Trends in genitourinary cancer mortality in the United States: analysis of the CDC-WONDER database 1999-2020.

Introduction: Sociodemographic disparities in genitourinary cancer-related mortality have been insufficiently studied, particularly across multiple cancer types. This study aimed to investigate gender, racial, and geographic disparities in mortality rates for the most common genitourinary cancers in the United States. Methods: Mortality data for prostate, bladder, kidney, and testicular cancers were obtained from the Centers for Disease Control and Prevention (CDC) WONDER database between 1999 and 2020. Age-adjusted mortality rates (AAMRs) were analyzed by year, gender, race, urban-rural status, and geographic region using a significance level of p < 0.05. Results: Overall, AAMRs for prostate, bladder, and kidney cancer declined significantly, while testicular cancer-related mortality remained stable. Bladder and kidney cancer AAMRs were 3-4 times higher in males than females. Prostate cancer mortality was highest in black individuals/African Americans and began increasing after 2015. Bladder cancer mortality decreased significantly in White individuals, Black individuals, African Americans, and Asians/Pacific Islanders but remained stable in American Indian/Alaska Natives. Kidney cancer-related mortality was highest in White individuals but declined significantly in other races. Testicular cancer mortality increased significantly in White individuals but remained stable in Black individuals and African Americans. Genitourinary cancer mortality decreased in metropolitan areas but either increased (bladder and testicular cancer) or remained stable (kidney cancer) in non-metropolitan areas. Prostate and kidney cancer mortality was highest in the Midwest, bladder cancer in the South, and testicular cancer in the West. Discussion: Significant sociodemographic disparities exist in the mortality trends of genitourinary cancers in the United States. These findings highlight the need for targeted interventions and further research to address these disparities and improve outcomes for all populations affected by genitourinary cancers.

Facile synthesis of elastin nanogels encapsulated decursin for castrated resistance prostate cancer therapy.

Nanogels offer hope for precise drug delivery, while addressing drug delivery hurdles is vital for effective prostate cancer (PCa) management. We developed an injectable elastin nanogels (ENG) for efficient drug delivery system to overcome castration-resistant prostate cancer (CRPC) by delivering Decursin, a small molecule inhibitor that blocks Wnt/ßcatenin pathways for PCa. The ENG exhibited favourable characteristics such as biocompatibility, flexibility, and low toxicity. In this study, size, shape, surface charge, chemical composition, thermal stability, and other properties of ENG were used to confirm the successful synthesis and incorporation of Decursin (DEC) into elastin nanogels (ENG) for prostate cancer therapy. In vitro studies demonstrated sustained release of DEC from the ENG over 120 h, with a pH-dependent release pattern. DU145 cell line induces moderate cytotoxicity of DEC-ENG indicates that nanomedicine has an impact on cell viability and helps strike a balance between therapeutics efficacy and safety while the EPR effect enables targeted drug delivery to prostate tumor sites compared to free DEC. Morphological analysis further supported the effectiveness of DEC-ENG in inducing cell death. Overall, these findings highlight the promising role of ENG-encapsulated decursin as a targeted drug delivery system for CRPC.

Patient-physician communication in intercultural settings: An integrative review.

