[Prevalence of erectile dysfunction in patients consulting urological clinics: multi-centric survey in the Algerian west]

Aim: The aim of this study was to make an inventory of the prevalence, the severity, the reasons for the patient's consultation and the therapeutic measures indicated by urologists for erectile dysfunction [ED] in the west of Algeria

Methods: This survey was conducted among 4 urologists. All male patients, aged over 18 years, presenting to clinics during the study period of 2 months were included. Data collection was based on a self-administered questionnaire on socio-demographic data, comorbidities especially urological and sexual health history. The evaluation of ED was achieved by the single question of John B. McKinlay. One more question was asked to evaluate trouble reported by the patient's partner

Results: This survey included 185 patients. It showed a high prevalence of ED [59.5%], correlated with age. The mean age was 61 +/- 13 years. Thirty four percent of patients had severe ED. The reason for consultation was dominated by prostatic diseases [70%], the ED accounted for only 9% of the reasons for consultation. Only 26% of patients reported having talked previously to a doctor about their ED. These disturbances were "unacceptable" for 25% of patients and "moderately acceptable" for 30%. A minority of patients [16%] was treated medically for their ED [half of them received PDE5 inhibitors alone or in combination]

Conclusion: This first survey in the urological Algerian community emphasizes the importance of sexual dysfunction in patients consulting in urology. Although the prevalence of ED is important, few patients consult specifically for this reason. As a result, treatment is limited. Better physician awareness of the problem of ED is recommended

Psma-Psa clones drived by full akt phosphorylation [t308+,s473+] recapitulate molecular features of human prostate cancer

Background: [PSMA+,PSA+] and [PSMA+,PSA-] are the two most individual clones that we have previously identified during prostate cancer [PC] progression. However, molecular signatures associated with these distinct PSMA-PSA prostate clones and their specific correlation with disease outcome is yet to be defined

Aim: Since Akt is a major pathway involved in the critical activating events that leads to malignant form of the disease, we studied the involvement of full Akt activation [T308+,S473+] connected with serum PSA levels, tissue PSMA expression and angiogenic activity on the emergence of [PSMA+,PSA+] and [PSMA+,PSA-] PC clones

Methods: The study was carried out in 6 normal prostate, 25 benign prostate hyperplasia [BPH] and 23 [PC]. Immunohistochemical analysis was performed to study the expression of PSMA, PSA, pAkt[T308], pAkt[S473] and CD34 in prostate tissues. The evaluation of angiogenesis was made by CD34 immune marker. Serum levels of PSA were assayed by Immulite autoanalyser

Results:The most relevant result showed that, among PC patients with pAkt [T308+,S473+] profile, patients that exhibit the [PSMA+,PSA+] clone have higher serum PSA levels, tissue PSMA expression and angiogenic activity than those with [PSMA+,PSA-] clone. Although have the same [PSMA+,PSA+] prostate clone, BPH patients have distinct molecular-biological features compared to PC patients among pAkt [T308+,S473+] profile. In fact, among patients with maximal Akt activation, the [PSMA+,PSA+] PC clone is characterized by higher serum PSA levels, tissue PSMA production and intensive angiogenic activity than [PSMA+,PSA+] BPH clone

Conclusion: These findings emphasize the potential role of the full Akt activation [T308+,S473+] in expansion of several PSMA-PSA prostate clones capable of driving both human PC initiation as well as progression to a metastatic phenotype. Pinpoint patients according to PSMA-PSA clones could recapitulate the histological and molecular features of human PC and may offer a novel approach for controlling metastasis

Imaging findings of urinary tuberculosis on computerized tomography versus excretory urography: through 46 confirmed cases

Imaging findings of urinary tuberculosis [TB] on excretory urography [IVP] and CT have been reported to be nonspecific although CT may provide detailed informations. We performed a retrospective study of patients with proven urinary TB to compare imaging findings on IVP and CT and to make a systemic approach to imaging analysis of urinary TB. Urinary TB was diagnosed in 46 patients who had IVP and CT examinations prior to definitive diagnosis and treatment. They were 30 females and 16 males with a mean age of 43.6 ys. We assessed the presence and frequency of urinary tract calcifications, autonephrectomy, renal parenchymal masses, renal parenchymal scarring, moth-eaten calices, amputated infundibulum, renal parenchymal cavities, hydrocalycosis, hydronephrosis, hydroureter and thick urinary tract walls. CT was most sensitive in detecting any renal parenchyma cavities [p=0.01], hydronephrois [p=0.0005], ureteral stricture [p=0.03] and walls thickening of the renal pelvis / ureter [p< 0.0001]. Four imaging patterns were noted in 20 IVPs [43%] and 34 CTs [74%] with multiple findings. They were hydrocalycosis, hydronephrosis or hydroureter du to multiple stricture sites, ureteral stricture with thick wall, autonephrectomy combined with at least 1 other type of imaging finding and thick wall of renal pelvis or ureters and bladder with at least 1 other type of imaging finding. Renal parenchymal cavities, hydronephrosis, ureteral stricture and thickened urinary tract walls were significantly more common on CT than on IVP. Multiple findings on CT were more common and very useful for TB diagnosis. Thus, we recommend CT as the standard exam in patients with suspicion of urinary TB

