Asian Journal of Research and Reports in Urology

Delayed Presentation and Surgical Intervention of Accidental Non-sex Related Penile Fracture with Urethral Injury: A Case Report

Friday Emeakpor Ogbetere — 2023-04-11

Penile fracture is a rare and unusual pathology resulting from a tear of the tunica albuginea of an erect penis. It is typically associated with sexual intercourse, masturbation, and a fall on or rolling over an erect penis. A cracking or popping sound followed by acute pain, rapid detumescence, and swelling of the penile shaft are frequent presenting symptoms. Prompt surgical intervention with repair of the tunica albuginea tear is the treatment of choice with satisfactory cosmetic and functional results.

We report the case of a 38-year-old man who presented to our urology outpatient clinic with a twenty-three-day history of penile trauma resulting from a forceful attempt to pull out his erect penis to urinate. Immediate penile exploration was performed following a diagnosis of penile fracture. He was found to have a tear of the tunica albuginea of the right corpora cavernosa with a urethral injury which was repaired successfully. This case of atypical aetiology, delayed presentation, and surgical intervention of penile fracture highlights the importance of maintaining a high index of suspicion in diagnosing this rarecondition, even in the absence of a typical mechanism of injury, in order to ensure that such injury is not missed.

Adrenal Myelolipoma: A Rare Case Report and Review of Literature

Houssame Lachhab — 2023-04-25

Adrenal myelolipoma is a rare benign tumor originating from the adrenal cortex. Composed of adipose tissue and bone marrow. The incidence of adrenal myelolipoma is 0.08 to 0.2% of autopsy cases and 0.06% of patients operated. Large tumors of a size greater than 7 cm should be removed. We report here the case of a 41 years old patient with a large right adrenal myelolipoma. The radiological outcomes and surgical management.

Urethroplasty for Female Urethral Stricture during the COVID-19 Pandemic: A Challenging Clinical Experience

Sunayana Chatterjee — 2023-09-14

Amidst the COVID-19 pandemic, managing female urethral strictures posed distinct challenges. Scar tissue development within the urethral sub-epithelial tissue led to constriction, causing lower urinary tract symptoms. Traditionally, urethral dilation was employed, but high recurrence rates prompted a shift towards formal urethroplasty. We observed 36 patients during this pandemic, gathering data on stricture management. Those with Q max >10 ml/sec underwent conservative measures; Q max <10 ml/sec cases received urethroplasty with vaginal mucosal grafts. The pandemic's impact on healthcare necessitated cautious surgical planning, while strict protocols ensured patient and staff safety. Prompt intervention remains vital for improved outcomes in female urethral stricture cases.

Ureteric Transection with Jejunal Injury Secondary to Bicycle Handle Bar Penetrating Injury in a 13 Year Old Boy

Ojas Vijayanand Potdar — 2023-03-25

Background: Ureteric trauma is rare, occurring in <1% of all traumas. Bicycle handlebar injury is a unique trauma mechanism especially noticed in childhood.

Case Presentation: We present a unique case of a 13-year-old male who sustained a penetrating abdominal injury from a bicycle handlebar. Upon initial examination there was herniation of bowel through the abdominal wound, so exploratory laparotomy was performed. There was transection of the jejunum at a distance of 10 cm from the duodeno-jejunal flexure with more than 75 % of the circumference of the jejunum and there was transection of the upper one third of left ureter near the left renal pelvis with foreign body (child’s cloth remnant) seen which was initially managed by placement of an infant feeding tube as a bridge between the two transected ends owing to a defect of 3 cm as a temporary emergency salvage procedure. He then underwent per cutaneous nephrostomy insertion. After 3 months, patient underwent definitive repair by left sided pyeloureterostomy over a DJ stent.

Conclusion: This case demonstrates the emergency and delayed definitive management of ureteric transection and jejunal injury secondary to penetrating bicycle handlebar injury.

Primary Mucinous Adenocarcinoma of Renal Pelvis- A Diagnostic Dilemma

Tewani Vipin — 2023-08-02

Introduction: Primary mucinous adenocarcinoma of the renal pelvis is extremely rare, with only ~100 cases reported till now. Its pathophysiology is thought to comprise glandular metaplasia of the urothelium of the calyces and pelvis, as well as malignant transformation of the metaplasia. Unfortunately, there are no distinguishing symptoms or radiological characteristics.

