Urinary tract infection in children: A narrative review of clinical practice guidelines.

Background: Urinary tract infection (UTI) has been a major burden on the community and the health-care systems all over the globe. It is the most common cause of bacterial infection in the pediatric age group, with an annual incidence of 3%. The aim of this study is to review and summarize all available guidelines on the diagnosis and management of children with UTI. Materials and Methods: This is a narrative review of the management of children with a UTI. All biomedical databases were searched, and any guidelines published from 2000 to 2022 were retrieved, reviewed, and evaluated to be included in the summary statements. The sections of the articles were formulated according to the availability of information in the included guidelines. Results: UTI diagnoses are based on positive urine culture from a specimen of urine obtained through catheterization or suprapubic aspiration, and diagnoses cannot be established on the bases of urine collected from a bag. The criteria for diagnosing UTI are based on the presence of at least 50,000 colony-forming units per milliliter of a uropathogen. Upon confirmation of UTI, the clinician should instruct parents to seek rapid medical assessment (ideally within 48 h) of future febrile disease to ensure that frequent infections can be detected and treated immediately. The choice of therapy depends on several factors, including the age of the child, underlying medical problems, the severity of the disease, the ability to tolerate oral medications, and most importantly local patterns of uropathogens resistance. Initial antibiotic choice of treatment should be according to the sensitivity results or known pathogens patterns with comparable efficacy of oral and parenteral route, for 7 days to 14 days duration. Renal and bladder ultrasonography is the investigation of choice for febrile UTI, and voiding cystourethrography should not be performed routinely unless indicated. Conclusion: This review summarizes all the recommendations related to UTIs in the pediatric population. Due to the lack of appropriate data, further high-quality studies are required to improve the level and strength of recommendations in the future.

Saudi Urological Association consensus guidelines on the use of robotic surgery in urology.

Over the past three decades, minimally invasive robotic technology has evolved substantially in urological practice, replacing many open procedures and becoming part of routine clinical practice. The Health Sector Transformation Program for the Kingdom's Vision 2030 aims to restructure the health sector and optimize its status and prospects as an effective and integrated ecosystem centered on the patient's health. Therefore, this consensus seeks to endorse the clinical practice guidelines for robotic surgery (RS) in the KSA, highlighting its effectiveness, safety, and favorable outcomes compared to open and laparoscopic surgeries in certain procedures when used by trained surgeons in well-structured RS programs.

Randomized trial of prophylactic antibiotics vs. placebo after midshaft-to-distal hypospadias repair: the PROPHY Study.

BACKGROUND: Use of prophylactic antibiotics after stented hypospadias repair is very common, but most research has not identified any clinical benefits of this practice. Only one study has found that postoperative prophylaxis reduces symptomatic urinary tract infections (UTIs). Data from the same trial suggested that prophylaxis may also reduce urethroplasty complications. No studies on this subject have been placebo-controlled. OBJECTIVE: We performed a randomized, double-blind, placebo-controlled study to evaluate the effect of postoperative prophylactic antibiotics on the incidence of infection or urethroplasty complications after stented repair of midshaft-to-distal hypospadias. STUDY DESIGN: Boys were eligible for this multicenter trial if they had a primary, single-stage repair of mid-to-distal hypospadias with placement of an open-drainage urethral stent for an intended duration of 5-10 days. Participants were randomized in a double-blind fashion to receive oral trimethoprim-sulfamethoxazole or placebo twice daily for 10 days postoperatively. The primary outcome was a composite of symptomatic UTI, surgical site infection (SSI), and urethroplasty complications, including urethrocutaneous fistula, meatal stenosis, and dehiscence. Secondary outcomes included each component of the primary outcome as well as acute adverse drug reactions (ADRs) and C. difficile colitis. RESULTS: Infection or urethroplasty complications occurred in 10 of 45 boys (22%) assigned to receive antibiotic prophylaxis as compared with 5 of 48 (10%) who received placebo (relative risk [RR], 2.1; 95% confidence interval [CI], 0.8 to 5.8; p = 0.16). There were no significant differences between groups in symptomatic UTIs, SSIs, or any urethroplasty complications. Mild ADRs occurred in 3 of 45 boys (7%) assigned to antibiotics as compared with 5 of 48 (10%) given placebo (RR, 0.6; 95% CI, 0.2 to 2.5; p = 0.72). There were no moderate-to-severe ADRs, and no patients developed C. difficile colitis. CONCLUSIONS: In this placebo-controlled trial of 93 patients, prophylactic antibiotics were not found to reduce infection or urethroplasty complications after stented mid-to-distal hypospadias repair. The study did not reach its desired sample size and was therefore underpowered to independently support a conclusion that prophylaxis is not beneficial. However, the result is consistent with most prior research on this subject. GOV IDENTIFIER: NCT02096159.

