Ureteral wall thickness as a predictor for non-invasive treatment success for steinstrasse. Can we save time?

PURPOSE: We aimed to define factors affecting the non-invasive overall treatment success (medical expulsive therapy (MET) ± shock wave lithotripsy (SWL)) for uncomplicated ureteral steinstrasse (SS) clearance. METHODS: We retrospectively evaluated consecutive patients who underwent SWL for renal stones between 2017 and 2021. Patients with uncomplicated SS were included. All patient's demographic and radiological data, e.g., age, gender, pre-SWL stenting, SS site, type, leading stone size in widest diameter (< 10 mm and ≥ 10 mm), ureteral wall thickness (UWT) in mm against the leading stone were collected. If SS was diagnosed, medical treatment was given for 4 weeks. In case of MET failure, either SWL for the leading stones + MET or direct URS was done. Non-invasive treatment success (SFR) was considered if complete clearance of SS occurred with no complications or the need for invasive intervention. RESULTS: A total of 145 patients were included with mean age of 45.9 ± 12.4 years. SFR in case of MET only occurred in 27.9%. Complications happened in 26 patients (17.9%). Non-invasive treatment SFR was achieved in 78 patients (53.8%) totally where SS type I, leading stone size ≤ 10 mm type and decreased UWT around the leading stone increased treatment success. CONCLUSION: Ureteral wall thickness is an important factor predicting SS management success. Besides the decreased UWT, non-invasive management should be offered for type I SS with leading stone ≤ 10 mm.

The Change of Erectile Function Post Recovery from COVID-19 Infection.

INTRODUCTION: We assess the correlation between COVID-19 infection and erection and evaluate the effect of aging and comorbidities on the male sexuality of patients with COVID-19 infection. METHODS: 100 patients were enrolled and diagnosed with COVID-19 based on reverse transcription-polymerase chain reaction tests of oropharyngeal and nasopharyngeal swabs according to the WHO guidelines. The International Index of Erectile Function (IIEF-5) questionnaire was used to evaluate sexual function. RESULTS: Patients were divided into two groups: the first group of 42 patients <50 years of age with a mean age (±SD) of 35.83 ± 7.8 and the second group of 58 patients ≥50 years of age with a mean age of 58.64 ± 7.7. The mean (±SD) IIEF in the first group pre-COVID-19 infection was 14.2 ± 2.37 while post-COVID-19 was 8.7 ± 2.77, 11.3 ± 2.9, 12.1 ± 3.02 at 1, 3, 6 months, respectively (p < 0.001), while in the second group, the mean (±SD) IIEF pre-COVID-19 infection was 10.04 ± 4.62 while post-COVID was 5.0 ± 2.1, 6.56 ± 2.6, 8.18 ± 2.04 at 1, 3, 6 months, respectively (p < 0.001). On multivariate analysis, old patients infected with COVID-19 and associated with comorbidities such as diabetes mellitus (OR = 8.53, CI = 0.00-2.01), hypertension (OR = 3.908, CI = 0.000-3.07), ischemic heart disease (OR = 2.863, CI = 0.000-2.68), and liver disease (OR = 0.670, CI = 0.000-1.670) were significantly correlated to erectile dysfunction (p < 0.001). CONCLUSION: COVID-19 significantly affects erection mostly in older patients with comorbidities, leading to subsequent use of oral and intracavernosal injection therapy for erectile dysfunction.

Comparison of holmium laser, bipolar and conventional monopolar transurethral resection of bladder tumour in primary non-muscle invasive bladder cancer.

