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Introduction: Benign prostatic hyperplasia (BPH) is the enlargement of the prostate gland, primarily occurring in aging men, in which transforming growth factor-beta (TGF-ß) plays a critical role in prostate cell hyperproliferation and leads to uncomfortable urinary symptoms in BPH patients. Pterocarpus indicus Willd. is well known for its ethnopharmacological applications for treating ailments such as diuresis and bladder stones. Methods: This study aimed to examine the effect of P. indicus extract (PI extract) on TGF-ß-induced WPMY-1 cell proliferation, followed by bioassay-guided fractionation to isolate the active metabolites. Angolensin (Ang) and maackiain (Mac) were isolated from bioassay-guided fractionation. Network analysis was performed to investigate the potential mechanisms. Furthermore, network analysis of the Ang-Mac combination in BPH highlighted the potential top ten pathways, including PI3K/AKT signaling pathway. Accordingly, subsequent investigation focused on evaluating the effect of PI extract, Ang, Mac, and Ang-Mac combination on the expression of PCNA, p53, and PI3K/AKT protein localization and expression. Methods: This study aimed to examine the effect of P. indicus extract (PI extract) on TGF-ß-induced WPMY-1 cell proliferation, followed by bioassay-guided fractionation to isolate the active metabolites. Angolensin (Ang) and maackiain (Mac) were isolated from bioassay-guided fractionation. Network analysis was performed to investigate the potential mechanisms. Furthermore, network analysis of the Ang-Mac combination in BPH highlighted the potential top ten pathways, including PI3K/AKT signaling pathway. Accordingly, subsequent investigation focused on evaluating the effect of PI extract, Ang, Mac, and Ang-Mac combination on the expression of PCNA, p53, and PI3K/AKT protein localization and expression. cells. This study suggests that PI extract, Ang, and Mac are promising compounds for treating BPH, as evidenced by in silico and in vitro studies. Additionally, Ang and Mac could be used to standardize PI extract in future investigations. [ABSTRACT FROM AUTHOR]

Introduction: Although laparoscopic cholecystectomy has replaced the open surgery for management of gall bladder stones, however, bile duct stones or choledocholithiasis remains to be a challenging task. Bile duct stones are seen in almost every 7th to 10th patient having gall bladder stonesi. There is controversy regarding the ideal approach for management of common bile duct (CBD) gallstones, more so, in view of availability of multiple options. Until the laparoscopic and endoscopic modalities came into picture, open cholecyststectomy was the only procedure for CBD exploration. Materials and methods: Prospective Study was done in all patients with a diagnosis of choledocholithiasis in OPD in surgery department at Era's Lucknow Medical College and hospital posted for elective surgery. All the patients above 18 years of age presenting with uncomplicated choledocholithiasis undergoing elective CBD exploration were included. Patients with cholangitis, gall stone pancreatitis, abnormal liver enzymes (greater than thrice the upper limit of normal), immunocompromised patient were excluded. All patients with a diagnosis of choledocholithiasis in surgery OPD at ELMCH were chosen by SNOSE technique for open and laparoscopic CBD exploration. Demographic information was obtained. Blood specimen were obtained for hematological and biochemical assessment. Pre-operative sonographic assessment was also done and stone size was assessed. All patients received preoperative parental broad spectrum antibiotics. All procedures were operated by the same experienced surgical team, under general anesthesia. Results: Out of a total of 88 patients enrolled in the study, a total of 44 (50%) underwent CBD exploration using laparoscopic procedure and comprised the Group 1 of study whereas remaining 44 (50%) patients underwent CBD exploration using open procedure and comprised the Group 2 of study. Majority of patients in both the groups were female. Proportion of males was 36.4% and 34.1% respectively in Groups 1 and 2. Overall, there were 31 (35.2%) males and 57 (64.8%) females. On comparing the data statistically, no significant difference was observed between the two groups with respect to sex of the patients (p=0.823). Mean neutrophil, lymphocyte eosinophil and monocyte count was 68.45±7.19, 26.45±7.51, 4.23±1.79 and 0.82±1.02% respectively in Group 1 as compared to 68.30±7.61, 27.32±7.69, 3.95±1.82 and 0.61±1.10% respectively in Group 2. For none of these variables, the difference between two groups was significant (p>0.05). Mean prothrombin time and INR were 12.12±1.62 seconds and 0.70±0.14 respectively in Group 1 as compared to 12.20±1.47 seconds and 0.68±0.11 respectively in Group 2. Statistically, there was no significant difference between two groups for both these parameters (p>0.05). Conclusion: The findings of the study show that except for a slightly longer duration of procedure, laparoscopic procedure was associated with fewer complications (intraoperative blood loss, post-operative infection, wound dehiscence, residual stones and Incisional hernia), shorter duration of post-operative hospital stay and cheaper overall cost. Thus laparoscopic exploration of CBD offered a better clinical outcome with fewer outcomes and could be recommended as the preferred modality for exploration of CBD. [ABSTRACT FROM AUTHOR]

To determine the rate of stone formation amongst patients of the exstrophy-epispadias complex with augmentation cystoplasty. We hypothesize that bowel segment choice influences the rate of stone formation after bladder augmentation and the rate of complications from bladder stone surgery. An IRB-approved institutional database of 1512 exstrophy-epispadias patients was reviewed retrospectively. Patients that had a history of bladder augmentation and were seen at our institution between 2003 and 2023 were included. Out of 259 patients, bladder stones developed in 21.6% (56), of which the bowel segment used was colon in 147 patients and ileum in 100. Stones formed in 19% of colon augments compared to 29% ileal augments, however, this was not statistically significant (P =.07). The most common primary stone component was dahllite, followed by struvite for all augments (Table 1). The median time to stone treatment after augmentation was 4.14 years (0.75-31). Seventy-four percentage of patients had a recurrence that required a second surgery. The median time from first to second surgery and second to third surgery was 1.4 years and 2.22 years, respectively. Bladder stone surgery complications occurred in 14% of patients, vesicocutaneous fistula being the most common, and complications did not differ by augment type. Median follow-up after first stone intervention was 6.07 years (0-19.5). The treatment of bladder stones in the exstrophy-epispadias complex remains challenging. Interventions to prevent recurrence are crucial as the majority of patients will require 2 or more stone surgeries in their lifetime. [ABSTRACT FROM AUTHOR]

Purpose: To share our recent experience of the pattern and demography of endemic bladder calculi in children and the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting. Material and Methods: This retrospective longitudinal study was carried out at a dedicated urology centre. All patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for categorical variables. Results: This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cysto- lithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8 ± 4.34 minutes for TUCL, 36.18 ± 7.4 minutes for open cystolithotomy, and 38.6 ± 5.2 minutes for PCCL. The most common stone composition was ammonium urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC. Conclusion: Paediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic back- grounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy. [ABSTRACT FROM AUTHOR]

Matrix lithiasis within the bladder is an extremely rare and diagnostically challenging condition, characterized by its atypical presentation and complex imaging appearance. We report the case of a 69-year-old woman with nonspecific urinary symptoms, including hematuria and abdominal pain. Initial ultrasonography revealed an echogenic lesion on the bladder wall, leading to further investigations using computed tomography (CT) and magnetic resonance imaging (MRI). CT imaging initially delineated the lesion's structure, revealing a complex, multilayered cystic mass. Subsequent MRI provided detailed insights into the internal architecture of the mass, further elucidating its layered structure. Although a parasitic etiology was initially suspected, matrix lithiasis was later confirmed. This case highlights the critical role of a comprehensive imaging strategy in diagnosing rare urological conditions and emphasizes the importance of multimodal imaging in differentiating potential diagnoses.

