Dietary protein intake and prostate cancer risk in adults: A systematic review and dose-response meta-analysis of prospective cohort studies.

OBJECTIVE: This study aimed to conduct a comprehensive systematic review and dose-response meta-analysis to summarize available findings on the associations between dietary protein intake and prostate cancer risk as well as the dose-response associations of total, animal, plant, and dairy protein intake with prostate cancer risk. METHODS: This study followed the 2020 PRISMA guideline. We conducted a systematic search in the online databases of PubMed, Scopus, ISI Web of Science, and Google Scholar to detect eligible prospective studies published to October 2021 that assessed total, animal, plant, and dairy protein intake in relation to prostate cancer risk. RESULTS: Overall, 12 articles containing prospective studies with a total sample size of 388,062 individuals and 30,165 cases of prostate cancer were included. The overall relative risks (RRs) of prostate cancer, comparing the highest and lowest intakes of total, animal, plant, and dairy protein intake, were 0.99 (95% CI: 92-1.07, I2 =12.8%), 0.99 (95% CI: 95-1.04, I2 =0), 1.01 (95% CI: 96-1.06, I2 =0), and 1.08 (95% CI: 1.00-1.16, I2 =38.1%), respectively, indicating a significant positive association for dairy protein intake (P = 0.04) and non-significant associations for other protein types. However, this positive association was seen among men who consumed ≥ 30 gr/day of dairy protein, such that a 20 g/d increase in dairy protein intake (equal to 2.5 cups milk or yogurt) was associated with a 10% higher risk of prostate cancer (Pooled RR: 1.10, 95% CI: 1.02-1.20, I2 = 42.5%). Such dose-response association was not seen for total, animal, and plant protein intake. CONCLUSION: Overall, dairy protein intake may increase the risk of prostate cancer in men who consumed > 30 gr/day of dairy protein. Larger, well-designed studies are still required to further evaluation of this association.

Bilateral same session renal stone surgery tolerance and complications.

INTRODUCTION: The prevalence rate of upper urinary tract calculi in Saudi Arabia is one of the highest globally. Bilateral renal stone management is an option but is still controversial. METHODOLOGY: The study was a retrospective study, including 31 patients with bilateral renal or ureteric stones who underwent bilateral same-session ureterorenoscopy (BSS-URS). The data collected included age, gender, body mass index (BMI), stone burden bilaterally, operative time bilaterally, hospital stay, stone location, type of anesthesia, stone history, renal anomaly as well as pre- and postoperative JJ stenting. In addition, data related to complications (ureteric injury, renal failure, urinary tract infection, pain requiring an emergency department visit within 1 week of the procedure), the stone-free rate (defined as £ 3 mm asymptomatic stone fragment identified with computed tomography Kidney, Ureter and Bladder 3 months after surgery was also collected. The data were collected from the electronic patient record system, entered in an Excel spreadsheet, and descriptive analysis was done. RESULTS: In total, 31 patients were included, with the majority (80.6%, n = 25) male. The mean age was 41.6 years, the mean BMI 28.7 ± 5.59, the mean operative time for each renal unit 46.53 ± 25.69 min, and the mean hospital stay 17.87 ± 8.43 h. The majority (96.7%, n = 30) received general anesthesia. Less than half (40.3%, n = 25) of the renal units had stones in multiple calyces and the majority (90.3%, n = 56) of the renal units were stone free at the 3-month follow-up. A small proportion (3.2%, n = 2) of the renal units were polycystic. Prestenting was documented in 40.3% (n = 25) of the renal units and the majority (95.2%, n = 59) were stented postoperatively. CONCLUSION: BSS-URS is a safe and a highly effective management option for bilateral renal stones.

Evaluation of the urology residency training program in Saudi Arabia: A cross-sectional study.

