Varicocele is one of the most prevalent reasons of men infertility, yet there is no consensus on the management of subclinical Varicocele (SCV). The aim of this work was to compare microsurgical varicocelectomy and conservative management among individuals with SCV and impaired semen parameters. This was a prospective randomized study that was carried out on 52 adult males with SCV and impaired semen parameters complaining of scrotal pain or infertility. Patients were randomized in two equal groups: Group A: microsurgical varicocelectomy group and Group B: conservative management group. Both groups were compared regarding semen parameters, spontaneous pregnancy rate and scrotal pain. Sperm count, and motility significantly enhanced in both group A and group B (P < 0.05). Group A had a significantly greater sperm count than group B (P < 0.05), while sperm motility was insignificantly different across the two groups. Pregnancy rate significantly improved in group A (P < 0.05), while scrotal pain was insignificantly different among the two groups. Microsurgical varicocelectomy is a promising therapeutic option for infertile men diagnosed with SCV with higher rate of natural pregnancy compared to conservative management. Given study limitations, these findings should be interpreted with caution. Larger, multi‑center trials are needed to confirm the observed benefits.

Introduction:We aimed to assess and compare the feasibility and perioperative outcomes using low-power thulium laser enucleation of the prostate (ThuLEP) compared to standard holmium laser enucleation of the prostate (HoLEP) in the management of BPO-related symptoms due to prostates volume exceeding 80 ml. Material and methods:One hundred and fifty patients with large prostates indicated for prostate enucleation were prospectively randomized into two groups: HoLEP group (74 patients), and the low-power ThuLEP group (76 patients). Preoperative assessment included digital rectal examination, serum prostate-specific antigen, transrectal ultrasonography, uroflowmetry, postvoid residual urine (PVR) measurement, and International Prostate Symptom Score (IPSS) and QoL scoring systems. Results:The mean age for the HoLEP group was 68 ±5.0 years and 69 ±4.8 years for the low-power ThuLEP group. The mean prostate volume was 87 ±11.5 cc for HoLEP and 90 ±12.0 cc for ThuLEP, with no statistically significant differences between both groups (p = 0.1079). There was a statistically significant difference between both groups with regard the mean total operative time, which was 72 ±10.5 minutes for HoLEP and 92 ±11.5 minutes for ThuLEP, and the mean enucleation time, which was 50 ±8.5 minutes for HoLEP and 70 ±7.0 minutes for ThuLEP (p <0.001). No significant differences between the groups regarding catheterization time, hospital stay, or haemoglobin drop. Subjective and objective voiding parameters as IPSS and Qol scores, Qmax, and PVR improved significantly after treatment with both techniques with no statistically significant difference between both groups. The complication rate was low. Conclusions:Although HoLEP offers shorter operative time, low-power ThuLEP is a feasible choice for surgical management of benign prostatic obstruction as it offers similar clinical outcomes.

To compare the perioperative and functional outcomes of low-power and high-power thulium:YAG VapoEnucleation (ThuVEP) of the prostate for the treatment of large-volume benign prostatic hyperplasia (BPH) (> 80 ml). A prospective analysis of 80 patients with symptomatic BPO and prostatic enlargement (more than 80 ml) was conducted. They were divided randomly into two groups (40 patients in each group). One group was treated with low-power ThuVEP, and the other group was treated with high-power ThuVEP. All patients were assessed preoperatively and early postoperatively, and 12-month follow-up data were analyzed. The complications were noted and classified according to the modified Clavien classification system. The mean age at surgery was 68 (± 6.1) years, and the mean prostate volume was 112 (± 20.1) cc, and there were no differences between the groups (p = 0.457). The mean operative time was 88.4 ± 11.79 min for group A and 93.4 ± 16.34 min for group B, while the mean enucleation time was 59.68 ± 7.24 min for group A and 63.13 ± 10.75 min for group B. There were no significant differences between the groups regarding catheterization time and postoperative stay. The quality of life (QoL), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoiding residual urine (PVR), and prostate volume improved significantly after treatment and were not significantly different between those treated with the different energies. The incidence of complications was low and did not differ between both the groups. Low-power ThuVEP is feasible, safe, and effective with comparable results with high-power ThuVEP in the treatment of BPO.

