Search

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]

Bisphenol A (BPA) is a widespread environmental pollutant caused mainly by the production, use, or disposal of plastics and the degradation of industrial plastic-related wastes. Growing data from studies on humans, lab animals, and wildlife supports the idea that BPA has a detrimental effect on male renal and reproductive function by disrupting the endocrine system. We reviewed the literature for a better understanding of the negative effects of BPA exposure, focusing on the impacts of BPA on kidney, prostate, and testicular health. Current data suggest an impaired renal function in individuals with chronic BPA exposure and raise an important issue regarding the presence of this plastic chemical in the dialysis product. The method by that BPA affects prostate tissue is intricated. The frequency of precancerous or cancerous lesions, such as a PIN or even prostate cancer, is rising among elderly males who have had their stem cells reprogrammed by estrogen-like action. Various studies revealed that early exposure to BPA could cause the prostate to develop several different epigenetic modifications, leading to neoplastic alterations of prostate cells. The idea that BPA has an endocrine-disrupting effect and adversely affects male reproductive function is supported by mounting data from studies on laboratory animals, wildlife, and people. By altering the production, expression, and activity of specific receptors for hormones (such as LH and FSH, androgen, and estrogen), BPA has an impact on the hypothalamic-pituitary-testicular axis (ER, AR). Sperm parameters are changed by these effects. By blocking antioxidant enzymes and promoting lipid peroxidation, BPA also causes oxidative stress in the testis and epididymis. [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 purpose of single-use flexible ureteroscopes (su-fURS) was to overcome the main limitations of conventional reusable ureteroscopes in terms of maneuverability and of the maintenance. We aimed to perform a systematic literature review on available su-fURS performance versus conventional reusable fURS with a focus on clinical data. Materials and Methods. A systematic research using electronic database Pubmed was performed for studies evaluating single-use fURS and reusable fURS in the setting of urinary tract stone disease. Prospective assessments and case series studies were included. The goal of this review was to provide an overview of these single use and disposable flexible ureteroscopes and to examine and compare their capabilities (deflection, irrigation, optical properties). Results. We found 11 studies which met our inclusion criteria, where it was compared the single use fURS with reusable fURS. The studies about single-use ureteroscopes included data on LithoVue (Boston Scientific), The Uscope UE3022 (Pusen, Zhuhai, China), NeoFlex-Flexible, (Neoscope Inc San Jose, CA), 23 YC-FR-A (Shaogang). Reusable ureteroscopes studies included data about three models, two digital (Karl Storz Flex-XC and Olympus URF-Vo) and one fiber optic (Wolf-Cobra). There were not significant statistical differences concerning stone-free rate, procedure duration, functional capabilities between single-use fURS and reusable fURS. Conclusions. Single-use fURS demonstrate a comparable efficacy with reusable fURS in resolving renal lithiasis. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Large meta-analyses demonstrated that wires and access sheaths (UAS) have their specific complications rate during and after flexible ureteroscopy (fURS). So, in selected cases, we applied no touch technique (NTT) by only visual insertion and progression of the flexible scope with intrarenal disintegration of the stones. Materials and Methods. A total of 288 patients with single pyelocaliceal stone (largest diameter between 11 and 29 mm) underwent fURS: 144 using the 12/14 Fr UAS (group 1) and 144 without UAS (Group 2). For NTT we used 4 types of ureteroscopes: Olympus URF-V2 (8.5 Fr) – 33 cases, Storz Flex X2 (8.4 Fr) – 60 cases, single-use PUSEN PU 3022 (9.5 Fr) – 37 cases and single-use PUSEN – PU 3033A (7.5 Fr) – 14 cases. For the group 1 patients we used the Olympus URF – V2 ureteroscope in 44 cases, the Storz Flex X2 in 58 cases, and the single-use PUSEN PU 3022 in 42 cases. We compared the operative time, hospitalization periods and complications. Clinical data and outcomes were compared between the 2 groups. Results. Successful access sheath insertion was 83.3% in Group 1 and successful ureteroscope insertion was 90.9% in Group 2. The average operative time was slightly higher in Group 1 vs. Group 2 (47 vs. 39 min.). SFRs were overall lower in the Group 2 (76.3% vs. 86.8%) at 1 month. At 3 months we didn’t find significant difference between these 2 Groups. Superficial mucosal ureteral wall lesions were found in 38.8% of the Group 1 and 4.1% in the Group 2. The average urinary tract infection rate was slightly higher in the Group 2 (11.1% vs 9%). Hospitalization periods were longer in Group 1 vs. Group 2 (21 vs. 29 hours). A special mention for single-use 7.5 Fr ureteroscope: the insertion was simple, we did not encounter any mucosal ureteral wall lesions, and all patients were discharged in the same day. Conclusions. Despite clear advantages of UAS using, there are a lot of disadvantages for the patient. Larger diameter UASs involve greater risk for ureteral wall injury. NTT seems to be very efficient and safe. The new Ureteroscope 7.5 Fr maximize surgical efficiency and minimize the complication rate in ureteroscopic treatment of renal stones. [ABSTRACT FROM AUTHOR]

