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Este mes en... Urology Annals:

  • The impact of surgical hemorrhoidectomy on male sexual function: A preliminary study
    Alsayed Saad Abdelaziz, Ayman Mohammed Ghoneem, Emad Ades Elewesy

    Urology Annals 2019 11(3):235-240

    Introduction: Erectile dysfunction (ED) is a highly prevalent condition among men all over the world and commonly associated with undiagnosed medical diseases as chronic pelvic pain and hemorrhoid. Objective: The purpose of this study was to study the impact of surgical hemorrhoidectomy on sexual function in men with erectile dysfunction (ED). Materials and Methods: In a prospective manner, we studied the effect of surgical hemorrhoidectomy on erectile function (EF) in male patients with ED. Hemorrhoidectomy was carried out in 82 patients with clinical hemorrhoid associated with ED (Group 1) and compared with 81 patients without operative intervention (Group 2; control). The primary efficacy variable was the mean change in the International Index of Erectile Function (IIEF) questionnaire. Results: In Group 1, the IIEF questionnaire increased significantly after hemorrhoidectomy, from 15.56 to 27.37 (P < 0.001), indicating improvement of EF. Thirty-six patients (41.1%) showed improvement of EF compared to 5.3% in the control group (P < 0.001). In Group I, but not in Group II, IIEF values increased significantly when compared with preoperative values (P < 0.001). Conclusion: We concluded that surgical hemorrhoidectomy is clearly related to improvement of EF in male hemorrhoid patients with ED.
  • Blunt renal trauma in pediatric population
    Basim Saleh Alsaywid, Muneera Yousef Alkhashan, Mahmoud Hussein Alrimawi, Nuha Mansour Abu-Alsaud, Hussein Mahmoud Al-Rimawi

    Urology Annals 2019 11(3):241-246

    Aims: This study aims to evaluate the magnitude and impact of renal trauma among pediatric population and to assess the effectiveness of conservative versus operative management. Subjects and Methods: All pediatric patients (age <18 years) with blunt renal trauma, who presented to King Khalid National Guard Hospital in Jeddah between January 2000 and December 2012, were retrospectively reviewed. Medical records were reviewed for demographics, mechanism of injury, length of hospital stay, grade of renal trauma, hematuria, renovascular injuries, associated nonrenal injuries, conservative versus operative management, renal outcomes, and complications. Results: Fifteen children with a blunt renal injury were identified, of which 14 met data inclusion criteria. The renal injury population had a mean age of 12.7 years (standard deviation 4.6) and was 85.7% male. The renal injuries were distributed as follows: Grade 1, n = 3 (21.4%); Grade 2, n = 3 (21.4%); Grade 3, n = 3 (21.4%); Grade 4, n = 3 (21.4%); and Grade 5, n = 2 (14.2%). Macroscopic hematuria was present in 64.3% of children. The median hospital length of stay was 13 days. Eleven children (78.5%) had traumatic injuries in multiple organs. Overall, 10 children (71.4%) were managed conservatively. Four children (28.5%) with high-grade trauma required operative intervention. Renovascular injuries were found in 4 cases (80%) of high-grade renal injuries. Conclusions: Conservative management of kidney injuries was highly successful in children with low-grade renal trauma. Furthermore, operative intervention in high-grade renal injuries proved to be successful and had good renal outcomes. Renal preservation was achieved in 92.8% of cases.
  • The medium- to long-term functional outcomes of women who have had successful anatomical closure of vesicovaginal fistulae
    Mandeep Grewal, Mahreen Hussain Pakzad, Rizwan Hamid, Jeremy Louis Ockrim, Tamsin Jillian Greenwell

