Case – Renal artery pseudoaneurysm: A life-threatening occurrence following thulium laser lithotripsy

Introduction Renal artery pseudoaneurysm post-laser lithotripsy is a rare and potentially life-threatening complication. Traditionally, the most common modalities used for treatment of urinary tract stones were holmium laser lithotripsy and extracorporeal shockwave lithotripsy. However, thulium laser has recently gained momentum in the treatment of urinary tract stones with increasing use and availability in healthcare systems. We report a case of renal artery pseudoaneurysm post-thulium laser lithotripsy who presented in hemorrhagic shock after ureteral stent removal and was subsequently stabilized by endovascular embolization.

Urology

This chapter explores urology, starting with the symptoms and signs. Symptoms in urology include pain, haematuria, urinary incontinence, male sexual dysfunction, haemotospermia, and lower urinary tract symptoms. Lower urinary tract symptoms refer to a group of symptoms that typically affect the ageing male. It is often caused by bladder outflow obstruction (BOO) related to prostatic enlargement and includes symptoms related to both voiding and storage. The chapter then looks at the investigations of urinary tract disease, detailing laboratory investigations, radiology investigations, and endoscopy. It deals with urinary tract stones; obstruction of the ureter; benign prostatic hyperplasia; stricture of the urethra; scrotal swellings; disorders of the foreskin; common conditions of the penis; and erectile dysfunction. The chapter also considers adenocarcinoma of the kidney; transitional cell tumours; adenocarcinoma of the prostate; carcinoma of the penis; testicular tumours; haematuria; acute urinary retention (AUR); and acute testicular pain.

Prevention and control of urinary tract stones using a smartphone-based self-care application: design and evaluation

Background Self-care and participation of patients in improving health and increasing awareness about the risk factors that affect the development of disease in patients with urinary tract stones are influential factors in controlling and improving the quality of life in these patients. In this regard, the availability and capability of smartphones increase patients’ self-care ability. The present study aimed to develop and evaluate a self-care application based on smartphones for patients with urinary tract stones. Methods The present study is a developmental and applied study that was conducted in three phases. First, the information needs and functionalities of the self-care application were determined by surveying 101 patients, 32 urologists and nephrologists, 11 nurses, and six other specialists. In the second phase, the initial sample of the smartphone-based application was created, and in the third phase, the designed application was evaluated by 15 experts using the standard Post-Study System Usability Questionnaire (PSSUQ 18.3) and Nielsen’s Attributes of Usability (NAU) questionnaire. Results of the questionnaires were entered into SPSS-23 software for analysis using descriptive statistics. Results In the first phase, 21 information elements and nine critical functionalities for the self-care application were identified, and then this application was designed by Java programming language. The evaluation of experts showed that two aspects of the quality of system user interface from the user's point of view and the overall performance of the application together obtained the highest score (6.43 from 7), which was equal to 91.85%. Then according to the experts, aspects of the degree of convenience and user-friendliness of the application received the highest score (6.10 from 7), which was equal to 87.14%, and also all aspects of the application were evaluated at an acceptable level. In general, results of the evaluation of application's usability by experts showed that the usability of the application for patients with urinary tract stones was at an acceptable level. Conclusion According to the results obtained from evaluating the smartphone-based application for patients with urinary tract stones, this self-care application can be used to prevent and control urinary tract stones and facilitate self-care and active patient participation in care.