Pediatric urology surgical practice in the time of COVID-19: Results from tertiary Saudi Arabia hospitals.

PURPOSE: Our study aimed to evaluate the effect of COVID-19 on pediatric urology practice in the Kingdom of Saudi Arabia (KSA). METHODS: Data of 10 tertiary hospitals in KSA were retrospectively analyzed. Data of outpatient department (OPD) visits and pediatric urology surgical procedures from January 1, 2019, to April 30, 2019, and from January 1, 2020, to April 30, 2020, were extracted. The primary outcome was to compare OPD visits and pediatric urology workload in the first third of 2020 versus 2019, where there was no curfew. The secondary outcome was to compare the same variables during the full curfew time, i.e., April 2020 versus April 2019. RESULTS: The number of OPD visits was lower in the first third of 2020 (7390 vs. 10,379 in 2019 P < 0.001). OPD visits in April 2020 were 78.6% lower than in April 2019, and teleclinics represented 850 (94.3%). Elective procedures in the first third of 2020 were 688, with a reduction rate of 34.3% compared to the same period of 2019 (P < 0.001). In April 2020, there were 18 elective surgeries, with a 91.4% decrease than in April 2019. Ureteric reimplantation, hypospadias, cryptorchidism, and circumcision stopped, while pyeloplasty (n = 14) and urolithiasis (n = 4) procedures had declined by 50% and 76.5%, respectively. Most of the procedures (71.8%) were day surgery. Emergency procedures were similar in the first third of 2020 (65 vs. 64 in 2019, P = 0.994) and declined in April 2020 by 6.7% versus April 2019. During the full curfew, the most common emergency intervention were cases with obstructive uropathy (42.8%), followed by torsion testis (28.6%), posterior urethral valve (14.3%), and urological trauma (14.3%). CONCLUSIONS: In KSA, the number of elective pediatric surgical procedures were reduced by >90%, while the number of emergency pediatric surgical procdures were similar during COVID-19 pandemic compared with non-COVID-19 time. Ureteric reimplantation, hypospadias repair, cryptorchidism, and circumcision procedures were postponed. Pyeloplasty and urolithiasis-related procedures were performed to prevent irreversible disease progression or organ damage. There was an increase in rate of teleclinic and day surgery to reduce the risk of COVID-19 infection.

Impact of COVID-19 pandemic on urology residency training.