    Urology Annals 2019 11(3):247-251

    Context: While much has been published on vesicovaginal fistula (VVF), little is known about the urinary, bowel, and sexual functional outcomes following successful anatomical closure. Aims: We assessed the medium- to long-term urological, sexual, and bowel function outcomes following the successful anatomical closure of VVF. Patients and Methods: We conducted interviews with 36 women (median age – 47.5 years) who had successful anatomical closure of their VVF (28 vaginally and 8 abdominally) with a median of 40.5 months earlier. All completed validated questionnaires on urinary (Urogenital Distress Inventory-6 [UDI-6] and Incontinence Impact Questionnaire-7 [IIQ-7]), bowel (low anterior resection syndrome [LARS] score), and overall function (EQ5D). Sexually active patients completed the pelvic organ prolapse/ urinary incontinence sexual questionnaire (PISQ-12). All women also completed these questionnaires retrospectively for their status immediately before VVF repair. Functional outcomes were compared with preoperative function, and outcomes of those women having vaginal repair were compared with those having abdominal repair. Statistical analysis was by Student's t-test and Mann–Whitney U-test. Results: Median UDI-6 and IIQ-7 scores (low score is better) reduced significantly (P ≤ 0.01) from 16.5 and 25.5 preoperatively to 4 and 2.5 postclosure. Median LARS score was not significantly altered. Sexual function was restored in 67.6% while overall function postclosure was good (PISQ12 – low score better). Both EQ5D (low score better) and health thermometer (high score better) medians were significantly improved (P < 0.01) from 9 and 25 to 6 and 75 postclosure, respectively. There was no significant difference in the medium- to long-term outcomes of women who had had vaginal repair of their VVF and those who had had abdominal repair. Conclusions: Successful repair of VVF results in medium- to long-term significant improvement in urinary symptoms and distress, general well-being, and quality of life with no long-term adverse effects on bowel function regardless of route of repair. Sexual function is restored in 67.6%.
  • Peyronie's disease is common in poorly controlled diabetics but is not associated with the Metabolic Syndrome
    Mohamad Habous, Ibraheem Malkawi, Esther Han, Mohammed Farag, Gordon Muir, Osama Abdelwahab, Mohammed Nassar, Saad Mahmoud, Richard Santucci, Saleh Binsaleh

    Urology Annals 2019 11(3):252-256

    Purpose: The purpose of the study is to investigate if metabolic syndrome (MS) and other comorbidities are associated with Peyronie's disease (PD). Methods: A total of 1833 patients retrospectively investigated and divided into two groups: Group A – PD patients (n = 319) and Group B – non-PD patients (n = 1303). The two groups were fully evaluated for diabetes mellitus (DM) with the glycated hemoglobin (HbA1c), hypertension (HTN), dyslipidemia (DL), obesity by measuring body mass index, total testosterone (T), penile vascular circulation measuring Peak systolic velocity (PSV) as indicator of arterial supply, end-diastolic velocity (EDV) as indicator of venous output, and finally, smoking. Results: The presence of diabetes was significantly correlated with PD (P = 0.005). Patients with diabetes had a 7% higher incidence of PD. However, patients with the highest HbA1c level of >8.5 had an increased odds ratio of 1.6 (P = 0.025, confidence interval [CI] =1.061–2.459) of having PD. Increased age was significantly correlated with PD (P = 0.025). For each year of life, the likelihood of having PD increases by an odds ratio of 1.019, or 2% per year (P = 0.001, CI = 1.004–1.027). Unexpectedly, DL (P = 0.006) and smoking (P = 0.041) were associated with lower incidences of PD. Patients with DL or smoking had a 5%–7% lower incidence of PD with an odds ratio of 0.6 (P = 0.006, CI = 0.410–0.864). HTN (P = 0.621) and the total number of comorbidities (P = 0.436) were not correlated with PD. Mean serum T values were statistically (P = 0.43) but not clinically significant among patients with Peyronie's versus patients without Peyronie's (4.62 vs. 4.38 ng/ml). Neither low PSV (Fisher's exact test P = 0.912) nor abnormal EDV (Fisher's exact test P = 0.775) was correlated with the finding of PD. Conclusions: While MS was not associated with PD, diabetes, particularly poorly controlled diabetes, was associated with an increased rate. Further research into the interaction of PD and metabolic disease is warranted.
  • Outcome of early experience of miniperc technique in pediatric age group
    Ehab Mohamad Galal, Amr Abdelhamid, Tarek Fath El-Bab, Ahmed Ali, Ahmad Anwar, Ahmed Abdelbary, Akrm A Elmarakbi, Mohamed H Abdelhamid, Ehab Tawfiek