PURPOSE: This study evaluates the satisfaction of urology residents with the Saudi Board of Urology (SBU) Training Program and identifies areas of weakness and strength to improve the educational environment, surgical competency, and overall satisfaction of urology residents with the program. METHODS: We administered an electronic self-made questionnaire that included two sections. One comprised demographic data (age, gender, weight, height, marital status, level of training, city of training, and center of training), while the other concerned SBU evaluation (satisfaction with different aspects of training, such as ways of assessment, mentors' feedback, surgical competency, research, and strengths and weaknesses of SBU). RESULTS: The overall satisfaction of urology residency program was 28.8% while 44.2% of residents had a neutral response. The highest level of satisfaction with clinical and surgical practice was among graduates (56.9%) and Riyadh residents (45.1%). Furthermore, good work/life balance received the lowest level of satisfaction (5.2%) among senior residents, while good clinical experience received the highest level (62.7%) among the graduates. Residents reported a high exposure in endourology and pediatric urology, while transplant, reconstructive, and neurourology had the lowest exposure. Forty-two percent of respondents undertook research during their residency training, but most respondents (54%) did not publish any research papers during their training. Sixty-two percent of graduates felt that their training program did not prepare them adequately to perform well on the board examinations. CONCLUSION: Our results confirmed that satisfaction of residents with the urology program process is variable according to the city of training. Having high satisfaction level in some cities reflects the improvement of urology training program after restructuring. We identified new areas in need of improvement, namely lack of mentorship, clear and formal assessment process, and variation of training process between central and peripheral programs.

Ureteral intussusception: a case report and review of literature.

Ureterorenoscopy (URS) is a minimal invasive procedure used for diagnosis and management of the upper urinary tract. Due to the vast advancement in URS technologies, the efficacy and safety greatly improved with lower complication rates. Intussusception is a rare complication of URS. We report a case of iatrogenic ureteral intussusception that was managed with ileal interposition.

Impact of COVID-19 on Urology Practice in Saudi Arabia.

From the moment the World Health Organization (WHO) declared COVID-19 to be a pandemic disease, COVID-19 began to affect the lives of many healthcare providers worldwide. In response to this pandemic, urology departments and training residency programs implemented urgent measures to reduce outpatient clinics, adopted the use of telemedicine, regulated emergency and outpatient urological procedures, promoted the use of operating theatres, and developed the use of sustainable e-learning alternatives to traditional urology educational activities. We reviewed the response of urologists in Saudi Arabia to the COVID-19 pandemic and how they react to the emerging pandemic both for patients and for healthcare of urologist personnel.

Assessment of burnout among urology residents in KSA: A cross-sectional study.

OBJECTIVES: There is a shortage of urology residents in the KSA, and patients may have to wait for nearly three months to seek medical consultation with qualified urologists. According to the literature, urology residents face work-related burnout, which may affect the quality of health services provided to Saudi patients. This study aims to investigate the prevalence of work-related burnout among urology residents in KSA. METHODS: A cross-sectional survey was carried out among Saudi urology residents using the Copenhagen Burnout Inventory (CBI), which includes personal, work, and patient-related burnouts. The survey was electronically sent to urology residents registered with the Saudi Commission for Health Specialties (SCFHS). Data were analysed using the SPSS program. RESULTS: Of the 247 selected residents, 215 (87.04%) completed the questionnaire. Concerning personal burnout, 12.6% reported 'always feeling tired', 13% 'always physically exhausted', and 19.1% reported being 'always emotionally exhausted'. In addition, approximately 14% described the work as emotionally exhausting to a very high degree, while 18.6% added that they felt burnt out because of the work to a very high degree. According to the CBI, the mean personal burnout was 57.92, while the mean work-related burnout was 55.26. CONCLUSIONS: Urology residents in KSA suffer from a high degree of burnout, and urgent interventions are essential to make their work-life balance less exhausting.

Subcapsular double-J stent following ureteroscopy: unique complication.

Double-J (DJ) ureteral stent is a standard procedure in daily urological practice performed to relive ureteral obstruction or as a part of other endourological procedures. Although it is a common procedure, the widespread use of ureteral stents has corresponded to the increase in possible complication. We report a unique complication for a patient who presented with a renal subcapsular complete misplacement of DJ stent postureteroscopy for a distal ureteric stone. This challenging complication of ureteral stents is rare and organ threatening.

Submucosal stone formation after 14-years of polydimethylsiloxane (Macroplastique®) endoscopic subureteric injection for vesicoureteral reflux: Unusual presentation for a rare complication.

Polydimethylsiloxane (Macroplastique®) endoscopic subureteric implantation is considered to be safe and effective for vesicoureteral reflux (VUR) treatment. The Macroplastique® implantation is popular for its high success rate and minimal complications. A 22-years-old male who underwent prior subureteric endoscopic therapy with Macroplastique for VUR 14-years ago was investigated for microscopic hematuria. Renal ultrasound confirmed the presence stone that was retrieved by cystolitholapaxy. Although endoscopic subureteric implantation with Macroplastique has a high success rate for VUR resolution, caution during the follow-up period in order to prevent potential long-term complications is required.