Purpose: About 50% of individuals with long-term indwelling catheters are affected by catheter encrustations and bladder stone formation. Therefore, prophylaxis of catheter encrustations is important. Currently, however, neither an established prophylaxis nor a standardized in-vitro model to test different measures exist. We have therefore developed and qualitatively evaluated an in-vitro model of catheter encrustation. Methods: Size 14 French suprapubic catheters were incubated under sterile conditions at 37 degrees Celsius in five different media: (1) sterile artificial urine (n = 16), (2) artificial urine with E. coli (n = 8), (3) with Pseudomonas aeruginosa (n = 8), (4) with Proteus mirabilis (n = 8), and (5) with a mix of these three strains (n = 8). Catheter balloons were inflated either a glycerine or a bactericidal solution. After 6 weeks, the catheters were removed from the solution, dried, and weighed, and a photometric determination of the retrieved encrustations was performed. Results: Most frequently and pronounced encrustations were detected in the Pseudomonas group. The median weight of these encrustations (50% struvite and brushite) was 84.4 mg (47.7 mg / 127.3 mg). Even on catheters stored in sterile urine, encrustations (69.2% struvite) were found. Bacterial growth was not affected by the medium used for catheter blockage. Conclusion: Although in-vitro models appear to be limited because they lack "the human factor", they are valuable for systematically assessing physico-chemical factors affecting encrustations. Therefore, our model, being reliable and cost-effective, may foster further research despite its limitations. [ABSTRACT FROM AUTHOR]

Vesical calculi are unusual in females, and giant calculi (weighing >100 g) are even more uncommon, considering the advances in contemporary diagnostic modalities. The entity is associated with a variety of pestering symptoms--frequency, dysuria, and hematuria, to name a few--causing serious effects on patients' quality of life. This report cites the case of an elderly female with a giant vesical calculus weighing 1.28 kg (12.5 cm in diameter). Our patient had no past surgical history or symptoms suggestive of bladder outlet obstruction or neurogenic bladder. As per our literature search, a stone as large as that of our patient has not yet been found in females. She underwent an uneventful open suprapubic cystolithotomy. A biopsy from a suspicious lesion during the surgery revealed squamous cell carcinoma. Given that such a large stone was found in an elderly female without any predisposing causative factors, it is worthwhile looking into the etiopathogenesis and management of giant vesical calculi. [ABSTRACT FROM AUTHOR]

To evaluate the long-term effectiveness and consequences of augmentation cystoplasty in adult patients with small capacity bladder due to genitourinary tuberculosis (GUTB). After approval of the institutional ethical committee, we retrospectively analyzed the database of adult patients with small capacity bladder due to GUTB treated by augmentation cystoplasty from January 2010 to December 2022 at our center. The patients were followed up at 6 weeks postoperatively, then every 3 months for first year and 6 months in second year, and then annually. Patients were assessed for symptoms, renal function, blood biochemistry levels, and ultrasound KUB at each follow-up visit. A total of 40 patients underwent augmentation cystoplasty were included. All patients underwent augmentation cystoplasty either with ileum (n = 35) or sigmoid colon (n = 5). On long-term follow-up, there was statistically significant improvement in bladder capacity, decrease in voiding frequency (P =.00), decrease in eGFR (P =.02) and increase in serum creatinine (P =.02). Significant complications were wound infection 4 (10%), intestinal obstruction 1(2.5%), urinary tract infection 6 (15%), bladder stone 2 (5%), mucus retention 3 (7.5%), hypocalcemia with metabolic acidosis 2 (5%) and need of intermittent catheterization in 11 (27.5%) patients. Multidrug therapy with judicious reconstructive surgery is the optimal treatment modality for GUTB with cicatrization sequelae. In GUTB, augmentation cystoplasty is a safe procedure and strict long-term follow-up is needed to prevent complications. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to study on clinical outcomes of single-stage (laparoscopic cholecystectomy [LC] and laparoscopic common bile duct [CBD] exploration using flexible videobronchoscope) versus dual-stage (endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy) for cholelithiasis with choledocholithiasis-prospective study in a tertiary care centre (BRACE STUDY-Bronchoscope-Assisted CBD Exploration [CBDE] Study). Patients and Methods: Between April 2022 and April 2023, patients who underwent LC with laparoscopic CBDE and endoscopic retrograde cholangiopancreatography (ERCP) followed by LC participated in this single-centre prospective research. The Institute Ethics Committee granted its approval after receiving an ethical review. The primary endpoint of the proposed research was the removal of the gall bladder and CBD stones. The secondary outcomes studied were complications using the Clavien-Dindo score, cost-effectiveness, patient satisfaction score and post-procedure duration of hospital stay. Results: A total of 168 patients were included in the study. The success rate of LC with laparoscopic CBD exploration using a flexible videobronchoscope (Group 1) was significantly higher as compared to ERCP f/b LC (Group 2) (96.4% vs. 84.5%, P value = 0.02). Out of the 84 patients in Group 1, direct choledochotomies were performed on 83 of them. Group 1 had a considerably shorter hospital stay (4.6 ± 2.4 vs. 5.3 ± 6.2 days; P = 0.03). Both the cost (P = 0.002) and the number of procedures per patient (P < 0.001) were considerably higher in Group 2. Major complications (Clavien-Dindo grade 3 and above) were significantly higher in Group 2 (P = 0.04). Patient satisfaction in Group 1 scored more favourably than those in Group 2 (2.26 ± 0.3 vs. 1.92 ± 0.7; P = 0.006). Conclusion: For concurrent gall bladder and CBD stones, single-stage management by LCBDE using a flexible videobronchoscope has a significantly better primary outcome and lower major complications than dual-stage management. The single-stage strategy also has advantages in terms of a shorter hospital stay, the need for fewer procedures, cost efficiency and patient satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between NAFLD and renal stone detected on computed tomography. Method: This study encompassed 240 patients who underwent noncontrast CT abdomen-pelvis computed tomography between November 2023 and April 2024. The nonalcoholic fatty liver disease group included those who had a reduced mean Hounsfield unit (HU) of the right lobe, lateral and left medial segment of the liver as compared to that of the spleen. The control group included patients who had liver parenchyma HU larger than spleen HU. All patients were examined for the presence or absence of radiopaque kidney, ureter, or urinary bladder stones, whether symptomatic or not. Results: From 240 patients, 122 were healthy (50.8%) without NAFLD or renal stone disease. NAFLD was found in 88 individuals with a mean age of 46.8 ± 17.7 years, 42 (47.7%) males and 46 (52.3%) women. Renal stone disease was detected in 70 patients, accounting for 29.1% of the total. The average age of these patients was 43.7 ± 19.3 years, with 32 males and 38 females. Forty individuals with NAFLD had renal stones (45.5%) which was significantly more than the prevalence in those who are NAFLD negative 13 (19.7%), P < 0.001. Females with NAFLD had a considerably greater renal stone rate (52.2%) compared to those without NAFLD (16.3%), P < 0.001. Conclusion: Patients with non-alcoholic fatty liver disease (NAFLD) had a significantly higher incidence of renal stone disease compared to persons with a healthy liver, especially among women. [ABSTRACT FROM AUTHOR]

Ureteral stents play a vital role in urologic surgeries, aiding in urinary flow maintenance, obstruction alleviation and facilitating healing. However, when stents are forgotten, they can lead to encrustation, resulting in significant patient morbidity and posing challenges for urologists Stent-related complications have been shown to increase with the duration of time the stent is left in place. This report details the clinical presentation, diagnostic process, and treatment of a 68-year-old male patient had a neglected stent placed 18 years ago after extracorporeal shockwave lithotripsy. He presented with severe stent encrustation, a solitary giant bladder stone, and renal stones. The patient underwent a cystolithotomy to remove the bladder stone followed by an ultrasound-guided percutaneous nephrolithotomy with pneumatic lithotripsy in a separate procedure. Preventive strategies such as implementing a stent registry, enhancing patient education, and encouraging follow-up appointments are crucial to avoid such complications. [ABSTRACT FROM AUTHOR]

