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Background: Patients hospitalized due to gross hematuria frequently complete evaluation in the outpatient setting. The use of office flexible cystoscopy during hospitalization may lead to prompt diagnosis and treatment but can be limited due to low visualization and artifacts that can hamper diagnostic ability. Objective: The objective of this study was to assess flexible cystoscopy findings and yield performed in patients hospitalized due to gross hematuria. Methods: Medical records of patients who underwent flexible cystoscopy while hospitalized during September 2018–December 2019 were reviewed. Cystoscopic findings were categorized into (1) suspicious mass in the bladder or prostate, (2) nonsuspicious changes in the bladder, and (3) nondiagnostic exam. Descriptive statistics were used to report the clinical characteristics of the study cohort and the findings of cystoscopy. Univariate logistic regression analyses were used to identify predictors of malignant findings. Results: The study cohort consisted of 69 patients (median age of 76 years). Initial cystoscopy findings were suspicious for malignancy in 26/69 patients (38%), nonsuspicious for malignancy in 34/69 patients (49%), and nondiagnostic in 9/69 patients (13%). The median follow-up time was 9 months (range 4–14 months). Twenty patients (29%) were diagnosed with malignancy (sensitivity of 75% and specificity of 78%). The procedure led to either diagnosis or treatment of 39 patients (57%). However, in 30 patients (43%), the initial cystoscopy did not aid in the diagnosis, led to misdiagnoses, or required a follow-up cystoscopy. On univariate analyses, none of the precystoscopy variables were predictive of bladder malignancy. Conclusion: Flexible cystoscopy in the setting of acute hematuria requiring hospitalization did not lead to diagnosis or treatment in over 40% of cases. In this setting, consideration should be given to performing an upfront cystoscopy under anesthesia.

Objective:To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods:We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values ofp < 0.05 were considered significant. Results:We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments >= 4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1vs27.7,p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5%vs2.6% (p = 0.99), 16.9%vs18.4% (p = 0.99), and 52.5%vs69.2% (p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5vs100 minutes,p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p < 0.001). The prone group had significantly more Clavien 2 complications than the supine (p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion:PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.

Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and February 2020. The first 20 procedures (Group A) were performed with conventional ultrasonic or pneumatic devices and the other 20 (Group B) were performed with the use of the new LSH. All patients were treated by tubeless supine PCNL. The groups were compared for demographics, clinical data, operative time, lithotrite effectiveness, stone clearance rate (SCR), and outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and density (Hounsfield units) ( p 3/min, hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%, respectively. Despite a trend toward better results with the new LSH, none of these comparisons reached statistical significance. Ineffective lithotripsy with the initial device (ultrasonic) requiring conversion to another modality (ballistic) occurred in six (30%) procedures in Group A, while all procedures were effectively accomplished with the LSH in Group B ( p = 0.02). There were two complications in Group A and none in Group B ( p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for performing PCNLs. This new tool completes the capabilities of the holmium laser high-power machines, enabling them to serve as the sole platform for all endourological treatments.

Introduction: We aimed to compare the treatment patterns and oncological outcomes, including postoperative morbidity and chemotherapy use, between octogenarians and patients

Aim: To assess the precision of preoperative ultrasonography (US)-determined prostate volume and to propose formulas for improving it. Methods: This retrospective study comprised 155 consecutive men who underwent open prostatectomy for benign prostatic hyperplasia (BPH) between 2013 and 2019. Preoperative prostate volume was estimated by either abdominal US (AUS) ( n = 92) or transrectal US (TRUS) ( n = 63), and was compared with the weight of surgically enucleated tissue at a conversion rate of 1 ml (US) = 1 g tissue. Statistical analysis was conducted and a novel formula for prostate volume was constructed. Results: The median prostate volumes by AUS and TRUS were 140 ml [interquartile ratio (IQR) 111–182] and 108 ml (IQR 93–120), respectively. Enucleated tissue weight was lower than the AUS assessment by a median difference of 50 g (IQR 28.7–75.7; p Conclusion: Assessment of prostate volume by US is imprecise for decision-making of whether to perform open simple prostatectomy for BPH. Our novel formulas may enhance stratification of patients with prostatic enlargement to a more optimal surgical approach. Future studies in larger cohorts are needed to substantiate our results.

Introduction: To assess long-term outcomes of double internal stents (DIS) for the relief of external malignant ureteral obstruction (MUO). Materials and Methods: DIS (7F each; 12-month indwelling ...

INTRODUCTION AND OBJECTIVE:Patients with secondary extrinsic malignant ureteral obstruction (EMUO) seek for durable, simple and low-cost solutions of drainage. We report on long-term outcomes with ...

INTRODUCTION AND OBJECTIVE:Non-contrast computed tomography (NCCT) is the gold reference for diagnosing urolithiasis and became highly available in emergency rooms (ER). We aimed to analyze pattern...

Introduction: We set out to investigate whether general anesthesia with low ventilation (LV, respiratory rate ≤8/minute and tidal volume

The American Southeast has been labeled the "Stone Belt" due to its relatively high burden of urinary stone disease, presumed to be related to its higher temperatures. However, other regions with high temperatures (e.g., the Southwest) do not have the same disease prevalence as the southeast. We seek to explore the association of stone disease to other climate-associated factors beyond temperature, including precipitation and temperature variation.We identified all patients who underwent a surgical procedure for urinary stone disease from the California Office of Statewide Health Planning and Development (OSHPD) databases (2010-2012). Climate data obtained from the National Oceanic and Atmospheric Administration (NOAA) were compared to population adjusted county operative stone burden, controlling for patient and county demographic data as potential confounders.A total of 63,994 unique patients underwent stone procedures in California between 2010 and 2012. Multivariate modeling revealed that higher precipitation (0.019 average increase in surgeries per 1000 persons per inch, p 0.01) and higher mean temperature (0.029 average increase in surgeries per 1000 persons per degree, p 0.01) were both independently associated with an increased operative stone disease burden. Controlling for county-level patient factors did not change these observed effects.In the state of California, higher precipitation and higher mean temperature are associated with increased rates of stone surgery. Our results appear to agree with the larger trends seen throughout the United States where the areas of highest stone prevalence have warm wet climates and not warm arid climates.

Objective To evaluate our results of epispadias repair with a modified Cantwell-Ransley (MCR) technique. Methods A retrospective Institutional Review Board-approved chart review of all patients who underwent an MCR epispadias repair was conducted between 1998 and 2015. Procedures were performed at birth or after the age of 8 months as part of the modern staged repair of exstrophy-epispadias complex (EEC) in patients with bladder exstrophy treated since birth, at presentation for older patients, and after the age of 6 months in isolated epispadias patients. Twenty-two children underwent MCR epispadias repair in our institute during the study period. Sixteen of them had EEC and 6 had isolated epispadias. Four patients underwent exstrophy and epispadias repair at the same session. Twelve children underwent epispadias repair as a second stage of modern staged repair at a mean age of 21 months (range 8-60). The procedures involved dissection of the corporeal bodies and urethral plate from the penile base to the tip of the penile glans. Results After a mean follow-up of 6.9 years (range 0.5-18), there were no complications in the isolated epispadias group and 4 complications in the bladder exstrophy group: urethrocutaneous fistula ( n = 1), residual dorsal curvature ( n = 1), and excess of penile skin ( n = 2). The meatal location was orthotopic in all cases. All of the complications were successfully addressed in a single subsequent surgical session. Conclusion MCR technique continues to be a reliable, reproducible option for epispadias repair in EEC patients and in cases of isolated epispadias.

