Background and Objective: Percutaneous nephrolithotomy (PCNL) is the gold standard technique used for the treatment of large renal stones ≥ 2 cm. However, in patients with chronic kidney disease (CKD), the effect of PCNL remains underreported. We aimed to prospectively evaluate the changes in estimated glomerular filtration rate (eGFR) after PCNL in patients with stage 2–4 CKD. Subjects and Methods: This prospective study included patients with stage 2–4 CKD who underwent PCNL in the period from December 2020 to December 2023. eGFR was measured using the Cockroft–Gault formula preoperatively and 3 months postoperatively. Patients were classified as either improved/stable or deteriorated. Perioperative complications and stone-free rate (SFR) were also evaluated. Results: The study included 50 patients (male/female = 33/17) with CKD who underwent PCNL. The mean operative time was 84.8 ± 27.4 min. A total number of 49 complications were reported in 21 patients. At a follow-up of 3 months, eGFR was improved/stable in 40 (80%) patients, and it deteriorated in 10 (20%) patients. The SFR was 76% at 3 months postoperatively. Factors that significantly affected the eGFR were bleeding, access number, incidence of perioperative complications, stone burden, and operative time. Conclusions: PCNL is an effective and safe treatment option for patients with stage 2–4 CKD with renal stones ≥2 cm. It is advisable to avoid long operative time, excessive bleeding, and multiple accesses as possible in these patients to minimize the risk of renal function deterioration.

Abstract Background Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature (IVCPC). This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication technique. Materials and methods This prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea (Essed-Schroeder technique) with a covering pair of absorbable sutures. The primary outcomes were successful correction (defined as a residual curvature ≤15 degrees) and patient satisfaction. Postoperative follow-ups were performed at 3, 6, and 12 months. Results A total of 23 patients were treated for IVCPC with a mean (range) age of 25.3 (18–31) years. Eighteen patients (78.3%) were single with cosmetic complaints, whereas the other 5 patients (21.7%) were married and presented with a difficult vaginal intromission. The mean (range) curvature, length, and operative time were 40 (30–50) degrees, 15 (10–19) cm, and 82 (65–100) minutes, respectively. Postoperative penile pain and numbness occurred in 13 patients (56.5 %) and 7 patients (30.4%) only within the first month, respectively. Palpable suture knots were reported in 15 patients (65.5%) without being bothersome up to 12 months. The postoperative means (ranges) of penile curvature and length were significantly different from that of the preoperative values at 3 (5 [0–20] degrees and 14.5 [9–18.5] cm), 6 (5 [0–20] degrees and 14.5 [9–18.5] cm), and 12 months (5 [0–30] degrees and 14.5 [9–18.5] cm; all p < 0.001). Age, preoperative penile curvature, penile length, postoperative pain, wound infections, and knot palpation insignificantly affected curvature recurrence. Seventeen patients (73.9%) were very satisfied with their surgical outcomes. Conclusions Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.

Background:Premature ejaculation (PE) is a common sexual dysfunction that harms both sex partners. Aim:To evaluate the safety, efficacy and impact on sexual satisfaction scores of the combined use of tramadol HCl and sildenafil citrate for the treatment of PE. Methods:One hundred and sixty otherwise healthy males complaining of PE (primary/secondary) were enrolled in this randomized, double-blind, placebo-controlled study. Only 155 patients (age range 22-48 years) completed the study. Of them, 81 patients had primary PE, and 74 had secondary PE. The comparative groups included the placebo group (n = 34), sildenafil citrate 50 mg group (n = 39), tramadol HCl 100 mg group (n = 40), and the combination therapy group (n = 42). The treatment duration for all groups was 10 weeks. Outcomes:This combination is safe and effective. Results:Five patients discontinued the study, all from the placebo group, due to a lack of improvement over the treatment course. No significant differences were reported between groups before treatment as regards Intravaginal ejaculatory Latency Time (p = 0.8), satisfaction score (p = 0.7), age (p = 0.9), or duration of marriage (p = 0.9). There was a significant improvement in IELT after treatment with a placebo (p = 0.0001), associated with an insignificant improvement in satisfaction score (p = 1.0). In the other three groups, there was a significant improvement in IELT after treatment (p = 0.0001 for all), which coincided with a significant improvement in satisfaction scores in all three groups (p = 0.0001 for all). Clinical Implications:We recommend this combination in the treatment of premature ejaculation. Strengths:It is a prospective randomized double-blind placebo-controlled clinical trial. Limitations:Limited number of participants. Conclusion:Combined therapy of PE, whether primary or secondary, with sildenafil citrate 50 mg and tramadol HCl 100 mg is safe and effective; and its therapeutic effect is superior to the utilization of either agent alone.

