Dilşad Dereli, Çiğdem Öztunalı, Emrah Şişli
et al.
In children, hydroureteronephrosis due to ureterovesical stenosis may develop from reflux or obstruction. In diagnostic cystoscopy, not only the findings of the ureteral orifice and ureteral tracing but also the findings of accompanying intra- and extravesical pathologies should not be overlooked. A five-year-old male patient had increased left hydroureteronephrosis on ultrasound follow-up and Mag-3 scintigraphy showed partial obstruction. Retrograde pyelography (RPG) was planned for diagnostic purposes. Cystoscopy showed pulsation in the subureteric area of the left ureteral orifice. RPG was performed. Distal passage problems and proximal hydroureteronephrosis were found on the left side. Postoperative abdominal computed tomography (CT) angiography was performed to investigate the cause of arterial pulsation. It was observed that the left iliac artery did not bifurcate at the normal level and was aberrant in the pelvis as an external iliac artery, single arterial structure that was tortuous and slightly wide. At this level, it extended into the posterior neighborhood of the bladder. This anatomical variation and the suburethral neighborhood of the artery caused marked intravesical arterial pulsation. No intervention was performed, and it was noted that if surgical intervention was necessary according to the follow-up, it should be performed in absolute extravesical exploration, considering the existing pathology. Pulsatile mass detected during cystoscopy for intravesical evaluation may be associated with rare extravesical vascular malformations. Following CT angiography, invasive interventions should be carefully planned if necessary. Expansion of invasive procedures without a thorough understanding of extravesical anatomy may lead to serious complications.
Surgery, Diseases of the genitourinary system. Urology
Background Elderly hemodialysis (HD) patients have a high risk of death. The effect of different types of HD membranes on survival is still controversial. The purpose of this study was to determine the relationship between the use of low-flux or high-flux membranes and all-cause and cardiovascular mortality in elderly hemodialysis patients.Methods This was a retrospective clinical study involving maintenance hemodialysis patients which were categorized into low-flux and high-flux groups according to the dialyzer they were using. Propensity score matching was used to balance the baseline data of the two groups. Survival rates were compared between the two groups, and the risk factors for death were analyzed by multivariate Cox regression.Results Kaplan–Meier survival analysis revealed no significant difference in all-cause mortality between the low-flux group and the high-flux group (log-rank test, p = 0.559). Cardiovascular mortality was significantly greater in the low-flux group than in the high-flux group (log-rank test, p = 0.049). After adjustment through three different multivariate models, we detected no significant difference in all-cause mortality. Patients in the high-flux group had a lower risk of cardiovascular death than did those in the low-flux group (HR = 0.79, 95% CI, 0.54–1.16, p = 0.222; HR = 0.58, 95% CI, 0.37–0.91, p = 0.019).Conclusions High-flux hemodialysis was associated with a lower relative risk of cardiovascular mortality in elderly MHD patients. High-flux hemodialysis did not improve all-cause mortality rate. Differences in urea distribution volume, blood flow, and systemic differences in solute clearance by dialyzers were not further analyzed, which are the limitations of this study.
Ahmed H. Gabr, Ahmed Abdelatif, Mostafa S. El sharkawy
et al.
Abstract Aim of the study To evaluate objective measurements of morphological changes of the prostate in Benign Prostatic Hyperplasia (BPH) as predictors of acute urinary retention (AUR). Methods Overall 169 consecutive patients older than 50 years of age were prospectively divided into group A (n = 61); men with acute urinary retention (AUR), or group B (n = 108); men with different degrees of lower urinary tract symptoms (LUTS). Transrectal ultrasound (TRUS) measurements of total prostate volume (TPV), transitional zone volume (TZV), ratio of TZV to TPV (TZV/TPV), and vesico-urethral angle (VUA) were recorded. Group B patients also had post-void residual (PVR) and maximum flow rate (Q-max) recorded. TZV/TPV and VUA were correlated with Q-max and PVR, and a comparison was made between the two groups. Results Group A had significantly larger TPV (p = 0.03) and TZV/TPV (p = 0.04) compared to Group B. VUA in Group A had a significant correlation with AUR (p = 0.02). In Group B, both TZV/TPV and VUA had significant correlation with PVR and Q-max. A TZV/TPV cutoff ratio of 0.67 as a predictor of AUR had a 68% overall accuracy with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88%, 53%, 44%, and 97%, respectively. VUA of < 90º as a predictor factor of AUR had a 67% overall accuracy with sensitivity, specificity, PPV and NPV of 88%, 50%, 44%, and 97%, respectively. Conclusion Morphological changes in BPH can be objectively quantified using ultrasound by TZV/TPV and VUA. These parameters may potentially serve as predictors of AUR in patients with BPH.