Case Presentation: A 75-year-old man presented with pain in his left flank and intermittent fever. A physical examination showed swelling in left flank on inspection which was soft, non-tender, and ballotable with no local rise of temperature. The results of most laboratory tests were within normal limits. Plain radiography of the kidneys, ureter, and urinary bladder showed a large radio-opaque mass in the left kidney. Abdominal computed tomography showed left kidney measuring 24.8 x 12.4 cm with gross hydronephrosis with severe cortical thinning with large calculus of 2.7 X 3.1 x3.6cm in left pelviureteric junction. Diuretic- enhanced 99mTc DTPA renal scanning showed that the relative function of the left versus the right kidney was 11.19 versus 88.81 %. On the basis of the imaging findings, kidney dysfunction due to ureteropelvic junction stenosis with a large stone was initially diagnosed.

Although the cytopathology of gelatinous material was negative for malignancy, we could not rule out other disease, such as hidden malignancies of the kidney. As a result, we did a radical nephrectomy, and pathological investigation of the kidney revealed a mucinous adenocarcinoma in the renal pelvis. A bone scan and positron emission tomography revealed no additional malignancies, metastases, or remnant cancer.

Conclusions: Primary mucinous adenocarcinomas of the renal pelvis are extremely rare, and the majority are discovered by post-operative examination of resected specimens. Despite the difficulty of preoperative diagnosis, urologists should evaluate the possibility of primary mucinous adenocarcinoma in patients with severe hydronephrosis, renal stones, and chronic inflammation.

When Erotic Curiosity Goes Wrong: A Case Study of Urethral Foreign Body Insertion

Bencherki Youssef — 2023-08-04

This article discusses a case report of a 44-year-old man who presented with acute retention of urine due to self-insertion of a nail in his urethra for erotic purposes. The diagnosis was confirmed by physical examination and imaging studies, and the nail was successfully extracted using endoscopic methods. The article also reviews the clinical presentation, diagnosis, and management of urethral foreign bodies, emphasizing the importance of prompt intervention and tailored treatment based on the size, nature, and mobility of the foreign body. The article concludes by highlighting the need for a high index of suspicion for underlying psychiatric illness in the management of such rare urological emergencies.

Sarcomatoid Bladder Tumor: A Rare Variant of Transitional Cell Carcinoma

Imad Ghantous — 2023-08-17

Aims: Transitional cell carcinoma (TCC) of the bladder encompasses various tumor variants, with the sarcomatoid subtype being aggressive and of rare incidence. This case report aims to present the clinical characteristics, diagnosis, surgical intervention, and post-operative management of a non-smoking 71-year-old female patient. This patient presented with gross hematuria and was subsequently diagnosed with a sarcomatoid bladder tumor through a series of diagnostic evaluations. The report intends to contribute to the existing literature on this rare tumor variant and shed light on the diagnostic challenges and meticulous surgical and post-operative management in the absence of chemoradiation therapy.

Study Design: This case report presents a single case study of a patient diagnosed with sarcomatoid bladder tumor.

Methodology: The patient was a 71-year-old female with no history of smoking, who presented with gross hematuria. Diagnostic evaluations, including imaging studies and histopathological examinations, were performed to determine the presence of a sarcomatoid bladder tumor. Surgical intervention was conducted to remove the tumor, followed by post-operative management without chemoradiation therapy.

Results: The case report presents the successful diagnosis and management of a sarcomatoid bladder tumor in the described patient. Detailed clinical, histopathological, and imaging findings are provided, showcasing the challenges and treatment decisions in the absence of chemoradiation. Conclusion: This case report underscores the significance of recognizing and managing rare tumor variants like sarcomatoid bladder tumor. It adds to the existing medical literature on this subject and emphasizes the importance of careful diagnostic evaluation and meticulous surgical and post-operative care to achieve favorable outcomes in patients affected by this aggressive variant. Further studies and case reports are warranted to advance our understanding and optimize the management of sarcomatoid bladder tumors.

