Asian Journal of Research and Reports in Urology <p style="text-align: justify;"><strong>Asian Journal of Research and Reports in&nbsp;Urology</strong>&nbsp;aims to publish&nbsp;high-quality&nbsp;papers related to all aspects of&nbsp;Urology.&nbsp;The journal also encourages the submission of useful reports of negative results. This is a quality controlled,&nbsp;OPEN&nbsp;peer-reviewed, open access INTERNATIONAL journal.</p> <p style="text-align: justify;">&nbsp;</p> en-US (Asian Journal of Research and Reports in Urology) (Asian Journal of Research and Reports in Urology) Wed, 28 Jul 2021 13:20:43 +0000 OJS 60 Circumcision and Meatal Stenosis of Boys with Bladder/Urethral Stones in a Hospital in Northern Ghana: Case Series <p>Neonatal circumcision of boys is a common practice among people living in Northern Ghana. These case series included 22 boys between the ages of 17–60 months admitted to the pediatric emergency ward of a tertiary hospital. All the boys diagnosed with meatal stenosis (20/22) were circumcised within 14 weeks after birth, 1 of 22 had hypospadias with preputial hood with a pin-point meatus, and the other was not circumcised. Among the 22 cases, all presented with recurrent urinary tract infections (UTIs) with<em> proteus</em> (68.2%), <em>Klebsiella</em> species (22.7%), <em>pseudomonas,</em> and <em>Serratia marcensis</em> (4.5% respectively) isolated from urine cultures.&nbsp; Routine abdomino-pelvic ultra-sound scans (kidney, ureter, bladder [KUB]) as well as ultrasound of the urethra and perineum were performed of which 13 of 22 children had stones in the bladder, 6 of 22 stones found in fossa navicularis, and 3 in the bulbar urethra. Meatal stenosis was a common finding among neonates after early circumcision and this needs to be made known as part of informed consent before neonatal circumcision. Surgically, a well-performed meatoplasty was carried out to correct it. In children whose stones were present in the bladder, these were fragmented and removed. More distal stones in the fossa navicularis were extracted after meatotomy. A delay in circumcision to later in life (at least 6 months after birth) is recommended as well as intensified educational programs on meatal stenosis, urinary tract infections, and blood borne infections in the communities since widespread neonatal circumcision is often carried out by “quacks doctors” (untrained native doctors). A balanced diet and adequate water intake will help prevent bladder or kidney stones formation.</p> Akisibadek Alekz Afoko, Yussif Adams, Vivian Afoko ##submission.copyrightStatement## Thu, 28 Oct 2021 00:00:00 +0000 Complete Amputation of the Male External Genitalia: Case Report and Review of Management Challenges in Sub-Saharan Africa <p><strong>Background:</strong> Amputation of the entire external genitalia is a rare surgical emergency. Spousal assault following misunderstanding, self-mutilation, and trauma are known aetiologies.&nbsp; Complete amputation of the external genitalia for possible ritual purposes is scarcely reported in the medical literature.</p> <p>Herein, we present a case of a 34-year-old security guard whose external genitalia was excised en-bloc and taken away by unknown persons for alleged ritual purposes. This case report lends credence to the occurrence of such uncommon injuries and to re-awaken interest in their prevention and medical management. The challenges of management in the sub-Saharan African setting are also discussed.</p> Odezi Fidelis Otobo, Mba Okpan Ozinko, Friday Emeakpor Ogbetere ##submission.copyrightStatement## Wed, 28 Jul 2021 00:00:00 +0000 Giant Primary Retroperitoneal Hydatid Cyst: A Case Report <p>Primary retroperitoneal hydatid cyst is rare. It's developed in retroperitoneal space without accompanied lesions in other organs. We present a rare case of a primary retroperitoneal hydatid cyst treated through surgical means. 55 years old woman living in a rural area, came with left lumbar pain and left lumbar mass. Ultrasonography, and Computed tomography revealed a giant multiloculated r retroperitoneal hydatid cyst.</p> <p>The cyst occupied all the retroperitoneal space and refuelling kidney and peritoneal viscera, hydatid serology test was highly positive. The other examination did not reveal lesions in the liver, lung, kidney or other organs. We confirmed the diagnosis through left lombotomy. Infected multiloculated hydatid cyst was adherent to psoas muscle ureter and iliac vessels, so we treated it by draining all hydatid fluid and removing hydatid vesicles and partial peri cystectomy.</p> Benatta Mahmoud ##submission.copyrightStatement## Thu, 18 Nov 2021 00:00:00 +0000 Penile Metastasis from Prostate Cancer: A Rare Case <p>The penis is a rare site of prostate cancer metastasis, the incidence of this metastatic site is less than 0.3%.