Frequency of Asymptomatic Bacteriuria in Pregnant Women

Objectives: To determine the frequency of asymptomatic bacteriuria in pregnantwomen. Study design: Descriptive, Cross sectional study Place and Duration: Department of Obstetrics & Gynaecology, Benazir Bhutto Hospital, Rawalpindi. 26th December 2017 to 25th June 2018 Materials & Methods: A total of 151 pregnant women of gestational age ≥28 weeks, 18 to 40 years of age were included. Patients with genital tract trauma, history of UTI in the past one year and urinary tract stones were excluded. Then clean-catch midstream urine was collected from each woman into a sterile universal container and sample was sent to the institutional laboratory for presenceor absence of asymptomatic bacteriuria. Results: Age range in this study was from 18 to 40 years with mean age of 28.78 ± 3.90 years. Majority of the patients 84 (55.63%) were between 18 to 30 years of age. Mean gestational age was 31.06 ± 1.67 weeks. Mean parity was 3.17 ± 0.99. Mean BMI was 27.44 ± 3.02 kg/m2. In our study, frequency of asymptomatic bacteriuria in pregnant women was found in 25 (16.56%) patients. Conclusion: This study concluded that frequency of asymptomatic bacteriuria in pregnant women is quite high. Keywords: Asymptomatic Bacteriuria, Pregnancy, Urinary Tract Infection.

Unani management of vesical calculus: a case report

Vesical calculus (Hisat-e-Masanah) accounts approximately 5% of all urinary tract stones. It has bimodal peaks age of incidence at 3 years in children in developing countries, and 60 years in adulthood. Despite advance technology of lithotripsy, the management of vesical calculus in children remains a challenge due to difficulty in passing of stone fragments and adverse effect of surgery. Hence alternative and safe treatment like Unani system of medicine can be adopted to avoid surgical procedure. The present paper deals with a case study in which a 10 years old male child patient suffered from a single vesical calculus was treated with Unani pharmacopeial medicine; Qurs Kaknaj (2 tablets), Qurs Kushta Hajrul Yahood (1 tablet) and Sharbat Buzoori Motadil (10 ml syrup) twice a day as oral administration, with the aim to evaluate the efficacy of drugs and to avoid surgery. Patient has shown excellent and significant result as 8×5 mm size of a stone flushed out at 3rd day of treatment without any operation.

662 Establishing an Acute Extracorporeal Lithotripsy Service in The COVID 19 Pandemic

Introduction In England, 40% of patients who present with urinary tract stones as an emergency are actively managed with a procedure, in the majority a stent. This commits them to an inpatient stay, a general anaesthetic and further surgery at a later date. Extracorporeal Shockwave Lithotripsy (ESWL) offers a promising, outpatient alternative especially during the COVID19 pandemic. With COVID19 limiting our ability to provide urgent stone care, we assessed our institutions compliance with Getting It Right First Time (GIRFT) guidelines- which recommends that 10% of patients with acute stones undergo ESWL. Method The audit comprised of 2 cycles; collecting data on the number patients that were admitted with renal colic over a 3-month period, and the percentage treated with ESWL. The first cycle collected data from February to April 2020, while the second cycle collected data from May 2020 to July 2020. Results The first cycle of the audit revealed that 0 patients were treated with acute ESWL. This required implementation of a referral pathway to Frimley Park Hospital who provided ESWL services. After implementation of a pathway, the 2nd cycle of the audit saw that of 32 patients, 6 patients were referred to Frimley for emergency ESWL (compliance rate: 19%). Conclusions With the implantation of a referral pathway, the percentage of patients that we referred for ESWL rose significantly from 0% to 19%, thereby meeting GIRFT guidelines. This audit re-iterates how the pandemic has shifted the way we provide urgent stone care with emergency ESWL in our local trust

Computer-aided diagnosis with a convolutional neural network algorithm for automated detection of urinary tract stones on plain X-ray