    Urology Annals 2019 11(3):257-260

    Background: The aim of this study is to report our experience with the Miniperc technique for treatment of renal stone in pediatric age group. Materials and Methods: From August 2012 to January 2015, 34 patients aged <15 years with renal stones <3 cm underwent Miniperc technique were included in our study. The procedure was done through 14 Fr sheath using 8/9.8 Fr semi-rigid ureteroscope, holmium laser, and pneumatic lithotriptor for stone fragmentation. Stone-free rate (SFR), operative time, hospital stay, and complication rate were evaluated. Results: A total of 34 Miniperc techniques were performed on children with a mean age of 8.8 ± 3.7 years. Stone size varied from 18 to 30 mm (mean 23 mm). Mean operative time was 50 min. The mean hospital stay was 48±12 hours. The overall SFR was 82.4% which increased after secondary procedures to 94%. Two postoperative complications recorded in the form of sepsis and bleeding that required no blood transfusion. Conclusion: Our initial experience concluded that Miniperc technique is a safe and effective treatment option for renal stones in pediatric population.
  • Chronic scrotal pain: A variable symptom of interstitial cystitis/bladder pain syndrome
    Philip Christian Bosch, C Lowell Parsons

    Urology Annals 2019 11(3):261-264

    Objective: Treatment of chronic idiopathic scrotal pain is a dilemma and challenge. Many men with this condition undergo multiple therapies and surgeries with no improvement in their symptoms. Patients with interstitial cystitis/bladder pain syndrome (IC/BPS) have a variable clinical presentation and initially complain of only one symptom of urinary urgency, frequency, or pain. We report on patients with chronic idiopathic scrotal pain treated with standard therapy for IC/BPS. Patients and Methods: Patients with chronic idiopathic scrotal content pain were evaluated, determined to have chronic idiopathic scrotal content pain, and were treated with either pentosan polysulfate sodium (PPS) or bladder instillations of alkalinized lidocaine and heparin. Results: Sixteen males were determined to have chronic idiopathic scrotal pain. Eight males received PPS and eight males received a bladder instillation of alkalinized lidocaine and heparin. All patients had improvement of their scrotal pain to a self-reported acceptable level. Conclusions: Chronic idiopathic scrotal pain may be one of the variable presenting symptoms of IC/BPS. This scrotal pain may actually be referred pain from the bladder. Standard therapies for IC/BPS may be a treatment option for chronic idiopathic scrotal pain.
  • The effect of closure versus nonclosure of lingual mucosa graft harvest site on postoperative morbidity in augmentation urethroplasty: A comparative study
    Anil Gulani, Sher Singh Yadav, Vinay Tomar, Shivam Priyadarshi, Vivek Kumar Singh

    Urology Annals 2019 11(3):265-269

    Objectives: The objective of this study is to compare postoperative morbidity of closure versus nonclosure of the lingual mucosa graft (LMG) harvest site in augmentation urethroplasty. Materials and Methods: From January 2015 to November 2016, a total of 42 patients who underwent LMG urethroplasty randomized in 2 groups. In Group 1, donor-harvesting site was left open while in Group 2, donor site was closed. Self-made questionnaires were to assess postoperative pain, difficulty in tongue protrusion, swelling and numbness in graft harvest site, speech impairment, and difficulty in tolerating liquid and regular diet. Results: Mean visual analog scales score was 7.1 in Group 1, and 7.9 in Group 2 on day 0, which was statistically significant. Nearly 90.47% of patients in closure group and 95.23% in nonclosure group were able to swallow liquid diet on day 0 (P = 0.5604). On day 3, 95.71% of patients in Group 1 and 80% in Group 2 were able to swallow soft diet (P = 0.1604). Numbness was present in 80.95% Group 1 and 71.42% in Group 2 on day 0, which improved to 28.57% pts in Group 1 and 33.33% in Group 2 on day 3. On day 3, slurring of speech was more frequent in closure group (80%). However, at the end of a week, there was no difference in both groups. Saliva production was significantly increased in Group 1 in the 1st week. Conclusion: Long-term morbidities of closing or nonclosing the LMG donor site are similar, but in short term, there is less pain, less edema, early recovery of tongue movements in nonclosure groups.
  • Changing profiles of patients undergoing transurethral resection of the prostate over a decade: A single-center experience
    Manav Agrawal, Manoj Kumar, Siddharth Pandey, Ajay Aggarwal, Satyanarayan Sankhwar