</p> <p>We present the case of a 67-year-old man who was consulted after the appearance of a painless red nodule on the penile glans that bled on touch. Digital-rectal examination revealed a nodular and hard prostate, and the PSA level was above 100 ng/ml.</p> <p>Prostate biopsy confirmed adenocarcinoma Gleason 4+4, and histological examination of the piece resection biopsy of the penile lesion confirmed that it was adenocarcinoma.</p> <p>MRI of the pelvis showed involvement of the corpus cavernosum and pubic bone by the adenocarcinoma</p> <p>Bone scintigraphy showed secondary localization to the fourth lumbar vertebra and ischio-pubic branch. The multidisciplinary concerting committee decided on first-line hormonal therapy and chemotherapy.</p> <p>The patient refused chemotherapy and took only hormonal therapy. We examined him 16 months later. The PSA level was 12 ng/ml , and the penile lesion had completely disappeared.</p> Benatta Mahmoud, Mohamed Allouche ##submission.copyrightStatement## Thu, 18 Nov 2021 00:00:00 +0000 Meato Cutaneous Fistula after Tubularized Incised Plate (TIP) Repair- An Unusual Delayed Complication <p><strong>Aims:</strong>&nbsp; To report a very unusual delayed complication after tubularised incised plate repair&nbsp; with preputioplasty for a distal penile hypospadias</p> <p><strong>Presentation of Case:</strong> A 2<sup>1/2-</sup>year-old boy presented with a distal penile hypospadias. He underwent an uneventful tubularized incised plate repair with preputioplasty(on parents’ request) in September 2018. 1 month after surgery there was a small preputial ulcer on the ventrum. Preputial retraction was done under general anaesthesia and the meatus and neourethra were normal. However, at 2 years the child presented with a fistula. During repair it was found that the neourethra was normal and the meatus was communicating with the prepuce giving the appearance of a fistula. Prepuce was retracted and the inner and outer prepuce layers were closed. Recovery was uneventful.</p> <p><strong>Discussion:</strong> Urethral fistula is the commonest complication after hypospadias surgery, the usual site being the neourethra. Suture line dehiscence and secondary phimosis are the commonest complications of preputioplasty, A fistula between the neomeatus and the prepuce occurring after 2 years is extremely uncommon. Treatment is separating the prepuce from the meatus and meticulously closing the two preputial layers.</p> <p><strong>Conclusion:</strong> A very unusual complication is reported after preputioplasty. Causes and treatment are discussed.</p> Siddharth U. Sathaye, Ulhas V. Sathaye ##submission.copyrightStatement## Fri, 26 Nov 2021 00:00:00 +0000 Early Outcomes of the Reprocessing and Reuse of Disposable Flexible Ureteroscope for Renal Stone Management: A Single-Center Study in Nepal <p><strong>Introduction</strong><strong>:</strong> The use of disposable flexible ureteroscopy for the management of renal stone has become an established procedure since last few years however discarding the instrument after single use possess a financial burden to the patient in resource limited countries.&nbsp;&nbsp; Therefore, it’s an attempt to assess the cost effectiveness and the safety profile of the procedure by reprocessing&nbsp;&nbsp; and reusing the disposable flexible Ureteroscope.</p> <p><strong>Methods:</strong>&nbsp;It was<strong>&nbsp;</strong>a hospital-based prospective observational cross-sectional study. LithoVue, Single Use Flexible Ureteroscope from Boston Scientific device was used for the procedure. Operative time, level of intra-operative performance alteration and fluoroscopic guided stone clearance were assessed. Early postoperative complications, durability of each scope, postoperative ultrasonographic stone clearance were also assessed. The cause of immature scope damage was also identified.</p> <p><strong>Results</strong><strong>:</strong> Thirty-eight&nbsp;&nbsp; disposable flexible ureteroscope were used for 186 procedures of mean age of 42.67&nbsp;±&nbsp;14.88 years. The mean size and average CT scan hardness of the stones were 14.65&nbsp;± 9.82mm&nbsp;and 1017&nbsp;± 340HU respectively. The number of disposable flexible ureteroscope and the patient ratio was found to be 1:5. The mean operative time was 44.26&nbsp;± 25.16&nbsp;minutes. The immature damage of the scope was seen in 9 scopes. Five patients (2.76%) developed urinary tract infection. Sonography after 6 weeks following the procedure showed that 11 patients (6%) had Clinically Significant Residual Fragment (&gt;5mm) whereas 32 patients (17%) had Clinically Insignificant Residual Fragment (&lt; 5mm).</p> <p><strong>Conclusion</strong><strong>:</strong> Reprocessing and reuse of disposable flexible ureteroscope is safe and cost-effective procedure with minimal probability of cross-infection and immature scope damage if reprocessing of the device is well supervised.