Investigation of risk factors in the development of recurrent urethral stricture after internal urethrotomy.

BACKGROUND: Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen. Although endoscopic methods are mostly used in its treatment, it has high recurrence rates. Therefore, open urethroplasty is recommended after unsuccessful endoscopic treatments. AIM: To investigate the risk factors associated with urethral stricture recurrence. METHODS: The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed. Demographic data, comorbidities, preoperative haemogram, and biochemical values obtained from peripheral blood and operative data were recorded. Patients were divided into two groups in terms of recurrence development; recurrence and non-recurrence. Initially recorded data were compared between the two groups. RESULTS: A total of 303 patients were included in the study. The mean age of the patients was 66.6 ± 13.6 years. The mean duration of recurrence development was 9.63 ± 9.84 (min-max: 1-39) months in the recurrence group. Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15 ± 24.07 (min-max: 12-84) months. In the comparison of both groups, the presence of diabetes mellitus (DM), hypertension (HT), and multiple comorbidities were significantly higher in the recurrence (+) group (P = 0.038, P = 0.012, P = 0.013). Blood group, postoperative use of non-steroidal anti-inflammatory drugs, preoperative cystostomy, cause of stricture, iatrogenic cause of stricture, location and length of stricture, indwelling urinary cathater size and day of catheter removal did not differ between the two groups. No statistically significant difference was observed between the two groups in terms of age, uroflowmetric maximum flow rate value, hemogram parameters, aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting blood sugar, creatinine, glomerular filtration rate, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, monocyte-lymphocyte ratio and AST/ALT ratios. CONCLUSION: In patients with urethral stricture recurrence, only the frequency of DM and HT was high, while inflammation marker levels and stricture-related parameters were similar between the groups.

Iatrogenic bladder neck rupture due to traumatic urethral catheterization: A case report.

BACKGROUND: In this article, we present a case of iatrogenic bladder neck rupture due to catheter insertion in a 94-year-old comorbid male patient. CASE SUMMARY: The patient, who had a urethral catheter inserted in the palliative service 3 d ago, was consulted because the catheter did not work. Because the fluid given to the bladder could not be recovered, computed tomography was performed, which revealed that the catheter had passed the bladder neck first into the retrovesical area then into the intraabdominal area. The appearance of the anterior urethra and verumontanum was normal at cystoscopy. However, extremely severe stenosis of the bladder neck, and perforated posterior wall of the urethral segment between the prostatic urethra and the bladder neck were observed. Internal urethrotomy was applied to the bladder neck with a urethrotome. An urethral catheter was sent over the guide wire into the bladder. The patient was followed in the palliative care service and the catheter was removed 7 d later. No extravasation was observed in the control urethrography. CONCLUSION: Although catheter insertion is a simple and frequently performed procedure in hospitalized patients, it is necessary to avoid unnecessary extra-indication catheter insertion.

Bladder stone due to late clip migration after prostatic urethral lift procedure: A case report.

BACKGROUND: Prostatic urethral lift (PUL) therapy is an alternative to minimally invasive and other surgeries in younger patients who want to preserve their sexual and ejaculatory functions, and in elderly male patients with benign prostatic hyperplasia who cannot be anesthetized because of the risk of anesthesia. The procedure can be performed as an outpatient and without anesthesia, and complications are few and temporary. In long-term follow-up, encrustations that require retreatment are rarely seen. CASE SUMMARY: In our case, a 62-year-old prostate patient who had a PUL operation 8 years ago and had a stone on the PUL material near the bladder neck was treated. The patient's stone was removed by endoscopic cystolithotripsy using pneumatic fragmentation. Bipolar transurethral resection of the prostate was applied to the patient in the same session. After the patient's 7-year follow-up, the patient's complaints relapsed, and cystoscopy was performed again. In cystoscopy, stone formation adjacent to the wall was observed at the junction of the bladder neck to the left lateral wall. The stone was fragmented with a pneumatic lithotripter. CONCLUSION: Placing clips too close to bladder neck in the PUL procedure may result in clip migration.

Carotid artery intima media thickness can predict the response to phosphodiesterase 5 inhibitors in patients with moderate erectile dysfunction.

Background: Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature. Aim: We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I). Methods: A total of 274 subjects were divided into two groups: ED patients (n = 150) and controls (n = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild-moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders. Outcomes: Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED. Results: Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group (P = .021, P = .006, and P < .001, respectively). The IIEF-5 score was significantly lower in the ED group (P < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders (P = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders (P = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682-0.921) (P = .001), and the cutoff value was determined to be 0.825 mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity. Clinical Implications: Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon. Strengths and Limitations: There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist. Conclusion: CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild-moderate ED.

The Impact of Ureteral Wall Thickness on Spontaneous Passage and Development of Long-term Ureteral Stricture in Patients with Ureteral Stone.

