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   Table of Contents - Current issue
January-March 2022
Volume 33 | Issue 1
Page Nos. 1-46

Online since Wednesday, March 2, 2022

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Step into 2022 with best luck p. 1
Yao-Chi Chuang
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Potential applications of low-intensity extracorporeal shock-wave therapy in urological diseases via activation of tissue resident stem cells p. 3
Bohan Wang, Amanda B Reed-Maldonado, Kim Ly, Guiting Lin, Tom F Lue
For many years, low-intensity extracorporeal shock-wave therapy (Li-ESWT) has been clinically applied as a noninvasive therapeutic method, for urological diseases. The major corresponding biological molecular mechanisms of Li-ESWT are to induce stem cell differentiation, neural regeneration, and angiogenesis. This narrative review aims to present an overview of the potential utility of Li-ESWT and its effects on stem cell therapies. Recent studies have also shown that the combination treatment of Li-ESWT and stem cell therapies can be a new option for the treatment of erectile dysfunction (ED), urinary incontinence, bladder dysfunction, and other diseases. The potential contributions of Li-ESWT on stem cell therapies for these diseases are studied, highlighting the influence of Li-ESWT on proliferation, viability, and differentiation capacity of certain stem cells. The potential mechanisms, including the increased expression of vascular endothelial growth factor, chemokine CXC motif ligand 5, and transforming growth factor-β1 are described herein. Li-ESWT can also activate many cellular signaling pathways. The combination of Li-ESWT and stem cell therapies is a promising strategy for urological diseases. However, a much greater understanding of the mechanisms by which Li-ESWT enhances the efficacy of stem cell therapy is still needed before this combined treatment can be recommended for large-scale clinical application.
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Comparative study of transperitoneal laparoscopic versus retroperitoneoscopic ureterolithotomy techniques p. 9
Sunil Mhaske, Vilas Sabale, Vikram Satav, Sonu Sharma, Shashikant Asabe, Hareesh Belagalli
Purpose: This study evaluated the effectiveness and safety of transperitoneal laparoscopic ureterolithotomy (TPLU) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the surgical management of ureterolithiasis. Materials and Methods: The current prospective study was conducted at the Department of Urology, Dr. D. Y. Patil Medical College. The complete patient medical history including patient's age, sex, stone (size, number, and laterality), and past history of stone surgeries were evaluated. Based on the treatment method, the patients were divided into TPLU and RPLU group. Both the procedures were evaluated for parameters including operative technique, operating time, hospital stay, intra- and postoperative complications, conversion rate, success rate, and surgical ergonomics. Results: A total of 50 patients were included (TPLU, n = 25; and RPLU, n = 25). The average age was 43.6 years in the TPLU and 46.7 years in the RPLU group. The average size of calculi was >15 mm in both the groups. The operation time and blood loss were relatively higher in the TPLU group than RPLU group. The complete stone clearance was observed in both the groups. The pain in loin area and burning micturition were the most common complaints reported by the patients from both the groups. One patient from RPLU group was converted to open surgery. The calculi size in TPLU group was positively correlated with operative time (r = 0.535, P = 0.006), blood loss (r = 0.440, P = 0.028), and hospital stay (r = 0.430, P = 0.032). Conclusion: TPLU and RPLU are feasible techniques for the management of large ureteric stones that are not amenable to ureteroscopy or extracorporeal shockwave therapy.
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#UroSoMe: Growth and innovation of the social media landscape of urology residency programs and applicants during the COVID-19 pandemic p. 14
Aaron J Huang, John R Heard, Isabelle K Sharma, Fradah E Gold, Omran Gdara, Corey Weinstein, Mahyar Kashani, Andrew G Winer
Purpose: The purpose of this study was to determine the impact of COVID-19 on the urology residency application cycle on social media engagement and account creation by urology residency programs and applicants. Materials and Methods: A list of accredited urology residency programs was taken from the Electronic Residency Application Service, excluding military-sponsored programs. Twitter, Instagram, and Facebook accounts of programs and applicants were then identified through Google and individual platform searches. Results: One hundred and nineteen out of 140 urology programs had Twitter accounts, with 29 created in 2020. Urology program Instagram accounts had the largest growth rate in 2020 of 227.8%. Almost all urology programs that had Instagram or Facebook accounts also had a Twitter account. Urology programs promoted a total of 277 virtual events on Twitter, 83 on Instagram, and 48 on Facebook. Sixteen subinternships were promoted on Twitter, two on Instagram, and two on Facebook. In the 2021 match, 136 of the 237 matched applicants on Twitter made their accounts in the year leading up to the match and 42 of the 162 matched applicants on Twitter created their Twitter accounts during the 2019 cycle. Conclusion: The number of urology programs on Twitter and Instagram increased in 2020 at a faster rate than previous years. Many programs used their accounts to promote virtual events and subinternships. Applicants who matched in 2021 made Twitter accounts during their application year at a higher rate than the previous application cycle. During the COVID-19 pandemic, urology programs and applicants utilized social media, especially Twitter, to engage and learn about each other.
