|Year : 2020 | Volume
| Issue : 5 | Page : 8-15
Abstract - SUA202 (Endourology/BPH)
|Date of Web Publication||9-Jun-2020|
|How to cite this article:|
. Abstract - SUA202 (Endourology/BPH)
. Urol Ann 2020;12, Suppl S1:8-15
| Current surgical procedures for benign prostatic hyperplasia and impression of new surgical modalities|| |
Abdullah M. Al Khayal1,2,3, Faisal K. Balaraj1,2,3, Turki A. Alferayan4, Khalid A. Alrabeeah1,2,3, Saad M. Abumelha1,2,3
1King Abdullah International Medical Research Center,2King Saud bin Abdulaziz University for Health Sciences,3Ministry of the National Guard- Health Affairs,4College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
E-mail: [email protected], [email protected]
Background: Surgery is considered the most effective treatment for BPH and transurethral resection of prostate (TURP) considered the gold standard. The goal of this study is to assess the surgical interventions used in Saudi Arabia, the difference in surgical procedures done depending on age and years of experience, and the participants impression on the new modalities in management of BPH.
Methods: An online survey using Google Forms was sent to the participants. The data were collected during Saudi Urological Association Annual Meeting February 2019. Additional data where gathered two months later. The study was closed in May 2019. No incentives were provided to participants.
Results: A total of 65 (54.1% respond rate) urologist participated in the survey, of whom 41.5% of respondents were aged less than 40 years, while 40% of them aged between 40 to 60 years. 47 (72.3%) out of 65 were consultants. The essential investigation used by most participants prior to surgical interventions are PSA, urine culture, urinalysis and abdominal US. The most used surgical interventions are unipolar TURP, BiTURP, and open prostatectomy. About 50% of respondents preferred open prostatectomy for prostate size above 100g. In general, 40-50 % of participants believe that Urolift, Rezum, Aquablation, Embolization and Robotic simple prostatectomy are useful options.
Conclusion: TURP continues to be the main intervention for prostate sizes less than 100g. Open prostatectomy is widely used intervention for prostate sizes more than 100g. New modalities gained little acceptance among urologists. Hands on workshops may help in educating urologists and introduce these new modalities for the future use.
| Evaluation of intermittent tamsulosin in treating symptomatic patients with benign prostatic hyperplasia|| |
Mohammed G. Soliman, Mohammed R. Al-Ghadeer, Hasan R. Al-Shabaan, Amer H. Al-Hamrani, Ali Y. Al-Turaifi, Khaled Z. Al-Qahtani, Zaid Al-Zaid, Abdullah K. Alabdulqader
College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
Purpose: To evaluate the influence of intermittent Tamsulosin treatment as a trial to increase the drug safety (in terms of reducing the side effects especially retrograde ejaculation) while maintaining the efficacy in relieving the patients' symptoms and its impact on the patients' quality of life.
Materials and Methods: Patients who enrolled in this study were suffering from LUTS due to BPH and were using 0.4 mg Tamsulosin daily to relieve their symptoms, but complain of ejaculatory problems. Baseline assessment involves medical history and evaluation of ejaculatory function, IPSS, quality of life assessed using global satisfaction, physical examination including digital rectal examination, renal function, abdominopelvic ultrasound and post-void residual volume (PVR) estimation. The patients consent to take 0.4 mg Tamsulosin intermittently every other day, and to proceed with their sexual activities in the days they did not take the drug in. Baseline assessment was repeated and recorded after 3 months from starting the treatment. Drug compliance and adverse events were analyzed in all patients.
Results: 25 patients had mean baseline IPSS of 6.6 ± 1 and baseline PVR of 87.6 ± 15.1 ml. At the third month of follow-up, mean IPSS was 7.3 ± 1.1 and mean PVR was 100.4 ± 15.1 ml. Moreover, 20 out of the total number of 25 patients (80%) reported improvement in ejaculation. The global satisfaction rate, all 20 patients who showed improvement in ejaculatory function are either satisfied or very satisfied (4 or 5).