Chromophobe Renal Cell Carcinoma (ChRCC) with Osteosarcomatous Differentiation and Osseous Pulmonary Metastasis- A Case Report

Philip Tojo Kalloopparamban — 2023-09-16

Chromophobe renal cell carcinoma, a subtype of Renal Cell Carcinoma (RCC) is associated with a better prognosis than clear cell RCC and comprises about 3-5 % of all RCCs. It is believed to originate from the intercalated cells of the distal nephron (Steven C. Campbell MD, 2016). Sarcomatoid differentiation can occur with any RCC, in which high-grade spindle cells co-exist with epithelial areas of the tumor. It suggests transformation to higher grade malignancy and an ominous outcome. The sarcomatoid component is homologous (Akin to parent RCC cells) in the majority of cases. We herein report a case of ChRCC with osteosarcomatous (heterologous) differentiation in an elderly gentleman, who developed pulmonary metastasis with an osseous component. Although metastasis is very rare in Chromophobe RCC, Sarcomatoid differentiation.

Prospective Evaluation of Preoperative Factors to Predict Intraoperative Difficulty during Transperitoneal Laparoscopic Simple Nephrectomy for Non-functioning Kidney Secondary to Urolithiasis

Baikuntha Adhikari — 2023-01-02

Background: Laparoscopic simple nephrectomy (LSN) for non-functioning kidney (NFK) due to urolithiasis is considered difficult with higher conversions to open surgery and complication rates than radical nephrectomy. Preoperative assessment of operative difficulty would be useful for optimal preoperative planning, to select patients with less difficulty in early phases of learning and to counsel patients. There is a paucity of the prospective studies assessing intraoperative difficulty during LSN for stone related NFK.

Objectives: To evaluate preoperative clinical and radiological characteristics that could predict difficulty during transperitoneal LSN for NFK due to urolithiasis.

Methods: A prospective study was done in National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal from September 2021 to August 2022 among patients undergoing transperitoneal LSN for NFK secondary to urolithiasis. Demographic and clinico-radiological parameters were documented preoperatively. A single experienced surgeon provided the difficulty score for major steps of surgery in a Likert scale of 1(easy) to 4 (most difficult). Final difficulty scale was calculated adding blood loss and operative duration as surrogate markers of difficulty. Patients were divided into two groups, Easy group, and Difficult group based on difficulty scale. Preoperative, intraoperative, and postoperative characteristics were compared between the groups. Univariate and multivariate analysis was done to identify factors that could predict intraoperative difficulty.

Results: There were 88 patients included in the final analysis. Presence of pyonephrosis (p<0.001) and preoperative percutaneous nephrostomy (p=0.04) showed significant correlation with intraoperative difficulty in univariate analysis. However, pyonephrosis was only significantly associated with difficulty during multivariate analysis (OR 3.87, 95% CI 1.00-14.96). Patients with pyonephrosis had higher conversion rates to open surgery and higher complication rates.

Conclusions: Pyonephrosis in NFK secondary to urolithiasis predicted higher intraoperative difficulty during LSN. Patients with pyonephrosis experienced higher conversions to open surgery and higher complications rate.

Ureteric Stenting and Percutaneous Nephrostomy Insertion for Acute Ureteric Obstruction: A Multi-centered Prospective Study to Compare the Quality of Life between both Procedures

W. S. Lim — 2023-03-01

Background: To compare the quality of life and pain scores between double J ureteric stenting and percutaneous nephrostomy (PCN) insertion in patients who presented with acute ureteral obstruction secondary to urolithiasis.

Methods: This is a prospective, multi-centre study which compares the quality of life in patients who have either done nephrostomy tube insertion or double J ureteral stenting. This study was performed over a span of 18 months at two urology centres in Malaysia.

40 double J ureteric stents and 40 percutaneous nephrostomy tube patients were recruited for this study. Patients’s pain scores and quality of life post procedures were assessed using the visual analogue scale and EuroQol questionnaires at 2 time points (Day1-2 and at 1 month post drainage).

Results: The patients’ demographics and pre-drainage data were similar except for where the stones were located. Most of the patients with proximal ureteric stones (75%) and those who presented with fever or sepsis (76%) underwent PCN insertion. At time 0, although both groups achieved similar overall QoL and pain scores, more post PCN patients reported difficulties in self-care (p=0.002), mobility (p=0.041) and resuming usual activities (p=0.012). Symptoms in PCN group improved with time, translating in the higher QoL scores at time 1. In contrary, more double J ureteric stenting patients presented to the emergency room with complaints related to their procedure. Moreover, their assessments scores deteriorated over time, and they had a significant higher score in the pain domain compared to PCN patients at time1 (p=0.014).

