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Objective: The aim of this study was to assess the efficacy and safety of mirabegron as a medical expulsive therapy in patients with distal ureteral stones of 5-10 mm size. Material and methods: A prospective, comparative study included 96 patients with radiopaque distal ureteral stones of 5-10 mm who were randomly allocated and treated by medical expulsive therapy in 2 groups from January 2019 to December 2020. Patients in group A received only ketorolac 30 mg/day for 5 days, then on demand. Patients in group B received mirabegron 50 mg/day for 4 weeks plus ketorolac 30 mg/day like in group A. The stone expulsion rate was the primary outcome. Results: There were no significant differences regarding age, gender, body mass index, laterality, degree of hydronephrosis, and stone size. After 4 weeks, stone expulsion rate was 52.1% for group A versus 89.6% for group B ( P < .001). The median (range) of time to stone expulsion was 14 (13-23) and 7 (3-16) days for groups A and B, respectively ( P = .004). The medians (range; interquartile range) of episodes of renal pain (1 (0-2; 1) vs. (0-2; 2); P < .001) and extra analgesic ampoules (1 (0-7; 4) vs. 0 (0-2; 0) vials; P < .001) were significantly higher in group A than those in group B, respectively. In multivariate analysis, only medical expulsive therapy ( P < .001) and stone size ( P < .001) were independent predictors of stone expulsion rate. Conclusion: Mirabegron is an effective and safe medical expulsive therapy agent in patients with 5-10 mm distal ureteral stones.

A Tayib, H Mosli, M Atwa, Cowper's Syringocele (Cyst of the Bulbar Urethra): A Case Report and Literature Review. 2003; 23(3-4): 194-195 Cowper's glands are two bulbourethral glands that lie superior to the perineal membrane and are invested in the broad base of the external urethral sphincter muscles.1 During sexual excitement these glands secrete clear mucous into the bulbous urethra. A syringocele is a deformity in the male urethra in which there is a distention of the bulbourethral Cowper's glands. In 1684, Merry described the bulbourethral gland. A complete description of the gland was published in 1699 by Cowper.1 Thesyringocele was first described by Fenwick. 2 A literature review found that Cowper's syringocele may be more common than currently realized. 3 We report a case of bulbous urethral cyst arising from the Cowper's gland in a 34-year old male patient. Case reportA 34-year old male presented to us with perineal pain and microscopic hematuria. There was no history of medical or surgical illness. Frequent urinalysis showed persistent microscopic hematuria. Intravenous pyelography and urine cytology were normal. Cystoscopic examination revealed a cystic swelling at the proximal part of the bulbar urethra close to the external urethral sphincter, which had a very tiny pin-hole aperture (Figure 1). A retrograde urethrogram showed swelling in the proximal bulbar urethra that did not empty after complete emptying of the bladder and urethra (Figure 2). We performed a transurethral endoscopic deroofing of the cyst. Cystourethroscopy and urinalysis 3 months later were normal. Our case was an imperforate synringocele. DiscussionThe dilated Cowper's gland ducts are referred to as asyringocele. Based on radiological and cystoscopicappearance, syringoceles are classified into four groups: 1)simple syringocele, a minimally dilated duct; 2) perforatedsyringocele, a bulbous duct thatdrains into the urethra via a patulous ostium and appears as a diverticulum; 3) imperforate syringocele, a bulbous duct that resembles a submucosal cyst and appears as a radiolucent mass; and 4) ruptured syringocele, the fragilemembrane that remains in the urethra after a dilated duct ruptures. 4 In a PubMed and Medline literature search, we found 20 cases of syringoceles. Twenty cases were group 2, 3, and 4 syringoceles, and 13 cases were group 1 syringoceles. Our case was an imperforate syringocele.