Despite the documented effects of the coronavirus disease 2019 (COVID-19) on spermatogenesis, the reversibility of these effects is uncertain. We aimed to assess the changes of sperm quality between the infection and recovery phases of COVID-19 in reproductive-aged men. The semen quality of men with mild-to-moderated COVID-19 (defined by the degrees of symptoms and chest involvement on computed tomography) was studied during October, 2020–May, 2021 at our hospital. Two semen samples were analyzed at timings estimated to represent spermatogenic cycles during the infection and recovery phases of COVID-19. A total of 100 patients were included with mean ± SD (range) age of 24.6 ± 3.3 (21–35) years. During infection, 33 NCT04595240 .

OBJECTIVE:To compare the efficacy and morbidity of transurethral cystolithotripsy (TUCL) and percutaneous CL (PCCL) in the management of bladder stones in male children.PATIENTS AND METHODS:A total of 100 boys, aged <14 years with a single bladder or urethral stone of <30 mm, were randomised into two equal groups. Initial diagnostic urethro-cystoscopy and push back of urethral stones were done for patients in both groups. Patients in Group A had TUCL, while those in Group B had PCCL through a 20-F sheath using a 12-F nephroscope. The two groups were compared regarding preoperative criteria, intraoperative details, and postoperative outcomes.RESULTS:The patients in this study had a median (range) age of 36 (4-144) months and stone size of 10 (5-26) mm. There was no statistically significant difference between the two groups for preoperative criteria. The assigned procedure was successful in 48 (96%) patients in Group A and 49 (98%) in Group B (P = 1). Complications were encountered in 11 (22%) patients in Group A and five (10%) in Group B (P = 0.171). The median (range) operative time was 21.5 (4-90) min in Group A and 13 (5-70) min in Group B (P < 0.001). In all, 47 (94%) stones needed disintegration in Group A vs 22 (44%) in Group B (P < 0.001).CONCLUSION:Both techniques have comparable success and complications rates. However, PCCL has a shorter operative time and less need for stone disintegration.

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6-12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

Background : The viral pandemic of the coronavirus disease 2019 (COVID-19) has become a serious worldwide public health emergency, evolving exponentially. While the main organ targeted in this disease is the lungs, other vital organs may be implicated. The main host receptor of the SARS-CoV-2 is angiotensin converting enzyme 2 (ACE2), a major component of the renin-angiotensin-aldosterone system (RAAS). The ACE2 is also involved in testicular male regulation of steroidogenesis and spermatogenesis. A recent report published in JAMA Network revealed that in an analysis 38 semen samples from COVID‐19 patients pcr +ve. As the SARS-CoV-2 may have the potential to infect the testis via ACE2 and adversely affect male reproductive system. From this point the purpose of this study is how covid-19 affect spermatogenesis. methods: Aim: how covid-19 affect spermatogenesis. Design and setting of the study: a100 patients had been enrolled in the study by a criteria suggesting good semen analysis. two sets of semen analysis done, the first after 72days of first positive swab for covid-19 to show changes in semen analysis from normal values in the cycle of spermatogenesis during infection, the other sample after 72 days from the first sample to show if the changes regress to normal and to compare it with the first sample. Results: a total number 100 patients first sample show 2% of patients oligospermia, 36% of patients teratospermia . the second sample show 4% of patients teratospermia . by comparing the two samples there is a significant increase in sperm concentration with mean concentration in the first sample 96.49 million /ml , mean concentration in the second sample 104.67 million /ml , a significant increase in motility (A+B) with mean percentage of 44% in the first sample and 46% in the second sample , a highly significant increase in the normal forms of sperms with mean percentage of 23.4 % in the first sample and 30.55 % in the second sample . Conclusions: covid-19 affect spermatogenesis in the form of reversible teratospermia, reversable decrease sperm count but within normal level, reversable decrease in the sperm motility but also within normal level.