Objectives: To compare the efficiency and safety profile of conventional monopolar, bipolar plasmakinetic and holmium laser techniques for transurethral resection of bladder tumour. Method: The prospective comparative study was conducted from July 2019 to May 2021 after approval from the ethicsreview committee of Kafrelsheikh University, Egypt, and comprised patients of either gender with primary non muscle invasive bladder cancer who qualified for transurethral resection of bladder tumour. The patients were stratified into low-risk group A, intermediate risk group B and high-risk group C in accordance with the guidelines of the European Association of Urology. Comprehensive cystoscopy and panendoscopy were done in all cases. Once panendoscopy was done, tumour resection was performed with monopolar resectoscope in group A, plasmakinetic resectoscope in group B and holmium laser in group C). Data was collected at preoperative, peroperative, postoperative and follow-up stages. Data was analysed using SPSS 21. RESULTS: Of the 84 patients, 67(79.76%) were males and 17(20.23%) were females. There were 27(32.14%) patients in group A; 21(77.8%) males and 6(22.2%) females withy mean age 60.63±11.76 years. Group B had 32(38%) patients; 26(81.2%) males and 6(18.8%) females with mean age 65.34±7.55 years. Group C had 25(29.76%) patients; 20(80%) males and 5(20%) females with mean age 59.48±12.6 years. The mean follow-up period was 12.97±2.70 months in group A, 12.81±2.75 monthsin group B and 13.48±3.3 monthsin group C. Visualised complete resection was done in 23(85.8%) group A patients, 29(90.6%) group B patients and 24(96%) group C patients(p=0.018). Visualised complete resection, tumour multiplicity, tumour size, catheter duration, and hospital stay were significant predictors (p<0.05). Survival analysis showed 26(96.3%), 30(93.75%) and 25(100%) cases in groups A, B and C, respectively. CONCLUSIONS: Bipolar plasmakinetic and holmium laser techniques were found to be more effective and safer than the conventional monopolar technique for transurethral resection of bladder tumour in patients with primary non-muscle invasive bladder cancer.

Optimization of shockwave lithotripsy use for single medium sized hard renal stone with stone density ≥ 1000 HU. A prospective study.

PURPOSE: To identify shock wave lithotripsy (SWL) success predictors in hard renal stones (average stone density ≥ 1000 HU). MATERIALS: We prospectively evaluated patients who underwent SWL for hard renal stones between April 2018 and December 2020. Radiological parameters were identified, e.g., stone site, size, the average density in addition to stone core and shell mean density, and renal cortical thickness (RKT). SWL sessions were performed using Doli-S lithotripter till a maximum of 3-4 sessions with 2-4 weeks interval. Initial response to SWL included stone fragmentation and decreased stone size after the first SWL. Treatment success was considered if complete clearance of renal stones occurred or in case of clinically insignificant residual fragments ≤ 4 mm after 12 weeks follow up by NCCT. RESULTS: Out of 1878 patients who underwent SWL, the study included 157 patients with hard renal stones. Treatment overall success was found in 92 patients (58.6%) where 69 patients (43.9%) had complete stone clearance. On multivariate analysis, stone shell density < 901 HU, maximum stone size < 1 cm, RKT > 1.95 cm and initial treatment response were associated with increased the success rate after SWL for hard renal stones (P = 0.0001, 0.009, < 0.0001 and < 0.0001, respectively). CONCLUSION: In hard renal stones, treatment overall success was found in 58.6% where complete stone clearance was found in 43.9%. Stone outer shell fragility, lower stone size, increased RKT and initial response to SWL were associated with a higher success rate at 12-week follow-up.

Duration of Medical Treatment of Benign Prostatic Hyperplasia: Impact on Urodynamics and Post-Prostatectomy Outcome.

