Penile Fracture at the Department of Urology and Andrology, University Hospital, Brazzaville

Objective: The objectives of this study, was to analyze epidemiological diagnosis, therapeutic option and evolutionary aspects. Materials and methods: This is a retrospective study regarding clinical data of nine penile fracture patients who have been admitted in the department of urology (university hospital, Brazzaville) from January 2006 to December 2018. The study parameters were: epidemiological, diagnosis, operative details, outcomes after treatment, and sexual disorders. Results: The mean age was 46.3 ± 14 years, ranged from 25 to 73 years. The etiology of penile fracture was coitus in 5 cases, masturbation in 3 cases and rolling of the penis on the bed in one case. 8 patients were managed surgically. The complications noticed in the postoperative period and during the follow-up visits were penile curvature in 2 cases, and erectyl dysfunction in 2 cases. Conclusion: The diagnosis of penile fracture remains clinic. Immediate surgical management is necessary for good functional result.

Epidemiological and Clinical Aspects of Male Infertility in Patients Consulting at the Urology Department of the Yaounde Central Hospital

Introduction: About 10 to 15% of couples in the world and 20 to 30% in Cameroon consult for infertility problems. Infertility is of male origin in 40% of cases. Our objective was to evaluate the epidemiological and clinical aspects of male infertility in our setting. Methods: This was a cross-sectional and descriptive study, with retrospective data collection from the files of patients received for male infertility, over 5 years and 6 months (from January 1st, 2016 to April 30th, 2021) at the Urology Department of the Yaounde Central Hospital. Phone calls were made to patients with incomplete records for completion following a verbal consent. Data reported on data collection forms were entered into a data entry form designed on CSPro software version 7.2. The database was later exported for descriptive statistics using the IBM SPSS software version 23. Qualitative variables were summarized in frequencies and percentages while quantitative variables were summarized in means with their standard deviations for normally distributed data, or medians and interquartile ranges otherwise. Results: Out of 110 patients whose records were analyzed, the median age was 37.0 years, with an interquartile range of 8.3, with 55.5% in the age group 30 to 39 years. Of these 95 (86.4%) were married, 58 (52.7%) were from the West region, 76 (69.1%) were employed. Past history was dominated by mumps 40 (36.4%), varicocele surgery 25 (22.7%), alcoholism 87 (79.1%) and smoking 15 (13.6%). A disorder of spermatogenesis was found in all our patients: 37 (33.6%) azoospermia, 27 (24.6%) asthenospermia and 26 (23.7%) oligospermia patients. Paraclinical evidence of chlamydia and gonococcal infections were found respectively in 38 (34.5%) and 14 (12.7%) patients, varicocele and testicular dystrophy respectively in 95 (86.4%) and 38 (34.5%) patients. Infertility was primary in 67 (60.9%) patients. Conclusion: Most patients with infertility were in their thirties, had risky social habits and comorbidities. An early start of health promotion activities, comorbidities prevention and early detection of spermogram abnormalities would make it possible to reduce the frequency of male infertility.

Treatment of Kidney Stones by Percutaneous Nephrolithotomy: Evaluation of the Results of the First Series of Our Experience in the Urology Department of the Idrissa Pouye General Hospital in Dakar

The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis;we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.

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.

Ambulatory Uretrocystoscopy in the Urology Andrology Department of Grand Mbour Hospital

Background: Urethrocystoscopy is a method of endoscopic exploration that allows direct visualization of the urethra and bladder for diagnosis or treatment of diseases of the lower urinary tract. Purpose: To determine the epidemiological profile of patients who underwent urethrocystoscopy and to present the indications and the results of this endoscopic examination. Patients and Methods: This is a retrospective, descriptive study of all patients who underwent outpatient urethrocystoscopy in the Urology and Andrology department of Grand Mbour hospital. The epidemiological data of the patients, the indications, the results of the endoscopic exploration and the additional procedures performed were entered and analyzed with Excel 2016. We performed descriptive statistics. Results: Of the 216 patients who underwent outpatient urethrocystoscopy, we counted 179 men (82.87%) and 37 women (17.13%). The sex ratio was 4.84. The mean age of the patients was 53.71 ± 18.76 years (age range 17 to 91 years). The main indications were lower urinary tract disorders (60.18%) and hematuria (28.70%). Endoscopic exploration revealed prostatic tumor in 69 patients (31.9%), 29 cases of bladder tumors (13.4%) and 19 cases of bilharzia cystitis (8.8%). The urethrocystoscopy was normal in 32 patients (14.8%). Conclusion: Urethrostoscopy is an endoscopic exploration examination that can be performed on an outpatient basis. Lower tract urinary disorders and hematuria were the main indications.

