Open Journal of Urology
ISSN / EISSN : 2160-5440 / 2160-5629
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 382
Latest articles in this journal
Open Journal of Urology, Volume 11, pp 17-29; https://doi.org/10.4236/oju.2021.111003
Background: Worldwide, prostatic adenocarcinoma is the most common tumour type among men. Aim: The aim of the present investigation was to develop a computer program to identify normal prostate biopsies and distinguish them from biopsies showing premalignant alterations (LGPIN, HGPIN) and adenocarcinoma. Method: Prostate biopsies (n = 2094) taken from 191 consecutive men during 2016 were stained with triple immunehistochemisty (antibodies to AMACRA, p63 and CK 5). Digital images of the biopsies were obtained with a scanning microscope and used to develop an automatic computer program (CelldaTM), intended to identify the morphological alterations. Visual microscopic finding was used as a reference. Result: Of the 191 men, 121 (63.4%) were diagnosed as having prostate adenocarcinoma and 70 (36.6%) as having no malignancy on the basis of the visual microscopy. In comparison, computer analysis identified 134 (70.2%) men with malignant disease and 57 (29.8%) with non-malignant disease after exclusion of artifacts, which constituted 10.4% of areas (indicated as malignant disease). Discrepant results were recorded in 15 (7.9%) men, and in 14 of these cases, HGPIN and areas suggestive of early invasion were common. Thus, it was uncertain whether these cases should be regarded as malignant or not. The agreement between the visual examination and the computer analysis was 92.1% (kappa value 0.823, sensitivity 99.2 and specificity was 0.80). Conclusion: It seems that computer analysis could serve as an adjunct to simplify and shorten the diagnostic procedure, first of all by ensuring that normal prostate biopsies are sorted out from those sent for visual microscopic evaluation.
Open Journal of Urology, Volume 11, pp 45-51; https://doi.org/10.4236/oju.2021.112006
Objective: To evaluate the efficacy and safety of Combined detrusor and external urethral sphincter BTX-A injections for detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) secondary to spinal cord injury. Study Design: Prospective study. Methods: The study was carried out in 18 SCI patients with detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) receiving Combined detrusor and external urethral sphincter BTX-A injections treatment. Contain 200 U botulinum toxin intradetrusor and 100 U external urethral sphincter injections. The effective outcomes included maximum detrusor pressure at first DO and DESD (PdetmaxDO-DESD), volume at first DO and DESD (VDO-DESD), maximum urethral closure pressure (MUCP), and Incontinence-Specific Quality-of-Life Instrument (I-QoL). Adverse events were recorded. Results: All patients experienced a significant mean reduction in PdetmaxDO-DESD (50.75%), maximum urethral closure pressure (26.34%) and a significant mean increase in VDO-DESD (63.00%) 12-weeks post-injection. Significant (p < 0.001) improvement in mean Incontinence-Specific Quality-of-Life Instrument was also found. No obvious adverse event and toxic effect was observed. Conclusion: Combined detrusor and external urethral sphincter BTX-A injections is a good choice for patients with DO and DESD secondary to spinal cord injury. It could not only protect the upper urinary tract but also improve quality of life.
Open Journal of Urology, Volume 11, pp 87-94; https://doi.org/10.4236/oju.2021.113009
Introduction: Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. Material and Methods: This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. Result: We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. Conclusion: Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.
Open Journal of Urology, Volume 11, pp 73-86; https://doi.org/10.4236/oju.2021.113008
Introduction: Complete cervico-urethral transection is a vesicovaginal fistula characterized by total disinsertion of the urethra from the bladder. It is a fistula of the cervico-urethral intersection threatening the mechanism of continence. The aim of this study was to describe the epidemiological and therapeutic aspects of this type of fistula. Patients and Methods: This was a descriptive retrospective study on patients who have had surgery for cervico-urethral transection from June 01, 2012 to June 01, 2015. Results: Cervico-urethral transections (n = 76) accounted for 33.77% of all urogenital fistulas admitted to our department of surgery during the study period. The average age was 25.02 ± 8, 6 years. Married patients accounted for 85.58%, 72.36% had not received any classical education. Fistulas less than one year old made up 56.58% of cases, associated lesions were perineal tears 25.0%, vaginal sclerosis, 21.05%, vaginal straps, 13.15%, rectovaginal fistula, 2.63% and the shortness of the urethra less than 2.5 cm in 42.10% of cases. All surgeries were performed vaginally with a 98.68% fistula closure rate and an average of 1.68 surgeries per patient. After closure of the fistula, 10.67% of patients presented a residual urinary incontinence. Conclusion: Complete cervico-urethral transection is a frequent vesicovaginal fistula. She sometimes exposes to urinary incontinence after closing the fistula. The results of his surgery are often good at the cost of multiple intervention.
