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Introduction and Objectives. Post-operative urinary tract infections continue to be a reality in emergency urology wards, even as the number of cases due to the SARS-COV2 pandemic is reduced. The purpose of this study is to determine the type of urinary tract infection most common in our clinic, as well as the possible procedures after which it begins. Materials and Methods. The study is retrospective, being conducted between January 2021 and January 2022 on a number of 534 patients, of which 256 were operated. Of the 534 hospitalized patients, 128 had a positive SARS-COV2 test at hospitalization. A percentage of (65) 25.4% of operated patients reported postoperative urinary tract infections. The diagnosis was considered postoperative if the patients showed positive results regarding the presence of germs in the urine sample in the first 15 days after the medical intervention compared to the "sterile" urine sample before the procedure. Results. The most common type of postoperative urinary tract infection is with: Escherichia Coli bacterium in 39.5% (211) cases, followed by Klebsiella pneumoniae in 24.1% (129 cases), Proteus mirabilis in 17.6% (94 cases), Enterococcus faecalis in a percentage of 10.8% (58 cases) and Pseudomonas aeruginosa in a number of 7.8% (42 cases). Of the patients diagnosed with SARS-COV2, a total of 33 cases required urological interventions, while 29 cases required only conservative treatment. The prevalence of germs in operated patients was 14 cases (42.4%) with E. coli infection, 13 cases (39.4%) with Klebsiella infection and 6 cases (18.2%) with Proteus infection. Of those who required conservative treatment, 19 cases (65.5%) had E. coli infection and 10 cases (34.5%) with Klebsiella. The rate of postoperative urinary tract infections was higher after endoscopic procedures (70.7 %%) compared to classical surgical ones (29.3%). Of the cases with SARS-COV 2 that presented associated urinary tract infections, a number of 17 (27.4%) showed severe clinical evolution with prolonged hospitalization or exitus. Conclusions. Urinary tract infections remain a current challenge especially in the COVID-19 era, when along with viral evolution, they can worsen the prognosis of patients, which leads to higher morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The COVID-19 pandemic definitely changed the management of patients with benign prostatic hyperplasia. This study followed the modalities of treatments in patients with benign prostatic hyperplasia associated with SARS-COV2 in the Urology Clinic of St. John's Emergency Clinical Hospital. Materials and Methods. The study included a number of 78 patients, with a mean age of 63.2 years (55-87) who presented with SARS-COV2 and BPH and who were admitted to our Urology Department between January 2021 and January 2022. The diagnosis of SARS-COV2 was made based on the PCR test, and that of BPH, using the diagnostic triad: digital rectal examination, PSA, freePSA and ultrasound examination. It should be noted that some of the hospitalized patients were already being treated with alpha blockers and/or 5 alpha reductase inhibitors at the time of admission. Results. Out of the 78 hospitalized cases, 11 required emergency endoscopic intervention under spinal anesthesia (TURP or TURisP) for haemostasis, the patients presenting with persistent hematuria, which did not respond to conservative treatment. A number of 16 cases showed acute urinary retention during hospitalization and a urethrovesical catheter was fitted and will be re-evaluated urologically after the COVID episode. Of the remaining 51 cases of BPH, 17 already had chronic urinary retention on admission, with urethrovesical probe present, 13 cases began during hospitalization with alpha blocker treatment associated with 5 alpha reductase inhibitors, meanwhile in the remaining 21 cases there were no urological interventions to modify the treatment regimen, these cases being managed strictly on the side of COVID-19 infection. Conclusions. There was no clear influence of the evolution of patients with benign prostatic hyperplasia due to SARS-COV2 pathology, and the general management trend was to delay chronic cases until the time of remission of viral infection. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Gross hematuria is one of the urological emergencies that require immediate assessment. Our retrospective study aimed to describe the demographic and clinical characteristics of patients with hematuria and SARS-CoV-2 infection treated in a urological emergency COVID care unit and compare them to pre-COVID-19 outcomes of the same duration. Materials and Methods. Over ten months, 55 patients with hematuria and SARS-CoV-2 infection were enrolled in the study and compared to pre-COVID-19 outcomes of similar duration. Data analyzed included patient age and gender, the etiology of hematuria, treatment applied, and follow-up time. Results. According to the analysis, there were 36 men (65.5%) and 19 women (34.5%), with an average age of 64.43 years (45 - 86). In men, 15 cases (41.7%) of hematuria were related to bladder tumors, eight cases (22.2%) to prostate adenocarcinomas, five cases (13.9%) to bladder stones, five cases (13.9%) to upper tract urothelial carcinomas, and three cases (8.3%) were related to large prostate adenoma. Among women, hematuria was associated with bladder tumors in 12 cases (63.2%) and with radiation cystitis in seven cases (36.8%). Conservative treatment was successfully applied in 17 cases (30.9%) and surgical treatment was necessary for 38 patients. (61.9%). As for SARS-CoV-2 infection, 40 patients (72.7%) showed a mild to moderate form of COVID-19, 12 patients (21.8%) had a severe course of the disease, with 3 cases (5.5%) resulting in death. All data were compared with pre-pandemic outcomes of similar duration. Conclusions. Hematuria associated with SARS-CoV-2 infection impairs a patient's prognosis. With SARS-CoV-2 infection, hematuria surgery is more challenging to perform. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Renal subcapsular abscess is a very rare entity that is defined by a suppurative process localized to a space between the renal capsule and the renal parenchyma. However, the pathogenesis and aetiology of this entity remain speculative. To our knowledge, only few cases have been reported in the English literature. Materials and Methods. We describe a 26-years old woman with renal subcapsular abscess where the imagery pleaded for an interventional procedure, while her clinical and biological status were more suitable for conservative management. The particularity of the cases consisted in a conservative management with good outcomes. We also performed research on the literature in order to find arguments pros and against our therapeutical decision. Results. Despite the definite diagnosis, the patient’s improved clinic and favourable evolution determined the decision to abstain from drainage, considering that this procedure could have a risk of complete compromise of left kidney. In agreement with the patient, it was decided to delay the surgical approach. We ensured this evolution through clinical, paraclinical and imaging evaluations - a CT re-evaluation 14 days after hospitalization, then only ultrasound evaluations, because we already had the CT-ECO correspondence and no other contrast administrations were justified. Conclusions. Although the renal abscess exceeded the 5 cm border, described in the literature as the limit from which surgery is performed, the favourable evolution of the patient, under double antibiotic therapy, decreased inflamma)tory syndrome, and good collaboration between the 2 specialists, nephrological and urological, together with the careful monitoring of the patient, saved the left kidney in a patient with pre-existing CKD and with a small right kidney (approx. 8 cm). [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The aim of the study is to evaluate and present the results of flexible ureterorenoscopy with holmium laser lithotripsy as treatment for kidney stone in pelvic ectopic kidney. Materials and Methods. Twelve patients with stones below 2.1 mm located in the pelvic ectopic kidney and treated by flexible ureterorenoscopy between 2012 - 2017 were retrospectively analyzed. Demographic data, stone characteristic and perioperative measurement were collected. Patients with incomplete data in the medical records were excluded. Results. We enrolled in the study seven males and five females with a mean age of 42.5 years (23 - 58 years). All patients were treated by flexible ureterorenoscopy under spinal anesthesia. The mean stone size was 14.9 mm (10 - 21 mm). Five stones were located in the renal pelvis, three in the middle calix and four in the lower calix. Also, in three cases was noted the presence of multiple stones. Eight patients had a double J stent placed before de surgery. The mean operation time was 66.2 minutes (45 - 100 minutes). Mean hospitalization time was 3.4 days (3 - 5 days). Stone free rate was 83.3% after one procedure. Reintervention was necessary in two cases (16.6%). Minor complications as persistent hematuria was observed in two cases (16.6%) and fewer in one case (8.3%). No severe complications were recorded. Conclusions. The use flexible ureterorenoscopy with laser lithotripsy in treatment of small and medium stones occurred in patients with pelvic ectopic kidney is an effective and safe procedure. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Digital flexible ureteroscopy (FURS) became an important diagnostic and follow-up procedure in upper urinary tract urothelial carcinoma (UTUC). Even so, many characteristics that can suggest nature of a lesion still represent a difficult challenge. The endpoint of the trial was to determine the diagnostic accuracy of NBI assisted digital flexible ureteroscopy versus standard FURS (WL) in upper tract urothelial carcinomas. Materials and Methods. White light (WL) and NBI-assisted digital FURS were performed in 65 patients, admitted for suspicion of UTUC. The inclusion criteria consisted of unilateral hematuria during cystoscopy, abnormal urinary cytology and pyelocaliceal system filling defects according to CT results. Patients with invasive UUT according to CT results were excluded. The investigation protocol included abdominal ultrasound, cytology, contrast CT scan and cystoscopy. The endoscopic examination use digital white light flexible ureteroscopy, followed by the NBI assessment of the renal collecting system