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Introduction and Objectives: In the modern context, where fertility is crucial for couples, male factors contribute 40–50% to subfertility. Testicular cancer survivors facing subfertility due to treatments like orchidectomy and chemotherapy can benefit from sperm banking. However, awareness is lacking, especially in culturally sensitive Asian populations where sex and fertility discussions are taboo. This study aims to assess attitudes and utilization of sperm banking, evaluate its impact on pregnancy outcomes, and identify implementation obstacles. Materials and Methods: A phone interview survey targeted testicular cancer patients treated at Hospital Sultanah Aminah Johor Bahru and Sarawak General Hospital in Malaysia (2019–2023). Of the 102 identified patients, 62 participated. Investigators, using contact details from medical records, conducted interviews with a blend of quantitative and qualitative inquiries. Bivariate analysis identified factors linked to the decision to pursue sperm banking. Results: Out of 62 participants, 58.1% were aware of sperm banking, yet 90.3% chose not to utilize it. Reasons for declining included physician non-offer (41.1%), cost concerns (21.4%), a desire for prompt treatment (16.1%), lack of interest (14.3%), and other factors (7.1%). Among six patients opting for sperm banking, 50% utilized banked sperm, resulting in successful progeny for two-thirds. Notably, one case led to multiple pregnancies. Ethnicity (p = 0.046) and religion (p = 0.026) significantly influenced decisions, with Muslim Malays being the least likely to utilize sperm banking. Conclusion: Sperm banking emerges as a cost-effective strategy for safeguarding fertility in testicular cancer patients. Healthcare providers should proactively offer this option before treatment, ensuring patients are well-informed and addressing concerns to foster informed decisions.

Objective: This study aimed to identify predictive factors for percutaneous nephrolithotomy (PCNL) bleeding risks. With better risk stratification, bleeding in high-risk patient can be anticipated and facilitates early identification. Methods: A prospective observational study of PCNL performed at our institution was done. All adults with radio-opaque renal stones planned for PCNL were included except those with coagulopathy, planned for additional procedures. Factors including gender, co-morbidities, body mass index, stone burden, puncture site, tract dilatation size, operative position, surgeon's seniority, and operative duration were studied using stepwise multivariate regression analysis to identify the predictive factors associated with higher estimated hemoglobin (Hb) deficiency. Results: Overall, 4.86% patients (n=7) received packed cells transfusion. The mean estimated Hb deficiency was 1.3 (range 0–6.5) g/dL and the median was 1.0 g/dL. Stepwise multivariate regression analysis revealed that absence of hypertension (p=0.024), puncture site (p=0.027), and operative duration (p=0.023) were significantly associated with higher estimated Hb deficiency. However, the effect sizes are rather small with partial eta-squared of 0.037, 0.066, and 0.038, respectively. Observed power obtained was 0.621, 0.722, and 0.625, respectively. Other factors studied did not correlate with Hb difference. Conclusion: Hypertension, puncture site, and operative duration have significant impact on estimated Hb deficiency during PCNL. However, the effect size is rather small despite adequate study power obtained. Nonetheless, operative position (supine or prone), puncture number, or tract dilatation size did not correlate with Hb difference. The mainstay of reducing bleeding in PCNL is still meticulous operative technique. Our study findings also suggest that PCNL can be safely done by urology trainees under supervision in suitably selected patient, without increasing risk of bleeding.

Abstract Objective The aim of this research is to study the prevalence of urolithiasis among the population of Sarawak Malaysia and the associated risk factors. Patients and Methods A survey was conducted among individuals aged ≥18 years age in three primary health care clinics in the main cities of Sarawak from March 2019 to March 2020. Participants underwent face‐to‐face interview using a predesigned and standardised questionnaire. Details on demographic data, comorbidities, dietary variables and lifestyle were collected. Ultrasonographic examination of the kidney, ureter and bladder was performed followed by blood and urine sampling. Prevalence was defined as the proportion of participants with kidney stones, and univariate logistic regression was used to estimate the associated factors. Results A total of 1087 participants (486 male, 601 female) completed the questionnaire. Ultrasonographic examination and laboratory investigation were carried out, with an overall response rate of 98.8%. The prevalence of ultrasonographic proven urolithiasis in the sample studied was 4.04%. The mean age of patients with urolithiasis was 50.05 (SD 14.6, range 18–89), and the male to female ratio was 1.2: 1. Univariate analysis showed that odd ratio of personal history of urolithiasis (0.16, p:0.00), salty food intake (0.39, p:0.02), family history of urolithiasis (0.39, p:0.01), and hypertension (1.77, p:0.04) was significantly associated with a greater risk of urolithiasis. Conclusion The prevalence of urolithiasis in this study population is 4.04%. It affects males and females equally; 61.4% are in the age group of 25–64 years. Hypertension, high salt diet, personal history of urolithiasis and family history of urolithiasis are significant risk factors.

Background: Vascular extension of Renal Cell Carcinoma (RCC) occurs in 4–10%. The most effective option is aggressive surgery, with radical nephrectomy and IVC thrombectomy, with reasonably good outcomes of 5-year survival rates ranging from 32% to 64%. Traditionally performed via open approach, newer studies have shown promising outcomes with robotic surgeries. However, laparoscopic techniques remained anecdotal. Objective: To describe our surgical technique of laparoscopic radical nephrectomy (LRN) and IVC thrombectomy and report its safety and intermediate outcomes. Design, setting and participants: We retrospectively reviewed 17 patients who underwent LRN and IVC thrombectomy between Jan 2014 to Oct 2016 across 3 tertiary institutions. Surgical procedure: Transperitoneal approach was performed in all cases. Limited IVC mobilisation is achievable in level I and mobile IVC thrombus. Higher thrombus levels required complete IVC exploration. The IVC defect is closed primarily with continuous laparoscopic stitching. Outcome measurements and statistical analysis: Intraoperative and postoperative clinical outcomes were recorded. A descriptive statistical analysis was performed. Results and limitations: Four patients had level I, 8 patients had level II and 5 had level III IVC involvement. The median operating time was 210 min (range 110–300) and median blood loss was 250 mls (range 100–550). No conversion to open surgey was required. The median length of hospital stay was 4 days (range 3–7), and only 3 patients developed Clavien Dindo Grade I complications (post-operative fever). All patients achieved negative surgical margins and histology was consistently clear cell carcinoma and Fuhrman Grade III-IV. Over a median follow-up period of 18 months, local recurrence occurred in 2 patients (11.8%). One patient had died of metastatic disease. Conclusion: Our technique of LRN with IVC thrombectomy is a safe and feasible alternative to open and robotic surgeries, with low complication rates and promising outcomes.