The efficacy and safety of retrograde ureteral stenting in the management of complicated cases of ureteral obstruction caused by urolithiasis.

PURPOSE: To investigate the efficacy and safety of retrograde double J stent (RDJS) placement in the management of complicated obstructive uropathy caused by urolithiasis. PATIENTS AND METHODS: An observational study done at a tertiary center was implemented in which a total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent RDJS or percutaneous nephrostomy (PCN) between 2017 and 2021 due to complicated obstruction caused by urolithiasis were included. RESULTS: A total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent kidney decompression between 2017 and 2021 due to complicated unilateral or bilateral kidney obstruction caused by ureteral stones were included. Twenty-two patients (81.48%) underwent successful RDJS placement, two patients had RDJS placement then PCN was also placed, and two patients underwent PCN placement. Three patients needed an intensive care unit "ICU" after intervention, two of them were in the ICU before intervention. All septic parameters were normalized within a short period postoperatively. Two patients with failed previous ureteroscopy had a successful RDJS placement. CONCLUSION: Retrograde DJS placement is a feasible option in the management of complicated cases of obstructive uropathy caused by urolithiasis. Short hospitalization period, low rate of complications and better quality of life are the most prominent advantages of RDJS placement. In the hands of experienced surgeons, RDJS should be offered as the first choice of decompression for obstructive uropathy caused by urolithiasis.

Intrarenal neurofibroma: unveiling a diagnostic challenge-a case report and literature review.

A 53-year-old male patient presented with an incidental finding of a left kidney mass after being evaluated for elevated serum creatinine without having any symptoms. The left kidney mass was confirmed by ultrasound, computed tomography 'CT' scan and magnetic resonance imaging 'MRI'. A left radical nephrectomy was done, and histopathology confirmed the presence of intrarenal neurofibroma with no evidence of malignancy.

Testis sparing surgery for Leydig cell tumor, surgical approach, and clinical outcome: A case report and review of literature.

Testicular Leydig cell tumors are rare neoplasms of the testes. These tumors are generally benign but malignancy and metastatic potential have been described. Here, we present a case of Leydig cell tumor in a 49-year-old male, incidentally discovered as a testicular mass. The patient had no significant previous medical history. Ultrasonography revealed a hypoechoic, well-defined, vascularized lesion measuring 7 × 7 × 4 mm adjacent to the tunica albuginea. The patient underwent testis sparing surgery, employing a modified approach including intraoperative ultrasound-guided localization, en-bloc wedge resection of the lesion with surrounding tunica albuginea and seminiferous tubules, and gubernaculum sparing surgery. Postoperatively, the patient had an uneventful recovery and was discharged on the same day. Histopathological examination confirmed the diagnosis of Leydig cell tumor, with no high-risk pathological features observed. Regular follow-up intervals were scheduled to monitor for potential recurrence, emphasizing the importance of vigilant postoperative surveillance in cases of testis-sparing surgery for Leydig cell tumors.

The correlation between academic stress, overactive bladder syndrome (OAB) and quality of life among healthy university students: A cross-sectional study.

INTRODUCTION: This study aims to assess the presence of overactive bladder syndrome (OAB), academic stress, and their impact on quality of life (QoL) of healthy university students. METHODS: A cross-sectional study recruited university students from different academic streams, between January 2021 to December 2021. Demographics, overactive bladder-validated 8 questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB) questionnaire, and Perception of Academic Stress (PAS) scale were collected. The correlation between the variables was assessed using the Social Sciences Statistical Package (SPSS) version 21. RESULTS: Three hundred and 89 people met the inclusion criteria. There were 241 (62%) females, and 248 (63.8%) of the students were under the age of 22. Four academic streams were included: Engineering 96 (24.7%), Humanities 121 (31.1%), Medicine 85 (21.8%) and Nursing 87 (22.4%). OAB was found among 103 (26%) students. The mean OAB-V8 score was 5.8 ± 6.6. The mean PAS scale was 53.9 ± 9.4. The mean ICIQ-OAB score was 1.5 (0-9). Male gender 62 (60%), smoking 42 (40.8%), academic stream (Humanity 40 (38.8%)) and year (third and fourth-year students 34 (33%) and 33 (32%), respectively) have a statistically significant positive correlation with OAB (p < 0.001). Humanity stream (mean rank 169.2) and junior students (first and second years with mean rank of 174 and 177), respectively, had high level of academic stress and low PAS scale. There is a weak but statistically significant inverse correlation between OAB and the PAS scale (r = -0.211) (p < 0.001). CONCLUSION: OAB is prevalent among healthy university students and is directly related to academic stress. Both OAB and academic stress have impact on quality of life. We hope this study will help to raise awareness of OAB among university students to early identify and treat such a condition, avoiding unnecessary bother among healthy university students.