OBJECTIVE: To evaluate the association of ureteral wall thickness (UWT) with spontaneous passage (SP) of ureteral stones and formation of ureteral stricture (US) in patients who underwent ureterorenoscopy for ureteral stones. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Turkey, between January 2019 and June 2021. METHODOLOGY: One hundred and sixty-nine patients with ureteral stones were restrospetively reviewed for maximum stone diameter, stone density, degree of hydronephrosis, parenchymal thickness, and UWT measurement from CT images. The patients were divided into two groups; patients who had (group 1) and had not (group 2) undergone SP of ureteral stones. These two groups were compared for stone characteristics and UWT. Ureterorenoscopy was performed on 52 patients who did not experience SP. Data related to the passage of guide wire and radio-opaque material, drainage method, ureteral wall injury and patients who developed US were recorded. Ureterorenoscopy group were divided into two groups of patients who did and did not develop stricture. These two groups were compared for stone characteristics and perioperative findings. RESULTS: Of the 169 patients, 106 (62,7%) patients spontaneously passed stones. Ureterorenoscopy was performed on 52 patients. US developed in 9 (17%) patients. Maximum stone diameter, density, and antero-posterior (AP) diameter of the renal pelvis and UWT were statistically different between both groups. The degree of hydronephrosis, ureteral wall injury, density, AP diameter of the stones, parenchyma thickness, length of hospital stay, and UWT were found to be significantly increased in the stricture group. CONCLUSION: UWT is a simple measurement that can be used to predict SP of ureteral stones. It can also predict the development of US after ureterorenoscopy in long-term. KEY WORDS: Ureteral calculi, Ureterorenoscopy, Ureteral wall thickness, Ureteral stricture.

Has the COVID-19 Pandemic Affected Community-Acquired Urinary Tract Infections in Children?

PURPOSE: To evaluate whether there were any changes in the rates of urinary tract infection (UTI) and antibiotic resistance in pediatric patients during the pandemic period. MATERIALS AND METHODS: Urine culture samples collected due to suspected UTI were searched retrospectively from our hospital database, and the patients with growth in urine culture were identified. They were divided into 2 groups as Group A (before COVID-19, March 11, 2019- March 11, 2020) and Group B (COVID-19 period, March 11, 2020- March 11, 2021). Also, COVID-19 period was divided into 3 subgroups (March 2020- June 2020: first epidemic peak, July 2020 - November 2020: normalization process, December 2020- March 2021: second epidemic peak). We adjusted the patient age as <1, 1-6 and 7-18 years. Age, gender, microorganism strain types, and their antibiotic resistance patterns were compared between the 2 groups Results: This cross-sectional study included 250 eligible patients (Group A, n=182 and Group B, n=68) with a mean age of 10.91 ± 5.58 years. The male/female ratio was higher in Group B than in Group A (p = .004). Incidence of UTIs was lower in the curfew and restriction periods due to epidemic peaks than normalization process (p = .001). The proportion of E.coli decreased from 80.2% to 61.8% during the pandemic period when compared to pre-pandemic period (p = .001). Group B had lower rates of resistance to ampicillin, fosfomycin and nitrofurantoin for E.coli than Group A (p = .001, p = .012 and p = .001, respectively). Also, Group B had higher rate of uncommon microorganisms and lower rate of resistance to nitrofurantoin for E.coli than Group A in patients aged 7-18 years (p = .003 and p = .023, respectively). CONCLUSION: Our study demonstrates that the ongoing COVID-19 pandemic process has caused alterations in community-acquired UTIs in children. More hygienic lifestyle may be considered as the main factor in this change.

Can continuous positive airway pressure improve lower urinary tract symptoms and erectile dysfunction in male patients with severe obstructive sleep apnea syndrome?

PURPOSE: We aimed to investigate the effect of continuous positive airway pressure (CPAP) administered for the treatment of obstructive upper airway on lower urinary tract symptoms and erectile dysfunction in male patients. MATERIALS AND METHODS: A total of 626 male with suspected obstructive sleep apnea syndrome (OSAS) were evaluated prospectively. Nocturnal polysomnography tests were administered to the male. After application of the exclusion criteria, 54 patients with severe OSAS (Apnea-Hypopnea Index ≥30) were included in the study. International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-15), and nocturia were assessed in all patients before and after CPAP therapy, and prostate volume, total prostate-specific antigen (tPSA), and uroflowmetric measurements were assessed in patients aged >40 years. RESULTS: The mean age of the 54 patients was 47.06±11.15 years. Post-treatment IIEF scores were better than pre-treatment scores (24.27±7.58 vs. 22.68±8.65, p=0.014). IPSS values, nocturia, and uroflowmetric outcomes significantly improved after CPAP therapy (p<0.05). On the other hand, mean values of body mass index, tPSA, prostate volume, and postvoid residual urine volume did not differ significantly after treatment. CONCLUSIONS: CPAP therapy improves lower urinary tract symptoms, nocturia, and erectile dysfunction in male with severe OSAS.