OBJECTIVES: The aim of this study was to assess whether the duration of preoperative benign prostatic hyperplasia (BPH) medication would affect the pressure flow study (PFS) parameters and the outcome of prostate surgery or not. MATERIAL AND METHODS: A retrospective study involving patients with LUTS/BPH aged 50 years or older who were compliant with BPH medications. PFS was performed prior to prostate surgery to determine BOO degree and detrusor overactivity. The efficacy of prostate surgery was determined at 3 and 6 months after surgery using the I-PSS, QOL index, Q-max, and PVR. Patients were categorized into group A, who received treatment for 12 months or less, and group B, who received the treatment for 12 months or more. The categorization starts once the patient prefers surgical intervention. RESULTS: A total of 114 patients were enrolled, 50 in group A and 64 patients in group B. The mean duration, in months, of medical treatment was 9.52 ± 2.24 and 22.50 ± 4.35 in group A and group B, respectively. Pdet@Qmax is significantly (p = 0.02) higher in patients of group B (63.85 ± 11.34 vs. 94.75 ± 19.53). The detrusor overactivity amplitude is slightly higher in group A (36.42 ± 37.27 vs. 16.42 ± 28.38) (p = 0.3). The mean I-PSS, Q-max, and PVR at 1, 3, and 6 months were comparable between the groups. CONCLUSION: After 24 months of BPH medical treatment, no profound PFS changes that may affect the decision of prostate surgery were observed. Patients who completed 24 months of medical treatment were safe as regards to detrusor muscle contractility with no urge to undergo prostate surgery earlier.

The short-term effects of tolterodine on nocturnal incontinence after ileal orthotopic neobladder: a randomised crossover placebo-controlled study.

OBJECTIVES: To assess the effect of tolterodine in the treatment of nocturnal urinary incontinence (NUI) after ileal orthotopic neobladder (ONB). PATIENTS AND METHODS: This is a prospective randomised placebo-controlled crossover study (clinicaltrials.gov: NCT02877901). Patients with NUI after ONB were randomly allocated into two equal groups. Group T received 4 mg extended-release tolterodine at bed-time and Group P received placebo for 4 weeks followed by 2 weeks of washout, then crossed over to the alternate therapy for 4 weeks. Patients were assessed by the number of pads used per night (PPN) and with the Arabic version of the International Consultation on Incontinence Modular Questionnaire-Short Form (ICIQ-SF) at both phases of the study. The outcomes were the rate of NUI improvement and medication adverse events. RESULTS: Out of 172 patients, 150 and 122 patients were evaluated at both phases of the study. The mean ICIQ-SF scores and PPN were significantly decreased in Group T compared to Group P in both study phases (P < 0.001). In Group T, 15 (10%) and 11 (9%) patients became dry after the first allocation and crossover, respectively. In Group T, 60 (77.9%) patients reported improvement vs four (5.5%) in Group P (P < 0.001) after the first allocation. Similarly, 46 (73%) and seven (11.9%) patients showed improvement in groups T and P after the crossover, respectively (P < 0.001). Dry mouth occurred in 31 (20.8%) patients. CONCLUSIONS: Tolterodine seems to be a good choice for treatment of NUI after radical cystectomy and ONB. However, further studies are needed to delineate the long-term effects and the associated urodynamic characteristics.

A randomised controlled trial evaluating renal protective effects of selenium with vitamins A, C, E, verapamil, and losartan against extracorporeal shockwave lithotripsy-induced renal injury.

OBJECTIVE: To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)-induced renal injury. PATIENTS AND METHODS: A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL. Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (>300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 h and 1 week after ESWL. The primary outcome was differences between albuminuria and uNGAL. Dynamic contrast-enhanced magnetic resonance imaging was performed before ESWL, and at 2-4 h and 1 week after ESWL to compare changes in renal perfusion. RESULTS: Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week (P < 0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL (P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased. CONCLUSIONS: Losartan was found to protect the kidney against ESWL-induced renal injury by significantly decreasing post-ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post-ESWL renal obstruction.

Evaluation of acute post-shock wave lithotripsy renal changes by dynamic magnetic resonance imaging: a prospective clinical study.