</p> Mahesh Bahadur Adhikari, Anil Kumar Sah, Bipin Maharjan, Jessica Kayastha, Samridha Malla ##submission.copyrightStatement## Thu, 29 Jul 2021 00:00:00 +0000 Bone Metastasis of Urothelial Carcinoma <p><strong>Background: </strong>Bone metastasis of urothelial carcinoma is the third most common metastasis after the lungs and liver. Bone complications adversely affect the quality of life. They are also associated with increased mortality. The objective of this study is to describe the epidemiological, clinical and prognostic aspects of bone metastasis&nbsp; of urothelial carcinoma</p> <p><strong>Materials and Methods: </strong>This is a retrospective, monocentric study of 8 cases of bone metastases of urothelial carcinoma, collected from January 2018 to September 2020 at the Ibn Rochd University Hospital in Casablanca, Morocco. The analyzed data were collected on an exploitation sheet. Incomplete records were excluded from the study.</p> <p><strong>Results: </strong>The average age of our patients was 61.37 years. All the&nbsp; patients&nbsp; were male&nbsp; and smokers. Pain was the main calling sign and was marked&nbsp; in seven patients. Four patients had anemia and 50% of the patients had acute obstructive kidney disease.</p> <p>CT scanning of the body&nbsp; was requested to all the patients and confirmed bone metastasis in seven patients with predominantly osteolytic lesions. The treatment was palliative and consisted of chemotherapy, radiotherapy or combined therapy. Among them,three patients&nbsp; died, two of them progressed to have&nbsp; new lesions and three others had stabilized lesions.</p> <p><strong>Conclusion: </strong>The presence of bone metastasis of urothelial carcinoma constitutes an unfavorable moment in the evolution of this cancer. These metastases are responsible for many complications that require multidisciplinary management.</p> Modeste Mayele-Kenfuni, Mohamed Hamirifou, Nedjim Abdelkerim Saleh, Redaa Safwate, Deogracias Nzambimana, Amine Moataz, Mohamed Dakir, Adil Debbagh, Rachid Aboutaieb ##submission.copyrightStatement## Tue, 03 Aug 2021 00:00:00 +0000 Study of Correlation between Intrarenal Pressure and Post-Operative Complications in Percutaneous Nephrolithotomy <p><strong>Introduction: </strong>Even after constant advancement and miniaturization in percutaneous nephrolithotomy complications are evident. Stone burden, pre-operative microbiological status of urine, comorbidity, age, operative time, intra-operative level of sterility and antibiotic prophylaxis are commonly discussed risk factors for post-operative complications during percutaneous nephrolithotomy. Assessment of relationship between intra renal pelvic pressure and the complications was the aim of this study.</p> <p><strong>Materials and Methods</strong>: A prospective study was undertaken in patients undergoing percutaneous nephrolithotomy under fluoroscopic guidance during twelve months’ duration. The demographic characteristics, body mass index, stone characteristics (burden, density and number), rise in intrarenal pressure in relation to position of surgery, different energy sources used and size of tract, duration of operation and perioperative complications during percutaneous nephrolithotomy were recorded and the findings and outcome analyzed.&nbsp;</p> <p><strong>Results: </strong>Out of 125 patients, intrarenal pelvic pressure was found to be raised &gt;30 mmHg in 72.8% (91 cases). Forty-one patients (32.8%), developed fever, found to be significantly associated with raised intrarenal pelvic pressure &gt;30 mmHg, (P = 0.01).&nbsp;&nbsp; WBCs counts were significantly high among the raised intrarenal pelvic pressure group. Age of the patients, gender, body mass index and hospital stay were insignificant variables for development of fever in relation with rise in intrarenal pelvic pressure. Stone burden, prolonged duration of surgery, prone position of surgery and use of pneumatic lithotripsy were significant variables causing rise in intrarenal pelvic pressure.</p> <p><strong>Conclusion: </strong>Raised intrarenal pelvic pressure (&gt; 30 mmHg) in association with increased stone burden, prolonged duration of surgery, prone position and pneumatic lithotripsy during percutaneous nephrolithotomy are significant risk factors for the development of post-operative complications mainly fever.</p> Chitaranjan Shah, Arbind Kumar Shah, Prabodh Regmi, Robin Bahadur Basnet, Anil Shrestha, Parash Mani Shrestha ##submission.copyrightStatement## Thu, 12 Aug 2021 00:00:00 +0000 An Analysis of Cases of Benign Prostatic Hyperplasia in a Tertiary Hospital in Eastern Nigeria: Incidence, Treatment, and Cost of Management <p><strong>Background: </strong>Benign prostatic hyperplasia (BPH) is one of the most common conditions in aging men. Although BPH is not life threatening, the clinical manifestations such as lower urinary tract symptoms (LUTS) reduce patients’ quality of life. BPH is associated with high healthcare costs and is a burden on the patients’ families and society.