Conclusion: Both double J ureteric stenting and PCN have negative impacts on a patient’s quality of life. Particularly in usual activities, pain and mobility. If there is a delay in definitive treatment, this study supports the usage of PCN as opposed to double J ureteric stenting. This is evidenced by a marked improvement in a patient’s quality of life score and wellness score with time. In contrary, with the use of double J ureteric stenting, the quality of life and wellness outcomes significantly deteriorates over time as compared to those who have PCN.

Study on Semen Quality among Men Seeking Infertility Treatment in Tamale, Ghana

Simon Bannison Bani — 2023-03-28

Background: Standard semen analysis is the surrogate measure of male fertility in clinical practice. According to recent studies, there is a slight increase in percentage of couples who are facing infertility problems globally. This study determined the semen quality trends of men seeking infertility treatment in the Tamale Metropolis, Ghana.

Methods: This is a retrospective cross-sectional study with data from archival records over a period of six years; from January 2015 to December 2020.

Results: A total of 785 semen analysis reports of men seeking infertility treatment over a period of 6 years were considered. In all, 187 (23.82%) had normozoospermia, 347 (44.20%) had oligozoospermia, and 251 (31.97%) had azoospermia. Out of the 785 subjects, 344 (57.91%) had abnormal semen parameters even though their semen volume was normal. Percentage abnormal motility, morphology and viability rose sturdily from 5.74%, 8.14%, and 12.59 in 2015 through 20.87%, 18.77%, 19.85% in 2017 to 26.85%, 27.95 and 21.55 respectively in 2020. Abnormal pH and volume also rose from 8% and 8.59 in 2015 to 23.69 and 24.91 respectively in 2020.

The highest variances were seen in the age group 31-40 years (p<0.0001). Males with hypospermia were 56% less likely to have abnormal sperm concentration than those with hyperspermia (OR=0.44; 95% CI=0.23–0.83; p=0.012).

Conclusion: This study shows a high rate of abnormal semen quality of male partners of infertile couples. The trend of oligozoospermia increased during the past six years while the trend of normozoospermia remain fairly constant. Oligoasthenoteratozoospermia has increased consistently from 2015 to 2020, buttressing the fact that, male infertility is on the ascendancy.

Relationship between the Neutrophil to Lymphocyte Ratio and International Prostate Symptoms Score in Men with a Benign Prostatic Enlargement

Muhd Zaki Azre Redzuan — 2023-07-03

Introduction: The aim of this study was to investigate whether the neutrophil to lymphocyte ratio (NLR) can be used as a biomarker to evaluate the severity of urinary symptoms in patients with benign prostatic enlargement (BPE).

Methods: This study assessed NLR in a cohort of 357 patients with BPE attending to our outpatient clinic from May 2022 till May 2023. We also evaluated other relevant parameters including the International Prostate Symptom Score (IPSS), prostate specific antigen (PSA) level and the maximum urinary flow rate (Qmax). Correlations between NLR and, IPSS, PSA, prostate volume and Qmax were assessed statistically.

Results: The study's findings demonstrated that patients with high IPSS had significantly higher NLR with positive correlation (r=0.22, p<0.001). Similar relationship was seen between NLR and PSA (r=0.33, p<0.001). Positive correlations were also seen between NLR, and age (r=0.014, p=0.79) and prostate volume (r=0.134, p=0.01) but there were not statistically significant. Negative correlation between NLR and Qmax was seen (r= -0.146, p=0.006). The Receiver-Operating Characteristic (ROC) curve analyses showed that NLR of between 1.9 to 2.0 can be used as a parameter to differentiate severe and non-severe symptoms with sensitivity of 74% and specificity of 34% (p<0.001).

Conclusion: These findings justifies that NLR can be utilized as a biomarker, in combination with other parameters such as age, Qmax and PSA to accurately and more objectively evaluate the severity of lower urinary tract symptoms in patients with prostate conditions. Further studies required as its potential usage as a marker for monitoring and assessing BPE patients’ progression and response to treatment.