Background: Intercultural communication between physicians and patients is a prominent challenge faced by health sectors. This integrative review aims to explore and summarize the current literature examining the cultural factors impacting the communication experience of patients and physicians in healthcare settings and provide an evidence-based solution. Methods: We used Whittemore and Knafl's (2005) approach to conduct this integrated review of the literature. Primary research studies meeting the search criteria were accessed from Medline/PubMed, Embassy, CINAHL, PsycInfo, ProQuest, Scopus, Web of Science, and Cochrane Review. We included studies published in English from 2008 to 2022. A total of 1731 studies were identified, of which 34 articles were included in this review. Results: The findings revealed a difference in physicians' communicative behaviour when encountering patients from different cultural backgrounds compared to encounters with patients from the same cultural background. When communicating with patients from different cultural backgrounds, physicians were found to be authoritarian, biomedical-focused, and not involve patients in decision-making. Patients' behaviours during consultations and experience and perception of quality of care in intercultural consultations were varied and inconclusive. Often patients were found to exaggerate respect for physicians, feel uncomfortable with the direct communication style of physicians, have a less proactive attitude, demonstrate low health literacy, and feel shy. These behaviours were attributed to language differences, differences in perception of disease, perception of health communication, prejudice, assumptions, training experience of physicians, and time allocated for consultations. Further, ineffective communication in intercultural consultations was found to impact patient satisfaction, medical adherence, continuity of care, physician's job satisfaction, and ability to diagnose correctly. Conclusions: Effective communication plays a significant role in patient and physician satisfaction. Health policymakers must formulate appropriate policies that encourage expatriate physicians to develop intercultural competencies to enhance intercultural communication, improve satisfaction, quality decision-making, correct diagnosis, and enhance public health.

Women as Urologists in Saudi Arabia: Career Choice and Practice Challenges: A Comparative Cross-Sectional Study.

Background: There is limited research on whether women choose urology as a future career. Therefore, we aimed in this study to assess the influencing and challenging factors among female physicians in Saudi Arabia. Methods: We approached 552 female physicians, including 29 (5.2%) urologists and 523 (94.7%) non-urologists. A cross-sectional survey was carried out, which included five sections and 46 items to assess and compare the perspectives of (urologists and non-urologists regarding influencing factors to choose urology, challenges toward applying to urology, and challenges during and after urology residency. Statistical analysis was conducted using SPSS software. Responses were presented as frequencies and percentages, while associations were studied using the Chi-squared test/Fisher's exact test. A p-value of ≤ 0.05 was considered significant. Results: Out of 552 female physicians, 466 completed the survey. The survey items compared urologists and non-urologists among female physicians. Among both cohorts, the most influencing factors in choosing urology were the diversity of practice and urological procedures (p =0.002, p<0.001). There were no social barriers or challenges when applying for urology residency (p<0.001). Overall, the majority of female urologists reported a high level of agreement that they have more time to work at the clinic (55.2%), they are satisfied as they are currently being urologists (75.8%), satisfied with their current lifestyle (72.6%). They would choose urology again as a future career (58.6%). Non-urologist female physicians 326 (74.6%) think they are more likely to have experienced gender discrimination than urologists 15 (51.7%) (p<0.001). Female urologists were less likely to face social barriers when applying for urology residency than non-urologists (p<0.001). Conclusion: As urologists, we must understand women's struggles, such as gender discrimination, a lack of academic advancement, and a lack of mentorship. To foster women's careers in urology, we must understand their unique needs, provide adequate mentorship, exterminate gender discrimination bias, and improve mentorship.

Hypothesis and Holistic Knowledge of Testicular Torsion Among the General Population of the Kingdom of Saudi Arabia.

Background Testicular torsion is a serious condition that requires immediate medical attention. It occurs when the spermatic cord, which carries blood to the testicles, twists, reducing blood flow and oxygen to the testicle. This can lead to tissue death and loss of the testis if not treated promptly. It is important to seek medical attention immediately when symptoms of testicular torsion arise, as prompt treatment can help prevent permanent damage to the testicle. This study aimed to explore the level of knowledge about testicular torsion among the general population in the Kingdom of Saudi Arabia. Methodology A descriptive cross-sectional study was conducted using a convenience sample recruited from the general population who fulfilled the inclusion criteria. The data were collected from participants using an electronic pre-structured questionnaire. The researchers developed the questionnaire through expert consultation and after an intensive literature review. The questionnaire was reviewed by a panel of three experts for validation and applicability. After a pilot study, the reliability coefficient (Cronbach's alpha) was 0.74. The data were analyzed using SSPS version 25 (IBM Corp., Armonk, NY, USA) and presented as percentages and frequencies. Chi-square and logistic regression were conducted. P-values ≤0.05 were considered statistically significant. Results A total of 732 participants were recruited, most of whom were male (486, 66.4%), with ages ranging between 18 and 30 years (452, 61.7%). Regarding testicular torsion knowledge, more than half of the participants had good knowledge (406, 55.5%) and knew about the signs, symptoms, and risk factors of testicular torsion. There was a statistically significant relationship between age and knowledge (p < 0.001) and an insignificant relationship between sex and knowledge (p > 0.05). Conclusions The study participants were found to have good knowledge. Fortunately, most participants knew that testicular torsion is an emergency and they must immediately visit the hospital. With further awareness programs, the overall knowledge level can be improved.

