Laparoscopic Partial Nephrectomy: Off-Clamp Versus on Clamp.

PURPOSE: The aim of this study is to describe our experience in laparoscopic partial nephrectomy and to compare the differences between off-clamp and on-clamp techniques in terms of clinical characteristics and outcomes. METHODS: A retrospective study was utilized. A purposeful sampling method was used to select the patients. The inclusion criteria for kidney tumors were as follows: exophytic, maximum diameter 3 cm, RENAL score 4 or more, solid or cystic, and suspected of malignancy. Around 32 participants were selected. The data were collected from patient files. RESULTS: There were no statistically significant differences between the mean of the off-clamp group and the on-clamp group in terms of tumor size, size of the kidney, and the position of the tumor. The average expected blood loss in the off-clamp group was 150.15 +/- 60.25 mL and in the on-clamp group was 75.25+/- 40.11 mL, with a p-value of less than 0.001. There was no statistically significant difference between the two groups in terms of the most common surgical complications, postoperative drainage, overall operation time, renorrhaphy time, and postoperative bedtime. CONCLUSION: The off-clamp group was shown to have a higher tumor resection duration as well as a higher rate of expected blood loss. The functional result of alterations in the estimated glomerular filtration rate seemed to be better in the off-clamp group. We expect to understand its long-term safety and oncological efficacy better as we continue to use this method.

New insights in treatment of monosymptomatic enuresis.

OBJECTIVE: Nocturnal enuresis (NE) is defined as uncontrollable bed-wetting for at least three consecutive months in children over 5 years. Sleep could be dramatically altered in children with primary nocturnal enuresis (PNE); consequently, this helps to confirm the assumption that PNE appears to modify sleep structure, or it might be the result of an irregular sleep structure itself. METHOD: This study conducted on 180 patients with monosymptomatic nocturnal enuresis. Their age was ranged from 6 to 18 years, and they were still having nocturnal enuresis episodes. We record two main points: first, if the child is a regular sleeper or not. The second point if the child is a regular bed wetter or not. This work fully compliant with the STROCCS criteria (Agha et al., 2019). RESULT: A total of 180 children were included (Male 122, 67.8%, Female 58, 32.2%). The mean age was 8.9 (±2.4). This study showed that children aged 7-10 years are significantly more inclined to be reported as specific time bed-wetter's, whereas those aged between 11 and 13 are significantly less likely to wet their bed at a specific time (p = 0.001). Children who tend to sleep more often near a specific time each night are 6.74 times more prone to bed-wet around a particular time during their sleep (p < 0.001). CONCLUSION: This study can be considered as hypothesis-generating that shed light on the possible correlation between the adherence to sleep at a specific time and its effect on the time of enuresis and the number of bedwetting.

Penile calciphylaxis diagnosis and treatment challenges a case report.

INTRODUCTION: Painful tip penile ischemic lesion that varies from ulceration to dry gangrene which is calcified in a patient with ESRD on chronic dialysis is a seriously complicated disease due to microvascular disease of subcutaneous and adipose tissue. CASE PRESENTATION: 72 gentleman who is on chronic dialysis for the last 8 years because of ESRD, In which he developed many vascular disease and amputation done for him presented with spreading black painful areas at the tip of the glans for which conservative treatment took place for about month. DISCUSSION: The diagnosis and management of this rare disease still unclear. Diagnosis mostly clinical, treatment conservative versus surgical. CONCLUSION: Controversies of for penile Calciphylaxis diagnosis and treatment for its rarity, high mortality rate, and as its part of systematic disease treatment till know individualized according to patient status and extent of the necrotic area.

Does severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) cause orchitis in patients with coronavirus disease 2019 (COVID-19)?

