Background/objectives: Renal access remains a limiting factor in Retrograde Intrarenal Surgery (RIRS), particularly in non pre- stented patients. Hyoscine butylbromide (Hbb) is an antispasmodic agent which has not been studied in RIRS. This study evaluates role of intravenous Hbb at induction for facilitating renal access in non-pre-stented RIRS patients, benchmarking outcomes against pre-stented patients. Methods: Retrospective analysis of prospectively maintained data from 360 RIRS procedures (Jan 2018-Dec 2024). Patients were divided into two groups: Group A (nonpre-stented + intravenous Hbb at induction, n=151), Group B (pre-stented, no Hbb, n=209). Men on Tamsulosin were excluded in group A (n=15). Outcomes included failed renal access, ureteric injury, stent duration and strictures. Results: Failed kidney access: Group A 3.9% and Group B 1.9% (A and B, p=0.33). Ureteric injury was observed in 10.59% and 5.3% in Groups A and B, respectively (A vs B, p=0.069). Mean stent duration in group A and B was 18 ± 11.4 and 49.01 ± 9.5 days, respectively (p<0.05). One ureteric stricture occurred in each group. Conclusions: Intravenous Hyoscine butylbromide at induction in non-pre-stented patients achieves renal access rates comparable to pre- stented RIRS patients, with shorter stent duration, reducing National Health Service costs from additional procedures and improving QoL by minimizing stent symptoms-a safe single session alternative.
Background: Sarcomatoid carcinoma of the urinary bladder (SCUB) is a rare and aggressive malignancy with limited clinical data due to its infrequency. This case report contributes to the existing knowledge by presenting a patient with SCUB and highlighting the diagnostic workup, treatment course, and clinical outcomes. Case presentation: A 57-year-old man presented with lower urinary tract symptoms and hematuria. Imaging revealed a 4 cm bladder tumor. Transurethral resection of bladder tumor (TURBT) confirmed pT2 sarcomatoid carcinoma. Radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversion was performed. Pathological examination confirmed SCUB with no lymph node involvement. The patient remains disease-free at two years follow-up. Conclusion: SCUB is an uncommon malignancy with a poor prognosis. Radical cystectomy is the preferred treatment; however, outcomes remain poor. A multimodal approach may offer improved outcomes for locally advanced diseases. Further research is needed to establish more effective treatment strategies.
Objective: To evaluate the prevalence of LUTS and it’s association with comorbidities such as hypertension, diabetes and smoking in individuals seen at a referral clinic in Urology in the Federal District. Methods: Descriptive, cross-sectional and analytical study, conducted in 410 individuals aged 40 years or older, attended at the Urology outpatient clinic of the North Wing Regional Hospital, in Brasília, Brazil, on December 1 from 2018 to April 1, 2019. The questionnaires were applied to assess urinary symptoms. Results: 64.15% had LUTS. In diabetics, the prevalence of LUTS had no statistical difference between the groups. HAS and LUTS were not associated, for this sample. The prevalence of LUTS increased in parallel with advancing age. 7.25% of the individuals were smokers. Conclusion: The prevalence and severity LUTS increase with advancing age. LUTS has not a been associated with DM and SAH in this study.
The prostate gland secretes citrate, the levels of which vary in benign prostatic hyperplasia and tumors. Multiparametric MRI of the prostate, although sensitive, has limitations in its specificity. Spectroscopy can quantify these cellular metabolites. At the La Trinidad Teaching Medical Center, 46 studies were carried out with 3D spectroscopy in patients referred from the urology service from January to June 2023. The objective was to verify the diagnostic usefulness of 3D spectroscopy with multiparametric Magnetic Resonance of the prostate. The findings in the 3D prostate spectroscopy metabolite map were described, the results of the mpMRI PIRADS score and the metabolite map were analyzed, and the anatomical pathological and 3D spectroscopy results were compared. A 1.5T Philips Anchieva resonator was used with 3D prostate spectroscopy sequences in 36 patients. The metabolites in 3D spectroscopy showed correlation with the suspicious criteria according to SCORE PI-RADS, especially in the suspicious nodular areas. The sensitivity and positive predictive value were 88%, while the specificity and negative predictive value were 96%. However, more studies are needed to obtain more conclusive results.
Secondary hyperparathyroidism is an early-stage complication of CKD (Chronic Kidney Disease). It is associated with disorders in bone metabolism, calcium deposition in vessels and organs, significantly increased risk of cardiovascular disease, and death. In recent years, an increasingly important role has been attributed to fibroblast growth factor (FGF 23) in regulating calcium/phosphate homeostasis, hyperparathyroidism, and its relation to vascular calcification, and left ventricular hypertrophy. This study conducted with 110 patients with varying degrees of renal insufficiency shows an increase in FGF23 and PTH when there is a decrease in glomerular filtration, a direct dependency between the levels of phosphate and PTH and FGF23, and a lack of such between calcium and PTH and FGF23. Of particular interest is the fact that patients treated with Calcitriol and Paricalcitol show a reduction in PTH levels, yet maintain high levels of FGF23. PTH serves as a marker for the rate of bone remodeling in patients, where elevated levels indicate renal bone disease. The analysis of FGF 23 is crucial in evaluating cardiovascular risk.
