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To identify predictive factors for the development of sepsis/septic shock postdecompression of calculi-related ureteric obstruction using the Sequential Organ Failure Assessment (SOFA) score and to compare clinical outcomes and odd risk ratios of patients developing sepsis/septic shock following the insertion of percutaneous nephrostomy (PCN) versus insertion of retrograde ureteral stenting (RUS).Clinico-epidemiological data of patients who underwent PCN and/or RUS in two institutions for calculi-related ureteric obstruction were retrospectively collected from January 2014 to December 2020.537 patients (244 patients in PCN group, 293 patients in RUS group) from both institutions were eligible for analysis based on inclusion and exclusion criteria. Patients with PCN were generally older, had poorer Eastern Cooperative Oncology Group status, and larger obstructive ureteral calculi compared to patients with RUS. Patients with PCN had longer durations of fever, the persistence of elevated total white cell and creatinine, and longer hospitalization stays compared with patients who had undergone RUS. RUS up-front has more unsuccessful interventions compared with PCN. There were no significant differences in the change in SOFA score postintervention between the two interventions. In multivariate analysis, the higher temperature just prior to the intervention (adjusted odds ratio [OR]: 2.039, p = 0.003) and Cardiovascular SOFA score of 1 (adjusted OR:4.037, p = 0.012) were significant independent prognostic factors for the development of septic shock postdecompression of ureteral obstruction.Our study reveals that both interventions have similar overall risk of urosepsis, septic shock and mortality rate. Despite a marginally higher risk of failure, RUS should be considered in patients with lower procedural risk. Patients going for PCN should be counseled for a longer stay. Post-HDU/-ICU monitoring, inotrope support postdecompression should be considered for patients with elevated temperature within 1 h preintervention and cardiovascular SOFA score of 1.

Purpose:We performed a systematic review comparing the incidence of infectious complications following transperineal ultrasound-guided prostate biopsy (TPB) in cases utilizing antibiotic prophylaxi...

Male circumcision is a well-known old surgery, and several recently developed techniques have been scaled up, including the introduction of laser technology, as alternative approaches to overcome morbidity of conventional surgery scalpel/suture method OBJECTIVES: We aimed to perform a systematic review and meta-analysis of studies comparing laser circumcision versus conventional circumcision technique in terms of perioperative outcomes and efficacy (complications, unacceptable appearance, reoperation rate) both in children and adults.This review was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were analyzed using the inverse variance of the mean difference with a random effect, 95% confidence interval (CI), and p-value. The incidence of complications, unacceptable appearance, and reoperation rate were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% CI, and p-value. Significance was set at p-value ≤0.05 and 95%CI.Seven studies were included. In comparison to the conventional circumcision, laser circumcision shoved lower visual analogue score at 24-h, and 7 days after surgery, a lower rate of overall complication rate (OR 0.33, 95% CI 0.24-0.47, p 0.001), scarring (OR 0.09, 95% CI 0.02, 0.41, p = 0.002), and unacceptable appearance (OR 0.09, 95% CI 0.05, 0.15, p 0.001). We found no statistically significant difference in surgical time, and incidence of bleeding, infection, wound dehiscence, and reoperation rate.Our review infers that laser-assisted circumcision is certainly a safe and strong contender as the procedure of choice in both children and adult populations.

Objectives To evaluate the impact of intralesional heterogeneity on the performance of multiparametric magnetic resonance imaging (mpMRI) in determining cancer extent and treatment margins for focal therapy (FT) of prostate cancer. Patients and Methods We identified men who underwent primary radical prostatectomy for organ‐ confined prostate cancer over a 3‐year period. Cancer foci on whole‐mount histology were marked out, coding low‐grade (LG; Gleason 3) and high‐grade (HG; Gleason 4–5) components separately. Measurements of entire tumours were grouped according to intralesional proportion of HG cancer: 0%, 12 mm vs 26% for ≤12 mm) and those containing HG cancer (44%, vs 20% for LG only). Size discrepancy analysis suggests an optimal tumour size of ≤12 mm and treatment margins of 5–6 mm for FT. For tumours ≤12 mm in diameter, applying 5‐ and 6‐mm treatment margins would achieve 98.6% and 100% complete tumour ablation, respectively. For tumours of all sizes, using the same margins would ablate >95% of the HG cancer components. Conclusions Multiparametric MRI performance in estimating prostate cancer size, and consequently the treatment margin for FT, is impacted by tumour size and the intralesional heterogeneity of cancer grades.

INTRODUCTION AND OBJECTIVE:Evaluating outcomes after benign prostate hyperplasia (BPH) surgery among men with lower urinary tract symptoms (LUTS) only versus those with urinary retention (UR)METHOD...

