Hypothesis / aims of study: Non-obstructive urinary retention presents as urologically challengin... more Hypothesis / aims of study: Non-obstructive urinary retention presents as urologically challenging condition, those patients usually depend on clean intermittent catheterization (CIC) or indwelling catheters to empty their bladders. This approach of treatment increases risk of recurrent urinary infections, trauma, and may affect the quality of life of those patients. Sacral Neuromodulation (SNM) has been shown to restore voiding functions in patients suffering from idiopathic urinary retention; InterStim® therapy was approved by FDA in 1999 as treatment modality for non-obstructive urinary retention. SNM is conducted in two steps; First step is called percutaneous nerve evaluation (PNE), then implantation of implantable pulse generator (IPG), second step, which is only reserved for patients who show 50% or more improvement in their voiding dysfunction parameters. The success of SNM in treating non-obstructive urinary retention has been reported in the range of 30-60%; this range has...
Hypothesis and Aim of Study: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a disabli... more Hypothesis and Aim of Study: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a disabling nonmalignant clinical condition of multifactorial etiology, characterized by suprapubic pain related to bladder filling, accompanied by other symptoms such as increased day time frequency and night-time frequency, in the absence of proven urinary infection or other obvious pathology. Sacral nerve root stimulation (SNS) has been proven clinically as a treatment of urinary frequency and urgency, urge incontinence and non-obstructive urinary retention. The aim of this study is to evaluate the response after 5 years follow up in patients who received unilateral sacral stimulator as a treatment for refractory PBS/IC and had initial good response. The latter was defined as 50% improvement in one or more of the voiding parameters as documented by the voiding diary.
Hypothesis / aims of study: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a chronic ... more Hypothesis / aims of study: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a chronic bladder condition characterized by urinary frequency, urgency, nocturia, and supra-pubic pain related to bladder filling. Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the absence of specific and unique organic pathology. Association between PBS/IC and IBS is in the range of 25-50% of cases. A common pathogenesis, that is the interaction of mast cells with nerve cells to produce neurogenic inflammation and pain, has been proposed for interstitial cystitis and irri table bowel syndrome. [1].Another potential link between interstitial cystitis and irritable bowel syndrome involves serotonin which may have a role in suppressing voiding and the urge to void, is abundantly stored inenterochromaffin cells located throughout the gastrointestinal tract. Investigators have assumed that molecular defects in the ...
Purpose. To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent re... more Purpose. To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent removal on urinary tract infections (UTIs) post renal transplantation. Methods. A retrospective study was performed including all adult renal transplants who were transplanted between January 2017 and May 2020 with a minimum of 6-month follow-up at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results. A total of 279 kidney recipients included in the study were stratified into 114 in the early stent removal group (ESR) and 165 in the late stent removal group (LSR). Mean age was 43.4 ± 15.8; women: n: 114, 40.90%; and deceased donor transplant: n: 55, 19.70%. Mean stent removal time was 35.3 ± 28.0 days posttransplant (14.1 ± 4.6 days in the ESR versus 49.9 ± 28.1 days in LSR, p < 0.001 ). Seventy-four UTIs were diagnosed while the stents were in vivo or up to two weeks after the stent removal “UTIs related to the stent” (n = 20, 17.5% in ESR versus n = 54, 32.7% in LSR; p = 0.006 )...
Introduction The COVID-19 pandemic represents an unprecedented challenge for healthcare systems a... more Introduction The COVID-19 pandemic represents an unprecedented challenge for healthcare systems around the world. Saudi Arabia was one of the first countries to experience a lockdown and postponement of elective surgical procedures. The objective of this study was to assess the trends of acute renal colic presenting to our emergency department. Methods This retrospective study targeted all patients who presented with acute renal colic during the lockdown period (March 23, 2019 to June 20, 2019). Patients' and stone data were collected. The patient's data included age, gender, BMI, and comorbidities. Stones' data included stone size, location, side, evidence of obstruction and UTI, and planned and conducted management. Results A total of 137 patients were identified; 92 (67.2%) patients were males with a mean age of 44 ± 16 years. Positive history of urolithiasis was reported in 47 (34.3%). The most common initial investigation was noncontrast CTs (93.4%). The majority of patients had a stone size of < 10 mm (93%) and ureteric stones (81.2%). A total of 32 patients (32.4%) had evidence of UTI and 63.4% had evidence of obstruction. Most of the patients (73.7%) were offered medical expulsive therapy (MET). Only 2.2% did not receive the planned management. Conclusion The observed pattern shows that the management during the lockdown did not differ from the original recommendations. This could be due to the fact that most patients had stone sizes between 5 and 10 mm and consequently were managed by METs. Larger data need to be conducted to provide concrete evidence. Such data are relevant to provide a clear guide for management and to establish protocols for emergency lockdown situations.
