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   Table of Contents - Current issue
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July-September 2021
Volume 33 | Issue 3
Page Nos. 61-94

Online since Thursday, January 12, 2023

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ORIGINAL ARTICLES  

The first national resident survey assessing the Greek urology residency training programs p. 61
Lazaros Tzelves, Ioannis Glykas, Lazaros Lazarou, Christos Zabaftis, Panagiotis Velissarios Stamatakos, Charalampos Fragkoulis, Aggeliki Leventi, Napoleon Moulavasilis, Dimitrios Tzavellas, Kimon Tsirkas, Konstantinos Ntoumas, Panagiotis Mourmouris, Athanasios Dellis, Ioannis Varkarakis, Andreas Skolarikos, Evangelos Liatsikos, Ioannis Gkialas
DOI:10.4103/HUAJ.HUAJ_36_21  
Background and Objectives: This is the first national survey regarding Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas that necessitate improvement. Materials and Methods: A 51-question survey was developed via an electronic platform and 87.5% of residents (91 out of 104) participated from March 2019 until May 2019. Fisher's exact test, Chi-square test, and Kruskal–Wallis test were used with statistical significance set at P = 0.05. Results: The median overall satisfaction from surgical training was 6/10, and was independent of working schedule, working in a University Department, postgraduate years or number of residents in clinic. Among diagnostic and therapeutic procedures, kidney-ureter-bladder ultrasound, cystoscopy, and double-J stent insertion were common for trainees. On the other hand, most residents have not performed any scrotal ultrasound or pressure-flow studies. About 70.4% of residents reported bureaucracy as a major issue. 80.2% have not performed any ESWL, while 58.2% of residents performed <10 ureteroscopies and only the last year trainees performed more than 10 TURBT and transurethral resection of prostate. Most of the participants mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. 44% rarely feel satisfied from their work and 59.3% sometimes suffer from burnout. Conclusions: Considering the results from this survey regulatory authorities should join forces to establish a structured curriculum of clinical, surgical, and research training in Urology across Europe.
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Comparison of cancer waiting time targets in urology, pre-COVID era, and during the COVID era – A single-center experience p. 70
Muhammad Faisal Khan, Lindamullage Amila Kamal De Silva, Georgios Tsampoukas, Shashank Iyer, Kayleigh Spellar
DOI:10.4103/HUAJ.HUAJ_44_21  
Objectives: The objective of this study is to measure the impact of COVID-19 pandemic on treatment targets for urgent urology cases in our hospital and compare it with previous research publications. Materials and Methods: We retrospectively collected and analyzed data over 10 months for 2 consecutive years. The data were analyzed from April to October in 2019 and 2020. This includes all suspected cancer. We collected a total number of referrals, time to the first consultation, and time of first definitive treatment. Results: The total number of patients referred in 2019 pre-COVID was 478 as compared to 278 in the subsequent year at the time of the first wave of COVID-19 pandemic. A total number of 118 cancers were detected in 2019 which makes up 24.6% of the total patients referred. Forty-one patients received treatment >62 days. This is 41 (34.7%) of the cancers or 8.5% of the referrals. Similarly, 60 patients were detected with cancer in 2020 making up 22.2% of the total referrals. Nineteen patients received treatment >62 days. This equates to 31.6% of the cancers or 7% of the total referrals. Conclusion: During the COVID-19 pandemic peak, though we did see a slight improvement in the total number of patients breached for their targeted dates of cancer treatment, this is largely due to the significant reduction of around 44% in the total number of referrals. This data also strengthens other large studies for other cancers which show a significantly lower number of patients being referred for cancer diagnosis.
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Peri-operative predictors of postoperative bleeding and sepsis after percutaneous nephrolithotomy p. 74
Ambala Tharakkal Rajeevan, Midhun P Gopalakrishnan
DOI:10.4103/HUAJ.HUAJ_49_21  
Introduction: Percutaneous nephrolithotomy (PCNL) is the most common minimal access method used for the management of large renal and pelvic stones. The two most common complications after PCNL are bleeding and sepsis. In this context, we did this study to find out perioperative predictors of postoperative bleeding and sepsis after PCNL. Materials and Methods: We conducted this study on 110 patients who came for PCNL at our institute from March 1, 2018 to August 31, 2019. Data were collected using a pro forma, and the same analyzed by appropriate statistical methods using the SPSS software. Results: The perioperative factors correlated to postoperative bleeding were stone size, density of stone, Guy's stone score, size of Amplatz sheath used, number of working tracts created, and duration of surgery. On regression analysis factors which were predictive of postoperative bleeding were size of Amplatz sheath and number of working tracts created. Peri-operative factors correlated with postoperative sepsis were body mass index of the patient, preoperative total count, density of stone, preoperative pyuria, preoperative positive urine culture, superior calyceal puncture, postoperative total leukocyte count, and postoperative fever within 24 h. The factors which were predictive of postoperative sepsis were preoperative pyuria, preoperative urine culture, superior calyceal puncture, and postoperative fever on regression analysis. Conclusion: This study shows perioperative predictors of postoperative bleeding and sepsis after PCNL. Out of 43.63% total complications, 20% were major and 23.63% minor complications.
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REVIEW ARTICLES Top