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A comparative study of the efficacy of silodosin versus tamsulosin versus oral hydration therapy in medical expulsion therapy for ureteral calculi p. 19
Dilip Kumar Pal, Ankit Kumar, Debansu Sarkar
Purpose: The use of various alpha-receptor antagonists (α-blocker) drugs as medical expulsive therapy (MET) for spontaneous clearance of ureteral calculi of various sizes has been extensive in the last decade by urologists across the world. Among all, α-blocker tamsulosin has been used widely. In contrast silodosin which is recently introduced in the market and more selective alpha-receptor antagonist and cardioselective drug but it has not been used widely as MET. In this study, silodosin (8 mg), tamsulosin (0.4 mg), and oral hydration therapy were compared in terms of efficacy and safety as MET in the management of ureteric stone along with rate of stone clearance, expulsion time, analgesic requirements, and adverse effects for treating ureteral stones size between ≥4 mm and ≤10 mm in diameter. Materials and Methods: Prospective randomized study was conducted between September 2018 and August 2020 with a total of 240 patients (80 patients in each arm) in tertiary care center of eastern India. First group received a single dose of silodosin (8 mg) daily, second group received a single dose of tamsulosin (0.4 mg) daily and third group received oral hydration therapy for 4 weeks. Results: There is no difference in the stone expulsion rate (SER), stone expulsion time (SET), and surgical intervention between tamsulosin, silodosin and oral hydration therapy group for ureteric stones ≤5 mm size. For ureteric stones of size 6 mm–10 mm, silodosin has better SER than tamsulosin with no difference in terms of SET. Analgesic requirement and pain episodes were more in the oral hydration group with no adverse effects (statistically significant). Conclusion: The proportion of passed-out stone was significantly higher among the patients treated with silodosin (65.0%) in comparison to other two groups (P < 0.05) with no difference in SET.
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Outcome analysis of dorsal buccal mucosal graft urethroplasty in perimenopausal women with urethral stricture disease p. 26
A Bhalaguru Iyyan, P Puvai Murugan, Shree Vishnu Siddarth Rajagopal, Sheik Asik Abu Sali
Purpose: To assess the clinical outcomes following dorsal buccal mucosal graft urethroplasty (BMGU) in perimenopausal women (PMW) suffering from urethral stricture disease. Materials and Methods: PMW (40–65 years) presenting with urinary symptoms were evaluated with uroflowmetry, voiding cystourethrogram (VCUG), and urethral calibration. PMW with maximum flow rate (Qmax) less than 10 ml/s or postvoid residual (PVR) volume greater than 50 ml, VCUG showing evidence of urethral stricture, and failure to calibrate with 14 Fr Foley catheter were included in the study. Patients with underactive bladder, carcinoma cervix, pelvic trauma, and oral submucosal fibrosis were excluded from the study. Patients satisfying inclusion and exclusion criteria underwent dorsal BMGU. Outcomes of the surgery were assessed by uroflowmetry at 3-monthly intervals. Results: The number of patients satisfying the inclusion and exclusion criteria between March 2014 and March 2020 was eight. The mean age of the patients was 52.1 years. The mean stricture length was 1.9 cm. The mean preoperative Qmax and PVR were 4.2 ml/s and 110 ml, respectively. The mean postoperative Qmax and PVR at 6 months were 15.4 ml/s and 39.1 ml, respectively. One patient had a recurrent stricture and underwent dilatation. Donor site complications were minor. The overall success rate of the procedure was 87%. Conclusion: Dorsal BMGU in females for urethral stricture disease offers successful urethral reconstruction and the advantage of least disruption of continence mechanism and resilience to hormonal changes in PMW.
