Efficacy of varicocelectomy on semen parameters and conception rates.

Objective: Varicocele, the dilation of the pampiniform plexus of the spermatic cord. It is discovered incidentally in most patients. Symptoms vary, but its impact is especially experienced in the field of fertility and reflected in semen parameters. Varicocelectomy is a surgical approach to correct the varicocele, however, reports are conflicting regarding its success. Our aim was to evaluate the efficacy of varicocelectomy on semen parameters and conception rates in patients who underwent surgery and its association with comorbidities such as diabetes, hypertension, and obesity. Materials and Methods: This cross-sectional study included the complete medical records of 86 patients. Data collection form included the patient's age, body mass index (BMI), chronic diseases, smoking, surgical history, medication usage, and the reason for performing surgery. Presurgical and postsurgical semen parameters were evaluated 3 months before surgery and an average of 6 months postoperatively. Data were analyzed with SPSS, Chi-square test, and independent and paired t-test. Results: No significant difference was found between primary and secondary infertility regarding semen analysis, postoperative semen analysis indicated an improvement in semen motility at 180 min with no effect on other parameters. Using spontaneous intercourse or in vitro fertilization (IVF) after varicocelectomy was significantly associated with increasing conception rates irrespective of the type of infertility. Diabetes, hypertension, BMI, and smoking did not appear to affect semen parameters. Conclusion: Patients who underwent varicocelectomy had improved sperm motility at 180 min and subsequently had a higher chance of successful conception either through spontaneous intercourse or IVF. Further studies are needed to understand the relationship between conception and sperm motility. Semen parameters were not affected if the patient had comorbidities such as diabetes and hypertension. Furthermore, smoking and BMI did not appear to affect the conception rate.

A Retrospective Single-Center Study of Sevelamer Hydrochloride for the Treatment of Hyperphosphatemia in Children With Tumor Lysis Syndrome.

Introduction Tumor lysis syndrome (TLS) is a life-threatening metabolic abnormality. The incidence of TLS depends on the underlying malignancy. In a recent analysis of hematological malignancy, the incidence of clinical TLS in children was 3.8%, laboratory TLS 46.2%, and hyperphosphatemia 32.7%. Sevelamer is effective for the treatment of hyperphosphatemia associated with renal failure; however, there is no clear data that it has the same effect in treating hyperphosphatemia with TLS. Methods This was a retrospective study among children aged ≤14 years with hematological malignancy who developed TLS and received sevelamer to treat hyperphosphatemia at Princess Norah Oncology Center, King Abdulaziz Medical City (KAMC) in Jeddah from January 2012 to December 2016. Results A total of 34 patients received sevelamer. The majority was male (64%), with a median age of six years. The median sevelamer dose per day was 1600 mg, while the median duration of use was two days. Phosphate level was significantly decreased at different times (24 hours, 48 hours, and 72 hours) during sevelamer usage, p-value <0.001. Conclusion In our study, the use of sevelamer resulted in a significant decrease in phosphate levels. This finding further consolidates the efficacy of sevelamer in treating hyperphosphatemia with TLS. However, further research into the drug's kinetics is recommended.

Urolithiasis: Prevalence, risk factors, and public awareness regarding dietary and lifestyle habits in Jeddah, Saudi Arabia in 2017.

INTRODUCTION: Urolithiasis is a public health concern, yet there are limited studies in our community. This study aimed to provide a current estimate of the prevalence of urolithiasis and to evaluate the public's awareness about dietary and lifestyle habits that impact on urolithiasis among the Jeddah population in 2017. METHODS: This is an observational cross-sectional study design where a self-administered questionnaire was distributed in two major malls in Jeddah. The total number of participants was 2173, who were Saudis and non-Saudis aged 18 years and above. The questionnaire includes five sections: demographics, general information related to urolithiasis, dietary information related to urolithiasis, lifestyle habits, and medical conditions. RESULTS: The overall prevalence of urolithiasis was 11.2%, 48.8% of which had a family history with a first-degree relative. The odds of urolithiasis among males was 1.8 times higher than in females (odds ratio [OR] =1.8, 95% confidence interval [CI], 1.4-2.4). The median age of stone disease was 33 years (25%-75%: 26-42 years). Diabetic individuals were 3.2 times more likely to have urolithiasis when compared to nondiabetic individuals (OR = 3.2, 95% CI, 2.1-4.9). Low level of awareness was observed in this cohort group with a mean score of 37.7%; 64.1% of the population were in the low awareness level, 35.3% were in the medium level, and only 0.6% participants were in the high level of awareness. CONCLUSION: This study highlights the lack of public awareness about urolithiasis and knowledge about its causation despite the high prevalence. There is a clear need to inform and educate the public on matters relating to the known risk factors associated with urolithiasis.

