Insight Urology

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Phitsanu Mahawong — Tue, 26 Dec 2023 00:00:00 +0700

Editorial Board

Phitsanu Mahawong — Tue, 26 Dec 2023 00:00:00 +0700

Risk factors of Fournier’s gangrene associated with mortality in Sunpasittiprasong Hospital

Thanawin Chotruangprasert, Tri Hanprasertpong, Nawat Oulansakoonchai — Tue, 26 Dec 2023 00:00:00 +0700

Objective: To determine the mortality rate in patients with Fournier’s gangrene (FG) in Sunpasittiprasong Hospital and to identify potential risk factors associated with mortality among patients of FG.

Materials and Methods: This retrospective cohort study investigated patients diagnosed with FG in Sunpasittiprasong Hospital from 2016 to 2021. Data related to clinical presentation, demographics, comorbidities, etiology, laboratory investigation, and therapeutic intervention of the patients were recorded. Prognostic severity indexes were calculated. All factors were statistically analyzed using univariate and then multivariate analysis.

Results: Of 62 patients, the mortality rate was 29% (18 of 62). The significant risk factors for death included patients with kidney disease, septic shock, respiratory failure, acute kidney injury, low mean arterial blood pressure (MAP), admission to ICU and prolonged ventilator used. Risk factors from the laboratory data included abnormal coagulogram, high serum creatinine, lactate, and low bicarbonate. Some prognostic scoring systems were able to predict prognosis and mortality. Multivariate analysis revealed that patients with kidney disease (p = 0.007) or respiratory failure at presentation (p = 0.020) were significantly associated with mortality.

Conclusions: The significant risk factors associated with mortality among patients with FG were kidney disease or respiratory failure. Some prognostic scoring systems may be applied to Thai patients with FG to predict prognosis.

Efficacy of inhalation of a nitrous oxide and oxygen mixture for pain management during rigid cystoscopy: a randomized controlled trial

Tanawat Lohityothin, Valeerat Swatesutipan — Tue, 26 Dec 2023 00:00:00 +0700

Objective: To evaluate the efficacy of pain management using inhalation of a nitrous oxide and oxygen mixture during rigid cystoscopy.

Materials and Methods: A total of 55 patients were prospectively selected and randomized to receive oxygen (27) or Entonox (28). Both groups were given the respective gas for 3 minutes via breath-activated facemask before cystoscopy and continued to breathe the gas until the end of the procedure. The oxygen and Entonox groups received 20 ml 2% lidocaine gel intraurethral 15 minutes before the procedure. Heart rate, and numeric pain rating scales were recorded before, during, and after the cystoscopy.

Results: Fifty-five patients were randomized into two groups, 27 were given oxygen and 28 Entonox. There were no statistically significant differences between the groups in terms of baseline patient characteristics. Intraoperative rigid cystoscopy pain scores were significantly lower in the Entonox group than in the oxygen group (2.4 vs 4.2, p = 0.009). There were no significant differences between the two groups as regards postoperative pain, intraoperative and post-operative heart rates, and side effects.

Conclusion: Entonox significantly reduces intraoperative cystoscopy-related pain, without significant complications.

Postoperative infection after ureterorenoscopic lithotripsy in Songkhla Hospital

Nawaporn Kittaweerat, Kant Buaban, Pasu Tansakul — Tue, 26 Dec 2023 00:00:00 +0700

Objective: Ureterorenoscopic lithotripsy (URSL) is the procedure of choice for treatment of ureteral stones. Postoperative acute pyelonephritis (APN) is a serious complication after URSL which may potentially progress to urosepsis and death. In this study we aimed to explore and record potential predictive factors associated with postoperative APN after URSL.

Materials and Methods: Ninety patients (2016-2022) with ureteral stone managed with URSL were identified. Postoperative APN was defined in patients with a body temperature > 38 °C which persisted for at least 48 hours after URSL with clinical symptoms and/or urine culture was positive for organism growth. Multivariable analysis with logistic regression was used to identify predictive factors for postoperative APN.

Results: Seven patients (7.8%) experienced postoperative APN and six patients (85.7%) developed systemic inflammatory response syndrome. All patients were managed conservatively with selective antibiotics, specifically treated with meropenem (n = 3), piperacillin/tazobactam (n = 3), and imipenem/cilastatin (n = 1). Most patients with postoperative APN were women (5/7 patients, 71.4%). The median age of the seven postoperative APN patients was 57.6 vs 54 years (p = 0.48) and the hospital stay was longer 5 vs 2 days, (p < 0.01). Preoperative APN was found in 12 patients (13.3%) and six patients (50%) developed perioperative APN. The multivariable analysis, showed that the only independent factor of postoperative APN was a history of preoperative APN

Conclusion: Postoperative infection is a serious condition after URSL that can increase the risk of morbidity and mortality. A single significant risk factor for postoperative infection was a history of preoperative APN. These patients should receive rigorous postoperative care to avoid serious complications.

Clinical outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in benign prostatic hyperplasia patients in Rajavithi Hospital

Chawawat Gosrisirikul — Tue, 26 Dec 2023 00:00:00 +0700

Objective: To evaluate the outcomes and safety of the surgical technique holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) for whom surgeryis indicated.