PurposeTo evaluate the impact of anterior urethroplasty on male sexual function.Patients and methodsA total number of 35 patients with anterior urethral stricture who underwent urethroplasty at Assiut Urology and Nephrology Hospital from March 2015 to March 2016 were included in the study. The mean age was 36.1 ± 11.1 years (range: 25–56 years). Evaluation of postoperative erectile function was done using a validated questionnaire (International Index of Erectile Function-5 questionnaire) at 3 and 6 months posturethroplasty, while evaluation of ejaculatory and orgasmic function was done by using ejaculation/orgasm score at 3 and 6 months posturethroplasty.ResultsThe mean age of the included patients was 36.1 ± 11.1 years (range: 25–56 years). As regards the incidence of Erectile dysfunction (ED) after urethroplasty, 3 months posturethroplasty, nine (25.7%) patients developed ED, with statistically significant difference (P = 0.001). At 6 months posturethroplasty, just two (5.7%) patients showed ED, with no statistically significant difference (P = 0.15). As regards the incidence of ED according to the etiology of urethral stricture, there was no statistically significant difference between postinflammatory and post-traumatic cases at 3 months (P = 0.636) and at 6 months (P = 0.234). According to the length of urethral stricture, the impact on erectile function after urethroplasty was greater in shorter urethral stricture segment (1.9 ± 0.2 cm) than in longer urethral stricture segment (3.1 ± 1.3 cm) with no statistically significant difference between the two groups (P = 0.514). ED occurred in anastomotic urethroplasty (39.1%) more than free graft urethroplasty (0%), with statistically significant difference (P = 0.012).ConclusionAnterior urethroplasty has a probability of causing transient ED in as much as 25% of patients, with recovery of erectile function occurring in 78% of cases within 6 months of urethroplasty. The incidence of ED is higher in patients undergoing anastomotic repair than in patients undergoing free graft urethroplasty. Urethral reconstructive surgery has a minimal effect on ejaculatory and orgasmic functions.

Background The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions. Methods A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at ( P < 0.05). All reported P values are two-sided. Results A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time ( P < .0001), catheterization period ( P < .001), hospital stay ( P < .0001), and overall complications rate ( P = .023). Conclusions The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.

Objective: To present our center’s experience with cases of long-term unconsummated marriage and the effect of traditional beliefs on seeking proper treatment. Methods: A retrospective search of our patients’ records was done for the reported cases of long-term unconsummated marriage during the period of July 1991-June 2016. Each case was studied for the demographic characteristics including marital ones, clinical works up, and management. Results: Eighteen couples had an unconsummated marriage that ranged between 7 months and 13 years. Averages of age (mean ± SD) of husbands and wives at disclosure were 24-43 (30.9 ± 5.1) and 19-32 (24.9 ± 3.4) years, respectively. Thirteen couples (72.2%) had rural residence and 15 couples (83.3%) had middle or lower education levels. The underlying etiology was a male factor in 12 cases (66.7%) due to premature ejaculation (16.7%), vasculogenic erectile dysfunction (33.3%), or psychogenic causes (11.1%). The female factor was the cause in 3 cases (16.7%) due to vaginismus (11.1%) or phobia of vaginal penetration (5.5%). All the couples attributed concealment of their conditions to the fear of societal embarrassment on disclosure and expressed beliefs in spiritual factors for etiology. The majority of couples sought traditional treatments including religious rituals or spells (88.9%) and traditional medicines (77.8%), while only 55.5% of cases received allopathic medications. Only 5 couples (27.8%) succeeded to consummate the marriage. Of the divorced 13 couples, 4 couples (30.7%) dropped out thereafter, but 9 females (69.2%) and only 3 males (33%) had consummated the second marriage. Conclusion: Long-term unconsummated marriage among the heterosexual couples is very rare with different underlying etiologies and high potentials for divorce. It may be concealed for several years without evaluation and proper treatment due to the constraints of low socioeconomic standards and sociocultural and traditional beliefs about its etiology and treatment.

