Mccabekamp6055

PURPOSE Patients presenting with prostate gland sizes greater than 200 cc pose a unique surgical challenge to both patients and surgeons. The objective of this study is to critically assess the efficacy and risks associated with performing holmium laser enucleation of the prostate (HoLEP) on glands ≥ 200 cc. MATERIALS AND METHODS Using a prospective maintained database, all consecutive benign prostatic hyperplasia (BPH) patients with gland size ≥ 200 cc who underwent HoLEP were included. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Subgroup analysis of outcomes was stratified by gland sizes 200-299 cc and ≥ 300 cc. Univariate analysis using Kruskal-Wallis and Fisher exact test was performed to compare the two groups. RESULTS There were 88 patients with a mean preoperative gland size of 255.9 cc (200-770 cc). Mean operative (171 vs 182 min) and enucleation time (77 vs 83 min) were not different between the two subgroups (200-299 cc vs ≥ 300 cc). Enucleation efficiency was greater for glands ≥ 300 cc (2.6 cc/min vs 2.0 cc/min, p = 0.04). Morcellation time was longer in the ≥ 300 cc group (74.5 min vs 46.8 min, p = 0.021). Mean length of stay was 1.8 ± 1.2 days and catheter duration was 2.6 ± 2.7 days. 1 (1.1%) patient required retreatment of BPH at last follow-up. The main limitation of this study is the retrospective data analysis. CONCLUSIONS Holmium laser enucleation for prostate glands volume > 200 cc is feasible with minimal morbidity. These data further reinforce the size independence success of this procedure for BPH.BACKGROUND Urinary tuberculosis (TB) is a challenging disease to cope with, as there has been no noticeable difference in basic diagnostic and therapeutic options in clinical practice over time. PURPOSE The aim of the current review was the critical assessment and evaluation of TB, which remains a major global health problem. METHODS The available literature regarding TB in the PubMed database was extensively searched. RESULTS New interdisciplinary team approaches such as next-generation sequencing are promising for the diagnosis and treatment of the disease. The epidemiology of the disease is changing with globalization and increasing migration events; however, the knowledge here is limited. Despite ongoing destruction, kidney functions need to be preserved as much as possible, and relatively rapid development of minimally invasive techniques relieved the surgeons in this regard. Experience is increasing in minimally invasive techniques that provide better comfort for patients compared to extensive radical surgeries. CONCLUSIONS Knowing the pathogenesis of urinary TB is essential for understanding the range of clinical manifestations. The onset of the disease is usually insidious. Despite modern TB drugs, reconstructive surgery, and minimally invasive procedures, progression cannot be prevented in some patients, and patient selection is essential, but we still do not have sufficient information and objective parameters to predict progression.PURPOSE To compare the outcome of shock wave lithotripsy (SWL) for upper lumbar ureteric stones using the alternating bidirectional approach versus the standard approach during the first session. METHODS Our study was a randomized controlled trial including patients with single radio-opaque stone  less then  1 cm located in the upper lumbar ureter (from the ureteropelvic junction till the level medial to the lower margin of the kidney). SWL was conducted using electromagnetic Dornier Gemini Lithotripter. In group 1, patients were treated with the alternating under and over-table approach during the first session only and if other sessions were needed, the standard under-table approach was used. In group 2, patients were treated with the standard under-table approach during all sessions. Stone disintegration after the first session was assessed by kidney-ureter-bladder X-ray, renal ultrasonography and noncontrast computed tomography. Moreover, the incidence and severity of postoperative complications were evaluated. RESULTS Forty-eight patients in each group completed the study. Patient demographics and stone characteristics were comparable in both groups. Complete disintegration was achieved in 41.7% of patients in group 1 versus 18.8% in group 2 (P = 0.021). Stone-free rate (SFR) was 58.3% and 20.8% in group 1 and 2 respectively (P = 0.001). The mean session time was 56.42 min in group 1 versus 46.35 min in group 2 (P  less then  0.001). There was no significant difference in postoperative complications. CONCLUSION Stone disintegration and SFR after the first SWL session are higher when using the alternating bidirectional approach for upper lumbar ureteric stones at the expense of longer procedural duration. TRIAL REGISTRATION ClinicalTrials identifier (ID NCT03243682), clinicaltrials.gov.The underlying pathogenic mechanisms of cardiomyopathy in Chagas disease are still unsolved. In order to better clarify the role of fat on the evolution of cardiomyopathy, the present study employed three murine models of chronic Trypanosoma cruzi infection (1) aP2-RIDα/β transgenic mice (RID mice; an adipose tissue model which express a gain-of-function potent anti-inflammatory activity), (2) allograft inflammatory factor-1 knockout mice (Aif1-/-), and (3) a Swiss outbred mice. RID mice and non-transgenic mice (wild type, WT) were infected with blood trypomastigotes of Brazil strain. During the acute stage of infection, RID mice had lower parasitemia, lower heart inflammation, and a decrease in the relative distribution of parasite load from cardiac muscle tissue toward epididymal fat. Nevertheless, comparable profiles of myocardial inflammatory infiltrates and relative distribution of parasite load were observed among RID and WT at the chronic stage of infection. Aif1-/- and Aif1+/+ mice were infected with bloodstream trypomastigotes of Tulahuen strain and fed with high-fat diet (HFD) or regular diet (RD). Interestingly, Aif1+/+ HFD infected mice showed the highest mortality. ZEN-3694 solubility dmso Swiss mice infected with blood trypomastigotes of Berenice-78 strain on a HFD had higher levels of TNFα and more inflammation in their heart tissue than infected mice fed a RD. These various murine models implicate adipocytes in the pathogenesis of chronic Chagas disease and suggest that HFD can lead to a significant increase in the severity of parasite-induced chronic cardiac damage. Furthermore, these data implicate adipocyte TLR4-, TNFα-, and IL-1β-mediated signaling in pro-inflammatory pathways and Aif-1 gene expression in the development of chronic Chagas disease.