Study of Hemorrhoid Disease in the Department of General Surgery of the Cs Ref of the Commune I Bamako

This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemorrhoidal disease, to identify the contributing factors, describe the clinical and therapeutic aspects and analyze the surgical consequences. We collected 73 patients with an average age of 37.8 years (range: 19 years and 77 years) with a sex ratio of 2.5 in favor of men. We operated on 49 patients or 67.1% of cases. 71.2% of our patients were married and lived in Bamako. Schoolchildren and middle managers made up 39.8% of cases. 82.2% of patients were seen in ordinary consultation and 69.9% complained of progressive anal pain in 66.7% of cases. This pain was triggered by defecation in 88.2% of our patients. The contributing factors were dominated by constipation (53.4%), working in a seated position (41.1%) and a sedentary lifestyle (16.4%) of cases. Stage IV external hemorrhoids and hemorrhoidal thrombosis represented 53.8% of surgical indications. The most used surgical technique was that of Milligan-Morgan, i.e. 51.9% of cases and 45.2% of patients treated medically received a combination of transit regulator, venotonics and analgesics. The surgical aftermath was marked by hemorrhage (3 cases), delayed healing (5 cases), urinary retention (1 case) and scarring anal stenosis (1 case). The morbidity rate was 5.48% of cases and a zero mortality rate. The average length of hospitalization was 2 days with extremes of 1 and 5 days.

Education and training evolution in urolithiasis:A perspective from European School of Urology

Objective:With the worldwide increase in urolithiasis prevalence,the present study aimed to delineate and summarise recent evolutions in training for the management of urolithiasis.Methods:A PubMed search using the key words“simulation”,“training”,“ureteroscopy”,“RIRS”,“URS”,“percutaneous nephrolithotomy”,“PCNL”,“virtual reality”,“augmented reality”,“artificial intelligence”,“healthcare”,“curriculum”,and“assessment”was used to examine how education and training in urolithiasis have adapted over recent years.Focus was placed on the role of high-and low-fidelity simulation models,virtual reality and artificial intelligence,and standardised assessment and curriculum.Results:This review supports the necessity to incorporate technology,simulation,and other skill enhancement training modalities into surgical training.However,these cannot solely replace mentored training with an experienced professional supervisor.Whilst technological and simulation advancements are likely to prove increasingly important in urolithiasis training,it is just as important for stratification of robust curricula with validated assessment.We also propose a pathway for future training.Conclusion:Endourology subspeciality training programmes have successfully incorporated simulation model-based training for skill acquisition,refinement,and improving operative outcomes.Success is achieved by maintaining a delicate balance between machine and in person mentor-based training.A trainee-centred model that follows the proposed curriculum could aid this balance for the future generation of trainees.

Marker Ki-67 is a potential biomarker for the diagnosis and prognosis of prostate cancer based on two cohorts

BACKGROUND Prostate cancer(PCa)is a widespread malignancy,predominantly affecting elderly males,and current methods for diagnosis and treatment of this disease continue to fall short.The marker Ki-67(MKI67)has been previously demonstrated to correlate with the proliferation and metastasis of various cancer cells,including those of PCa.Hence,verifying the association between MKI67 and the diagnosis and prognosis of PCa,using bioinformatics databases and clinical data analysis,carries significant clinical implications.AIM To explore the diagnostic and prognostic efficacy of antigens identified by MKI67 expression in PCa.METHODS For cohort 1,the efficacy of MKI67 diagnosis was evaluated using data from The Cancer Genome Atlas(TCGA)and Genotype-Tissue Expression(GTEx)databases.For cohort 2,the diagnostic and prognostic power of MKI67 expression was further validated using data from 271 patients with clinical PCa.RESULTS In cohort 1,MKI67 expression was correlated with prostate-specific antigen(PSA),Gleason Score,T stage,and N stage.The receiver operating characteristic(ROC)curve showed a strong diagnostic ability,and the Kaplan-Meier method demonstrated that MKI67 expression was negatively associated with the progression-free interval(PFI).The time-ROC curve displayed a weak prognostic capability for MKI67 expression in PCa.In cohort 2,MKI67 expression was significantly related to the Gleason Score,T stage,and N stage;however,it was negatively associated with the PFI.The time-ROC curve revealed the stronger prognostic capability of MKI67 in patients with PCa.Multivariate COX regression analysis was performed to select risk factors,including PSA level,N stage,and MKI67 expression.A nomogram was established to predict the 3-year PFI.CONCLUSION MKI67 expression was positively associated with the Gleason Score,T stage,and N stage and showed a strong diagnostic and prognostic ability in PCa.

