Ahmed Refat El-Nahas

Objectives: To compare functional outcomes and complications of HoLEP using 22–26 F sheath. Patients and Methods: This retrospective analysis included data from patients who underwent HoLEP between May 2023 and September 2024. Patients were divided into two groups: Group 1 (22 F sheath) and Group 2 (26 F sheath). Functional outcomes assessed included International Prostate Symptom Score (IPSS), maximum flow rates (Q-max), and postvoid residual (PVR). Assessed complications were incidence of stress and urge incontinence, and urethral stricture. Follow-up was done at 1, 3, 6, and 12 months. Results: A total of 190 patients were included (94 in Group 1 and 96 in Group 2). Intraoperative complications (two patients in group 2) and re-admission rates (one patient for each group for clot retention) were comparable. No major complications were reported. Group 1 demonstrated significantly lower IPSS scores at all follow-up intervals. Starting from third month follow-up, Q-max was significantly better for group 2. PVR was significantly better in group 2 in all follow-up intervals. Transient stress urinary incontinence rates were lower in group 1 at one and three months ( P < 0.001 and 0.045 respectively). Then both groups had comparable results. Urge urinary incontinence rates were lower in group 1 at one month ( P = 0.001), then they became comparable. Urethral stricture rates were 3.2% for 22 F group versus 6.2% for 26 F group, P = 0.321. In multivariate analysis, Sheath size was the only independent predictor of overall complications where odds ratio for 26 F sheath was 3.123, 95%CI: 1.15–8.48, P = 0.025). Conclusions: The use of 22 F sheath in HoLEP showed improving IPSS and better early continence. The use of 26 F sheath resulted in better urine flow but was associated with more overall complications.

Purpose: To determine predictors for missing trifecta in patients who underwent flexible ureteroscopy (FURS) for treatment of renal and upper ureteric calculi. Patients and Methods: The data of adult patients with renal or upper ureteral stones who underwent FURS from June 2021 through December 2022 were retrospectively reviewed. Stone-free status (no residual stones > 3 mm) was evaluated after 3 months with non-contrast CT. Modified Clavien classification was used to grade complications. A stone-free status after a single intervention of FURS without complications was defined as trifecta. Patients were divided into two groups (trifecta and non-trifecta). Risk factors for missing trifecta were compared between both groups using univariate and multivariate analyses. Results: Three hundred twenty-three patients with mean age 48.9 +/- 13 years and mean stone length 16 +/- 5.9 mm were included. The trifecta criteria were applicable for 250 patients (71%). On multivariate analysis, risk factors for missing trifecta were stone multiplicity (OR: 3.326, 95%CI: 1.933-5.725) and non-experienced surgeons (OR: 1.819, 95%CI: 1.027-3.220). Conclusions: Multiple stones and performance of FURS by non-experienced surgeons are the independent risk factors for missing trifecta of FURS.

Introduction and Purpose: Extracorporeal shockwaves lithotripsy (SWL) is the treatment of choice for small non-complicated upper urinary tract calculi because of its non-invasive nature. This review is intended to provide practical guidance for urologists to optimize the use of SWL in clinical practice in order to achieve the maximum stone-free rate and minimize the incidence and severity of complications.. Methods: A PubMed search using the keywords SWL, extracorporeal shockwaves, and ESWL was conducted for articles published in the past 20 years. In addition, recent international guidelines of urolithiasis were reviewed. Results: All relevant research articles, reviews and metanalyses were read to construct a clinically oriented guidance for indications, contraindications, pre-SWL preparation, patients’ management during and after SWL session, and methods to improve efficiency. Conclusions: The keys to achieve best stone-free rates with minimal complications after SWL are proper patients’ selection, adherence to guidelines recommendations to improve stone disintegration, and adequate follow-up till elimination of the stone fragments.

