Urology Journal

Purpose: The aim of this study is to determine whether antibiotic prophylaxis is required in this outpatient procedure.
Materials and Methods: A non-randomised, prospective observational study that included 184 patients subjected to flexible cystoscopy divided into three groups: - Group 1:60 patients with prophylaxis of 500 mg of ciprofloxacin;- Group 2:62 patients with prophylaxis of 3 g of phosphomycin; and Group 3:62 without antibiotic prophylaxis. Prior to inclusion in the study, absence of infection was checked by means of a urine culture obtained 7 days before the procedure. An analysis was made of urinary infection after 7 days, the cystoscopy indications and its diagnosis, the presence of comorbidities, and the urinary symptoms during the following 7 days.
Results: The mean age of the patients in Group 1 was 65.3 (SD: 12.5) years, 66.7 (10.8) years in Group 2, and 66.9 (10.8) years in Group 3 (P = .7). Bacteriuria was present in 15% of the patients in Group 1, compared to 22.6% in Group 2, and 12.9% in Group 3, with the differences not statistically significant. In multivariate analysis, it was observed that there was no association with the appearance of bacteriuria between the groups for age (P = .8), diabetes (P = .2), smoking (P = .4), lower urinary tract symptoms (P = .7), or immunosuppression (P = .6).
Conclusion: The use of ciprofloxacin or phosphomycin as prophylaxis does not appear to be indicated in flexible cystoscopy in our health area.

Purpose: Treatment of renal calculi in patients with severe skeletal deformities can be challenging. We present our experience in order to provide an assessment of technical difficulties, associated complications, and outcomes of percutaneous nephrolithotomy (PCNL) as a treatment option in this special patient group.
Materials and Methods: Our study included eight patients treated with PCNL for renal stones. All had severe skeletal deformities including six with severe kyphoscoliosis, one with osteogenesis imperfecta, and another with
rickets. After pre-operative evaluation the procedure was performed under fluoroscopic and/or ultrasonic guidance. In all but one case, PCNL was performed with the patient in the prone position. Silicone rolls and soft padded bolsters were used to obtain the best positioning for the procedure. Clearance rates and complications were assessed.
Results: Complete stone-free rate was achieved in six patients (75%) after first-PCNL. The two patients with residual stones underwent a second-look PCNL, after which one was completely cleared. The overall complete
stone-free rate after second PCNL was 87%. Only minor complications were seen in two patients (25%).
Conclusion: We found PCNL to be safe and effective for managing kidney stones in patients with severe skeletal deformities.

Purpose: Various etiological factors have been studied which negatively affect female sexual function, but the
effects of ureteroscopic stone surgery on women's sexual dysfunction remain unknown. The aim of this study was
to investigate the effect of ureteroscopic stone surgery with postoperative stenting on female sexual function.
Materials and Methods: This study included 30 sexually active female patients who underwent ureteroscopic
stone surgery with JJ stenting (study group) and 26 age-matched female patients with ureteral stone surgery
without JJ stenting (control group). Sexual function was assessed at preoperative and at the first and 3rd months
postoperative using the Female Sexual Function Index. Overall satisfaction in relation to the age, operation time,
presence of stents, body mass index, educational status, previous operations, income status, and psychogenic status
was evaluated.
Results: Sexual function was adversely affected by ureteroscopic stone surgery with JJ stenting; but psychogenic,
educational and income status remained stable. Mean individual female sexual function subscores were statistically significant between the study and control groups, but the differences in the mean Beck scores minimally improved between the two groups at preoperative (p = 0.19) visit, whereas first month (p = 0.08) and third month (p = 0.31) of postoperative controls were deteriorated but the differences were not statistically significant, respectively.
Conclusion: Ureterorenoscopy with JJ stenting has considerably negative effects on female sexual function. JJ stenting causes temporary sexual deterioration in women and it generally ceases at the end of the 3rd month after ureteroscopic surgery. Therefore, JJ stenting should be avoided or used for as short a time as possible. If JJ stenting is inevitable, patients should be warned about a temporary decline in their sexual function during the first month of the operation that resolves at most in three months.