Bilateral persistent sinus tracts formation post bilateral microsurgical inguinal varicocelectomy: A case report.

Varicocele is a common case encountered in urology practice accounting for 15-20% of the general population. We are reporting a rare case of infected inguinal wounds post bilateral microsurgical varicocelectomy which led to persistent bilateral wound sinus formation. After multiple bedside wound debridement and sinus tract excision in operation theater, the patient's wounds were healed. We advise managing post-operative subcutaneous collections very closely to avoid such complications. When it happens and wound debridement is planned, we advise not to leave any dead space behind via using fat flaps.

Efficacy of follicle-stimulating hormone as a treatment of severe idiopathic oligospermia: A retrospective study.

INTRODUCTION: About 15% of couples are infertile, with the male factor being responsible for about 50% of these cases of infertility. Idiopathic oligospermia (IO) is a dilemma that faces every andrologist and yet is one of the most common causes of male infertility. Although studies have shed some light on multiple treatment modalities and their effectiveness, one of the most fascinating ones is follicle-stimulating hormone (FSH). METHODOLOGY: This is a single tertiary center retrospective study; all patients with severe IO (sperm count of <5 million/ml) from January 2016 till January 2018 were included in the study. We divided our retrospective population into 2 groups, Group 1 who received FSH 75 IU (Menogon®) twice a week and Group 2 who received FSH 150 IU (Menogon®) twice a week. Semen parameters were recorded pretreatment and posttreatment. RESULTS: Number of the patients included in the study was 32. Group 1 included 16 patients who received FSH 75 IU. Group 2 included 16 patients who received FSH 150 IU. After 4 months of treatment, the mean sperm count in Group 1 increased to 4.745 million/ml (pretreatment was 1.235 million/ml), while in Group 2, it was 1.516 million/ml (pretreatment was 0.578 million/ml). The mean total motility in Group 1 was 20.3%, while Group 2 mean total motility was 27.5%. CONCLUSION: In conclusion, our study elicited that a dose of FSH as low as 75 IU can improve sperm count significantly in patients with severe IO.

Failure of ureteral access sheath insertion in virgin ureters: A retrospective tertiary care center study.

OBJECTIVE: The objective of the study was to identify the failure rate of insertion of ureteral access sheath (UAS) during primary flexible ureteroscopy (FURS). MATERIALS AND METHODS: This was a single-surgeon, single-tertiary care center retrospective study. All patients who underwent primary FURS for proximal ureteric or renal stones from November 2014 to May 2018 were included in the study. Patients with a stone burden of more than 20 mm were excluded from the study. A 10/12-Fr coaxial UAS (Bi-Flex, Rocamed) was used. Data collection included age, sex, body mass index (BMI), stone burden and location, previous spontaneous passage of stones, type of anesthesia, and preexisting congenital anomalies. The Chi-square test and t-test were used for the statistical analyses. RESULTS: One hundred and twelve patients were included in the study. All patients underwent primary FURS. The failure rate of primary UAS insertion was 10.7% (n = 12). No statistically significant difference was found in age, BMI, type of anesthesia, previous history of spontaneous stone passage, and stone burden between the success and failure groups (P > 0.05). CONCLUSIONS: We believe that our study opens the door for a multicentric prospective trial. Identifying factors leading to a failed primary FURS and UAS insertion is crucial to properly counsel patients preoperatively about the number of procedures that they might need and to prevent the financial loss associated with failed UAS insertion.

A 3-piece penile prosthesis salvage in the presence of late-onset infected hematoma: Clinical, radiological and intraoperative findings-A case report.

INTRODUCTION: Erectile dysfunction (ED) is a common health problem affecting 30% of young men worldwide. Despite the availability of non-invasive lines of management, penile prosthesis insertion is considered as a definite solution for ED. Despite strict perioperative measures, infection still complicates around 3% of penile prosthesis surgeries. PRESENTATION OF CASE: This is a case of a 36-year-old male who had an infected scrotal hematoma that led to prosthesis malfunction due to the inability to locate the pump to activate and deactivate the device. Intraoperatively, the prosthesis was salvaged after hematoma evacuation and ensuring a good device functionality. DISCUSSION AND CONCLUSION: Infected penile prostheses are usually either removed completely with a new device insertion a few months later or exchanged at the same setting with vigorous wound washout. We suggest salvaging penile implants which are surrounded by infected hematomas in selected patients who don't manifest systemic signs of infection. This approach will help in cost reduction and avoiding further intraoperative complications.

