|GENERAL UROLOGY ABSTRACTS
|Year : 2015 | Volume
| Issue : 5 | Page : 45-48
General Urology Abstracts
|Date of Web Publication||20-Mar-2015|
|How to cite this article:|
. General Urology Abstracts. Urol Ann 2015;7, Suppl S1:45-8
Nephrectomy bench model: Determining the tear strength and resistance of a synthetic silicone composition
King Khalid University, Abha, Saudi Arabia
Objectives: To assess the tear strength and tissue resistance of various synthetic silicone compositions to develop a LPN bench model with high-fidelity tissue handling characteristics.
Methods: Different silicone samples were made by adding varying percentages of platinum silicone additive (0%, 5%, 10%, 15% and 16%). This resulted in samples with different consistency and texture. Using ten samples of each composition, the tear strength was measured by placing a 2/0 vicryl through each sample, which was attached to a strain gauge fixed within a standardized traction applying apparatus. The tear strength reading was taken at the moment the suture began tearing the material. The resistance of the silicone samples was measured using a commercial Durometer fixed to a Keith needle. The tear strength and resistance values from these samples were compared to readings from human kidneys. Kruskal-Wallis non-parameteric statistics were utilized.
Results: The median tear strength for the 0%, 5%, 10%, 15% ,16% and human kidney samples were 1900, 645, 665, 460, 210, 445 g respectively. Post-hoc analysis showed there was no difference between the 15% sample and the human kidney (P = 0.97). The median resistance values for the same samples were 80, 62, 112, 85, 89 and 26 units respectively. There were statistically significant differences noted.
Pattern of scrotal examination by physicians in the eastern province of Saudi Arabia
Waleed Mahfooth Alamrai, Abdullah Alabdrabalnabi, Nasir Al Fareed, Ali Matouq, Mohammed Alazzam, Raed Al Ajrafi, Ali Al-zahrani
Department of Urology, University of Dammam, Saudi Arabia
Introduction and Objective: A wide variety of pathological lesions affect the scrotal contents. They include both benign and malignant lesions. Missed or delayed diagnosis of such lesions can lead to compromised fertility, cosmetic deformities, testicular loss or even death. Early diagnosis of scrotal lesions can prevent the possible development of such complications. The pattern of scrotal examination by physicians in the Eastern Province of Saudi Arabia was evaluated in this study to assess the extent of efficacy for early diagnosis.
Methods: In this cross sectional study of scrotal pathology, self-administered questionnaires regarding scrotal evaluation were answered by physicians of different disciplines as emergency care, internal medicine, pediatric surgery, family medicine and general practitioners. The questionnaires included direct questions on clinical examination of the scrotum as well as clinical scenario quizzes. Collected data were analyzed with SPSS version 17. Chi-square test was used to analysis categorical variables, while the t-test was used for continuous variables. Factors affecting scrotal evaluation were assessed by logistic regression method.
Results: The questionnaires available for analysis were 257. Routine evaluation of the scrotum was performed by only 14% of respondents. Among the physicians who did not perform routine scrotal examination, 64.2% restricted it to cases with scrotal complaints, and 16% considered the conservative cultural nature of their patients a hindering factor. Forty-five percent did not perform scrotal examination in the standing position. Only 27.8% advised patients with high risk of testicular cancer to perform routine self-examination of their testicles.
Conclusion: This study revealed a significant deficiency of early detection of scrotal disease by physicians in the Eastern Province of Saudi Arabia with a high probability of development of complications. We recommend that all physicians be advised to follow a well-structured protocol for scrotal examination during routine practice.
Urinary tract involvement in crohn's disease: A challenging problem
King Fahd Specialist Hospital, Dammam, Saudi Arabia
Purpose: Crohn's disease is a complex disease where urinary involvement is not uncommon. Many of these patients are asymptomatic, but some present with complex urological involvement and are difficult to manage. Here we report 6 patients with crohn's disease with complex urinary tract involvement.
Methods: 6 patients of crohn's disease with complex urinary tract involvement were identified in our records. They were reviewed as regards to clinical presentation, diagnostic workup, management and outcome.