Introduction Obstructive anuria can be managed by primary ureteroscopy (URS) or deferred URS after initial ureteral stenting.We want to compare the primary URS and deferred URS in the management of calculus anuria regarding the feasibility and clinical outcome.Material and methods Between January 2012 and December 2014, 150 patients with anuria due to ureteral calculi were prospectively randomized according to the timing of ureteroscopic intervention into two groups; deferred URS group (69 patients who were treated initially by ureteral stenting) and primary URS group (81 patients who were treated by emergency URS).Follow-up was at least 6 months postoperatively.Results Complete stone clearance was 87 % and 75.3% for deferred and primary URS groups, respectively (p = 0.097).Renal function normalized in 94.2% of deferred URS vs. 97.5% of primary URS (p = 0.414).Deferred URS group had a 2.9 % overall complication rate in comparison to 9.9 % for the primary URS group (p = 0.109).Ureteral perforation/pyelonephritis was noted in 6.2% of the primary URS group only (p = 0.043).The median number of maneuvers required until stone clearance was one (range 1-5) for primary URS vs. two (range 2-3) for deferred URS (p <0.001).The cost of primary URS was significantly less (p <0.001).On a multivariate analysis, lower ureteral calculi (OR 13.03, 95% CI 4.07-41.7,p <0.001) and deferred URS (OR 2.84, 95% CI 1.07-7.49,p = 0.035) were independent predictors for an eventless and successful URS.Conclusions Primary URS for calculus anuria is feasible and cost-effective.It has a short hospital stay, but is still technically demanding.The perioperative complications are comparable to URS in normouric patients.

Introduction: "Difficult ureter" is a known problem that increases the complications during ureteroscopy. Objective: To categorize ureters according to their distensibility, and to determine whether ureteric distensibility is associated with the success of ureteroscopy and its complications.Subjects and methods: Between January 2010 and September 2012, we tested ureteral distensibility in 306 patients who had a unilateral single radiopaque ureteral stone, 6-20 mm in diameter. Ureteral distensibility was classified into two categories according to the maximum size of a ureteral dilator that could be introduced before ureteroscopy: non-distensible ureters, which admitted a dilator up to 10 Fr and distensible ureters, which admitted a dilator > 10 Fr. Correlations between distensibility and the success rate and complications of ureteroscopy were determined.Results: Overall, 102 patients (33.3%) had non-distensible ureters and 204 (66.7%) had distensible ureters. Distensibility was correlated with the success of ureteroscopy because initial ureteroscopy failed in 38.2% of non-distensible ureters. Ureteroscopy was successful in all distensible ureters. The incidence of ureteric injury was higher in non-distensible ureters than in distensible ureters.Conclusions: Our results suggest that ureteric distensibility should be tested before ureteroscopy. Primary ureteroscopy is recommended in distensible ureters because of its low complication rates and favorable outcome. Pre-stenting may be necessary before ureteroscopy in non-distensible ureters; secondary ureteroscopy may be safer and more feasible in these settings. (C) 2016 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B. V. All rights reserved.