Urachus is a tubular structure connecting the allatois to the bladder's apex, in the embryonic development. We report a rare case of a 5-year-old boy, with no past medical history, complaining of secondary enuresis, pollakiuria and urgent incontinence. Physical exam revealed a hypogastric mass. Echo guided percutaneous biopsy followed by a histological analysis showed embryonal RMS. The remainder of the staging ruled out metastasis. The patient received neoadjuvant chemotherapy before proceeding to complete tumor excision. Surgical exploration revealed that the tumor was primitively related to the urachus. Total resection was performed. The one year follow-up was uneventful.
Marah C. Hehemann, Omer A. Raheem, Saneal Rajanahally
et al.
Aims: To assess if marijuana consumption – prevalent among men of reproductive age and becoming widespread due to decriminalization – is associated with changes in semen parameters. Marijuana’s active metabolite, tetrahydrocannabinol, can alter signaling pathways within spermatozoa, affecting spermatogenesis and fertility. Methods: We prospectively evaluated semen analyses (SA) from men presenting for infertility evaluation at one institution from July 2017 to April 2018. Participants completed a reproductive health questionnaire including items regarding marijuana consumption. SA was performed in accordance with World Health Organization (WHO) 5th Edition criteria. SA parameters included volume (ml), concentration (million/ml), motility (%), progressive motility (%), and Tygerberg strict morphology (%). Results: A total of 409 patients completed the questionnaire; 174 (43%) men reported marijuana use (ever-users). Current and past users comprised 71 (17%) and 103 (25%), respectively. Compared with never-users, current and past users had a significantly higher likelihood of abnormal sperm strict morphology (33.1% versus 50.7% and 53.4%, respectively; p < 0.001). However, sperm motility was more likely to be less than WHO reference values in never-users than current and past-users (38.3% versus 21.1% and 27.2%, respectively; p = 0.01). In multivariate logistic regression analyses, current use was associated with increased odds of abnormal strict morphology [odds ratio (OR) 2.15, 95% confidence interval (CI): 1.21–3.79] and semen volume less than WHO reference value (OR 2.76, 95%CI: 1.19–6.42), while odds of less than WHO reference value sperm motility were reduced (OR 0.47, 95%CI: 0.25–0.91). Conclusion: Marijuana use is common among men presenting for fertility evaluation, and may have a detrimental effect on semen quality, particularly morphology and volume, but may be protective against abnormal sperm motility. Large, prospective studies of both semen quality and fertility in this growing, at-risk population are warranted.
Julián Chavarriaga, Luis Miguel Becerra, Diego Camacho
et al.
Isolated renal fossa recurrence and port site metastasis after laparoscopic nephrectomy are two different entities, and despite being rare, in selected cases would benefit from surgical resection. We report the case of a 61-year-old male with local renal fossa recurrence with synchronous metastasis involving the port site, the abdominal wall and the appendix, which was successfully treated with open surgical resection and is free of metastasis or recurrence. To conclude opportune treatment of similar cases, remain a safe and curative option, and should be considered after reviewing the case within a multidisciplinary team.
Chaudhry Adeel Ebad, Nabeehah Moollan, Adeel Rafi Ahmed
et al.
Leptospirosis is an exceptionally rare infectious disease in the Republic of Ireland. Leptospirosis can present with or mimic thrombotic microangiopathies (TTP/HUS). A 48-year-old male presented to a peripheral hospital with a short history of diarrhoea, anaemia, hyperbilirubinemia, raised lactate dehydrogenase, thrombocytopenia, and severe acute kidney injury and was transferred to our tertiary care kidney centre. A form of acute thrombotic microangiopathy (TMA) was suspected. However, no schistocytes were seen on the blood film, and the reticulocyte count was depressed. A kidney biopsy was performed before initiating any potential treatment which revealed acute interstitial nephritis (AIN). Leptospirosis was considered and subsequently serologically confirmed. The patient was managed with antimicrobials and supportive therapy. Acute kidney injury is common in leptospirosis and is often due to AIN. Initial presentation can mimic TMA; however, a differential diagnosis of leptospirosis should be considered even in nonendemic areas due to re-emergence of the disease.
Metin İshak Öztürk, Orhan Koca, Muzaffer Oğuz Keleş
et al.
Abstract
Objective: The International Prostate Symptom Score (IPSS) is one of the most frequently used symptom scores in current urology practices. In the present study, the relationship between the accuracy of the answers to the IPSS questionnaire and age, level of education, and the level of comprehension was investigated.