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Objective: We evaluated the safety and efficacy of photoselective vaporization of the prostate (PVP) using GreenLight 120-W lithium triborate (LBO) laser to treat symptomatic small-to-medium sized benign prostatic hyperplasia (BPH). Methods: This prospective non-controlled observational study included symptomatic BPH men ≥50 years with international prostate symptom score (IPSS) ≥14, prostate volume (PV) ≤80 cc and maximum flow rate (Q-max) ≤15 mL/s. PVP was performed using the GreenLight 120-W LBO laser machine. Patients were assessed at baseline and postoperatively at discharge, 2 weeks, and 3, 6 and 12 months. We measured changes in IPSS, PV, PSA, Q-max, post-void residual (PVR), hemoglobin (Hb), serum sodium (Na+) and reported complications. Statistical significance was p < 0.05. Results: The study included 103 men with mean age of 67 (±stan-dard deviation)±9.7 years. Thirty patients were on indwelling urethral catheters for refractory urinary retention and 12 on ongoing anticoagulants. The mean baseline IPSS, PV, PSA, Q-max and PVR parameters significantly improved at follow-up (p < 0.001; each). Mean measurements at baseline versus at six months were: IPSS 25.6 ± 4.2 vs. 7.4±2.3; PV 44.6 ± 9.2 vs. 21.6 ± 6.3 cc (51.6% reduction); Q-max 5.8 ± 3.4 vs. 20.4 ± 4.8 mL/s; PVR 110 ± 40 vs. 35 ± 9 cc. Mean baseline Hb and serum Na+ declined nonsignificantly (p > 0.05) at discharge and at 2 weeks. No patient needed a blood transfusion. Secondary procedures were needed in 2 patients for urethral and bladder neck strictures. The re-treatment rate for residual adenoma was 0.97%. Conclusion: PVP using the GreenLight 120-W LBO laser to treat small-to-medium sized symptomatic BPH demonstrated significant improvements in efficacy parameters and high safety profile within 12 months of follow-up. The procedure entails good hemostasis with minimal blood loss even in patients receiving ongoing anticoagulants.

To evaluate the necessity to do voiding cystogram and retrograde pyelography in the preoperative evaluation of children undergoing pyeloplasty In the present study, the records of 64 children were reviewed who underwent 72 dismembered pyeloplasty for Ureteropelvic Junction (UPJ) Obstruction between January 1992 and June 2002. The preoperative clinical evaluation included urinalysis, renal function profile, renal and bladder Ultrasound, diuretic renal isotope scan studies, intravenous pyelogram, voiding cytourethrogram, and retrograde pyelogram. The patients were divided into 3 groups according to either they had retrograde pyelogram and voiding cytourethrogram or not. All patients had done ultrasonography and dilated upper ureter was found in 3 cases only. Voiding cytourethrogram had showed vesicoureteral reflux in 5 patients (9.6%) in Groups 1 and 2, one patient had a successful Ureteral reimplantation for bilateral vesicoureteral reflux. In Group 2, the retrograde pyelogram revealed abnormalities in 3 cases (8.1%) and there was no significant difference in the success rate of pyeloplasty among the three groups. Cystoscopy and retrograde pyelogram are unnecessary in preoperative evaluation prior to pyeloplasty.

Objective: To confirm the feasibility and safety of laparoscopic pyelolithotomy in partial staghorn stones. Patients and Methods: Seventeen patients who underwent laparoscopic pyelolithotomy for partial staghorn stone were included in the prospective study at King Abdulaziz University Hospital in the period between May 2007 and Feb 2009. Preoperatively all patients had blood work, urine culture, ultrasonography and CT renal stone study. Inclusion criteria included stones with largest diameter of more than 25 mm (measured by CT), branching into one or more group of calices, and no contraindication for laparoscopic surgery. All patients underwent cystoscopy, double J stent insertion prior to the procedure, while prophylactic antibiotics were provided for all the patients with or without positive urine culture. Results: All patients were completed laparoscopically where none required conversion to open surgery or developed intraoperative complications. The largest diameter of the stones varied between 29 and 48 mm with mean diameter of 41 mm, and the number of stones removed was 1–4 with mean of 1.3. The mean operative time was 175 minutes (range 125–240 minutes) and the estimated blood loss was 20–150 ml with mean of 49 ml. All patients cleared from their stones except 2 patients had small residual stones of 5 and 7 mm which were managed later by extracorporeal shock wave lithotripsy. One patient developed ileus postoperatively. Conclusion: Laparoscopic removal of partial staghorn stones is safe and feasible and has an equal outcome to open surgery.