Laser fragmentation of foreign bodies in the urinary tract: an in vitro study and clinical application

Dietary B group vitamin intake and the bladder cancer risk: a pooled analysis of prospective cohort studies

PURPOSE

Diet may play an essential role in the aetiology of bladder cancer (BC). The B group complex vitamins involve diverse biological functions that could be influential in cancer prevention. The aim of the present study was to investigate the association between various components of the B group vitamin complex and BC risk.

METHODS

Dietary data were pooled from four cohort studies. Food item intake was converted to daily intakes of B group vitamins and pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were obtained using Cox-regression models. Dose-response relationships were examined using a nonparametric test for trend.

RESULTS

In total, 2915 BC cases and 530,012 non-cases were included in the analyses. The present study showed an increased BC risk for moderate intake of vitamin B1 (HRB1: 1.13, 95% CI: 1.00-1.20). In men, moderate intake of the vitamins B1, B2, energy-related vitamins and high intake of vitamin B1 were associated with an increased BC risk (HR (95% CI): 1.13 (1.02-1.26), 1.14 (1.02-1.26), 1.13 (1.02-1.26; 1.13 (1.02-1.26), respectively). In women, high intake of all vitamins and vitamin combinations, except for the entire complex, showed an inverse association (HR (95% CI): 0.80 (0.67-0.97), 0.83 (0.70-1.00); 0.77 (0.63-0.93), 0.73 (0.61-0.88), 0.82 (0.68-0.99), 0.79 (0.66-0.95), 0.80 (0.66-0.96), 0.74 (0.62-0.89), 0.76 (0.63-0.92), respectively). Dose-response analyses showed an increased BC risk for higher intake of vitamin B1 and B12.

CONCLUSION

Our findings highlight the importance of future research on the food sources of B group vitamins in the context of the overall and sex-stratified diet.

Sexual dysfunction associated with chronic retention of foreign bodies in the low urinary tract

We sought to evaluate the association between sexual dysfunction and chronic retention of foreign bodies in the lower urinary tract (LUT) for long-term periods (≧4 weeks) in patients seen at three medical centres between January 2015 and September 2020, followed by assessing the impact of long-term retention of a foreign body in the LUT on sexual function. Thirty-eight patients were studied in the long-term group, among whom the aetiology of the foreign bodies included sexual desire with masturbation (n = 22, 58%), sexual inquisitiveness (n = 10, 26%), dysuria (n = 3, 8%) and seeking to relieve itching (n = 3, 8%). There were various types of foreign bodies, including a string of magnetic beads (n = 13), a thermometer (n = 5), plastic electric wire (n = 5) and others (n = 15). All cases presented with sexual dysfunction and LUT symptoms. Three months after foreign body removal, sexual dysfunction symptoms were significantly improved in 22 male cases and seven female cases. We found that chronic retention of foreign bodies in the LUT causes sexual dysfunction in both men and women. The psychological effects of fear may prevent these patients from seeking medical help. Thus, education on sexual medicine and timely removal of foreign bodies is necessary to avert sexual dysfunction and urinary tract infection.

Prospective Analysis of a Complete Retrograde Ureteroscopic Technique with Holmium Laser Stent Cutting for Management of Encrusted Ureteral Stents

Purpose: To propose and evaluate a new endoscopic technique using only a retrograde ureteroscopic approach for the removal of heavily encrusted ureteral stents. Methods: Data from 51 consecutive patients with encrusted and retained ureteral stents were prospectively collected. Description of the successive steps of surgery is detailed. The holmium yttrium aluminum garnet (Ho:YAG) laser properties offer the opportunity for fragmentation of stent-attached encrustation and the ability to cut the stent itself. Reducing the length of the stent is critical to creating space in the ureter and to allow free access for ureteroscopes or ureteral access sheath placement. The primary outcome of this study was the feasibility and the safety of this retrograde intrarenal approach. Some factors of encrustation and outcomes are also discussed in comparison with lithotripsy, percutaneous, laparoscopic, open surgery, or a combination of these techniques. Results: The removal of the encrusted stent was possible with only this retrograde technique in 98% of patients. The transection of the encrusted stent with the Ho:YAG laser was useful in 71% of the patients. Mean operative time was 110 minutes and mean hospital stay was 2.33 days. Postoperative complications were mainly nonobstructive pyelonephritis (10%). The most significant predictor of this life-threatening complication was the presence of struvite stones with the encrusted stent (p = 0.018). Contrariwise, operative time, body mass index, gender, and encrustation rate were not associated with postoperative pyelonephritis. Both cystine stone disease and pregnancy led to faster stent encrustation. Conclusions: Retrograde ureteroscopic surgery is efficient and safe for removing retained stents and associated stone burdens. The Ho:YAG laser is essential to perform the encrustation removal and sectioning of the stent.

Curious foreign body in the bladder of an adolescent

We report the case of a 14 year old boy who presented at our emergency department because of increasing alguria and dysuria one year after inserting a wire cable into his bladder for autoerotic purposes. Endoscopic transurethral removal of the foreign body proved to be impossible because the cable was of a stiff consistency and was trapped in scar tissue at the bladder neck. The foreign body therefore had to be extracted using a Pfannenstiel approach. Urethrocystoscopy and uroflow performed one week later were normal. Filiform intravesical foreign bodies can create particular challenges. Adequate diagnostic imaging, awareness of possible complications, and knowledge of the different available techniques are essential in planning safe extraction.

Encrusted Ureteral Stent Retrieval Using Flexible Ureteroscopy with a Ho: YAG Laser

A 23-year-old female had bilateral ureteral stents placed due to bilateral renal stones and hydronephrosis. The bilateral ureteral stents were changed every 3 months. A kidney ureter bladder (KUB) film showed left encrustation along the ureteral stent thus necessitating removal; however, the ureteral stent could not be removed cystoscopically. The ureteral stent was, therefore, extracted using flexible ureteroscopy (URS) with a holmium (Ho): yttrium aluminum garnet (YAG) laser.

Successful treatment of stent knot in the proximal ureter using ureteroscopy and holmium laser

Knotted ureteral stent is rare yet tedious complication that might represent a treatment challenge to the endourologist. Only twelve cases of knotted stent have been reported. Different management options have been reported, including simple traction, ureteroscopy, percutaneous removal, and open surgery. In this paper, we present the successful untying of the knot using ureteroscopy with holmium laser.

Cystoscopic suture removal by Holmium-YAG laser after Burch procedure

Burch colposuspension remains one of the successful operations performed for stress incontinence. Accidental suturing of the bladder wall during the procedure or subsequent erosion may lead to lower urinary tract symptoms. Diagnosis and management of these sutures indicate precise evaluation for which a 70 degree cystoscope is used. In selected cases, Holmium-YAG laser may enable us to manage long-standing, encrustated neglected sutures. Here we would like to report successful removal of intravesical sutures using the Holmium-YAG laser.