Background: Uric acid, which was originally identified in 1776, is a component of bladder stones that is regulated by metabolism, renal excretion and synthesis. Acidic urine and metabolic syndrome are associated with an increased risk of uric acid stones. The primary goals of this research are to determine the age and gender distribution, as well as the predisposing and causative variables and clinical presentation of uric acid urolithiasis. Methods and materials: A clinical investigation on radiolucent stones was carried out at SCB Medical college and Hospital, Cuttack from July 2021 to July 2023. Fifty examples of symptomatic uric acid calculi were chosen based on clinical symptoms and radiological findings. To collect comprehensive data on uric acid calculi, a history, physical examination, blood and urine tests, and radiographic examinations were performed. Results The research included 72% male and 28% female participants, with an average age of 34.5 years. A high-protein diet was connected to an increased risk of uric acid stones, with discomfort in the loin being the most often reported symptom. Conclusion Uric acid calculi are more common in males (M:F ratio 5.5:1) and frequently develop between the ages of 20 and 40 (mean age 34.5). Low urine pH and volume aid in their development. The stones are more prevalent in July and August. Management consists on increased fluid intake and alkalinizing procedures, ideally with potassium citrate with or without bicarbonate. Conservative treatment is beneficial for the vast majority of patients. [ABSTRACT FROM AUTHOR]

An intact male terrier dog aged 6.25 years was referred with a history of dysuria and intermittent hematuria for the past 2 years. Clinical examination, abdominal radiography and ultrasonography revealed the presence of prostatomegaly and cystolithiasis. A large radio-opaque calculus was observed inside the urinary bladder and ultrasonographic size of the prostate gland was 5. 7 9 × 3. 5 5 cm 2 . The animal was diagnosed with benign prostatic hyperplasia based on anamnesis, physical examination findings and paraclinical investigations. The presence of a single large calculus within the urinary bladder was associated with incomplete voiding resulting from enlargement of the prostate. The bladder calculus which was removed by cystotomy was a mixed type of stone consisting of ammonium (10%), phosphate (20%), calcium (20%), oxalate (40%) and magnesium (10%). The enlargement of the prostate gland was also confirmed by intraoperative examination. Cystolithiasis associated with canine benign prostatic hyperplasia has not been previously reported in the literature. [ABSTRACT FROM AUTHOR]

Abstract Background Bladder lithiasis comprises 5% of urological lithiasis. Large bladder stones associated with vesicovaginal fistulas are rare, and the risk factors are not an isolated process. There are metabolic comorbidities associated with this pathology, including diabetes mellitus. Case presentation A 70-year-old Mestizo patient is presented, reporting dysuria, pollakiuria, and abdominal pain of 4 months of evolution, located in the hypogastric region, also with a sensation of a foreign body in the vaginal introitus. In her pathological history, she presented type 2 diabetes mellitus. A computed tomography scan of the abdomen and pelvis was performed, reporting a tumor lesion in the abdominal wall. Therefore, surgical intervention was performed by cystolithotomy, obtaining a giant stone adhered to the vaginal wall with a size of 10 cm × 12 cm. Conclusion Early detection of this pathology should be exhaustive in patients with characteristics and comorbidities associated with stone development to avoid possible complications, such as vesicovaginal fistulas.

Background: Double-J (D-J) ureteric stents are widely applied in urological operations as they play a vital role in maintaining postoperative functionality of the patient's urinary system and thereby accelerating recovery. D-J stent encrustation may occur due to prolonged retention and lead to secondary complications. We report the case of a forgotten D-J stent that gradually formed into a bladder stone. Case Report: A 54-year-old man was referred to the Urology Department due to intermittent hematuria, left flank pain, and lower urinary tract symptoms that persisted for 2 weeks. His history was significant for undergoing left ureterolithotripsy followed by the implantation of an ipsilateral D-J stents 2 years ago in a local hospital. The patient did not follow-up regularly or actively seek medical attention for his urinary tract symptoms. Computed tomographic urography revealed a hyperdense tubular object protruding from the left distal ureter to the bladder. The patient underwent cystolithotripsy, left ureteric stent removal, and left ureteroscopy to clear away the bladder stone and its D-J stent core. Conclusions: Formation of bladder stones secondary to prolonged indwelling D-J stent and its encrustation is not uncommon in developing countries where the level of public education is low. Prompt D-J stent removal can prevent complications associated with its retention and avoid unnecessary secondary procedures. Endoscopic urologic procedures are safe and feasible management options, and doctor-to-patient communication is vital for a better prognosis. [ABSTRACT FROM AUTHOR]

Intrauterine contraceptive devices (IUCD) are widely used as a reversible method of contraception. Although uterine perforation caused by an IUCD is rare, in some cases, the device may migrate to the pelvic/abdominal cavity or nearby structures. When the IUCD migrate to the bladder, it can lead to various symptoms. These include pain or discomfort in the lower abdomen, difficulties or pain during urination, frequent urinary tract infections, and the development of bladder stones. This article presents a case report of a 24-year-old woman with an intrauterine contraceptive device (IUCD) that had migrated completely into the bladder. She had an IUCD inserted by a midwife four years earlier and became pregnant a year later, unaware of the IUCD's presence. She later presented with lower abdominal pain, hematuria, and dysuria three months before being admitted to our hospital. Imaging confirmed the intravesical location of the IUCD. She underwent successful cystoscopy treatment to remove the migrated IUCD. Prompt diagnosis and appropriate management are crucial in preventing complications and improving patient outcomes. Clinicians should be aware of this potential complication and consider it when patients present with symptoms or complications after IUCD insertion. Regular monitoring and timely intervention can help detect and address IUCD migration effectively. [ABSTRACT FROM AUTHOR]

Introduction: The study aim was to analyze the presentation, management, and follow-up of renal transplant patients developing bladder calculi. Methods: Patients who underwent renal transplant with postoperative follow-up at our institution were retrospectively analyzed (1984–2023) to assess for the development of posttransplant bladder stones. All bladder stones were identified by computerized tomography imaging and stone size was measured using this imaging modality. Results: The prevalence of bladder calculi post-renal transplantation during the study window was 0.22% (N = 20/8,835) with a median time to bladder stone diagnosis of 13 years posttransplant. Of all bladder stone patients, 6 (30%) received deceased donor and 14 (70%) living donor transplants. There were 11 patients with known bladder stone composition available; the most common being calcium oxalate (N = 6). Eleven (55%) patients had clinical signs or symptoms (most commonly microhematuria). Fourteen of the bladder stone cohort patients (70%) underwent treatment including cystolitholapaxy in 12 subjects. Of these 14 patients, 9 (64%) were found to have nonabsorbable suture used for their ureteroneocystostomy closure. Conclusions: The prevalence of bladder stones post-renal transplant is low. The utilization of nonabsorbable suture for ureteral implantation was the main risk factor identified in our series. This technique is no longer used at our institution. Other factors contributing to bladder stone formation in this population warrant identification. [ABSTRACT FROM AUTHOR]

Background: As widely known, an intrauterine device (IUD) is a small, typically T-shaped contraceptive device that offers long-term reversible birth control. However, neglecting to remove the IUD can lead to severe complications. This case report showcases an exceptional instance that underscores the potential risks associated with retention of an IUD. Case presentation: This case report documents a 40-year-old female who failed to remove her intrauterine device for eight years. Upon her visit to our clinic, she presented with increased urinary frequency, burning micturition, dysuria, and discomfort while emptying her bladder. Medical review consisting of ultrasound (KUB) and X-ray pelvis revealed the intrauterine device had migrated and was encrusted with a stone. We used Holmium laser lithotripsy to break down the stone, before using cystoscope to manually remove the intrauterine device. She made a rapid recovery without any complications. Conclusions: In order to raise awareness about forgotten or misplaced IUDs and their complications, we are presenting a case of complete intravesical IUD migration at our clinic. This serves as an educational opportunity to shed light on this uncommon occurrence and emphasize the importance of timely removal and follow-up in patients using intrauterine devices (IUDs). [ABSTRACT FROM AUTHOR]