Objective: The objective of the study was to identify the failure rate of insertion of ureteral a... more Objective: The objective of the study was to identify the failure rate of insertion of ureteral access sheath (UAS) during primary flexible ureteroscopy (FURS). Materials and Methods: This was a single-surgeon, single-tertiary care center retrospective study. All patients who underwent primary FURS for proximal ureteric or renal stones from November 2014 to May 2018 were included in the study. Patients with a stone burden of more than 20 mm were excluded from the study. A 10/12-Fr coaxial UAS (Bi-Flex, Rocamed) was used. Data collection included age, sex, body mass index (BMI), stone burden and location, previous spontaneous passage of stones, type of anesthesia, and preexisting congenital anomalies. The Chi-square test and t-test were used for the statistical analyses. Results: One hundred and twelve patients were included in the study. All patients underwent primary FURS. The failure rate of primary UAS insertion was 10.7% (n = 12). No statistically significant difference was found in age, BMI, type of anesthesia, previous history of spontaneous stone passage, and stone burden between the success and failure groups (P > 0.05). Conclusions: We believe that our study opens the door for a multicentric prospective trial. Identifying factors leading to a failed primary FURS and UAS insertion is crucial to properly counsel patients preoperatively about the number of procedures that they might need and to prevent the financial loss associated with failed UAS insertion.
What's known on the subject? and What does the study add? The literature presents a gap when it c... more What's known on the subject? and What does the study add? The literature presents a gap when it comes to the trends and outcomes of sacral neuromodulation (SNM) globally, especially in the Middle East. This study evaluated the trends and outcomes of SNM in our patient population. The study could be an incentive for larger multicenter studies. Exploring the outcomes of SNM on a larger scale will improve the procedure.
Hypothesis / aims of study: Urological complications such as post-hysterectomy urinary retention ... more Hypothesis / aims of study: Urological complications such as post-hysterectomy urinary retention are rare conditions, accounting for about 0.1% of cases; these complications seem to be more commonly associated with total hysterectomy than subtotal and radical hysterectomies or hysterectomy for benign diseases. Urine retention, as an isolated complication, is related to de-afferentiation of the bladder and bladder neck, or de-afferentiation with a concomitant factor like Fowler syndrome. [1]. Sacral neuromodulation was approved by FDA in 1999 as treatment option for non obstructive urine retention. Long term results were encouraging and more than 75% of patients continued to void after permanent implantation. Due to paucity of studies evaluating the long term follow-up of sacral neuromodulation (SNM) as a treatment for post-hysterectomy urine retention, we are reporting our experience in using SNM as treatment for this subset of patients; another aim of this study is to explore if ra...
Introduction: The prevalence rate of upper urinary tract calculi in Saudi Arabia is one of the hi... more Introduction: The prevalence rate of upper urinary tract calculi in Saudi Arabia is one of the highest globally. Bilateral renal stone management is an option but is still controversial. Methodology: The study was a retrospective study, including 31 patients with bilateral renal or ureteric stones who underwent bilateral same-session ureterorenoscopy (BSS-URS). The data collected included age, gender, body mass index (BMI), stone burden bilaterally, operative time bilaterally, hospital stay, stone location, type of anesthesia, stone history, renal anomaly as well as pre- and postoperative JJ stenting. In addition, data related to complications (ureteric injury, renal failure, urinary tract infection, pain requiring an emergency department visit within 1 week of the procedure), the stone-free rate (defined as £ 3 mm asymptomatic stone fragment identified with computed tomography Kidney, Ureter and Bladder 3 months after surgery was also collected. The data were collected from the electronic patient record system, entered in an Excel spreadsheet, and descriptive analysis was done. Results: In total, 31 patients were included, with the majority (80.6%, n = 25) male. The mean age was 41.6 years, the mean BMI 28.7 ± 5.59, the mean operative time for each renal unit 46.53 ± 25.69 min, and the mean hospital stay 17.87 ± 8.43 h. The majority (96.7%, n = 30) received general anesthesia. Less than half (40.3%, n = 25) of the renal units had stones in multiple calyces and the majority (90.3%, n = 56) of the renal units were stone free at the 3-month follow-up. A small proportion (3.2%, n = 2) of the renal units were polycystic. Prestenting was documented in 40.3% (n = 25) of the renal units and the majority (95.2%, n = 59) were stented postoperatively. Conclusion: BSS-URS is a safe and a highly effective management option for bilateral renal stones.