Introduction: Upper-tract urothelial carcinoma (UTUC) accounts for 5-10% of urothelial carcinomas. The 'gold standard' surgical treatment for UTUC is still represented by radical nephroureterectomy (RNU) with bladder cuff excision. The European Association of Urology guidelines recommend offering kidney-sparing surgery (KSS) as primary treatment option to patients with low-risk disease. Sometimes, there is a lack of certainty regarding the diagnosis and tratment strategy of UTUC despite all techniques available such as cystoscopy, urinary citology, and computed tomography urography (CTU) which do now always allow correct tumor staging and grading. Diagnostic ureteroscopy (d-URS) may be of crucial importance in establishing the appropriate therapeutic approach. Evidence acquisition: A systematic review of the literature using Pubmed electronic database was performed for studies evaluating the diagnostic modalities and tratment strategies in UTUC. Overall, 74 full-text articles were assessed for eligibility. After a quantitative review of the selected literature, 24 studies were considered relevant for this review. Results: CTU has a sensitivity and specificity for UTUC of 92% and 95% respectively, but is not able to detect small or flat lessions with adequate accuracy. Urine citology for UTUC has a sensitivity of around 67-76% and is considered to offer poor prediction of muscle-invasive or high-grade disease. As no technique offers a diagnosis certainty, diagnostic ureteroscopy with enhanced technical improvements and emerging technologies can allow an increase in diagnostic accuracy by distinguishing between normal tissue and low- and high-grade tumors. Conclusions: Endoscopic treatment of even large, multifocal, low grade upper urothelial carcinoma is feasible also depending on each comfort level of expertise, does not involve significant complications and has good short-term oncologic outcomes. Proper patient selection is the main key for a better outcome when treating UUTC endoscopically. A better appreciation of the diagnostic limitations may help with choosing the weapon wisely. Maybe the most important feature of all is that the patient needs to be willing to undergo a close follow up with repetead endoscopic evaluations. [ABSTRACT FROM AUTHOR]

Ureteral stents are a fundamental element in the arsenal of urologists from their appearance until now. Due to the widespread usage of ureteral catheters, a number of possible complications such as migration, infection, encrustation, calcification, and fragmentation have been noted. In this manuscript, we present a case of a 70-year-old female patient who was admitted to the emergency room with bilateral flank pain for about 7 days and fragments of ureteral stent protruding through the urethra. The urine analysis showed leukocyturia, proteinuria, and microscopic hematuria. The X-ray highlighted multiple fragments of double J stent on the projection area kidneys and bladder. CT examination described atrophic kidneys with pelvic dilatation and ureteral catheter parts in both renal pelvis and bladder. Cystoscopy was performed under local anesthesia, residual ureteral stents fragments were removed from the bladder, and bilateral double J stents were placed for hydronephrosis remission. Bilateral double J stents were extracted after 3 weeks during a scheduled endoscopic procedure when the residual parts of double J were also evacuated by ureteroscopy from both kidneys. The postoperative evolution was favorable, simple. The particularity of the case is given by the fragmentation of the ureteral stents bilaterally in the same period of time. [ABSTRACT FROM AUTHOR]