Background: Incidental gall bladder cancer (IGBC) is often discovered unexpectedly in patients after cholecystectomy. Currently, magnetic resonance imaging (MRI) has been widely applied in the pre-operative diagnosis of gall bladder diseases as laparoscopic cholecystectomy developed into the preferred method. Aims and Objectives: This study aimed to evaluate the pre-operative MRI application and laparoscopic management in the IGBCs. Materials and Methods: Between January 2011 and January 2020, a total of 7917 patients with gall bladder diseases treated by laparoscopy were enrolled in this study. Results: Amongst 49 patients diagnosed with IGBCs, the incidence of IGBCs in polypoid lesions, biliary pancreatitis, cholecystitis, cholecystocholedocholithiasis and gall bladder stones was 0.42%, 1.19%, 0.62%, 1.20% and 0.49%, respectively. MRI evaluation showed more remarkable pre-operative imaging as compared to ultrasonographic evaluation (40.8 vs. 26.5, P < 0.05). Furthermore, 14 patients were diagnosed with gall bladder cancer through intraoperative histological examination and 11 received laparoscopic extensive resection after cholecystectomy. MRI findings with diffuse thickening of the gall bladder detected IGBCs with 6.1% sensitivity, 96.02 specificity, 0.95% positive predictive values and 99.4% negative predictive values; diffuse thickening of the gall bladder with suspicion of malignancy detected IGBCs with 12.2% sensitivity, 99.1% specificity, 7.6% positive predictive values and 99.5% negative predictive values; focal thickening of the gall bladder detected IGBCs with 16% sensitivity, 99.8% specificity, 32% positive predictive values and 99.5% negative predictive values; moreover, suspicious lesion detected IGBCs with 6.1% sensitivity, 99.6% specificity, 8.8% positive predictive values and 99.4% negative predictive values. Conclusions: Patients with biliary pancreatitis and cholecystocholedocholithiasis have a higher incidence of IGBC. MRI evaluation could provide more accurate information for the IGBCs, which should be recommended for patients accepting cholecystectomy. MRI findings exhibited an unsatisfactory sensitivity when detecting IGBCs, but they represented high specificity. Pre-operative MRI evaluation and intraoperative histological examination may help some IGBCs to achieve one-stage laparoscopic extensive resection. [ABSTRACT FROM AUTHOR]

Urolithiasis is a common urinary tract condition frequently encountered in veterinary practice. This report aims to present the case of a 4-year-old female German Spitz dog with a historic of recurrent struvite urinary calculi in the bladder. The treatment of choice is cystotomy surgery for complete removal of the urinary calculi. Therefore, the combination of cystotomy and urine culture is important for clinical and surgical management in order to achieve more favorable outcomes and prognoses. [ABSTRACT FROM AUTHOR]

Bladder storage dysfunction is associated with low quality of life in men and remains a challenging field in pharmacotherapy because of low persistence followed by patient-perceived lack of efficacy and adverse effects. The persistent desire for the development of novel pharmacotherapy is evident, leading to numerous research efforts based on its pathophysiology. This review describes the pathophysiology, current pharmacotherapeutic strategies, and emerging novel drugs for male bladder storage dysfunction. The section on emerging pharmacotherapy provides an overview of current research, focusing on high-potential target molecules, particularly those being evaluated in ongoing clinical trials. As pharmacotherapies targeting alpha-adrenergic, beta-adrenergic, and muscarinic receptors – the current primary targets for treating male bladder storage dysfunction – have demonstrated insufficient efficacy and side effects, researchers are exploring various alternative molecular targets. Numerous targets have been identified as central to regulating bladder afferent nerve activity, and their pharmacological effects and potential have been evaluated in animal-based experiments. However, there is a limited number of clinical trials for these new pharmacotherapies, and they have not demonstrated clear superiority over current treatments. Further research is needed to develop new effective pharmacotherapies for bladder storage dysfunction in men. [ABSTRACT FROM AUTHOR]

Background: Bladder lithiasis comprises 5% of urological lithiasis. Large bladder stones associated with vesicovaginal fistulas are rare, and the risk factors are not an isolated process. There are metabolic comorbidities associated with this pathology, including diabetes mellitus. Case presentation: A 70-year-old Mestizo patient is presented, reporting dysuria, pollakiuria, and abdominal pain of 4 months of evolution, located in the hypogastric region, also with a sensation of a foreign body in the vaginal introitus. In her pathological history, she presented type 2 diabetes mellitus. A computed tomography scan of the abdomen and pelvis was performed, reporting a tumor lesion in the abdominal wall. Therefore, surgical intervention was performed by cystolithotomy, obtaining a giant stone adhered to the vaginal wall with a size of 10 cm × 12 cm. Conclusion: Early detection of this pathology should be exhaustive in patients with characteristics and comorbidities associated with stone development to avoid possible complications, such as vesicovaginal fistulas. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 5% of bladder stones occur in women and are usually associated with foreign bodies or urinary stasis. Spontaneous migration of the intrauterine device (IUD) into the bladder is a rare complication. In this report, we present 2 cases of migrated IUD who had undergone surgery at our clinic due to bladder stones. Case Presentations: We detected migrated IUDs into the bladder in 2 female patients, aged 37 and 56 years, who presented with lower urinary tract symptoms and urinary tract infection. In the first case, endoscopic cystolithotripsy was performed, and the IUD was removed without complications. In the second case, the IUD could not be removed endoscopically since it had fractionally invaded the bladder wall, and the IUD was removed without complications by performing an open cystolithotomy. Conclusion: A comprehensive gynecological history should be taken from every female patient presenting with recurrent urinary tract infections and lower urinary tract symptoms. If these patients have a history of IUD placement, the possibility of the intravesical migration of this device should be kept in mind. [ABSTRACT FROM AUTHOR]

In the realm of unusual gynecological complications, the displacement of an intrauterine device (IUD) into the bladder, resulting in stone formation, stands out as an exceptionally rare and perplexing condition. Such occurrences challenge diagnostic and therapeutic protocols, often leading to unique case studies that expand our understanding of IUD-related complications. We present an interesting case of a 50-year-old woman with a stone-forming ectopic IUD in the bladder diagnosed with imaging modalities and treated with cystoscopy, with a subsequent resolution of symptoms. This case underscores the importance of considering ectopic IUD placement in the differential diagnosis of patients presenting with urinary symptoms and a history of IUD use. Moreover, it emphasizes the role of imaging in the accurate diagnosis of such cases and highlights cystoscopy as an effective treatment modality for the removal of IUD and stones. [ABSTRACT FROM AUTHOR]

Background: Evidence-based guidelines are published by urological organisations for various conditions, including urolithiasis. In this paper, we provide guidance on the management of kidney stone disease (KSD) and compare the American Urological Association (AUA) and European Association of Urologists (EAU) guidelines. Methods: We evaluate and appraise the evidence and grade of recommendation provided by the AUA and EAU guidelines on urolithiasis (both surgical and medical management). Results: Both the AUA and EAU guidelines provide guidance on the type of imaging, treatment options, and medical therapies and advice on specific patient groups, such as in paediatrics and pregnancy. While the guidelines are generally aligned and based on evidence, some subtle differences exist in the recommendations, but both are generally unanimous for the majority of the principles of management. Conclusions: We recommend that the guidelines should undergo regular updates based on recently published material, and while these guidelines provide a framework, treatment plans should still be personalised, respecting patient preferences, surgical expertise, and various other individual factors, to offer the best outcome for kidney stone patients. [ABSTRACT FROM AUTHOR]

