Do I need to see a urologist for my vasectomy?A comparison of practice patterns between urologists and family medicine physicians

Urologists perform the majority of vasectomies in the United States;however,family medicine physicians(FMPs)perform up to 35%.We hypothesized that d iff ere nces exist in practice patterns and outcomes between urologists and FMPs.Patie nts who underwent a vasectomy from 2010 to 2016 were identified.Postvasectomy semen analysis(PVSA)practices were compared between urologists and FMPs,before and after release of the 2012 AUA vasectomy guidelines.From 2010 to 2016,FMPs performed 1435(35.1%)of all vasectomies.PVSA follow-up rates were similar between the two groups(63.4%vs 64.8%,P=0.18).Of the patients with follow-up,the median number of PVSAs obtained was 1(range 1-6)in both groups(P=0.22).Following the release of guidelines,fewer urologists obtained multiple PVSAs(69.8%vs 28.9%pre-and post-2012,P<0.01).FMPs had a significant but lesser change in the use of multiple PVSAs(47.5%vs 38.4%,P<0.01).Both groups made appropriate changes in the timing of the first PVSA,but FMPs continued to obtain PVSAs before 8 weeks(15.0%vs 6.5%,P<0.01).FMPs had a higher rate of positive results in PVSAs obtained after 8 weeks,the earliest recommended by the AUA guidelines(4.1%vs 1.3%,P<0.01).Significant differences in PVSA utilization between FMPs and urologists were identified and were impacted by the release of AUA guidelines in 2012.In summary,FMPs obtained multiple PVSAs more frequently and continued to obtain PVSAs prior to the 8-week recommendation,suggesting less penetration of AUA guidelines to nonurology specialties.Furthermore,FMPs had more positive results on PVSAs obtained within the recommended window.

Revisiting the morphology of pelvicalyceal system in human cadaveric kidneys with a systematic review of literature

Objective:Renal collecting system macroscopically consists of minor calyx,major calyx,renal pelvis and ureter.Stone in renal collecting system is a common presentation in everyday urological practice.The prevalence of renal calculi ranges from 4%to 20%in different geographical distribution.Anatomical variation in renal collecting system plays a significant role in formation of calculi in its parts.The large extra renal pelvis leads to stagnation of urine for longer durations and formation of stones.The stone free rate after percutaneous nephrolithotomy and extra corporeal shock wave lithotomy is significantly related to anatomical factors,particularly the type of renal pelvis and dimensions(length and width)of lower infundibulum.Previous authors described the morphology of pelvicalyceal system in a highly variable manner and the available anatomical description of pelvicalyceal system is contradictory and incomplete.Hence an attempt has been made to provide the precise anatomy of pelvicalyceal system in adult human kidneys.Methods:We studied 196 formalin embalmed kidneys to note the number of infundibulum,major and minor calyces.The location and shape of pelvis were also studied.Results:The intra-renal pelvis was narrow and had funnel shaped appearance in 95 of total 196(48.5%)specimens,and the extra-renal pelvis was dilated as balloon shaped in 43 of 196(21.9%)specimens.In 41(20.9%)specimens,the renal pelvis was having partially intra-and extra-renal in location.Bilateral symmetry was found in only 27.1%of 196 renal collecting systems.The length of lower infundibulum was more than 22 mm in 19(9.7%)of 196 cases which directly affects the stone clearance rate during open and endoscopic surgeries on pelvicalyceal system.Conclusion:This study provides the accurate morphological details of the shape and dimensions of renal pelvicalyceal system to help the urologists and nephrologists.

Epidemiology of Male Sexual Dysfunction (MSD) in Patients Consulting in Some Health Services in the City of Douala, Cameroon

Sexual dysfunction is a group of diseases, disorders or difficulties experienced by men or women during any stage of normal sexual activity. In Africa in general and Cameroon in particular, statistical data concerning the prevelance and the main causes of male sexual dysfunction are rare due to socio-cultural and religious burdens and sometimes self-medication. The objective of this work was to determine the prevalences, comorbidities and the risk factors of the main sexual dysfunction in some hospitals in city of Douala. Through a descriptive retrospective study carried out from Novembre 2019 to June 2021, sociodemographic parameter, reasons of consultation, risk factors and type of male sexual dysfunction (erectile dysfunction or erectile dysfunction (ED), ejaculation disorders (EjD), libido disorders (LD) and disorders of sexual activity with pain or painful sexual intercourse (PSI)) were collected in the medical files of patients who have made urological consultation between 2016 and 2020 at the Deido District hospital, Laquintinie Douala Hospital and Douala General hospital respectively. At the end of our data collection, out of a total of 24995 consultations, 2743 (10.98%) patients were suffering from at least one male sexual dysfunction. Moreover, sexual disorders were the 2nd reason of urological consultation (13.69%) after urinary disorders (33.85%). Among sexual disorders, erectile (76%) and ejaculatory (20%) disorders were the predominant pathologies recorded with the prevalences of 9.79 et 2.62% respectively, and were mostly represented in patients from [41 - 50] for erectile dysfunction, and [18 - 30] years old for ejaculative dysfunction. In addition, the number of patients with ejaculatory and erectile dysfunctions was more important in patients from [18 - 30] and [31 - 40] years old respectively. Among patients presenting sexual disorders, several risk factors or pathologies were associated with the dysfunction: benign prostatic hyperplasia and metabolic syndrome (in patients over 50 years old);psychosocial problems, infections, and alcohol (in patients under 50 years old). These findings could be useful in the elaboration of therapeutic strategies for the management of the Cameroonian population suffering from sexual dysfunctions.