CONTEXT: The COVID-19 pandemic has led a lot of countries worldwide to go on lockdown. Potential collateral damage is the impact of residency. AIMS: The aim of this study is to assess the impact of COVID-19 pandemic on urology training aspects, study habits of residents, and their awareness and training regarding COVID-19. SETTINGS AND DESIGN: A questionnaire aiming to assess the impact of COVID-19 pandemic on different urology training aspects. The questionnaire was sent to all urology residents under the Saudi Commission for Health Specialties (SCFHS) programs. SUBJECTS AND METHODS: Urology residents under SCFHS programs, excluding 1st-year residents. The questionnaire included the following sections: demographic data, studying habits during the pandemic, involvement in training before the pandemic, involvement in training during the pandemic, and training related to COVID-19. STATISTICAL ANALYSIS USED: Using the SPSS software, frequencies of all data were calculated, and a Wilcoxon-signed rank test was done to assess the change in ordinal data. RESULTS: A total of 77 residents completed the survey (38% response rate). Most residents (40.5%) reported that they "strongly agree" with the statement that they have more time for reading. There has been a decrease in on-call duties, outpatient visits, diagnostic procedures, endoscopic surgeries urology, minimally-invasive surgeries, and major open surgeries in comparison to before the pandemic, with a decrease in mean scores in all domains, especially in diagnostic procedures. CONCLUSIONS: There has been a decrease in residents' involvement in all training domains, and this has been similar to the results of other studies. E-learning sources, during these times, present themselves as a valuable source to compensate for what has been missed in training.

Survey of Saudi urology program directors: What do you look for in a candidate?

INTRODUCTION: Prospective urology applicants in Saudi Arabia must go through a rigorous matching process. Defining which aspects of an applicant's portfolio or interview will get them matched is difficult. Our objective is to provide information on which aspects of an application are the most important. SUBJECTS AND METHODS: In this cross-sectional study, an electronic survey was sent out to all urology program directors (PD). The survey included 27 items from an application that were rated by the respondent using a 5-point Likert scale. RESULTS: Twenty-three urology PD completed the survey (79.3% response rate). Most of the PD subspecialized in endourology and minimally invasive surgery. The three most important aspects as perceived by all responding PD were as follows: performance during rotation at the respondent's centre, publications in urology, and the total number of electives in urology. The three least important factors were as follows: presentations in fields other than urology, recommendation letters from nonurologists, and quality reference letters from nonurologists. CONCLUSION: Performance during rotations has been shown in our and other studies to be one of the most important factors in an application. Surveying PD on what they value the most in an applicant, provides valuable information and more transparency regarding the match processes. We also recommend that our colleagues from different specialties conduct similar studies.

Neural Network Analysis of Crystalluria Content to Predict Urinary Stone Type.

PURPOSE: To investigate the relationship between urinary stone type and the type of crystals in the urine. PATIENTS AND METHODS: This retrospective study involved 485 patients with urinary stones treated at King Saud University Medical City from May 2015 to June 2017. Clinical data were obtained from medical records. Different statistical analysis methods were applied, including basic contingency analysis, analysis of variance, logistic regression, discriminant analysis, partition modeling, and neural network evaluations. RESULTS: Of 485 patients, 47 had crystals detected by urinalysis. The most common type of crystal was calcium oxalate (n = 31), which had the highest association with calcium oxalate stones. Uric acid crystals (n = 8) were associated with uric acid stones. The neural network model used for determining the sensitivity and specificity showed an R-square value of 0.88, with an area under the curve of 0.94 for calcium oxalate, 0.94 for carbonate apatite, and 1.0 for uric acid. CONCLUSION: The predictive algorithm developed in the present study may be used with a patient's clinical parameters to predict the stone type. This approach predicts the stone types associated with certain patient characteristics with a high sensitivity and specificity, indicating that the models may be a valuable clinical tool in the diagnosis, management, and monitoring of stone diseases.

Parents' awareness and knowledge of testicular torsion: A cross-sectional study.