Acontractile detrusor as an initial presentation of sacral spinal cord lesion: Case series.

OBJECTIVES: This study aims to investigate cases of acontractile bladder as the initial presentation of benign and malignant spinal conditions. The focus is on the challenges in making a diagnosis and the importance of a thorough neurological evaluation. METHODS: We conducted a retrospective case series involving three patients who exhibited symptoms of acontractile bladder. Detailed clinical histories, urodynamic studies, and imaging techniques such as lumbosacral magnetic resonance imaging (MRI) were analyzed. Histopathological findings from relevant biopsies were also taken into account. RESULTS: Case 1: A 14-year-old female presented with urinary retention, back pain, and an acontractile bladder on urodynamic study. Further examination, including lumbosacral MRI and histopathology, confirmed a diagnosis of metastatic Ewing's Sarcoma. Case 2: A 39-year-old female with urinary incontinence and elevated post-void residual exhibited delayed bladder sensation. Lumbar spine MRI revealed a grade I Schwannoma after surgical resection. Case 3: A 15-year-old male with lower urinary tract symptoms and an acontractile detrusor on urodynamic study was found to have a Tarlov cyst on lumbosacral MRI. CONCLUSION: Atonic or Underactive bladder syndrome may be the initial presentation of a serious spinal condition. Complete neurological evaluation is mandatory if no obvious clinical cause.

Primary intravesical insertion of intrauterine device for 10 years: Clinical presentation and outcome.

Intrauterine device (IUD) is considered the second most widely used method of contraception. Migration of the IUD into the urinary system has been reported. Nevertheless, a missed IUD which is mistakenly inserted into the bladder has rarely been reported. We report a female patient experienced recurrent urinary tract infection (UTI) for 10 years without appropriate evaluation. The underlying problem was an IUD that inserted into the bladder led to the formation of bladder stone. The clinical course and the endoscopic management of the stone and the IUD is reviewed in this case report.

Spontaneous ureteric perforation: A rare complication of tuberculosis.

Genitourinary tuberculosis (GU TB) is a rare condition that has historically been described as a great imitator, owing to its variable and deceptive clinical presentation and course. GU TB may affect any part of the urological system and lead to serious complications such as kidney and ureteric damage. The diagnosis of GU TB requires high index of suspicion especially if complications occur. We describe the first case of spontaneous ureteric perforation secondary to GU TB as spontaneous bladder perforation was previously described.

Dismembered pyeloplasty for post-traumatic ureteropelvic junction avulsion in a child.

Non - iatrogenic ureteral injury is rare because of the well-protected retroperitoneal location of the ureter with an incidence of less than 1%. Furthermore, isolated ureteropelvic junction (UPJ) avulsion as a result of acceleration/deceleration injury is extremely uncommon and may lead to significant morbidity if the diagnosis has not been made early using CT scan with delayed execratory phase. Endourological management of partial ureteric injuries is feasible, however, uretero-ureterostomy is the standard of care for complete upper ureteric injuries. We present a fourteen years old boy presented with UPJ avulsion secondary to blunt trauma treated with dismembered pyeloplasty approach.

Laparoscopic heminephrectomy in a horseshoe kidney affected by xanthogranulomatous pyelonephritis: A modified approach.

Horseshoe kidney (HSK) is a common congenital kidney anomaly that is encountered frequently by urologists. It is rare for HSK to be affected by xanthogranulomatous pyelonephritis (XGP), a potentially life-threatening condition. The standard of care for XGP is open nephrectomy, but recently a few case reports have been published showing the feasibility of minimally invasive surgery to deal with XGP. We present a case of HSK affected by XGP treated successfully with modified laparoscopic transperitoneal heminephrectomy. The rarity of such a combination, the modified approach, and the successful outcome encouraged us to report it.

Lower Urinary Tract Symptoms Among Females with Rheumatoid Arthritis: A Prospective Cross-Sectional Study.