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic painful bladder condition characterized by pelvic pain and urinary symptoms without another identifiable cause. Cystoscopy as primary initial investigation for IC/BPS has not been accepted yet and needs more studies to definitely conclude. Aims and objectives: We aimed to assess cystoscopy findings in patients of interstitial cystitis/bladder pain syndrome and to prove role of cystoscopy as primary initial investigation for interstitial cystitis/bladder pain syndrome. Materials and methods: Our prospective observational study included 35 female patients aged 18–69 years presenting to the Urology OPD at SMS Hospital with suprapubic or pelvic pain for 6 months, bladder pain that worsens with bladder filling and reduced with voiding, dysuria, urinary frequency and urgency, nocturia, dyspareunia. Those with history of bladder capacity more than 350 ml, duration of symptoms less than 6 months, day time frequency less than eight times per day, diagnosis of bacterial cystitis or prostatitis, bladder or ureteral calculi, active genital herpes, any existing urological malignancy, radiation cystitis were excluded from the study. They were then subject to cystoscopy and the findings of the cystoscopy were analyzed. Results: Out of the 35 patients, 11 (31.43%) had a normal cystoscopy. Of the 24 patients (68.57%) who had a positive cystoscopy, cystoscopy in seven patients (20.0%) revealed an ulcer. All these seven patients underwent fulguration. In the remaining 17 patients the abnormal findings were petechiae, large submucosal bleed. The sensitivity of cystoscopy in detecting the ulcerative type of Interstitial cystitis was found to be 20.0%. Conclusion: Our study found that Cystoscopy, if employed in initial investigation can help early detection of ulcerative variety of IC/BPS and can act as therapeutic modality by using fulguration plus hydrodistension. Larger comparative studies are needed for diagnostic/Therapeutic value of cystoscopy. [ABSTRACT FROM AUTHOR]

Introduction: Bladder stones account for 5% of all urolithiasis. Patients present with LUTS or acute urinary retention. Thus, warranting an early intervention. Minimally invasive approach with laser lithotripsy is the present gold standard to treat bladder stones. Aims and objectives: To evaluate the outcomes of TFL (60 W) for bladder stones performed under local anesthesia as a day-care procedure. Materials and methods: This was a retrospective single-center study conducted after obtaining IRB approval. Study period was between June 2021 and June 2022 were included. All patients were operated under local anesthesia as a day care procedure. The procedure was carried out using an 18 Fr laser sheath and calculus dusted using TFL energy (15–30 W). Parameters including operative time in minutes, complications were recorded. Patients were encouraged oral and normal voiding in the immediate post-op period. Results: A total of 47 patients with bladder stones presented during this period. Of these, 30 underwent laser lithotripsy (TFL) for bladder calculi. The clinical presentation of patients was LUTS in 28 (93%) and 5 (16%) patients had AUR. The average size of the stone in this series was 15 ± 2.8 mm. The mean duration of laser lithotripsy was 15 ± 5.4 min. Energy to dust the stone was variable with mean LASER energy of 18.23 ± 10 W. All patients tolerated the procedure well and none required conversion to conventional anesthesia. One patient failed to void in the post-op period. 100% clearance rate was documented in all patients. Conclusion: Thulium fiber laser for transurethral cystolithotripsy of bladder stones under local anesthesia is a feasible technique with minimal morbidity and good outcome. [ABSTRACT FROM AUTHOR]

Objective: To estimate the pooled prevalence, as well as the spatial and temporal distribution, of urolithiasis among subjects in China. Materials and Methods: We conducted a comprehensive search of both Chinese and English databases to retrieve literature pertaining to the prevalence of urolithiasis in the indigenous Chinese population. A random‐effects meta‐analysis model was employed to calculate the pooled prevalence of urolithiasis. Subgroup analyses were conducted based on factors such as time, region, gender, and sample size. Prevalence and spatial distribution maps were created based on provinces and latitude/longitude coordinates. Results: A total of 46 studies conducted in 22 provinces across China were included in this meta‐analysis and the pooled prevalence of urolithiasis, kidney stones, ureteric calculi, urethral and bladder stones were 8.1% (95% confidence interval [CI] 5.6–11.1%), 7.8% (95% CI 5.8–10.0%), 3.2% (95% CI 0.6–5.7%), 0.5% (95% CI 0.1–0.9%). Most of the urolithiasis prevalence screening in China was concentrated between 100° E and 120° E, with higher rates observed in low latitude areas. Subgroup analysis of kidney stones revealed that Guangdong (12.7%) and Guangxi (10.3%) had the highest prevalence, with the eastern developed area exhibiting higher rates compared to the west. The prevalence in males was higher than in females (odds ratio 1.67, 95% CI 1.46–1.92), although the gender gap has significantly reduced since 2006. Moreover, a greater sample size is associated with a decreased prevalence of urolithiasis. Conclusions: The prevalence of urolithiasis is increasing in China, and there are noteworthy regional or provincial disparities in occurrence. It is worth noting that the current number of screening studies in some areas is insufficient. Additional investigations with appropriate sample sizes should be supplemented in time. [ABSTRACT FROM AUTHOR]

Justiciaflava (Acanthaceae) is utilized in folk medicine for treating malaria, inflammatory conditions, and respiratory infections. In this study, the antiplasmodial and anti-inflammatory activities of the 70% hydroalcoholic leaf extract of J. flava (JFE) were investigated. The antiplasmodial activity was assessed by the suppressive test and Rane's curative test. The carrageenan-induced paw oedema assay in chicks was used to assess the anti-inflammatory activity. In Rane's curative test, JFE significantly suppressed the parasitaemia level (p < 0.0001) by 56.85%, 63.85%, and 77.85% at 30, 100, and 300 mg·kg−1, respectively. The highest suppression of parasitaemia in the suppressive test was 51.31% at 300 mg·kg−1. The extract prolonged the survival time of infected mice significantly and prevented weight loss and hypothermia which are cardinal signs of P. berghei-induced infection. JFE inhibited foot oedema in chicks with a maximum percentage inhibition of 54.00 ± 5.20%. Pharmacognostic characterization of J. flava revealed it to have simple, petiolate, oppositely arranged leaves which are broadly lanceolate in shape with entire to slightly crenate margins. Microscopy of the leaf showed wavy-walled epidermal cells, diallelocytic stomata, abundant clothing and secretory trichomes, pitted vessels, collateral conjoint vascular bundles, cystoliths, and prismatic calcium oxalate crystals. Flavonoids, tannins, phytosterols, triterpenoids, coumarins, alkaloids, and saponins were detected in the plant. This study has provided important parameters for the correct identification of J. flava and given the scientific credence to its antimalarial and anti-inflammatory effects in traditional medicine. J. flava is a potential source of new antimalarial and anti-inflammatory compounds. [ABSTRACT FROM AUTHOR]

Purpose: Technological advancements in laser lithotripsy are expanding into numerous fields of urology, like ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and benign and malignant soft-tissue treatments. Since the amount of research regarding lasers in urology has grown exponentially, we present a systematic review of the most recent and relevant advances encompassing all lasers used in urological endoscopic treatment. Methods: We performed a literature search using PubMed (May 2023) to obtain information about lasers for urological purposes. We included only recent data from published articles between 2021 and 2023 or articles ahead of print. Results: Lasers are widely used in lithotripsy for ureteric, renal, and bladder stones, benign prostate surgery, and bladder and upper tract tumor ablation. While the holmium (Ho:YAG) laser is still predominant, there seems to be more emphasis on pulse modulation and newer lasers such as thulium fiber laser (TFL) and pulsed Tm:YAG laser. Conclusion: The use of lasers and related technological innovations have shown increasing versatility, and over time have proven to be invaluable in the management of stone lithotripsy, treatment of benign and malignant prostate diseases, and urothelial tumors. Laser endoscopic treatment is heavily based on technological nuances, and it is essential to know at least the basics of these technologies. Ultimately the choice of laser used depends on its availability, cost, surgeon experience and expertise. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In developing countries, VVF mainly occurs due to obstructed labor unlike developed countries where common causes are radiotherapy and malignancy. Due to social taboos, patients do not seek medical attention for problems like urinary incontinence and dysuria, thus presenting very late. [ABSTRACT FROM AUTHOR]

