Search

To investigate the association between urodynamic findings and lower urinary tract symptoms (LUTS) before and after surgical treatment of pelvic organ prolapse (POP).Seventy-four patients with stage II or more anterior POP associated with LUTS and eligible for surgical repair of POP were included in this prospective study. All cases had clinical evaluation and urodynamic testing (UDS) before and 6 months after surgical repair of POP.Mean age was 45 ± 9 years. Mean BMI was 28 ± 6 kg/mPatients had significant improvement in LUTS after POP surgery with or without an anti-incontinence procedure. Detrusor underactivity was associated with persistence of voiding LUTS. Meanwhile, preoperative DO and post-void residual urine volume were of limited prognostic value.

A statistical optimization based on experimental work was conducted to consider ultimate tensile strength (UTS) and elongation of dissimilar joints between AA5454 and AA7075 by friction stir weld (FSW). The goal of this work is to develop a comparative study of the optimization of FSW parameters using different orthogonal arrays, i.e., L12 and L16. Four parameters correlated to softening and forging requirements (rotational speed, traverse speed, tilt angle, and plunge depth), one parameter associated with the location of base metal in the dissimilar joint, and two parameters related to an FSW tool (pin profile and Dshoulder/dpin ratio) were considered and arranged in the employed arrays. Moreover, the investigation explored the microstructure and fractography of dissimilar joints and base metals by using optical and scanning electron microscopes. The results showed that the L16OA is more accurate than L12OA for the optimization of seven parameters due to the small statistical errors. For UTS, the errors range from 0.78 to 24% for L16OA and from 27.23 to 44.14% for L12OA. For elongation, the errors run from 11 to 12.9% for L16OA and from 33.77 to 49.73% for L12OA. The accuracies of generated models range from 50 to 99.5% for L16OA and range from 30.7 to 94.9% for L12OA. Tightening the levels (narrow domain) is the main reason for switching some optimum levels between both arrays. The highest UTS obtained is 221 MPa based on the optimum levels attained from L16OA, and the highest elongation is 12.83% according to the optimum levels acquired from L12OA. Despite the deficiency of effective intermixing, the study revealed that FSW acceptably could assemble joints between AA5454 and AA7075, presenting the proficiency of FSW with welding dissimilar aluminum alloys.

The current study aims to explore the tensile fracture mechanism and thermo-mechanical efficiency of polyamide-6 (PA6) reinforced with titanium dioxide (TiO2) and multiwalled carbon nanotubes (MWCNTs). The uniform dispersion of the MWCNTs and appreciable interfacing between PA6, TiO2, and MWCNTs were revealed in the fractography figures. The crystallization temperature and degree of crystallinity have been enhanced by the addition of nanoparticles to the PA6 matrix. Young’s modulus, tensile strength, and Charpy impact strength improved proportionally concerning reinforcement content. The essential work of fracture (EWF) method was applied to evaluate the toughening and fracture behavior of PA6 hybrid systems. Considerable improvement (+60.6%) in the EWF of PA6–TiO2–MWCNT nanocomposites was observed at 4 wt.% CNT and 2 wt.% TiO2. Limiting oxygen index (LOI) findings demonstrate that a polymer with a combination containing titanium dioxide and multiwalled carbon nanotubes has a highly substantial retardant influence. As a result, the TiO2–CNT combination acts as a synergist filler, offering versatile PA6 composite products.

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are one of the most common morbidities in elderly men, especially in aging societies. Minimally invasive surgical treatments (MISTs) for BPH have gained an increasing interest in the current time. Rezum system is a novel MIST that uses water vapour-based convective thermal therapy to ablate prostatic tissue. According to our evaluation of the existing literature, Rezum offers a meaningful relief of LUTS with a high safety profile without compromising the sexual activity especially to those who are unfit for surgery or to those who do not desire to continue on lifelong pharmacotherapy.

Background Chronic Obstructive Pulmonary Disease (COPD) predominantly prevalent in men, is a chronic inflammatory disorder of the airway and lungs. COPD is associated with increased risk of Benign prostatic hyperplasia (BPH). Judging from the association between COPD and BPH in ageing male population, and the samilarities between receptors in airways and the urinary bladder. Objectives the aim of the study was to show the effect of treatment of symptomatic BPH on the airways of COPD patients by spirometric assessment before and after starting treatment of BPH. Patients and Methods The present study was conducted upon 60 subjects during the period from March 2019 to August 2019 in Ain Sham University Hospitals. Type of Study prospective study, there were two groups of patients first group received tamsulosin and the second group received tamsulosin and solifenacin Results By comparison of the two groups, there was non-significant change. as regard percent of change of forced vital capacity (FVC), first group’s median was 7.9% and second group median was 5.6%. as regard percent of change of forced expiratory volume 1 (FEV1), in first group’s median was 5.7% and second group’s median was 7.4%. Conclusion There was significant improvement in spirometric values in each group before and after starting treatment, but by comparison between the two groups, there was insignificant change.