BACKGROUND:We aimed to assess the safety and effectiveness of TRUS guided betamethasone injections in refractory cases of chronic nonbacterial prostatitis. PATIENTS AND METHODS:Forty-five patients with refractory CNP were included in a prospective cohort clinical trial. Six injections of betamethasone sodium sulfate were guided by TRUS. After injection: assessment of NIH-CPSI, IPSS, IIEF, GRA and VAS were performed 1, 4, and 12 weeks after injection. Prostatitis symptoms were measured by NIH-CPSI. We considered the minimal clinically important difference (MCID) as a 25% decrease or a six-point reduction from baseline. We considered the MCID of the IIEF to be at least an increase of 4 points. We considered the MCID of the IPSS score to be three points and the MCID for the VAS score to be a 25%-35% change of the initial score. Regarding the global response assessment (GRA), scores 5-7 means significant success rate of perceived treatment. RESULTS:According to total NIH CPSI score, the success rate of injected cases was 71% after 1 week, dropping to 55.6% after 4 weeks and 44.4% after 12 weeks. According to IPSS questionnaire, the MD (mean difference) is -4.09 ± 3.5, -3.8 ± 3.83 and -3.47 ± 3.92. According to the IIEF questionnaire, the success rate was 22% and 26.7% after 4 and 12 weeks respectively. According to GRA, successful pain control was reported in 82%, 71% and 64.4% after 1, 4 and 12 weeks, respectively. CONCLUSION:Intraprostatic betamethasone injection is a simple, safe, and feasible procedure in refractory cases with CNP with predominant pain and urinary symptoms.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP11)1 May 2024MP11-16 DOES TRANS-RECTAL INJECTION OF BETAMETHASON IMPROVE SYMPTOMS OF REFRACTORY CHRONIC NON-BACTERIAL PROSTATITIS? A PROSPECTIVE STUDY Ahmed Abdelaziz, Mohammed Keshk, Alaa Meshref, Hany Elfayoumy, Ahmed Rammah, and Ahmed Abozamel Ahmed AbdelazizAhmed Abdelaziz , Mohammed KeshkMohammed Keshk , Alaa MeshrefAlaa Meshref , Hany ElfayoumyHany Elfayoumy , Ahmed RammahAhmed Rammah , and Ahmed AbozamelAhmed Abozamel View All Author Informationhttps://doi.org/10.1097/01.JU.0001008564.85995.11.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic nonbacterial prostatitis (CNP) is an ill-defined, common painful clinical condition that is characterized by various nonspecific symptoms with an impact on quality of life of patients. Management should be multimodal and phenotypically directed. This study aims to evaluate of safety and efficacy of TRUS guided injection of betamethasone in chronic non-bacterial prostatitis patients resistant to medical treatment. METHODS: This is a prospective cohort clinical study including 45 male patients (mean age 32.56 ± 7.02 years) with refractory CNP based on the expressed prostatic secretion culture (EPS). The study was conducted from July 2020 to March 2022 at Kasr Alainy Cairo University Hospital. The procedure begins with prostate block by periprostatic infiltration with local anaesthetic then TRUS guided six injections of betamethasone sodium sulphate, under cover of aminoglycoside (amikacin) which were both injected separately into the gland and distributed equally to cover the whole gland (apex, mid-zone and base) on both sides. We assessed the improvement of prostatic symptoms 1week then 1 month and 3 months after injection. RESULTS: According to total National Institutes of Health Chronic Prostatitis Symptom Index (NIH CPSI) score; the mean difference is -8.51 ± 4.73, -6.87 ± 5.22 and -6 ± 4.9 1 week, 1 month and 3 months respectively which. The success rate of injected cases was 71% after 1 week of injection, dropping to be 55.6% after 1 month and further drop was 44.4% after 3 months. According to IPSS questionnaire, the MD is -4.09 ± 3.5, -3.8 ± 3.83 and -3.47 ± 3.92. According to the IIEF questionnaire, the MD of 1.65 ± 2.12 and 1.87 ± 2.66. The success rate was 22 %and 26.7 %after 1 and 3 months of injection respectively. According to global response assessment score (GRA) for treatment of pain, after 1 week of injection , 37 patients (82%) had successful treatment for pain then success rate became 71% (32patients) after 1 month then success rate dropped to 64.4% (29 patients) after 3 months. CONCLUSIONS: The results of our study is supportive of usage of this method as a simple, safe, cheap and feasible method for symptomatic relief of refractory cases with CNP with predominant pain and urinary symptoms for which it is most effective. Source of Funding: No © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e157 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ahmed Abdelaziz More articles by this author Mohammed Keshk More articles by this author Alaa Meshref More articles by this author Hany Elfayoumy More articles by this author Ahmed Rammah More articles by this author Ahmed Abozamel More articles by this author Expand All Advertisement PDF downloadLoading ...