PURPOSE: To assess the presence of lower urinary tract symptoms (LUTS) in rheumatoid arthritis (RA) female patients with assessment of LUTS and its impact on quality of life (QoL). PATIENTS AND METHODS: A prospective, cross-sectional study of female patients with RA was conducted. Demographics and clinical data, Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS), and the RA Disease Activity Score 28 (DAS28) were all collected. A correlation has been made between all variables to assess the factors that induce LUTS in RA and the impact on QoL. RESULTS: Eighty-nine patients were enrolled. About 94.4% of RA patients had at least one symptom of LUTS. Concerning DAS28, 55.1% had moderate disease activity and 16.9% had high disease activity, which was not significantly associated with BFLUTS or QoL. The prevalence of overactive bladder syndrome symptoms (OAB: frequency, urgency, nocturia, and urgency incontinence) were found to be 65.2%, 59.6%, 56.2%, and 30.3%, respectively. Stress incontinence was prevalent in 40.4% of patients. The overall interference with life was evident in 27 (30.3%) patients secondary to LUTS. Body mass index (BMI) was positively and significantly correlated with the presence of storage symptoms (r = 0.306, p = 0.004) and with the total BFLUTS (r = 0.251, p = 0.018). BFLUTS subdomains and total scores were significantly correlated to poor QoL. The correlation of the BFLUTS QoL was found to be r = 0.584, p < 0.001 with storage symptoms, r = 0.399, p < 0.001 with voiding symptoms, and r = 0.757, p < 0.001 with incontinence. CONCLUSION: LUTS is a prominent and significant disability that directly affects QoL in RA. BMI is an independent factor that is linked to LUTS in RA patients.

Clinical and Radiological Predictors of Early Intervention in Acute Ureteral Colic.

PURPOSE: Acute ureteric colic (AUC) is generally one of the most common reasons for emergency department attendance. Expectant management is recommended in non-complicated ureteral calculi. However, data regarding the optimal duration of observation or indications of early intervention (EI) are not well understood. This article describes the clinical and radiological factors that promote EI in AUC. PATIENTS AND METHODS: This was an observational and retrospective cohort study. Patients with AUC diagnosed based on non-contrast computerized tomography (NCCT) between 2019 and 2020 were enrolled in the study. These patients were classified into two main categories: spontaneous passage of stone (SSP) and EI. In addition, a comparative analysis was performed to identify clinical and radiological variables that promote EI. RESULTS: One-hundred and sixty-one patients were included. High WBCs are associated with a significant increase in EI. Forty-three percent (n=37) of patients with serum WBCs higher than 10 had an EI, while 23% had SSP (n=17;p<0.001). High CRP level is also significantly associated with EI (n=36; 86%; p<0.001). Upper and middle ureteral calculi are statistically associated with EI (n=54; 62%) in comparison to the SSP cohort (n=22; 30%;p<0.001). EI is also linked to the maximal length of ureteric calculi (MCL) of 9 mm (6-13mm), and HU density of stone of 700 (430-990) H.U (p<0.001). Ureteric stone volume of 0.2 (0.06-0.3) cm3 is significantly associated with EI (p<0.001). Ureteral wall thickness of 3 (2-3 mm), the presence of extrarenal pelvis (n=20; 23%), and AP diameter of renal pelvis 18 (13-28 mm) are all significantly associated with a higher rate of EI (p<0.001). Multiple binary logistic regression analysis showed that MCL is the strongest predictor of EI. CONCLUSION: MCL is an independent and robust predictor of EI in AUC. Biochemical variables and radiological characteristics can also act as an adjunct to promote EI.

Characterization and prevalence of metabolic syndrome among overweight and obese young Palestinian students at An-Najah National University.

OBJECTIVES: Metabolic Syndrome "MetS" is characterized by the presence of several factors that play a major role in the development of cardiovascular diseases and diabetes mellitus. This study was conducted to establish the prevalence of MetS and its individual components among the overweight and obese students at An-Najah National University (ANU) using IDF and modified NCEP ATP III definition and to identify conditions associated with it. MATERIALS AND METHODS: A cross-sectional study was conducted in 2016. Data were collected in two stages: first stage included anthropometric and blood pressure measurements for 850 participants. Second stage included a self-administered questionnaire and biochemical analysis for only overweight or obese (154) participants. RESULTS: The prevalence of overweight and obesity was 26.2%, with significant increase among males (36.4%) compared with females (19.1%). The prevalence of MetS among obese and overweight was (28.6%) according to IDF with no significant increase compared to NCEP ATP criteria (24%). Reduced HDL- cholesterol was the most prevalent component (74.7%) in obese and overweight participants followed by central obesity (72.1%), raised blood pressure (29.9%), elevated fasting blood sugar (24%), and lastly increased triglycerides (18.2%). No significant differences were found between males and females according to both criteria. Moreover, no significant associations with geographic locality, house-hold income, smoking, physical activity, or family history were determined. CONCLUSIONS: The prevalence of MetS among overweight and obese young adult Palestinians was high and demands immediate intervention, given the potential for these adults to develop chronic diseases.