Evolution and prognosis of bladder papillomatosis managed by endoscopic resection and endovesical BCG therapy: about 24 cases

Bladder papillomatosis is a diffuse tumor proliferation even up almost all of the bladder mucosa. We analyzed prognosis of this rare entity after conservative treatment. We retrospectively analyzed epidemiological, clinical, therapeutic and evolutive data in 24 patients with newly diagnosed bladder transitional cell carcinoma papillomatosis. All patients underwent a complete endoscopic transurethral resection [TUR] with curative intent. A second look was performed within 30 days. The intravesical therapy regimen consisted on weekly instillations for 6 weeks, and then monthly for 6 months. If the tumor recurred without muscle invasion, TUR was repeated with a second intravesical BCGtherapy regimen. Parameters investigated included age, gender, risk factors, cystoscopic findings [aspect, multiplicity and location of bladder lesion], tumor stage, tumor grade, recurrences and progression times from diagnosis to last follow up. The mean age of the patients at initial diagnosis was 64,9 +/- 6,1 years. They were males in 23 cases. Initial cancer staging was as follow: pTa [n=6] and pT1 [n=18]. The recurring tumors were reported in 17 patients [70,8%]. They were stage Ta in 5 patients and stage T1 in 12. The median interval of time between the initial TUR and the first recurrence was 10,3 months. Six patients remain tumor free. From the 17 recurrences, 6 patients developed progression with muscle invasion in 4 of them. Radical cystectomy with ileal conduit was performed in 3 patients and one patient died before radical treatment. Univariate analysis didn't reveal any prognostic factor: age [p=0,7], tumor location and aspect [p= 0,7 and p= 0,5 respectively], tumor stage [p=0,7] and grade [p=0,09]. TCC bladder papillomatosis is a rare entity. TUR with intravesical BCG therapy may be indicated as a first option despite correct follow up. Radical cystectomy should be considered in cases of recurrent or non-resectable tumours

Evaluation of urolithiasis in Crohn's disease in Tunisian patients

To investigate the characteristics of urolithiasis associated with Crohn's disease [CD] in a sample of Tunisian population. We retrospectively studied 184 patients with CD to reveal any urolithiasis during evolution. Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography and computed tomography. Renal calculi were found in only three patients with CD. All patients were woman. Mean time from diagnosis of CD to diagnosis of calculi was 22 months [range 6 to 48 months]. Clinical features were not specific. Calculi were bilateral in two cases. The rate of concurrent urolithiasis was very low in the present series of Tunisian patients. Although rare, efficient treatment and prevention of calculi formation are mandatory in CD patients'

Cellular distribution and heterogeneity of PSA and PSMA expression in normal, hyperplasia and human prostate cancer

As promising targets for in vivo diagnostic, prognostic and therapeutic approaches, the distribution and staining pattern of prostate specific antigen [PSA] and prostate specific membrane antigen [PSMA] in tumors are of significant interest. To compare the cellular distribution and heterogeneity of PSA and PSMA expression in normal prostate [NP], benign prostatic hyperplasia [BPH] and primary prostatic tumors and to analyze their relation with the angiogenic activity according to Gleason grade [low, medium and high] in primary PC. The study was carried out in 6 NP, 44 BPH and 39 PC. Immunohistochemical analysis was performed. Monoclonal antibodies 3E6 and ER-PR8 were used to assess PSMA and PSA expression respectively. The evaluation of angiogenesis was made by CD34 immune marker. In our study we noticed differences in the intracellular localization of the PSMA immunostaining which seem to be related to the normal and pathological context. A significant number of primary tumors presented with apical pattern of PSMA [28/39]; whereas a relevant part of NP samples and BPH samples showed cytoplasmic localization [4/6 and 30/44, respectively] in luminal epithelial cells. Compared to PSMA, PSA was preferentially localized in cytoplasmic compartment in all type of prostate. A direct correlation between histological grade, PSMA expression and angiogenic activity could be demonstrated in primary PC. Simultaneous stains with PSA and PSMA in individual prostate tissue will greatly improve the detection rate and identify a high risk PC that could progress to metastatic phenotype. Our findings clearly support the feasibility but also direct the potential of PSMA-targeted in vivo therapeutic approaches in PC patients rather than PSA especially those with poorly differentiated adenocarcinoma