Conclusion: Patients suffering from LUTS/BPH and complaining from abnormal ejaculation, especially absent ejaculate, intermittent Tamsulosin therapy (0.4 mg/every other day) is well tolerated and shows a potential advantage in their recovery. Even with the significant change in IPSS and PVR after intermittent Tamsulosin therapy, most patients show a higher overall satisfaction with the treatment compared to the standard dose (0.4 mg/daily).
| The effectiveness of ultrasound-guided percutaneous aspiration of simple renal cysts in hospitals of Aljouf Region, Saudi Arabia: A prospective study|| |
Mohammed J. Alenzi, Ahmed S. Alshlash1, Ziyad Nawaf Aljazi2, Mohammed Saleem Aldaghmani2, Fawaz F. Alrashed3
Department of Urology, College of Medicine, Jouf University,1Jouf Univerity,2Prince Mutaib Hospital, Sakaka, Aljouf,3Hail University, Ha'il, Saudi Arabia
E-mail: [email protected]
Objectives: To assess the effectiveness and complications of ultrasound (US) guided percutaneous aspiration of renal cysts with 99% ethanol as sclerosing material in the treatment of simple symptomatic renal cysts.
Methodology: This observational prospective study was done among 42 patients who had a total of 47 symptomatic simple renal cysts. This study was done between 2014-2017 in the outpatient clinic of Prince Mutteb Hospital among the patients aged between 23-62 years including male (19) and females (23). An US guided ablation of renal cyst was done under local anesthesia. After that, an equal volume of contrast medium was injected through the needle into the cyst cavity to delineate the cyst wall. The sterile 99% ethanol, with one fourth of total cyst volume was injected into the cyst after complete aspiration of the contrast medium. After the treatment, the ethanol was aspirated, and volume was measured. The follow-up of evaluation on each patient was done every 6 months intervals. The post-sclerotherapy outcome was categorized into the complete success, partial success and failure as per standard criteria.
Results: The post-sclerotherapy complications were minimum including, hematuria in 8 (17%) patients and low-grade fever in 7 (14.8%) patients and mild flank pain in 5 (10.6%) patients were observed. During the follow-up after the sclerotherapy out of 47 cysts, 20 (42.5% ) cysts with different sizes showed statistically significant (P < 0.05 )complete resolution and not appeared again during the later follow-up sessions. The overall success rate in the current study procedure was 100%.
Conclusion: We conclude that percutaneous aspiration with a single injection of 99% ethanol sclerotherapy will give a high success rate in the treatment of simple renal cysts with good optimization of sclerosing material and effective aspiration skill of uro-surgeon.
| The change of prostate size post prostatic artery embolization for benign prostatic hyperplasia|| |
Ali Al-Gonaim1,2, Hossam S. El-Tholoth1, Murtadah Alnemer1, Ibrahim Alrashidi3, Faisal Alahmari3, Fares Garad3, Mohamed Said1
Departments of1Urology and3Radiology, Prince Sultan Military Medical City, Riyadh,2College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
E-mail: [email protected]
Introduction: Prostatic artery embolization (PAE) is an emerging minimally invasive treatment for begin prostatic hyperplasia (BPH). Till now it has a variable outcomes and still fighting for a place in management of BPH. We report our short-term outcome for this procedure.
Methods: From our early experience in applying PAE as one of the treatment options for BPH in selected cases started from October- 2015 until October -2019. We reviewed the patient presentation; preoperative prostate size, symptoms score, uroflow finding, patient welling and patient comorbidities. Patients included in the study after full explanation of all BPH management options. PAE was recommend mainly to the patients with multiple comorbidities and high anesthetic risk. Then we showed the follow up outcome excluding missed follow up patient.
Results: We had 33 patients with mean age 70.6 years. 25 Patients had multiple comorbidities and 13 of them have high anesthetic risks (ASA score ≥3). 19 patient presented with acute urine retention on indwelling catheter, fourteen had severe BPH symptoms, five of these patients requested this procedure for fertility issue and worried about the retrograde ejaculation. During follow up 9 patients failed management (2 still on indwelling catheter), 3 booked for re-embolization one of them done and improved, one shifted to TURP and improved, the third patient developed a prostatic abscess managed by transurethral drainage. All the failed patients did not show any significant change in the prostate size by the ultrasound. 24 (72.7%) patients have shown improvement in the International Prostatic Symptom Score (IPSS) score by 5-10 points and decreased the prostate size by 16-47 grams on follow up ultrasound (representing about 32% of the pre-embolization prostate size). The average flow rate increased to a range 9-14 ml/ sec.