PURPOSE: We studied acute renal morphological and hemodynamic changes after shock wave lithotripsy of renal stones. MATERIALS AND METHODS: A total of 60 adult patients with a single renal stone 25 mm or less in a radiologically normal urinary tract were eligible for shock wave lithotripsy and included in analysis. Study exclusion criteria were hypertension, diabetes mellitus, previous recent stone management and other contraindications to shock wave lithotripsy. Renal perfusion and morphological changes were evaluated by dynamic magnetic resonance imaging before, and 2 to 4 hours and 1 week after lithotripsy. RESULTS: In all cases there was a statistically significant decrease in renal perfusion 1 week after shock wave lithotripsy compared to before and 2 to 4 hours after lithotripsy (66% vs 71% and 72% of the aortic blood flow, respectively, p <0.05). At 1-week followup 39 unobstructed renal units (65%) showed no significant difference in renal perfusion at any time while 21 (35%) obstructed renal units showed a significant decrease in renal perfusion compared to before and 2 to 4 hours after lithotripsy (63% vs 76% and 75%, p = 0.003 and 0.005, respectively). Hematomas were observed in 7 cases (12%) 2 to 4 hours after lithotripsy, of which 5 were subcapsular and 2 were intrarenal. Three subcapsular hematomas resolved after 1 week. Localized loss of corticomedullary differentiation was observed in 2 patients (3.3%) with intrarenal hematoma 2 to 4 hours after treatment. Generalized loss of corticomedullary differentiation was observed 1 week after lithotripsy in 5 cases (8.3%). CONCLUSIONS: Shock wave lithotripsy alone induces minimal, reversible acute renal morphological changes and does not induce significant changes in renal perfusion. Posttreatment obstruction has a major effect on renal perfusion on the treated side and must be managed urgently.

Evaluation of factors predicting recoverability of renal function after pyeloplasty in adults.

AIM: To analyze the status of renal function after pyeloplasty in a large contemporary adult series and to detect which variables predict improvement of renal function. MATERIALS AND METHODS: 85 adult patients were retrospectively identified who had undergone pyeloplasty between January 2002 and May 2011 with available pre- and postoperative diuretic scintigraphy. Preoperative differential renal function (DRF) and single-kidney GFR (SKGFR) were obtained by (99m)Tc-MAG-3 diuretic scintigraphy. Baseline-weighted (bw-) DRF and SKGFR were calculated between baseline conditions and time of last follow-up. Factors that explain the variance of bw-DRF and bw-SKGFR were determined. RESULTS: The mean (SD) preoperative DRF significantly increased from 34% (11.6) to 37.2% (11.8) after pyeloplasty (p < 0.001). Similarly, mean (SD) SKGFR showed a significant improvement from 31.2 (12.9) to 35.9 (15) ml/min (p < 0.001). Patients with a lower baseline DRF (≤40%) showed a significant improvement as opposed to those with a higher baseline DRF (>40%) (p < 0.001 and 0.3, respectively). Baseline DRF and cortical thickness explained the variance in bw-DRF and bw-SKGFR with more contribution of baseline DRF. CONCLUSIONS: Renal function showed improvement after pyeloplasty in adults and preoperative DRF and cortical thickness were the predicting variables.

Health-related quality of life after radical cystectomy and neobladder reconstruction in women: impact of voiding and continence status.

OBJECTIVES: To assess health-related quality of life, and the impact of night-time incontinence and chronic urinary retention on health-related quality of life in women with bladder cancer after radical cystectomy and orthotopic neobladder. METHODS: The study included 74 women who underwent radical cystectomy and orthotopic neobladder, and completed 1 year of follow up. Health-related quality of life was evaluated using the questionnaires of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and the Functional Assessment of Cancer Therapy bladder cancer-specific form. Health-related quality of life was compared with an age-matched control group. The impact of night-time incontinence and chronic urinary retention on health-related quality of life was assessed. RESULTS: The study group included 18 completely continent patients with spontaneous voiding, 29 with night-time incontinence and 27 with chronic urinary retention. The study group was statistically significantly lower in all domains of health-related quality of life than the control group. In all domains of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and Functional Assessment of Cancer Therapy bladder cancer-specific form, completely continent women were comparable with those with chronic urinary retention. Women with night-time incontinence had a significantly worse health-related quality of life than completely continent women, shown by the mean global health score (P = 0.038), social functioning score (P = 0.012), pain European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire score (P = 0.04), and functional well-being Functional Assessment of Cancer Therapy bladder cancer-specific form (P = 0.049) score. CONCLUSIONS: After radical cystectomy and orthotopic neobladder in women, health-related quality of life is lower than that of the normal population. Night-time incontinence has a negative impact on social life and most domains of health-related quality of life. Thus, night-time incontinence has a higher social impact than chronic urinary retention.