Objective To identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia. Me... more Objective To identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia. Methods A retrospective study of seven tertiary hospitals from January 2019 to April 2019, and from January 2020 to April 2020 was performed. Records of urology outpatient department (OPD) visits and endourology procedures in the first third of 2020 were analyzed and compared with those in the first third of 2019, as well as, during the full curfew time, i.e. April 2020 versus April 2019. Results Number of OPD visits in the first third of 2020 and 2019 were 19 499 and 26 594, respectively (p<0.001). Number of OPD visits in April 2020 was 1512, with a 78.6% decrease compared to that in April 2019, and among them 1373 (90.8%) were teleclinics. Number of elective procedures in the first third of 2020 has decreased by 34.3% (from 3025 to 1988) compared to that in the first third of 2019 (p<0.001). There were 120 elective procedures in April 2020, 84.1% lower than that in April 2019. Percutaneous nephrolithotomy, shockwave lithotripsy, and transurethral resection of prostate procedures declined by 94.2%, 98.5%, and 93.8%, respectively. Most procedures were performed as day surgery (85.0%). Number of emergency procedures in 2020 have fallen by 9.3% compared to 2019 (p=0.286). Urolithiasis was the commonest pathology (52.6%) presented to the emergency room (52.6%). Conclusion During COVID-19 pandemic, urology services slashed by >75%, including OPD visits and elective endourology procedures. Most hospitals have changed their strategic preventive measures by increasing the rate of teleclinics and day surgeries.
Benign prostatic hyperplasia (BPH) is the most prevalent urological disease in men that leads to ... more Benign prostatic hyperplasia (BPH) is the most prevalent urological disease in men that leads to lower urinary tract symptoms (LUTS). The clinical presentation is, most likely, obstructive symptoms such as intermittency, hesitancy and poor stream, due to the obstructive nature of the pathology. BPH treatment approach varies. However, they can be divided into two main approaches which are non-surgical and surgical. Non-surgical methods usually started first, such as lifestyle modifications, watchful waiting, and medications. Hence, surgical intervention remains the mainstay of treatment to relieve clinical symptoms. Although transurethral resection of the prostate (TURP) is the gold standard, management is shifting towards minimally invasive surgeries such as Rezūm due to its good outcome and fewer adverse effects. We present a case of prostatic tissue sloughing, a rare complication post Rezūm system therapy in a 50-year-old male.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been linked to thromboembolic co... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been linked to thromboembolic complications. Priapism has been reported only once in link to SARS-CoV2. Here we report the second case of priapism in a patient with SARS-CoV2; our case is unique in being that the patient had priapism for 10 days while being hospitalized. We discuss potential causes and possible prevention strategies. The patient was managed by aspiration and Phenylephrine injection and achieved detumescence and reported normal erection at 2 weeks follow-up.
Double-J (DJ) ureteral stent is a standard procedure in daily urological practice performed to re... more Double-J (DJ) ureteral stent is a standard procedure in daily urological practice performed to relive ureteral obstruction or as a part of other endourological procedures. Although it is a common procedure, the widespread use of ureteral stents has corresponded to the increase in possible complication. We report a unique complication for a patient who presented with a renal subcapsular complete misplacement of DJ stent postureteroscopy for a distal ureteric stone. This challenging complication of ureteral stents is rare and organ threatening.