Conclusion: Prostatic artery embolization can be used for selected cases, decreased prostate size post embolization was associated with symptoms improvement. Large number and longer term outcomes are needed.
| Seasonal variation in the incidence of acute renal colic|| |
E-mail: [email protected]
Background: Urolithiasis is one of the most common medical diseases affecting the general population. Many epidemiological studies have shown association between geographic area with high mean daily temperature and urolithiasis disease. However, it is unclear if the seasonal variation within high temperature geographical area will affect the acute presentation of renal colic to the Emergency department (ED). The aim of this study is to identify the influence of seasonal variation in the acute presentation with urolithiasis disease.
Methods: A retrospective study, the database in King Abdullah International Medical Research Center (KAIMRC), Riyadh, Kingdom of Saudi Arabia has been reviewed in the last 4 years. All patients that have presented with renal colic and have been diagnosed with urolithiasis by non-contrast enhanced CT scan have been included in our study.
Results: A total number of 1057 patients have been enrolled in this study . 753 (71.24%) were males and 304 (28.76%) were females, with a mean age of 42.33±16.12. Most of the patients presented in summer (31.22%), followed by spring (26.87 %), fall (24.12%) then winter (17.79%) respectively.
Most of the patients (84.77%) presented with ureteral stones, while (15.23%) presented with kidney stones. (78.33%) of patients have no history of previous stone formation, while (21.67%) of patients were recurrent stone former.
Conclusion: Acute presentation with urolithiasis is higher during summer followed by spring, fall then winter respectively. Public educational program is highly recommended to increase awareness about stone formation and appropriate methods to avoid it. To this end, further study is needed to know the stone composition and appropriate methods to avoid developing urolithiasis.
| Effectiveness of medical expulsive therapy in expectant ureteric stones management|| |
B. Bugis, S. Alzahrani, S. Abuanz, A. Alzahrani, A. Alawwad, A. Y. Mohammed
Department of Urology, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
E-mail: [email protected]
Introduction: Medical expulsive therapy (MET) is considered reasonable option in facilitating stone passage in patients diagnosed with ureteric stones and treated conservatively. Although it's a debatable option since its efficacy has been questionable over the last few years with some recent studies denying its benefits. And due to the variety of response in different patients. However, it's still used in our practice with acceptable results.
Objectives: To assess the effectiveness of medical expulsive therapy in ureteric stone passage at our center.
Methods: 95 Patients in whom expectant management were adopted, received medical expulsive therapy (tamsulosin 0.4 mg daily) at King Fahd Military Medical Complex - Dhahran and were followed up for a period of 4 - 6 weeks for stone clearance, over two years period (2015 to 2017).
Results: We evaluated a total of 95 patients who received tamsulosin 0.4 mg and were observed for a period of 4-6 weeks for response. 35 (36.8%) patients passed stones whereas 60 (63.2%) patients didn't.
Of the 35 patients who passed stones with tamsulosin, 27 (77.14%) had stones in the lower ureter, 3 (8.6%) and 5 (14.3%) in middle and upper ureter respectively. 25 (71.4%) patients in this group had stone size less than 5 mm and 10 (28.6%) had 5 -10 mm.
60 (63.2%) patients who didn't pass stones with tamsulosin, 30 (50%), 8 (13.3%) and 22 (36.7%) patients had the stones in lower, middle and upper ureter respectively. 15 (25%) patients had stone size less than 5 mm and 45 (75%) had 5 -10 mm stone size.