Testicular Cancer and Testicular Self-examination: An Investigation into the Degree of Knowledge and Practices of Self-care among Nigerian Male Non-health Undergraduates

Friday Emeakpor Ogbetere — 2023-07-11

Purpose: Testicular cancer (TC) is a malignant tumour that commonly affects young men in their second and third decades of life. Regular testicular self-examination (TSE) results in early detection and treatment of TC. This study was conducted to assess the degree of knowledge and practice of TC and TSE among male non-health undergraduate students of Edo north senatorial district of Edo state, Nigeria.

Materials and Methods: This research was a descriptive cross-sectional study conducted at a higher institution in Edo state. The research population consisted of non-medical students of the institution, selected by convenient sampling techniques, and structured self-administered questionnaires were used. The data were analyzed using Statistical Programming for Social Sciences version 22 (SPSS Inc., Chicago, IL, United States). P < 0.05 was regarded as significant.

Results: Only about half (50.2%) of the students participants of the research have heard of TC. The majority (65.8%) of them had never heard of TSE. Forty-six participants (20.4%) knew the frequency of carrying out TSE and 43 (19.1%) had practiced it. The participants’ age (P=0.005) and year of study (P=0.005) are the two statistically significant sociodemographic variables that contributed to the level of knowledge about TSE. The majority (58.2%) of the respondents showed a favourable knowledge about TC and carrying out TSE.

Conclusion: The knowledge of TC and TSE is low among the students. We recommended the inclusion of these themes in the general studies curriculum of undergraduates.

Ex-vivo Management of Renal Calculi in Living Donor Kidneys: A Retrospective Study from Malaysia

Jeffery Z. K. Lim — 2023-07-12

Renal transplantation has significantly improved outcomes for patients with End Stage Renal Disease (ESRD), with living kidney donors offering advantages such as better long-term survival and immediate graft function. However, the presence of renal stones in potential living donors has historically been a contraindication for transplantation due to the risks it poses to both the recipient and the donor. The objective of the study is to evaluate the feasibility and safety of ex-vivo management of renal calculi in living donor kidneys and its potential impact on the transplantation process. This retrospective study from Malaysia describes the ex-vivo management of renal calculi in living donor kidneys prior to transplantation, aiming to expedite the transplantation process for recipients in urgent need.

A total of four living donors with incidental non-obstructing renal stones underwent ex-vivo surgery at University Malaya Medical Centre. Preoperative evaluations and risk stratification were performed to ensure the well-being of the remaining kidney. Intraoperatively, flexible uretero-renoscopy (URS) was used to visualize the collecting system of the graft kidney. In one case, the stone was successfully removed using a stone basket, while in the remaining cases, no stones were found, and the radio-opacity seen in preoperative imaging was identified as benign Randall's plaques.

No immediate complications or compromise in early graft function were observed. Both donors and recipients remained well during the follow-up period, with no occurrences of urolithiasis. The ex-vivo procedure added minimal cold ischemia time to the transplantation process, allowing quick access to the collecting system while being cautious not to injure the ureter.In conclusion, ex-vivo management of renal stones in living donor kidneys represents a potential solution to expand the pool of suitable organs for transplantation. However, the optimal operative management of graft urolithiasis remains debatable, and individualized assessment and multidisciplinary team discussions are necessary to ensure safety and success.

Long-term follow-up and larger studies are required to evaluate the impact of this technique on graft function and outcomes.

Clinicopathologic Prognostic Factors in NMIBC for Recurrence & Progression

Praveen Gopi — 2023-07-19

Introduction: Transitional cell carcinoma (TCC) accounts for more than 90% of all the bladder cancers out of which 70% are non-muscle invasive bladder cancer (NMIBC) at diagnosis. The high rate of recurrence and progression following transurethral bladder resection of tumor makes the follow up essential as well as crucial in detecting early recurrence of tumor. In our study, we investigated the predictive value of various factors for recurrence and disease progression which could help in identifying patients for early definitive treatment.

Objectives: To determine the predictive factors of recurrence and progression of NMIBC managed in a single centre.

Methods: Retrospective study of 256 patients of NMIBC after TURBT was done to review the factors related with recurrence and progression. Bivariable analysis (Chi square test &Mann U Whitney test) and multivariable binary logistic regression were used to identify predictors of recurrence and progression.

