Adult Urological Cancers at Zinder National Hospital

The aim of this study was to present the epidemiological, clinical and therapeutic aspects of adult urological cancers in the department of urology at Zinder National Hospital. Patients and Methods: This was a cross-sectional study of adult primary urologic cancers during the period of January 2019 to December 2023. Data were obtained from the record of patients admitted to urology, and the medical oncology department. The parameters studied were;frequency, age, sex, urogenital distribution, anatomopathological type, and therapeutic aspects. Data were recorded on Excel 2013 and analyzed with Epi-info version 7.2.5. Results: Epidemiology: About 289 cancers were diagnosed through 6017 consultations during the period, corresponding to 4.80% of urological pathologies: prostate cancer (n = 221;76.47%), bladder cancer (n = 46;15.92%), kidney cancer (n = 13;04.5%), testis cancer (n = 09;03.11%). Median age of patients was 50.42 years. Prostate cancer: was Adenocarcinoma in 100% (n = 221) with Gleason scores > 7 (77.83%) and prostatique specific antigen (PSA) > 20 ng/ml in 90.04%. Extension evaluation 134 cases (60.63%). Treatment was chirurgical castration in (62.44%) and resistance to castration appeared between 8 and 11 months. Hospital mortality for prostate cancer was 16.29%. Bladder cancer was found in 46 cases with Sex ratio 7/1. Cystoscopy was performed for all. Histology revealed squamous cell carcinoma (n = 41;89.13%), and (n = 5;10.87%) urothelial. Endoscopic resection performed (n = 14;30.43%). Kidney cancers were 13 cases (10 men, 03 women). Nephrectomy was performed in (n = 8;61.54%) cases and Histology revealed renal cell cancer in 76.92%. Testicular cancers were diag 09 cases. History of cryptorchidism was found in 4 cases, 4-year infertility in 3 cases. Orchidectomy was done in all cases. Chemotherapy in 3 cases. Conclusion: urological cancers are frequent, dominated by prostate cancer. The endemicity of bilharziasis has increased squamous cell carcinoma. The majority of patients have advanced form of the disease, which poses management problems.

Urological Emergencies at the University Hospital of Brazzaville: Epidemiological, Clinical, and Therapeutic Aspects

Introduction: Urological emergencies play a significant role in the medical and surgical activity of a urology department. The objective of this study was to determine the hospital prevalence of urological emergencies at the University Hospital of Brazzaville (CHUB), identify the different pathologies requiring urgent care, and list the various therapeutic methods. Patients and methods: A retrospective study of patients admitted to the medical and surgical emergencies department of CHUB over a 5-year period. Patient records admitted and treated for a urological emergency were included. The variables studied were the frequency of urological emergencies, patient age at admission, gender, nature of the emergency, and various therapeutic options. Results: Urological emergencies accounted for 4.3% of all medical and surgical emergencies. The mean age was 57 ± 28 years with a range of 3 to 93 years. The male-to-female ratio was 7.1. The most common conditions were urinary retention (54.67%), hematuria (17.20%), and renal colic (8.13%). Therapeutically, surgical urinary drainage was dominated by cystostomy. Conclusion: Urological emergencies are infrequent at the University Hospital of Brazzaville. Their management is often delayed.

Surgical Treatment of the Upper Urinary Tract Lithiasis at the Urology Department of the Hopital General Idrissa Pouye

Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.

Daily activities and training experiences of urology residents during the coronavirus disease 2019 pandemic in Indonesia: A nationwide survey