Introduction: Percutaneous nephrolithotomy (PCNL) is still the mainstay and the treatment of choi... more Introduction: Percutaneous nephrolithotomy (PCNL) is still the mainstay and the treatment of choice for most complex renal stones. The success of PCNL is defined by achieving a stone-free rate (SFR). Lower calyceal access PCNL is established to be the safest percutaneous access to the renal system, but controversy is present when it comes to SFR in comparison to upper calyceal and middle calyceal accesses. Aim: We aim to prove that lower calyceal access PCNL is the safest PCNL access and has the same efficacy as upper calyceal access PCNL for staghorn stones. Methodology: All lower calyceal access PCNLs done from May 2012 to August 2017 were included in the study. Postoperative complications were reported using the modified Clavien Grading System. Results: Sixty-seven patients were included in the study. The mean age was found to be 49.39 years; most (36 [53.73%]) patients were male. The prevalence of diabetes, hypertension, dyslipidemia, and chronic kidney disease was 40.91%, 47.76%, 37.31%, and 20.00%, respectively. The mean hospital stay was 7.9 days; mean operative time was 138.52 min. The mean staghorn stone burden was 476.34 mm2. About 80.59% (n = 54) of patients had complete stone resolution after the first session. Only 3 (4.47%) patients had complications and classified as Grade 2 on the modified Clavien Grading System and the remainder were classified as Grade 1, two patients needed postoperative blood transfusion, and one had a renal pelvis perforation. Conclusion: When it comes to safety and efficacy, the use of lower calyceal single-access PCNL has a very low complication rate compared to upper calyceal access PCNL, especially pneumothorax and bleeding.
Neuromodulation: Technology at the Neural Interface, 2011
Objectives: This study sought to determine the association between stimulation parameters at the ... more Objectives: This study sought to determine the association between stimulation parameters at the time of implantation and loss of efficacy on long-term follow-up. Material and Methods: Between 2002 and 2007, 143 patients underwent selective sacral nerve root stimulation at our center as a treatment for voiding dysfunction. Nine patients were explanted because of loss of efficacy. The patients' charts were retrospectively reviewed and compared with those of a well-matched group of 12 positive responders. A t-test was used to determine the differences in voiding parameters and stimulation parameters between both groups (at p < 0.05). Results: The baseline amplitude levels in the loss of efficacy group were significantly higher than those of the control group (2.08 Ϯ 0.35 V vs. 1.27 Ϯ 0.25 V) (p = 0.008). The impedance levels were significantly higher in the loss of efficacy group than the control (1032.4 Ϯ 181 W vs. 590 Ϯ 44.6 W) (p = 0.025). Conclusion: High stimulation parameters at the time of implantation were associated with loss of efficacy at the long-term follow-up.
Hypothesis / aims of study: Non-obstructive urinary retention presents as urologically challengin... more Hypothesis / aims of study: Non-obstructive urinary retention presents as urologically challenging condition, those patients usually depend on clean intermittent catheterization (CIC) or indwelling catheters to empty their bladders. This approach of treatment increases risk of recurrent urinary infections, trauma, and may affect the quality of life of those patients. Sacral Neuromodulation (SNM) has been shown to restore voiding functions in patients suffering from idiopathic urinary retention; InterStim® therapy was approved by FDA in 1999 as treatment modality for non-obstructive urinary retention. SNM is conducted in two steps; First step is called percutaneous nerve evaluation (PNE), then implantation of implantable pulse generator (IPG), second step, which is only reserved for patients who show 50% or more improvement in their voiding dysfunction parameters. The success of SNM in treating non-obstructive urinary retention has been reported in the range of 30-60%; this range has...
Hypothesis and Aim of Study: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a disabli... more Hypothesis and Aim of Study: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a disabling nonmalignant clinical condition of multifactorial etiology, characterized by suprapubic pain related to bladder filling, accompanied by other symptoms such as increased day time frequency and night-time frequency, in the absence of proven urinary infection or other obvious pathology. Sacral nerve root stimulation (SNS) has been proven clinically as a treatment of urinary frequency and urgency, urge incontinence and non-obstructive urinary retention. The aim of this study is to evaluate the response after 5 years follow up in patients who received unilateral sacral stimulator as a treatment for refractory PBS/IC and had initial good response. The latter was defined as 50% improvement in one or more of the voiding parameters as documented by the voiding diary.
Hypothesis / aims of study: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a chronic ... more Hypothesis / aims of study: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a chronic bladder condition characterized by urinary frequency, urgency, nocturia, and supra-pubic pain related to bladder filling. Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the absence of specific and unique organic pathology. Association between PBS/IC and IBS is in the range of 25-50% of cases. A common pathogenesis, that is the interaction of mast cells with nerve cells to produce neurogenic inflammation and pain, has been proposed for interstitial cystitis and irri table bowel syndrome. [1].Another potential link between interstitial cystitis and irritable bowel syndrome involves serotonin which may have a role in suppressing voiding and the urge to void, is abundantly stored inenterochromaffin cells located throughout the gastrointestinal tract. Investigators have assumed that molecular defects in the ...