BACKGROUND: Uterine artery embolization (UAE) has been used to treat symptomatic uterine leiomyomas since 1995. This case report describes a rare complication of UAE, with delayed recognition, ultimately requiring definitive hysterectomy. CASE: A 53-year-old women with symptomatic leiomyomas underwent imaging demonstrating an enlarged (16.9×11.3×11.5 cm) uterus with multiple leiomyomas. She underwent UAE and, over the subsequent 3 months, and had five emergency department visits for abdominal pain and dysuria. Pelvic magnetic resonance imaging (MRI) 4 months postprocedure showed nodular mural enhancement of the right anterior bladder dome, and cystoscopy demonstrated irregular tissue on the right dome of the bladder. The patient ultimately underwent total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, partial cystectomy with reconstruction, and omental flap for bladder necrosis and leiomyoma fistulization. CONCLUSION: Bladder necrosis and leiomyoma fistulization are rare complications of UAE that can present with pelvic pain, hematuria, and recurrent bladder stones. Computed tomography and MRI can be useful tools in evaluating for complications, but clinicians should have a low threshold to use cystoscopy to directly visualize potential abnormalities identified on imaging. Patients with complex cases with suspected post-UAE complications warrant referral to tertiary care centers for a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Abstract Background The Mitrofanoff (appendicovesicostomy) procedure is a contraindicated urinary modification that maintains urinary continence by forming a flap-valve mechanism at the site of anastomosis between the appendage and bladder wall, which is used as a guide for urinary drainage. This technique has been used by intermittent self-catheterization patients who have difficulty voiding from the native urethra or in cases where voiding from the abdominal wall would improve quality of life. However, the risk of stone formation is high due to intermittent urinary catheterization using the Mitrofanoff conduit urethrostomy as a conduit. Case presentation The patient was a 22-year-old Asian-Japanese woman. At 6 years of age, she underwent bilateral vesicoureteral reflux surgery, Mitrofanoff urethrostomy using the appendix, abdominal wall plication, and vaginoplasty using the ileum. During follow-up, ultrasound performed due to persistent pain during urinary drainage revealed a 26 mm bladder stone. We performed ureteroscopic lithotripsy 6Fr using ureteral access sheath and made lithotripsy using Ho: YAG laser, then successfully removed the target stone. Conclusions We report a case of transurethral laser lithotripsy using the Mitrofanoff urethral conduit for bladder stones. Using with ureteral access sheath made lithotripsy and retrieved ureteral stone more effective.

Introduction and hypothesis: Intravesical mesh is an uncommon complication following synthetic midurethral sling placement. Management options have included endoscopic techniques such as laser ablation or surgical excision. We present our technique for robotic-assisted excision of intravesical mesh following a retropubic midurethral sling. Methods: The patient is a 66-year-old woman with a remote history of laser ablation of intraurethral mesh after midurethral sling, and persistent symptomatic intravesical mesh with associated stone at the bladder neck and right bladder wall. Robotic excision of the intravesical mesh and stone was performed by entering the space of Retzius, carrying the dissection along the right arm of the retropubic sling, performing two cystotomies to free and remove the mesh, and finally closing the cystotomies in two layers. Results: The patient was discharged on postoperative day 1. A cystogram prior to catheter removal showed no extravasation and a competent bladder neck. She reported no new stress incontinence and had improvement in overactive bladder symptoms. Conclusions: Robotic excision of intravesical mesh after synthetic midurethral sling was safely performed in this patient who had multiple areas of intravesical mesh. Management aspects reported here may be helpful for complex presentations of intravesical mesh. [ABSTRACT FROM AUTHOR]

Case: Intrauterine device (IUD) is used worldwide as an effective contraceptive method, but the migration of IUD is a serious complication. We report the case of IUD migration leading to bladder calculus formation and a minimally invasive transurethral surgical approach was performed for treatment. Holmium laser was used to break up the bladder calculus and cut through the bladder mucosa where the IUD was attached, finally the IUD was removed through the urethra. this minimally invasive procedure is a safe and effective treatment for IUD migration, and similar cases have not been reported in the literature. Conclusion: that the secondary bladder calculus were smashed by intense pulse mode of holmium laser, and the bladder tissue around the attached IUD was opened by cutting mode of holmium laser, and finally the IUD was completely removed from urethra, this surgical method is safe and effective, and there is no case report on IUD removal of transurethral cystoscope in the literature. [ABSTRACT FROM AUTHOR]

Introduction and Objective: A variety of laser sources are available to treat bladder stones. The aim of this study was to compare time and cost efficiency of the thulium fiber laser (TFL) to four holmium lasers (HLs) with different powers or technologies, including MOSES™ during simulated cystolithotripsy. Materials and Methods: In a benchtop simulation of laser cystolithotripsy, 25 identical 4-cm BegoStones (calcium oxalate monohydrate consistency) were placed on a grid within a 3D-printed bladder model. Lasers were operated at maximal energy, using a 550 μm fiber. Lasers compared were as follows: 60 W TFL, 120 W HL with MOSES, and conventional 120, 100, and 30 W HLs. Five trials were performed for each laser with endpoints of laser time, total time, number of fiber strippings, and total energy. Cost-effectiveness was modeled using laser purchase price, fiber, and operating room (OR) time cost. ANOVA with Tukey's B post hoc was performed to compare outcomes. Spearman's test was used to assess correlation between laser power and procedure time. Results: The laser and total operating times were significantly different between the five systems (p < 0.001). The 120 W HL with MOSES was the fastest with 60.9 minutes of laser and 68.3 minutes of procedure times, while the 30 W HL was the slowest with 281.2 minutes of laser and 297.5 minutes of procedure times. The 60 W TFL was faster than the 30 W HL, but slower than the higher power HLs. Higher laser power was associated with shorter procedure time (Rs = −0.98; p = 0.002). When estimating cost per procedure, the MOSES HL was the cheapest, but had the highest purchase cost. The TFL was not cost-effective for large bladder stones compared with the 100 W HL. Conclusions: When treating large bladder stones, total laser power was highly correlated with laser and procedure times and the TFL was limited by its total power. The most cost-effective laser for use will depend on the case volume. [ABSTRACT FROM AUTHOR]