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.

Genetic variation of circHIBADH enhances prostate cancer risk through regulating HNRNPA1-related RNA splicing

The current study aimed to investigate associations of circRNAs and related genetic variants with the risk of prostate cancer(PCa)as well as to elucidate biological mechanisms underlying the associations.We first compared expression levels of circRNAs between 25 paired PCa and adjacent normal tissues to identify riskassociated circRNAs by using the MiOncoCirc database.We then used logistic regression models to evaluate associations between genetic variants in candidate circRNAs and PCa risk among 4662 prostate cancer patients and 3114 healthy controls,and identified circHIBADH rs11973492 T>C as a significant risk-associated variant(odds ratio=1.20,95%confidence interval:1.08-1.34,P=7.06×10^(-4))in a dominant genetic model,which altered the secondary structure of the corresponding RNA chain.In the in silico analysis,we found that circHIBADH sponged and silenced 21 RNA-binding proteins(RBPs)enriched in the RNA splicing pathway,among which HNRNPA1 was identified and validated as a hub RBP using an external RNA-sequencing data as well as the in-house(four tissue samples)and publicly available single-cell transcriptomes.Additionally,we demonstrated that HNRNPA1 influenced hallmarks including MYC target,DNA repair,and E2F target signaling pathways,thereby promoting carcinogenesis.In conclusion,genetic variants in circHIBADH may act as sponges and inhibitors of RNA splicing-associated RBPs including HNRNPA1,playing an oncogenic role in PCa.

Symptomatic Urinary Lithiasis: Epidemiology and Management at Urology Department of University Hospital of Cotonou

Purpose: To study the epidemiology and treatment modalities of urolithiasis at Urology Department of University Hospital of Cotonou. Materials and Methods: It was a retrospective and descriptive study over a 10 years period ranging from January 1st, 2004 to December 31st, 2013. One hundred and two patients who were hospitalized for symptomatic urolithiasis at the Urology Department of University Hospital of Cotonou were enrolled. Results: Hospital incidence of urolithiasis was 3.7%. Patients mean age was 39.6 years (extremes: 10 years to 73 years). Male to female ratio was 2.2. The main reason for consultation was renal colic for 81 patients (79.4%). Average duration of symptoms at presentation was 5 months (range: 1 day to 10 years). A total of 173 stones were identified with an average size of 12 mm (range: 1 mm to 95 mm). Calyceal stones were seen in 32.9% of cases, renal pelvis stones in 21.4% of cases, ureteral stones in 34.1% and bladder stones in 11.5% of cases. Open surgery was the main treatment for stones that could not be managed medically. 50.8% of patients underwent surgery with extraction of 116 stones. This represented 67.1% of all stones. 9 patients (8.8%) had expelled their stone during urination. The postoperative course was uneventful in 77.5% of cases. Conclusion: Modern treatment options for urolithiasis remain rudimentary in our health facilities. Open surgery is still the main stay of treatment in our countries with limited resources.

ArtiSentialTM Revolutionizes Traditional Laparoscopy in Urology by Introducing the Dexterity of a Robotic System to a Laparoscopic Instrument —First Experiences in Urology in Europe by the Ukrb in Neuruppin

We describe the first two conventional, laparoscopic renal operations with a new multi-degree of freedom articulated single-use laparoscopic instrument (ArtiSentialTM). The two patients underwent different laparoscopic interventions at Ukrb University (Neuruppin, Germany): nephrectomy and Anderson-Hynes-pyeloplasty. All procedures were completed, with no need for conversion or placement of additional ports. No intraoperative complications or technical failure of the instrument was recorded. The mean operative time was 180 min median length of stay was 11.5 d. The instrument could be opened out of the sterile packaging and used at once when it was needed, because it is a single-use instrument. There was real haptical feedback and the costs are minimal compared to robot surgery. The use was straightforward and rapid processes after an intensive training of 4 h in a dry lap. Awaiting future investigations in larger series, this study proves the safety and feasibility of renal surgery with ArtiSentialTM and provides relevant data that may help early adopters of this surgical instrument.

Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes

Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature.However,existing studies are small,heterogeneous case series.The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.Methods:We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men.Articles in non-English,author replies,editorials,pediatric-based studies,and reviews were excluded.Outcomes of interest were patency and incontinence rates,which were pooled when appropriate.Results:After identifying 158 articles on initial search,we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction.All were case series published from March 2018 to March 2022 ranging from six to 32 men,with the median follow-up of 5e23 months.A total of 119 patients were included in our analysis.A variety of etiologies and surgical techniques were described.Patency rates ranged from 50%to 100%,and pooled patency was 80%(95/119).De novo incontinence rates ranged from 0%to 33%,and pooled incontinence was 17%(8/47).Our findings were limited by small sample sizes,relatively short follow-ups,and heterogeneity between studies.

Prevention of complications in endourological management of stones:What are the basic measures needed before,during,and after interventions?

Objective:This narrative review aims to describe measures to minimise the risk of complications during percutaneous nephrolithotomy(PCNL),ureteroscopy,and retrograde intrarenal surgery.Methods:A literature search was conducted from the PubMed/PMC database for papers published within the last 10 years(January 2012 to December 2022).Search terms included“ureteroscopy”,“retrograde intrarenal surgery”,“PCNL”,“percutaneous nephrolithotomy”,“complications”,“sepsis”,“infection”,“bleed”,“haemorrhage”,and“hemorrhage”.Key papers were identified and included meta-analyses,systematic reviews,guidelines,and primary research.The references of these papers were searched to identify any further relevant papers not included above.Results:The evidence is assimilated with the opinions of the authors to provide recommendations.Best practice pathways for patient care in the pre-operative,intra-operative,and post-operative periods are described,including the identification and management of residual stones.Key complications(sepsis and stent issues)that are relevant for any endourological procedure are then be discussed.Operation-specific considerations are then explored.Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury.The role of endoscopic combined intrarenal surgery in this regard is discussed.Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury.The role of anaesthetic assessment is discussed.The importance of specific comorbidities on each step of the pathway is highlighted as examples.Conclusion:This review demonstrates that the principles of meticulous planning,interdisciplinary teamworking,and good operative technique can minimise the risk of complications in endourology.

Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they should be a part of every urologist's technical education.

Prognostic role of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with non-metastatic and metastatic prostate cancer:A meta-analysis and systematic review

Objective: To analyze data available in the literature regarding a possible prognostic value of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in prostate cancer (PCa) patients stratified in non-metastatic and metastatic diseases.Methods: A literature search process was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. In our meta-analysis, the pooled event rate estimated and the pooled hazard ratio were calculated using a random effect model.Results: Forty-two articles were selected for our analysis. The pooled risk difference for non-organ confined PCa between high and low NLR cases was 0.06 (95% confidence interval [CI]: −0.03-0.15) and between high and low PLR cases increased to 0.30 (95% CI: 0.16-0.43). In non-metastatic PCa cases, the pooled hazard ratio for overall mortality between high and low NLR was 1.33 (95% CI: 0.78-1.88) and between high and low PLR was 1.47 (95% CI: 0.91-2.03), whereas in metastatic PCa cases, between high and low NLR was 1.79 (95% CI: 1.44-2.13) and between high and low PLR was 1.05 (95% CI: 0.87-1.24).Conclusion: The prognostic values of NLR and PLR in terms of PCa characteristics and responses after treatment show a high level of heterogeneity of results among studies. These two ratios can represent the inflammatory and immunity status of the patient related to several conditions. A higher predictive value is related to a high NLR in terms of risk for overall mortality in metastatic PCa cases under systemic treatments.

Diagnosing upper tract urothelial carcinoma: A review of the role of diagnostic ureteroscopy and novel developments over last two decades

Objective: The role of ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the field.Methods: A literature search of the last two decades (from 24th May, 2001 to 24th May, 2021) was carried out identifying 147 papers for potential inclusion within this narrative review.Results: Diagnostic ureteroscopy is undeniably useful in its ability to visualise and biopsy indeterminate lesions, and to risk stratify malignant lesions that may be suitable for kidney sparing surgery. However, an increased risk of intravesical recurrence following nephroureterectomy when a prior diagnostic ureteroscopy has been performed, inadequate sampling at biopsy, complications from the procedure, and difficult ureteric access are all potential drawbacks. Furthermore, whilst generally an accurate diagnostic procedure, it risks missing carcinoma in-situ lesions. Despite this, evidence shows that routine use of ureteroscopy changes the management of patients in a large proportion of cases, preventing unnecessary surgery or facilitating kidney sparing surgery. The overall rate of complications is low, and improved biopsy techniques and the use of tissue biomarkers for improved staging and grading are encouraging. The risks of delays to definitive management and post-ureteroscopy intravesical recurrence do not seem to affect survival, and trials are in progress to determine whether intravesical therapy can mitigate the latter. Further promising techniques are being investigated to improve shortcomings, particularly in relation to improved diagnosis of carcinoma in situ and preoperative staging.Conclusion: Ureteroscopy has a role in the diagnosis of upper tract malignancy, though whether it should be used routinely is yet to be determined.

