Monaghanstentoft0940

Polio is a deadly viral disease that has been paralyzing many children in Afghanistan. Despite fundamental efforts, primarily vaccination, to reduce the number of cases in Afghanistan, there are still many children who are deprived of the vaccine every year. Afghanistan is one of the two remaining countries endemic for polio, and the country has undergone various challenges that have hampered the eradication of this disease. The underlying challenges include inaccessibility of unsecured areas, illiteracy, refusal, and, most recently, COVID-19. The country is in the midst of a battle against COVID-19, and polio has almost entirely been neglected. Sadly, polio cases are increasing in the country, particularly in polio-free provinces. After an initial lockdown, many businesses have been allowed to resume, but the mass polio vaccination campaign has not restarted. New cases of polio will surge if endemic regions remain unvaccinated or inaccessible. To curb the further spread of polio, Afghanistan needs to resume nationwide house-to-house vaccination as restrictions due to COVID-19 are loosened.Xanthogranulomatous pyelonephritis is a rare variant of pyelonephritis that often requires radical surgery. We report a case of a 51-year-old female patient who was managed with prolonged placement of nephrostomy tubes prior to surgery. This case illustrates the importance of surgical optimization of a poor operative candidate and the use of nephrostomy tubes as a temporizing management strategy.Pazopanib, a tyrosine kinase inhibitor, has been a standard first-line treatment for metastatic renal cell carcinoma (mRCC). Recent trials combining pazopanib with programmed cell death protein 1 (PD-1) inhibitors, including pembrolizumab, have shown excessive hepatotoxicity. We report a case of fatal hepatotoxicity from vanishing bile duct syndrome (VBDS) associated with pazopanib treatment, in a patient previously exposed to pembrolizumab. This is the first report of pazopanib-induced VBDS. We postulate whether prior exposure to pembrolizumab predisposed towards pazopanib-induction of VBDS, and discuss potential risks of sequential PD-1 inhibitor followed by pazopanib in mRCC, due to prolonged half-lives of PD-1 inhibitors.Condyloma acuminata are epidermal lesions caused by the human papillomavirus (HPV) most commonly affecting the anogenital region. Urethral involvement is uncommon, and may mimic other urethral lesions. In this case report, a 62-year-old patient presents with what was believed to be a urethral caruncle and underwent successful resection with the final pathologic diagnosis of urethral condyloma. The clinical features and diagnosis are reviewed. This condition should be considered in the differential diagnosis of females with known HPV or those who are deemed higher risk with unprotected sexual encounters.

Management of pediatric renal masses has lagged behind adult paradigms adopting minimally invasive surgery (MIS) and nephron-sparing surgery (NSS). This study investigated national practice patterns between pediatric urologists (PU) and pediatric surgeons (PS) in pediatric renal malignancy.

The Pediatric National Surgical Quality Improvement Program database was queried for CPT codes for radical/partial nephrectomy from 2012-2017 performed for renal malignancy. Patients were grouped by specialty and operative approach.

PU managed 175 (17%) patients while PS managed 811 (77%). PU were more likely to use MIS (14% versus 5%, p < 0.001) and NSS (33% versus 13%, p < 0.001) compared to PS. PS more commonly performed lymph node (LN) sampling/tumor thrombectomy, especially in MIS cases (67% versus 35%, p = 0.008). PS operated on younger patients with higher ASA class compared to PU, but had higher transfusion rates and longer length of stay. Central venous access surgery was more commonly performed on pat necessary.Urethral stricture disease can be difficult to treat and stricture recurrence is common. The management of stricture disease has evolved and urethroplasty can achieve a high rate of lasting urethral patency. Nevertheless, endoscopic treatments still seem to have sub-optimal outcomes with high stricture recurrence rates. The Optilume drug-coated balloon represents a step forward in the endoscopic management of urethral strictures. The drug-coated balloon may offer an intermediate step prior to repeated dilations, urethrostomies, or urethroplasty. This treatment modality is a promising alternative to current endoscopic management and an option for patients that are poor surgical candidates or decline urethroplasty.

To determine the efficacy and safety of using the semi-rigid ureteroscope as the only ureteral dilator for primary ureteroscopy (URS) in the treatment of renal stones.

A retrospective review of primary URS for renal stone disease was performed on consecutive patients treated by a single provider from 2013 to 2017. Utilizing wire placement under fluoroscopic guidance and direct visual ureteroscopic dilation with a semi-rigid ureteroscope, primary outcome was successful completion of stone treatment. In addition, perioperative safety was evaluated.

A total of 126 consecutive cases of primary URS using the semi-rigid ureteroscope as the only ureteral dilator were attempted for renal stone treatment. The renal stones were treated in 124 (98.4%) patients without other forms of active ureteral dilation. Two (1.6%) patients required ureteral stent placement for passive dilation despite attempted other dilating techniques. No intraoperative ureteral perforations were identified. Postoperative radiographic follow up was available for 67% patients with a 91% stone free rate and no hydronephrosis or ureteral strictures were detected.