</p> <p><strong>Objective: </strong>To assess the incidence, treatment pattern, and direct cost of management of BPH in a tertiary hospital, in Eastern Nigeria.</p> <p><strong>Methods:</strong> A retrospective descriptive assessment of case notes of patients diagnosed with BPH between September 2017 and August 2019. The treatment pattern was assessed for 12 months. Costs were calculated for BPH-related clinical procedures and medications.</p> <p><strong>Results:</strong> The incidence rate of BPH in this population is 6.7%. One-hundred and two case notes were retrieved and evaluated. About 50.4% of the patients visited the hospital between 2 to 4 times, with a mean visit of 4.4 times a year. Ninety-nine percent of the patients received pharmacological interventions, while the combination of alpha blockers and 5-alpha reductase inhibitors was the most frequently prescribed drug therapy for BPH. The total annual direct cost of managing BPH in this healthcare facility is about N4,966,080 (Nigerian Naira), an equivalent of $12,810 USD.</p> <p><strong>Conclusion: </strong>The combination of alpha blockers and 5-alpha reductase inhibitors was the most frequently prescribed drugs for BPH in this facility. Most patients made out-of-pocket payments hence, appropriate treatment options must be selected for each patient in other to prevent complications and reduce costs.</p> Chioma Nneoma Igwe, Unyime Israel Eshiet ##submission.copyrightStatement## Mon, 16 Aug 2021 00:00:00 +0000 The Role of Urinary Cytology for Detection of Urothelial Cancer in Asymptomatic Hematuria Investigations <p><strong>Objective</strong><strong>:</strong> To determine the diagnostic accuracy of urinary cytology to diagnose urothelial cancer for patients with asymptomatic hematuria.</p> <p><strong>Patients and Methods:</strong> A retrospective cohort study was undertaken of asymptomatic hematuria patients referred from primary care to the Department of Urology in our institution.&nbsp; All patients with asymptomatic hematuria received urinary cytology examination. Urinary cytology was classified according to the Paris System. &nbsp;Patients with visible hematuria (VH) underwent to examine the kidney and bladder with filling using ultrasonography (KBFU), computed tomography urography (CTU) and flexible cystoscopy, while patients with non-visible hematuria (NVH) underwent initially KBFU, and in cases of having risk factors such as smoking history and exposed to chemical substances CTU and flexible cystoscopy were additionally performed.&nbsp;</p> <p><strong>Results: </strong>The study included 790 patients with a median age of 69 years.&nbsp; Of these patients 235 (29.7%) had VH and 555 (70.3%) were referred for NVH.&nbsp; In the VH patients 61 (30.0%) and 5 (2.1%) were histologically diagnosed as bladder cancer and upper tract urothelial cancer (UTUC), while in the NVH patients 30 (5.1%) and 2 (0.4%) were histologically identified as bladder cancer and UTUC, respectively.&nbsp; In the VH group the accuracy of urothelial cancer in the urinary cytology was: sensitivity 24.2% and specificity 100%, while in the NVH group sensitivity 31.2% and specificity 100%.&nbsp; In histologically confirmed 98 patients with bladder cancer / UTUC the rate of sensitivity in the urinary cytology for even high-grade cancers had only 46.0%.&nbsp; The rates of sensitivity in any type of hematuria and grade increased by approximately two times with adding atypical cytology results as positive.</p> <p><strong>Conclusion: </strong>Although urinary cytology is a convenient and noninvasive test with histologically high specificity for urothelial cancer, the rates of sensitivity of urinary cytology are inferior.&nbsp; However, adding atypical cytology results as positive improves accuracy of detection of urothelial cancer and prevent from the missing diagnosis.&nbsp; Nevertheless, urinary cytology has its place as an additive diagnostic tool to cystoscopy and imaging diagnosis for the investigations of asymptomatic hematuria.</p> Daisaku Hirano, Hiroki Yoshioka, Yuki Irie, Maiko Yamada, Sumito Hamano, Yoshiaki Kusumi, Fuminori Sakurai, Sho Ohno, Kenichiro Kobayashi ##submission.copyrightStatement## Mon, 16 Aug 2021 00:00:00 +0000 Perioperative Complications in Monopolar Transurethral Resection of Prostate: Single Center Retrospective Evaluation of 942 Cases <p><strong>Aims:</strong> To describe the perioperative complications in monopolar transurethral resection of prostate (M-TURP) among the patients who underwent M-TURP for benigh prostate enlargement or palliative “channel” TURP in the hospital from the year 2010 to 2019.</p> <p><strong>Study Design:</strong> Retrospective single center study.</p> <p><strong>Place and Duration of Study:</strong> Department of Urology, B and B Hospital, Gwarko, Lalitpur, Nepal, between January 2010 and December 2019.