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Byline: Mudassir. Wani, Abdul. Durrani Objective: Laparoscopic ureterolithotomy, which has been quoted to have a success rate equivalent to open ureterolithotomy for uretric stones, can be performed transperitoneally and retroperitoneally. [...]

Radical prostatectomy (RP) is one of the recommended treatments to achieve oncological outcomes in localized prostate cancer. However, a radical prostatectomy is a major abdominopelvic surgery. Venous thromboembolism (VTE) is a well-known complication associated with surgical procedures, including RP. There is a lack of consensus regarding VTE prophylaxis in urological procedures. The aim of this systematic review and meta-analysis was to investigate different aspects of VTE in post-radical prostatectomy patients. A comprehensive literature search was performed, and relevant data were extracted. The primary aim was to perform a systematic review and meta-analysis (wherever possible) of VTE occurrence in post-RP patients in relation to surgical approach, pelvic lymph node dissection, and type of prophylaxis (mechanical or combined prophylaxis). The secondary aim was to investigate the incidence and other risk factors of VTE in post-RP patients. A total of 16 studies were included for quantitative analysis. Statistical methods for analysis included the DerSimonian–Laird random effects. We were able to conclude that the overall incidence of VTE in post-radical prostatectomy is 1% (95% CI) and minimally invasive procedures (MIS), including laparoscopic, as well as robotic procedures for radical prostatectomy and RP without pelvic lymph node dissection (PLND), are associated with less risk of developing VTE. Additional pharmacological prophylaxis to mechanical methods may not be necessary in all cases and should be considered in high-risk patients only. [ABSTRACT FROM AUTHOR]

About 275 million people worldwide aged between 15 and 64 years used drugs at least once since 2016. Initial estimations suggest that 13.8 million young people between 15 and 16 years used cannabis every year. Recreational drug use contributes significantly to mortality as well as physical and mental health problems. A number of urological complications can arise from the use of common and emerging recreational drugs which can present as wide spectrum affecting lower and upper urinary tracts, kidneys, sexual organs as well as sexual dysfunction. In order to effectively manage these issues, urologists need to be cognizant of these complications in their patients, particularly among youths. This review attempted to consolidate available data and provide insight into this issue; however, further population-based epidemiological studies are needed to provide necessary guidelines. [ABSTRACT FROM AUTHOR]

Introduction The aim of this article was to investigate quality and cost benefits of managing urolithiasis by primary ureteroscopic procedures (P-URS) during index admission to hospital. With the rise in prevalence of urolithiasis, the focus has shifted to manage these patients during their first admission rather than using temporary measures like emergency stenting (ES) or nephrostomies which are followed by deferred ureteroscopic procedures (D-URS). We compared results of P-URS, D-URS and ES procedures in terms of quality and cost benefits. Material and methods Data was collected retrospectively for all P-URS, D-URS and ES procedures performed during year 2019. A total of 85 patients underwent ES while as 138 patients underwent elective URS (26 had P-URS and 112 had D-URS). The quality assessment was based in relation to patient factors including-number of procedures per patient, number of days spent at hospital, number of days off work. Cost analysis included theatre and hospital stay expenses, loss of working days. Results This study revealed that the average hospital stay of patients on index admission who had a ES was 1.35 days (Total 3.85) and who had P-URS was 1.78 days (Total 2.78). Overall, additional expenditure in patients who did not undergo primary URS was in the range of 1800-2000€ (excluding loss of work for patients, who needed to return for multiple procedures). Conclusions We conclude approach of P-URS and management of stones in index admission is very effective in both improving quality of patients as well as bringing down cost expenditure effectively. [ABSTRACT FROM AUTHOR]