Background Recent increased use of medical images induces further burden of their interpretation for physicians. A plain X-ray is a low-cost examination that has low-dose radiation exposure and high availability, although diagnosing urolithiasis using this method is not always easy. Since the advent of a convolutional neural network via deep learning in the 2000s, computer-aided diagnosis (CAD) has had a great impact on automatic image analysis in the urological field. The objective of our study was to develop a CAD system with deep learning architecture to detect urinary tract stones on a plain X-ray and to evaluate the model’s accuracy. Methods We collected plain X-ray images of 1017 patients with a radio-opaque upper urinary tract stone. X-ray images (n = 827 and 190) were used as the training and test data, respectively. We used a 17-layer Residual Network as a convolutional neural network architecture for patch-wise training. The training data were repeatedly used until the best model accuracy was achieved within 300 runs. The F score, which is a harmonic mean of the sensitivity and positive predictive value (PPV) and represents the balance of the accuracy, was measured to evaluate the model’s accuracy. Results Using deep learning, we developed a CAD model that needed 110 ms to provide an answer for each X-ray image. The best F score was 0.752, and the sensitivity and PPV were 0.872 and 0.662, respectively. When limited to a proximal ureter stone, the sensitivity and PPV were 0.925 and 0.876, respectively, and they were the lowest at mid-ureter. Conclusion CAD of a plain X-ray may be a promising method to detect radio-opaque urinary tract stones with satisfactory sensitivity although the PPV could still be improved. The CAD model detects urinary tract stones quickly and automatically and has the potential to become a helpful screening modality especially for primary care physicians for diagnosing urolithiasis. Further study using a higher volume of data would improve the diagnostic performance of CAD models to detect urinary tract stones on a plain X-ray.

Heavy metals in urinary stones in the Democratic Republic of Congo

Background The Democratic Republic of Congo has been a country of intensive mining activities for centuries, but the data on the presence of heavy metals in stones are lacking. This study aimed to identify different heavy metals in urinary tract stones and to investigate their association with the main components of urinary stones. Methods Thirty-six stones from urolithiasis patients (n = 36) followed in 10 hospitals in the Democratic Republic of Congo between January 2016 and September 2019 were analyzed by Fourier transform infrared spectrophotometry. Further analysis using X-ray fluorescence was conducted at the Laboratory of Solids Physics. Results Eight heavy metals were detected in all the stones analyzed. The average (SD) number of heavy metals detected by stone was 5 (1.2). Iron and strontium were detected in all the stones analyzed. Other heavy metals detected included zinc, copper, bromine, rubidium, lead and nickel. Rubidium had the highest concentration in the stones regardless of the sampling site. There was no statistically significant association between the content of heavy metals at the center level and at the crown level of the stones. Rubidium had more affinity with phosphates and purines (p ˂ 0.001). Iron and strontium exhibited a high affinity with weddellite than with whewellite. Conclusion Iron and Strontium were present in all stones analyzed. The presence of heavy metals in stones analyzed might suggest environmental pollution rather than crystalline induction factors.

Urinary Tract Stones Risk Factors in Patients with Benign Prostatic Hyperplasia in West Java, Indonesia

Background: Urinary tract stones are common in patients with benign prostatic hyperplasia (BPH); therefore, an imaging test is needed for patients who have risk factors for the formation of urinary tract stones. The purpose of this study was to explore the factors associated with the presence of urinary tract stones in patients with BPH as information to conduct imaging tests.Methods: A cross-sectional quantitative analytic study was conducted on medical records of patients with BPH, both with and without urinary tract stones, or patients with urinary tract stones registered at the Department of Urology, Dr. Hasan Sadikin General Hospital, Indonesia, from 2015 to 2018. Data on age, body mass index, hypertension, use of antihypertensive drugs, diabetes mellitus, and hyperuricemia were collected and analyzed using the Mann-Whitney, Chi-square, Fisher exact test, and multivariate logistic regression statistical test to compare variables between BPH with and without urinary tract stones.Results: In total, 235 BPH patients were registered, of whom 74 (31.5%) had urinary tract stones. The median age was 64 years old. There was a relationship between age (p=0.030), diabetes mellitus (p=0.043), and the occurrence of urinary tract stones in patients with BPH. The most dominant risk factor was diabetes mellitus (OR=3.000, 95%CI 1.03-8.69).Conclusions: Age and diabetes mellitus are the risk factors for urinary tract stones in patients with BPH. BPH patients with diabetes mellitus are at a 3-fold risk for urinary tract stones. Diabetes mellitus in BPH patients is an indication to conduct imaging tests.