Changes in differential renal function after pyeloplasty in children.

PURPOSE: Previous series showed controversial differential renal function outcomes after pyeloplasty in children. However, they were limited by study power, methodology and lack of comparable end points. We determined the status of differential renal function after pyeloplasty in children in what is to our knowledge the largest series to date. MATERIALS AND METHODS: After excluding patients with renal anomalies, solitary kidney or bilateral pyeloplasty from analysis, we retrospectively identified 196 younger than 18 years who were treated with pyeloplasty between May 2002 and January 2010 and had preoperative and postoperative renal scintigraphy available. Primary outcome measures were greater than 5% improvement in baseline differential renal function and baseline weighted differential renal function at last followup. Clinical variables predicting outcome measures were determined using univariable and multivariable analyses. RESULTS: During a median followup of 12 months, mean ± SD differential renal function improved from 35.8% ± 10% to 38.7% ± 11% (p <0.001). In the poor and intermediate groups baseline differential renal function improved, while in the good group function was static postoperatively (p <0.001). The linear regression model showed that only baseline differential renal function explained the variance in baseline weighted differential renal function (ß = -0.393, p <0.001). In the Cox proportional hazards model baseline differential renal function (less than 35% HR 3.196, p <0.001 and 35% to 40% HR 2.733, p = 0.002) and cortical thickness (HR 2.114, p = 0.029) were the only predictors of a greater than 5% improvement in postoperative differential renal function. CONCLUSIONS: Renal function improves after pyeloplasty in children. Baseline differential renal function and cortical thickness predict improvement after surgery.

Bladder perforation as a complication of transurethral resection of bladder tumors: the predictors, management, and its impact in a series of 1570 at a tertiary urology institute.

OBJECTIVES: To report the incidence, predictors, the impact of bladder perforation (BP), and our protocol of management in patients who underwent trans-urethral resection of bladder tumor (TURBT). METHODS: This is a retrospective study, between 2006 and 2020, on patients who underwent TURBT for non-muscle-invasive bladder cancer (NMIBC). Bladder perforation was defined as any full thickness resection of the bladder wall. Bladder perforations were managed based on their severity and type. Small BP with no or mild symptoms were managed with prolongation of urethral catheters. Those with significant extraperitoneal extravasations were managed by insertion of a tube drain (TD). Abdominal exploration was done for extensive BP and all intraperitoneal extravasations. RESULTS: Our study included 1,570 patients, the mean age was 58 ± 11 years and 86% were males. Bladder perforation was recorded in 10% (n = 158) of the patients. The perforation was extraperitoneal in 95%, and in 86%, the perforation was associated with no symptoms, mild symptoms, or mild fluid extravasation that required only prolongation of the urethral catheter. On the other hand, active intervention was required for the 21 remaining patients (14%) with TD being the most frequent management. History of previous TURBT (p = 0.001) and obturator jerk (p = 0.0001) were the only predictors for BP. CONCLUSIONS: The overall incidence of bladder perforation is 10%; however, 86% required only prolongation of urethral catheter. Bladder perforation did not affect the probability for tumor recurrence, tumor progression nor radical cystectomy.

Impact of COVID-19 pandemic on lower urinary tract symptoms in patients with benign prostatic hyperplasia and predictors of urine retention in such patients.