Background:The aim of this study was to assess the effect of a 4-week dutasteride treatment on reducing the intraoperative and postoperative bleeding, as well as the amount and duration of irrigation required to clear the urine after transurethral resection of the prostate (TURP) ≥50 g in men receiving the antiplatelet drug (APD). Materials and methods:This double-blind randomized clinical trial included patients with a prostate size ≥50 g who were indicated for TURP and were already receiving APD. The study was conducted in the Urology Department of Cairo University over a 12-month period. Routine preoperative laboratory investigations were performed in all patients. Moreover, baseline prostate size, serum prostate-specific antigen level, and International Prostate Symptom Score were estimated. The patients were randomly divided into 2 equal groups (groups A and B). Group A, the dutasteride group, received dutasteride (0.5 mg) once daily for 4 weeks. Group B, the placebo group, received a placebo capsule once daily for 4 weeks. Both groups underwent bipolar TURP. Fifteen patients were excluded from the study; 9 patients from group A and 6 patients from group B, either due to drug intolerability or loss follow-up. Results:The mean blood loss was insignificant between the 2 groups immediately after and 24 hours after surgery (Δ hemoglobin: 1.41 ± 0.63 g/dL vs. 1.48 ± 0.54 g/dL, 2.12 ± 0.70 g/dL vs. 2.31 ± 0.78 g/dL, respectively, p = 0.631, p = 0.333; Δ hematocrit: 2.97% ± 1.51% vs. 3.16% ± 1.36%, 4.96% ± 1.87% vs. 5.73% ± 4.39%, respectively, p = 0.610, p = 0.380). However, there were significant differences in duration of indwelling urethral catheter (5.10 ± 0.55 days vs. 5.80 ± 1.79 days, p = 0.048), duration of bladder irrigation (13.60 ± 2.85 hours vs. 16.33 ± 6.62 hours, p = 0.044), and the amount of saline used for bladder irrigation (11.03 ± 2.30 L vs. 13.87 ± 6.13 L, p = 0.046) between group A and group B. respectively. Conclusions:Treatment with dutasteride for 4 weeks before TURP in men receiving APD did not significantly reduce intraoperative or postoperative bleeding after TURP but could significantly reduce the duration of indwelling catheter placement, as well as the duration and amount of saline irrigation.

Objectives: Benign Prostatic Hyperplasia (BPH) is the most common cause of the Lower Urinary Tract Symptoms (LUTS) in ageing men. TURP is still the gold-standard procedure for the treatment of LUTS-BPH, however new minimally invasive modalities like Urolift procedure has been introduced.Methods: Patients with prostate size up to 100 g were offered both treatment modalities. Hundred patients were included in the study, 100 in TURP group (group A) and 100 in Urolift group (group B). International Prostate Symptom Score (IPSS) was used at initial contact and for evaluation of response to treatment. Group A underwent TURP under regional anaesthetic, while group B underwent Urolift under sedation.Results: The mean age in both groups was 66.4 years. The IPSS score improvement among both groups is attached in the diagram. Group B patients had less hospital stay, better erectile and ejaculatory function compared to group B, and no stress incontinence was detected in group B while 6.7% of the patients in group A suffered some stress incontinence.Conclusion: Urolift has the benefit of preserving the ejaculatory function and less complications. Nevertheless, it has size limitations and the IPSS score improvement is less satisfactory when compared to TURP.

Background The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g. Methods One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months. Results There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60 min, which was not significantly longer than that of top-down HoLEP (52 min) ( p = 0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), ( p = 0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. Conclusions The HoLEP procedure significantly improves patients’ urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.