Results: Among the 6 cases, 4 were males and 2 females with a median age of 36 years. All patients were diagnosed as crohn's disease and were on medical treatment. Patients were referred to urology because of upper urinary tract obstruction in 3, complex fistula in 2 and dysuria in one. The diagnostic imaging (CT, MRI, or Fistulogram) showed complex urinary fistulae in 5 (involving bladder in all 5 and urethra in 2), unilateral hydronephrosis in 2 and bilateral in 1. All patients underwent fecal diversion. Initially, the 3 patients with obstructive uropathy were managed by percutanous nephrostomy in 2 and double J stent in 1; 3 patients with vesicoenteric fistula or urethral fistula were diverted by Suprapubic tube in one and by temporary Foley's catheter in 2. All patients improved clinically. The patient with only colovesical fistula was cured spontaneously after the medical treatment. One patient with ileovesical and vesicocutanous fistulae was managed by open repair. The other 4 patients are still waiting for possible further surgical intervention .
Conclusion: Crohn's disease is a challenging medical problem. Urinary tract involvement may present as vesical or urethral fistulae or ureteric obstruction. Medical treatment is the initial corner stone of management. Not infrequently, these patients need initial fecal and/or urinary diversion. Medical treatment may be curative in some patients while surgical intervention may be required in others.
The effect of animated biofeedback training in treating patients with voiding dysfunction
A. Alshaikh, A. Al Abbad, M. Aggamy, F. Alkawai, M. Gomha, Al Mousa Riyad
King Fahd Specialist Hospital, Dammam, Saudi Arabia
Hypothesis/Aims of Study: The purpose of this study is to determine the effect of animated biofeedback training in treating patients with voiding dysfunction in a single tertiary health care centre in Saudi Arabia.
Study Design, Materials and Methods: We retrospectively reviewed the charts for all patients with voiding dysfunction who underwent animated biofeedback sessions training using urostym machine in the Department of Urology at king Fahd specialist Hospital -Dammam between March 2010 and February 2014.
Data sheet from the machine was used to retrieve the following variables: Age, gender, diagnosis, basic labs, UTI episodes, urgency/frequency, urinary incontinence , nocturnal enuresis,and post void residual.
All patients who didn't complete at least 6 sessions of biofeedback were excluded from the study. Success was considered if there is at least 50% improvement of the presenting complaint. The ethics committee of the hospital approved this study. Descriptive statistics was used for analysis.
Results: Sixty-nine patients out of 80 met the criteria for the study. The median age of the patients was 31 years (IQR: 9-49) with a female: male ratio 3:1. From these about 60% were adults.About 49% were diagnosed as dysfunctional voiding, 19% had stress urinary incontinence, .....% had mixed incontinence, .....% had overactive bladder, .....% had nocturnal enuresis and .....% had neurogenic bladder.
Presenting complains were: Urinary incontinence in 41 patients, frequency/urgency in 46, recurrent UTI in 18 patients, had high post void residual in 18 , and Nocturnal enuresis in 17 patients. About 71% (n = 41) of patients who presented with urinary incontinence had more than 50% improvement after biofeedback and 5% were completely dry and. 65% (n = 46) of patients who presented with frequency/urgency had more than 50% improvement and 9% had a complete response. 47% (n = 17) of patients who presented with nocturnal enuresis had more than 50% improvement and 18% had complete improvement. 82% (n = 22) of patients who had recurrent UTI improved more than 50% and finally, 67% (n = 18) of patients who presented with post void residual urine improved more than 50%.
Interpretation of Results: The majority of patients improved after urostym training sessions with a success rate about 76% for patients presenting with urinary incontinence, 74% for patients presenting with frequency/urgency, 65% for patients presenting with nocturnal enuresis, 67% for patients presenting with post void residual and 82% for patients presenting with recurrent UTI. It is important to notice that about one quarter to one third did not show any improvement. Considering the cost of this type of biofeedback further studies need to be done to determine who are the patients who will benefit more of this type of management.
Concluding Message: Treatment of patients with voiding dysfunction using biofeedback urostym training is associated with improved urinary incontinence, urgency frequency symptoms,nocturnal enuresis episodes and decreased urinary tract infection rates.