Objective:To explore the impact of the coronavirus disease 2019(COVID-19)pandemic on the training experiences of urology residents in Indonesia.Methods:A cross-sectional study using a web-based questionnaire(SurveyMonkey)involved all registered urology residents in Indonesia.The questionnaire was structured in Bahasa Indonesia,composed of 28 questions,and divided into three sections:demographic characteristics,current daily activities,and opinions regarding training experiences during the COVID-19 outbreak.The survey was distributed to all respondents via chief of residents in each urology center from May 26,2020 to Jun 2,2020.Results:Of the total 247 registered urology residents,243 were eligible for the study.The response and completeness rate for this study were 243/243(100%).The median age of respondents was 30(range:24e38)years old,and 92.2%of them were male.Among them,6(2.5%)respondents were confirmed as COVID-19 positive.A decrease in residents’involvement in clinical and surgical activities was distinguishable in endourological and open procedures.Most educational activities were switched to web-based video conferences,while others opted for the in-person method.Smart learning methods,such as joining a national or international speaker webinar or watching a recorded video,were used by 93.8%and 80.7%of the respondents,respectively.The respondents thought that educational activities using web-based video conferences and smart learning methods were effective methods of learning.Overall,the respondents felt unsure whether training experiences during the COVID-19 pandemic were comparable to the respective period before.Conclusion:The COVID-19 pandemic negatively affected urology residents’training experiences.However,it also opened up new possibilities for incorporating new learning methodologies in the future.

Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients:A single center experience

Objective To determine incidence and risk factors for venous thromboembolism(VTE)development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.Methods Consecutive 1453 inpatients who were admitted to a non-oncological urological ward in the tertiary hospital from January 1,2018 to December 31,2018 were enrolled in the study,and the VTE events were diagnosed by ultrasound or computed tomographic pulmonary angiography.Patients’occurrence of VTE and characteristics which may contribute to the development of VTE were collected and analyzed as incidence and risk factors.Results The incidence of VTE in non-oncological urological inpatients is 2.3%.In our cohort,patients who experienced previous VTE(adjusted odds ratios[aOR]14.272,95%CI 3.620-56.275),taking anticoagulants or antiplatelet agents before admission(aOR 10.181,95%CI 2.453-42.256),D-dimer(max)≥1μg/mL(aOR 22.456,95%CI 6.468-77.967),lower extremity swelling(aOR 10.264,95%CI 2.242-46.994),chest symptoms(aOR 79.182,95%CI 7.132-879.076),operation time of more than or equal to 180 min(aOR 10.690,95%CI 1.356-84.300),and Caprini score(max)of more than or equal to 5(aOR 34.241,95%CI 1.831-640.235)were considered as risk factors for VTE.Conclusion In this study,we found that the incidence of VTE in non-oncological surgery was about 2.3%,which was higher than some previous studies.Risk factors could be used for early detection and diagnosis of VTE.

Practice of Endo-Urology in the Centre of Ivory Coast: Overview and Results

Background: Endoscopic exploration and treatment of urinary tract disorders, whether by retrograde, percutaneous or endoscopic approach, defines endo urology. Objective: To report the results of endo urology practice in Bouaké during the two practice sessions. Patients and Methods: Cross-sectional and descriptive study of patients followed up and had benefited from exploration and/or endoscopic surgery in Bouaké. Our study was carried out in a facility in Bouaké, for two years, from January 2021 to December 2022. The parameters of interest were clinical, diagnostic, endoscopic procedure and results. Results: During the study period, 157 patients underwent endoscopic exploration and/or intervention. The mean age was 58.9 years (range 28 - 90 years). Males predominated with 95.5% (n = 150). Acute urinary retention was the most frequent reason for consultation (55.41%). Benign prostatic hyperplasia (BPH) was the most frequent pathology at 22.92% (n = 36). Urethrocystoscopy was performed in 52 cases (33.12%), Transurethral resection of the prostate (TURP) in 36 cases (22.92%), Endoscopic resection of secondary cervical sclerosis in 23 cases (14.64%), Endoscopic internal urethrotomy (EUI) in 15 cases (9.55%) and Transurethral resection of the bladder (TURB) in 10 cases (6.36%). Post-operative management was straightforward in 93.63% of cases (n = 147). Operative times of between 21 and 35 minutes were more frequent in 55.41% of cases (n = 87). Urinary tract infections accounted for 3.8% (n = 6) of surgical morbidity. The germ responsible for the infections was essentially Escherichia coli (E. coli). The mean duration of post-operative urinary drainage was 5.5 days (range: 4 - 6 days) for patients who underwent TURP, TURB and endoscopic resection of secondary sclerosis of the bladder neck. The mean duration of drainage after endoscopic internal ureterotomy was 21.6 days (range 14 - 30 days). Of the 157 endoscopies performed, 154 patients (98.08%) had a favourable outcome, with adenomyofibroma of the prostate being the most common histological type (52.17%, n = 36). Mortality was 1.27% (n = 2) in our series. Conclusion: Endo urology should be the urologist’s first choice for both exploration and surgery, given the satisfactory results.