OBJECTIVES: To assess the prevalence of clinical orchitis in patients with coronavirus disease 2019 (COVID-19). PATIENTS AND METHODS: This was a retrospective clinical observational study using data of male patients who were admitted to hospital with COVID-19 confirmed by reverse transcriptase polymerase chain reaction testing between 1 March and 4 May 2020. Patients were categorised according to age groups and disease severity. Sociodemographic information and general clinical symptoms of COVID-19 and orchitis were collected. RESULTS: We identified a total of 253 male patients, with a mean (range) age 43 (1-78) years. Patients were followed-up until their recovery or for 21 days. We did not observe any symptoms or signs of orchitis in any patient during follow-up across all age groups and different disease status. CONCLUSION: Although we did not identify any patients with COVID-19 with symptoms or signs of orchitis, such an association cannot be excluded, and further studies are needed to validate our hypothesis and exclude any association at a molecular level. ABBREVIATIONS: ACE2: Angiotensin-converting enzyme 2; COVID-19: coronavirus disease 2019; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; HIV: human immunodeficiency virus; IRB, Institutional Review Board; ISH, in situ hybridisation; RT-PCR: reverse transcriptase-PCR; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; TMPRSS2: transmembrane protease, serine 2; WBC: white blood cell.

Urinary bladder pheochromocytoma managed with TURBT. Case report and review of literature.

Bladder pheochromocytomas are rare catecholamine-secreting tumours of chromaffin cells. Sympathetic system stimulation due to Catecholamine over secretion during micturation is the most common presentation. Unsuspected bladder pheochromocytoma can result in hypertensive crisis during transurethral resection of bladder tumor (TURBT). In contrast to the urothelial tumours, bladder pheochromocytomas are hypervascular on enhanced CT scan. In this article we report a case of pheochromocytoma managed successfully by TURBT and followed up for 1 year.

Common iliac artery aneurysm as a cause of massive hematuria post TURBT. Case report.

INTRODUCTION: Transurethral resection of bladder tumor (TURBT) is an outpatient simple procedure that aims to remove bladder masses. Bleeding post TURBT is usually minimal and resolve completely within days or weeks. Massive bleeding after TURBT for small bladder masses is unusual. In this article we will report a case of unexpected massive hematuria that occurred after simple TURBT. PRESENTATION OF CASE: A 69 patient who presented to our clinic complaining of intermittent painless gross hematuria. Ultrasound showed 1 cm bladder mass for which TURBT was done. On the 3rd post operative day the patient presented to ER complaining of massive hematuria and drop in hemoglobin. CT scan showed large left common iliac artery aneurysm which was managed using Endovascular graft repair (EVAR). DISCUSSION: Common iliac artery aneurysm is rare entity. Usually it is asymptomatic. However if it is large it can compress the perivesical vessels causing engorgement of these vessels that can manifest as massive hematuria after minimal endoscopic manipulation of the bladder. CONCLUSION: Massive hematuria after simple TURBT is unusual for urologists. If it happens it may indicates iliac aneurysm or vascular malformation.

External validation of Chun, PCPT, ERSPC, Kawakami, and Karakiewicz nomograms in the prediction of prostate cancer: A single center cohort-study.

OBJECTIVES: The aim of our study was to analyze the performance of 5 different risk calculators for prostate cancer diagnosis: Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC), European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSP-RC), Karakiewicz nomogram, Chun nomogram, and Kawakami Nomogram. METHODS: From 2008 onwards, we consecutively enrolled, at a single institution in Italy, men undergoing 12-core transrectal ultrasound-guided prostate needle biopsy. Demographic, clinical, and pathological data were collected. The risk of prostate cancer (PCa) was calculated according to the PCPT-RC, ERSPC-RC, Karakiewicz, Kawakami, and Chun nomograms. Calibration and discrimination were assessed using calibration plots and receiver operator characteristic analysis. Additionally, decision curve analyses (DCA) were used to assess the net benefit associated with the adoption of each model. RESULTS: Overall, 1,100 patients were evaluated, 39% presented PCa and out of them 26% presented high-grade PCa (defined as Gleason ≥ 4 + 3). All the models showed good discrimination capacities for PCa on receiver operator characteristic analysis (area under the curve: 0.59-0.72) On calibration curves the ERSCP, the PCPT and the Chun nomogram underestimated the risk of PC while the Kawakami overestimated it. At DCA, the net benefit associated with the use of the models in the prediction of cancer was observed when the threshold probability was between 40% and 60%. CONCLUSION: In a cohort of Italian men undergoing prostate biopsy, the performance accuracy of these calculators for the prediction prostate cancer is suboptimal. According to our experience the use of these calculator in clinical practice should be encouraged. Although integration with new serum/urine markers or magnetic resonance imaging results is warranted.