We sought to validate the use of crowdsourced surgical video assessment in the evaluation of urology residents performing flexible ureteroscopic laser lithotripsy.We collected video feeds from 30 intrarenal ureteroscopic laser lithotripsy cases where residents, postgraduate year (PGY) two through six, handled the ureteroscope. The video feeds were annotated to represent overall performance and to contain parts of the procedure being scored. Videos were submitted to a commercially available surgical video evaluation platform (Crowd-Sourced Assessment of Technical Skills). We used a validated ureteroscopic laser lithotripsy global assessment tool that was modified to include only those domains that could be evaluated on the captured video. Videos were evaluated by crowd workers recruited using Amazon's Mechanical Turk platform as well as five endourology-trained experts. Mean scores were calculated and intraclass correlation coefficients (ICCs) were computed for the expert domain and total scores. ICCs were estimated using a linear mixed-effects model. Spearman rank correlation coefficients were calculated as a measure of the strength of the relationships between the crowd mean and expert average scores.A total of 30 videos were reviewed 2488 times by 487 crowd workers and five expert endourologists. ICCs between expert raters were all below accepted levels of correlation (0.30), with the overall score having an ICC of0.001. For individual domains, the crowd scores did not correlate with expert scores, except for the stone retrieval domain (0.60 p = 0.015). In addition, crowdsourced scores had a negative correlation with the PGY level (0.44, p = 0.019).There is poor agreement between experts and poor correlation between expert and crowd scores when evaluating video feeds of ureteroscopic laser lithotripsy. The use of an intraoperative video of ureteroscopy with laser lithotripsy for assessment of resident trainee skills does not appear reliable. This is further supported by the lack of correlation between crowd scores and advancing PGY level.

Summary Objective To report very rarely encountered scrotal injuries during neonatal circumcision. Hospitals and physicians in the authors' country are mandated to report circumcision complications to the Ministry of Health. Those reports include the discharge summary from the emergency room or the admitting department. This is believed to be the first case series describing scrotal injuries during ritual circumcision. Patients and methods Reports of all circumcision complications between 2007 and 2014 were evaluated. Retrieved data on cases of scrotal injuries included patient's age, time between injury and hospital admission, nature of the injury, and administered treatment. Results Twelve of a total of 489 reports of circumcision injuries involved the scrotum (2.5%). All circumcisions were performed during the neonatal period, and the infants were admitted on the day of injury. The only related genital injury was significant shortage of penile skin reported in six patients. Scrotal exploration and skin closure in the operating room was undertaken in six cases, five under general anesthesia. Suture closure in the emergency department was performed in three patients, and the scrotal skin was left to heal with secondary intention in three other patients. Scrotal content injury that extended to the tunica vaginalis of the testis was noted in one exploration. Discussion The injuries sustained by the 12 study infants were mostly superficial and are not expected to cause long-term damage, although half of the patients required treatment under general anesthesia in the operating room or under sedation in the emergency department. While all reported patients emerged unscathed from the anesthetic procedures, the possible immediate complications of anesthesia as well as its long-term effects are not to be taken lightly, especially when treating a newborn. Further education of medical providers as well as performers of ritual circumcisions may help lower the risk of this rare injury as well as other more severe complications. Conclusion Scrotal injury during neonatal circumcision is rare. While half of the 12 reported patients required exploration in the operating room, the injuries were mostly superficial and did not involve scrotal content, although they often involved extensive resection of penile skin. Download : Download high-res image (485KB) Download : Download full-size image Summary Fig. 1 . Scrotal skin injury and penile skin deficiency following neonatal circumcision, left to heal by secondary intention.

Background: Obstructive nephropathy is an uncommon side effect of sulfadiazine, which is used for the treatment of toxoplasmosis. We present a case of acute renal colic and urine extravasation of a patient shortly after she was started on this medication. Case Presentation: A 31-year-old female presented with acute renal colic 2 weeks after starting treatment with sulfadiazine and pyrimethamine for ocular toxoplasmosis. Results: A noncontrast computed tomography revealed left hydronephrosis and fluid located around the kidney and in the left gutter. There were no urinary stones. Administration of intravenous contrast revealed significant urine extravasation at the level of the ureteropelvic junction. Intravenous contrast injection confirmed that the extravasation consisted of urine leakage at the ureteropelvic junction. Her clinical condition improved with the insertion of an internal stent, which was left in place for 4 weeks. A retrograde pyelography performed at the time of the internal stent removal ruled out persistent extravasation and filling defects in the left upper urinary tract. Considering the clinical circumstances and the imaging results, it appears that this is a first reported case of sulfadiazine-induced obstructive uropathy associated with urine extravasation. Conclusion: Although rare, obstructive uropathy related to sulfadiazine medication should be promptly suspected, diagnosed, and treated. Patients should be instructed to substantially increase their liquid intake while on that medication.

Objective: Nephrostomy tubes (NTs) inserted in emergency settings by interventional radiologists are frequently unsuitable for subsequent percutaneous nephrolithotomy (PCNL). We report a n...

Introduction The aim of this study was to evaluate the current literature on single-session bilateral endoscopic surgery for renal stones, analyzing their effectiveness and safety. Evidence acquisition A systematic literature review was performed to identify articles published between 1995 and July 2016 that reported data on bilateral single-session endoscopic surgery for renal stones. Articles were separated into the following categories: bilateral PCNL, bilateral FURS and bilateral PCNL with contralateral FURS. We used a narrative synthesis for the analyses of the studies. Evidence syntesis Five reports of bilateral FURS were identified in the literature search. These studies included a total of 218 patients that underwent bilateral FURS for renal stones. The primary SFR ranged from 64% to 92.8%. Postoperative complications were mostly described as minor complications; one major complication (0.5%) (grade V) was reported. Thirteen reports of bilateral PCNL were identified. These case studies included a total of 729 patients undergoing bilateral PCNL for renal stones. The primary SFR ranged from 24% to 100%. In all the studies a total of 29 (4%) major complications were described: 28 of them grade III while one was grade IV. One single study of bilateral PCNL with contralateral FURS for renal stones was identified. This report included 26 patients and the primary SFR was 92.3%. Two major complications (7.7%) (Grade III) were described. Conclusions Bilateral single-session endoscopic procedures for bilateral renal stones are effective and safe. It should be considered a viable treatment option in carefully selected patients, performed by experienced urologists in high-volume centers. Key to success is the proper selection of patients and extending surgery on the second side only when the first side has been uneventful.