Urological Emergencies at Kara Teaching Hospital (Togo): Epidemiological, Clinical and Therapeutic Profile

Background: The urology department of the teaching hospital of Kara is the second urology department in Togo, after that of the teaching hospital Sylvanus Olympio, in Lomé the capital. It is a very young service, created less than 5 years ago. Urological emergencies were previously managed by general surgeons, for lack of urologists. The influx of patients with urological pathologies has increased with the arrival of urologists. The update on urological emergencies having been made in Lomé, we therefore wanted to take stock of urological emergencies at the teaching hospital of Kara. Objective: To describe the epidemiological, clinical, and therapeutic aspects of urological emergencies received at the teaching hospital of Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department, and in the surgical emergency department of the teaching hospital of Kara, over a period of 18 months, from January 2021 to June 2022. The on-call medical team consisted of the intern in on-call medicine, and an on-call urologist, whom the intern called upon when he received a urological emergency. Pediatric urological emergencies were managed by the pediatric surgeon and were not considered in our study. The operating room register, the surgical emergency consultation register, the urology department consultation register, and the records of patients hospitalized in the urology department were used for data collection. The following parameters were studied: age, sex, type of urological emergency, and therapeutic management;epi info 7 software was used for data processing. Results: The average age of the patients was 52.5 ± 19.6 years with extremes ranging from 16 years to 102 years. Note that 57.7% of the patients were over 50 years old. The sex ratio was 8.9. Urinary retention was the most common urological emergency in 47.7% (52) of cases;follow-up of infectious pathologies in 30.2% (33) of cases. Among the patients who had been seen for urinary retention, 84.6% (44) of the cases had presented with acute urinary retention. Urethral catheterization was the type of care most received by patients, in 30.2% (33) of cases;follow-up of medical treatment in 27.5% (30) of cases. The most common etiology of urinary retention was prostate tumours, in 71.1% (37) of cases, followed by urethral stricture in 15.3% (8) of cases. We also found in our series, traumatic emergencies in 10% of cases;these were traumatic urethral injuries, traumatic injuries of external genitalia, traumatic injury of bladder, and traumatic injury of kidney in respectively: 4.5% (5);2.7% (3);1.8% (2);and 0.9% (1) of cases. Torsion of the spermatic cord was found in 2.7% (3) of cases. Conclusion: Urine retention is the most common urological emergency at Kara University Hospital. They are most often found in elderly males. Urethral catheterization was the most common type of care.

Management of Non-Traumatic Urological Emergencies at Souro Sanou University Teaching Hospital of Bobo-Dioulasso (Burkina Faso)

Background: Generally, urological emergencies are assumed not to be very common, however, recent reports showed that they constitute an important aspect of the day-to-day urological practice. If not well and promptly managed, they may lead to serious morbidity or mortality. Objectives: To study the pattern of presentation, diagnosis and outcome of management of non-traumatic urological emergencies seen at the Emergency Department of Souro Sanou University Hospital in Bobo-Dioulasso. Patients and Methods: This was a retrospective and descriptive study over four years. It included patients of all ages and both sexes, admitted for non-traumatic urological emergencies in the surgical emergency department of Souro Sanou University Hospital. It took place from January 1, 2017 to December 31, 2020. Results: A total of 584 patients were reviewed in our study. Non-traumatic urological emergencies account for 6.3% of all surgical emergencies seen during the study period. The male-to-female ratio was 9.2 to 1. The mean age of the patients was 51.9 ± 23.9 years. Forty-five per cent of the patients presented within 48 hours of symptoms. The vast majority of the patients presented with difficulties with passing urine (41.6%), followed by cases of hematuria (18.4%). On admission, 154 patients (26.4%) presented with severe conditions such as anemia as seen in 40.9% of the cases and deterioration in the general health condition as seen in 34.4% of the patients. Leukocytosis was noted in 18.7% of the patients and anemia in 17.9%. Urine culture was positive in 15.4% of the patients and Escherichia coli was the most common pathogen found (40.6%). Ultrasound was the most requested examination (81.2%), followed by a computerized tomography (CT) scan (22%). The most frequent diagnoses were urine retention (42.9%), hematuria (16.9%) and renal colic (10.1%). Emergency interventions were carried out in 525 patients (89.9%) who include bladder catheterization (46.1%), bladder lavage and/or bladder irrigation (20.9%) and suprapubic cystocatheterization (10.1%). Most of the patients (61.3%) were discharged after a mean stay in the hospital of about 5.1 ± 7.5 days. A mortality rate of 3.8% was also recorded among the patients studied. Conclusion: Non-traumatic urological emergencies are common and are an important aspect of daily urological practice. The majority of the patient presents late with usually a severe form of the disease, which adversely affects the outcome even after treatment.

