Etiology, Pathogenesis, And Management Options Of Infra-Vesical Obstruction Due To Benign Prostatic Hyperplasia, Urinary Bladder Stone, Or Both: Review Article

Abstract Background: Urinary bladder stones may be a primary stone formed in the urinary bladder or migrating calculus from the upper urinary tract. Bladder stones become more symptomatic when associated with infra-vesical obstruction.The most common cause of infra-vesical obstruction in elderly men is benign prostatic hyperplasia. Benign prostatic hyperplasia can be identified clinically by a complex of symptoms. These symptoms, known as lower urinary tract symptoms, range from incomplete emptying, weak stream, nocturia, and increased urinary frequency, and can potentially progress to urinary urge incontinence and urinary retention. About 35% of elderly men above fifty years will seek medical advice and have medical treatment for infra-vesical obstruction. About 24% of patients with mild to moderate LUTS will undergo surgical management for BPH. The strong association between infra-vesical obstruction due to benign prostatic hyperplasia and urinary bladder stones has led to the dogma that any BPH associated with bladder stones should be managed surgically. This study aims to review the etiology, pathogenesis, and management options of infra-vesical obstruction caused by BPH, urinary bladder stones, or both. We have searched literature in the American National Center for Biotechnology Information (NCBI), PubMed, Google scholar, Egyptian bank of knowledge,and science direct

A comparative study between dexmedetomidine and propofol in combination with fentanyl for conscious sedation during extracorporeal shock wave lithotripsy

Background: Extra-corporeal shock wave lithotripsy (ESWL) is a painful procedure. Sufficient analgesia is mandatory to achieve good treatment results, as well as patient compliance and comfort. Dexmedetomidine, owing to its sedative and its analgesic effects, may be suitable for conscious sedation during ESWL. The aim of this study was to evaluate the use of dexmedetomidine compared with propofol for its safety and efficacy during ESWL. Patients and methods: Fifty-two patients were randomly divided into 2 groups that received either dexmedetomidine or propofol for elective ESWL. A dose of 1.5 μg/kg of fentanyl was given intravenously (IV) to all patients 10 min before the ESWL procedure. In the dexmedetomidine group, patient received an initial loading dose of 1 μg/kg of dexmedetomidine infused IV over 10 min, followed by an infusion rate of 0.3 μg/kg/h. In the propofol group, the initial loading dose of 1 mg/kg of propofol was infused IV over 10 min, followed by an infusion rate of 3 mg/kg/h. The Observer’s Assessment of Alertness/Sedation (OOA/S) scores, visual analog scale (VAS), and hemodynamic and respiratory variables were recorded regularly at 5-min interval during ESWL. Hospital discharge time was determined according to Kortilla’s criteria for outpatient surgeries. Results: The OOA/S scores in the dexmedetomidine group at the 25- to 45-min assessments were significantly lower than those seen in the propofol group (P  0.05). Conclusion: Dexmedetomidine with fentanyl can be used safely and effectively, and it may be a valuable alternative to propofol with fentanyl for conscious sedation during ESWL

Management of long segment anterior urethral stricture (≥ 8cm) using buccal mucosal (BM) graft and penile skin (PS) flap: outcome and predictors of failure

ABSTRACT Purpose To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. Patients and methods Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. Results Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure

Risk factors for ureteroenteric stricture after radical cystectomy and urinary diversion: A systematic review

ABSTRACTIntroduction Ureteroenteric stricture (UES) is the leading cause of renal function deterioration after radical cystectomy (RC) and urinary diversion (UD). The aim of the present review is to summarize studies that discussed the risk factors associated with UES development. Identifying the responsible factors is of importance to help surgeons to modify their treatment or follow-up strategies to reduce this serious complication.Materials and Methods A comprehensive search of the literature using the PubMed database was conducted. The target of the search was only studies that primarily aimed to identify risk factors of UES after RC and UD. References of searched papers were also checked for potential inclusion.Results The search originally yielded a total of 1357 articles, of which only 15 met our inclusion criteria, comprising 13, 481 patients. All the studies were observational, and retrospective published between 2013 and 2022. The natural history of UES and the reported risk factors varied widely across the studies. In 13 studies, a significant association between some risk factors and UES development was demonstrated. High body mass index (BMI) was the most frequently reported stricture risk factor, followed by perioperative urinary tract infection (UTI), robotic-assisted radical cystectomy (RARC), occurrence of post-operative Clavian grade ≥ 3 complications and urinary leakage. Otherwise, many other risk factors were reported only once.Conclusion The literature is still lacking well-designed prospective studies investigating predisposing factors of UES. The available data suggest that the high BMI, RARC and complicated postoperative course are the main risk factors for stricture formation