Young Academic Urologists' benign prostatic obstruction nomogram predicts clinical outcome in patients treated with transurethral resection of prostate: an Italian cohort study.

BACKGROUND: The aim of this study was to test the Young Academic Urologist nomogram for the prediction of transurethral resection of prostate outcome in patients with lower urinary tract symptoms and benign prostatic enlargement. METHODS: Between April 2014 and March 2016, a consecutive series of patients with lower urinary tract symptoms undergoing trans-urethral resection of prostate in one center were enrolled. At baseline patients were assessed with international prostate symptom score, prostate specific antigen, prostate volume, transitional zone volume, maximal urinary flow rate and post void residual urine. At 3 months after trans-urethral resection of prostate patients were evaluated with uroflowmetry and international prostate symptom score questionnaire. Maximum urinary flow and transitional zone volume were plotted on the Young Academic Urologist nomogram to predict trans-urethral resection of prostate outcome. Receiver-operator characteristics curve analysis was used to evaluate predictive properties of the nomogram for the outcome of transurethral resection of the prostate. RESULTS: A total of 232 patients were consecutively enrolled. Out of them, 149 patients (65%) presented a positive outcome. The novel Young Academic Urologist nomogram presented an area under the curve of 0.77 (95% CI: 0.70-0.83) for trans-urethral resection of prostate outcome prediction. At the best cut-off value of 75% (nomogram probability) the sensitivity was 62% and specificity was 73%, the positive predictive value was 81% and the negative predictive value was 52%. CONCLUSIONS: The Young Academic Urologist nomogram was, in our experience, an excellent tool to predict a positive outcome after transurethral resection of prostate, although further studies are needed to confirm our results.

Metabolic Syndrome Does Not Increase the Risk of Ejaculatory Dysfunction in Patients With Lower Urinary Tract Symptoms and Benign Prostatic Enlargement: An Italian Single-center Cohort Study.

OBJECTIVE: To evaluate the relationship between metabolic syndrome (MetS) and ejaculatory dysfunction (EjD) in patients with lower urinary tract symptoms and benign prostatic enlargement. MATERIALS AND METHODS: From 2012 to 2016, a consecutive series of men with lower urinary tract symptoms and benign prostatic enlargement who were attending our prostate clinic were evaluated using the International Prostate Symptom Score (IPSS) and were subsequently enrolled into a prospective database. All patients were assessed using the short form of the International Index of Erectile Function (IIEF-SF) and the Male Sexual Health Questionnaire ejaculatory dysfunction short form (MSHQ-EjD-SF) that evaluates the ability to ejaculate, the ejaculation force, the ejaculation volume, and subjective bother associated with EjD. MetS was defined according to the Adult Treatment Panel III criteria. RESULTS: A total of 220 patients were enrolled; 48 of 220 patients (22%) presented a MetS. Mean age was 70 ± 8 years, mean IPSS was 8.3 ± 6.2, mean IIEF score was 17.3 ± 7.9, and mean MSHQ-EjD-SF was 9.9 ± 4.7. Overall, 109 of 220 patients (50%) were affected by a moderate or severe EjD. On multivariate analysis, age (odds ratio [OR]: 1.058, 95% confidence interval [CI]: 1.016-1.123; P = .007), IIEF score (OR: 0.899, 95% CI: 0.856-0.943; P = .000), and IPSS (OR: 1.065, 95% CI: 1.011-1.123; P = .018) were found to be predictors of EjD. In our series MetS was not found to be predictive of EjD. CONCLUSION: In our single-center study, MetS has no influence on the EjD evaluated with the MSHQ-EjD-SF.