ObjectivesTo evaluate the efficacy of solifenacin, tamsulosin oral-controlled absorption system (OCAS), and the combination of both drugs on JJ stent-related symptoms using the validated Arabic version of the ureteric stent symptom questionnaire (USSQ).Patients and methodsIn all, 260 patients who had undergone JJ stenting of the ureter for different endoscopic urological procedures were postoperatively randomly assigned into four equal groups. Patients in Group I received no treatment and served as the control group, Group II patients received tamsulosin OCAS 0.4 mg daily, Group III patients received solifenacin 5 mg daily, and Group IV patients received a combination of both drugs. Before stent removal, all patients completed the Arabic version of the USSQ.ResultsIn all, 234 patients completed the study, comprised of 56 in Group I, 59 in Group II, 58 in Group III, and 61 in Group IV. Baseline characteristics and indications for JJ stenting were comparable in the four groups. There were highly significant differences in all items of the USSQ between the treatment groups and the controls, while Group II and III were comparable. The USSQ score was significantly lower in Group IV vs Groups II and III. Crossing of the distal curl of the stent to the midline had a significant positive correlation with the severity of the urinary symptoms, body pain, general health, and work performance in the medicated groups.ConclusionsCombined therapy with tamsulosin OCAS 0.4 mg daily and solifenacin 5 mg daily is a safe and well-tolerated management for stent-related symptoms. However, stent position remains a significant factor affecting response to medical therapy and patients’ health-related quality of life.

PurposeTo prospectively compare the diagnostic accuracy of intravesical prostatic protrusion (IPP), detrusor wall thickness (DWT), prostate volume (PV) and serum prostate specific antigen (PSA) levels for detecting bladder outlet obstruction (BOO) and predicting acute urinary retention (AUR) secondary to benign prostatic obstruction.Patients and methodsIn all, 135 men who presented with lower urinary tract symptoms due to benign prostatic enlargement were enrolled in the study; among them, 50 presented with AUR. Thirty normal men in the same age group were included and represented a control group for normative data. Their evaluation included a digital rectal examination, International Prostate Symptom Score and quality-of-life question, uroflowmetry and serum total PSA assay. Transabdominal ultrasonography was used to measure the PV, IPP DWT and post-void residual urine volume. Pressure-flow urodynamic studies were used as the reference standard test for BOO, differentiating obstructed from unobstructed bladders. DWT, IPP, PV and total PSA level served as index tests. To compare the usefulness of the various indices, the area under the curve (AUC) of receiver-operator characteristic curves was calculated for each index.ResultsAccording to presentation and urodynamic studies, patients were classified into three groups: Group 1 (no BOO), 50 patients with a BOO index (BOOI) of <40; group 2 (BOO), 35 with a BOOI of >40; and group 3 (AUR), 50 who presented with AUR. The IPP, DWT, PV and PSA levels differed significantly between obstructed and unobstructed patients, with a significant correlation with the BOOI. The AUC for IPP, DWT, PSA and PV were 0.885, 0.783, 0.745 and 0.678, respectively. The IPP threshold at 8 mm provided the best diagnostic accuracy (80%) for detecting BOO, followed by combined DWT and IPP (77.6%). Between patients with and without AUR, there was a highly significant difference in IPP, DWT and PSA; a combined IPP threshold of >8 mm and DWT >2 mm detected AUR in 45 of 50 patients (90%).ConclusionAll four noninvasive indices were correlated significantly with BOOI. The IPP as a single variable and combined with DWT predicted BOO and AUR better than PSA or PV.

Introduction Urinary Interleukin-6 (IL-6) a pleiotropic cytokine with pro-inflammatory and immune-regulatory functions is a key mediator of inflammation in children with Urinary tract infection (UTI). Aim of the study The aim of this study is to estimate the role of urinary IL-6 (UIL-6) in diagnosis of acute UTI in children and its usefulness in differentiation between upper urinary tract infection (UUTI) (pyelonephritis) and lower urinary tract infection (LUTI) (cystitis). Patients & Methods This study conducted on a total 56 children divided into 36 patients suffering from UTI with mean age 4.3 ± 3.1 and 20 apparently healthy children age and sex matched with the cases. All patients were subjected to routine investigation and urine IL-6 assay. Results Urinary IL-6 was significantly higher in patients with UTI than control group, Sensitivity was 94.4 %, specificity of 92.1%, positive predictive value was 85%, negative predictive value was 97.2% and diagnostic accuracy was 92.8% and the best cut off value >17 pg/ml. Also Urinary IL-6 was significantly higher in acute pyelonephritis (APN) in comparison to lower UTI cases and there was a positive correlation between urinary IL-6 level and fever, CRP,

2019) Modified tubeless minimally invasive percutaneous nephrolithotomy for management of renal stones in children: A single-centre experience, Arab ABSTRACT Objectives: To evaluate the safety, effectiveness and morbidity, as well as the usefulness of a modified supine mini-percutaneous nephrolithotomy (PCNL) for managing renal stones in children.Patients and methods: We studied 50 children, from September 2017 to September 2018, who were aged 4-16 years with a single renal pelvic or calyceal stone of <2 cm. We used a 9-F short ureteroscope through a 16-F metal access sheath with an alternative approach that allows a second percutaneous procedure using the same tract. If a residual stone was present, we recovered the track back through the exteriorised ureteric catheter at the flank. Results: Of all 50 patients, 48 (96%) underwent the modified supine mini-PCNL technique, which produced a primary stone-free rate of 80% that increased to 100% after treating the residual stones by a second look. The mean operative and fluoroscopic times were 89.10 and 7.68 min, respectively. One case (2%) had significant bleeding and one case (2%) had pelvic perforation; and a nephrostomy tube was inserted in both cases. The mean haemoglobin drop was 0.91 g/dL (P < 0.001). The mean hospital stay was 1.42 days and the mean pain score was 2.08, the pain score was 5 in the two cases in which a nephrostomy tube was inserted. Conclusion: The modified supine mini-PCNL is a safe and effective method for managing renal stones in children, with less postoperative pain and discomfort, less analgesic requirement, and provides access back for a second look.Abbreviations: ESWL: extracorporeal shockwave lithotripsy; Hb: haemoglobin: PCNL: percutaneous nephrolithotomy; SFR: stone-free rate ARTICLE HISTORY

Background: Tympanosclerosis is the calcification of connective tissue in the middle ear, particularly the tympanic membrane, which can arise following middle ear infection. Inflammatory reactions are induced and maintained by tumour necrosis factor (TNF) in a variety of illnesses, including chronic otitis media with effusion (COME). The goal of this study was to determine the plasma level of Tumer necrosis factor (TNF) gene expression in individuals who had tympanosclerosis as a result of ventilation tube insertion. Methods: This study comprised sixty patients who were separated into two groups: 60 patients were assigned to Group A based on inclusion and exclusion criteria, whereas 20 volunteers were assigned to Group B. Patients were given a medical history, a thorough physical examination, and a TNF-gene expression test in the lab (qRT-PCR). Results: There was a significant difference in TNF-gene expression across groups, with the mean TNF in the cases group (3.87) being significantly greater than the control group (1), p0.001. TNF levels were statistically different depending on the number of tubes inserted (p=0.005) and the time of secretory OM (p=0.042). There was no significant difference in TNF levels when it came to medication usage or acute OM episodes. Conclusion: TNF-gene profile expression was statistically significant higher in selected middle-ear structures with tympanosclerosis than in the control group.