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   Table of Contents - Current issue
November-December 2020
Volume 31 | Issue 6
Page Nos. 243-290

Online since Saturday, December 26, 2020

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Time to Change Highly accessed article p. 243
Stephen Shei-Dei Yang
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Recent literature on the minimally invasive management of pediatric urolithiasis: A narrative review p. 244
Jin Kyu Kim, Michael Erlano Chua, Stephen Shei-Dei Yang, Jessica M Ming, Joana Dos Santos, Walid A Farhat
Although the surgical management of pediatric urolithiasis does not differ significantly from that of adults, there are anatomical and physiological differences that necessitate special considerations. This review aims to summarize the existing high-level evidence (systematic review, meta-analysis, randomized controlled trials) for surgical management of pediatric urolithiasis, with a discussion on different technical tips to make these surgical approaches achievable. A PubMed web-based medical literature search was performed on May 26, 2020, using the search strategy (Pediatric or children) and (urolithiasis or stone) and Urology. The search was limited to meta-analysis, systematic reviews, and randomized controlled trials published in the past 10 years. Only studies that focused on surgical management of pediatric urolithiasis were included. Fifty-seven records were identified and 47 were excluded as these records were duplicates, did not assess surgical management, or were trials that were included in systematic reviews/meta-analyses that were included in this study. Ten studies were included in this review. Depending on the review/trial, the stone-free rate (SFR) had wide ranges for all of the surgical management options assessed (shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy). There are many considerations in choosing the appropriate surgical management for a patient presenting with pediatric nephrolithiasis–SFRs, radiation exposure, and adverse events being some of these features. All three procedures assessed had different characteristics, with advantages and disadvantages unique to each procedure. As each surgical technique for pediatric urolithiasis provides its advantages and disadvantages, surgeons should discuss all options to provide the best-informed decision-making process to a patient or family who may require surgical management of pediatric nephrolithiasis.
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Risk factors of morbidity and mortality after flexible ureteroscopic lithotripsy p. 253
Te-Yen Chuang, Ming-Hong Kao, Po-Cheng Chen, Chung-Cheng Wang
The use of the flexible ureteroscope for treating renal and ureteral calculi has rapidly increased in the last decade. Although the use of the flexible ureteroscope by experienced surgeons has excellent outcomes and safety profiles, several studies have reported many surgical complications with its use. We conducted a narrative review of the published literature sourced from PubMed. We used a combination of three keywords: “ureteroscope,” “morbidity,” and “urolithiasis,” with or without the additional keywords of “infection,” “mortality,” “hematoma,” and “ureteral injury.” Infection, bleeding, and ureteral injury are the main complications. We analyzed the possible causes of morbidity and death after the use of a flexible ureteroscope. Finally, we propose recommendations to prevent these complications.
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Conservative management of upper tract urothelial carcinoma with endoscopic thulium laser ablation: A retrospective study with subgroup analyses p. 258
Yu-Che Hsieh, Steven K Huang, Chia-Cheng Su, Jhih-Cheng Wang, I-Jung Feng, Allen W Chiu, Chien-Liang Liu
Purpose: The gold standard treatment for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy. The combination of ureterorenoscopy and laser ablation has recently become more accepted. This study aims at investigating the risk factors of tumor recurrence associated with the thulium laser ablation of UTUC and reporting its clinical outcomes with subgroup analyses. Materials and Methods: Patients who underwent endoscopic thulium laser ablation of UTUC as the primary treatment from June 2012 to November 2018 were reviewed retrospectively. Sixty-eight patients were enrolled, of whom 34 had complete data for analysis after applying the exclusion criteria. Bivariate analysis was performed to compare patients with and without recurrence. Multivariable Cox regression models were applied. Kaplan–Meier survival estimates were presented, and three tumor characteristics were used for subgroup analyses. Results: Fifteen patients (44%) had local tumor recurrence. Four patients (12%) had cancer-specific death. In bivariate analysis, statistical significance was noted for age, tumor grade, and tumor size (P = 0.018, 0.047, and 0.014, respectively). In multivariate analysis, statistical significance was noted for age and tumor size (P = 0.017 and 0.042, respectively). In the Kaplan–Meier estimates for subgroup analysis, statistical significance was noted only in the tumor size and tumor grade group (P = 0.0275). The study limitations included the retrospective design and small sample size. Conclusion: Tumor size and tumor grade are influential recurrence factors. The tumor stage did not show statistical significance in recurrence analysis. In subgroup analyses, tumor size was more influential than tumor grade with respect to the prognosis of local recurrence.
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Surgical and functional outcomes of robotic-assisted radical prostatectomy in patients with previous transurethral resection of the prostate p. 267
Sih-Han Chen, Chun-Hsien Wu, Richard Chen-Yu Wu, Wade Wei-Ting Kuo, Yen-Hsi Lee, Ryh-Chyr Li, Yung-Yao Lin, Victor Chia-Hsiang Lin
Purpose: The purpose of this study was to assess the surgical and functional outcomes of robotic-assisted radical prostatectomy (RARP) in patients with previous transurethral resection of the prostate (TURP). Materials and Methods: The present article studies 99 patients who underwent RARP, including 13 patients with previous TURP at a single institution, in the period from April 2016 to February 2019. Propensity score matching 1:1 was performed to identify 13 patients with no previous TURP. The matched variables were age and preoperative prostate-specific antigen level. Surgical and functional outcomes were compared between the two groups. Descriptive statistics were evaluated using the Chi-square test. t-test was performed for continuous variables. Results: Regarding preoperative characteristics, no previous TURP group had a higher clinical stage (P = 0.026). The nerve-sparing procedure was similar between the two groups. Concerning intraoperative outcomes for the group with previous TURP history, the operating room time was increased by 25 min (P = 0.140), and the estimated blood loss was increased by 50 ml (P = 0.192). As for the postoperative pathological characteristics, there was no significant difference in the positive surgical margin rate between the two groups. The continence rate in the 3rd month for the group with previous TURP history was 69.2% versus 92.3% for the group with no previous TURP history, and after the 1st year, the rates were 100% versus. 92.3%. There was no significant difference in the potence recovery rate between the two groups after 1-year follow-up. Conclusion: RARP is safe and feasible in patients with localized prostate cancer with previous TURP history. Functional outcomes after 1-year follow-up were comparable for patients with previous TURP.