Purpose. To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent re... more Purpose. To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent removal on urinary tract infections (UTIs) post renal transplantation. Methods. A retrospective study was performed including all adult renal transplants who were transplanted between January 2017 and May 2020 with a minimum of 6-month follow-up at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results. A total of 279 kidney recipients included in the study were stratified into 114 in the early stent removal group (ESR) and 165 in the late stent removal group (LSR). Mean age was 43.4 ± 15.8; women: n: 114, 40.90%; and deceased donor transplant: n: 55, 19.70%. Mean stent removal time was 35.3 ± 28.0 days posttransplant (14.1 ± 4.6 days in the ESR versus 49.9 ± 28.1 days in LSR, p < 0.001 ). Seventy-four UTIs were diagnosed while the stents were in vivo or up to two weeks after the stent removal “UTIs related to the stent” (n = 20, 17.5% in ESR versus n = 54, 32.7% in LSR; p = 0.006 )...
Introduction The COVID-19 pandemic represents an unprecedented challenge for healthcare systems a... more Introduction The COVID-19 pandemic represents an unprecedented challenge for healthcare systems around the world. Saudi Arabia was one of the first countries to experience a lockdown and postponement of elective surgical procedures. The objective of this study was to assess the trends of acute renal colic presenting to our emergency department. Methods This retrospective study targeted all patients who presented with acute renal colic during the lockdown period (March 23, 2019 to June 20, 2019). Patients' and stone data were collected. The patient's data included age, gender, BMI, and comorbidities. Stones' data included stone size, location, side, evidence of obstruction and UTI, and planned and conducted management. Results A total of 137 patients were identified; 92 (67.2%) patients were males with a mean age of 44 ± 16 years. Positive history of urolithiasis was reported in 47 (34.3%). The most common initial investigation was noncontrast CTs (93.4%). The majority of patients had a stone size of < 10 mm (93%) and ureteric stones (81.2%). A total of 32 patients (32.4%) had evidence of UTI and 63.4% had evidence of obstruction. Most of the patients (73.7%) were offered medical expulsive therapy (MET). Only 2.2% did not receive the planned management. Conclusion The observed pattern shows that the management during the lockdown did not differ from the original recommendations. This could be due to the fact that most patients had stone sizes between 5 and 10 mm and consequently were managed by METs. Larger data need to be conducted to provide concrete evidence. Such data are relevant to provide a clear guide for management and to establish protocols for emergency lockdown situations.
Objective: The objective of the study was to identify the failure rate of insertion of ureteral a... more Objective: The objective of the study was to identify the failure rate of insertion of ureteral access sheath (UAS) during primary flexible ureteroscopy (FURS). Materials and Methods: This was a single-surgeon, single-tertiary care center retrospective study. All patients who underwent primary FURS for proximal ureteric or renal stones from November 2014 to May 2018 were included in the study. Patients with a stone burden of more than 20 mm were excluded from the study. A 10/12-Fr coaxial UAS (Bi-Flex, Rocamed) was used. Data collection included age, sex, body mass index (BMI), stone burden and location, previous spontaneous passage of stones, type of anesthesia, and preexisting congenital anomalies. The Chi-square test and t-test were used for the statistical analyses. Results: One hundred and twelve patients were included in the study. All patients underwent primary FURS. The failure rate of primary UAS insertion was 10.7% (n = 12). No statistically significant difference was found in age, BMI, type of anesthesia, previous history of spontaneous stone passage, and stone burden between the success and failure groups (P > 0.05). Conclusions: We believe that our study opens the door for a multicentric prospective trial. Identifying factors leading to a failed primary FURS and UAS insertion is crucial to properly counsel patients preoperatively about the number of procedures that they might need and to prevent the financial loss associated with failed UAS insertion.
What's known on the subject? and What does the study add? The literature presents a gap when it c... more What's known on the subject? and What does the study add? The literature presents a gap when it comes to the trends and outcomes of sacral neuromodulation (SNM) globally, especially in the Middle East. This study evaluated the trends and outcomes of SNM in our patient population. The study could be an incentive for larger multicenter studies. Exploring the outcomes of SNM on a larger scale will improve the procedure.