Introduction:The aim of this study was to assess the effectiveness of low-power thulium (30 W) and the duration necessary to eliminate adenomas at the level of the surgical capsule, as well as its impact on postoperative urinary and sexual function.Material and methods:Patients with symptomatic benign prostatic hyperplasia (BPH), who had ThuLEP between December 2019 and March 2022 and had a prostate size >80 mL and had not responded to the medication therapy, were included. The prostate size, prostate-specific antigen (PSA), enucleation and morcellation times, postoperative International Prostate Symptom Score (IPSS), and International Index of Erectile Function-5 (IEFF-5) records at 1, 3, 6, and 12 months were among the information gathered.Results:The average age of the 80 patients who received ThuLEP was 66.7 ±6.4 years, with a mean prostate volume of 112.65 ±19.3 mL. The mean duration for enucleation was 71 ±11 min. At the initial follow-up after one month, the mean IPSS was 8.012 ±1.78 mL and the mean Qmax enhancement was 30.16 ±4 mL s-1. In contrast to baseline, our findings demonstrated a substantial improvement in postoperative urgency and urgency urinary incontinence (UUI) (p = 0.005) but no meaningful variation in IIEF-5 score at the 12-month follow-up.Conclusions:Low-power ThuLEP is worthwhile for therapeutic use because it effectively treats patients with large prostates with satisfactory urinary and sexual effects.Clinical trials .gov ID: NCT05494944.

Despite the reliance on Western guidelines for managing prostate cancer (PC), there are wide variations and gaps in treatment among developing countries such as the Middle East African (MEA) region. A multidisciplinary team of experts from the MEA region engaged in a comprehensive discussion to identify the real-world challenges in diagnostics and treatment of Metastatic Castration-Resistant Prostate Cancer (mCRPC) and provided insights on the urgent unmet needs. We present a consensus document on the region-specific barriers, key priority areas and strategic recommendations by experts for optimizing management of mCRPC in the MEA. Limited access to genetic testing and economic constraints were highlighted as major concerns in the MEA. As the therapeutic landscape continues to expand, treatment selection for mCRPC needs to be increasingly personalized. Enhanced genetic testing and judicious utilization of newer therapies like olaparib, articulated by reimbursement support, should be made accessible for the underserved populations in the MEA. Increasing awareness on testing through educational activities catalyzed by digital technologies can play a central role in overcoming barriers to patient care in the MEA region. The involvement of multidisciplinary teams can bridge the treatment gaps, facilitating holistic and optimal management of mCRPC. Region-specific guidelines can help health-care workers navigate challenges and deliver personalized management through collaborative efforts - thus curb health-care variations and drive consistency. Development of region-specific scalable guidelines for genetic testing and treatment of mCRPC, factoring in the trade-off for access, availability, and affordability, is crucial.

You have accessJournal of UrologyCME1 May 2022LBA01-02 EFFICACY OF LOW-POWER THULIUM LASER ENUCLEATION OF PROSTATE LARGER THAN 80 GRAMS Samer Morsy, Islam Kamal, Alaa Meshref, Ahmed Yehia, and Mahmoud Abdel-Hakim Samer MorsySamer Morsy More articles by this author , Islam KamalIslam Kamal More articles by this author , Alaa MeshrefAlaa Meshref More articles by this author , Ahmed YehiaAhmed Yehia More articles by this author , and Mahmoud Abdel-HakimMahmoud Abdel-Hakim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002669.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Thulium laser prostate enucleation (ThuLEP) has become a novel treatment option for BOO. Most studies evaluated the safety and efficacy of high-power thulium enucleation using 120-200 W. we evaluated the use of low-power thulium (30 W) as regard efficacy and time needed to remove the adenoma at the level of the surgical capsule and postoperative urinary and sexual functions. METHODS: Patients with symptomatic BPH who failed medical treatment or developed BPH-related complications with prostate size larger than 80 ml and candidates for ThuLEP during the period from December 2019 to June 2021 were included. We used a 30 W Thulium laser with a 550µm laser fiber and a 26 Fr continuous flow resectoscope. Data collected included prostate size, PSA, enucleation and morcellation time, postoperative IPPS, & IEFF-5 scores at one week, 1, 3 & 6 months. RESULTS: Thirty-seven patients underwent ThuLEP with a mean age of 68±6. Refractory retention was the main indication for surgery in 21.6% of patients, hematuria in 8% & failed medical treatment in 70%.3 with a mean IPPS score of 25.6±2.2. The mean prostate size was 111±20 ml and the mean Qmax was 6.8±2 ml/sec. The mean enucleation time was 70±10 min, and the mean morcellation time was 24±6 min. The mean reduction in PSA level after 6 months was 3.4±1.1 & the mean hemoglobin drop was 1.7±0.6 mg/dl. The 1st follow-up visit was at one week with a mean IPSS 8.3±1.9, mean Qmax improvement of 26±4.6 ml/s. Our results showed significant improvement in postoperative urgency and UUI (p-value=0.005) with no significant change in IIEF-5 score at 6-month follow-up compared to baseline. CONCLUSIONS: Low–power ThuLEP is an efficient technique for prostate enucleation with less escharing effects and satisfactory urinary and sexual outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1035 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samer Morsy More articles by this author Islam Kamal More articles by this author Alaa Meshref More articles by this author Ahmed Yehia More articles by this author Mahmoud Abdel-Hakim More articles by this author Expand All Advertisement PDF downloadLoading ...