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Comparison of stone-free rate, operation procedure, and complication rate according to guy's stone score in supine percutaneous nephrolithotomy p. 273
Vicky Ferdian, Yulfitro Manurung
Background and Aim: Percutaneous nephrolithotomy (PCNL) was considered a safe and efficient method for removing kidney stones, with a low incidence of complications. This study aims to compare the success rate of PCNL based on guy's stone score (GSS) operating procedure and its complications. Methods: Data were collected from patients with kidney stones who underwent PCNL. A stone-free rate (SFR) was considered if the patient was either had no stone or had any stone that is <4 mm and asymptomatic residual fragment. Complications were assessed using the modified Clavien score, and SFR was assessed by abdominal radiography. Results: A total of 198 patients were included in this study. There was a significant difference in SFR between simple (GSS I and II) and complex stone (GSS III and IV) groups (P = 0.000). The operation procedure was longer in the complex group compared to the simple groups for both total operating time and stone fragmentation time (P = 0.000). X-ray time was not significantly different (P = 0.061). Almost all patients were classified as Clavien I, as there was no significant difference between the two groups for complication (P = 0.277) or blood loss (P = 0.176). Conclusion: The success rate of PCNL based on the GSS at Gunung Jati Regional Hospital is quite good. There was a difference in the SFR between the groups, and the operating procedure time was longer in the complex stone group. There was no difference between the simple stone and complex stone groups in PCNL complications, which indicated a good surgical practice.
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The simple solution for infertile patients with aspermia in the modern era of assisted reproductive technique p. 277
Le-Wei Fan, I-Hung Shao, Ming-Li Hsieh
Purpose: The purpose is to investigate the feasibility and outcomes of loupe-assisted vasostomy for sperm retrieval in male infertility due to anejaculation or retrograde ejaculation. Materials and Methods: We retrospectively reviewed the vasal sperm aspirations of 9 patients with anejaculation or retrograde ejaculation from 2015 to 2017. We collected preoperative serum hormone data (testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin) and comorbidities of each patient. The patients underwent standard loupe-assisted modified vasostomy by a single surgeon with immediate specimen interpretation, with follow-up at the clinic. Results: Of the 9 patients, 4 had retrograde ejaculation, and 5 had anejaculation. Seven patients had controlled diabetes mellitus; of them, one had an ejaculating duct stone, and only one had no comorbidity. Aspirations were performed for sequential assisted reproductive techniques in 7 patients and cryopreservation in another two. The average total sperm count was 213 × 106, with motility between 9% and 67% and normal sperm morphology between 4.5% and 50.0%. One patient had undergone microsurgical epididymal sperm aspiration before vasal aspiration, but the semen analysis indicated poor sperm quality and could not be used for in vitro fertilization. In total, 7 of the 8 aspirations (87.5%) resulted in pregnancy. No complications have been observed to date. Conclusion: Vasal sperm aspiration is a simple and effective alternative method for sperm retrieval, with the advantage of a high success rate and less invasiveness and destruction of the reproductive system. It may be performed before sperm retrieval from the epididymis or testis in infertile men with aspermia.
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Tubular ectasia of the rete testis: A cautionary tale p. 282
Hui-Ming Chun
A 60-year-old male reported a painless left scrotal mass for months. The testicle was removed due to the fact that malignancy could not be excluded from physical examination, tumor markers, or scrotal imaging. Afterward, further pathological examinations diagnosed the patient's condition as tubular ectasia of the rete testis (TERT) rather than malignancy. TERT is a rare benign lesion that may be mistaken for malignant tumors at first glance. However, distinguishing diagnoses can be made with a combination of sonography and magnetic resonance imaging without much difficulty. That is why it is highly recommended to consider this condition before confirming the final diagnosis of similar cases.
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Immunoglobulin g4-related bilateral kidney disease: The clinical course and outcome: A case report p. 285
Apiwich Anukoolphaiboon, Worapat Attawettayanon
Immunoglobulin G4-related disease (IgG4-RD) is uncommon and is characterized by dense tissue infiltration of IgG4-positive plasma cells or mass-like sclerosing lesions. In addition, it can involve any anatomic site, which has frequently elevated serum IgG4 concentrations. Japanese gastroenterologists are the ones who first discussed the concept of IgG4-RD; they first introduced the term IgG4-related kidney disease (IgG4-RKD), which refers to the involvement of the kidney and its surrounding tissues. Common urologic indicators of IgG4-RKD typically include subacute pain, on the detection of a tumor-like mass or enlargement, with or without tubulointerstitial nephritis. Conventional imaging computed tomography and magnetic resonance imaging are of limited usefulness in determining IgG4-RKD. The gold-standard for the diagnosis of IgG4-RD is the identification of typical histopathological features of dense lymphoplasmacytic infiltration, storiform fibrosis (an irregular cartwheel like fibrotic pattern), and obliterative phlebitis; these are the three hallmarks of IgG4-RD. The current report discusses a case of IgG4-RKD, who came into our hospital with chronic flank pain.
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Corrigendum: Dorsolateral onlay buccal mucosal urethroplasty for anterior urethral strictures by unilateral urethral mobilization: a prospective study p. 288

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CME Test p. 289

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