Conclusion: Medical expulsive therapy is a reasonable option as initial therapy for patients with ureteric stones. Despite low grade evidence, its benefits for stone clearance especially for small lower ureteric stones is valuable and may well need to be considered.
| Evaluation of single-use flexible ureteroscopes available in the Saudi market: In vitro comparison between four disposable ureteroscope clinically oriented approach|| |
Wissam Kamal, Mohammed Abuzenada, Yasser Aloabiri, Aiman Al Solumany, Ali Alhazmy, Majid Alharthi
Department of Urology, King Fahd Hospital Jeddah, Jeddah, Saudi Arabia
E-mail: [email protected]
Objective: In vitro comparison between four single-use flexible ureteroscopes available at the Saudi market.
Materials and Methods: Four single-use flexible ureteroscopes; Wiscope® (OTU Medical), Pusen (1rs. generation; Zhuhai Pusen Medical Technology Company Limited, China), LithoVue (Boston Scientific) and EU-Scope (Innovex Medical) were tested and compared in an vitro setting mimicking clinical based scenarios. Parameters which could potentially affect surgical technique were compared between the four scopes.
Results: [Table 1] shows the results of different parameters comparison. Wiscope was the lightest ureteroscope (185g) while the Lithovue was the heaviest(260 g). Wiscope and EU-Scope had the highest deflection with an empty channel reaching up 285°, followed by Lithovue at 273°, then Pusen with 270° .Wiscope and EUscope had the lowest deflection loss with the 200 μm laser, 2.2 Fr basket and 365 μm laser. EU-Scope had the longest working length (790 mm) and Pusen had the shortest working length (630 mm).Even though the working channel diameter is the same for all scopes (3.6 Fr), with an empty channel; Pusen, Wiscope and EU-Scope had the highest irrigation rate at 50 ml/minute while Lithovue had an irrigation rate of 42 ml/minute. Nonetheless, Wiscope was the least scope to be affected in terms of irrigation with the introduction of 200 μm laser fiber (25.5ml/min) and 2.2 Fr basket (10 ml/min), while the Pusen scope showed the greatest loss in the irrigation rate between the scopes (18.6 ml/min) with the 200 μm and (7ml/min) with the 2.2 basket..EU-Scope had the highest field of view, while the pusen had the lowest. The Lithovue and Pusen requires their specific monitor, while EU-Scope and Wiscope are connected to a processor with outlets that could be connected to any monitor. Both Wiscope and Pusen had an autolock mechanism with deflection.
Conclusion: Wiscope was the lightest scope, had the lowest shaft and tip diameter, the shortest loop diameter of the deflective part and showed the least irrigation loss with instruments in the working channel. Wiscope and EU-scope had the highest deflection angle. EU-scope had the longest working length.
| Saudi trend in the surgical treatment of benign prostatic hyperplasia|| |
Emad Alwashmi1,2, Abdullah M. Alenizi1
1Division of Urology, Security Forces Hospital, Riyadh,2Faculity of Medicine, Qassim University, Qassim, Saudi Arabia
E-mail: [email protected]
Objective: To review the current trends in Saudi Arabia and the factors affecting those trends. We also sought to assess urologists' level of awareness to the new modalities and their indications.
Methods: An online questionnaire has been distributed among practicing urologists in the different provinces of Saudi Arabia. The questionnaire consisted of demographic data, questions related to qualification, years of practice and country of training. Other questions were assessing the common indications for surgical intervention, the most commonly used surgical modality and the factors affecting the selection.
Results: A total of 48 practicing Urologist participated in the questionnaire. 27 (56%) participants aged between 35-44 years, 97.9% were males. The majority of participants were from central region(45.8% ). Among all indications of surgical intervention for BPH, failed medical treatment and urinary retention were the most common (54.2% and 45.8% respectively). The most commonly used modalities were Monopolar and Bipolar TURP (60.4% and 35.4% respectively). With regard to large prostates (>100cc), participants perform open prostatectomy, bipolar TURP, monopolar TURP, robotic prostatectomy (RASP) and greenlight in 50%, 25%, 18.8%, 4.2% and 2.1% respectively. However, 17% of respondents believe that HoLEP is the best option for large prostates. In addition, although 58.3% and 20% of respondents think that greenlight and HoLEP are the best options for anticoagulated patients respectively, only 41.7% and 10.4% actually use them respectively. In general, 77.1% of participant don't use laser (holmium/greenlight). When asked why, 66.7 % of them think that the cost is reason whereas 38.9% think that lack of training is the reason.