Purpose: The potential effects of statins on clinical and histopathologic variables, prostate size, or PSA density (PSAD) and resulting influences on active surveillance eligibility have not been adequately explored. This study examines the effect of statins on prostate specimens following prostatectomy.
Materials and Methods: Patients that received robotic-assisted laparoscopic prostatectomy (RALP) (n = 2,632) were dichotomized according to preoperative statin use. Logistic regression was used to evaluate associations between statin use and patient clinical and pathological characteristics.
Results: Men using statins at the time of prostatectomy were older (61.6 ± 6.4 versus 58.8 ± 7.2 years, P < .001), and had poorer health status (P < .001). Biopsy Gleason grade, clinical stage and prostate size were similar among the two groups, although statin users had lower diagnostic PSA levels (5.5 ± 3.6 versus 6.3 ± 4.9 ng/mL, P < .001) and PSAD (.12 versus .13, P = .001).
Conclusion: Men taking statins at the time of prostatectomy had similar histopathologic characteristics to non-users, despite having significantly lower serum PSA, being older and having similar sized prostates. This supports prior studies suggesting a PSA reduction effect of statins may warrant consideration of statin usage in decision
algorithms for active surveillance.

Purpose: Circumcision is one of the oldest surgical procedures that originated for religious purposes. Circumcision in infancy is a common procedure in our country and secondary meatal stenosis due to circumcision is a common complication. The aim of our study is to determine the effect of meatal stenosis on the lower and upper
urinary tract of circumcised boys by using ultrasonography.
Materials and Methods: In this cross-sectional study, we enrolled 87 circumcised boys between 4 to 8 years old with severe meatal stenosis. Clinical findings of our subjects were gathered by a checklist that included: thin stream of urine, upward urine stream deviation, infrequent voiding, urinary tract infections, voiding dysfunction, and urge incontinency. In lab data analysis, complete blood cell count (CBC), urine analysis, urine culture, blood urea nitrogen (BUN), and plasma creatinine level were evaluated. Ultrasonography detected hydronephrosis, hydroureter, bladder wall thickening in a full and empty bladder, bladder volume, and residual urine volume.
Result: Narrowing of urine stream is commonly seen (about 54%) among patients with severe meatal stenosis, and similarly in sonographic evaluations the most common symptoms among patients was thickening of the bladder wall that increased in an empty and a full bladder (about 82%).
Conclusion: The author of this study recommends performing long-term follow up after circumcision and ultrasonography
to detect meatal stenosis before permanent renal damage occurs.

Purpose: Urinary incontinence, be stress incontinence or urge incontinence or a mixed type incontinence affects women of all ages. The aim of this study was to describe the prevalence and risk factors of urinary incontinence in Sri Lanka.
Materials and Methods: A community based cross-sectional study was performed in Sri Lanka. The age group of the women in Sri Lanka was categorized into 3 age groups: Less than or equal to 35 years, 36 to 50 years of age and more than or equal to 51 years of age. A sample size of 675 women was obtained from each age category obtaining a total sample of 2025 from Sri Lanka. An interviewer-administered questionnaire consisting of two parts; Socio demographic factors, Medical and Obstetric History, and the King's Health Questionnaire (KHQ), was used for data collection. Stepwise logistic regression analysis was performed.
Results: The Prevalence of women with only stress incontinence was 10%, with urge incontinence was 15.6% and with stress and urge incontinence was 29.9%. Stepwise logistic regression analysis showed that the age groups of 36 - 50 years (OR = 2.03; 95% CI = 1.56 - 2.63) and 51 years and above (OR = 2.61; 95% CI= 1.95 - 3.48), Living in one of the districts in Sri Lanka (OR = 4.58; 95% CI = 3.35 - 6.27) and having given birth to multiple children (OR = 1.1; 95% CI = 1.02 - 1.21), diabetes mellitus (OR = 1.97; 95% CI = 1.19 - 3.23), and respiratory diseases (OR = 2.17; 95% CI = 1.48 - 3.19 ) showed a significant risk in the regression analysis.
Conclusion: The risk factor, mostly modifiable, if prevented early, could help to reduce the symptoms of urinary incontinence.

Purpose: To identify any relationship between known reasons of male infertility and 2D:4D ratio.
Materials and Methods: A total of 371 males were included in the study. The cases were grouped into 6 groups including sperm count < 5 million/mL, sperm count ≥ 5 million/mL, Klinefelter Syndrome, hypogonadotropic hypogonadism, vasal agenesis and control. Groups were compared with each other in terms of 2D:4D ratios and groups with a 2D:4D ratios below 1 and equal/above 1 were compared.
Results: The greatest ratios were in the vasal agenesis and hypogonadotropic hypogonadism groups and analysis of the data with logistic regression analysis showed that there was a significant difference in terms of 2D:4D ratios for these groups when comparing with control group. The other groups showed no statistically significant
differences.
Conclusion: The results of the present study showed some significant difference between 2D:4D ratios for the subgroups of the fertile and infertile cases. Although, 2D:4D ratio is not an unaccompanied parameter to reveal causes of male infertility, it can be associated with some situations that are related with male infertility.

