Association of Chronic Hyperglycemia With the Risk of Urolithiasis.

Background The incidence of urolithiasis is increasing along with elevated rates of chronic hyperglycemia. Therefore, this study aimed to assess the association between high hemoglobin Alc (HbAlc) levels, in the form of type 2 diabetes mellitus (T2DM), and the risk of kidney stone formation among those living in the Eastern Province of Saudi Arabia. Methodology We conducted a cross-sectional study on a total of 501 patients with known cases of urolithiasis who visited King Fahad University Hospital (Khabar, Saudi Arabia). We calculated odds ratios (ORs) of having stones with respect to three parameters, namely, fasting blood glucose level, random blood glucose level, and glycosylated HbA1c testing. Results Of the 501 cases with urinary stones included in this study, the majority (223, 44.5%) were 41-59 years of age, and 350 (69.9%) were males. Our results showed that T2DM was significantly associated with high stone burden, with increased fasting plasma glucose, increased random blood glucose, and increased HbA1c being strong predictors. The significant associations between glycemic control measures and the risk of urolithiasis remained even after adjusting for factors related to insulin resistance. Conclusions According to our results, glycemic control can be an independent risk factor for urolithiasis. This critical finding demonstrates the need for further studies to investigate this particular group of patients.

Severe penile torsion of 180 degrees in an adult patient: a uro-radiological case report.

Penile torsion is the abnormal three-dimensional twisting of penile corporal bodies. It can be classified as mild, moderate, or severe, depending on the degree of torsion. Severe penile torsion (>90°) is a very rare condition, with an estimated incidence of 0.4%-1% among all penile torsion cases. Our patient was a 37-year-old man complaining of a 2-year history of lower urinary tract symptoms. These symptoms appeared after the patient sustained an iatrogenic injury during Foley catheter insertion. Physical examination incidentally revealed an obvious counterclockwise penile rotation of 180°. Several theories have been proposed to explain the etiology of penile torsion, including theories based on genetic factors, abnormal urethral development, and abnormal attachment of the dartos fascia to the skin. Penile torsion may be associated with other penile anomalies, including chordee, hypospadias, and epispadias; however, it is often detected as an isolated finding. Clinical examination is sufficient to confirm its diagnosis without the need for further imaging. While no standardized procedure has been indicated for all penile torsion cases, the severity of torsion and the presence of other anomalies determine the most suitable procedure. No reports on the imaging features of penile torsion (irrespective of the degree of torsion) are available. We present the first such report on the imaging features, including advanced magnetic resonance imaging findings, of a 180° penile torsion in an adult patient.

Transurethral Resection for the Treatment of an Inflammatory Myofibroblastic Tumor of the Urinary Bladder: A Case Report.

Inflammatory myofibroblastic tumors (IMT) of the urinary bladder is a remarkably rare bladder tumor. To this day, no standardized treatment protocol has been recognized. Here we report a case of bladder IMT in a 14-year-old girl presenting with urgency, frequency, and gross painless hematuria for a week. Complete excision of the bladder IMT was amenable with transurethral resection of bladder tumor (TURBT). Follow-up cystoscopy did not detect any recurrence. Minimally invasive bladder-sparing treatments are a valid option for treating IMT of the bladder.

Corrigendum to "Overcoming scarring in the urethra: Challenges for tissue engineering".

[This corrects the article DOI: 10.1016/j.ajur.2018.02.002.].

Lower urinary tract symptoms and feeling of incomplete emptying in Saudi Arabian men and its correlation with postvoid residual urine.

PURPOSE: This study was conducted to assess the clinical value of postvoid residual (PVR) urine measurement and associate it with the feeling of incomplete emptying in men with lower urinary tract symptoms. METHODS: Two hundred men were surveyed in the King Fahd Hospital of the University. Patients who had previous urological surgery and patients who are currently on urology treatment were excluded. Information from the remaining 181 patients was analyzed. International Prostate Symptom Score (IPSS) sheets were filed, and then, the PVR was measured. RESULTS: Data from IPSS sheets were evaluated: 45 patients (24.8%) were characterized as experiencing no symptoms (Score: 0 and 1), 87 (48%) as mild-to-moderate symptoms (Score: 2 and 3), and 49 (27%) as severe symptoms (Score: 4 and 5). The PVR measurement showed no statistical difference in all three categories (being 10, 13, and 12, respectively). Feeling of incomplete emptying despite little PVR was frequently observed. CONCLUSION: The study concluded that the feeling of incomplete emptying was poorly correlated with PVR urine volume measurement. This feeling was significantly associated with worsening of both voiding and storage symptoms.

The treatment of complex female urethral pathology.

Lower urinary tract symptoms (LUTS) in women produce significant bother. Common conditions causing LUTS in women include urinary tract infections, overactive bladder, and stress incontinence. Urethral diverticulae and female urethral strictures are rare pathologies. They can cause symptoms, which can mimic commoner conditions, leading to delay in diagnosis and unnecessary delay in treatment. In this article, we discuss in detail the definition, symptoms, epidemiology, pathogenesis, diagnosis, and treatment option for these two conditions. Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.