Introduction. This study aimed to evaluate the experience of 10 years in the Department of Urology, "St. John" Emergency Clinical Hospital, Bucharest focusing on perioperative safety and morbidity but also on the evolution regarding the distribution of the number of interventions over time. Material and method. A total of 268 patients diagnosed with benign prostatic hyperplasia (BPH) who underwent suprapubic prostatectomy for a period of 10 years (January 2010 - December 2020) in the Department of Urology, "St. John" Emergency Clinical Hospital, Bucharest were included. The analyzed data was the age of the patients, the preoperatory symptoms, modifications in the bladder and prostate, and postoperative complications. Patients with malignant findings on histopathological examination were excluded. Results. The median age was 74 years. The most common symptoms at admission were frequency in 223 (83.2%), weak stream in 215 (80.2%) and dysuria in 213 (79.5%). The most common complications at presentation were urinary tract infection 79 (29.5%), acute urinary retention 45 (16.8%) and bladder stones 40 (14.9%). The average volume of the prostate measured by ultrasound was 121.2 cm3. The comorbid medical conditions were hypertension, diabetes, and Parkinson's disease. In all cases, a transvesical prostatectomy was performed. The following changes were observed during the surgery: thickened bladder wall in 145 patients (54.1%), trabeculations in 120 cases (44.7%), bladder diverticula in 58 patients (21.6%), bladder stones in 40 (14.9%) cases and 50 (18.6%) patients had prostate with a median lobe comparatively with 218 patients (81.3%) with overall prostate enlargement. Conclusions. Open prostate surgery is still required in the treatment plan for bulky prostate adenomas or in complications of BPH that indicate suprapubic prostatectomy at the expense of minimally invasive treatment methods. For superior results on operative safety and decreased risk of postoperative complications, patient comorbidities require careful management before surgery. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Collecting system duplication is one of the most common congenital anomalies of the urinary tract. Complete or incomplete duplication could be associated with ureteral or renal stones. Our objective was to compare urolithiasis treatment outcomes in patients with and without ureteral duplication. Material and methods. A total of 68 patients with ureteral duplication who underwent ureteroscopy (URS) for ureteral and renal stones were retrospectively evaluated from 1995 to 2019. We compared the outcome after ureteroscopy for 3 groups: Group 1 (47 patients with incomplete duplication), Group 2 (21 patients with complete duplication) and Group 3 (control group - 68 patients without ureteral anomalies). Pre- and postoperative data were analyzed. Stone location and size were perfect matched. Clinical data and outcomes were compared between the 3 groups. Results. For ureteral location (stones between 7-19 mm. diameters) there are differences concerning operative time (slightly longer for duplication cases): group 1 (19/47) average 36 min. (range 22 to 67 min.), group 2 (11/21) average 33 min. (range 19 to 71 min.) and group 3 (32/68) average 28 min. (range 20 to 48 min.). For renal location (stones between 9-28 mm. diameters) we found the same differences: group 1 (28/47) average 56 min. (range 27 to 81 min.), group 2 (10/21) average 49 min. (range 29 to 67 min.) and group 3 (36/68) average 39 min. (range 27 to 70 min.). Ureteral duplication had no effect on stone-free rates or need for additional procedures for ureteral stone location. For renal location we found a difference between Group 1 and 3 (68% stone-free for Group 1 vs. 79% for Group 3). Complication rate (Clavien1-3) was similar in all groups. We didn't describe any cases with Clavien 4 and 5. Also, the location of ureteral duplication did not affect operative time or stone-free rates. Conclusions. Ureteral duplication seems to have no significant effect on ureteroscopy safety and efficacy for upper urinary stones. We described a slightly longer operative time for duplication cases. The stone-free rate is significantly lower especially in incomplete duplication cases. [ABSTRACT FROM AUTHOR]