Introduction Several studies have reaffirmed the use of regular pentoxifylline therapy in increasing the penile brachial pressure index in men affected by erectile dysfunction when compared to placebo. Aim The aim of this study was to evaluate the efficacy of pentoxifylline as an adjunctive treatment for patients with erectile dysfunction. Methods This study was a single center, prospective, randomized, double-blind, placebo-controlled trial. Subjects were recruited between April 2014 and November 2016 from the National University Hospital, Singapore. The combination therapy group was given pentoxifylline 400 mg thrice daily orally and the monotherapy group was given placebo capsules thrice daily orally. Both groups continued their on-demand 100 mg sildenafil. The treatment duration was 8 weeks. Efficacy was measured via the International Index of Erectile Function (IIEF-5) questionnaire at the eighth week. Differences in mean IIEF-5 score and the domains of the IIEF at 8 weeks between the 2 treatment groups were compared using independent sample t-test. Main Outcome Measure Baseline IIEF-5 and the IIEF-15 score vs post-therapy IIEF-5 and the IIEF-15 score. Results 50 patients were randomized into 2 groups. Patients in the 2 groups were comparable in terms of the demographic and clinical characteristics, comorbidities, and baseline IIEF-5 scores. The mean IIEF-5 score post-therapy of the combination therapy group vs the monotherapy group was 14.11 and 14.87, respectively. There was no significant difference between the outcomes of these 2 groups (unadjusted mean difference -0.76; 95% CI -4.01 to 2.49; P = .641) and the outcomes are the same even after adjusting for baseline IIEF-5 scores. There was a significant improvement in the “overall satisfaction” portion of the IIEF score for the combination therapy group as compared to the monotherapy group (unadjusted mean difference 0.12; 95% CI -1.49 to 1.25) and even after adjustment for baseline scores (adjusted mean difference 1.11; 95% CI 0.10 to 2.12; P = .032) the improvement is significant. Conclusion Our trial suggests that the use of combination therapy does not improve the management of patients compared to monotherapy.

Purpose: Transurethral needle ablation (TUNA) is a minimally invasive procedure for the treatment of symptomatic benign prostatic hyperplasia (BPH). Compared to transurethral resection of the prostate (TURP), office-based TUNA is an attractive alternative as it is minimally invasive and avoids general anaesthesia. The aim of this study is to evaluate the efficacy of single session office-based TUNA. Materials and Methods: Data of 121 patients who had undergone TUNA was retrieved from June 2008 to March 2017. Patients were followed-up with visits at 1, 3, 6, and 12-months with the International Prostate Symptom Score (IPSS), quality of life (QoL) scoring and uroflowmetry. Results: Patients were 39 to 85 years old. The prostate volumes were 20.00 to 96.90 mL with a median of 26.95 mL. The median IPSS score pre-TUNA was 19, median QOL score pre-TUNA was 4 and median maximum urinary flow (Qmax) pre-TUNA was 10.3 mL/s. There is 65% improvement of IPSS post-TUNA (p

INTRODUCTION AND OBJECTIVE:The aim of this study is to validate PIRADSv2 on biopsy-naive – mpMRI in detecting all prostate cancer lesions and clinically significant prostate cancer by correlation w...

A 95 year old woman was admitted to hospital after a fall. She had sustained a hip fracture. She had Alzheimer’s disease, hypertension, and type 2 diabetes mellitus, for which she was taking metformin. A radiograph of the pelvis was obtained (fig 1⇓). Other than the hip fracture, what is the likely diagnosis? Fig 1 Radiograph of the pelvis ### Answer #### Short answer Right femoral neck fracture (incidental finding of emphysematous cystitis). #### Discussion The pelvic radiograph shows a ring of radiolucent gas with central mottled lucencies in the expected location of the bladder, suggestive of emphysematous cystitis (fig 2⇓). A right femoral neck …

Aggressive angiomyxoma is a mesenchymal tumor arising from the pelvis and perineum, classically seen in women and rarely found in men. Due to its rarity, there is a low index of suspicion for diagnosis. We describe an unusual case of aggressive angiomyxoma in a male with intellectual disability. A thorough review of existing 73 cases was also conducted. This report affirms vimentin as the most sensitive marker and S-100 is the most specific marker. Desmin seems to stain positively and negatively in a sporadic fashion, making it less reliable as an immunohistochemical marker. Wide excision is commonly regarded as the treatment for aggressive angiomyxoma in men. To date, there are no established clinical guidelines on the optimal duration of follow-up. Long-term follow-up may be required even up to 10 years to detect local recurrences.

AIMS To evaluate outcomes after benign prostate hyperplasia (BPH) surgery among men with lower urinary tract symptoms (LUTS) only versus those with urinary retention (UR). METHODS The protocol was registered in PROSPERO with ID#232253. Eligible studies identified from four electronic databases. Search, data extraction and quality assessment were performed independently by two reviewers. Studies with perioperative, functional, early and late complication outcomes included. RESULTS Twenty-five studies, 14 593 patients including 1 randomized controlled trial, 11 prospective and 13 retrospective studies included for meta-analysis. This showed higher risk of immediate transient recatherization (risk ratio [RR]: 5.29, p