Prevalence of Comorbidities in the Urological Patients at the Former Military Teaching Hospital of Cotonou

Background: Comorbidities are additive diseases and care burdens in urological patients. Determining the epidemiologic profile of comorbidities in urological patients in our setting may help us to better the management of urological disease. Objective: To evaluate the prevalence of comorbidities in urological patients. Patient and Method: We collected comorbidity, urological disease and demographic data in all urological patients managed at the former Military Teaching Hospital of Cotonou from January 1, 2012, to December 31, 2020. We used the software R 4.2.2 to perform descriptive and bi-varied data analysis. Student’s t test was used to compare means. Results: The prevalence of comorbidities was 14.2%, i.e., 601 comorbidity-affected among 4242 patients. The comorbidities predominantly affected men: the sex ratio was 13:1. The presence of comorbidity was correlated with patients’ age (p < 0.001). The comorbidities observed in the 601 affected patients were hypertension (84.5%), diabetes (26.5%), asthma (2%), and heart failure (1.2%). Hypertension (p = 0.001) and asthma (p = 0.030) were correlated with age. No comorbidity was associated with gender. The comorbidities’ prevalence was highest in patients aged 40 - 80 years who presented urological diseases such as BPH (68.9%), Erectile dysfunction (ED) and ejaculatory disorders, overactive bladder (OAB) and neurogenic lower urinary tract dysfunction (LUTD), renal cyst (5%), inguinal hernia (4.2%), urinary stones (2.8%), and prostate cancer (2.3%). Conclusion: The comorbidities’ prevalence was 14.2% in the urological patients. The main comorbidities were hypertension (84.5%) and diabetes mellitus (26.5%).

Post-Operative Mortality Analysis in the Urology Department of Conakry University Hospital

Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure operates with limited resources and more than half of the population lives below the poverty line. The objective of this study was to determine the frequency of post-operative mortality, to describe the main comorbidity factors responsible for this mortality and to identify the main cause of post-operative death in the urology department of the Ignace Deen National Hospital Material and Method: This was a retrospective descriptive study lasting 5 years from January 1, 2015 to December 31, 2019. It had focussed on all the files of patients operated on at the Urology Department of the Ignace Deen National Hospital, either in an emergency or planned and who died in per or post-operative immediately or 30 days later. Results: We recorded 63 cases of post-operative death, or a frequency of 1.84%. The average age was 61.92 ± 16.91 with the extremes of 12 and 91 years. Bladder (20.63%) and prostate tumours (60.3%) were the main admission diagnoses. High blood pressure was the main comorbidity factor found with 38.09% of cases followed by diabetes with 12.69%. Transurethral resection of the prostate, transurethral resection of the bladder and prostate adenocomectomy were the most performed surgical procedure with respective proportion of 19.04%, 20.63% and 38.09%. Probable cause of death were anemia in 25 cases (39.68%), septic in 20 cases (31.75%), heart failure in 6 cases (9.52%), pulmonary embolism in 5 cases (7.94%), obstructive renal failure 4 cases (6.35%) and stroke in 3 cases (4.76%). Conclusion: The majority of deaths occurred in patients over the age of fifty. Anaemia was the main cause of deaths. Difficulties in procuring blood products as well as the lack of modern therapeutic means are factors that make it difficult for patients to adequately manage.