To compare the mid-term safety and efficacy of holmium laser enucleation of the prostate versus bipolar transurethral resection of the prostate in the management of large-volume benign prostatic hyperplasia.From December 2016 to March 2018, patients with benign prostatic hyperplasia (≥80 cc) were randomized (block randomization, computer-generated random list) to holmium laser enucleation of the prostate (57 patients) or bipolar transurethral resection of the prostate (55 patients). Patients were excluded if they had an International Prostate Symptom Score <13, a maximum urinary flow rate >15 mL/s or presence of prostate cancer, bladder stone, urethral stricture, neurogenic bladder, or previous prostate surgery. The primary outcome was hemoglobin loss. The analysis was intention-to-treat. Postoperative findings (36 months) were compared to baseline characteristics. Univariate and logistic regression analyses were performed for risk factors predicting hemoglobin loss or operative time in all patients.There was no significant difference in baseline characteristics between the two groups. Holmium laser enucleation of the prostate was associated with significantly better operative time (P = 0.019), operative efficiency (P < 0.001), hemoglobin loss (P < 0.001), catheterization duration (P < 0.001) and hospital stay (P < 0.001) compared to bipolar transurethral resection of prostate. Both procedures were safe, with no significant difference in total complications (P = 0.128). Blood transfusion (P = 0.026) and capsular perforation (P = 0.239) were reported only in the bipolar transurethral resection of the prostate group. There was no significant difference in rates of urinary tract infections (P = 0.714), urethral strictures (P = 0.359), or transient stress incontinence (P = 0.717). At the last follow-up (3 years), holmium laser enucleation of the prostate was associated with significantly better International Prostate Symptom Scores, prostate-specific antigen levels and maximum urinary flow rates compared to bipolar transurethral resection of the prostate (P < 0.05). In logistic regression analyses, prostate size and bipolar transurethral resection of the prostate were associated with significantly greater hemoglobin loss, whereas prostate size, capsular perforation, and bipolar transurethral resection of the prostate were associated with significantly longer operative time.Holmium laser enucleation of the prostate and bipolar transurethral resection of the prostate are effective and safe for the management of moderate-to-severe lower urinary tract symptoms attributable to large-volume benign prostatic hyperplasia (≥80 cc). However, if both techniques are available, holmium laser enucleation of the prostate is preferred due its better efficacy and safety profile.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Medical & Non-surgical Therapy1 Apr 2016PD22-03 EARLY VERSUS LATE CATHETER REMOVAL IN PATIENTS WITH ACUTE URINARY RETENTION (AUR) SECONDARY TO BENIGN PROSTATIC HYPERPLASIA UNDER TAMSULOSIN TREATMENT Hosni Salem, Tamer Zakaria, Samer Samir, and Alaa Meshref Hosni SalemHosni Salem More articles by this author , Tamer ZakariaTamer Zakaria More articles by this author , Samer SamirSamer Samir More articles by this author , and Alaa MeshrefAlaa Meshref More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1496AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Currently, there is no consensus on the optimal management of AUR in terms of duration of catheterization and management following catheterization. The optimum duration of treatment with a1 blockers has not been fully assessed, and there is controversy about the length of time the catheter should remain in situ for the initial treatment phase. The aim of the work is to assess early (3 days) and late (7 days) Foley’s catheter removal in patients with urine retention secondary to BPH under Tamsulosin therapy METHODS Our study included; a total of 50 patients with AUR due to BPH who failed trial without catheter or presented for us with indwelling catheter in outpatient clinic or in emergency room. All men assigned for a second trial of TWOC and received an Alpha-1 Blocker (Tamsulosin) before catheter removal The patients were randomly divided (envelop method) into 2 groups according to onset of catheter removal: group I included 25 patients received Tamsulosin (0.4 mg) once daily and catheter removed after 3 days and group II included 25 patients received Tamsulosin (0.4 mg) once daily and catheter removed after 7 days. A successful catheter-free void defined as a peak flow rate of >5ml/sec, voided urine volume >100 ml and a residual urine volume < 100ml. All patients undergone complete history taking (LUTS symptoms before AUR), DRE. Routine urine analysis, serum PSA, pelvi-abdominal and /or Trans-rectal ultrasound to determine the prostate size. Uroflowmetry and Post Voiding Residual urine were performed after catheter removal in patients who micturated. RESULTS On catheter removal, 70% voided successfully while 30% had failed second TWOC. Eighteen cases (36%) developed tamsoline side effects (fig.); dizziness in 16%, diarrhea in 8%, headache in 8%, back pain in 4% (table). The overall complication rate of catheterization was 32% (urine leakage in 6%, hematuria in 6%, asymptomatic bactiruria in 8%, lower UTI in 8% and catheter obstruction in 4%). No statistically significant differences were found between the 2 groups as regard mean age, mean size of the prostate, mean size of the adenoma, serum PSA or prevalence of co-morbidities. Group I had a success rate 64% and group II 76% (p=0.5). The mean residual urine of group I was 76.6±69.0 cc versus 83.6±60.5 cc in group II (p=0.098). Side effects related to Tamsulosin occurred in 36% of group I and 36% of group II (p=1.0) (table). Group I had a complication rate 16% and it was significantly lower when compared to group II (48%) (p=0.03). The Overall complications rate of catheter was higher in group II (48%) when compared to group I (16%) and this difference was statistically significant (p=0.032). CONCLUSIONS Tamsulosin can be recommended for treating men after catheterization for AUR, and can reduce the likelihood of the need for re-catheterization. Keeping patients catheterized for 7 days (while on Tamsulosin treatment) was associated with a higher complication rate and increased incidences of urinary tract infection. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e462 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hosni Salem More articles by this author Tamer Zakaria More articles by this author Samer Samir More articles by this author Alaa Meshref More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