BACKGROUND: Testicular torsion (TT) is one of the most common emergencies in pediatric urology. Family awareness of this condition could lead to early diagnosis and intervention and salvage of the effected testicle. The purpose of this study is to assess parental awareness about TT and their source of knowledge. We also evaluated the response of the parents to their children's scrotal pain. METHODS: A quantitative, observational, cross-sectional study was conducted from March 2017 to September 2017 at our institution. The study target were parents attending the pediatric urology clinic and the comparison group included parents attending the general pediatric clinic in the same period. We distributed a questionnaire and then compared the results in both groups. RESULTS: A total of 200 parents participated in this study (100 parents from each clinic). Nineteen percent of pediatric urology clinic parents were aware and 14% of general pediatric clinic parents were aware about TT with no statistically significant difference observed (P = 0.341). The parents in urology clinic choose doctor as their main source of knowledge (42.1%), while in general pediatric clinic, doctor and through a friend as the main source of knowledge had the same percentage (28.6%). Response of the parents to their children's scrotal pain during working hours in urology and general pediatric clinics was to drive their children to the emergency room immediately with 85% and 82%, respectively. The response of the parents after working hours in both clinics did not show difference, with 83% of parents in pediatric urology clinic and 85% in general pediatric clinic driving their children immediately to the emergency room. CONCLUSION: TT in boys is a common problem we face as pediatric urologists and it may lead to testicular loss if not diagnosed and treated early. We found that the awareness of TT in children is low in our community and it is our responsibility to raise it to improve our children's well-being.

Utilization of scrotal orchidopexy for palpable undescended testes among surgeons.

INTRODUCTION: Scrotal orchidopexy for palpable undescended testicle (UDT) has received attention in the last decade due to its lower morbidity. This study was conducted to determine the frequency and factors related to the use of the scrotal approach in the surgical treatment of palpable UDT among surgeons. METHODS: An observational cross-sectional study was carried out using an online survey, which was sent to different pediatric urologists, pediatric surgeons, and urologists groups. The survey consisted of questions on demographics as well as surgeons opinions and experience toward scrotal orchidopexy. RESULTS: Of 163 respondents, 57 (35.0%) were pediatric surgeons, 98 (60.1%) were pediatric urologists, and 8 (4.9%) were urologists. There were 86 respondents (52.8%) who used the scrotal orchidopexy approach for UDT at any time in their practice. Pediatric urologists tended to use the scrotal orchidopexy approach for UDT more significantly than others (P < 0.001). There were significantly more scrotal orchidopexies for UDT performed by the pediatric urologists throughout their practice and per year compared to others, respectively (P < 0.001). Fifty-two respondents (31.9%) claimed that scrotal orchidopexy is not a good option for their patients, while seven respondents (4.3%) claimed that the procedure was hard to perform. DISCUSSION: Based on the results of this study, we believe that there is a discrepancy in the reported advantages and success rate of scrotal orchidopexy in the published literature and the utilization of such an approach among surgeons managing palpable UDT in children. CONCLUSION: Scrotal orchidopexy is an underutilized approach in the management of palpable UDT in children. Only 52.8% of our respondents used it for UDT. One of the main reasons why scrotal orchidopexy is underutilized is due to the surgeons' perception that scrotal orchidopexy is not the procedure of choice for their patients and their unfamiliarity with the procedure.

Intraoperative blood transfusion in pediatric patients undergoing renal transplant-Effect of renal graft size.