Epidemiological Aspect and Evaluation of the Management of Urologic Emergencies at the Urology Unit of Labe Regional Hospital

Aim: To contribute to improving the management of urological emergencies at Labé Regional Hospital. Patients and Method: This was a dynamic, descriptive study lasting six months from July 1 to December 31, 2017. Results: Urological emergencies represented 45.14% (n = 218) of all admissions to the urology unit. The mean age of our patients was 56.60 years with extremes of fifteen days and 93 years. The 71 - 80 age group was the most represented with 28.03% (n = 61) followed by 61 - 70 years with 24.31% (n = 53). Our patients’ activities were dominated by agriculture, with 35.77% (n = 88), and the city center was most affected by urological emergencies, with 39.44% of cases (n = 86). 70.18% (n = 153) of our patients had bladder retention on admission, and 53.21% (n = 116) underwent urethral catheterization, including 3 women. The etiology of bladder retention in these 3 women was dominated by two cases of bladder lithiasis and one case of neurological bladder. Conclusion: The management of urological emergencies requires specific material and human resources. Their knowledge will enable us to better understand this problem and could serve as a basis for a broad reflection on the organization of the management of urological emergencies in our region.

A Panorama of the Urological Diseases at the Former Military Teaching Hospital of Cotonou

Background: Urological care has been advancing quickly over the last ten years in Benin. In order to conveniently support that trend towards better urological care standards, decision-makers need sound data on urological diseases in the country. Objective: To determine the prevalence of urological diseases in the former Military Teaching Hospital of Cotonou. Patients and Method: We retrospectively collected the urological diseases that the institution had managed from January 2012 to December 2020. We used Excel© 2010 and SPSS© to analyze the collected data. Results: 4244 patients, i.e. 3717 males (87.58%) and 527 females (12.42%) were managed during the study period. The main diseases diagnosed were benign prostatic hyperplasia (32.61%, n = 1384), erectile dysfunction (10.44%, n = 443), chronic prostatitis (5.94%, n = 252), prostate cancer (4.03%, n = 171), and ejaculatory disorders (3.44%, n = 146). In patients ≤ 15 years, predominant diseases were peritoneal vaginal canal (15.9%, n = 43), circumcision (15.6%, n = 42), testicular dystopia (10.7%, n = 29), hydrocele (7.8%, n = 21), and hypospadias (5.6%, n = 15). Wilms tumor (1.9%, n = 5) was the first cancer, testicular (0.4%, n = 1) and para-testicular (0.4%, n = 1) tumors were the next. In patients > 15 and ≤40 years, the main diseases were infertility (14.1%, n = 189), chronic prostatitis (12.9%, n = 173), erectile dysfunction (10.1%, n = 135), ejaculatory disorders (6.2%, n = 83), genital infections (6.2%, n = 83) and urinary stone (4.9%, n = 66). The first cancer was kidney cancer (0.97%, n = 13) followed by bladder cancer (0.3%, n = 4) and testicular tumor (0.3%, n = 4). In patients >40 years, the most prevalent diseases were BPH (52.0%, n = 1370), erectile dysfunction (11.7%, n = 308), prostate cancer (6.5%, n = 171), inguinal hernia (5.1%, n = 134), and urinary stone (3.9%, n = 102). Prostate cancer is the first cancer;the next were bladder (0.95%, n = 25) and kidney (0.68%, n = 18) cancers. Conclusion: Benign prostatic hyperplasia and urological cancers (prostate, bladder and kidney cancers) were the main urological diseases at the former Military Teaching Hospital of Cotonou. Urological malformations and Wilms tumor were the main diseases in the children.