To compare the expression of two promising circulating micro-ribonucleic acids (miRNAs 21 and 221) in patients with prostate cancer to subjects without cancer and to evaluate their potential role as specific noninvasive molecular biomarkers for prostate cancer diagnosis, circulating miRNAs 21 and 221 expression profiles were analyzed in 20 men aged 50–75 years, presenting with lower urinary tract symptoms (LUTSs) and undergoing transrectal ultrasound (TRUS)-guided prostate biopsy based on either elevated serum prostate-specific antigen (PSA) (>4.0 ng/ml) or suspicious digital rectal examination (DRE). The performance of miRNAs 21 and 221 in differentiating prostate cancer from nonmalignant cases was evaluated and compared to DRE and elevated PSA. miRNA 21 was overexpressed in 90 % of group A vs. 10 % of group B, while miRNA 221 was overexpressed in 80 % of group A vs. 20 % of group B (p = 0.001). MiRNA 21 overexpression had the highest performance as a diagnostic test with a sensitivity of 90 % and a specificity 90 % (p = 0.02). No correlations were noted between Gleason score of prostate cancer cases and relative quantity (RQ) 21 (r = −0.355, p = 0.292) or RQ 221 (r = −0.044, p = 0.892). Our study showed that serum miRNAs 21 and 221 expression profiling tests may be used as specific noninvasive molecular biomarkers for prostate cancer diagnosis due to their higher sensitivity and specificity with a high negative predictive value leading to a decrease in the biopsies taken for patients with elevated serum PSA values.