Transurethral Resection of the Prostate (TURP) —An Experience of the Urology Department of the University Hospital of National Reference of N’Djamena (TCHAD)

Introduction: Transurethral Resection of the Prostate (TURP) is a multi-invasive technique in the management of Benign Prostatic Hyperplasia. It constitutes a reference in developed countries;however in sub-Saharan Africa, it is prostatic adenomectomy which is mostly used. The aim was to analyze the results of the TURP carried out at the General National Reference University Hospital in N’Djamena (Chad). Patients and Methods: This is a retro-prospective study which extended over a period of 2 years, from June 2014 to May 2016. The records of all patients who had undergone TURP during this period were listed and analyzed. We did frequencies and average calculations. Results: 59 patients’ results that were treated with TURP were collected. TURP represented 33.4% of all interventions performed for prostate pathologies. The average age of our patients was 66 ± 8.06 years (50 to 92). Urinary retention was the main reason for consultation (45.7%;n = 27) followed by dysuria (27.1%;n = 16). TURP was associated with another procedure in 28.8% (n = 17). The average duration of hospitalization of our patients was 4.15 days with extremes of 2 to 9 days. Perioperative complications represented 13.6% of cases, early complications represented 15.3% of cases and late complications represented 6.8% of cases. The postoperative voiding status with an average follow-up of 6 months was judged to be good in 72.8% of cases (n = 43). Conclusion: TURP occupies an important place in the management of prostate pathologies with precise indications. It offers many advantages. It must be popularized in our countries;this will make it possible to limit morbidity and mortality rates and slow down medical evacuations abroad.

Performance in the Fundamentals of Laparoscopic Surgery: Does it reflect global rating scales in the Objective Structured Assessment of Technical Skills in porcine laparoscopic surgery?

Objective:To correlate the utility of the Fundamentals of Laparoscopic Surgery(FLS)manual skills program with the Objective Structured Assessment of Technical Skills(OSATS)global rating scale in evaluating operative performance.Methods:The Asian Urological Surgery Training and Educational Group(AUSTEG)Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training.Delegates’basic laparoscopic skills were assessed using three different training models(peg transfer,precision cutting,and intra-corporeal suturing).They also performed live porcine laparoscopic surgery at the same workshop.Live surgery skills were assessed by blinded faculty using the OSATS rating scale.Results:From March 2016 to March 2019,a total of 81 certified urologists participated in the course,with a median of 5 years of post-residency experience.Although differences in task time did not reach statistical significance,those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks.However,they took longer to complete the precision cutting task than participants with less experience.Overall OSATS scores correlated weakly with all three FLS tasks(peg transfer time:r=0.331,r^(2)=0.110;precision cutting time:r=0.240,r^(2)=0.058;suturing with intracorporeal knot time:r=0.451,r^(2)=0.203).Conclusion:FLS task parameters did not correlate strongly with OSATS globing rating scale performance.Although FLS task models demonstrated strong validity,it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence,as evaluated by FLS and OSATS,respectively.

Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study

Objective:To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation(BD)for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence.Methods:This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019.Data about the patient age,stricture characteristics,and recurrence date were recorded,along with information on postoperative indwelling catheter use and operative complications.Furthermore,information about the self-calibration procedure was collected and where available,free flow(FF)measurements during the follow-up period were recorded and analyzed.Success was defined as a lack of symptoms and acceptable FF rates(maximum flow rate>12 mL/s).Results:The final analysis was conducted on 187 patients.The mean follow-up period was 37 months.The long-term overall success rate at the end of our study was 66.8%.Our recurrence rate was 7.4%at 12 months,24.7%at 24 months,and reached 33.2%at the end of our study.The time to recurrence ranged from 91 days to 1635 days,with a mean of 670 days.The stricture-free survival was significantly shorter with lengthy peno-bulbar(p=0.031)and multiple strictures(p=0.015),and in the group of patients who were not committed to self-calibration protocol(p<0.011).However,post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence(odds ratioZ5.85).Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4%in the non-self-calibration group to 15.1%in the self-calibration one(p<0.001),but also improved the overall stricture-free survival and FF parameters.