    Urology Annals 2019 11(3):270-275

    Context: Patients with benign prostatic hyperplasia (BPH) usually form the bulk in urology outpatient departments. The management options include medical therapy or surgery. Transurethral resection of the prostate (TURP) has been the mainstay of surgical management. The use of medical therapy has increased over the years. This has led to a shift in the profiles of patients undergoing surgical management of BPH. Aims: We conducted this study to analyze the differences in profiles of patients undergoing TURP over a decade. Settings and Design: This was a retrospective study. Subjects and Methods: We retrospectively reviewed the medical records of all patients who underwent TURP from January 1 to December 31 in 2006 and 2016. The age, preexisting comorbidities, prostate volume, operative time, mean prostatic tissue removed, duration of hospitalization, and complications were evaluated among the two groups of patients. Charlson comorbidity index was used to evaluate the preexisting comorbidities, and the modified Clavien classification system was used for evaluating the perioperative and postoperative complications. Results: A total of 114 and 125 patients underwent TURP in 2006 and 2016, respectively. The mean age of the patients was 62.1 ± 8.22 and 66.94 ± 9.12 years in 2006 and 2016, respectively. The serum prostate-specific antigen levels increased from 4.39 ± 4.425 to 5.59 ± 7.61 ng/ml a decade apart. A number of patients taking medical therapy before surgical intervention increased from 62.23% to 75.2% (P < 0.05). There was a significant increase in the mean prostatic volume and weight. There was only a modest increase of 1.94% in the total number of complications (P > 0.05) and no significant change in the rates of complications. Conclusions: Medical therapy for BPH patients has resulted in delayed surgical interventions. The complication rates have not increased. Thus, the increased use of medical therapy in BPH patients is justified though TURP may still be considered the gold standard.
  • Ureteral stricture after ureteroscopy for stones: A prospective study for the incidence and risk factors
    Amr E Darwish, Mohamed M Gadelmoula, Islam F Abdelkawi, Atef M Abdellatif, Ahmed M Abdel-Moneim, Hisham M Hammouda

    Urology Annals 2019 11(3):276-281

    Context: A ureteral stricture is a serious complication of ureteroscopy (URS) that was reported in the literature in highly variable rates from 0.2% to 24%. Aims: Our aims are to estimate the incidence and to detect the risk factors of ureteral stricture after URS. Settings and Design: This is a prospective, case-series study. Materials and Methods: During the period from May 2015 to August 2016, 251 adult patients underwent 263 URS for the treatment of 304 ureteral stones. Postoperative regular follow-up was done for 12 months by ultrasound. Computed tomography urography and diuretic renogram were performed for the cases developed hydronephrosis to confirm and detect the level of the stricture. Statistical Analysis: IBM SPSS Statistics for Windows, Version 19.0, Armonk, NY: IBM Corp. used for data analysis. Chi-square and Fisher's exact tests were used to compare between qualitative variables. Mann–Whitney test was used to compare between two quantitative variables in case of nonparametric data. Multiple logistic regression analysis was done to measure the risk factors. P value was considered statistically significant when <0.05. Results: The mean age was 43.5 years (standard deviation [SD]: ±13.6), and the mean body mass index was 28.39 (±3.96). The mean total stone burden was 12.8 mm (SD: ±5.9). Bilateral URS was performed in 12 cases. The mean operative time was 54.8 min (SD: ±22.68). Initial and final stone-free rates were 83.3% and 100%, respectively. The overall complications rate was 28.1%. Stricture occurred in four cases (1.5%). Conclusions: In our experience, the incidence of post-URS ureteral stricture is low. The impacted stone is the most common cause of URS complications and hence stricture formation.
  • Preoperative ureteral stenting prior to ureteroscopy for management of urolithiasis does not impact the postoperative return for unplanned care
    Andrew F Navetta, Amr Elmekresh, Karen Doersch, Trey D Durdin, G Luke Machen, Adam Cohen, Patrick S Lowry, Marawan M El Tayeb