urothelium. Results. A total of 78 UTUC lesions (23 pTa, 37 pT1 and 18 CIS) were confirmed by pathology in 65 patients. pTa, pT1 and CIS tumors detection rates were determined for WL combined with NBI mode by comparison to the WL evaluation overall UTUC 78 lesions (100%) versus 67 lesions (85.9%); pTa 23 lesions (100%) versus 17 lesions (73.9%); pT1 37 lesions (100%) versus 35 lesions (94.5%) and CIS 18 lesions (100%) versus 15 lesions (83.3%). Detection rate was improved in WL combined with NBI mode when compared with standard FURS (100% versus 84.4%). A total of 11 (14.1%) UTUC tumors (6 pTa, 2 pT1 and 3 CIS) were solely observed in NBI. Targeted biopsies’ specificity Rate of false-positive results 10.3% vs. 17.8% (WL vs. WL+NBI). Conclusions. NBI was an important tool regarding detection because it is providing a significant diagnostic improvement during digital flexible ureteroscopy. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The large BPH treatment alternative consisting of bipolar plasma enucleation of the prostate (BPEP) was retrospectively matched against standard open transvesical prostatectomy (OP). Materials and Methods. In the BPEP study arm, 24 BPH patients were enrolled based on the selection criteria of prostate volume over 80 mL, Qmax below 10 mL/s and IPSS over 19. In the control group, a similar number of cases matching the respective features underwent OP. Patients were assessed at 1, 3 and 6 after the initial intervention by IPSS and QoL scores, Qmax and PVR. Results. Resembling mean operating times (94.1 versus 85.6 minutes) and resected adenoma tissue weights (102.9 versus 113.7 grams) characterized BPEP and OP. Significantly decreased mean hemoglobin level drop (1.5 versus 3.2 g/dL), catheterization period (2.5 versus 6 days) and hospital stay (3 versus 7 days) were described among BPEP patients when compared to OP. During the 1, 3 and 6 months' follow-up check-ups, no significant variations were determined concerning the mean IPSS, Qmax, QoL and PVR values displayed in the 2 series. Conclusions. By comparison to OP, BPEP emphasized equivalent surgical efficiency and prostatic bulk ablation capacity, reduced perioperatvie bleeding and shorter recovery period. Similar short term follow-up parameters were established. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Varicocele is one of the most common causes of infertility. Our aim was to compare laparoscopic varicocelectomy (LV) versus open varicocelectomy (OV) in terms of operative and postoperative outcomes. Materials and Methods. A number of 32 patients with a mean age of 29.6 years underwent open (14) and laparoscopic (18) left side varicocelectomy during May 2017 and May 2018 was analyzed. All patients performed testicular ultrasonography and spermogram before the procedure. Results. LV is performed under general anesthesia, while OV under local or spinal anesthesia. Mean operating time was 37.2 minutes for LV and 53.3 minutes for OV. The mean hospital stay was 1.2 days for LV versus 1.9 days for OV. The overall incidence of postoperative complications including hydrocele, epididymitis, scrotal edema and local pain was significantly higher among patients undergoing OV compared with LV (14.2% vs 5.5%). The incidence of persistent varicoceles was not significantly different between the 2 groups. Also, there was no incidence of testicular atrophy in both groups. Semen characteristics - sperm motility and density - improved in both groups. Conclusions. LV is less invasive that OV and had better outcomes in terms of complications and of operative parameters, so it should be considered first choice in treatment of male varicocele, being safe and effective. In addition, laparoscopic procedure is recommended in case of bilateral disease. [ABSTRACT FROM AUTHOR]

Introduction: The present study was aimed to assess in a retrospective manner the impact of narrow band imaging (NBI) cystoscopy concerning the detection of recurrent tumors during the follow-up protocol for previously confirmed non-muscle invasive bladder cancer (NMIBC) patients. Materials and Methods: Between June 2014 and January 2015, a total of 45 known NMIBC cases (based on the initial pathology findings subsequent to standard transurethral resection of bladder tumors - TURBT) were confirmed as presenting tumor recurrence. All cases underwent both standard white light (WLC) and NBI cystoscopy, followed by the classical resection of all WLC detected tumors and NBI guided TURBT for lesions solely observed in NBI vision. Results: In light of the pathological exam, 43 cases were diagnosed with NMIBC recurrence (2 patients had muscle invasive tumors and were excluded from the analysis). The NBI mode was characterized by a higher patients' detection rate when compared to conventional cystoscopy (95.3% versus 83.7%). On a lesions' related basis, the NBI evaluation also displayed an improved diagnostic accuracy by comparison to white light (91.5% versus 79.7%). On the other hand, NBI cystoscopy was marked by an increased rate of false positive results (19.2% versus 13.2%). Conclusions: The use of NBI assessment during the periodical cystoscopic NMIBC follow-up was confirmed to benefit from superior sensitivity leading to more recurrent tumors being identified and resected. [ABSTRACT FROM AUTHOR]