OBJECTIVES: We assess the effect of coronavirus disease 2019 (COVID-19) on lower urinary tract symptoms (LUTS) of patients with benign prostatic hyperplasia (BPH). Moreover, we delineate risk factors for urine retention in such patients. METHODS: All COVID-19 infected males were expeditiously evaluated. All enrolled patients were assessed using the International Prostate Symptom Score (IPSS), uroflowmetry, and pelvi-abdominal ultrasonography for prostate volume and postvoiding residual urine (PVR) estimation. RESULTS: Fifty patients, who were diagnosed with BPH, were enrolled. The mean age (±SD) was 62.64 ± 7.69. In the pre- and post-COVID-19 group, the mean (±SD) IPSS was 13.42 ± 4.32 and 26.62 ± 5.77, respectively (P < .001), while PVR was 90.40 ± 32.75 and 185.42 ± 73.42, respectively (P < .001), and maximum flow rate was 14.40 ± 2.75 and 10.74 ± 3.43, respectively (P < .004). After infection with COVID-19, 13 (26%) patients were managed by urethral catheter fixation owing to urine retention. On bivariate analysis, age, diabetes, large prostate on digital rectal examination, alpha-blocker monotherapy, microscopic hematuria, positive urine culture, and pre-COVID-19 IPSS were significantly correlated with urine retention (P < .001, P = .01, P < .001, P = .06, P < .001, P = .04, and P < .001, respectively). On multivariate analysis, age, pre-COVID-19 IPSS, and positive urine culture were the independent predictors of urine retention (P = .05, P < .001, and P = .01, respectively). CONCLUSION: LUTS in BPH patients were significantly affected by COVID-19. COVID-19 increases IPSS leading to a change in the treatment modality of BPH. On multivariate analysis, age, pre-COVID-19 IPSS, and positive urine culture were the independent predictors of urine retention post COVID-19 infection.

Male sexual health predictors during the Covid-19 outbreak: a multicenter study.

Background: Pandemic-induced feelings of fear and worry are all psychological implications of the COVID-19 pandemic. The goal of this study was to see how the COVID-19 pandemic affected male Sexual Health and to look for plausible predictors. Methods: Married males were asked to fill out an Arabic Sexual Health questionnaire. Before and during the lockdown. Additionally, generalized Anxiety Disorder-7 and International Index of Erectile Function-5 questionnaires. Results: A multicenter study. The survey was completed by 281 men in total. Only 130 males (47.3%) were satisfied with their Sexual performance before lockdown, compared to 170 males (56.5%) who were not satisfied (P 0.000). Financial issues (P ≤ 0.000), smoking habit prior to lockdown (P ≤ 0.001), spots practice (P ≤ 0.001), smoking during lockdown (P ≤ 0.001), presence of depressive disorder on the PHQ-9 total score (P ≤ 0.001), diagnosis of anxiety on the GAD-7 score (P ≤ 0.001), and presence of ED on the IIEf-5 questionnaire (P ≤ 0.001) were all found to be significant on univariate analysis. On bivariate analysis, financial issues (odds ratio [OR]: 3.56, P ≤ 0.000), presence of anxiety on GAD-7 (OR: 6.40, P ≤ 0.001), PHQ score (OR: 2.50, P ≤ 0.001), and diagnosis of ED on the IIEF-5 scale (OR: 7.50, P ≤ 0.001) were significantly associated with Sexual relationship stress and Sexual Health. Conclusion: During and after COVID-19 lockdown, the presence of anxiety on the GAD-7 scale, PHQ score, and the diagnosis of ED on the IIEF-5 scale were all independent predictors of Sexual Health.

One-stage versus staged ureteroscopy and percutaneous nephrolithotomy for simultaneous ureteral and renal stones.

Objectives: This study is aimed to investigate the outcome of one-stage ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) for simultaneous ureteral and renal stones over 10years at a tertiary urology institute. Materials and methods: We retrospectively analyzed the data of patients who were operated on for simultaneous ureteral and renal stones from January 2011 to December 2020. Patients were divided into 2 groups: group A, who underwent one-stage URS and prone PCNL, and group B, who underwent staged procedures. The overall success, complications, operative time, and hospital stays were compared between the 2 groups. Results: Data for 190 patients were reviewed; mean age was 50 ± 13years old, and 146 (77%) were male. The one-stage (A) and staged (B) groups included 102 and 88 patients, respectively. Group A included older patients, with a high The American Society of Anesthesiologists score, while group B included more patients with multiple or staghorn stones. The one-stage group recorded shorter operative time (120 ± 12min vs. 140 ± 16min, p = 0.02) and shorter hospital stays (3days [2-6] vs. 4days [3-9], p = 0.06). Otherwise, both groups had equal outcomes in terms of success rates and complications. Conclusions: PCNL and URS can be performed in one-session for simultaneous ureteral and renal stones, except for multiple renal and staghorn stones. The results are comparable to those of the staged procedure in terms of success rate and complications, with the advantage of a shorter operative time and hospital stay.

