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Purpose: To address the pattern of urodynamic findings in diabetic patients with lower urinary tract symptoms (LUTS), comparing short-standing and long-standing type 2 diabetes mellitus (T2DM). Methods: A prospective study was conducted on 50 patients presenting with LUTS and a concurrent diagnosis of T2DM, between February 2016 and May 2018. Patients were classified and evaluated according to the duration of diabetes into two groups: short-standing DM (< 15 years, n = 31), and long-standing DM (= 15 years, n = 19) groups. The impact of LUTS and quality of life were assessed in female patients using ICIQFLUTS and male patients using ICIQ-MLUTS. Results: A total of 50 patients were included in the study. The mean duration of T2DM was 10 ± 0.7 years. The mean age was 56.3 ± 1.2 years, and the mean HbA1c was 7.5 ± 1.2%. Urodynamic evaluation detected significantly higher detrusor overactivity (DO) and increased bladder sensation with the short-standing DM group (35.5 vs. 15.8%, p = 0.01 and 32.3 vs. 5.3%, p = 0.01, respectively). Comparatively, weak, or absent detrusor contractility were more frequent in patients with longstanding DM (52% and 26% respectively p = 0.01). As expected, overflow incontinence and straining during voiding were significantly higher in the long-standing DM group (p = 0.04 and p = 0.03, respectively). Surprisingly, there was no significant correlation between patients presenting with urgency in their voiding diary (subjective) and urodynamic detection of DO (p = 0.07). Conclusions: There are different patterns in urodynamic characterizations of T2DM. Patients with short-standing DM present more commonly with storage symptoms and detrusor overactivity on urodynamics. Contrastingly, patients with long-standing DM present more frequently with voiding symptoms and detrusor underactivity on urodynamics. Thus, screening for an underactive bladder is advisable in patients with long-standing T2DM. [ABSTRACT FROM AUTHOR]

Introduction: Siliconoma represents an inflammatory tissue response to extravasated silicone. Penile enhancing silicone injections have been described for over 50 years. Most of the publications report complications including negative effects on penile appearance and function which require corrective procedures. Penile circumferential skin and siliconoma excision with skin grafting has been described in multiple case reports and series as an effective and feasible option to remove the silicone and achieve good esthetic results. Methods: We describe a simple and feasible single stage procedure removing the siliconoma with adjacent non-viable skin while preserving 50% of healthy penile skin and resurfacing the defect with a split-thickness skin graft to treat a long-term complication of penile silicone injection associated with recurrent infections and a chronic skin ulceration. Conclusion: Partial excision of the affected penile skin and siliconoma with defect resurfacing with a split-thickness skin graft is a feasible with good functional and cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Objective: To quantify the predictors for the ancillary treatments after extracorporeal shock wave lithotripsy (SWL) for renal and upper ureteral stones. Materials and methods: From January 2014 to January 2017, patients undergoing SWL using an electromagnetic lithotripter machine (Compact Delta; Dornier MedTech GmbH, Wessling, Germany) for renal and upper ureteral stones = 20 mm were retrospectively reviewed. All patients underwent CT urography prior to SWL. The cohort was subdivided into three groups according to stone attenuation values in Hounsfield Units (HU). Group I; HU < 500 (n = 20), group II; HU 500-1000 (n = 51) and group III; HU = 1000 (n = 180). The parameters included for multivariate analysis were stone size, location, multiplicity, stone attenuation value, number of shocks and stone clearance rate by 3 months. The ancillary treatments were ureteroscopy (URS), ureteral stenting and hospital readmission for pain or fever. Results: A total of 251 patients were included in the study. The overall SWL success rate was 92.4%. Mean stone size was 10.9 ± 2.1, 11.6 ± 3 and 11.4 ± 3.6 mm and mean stone attenuation values were 364 ± 125, 811 ± 154 and 1285 ± 171 HU for groups I, II and III respectively. The stone clearance rates by 3 months were 96%, 92% and 88.4% for groups I, II and III respectively. On subgroup analysis, group III required ancillary treatments in 70% of patients whereas group I, II, did not require any ancillary treatments. On multivariate analysis, stone multiplicity, stone location (lower calyceal stones) and HU were independent significant predictors for the need for ancillary treatments after SWL (p values < 0.05). Conclusions: Patients with stone attenuation value (HU) > 1000, multiple stones and/or lower calyceal stones have higher risk to necessitate ancillary treatments after SWL. These patients would likely benefit from upfront endoscopic lithotripsy for treating symptomatic renal or upper ureteral stones. [ABSTRACT FROM AUTHOR]

Introduction: Penile compression using a tourniquet is common with several materials and designs that have been previously described. The objective of the tourniquet is to induce an artificial erection through corporal occlusion for intra-operative penile curvature assessment or to obtain a clear visible bloodless surgical field. Objective: We sought to describe our novel step-by-step technique of applying penile tourniquet using silicone Penrose drain tube designed as a strap by creating a small hole on the side of the tube to obtain a loop at the base of the penis Conclusions: This novel technique is simple, effective and requires no additional materials nor special equipment, and facilitates the application and release of a tourniquet during penile surgery. [ABSTRACT FROM AUTHOR]