Open Journal of Urology, Volume 11, pp 124-136; https://doi.org/10.4236/oju.2021.114013
Background: Varicocele is abnormal dilation and tortousity of the scrotal venous pampiniform plexus that drain blood from each testicle. Recently, it has been linked to low serum total testosterone (TT) levels by affecting the optimal functioning of the leydig cell via increasing the scrotal temperature. Varicocele repair has been found post-operatively to increase the serum levels of TT. This study looks at the pre and post-subinguinal microsurgical varicocelectomy serum TT levels in male patients with clinical varicocele. Methods: The study involved 88 male patients with clinical varicoceles who met the inclusion criteria. These patients after good history taking and physical examination had their serum TT levels measured pre varicocelectomy and 6 months post-subinguinal microsurgical varicocelectomy. The varicoceles were diagnosed by physical examination and use of scrotal color Doppler ultrasonography (US). Results: The number of patients with varicocele were 88 males. The mean age of the patients was 33.43 ± 7.82 years. There was isolated left varicocele in 57 (64.8%) patients and bilateral varicocele in 27 (30.7%) patients. Pre varicocelectomy, 61 (69.3%) patients had serum TT of between 100 - 290 nanogram/deciliter (ng/dl) and a mean value of 241 ± 0.91 ng/dl. Post varicocelectomy 56 (63.6%) patients had serum TT in the range of 300 - 490 ng/dl with a mean of 482 ± 2.87 ng/dl, showing a robust significant increase in the serum TT post-operatively (P < 0.001). Conclusion: There was statistically significant improvement in the serum TT levels with 55 (79%) patients exhibiting normalization of serum TT levels after subinguinal microsurgical varicocelectomy.
Open Journal of Urology, Volume 11, pp 177-186; https://doi.org/10.4236/oju.2021.115016
Objective: To investigate the effect of hard bed on postoperative complications and comfort level of patients after renal puncture biopsy. Methods: A total of 115 patients who underwent renal needle biopsy in the Department of Nephrology of The First Affiliated Hospital of Jinan University from May 2020 to February 2021 were selected, and 57 patients who received hard bed nursing after renal needle biopsy were set as the control group, the others were selected as the observation group. The incidence of postoperative bleeding at the puncture mouth, gross hematuria and dysuria, as well as the postoperative comfort level of 6 h and 18 h were compared between the two groups. Results: There was no significant difference in the incidence of postoperative bleeding, gross hematuria and dysuria between the two groups (P > 0.05), but the comfort scores at 6 h and 18 h in the observation group were higher than those in the control group (P < 0.05). Conclusion: There is no significant difference in the incidence of postoperative complications, such as bleeding at the puncture mouth, gross hematuria and dysuria, among patients with renal needle biopsy, whether to use hard bed nursing or not. Eliminate hard bed nursing can improve the comfort level of patients, reduce the occurrence of pressure ulcers, and relieve the negative psychological emotions of patients.
Open Journal of Urology, Volume 11, pp 1-5; https://doi.org/10.4236/oju.2021.111001
Background: Penile metastasis of colorectal carcinoma is a rare phenomenon in clinical setting. They normally manifest as penile lesion and acute urinary retention. However, presentation of priapism is exceedingly rare. Aims: Discussion of this rare presentation as well as the diagnostic processes and subsequent management. Case Presentation: A 54-year-old male with a history of colorectal cancer presents with acute urinary retention. Examination of the patient demonstrates a semi-erect penis, with multiple palpable nodules on the shaft and penile meatus. Histological and imaging findings indicate penile metastasis of colorectal cancer. Conclusion: Biopsy via cystoscopy is used to obtain definitive diagnosis of penile metastasis. Urinary drainage followed by further cancer intervention or palliative care is crucial for effective management.