Prostatic resection cavity large stone post transurethral resection of the prostate (TURP). A rare case scenario.

INTRODUCTION: Transurethral resection of the prostate (TURP) compromise the mainstay surgical treatment of LUTS due to benign prostatic hyperplasia (BPH). The storage symptoms post TURP may be attributed to urinary tract infection (UTI), preoperative detrusor over-activities, and residual prostatic adenoma causing voiding symptoms. PRESENTATION OF CASE: A 56 year old male presented storage LUTS (mainly frequency and urgency) since two years. Two years earlier, he underwent uncomplicated monopolar TURP. The patient has occasional straining and intermittent urine. No history of hematuria. No notable medical history was present. Digital rectal examination showed small prostate. Anal tone and Bulbocavernosal reflex were intact. CT showed a large vesical stone extending into the prostatic fossa measuring 51.5 mm × 67.0 mm. The patient was managed by suprapubic cystolitholapaxy. DISCUSSION: Post TURP LUTS necessitates evaluation with a thorough history and physical, including International Prostate Symptom Score, and urine culture to rule out infection. In a rare case report, delayed occurrence of storage and obstructive voiding symptoms after TURP can be caused by dystrophic calcification of the prostatic resection cavity. The stone could have been due to a metal or plastic piece of the resectoscope embedded in the prostatic cavity, but, this postulation was deferred based on the non-attached stone to the mucosa as confirmed by cystoscope. In such case, based on the large stone burden, more cost would be a potential burden, and longer operative time, the open cystolitholapaxy is the modality of choice. CONCLUSION: Prostatic cavity stone is a rare pathology. Incidental stone occupying the prostatic fossa post TURP is a remote possibility but it should by highlighted to raise urologist awareness for its possibility.

The Weight of HLA-DPA1 rs3077 Single Nucleotide Polymorphism in Prostate Cancer, a Multicenter Study.

Prostate cancer (PCa) has almost the highest genetic transmission that mimics an autosomal dominance hereditary pattern of cancers in some families. Its incidence in Arab countries was reported to be steadily increasing. Aim. To determine the relevance of HLA-DPA1 rs3077 (A/G) SNP with prostate cancer's risk and/or severity. Subjects and Methods. Forty PCa patients and forty age matched patients with benign prostatic hyperplasia (BPH), as a control group, were enrolled in the study. Serum levels of urea, creatinine, total prostate-specific antigen (PSA), and free PSA were measured. PSA ratio was determined as well. Genotyping of HLA-DPA1 rs3077 (A/G) SNP was done using real-time PCR. Results. The measured lab parameters, except free PSA, were significantly higher among PCa patients in comparison to controls (P < 0.001 ∗ ). Moreover, PSA ratio was significantly high among PCa patients (P < 0.001 ∗ ). HLA-DPA1 rs3077 GG genotype was more frequent in PCa patients and the associated OR was 2.546 (P=0.059), while AA genotype was more frequent in the control group and the associated OR was 0.145 (P=0.081). Frequency of G allele was higher among PCa patients than the control group while A allele frequency was significantly decreased (P=0.034 ∗ ) (protective allele). On multivariate analysis, there is no significant correlation found between HLA-DPA1 rs3077 SNP and PSA ratio (OR = 4.5, 95% CI = 1.2-17.4, P=0.856). Conclusion. HLA-DPA1 rs3077 G allele could be a risk factor for prostate cancer. However, HLA-DPA1 rs3077 SNP has no relation to PCa severity.

The Effect of Pre-Incision Urethral Plate Width and Glanular Width on the Outcome of Tubularized Incised Urethral plate repair surgery in Distal Penile Hypospadias, A prospective study.