Hypothesis / aims of study: Urological complications such as post-hysterectomy urinary retention ... more Hypothesis / aims of study: Urological complications such as post-hysterectomy urinary retention are rare conditions, accounting for about 0.1% of cases; these complications seem to be more commonly associated with total hysterectomy than subtotal and radical hysterectomies or hysterectomy for benign diseases. Urine retention, as an isolated complication, is related to de-afferentiation of the bladder and bladder neck, or de-afferentiation with a concomitant factor like Fowler syndrome. [1]. Sacral neuromodulation was approved by FDA in 1999 as treatment option for non obstructive urine retention. Long term results were encouraging and more than 75% of patients continued to void after permanent implantation. Due to paucity of studies evaluating the long term follow-up of sacral neuromodulation (SNM) as a treatment for post-hysterectomy urine retention, we are reporting our experience in using SNM as treatment for this subset of patients; another aim of this study is to explore if ra...
Introduction: The prevalence rate of upper urinary tract calculi in Saudi Arabia is one of the hi... more Introduction: The prevalence rate of upper urinary tract calculi in Saudi Arabia is one of the highest globally. Bilateral renal stone management is an option but is still controversial. Methodology: The study was a retrospective study, including 31 patients with bilateral renal or ureteric stones who underwent bilateral same-session ureterorenoscopy (BSS-URS). The data collected included age, gender, body mass index (BMI), stone burden bilaterally, operative time bilaterally, hospital stay, stone location, type of anesthesia, stone history, renal anomaly as well as pre- and postoperative JJ stenting. In addition, data related to complications (ureteric injury, renal failure, urinary tract infection, pain requiring an emergency department visit within 1 week of the procedure), the stone-free rate (defined as £ 3 mm asymptomatic stone fragment identified with computed tomography Kidney, Ureter and Bladder 3 months after surgery was also collected. The data were collected from the electronic patient record system, entered in an Excel spreadsheet, and descriptive analysis was done. Results: In total, 31 patients were included, with the majority (80.6%, n = 25) male. The mean age was 41.6 years, the mean BMI 28.7 ± 5.59, the mean operative time for each renal unit 46.53 ± 25.69 min, and the mean hospital stay 17.87 ± 8.43 h. The majority (96.7%, n = 30) received general anesthesia. Less than half (40.3%, n = 25) of the renal units had stones in multiple calyces and the majority (90.3%, n = 56) of the renal units were stone free at the 3-month follow-up. A small proportion (3.2%, n = 2) of the renal units were polycystic. Prestenting was documented in 40.3% (n = 25) of the renal units and the majority (95.2%, n = 59) were stented postoperatively. Conclusion: BSS-URS is a safe and a highly effective management option for bilateral renal stones.
Objective To identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia. Me... more Objective To identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia. Methods A retrospective study of seven tertiary hospitals from January 2019 to April 2019, and from January 2020 to April 2020 was performed. Records of urology outpatient department (OPD) visits and endourology procedures in the first third of 2020 were analyzed and compared with those in the first third of 2019, as well as, during the full curfew time, i.e. April 2020 versus April 2019. Results Number of OPD visits in the first third of 2020 and 2019 were 19 499 and 26 594, respectively (p<0.001). Number of OPD visits in April 2020 was 1512, with a 78.6% decrease compared to that in April 2019, and among them 1373 (90.8%) were teleclinics. Number of elective procedures in the first third of 2020 has decreased by 34.3% (from 3025 to 1988) compared to that in the first third of 2019 (p<0.001). There were 120 elective procedures in April 2020, 84.1% lower than that in April 2019. Percutaneous nephrolithotomy, shockwave lithotripsy, and transurethral resection of prostate procedures declined by 94.2%, 98.5%, and 93.8%, respectively. Most procedures were performed as day surgery (85.0%). Number of emergency procedures in 2020 have fallen by 9.3% compared to 2019 (p=0.286). Urolithiasis was the commonest pathology (52.6%) presented to the emergency room (52.6%). Conclusion During COVID-19 pandemic, urology services slashed by >75%, including OPD visits and elective endourology procedures. Most hospitals have changed their strategic preventive measures by increasing the rate of teleclinics and day surgeries.