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-09 PRIMARY VERSUS DEFERRED URETEROSCOPY FOR MANAGEMENT OF CALCULUS ANURIA: A PROSPECTIVE RANDOMIZED TRIAL Mohammed A. Elgammal, Ahmad A Elderwy, Mohamed M. Gadelmoula, Diaa A. Hameed, Hosny M Behnsawy, Mahmoud M. Osman, and Adel Kurkar Mohammed A. ElgammalMohammed A. Elgammal More articles by this author , Ahmad A ElderwyAhmad A Elderwy More articles by this author , Mohamed M. GadelmoulaMohamed M. Gadelmoula More articles by this author , Diaa A. HameedDiaa A. Hameed More articles by this author , Hosny M BehnsawyHosny M Behnsawy More articles by this author , Mahmoud M. OsmanMahmoud M. Osman More articles by this author , and Adel KurkarAdel Kurkar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.464AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of ureteroscopy (URS) in management of acute renal failure caused by ureteral calculi could be primary or deferred after ureteral stenting. In this study we evaluate both approaches as regards the feasibility and clinical outcome. METHODS Between January 2012 and December 2014, 150 patients with anuria / oliguria with a significant increase in serum creatinine due to ureteral stones (114 men and 36 women); including 72 solitary functioning kidney. Patients were prospectively randomized according to timing of ureteroscopic intervention into two groups; deferred URS group (69 patients who were treated initially by ureteral stenting then URS in another session) and primary URS group (81 patients who were treated by emergency URS). Follow up was at least 6 months postoperatively. RESULTS Stone distribution was: 56% lower ureteral, 32% mid ureteral, and 12% upper ureteral. Both groups were comparable at presentation. Complete ureteroscopic stone clearance was 87 % and 75.3% for deferred and primary URS groups respectively (p=0.097). Normal renal function returned in 94.2% of deferred URS vs. 97.5% of primary URS (p=0.414). Deferred URS group had 2.9 % overall complication rate in comparison to 9.9 % for primary URS group (p=0.109). Ureteral perforation/pyelonephritis was noted in 6.2% of primary URS group only (p=0.043). Median number of maneuvers required till stone clearance was one (range 1-5) for primary URS vs. two (range 2-3) for deferred URS (p < 0.001). The cost of primary URS was significantly lower (p < 0.001). On multivariate analysis, lower ureteral calculi (OR 13.03, 95% CI 4.07- 41.7, p<0.001) and deferred URS (OR 2.84, 95% CI 1.07- 7.49, p=0.035) were independent predictors for eventless successful URS. CONCLUSIONS Deferred URS is still the standard treatment for calculus anuria. Primary URS is feasible but technically demanding and has higher complication rate especially for middle/upper ureteral calculus anuria. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e684 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mohammed A. Elgammal More articles by this author Ahmad A Elderwy More articles by this author Mohamed M. Gadelmoula More articles by this author Diaa A. Hameed More articles by this author Hosny M Behnsawy More articles by this author Mahmoud M. Osman More articles by this author Adel Kurkar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Objectives: The objective of this study is to assess the dose-related effects of tramadol on a group of patients with premature ejaculation (PE). Subjects and Methods: During the period of months between June 2010 and July 2012, 180 PE patients presented to outpatient clinic of our hospital. Patients were randomized in a 1:1:1 fashion to receive different sequences of the three medications: placebo, 50 mg of tramadol and 100 mg of tramadol. Every patient received 10 doses of each medication for 2 months. Intra-vaginal ejaculatory latency time (IELT) was recorded in seconds initially and for each arm. Successful treatment of PE is defined if IELT exceeded 120 s. Side-effects of medications were reported. Results: Of patients enrolled, 125 (69.4%) continued the study. Patients age range was 20-55 years with PE complaint of 1 to 10 years duration. Mean IELT was 72 at presentation, 82 for placebo, 150 for tramadol 50 mg, and 272 for tramadol 100 mg (P < 0.001 for all comparisons). PE was successfully treated in only 2.4% of patients with placebo, in contrast to 53.6% and 85.6% with 50 and 100 mg tramadol, respectively (P < 0.001 for all comparisons). On multivariate logistic regression analysis, baseline IELT was the only predictor of successful treatment of PE with both tramadol 50 mg (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.03-1.07, P < 0.001) and tramadol 100 mg (OR: 1.07, 95% CI: 1.04-1.11, P < 0.001). Postmicturition dribble annoyed 12.8% of those who received 50 mg tramadol and 33.6% of those who received 100 mg tramadol (P < 0.001). Weak scanty ejaculation was the main complaint in 7.2% versus 21.6% of those using 50 and 100 mg tramadol, respectively (P = 0.002). Two patients discontinued tramadol 100 mg due to side-effects. Conclusion: Tramadol hydrochloride exhibits a significant dose-related efficacy and side-effects over placebo for treatment of PE.

Selective serotonin reuptake inhibitors (SSRIs) are utilized to treat premature ejaculation (PE). However, their effect is moderate, with no universally adopted schedule. A possible role for pelvic floor dysfunction in the pathogenesis of PE was reported previously. The aim of this study was to compare the efficacy of combined sertraline and pelvic floor rehabilitation with either line in patients with an unsatisfactory response to SSRIs. From June 2009 to December 2012, 74 PE patients with an unsatisfactory response to sertraline 50 mg were enrolled and subjected to pelvic floor rehabilitation as an alternative therapy, and then a combination of both was tested on the same group. Relationships with outcome were analyzed using the Student t-test, Pearson’s correlation, and linear regression. The baseline intravaginal ejaculatory latency time (IELT) was 20–110 s (mean ± SD = 56.35 ± 21.67). With sertraline 50 mg therapy alone, IELT reached 90–180 s (mean ± SD = 121.69 ± 21.76, P = 0.0001). Of them, 44 (59.46%) patients failed to exceed an IELT of 120 s. With pelvic floor rehabilitation alone, IELT reached 90–270 s (mean ± SD = 174.73 ± 45.79, P = 0.0001). Of them, 13 (17.56%) patients failed to exceed an IELT of 120 s. Using a combination therapy of both, IELT reached 180–420 s (mean ± SD = 297.57 ± 59.19, P = 0.0001). This response was significantly higher than the baseline IELT and that of either lines alone (P = 0.0001, for all tests). Pelvic floor rehabilitation is an important addition when treating PE, particularly in patients with pelvic floor dysfunction. We recommend this combination in patients with an unsatisfactory response to SSRIs. Causes of PE differ considerably. In this paper, we compared the outcomes of two single treatment lines together with a combination of both. The combination therapy was more effective than either line alone.