    Urology Annals 2019 11(3):282-286

    Introduction: Return for unplanned postoperative care is an important quality metric in the United States. Most of our postoperative return visits occur after ureteroscopy. Routine preoperative ureteral stenting is not recommended by the American Urological Association due to its impact on the quality of life, despite its proposed operative advantages. We evaluated the association between preoperative ureteral stenting and the resulting perioperative outcomes in the context of quality measures such as return to the emergency department (ED) and readmission rates. Materials and Methods: After the Institutional Review Board approval, a retrospective review of patients undergoing ureteroscopy from February 2014 to present was conducted. Patient's demographics and perioperative outcomes were compared based on the presence or absence of a ureteral stent before ureteroscopy. Details and rates of nurse calls, returns to the ED, and readmissions within 90 days were also compared. Results: A total of 421 instances of ureteroscopy, 278 prestented ureteroscopy (psURS), and 143 direct ureteroscopy (dURS) were included for analysis. Preoperative demographics were similar. The psURS cohort was more likely to undergo flexible ureteroscopy, utilized an access sheath more often (P < 0.0001), and had less ureteral dilation (P < 0.0001). Prestenting did not influence operative time (P = 0.8534) or stone-free rates (P = 0.2241). dURS patients were more likely to call the nurse; however, psURS versus dURS yielded no difference in return to the ED or readmission within 90 days. Conclusions: In this study, preoperative stenting offered few operative advantages and did not meaningfully influence returns to the ED and readmissions within 90 days after ureteroscopy.
  • Microdissection testicular sperm extraction: Overall results and impact of preoperative testosterone level on sperm retrieval rate in patients with nonobstructive azoospermia
    Shahbaz Mehmood, Shima Aldaweesh, Noor Nabi Junejo, Waleed Mohamed Altaweel, Said Abdulghani Kattan, Naif Alhathal

    Urology Annals 2019 11(3):287-293

    Objective: The main objective is to review the overall result and impact of preoperative testosterone level on sperm retrieval rate (SRR) by microdissection testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Materials and Methods: We retrospectively reviewed the files of patients who underwent micro-TESE for NOA from August 2013 to December 2014. All patients were evaluated with history, physical examination, and hormonal assessment. Patients who had previous micro-TESE, obstructive azoospermia, or who took hormone therapy were excluded from the study. Patients were classified into two groups. Group A included patients who had low testosterone (<10 nmol/L), and Group B included patients with normal testosterone (>10 nmol/L). The primary endpoint was to review the overall results of the procedure and the impact of preoperative testosterone level on sperm retrieval. Results: A total of 264 patients with NOA underwent micro-TESE. Group A included 133 patients with low testosterone (<10 nmol/l) with a median age of 36 ± 6.59 years, and Group B included 131 patients with normal testosterone (>10 nmol/L) with a median age of 33 ± 7.88 years (P = 0.1350). There was no significant difference in follicle-stimulating hormone (P = 0.2467), luteinizing hormone (P = 0.1078), prolactin (P = 0.5619), and testicular volume (P = 0.4052), whereas a significant difference was found in testosterone level (P = 0.0001) in both groups. Overall, sperm were successfully retrieved in 48.8% of men. SRR in Group B was significantly higher (57.25%) than that in Group A (40.60%) (P = 0.0068). SRR in patients with Sertoli-cell-only pathology was 30.35%, hypospermatogenesis was 89.74%, and maturation arrest was 32.43%. Conclusion: Micro-TESE is a successful and safe procedure in NOA patients with a poor prognosis. Preoperative testosterone level has a significant impact in the SRR by micro-TESE.
  • Predictive value of the immediate effect of first dose of tamsulosin on lower urinary tract symptoms improvement in benign prostatic hyperplasia patients
    Ayman Salah Moussa, Rabie M Ibrahim, Mahmoud Shoukry ElAdawy, Ahmed M Ragheb, Ahmad A El-Dessoukey, Ahmed M Abdelbary, Ahmed Hassan Mohammed, Amr Massoud