Stone fragments migration into subcapsular renal hematoma post flexible ureterorenoscopy (unique presentation).

This is a case report of 45-year-old female patient who presented with right flank pain. Abdominopelvic CT scan showed right renal pelvis stone measuring 20 mm. Right flexible ureterorenoscopy with holmium laser was performed in our institute. Postoperatively, she was febrile and pale. Immediate Abdominopelvic CT scan was obtained which revealed a large right subcapular hematoma. Conservative management was maintained for a week. Two months later, repeated Abdominopelvic CT scan showed regression of right subcapsular renal hematoma with stone fragments migration into the perinephric space as a first presentation in the world.

Assessment of lower calyceal single-access percutaneous nephrolithotomy for staghorn stones: A single-surgeon and a single-center experience at KAMC, Riyadh.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is still the mainstay and the treatment of choice for most complex renal stones. The success of PCNL is defined by achieving a stone-free rate (SFR). Lower calyceal access PCNL is established to be the safest percutaneous access to the renal system, but controversy is present when it comes to SFR in comparison to upper calyceal and middle calyceal accesses. AIM: We aim to prove that lower calyceal access PCNL is the safest PCNL access and has the same efficacy as upper calyceal access PCNL for staghorn stones. METHODOLOGY: All lower calyceal access PCNLs done from May 2012 to August 2017 were included in the study. Postoperative complications were reported using the modified Clavien Grading System. RESULTS: Sixty-seven patients were included in the study. The mean age was found to be 49.39 years; most (36 [53.73%]) patients were male. The prevalence of diabetes, hypertension, dyslipidemia, and chronic kidney disease was 40.91%, 47.76%, 37.31%, and 20.00%, respectively. The mean hospital stay was 7.9 days; mean operative time was 138.52 min. The mean staghorn stone burden was 476.34 mm2. About 80.59% (n = 54) of patients had complete stone resolution after the first session. Only 3 (4.47%) patients had complications and classified as Grade 2 on the modified Clavien Grading System and the remainder were classified as Grade 1, two patients needed postoperative blood transfusion, and one had a renal pelvis perforation. CONCLUSION: When it comes to safety and efficacy, the use of lower calyceal single-access PCNL has a very low complication rate compared to upper calyceal access PCNL, especially pneumothorax and bleeding.

Intra-scrotal testicular torsion of a classical seminoma in an elderly patient: a case report and literature review.

Intra-scrotal testicular torsion of a seminoma is extremely rare and has been reported scarcely in literature. On the other hand testicular torsion by itself is rare in old age as well. We report a 63-year-old male who was presented to our Emergency Department with a right scrotal swelling and pain for 1 week. The patient had intra-scrotal testicular torsion of a seminoma which was overlooked initially by Doppler ultrasound, progression of symptoms led to a computed tmomgraphy scan which showed a testicular torsion. Intra-operative findings showed a torsed right testis with completely engorged cord. Right radical orchiectomy was done and indecently histopathology revealed a classical seminoma. Urologist should be aware and more vigilant of testicular torsion as a presentation of malignancy in old age especially with the presence of diagnostic limitations.

Physician job satisfaction in Saudi Arabia: insights from a tertiary hospital survey.

BACKGROUND AND OBJECTIVES: Job satisfaction refers to the extent to which people like or dislike their job. Job satisfaction varies across professions. Few studies have explored this issue among physicians in Saudi Arabia. The objective of this study is to determine the level and factors associated with job satisfaction among Saudi and non-Saudi physicians. METHODS: In this cross-sectional study conducted in a major tertiary hospital in Riyadh, a 5-point Likert scale structured questionnaire was used to collect data on a wide range of socio-demographic, practice environment characteristics and level and consequences of job satisfaction from practicing physicians (consultants or residents) across different medical specialties. Logistic regression models were fitted to determine factors associated with job satisfaction. RESULTS: Of 344 participants, 300 (87.2%) were Saudis, 252 (73%) males, 255 (74%) married, 188 (54.7%) consultants and age [median (IQR)] was 32 (27-42.7) years. Overall, 104 (30%) respondents were dissatisfied with their jobs. Intensive care physicians were the most dissatisfied physicians (50%). In a multiple logistic regression model, income satisfaction (odds ratio [OR]=0.448 95% CI 0.278-0.723, P < .001) was the only factor independently associated with dissatisfaction. CONCLUSION: Factors adversely associated with physicians job satisfaction identified in this study should be addressed in governmental strategic planning aimed at improving the healthcare system and patient care.