Introduction: For the surgeries of the biliary tract and gall bladder region, the gold standard surgical procedure considered is LC (Laparoscopic cholecystectomy). However, various complications are seen associated with these procedures of LC where significantly high mortality and morbidity are seen associated with PSIs (port site infections). Aims: The present study was conducted to comparatively evaluate the non-bag to bag extraction of gall bladder stones via laparoscopy concerning the incidence of port-site infections. Methods: The present randomized controlled trial was conducted on 164 study subjects having a history of Laparoscopic cholecystectomy for 2 years, and was randomly divided into two groups of bag extraction and non-bag extraction. All the subjects were postoperatively followed for 1 week to assess the incidence of PSI. Results: Serum creatinine was 1.2±0.3 in non-bag and 1.1±0.3 for bag extraction group, serum albumin was 3.6±0.5 and 3.4±0.7 for non-bag and bag extraction group, BMI for non-bag and bag extraction group was 24.9±4.4 and 26.4±3.4 respectively, and HbA1c values were 5.4±1.2 and 5.7±1.2 respectively for non-bag and bag extraction groups. All these values were statistically non-significant with respective p-values of 0.3, 0.3, 0.12, and 0.11. In non-bag extraction group, infection was seen in 1.06% (n=1) study subject, whereas, for bag extraction group, infection was seen in 8.57% (n=6) study subjects. Infective pathology was significant in the non-bag extraction group with p<0.01. The immunocompromised state was significant for non-bag extraction with p=0.002. HbA1c and diabetes was also statistically significant in the non-bag extraction group with the p-value of <0.01, whereas, for bag extraction, these values were statistically non-significant with respective p-values of 0.732 and 0.116 respectively Conclusion: The present study concludes that lower rates of infection are associated with bag extraction, and hence, bag extraction should be routinely employed in all laparoscopic cholecystectomy surgeries, especially in subjects with higher risks as immunocompromised state and diabetes mellitus. [ABSTRACT FROM AUTHOR]

Introduction-The urethra becomes narrower in the Urethral Stricture. It is caused due to inflammation. It may be asymptomatic in some cases, while it shows concerning symptoms too in many cases. There may arise problems associated with urination. Those problems include pain while urinating and slowing of the urine stream than normal. When it is left untreated or delayed treatment is done it may lead to complications like damage to the kidneys and bladder and infertility. In this study, we have evaluated the causes, anatomical locations, clinical and radiological presentation, and compared the outcomes of various management methods available for anterior urethral strictures, such as: • Urethral dilatation • Internal urethrotomy • Urethral stents (not included in present study) • Open reconstruction In patients undergoing these above mentioned treatment procedures, the commonest complication seen in clinical practice is stricture recurrence. Methods: This study was conducted on 50 consecutive patients diagnosed with urethral stricture attending the Outpatient department and getting admitted to Department of surgery, J.A. Group of hospitals, Gwalior during the period of September 2020-September 2021 Result: -Closed methods (78%) were preferred to open methods, considering the length of strictures and owing to COVID - 19 pandemic situation, with internal urethrotomy being the most frequently used method. Short segment strictures were more frequently seen during the course of this study, as 86% of patients had stricture length less than 2cms. Conclusion: Anterior urethral stricture disease is one of the commonest complications of urethral injuries and has a substantial impact on quality of life resulting in infection, bladder calculi, fistulas, sepsis and ultimately renal failure.proper catheterisation was attempted under aseptic precaution. [ABSTRACT FROM AUTHOR]

Background: Smartphone users frequently connect to the Internet via mobile data or Wi-Fi. Over the past two decades, the worldwide percentage of people who connect to the Internet using their mobile phones has increased drastically. Objective: This study aimed to evaluate the potential link between mobile cellular data/and Wi-Fi use and adverse health effects. Material and Methods: This cross-sectional study was conducted on 2,796 employees (52% female and 48% male) of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran. The sociodemographic data (e.g., gender, age, nationality, and education level) were collected for all the participants. They were also requested to provide information about their smartphone use including the characteristics of the connection to the Internet using their smartphones (mobile data and Wi-Fi). In addition, the participants' history of diabetes, hypertension, cardiac ischemia, myocardial infarction, renal failure, fatty liver, hepatitis, chronic lung disease, thyroid disease, kidney stone, gall bladder stone, rheumatoid disease, epilepsy, and chronic headache was recorded through face-to-face interviews. Results: 94% of people participating in this study reported using mobile/Wi-Fi internet. The mean (±SD) Internet usage per day was 117.85±122.70 minutes including 76±98 minutes of mobile data and 42±81 minutes of Wi-Fi use. Conclusion: Our findings showed no link between mobile phone Internet usage and the risk of the above-mentioned health problems. As in 2021, the global average daily time spent on the Internet using mobile phones was 155 minutes, the participants' lower use time could explain the failure to show any detrimental effects. Considering the study limitations, further large-scale studies are warranted. [ABSTRACT FROM AUTHOR]

Background: The Mitrofanoff (appendicovesicostomy) procedure is a contraindicated urinary modification that maintains urinary continence by forming a flap-valve mechanism at the site of anastomosis between the appendage and bladder wall, which is used as a guide for urinary drainage. This technique has been used by intermittent self-catheterization patients who have difficulty voiding from the native urethra or in cases where voiding from the abdominal wall would improve quality of life. However, the risk of stone formation is high due to intermittent urinary catheterization using the Mitrofanoff conduit urethrostomy as a conduit. Case presentation: The patient was a 22-year-old Asian-Japanese woman. At 6 years of age, she underwent bilateral vesicoureteral reflux surgery, Mitrofanoff urethrostomy using the appendix, abdominal wall plication, and vaginoplasty using the ileum. During follow-up, ultrasound performed due to persistent pain during urinary drainage revealed a 26 mm bladder stone. We performed ureteroscopic lithotripsy 6Fr using ureteral access sheath and made lithotripsy using Ho: YAG laser, then successfully removed the target stone. Conclusions: We report a case of transurethral laser lithotripsy using the Mitrofanoff urethral conduit for bladder stones. Using with ureteral access sheath made lithotripsy and retrieved ureteral stone more effective. [ABSTRACT FROM AUTHOR]

Ureteral obstruction is blockage in one or both of the tubes (ureters) that carry urine from the kidneys to the bladder which is a potential common cause of reversible renal injury. It can be caused by benign or malignant pathologies. Decompression of the obstruction is considered a vital step in management. Percutaneous nephrostomy (PCN) and ureteral stenting are the two common diversion surgical techniques used for the treatment of obstruction. In cases of benign ureteric obstruction, the choice between PCN or stenting is highly arguable among urologists and is dependent on factors such as the cause, severity of obstruction availability of treatment modalities, and surgeon experience, and both techniques are considered similar successful in treating such case. For ureteric stones, urologists typically try stenting first and resort to PCN if stenting fails. The choice between the two is dependent on the availability of resources and surgical experience. On the other hand, PCN is the preferred initial method in cases of malignant obstruction because of high late failure rates in cases of ureteral stenting. Percutaneous nephrostomy cases had the drawback of the need for a collection instrument placed externally which impacted the patient’s life [ABSTRACT FROM AUTHOR]

Urinary stone remains a common urological disorder. Urinary bladder stone accounts for 5% of the urinary tract calculi. They are usually small and rarely present with complications; they may progressively increase in size, occupying the urinary bladder and resulting in the development of symptoms and complications. Our aim was to report the first case of a giant urinary bladder stone in association with severe kidney dysfunction in our Community. We report the case of a 65-year-old man with a 1-week history of decrease in urinary output and uremia following a referral from the general hospital. Remarkable findings on clinical examination were an elderly man that was confused, pale, and dehydrated. He had a suprapubic bladder Foley catheter which was inserted at the source of referral. Laboratory and imaging investigation revealed raised creatinine levels, bilateral hydronephrosis, and giant urinary bladder stone. These were suggestive of obstructive uropathy likely from the stone in association with severe kidney dysfunction. He had emergency open cystolithtomy and a 400g stone was removed. There was an immediate improvement in the urinary output and renal function. We have reported our experience on the successful management of giant urinary bladder stone in association with acute kidney injury. The patient recovered satisfactorily from acute kidney injury following emergency open cystolithotomy. [ABSTRACT FROM AUTHOR]