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Primary ureteroscopy for diagnosing and treating acute urolithiasis during the COVID-19 pandemic: Quality and cost benefits p. 30
Mudassir Maqbool Wani, Iqbal M Sheikh, Howard Marsh, Matin Sheriff, Zubair Bhat, John Mullighan
Purpose: The purpose of this study was to investigate the management of acute urolithiasis during index admission by primary ureteroscopy (P-URS) during coronavirus disease-2019 (COVID-19) pandemic. With the rise in prevalence of urolithiasis, the focus has shifted to manage patients presenting with acute ureteric colic during their first admission rather than using temporary measures such as emergency stenting (ES) or nephrostomies which are followed by deferred ureteroscopic procedures Deferred Ureteroscopy (D-URS). We compared the results of ES with P-URS procedures in terms of quality and cost benefits during COVID-19 pandemic. Materials and Methods: Data were collected prospectively from April 2020 to March 2021 for all emergency urolithiasis procedures performed including ES and P-URS. The quality assessment was based in relation to patient factors including the number of procedures per patient, number of days spent at hospital, number of days off work, and expertise of person operating. Cost analysis included theater expenses, hospital stay charges, and loss of working days. Results: This study revealed that the average stay of patients on index admission who had an ES was 1.35 days compared to 1.78 days in patients who underwent P-URS. Patients who had ES had to undergo D-URS and spent another average of 1.5 days in the hospital. Overall, additional expenditure in patients who did not undergo primary ureterorenoscopy was on an average in the range of £1800 (excluding loss of work for patients, who needed to return for multiple procedures). Conclusion: We conclude that the approach of P-URS and management of stones in index admission is very effective in both improving quality of patients (during the COVID-19 pandemic) and bringing down cost expenditure effectively.
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Single versus multiple mini-tract percutaneous nephrolithotomy for staghorn renal stone: A single-center study p. 35
I-Chen Tsai, Zhi-Hao Chen, Kau-Han Lee, Chien-Liang Liu, Steven K Huang, Allen W Chiu
Purpose: Percutaneous nephrolithotomy (PCNL) is the standard procedure used for large kidney stones, and multiple tracts of PCNL are applied to achieve better stone clearance. However, the creation of multiple tracts may have the potential risk of bleeding and higher complication rates compared with single-tract procedures. We reviewed our experience managing staghorn calculi with multiple tracts compared with a single tract. Materials and Methods: Records of 36 patients with staghorn calculi who underwent PCNL at our institution between January 2018 and April 2020 were reviewed retrospectively. Nineteen patients were managed by single-tract access (Group 1), and 17 patients underwent multiple-tract access (Group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Results: The mean number of percutaneous accesses in the multiple-tract group was 2.88, with most patients requiring two tracts. The mean duration of fluoroscopy screening and operative time was longer in Group 2. Stone-free rates were 59% and 70.5% in Groups 1 and 2, respectively. The mean hospital stay was similar in both groups. Complications included blood transfusion, resulting from a hemoglobin drop of 2.15 ± 0.96 and 1.59 ± 0.69 g/dL in Groups 1 and 2, respectively. Mean pre- and post-operative creatinine concentrations were 1.212 and 1.211 mg/dL in Group 1 and 1.206 and 1.157 mg/dL in Group 2. Mean changes in creatinine values were not statistically significant between the groups. Clavien–Dindo Classification Grade II complications included urosepsis and blood transfusion, which occurred in five patients in Group 1 and three in Group 2. Pseudoaneurysm attributed to Grade III complications occurred in one patient in Group 1. Conclusion: Multiple-tract access during PCNL is a safe and efficient method to manipulate staghorn kidney stones. Mini PCNL with multiple-tract access is a successful alternative to deal with staghorn stones involving multiple calyces.
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Transperineal urethroplasty for urethral distraction defects caused by pelvic fracture: Outcome analysis in 36 patients p. 42
Pai-Yen Pan, Ta-Min Wang, Kuo-Jen Lin, Hsu-Han Wang, Sheng-Hsien Chu, Yang-Jen Chiang, Chih-Te Lin
Purpose: We report the outcomes of transperineal urethroplasty in patients with pelvic fracture urethral distraction defects (PFUDDs) over the past 12 years. Materials and Methods: Patients who received transperineal anastomotic repair of PFUDDs from January 2007 to December 2019 were retrospectively analyzed, specifically focusing on demographic findings, pelvic fracture type, urethral distraction defect length (based on retrograde urethrography and cystography), previous treatments, and ancillary maneuvers during surgery. Simultaneously, differences in clinical factors between successful and failed cases were also analyzed. Results: A total of 36 patients were included, with a final success rate of 83%. The mean age was 40.4 years, whereas the mean urethral distraction defect length was 31.9 mm. Most patients (69%) presented with unstable pelvic fractures. Treatment before referral included endoscopic treatment and urethroplasty in 13 (36%) and 2 cases (6%), respectively. For difficult cases, ancillary procedures, which included corporeal splitting (61.1%) and inferior pubectomy (8.3%), were performed. The postoperative average peak flow rate was 14.9 mL/s in the success group. Age and urethral defect length differed significantly between the success and failure groups. Conclusions: Over the past 12 years, transperineal urethral reconstruction demonstrated a success rate of 83% in 36 patients with PFUDD. Age and urethral defect length were identified as the two main factors affecting surgical prognosis.
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Reviewer Acknowledgement  
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