To assess whether morphometric and clinical parameters influence accessibility to the upper calyx through a lower calyx tract during supine percutaneous nephrolithotomy (SPCNL).Data for 114 consecutive SPCNLs performed between June 2014 and March 2016 in an academic medical center were analyzed. Successful approachability was defined as rigid nephroscopic access to the upper calyx introduced through a lower calyx access as attested by direct visualization of the upper calyx papillae and position of the nephroscope on intraoperative pyelography. Demographic, morphometric, and clinical parameters were assessed. Analysis of variance, Fisher's exact, chi-square tests, and univariate and multivariate models were applied.Successful approach was achieved in 94 (82%) patients. In univariate analyses previous kidney operations (p = 0.03), body weight (p = 0.04), and acute lower calyx access to the upper calyx axis angle (p = 0.01SPCNL offers effective endoscopic accessibility through a lower calyx access. Previous kidney operations and body weight tend to negatively influence this accessibility. An acute angle between the lower calyx and the upper calyx is the single independent factor associated with failed accessibility.

The use of a ureteral access sheath (UAS) may provide significant advantages, particularly, in the treatment of a large renal stone burden. However, in some patients, the passage of a UAS up the ureter is impossible. We prospectively evaluated the ability to insert a 14F UAS and analyzed the possible predictors for an effective insertion.In a bicenter prospective study, 248 consecutive patients undergoing ureteroscopy and retrograde intrarenal surgery (RIRS) were recruited. In each case, we attempted initially to pass a 14F Flexor-Cook UAS. If passage was difficult, gradual dilation using semirigid ureteral dilators (Cook Medical) was performed. Patients were categorized into three groups: effective passage, with and without dilation, and failure to pass the UAS. Age, gender, body-mass index (BMI), an indwelling Double-J stent, and a history of previous ureteroscopy or Double-J stent were all analyzed, as possible predictors for an effective UAS insertion.In 22% of the patients, we could not pass a 14F UAS. Of the preoperative parameters that were examined, we found three independent predictors for an effective 14F UAS insertion: age (odds ratio: 1.5 and 95% CI [1.3, 1.9]), previous same-side procedures (odds ratio: 9.7 and 95% CI [8.3, 14.5]), and an indwelling Double-J stent (odds ratio: 21.73 and 95% CI [20, 30]). The gender, BMI, and side of surgery did not predict the success rate.Insertion of a 14F UAS before RIRS may fail in approximately one-fifth of the patients. An indwelling Double-J stent, a history of previous ureteroscopy or Double-J stent, and older age are all significant predictors for an effective 14F UAS insertion.

Objective To describe the post-percutaneous nephrolithotomy (PNL) non–contrast-enhanced computed tomography (NCCT) findings and assessed their clinical significance. NCCT evaluates stone clearance after PNL and also reveals procedure-related changes. Methods One hundred consecutive patients who underwent PNL were evaluated by NCCT one day post-procedure. Two radiologists analyzed the type and severity of the NCCT findings, which were then statistically analyzed in relation to the patient's clinical course. Results The patients' mean age was 54 years (range 18–82) and the mean maximal stone diameter was 37 mm (range 15–70). The median operative time was 110 minutes for an immediate stone-free rate of 83%, changing to 94% (P = .073) after a second-look PNL in 11 patients. The post-PNL NCCT findings were hydronephrosis (70%), atelectasis (54%), ipsilateral pleural effusion (52%), paracolic gutter fluid (44%), perinephric hematoma (40%), perinephric fluid (32%), ureteronephrosis (31%), renal swelling (23%), contralateral pleural effusion (22%), residual fragments (RFs) (17%), subcapsular hematoma (10%), and flank hematoma (6%). Univariate analysis revealed a significant association with clinical variables for all NCCT findings except for atelectasis, ureteronephrosis, contralateral pleural effusion, RFs, and flank hematoma. In multivariate analysis, only perinephric fluid (P = .007) and ipsilateral pleural effusion (P = .034) were associated with longer hospitalization, and perinephric fluid with longer recovery (P = .004). The complication rate was 12%, but none were linked with the radiological findings. Conclusion This work describes the post-PNL NCCT findings and their clinical significance. Perinephric fluid and ipsilateral pleural effusion were found to independently predict longer hospitalization and recovery time.

OBJECTIVE To investigate whether endourological interventions are associated with postoperative sexual dysfunction. PATIENTS AND METHODS The study comprises a consecutive and prospective series of patients, referred for endourological procedures. General anaesthesia was used and JJ stents were placed when required. Changes in sexual function, as assessed by the International Index of Erectile Function questionnaire that the participants filled in the day before the procedure and 1 month and up to 3 months afterwards, were analysed. RESULTS The study group consisted of 50 men aged (mean ± SD) 45 ± 13 years, of whom 25 underwent ureteroscopy, 9 underwent retrograde intrarenal surgery (RIRS) and 16 underwent combined RIRS and percutaneous nephrolithotomy. JJ stents were postoperatively placed in 33 patients (66%). The study cohort self-reported a significant decrease in erectile function (P= 0.007), intercourse satisfaction (P < 0.001), orgasmic function (P= 0.001), sexual desire (P < 0.001) and overall satisfaction (P= 0.002) at 1 month following endourological procedures. This dysfunction was not related to chronic disease, age, smoking, preoperative or postoperative stenting, type of procedure, operative duration or surgeon expertise. The sexual function of all subjects returned to baseline within 3 months (P < 0.005). Postoperative erectile function in the stented group revealed a negative tendency that did not reach statistical significance. CONCLUSIONS Endourological procedures are associated with temporary postoperative sexual dysfunction, which completely recovers within 3 months. The impact of postoperative stenting on sexual function was not significant. These findings contribute to enhanced preoperative patient counselling.

To assess the long-term outcome of early endoscopic realignment (EER) of complete posterior urethral disruption.The study included 11 consecutive patients with complete posterior urethral disruption secondary to a road accident (n = 9) or a falling impact (n = 2). EER was performed using a simultaneous endoscopic transvesical and transurethral approach under fluoroscopic guidance. An 18F Foley urethral catheter was left for 4 weeks. All patients were evaluated postoperatively for incontinence, erectile dysfunction, and urethral strictures.The patients' mean age was 32 years (range 20-62 y). The mean duration of the realignment procedure was 40 minutes (range 30-60 min), and it was performed within an average of 48 hours (range 3-72 h) from hospitalization. Efficient erection was maintained in five (45%) patients, and incontinence did not develop in any patient. Five (45%) patients in whom urethral strictures developed were treated initially by endoscopic urethrotomy (EU), which was successful in one patient. Three of the four in the EU failure group remained on periodic urethral dilation, refusing to undergo urethroplasty, and one patient with interposition of a pubic bone fragment underwent successful urethroplasty. There were no other complications during a mean follow-up of 4.3 years (range 2-7 y).EER is a valuable alternative to long-term suprapubic drainage and delayed urethroplasty. Realignment failure did not interfere with the results of open urethroplasty. A further search for prognostic factors should improve the selection of patients for the early or the delayed approach.