</p> <p><strong>Methodology:</strong> Hospital based electronic records were retrieved for all M-TURP done during the above mentioned period. Variables considered were age, presenting symptoms, comorbidities, diagnosis, anesthesia type, operative duration, amount of prostatic tissue resected and any perioperative complication. Multinominal logistic regression model was used to calculate adjusted odds ratio of complications between different subgroups and <em>P</em> value &lt; .05 was considered significant.</p> <p><strong>Results:</strong> The overall perioperative morbidity and mortality rate was 10.3% and 0.11% respectively. Most common complications were clot retention requiring bladder wash (3.29%), urinary tract infection (2.87%) and transurethral resection syndrome (1.06%). Incontinence, bladder injury and iatrogenic urethral injury occurred in 0.96%, 0.53% and 0.53% respectively. Single case of conversion to open surgery was recorded (0.11%). Average prostatic tissue resected was 35.4 ± 15.6 grams. Operative duration more than 90 minutes was significantly associated with complication with adjusted odds ratio 2.34 (95% CI 1.17-4.66, <em>P</em> value .02). Factors such as age, preoperative urinary retention, predominantly storage or voiding lower urinary tract symptoms, comorbidities, anti-platelet therapy, anesthesia, amount of prostate tissue resected did not show significant association.</p> <p><strong>Conclusions:</strong> Monopolar TURP has acceptable morbidity and mortality rates which can be further minimized by limiting the duration of surgery to 90 minutes.</p> Sumeet Karna, Kinju Adhikari, Mahesh Bahadur Adhikari, Rajesh Batajoo, Binod Shrestha, Atul Kasaju, Jagdish Lal Baidya ##submission.copyrightStatement## Tue, 24 Aug 2021 00:00:00 +0000 Endourology Techniques in Children: Experience of a Nord Africain Center <p><strong>Introduction</strong><strong>:</strong> Bladder endoscopy in children has been improving over the last few years because of the miniaturization of the instruments. It seems to be now the method of choice for the diagnosis and the management of many pediatric diseases with low morbidity and excellent results.</p> <p>The aim of our study was to discuss the role of cystoscopy in pediatric surgery and to overview its future prospects.</p> <p><strong>Methods: </strong>Between January 1st, 2019 to December 31, 2019, patients who underwent a cystoscopy were reviewed retrospectively. This monocentric study has been conducted by the department of Pediatric Surgery in Habib Thameur Hospital., Tunisia.</p> <p><strong>Results: </strong>39 males and 27 females were included in our study.&nbsp; The average age was three years. The different etiologies were: the vesico-ureteral reflux in 29 patients; pelvi-ureteric junction obstruction in 22 patients, ureterocele in 4 patients, posterior urethral valves in 2 patients, megaureter in 2 patients, and others in 7 patients. The endoscopy was performed for a therapeutic purpose in 60 cases and for a diagnostic one in 6 cases.</p> <p>The endoscopy made it possible to diagnose a bladder tumor and to perform a biopsy, to investigate hematuria or a gender ambiguity, or to exclude. the diagnosis of urethral valves.</p> <p>The urethrocystoscopy was performed for the injection of Deflux®, the treatment of posterior urethral valves, and ureteroceles. It was also used for placing or removing JJ stents.</p> <p><strong>Conclusion: </strong>Many instrumental innovations have expanded the indications for bladder endoscopy in children. The field of robotics is also knowing as a big expansion with a high precision of work and great results but the high cost of these technics remains a big challenge in our country.</p> M. Boughdir, S. Bellila, A. Daib, Y. Hellal, S. Nechi, M. A. Sbai ##submission.copyrightStatement## Tue, 26 Oct 2021 00:00:00 +0000 Bladder Tumors in Women, What about Our Context? <p>Bladder cancer ranks 7th among all cancers, with smoking as the main risk. It is the second urologic cancer after prostate cancer. Their incidence is increasing by about 1% per year, with a greater incidence in women than in men. In nearly 70% of cases, bladder cancer is of the non-muscle-infiltrating type. Although they are less frequent in women, they present some very particular characteristics.</p> <p><strong>Objective:</strong> To analyze and describe the epidemiological, clinical, anatomopathological, and therapeutic manifestations in women. Patients and methods: Thirty-four (34) files were retrospectively analyzed over 5 years (March 2011 and December 2015).</p> <p><strong>Results:</strong> The mean age was 58.1 years with a mean delay of consultation of 14 months. Hematuria was the most frequent symptom (95%). Non-infiltrating tumors were in the majority (in 20 cases), followed by infiltrating tumors (14 cases), urothelial carcinoma was the only histological type observed. Eighteen(18) patients had shown improvement from BCG instillations and anterior pelvectomy had been performed in 2 cases, and 6 cases respectively for NIMV and IMV. Sexual life was disrupted in 37.5% and 33.33% of cases of Bricker and neovessia. The recurrence and progression rates were 25 and 15% respectively.