Objectives: To assess the ideal interval between repeated shockwaves lithotripsy (SWL) for renal stones. Patient and Methods: Eligible patients with a single renal stone ≤20 mm who required SWL were randomly assigned to one of three groups based on intervals between 1st and 2nd sessions. Patients underwent the 2nd session after 3, 7, and 14 days in groups 1, 2, and 3 respectively. Tubular functions were assessed through comparisons of urinary execration of Kidney Injury Molecule-1 (KIM-1), Neutrophil Gelatinase Associated Lipocalin (NGAL), and Interleukin-18 (IL-18) with pre-SWL values. While glomerular function was assessed by comparisons of protein/creatinine ratio with pre-SWL and changes in ipsilateral renal function on isotope scans. Treatment success was assessed by non-contrast CT after 3 months. Results: All demographics of the 166 patients included in the study were comparable between the three groups. There were significant elevations of tubular biomarkers and protein/creatinine ratio after 1st and 2nd SWL sessions when compared to pre-SWL values (P<0.0001). All tubular biomarkers returned to pre-SWL values at 7 and 14 days after second session while they remained significantly elevated 3 days after second session (P=0.027, <0.001 and <0.001 for KIM-1, NGAL, and IL-18 respectively). SWL success was 73.6% in Group 1, 83.7% in Group 2, and 81% in Group 3. A significant decrease in ipsilateral renal split function was observed in group 1 at the 3-month follow-up. Conclusions: An interval of 7 days is required between SWL sessions when treating renal stones to allow for complete recovery of kidney functions.

Safety of GreenLight™ laser prostatectomy (GL-LP) in patients with ongoing blood thinners has been proven. Yet, the possibility of drug manipulation makes it a less challenging situation compared t...

To examine the health-related quality of life (HRQoL) of patients with prostate cancer managed with active surveillance (AS) compared with those who receive definitive treatment using the Expanded Prostate Cancer Index Composite (EPIC) Survey. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched PubMed and ScienceDirect for articles published between April 2010 and April 2020. Eligible studies reported original data on the HRQoL of men undergoing AS for prostate cancer, including studies comparing AS to curative methods particularly radical prostatectomy, radiotherapy, and brachytherapy. We identified nine eligible articles, all were non-experimental observational studies of which seven were longitudinal and two were cross-sectional studies. The EPIC questionnaire was the main instrument used in all studies to assess the HRQoL. AS was noted to show the highest calculated mean score among management groups in all comparative studies at study endpoints including cross-sectional studies (95% confidence interval 2.17–5.75, P < 0.001). The maximum score deterioration for patients who were managed with AS in all studies was only 7.5 points (12.2%) after 2 years follow-up. AS had the least mean score decline among all management groups. Patients with a normal testosterone level were found to have high HRQoL scores. The number of prostate biopsies did not correlate with the HRQoL score. Patients with prostate cancer managed with AS report less impacts on their HRQoL compared to patients who receive definitive treatments. However, further high-quality research with long-term data are required to help both the patient and the physician in making a well-informed management decision.

Objectives: In performing mini-percutaneous nephrolithotomy (PCNL), we aimed at achieving the trifecta of stone-free status and no complications in a single treatment session. We analyzed our experience to determine negative predictors for achieving these three-fold goals. Patients and Methods: The data of all consecutive patients who underwent tubeless mini-PCNL between July 2015 and March 2020 in two hospitals were retrospectively reviewed. Stone-free was defined as no residual stones. Complications were recorded and graded according to modified Clavien classification. Patients were divided into two groups according to the outcome (trifecta and non-trifecta). Factors affecting the outcome were compared between both groups by using univariate and multivariate analyses to detect independent unfavorable risk factors. Results: The study included 944 patients with mean age 40.2 years (standard deviation: 13.6). The stone-free rate after one session of mini-PCNL was 90.7%. Auxiliary procedures were needed in 14 patients (1.5%). Complications were observed in 76 patients (8.1%). Trifecta was achieved in 792 patients (84%). Independent unfavorable risk factors in multivariate analysis were number of caliceal groups affected by the stones (relative risks were 1.95 to 2.27 and 5.7 for one, two, and three caliceal groups respectively) and number of percutaneous tracts (relative risk was 2.2). Stone size and complexity were not significant predictors of missing trifecta in multivariate analysis. Conclusions: Mini-PCNL can achieve a high rate of trifecta (84%) for different stone sizes and complexities. Stones distribution in multiple caliceal groups and multiple tracts are the independent unfavorable risk factor.

I have read with interest this retrospective study that reviewed the results of fluoroless endourological treatment of 183 cases of complex renal and ureteric stones. All cases were performed by an...