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.

Molecular detection and phylogenetic analysis of newly emerging foot-and-mouth disease virus type A, Lineage EURO-SA in Egypt in 2022.

A newly emerging and exotic foot-and-mouth disease virus (FMDV) caused a recent outbreak of serotype A in Egypt in 2022, which affected cattle and water buffalo. Previous phylogenetic studies on FMDV circulating in Egypt have mainly focused on genomic regions encoding the structural proteins which determine FMDV serotype. No study has yet determined structural proteins sequences of the newly emerging Europe-South America (EURO-SA) lineage which was recently isolated from Egypt during a routine surveillance in 2022. The objective of the current study was to analyze the structural proteins of the Venezuelan type which belongs to EURO-SA. The new isolate was related to serotype A lineage Euro-South America. Phylogentic analyses have reveled that the newly isolated lineage samples were closely related to reported sequences that have been identified in Venzuela and Colombia. Analysis of structural protein sequences revealed the recent isolates belong to prototype strain A24 Cruzeiro. Notably, nucleotide sequences of the Egyptian isolate was related to Venezuelan, Brazilian, and Colombian strains with identity not exceeding 90%. The divergence which appears in the genetic identity of the Egyptian A/EURO-SA lineage from other related strains may be attributed to the absence of Euro-SA lineage sequence from Egypt. The present study is the first report on the detection of EURO-SA lineage in Egypt. The recent detection of the EURO-SA lineage samples may be explained due to imported animals from Colombia or Brazil which share geographical borders with Venezuela. The findings of the present study highlight the significance of continuous monitoring of FMDV in Egypt for newly emerging FMDVs.

Internal versus external ureteric stents for uretero-ileal anastomosis after laparoscopic radical cystectomy with orthotopic neobladder: A prospective comparative study.

OBJECTIVE: To prospectively compare the use of external ureteric stents with internal JJ stenting of the uretero-ileal anastomosis in patients undergoing laparoscopic radical cystectomy (LRC) with a Y-shaped ileal orthotopic neobladder (ON). PATIENTS AND METHODS: The study included 69 patients undergoing LRC with ON. Patients were grouped according to the type of uretero-ileal stents used. An external ureteric stent was used in Group A (33 patients) and a JJ stent was used in Group B (36). We prospectively compared the duration of hospital stay, the incidence of short- and intermediate-term complications in the two study groups. RESULTS: The mean (SD) follow-up periods were 29.18 (3.94) and 28.19 (3.37) months for patients in Groups A and B, respectively. Perioperative patient characteristics were comparable in the two study groups. The use of JJ stenting was associated with a shorter hospital stay compared with external stenting, at a mean (SD) of 14.63 (3.74) and 6.8 (3.03) days in Groups A and B, respectively (P < 0.001). The incidence of urinary leakage was comparable in the two study groups, at 6.1% in Group A vs 8.3% in Group B (P = 1.0). Strictures of the uretero-ileal anastomosis occurred in two patients (6%) in Group A and confirmed by intravenous urography. All strictures were treated with antegrade JJ fixation. CONCLUSION: JJ stents could be used as an effective alternative to external ureteric stents to support the uretero-ileal anastomosis. JJ stenting is associated with a shorter hospital stay and similar complication rates compared with external stenting in patients undergoing LRC with ON.

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study.

OBJECTIVES: To compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. PATIENTS AND METHODS: A database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, Mann-Whitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. RESULTS: The mean ± sd (range) age of the study cohort was 5.05 ± 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean ± sd follow-up was 4.52 ± 1.55 and 4.07 ± 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. CONCLUSION: Acceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.

Holmium laser enucleation of the prostate: initial report of the first 230 Egyptian cases performed in a single center.

OBJECTIVES: To report our experience with the first 230 cases of holmium laser enucleation of the prostate (HoLEP) performed in a single center. METHODS: A total of 230 cases of HoLEP were performed between June 2007 and June 2008. Mean age of patients was 69.8 +/- 10.3 years, and 21.3% of patients were either on anticoagulant or antiplatelet treatment. There was no limit for prostate size, with a mean prostate size of 86.5 +/- 65.4 g (range: 20-350 g). Follow-up was performed regularly at 1, 3, 6, and 12 months, assessing the Q(max), PVR, and International Prostate Symptom Score. RESULTS: Weight of prostate chips retrieved after morcellation was 78.6 +/- 61.3 g (range: 10-350), with enucleation time 102.2 +/- 55.4 minutes and morcellation time 19.3 +/- 10.1 minutes, leading an estimated efficiency rate of 0.64 g/min. The rate of decrease in prostate volume and prostate-specific antigen was 90.8% and 82.5%, respectively. At 1 month, mean Q(max) increased from 7.7 +/- 2.3 to 25.8 +/- 10.1 mL/s (P

Antegrade ureteral stenting during laparoscopic dismembered pyeloplasty: intraoperative findings and long-term outcome.

OBJECTIVE: The objective of this study was to compare the results of antegrade (AG) ureteral stenting with retrograde (RG) stenting during laparoscopic dismembered pyeloplasty. MATERIALS AND METHODS: Between October 2003 and April 2007, a case series of 47 laparoscopic dismembered pyeloplasties were done by three surgeons of equal expertise in laparoscopic surgery, where the Double-J ureteral stent was placed by the RG method (RG stenting group) in 15 cases and by the AG method (AG stenting group) in 32 patients. Intraoperative findings and operative data were recorded. Clinical and radiological outcomes were evaluated during the follow-up visits at 3, 6, 12 months and then annually. RESULTS: Differences in patient's age and body mass index were not statistically significant. Laparoscopic pyeloplasty was successfully completed in 45 patients, with two cases of conversion to open (one in each group). A crossing vessel was identified in 42% of RG stenting group versus 45% of AG stenting group. A state of high ureteral insertion was identified in 16% of AG stenting group, a finding that was never seen in RG stenting group. Mean operative time was 271 +/- 21 minutes for RG stenting group versus 199 +/- 34 minutes for AG stenting group, a difference that was statistically significant (p

Laparoscopic augmentation ileocystoplasty: results and outcome.

BACKGROUND: Routine use of laparoscopic augmentation ileocystoplasty has not yet been established. OBJECTIVES: To assess the outcome of laparoscopic augmentation ileocystoplasty. DESIGN, SETTING, AND PARTICIPANTS: Twenty-three patients underwent laparoscopic augmentation ileocystoplasty for hypocompliant bladder. INTERVENTION: Bladder dissection and reconstruction of the ileovesical anastomosis were performed laparoscopically, whereas the ileal pouch was prepared extracorporeally through a small 3- to 4-cm muscle-splitting incision. MEASUREMENTS: Patient data, operative details, and follow-up were recorded. Urodynamic evaluation was performed preoperatively and after 12 mo, taking the bladder capacity and the maximum detrusor pressure as a measure for the outcome of the procedure. RESULTS AND LIMITATIONS: All cases were completed laparoscopically, with a mean operative time 202 min; mean hospital stay 5 d, and mean urethral catheter duration 11 d. After 12 mo, the estimated bladder volume increased from a mean 111 ml to 788 ml (p<0.01), whereas the maximum detrusor pressure dropped from a mean 92 cm H(2)O to 15 cm H(2)O (p<0.01). During a mean follow-up of 39 mo, two long-term complications have been reported: bladder stone and spontaneous rupture of the augmented bladder due to neglected clean intermittent self-catheterization. CONCLUSIONS: Laparoscopic augmentation ileocystoplasty is a safe procedure, technically feasible and with favourable urodynamic outcome.