The impact financial resources on implementation of large-scale electronic health records in the Saudi Arabia's primary healthcare centers: Mixed methods.

Introduction: There is worldwide demand for the implementation of electronic health systems and a transformation to electronic transactions in healthcare organizations. This move to e-health transformation stems from the perceived positive impact that e-health systems have in improving the quality of healthcare and, in turn, reducing expenses. Despite this, more than half of previous Electronic Health Record System (EHRS) implementation projects have failed due to several barriers and challenges such as cost. Aim of the study: To evaluate the impact of financial resources (FR) on the implementation of the EHRS in PHCs in SA. Methods: A mixed methods approach was implemented. SPSS and AMOS-SEM are used to test reliability and validity and hypotheses. Thirty-one (59%) out of 51 policy makers at the MoH filled and returned the questionnaire while 13 policymakers were interviewed using semi-structure interviews. Results: Results revealed that both measurement model and structural models met the threshold. All scales are found reliable and valid. Furthermore financial resources have positive impact on EHRS implementation. Findings from both studies show that financial resources have a very positive impact to facilitate large-scale EHRs implementation and overcome barriers that may lead to the failure of the project.

Effect of COVID-19-Induced Stress among Males on the Partner Relationship and Sexual Activity during COVID-19 Pandemic: A Cross-Sectional Study.

Introduction: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, there have been some reports regarding the impact of COVID-19 on male psychosexual health. Aims and Objectives: To assess the severity of stress during COVID-19 and to determine the association of stress levels with partner relationships and sexual activity. Methodology: A cross-sectional study was conducted in Saudi Arabia through social media platforms via an online questionnaire between 1 December 2020 and 31 January 2021 among 871 participants after a pilot study among 20 participants, of which 497 were included in the study. Stress levels were assessed using the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-21). Statistical analysis was conducted using SPSS version 20.0. Responses were presented as frequencies and percentages, and associations were studied using the Chi-squared test/Fisher's exact test. A value of p ≤ 0.05 was considered significant. Results: A total of 497 participants who had been infected with COVID-19 completed the survey. In total, it was found that 203 (40.8%) had severe stress scores (severe and extremely severe scores merged), while 131 (26.4%) had moderate stress scores. About 84 (16.9%) participants agreed that their sexual desire decreased, 91 (18.1%) confirmed their sexual intercourse frequency decreased, and sexual satisfaction decreased in 76 (15.3%). A significant positive correlation was found in that those who disagreed with having a good sexual relationship tended to have severe stress (p < 0.001). Conclusion: There were increased levels of stress during the lockdown period, which impacted psychosexual health.

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.

A Qualitative Investigation of Factors Affecting Saudi Patients' Communication Experience with Non-Saudi Physicians in Saudi Arabia.