</p> <p><strong>Conclusion:</strong> Bladder tumors in women are less frequent, their treatment is based either on immunotherapy or surgery or multimodal. Strict surveillance is mandatory because the evolution of these tumors is unpredictable.</p> Dibingue Clehaude, Nedjim Abdelkerim Saleh, Al Afifi Mahmoud, Abdi El Mostapha, Ali Hannaoui, Moataz Amine, Dakir Mohamed, Debbagh Adil, Aboutaieb Rachid ##submission.copyrightStatement## Fri, 05 Nov 2021 00:00:00 +0000 Outcomes of Multi-parametric MRI-US Cognitive Fusion Template-guided Transperineal Prostate Biopsy: A Single Centre Experience <p><strong>Aims: </strong>The aim of this study was to report the outcomes of multiparametric Magnetic Resonance Imaging-Ultrasound (mpMRI-US) cognitive fusion template-guided transperineal prostate biopsy (TPB) performed in a single tertiary institution.</p> <p><strong>Study Design:</strong>&nbsp; Retrospective.</p> <p><strong>Place and Duration of Study:</strong> Sample: Department of Urology, Kuala Lumpur General Hospital, between April 2017 and December 2019.</p> <p><strong>Methodology:</strong> Patients with Prostate Imaging-Reporting and Data System (PI-RADS) 3-5 on mpMRI who underwent cognitive mpMRI-US fusion template-guided TPB were recruited retrospectively. Data was analyzed to determine prostate cancer (PCa) detection rate, diagnostic accuracy of mpMRI and post-TPB complication rates. Clinically significant PCa (csPCa) was defined as Gleason ≥3+4.</p> <p><strong>Results:</strong> 122 patients were enrolled and 330 PI-RADS 3-5 lesions were analyzed. The mean age was 66, mean prostate specific antigen was 15.5 ng/mL and mean number of biopsy cores was 56.6. 54.1% were Chinese, 38.5% were Malays, 4.9% were Indian and 2.5% were Others. There were 3 subgroups: repeat biopsy (70.5%), biopsy naïve (21.3%) and re-staging (8.2%). The detection rate of overall PCa and csPCa was 43.4% and 24.6% respectively. csPCa was detected in 43.8%, 48.6% and 66.7% in PI-RADS 3, 4 and 5 respectively. mpMRI missed 19.4% of PCa, of these 66.7% was Gleason 6. 50% patients on active surveillance had disease upstaged. For csPCa detection, mpMRI had a sensitivity of 87%, specificity of 86.1%, positive predictive value of 13.1% and negative predictive value of 99.6%. On multivariate analysis, age (<em>P </em>&lt; .001), Indian race (<em>P </em>= .007) and prostate volume (<em>P</em> &lt; .001) were statistically significant. The complication rate was low (acute urinary retention 4.9%, hematuria 9%, infection 0.8%) and mortality was zero.</p> <p><strong>Conclusion:</strong> mpMRI plays a major role in diagnosing csPCa. The higher the PI-RADS, the more csPCa was detected. Our experience with cognitive MRI-US fusion template-guided TPB yield a consistent result with other studies in terms of overall PCa detection, rate of low-grade PCa in ‘missed’ lesions in mpMRI, correlation between PCa detection and larger prostate size and comparable diagnostic accuracy of mpMRI. We also reported a high diagnostic accuracy of mpMRI in PCa detection and low complication rates of TPB.</p> Mohd Najib Aziz, Vijayan Manogran ##submission.copyrightStatement## Tue, 09 Nov 2021 00:00:00 +0000 Effect of Repeat Transurethral Resection to Bacillus Calmette-Guerin Therapy in High-Grade T1 Non-Muscle Invasive Bladder Cancer <p><strong>Background:</strong> Standard treatment of high<strong><em>-</em></strong>risk non<strong><em>-</em></strong>muscle-invasive bladder cancer (NMIBC) consists of transurethral resection of bladder tumor (TURBT) with the addition of intravesical Bacillus Calmette-Guerin (BCG). Despite this standard treatment, patients with NMIBC are experiencing recurrence and progression<strong><em>. </em></strong>To reduce the failure rate of BCG therapy, repeat transurethral resection (TUR) has emerged as a new standard of care for high-risk NMIBC approved by different guidelines.</p> <p><strong>Aim of the Study:</strong> The study aimed to compare the findings of repeat and no-repeat transurethral resection to Bacillus Calmette-Guerin therapy in high grade T1 non<strong><em>-</em></strong>muscle-invasive bladder cancer. <strong>Methods:</strong> This comparative study was conducted in the Department of Urology, Dhaka Medical College Hospital Dhaka, Bangladesh, from August 2018 to January 2020<strong><em>. </em></strong>A total of 40 patients with T1 bladder cancer fulfilled the selection criteria<strong><em>. </em></strong>Patients were divided into two groups<strong><em>. </em></strong>In the repeat TUR group (Group A), there were 20 patients, and in the no-repeat TUR group (Group B), there were other 20 patients<strong><em>. </em></strong>All the patients of both groups received induction of intravesical BCG therapy All the patients were followed up with predefined schedule.