Open Journal of Urology, Volume 11, pp 214-225; https://doi.org/10.4236/oju.2021.116019
Background: The traumas of scrotum are often traumas caused by accidents on the public highway or in sport. However, fractures of the penis are secondary to a direct trauma to the penis with rupture of the albuginea causing hematoma, pain and deviation of the penis. Animal bites are rare. Purpose: To describe the management of traumatic emergencies of the external genital organs at the CHU Bouaké. Patients and Methods: Retrospective and descriptive study on the patients treated at Bouaké University Hospital for traumatic emergencies of the external genital organs during the period from January 01, 2012 to December 31, 2018. The parameters studied were epidemiological, clinical and therapeutic. Results: The study period registered 26 patients. The mean age was 34.5 years, Closed trauma to the scrotum was a frequent reason with 30.8%, the trauma sat on the scrotum in 53.8%, the penis in 42.3%, the vulva in 3.8% of cases. The circumstances of discovery of trauma to the penis were dominated by coitus missteps (45.5%), on the stock exchange and vulva by accidents on the public highway (60.8%). Scrotal swelling was the frequent clinical sign (26.9%). Treatment was dominated by surgery in 92.30%. Seven patients (29.16%) underwent exploratory scrototomy associated with hematoma evacuation, five patients (20.83%), a simple trimming, five patients (20.83%), an evacuation of the hematoma associated with a cavernous suture, one patient (4.16%), a trimming associated with a suture of the vulva, one patient (4.16%), a trimming associated with a right orchiectomy. The hospital stay was less than 5 days. The course was simple in 92.30% of the cases; two patients (7.7%) had complications such as testicular necrosis and atrophy which have been treated by orchidectomy. Conclusion: Traumatic emergencies of the external genitalia are rare but serious. Treatment is dominated by surgery.
Open Journal of Urology, Volume 11, pp 251-263; https://doi.org/10.4236/oju.2021.117023
Background: According to the main prostate cancer guidelines, the response to treatment with abiraterone plus prednisone (AA+P) must be evaluated by assessing prostate-specific antigen (PSA) levels at 12 weeks. Recent studies have shown that early PSA decline, at 4 weeks, maybe a surrogate marker for survival. The objective of this work was to analyze if a decline in PSA at 4 weeks correlates with a better outcome in terms of OS (overall survival) and PFS (progression-free survival). Methods: We evaluated 168 patients (with a median age of 71 years) with prostate cancer who had started AA+P treatment between February 2012 and July 2019. Patients were divided into three different groups according to the decline of PSA (≥30%, ≥50%, and ≥90%) at 4, 8, and 12 weeks. Statistical survival analysis was performed using the Kaplan-Meier method. Results: After a follow-up of 69 months, a PSA decline ≥ 30% at 4 weeks was associated with longer median OS times (28 vs. 18 months; p = 0.027). A decline in PSA by ≥50% was also associated with increased median OS times (36 vs. 21; p = 0.003). Cox univariable analysis indicated that a decrease in PSA (both by ≥30% and ≥50) were predictive of OS at 4 weeks (PSA ≥ 30%: HR = 1.568, 95%CI [1.041, 2.360], p = 0.031; PSA ≥ 50%: HR = 1.901, 95% CI [1.222, 2.956], p = 0.004); although multivariable analysis did not confirm these results. The prior administration of chemotherapy was an independent risk factor for death (HR = 2.511; p < 0.001) and progression (HR = 3.238; p < 0.001), probably because of different factors. Conclusion: A decrease in PSA by ≥30% or ≥50% at 4 weeks after starting treatment with AA+P correlated with longer PFS and OS, and provides clinically meaningful information guiding the physicians towards a personalized treatment.
Open Journal of Urology, Volume 11, pp 326-331; https://doi.org/10.4236/oju.2021.119031
This case report is about a 61 years old woman who consulted for hematuria, the cystoscopy performed revealed an intra-diverticular bladder tumor. After tumor resection, an anatomopathological exam revealed the urothelial carcinoma pT1. A few months later she presented with a local reccurence of bladder tumor. We proposed her anterior pelvectomy but she refused it and she was lost to follow-up. The aim of this study is to show the anatomopathological and evolutionary characteristics and the therapeutic difficulties of IDBT. These tumors are in the majority of cases infiltrating from the outset with a high potential for recurrence after transurethral resection of bladder (TURB). The standard treatments are TURB and total cystectomy.