Background Stenting has been primarily used to treat urinary obstruction and the frequency of this use is increasing with the increase in ureteroscopic management. In cases of acute obstruction, a stent is used temporarily to stabilize the patient until definitive therapy. The stent is generally placed if there is accompanying ureteric injury or in those with a residual stone after ureteroscopic lithotripsy. Placing a ureteric stent after ureteroscopy with stone extraction is done by some urologists routinely to prevent possible stenosis or to decrease secondary pain caused by mucosal oedema. However, routinely placing a stent to prevent late complications or to relieve flank pain from a ureteric stricture or mucosal oedema after surgery is questionable. Stent-related symptoms are quite problem in nearly 80% of patients that has been implicated in short-term morbidities in terms of negative impact on the patients’ quality of life, body pains and hematuria. Various attempts had been made to minimize these symptoms but pharmacological treatment is the simplest and a noninvasive option. Numerous drugs had been tried to relieve these symptoms like alpha blockers, anticholinergics and analgesics. Objective To compare the efficacy of tamsulosin alone, tamsulosin in combination with solifenacin and tamsulosin in combination with trospium chloride in in the relief of Double-J stentrelated symptoms following uncomplicated ureteroscopic lithotripsy (URSL). Patients and Methods The present study was a prospective randomized comparative study conducted on 60 patients whith double-J stent inserted following uncomplicated ureteroscopic lithotripsy (URSL) in Ain Shams University Hospital and Karmouz Hospital over a period of 1 year. The patient were randomized into 3 equal groups (1:1:1 randomization): Group A:20 patients were treated by Tamsulosin (0.4 mg) alone once daily. Group B:20 patients were treated by Tamsulosin (0.4 mg) once daily in combination with Solifenacin (5 mg) once daily. Group C: 20 patients were treated by Tamsulosin (0.4 mg) once daily in combination with Trospium chloride (20 mg) twice daily. All patients were assessed 1 week postoperatively after Double-J stent insertion. Then, the patients were start the medical treatment and were assessed 3 weeks after starting the medical treatment. Results The study shows that the combination of the tamsulosin 0.4 mg/day and trospium chloride 20 mg twice/day are significantly superior to the tamsulosin 0.4 mg once alone / day and the combination of the tamsulosin 0.4 mg /day and the solifenacine 5 mg /day for the treatment of the LUTS in d.j stent cases except in the frecuncy the combination of tamsulosin 0.4 mg/day and the solifenacine 5 mg/day are signicantly superior. Also, the drugs are safe with mild few side effects. There were no significant differences regarding headache, dizziness, backache, myalgia and orthostatic hypotension. Conclusion The study show that the combination of the tamsulosin 0.4 mg/day and the trospium chloride 20 mg twice /day are significantly superior to the tamsulosin 0.4 mg once alone / day and the combination of the tamsulosin 0.4 mg /day and the solifenacine 5 mg /day for the treatment of the LUTS in d.j stent cases except in the frecuncy the combination of tamsulosin 0.4 mg/day and the solifenacine 5 mg/day are signicantly superior.

Objectives: To evaluate the incidence and risk factors for the development of flank incisional hernias or bulges following surgical flank approaches to the kidney. Patients and methods: In all, 100 consecutive adult patients who underwent variable renal surgeries via flank approaches were included in this prospective study. The incidence and risk factors for flank hernias and bulges were studied at 1- and 6-months postoperatively. Results: At 6 months postoperatively, the incidence of flank bulge was 14% and for lumbar hernia was 10%. The univariate analysis showed 13 significant factors to be associated with the occurrence of a flank bulge or hernia following flank incisions. When the significant risk factors in the univariate analysis were studied by multivariate analysis, using a logistic regression analysis, four independent risk factors were identified. These were: body mass index (BMI) ≥26.3 kg/m2 (P = 0.04), the use of a self-retaining retractor during surgery (P = 0.02), not preserving or identifying the neurovascular bundle (NVB) during surgery (P = 0.028), and postoperative abdominal distention (P = 0.001). Moreover, all cases included in our study who underwent en masse wound closure, developed surgical wound infection or who had constipation developed postoperative flank bulge or hernia. Conclusion: High BMI, the use of self-retaining retractor, not identifying or preserving the NVB, postoperative abdominal distention, en masse wound closure, surgical wound infection, and constipation are significant risk factors associated with postoperative flank hernia and bulge. Keywords: Abdominal hernia, Flank, Hernia, Incisional hernia, Postoperative hernia