(1) Background: Communication is the main issue between the patient and physician. Communication gaps lead to medical errors, mistakes, and wrong diagnoses and treatments. It would certainly be a cause of patient dissatisfaction, the physicians' job dissatisfaction, and the increase in the cost of health services. (2) Objectives: The objective of the study was to explore the perception of Saudi patients when they meet non-Saudi consultants at hospitals. (3) Material and Methods: This study is exploratory in nature. Semi-structured face to face interviews were conducted. Study participants were patients from the outpatient department of the Hospitals of Qassim province, Saudi Arabia. A total of eight respondents, four male and four female, participated in the study. (4) Results: Interviews were transcribed verbatim and analyzed using a thematic analysis approach. Two main themes emerged: the first theme is encountering difference, with three sub-themes, while the second one is the absence of partnering, with four sub-themes. (5) Conclusions: The analysis of the patients' experiences of their medical encounters revealed that the effectiveness of the physician-patient communication was jeopardized by two challenges: encountering differences and the absence of partnering. (6) Limitations: This study was conducted in one site only and hence findings must be tested in application to other sites in other parts of Saudi Arabia and in other similar countries. A further limitation of this study was the cultural barrier that was encountered by the researcher during the interview process.

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.

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.

Burnout and depression among psychiatry residents during COVID-19 pandemic.

Very few studies have been concerned with assessing the prevalence of burnout and depressive symptoms, especially during an infectious outbreak on non-frontline health care workers, such as a psychiatrist. In such instances, the role of psychiatrists and other mental health providers as a source of psychological support to the public and frontline workers is indispensable and valuable. This study aims to assess the prevalence of burnout and depressive symptoms, and their correlation, during the COVID-19 pandemic among psychiatry residents in Saudi Arabia. A total of 121 out of 150 psychiatry residents in Saudi Arabia completed the Maslach Burnout Inventory and Patient's Health Questionnaire for the assessment of burnout and depressive symptoms. Burnout symptoms were found in 27.3%, and another 27.3% reported having depression symptoms. In addition, 16.5% reported having both burnout and depressive symptoms, with a significant relationship between them. Participants in the first 2 years of training and having a history of receiving mental health treatment in the past 2 years were at higher risk. The need is urgent to increase investment in mental health services and to construct a plan to reduce this risk of burnout and depression among psychiatrists by developing preventative strategies to prevent burnout and promote wellness is more important than ever.

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.

Factors Associated with Varicocele Recurrence After Microscopic Sub-Inguinal Varicocelectomy.

PURPOSE: This study has been conducted to identify the rate of varicocele recurrence in patients who underwent microscopic subinguinal varicocelectomy at our center. We also aimed to determine the contributing factors to varicocele recurrence. PATIENTS AND METHODS: A total of 34 married male patients who underwent microscopic sub-inguinal varicocelectomy were retrospectively included in this study. The medical records of recruited patients were reviewed. The diagnosis of varicocele was based on physical examination, while recurrent varicocele was diagnosed based on both physical examination and colored doppler ultrasound. We investigated contributing factors to varicocele recurrence, including demographic characteristics (such as body mass index), clinical (varicocele grade and size of dilated veins), and laboratory data (semen analysis). Patients were followed up at 3 and 6 months after surgery. RESULTS: The mean age of patients was 32.53 years. The majority of patients had left-sided varicocele (70.6%) and underwent surgery due to scrotal pain (82.4%), with a mean operation duration of 92 minutes. Left-sided varicoceles were grade II in 51.7% of patients, while right-sided varicoceles were grade II in 16.1% of patients. Recurrence occurred in 2.9% after 3 and 6 months. Pain recurred in 8.8% and 10.5% of patients at 3 and 6 months, respectively. Pregnancy rates were 44.1% at 3 months and 11.8% at 6 months after surgery. The grade of varicocele (P = 0.24) and the size of the left dilated vein (P = 0.002) was significantly associated with recurrence. CONCLUSION: There was a significant association of advanced grade on the left side and large vein diameter before and after surgery with an increased rate of recurrence; however, due to the small sample size of our study, more and larger studies are still warranted.

Small Ureteral Access Sheath in Treating Paediatric Urolithiasis: A Single Centre Experience.