In pediatric RT, donor allograft size often exceeds the expected recipient norms, especially in younger recipients. An "oversize" graft might not only present a technical- and space-related challenge, but may possibly lead to increased demands in perioperative volume requirements due to the disparity between donor and recipient in renal blood flow. We evaluated transfusion practices at a single tertiary institution with special consideration of kidney graft size, hypothesizing that oversize graft kidneys might lead to a quantifiable increased need of blood transfusion in smaller recipients. Retrospective analysis of all patients who underwent pediatric RT from January 2004 to June 2014 at a tertiary pediatric centre was performed. Variables analyzed included patient age, weight, pre- and postoperative Hb concentration, graft size, EBL, amount of intraoperative blood transfusion, and preoperative use of erythropoietin. Based on graft size in relation to patient's age, a SMR and an OvR were identified. A subcohort of age-matched pairs was used to allow for comparison between groups. We calculated the expected procedure- and transfusion-induced changes in Hb and compared these changes to the observed difference in pre- vs postoperative Hb to assess the influence of graft size on transfusion requirements. RT was performed in 188 pediatric recipients during the study period. In the matched cohort, percentage of transfused patients during transplantation in the OvR group was more than double compared with SMR (89% vs 39%, P < .001); similarly, the median number of transfused PRBC units in OvR was 1, while the median of SMR did not receive transfusion (P < .001). The difference between expected (calculated) and observed change in Hb was significantly higher in OvR with a median of 1.9 g/dL compared with SMR with a median of 1.0 g/dL (P = .026). Correspondingly, the calculated median volume taken up by a regular size kidney was significantly higher with 213 mL compared with 313 mL (P = .031) taken up by an oversize graft kidney. Median estimated intraoperative blood loss was significantly higher in OvR than in SMR (6.9 mL/kg, vs 5.3 mL/kg, respectively; P = .04). Median postoperative Hb was similar among groups (10.4 g/dL vs 10.6 g/dL for SMR vs OvR, respectively). Transplantation of an oversized kidney in pediatric RT recipients is associated with a quantifiable higher need for blood transfusion. This may be caused by a higher intraoperative EBL and/or greater blood volume sequestered by the larger renal allograft and requires further evaluation.

Routine histopathological examination of the foreskin after circumcision for clinically suspected lichen sclerosus in children: Is it a waste of resources?

INTRODUCTION: Circumcision is one of the most widely performed procedures in the world. One of the indications for circumcision is lichen sclerosis (LS). The natural history of LS in children is not as well-documented as in adult patients. Surgeons use the appearance of the foreskin or meatus to predict the diagnosis of LS. Indeed, if the diagnosis of LS is made in childhood, does it change management in the long-term? Pathological analysis of the excised foreskin is routinely done if there is suspicion of LS. Our aim is to assess the concordance between the clinical and pathological diagnosis of suspected LS and to assess the need for sending the foreskin for pathological examination. METHODS: We conducted a retrospective chart review of 64 of 420 boys who underwent circumcision in a tertiary children's hospital from June 2005 to June 2014, and who had their foreskin sent for pathology due to the clinical suspicion of LS. Demographics, presenting symptoms, presumed clinical diagnosis, pathological findings, and followup data were collected and analyzed. RESULTS: Over the review period, 64 patients underwent circumcision for presumed LS. The mean age of the children was 9.7 years (range 3-16.5). All the children who had circumcision for presumed LS diagnosis were symptomatic. LS was confirmed in 47 of 64 foreskins (73.5%). Balanitis xerotica obliterans (BXO) was clinically suspected in 40 (85%) of the 47 patients. The mean followup was 10 months (range 1-15), with seven recurrences (15%) during that period. The recurrences required revision surgery in two patients and five were managed with steroids only. CONCLUSIONS: In our series, the clinical diagnosis correlated with the pathological diagnosis in most cases. A clinical suspicion of LS without routine foreskin pathological assessment will reduces the overall cost to the healthcare system. Appropriate counselling of the patient/parents and their primary caregiver is imperative, as recurrence is common.

Side-to-Side Refluxing Nondismembered Ureterocystotomy: A Novel Strategy to Address Obstructed Megaureters in Children.