Summary: Background/Objective: To unveil the real effect of surgical drains on the outcomes of thyroidectomy for benign thyroid disorders. Methods: A prospective randomized study was conducted at Abha Private Hospital, Saudi Arabia on 108 patients suffered from benign thyroid disorders undergoing elective thyroidectomy from 1 August 2015 to 28 February 2017. Patients were allocated randomly into drainage group (A) and non-drainage group (B). The demographic data, operation (type and duration), postoperative complications, histopathological results and length of stay were assessed, documented and statistically verified to check its significance. Results: A total of 108 patients were enrolled in the study; 94 females and 14 males with mean age of 38.02 years, two patients developed hematoma (1.85%); one in each group and another two patients had seroma with no significant difference between both groups, the mean length of stay was significantly higher in group (A) (p = 0.001). Conclusion: This prospective study verified that routine drainage adds no significant advantage in the prevention of post-thyroidectomy bleeding, but it prolongs hospitalization. This aids in changing the concept from the “wide” use of drains into the “wise” use in selected patients with risk factors of bleeding. Keywords: Thyroid, Thyroidectomy, Post thyroidectomy bleeding, Surgical drains

Advancements in the diagnosis and treatment of prostate cancer (PC) have rapidly progressed through the past years. Various factors should be taken into account while treating individual patients to ensure optimal and careful decision making. The purpose of this consensus review is to summarize the current practice patterns when managing patients with advanced prostate cancer (APC) as there is still a lack of or very limited evidence on its clinical management in some areas. Pre-defined questions were shared with experts prior to the consensus session that took place in Cairo, Egypt in April 2019 during the 8th International gastrointestinal, liver and uro-oncology conference (IGILUC). Voting was based mainly on the expert opinions of the panel after a thorough discussion and review of available evidence from guidelines or best evidence available concerning the topic at hand. A strong consensus or unanimity was reached on 47% of the proposed questions. Notably, the panelists reached consensus on several topics based on high-level expert opinion. These findings contribute in several ways to our understanding of the management of PC and provide a basis for future recommendations. There was also a lack of consensus on other several topics, which suggests the need for further supporting data addressing these knowledge gaps. This review offers a thorough understanding of APC practice and offers insight on the various opinions shared amongst experts in the field that can serve as guidance regionally and deepens our understanding of disease management globally.

Objectives To determine the preoperative, intraoperative and postoperative risk factors that influence the development of persistent post-transurethral resection of the prostate (TURP) urinary tract infection (UTI) defined as pyuria and/or bacteriuria remaining for 3 weeks after surgery. Patients and methods This is a prospective study including 100 patients scheduled for TURP. Urine analysis and culture was performed immediately after catheter removal, then at 1 and 3 weeks postoperatively, and the results were correlated to various preoperative, intraoperative and postoperative potential risk factors to detect any significant relation to persistent UTI. Results There was a statistically significant relationship between bacteriuria and the following risk factors: old age, past history of diabetes mellitus, large prostatic size, positive preoperative urine analysis and culture, preoperative catheter use, previous urological interventions, large size of sheath, long duration of operation, postoperative catheter events and postoperative manual wash. Conclusions Many risk factors have been found to contribute to the development of post-TURP UTI and avoiding these factors can enhance recovery of patients undergoing TURP.

Conventional coring does not provide core samples that are characteristic of the original formation condition. Thus, pressurized coring is required to capture samples that represent the in-situ composition of gases and liquids; pressure, volume, and temperature (PVT) data of the fluids, and porosity, permeability, and wettability, which are critical to reservoir interpretation and development. A customized high-performance water-based mud (HPWBM) was used successfully where prior attempts with conventional water-based mud (WBM) had failed. The key well challenges included wellbore instability with caving shale and depleted reservoir sands. Previous attempts to retrieve pressurized core using conventional WBM proved unsuccessful because of the early activation of the pressurized capture mechanism caused by an accumulation of wellbore and mud solids linked to insufficient hole stability. A HPWBM containing liquid additives was customized to minimize solids content while stabilizing the shales and to minimize the differential sticking potential in the depleted reservoir. The formulation was finalized, based on laboratory testing, to optimize the bridging and inhibition package for the formations drilled. Drilling and logging were successfully completed with no incidents; the fluids parameters were maintained to effectively clean the hole while controlling equivalent circulating density (ECD) through minimizing solids in the mud. The combination of salinity and liquid additives used minimized the total solids of the mud while effectively stabilizing the wellbore, which helped to reduce the premature activation tendency of the catcher system of the pressurized coring tool. Pressurized cores were successfully retrieved with in-situ conditions and analyzed on-site, maintaining a pressure equivalent to the pore pressure. The core samples were retained in their native state for future studies. There was no nonproductive time (NPT) related to wellbore instability, and differential sticking was avoided by the customized bridging across the depleted reservoir. The successful collection of data enabled improved reservoir modeling. This paper discusses the design of the HPWBM system, along with its technical features and benefits, which helped to successfully complete the first global 12 ¼-in. pressurized coring application. The customized HPWBM provided good shale inhibition, low solids and excellent lubricity, and eliminated the need for conventional shale stabilizing materials, which could have interfered with the capture of the pressurized core.

