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.

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.

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.

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.

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.

Renal Transplant in Abnormal Bladder: Treatment Options and Their Effects on Graft Outcome.

OBJECTIVES: Correction of structural urologic disorders and optimization of emptying and storage function of the bladder should be achieved before renal transplant in patients with abnormal urinary bladders to protect the new transplanted kidney. The aim of this study was to determine the outcomes of renal transplant among the differently treated abnormal bladder patients. MATERIALS AND METHODS: This was a retrospective study of 30 renal transplant recipients with abnormal bladders who were divided into 2 groups based on abnormal bladder management. Group A included 12 patients who required surgical procedures for their bladder, including 6 with augmentation cystoplasty, 1 with Mitrofanoff procedure, 2 with ileal conduit, 1 with vesicostomy, and 2 who required artificial urinary sphincter. Group B included 18 patients who were treated with oral anticholinergics or beta-3 sympathomimetic drugs, clean intermittent catheterization, suprapubic catheterization, or a combination of these options. Graft function, survival, and complications were compared between both groups. RESULTS: Mean estimated glomerular filtration rates at 1, 3, and 5 years were higher in group A than in group B but not statistically significant. We also found no significant differences in graft survival between the 2 groups. Among all postoperative complications, only incidence of wound infection was significantly higher in group A than in group B (33% vs 5%; P = .04). CONCLUSIONS: The options of abnormal bladder treatment (either by surgical procedures or other methods of treatment) did not have an impact on graft outcome after renal transplant as long as a safe and suitable bladder was achieved.

Testicular Biopsy Histopathology as an Indicator of Successful Restoration of Spermatogenesis after Varicocelectomy in Non-obstructive Azoospermia.

PURPOSE: We aimed to evaluate the efficacy of using testicular biopsy histopathology as an indicator of the success of loupe-assisted subinguinal varicocelectomy in non-obstructive azoospermia (NOA) patients. MATERIALS AND METHODS: In a 2-year period, a prospective study was carried at Minoufiya University Hospital on 20 NOA patients with clinical bilateral varicoceles. These patients underwent loupe-assisted subinguinal varicocelectomy with simultaneous testicular biopsy. All patients were evaluated by determining their hormonal profile and performing semen analyses and scrotal Doppler and transrectal ultrasonography. Two semen analyses showing azoospermia were performed before the surgery and two semen analyses were received at 3 and 6 months post-operatively for follow-up. RESULTS: The mean age was 29.9±6.7 years, and the mean follow-up duration was 17.3±8.3 months. We noted the restoration of spermatogenesis in six men (30% of all patients). Testicular biopsy results were as follows: hypospermatogenesis in 7 patients, maturation arrest in 3, and Sertoli cell-only syndrome in 10. The improvement in the sperm counts of these patients ranged from 3 million to 15 million/mL. Sperms were recovered in the hypospermatogenesis (6 patients, 85.5%) patients only, but other patients with testicular biopsy results of Sertoli cell-only or maturation arrest did not show any improvement in their semen parameters. CONCLUSIONS: Testicular biopsy results showed that hypospermatogenesis patients have a better chance of improvement in their semen analysis after varicocelectomy in contrast to NOA patients with Sertoli cell-only syndrome or maturation arrest.