    Urology Annals 2019 11(3):294-297

    Objectives: The objective is to study the effect of tamsulosin within hours after the first dose and its prediction of the future improvement of LUTS. Materials and Methods: From May 2016 until August 2017, 340 patients aged over 40 years with benign prostatic hyperplasia (BPH)-related symptoms were prospectively enrolled; 0.4 mg tamsulosin for 3 months was given. The first visit was before beginning of tamsulosin; uroflowmetry (UFM), postvoid residual urine volume (PVR), international prostate symptom score (IPSS), and quality of life (QoL) were measured. The second visit was after 6 h from the administration of tamsulosin. UFM and PVR were measured. The third visit was after 1 month and the fourth visit was after 3 months, on which UFM, PVR, IPSS, and QoL were also measured. Results: The mean patients' age was 63 ± 6.18 and the mean prostate volume was 52.23 ± 24.59 cc. The mean Qmax at 1st, 2nd, 3rd, and 4th visits was 10.28 ± 3.06 s, 14.58 ± 4.84 s, 14.46 ± 4.94 s, and 14.28 ± 5.07 s, respectively, P = 0.04. The mean voiding time at 1st, 2nd, 3rd, and 4th visits was 41.24 ± 27.18 s, 33.84 ± 18.14 s, 31.96 ± 22.02 s, and 30.14 ± 17.52 s, respectively, P = 0.03. The mean PVR at 1st, 2nd, 3rd, and 4th visits was 46.40 ± 22.14 ml, 27.76 ± 26.10 ml, 25.16 ± 28.36 ml, and 25.58 ± 28.10 ml, respectively, P = 0.001. The first dose of tamsulosin significantly increases Qmax and decreases voiding time and residual urine (RU); there was no statistical significant difference between 1st dose, 1 and 3 months in Qmax, voiding time, and RU. QOL and IPSS were significantly improved after 1 and 3 months, P < 0.001. Conclusion: The first dose of tamsulosin improves UFM and predicts the mid-term change in UFM as well as IPSS and QoL indices in the treatment of BPH-related LUTS.
  • Autologous buccal mucosa harvest under local anesthesia: Feasibility, safety, and acceptance for substitution urethroplasty
    Abdulwahab Akanbi Ajape, Sulyman Alege Kuranga, Mohammed Mustapha Kura, Hamid Babajide Olanipekun

    Urology Annals 2019 11(3):298-303

    Objective: The objective of the study is to report our experience with buccal mucosa harvest under local anesthetic agent infiltration for urethroplasty. Materials and Methods: All patients who had buccal mucosa graft harvest under local anesthesia (1% Xylocaine) for repair of their urethral stricture, from January 2007 to December 2016, were retrospectively studied from two public urologic service centers. The demographic data of the patient, length of graft harvested, complications recorded, among other things, were entered into a pro forma and the data were analyzed using IBM SPSS Statistics version 16. Results: A total of 102 patients underwent urethroplasty with buccal mucosa harvested under local anesthesia; however, only 88 patients had complete data for analysis. The mean age was 55.03 years (±12.30). The mean harvested graft length was 5.41 cm (±2.62 cm). There was no need for conversion to general anesthesia. The majority of them (94.3%) reported that it was “easy” or “very easy” to maintain the mouth opened during the procedure. Over 91% do not have difficulty opening their mouth after the harvest. Only a patient had bothersome primary hemorrhage that required gauze packing. No significant oral cavity pain was experience in 69.3% of patients; among those with pain, the perineal pain was more. Over 90% of the patients will be willing to undergo the procedure again under local anesthetic infiltration again. Conclusion: Buccal mucosa harvest under local anesthesia infiltration is feasible, safe, and acceptable among our patients who had urethroplasty for urethral stricture disease.
  • Utilizing da vinci® surgical system to treat challenging urinary stones
    Basmah Al Tinawi, Morris Jessop, Mohamad W Salkini

