Surgical outcomes of low-power thulium laser enucleation of prostates >80 g. One-year of follow-up.

Introduction: The aim of this study was to assess the effectiveness of low-power thulium (30 W) and the duration necessary to eliminate adenomas at the level of the surgical capsule, as well as its impact on postoperative urinary and sexual function. Material and methods: Patients with symptomatic benign prostatic hyperplasia (BPH), who had ThuLEP between December 2019 and March 2022 and had a prostate size >80 mL and had not responded to the medication therapy, were included. The prostate size, prostate-specific antigen (PSA), enucleation and morcellation times, postoperative International Prostate Symptom Score (IPSS), and International Index of Erectile Function-5 (IEFF-5) records at 1, 3, 6, and 12 months were among the information gathered. Results: The average age of the 80 patients who received ThuLEP was 66.7 ±6.4 years, with a mean prostate volume of 112.65 ±19.3 mL. The mean duration for enucleation was 71 ±11 min. At the initial follow-up after one month, the mean IPSS was 8.012 ±1.78 mL and the mean Qmax enhancement was 30.16 ±4 mL s-1. In contrast to baseline, our findings demonstrated a substantial improvement in postoperative urgency and urgency urinary incontinence (UUI) (p = 0.005) but no meaningful variation in IIEF-5 score at the 12-month follow-up. Conclusions: Low-power ThuLEP is worthwhile for therapeutic use because it effectively treats patients with large prostates with satisfactory urinary and sexual effects.Clinical trials .gov ID: NCT05494944.

Effect of sulfur doping of zinc-imidazole coordination polymer (ZnIm CP) as a novel photocatalyst for degradation of ionic dyes.

Zinc-Imidazole coordination polymer (ZnImCP) was simply synthesized hydrothermally at relatively low temperature (70 °C) from zinc acetate and imidazole. ZnImCP was treated by sulfide solution to produce sulfur-doped samples (S-ZnImCPs). Structures of the synthesized ZnImCP and S-ZnImCPs were characterized through FTIR, PXRD, and, Raman, SEM/EDX, N2-BET, UV-VIS DRS, and pHpzc analyses. The photocatalytic performances of pristine CP and sulfur modified CPs under visible and ultra-violet irradiations for degrading the cationic methylene blue (MB) and the anionic methyl orange (MO) were investigated considering different initial pH values 4, 7 and 10. Under visible light, the results indicate that these CPs display considerable photocatalytic degradation towards the cationic MB for the initial pH 4 and 7 where degradation increases with sulfur content. While under ultra-violet, results indicate considerable photocatalytic degradation towards both dyes for the initial pH 7 and 10 where degradation increases with sulfur content which indicates the gainful of non-metal dopping. The buffering nature of CPs and the type of radiation considering determined band-gap values effectively influence the degradation mechanisms.

Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife.

PURPOSE: To compare efficacy and safety of visual internal urethrotomy (VIU) using holmium laser (Ho:YAG) (group A) versus cold knife (group B) in children with urethral strictures. It may be the first comparative study on this issue in children. METHODS: This study compared Ho:YAG group, which was evaluated prospectively from January 2014 till January 2016, versus cold knife group, which was a historical control performed from March 2008 till February 2010. Children ≤ 13 years old with urethral strictures ≤ 1.5 cm were included successively. Recurrent cases, congenital obstructions and cases with complete arrest of dye in voiding cystourethrography were excluded. Scar tissue was incised at twelve o'clock. Outcome was compared using Student's t, Mann-Whitney, Chi-square or Fisher exact tests as appropriate. RESULTS: Each group included 21 patients. Mean age was 6.27 ± 3.23 (2-13) years old. Mean stricture length was 1.02 versus 1 cm in group A versus B, respectively (p = 0.862). Ten cases of penile/bulbous strictures and another 11 cases of membranous strictures were found in each group. There was no significant difference between both groups in preoperative data. Success rate for initial VIU was 66.7% in group A versus 38% in group B (p = 0.064). This was associated with significantly higher Qmax in group A (mean 16.52 vs 12.09 ml/s; p = 0.03). Success rate after two trials of VIU was 76.2% for group A and 47.61% for group B (p = 0.057). No complications were reported in both groups. CONCLUSION: Laser VIU has a higher success rate than cold knife VIU for urethral strictures ≤ 1.5 cm in children with significantly higher Qmax. Both are easy to perform, low invasive and safe.

Role of plasma amino acids and urinary organic acids in diagnosis of mitochondrial diseases in children.