Urological and genital surgery in ancient Egypt

Background:Ancient Egypt might be considered the cradle of medicine.The modern literature is somewhat too enthusiastic regarding the procedures given an Egyptian origin.The aim of the current paper is to briefly analyze the claims regarding urological and genital surgery in Egypt,in order to decide what the Egyptian actually do,and what has incorrectly been ascribed to them.Methods:The original sources as well as the modern literature was reviewed regarding surgery in ancient Egypt.Results:There is only one source indicating a urological procedure for medical indications in the Egyptian material.The Ebers papyrus can be interpreted as describing a surgical treatment for hydrocele.The sources are more abundant regarding male circumcision,while female circumcision is mainly documented from a later period.The suggestions that castration and lithotomy were performed are based on a lack of understanding of the sources.Conclusion:The ancient Egyptians did possibly treat hydrocele with a minor surgical procedure,but there are no indications in the sources that other urological procedures were performed.Circumcisions were common,but were not performed on a medical indication.These findings are in line with the general level of Egyptian surgery.

The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Objective:Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are increasingly being used to treat peritoneal malignancies.Urological resections and reconstruction(URR)are occasionally performed during the surgery.We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients.Methods:A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed.Outcomes between patients who had surgery involving,and not involving URR were compared.Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit(ICU)and hospital.Secondary outcomes were that of overall survival(OS)and prognostic factors that would indicate a need for URR.Results:A total of 214 CRS-HIPEC were performed,21 of which involved a URR.Baseline clinical characteristics did not vary between the groups(URR vs.No URR).Urological resections comprised of 52%bladder resections,24%ureteric resections,and 24%involving both bladder and ureteric resections.All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses,one ureto-uretostomy,five direct implantations into the bladder and three boari flaps.URR were more frequently required in patients with colorectal peritoneal disease(p Z 0.029),but was not associated with previous pelvic surgery(76%vs.54%,p Z 0.065).Patients with URR did not suffer more serious complications(14%vs.24%,p Z 0.42).ICU(2.2 days vs.1.4 days,p Z 0.51)and hospital stays(18 days vs.25 days,p Z 0.094)were not significantly affected.Undergoing a URR did not affect OS(p Z 0.99),but was associated with increased operation time(570 min vs.490 min,p Z 0.046).Conclusion:While concomitant URR were associated with an increase in operation time,there were no significant differences in postoperative complications or OS.Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours,and needs to be considered during pre-operative planning.

Urgent Urologic Surgery in Patients with Acute Coronary Syndrome

Urgent urologic interventions create a challenging scenario when they occur in patients suffering from concurrent acute coronary syndrome. Herewith we report two patients with this scenario. Case 1, a male patient was admitted with non-ST elevation myocardial infarction in which dual antiplatelet therapy was initiated. He developed symptomatic right obstructive uropathy. Case 2, a male patient developed non-ST elevation myocardial infarction and was commenced on dual antiplatelet therapy. Subsequently, he developed gross hematuria unresponsive to conservative measures. Urgent urological intervention was carried out while on aspirin in both cases with uneventful recovery. Upon coronary angiography, both cases were found to have multi-vessel disease requiring coronary artery by-pass graft later. Due to their concurrent urologic problems the patients described were not optimized fully to undergo coronary angiography. In close collaboration with cardiology, patients with acute coronary syndrome can be carefully selected to undergo urgent urologic interventions prior to coronary angiography/primary coronary intervention.

Robotic surgery in pediatric urology

While robotic surgery has shown clear utility and advantages in the adult population,its role in pediatrics remains controversial.Pediatric-sized robotic instruments and equipment are not readily available yet,so certain modifications can be made in order to make robotic surgery successful in children.While the cost of robotic surgery remains high compared to open procedures,patients experience greater satisfaction and quality of life with robotic surgery.Robotic pyeloplasty is a standard of care in older children,and has even been performed in infants and re-do surgery.Other robotic procedures performed in children include heminephroureterectomy,ureteroureterostomy,ureteral reimplantation,urachal cyst excision,bladder diverticulectomy,and bladder reconstructive procedures such as augmentation,appendicovesicostomy,antegrade continence enema,bladder neck reconstruction and sling,as well as other procedures.Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection.Future improvements in technology with production of pediatric-sized robotic instruments,along with increases in robotictrained pediatric urologists and surgeon experience along each’s learning curve,will help to further advance the field of robotic surgery in pediatric urology.

