Safety and efficacy of en bloc renal hilum control during laparoscopic nephrectomy and nephroureterectomy: A single-center experience in Saudi Arabia.

Objective: The objective of the study is to evaluate the safety, efficacy, and long-term outcome of en bloc renal pedicle control during laparoscopic nephrectomy and nephroureterectomy. Patients and Methods: A total of 126 nephrectomies and nephroureterectomies that underwent en bloc renal pedicle control using the endovascular stapler (45 or 60 mm vascular reload) were retrospectively analyzed. Perioperative outcomes, including the risk of arteriovenous fistula (AVF), hospital stay, and estimated blood loss, were recorded. Complications were reported using Clavien classification. Results: En bloc pedicle control was employed in 126 laparoscopic nephrectomies and nephroureterectomies on 126 patients with a mean age of 55.7 years (range: 18-94) and a mean body mass index of 29.2 kg/m2 (range: 17-42). All laparoscopic nephrectomies were performed or supervised by one of three minimally invasive surgeons using identical surgical techniques, even in cases of multiple hilar vessels. During follow-up with a mean 23.3 months (range: 12-48), no patients presented with radiological or clinical signs of AVF (91 patients where followed up with either Doppler ultrasound, computed tomography with contrast, or magnetic resonance imaging for different indications). The mean operative time was 91.8 min (range: 45-215). Intraoperative blood transfusion was required in two cases. Diaphragmatic injury occurred in one case but was repaired laparoscopically. Open conversion occurred in two cases with severe colonic adhesions and injury, with one requiring primary repair, and the other managed with a colostomy. One patient developed fever; two patients developed paralytic ileus. Hospital stay mode was 5 days, ranging from 3 to 10 days. Conclusion: En bloc renal pedicle control during laparoscopic nephrectomies is safe with reasonable operative time, and there were no indications of AVF with this technique over the long term.

Urolithiasis and water intake in Saudi Arabia, is it a matter of quality or quantity?

Introduction: Urolithiasis is a significant problem with an increasing incidence and prevalence worldwide. Multiple factors such as water intake, climate change, dietary habit, and genetic factors can affect stone formation. Our aim is to clarify the relationship between water intake and urolithiasis in Saudi Arabia as a hot climate area. Methods: This cross-sectional internet-based survey was conducted in November 2017. Our study was performed using a standard web-based questionnaire using social media open to all internet users. We excluded the incomplete responses. Analysis of the data was then carried out using Chi-square test and SPSS package version 20. Results: We found a great response to our survey, where 9100 participants responded. Among the participants, 76.6% were females and 23.4% were males. The largest age group was between 18 and 30 years (60.8%). Of the participants, 842 (9.3%) had history of urinary tract stones. About 74.3% of the participants with a history of urinary tract stones were drinking <1 L/day of water in comparison with those who had no history of urinary tract stones who were drinking a minimum of 1.25 L/day in 55.1%. Regarding the type of water intake, there was no significant relationship between the type of water and the incidence of stones formation (P =0.096). The amount of water was significantly correlated with the urolithiasis (P = 0.000). Conclusion: We concluded that the amount of water intake per day significantly correlated with urolithiasis, and according to our study, the minimally accepted intake was ≥1.25 L/day. However, the type of water consumed has no statistically significant impact on stone formation.

Histopathological diagnoses and patterns in transrectal ultrasound-guided prostatic biopsy series from a large tertiary care center in Saudi Arabia.

AIM: The aim of the study was to report our transrectal ultrasound (TRUS)-guided prostatic biopsy histopathological diagnoses and clinical findings in our prostate cancer patients in a tertiary care center. METHODS: We have reviewed our TRUS biopsy series done in our department from January 2011 to December 2016. We reviewed our patient's prebiopsy prostate-specific antigen (PSA) findings and the histopathological diagnoses and determined the clinical and pathological features of prostate cancer patients in our series. RESULTS: A total of 398 patients underwent 12 core TRUS biopsies. Benign prostatatic hyperplasia was found in 48.5% of the patients and prostate cancer was found in 113 patients (28.4%). Among them, metastatic prostate cancer was found in 51.7% of them. High Gleason score (8-10) was found in 56.6% and a PSA of more than 20 was found in 63.3% of the patients. CONCLUSION: We recommend a mass public awareness program to encourage our patients to seek early prostate cancer screening and to alert the medical community to encourage more awareness of prostate cancer screening.

Vesical tumor within an inguinal bladder hernia: A case report.

Bladder herniation through the inguinal canal is a rare condition, accounting for only 1-4% of all inguinal hernias. Most patients are asymptomatic or have atypical symptoms. 65-year-old male who presented with gross hematuria, right inguinal swelling. Diagnosed preoperatively by CT scan to have bladder neoplasm within a right inguinal vesical hernia. Patient. Underwent TURBT and hernia repair. Inguinal bladder hernia is rare and occurs more commonly in obese male patients above 50 years of age. CT scan is the radiological modality choice to confirm the diagnosis prior intervention to avoid intraoperative complications such as bladder injury.

Does spontaneous renal hemorrhage mandate close surveillance for impending renal cell carcinoma? A case report and literature review.

INTRODUCTION: Renal cell carcinoma (RCC) classically presents as a triad of hematuria, loin pain, and a palpable mass. However, Renal cell carcinomas (RCCs) nowadays are more commonly present as incidental findings rather than symptomatic. Wunderlich syndrome is a rare first presentation of RCC. PRESENTATION OF CASE: We present a clinical case of spontaneous renal hemorrhage with unclear etiology that was treated with therapeutic embolization and was found to have renal mass after long follow up. DISCUSSION AND CONCLUSION: In regards to treating Wunderlich syndrome, some authors favor angioembolization and follow up. Others proposed radical nephrectomy in conditions with no apparent etiology and normal contralateral kidney because of the high incidence of small renal tumors. Spontaneous perinephric hematoma of unknown etiology should be followed up regularly with a CT image for concerning of impending renal tumor.