OBJECTIVES:To evaluate the impact of age, stone size, location, radiolucency, extraction of stone fragments, size of ureteroscope and presence and degree of hydronephrosis on the efficacy and safety of holmium:YAG (Ho:YAG) laser lithotripsy in the ureteroscopic treatment of ureteral stones in children. METHODS:Between October 2011 and May 2013, a total of 104 patients were managed using semirigid Ho:YAG ureterolithotripsy. Patient age, stone size and site, radiolucency, use of extraction devices, degree of hydronephrosis and size of ureteroscope were compared for operative time, success and complications. RESULTS:In all, 128 URS were done with a mean age of 4.7 years. The mean stones size was 11 mm. Success rate was 81.25 %. Causes of failure were 12.5 % access failure, 1.5 % extravasation and 4.7 % stone migration. Overall complications were 23.4 %. Failure of dilatation and extravasation were detected only in children <2 years old. Extravasation was significantly higher in smaller ureters and cases with stone size >15 mm. Stone migration was significantly higher in upper ureteric stones. CONCLUSIONS:Failure and complications rates in Ho:YAG ureterolithotripsy were significantly affected by younger age (<2 years), upper ureteric stones and smaller ureters but were not related to stone radiolucency or degree of hydronephrosis. Larger stones (>15 mm) were associated with increased complications. After multivariate analysis, the age of the patients remained significant predictor for failure of dilatation and stone migration, while size of the ureter was the only significant predicting factor for failure.

OBJECTIVES To report our experience with the first 230 cases of holmium laser enucleation of the prostate (HoLEP) performed in a single center.METHODS A total of 230 cases of HoLEP were performed between June 2007 and June 2008. Mean age of patients was 69.8 +/- 10.3 years, and 21.3% of patients were either on anticoagulant or antiplatelet treatment. There was no limit for prostate size, with a mean prostate size of 86.5 +/- 65.4 g (range: 20-350 g). Follow-up was performed regularly at 1, 3, 6, and 12 months, assessing the Q(max), PVR, and International Prostate Symptom Score.RESULTS Weight of prostate chips retrieved after morcellation was 78.6 +/- 61.3 g (range: 10-350), with enucleation time 102.2 +/- 55.4 minutes and morcellation time 19.3 +/- 10.1 minutes, leading an estimated efficiency rate of 0.64 g/min. The rate of decrease in prostate volume and prostate-specific antigen was 90.8% and 82.5%, respectively. At 1 month, mean Q(max) increased from 7.7 +/- 2.3 to 25.8 +/- 10.1 mL/s (P < .001), mean PVR decreased from 171.3 +/- 126.3 to 41.6 +/- 45.7 mL (P <= .001), and mean international prostate symptom score improved from 17.3 +/- 6.7 to 6.6 +/- 3.4 (P <= .001). These improvements were sustained throughout a 12-month follow-up period. Temporary irritative symptoms were evident in 34.6% and stress urinary incontinence in 9%, both of which were self-limited on medical treatment and Kegel exercises, respectively. Only 1 patient with pancytopenia required blood transfusion and there was no case for transurethral resection syndrome.CONCLUSIONS HoLEP is a safe and an effective modern modality for the treatment of symptomatic BPH regardless of the gland size, with satisfactory clinical outcome. UROLOGY 76: 448-452, 2010. (C) 2010 Elsevier Inc.

OBJECTIVES To describe our experience of adding extreme apical cores in men undergoing initial biopsy. Prostate cancer detection efforts have focused on increasing the number of cores. A more significant factor, however, may be their location. Laterally directed and apical cores have been associated with the highest cancer detection rate, especially the apical cores for men undergoing repeated biopsies.METHODS A prospective trial was conducted between September 2007 and April 2009. A total of 181 men with increased prostate-specific antigen (PSA) or abnormal digital rectal examination (DRE), or both, underwent an initial transrectal ultrasound-guided biopsy (TRUS-BX). All patients underwent a standard 12-core biopsy scheme plus 2 additional cores taken from the extreme anterior apex, defined as the site immediately lateral to the junction of apex and urethra. Each core was marked by a special colored ink for identification. Site-specific detection and tumor characteristics were reported.RESULTS Prostate cancer was detected in 86 patients (47.5%). The apical cores (3 on each side) achieved the highest cancer detection rate (73.6% of all cancers), and the additional extreme anterior apical cores (1 on each side) achieved the highest rate of unique cancer detection (P = .011).CONCLUSIONS From our experience, the apical cores, especially the extreme apical cores, increase prostate cancer detection on initial TRUS-BX and minimize the potential for misdiagnosis and need for repeat biopsy. UROLOGY 75: 1034-1039, 2010. (C) 2010 Elsevier Inc.