Xanthogranulomatous orchitis has been reported to be an extremely rare inflammatory change caused by infection and is difficult to distinguish from testicular tumor. We report a 28-year-old man who presented with a lump in his left testis after a blunt testicular trauma. Based on a series of imaging tests, we suspected benign tumor such as epidermoid cyst and performed tumor enucleation (testis-sparing surgery) on the patient. Histopathological findings showed xanthogranulomatous orchitis. It is assumed that xanthogranulomatous orchitis in this case was caused by blunt testicular trauma and this is the first successful case of xanthoglomatous orchitis in salvaging the testis.

To present our experience with coagulation/laser treatment of urethral hemangiomas. Three cases with small to medium sized urethral hemangiomas in penile and posterior urethra presented with hematuria or urethral bloody discharge. All patients were male. They were treated with thermal or Nd-YAG laser coagulation in the first session. Recurrence of hematuria/bloody discharge happened in two patients within one month from the first treatment that was managed with a second session of laser coagulation. No third session of intervention for hematuria/bloody discharge was required in any patient during 10-39 months of follow up. In cases of relapse after thermal or laser coagulation of small to medium sized urethral hemangiomas, after appropriate consultation with the patient, a second session of laser coagulation can be successful before contemplating more invasive measures like open surgery.

Purpose: To determine the prevalence of fluoroquinolone-resistant (FQR) bacteria carriage in patients undergoing transrectal ultrasound prostate biopsy (TRUS-Bx), and the relationship between the risk factors and FQR carriers as well as infections after prostate biopsy.
Materials and Methods: Rectal swabs were obtained from 158 patients undergoing TRUS-Bx. The FQR organisms were isolated using selective media, and the antibiotic susceptibility pattern was determined. Moreover, after prostate biopsy, blood and urine samples were collected from patients with post-biopsy infection (PBI) during 30
days of follow up.
Results: In total, 73 (46.2%) patients were positive for ciprofloxacin-resistant bacteria in rectal cultures. The most dominant isolates were Escherichia coli (95.9%). The antibiotic susceptibility patterns for the FQR rectal and clinical isolates showed high levels of resistance to ampicillin (94%) and trimethoprim-sulfamethoxazole (89.5%), while the resistance to amikacin, fosfomycin and imipenem remained very low. The multivariate analysis showed that previous use of FQs (OR, 2.54; 95% CI, 1.17-5.49; P = .019) and history of hospitalization (OR, 7.85; 95% CI, 2.075-29.744; P = .002) were significantly risk factors for the FQR carriage. On the other hand, the risk of PBI was higher among intestinal carriers of fluoroquinolone resistant bacteria compared with noncarriers, that this difference was statistically significant (24% versus 3.5%, P < .001).The rates of PBI and hospitalization after TRUS-Bx were 12.5%, and 4.43%, respectively.
Conclusion: An increase in the rectal FQR bacteria carriage is associated with elevated PBI, which strongly recommends
the need for an appropriate prophylaxis to reduce infections in patients undergoing TRUS-Bx.

Purpose: loss of significant lengths of ureter when substitution with bowel or bladder fails is a disaster in urology. This study is conducted to evaluate the results of subcutaneous nephron-vesical bypass (SNVB) in ureteral damage of different etiologies.
Materials and Methods: Seventeen SNVB were employed in patients with ureteral injuries. We employed a device consisted of an internal silicone tube covered by a coiled PTFE tube to replace the ureter. This is called artificial ureter (AU). Proximal end of the AU was introduced in the kidney percutaneously, the tube was passed through a subcutaneous tunnel, while the distal end was inserted in the bladder through a small suprapubic incision.
Results: Follow-up ranged from six months to ten years. We removed the prosthetic ureter in one patient due to gross hematuria two months after insertion. One of the patients was reoperated two days after the procedure because of urinary leakage. In all other patients, the procedure was safe and effective.
Conclusion: Subcutaneous nephron-vesical bypass is a safe and appealing alternative to a nephrostomy tube. This is a permanent device with no need for exchange. The technique can be applied in ureteral injuries due to various causes.