Tubeless percutaneous nephrolithotomy (PCNL) has been successfully performed in selected patients. We assessed its applicability for use without imposing preoperative restrictions.The study consisted of a prospective and consecutive series of 126 patients. Tubeless PCNL was performed when perforation, residual stones, and significant bleeding had been intraoperatively excluded by fluoroscopy, nephroscopy, and hemodynamic assessment. Staghorn stones, supracostal and/or multiple access, anatomic anomalies, previously operated kidneys, solitary kidneys, and operative time were not considered contraindications. The demographic, clinical, and intraoperative and postoperative data were statistically analyzed.Using this protocol, we performed 66 (52%) tubeless and 60 (48%) regular PCNLs. The average patient age (54 years versus 52 years), stone burden (924 versus 1044 mm2), operative time (116 versus 130 minutes), complication rate (9% versus 13%), hemoglobin decrease (1.2 versus 1.1 mg/dL), and immediate stone-free rate (92% versus 90%) were similar for the tubeless and regular PCNL groups, respectively (P0.05). The reasons for performing standard PCNL were an expected second-look procedure (n = 35, 58%), an impression of active bleeding (n = 16, 27%), significant extravasation (n = 5, 8%), and suspected hydrothorax (n = 4, 7%). The overall transfusion rate was 3%. The average analgesia requirement (pethidine HCL) was 0.4 and 1.2 mg/kg (P0.01), the median hospital stay was 1 and 4 days (P0.0001), and the median back-to-work time was 7 and 15 days (P0.001) for the tubeless and regular PCNL groups, respectively.The results of our study have shown that tubeless PCNL can be safely and effectively performed based on intraoperative factors, without preoperative contraindications. Compared with the standard procedure, tubeless PCNL was associated with reduced postoperative pain, hospital stay, and recovery time.

Exstrophy reconstruction is challenging and requires expertise and experience. However, many patients are treated at low volume centers. We evaluated whether classic bladder exstrophy could be safely and successfully reconstructed at a low volume center.A total of 31 patients with classic bladder exstrophy were primarily treated at our low volume center during a 17-year period. A total of 22 patients underwent primary closure within 5 days of birth and 9 underwent delayed closure with osteotomy. Of the patients 29 underwent planned modern staged repair and 2 underwent attempted complete primary repair.The bladder was successfully closed in all 31 children. All 22 newborns underwent primary bladder closure without osteotomy, including 4 with extremely small bladder plates. Bladder neck obstruction developed in 3 patients (10%), of whom 2 were treated successfully with transurethral dilation and 1 underwent open repair. Epispadias repair was successful in 12 of 15 patients undergoing the Cantwell-Ransley technique and in 2 of 4 undergoing complete primary repair. A total of 16 patients underwent bladder neck reconstruction, of whom 9 are awaiting appropriate age or capacity, 4 were lost to followup, 1 is continent after bladder closure alone and 2 underwent continent diversion (1 after failed bladder neck reconstruction). Of the 15 patients with at least 1 year of followup after bladder neck reconstruction 9 are continent day and night, 2 are continent only during the daytime and 4 are incontinent, for a 73% post-bladder neck reconstruction continence rate (11 of 15 patients).Successful exstrophy reconstruction is achievable at a low volume center, with results comparable to those of high volume centers.

Objective. To assess the effect of sildenafil on nocturnal erectile function (EF) in young healthy volunteers with normal sexual function (SF) according to the International Index of Erectile Function (IIEF) questionnaire. Methods. Thirty-three young (mean age 21 +/- 0.3 years; range 18-2 5) healthy volunteers not taking any medications who had normal SF and an EF domain > 26 on the 11EF questionnaire were evaluated. Erectile function was assessed using the RigiScan (TM) (Dacomed Corp., MN, USA) during three nights: night I = adaptation to the NPT-Rigiscan apparatus, night 2 = baseline recording of eight parameters, and night 3 = recordings after ingestion of sildenafil 100 mg. Data on the number of erections, erection duration, minimal and maximal base tumescence, minimal and maximal tip tumescence, and base and tip rigidity were analysed using ANOVA with repeated measures. Results. A statistically significant improvement in all eight parameters was observed as a result of sildenafil administration: number of erections from 3.1 +/- 0.7 to 4.0 +/- 0.7 (P < 0.05), erection time 22 +/- 3.5 to 34.2 +/- 5.9, minimal base tumescence 8.2 +/- 0.8 to 8.7 +/- 0.8, maximal base tumescence 12.1 +/- 0.7 to 14.2 +/- 0.7, base rigidity 75.6 +/- 3.1 to 81.6 +/- 3.6, tip rigidity 70.6 +/- 1.5 to 75.9 +/- 3.1, minimal tip tumescence 5.9 +/- 0.5 to 6.5 +/- 0.6, and maximal tip tumescence 8.6 +/- 0.6 to 11.7 +/- 0.7 (P < 0.0001 for each of the last seven parameters). The mean sleep duration, 7.3 hours (range 6.30-9.20 hours), was similar for both nights of recording. Conclusions. Sildenafil increases the quality and number of nocturnal erections as tested by the NPT-RjgiScan (TM) in young healthy volunteers with normal EF. Objective. To assess the effect of sildenafil on nocturnal erectile function (EF) in young healthy volunteers with normal sexual function (SF) according to the International Index of Erectile Function (IIEF) questionnaire. Methods. Thirty-three young (mean age 21 +/- 0.3 years; range 18-2 5) healthy volunteers not taking any medications who had normal SF and an EF domain > 26 on the 11EF questionnaire were evaluated. Erectile function was assessed using the RigiScan (TM) (Dacomed Corp., MN, USA) during three nights: night I = adaptation to the NPT-Rigiscan apparatus, night 2 = baseline recording of eight parameters, and night 3 = recordings after ingestion of sildenafil 100 mg. Data on the number of erections, erection duration, minimal and maximal base tumescence, minimal and maximal tip tumescence, and base and tip rigidity were analysed using ANOVA with repeated measures. Results. A statistically significant improvement in all eight parameters was observed as a result of sildenafil administration: number of erections from 3.1 +/- 0.7 to 4.0 +/- 0.7 (P < 0.05), erection time 22 +/- 3.5 to 34.2 +/- 5.9, minimal base tumescence 8.2 +/- 0.8 to 8.7 +/- 0.8, maximal base tumescence 12.1 +/- 0.7 to 14.2 +/- 0.7, base rigidity 75.6 +/- 3.1 to 81.6 +/- 3.6, tip rigidity 70.6 +/- 1.5 to 75.9 +/- 3.1, minimal tip tumescence 5.9 +/- 0.5 to 6.5 +/- 0.6, and maximal tip tumescence 8.6 +/- 0.6 to 11.7 +/- 0.7 (P < 0.0001 for each of the last seven parameters). The mean sleep duration, 7.3 hours (range 6.30-9.20 hours), was similar for both nights of recording. Conclusions. Sildenafil increases the quality and number of nocturnal erections as tested by the NPT-RjgiScan (TM) in young healthy volunteers with normal EF.

