anterior suture line of the pouch was left open as an outlet. Patients were randomly assigned to either group using computer-generated random numbers (JMP, Version 12.0.1; SAS Institute, Cary, NC, USA) via a sealed envelope. The functional outcomes of both groups were compared especially at the urethro-enteric anastomosis. RESULTS: There were no intraoperative complications. Early postoperative complications occurred in 9 patients (5 in group I and 4 in group II, p = 0.484). Prolonged urinary leakage persisted for 11 and 14 days in 2 patients in group I and 10 and 16 days in 2 patients in group II. Delayed postoperative complications occurred in 11 patients (5 [12.5%] in group I and 6 [15.6%] in group II) (p = 0.711). Three patients developed urethro-enteric strictures (2 in group I and 1 in group II) (p = 0.571). CONCLUSION: The "non-hole" technique of urethral anastomosis was not associated with a significant increase in the complication rate when compared to the commonly performed "hole" technique.