PURPOSE: A nonrefluxing megaureter is a relatively common cause of antenatal hydronephrosis. Although nonoperative management is favored, surgical intervention is sometimes warranted. However, there is controversy regarding the best approach, particularly in young children. We describe our experience with nondismembered side-to-side refluxing ureterocystotomy as a simple option to address obstruction. MATERIALS AND METHODS: Between January 2012 and January 2017, 32 patients underwent ureterocystotomy at 4 referral centers in North America. Demographics, surgical indications, complications, need for further interventions and change in hydronephrosis were captured. Patients were monitored clinically and with serial ultrasounds. RESULTS: Mean age at surgery was 3.7 months (range 0 to 33) and 25 (78%) patients were male. Unilateral procedures were performed in 29 patients. All patients were initially identified based on the presence of antenatal hydronephrosis and symptoms developed in 10. The procedure was conducted for primary nonrefluxing megaureter in 27 patients and to address secondary obstruction in the remainder. Mean followup was 34.3 months (range 6 to 58). At the most recent evaluation most children demonstrated significant improvement in dilation (86%). To date, 6 patients have undergone further procedures, including a circumcision and 2 ureteral reimplantations for recurrent infections. CONCLUSIONS: Our results suggest that side-to-side refluxing ureterocystotomy is a straightforward, minimally invasive alternative for the surgical management of nonrefluxing megaureter. Despite the trade-off of relieving obstruction and creating reflux, it can be considered a potentially definitive procedure in patients who remain infection-free, particularly circumcised boys. Extended followup with close monitoring is critical to document long-term results with this intervention.

Outcomes of seromuscular bladder augmentation versus standard ileocystoplasty: A single institution experience over 14 years.

INTRODUCTION: Ileocystoplasty is the standard technique used for bladder augmentation, and has been used widely for decades. However, it is known to be associated with complications such as stone formation, mucus production, metabolic acidosis, urinary tract infections, intestinal obstruction, and a long-term risk of bladder cancer. Seromuscular bladder augmentation (SMBA) is an alternative to the standard ileocystoplasty, and has been associated with a lower incidence of bladder stones. Few reports have been published on intermediate outcomes of SMBA. Herein, we report long-term outcomes of SMBA from a single institution compared with standard ileocystoplasty. METHODS: After Institutional Review Board approval, a retrospective chart review of all patients who underwent bladder augmentation at our institution over a 14-year period was performed. The status of patients after SMBA (10 patients) was compared according to age, sex, and diagnosis with patients who underwent traditional ileocystoplasty (30 patients). Parameters such as demographic information, pre- and postoperative bladder capacity as assessed by urodynamic studies, urinary tract infections (UTIs), bladder calculi, incontinence, need for secondary surgical procedures, and spontaneous bladder perforation were compared in the two groups. All the patients were on a clean intermittent catheterization (CIC) regimen. RESULTS: Over the study period, 10 patients underwent SMBA and 30 patients (according to age, sex, and diagnosis) underwent standard ileocystoplasty; the average age at surgery was 10.3 and 10 years respectively, with a mean follow up of 6.7 years in the SMBA group and 6 years in the ileocystoplasty group. There were no statistically significant differences in the rate of UTIs, urinary incontinence, subsequent surgery, or spontaneous bladder perforation. The mean bladder capacity increased significantly for both groups as assessed by pre- and postoperative urodynamic studies, although the difference in the rate of bladder calculi between the two groups (0 [0%] vs. 8 [27%], p = 0.06) did not reach statistical significance (Table). CONCLUSIONS: SMBA is safe and efficacious and may result in a lower rate of stone formation than standard ileocystoscopy. SMBA should be considered as a viable alternative to standard ileocystoplasty.

Laparoscopic partial nephrectomy for >4 cm renal masses.