Benign prostatic hyperplasia (BPH) is the most prevalent urological disease in men that leads to ... more Benign prostatic hyperplasia (BPH) is the most prevalent urological disease in men that leads to lower urinary tract symptoms (LUTS). The clinical presentation is, most likely, obstructive symptoms such as intermittency, hesitancy and poor stream, due to the obstructive nature of the pathology. BPH treatment approach varies. However, they can be divided into two main approaches which are non-surgical and surgical. Non-surgical methods usually started first, such as lifestyle modifications, watchful waiting, and medications. Hence, surgical intervention remains the mainstay of treatment to relieve clinical symptoms. Although transurethral resection of the prostate (TURP) is the gold standard, management is shifting towards minimally invasive surgeries such as Rezūm due to its good outcome and fewer adverse effects. We present a case of prostatic tissue sloughing, a rare complication post Rezūm system therapy in a 50-year-old male.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been linked to thromboembolic co... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been linked to thromboembolic complications. Priapism has been reported only once in link to SARS-CoV2. Here we report the second case of priapism in a patient with SARS-CoV2; our case is unique in being that the patient had priapism for 10 days while being hospitalized. We discuss potential causes and possible prevention strategies. The patient was managed by aspiration and Phenylephrine injection and achieved detumescence and reported normal erection at 2 weeks follow-up.
Double-J (DJ) ureteral stent is a standard procedure in daily urological practice performed to re... more Double-J (DJ) ureteral stent is a standard procedure in daily urological practice performed to relive ureteral obstruction or as a part of other endourological procedures. Although it is a common procedure, the widespread use of ureteral stents has corresponded to the increase in possible complication. We report a unique complication for a patient who presented with a renal subcapsular complete misplacement of DJ stent postureteroscopy for a distal ureteric stone. This challenging complication of ureteral stents is rare and organ threatening.
Introduction: Percutaneous nephrolithotomy (PCNL) is still the mainstay and the treatment of choi... more Introduction: Percutaneous nephrolithotomy (PCNL) is still the mainstay and the treatment of choice for most complex renal stones. The success of PCNL is defined by achieving a stone-free rate (SFR). Lower calyceal access PCNL is established to be the safest percutaneous access to the renal system, but controversy is present when it comes to SFR in comparison to upper calyceal and middle calyceal accesses. Aim: We aim to prove that lower calyceal access PCNL is the safest PCNL access and has the same efficacy as upper calyceal access PCNL for staghorn stones. Methodology: All lower calyceal access PCNLs done from May 2012 to August 2017 were included in the study. Postoperative complications were reported using the modified Clavien Grading System. Results: Sixty-seven patients were included in the study. The mean age was found to be 49.39 years; most (36 [53.73%]) patients were male. The prevalence of diabetes, hypertension, dyslipidemia, and chronic kidney disease was 40.91%, 47.76%, 37.31%, and 20.00%, respectively. The mean hospital stay was 7.9 days; mean operative time was 138.52 min. The mean staghorn stone burden was 476.34 mm2. About 80.59% (n = 54) of patients had complete stone resolution after the first session. Only 3 (4.47%) patients had complications and classified as Grade 2 on the modified Clavien Grading System and the remainder were classified as Grade 1, two patients needed postoperative blood transfusion, and one had a renal pelvis perforation. Conclusion: When it comes to safety and efficacy, the use of lower calyceal single-access PCNL has a very low complication rate compared to upper calyceal access PCNL, especially pneumothorax and bleeding.
Neuromodulation: Technology at the Neural Interface, 2011
Objectives: This study sought to determine the association between stimulation parameters at the ... more Objectives: This study sought to determine the association between stimulation parameters at the time of implantation and loss of efficacy on long-term follow-up. Material and Methods: Between 2002 and 2007, 143 patients underwent selective sacral nerve root stimulation at our center as a treatment for voiding dysfunction. Nine patients were explanted because of loss of efficacy. The patients' charts were retrospectively reviewed and compared with those of a well-matched group of 12 positive responders. A t-test was used to determine the differences in voiding parameters and stimulation parameters between both groups (at p < 0.05). Results: The baseline amplitude levels in the loss of efficacy group were significantly higher than those of the control group (2.08 Ϯ 0.35 V vs. 1.27 Ϯ 0.25 V) (p = 0.008). The impedance levels were significantly higher in the loss of efficacy group than the control (1032.4 Ϯ 181 W vs. 590 Ϯ 44.6 W) (p = 0.025). Conclusion: High stimulation parameters at the time of implantation were associated with loss of efficacy at the long-term follow-up.
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Papers by Yahya Ghazwani