Hydrocele can be found as a collection of fluid within the testicular tunica vaginalis. According to the etiology and pathophysiology of the disease, it can be classified into primary and secondary. Furthermore, primary hydrocele might include the closed or non-communicating, the communicating type, the congenital and or neonatal type. Many management approaches have been proposed for both the communicating and non-communicating hydrocele with different post-operative and prognostic outcomes. In this literature review, we have discussed the current management approaches and prognosis of communicating and non-community hydrocele. Adequate diagnosis of the condition is the first step to achieve favorable management outcomes. Although the reported management outcomes are reported to be effective in the literature, the surgical approaches seem to be superior. However, many side effects might be associated with these operations. Estimates show that following varicocelectomy procedures, ipselateral (left) hemi-scrotal varicocele is the most common condition to occur, which might even develop following the procedure by several months and years (in some cases). Further investigations are still needed because the current evidence is largely based on case reports and small case series investigations. Therefore, larger studies are needed to help draw effective management protocols and enhance the outcomes and prognosis.
Urethral strictures can significantly impact the quality of life for patients because it can be associated with significant complications such as fistulas, bladder calculi, infections and sepsis. Additionally, it might even lead to renal failure. The worldwide prevalence of urethral strictures is high, with an estimated rate of 229-627 patients per 100,000 population. In this literature review, the aim was to discuss the types and etiology of urethral strictures and the recurrence rates following the different management modalities. Studies that were included in this review were published between January 2005 until May 2021. The results support the current evidence that the idiopathic and iatrogenic bulbar strictures are the most common types while penile strictures, the iatrogenic and inflammatory are the most common causes. Recurrence rates are reported after management with almost all of the current management modalities, indicating the need for better interventions to enhance the outcomes and alleviate the quality of care. The recurrence rate of strictures after treatment with internal urethrotomy and direct vision internal urethrotomy by three years is 65%. Other studies reported that the rate of recurrence was estimated to be around 14 after 6 months from internal urethrotomy and up to 27% after 12 months. The rate of complications and recurrence following treatment with anastomotic urethroplasty was estimated to be less than 5%. Detailed information and discussion were provided in the study manuscript.
Many investigations have reported the impact of resident involvement in urological surgeries. We aimed to conduct this systematic review to create enough evidence regarding this impact based on the outcomes obtained from the relevant studies. We have performed both manual and electronic search through many databases like Google Scholar, Web of science, PubMed, Scopus, Cochrane library, the international standard randomised controlled trial number registry, and the world health organization virtual health library to obtain all the relevant citations. Our intended outcomes included the risk of developing complications, operative time, and rate of reoperations. We have included 17 studies that reported the impact of residents’ involvement in urological surgical operations. while some studies reported some complications, the risk of developing complications was not significantly associated with residents' involvement according to most studies. Only one study reported that complications were significantly associated with residents’ involvement. The rate of reoperation and readmission after the primary surgery was also non-significant. On the other hand, most of the included studies showed that residents’ involvement was significantly associated with increased hospital stay and prolonged operative time. Our results indicate the residents’ involvement does not impact the overall safety of the urological procedures and that this practice should be encouraged with adequate supervision.
Urethral stricture is defined as pathological urethral narrowing caused by corpus spongiosum fibrosis. The etiology of this condition is mostly idiopathic, which can also result from iatrogenic (like previous urethral surgeries, catheterization, or resection), inflammatory and traumatic causes. The evidence discussing the management of urethral strictures is scarce. The management starts with an appropriate evaluation of the condition through a comprehensive history taking (obstructive symptoms) and physical examination. Diagnostic investigations include cystoscopy (the most specific), urethrography, patient reported scales, like American urological association symptom index, uroflowmetry, and retrograde urethrography. Previous literature shows urethroplasty is cost effective, whether when it is used as the primary treatment or following a non-successful dilation and direct visualization internal urethrotomy. Moreover, open urethroplasty and endoscopic urethrotomy were comparable among both procedures in terms of voiding improvement; however, urethroplasty benefit was more durable. Akin to that, urethroplasty was found to be a successful procedure in up to 95% of the cases with the appropriate experience level. Although excision and primary anastomosis and augmentation/substitution urethroplasties have considerable long-term success rates, the EPA procedures have a controversial influence on sexual function, which may be unacceptable to some reconstructive urologists. In general, there are a few large scales, multi center studies that can produce high-quality evidence. There is an urge to develop more high-grade research in terms of ideal management of urethral strictures.
Nocturnal enuresis or night time incontinence is a common condition that usually affects children and can be associated with significant psychological effects on the affected child if left untreated. It can be defined as night time wetting of the bed that usually occurs in children that are ≥5 years old. In this literature review, the aim was to discuss the etiology and management of nocturnal enuresis and the impact of the condition on the different age groups. Management of the underlying comorbidities, taking care of the overactive bladder and dealing with the potential psychological conditions might be the main key factors to nocturnal enuresis. Many pharmacological and non-pharmacological approaches have been proposed for these patients. However, the success rates of applying behavioral management approaches have been reported to be the highest as compared to other approaches. Early interventions should be applied for children that have multiple risk factors or with parents that once suffered from the condition as genetics were reported in the literature to have a significant role in the development of nocturnal enuresis. Pharmacological therapies have also been reported as effective modalities in resistant cases and desmopressin was reported to achieve a 100% success rate if used with alarm therapy. However, clinicians should care for the potential adverse events when approaching the pharmacological modalities.
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