Objectives. To assess the feasibility of performing endourologic interventions combined with other operations during the same operative session. Methods. Eighteen patients underwent simultaneous operations endourologically for upper urinary tract pathologic findings and other surgical and urologic indications. The operating time, technical feasibility, operative success, complications, hospital stay, and patient satisfaction were analyzed. Results. The average patient age was 63 years (range 40 to 83). Five patients underwent percutaneous nephrolithotomy combined with either contralateral laparoscopic nephrectomy, contralateral open nephrectomy, radical retropubic prostatectomy, inguinal/umbilical hernia repair, transurethral resection of prostate, or cystolithotripsy. Thirteen patients underwent 15 retrograde endoscopic procedures (13 for stone disease and 2 for diagnostic purposes) that were combined with open contralateral nephrectomy, inguinal hernia repair, circumcision, closure of ileostomy, transurethral resection of bladder tumor, excision of lymphoma of thigh, drainage and sclerozation of hydrocele, or percutaneous gastrostomy. All procedures were successfully completed without complications. The average hospital stay was 5 days (range 3 to 6) in the percutaneous nephrolithotomy group and 2 days (range 1 to 5) in the retrograde endoscopic procedure group. The duration of hospitalization was related to the more complex operation; combining the procedures did not prolong it. The average follow-up was 11 months (range 3 to 24). All patients were highly satisfied because they were spared the need for more than one surgical session. Conclusions. Our results support the concept of performing simultaneous endourologic procedures and other operations during one surgical session. This approach obviates the need for repeated anesthesia, patient inconvenience, the psychological stress related to multiple operations, and reduces the total hospital stay. UROLOGY 64: 900–903, 2004. © 2004 Elsevier Inc.

Objectives To present a combined endourologic approach to treat bladder calculi consisting of simultaneous percutaneous suprapubic and transurethral cystolithotripsy. Methods We report on a series of 12 consecutive patients with bladder stone burdens of 40 mm or greater. Percutaneous 30F access was obtained under cystoscopic control. Fragmentation and stone removal were performed simultaneously by two urologists using a Swiss lithoclast, holmium laser, and/or ultrasound lithotriptor through both percutaneous and transurethral routes. Suprapubic and transurethral catheters were placed postoperatively. Results Twelve patients with a median age of 66 years (range 33 to 80) were treated by simultaneous percutaneous suprapubic and transurethral cystolithotripsy. Six underwent transurethral resection of the prostate at the completion of stone clearance. The median stone size was 60 mm (range 40 to 80), and the median lithotripsy time was 56 minutes (range 45 to 70). The median postoperative hospitalization was 2.7 days (range 2 to 5), and complete stone clearance was achieved in all cases. One patient, who underwent concomitant transurethral resection of the prostate, developed urinary retention 1 week postoperatively and was successfully treated by temporary transurethral catheterization. One patient with a positive urine culture preoperatively developed fever on the first postoperative day and was treated with intravenous antibiotics according to the antibiogram results for 5 days. No other complications had occurred after a median follow-up of 10 months (range 3 to 15). Conclusions Simultaneous percutaneous suprapubic and transurethral cystolithotripsy appears to be a safe approach for the management of large bladder calculi and may shorten the total fragmentation time. It can be combined with transurethral resection of the prostate without prolonging hospitalization. The simultaneous use of two modalities of stone fragmentation represents an effective and minimally invasive way of treating large bladder calculi.

Men not entirely satisfied with erectile function after separate use of sildenafil or a vacuum entrapment device (VED) are usually given more invasive alternatives. This prospective study was designed to evaluate the efficacy of concomitant use of sildenafil and a vacuum entrapment device in men not satisfied with erectile function while using each of these treatment modalities separately.A total of 161 patients suffering from erectile dysfunction for at least 6 months were evaluated and treated with 100 mg sildenafil and a VED each as monotherapy. The 41 patients not satisfied with erectile function while using either modality alone were treated with concomitant use of sildenafil and a VED. The International Index of Erectile Function and global assessment question about satisfaction from treatment were used to evaluate satisfaction before and after each treatment.All 41 patients stated on the global assessment question that they had a greater level of satisfaction with the results of combined treatment than with each treatment alone (p0.0001). Older (age greater than 60 years) participants reported better overall satisfaction. There was no correlation between treatment outcome and erectile dysfunction etiology or between satisfaction from treatments and the order in which they were given and the pretreatment scores for the International Index of Erectile Function domains.Combined use of sildenafil and a VED may be offered to patients not satisfied when either treatment is used alone.

To determine whether intravenous urography (IVU) is a prerequisite for shockwave lithotripsy (SWL) of renal stones by addressing whether using non-contrast-enhanced CT (NCCT) instead of IVU for delineating urinary tract anatomy is associated with post-SWL complications.Thirty-eight patients treated by SWL (Econolith 2000) for radiopaque renal stones underwent either IVU or NCCT. Twenty patients with normal urinary tracts or with mild hydronephrosis proximal to the stone on urography comprised the IVU group. Eighteen patients who underwent NCCT and plain abdominal (KUB) films and had urinary tract systems similar in appearance to the IVU group comprised the NCCT group. The two groups were of similar mean age (45.75 years, range 24-73 years; and 49.0 years, range 26-72 years, respectively) and had a similar mean stone size (10.1-10.2 mm). Patients with internal ureteral or nephrostomy catheters were excluded. Information on episodes of intractable renal colic, urinary tract infections, and hospitalization was recorded at follow-up 2 to 6 weeks post-SWL.The IVU and NCCT patients had similar mean stone fragmentation rates (80% and 74%, respectively) at 2 to 6 weeks post-SWL. Four IVU patients (20%) had intractable renal colic. One NCCT patient (5.5%) had a urinary infection. Complication and hospitalization rates in the two groups were not significantly different (P = 0.34; Fisher' exact test).Using only NCCT before SWL was not associated with higher complication rates. Thus, IVU is not a prerequisite for SWL of radiopaque renal stones in patients with a normal urinary tract anatomy as seen on NCCT.

