Study Type – Harm (case series)Level of Evidence 4What's known on the subject? and What does the study add?Recent studies show no advantage of bowel preparation before ileal urinary diversion and that avoidance of bowel preparation led to early restoration of intestinal function and shorter hospital stay. However, this was not tested in a prospective comparison.The current study is a prospective comparison to test for the safety of omitting bowel preparation before ileal urinary diversion. This study also examines simultaneous effects of bowel preparation on the ileal flora and mucosa.OBJECTIVE To evaluate the safety of no bowel preparation before ileal reconstructive procedures of the lower urinary tract, in comparison to standard 3‐day bowel preparation. The present study also examines the effects of bowel preparation on small bowel wall and bacterial flora. PATIENTS AND METHODS This study enrolled 40 patients scheduled for radical cystectomy and ileal urinary diversion, presenting to the department of urology, Alexandria University, Alexandria, Egypt during the period from January 2009 to September 2010. Patients were prospectively randomized into two groups: Group (I) had standard 3‐day bowel preparation. Group (II) had only over‐night fasting before surgery. Intra‐operatively, one ml of ileal fluid was collected for bacteriological studies and an ileal wall biopsy was taken for histopathological examination. Postoperative complications were reported for all patients using modified Clavien system. RESULTS Both groups showed insignificant difference regarding the frequency and Clavien grade of postoperative complications (P = 0.30). Under aerobic and anaerobic conditions, 5 cases in group (I) had bacterial overgrowth of E. coli (>105) versus none in group (II) (P = 0.04). Eight patients in group (I) had sterile ileal fluid cultures versus 18 patients (90%) in group (II). No correlation could be made between would infections and the organisms isolated in ileal fluid cultures. Histopathological examination of ileal biopsies revealed mucosal edema and submucosal congestion in 9 cases in group (I) versus 2 cases in group (II) (P = 0.0310). CONCLUSIONS Omitting bowel preparation before ileal urinary diversion is safe, with no added complications. Non‐preparation of the small bowel is not associated with bacterial overgrowth.

ObjectiveTo compare the safety and efficacy of bipolar vs monopolar transurethral resection of bladder tumour (TURBT) in patients maintained on low-dose aspirin with tumours >3 cm.Patients and methodsA prospective randomised single-centre study was performed including 200 patients with bladder tumours of >3 cm, as measured by ultrasonography. All patients were using low-dose aspirin (81 mg/day), which was not stopped in the perioperative period. Patients were randomised into two groups: Group A, monopolar TURBT (M-TURBT); Group B, bipolar TURBT (B-TURBT). The primary endpoint of the study was the decrease in postoperative haemoglobin (Hb) concentration measured using an automated cell counter. The secondary endpoints of the study were intraoperative blood transfusion or the occurrence of urethral trauma during cystoscopy and the need for re-coagulation.ResultsThe postoperative reduction in Hb concentration, was significantly lower in the B-TURBT group [mean (SD) 0.55 (0.26) g/dL] compared with the M-TURBT group [mean (SD) 1.24 (0.61) g/dL] (P < 0.001). There was also a significant difference (in favour of B-TURBT) between the groups in the mean postoperative reduction in haematocrit and the mean postoperative hospital stay. There was no significant difference between the groups for the occurrence of obturator jerk, bladder perforation, and the need for blood transfusion.ConclusionB-TURBT in patients maintained on low-dose aspirin is better than M-TURBT for minimising postoperative drop in Hb concentration.

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This study aimed to investigate the potential application of DDX4 gene expression in cell-free seminal mRNA as a noninvasive biomarker for the identification of the presence of germ cells in men with nonobstructive azoospermia and to correlate this factor with testicular biopsy. Male reproductive organ-specific genes were chosen: DDX4, which is a germ cell-specific gene and transglutaminase 4, which is a prostate-specific gene that was used as a control gene. Thirty-nine azoospermic males and twenty-eight normospermic fertile males (serving as a control group) participated in the study. Histopathological examination of testicular biopsies categorised azoospermic males into 20.5% with maturation arrest, 17.9% with incomplete Sertoli cell-only syndrome and 61.5% with complete Sertoli cell-only syndrome. Using real-time polymerase chain reaction, positivity for DDX4 gene was detected in 17 of 39 males with NOA which was due to maturation arrest in 35.3% (n = 6/17) of cases, due to incomplete Sertoli cell only in 23.5% (n = 4/17) and due to complete Sertoli cell only in 41.2% (n = 7/17). The study recommends joint utilisation of molecular transcripts as noninvasive biomarkers and histopathological examination of testicular biopsies in management of cases with azoospermia of the nonobstructive type.