Results: On multivariate analysis, patients with tumor-size >3 cm and multiple tumors were found to have 1.7 times and 3 times greater odd of recurrence respectively as compared to patients with tumor size < 3cm and single tumor. Patients diagnosed with T1 stage and multiple lesions were found to have 1.9 times and 1.8 times greater odds of progression respectively as compared to patients with Ta stage and single lesion. With regard to quantitative factors, none of them were significantly associated for prediction for recurrence and progression.

Conclusion: Multiple tumors had increased risk for the development of both recurrence and disease progression. Size of tumor >3 cm is a risk factor for the development of recurrence and T1 stage was found to be a risk-factor for progression of the disease.

Efficacy of Voltaren Suppository in Adjunct with Peri- Prostatic Nerve Block with Lignocaine as Analgesia for Transrectal Ultrasound- Guided Biopsy of Prostate

H. Y. Khor — 2023-08-28

Objectives: To evaluate the efficacy of suppository voltaren as an adjunct analgesia during transrectal ultrasound (TRUS) biopsy using numerical pain score.

Methods: A total of 48 patients who were subjected to TRUS biopsy of prostate were enrolled in this study. The patients were randomly divided into 2 groups equally. In group 1, the patients received the standard peri- prostatic nerve block (PPNB) consisting of 10ml of 1% lignocaine. In group 2, the patients received peri- prostatic nerve block consisting of 10ml 1% lignocaine and in addition of voltaren suppository 100mg which was administered 1 hour before the procedure. During procedure, the patients were assessed on their pain score using numerical pain score 0-10 during insertion of transrectal probe, administration of peri- prostatic nerve block, during biopsy and 1- hour post- biopsy.

Results: There was significant lower pain score in with regard to group 2 patients during probe insertion, PPNB administration and during biopsy. Pain score 1 hour post- procedure was not significant as the pain score in both groups were generally low.

Conclusions: We believe that by adding voltaren suppository 100mg 1 hour before the procedure would be an advantage for patients as this study had shown significant lower pain score throughout the procedure with no increase in morbidity.

A Comparative Study of Post Turp Outcomes and Complications between Benign Prostatic Hyperplasia Patients, Presenting with and without Acute Urinary Retention

Lingesh Sairam Chelliah — 2023-09-01

Introduction: Benign Prostate Hyperplasia, BPH most common in elderly people are most common causes of lower urinary tract symptoms. Failure to recognize these symptoms leads to progression of disease process that may ultimately lead to Acute urinary retention. An analysis of post TURP complications between patients presenting with and without AUR was done. And found that early intervention helped in preventing better recovery of patients with minimal acceptable complications than in those who had acute urinary retention and this study provides an educational insight to patients about the need of early intervention in patients presenting with LUTS

Aim and Objective of the Study: To compare the post TURP outcome and complications of Benign Prostatic Hyperplasia patients presenting with and without Acute Urinary Retention.

Materials and Methods: This is a prospective study. Patients with LUTS secondary to Benign Prostatic Hyperplasia and who presented with and without Acute Urinary Retention were included in the study. Patients were analyzed with detailed History & Physical examination, Digital Rectal Examination, S.PSA, USG KUB, Bladder Wall Thickness Uroflow & Post Void Residual urine. Patients who were more than 75 years, men with neurological disease, prostate cancer, urethral stricture, previous prostate or urethral surgery were excluded.

Post operative variables which were evaluated are Post op UTI, sepsis, Re-catheterisation rate , resurgery, onset of TUR syndrome, persistent hematuria requiring blood transfusion, post op stricture, LUTS, Q max, PVR and length of hospital stay, were compared between the two groups

Results: The study finding includes significant distribution in age distribution in patients presenting with and without acute urinary retention with patient in acute urinary retention being of advanced age and since they presented late they tend to have higher prostate volume with an associated increase in S.PSA and when these patients when undertaken for surgery tend to have increased post operative incidence of UTI and need for recatheterisation rate thereby causing prolonged hospital stay. Incidence of TUR syndrome Hematuria and need for blood transfusion were comparable between two groups.

Conclusion: Thus this study act as educational insight to patients stressing on the need for early intervention in BPH as incidence of age and associated complications like Post operative UTI and an increased need for Recatheterisation and prolonged hospital stay.