Overcoming scarring in the urethra: Challenges for tissue engineering.

Urethral stricture disease is increasingly common occurring in about 1% of males over the age of 55. The stricture tissue is rich in myofibroblasts and multi-nucleated giant cells which are thought to be related to stricture formation and collagen synthesis. An increase in collagen is associated with the loss of the normal vasculature of the normal urethra. The actual incidence differs based on worldwide populations, geography, and income. The stricture aetiology, location, length and patient's age and comorbidity are important in deciding the course of treatment. In this review we aim to summarise the existing knowledge of the aetiology of urethral strictures, review current treatment regimens, and present the challenges of using tissue-engineered buccal mucosa (TEBM) to repair scarring of the urethra. In asking this question we are also mindful that recurrent fibrosis occurs in other tissues-how can we learn from these other pathologies?

Contemporary outcomes of hypospadias retrieval surgery in adults.

OBJECTIVE: To describe the surgical approach and outcomes in the treatment of adult patients with complications of childhood hypospadias surgery, as such patients present a significant reconstructive challenge due to the combination of anatomical and cosmetic deformity, which often results in major functional and psychosexual sequelae. PATIENTS AND METHODS: We analysed prospectively collected data on 79 adults with complications of childhood hypospadias surgery, who were operated on between 2004 and 2016. Of the 79 patients, 48 underwent a two-stage urethroplasty using a buccal mucosa graft, and 31 underwent a one-stage distal urethroplasty. RESULTS: Patients were followed up using flexible cystoscopy (every 6-9 months). The mean (range) follow-up was 48 (12-96) months. Of the 48 patients who underwent a two-stage repair, eight (16%) needed a revision of the first-stage graft. In total, nine of the 48 patients (16%) developed fistula requiring closure after the second stage; all but one was closed successfully on the first attempt, whilst one required two attempts before closure. Only two of the 48 patients that underwent a two-stage procedure required a re-do urethroplasty within 3 years. Of the 31 patients who underwent a one-stage repair, six (19%) needed fistula closure, all of which were successful. No patient required a further urethroplasty during follow-up. CONCLUSIONS: Despite the significant surgical challenges found in this patient group, excellent long-term functional outcomes can be achieved. As expected there is a need for additional intervention, either for revision of the first stage or to close fistulae and less commonly for further reconstruction for stricture recurrence.

Underactive bladder: Pathophysiology and clinical significance.

Underactive bladder (UAB) is a voiding disorder which generates disabling lower urinary tract symptoms (LUTS) due to the inability to produce an effective voiding contraction sufficient to empty the bladder. The underlying abnormality, that is usually appreciated when performing urodynamic studies, has been defined by the International Continence Society (ICS) as detrusor underactivity (DUA). DUA is a common yet under-researched bladder dysfunction. The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated. Currently there is no effective therapeutic approach to treat this condition. An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment. The purpose of this review is to discuss the epidemiology, pathophysiology, common causes and risk factors potentially leading to DUA; to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.

Management of the patient with failed hypospadias surgery presenting in adulthood.

The management of patients who have had complications of primary surgery for the resolution of a hypospadiac deformity remains a therapeutic challenge. Adults with complications following childhood hypospadias repairs are undoubtedly a difficult population to treat, as there is usually a cosmetic deformity, lower urinary tract symptoms, and resulting psychosexual consequences. A surgeon's experience has been and still remains an important factor in determining subsequent surgical outcomes, particularly with more severe or complex cases. The purpose of this review is to evaluate the complications of hypospadias repair that present in adults and review published experience in treating them.

Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors.

PURPOSE OF REVIEW: Lower urinary tract symptoms are bothersome and significantly impair patient's quality of life. Incomplete bladder emptying affects both men and women, and has shown to increase in incidence with aging. Incomplete bladder emptying is consequent upon an inability of the detrusor muscle to adequately contract to completely empty the bladder, with or without an increased bladder outlet resistance; this can be defined urodynamically as detrusor underactivity (DUA). The symptom complex consequent upon DUA is referred to as underactive bladder (UAB). Although the occurrence of DUA increases with age, and is commonly encountered in clinical practice, it is a largely unrecognized and consequently under researched condition. RECENT FINDINGS: In this article, we will highlight the importance of DUA. We will review UAB as currently defined, the symptoms of DUA, its epidemiology, and etiopathogenesis, risk factors for developing DUA, and methods of diagnosis with an up-to-date review of the contemporary literature. SUMMARY: DUA and its associated symptoms and signs are still poorly recognized entities. Difficulty and confusion arise in properly diagnosing DUA, as at present it can only be accurately defined on the basis of pressure flow urodynamics. Current attention is focused on validating a satisfactory definition for the syndrome complex of UAB.