To evaluate the effectiveness and safety of supine bilateral percutaneous nephrolithotomy (BPCNL) performed in the same session in patients affected with bilateral renal calculi.We retrospectively identified patients with bilateral renal stones with diameters2 cm for each side, who had been treated with supine BPCNL in the same session, from November 2006 to April 2014. We reviewed demographic and stone characteristics, intraoperative and perioperative outcomes, and complications related to the procedure adopted. The stone size was calculated by measuring the maximum stone diameter by computed tomography scan. Stone-free rate was defined as clinically insignificant when residual fragments of ≤2 mm were detected by computed tomography scan.Twenty-five patients were included in the study; the mean age was 51.9 ± 11.4 years; the mean maximum stone diameter per renal unit was 3.1 ± 0.8 cm. Statistical significant differences in creatinine serum levels were detected at day 1 postoperatively compared with the baseline (P .0001) values that became insignificant at 1 week and 1 month postoperatively (P.05). The primary stone-free rate was 80%; ancillary procedures were performed in 3 of 25 patients (12%). Grade I complications occurred in 3 patients (12%), grade II in 4 patients (16%), and grade IIIA in 1 patient (4%).Supine BPCNL performed in the same session is a safe and effective procedure in patients affected with bilateral renal calculi. On the other hand, it is still a very challenging operation, and consequently, it should be performed only by experienced surgeons in a tertiary center.

Purpose: We assessed the effect of location and number of positive margins on biochemical progression in patients after radical retropubic prostatectomy for prostate cancer.Materials and Methods: The incidence, location and number of positive surgical margins as well as recurrence and time to recurrence were evaluated in a consecutive series of 734 men who underwent radical retropubic prostatectomy for localized prostate cancer from 1992 through February 1999.Results: Surgical margins were positive in 210 patients (29%), of whom 157 (75%) and 53 (25%) had 1 and more than 1 positive margin, respectively. Of the patients 53 (25%) with tumor at any inked margin had biochemical recurrence. We identified no significant association of a particular location with biochemical recurrence. Bladder neck location did not carry an increased risk of recurrence (hazard ratio 1.23, 95% confidence interval 0.54 to 2.80). However, these findings were made in a limited number of cases with positive bladder neck margins. Pati...

PURPOSE: To assess the effect of nerve-sparing (NS) radical retropubic prostatectomy (RRP) on surgical margins and biochemical recurrence. PATIENTS AND METHODS: Location and incidence of positive surgical margins, recurrence, and time to recurrence were assessed in a consecutive series of 734 men who underwent RRP for localized prostate cancer from 1992 through February 2000. NS procedures were used in 33% (n = 240) of 734 patients studied. RESULTS: Surgical margins were positive for 24% (n = 58) and 31% (n = 152) of NS and non-NS patients, respectively (P = .06). No significant difference between the groups was found in location of positive margins (P = .92). Prostate-specific antigen level greater than 10 ng/mL, extraprostatic extension, tumor volume more than 20%, capsular penetration, Gleason score ≥ 7, positive margins, and seminal vesicle invasion were associated with significantly increased risk of recurrence. However, NS patients were not at increased risk of recurrence compared with non-NS patients (hazard ratio, 0.96; 95% confidence interval, 0.53 to 1.72). The cumulative risk of recurrence within 3 and 5 years of surgery in NS patients was 9.7% and 14.4%, respectively, as compared with 17.1% and 21.1% for non-NS patients. CONCLUSION: In patients with localized prostate cancer, neither margin status nor biochemical-free survival within 5 years of surgery were altered by the nerve preservation technique. Given our experience, we recommend preservation of neurovascular bundles in these patients whenever the procedure is technically feasible.

Purpose: The management of ureterointestinal stricture in patients who have undergone urinary diversion can be challenging. Endourological techniques have been increasingly used in recent years for ureteral stricture. While long-term results may not be as reliable or durable as those of traditional open reconstructive surgical techniques, associated morbidity is much less. The holmium (Ho):YAG laser, which has cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with and long-term results of Ho:YAG laser endoureterotomy for ureterointestinal strictures.Materials and Methods: We reviewed the charts and followup history of 23 patients in whom the Ho:YAG laser was used to treat ureterointestinal anastomotic stricture. Strictures were treated percutaneously via the antegrade approach with flexible endoscopes and the holmium laser. A reversed 12/6Fr endopyelotomy stent was left indwelling for 6 weeks postoperatively. Success was defined as sym...

To assess the outcome of segmental ureteral replacement using a new multilayer porcine small-intestinal submucosa (SIS), Surgisis ES (Cook Inc., Stouffville, ON, Canada) designed to provide enhanced strength.The ureters of five female farm pigs were accessed through a median laparotomy incision. A segment of 2-cm midureter was resected bilaterally. The left ureteral segments were replaced by 10F tubularized SIS segments using 5-0 PDS interrupted sutures. The right ureters were primarily end-to-end anastomosed, serving as controls. Internal pigtail stents were left bilaterally for 6 weeks. One animal at 3 weeks, one animal at 6 weeks, and three animals at 12 weeks were sacrificed. The patency of the ureters was assessed by retrograde pyelography at 6 and 12 weeks, while inflammation and regeneration were assessed grossly and histologically.At 3 and 6 weeks, both experimental and control ureters were patent without extravasation on retrograde studies. Adhesions and signs of ureteral inflammation were found only on the SIS side. The graft was partially and completely epithelialized at 3 and 6 weeks, respectively. However, at 12 weeks, all the ureters on the experimental side were completely occluded, while on the control side, all were patent. Although histologically, urothelium and muscular cells had proliferated over the graft, they were embedded in an intense fibrotic and inflammatory process. At 12 weeks, all animals had developed hydroureteronephrosis above the grafts.Technically, Surgisis ES was easily modeled, providing conditions for a water-tight anastomosis. None of the animals developed urinary fistula. Regeneration of urothelium and muscle were induced and supported by the graft. However, functional replacement was not successful. A suitable material for this purpose has yet to be discovered.

Purpose: A prospective randomized controlled trial was performed to determine whether stents may be eliminated after uncomplicated ureteroscopic lithotripsy for ureteral stones.Materials and Methods: A total of 58 patients underwent uncomplicated ureteroscopic intracorporeal lithotripsy. After stone fragmentation patients were randomized to a nonstented (29) or a stented (29) treatment group. Intracorporeal lithotripsy was performed with the holmium laser in 57 cases and by electrohydraulic lithotripsy in 1 without balloon dilation or the extraction of stone fragments. Patients were followed 1, 6 and 12 weeks postoperatively. In stented cases the stent was removed at 1 week. Outcome measures included postoperative symptoms assessed with a visual analog scale, postoperative analgesic requirements, complications and the stone-free rate.Results: At 1 week the symptoms of flank pain, abdominal pain, dysuria and frequency were significantly greater in the stented group (p

Both RigiScan and the Snap Gauge band devices are used to objectively measure penile rigidity. The Snap Gauge band is the more simple and inexpensive of the two techniques. We investigated the correlation between the results obtained by both devices in order to evaluate whether the Snap Gauge band could be employed as the sole method of rigidity evaluation while not affecting the quality of diagnosis. Forty eight patients who were presented to our erectile dysfunction clinic used the two devices simultaneously, each according to the accepted protocols. Breakage of two and three strings of the Snap Gauge (good rigidity) correlated well with good tip and average rigidity as evaluated by the RigiScan. Snap gauge results also correlated with duration of erection, number of erections, the number of adequate erections, and the longest duration of erection measured by the RigiScan. Therefore, good rigidity according to the Snap Gauge test correlated well with the results of functional erections (number, rigidity, duration) as obtained by the RigiScan. The Snap Gauge band can be used to adequately evaluate penile rigidity. RigiScan measurements, which are more complicated and more expensive, should be reserved for selected patients in whom the results of the Snap Gauge band are inconclusive or when more detailed information is required.