Utilizing direct visual semi-rigid ureteroscopic dilation with a semi-ridged ureteroscope prior to flexible ureteroscopy leads to successful primary ureteroscopy for renal stone treatment in most patients. This technique is an effective, safe and possibly cost-effective method of obtaining ureteral access to facilitate primary URS for renal stone treatment.

Utilizing direct visual semi-rigid ureteroscopic dilation with a semi-ridged ureteroscope prior to flexible ureteroscopy leads to successful primary ureteroscopy for renal stone treatment in most patients. This technique is an effective, safe and possibly cost-effective method of obtaining ureteral access to facilitate primary URS for renal stone treatment.

To objectively assess the self-reported adequacy and utility of exposure of our students to urology during their training.

A questionnaire was sent to the University of the West Indies graduating class of 2018, now functioning as medical interns. A questionnaire was designed to collect information regarding respondent demographics, perceptions of their urology exposure during their medical school training as well as their attitudes towards the specialty. The survey was also designed to capture respondents' comfort levels with commonly encountered urological scenarios and investigations. The survey was distributed in February 2019 using the online survey tool, Survey Monkey.

A total of 196 surveys were distributed, of which 107 responses were returned. Clinic exposure was the most common form of interaction with the specialty during training. Their exposure to common urological procedures was low with only 9.3% and 4.7% having seen a circumcision or prostate biopsy respectively by graduation; 21.7% and 4, but further afield.

Men with unexplained infertility (UI) should undergo an initial hormonal evaluation including serum FSH and total testosterone (TT). Unfortunately, there is no consensus regarding which TT cut point should be used to define hypogonadism in such men. To determine the best definition for hypogonadism, three different, literature-based TT cut points were used to assess associations between TT and semen parameters. The hypothesis was that the lowest TT cut point would associate with poorest sperm parameters.

We performed an IRB-approved retrospective chart review of 247 consecutive males presenting for evaluation of male factor infertility. After exclusions, basic statistics and correlation analysis of semen analysis parameters, TT, age, and body mass index (BMI) were evaluated on 128 men (age 34+/-33.5) categorized by three different TT cut points 65 males were hypogonadal according to a TT cutoff of < 264; 16 with a cutoff of 264-300; 44 with a cutoff of 301-400; and 42 with a TT over 400 ng/dL. Basic statistics, one-way ANOVA and Levene comparative analysis were performed. Besides a negative correlation between TT and BMI, there was no significant association between the three TT literature-based cut points and the other studied parameters. These findings were further supported by multiple comparison analyses.

For men with UI, regardless of how hypogonadism was defined, no relationship between semen parameters and TT was found.

Conventional, TT-based definitions of male hypogonadism in the setting of UI need to be clarified. Clinically relevant, accurate and reproducible multivariable biomarkers need to be investigated to further advance best practices for treating men with UI.

Conventional, TT-based definitions of male hypogonadism in the setting of UI need to be clarified. Clinically relevant, accurate and reproducible multivariable biomarkers need to be investigated to further advance best practices for treating men with UI.

Data on the prevalence of lower urinary tract symptoms (LUTS) and urinary incontinence (UI) in Canada are dated. This study aims to describe the current prevalence of LUTS and UI, to assess the state of knowledge of these conditions, the treatment for them and the treatment experience of symptomatic persons.

A nationally representative adult (= 18 years) sample was surveyed using a questionnaire based on the EPIC study. read more The margin of error associated with this probability-based sample was +/-3.1%, 19 times out of 20.

Of the 1000 people contacted, (52% female, 48% male), 78.4% were either aware or vaguely aware of the term 'incontinence'. A total of 43.7% of respondents felt that UI was a serious problem that could easily ruin quality of life. When asked, 93.7% of respondents felt that people with UI should seek medical advice, but only 41.4% (27.4% men, 54.3% women) knew what help was available. Of 23.7% of the sample with UI, 145 (61.2%) experienced leakage a few times a month or more frequently and 23.7% had UI for > 11 years. A total of 48.8% of people with UI had initiated a discussion with their healthcare provider about their urinary symptoms, 52.4% within the last year.

The current distribution of UI in Canada is similar to that found in 2004. There remains a lack of awareness of the available treatments despite an acknowledgement that UI is an important medical condition. Few people had actively engaged with treatments. Men remain less aware and less likely to seek help than women.

The current distribution of UI in Canada is similar to that found in 2004. There remains a lack of awareness of the available treatments despite an acknowledgement that UI is an important medical condition. Few people had actively engaged with treatments. Men remain less aware and less likely to seek help than women.