A case report of a xanthogranulomatous pyelonephritis case mimicking the recurrence of renal cell carcinoma after partial nephrectomy
Rakan Aldarrab, Hamad S. AlAkrash1, Sultan S. AlKhateeb2, Nassir M. Albqami2
King Saud Bin Abdulaziz University for Health Scinces, National Guard Hospital, 1Prince Sultan Military Medical City, 2King Abdulaziz Medical City NGHA, Riyadh, Saudi Arabia
A 44-year-old female presented to the urology clinic with flank pain and tenderness. After full assessment the patient was booked for surgery for partial nephrectomy. The diagnosis of renal cell carcinoma chromophob type was established. 6 months later, the patient came back for follow up; a mass was detected on the same kidney. Radical nephrectomy was performed to excise what is thought to be a recurrence of renal cell carcinoma. The tissue was then sent to pathology. The post-operative pathology report confirmed the presence of xanthogranulomatous pyelonephritis rather than renal cell carcinoma recurrence.
Prevalence of urological complications in patients with sickle cell disease
King Khalid University, Abha, Saudi Arabia
Objective: To determine the prevalence of urological manifestations in patients with sickle cell disease.
Methods: A retrospective study at Aseer Central Hospital over a period of 8 years. Medical records of patients with SCD were reviewed. Urological manifestations in patients with SCD were looked at, data were gathered after obtaining all the necessary ethical and legal approvals. These were entered in SPSS version 20 7 for further analysis and investigation. Descriptive statistics were obtained regarding the demographic variables and laboratory examinations. Further statistical tests (t-test and Chi-square tests) were applied to find out the significance differences among the variables. Person correlation test was also applied to measure the degree of the correlations.
Results: Study included 100 patients. Among them, 70% were males while 30% were females. Age groups lies between 2 months to 70 years, mean age is of 10.8 years. In these 100 SCD patients, we found 45 patients (45%) have urological manifestations. Hematuria/dark urine was the most common manifestation (53%), followed by priapism (20%). ESRD and papillary necrosis were found in (6%) and (5%) of patients respectively. Five percent of patients had UTI. We observed that 78% of patients with priapism were belonging to the age group of 10-25 years. By applying the Pearson correlation, we found a significant correlation (70%) between ESRD and age. while it was (44%) between Hematuria and age, and 35% between medullary carcinoma and age. For hematuria, there was a significant difference with regards both gender and age (P-value < 0.05).
Conclusion: Awareness of the urological complications of SCD may prevent end stage disease including renal failure and impotence. These serious complications can be prevented or delayed when an early and prompt care introduced to the SCD patients.
Urine analysis assessment among primary health care providers in eastern province of Saudi Arabia
Abdul-Aziz M. AlSharydah, Ibrahim M. AlBwardi and Ali A. Al-Zahrani
Department of Urology, University of Dammam, Saudi Arabia
Introduction and Objective: Urine analysis is often ordered by primary health care providers (PHCP) during routine general assessment of their patients. A major indication for urine analysis is early detection of urothelial cancer. This condition is highly suspected in the presence of microscopic hematuria (3 or more RBC/HPF in 2 consecutive urine analyses). Early detection increases the chances of complete removal of the tumor and cure. This study evaluated the preference of the PHCP to perform urine analysis as a screening test for urothelial cancer. It further evaluated the PHCP's referral preference, whether to the urologist or to another specialist.
Methods: A written questionnaire was filled by the PHCP (the first line physician who encounters patients). PHCP includes family physicians, general practitioners and emergency physicians. The questionnaire consisted of true/false questions and multiple-choice questions. This study was approved by the Local Institution Research.
Results: The study was completed in 4 months between October 2013 and February 2014. Out of 258 questionnaires made, 184 were appropriate for the analysis. Around 45% of PHCP stated that urine analysis is done as a routine procedure to all patients. In contrast, 45.7% could not appreciate the concept of risk factors for urothelial cancer. Only 44.6% of PHCP had available facilities to perform microscopic urine examination. PHCP who performed urine analysis when a risk factor was present did not agree on the nature of those risk factors. Only 3.8% considered smoking a risk factor. The remaining believed that age was the major risk factor. Both old age and young age where considered to be risk factors by 28.8% and 20.1% of PHCP, respectively. When PHCP were asked to define microscopic hematuria, 32.6% were able to give a correct answer. The majority (61.4%) gave an incorrect definition as they believed that microscopic hematuria is presence of more than 10 RBCs per high power field.
Conclusion: PHCP performance to utilize urine analysis effectively as a screening test for early detection of urothelial cancer is considerably deficient. This is largely because of lack of knowledge about the risk factors involved. It is recommended that educational courses by specialized urologists be implemented to the PHCP. The objective of these courses is to explain how urine analysis can be correctly used for the early detection of urothelial cancer.
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