Antimuscarinics, ß-3 Agonists, and Phosphodiesterase Inhibitors in the Treatment of Male Lower Urinary Tract Symptoms: An Evolving Paradigm.

It is increasingly recognized that the bladder is the originator of storage lower urinary tract symptoms, including overactive bladder in men. As these symptoms are most bothersome for patients, there has been an increasing interest in the evaluation of drug treatment to better target the bladder. Consequently, several new drug classes have been introduced to the therapeutic armamentarium. Antimuscarinics, which were previously avoided due to the concern regarding urinary retention, are now used in routine practice; however, their use is still hampered by discontinuation due to side effects.

Iatrogenic submucosal tunnel in the ureter: a rare complication during advancement of the guide wire.

BACKGROUND: Inserting a guide wire is a common practice during endo-urological procedures. A rare complication in patients with ureteral stones where an iatrogenic submucosal tunnel (IST) is created during endoscopic guide wire placement. OBJECTIVE: Summarize data on IST. DESIGN: Retrospective descriptive study of patients treated from from October 2009 until January 2015. SETTING: King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. PATIENTS AND METHODS: Patients with ureteral stones were divided to 2 groups. In group I (335 patients), the ureteral stones were removed by ureteroscopy in one stage. Group II (97 patients) had a 2-staged procedure starting with a double J-stent placement for kidney drainage followed within 3 weeks with ureteroscopic stone removal. MAIN OUTCOME MEASURE(S): Endoscopic visualization of ureteric submucosal tunneling by guide wire. RESULTS: IST occurred in 9/432 patients with ureteral stones (2.1%). The diagnosis in group I was made during ureteroscopy by direct visualization of a vanishing guide wire at the level of the stone (6 patients). In group II, IST was suspected when renal pain was not relieved after placement of the double J-stent or if imaging by ultrasound or intravenous urography showed persistent back pressure to the obstructed kidney (3 patients). The condition was subsequently confirmed by ureteroscopy. CONCLUSION: Forceful advancement of the guide wire in an inflamed and edematous ureteral segment impacted by a stone is probably the triggering factor for development of IST. Definitive diagnosis is possible only by direct visualization during ureteroscopy. Awareness of this potential complication is important to guard against its occurrence. LIMITATIONS: Relatively small numbers of subjects and the retrospective nature of the study.

Scrotal Abscess, an Unusual Manifestation of Crohn's Disease.

Crohn's disease (CD) is a chronic inflammatory disorder of the alimentary tract, usually involving the ileum and proximal colon, which is sometimes associated with extra intestinal manifestations. Urologic complications of CD are rarely reported in literature. CD-related complications involving the urinary tract include infections and urolithiasis as the most common manifestations. Rare more serious occurrences associated with penetrating type disease include ureteral obstruction and enterovesical fistulization. Here, a rare case of CD complicated with a recto-scrotal fistula and the scrotal abscess is presented.

Prostatic diseases under focus in a university hospital in Eastern Saudi Arabia. A 15-year experience.

OBJECTIVES: To explore the spectrum of pathologies diagnosed in prostatic biopsies of Saudi men, and test whether the frequency of diagnosing the malignant fraction has been changed over the last 15 years, and assess the association between chronic inflammation (CI) with both benign prostatic hyperplasia (BPH) and cancer (PCa), and investigate the histological findings of cases presented with acute urinary retention (AUR) clinically. METHODS: This is a retrospective cohort study including all prostatic biopsies accessed in the files in the Surgical Pathology Laboratory of King Fahd University Hospital, Alkhobar, Kingdom of Saudi Arabia over 15 years (1999-2013) for Saudi men. Age, procedure indication, and final diagnoses were retrieved and slides were reviewed. RESULTS: There were 360 cases included in this study with a median age of 65 year-old. The BPH comprised the most (64.7%), while PCa accounted for 89 cases, 13.5% of which were incidental. Most cases of both BPH and PCa were diagnosed in the seventh decade. The frequency of diagnosing PCa did not show a solid rise or fall over time. Chronic inflammation is more related to BPH than to PCa. Only CI showed a significant statistical association with AUR. CONCLUSION: Prostatic diseases show a stable trend over time. While CI is a common dominator for both BPH and PCa, it is associated more with BPH. Among all histological findings, only CI is related to the clinical presentation of AUR.

Psoas Abscess Secondary to Urinary Tract Fungal Infection.

Psoas abscess is a rare condition where infection spreads from a nearby or distant septic focus to the psoas sheath. The causative bacterial organisms at distal sites reach the psoas via lymphatic or hematogenous spread, whereas infection from nearby sites that include the urinary system reaches the psoas directly. There are few reports that account for bacterial infection after endourological procedures as the cause of direct spread of infection to the psoas muscle.(2) We report a case of psoas abscess caused by fungal infection that spread from an injured left ureter to the psoas sheath.