To assess efficacy and safety of Thulium laser enucleation of prostate (ThuLEP) for benign prostatic hyperplasia. It is a systemic review based on a comprehensive search of PubMed, Cochrane, and Google scholar databases from inception to 31 March 2020. All studies in English evaluating ThuLEP as well as those comparing it with Transurethral resection of prostate (TURP) and Holmium Laser enucleation of prostate (HoLEP) were enrolled. The primary outcome was to evaluate operative, postoperative, and functional outcomes (IPSS, QoL, Qmax, PVR) in patients undergoing ThuLEP. Secondary outcome was to compare operative, postoperative, and functional outcomes with TURP and HoLEP in comparative studies. Fourteen studies with a total of 2,562 patients were included in this review. 2,034 underwent ThuLEP, 349 underwent TURP, and remaining 139 had HoLEP. We found that ThuLEP is safe as well as efficacious in all age groups as well as across all prostate sizes and with all four functional outcomes (IPSS, QoL, Qmax, PVR) revealing marked improvement at 3, 6, 12, and 24 months. Compared to TURP and HoLEP, Thulep is non-inferior in terms of operative and functional outcomes and, in fact, is associated with lesser catheterization duration as well as shorter hospital stay. Further, Thulium fiber laser (TFL) has advantages of being light weight, having high frequency, less fiber degradation, and less energy consumption, making it cost effective for operational and maintenance purpose. ThuLEP is a safe, efficacious, and cost-effective procedure for BPE. [ABSTRACT FROM AUTHOR]

Objective: Acute appendicitis is a common surgical emergency. But often arriving at correct diagnosis is challenging. CT scan has reduced the rates of negative appendectomies but it has radiation risk. We compared CT with Alvarado score (AS) in acute appendicitis in terms of positive operative and histopathological findings with the aim to use CT evaluation appropriately. Patients and methods: We collected retrospectively data of 358 patients admitted in a single hospital over a period of one year. All patients had Alvarado scoring done at the time of admission. CT was performed in 293 patients on consultant directions. CT and AS were compared in correlation with positive histopathological findings. Results: The study included 224 males (62.56%) and 134 females (37.43%). CT was performed in 293 patients (81.84%) patients. 320 (89.38%) patients underwent surgery while 38 (10.615) patients were managed conservatively. Among the operated group, 268(83.75%) patients had uncomplicated appendicitis while 52 (16.25%) had complicated appendicitis. Histopathology was positive for appendicitis in 285 patients (89.06%). Conclusions: An AS of 7 and above is as significant as CT scan so for these patients one can rely on AS score for deciding surgery. On the other hand if scores are less than 6 and there is strong suspicion of Appendicitis one should go ahead with CT. [ABSTRACT FROM AUTHOR]

We studied the expression of αα1-syntrophin (SNTA1) protein in histologically confirmed esophageal, stomach, lung, colon, rectal and breast cancerous tissue samples. Our results suggest a significant decrease in the expression level of SNTA1 protein in both esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) compared with their respective controls while a significant increase in expression of SNTA1 protein compared with the normal tissue was observed in breast carcinoma samples. No significant difference in expression of SNTA1 protein was observed in stomach, lung, colon and rectal cancers. Our results suggest that SNTA1 has a role in carcinogenesis and could possibly be used as a novel diagnostic or prognostic marker in esophageal and breast cancers. [ABSTRACT FROM AUTHOR]

In developing countries, due to limited availability of modern anesthesia and overcrowding of the hospitals with patients who need surgery, high-risk patients with "intertrochanteric" fractures remain unsuitable for open reduction and internal fixation. The aim of this study was to analyze the results of external fixation of "intertrochanteric" fractures in high-risk geriatric patients in a developing country. The results of 62 ambulatory high-risk geriatric patients with a mean age of 70 years (range 58-90 years) with "intertrochanteric" fractures, in whom external fixation was performed, are reported. Eight patients died during follow-up due to medical causes unrelated to the surgical procedure. So only 54 patients were available for final assessment. Procedure is simple, performed under local anesthesia, requires less time for surgery and is associated with less blood loss. Good fixation and early ambulation was achieved in most of the patients. Average time to union was 14 weeks. Thirty-one patients developed superficial pin tract infection and 28 patients had average shortening of 15 mm due to impaction and varus angulation. Functional outcome was assessed using Judet's point system. Good to excellent results were achieved in 44 patients. This study demonstrated that external fixation of "intertrochantric" fractures performed under local anesthesia offers significant advantage in ambulatory high-risk geriatric patients especially in a developing country. [ABSTRACT FROM AUTHOR]