Introduction: Acidogenic diets cause a drop in urinary pH, and increasing features of metabolic syndrome are associated with increased calcium oxalate precipitation. Nowadays, it is well accepted that dietary variables promote the formation of vesical calculi, contributing to the prevalence of vesical stones. Aim: The aim of this study is to estimate the impact of nutritional status on the management of vesical calculi. Materials and Methods: A literature search was conducted in PubMed, Medline, Web of Science, Cochrane library, as well as additional sources such as Google Scholar and ClinicalTrials. gov, covering the period from 2001 to 2022. The most important electronic databases were checked, and all types of studies, including expressive studies, trials, commentaries, and editorials, were considered due to the nature of the studies. The risk of bias was assessed using the recommended methodology. A two-part tool was used to address five specific domains: selection bias, performance bias, attrition bias, selective reporting, and other biases. Quality diagnostic accuracy studies were evaluated using a quality assessment tool. Results: This study included 12 literature sources, of which five were nutrition-based studies and seven were focused on vesical calculi. Dietary modifications and medical treatments were found to be the most important factors in preventing recurrence. Conclusion: Dietary and medical treatments are of utmost importance in preventing recurrence. As per physician advice for vesical calculi, a proper dietary plan that includes a mineralrich diet is needed. Consumption of ample fluids is essential for the removal of stones. [ABSTRACT FROM AUTHOR]

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Bladder augmentation can be a valuable life-changing operation for patients with bladder dysfunction, however, are associated with several complications that require long-term management. One of the most common complications seen in these patients are bladder calculi. If bladder stones are left untreated, they can become extremely large and cause pain, urinary tract infections, or difficulty emptying the bladder. We present the case of a patient with an augmented bladder who had numerous large bladder stones and his management.

Bladder calculi are rare in women. We report a case of bladder calculi complicating irreducible uterovaginal prolapse. It provides diagnostic and operative challenges to the management team. A 77-year-old woman presented with irreducible complete uterovaginal prolapse. Bladder stones were appreciated on examination and confirmed with imaging. The patient was managed surgically with transabdominal hysterectomy with bilateral uterosacral colpopexy followed by cystolithotomy. The patient's postoperative course was uncomplicated, and she had an uneventful recovery at her 3-month postoperative visit without a recurrence of prolapse and gained good continence. The presence of bladder calculi should be considered in the setting of irreducible pelvic organ prolapse. The abdominal approach of cystolithotomy with a concomitant hysterectomy and vaginal apical suspension is safe and effective. [ABSTRACT FROM AUTHOR]

To investigate the safety, efficacy, and surgical approach of percutaneous bladder calculi removal in adult patients with prior lower urinary tract reconstruction utilizing bowel using a single-institution database. Twenty patients with prior history of lower urinary tract reconstruction (continent cutaneous urinary reservoir, augmentation enterocystoplasty with catheterizable channel, or ileal neobladder) who underwent percutaneous cystolitholapaxy from 2014 to 2020 were identified from an IRB-approved database. Analysis of patient demographics, operative details, stone composition, stone-free rates, recurrence, and associated complications was performed. Percutaneous access and either ultrasonic lithotripter or laser lithotripsy were utilized to remove bladder stones. Over half of the patients also underwent concomitant renal stone removal via percutaneous removal or retrograde ureteroscopy. Postoperative computed tomography imaging revealed complete bladder stone clearance in 90% of patients. There were no notable complications from percutaneous bladder stone removal and most patients were discharged either the same day or within 24 hours. Urine and stone analysis revealed infection was present in the majority of patients. Bladder stones recurred in 45% of patients after more than 2 years of follow-up, on average. Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it the approach of choice at our institution. [ABSTRACT FROM AUTHOR]

Vesicovaginal fistulas (VVFs) are an iatrogenic complication, most often of obstetric/gynecological surgery or radiotherapy. VVFs greatly concern urologists because they significantly impair patients’ quality of life and are often difficult to treat. Herein, we report a case of refractory VVF that recurred after multiple procedures to close it. The patient eventually underwent laparoscopic repair without resection of the fistula. A 55-year-old woman was referred to our department because of persistent fluid discharge from her vagina after a radical hysterectomy. She was diagnosed by cystography and cystoscopy as having a VVF and underwent two transvaginal and one laparoscopic VVF repair without improvement of her symptoms. She was managed with an indwelling bladder catheter for 6 years after the original gynecological surgery and required transurethral lithotripsy for bladder stones resulting from the long-term use of indwelling balloon catheters. At this point, she expressed a strong desire for VVF repair and accordingly underwent laparoscopic VVF repair. Intraoperatively, the fistula was deliberately left in situ. Rather than resecting it, the VVF was repaired by double suturing the bladder mucosa at the fistula and the vaginal wall around the fistula. Three months after this procedure, there was no recurrence of the VVF. [ABSTRACT FROM AUTHOR]

The incidence of cancer within a bladder diverticulum is 0.8-10 %, and early diagnosis and appropriate treatment options are important because of its early invasion. We herein report three cases of intradiverticular bladder cancer. (Case 1) A 75-year-old male. The chief complaint was gross hematuria. He had a 25 mm diverticular mass on the left wall. The initial transurethral biopsy (TU-biopsy) did not lead to a diagnosis, and two months later, TU-biopsy and percutaneous needle biopsy were performed again, and a diagnosis of invasive UC, high grade, cT3N0M0 was made. Radical cystectomy was performed after chemotherapy, but the left pelvic wall was infiltrated, and pelvic recurrence and peritoneal dissemination were observed early after the operation, and the patient died of cancer. (Case 2) A 50-year-old male. The chief complaint was gross hematuria. After the spontaneous passage of a bladder diverticulum stone, the patient had recurrent cystitis, and MRI revealed a 7 mm diverticular tumor. He was diagnosed with invasive UC, high grade, cT1N0M0 by TU-biopsy, and underwent laparoscopic bladder diverticulectomy after chemotherapy. The pathological diagnosis was pT0. The patient remains recurrence-free at 1 year postoperatively. (Case 3) A 57-year-old male. The chief complaint was gross hematuria. MRI showed a 15 mm tumor consistent with a left wall diverticulum. He underwent TURBT with a diagnosis of cTaN0M0 and presented with non-invasive UC, low grade. He has been recurrence-free 8 months after the operation. [ABSTRACT FROM AUTHOR]

Background: The aetiology & diagnosis of the pancreato-biliary ductal system diseases that cause symptoms such as obstructive jaundice is crucial for the best treatment approach. In the current study, we prospectively examined patients with various biliary tract and/or pancreatic illnesses using MRI with MRCP and USG in order to assess the effectiveness of MRI with MRCP as a preferred imaging modality. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients 20-70 years age, either gender, clinical history and laboratory criteria suggestive of having cholelithiasis or choledocholithiasis & findings of cholelithiasis or choledocholithiasis or dilated common bile duct on other imaging modalities especially ultrasound underwent further evaluation with MRCP. Results: Among 65 patients, the majority were from the 21-40 and 41-60 age groups (33.8% each), females (78.5%) and had abdominal pain (90.77%), jaundice (41.54%), nausea/ vomiting (36.92%). USG detected 29.2% dilated IHBR pathologies, whereas 58.5% detected dilated IHBR pathologies with the help of the MRCP technique. Among pancreatico biliary pathologies, USG detected in pathologies such as gall bladder calculus (32.3%), CBD calculus (35.4%) & pancreatitis (15.4%). Among pancreatico biliary pathologies, MRCP were detected following pathologies as gall bladder calculus (35.4%), CBD Calculus (49.2%) and non-calculus (63.2%), pancreatitis (18.5%) and neoplastic changes in the pancreas (1.5%). MRCP had the highest area under the curve (AUC) of 0.942, whereas USG had 0.923 accuracies in the diagnosis of hepatobiliary and pancreatic pathologies. Conclusion: When comparing MRCP to USG, MRCP had the highest sensitivity, AUC with Dilated IHBR, calculus, non-calculus gall bladder pathologies, calculus, non-calculus common bile duct pathologies, and pancreatic pathologies. [ABSTRACT FROM AUTHOR]