Materials and methods: Two hundred thirty-eight male patients aged 20-83 years presenting to the urology outpatient clinic for any reason were evaluated. Patients were asked to complete IPSS questionnaire and a test to evaluate the level of comprehension. After 48-96 hours, the IPSS form was recompleted with the assistance of the physician. The relationship of the difference between the self-administered and physician-assisted IPSS; to age, level of education, and the level of comprehension was evaluated.
Results: Among the patients with a high school or higher level of education, no significant difference was found between the self-administered and physician-assisted IPSS. Self-administered forms were significantly different from physician-assisted IPSS for patients ≥60 years and for patients with a score of ≤50/100 on the comprehension test.
Conclusion: We suggest to complete the IPSS with the assistance of a physician for patients with advanced age or low education level. Furthermore, we think that using comprehension test in uncertain cases are important in evaluating the symptoms, thus treatment options.
Ali Abdel Raheem, Hyun Jung Song, Ki Don Chang
et al.
The robotic nurse plays an essential role in a successful robotic surgery. As part of the robotic surgical team, the robotic nurse must demonstrate a high level of professional knowledge, and be an expert in robotic technology and dealing with robotic malfunctions. Each one of the robotic nursing team “nurse coordinator, scrub-nurse and circulating-nurse” has a certain job description to ensure maximum patient's safety and robotic surgical efficiency. Well-structured training programs should be offered to the robotic nurse to be well prepared, feel confident, and maintain high-quality of care.
Alexander Casallas, Camilo Castaneda-Cardona, Diego Rosselli
Urinothorax, the presence of urine in the pleural space, is a rare cause of pleural effusion, usually associated with obstructive uropathy, or urinary trauma. We present the case of a 3 year-old boy and a systematic review of the literature of the 44 cases encountered. After resection of a Wilm's tumour in the right kidney our patient presented acute respiratory distress associated with radiographically confirmed pleural effusion. With the initial diagnosis of pneumonia or malignant pleural effusion, a closed thoracotomy was performed. The liquid obtained suggested urine, which was confirmed by the laboratory. Cystoscopy with retrograde pyelography detected a fistula on the posterior wall of the right kidney. The report of cases worldwide is low, probably due to its low incidence but also to underdiagnosis. Respiratory symptoms are not always present and urological symptoms usually predominate. Diagnosis requires a high degree of clinical suspicion and is confirmed by the main biochemical marker: The ratio >1 .0 pleural fluid creatinine and creatinine serum.
Dennis J Horvath, Shareef M Dabdoub, Birong Li
et al.
Urinary tract infections (UTIs) represent one of the most commonly acquired diseases among the general population as well as hospital in-patients, yet remain difficult to effectively and consistently treat. High rates of recurrence, anatomic abnormalities, and functional disturbances of the urinary tract all contribute to the difficulty in management of these infections. However, recent advances reveal important molecular and genetic factors that contribute to bacterial invasion and persistence in the urinary tract, particularly for the most common causative agent, uropathogenic Escherichia coli. Recent studies using animal models of experimental UTIs have recently provided mechanistic insight into the clinical observations that question the effectiveness of antibiotic therapy in treatment. Ultimately, continuing research will be necessary to identify the best targets for effective treatment of this costly and widespread infectious disease.
Shioyama Yasukazu, Honda Mikihiko, Abe Hideyuki
et al.
<p>Abstract</p> <p>Background</p> <p>Single minimum incision endoscopic surgery (MIES) involves the use of a flexible high-definition laparoscope to facilitate open surgery. We reviewed our method of radical nephrectomy for renal tumors, which is single MIES combined with preoperative virtual surgery employing three-dimensional CT images reconstructed by the volume rendering method (3D-CT images) in order to safely and appropriately approach the renal hilar vessels. We also assessed the usefulness of 3D-CT images.</p> <p>Methods</p> <p>Radical nephrectomy was done by single MIES via the translumbar approach in 80 consecutive patients. We performed the initial 20 MIES nephrectomies without preoperative 3D-CT images and the subsequent 60 MIES nephrectomies with preoperative 3D-CT images for evaluation of the renal hilar vessels and the relation of each tumor to the surrounding structures. On the basis of the 3D information, preoperative virtual surgery was performed with a computer.</p> <p>Results</p> <p>Single MIES nephrectomy was successful in all patients. In the 60 patients who underwent 3D-CT, the number of renal arteries and veins corresponded exactly with the preoperative 3D-CT data (100% sensitivity and 100% specificity). These 60 nephrectomies were completed with a shorter operating time and smaller blood loss than the initial 20 nephrectomies.</p> <p>Conclusions</p> <p>Single MIES radical nephrectomy combined with 3D-CT and virtual surgery achieved a shorter operating time and less blood loss, possibly due to safer and easier handling of the renal hilar vessels.</p>