SummaryVarious prognostic factors which could be implicated in late complications associated with intraurethral stents and coils were evaluated. A consecutive series of 107 subjects with BPH or prostatic cancer who required intraurethral stents and randomly received either the Prostakathr` or Urospiralr` type were followed for 2–7 years. Data on stent-associated complications were collected. Factors directly associated with the complication rate were the pre-treatment presence of an indwelling catheter and asymptomatic bacteriuria, as well as post-treatment low urinary flow rate. Stent type and length did not influence outcome. It is concluded that in selected patients, either of the two studied intraurethral stents is a feasible and durable treatment. Men with indwelling catheters and/or bacteremia are at high risk of complications (e.g. migration, stone formation, strictures), as are those with post-stent insertion low uroflow. Although stents may be left in situ for years, these subgroups of men should...

Purpose: We evaluated the efficacy of testosterone gel (T-gel) alone and in combination with sildenafil in hypogonadal patients with erectile dysfunction (ED). Materials and Methods: A total of 49 hypogonadal men (mean age 60.7 years) with ED participated for a mean of 20.2 months. Blood was tested for total and bioavailable testosterone, and prostate specific antigen. Sexual function was assessed using the International Index of Erectile Function questionnaire and a global assessment question (GAQ). Men received 1% 5 gm T-gel for 6 months, and 100 mg sildenafil was added to those with a “no” response to the GAQ after 3 months on testosterone supplement. Results: A total of 31 patients reported significant improvement in the sexual desire domain (from a mean SD of 4.2 0.8 to 8.6 0.4) and erectile function (EF) domain (from 13.6 1.9 to 27 0.8) following treatment with testosterone supplement alone. One patient was excluded from study after urinary retention developed and 9 reported irritation at the gel application site. In spite of normalization of total and bioavailable testosterone values, and significant improvement of sexual desire domain scores, the EF of 17 men remained less than 26 or they responded “no” to the GAQ. These men received combined T-gel and sildenafil, after which all graded EF greater than 26 and responded positively to the GAQ. Conclusions: Combined treatment with sildenafil and T-gel has a beneficial effect on ED in hypogonadal patients in whom treatment with testosterone supplement alone failed.

Objective Our institutional protocol for the treatment of exstrophy-epispadias complex includes routine endoscopic and cystographic evaluation of the bladder with the child under general anesthesia. The protocols briefly described in the literature include a cystographic evaluation and the measurement of bladder capacity, but there are no reports on concurrent endoscopic findings and the value of examinations in this setting. Our objective is to evaluate the role and necessity of our management protocol by reviewing the findings in our patients' medical charts. Study design Cystoscopies are performed in children with exstrophy-epispadias complex during the second year of life and then every 18 months until a capacity of 90 mL has been reached and bladder neck reconstruction, the last stage of modern staged repair, is performed. Patients referred from other institutions are evaluated on presentation. The examinations are performed by means of a pediatric cystoscope with the child under general anesthesia. Cystography is performed under a pressure of 30 cm/H2O. The contribution of the findings of these periodic evaluations vis-a-vis the surgical findings were studied. Results The medical charts of 49 patients who had been surgically treated for exstrophy-epispadias complex in our institution between 2000 and 2014 were reviewed. Thirty patients underwent at least one evaluation. Eighteen underwent serial examinations: four underwent two procedures, eleven underwent three procedures, and three underwent four procedures. The findings in eight cases were significant and they were treated on detection: bladder neck stricture (n = 5), bladder scar bridge (n = 2), and bladder stone (n = 1). Vesicoureteral reflux was present in all 30 patients, and high-grade reflux was present in 10 patients, of whom four had a bladder neck stricture. Fourteen of the 30 patients had a bladder capacity of 90 mL on the first evaluation, as did an additional eight children during later evaluations. Bladder capacity decreased below 90 mL in one child. Seven children did not reach the target capacity (Figure). Conclusion Cystoscopic and cystometrographic evaluation of an exstrophic bladder allows early diagnosis of treatable bladder pathologies and monitoring of bladder capacity. It is a valuable tool in the follow-up period preceding bladder neck reconstruction. Figure. (A), (B) Good bladder capacity (95 mL), bilateral low-grade VUR, smooth bladder contour. Scheduled for bladder neck reconstruction. (C), (D) Small bladder capacity (55 mL), unilateral VUR, smooth bladder contour. (E), (F) High-grade bilateral VUR, bladder outlet obstruction, irregular bladder contour. A fibrotic bladder scar bridge was incised. Figure options Download full-size image Download high-quality image (848 K) Download as PowerPoint slide

We assessed the feasibility of immediate sealing of nephrostomy tube wounds after percutaneous surgery using a tissue adhesive.The study represents a prospective series of 27 consecutive percutaneous procedures. After nephrostographic exclusion of infrarenal urinary obstruction the nephrostomy tubes were removed and the wound edges were glued together using 2-octyl cyanoacrylate. The wound was covered by gauze to assess the efficiency of sealing and the patients were followed clinically. Another consecutive series of 20 patients who had been treated during 6 months before the current study were used for comparison. The nephrostomy wound in this group was dressed and left to close spontaneously.A total of 27 percutaneous procedures were performed in 25 patients with a median age of 51 years (range 9 to 77). There were 26 cases of percutaneous nephrolithotomy for an average stone burden of 32.6 mm. (range 16 to 70) and 1 pediatric case of percutaneous antegrade balloon dilation of ureteral stricture related to Cohen reimplantation. Median size of the nephrostomy tubes was 16Fr (range 12Fr to 24Fr) and they were maintained a median of 4 days (range 1 to 16) postoperatively. Urinary leakage ceased immediately after tissue adhesive application in all cases. One patient in whom renal colic developed secondary to edema of the ureteral orifice underwent temporary stenting in retrograde fashion. There were no additional complications at a median followup of 5 months (range 3 to 7). The study group had a significantly shorter hospital stay than the wound dressing group (p0.001).Wound sealing following nephrostomy tube removal using 2-octyl cyanoacrylate appears to be a safe, simple and efficient method for immediate abolishment of urinary leakage. This novel approach avoids patient and medical personnel inconvenience, permitting early release from the hospital without physical and social limitations related to persistent wound urinary discharge.

