Clinical Outcomes of Intravesical Prostatic Protrusion in Patients With Benign Prostatic Hyperplasia.

Background Benign prostatic hyperplasia (BPH) is a disorder that is characterized by the hyperplasia of the cellular elements of the prostate, leading to an enlarged prostate. One of the parameters affecting urinary outflow is intravesical prostatic protrusion (IPP). It is a phenomenon wherein the enlargement of the prostate protrudes into the bladder along the plane of least resistance. This condition can lead to various clinical effects, including symptoms such as the feeling of incomplete void and weak, interrupted urine stream. Hence, investigating the potential associations between different grades of IPP and clinical urological outcomes holds crucial implications for optimizing patient care, refining risk stratification, and enhancing treatment approaches. Methodology We examined patients who were following up at the urology outpatient clinics due to BPH between June 1, 2021, and December 31, 2022. All patients included in this study were required to undergo a transabdominal prostate ultrasound. Patient records were reviewed for various factors, including demographic stratification, the presence of urine routine or culture with evidence of urinary tract infection (UTI) within the past two years, and whether patients were scheduled for surgical intervention. The radiological parameters were recorded by viewing the midsagittal and transverse ultrasound images retrospectively by two specialist radiology physicians. The parameters measured included IPP Grade, prostate volume (PV), presence of bladder stones, anatomical abnormalities (such as bladder diverticulum), and post-void volume. Results The total sample size was 184 patients. Out of these, 53 (28.8%) had IPP Grade I, 72 (39.1%) were classified as Grade II, 42 (22.8%) had Grade III, and 17 (9.2%) were categorized as Grade IV. The data collected also showed that 12 (6.5%) patients had bladder stones on ultrasound examination. Additionally, 17 (9.2%) patients had bladder diverticulum. Furthermore, when controlled for age and PV, multivariate analysis using logistic regression models to calculate the odds ratio (OR) showed that increasing IPP Grade is associated with an increased risk of developing UTIs, acute urinary retention, and the need for surgical intervention. The highest risk group of patients is IPP Grade IV, with odds ratios (ORs) of 6.8, 7.2, and 6.4 for developing UTIs, experiencing acute urinary retention, and requiring surgical intervention, respectively. Conclusions The results provide compelling evidence of the adverse relationships between higher grades of IPP and worsening urological outcomes and patient morbidity. Hence, we recommend further studies be conducted on the clinical effects of IPP and that these measurements should be considered as part of routine ultrasound prostate imaging to aid in the management of BPH cases.

Challenges of Retrograde Ureteroscopic Procedures in Overweight Patients.

BACKGROUND: Obesity and urolithiasis are both prevalent conditions that have an impact on the healthcare system. The ureteric diameter and accessibility play a crucial role in the management of urolithiasis in both overweight and normal weight patients. Studies have shown that obesity can lead to changes in ureter diameter where excessive body fat can exert pressure on the kidneys, causing them to enlarge in size and this enlargement can result in a compression of the adjacent structures, including the ureter. The aim of this study is to assess the incidence of intraoperative challenges faced during retrograde ureteroscopic procedures in overweight patients with ureteric and renal calculi. METHODS: We retrospectively reviewed patients who underwent retrograde ureteroscopic surgery (RURS) for urolithiasis from 1st January 2021 until 30th August 2023. The outcome and any complications were documented and compared with the patient's Body Mass Index (BMI). All patients who undergo RURS in our facility have to have a Non-Contrast CT scan prior to surgery. Procedural success was determined by the ability to obtain access to the stone site intraoperatively and stone-free status in kidney, ureter, and bladder (KUB) X-ray post-operatively. Post-operative complications were recorded up to two weeks post-operatively and classified according to the Calvein Dindo Classification. RESULTS: Our total sample size was 146 patients out of which 75 were overweight and 71 were normal weight patients. In 34 (45%) of overweight patients' access to the ureter was restricted due to a narrow ureteric orifice with ureteroscopy not successful; on the contrary 13 (18%) of normal weight patients faced this same issue. This was statistically significant with a p-value of .004. The stone clearance rates were 91% and 95% in overweight and normal weight patients respectively, which is higher in normal weight patients however this difference was not found to be a statistically significant finding (p-value .028). Overweight patients had 12% Grade I and 8% Grade II complications whereas normal weight patients had 11% Grade I complications and 1.4% Grade II with no higher-grade complications. CONCLUSION: Retrograde ureteroscopic procedures are a safe treatment modality for patients with urolithiasis in both overweight and normal weight populations. They are shown to have similar success rates between both populations once ureteric access is obtained. However, access failure rates are shown to be slightly higher in overweight patients. Hence, further preoperative patient counselling and technical considerations should be undertaken.

Renal Carcinoma Patterns and Prevalence in Bahrain: A Descriptive Study.