Antibiotic prophylaxis in children with ureteric stents: Bliss or misery?

INTRODUCTION: The risk of urinary tract infection (UTI) in patients with a ureteric stent is influenced by several factors such as duration of stenting. Antibiotic prophylaxis has been previously used for the prevention of UTI in patients with common urological pathologies. The aims of this study were to evaluate the incidence, to identify the risk factors of symptomatic UTI in pediatric patients with ureteric stents, and to review the effectiveness of antibiotic prophylaxis in reducing the rate of symptomatic UTI compared to a no intervention (control) group. MATERIALS AND METHODS: This was a retrospective cohort study that was held at a tertiary hospital in Jeddah, Saudi Arabia. The study included 110 pediatric patients who were younger than 18 years and who required ureteric stent insertion. Disregarding gender difference, the patients were divided into two main groups: an antibiotic group and a control group. The patients in the antibiotic group (Group 1) received continuous antibiotic prophylaxis from the date of ureteral stent insertion until removal, while the patients in the control group (Group 2) received antibiotics during the perioperative period only. RESULTS: A total of 110 patients were included in the final analysis. Group 1 patients who were given antibiotic prophylaxis during the presence of ureteric stent were 54 patients (49%). Group 2 patients who were only given antibiotic during the perioperative period were 56 (51%). Males compromised 73% (n = 80) of the sample population, while females were 27% (n = 30). The prevalence of symptomatic UTI was significantly reduced from 25% in the control group to 7% in the antibiotic group (P < 0.004). CONCLUSION: Antibiotic prophylaxis has significantly reduced the risk of symptomatic UTI by 68% in comparison to the control group.

Role of tubularization of urethral plate in development of urethrocutaneous fistula post hypospadias repair.

INTRODUCTION: This study aimed to demonstrate the outcome of hypospadias repair in the pediatric population using the tubularized urethral plate technique and to compare the incidence of fistula between incised and unincised urethral plate. METHODOLOGY: This is a retrospective cohort study of pediatric patients who had hypospadias repair in a tertiary hospital in Jeddah, Saudi Arabia, between January 2000 and December 2012. They were divided into two main groups according to the status of the urethral plate: Group A included patients who had incision of the urethral plate just before tubularization, and Group B included patients who underwent tubularization without incision. RESULTS: After reviewing 310 medical records, 106 patients were included in the final analysis, with a median age of 2 years (interquartile range = 3 years). There was no statistically significant relationship between types of hypospadias and the development of fistula (P = 0.26). In Group A, we identified 87 patients (82%), and in Group B, there were 19 patients (18%). The overall incidence of fistula was 34.9% (n = 37). The incidence of fistula in Groups A and B was 36% (n = 31) and 32% (n = 6), respectively. This difference was not statistically significant. Despite a high fistula rate, only 12 patients (11%) were required to repeat surgery. CONCLUSION: Incision of the urethral plate did not affect the fistula rate. In comparison to international literature, the incidence of fistula was significantly higher which could be explained by the fact that one-third of those patients had a previous hypospadias repair.

Emphysematous pyelonephritis: Is nephrectomy warranted?

INTRODUCTION: Emphysematous pyelonephritis (EPN) is associated with high mortality rate, up to 25%. There is still conflicting reports regarding the most appropriate management, conservative versus nephrectomy. OBJECTIVE: To describe the outcome of patients with EPN. METHODS: We retrospectively reviewed the medical records of patients diagnosed with EPN by computed tomography from three tertiary institutes in Jeddah, Saudi Arabia. Type of management was classified as conservative and surgical. The conservative includes medical and minimally invasive procedures, such as percutaneous drainage and nephrostomy. The surgical which is nephrectomy. The outcome observed was preservation of the kidney function or patient's life. RESULTS: A total of 10 patients were included (9 females and 1 male), median age was 55 years and 63% were diabetic. The most common presentation was flank pain (100%), fever (75%), and vomiting (63%). The most common organism isolated was Escherichia coli. Nephrectomy was not associated with increased survival rate, while conservative management was associated with a good outcome, less morbidity (not dialysis-dependent). CONCLUSION: Nephrectomy was not associated with high survival rate. Patients managed conservatively had a better overall performance and better survival. This study will add to other studies, which are encouraging conservative management.