    Urology Annals 2019 11(3):304-309

    Introduction: A worldwide mounting in the incidence and prevalence of urolithiasis has been observed. The standard treatment of urologic stone disease (USD) has changed from open surgery to extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy (PCNL), or ureteroscopy depending on the size and location of the stone. We are sharing our experience in utilizing Da Vinci® robotic surgical system to treat patient with urolithiasis instead of open surgical approach. Patients and Methods: We reviewed prospectively collected data of 19 patients who underwent robotic-assisted stone surgery (RSS) between January 2010 and March 2018 at our institute for USD involving 22 nephroureteral units. Results: A total number of 22 RSS were accomplished with no conversion to open. Three patients had bilateral stone and needed to have RSS on each side separately. Eleven RSS were performed on the right. The indications for RSS included as follows: morbid obesity (n = 8, mean body mass index 56.4 kg/m2), need for concurrent renal surgery (n = 3) severe contractures limiting positioning for retrograde endoscopic surgery or PCNL (n = 2), symptomatic calyceal diverticular stone with failed endoscopic approach (n = 4), and after failed PCNL (n = 2). Twenty nephrouretral unit (91%) were rendered stone free on the first attempt with complication occurring after four cases (18%). Conclusion: RSS is viable options in the treatment of challenging urologic stone with high success rate and low risk of complication. The need for open stone surgery was eliminated by RSS at our center.
  • Treatment of fragmented and severely encrusted ureteral double-J stent forgotten for 11 years through multimodal endourological methods
    Abdülkadir Kandemir, Mehmet Giray Sönmez

    Urology Annals 2019 11(3):310-313

    Ureteral catheters are frequently used in urology clinics for intrinsic or extrinsic pathologies which cause ureteral obstruction to provide urinary drainage from the kidney to the bladder. With the increase in stent use, an increase is observed in complications occurring due to ureteral stents in direct proportion with this increase, and ureteral double-J (DJ) stents forgotten in the urinary system are observed commonly in urological cases when the patients do not refer to a health institution in this condition and may cause severe problems, such as infection, stent fragmentation, migration, kidney failure, encrustation, and hydronephrosis conditions. A 30-year-old male patient referred to our clinic with right-side pain, dysuria, and incontinence complaints. It was learned that the patient had endoscopic stone surgery due to right ureteral stone and kidney stone 11 years before the presentation. In the imaging methods of the patient, it was observed that the DJ stent forgotten had separated into three parts, and stones were observed in the right ureter. Cystoscopy was made under general anesthesia. The torn distal end of DJ stent was observed in distal urethra. The foreign object was removed with forceps. Then with ureterorenoscope, the stones integrated with the stent at the end of the piece of DJ stent in the ureter were fragmented with pneumolithotriptor. Stone pieces and the second removed part of the stent were extracted with foreign object forceps. Then using nephroscope through percutaneous intervention, the stones at the end of the third torn piece of DJ stent were fragmented with pneumolithotriptor. They were extracted with forceps. After DJ stent installation, each patient should be checked by giving required information and told that the stent must be removed. In cases with forgotten stents and complications, the stents should be removed with suitable medical, endourological, or minimally invasive surgical methods taking care to protect kidney functions.
  • Median raphe cyst of the penis: A startling diagnosis for the unaccustomed clinician
    Sheena Alphones, Manjiri Phansalkar, Peter Manoharan

    Urology Annals 2019 11(3):314-316

    Penile median raphe cysts are uncommon lesions occurring predominantly in the ventral aspect of the glans penis of young men. In most patients, the cysts, which are asymptomatic or unrecognized during childhood, may progress later and become symptomatic during adolescence or adulthood. A differential diagnosis must be made from other penile skin lesions such as glomus tumors, dermoid cysts, pilonidal cysts, epidermal inclusion cysts, urethral diverticula, and steatocystomas that originate in the genital region. The usual treatment is complete surgical excision. We are presenting a case of a penile median raphe cyst which presented in a middle-aged adult.
  • Gangrenous cystitis: An extremely rare infectious condition managed by neobladder – A case report with review of literature
    Ramanitharan Manikandan, Ketan Mehra, Lalgudi Narayanan Dorairajan, Sri Harsha Bokka

    Urology Annals 2019 11(3):317-319

    Gangrenous cystitis (GC) is an extremely rare infectious entity in the modern era. GC in young patients decreases the quality of life as bladder function is totally jeopardized. The management in such cases is challenging. We present a case of GC postpartum managed by Studer neobladder reconstruction restoring the normal voiding pattern and quality of life.
  • Self-insertion of an odd urethral foreign body that led to fournier's gangrene
    Mohamed Mohamed Elawdy, Samer El-Halwagy, Emad E Mousa, Joseph Maliakal