Cancer is a major health problem with a significant impact on society and healthcare systems. In 2018, approximately 18.1 million cases of cancer were diagnosed and 9.6 million deaths were documented. Urological cancers account for 12.9% of new cases recorded and 8% of deaths due to cancer worldwide. The latest cancer registries covering the Gulf Cooperation Council (GCC) countries report that 4078 cases of renal cell carcinoma were diagnosed from 1998 to 2012. Urological cancers comprised 9.4% of all cases with an incidence rate of 16.1% in males and 3.2% in females. All renal cancer cases documented in Salmaniya Medical Complex (SMC) from 2014 to 2018 were reviewed. Data collected for all patients from the electronic health record system included age at diagnosis, gender, laterality of cancer (where applicable), histological type, and TNM (tumor, node, metastasis) classification and staging. Furthermore, World Health Organization (WHO) grade and data were collected for kidney cancer cases. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp, Armonk, NY). From 2014 to 2018, there were 65 documented cases of kidney cancer with an average caseload of 13 cases per year. The mean age at diagnosis was 57.6 years. Clear cell carcinoma was the most common histological subtype (37.5%). Stage 1 was the most common stage at diagnosis (35.4%) and the age-standardized mortality rate for males and females were 4.59 and 4.58 in 100,000, respectively. Kidney cancer is a urological malignancy that can pose a burden on both the patient and the healthcare system. There should be a national effort to better understand the etiology and epidemiology of this disease entity with regard to our population. Such efforts would make data regarding diagnosis, management, and follow-up more accessible and would add positively to our healthcare system.

Testicular Germ Cell Tumor Presenting as Torsion in a Young Patient.

Testicular torsion is a relatively common urological emergency, which involves the twisting of the spermatic cord and its contents leading to ischemia to the testes, which usually presents as sudden, severe scrotal pain. In comparison, testicular neoplasms are far less commonly encountered in the emergency department as they often present as painless hard masses that grow slowly over longer periods of time. Extremely rare cases of testicular neoplasms present as sudden scrotal pain that causes a challenging task in the emergency department as physical examinations and ultrasound findings could vary and not be specific enough in confirming the diagnosis. In this case, we report a 22-year-old male who was referred from the emergency department (ED) as a case of testicular torsion from the presenting history; however, his physical examination and Doppler ultrasound findings were suspicious of testicular malignancy. The patient presented with a history of right scrotal pain for a few hours with no predisposing factors; however, examination and imaging were highly suspicious of an underlying neoplasm. The patient underwent an inguinal orchidectomy, and histology confirmed the presence of a germ cell tumor of varying components. In conclusion, a high index of suspicion for testicular torsion should always be present when a patient presents with sudden onset testicular pain; however, the differential diagnosis including testicular neoplasms should not be overlooked as it can change the management and outcome.

Laparoscopy-Assisted Percutaneous Nephrolithotripsy (PCNL) in Ectopic Pelvic Kidney.

An ectopic kidney is a rare developmental anomaly in which the kidney can be pelvic, iliac, abdominal, and thoracic, and affected patients are more prone to conditions such as reflux, pelvic ureteric junction (PUJ) obstruction, hydronephrosis, nephrolithiasis, and even renal failure than patients with normally structured kidneys. In this case, we present a 43-year-old male who is a known case of ectopic left pelvic kidney and presented with chronic lower abdominal pain. Upon imaging, it was revealed that he had a staghorn stone for which he underwent laparoscopy-assisted percutaneous nephrolithotripsy (PCNL). Postoperatively, the patient underwent a quick recovery and was discharged on postoperative day 3 without any perioperative complications. Hence given our experience with this case and the similar experiences of urologists over time, the use of laparoscopy-assisted PCNL appears to create a safe way of entering the abdomen and locating the ectopic kidney as well as provide visual guidance in puncture and dilatation all the while protecting the adjacent structures from harm. This demonstrates that laparoscopy-assisted PCNL is a feasible safe and minimally invasive procedure for patients with ectopic kidneys presenting with large stones.

Ultrasound heterogeneity as an indicator of testicular salvage in testicular torsion: A single center experience.

OBJECTIVE: Testicular torsion is a common urological emergency, mainly in the younger population. Our aim is to evaluate the efficacy and value of testicular echogenicity in predicting testicular viability. METHODS: Patients who were older than 13 years of age and were discharged with the diagnosis of testicular torsion were reviewed. Data obtained included demographic data, history, physical examination results, ultrasound findings including size, color Doppler flow, and echotexture, torsion degrees, and surgical procedure. In addition, the histopathological findings of patients who underwent orchiectomy were reviewed. RESULTS: A total of 71 cases were diagnosed with testicular torsion between January 2016 to December 2018. The mean age at presentation was 20.4±7.0 years. The average time from the onset of pain until the presentation was 36.0±55.1 h. Out of the 71 ultrasound scans reviewed, 45.1% showed homogenous echotexture and 54.9% showed heterogeneous echotexture of the affected testis. On scrotal exploration, the mean degree of torsion was 475.7±301.8 degrees; 66.2% of the patients had a viable testis; and bilateral orchidopexy was done. The remaining 33.8% had a non-viable testis. Homogenous echotexture was after an average of 13.5 h of scrotal pain, while heterogeneous echotexture presented after 53.7 h of scrotal pain. There was a statistically significant difference between the time of presentation and echotexture changes on scrotal ultrasonography (p<0.01). The relationship between echotexture changes and testicular viability was statistically significant as well (p<0.001). CONCLUSION: A long time since the onset of pain coupled with heterogeneous changes in testicular parenchyma is a good indicator of non-viability. However, we still advocate for surgical exploration as the gold standard in diagnosis and management.