INTRODUCTION: Laparoscopic partial nephrectomy (LPN) is frequently used to manage cT1a renal masses. While data on safety and long-term oncological outcomes of LPN for T1a tumours are widely available, it is limited for >T1a lesions. We report our experience with LPN for >4 cm renal masses from a Canadian tertiary centre. METHODS: Between January 2003 and July 2011, 52 consecutive LPN for >4 cm renal masses were performed. Demographic, pathological and clinical data were obtained from a prospectively maintained database. RESULTS: The mean patient age was 60 years (62% male). Median tumour size was 4.8 (range: 4.2-11) cm. The median surgical time was 145 minutes, and the median estimated blood loss was 100 mL. The median warm ischemia time was 24 minutes. Four (7.7%) cases required conversion to open surgery. One case was converted to total nephrectomy for clinical and pathological evidence of T3 disease. The surgical margin was positive in 1 case (1.9%). Four (7.7%) patients developed a urine leak postoperatively; 3 of them managed with a ureteric stent. Four (7.7%) patients developed postoperative bleeding requiring selective angioembolization. The median hospital stay was 4 days. There was no statistically significant difference between preoperative and postoperative estimated glomerular filtration rate and mean arterial blood pressure (p = 0.5, p = 0.1, respectively). CONCLUSION: This series demonstrates that LPN although technically challenging has acceptable short-term surgical outcomes. Long-term assessment of oncological outcomes is required. Laparoscopic partial nephrectomy >4 cm renal tumours should not be considered a standard of care, but excellent results can be achieved in well-selected patients and in experienced hands with no impact in renal function or blood pressure.

Impact of body mass index on clinical outcomes associated with percutaneous nephrolithotomy.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for patients with large renal calculi or stones that have not responded to extracorporeal shock wave lithotripsy (ESWL). The objective of this study was to compare outcomes and complications of PCNL in patients of various body mass indices (BMI) to determine the safety of this procedure in patients with elevated BMI. METHODS: A retrospective chart review of 114 patients who underwent PCNL between 2006 and 2009 was performed. Patients were separated into 4 groups with respect to their BMI: (1) ideal body weight (BMI <25 kg/m(2)), (2) overweight (BMW 25-29 kg/m(2)), (3) obese (BMI 30-39 kg/m(2)) and (4) morbidly obese (BMI ≥40 kg/m(2)). One-way ANOVA and univariate logistic regression analysis were used to assess the association between BMI (classified into 4 levels) and variables including age, sex, stone size, length of stay, incidence of complications and stone-free rates. RESULTS: The distribution of the 114 patients in each BMI category was: ideal body weight 39 (34%), overweight 24 (21%), obese 41 (36%), morbidly obese 10 (9%). There was no difference in the composition of groups with respect to age, sex, pharmacologically treated comorbidities or stone size. Mean length of stay in days, intra- and postoperative complication rates were not statistically different. Stone-free rates showed no significant difference between groups: 90% ideal body weight; 87% overweight; 90% obese; 80% morbidly obese (p = 0.83). INTERPRETATION: Outcomes of PCNL were statistically independent of BMI. PCNL is a safe and efficacious treatment of stone disease in patients of all sizes.

Effect of drinking parsley leaf tea on urinary composition and urinary stones' risk factors.

To investigate the effect of parsley leaf tea on urine composition and the inhibitors of urinary tract stones formation, we studied 20 healthy volunteers who were divided into two groups: the first group of 10 subjects drank daily 1,200 mL of parsley leaf tea for 2 weeks, while the second group drank at least 1,200 mL daily of bottled water for the same period. This was followed by a 2-week "washout" period before the two groups were crossed over for another 2 weeks. During the experimental phase, 24-h urine samples were collected at baseline, on day 14, and at the end of the 6-week period and different urinary parameters were measured and analyzed statistically. We found no significant difference in the urine volume, pH, sodium, potassium, chloride, urea, creatinine, phosphorus, magnesium, uric acid, cystine, or citric acid. Further research is needed to evaluate the effects of parsley leaf tea on urinary parameters in healthy and stone-forming patients.

Robotic-assisted transperitoneal radical prostatectomy in a patient with pelvic kidney.

Robots are increasingly utilized in urology, due to their favorable performance characteristics especially in prostatectomy and pyeloplasty. However, preoperative diagnosis of urogenital congenital anomalies and preoperative planning are important aspects to be considered. The presence of ectopic pelvic kidney is a challenge for the surgeon to perform robotic-assisted radical prostatectomy RARP without injury to the pelvic kidney PK or its blood supply. We report our experience of performing RARP in a patient with a PK.