</p> <p><strong>Results:</strong> Among 20 patients of Group A, the residual tumor was found in 35% of patients at 6 weeks, and there was no upstaging at 6 weeks. Recurrence between two groups was statistically significant at 3, 6, 9, and 12 months follow up (p &lt;0<strong><em>.</em></strong>05). Total recurrence was detected in 20% of the patients in Group A and 70% in Group B at 12 months of follow-up<strong><em>. </em></strong>The most frequent recurrence was seen at 3 months in patients with Group B, which was 5 times higher than Group A. In Group A and Group B, disease progression seen at 12 months follow-up was 5% and 20%, respectively, p&lt;0.001.</p> <p><strong>Conclusion:</strong> Repeat-transurethral resection improves the initial response to BCG therapy by significantly decreasing the recurrence rate and progression in patients with high-grade T1 TCC of the urinary bladder.</p> Tasnim Alam Manzer, Nahid Rahman Zico, K. M. Arifur Rahman, Fahim Hossain, Sayeef Ullah Sujan, A. S. M. Badruddoza, Md. Ashraful Islam ##submission.copyrightStatement## Mon, 06 Dec 2021 00:00:00 +0000 Vesicoureteral Reflux in the Transplanted Kidney – Risk and Prognostic Factors: A Single-center Experience <p><strong>Aims: </strong>To evaluate the impact of vesicoureteral reflux in transplanted kidneys, identify its possible risk factors and define its clinical consequences in a public transplant center.</p> <p><strong>Study Design: </strong>Retrospective study.</p> <p><strong>Place and duration of the study: </strong>Division of Urology, Department of Surgery; Radiology Department and Medical Clinical Department, Campinas State University, between September 2019 and October 2020.</p> <p><strong>Methodology: </strong>We analyzed data from patients who underwent kidney transplantation and progressed to kidney failure requiring dialysis due to graft failure. Preoperative evaluation for the new transplant included voiding cystourethrography and ultrasonography of the urinary tract. Twenty-six patients were selected between 2008 and 2018, in whom the preoperative voiding cystourethrography identified vesicoureteral reflux to the previously transplanted kidney. The patients were divided into 2 groups, low-grade and high-grade reflux. The Fisher and Mann-Whitney tests were used for statistical analysis, with a significance level set at 5%.</p> <p><strong>Results: </strong>Twenty-six patients were included, with a mean age of 47.8 years, of whom 73.1% were male. The graft had a similar survival, regardless of the degree of vesicoureteral reflux that the transplant presented. The longer the duration of ischemia, the greater the chance of developing high-grade reflux. A correlation was also found between weight gain and high grades of reflux. No relationship was found between the surgical transplant technique and the prevalence of vesicoureteral reflux, or the presence of bacteriuria, the etiology of renal failure, the duration of pre-transplantation dialysis and the age of the patient.</p> <p><strong>Conclusions: </strong>The presence of vesicoureteral reflux has no negative impact on renal graft function. There are indications that higher patient weight and prolonged organ ischemia can lead to the occurrence of higher-grade reflux.</p> Brunno Raphael Iamashita Voris, Leopoldo Osvaldo Dias Ferreira, Ivan Borin Selegatto, João Marcos Ibrahim de Oliveira, Gabriel Chahade Sibanto Simoes, Arthur Degani Ottaiano, Renan Jose Rigonato, Graziele Ambrosio, Helena da Cunha Lopes de Lima, Mariana da Cunha Lopes de Lima, Marilda Mazzali, Marcelo Lopes de Lima ##submission.copyrightStatement## Mon, 13 Dec 2021 00:00:00 +0000 Anti-tumour Potential of Punica granatum (Pomegranate) Seed in Testosterone-induced Benign Prostate Hyperplastic Wistar Albino Rats <p><strong>Aim: </strong>The aim of this study was to assess the anti-tumour potentials of <em>Punica granatum </em>(Pomegranate) seed in testosterone-induced Benign Prostate Hyperplastic Wistar albino Rats.</p> <p><strong>Study Design:</strong> This study is an experimental study.</p> <p><strong>Place and Duration of Study:</strong> The experimental aspect of this study was conducted at the animal house, Department of Pharmacology, University of Port Harcourt between April and September, 2019.