BACKGROUND: Diagnostic difficulty in mitochondrial diseases (MD) results not only from the wide spectrum of symptoms and signs but also from the absence of a reliable screening or diagnostic biomarker. AIM: To investigate the likelihood of MD in patients with symptoms and signs impressive of MD through quantitative measurement of plasma amino acids, and urinary organic acids. METHODS: Twenty patients with symptoms and signs suggestive of MD were further evaluated by quantitative plasma amino acids and urinary organic acids assay and neuroimaging. RESULTS: Plasma amino acid results revealed elevation of alanine in 11, glycine in five, and proline in two patients. Abnormal urinary organic acid analysis was present in six patients; increased urinary lactate (20%), dicarboxylicaciduria (15%), and urinary ketone bodies (10%). Upon enrollment our patients scored as possible MD according to the MD scoring system. At the end of the study, five patients still scored as possible MD, eight patients as probable MD, and seven patients as definite MD. All patients with definite MD had elevated serum lactate. In three patients, elevated urinary lactate was the only abnormality. Alanine was elevated in all patients with definite MD, whereas proline was elevated in only one. Magnetic resonance imaging of the brain showed atrophic changes in one patient and bilateral basal ganglia hyperintensity in another. CONCLUSION: Urinary organic acids and quantitative plasma amino acids can help in the diagnosis of MD, especially when the economic burden and absence of specialized centers limits the diagnosis.

Slow vs rapid delivery rate shock wave lithotripsy for pediatric renal urolithiasis: a prospective randomized study.

PURPOSE: We compared slow vs fast shock wave frequency rates in disintegration of pediatric renal stones less than 20 mm. MATERIALS AND METHODS: Our study included 60 children with solitary 10 to 20 mm radiopaque renal stones treated with shock wave lithotripsy. Patients were prospectively randomized into 2 groups, ie those undergoing lithotripsy at a rate of 80 shock waves per minute (group 1, 30 patients) and those undergoing lithotripsy at a rate of 120 shock waves per minute (group 2, 30 patients). The 2 groups were compared in terms of treatment success, anesthesia time, secondary procedures and efficiency quotient. RESULTS: Stone clearance rate was significantly higher in group 1 (90%) than in group 2 (73.3%, p = 0.025). A total of 18 patients in group 1 (60%) were rendered stone-free after 1 session, 8 required 2 sessions and 1 needed 3 sessions, while shock wave lithotripsy failed in 3 patients. By comparison, 8 patients (26.6%) in group 2 were rendered stone-free after 1 session, 10 (33.3%) required 2 sessions and 4 (13.3%) needed 3 sessions to become stone-free. Mean general anesthesia time was significantly longer in group 1 (p = 0.041). Postoperatively 2 patients in group 1 and 4 in group 2 suffered low grade fever (Clavien grade II). Significantly more secondary procedures (percutaneous nephrolithotomy, repeat shock wave lithotripsy) were required in group 2 (p = 0.005). The predominant stone analysis was calcium oxalate dihydrate in both groups. Efficiency quotient was 0.5869 and 0.3437 for group 1 and group 2, respectively (p = 0.0247). CONCLUSIONS: In children with renal stones slow delivery rates of shock wave lithotripsy have better results regarding stone clearance than fast delivery rates.

Safety and efficacy of tubeless percutaneous renal surgery.

PURPOSE: We challenge the requirement for routine placement of a nephrostomy tube after percutaneous renal surgery, assessing the outcome, safety, and efficacy of tubeless procedures. PATIENTS AND METHODS: A total of 128 patients underwent tubeless percutaneous renal surgery from May 2001 to May 2004: stone extraction in 120 patients and endopyelotomy +/- stone extraction in 8. The stone sizes ranged from 2 to 7 cm with a mean of 4.1 cm. An external ureteral catheter was used in 120 patients and was removed after 24 hours if a retrograde study revealed no extravasation. An antegrade Double-J stent was used in 8 patients and removed 4 to 6 weeks postoperatively. Among the 128 patients treated by the tubeless technique, we met situations that mandated insertion of a nephrostomy tube in 18. RESULTS: The stone free-rate was 90.4%. The mean hospital stay was 1.7 days. The incidence of significant intraoperative bleeding was 1.5% and that of significant postoperative hematuria was 4.6%. Postoperative sonography revealed a small perirenal collection (<50 mL) in 10 patients (7.8%) and significant perirenal collections (100-250 mL) in 3 (2.3%). The postoperative retrograde study revealed minor extravasation in 14 patients (12%) and significant extravasation in 3 (2.3%) CONCLUSION: Tubeless percutaneous renal surgery with an externalized ureteral catheter is a safe procedure that is suitable for any patient who can be rendered stone free with a single procedure regardless of the initial stone burden.