To evaluate temporary double J ureteric stenting (TDJS) as a test to diagnose ureteropelvic junction obstruction (UPJO) in equivocal cases.One hundred and nine consecutive adult patients with loin pain and ipsilateral equivocal UPJO (EqUPJO) on radioisotope diuretic renogram (RDR) were enrolled in the present study. All patients underwent TDJS for 3 weeks. According to the response (relief of pain) to TDJS, which was assessed by visual analogue pain score (VAPS), patient preference and further management, patients were classified into five groups: Group Ia non-responders who elected conservative treatment for their condition, Group Ib non-responders who elected intervention, Group IIa responders who elected conservative treatment and Group IIb responders who elected intervention. Last group patients were randomized to either early (Group IIb(1)) or delayed intervention 3 months later (Group IIb(2)). Intervention was in the form of pyeloplasty (24 patients) and endopyelotomy (38 patients). All patients were followed up by measuring VAPS and RDR.After at least 6 months from management decision, 97 patients were available for evaluation. The VAPS dropped by 21.25% (P0.001), 32% (P = 0.004), 2% (P = 0.6), 54% (P0.001) and 65% (P0.001) in groups Ia, Ib, IIa, IIb1, and IIb2, respectively. On the other hand the T (1/2) of RDR dropped significantly only in groups Ib, IIb1, and IIb2 by a mean of 6.5 min (P = 0.005), 8.02 min (P0.001), and 7.3 min (P0.001), respectively.TDJS in cases of EqUPJO with loin pain is helpful in defining cases suitable for intervention versus conservative treatment.

Objectives Long bulbar urethral strictures (>2cm) are not amenable to stricture excision and primary anastomosis procedure, which may result in a short urethra and chordee formation. For such strictures many procedures have been advocated including stricturotomy with subsequent graft or flap onlay, augmented anastomosis, and staged procedures, which is a combination of the Russell graft. We present our 10-yr experience with the augmented Russell procedure using a ventral onlay buccal mucosal patch graft for treatment of long bulbar urethral strictures not amenable to excision and primary anastomosis. Methods A total of 234 patients diagnosed by urethrograms as having long bulbar urethral strictures (mean, 4.2cm) were managed by the augmented Russell urethroplasty. The procedure included excision of most of the diseased segment (mean, 2.8cm) and anastomosis of a dorsal strip leaving an oval ventral defect. Augmentation was done in all patients using a buccal mucosa patch graft (mean, 4.7cm). Results Mean follow-up was 36 mo. Urethrograms were done at 3 wk and 3 and 6 mo postoperatively and if the patients were symptomatic thereafter. Urethrocystoscopy was performed at 12 and 18 mo. A total of 223 patients completed the follow-up protocol; the overall success rate was 93.7% with 14 (6.3%) patients showing stricture recurrence at different intervals postoperatively. Ten patients in the failure group were successfully managed by single visualized internal urethrotomy (VIU), whereas the other four patients were treated by ventral penile pedicled flap. Postoperative dribbling of urine was noticed by 90 patients (40.4%) and temporary perioral numbness in most patients; no major donor site complications were noted in our series. Conclusion The augmented Russell technique is beneficial for long bulbar urethral strictures; 93.7% of the patients were stricture free. In the bulbar region, both ventral and dorsal onlays are applicable with nearly equal success rates. The buccal mucosa patch graft offers excellent material for augmentation.

Background Spinal cord injury (SCI) patients with lesions above T6 are susceptible to develop autonomic dysreflexia (AD) during surgery. The aim of this study was to investigate the efficacy of epidural fentanyl for the prevention of AD in chronic SCI patients undergoing urological procedures. Patients and methods Thirty chronic SCI patients scheduled for cystoscopy were randomized to receive epidural anesthesia using 5 ml bupivacaine 0.25% with fentanyl 50 µg in 10 ml saline (group F) or 5 ml bupivacaine 0.25% in 10 ml saline (group C). Results There was a significant decrease in the blood pressure and the heart rate 20 min after epidural anesthesia in both groups, with significantly lower systolic and diastolic blood pressures in group F compared with group C; however, the systolic and diastolic blood pressure showed a significant increase, with a decrease in the heart rate, in group C compared with group F during bladder manipulation (25 min). Six patients in group C showed manifestations of autonomic dysreflexia, with an increase in the systolic blood pressure more than 160 mmHg and diastolic blood pressure more than 100 mmHg in three of them. Conclusion The addition of fentanyl to epidural bupivacaine succeeded in preventing AD manifestations in chronic SCI patients undergoing cystoscopy.