INTRODUCTION: Urolithiasis is not commonly encountered in the pediatric population. The adoption of ureteral access sheaths (UAS) facilitates the passage to the pediatric ureter and limits the harm and ureteral injury. However, the debate continues regarding whether or not to use UAS in children. OBJECTIVE: To assess the safety and outcomes of using UAS in the treatment of pediatric renal and ureteral stones. STUDY DESIGN: This was a prospective cohort study of 14 pediatric patients who underwent flexible ureteroscopy (fURS) with the use of UAS for symptomatic renal and ureteric stones. RESULTS: Of the fourteen enrolled patients, nine (64.3%) were males, and five (35.7%) were females with an average age of 9.5 years. Eleven (78.6%) of the patients were rendered stone-free. The average operative time was 55.7 min. None of the patients developed any complications. The stone-free rate was significantly higher with stone burdens of ≤10 mm (p ≤ 0.05). CONCLUSION: The use of UAS in children facilitates the passage of a flexible ureteroscope without complications. The procedure is considered to be efficient and safe with minimal morbidity.

Testicular fibrothecoma: A case report and literature review.

Sex cord Stromal are neoplasms containing granulosa, Sertoli, and Leydig cells. The problem usually occurs among females that are hormonally active and is associated to Gorlin-Goltz syndrome. The present study reports a 37-year-old male was referred to Urologist due to a firm right testicular mass for which orchiectomy was performed. Tumor markers were all within normal range. Histopathological examination revealed compact spindle tumor involving the rete-testis in keeping with pure fibrothecoma. The results of the given study are valuable for medical professionals related to the field of urology and pathology.

Study Habits of Urology Residents in Saudi Arabia: Identifying Defects and Areas for Curricular Development - A Trainee-Based Survey.

PURPOSE: This study evaluated the study habits of Saudi urology residents throughout their residency training. It examines the study time and quality of study materials used by Saudi urology residents and identifies ways to maximize study benefits. PATIENTS AND METHODS: An online questionnaire was distributed to 152 registered residents in regions throughout Saudi Arabia (response rate: 93.4%). The questionnaire addressed study habits throughout training, motivations for studying, preferred study resources, impressions on teaching quality, study preparation methods, and exam preparedness among junior and senior residents. RESULTS: Among all residents, 37.3% read for 2-5 hours weekly. Juniors read significantly more than seniors (P = 0.034). Marital status affects seniors' study habits (P = 0.029). For most seniors, preparation for the final board exam is the greatest motivation for studying (P = 0.006). The AUA/EAU guidelines were useful information source for seniors (P = 0.001). Fifty-four percent (54.4%) of residents felt that their residency program did not provide protected study time prior to the board exams. Moreover, the majority (64.8%) felt that the training program did not adequately prepare them for the board exams. CONCLUSION: We recommend that local program directors implement more effective teaching methods. Structured reading habits and specific study materials were found to be positive predictors of successful performance. Residents should also be educated in balancing working hours, social life, and study.

Bladder stones in a closed diverticulum caused by Schistosoma mansoni: A case report.

BACKGROUND: Genitourinary (GU) schistosomiasis is a chronic infection caused by a parasitic trematode, with Schistosoma haematobium (S. haematobium) being the prevalent species. The disease has a variable prevalence around the world, with a greater burden on, but not limited to Africa, South America, Asia, and the Middle East. CASE SUMMARY: We report the case of a 30-year-old man who presented with symptoms of bladder stones. During endoscopic cystolithalopaxy, we did not detect any stones in the bladder. Upon careful scanning of the urinary bladder trigone, sandy patches were detected. We performed endoscopic resection, which revealed a closed diverticulum with bladder stones. The diverticular wall was sent for histopathology and revealed features of chronic granulomatous inflammation with numerous embedded Schistosoma eggs, with some of the eggs having lateral spines. The patient was treated with praziquantel, and his symptoms completely resolved. CONCLUSION: GU schistosomiasis is primarily caused by S. haematobium. However, Schistosoma mansoni mediated GU schistosomiasis is unusual, making this a quite interesting case.

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.

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.