Urinary stones: Medical dissolution and monitoring p. 80
Lazaros Tzelves, Panagiotis Mourmouris, Andreas Skolarikos
DOI:10.4103/HUAJ.HUAJ_40_21  
Surgical management is the cornerstone of urolithiasis treatment, but since prevention is better than treatment, we need to explore other measures for treating and especially for monitoring patients before recurrence. Several laboratory studies have performed testing of experimental treatments to reduce kidney stone formation and cellular damage and showed encouraging results. A few prospective and randomized studies proved the efficacy and safety of oral chemolysis for radiolucent stones. The purpose of this review is to present the most recent data regarding dissolution therapy and ways of monitoring stone patients.
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Renal infarction: A nonurologic disease mimicking a urologic emergency event p. 83
Diomidis Kozyrakis, Michael Lardas
DOI:10.4103/HUAJ.HUAJ_35_21  
Renal infarction is a rare vascular disease describing the obstruction of the renal artery or its branches from blood clots formed in the vascular system of the patient. The correct diagnosis may prove to be a challenging procedure considering that the disease may mimic the symptomatology of urinary lithiasis or other urologic emergencies. A discussion of the diagnostic dilemmas, imaging modalities, treatment options, and prognosis of the disease, based on the more recent findings, is presented in this review.
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CASE REPORTS Top

Recurrence of primary hydrocele 1 month after hydrocelectomy in a 35-year-old patient p. 88
Theodoros Spinos, Anastasios Thanos, Iason Kyriazis
DOI:10.4103/HUAJ.HUAJ_33_21  
A hydrocele is a painless enlargement of the scrotum resulting from an irregular accumulation of serous fluid between the parietal and the visceral layers of the tunica vaginalis which surrounds the testis To treat hydrocele various modalities are used, the gold standard of which being open hydrocelectomy. Hydroceles can sometimes be recurrent. Rarely, in these cases, an underlying pathological condition such as hypoproteinemia, filarial infection, pelvic cavity malignancy, or a concurrent inguinal hernia is found during investigation. This paper describes a rare case of hydrocele recurrence immediately after open hydrocelectomy. The presence of intact tunical anatomy of the scrotum found during revision hydrocelectomy in our case raised questions concerning the extent of the previous excision and as such recurrence should be attributed to the uninverted remaining tunical sack.
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Bilateral synchronous testicular mass from testicular adrenal rest tumors, in a patient with congenital adrenal hyperplasia, or testicular leydig cell tumors? Dilemma for bilateral orchiectomy or not p. 91
Christos Leventis, Panagiotis Panagopoulos, Eleftheria Delliou, Antonia Syrnioti, Virginia Papamichail
DOI:10.4103/HUAJ.HUAJ_46_21  
Congenital adrenal hyperplasia (CAH) refers to a group of autonomic disorders due to enzyme deficiency for the biosynthesis of steroid hormones. These disorders entail an increase in ACTH levels and as followed by adrenal hyperplasia. CAH is categorized into two types, classic and non-classic. In the common type we have a deficiency of 21-hydroxylase observed in a prevalence of 1 per 5000 per 145,000 births. We have insufficient aldosterone and cortisol production and as a result, elevated plasma ACTH levels, with subsequent disorders that this entails, depending on the level of deficiency. Testicular adrenal rest tumor (TART) develops from isletsectopic adrenal tissue within the gonads, directly affected by ACTH overproductions a complication of CAH, with a prevalence ranging from 27% to 47%. These are benign tumors that are recognized as palpable masses. A biopsy of these tumors is recommended as well as their surgical removal, so as to rule out malignancy.In this case report we present a case of bilateral synchronous TART tumor in association with medullolipoma in a patient with CAH. The dilemma arises regarding the decision of bilateral orchiectomy.
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