Robotic nurse duties in the urology operative room:11 years of experience

The robotic nurse plays an essential role in a successful robotic surgery.As part of the robotic surgical team,the robotic nurse must demonstrate a high level of professional knowledge,and be an expert in robotic technology and dealing with robotic malfunctions.Each one of the robotic nursing team“nurse coordinator,scrub-nurse and circulating-nurse”has a certain job description to ensure maximum patient’s safety and robotic surgical efficiency.Well-structured training programs should be offered to the robotic nurse to be well prepared,feel confident,and maintain high-quality of care.

Natural orifice transluminal endoscopic surgery in urology: The Chinese experience

Objective:To describe the Chinese experience of natural orifice transluminal endoscopic surgery(NOTES)in urology.Methods:From December 2008 to May 2017,35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions(NOSE)were performed in China.The animal experiments included five kidney biopsies,24 nephrectomies and six partial nephrectomies.The clinical surgeries included 12 transvaginal NOSE(TV-NOSE),266 hybrid transvaginal NOTES(TV-NOTES)and 27 pure TV-NOTES.The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site(U-LESS)nephrectomies,four suprapubic-assisted laparoendoscopic single-site surgery(SA-LESS)nephroureterectomies,and three laparoscopic radical cystectomies.The hybrid TV-NOTES procedure included 210 nephrectomies,31 adrenalectomies,eight nephroureterectomies,13 partial nephrectomies,and four heminephrectomies.The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies.Results:A total of 29 animal experiments were successfully performed.One partial nephrectomy was converted to standard laparoscopic surgery.Two kidney biopsies and two nephrectomies were unsuccessful.A total of 297 clinical surgeries were successfully performed.Six patients who underwent hybrid TV-NOTES were converted to open surgery.Two patients who underwent pure TV-NOTES were converted to SA-LESS.There were 22 major complications,16 occurred intraoperatively and six postoperatively.The mean visual analog score(VAS)of 48 h after the operation was 2.5 points in TV-NOSE,2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES.The mean follow-up of 50.6(3.0-87.0)months showed that all patients were in good condition.The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES.The vaginal incision healed well.Conclusions:TV-NOSE and TV-NOTES are feasible,safe,and effective with little injury,low pain,fast recovery,and good cosmetic outcomes in properly selected patients.They are worth consideration for urological clinical practice.

Effect of ureteric stents on urological infection and graft function following renal transplantation

AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.RESULTS: Overall, 196(183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3%(12/277) with no difference between those with or without stents- 7/183 vs 5/102, P = 0.746. Overall, 54%(99/183) of stented patients developed a urological infection compared to 38.1%(32/84) of those without stents(P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent(Wald χ2 = 5.505, P = 0.019) and diabetes mellitus(Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.

Control Performance Evaluation of Serial Urology Manipulator by Virtual Prototyping

Prostatic hyperplasia and tumor are common diseases,and the minimally invasive surgery inserting the instruments through the urethra into the prostate is commonly conducted.Taking the robotic manipulator for such surgery into consideration,this paper analyses the workspace of the end effector,and proposes the distribution error of the fixed point and the tracking error of manipulator end effector on the cone bottom surface of the workspace as the basis for control implementation of the manipulator.The D-H coordinate system of the manipulator is established and the trajectory planning of the end effector in the Cartesian space is carried out.The digital model was established,and dynamics simulation was performed in Solidworks and Matlab/Simulink environment to guide the manipulator design.Trajectory mapping and synchronization control between virtual model and the actual manipulator are realized based on digital twin technique.The virtual manipulator can reflect the real-time state of the manipulator with data interaction by comparing the dynamics simulation results with the motor current values obtained by experiment.Experiment was carried out with PD feedback control and Newton-Euler dynamics based feedforward control to get the trajectory tracking characteristic of each motor,errors of the fixed point and tracking performance of the end effector of the manipulator.The results show that compared with PD feedback control,feed forward control implementation can achieve a reduction of 30.0%in the average error of the fixed point of the manipulator and a reduction of 33.3%in the maximum error.