Objectives To present the results of ventral plication for the repair of dorsal curvature. Methods A total of 33 patients (mean age 38 months, range 7 months to 15 years) with a dorsal curvature of >30° degrees underwent ventral plication. A subcoronal incision was performed, followed by degloving of the skin to the penile base. The point of maximal curvature was noted and marked during an erection test. Two polypropylene 5-0 plication sutures were placed in the tunica albuginea of both corporeal bodies, just lateral and adjacent to the corpus spongiosum. Proper alignment and a straight penis were confirmed with a repeat erection test. The skin incision was closed with absorbable sutures. Surgical success was determined by parental and physician satisfaction with the final outcome during follow-up. Results No immediate or late complications (mean follow-up 25 months, range 3-65) developed. A straight penis was achieved in 28 of 33 patients (85%). Four patients with residual curvature did not require a second procedure, and the fifth patient successfully underwent reoperation using the same technique. Conclusions The results of our study have shown that ventral plication is a simple and efficient technique for the repair of dorsal penile curvature.

The approach to urinary-stone disease has changed dramatically over the last three decades with a transition from open surgery to minimally invasive procedures. Percutaneous nephrolithotripsy (PCNL) is a cornerstone of the treatment of kidney and selected upper-ureteral stones and continues to evolve with advances in techniques and instrumentation. The purpose of this study was to assess outcomes and trends prospectively in a large contemporary group of patients undergoing PCNL.Between July 1990 and December 2005, all 1338 patients at a single center scheduled for PCNL (N = 1585 procedures) were enrolled. Their mean age was 53 years (range 4-89 years). Data including comorbidities, stone burden, stone location, surgical time, hospital length of stay, rate of secondary procedures, and adverse events were collected prospectively. The primary outcome measures were stone-free rate and complications.There was a substantial incidence of comorbid medical conditions (48.8%) and anatomic renal abnormalities (25.3%), demonstrating the diverse and challenging patient population in this contemporary series. The overall stone-free rate at 3 to 6 months of follow-up was 94.8%.Percutaneous nephrolithotripsy is a highly effective procedure and may be performed in a diverse group of patients with comorbid conditions and renal abnormalities. Improved intracorporeal lithotripters, balloon dilation of the tract, use of flexible instruments, and liberal use of secondary nephroscopy result in excellent stone-free rates with low morbidity.

OBJECTIVES To assess the outcome of pediatric patients treated by ureteroscopy for various pathologic findings. METHODS A total of 31 children (median age 5 years, range 0.3 to 14) were ureteroscopically treated for ureteropelvic junction obstruction (UPJO) (n = 6, 1 primary and 5 secondary), ureteral strictures (n = 4), and calculi (n = 21). Miniscopes with a holmium laser were used for lithotripsy and ureterotomy. RESULTS The average age in the UPJO group was 1.8 years (range 0.3 to 4), the operative time was 40 minutes (range 30 to 50), and the hospitalization was 1.2 days (range 1 to 2). A successful clinical and functional outcome was maintained after an average follow-up of 16 months (range 8 to 30). The 4 cases of ureteral stricture included two located in the middle ureter and two at the ureterovesical junction. No failures had occurred in this group after an average follow-up of 25 months (range 8 to 40). The calculi cases comprised 10 lower ureteral, 2 upper ureteral, and 9 renal stones, with an average stone burden of 11 mm (range 5 to 20). Three patients (14%) underwent preoperative stenting. Two patients (10%) required ureteral orifice dilation. Postoperatively, 4 patients (18%) had a ureteral catheter left in place, 15 (71%) had an internal stent with an externalized string, and 2 (10%) did not require drainage. The average operative time was 39 minutes (range 15 to 90), and the hospitalization was 1 day (range 0.5 to 2). All patients were rendered stone free. CONCLUSIONS The results of our study have shown that the ureteroscopic approach in children with UPJO, ureteral strictures, and urinary calculi is safe and highly effective. Routine preoperative stenting and intraoperative ureteral dilation are not necessary. Stents with external strings were well tolerated and easily removed without anesthesia.

We questioned the need for more than one RigiScan recording for accurate assessment of sleep-associated penile erections and determine the necessity of consecutive nightly recordings for valid evaluation of sleep-associated erections. Men complaining of erectile dysfunction (ED) and referred to RigiScan evaluation for the first time participated. Recordings were performed at the patient's home during two consecutive nights, and data on test time, number of erections, erection duration, minimal and maximal base and tip tumescence and rigidity were retrieved for both nights. Normal erectile function was defined with the recording of at least one erection (70 out of 100% tip rigidity lasting for at least 10 min during either night). The main outcome measures were RigiScan recordings. Group 1 consisted of 29 men (mean age 42.4+/-13.8 years, range 22-71) who had normal erections, all during the first night. Group 2 consisted of 26 men (mean age 48.6+/-13.5 years, range 25-70) who failed to fulfill both criteria for normal erection. In Group 2, only the values for penile base rigidity and erection duration were normal during the first night: the parameters of maximal base tumescence, tip rigidity, number of effective erections and duration of effective erections that were impaired during the first night were significantly worse (P0.01) during the second night. The required information for the diagnosis of psychogenic ED was obtained during the first night in50% of the participants. Men with normal erections during the first night can be spared the inconvenience and cost of re-testing. Consecutive night recording should be reserved for patients whose recorded data during the first night did not fulfill the criteria for normal erection.

Background : Various methods of urinary bladder augmentation have been attempted in order to try and achieve adequate bladder capacity, urinary continence, control urinary tract infection and preserve the upper urinary tract; however, long-term complications have been unavoidable. Objective : To evaluate our experience with ureterocystoplasty as to whether it is the preferred method for bladder augmentation to achieve continence and preserve the upper urinary tract. Design : Retrospective study. Setting : Paediatric urology unit, Dana Children\'s hospital, Tel Aviv Medical Center (affiliated to the Sackler School of Medicine), Tel Aviv University. Subjects : Four children; three girls, one boy, mean age 7.3, range (3-14) years. Two had neurogenic bladder due to occult spinal dysrraphism, the other two had non-neurogenic neurogenic bladder. The indications for surgery were urinary incontinence with recurrent urinary tract infections in all patients, one also had upper tract dilatation. Interventions : All underwent augmentation ureteroplasty, two required nephrectomy due to non-functioning kidney, two required clean intermittent catheterizatiom postoperatively. Main Outcome Measures : Urinary continence, bladder capacity, vesicoureteral reflux, renal function tests, urinary tract infection rate and surgical complications encountered. Results : In a mean follow-up period of 24 (6-46) months, all of the patients achieved urinary continence, two of the patients who have a normal bladder outlet are continent and void spontaneously with no residual urine. The other two patients are continent on clean intermittent catheterization. Only one episode of urinary tract infection was seen, none of the patients are currently on prophylactic antibiotics. The urinary bladder in all patients is spherical with good capacity and no vesicoureteral reflux was demonstrated. The upper urinary tracts are stable and the renal function tests are normal. Conclusion : Ureterocystoplasty is our preferred choice of bladder augmentation in patients with small, inelastic, poor compliant bladder with at least a moderately dilated ureter. Complications normally seen with enterocystoplasties are minimal. East African Medical Journal Vol. 82(5) 2005: 247-249