Fournier's gangrene: what are the prognostic factors? Our experience with 40 patients

Fournier's gangrene [FG] is a serious, extensive fulminant infection of the genitals and perineum. Indeed, despite antibiotics and aggressive debridement, the mortality rate of FG remains high. Through our experience, we intent to identify effective factors in the survival of patients with FG and we try to determine how the Fournier's gangrene severity index score [FGSIS] is accurate. Between 1995 and 2010, 40 patients with Fournier's gangrene were treated in our institution. All of them were treated with broad spectrum triple antimicrobial therapy, broad debridement and exhaustive cleaning. Then they underwent skin grafts or delayed closure as needed. Data were collected on demographics, medical history, predisposing factors of FG, etiological infection agents, admission signs and symptoms, physical examination, admission laboratory studies and bacteriology. Timing and degree of surgical debridement as well as outcomes were also reviewed. The extent of disease was calculated from body surface area nomograms. All the 40 patients included in this study were males; their mean age was 52,75 years [21-75 years]. Twelve patients [30%] had FG secondary to anorectal pathological conditions. No etiologic factors of FG were found in 6 patients [15%]. Diabetes mellitus as predisposing factor was found in 13 patients [32.5%]. The mean hospital stay was 8.72 days [range, 3 to 30]. All the patients underwent surgical debridement. Orchidectomy was done in 7 cases [17.5%]. Skin grafts were applied to 6 patients [15%] and the remaining wounds, once cleaned, were approximated. The overall mortality rate was 17.5% [7 patients] due to severe metabolic acidosis in relation to diabetic decompensation and sepsis. We individualized two groups: those who died [n = 7] and those who survived [n = 33]. We evaluated the admission laboratory parameters that are significantly correlated with outcome included hematocrit [p=0.003] and serum sodium [p=0.05]. The extent of body surface area involved among patients who died was not found significantly different statistically between the two groups [4.07% and 3,14%, p=0,4]. The mean FGSIS [without counting bicarbonate serum level] for survivors was 9.1 compared with 6,8 for non-survivors [p=0.16]. FG is a rapidly progressive, fulminant infection's condition. Hematocrit and serum sodium levels were found to be the only prognostic factors. It doesn't seem that the FGSIS has a prognostic value

Iatrogenic ureteric injury: a real medicolegal dilemma

Iatrogenic ureteral injuries are not so rare and may have serious medicolegal repercussions. To report a case of iatrogenic ureteral injury, secondary to ureterolysis and treated by substitutive non-modeled ureteroileoplasty. A 70-year-old man, who presented extrinsic ureteral compression due to idiopathic retroperitoneal fibrosis, underwent ureterolysis. Peroperatively, the ureter was injured and the damage was so important that the surgeon decided and performed a substitutive non-modeled uretero-ileoplasty. Immediate postoperative course was normal. Many years after, he developed hydronephrotic poor functioning kidney with multiple renal lithiasis and a large ileal tube stone. He underwent a nephroureterectomy with ileal tube excision. Through this observation, we evaluate the operator peroperative decisions and the medicolegal consequences

From an urologist view: are we safe with endoscopic surgery? overview of ergonomic problems encountered by the urologist during video endoscopic surgery

The importance of minimally invasive surgery in urology has constantly increased in the last 20 years. Endoscopic resection of prostate and bladder tumors is actually a gold standard with many advantages for patients. To analyze the problems related to the ergonomic conditions faced by urologist during video endoscopic surgery by review of the recent literature. All evidence-based experimental ergonomic studies conducted in the fields of urology endoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches. Data from ergonomic studies were evaluated in terms of efficiency as well as comfort and safety aspects. Constraint postures for urologists are described and ergonomic requirements for optimal positions are discussed. The ergonomics of urological endoscopic surgery place urologists at risk for potential injury. The amount of neck flexion or extension, the amount of shoulder girdle adduction or abduction used, and stability of the upper extremities during surgery; which are maintained in a prolonged static posture; are the main risk factors. All these constraints may lead to muscle and joint fatigue, pain, and eventual musculoskeletal injury. Moreover, these issues may impact surgical accuracy. Urologist posture, operating period, training are important ergonomic factor during video surgery to prevent musculoskeletal disorders