PURPOSE: To determine hypospadias repair's cosmetic and functional outcome concerning the urethral plate width and glanular width. MATERIALS AND METHODS:  A prospective study including 38 patients. The urethral plate width (UPW) was measured preoperatively. The cosmetic outcome was evaluated by hypospadias objective penile evaluation [HOPE] score, and the urinary stream evaluated functional outcome. We included boys with distal penile hypospadias and excluded recurrent cases with severe chordee. All patients were operated on by Snodgrass tubularized incised plate repair (TIP); they were followed up for one year. Success was defined as slit-shaped meatus at the tip of the glans without fistula. RESULTS: The mean age of surgery was 4.5 ± 2.1 years. UPW was < 8 mm in 24 patients (63.2 %) (Group A), while 14 patients (36.8 % ) (Group B) had a UPW ≥ 8 mm. Overall, the mean ± SD of UPW was 4.84 ± 1.29 mm. The mean ± SD of GW was 9.52 ± 1.56 mm. Overall success was documented in 35/38 patients (92.1 %). No significant relation was founded between the complications and UPW of the patients (p-value = 0.7). Overall, the mean ± SD HOPE score was 39.1 ± 8.83. A significant relation was found between the cosmetic outcome of the two groups and the HOPE score (p-value = 0.02). CONCLUSION: The pre-incision urethral plate width and glanular width were not correlated with the TIP outcome. A better HOPE score is associated with a wide urethral plate.

Concurrent bilateral emphysematous pyelonephritis and secondary iliopsoas abscess extending to thigh muscles with profuse rectal bleeding. A rare case scenario.

INTRODUCTION: Bilateral emphysematous pyelonephritis is exceedingly rare. CASE PRESENTATION: A 56 year old diabetic male presented with high grade fever 40o c, chills, and bilateral loin pain since two weeks a picture of septic shock. CT showed bilateral emphysematous pyelonephritis, the left kidney was smaller in size, the right renal unit showed marked hydronephrosis, right iliopsoas abscess extending to the thigh. The patient was managed by bilateral nephrostomy tubes and two retroperitoneal drains. Initially, the patient recovered, but the general condition deteriorated and profuse rectal bleeding occurred. Colonoscopy showed bleeding colonic mucosa. CONCLUSION: Bilateral emphysematous pyelonephritis is devastating disease that should be managed promptly to avoid septic shock.

A large renal bullet that resembles a large renal stone. A rare case scenario.

INTRODUCTION: Genitourinary trauma secondary to a gunshot wound is uncommon as it only occurs in about 10% of cases. We present a case of a gentleman who suffered a gunshot wound to the kidney. PRESENTATION OF CASE: A 28 year old man presented with irritative lower urinary tract symptoms (LUTs) since three months. The medical history was irrelevant. He is known case of neurogenic bladder maintained on regular clean intermittent catheterization (CIC). He has history of gunshot to the back since few years that resulted in spinal injury. CTUT showed retained bullet inside the right kidney that look alike hyperdense renal stone, Moreover, multiple vesical stones. The vesical stones were treated with cystolitholapaxy. Given that the patient is asymptomatic, conservative management for the retained right renal bullet is the feasible option. DISCUSSION: Based on the ASST classification, renal gunshot injury results in a grade IV injury. Abdominal exploration was reserved only in selected scenarios. Gunshot injuries to the kidney are commonly associated with thoracic and abdominal injuries. Gunshot injuries may be caused by low-velocity or high-velocity bullets. Given the paucity of cases reported in the literature, it is not obvious what is the optimum management of such patients with a retained renal bullet? We present the radiological findings and a clinical case summary as well for those who have Grade IV kidney injury and retained bullet managed conservatively. CONCLUSION: Retained renal bullet post gunshot injury to the back is unusual presentation. A characteristic star-like pattern produced by lead shots and not by "stone," consisting of plastic detonating cap will aid the urologist to differentiate retained renal bullet from renal stone. In such scenario, asymptomatic renal bullet look alike renal stone doesn't necessitate treatment.