Conclusion: Despite the rapidly evolving Surgical BPH therapy, TURP is still the most commonly utilized modality in Saudi Arabia. Large prostates (>100cc) and anticoagulation remain a challenge to most young Saudi urologists due to the unavailability of some surgical modalities. Greenlight, HoLEP and robotic simple prostatectomy are not widely adopted by Saudi urologist due to cost and lack of training.
| Trends of percutaneous nephrolithotomy in Saudi Arabia|| |
Wissam Kamal, Yasser Aloabiri, Aiman Al Solumany, Ali Alhazmy, Majid Alharthi
Department of Urology, King Fahd Hospital Jeddah, Jeddah, Saudi Arabia
E-mail: [email protected]
Objective: To present the current practice patterns on percutaneous nephrolithotomy (PCNL) in a Saudi Arabia and to compare it with the international patterns and to observe the adherence to the guidelines.
Materials and Methods: [Table 1] shows a survey consisting of 28 questions was sent to urologists working in Saudi Arabia using a Google Forms questionnaire. The questioner covered most aspects of performing PCNL starting from preparing the patient tell discharging him.
Results: [Table 1] shows the summary of answers from the particepants. 132 replied to the survey. 70.2 % performed PCNL, 59.1 % of them learned PCNL during residency. The access was obtained by the surgeon in 80.3 %, 68.2 % using fluoroscopy. The majority (80.3%) performs PCNL in the prone position. 69.7 % uses the balloon dilators and 16.7 % uses the Amplatz dilators. For kidney drainage, 60.6% place a nephrostomy tube and a Double J stent together and 4.5% performs tubeless PCNL (DJ stent only). 45.5% stated that the introduction of Flexible Ureteroscopy decreased the rate of doing PCNL for more than 20%.
Conclusions: Data obtained from a group of urologists in Saudi Arabia, showed that the majority of urologists practicing in Saudi Arabia perform PCNL. They usually learn PCNL during residency. We observe that the majority of urologists attach to the original patterns in PCNL i.e. they predominantly prefer the prone position, use fluoroscopy to gain the PCNL access. Also, the data showed that new trends in PCNL did not gain a lot of momentum as few practices miniaturized PCNL and tubeless PCNL. The majority uses balloon dilators and combined ultrasonic/pneumatic lithotripters. The complication rate encountered by the participants are concomitance with the published international figures. The introduction of Flexible Ureteroscopy highly decreased the rate of doing PCNL for most urologists.
| Types of urolithiasis in Eastern Region of Saudi Arabia according to laboratory stone analysis: Single center experience|| |
W. Alamri, S. Alzahrani, S. Abuanz, A. Alzahrani, H. Alshubaili, A. Y. Mohammed
Department of Urology, King Fahad Military Medical Complex, Dahran, Dammam, Saudi Arabia
Email: [email protected]
Introduction: Urolithiasis is a common urological disease with higher incidence and prevalence. The prevalence of urolithiasis types in Eastern Region of Saudi Arabia are Calcium Oxalate 74.2%, Uric Acid stones 12.8% and mixed stones 10.4% based on study conducted in 2016.
Objective: This study aimed to assess the prevalence of the stone types in the eastern region of Saudi Arabia according to the laboratory stone analysis.
Methodology: Retrospective study was conducted over one-year (November 2017- 2018) period at King Fahad Military Medical Complex-Dhahran. 113 patients were enrolled in this study and data obtained include patient's Gender and stone analysis using Infrared Spectrum Analysis.
Results: 113 Patients were enrolled in the study, with the majority male patients (88.35%) and Female Patients (11.5%). 65.2% of 113 had Calcium oxalate Monohydrate stones; 65 % male and 64.3 % female, Calcium Oxalate Dihydrate 18%, Uric acid Dihydrate 6.6% , and Uric acid, Cystine, Calcium carbonate phosphate 2.2 % each. Struvite and Ammonium hydrogen urate was <0.9%.
Conclusion: The prevalent stone type in Eastern Region of Saudi Arabia in Our center was Calcium Monohydrate with No Gender difference was notice in our study.
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