    Urology Annals 2019 11(3):320-323

    Self-inserted urethral foreign bodies (FBs) are rare. Neither reported case was the self-inflicted FB due to a lack of financial resources nor was either case complicated by Fournier's gangrene. We present a 54-year-old male who inserted a household pipe to relieve his urine retention. Unfortunately, the FB became stuck inside, perforated the urethra, and required perineal exploration. After it was removed, the urethra was closed over a 16F urethral catheter. The wound was complicated by severe infection and resulting Fournier's gangrene. This required an additional surgery for debridement and urine diversion. Retrospectively, it would have been better if the urethra had been left open with SP tube only. We are sharing a clinical lesson learned by the practicing urologist and surgeons. Conclusively, self-inserted FBs in the urethra may lead to a series of complications. Patients with limited financial resources need more attention and care because they may hurt themselves unintentionally.
  • Placenta percreta with bladder invasion: The armamentarium available in its management
    Neeraja Tillu, Abhishek Savalia, Sujata Patwardhan, Bhushan Patil

    Urology Annals 2019 11(3):324-327

    Placenta percreta is a rare life-threatening condition associated with high morbidity and mortality due to severe obstetric hemorrhage. It can be associated with bladder invasion which leads to hematuria. Treatment is decided on a case-to-case basis, and there have been no guidelines proposed so far. Strategies include obstetric hysterectomy, leaving the placenta in situ with postoperative methotrexate therapy and removal of the placenta with bladder reconstruction in a single stage. An unusual case of a patient with placenta percreta and bladder invasion who presented with delayed hematuria after the placenta was left in situ has been reported. The patient was managed conservatively for 10 days postdelivery after which a decision to do an obstetric hysterectomy with focal cystectomy was taken in view of persistent hematuria. An algorithm for managing cases of placenta percreta with bladder invasion has been proposed to manage these difficult situations.
  • A case of cavernosal abscess after neglected penile fracture and bacteremia
    Lazaros Lazarou, Marinos Berdempes, Titos Markopoulos, Nikolaos Kostakopoulos, Konstantinos Spyropoulos, Iraklis C Mitsogiannis

    Urology Annals 2019 11(3):328-330

    Penile abscess is a urological entity rarely described in the literature. It has been associated with injection therapy for erectile dysfunction, penile instrumentation, trauma and priapism. Identified risk factors include immunosuppresion and pre-existing local or distant infection. Common causal microorganisms include Staphylococcus aureus, Streptococci and Bacteroides. We herein report on a case of penile abscess in a 37-year-old patient occurring after sexual trauma and presenting with bacteremia.
  • Metastatic urothelial carcinoma presenting as acute cholecystitis
    Xing Yao Ling, Jasmina Kevric, Alexandra DuGuesclin, Julie Teague, Marlon Perera, Elizabeth Penington

    Urology Annals 2019 11(3):331-333

    Metastatic involvement of the gallbladder is uncommon. We report a case of an 84-year-old male who presented with acute cholecystitis secondary to metastatic urothelial carcinoma (UC). An 84-year-old man presented with right upper quadrant pain and a positive Murphy's sign on the background of known metastatic UC. He was diagnosed with acute cholecystitis and underwent laparoscopic cholecystectomy. His postoperative period was complicated by a cardiac event, and he died 2 days later. Histology of the gallbladder revealed extensive infiltration by nested malignant epithelioid proliferation, consistent with UC. This case demonstrates that although uncommon, UC may metastasize to unusual sites, including the gallbladder. This serves as a reminder for surgeons to consider metastatic disease as a cause for acute cholecystitis.
  • Segmental testicular infarction: Case series and brief literature review of a great mime
    Franco Palmisano, Mariapia Serrago, Andrea Gallioli, Vito Lorusso, Franco Gadda, Matteo Giulio Spinelli, Emanuele Montanari

    Urology Annals 2019 11(3):334-337

    Segmental testicular infarction is rare, and the etiology is mostly idiopathic. We report a case series of four young patients, one of them with metachronous bilateral disease, presenting with an acute scrotum and treated with a testis-sparing approach, if feasible, after a negative intraoperative biopsy. Etiology, differential diagnosis, and management are reviewed. To be aware of clinical and imaging features of this benign testicular pathology, it is crucial to avoid unnecessary orchiectomies to preserve vital testicular tissue left.
  • Retraction: Impact of genital hygiene and sexual activity on urinary tract infection during pregnancy

    Urology Annals 2019 11(3):338-338



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