</p> <p><strong>Methodology:</strong> Seventy (70) adult albino Wistar rats were used for this study. They were divided into 12 groups of 5 rats each (apart from normal control, BPH and PC control groups that contained 10 rats each) that were further divided into 5 rats for each group and fed with commercial rat diet and clean drinking water <em>ad libitum</em>. Aqueous and ethanol extracts of <em>Punica granatum</em> seed were prepared using the maceration method. Benign Prostate Hyperplasia was induced in rats after they submitted to bilateral orchiectomy by daily injections of testosterone propionate (TP) (4 mg/kg Rats were treated with 500 or 1500 mg/kg b.wt. of aqueous or ethanoI extracts of <em>Punica granatum</em> seed, dutasteride or in combination. Administration of extracts was done by gavage. At the end of 30 days, the rats were anaesthetized with chloroform and blood samples were collected into lithium heparin bottles through cardiac puncture and serum prostate specific antigen (PSA) was analyzed using rat specific ELISA kits for PSA. The prostate gland was excised, washed, weighed and length, breath and width were measured. The organs were later preserved in formalin for histological analysis. Statistical analysis was done using statistical package for social sciences (SPSS) version 22.0 and P values less than <em>.05 </em>were considered significant.</p> <p><strong>Results:</strong> The results showed that subcutaneous administration of 4mg/kg of testosterone propionate caused a significant increase in prostrate weight (from 216.2 ± 10.5 to 635 ± 78.8 mg), prostate volume (from 0.83 ± 0.11cm<sup>3 </sup>to 0.23 ± 0.05 cm<sup>3</sup>) and prostate specific antigen (from 76.34 ± 3.55 to 716 ± 56.1 pg/ml) at <em>p&lt;.05. </em>However, when the rats were treated with both aqueous and ethanol extracts of <em>Punica granatum s</em>eed, in combination with dutasteride and when simultaneously administered with testosterone, the above stated parameters were observed to have significantly decreased. Moreover, histological findings for rat prostates corroborated with the biochemical findings.</p> <p><strong>Conclusion:</strong> From our findings of the biochemical and histological changes in rats, BPH was induced in castrated male rats after the subcutaneous injection of 4mg/kg b.wt. testosterone propionate. It was also observed that extracts of <em>Punica granatum </em>seed administered orally ameliorated BPH in rats, by decreasing prostate size and weight, prostate index and prostate specific antigen levels in treated rat groups compared with the BPH model group. Both doses of the two plant extracts individually and in combination with dutasteride also markedly reduced prostate parameters.</p> U. A. Obisike, E. O. Nwachuku, N. Boisa ##submission.copyrightStatement## Wed, 29 Dec 2021 00:00:00 +0000 Efficacy of Mirabegron Compared with Tolterodine, Placebo, and Different Doses of Mirabegron on OAB Patient Evaluated in 4 Weeks Period: A Meta-Analysis <p><strong>Introduction: </strong>Mirabegron is one of the therapeutic options in overactive bladder where its efficacy and safety are better than antimuscarinics in several existing studies. Tolerability, treatment duration, and cost are often the deciding points for patient adherence and compliance in taking treatments. Many patients and doctors expect fast and visible results with relatively short treatments duration. This meta-analysis study describes and compares the efficacy of mirabegron compared with antimuscarinic, placebo or different doses of mirabegron over 4 weeks’ treatment range.</p> <p><strong>Methods: </strong>A literature search was performed using the Cochrane Library, Pubmed, and 5 other journal database. The literature reviewed included randomized and nonrandomized prospective and clinical trial studies. Mean difference (MD) was used to assess micturition frequency, incontinence episode, mean volume voided, nocturia episodes, urgency episodes, urgency incontinence episodes, and level of urgency of patients recorded within 4 weeks treatment duration. We used the Cochrane Collaboration’s Review Manager 5.4.1 software for statistical analysis</p> <p><strong>Results: </strong>Six publications that met eligibility criteria was included in this study. Meta-analysis of extractable data showed that Mirabegron was found significantly more efficacious than placebo for majority of efficacy endpoints recorded within 4 weeks’ treatment duration. In contrast, the comparison of mirabegron with tolterodine 4 mg showed no significant difference in outcome across all seven assessment criteria. On the other hand, mirabegron was also found to be more efficacious when administered in higher doses compared to lower doses at the majority efficacy endpoint</p> <p><strong>Conclusion:</strong> Withtin 4-week treatment duration, Mirabegron can provide significant results compared to placebo. However, the results are still not much different from tolterodine. Higher doses of mirabegron also provide a better result when compared with lower doses. The lowest dose with statistically significant results compared to placebo was obtained from mirabegron 25 mg.</p> Christian Nurtanto Putra, Kevin Ivandi, Kadek Adit Wiryadana, Pande Made Wisnu Tirtayasa, Gede Wirya Kusuma Duarsa ##submission.copyrightStatement## Tue, 05 Oct 2021 00:00:00 +0000