Materials and Methods: The demographic characteristics, duration of surgery, blood transfusion rate, weight of tissue removed, catheterization time and complica- tions were recorded in 25 patients who underwent HoLEP surgery between January 2021 and May 2022 in Rajavithi Hospital. The International Prostate Symptom Score (IPSS), quality of life score (QoL), peak flow rate (Q-max), post-void residual urine volume (PVR), hematocrit (Hct) and prostate-specific antigen (PSA) levels were comparedbefore and after surgery.

Results: The mean age of the patients was 71.28±7.54 years. There were statistically significant differences between mean preoperative and postoperative Hct (%) (40.5± 5.9 and 38.4±5.1), p = 0.001. Only 1 in 25 patients had 1 unit of blood transfusion. One month postoperatively the mean PSA had decreased from 4.55 to 1.2 ng/ml (p < 0.001); mean IPSS had improved from 21.0 to 7.0 (p < 0.001); mean QoL score had improved from 4.47 to 1.10 (p < 0.001); mean PVR had decreased from 98.0 to 39.7 ml (p = 0.002) and the mean Q-max had increased from 8.0 to 17.8 ml/sec (p = 0.015). The mean catheterization time was 2.40±0.57 days. There were no serious complications or incidence of TUR syndrome in this study.

Conclusion: HoLEP is a safe alternative to the current gold standard transurethral resection of the prostate for BPH patients as there are fewer complications with similar functional outcomes

Editorial

Phitsanu Mahawong — Tue, 26 Dec 2023 00:00:00 +0700

Management of a long segment of bilateral ureteric injury: A combination of Boari flap and ureteroneocystostomy with psoas hitch

Praween Tubsaeng — Tue, 26 Dec 2023 00:00:00 +0700

Iatrogenic ureteric injuries are a relatively common complication of pelvic and gynecological surgeries which, if left untreated, could lead to medical and legal issues. Therefore, reconstruction of the ureter is still regarded as requiring a sophisticated approach which demands a specialist urologist. This case involves a post-hysterectomy and bilateral salpingo-oophorectomy 46-year-old woman who presented with a bilateral ureteric injury. A left Boari flap and right Lich-Gregoir ureteroneocystostomy with psoas hitch was performed for the correction of the bilateral long segment defect.

Phitsanu Mahawong — Tue, 26 Dec 2023 00:00:00 +0700

Instructions for Authors

Phitsanu Mahawong — Tue, 26 Dec 2023 00:00:00 +0700

Bibliometric analysis of the relationship between metabolic study and urolithiasis. A key tool in patient management

Tue, 26 Dec 2023 00:00:00 +0700

Objective: Our objective was doing an analysis of available bibliography to understand tendencies in publications regarding the role of metabolic evaluation in the management of urolithiasis.

Materials and Methods: A retrospective bibliometric analysis of the available medical literature ranging from the year 2001 to 2022 was performed on the Web of Science platform. The graph analysis was done using Microsoft Excel and the bibliographic mapping analysis was done on the VOSviewer software.

Results: A total of 120 references were found in 63 journals, with a decrease in the rate of publications in the last 5 years. The country, journal, and institution with the largest number of manuscripts were the United States, Journal of Urology, and the University of Bonn, respectively. The author with the largest number of publications was Sarica Kemal. The mapping and analysis of the keyword evolution with respect to the timeline centered on the terms: “prevention”, “metabolic risk factors”, “obesity”, “primary hyperoxaluria”, and “medical management”.

Conclusion: Metabolic evaluation is a fundamental tool in the overall approach of these patients. Despite the decrease in the rate of research on the association between metabolic evaluation and urolithiasis in recent years, the importance of a complete assessment of these patients from the first symptomatic episode has been demonstrated, as it helps to determine the risk of recurrence of the disease, and to establish a treatment plan focused on prevention. This first bibliometric analysis on metabolic evaluation and urolithiasis depicts the importance of giving continuity to research on the risk factors of urolithiasis that may be modified and treated.

Urological malignancies in kidney transplant recipient patients

Peng Hong Min, Simone Ong, Tiong Ho Yee — Tue, 26 Dec 2023 00:00:00 +0700

Kidney transplantation is now established as the ideal treatment option for end-stage renal disease (ESRD) and renal cell carcinoma (RCC) patients. Since the first kidney transplant in the 1970s, research has allowed us to understand the long term sequelae of kidney transplant patients (TXPs) including the risks of increased malignancy from immunosuppression.

Insight Urology

Cover

Editorial Board

Risk factors of Fournier’s gangrene associated with mortality in Sunpasittiprasong Hospital

Efficacy of inhalation of a nitrous oxide and oxygen mixture for pain management during rigid cystoscopy: a randomized controlled trial

Postoperative infection after ureterorenoscopic lithotripsy in Songkhla Hospital

Clinical outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in benign prostatic hyperplasia patients in Rajavithi Hospital

Editorial

Management of a long segment of bilateral ureteric injury: A combination of Boari flap and ureteroneocystostomy with psoas hitch

Contents

Instructions for Authors

Bibliometric analysis of the relationship between metabolic study and urolithiasis. A key tool in patient management

Urological malignancies in kidney transplant recipient patients