Introduction: Possible approaches for postoperative analgesia after pediatric inguinoscrotal surgery are caudal block by bupivacaine/ketamine (BK) and bupivacaine/magnesium sulfate (BM). Aim: The purpose of the following study is to compare the analgesic efficacy and safety of ketamine and magnesium sulfate in combination with bupivacaine for caudal blockade in pediatric patients after inguinoscrotal operations. Materials and Methods: Patients randomly received one of the two solutions for caudal epidural injection after induction of general anesthesia. Group-BK: Were given a mixture of 0.25% bupivacaine and 0.5 mg/kg of ketamine. Group-BM: Were given a mixture of 0.25% bupivacaine and 50 mg magnesium sulfate. Postoperatively, a blinded post-anesthesia care unit nurse assessed the quality of analgesia with a visual pain analog scale (VPAS). Significant pain is defined as one that has a VAPS of ≥3. Results: Forty American Society of Anesthesiologists I-II children (20 in each group) completed the study. The two groups were comparable regards age, sex, body mass index, anesthesia and surgery durations, recovery time and sevoflurane concentration. The mean duration of caudal analgesia ± standard deviation was 462 ± 17.2 min versus 398.05 ± 12.9 min for BK and BM groups, receptively (P < 0.001). Supplemental rectal paracetamol within 12 h postoperatively were 15% for BK group versus 25% for BM (P = 0.05). Four patients in BK group only experienced postoperative nausea and vomiting (P = 0.053). Conclusion: Caudal administration of BK is efficient and safe for pediatric inguinoscrotal operations with longer postoperative analgesia than BM sulfate.

Objective: Peeping testis is an inconsistently palpable/ seen undescended testis that migrates back and forth at the internal inguinal ring. Both open and laparoscopic orchiopexy are effective forms of management. The present study aimed to evaluate the efficacy and safety of both approaches.Patients and methods: Between September 2007 and January 2012, 46 peeping inguinal testes were randomly treated with either open (25 cases) or laparoscopic (21 cases) orchiopexy procedures. Spermatic vessels were preserved for all cases. Operative details, postoperative morbidity and final testicular site and size were recorded.Results: The median age of the children was 2.5 years (range 0.5-12.0). The follow-up period ranged from 1.0 to 5.5 years. Of these testes, 20 in the open surgery group and 19 in the laparoscopic group maintained correct intrascrotal position (P = 0.428). Re-do orchiopexy was indicated for two cases in the surgical group (P = 0.493). No cases of testicular atrophy or hernia were encountered.Conclusion: Open and laparoscopic orchiopexy procedures for peeping testes are fairly comparable. However, laparoscopy is relatively more effective, as two re-do orchiopexies were required in the open surgical group. (C) 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Nowadays, tramadol hydrochloride is frequently used as a pain reliever, and for the treatment of premature ejaculation. Decreased semen quality was noted in chronic tramadol users. The present study aimed to elucidate the effects of tramadol on the testicular functions of adult male rats. A total of 40 albino adult male rats were divided into control and tramadol groups, with 20 rats for each group. Rats of the tramadol group were subcutaneously injected with 40 mg/kg three times per week for 8 weeks. The control group received normal saline 0.9%. Blood samples from each animal were obtained. Plasma levels of different biochemical substances were determined. Nitric oxide was measured in testicular tissue samples. Those samples together with epididymal tissue samples were processed for histopathological examination. Tramadol significantly reduced plasma levels of luteinizing hormone, follicle-stimulating hormone, testosterone and total cholesterol, but elevated prolactin and estradiol levels compared with the control group. In addition, tramadol increased the testicular levels of nitric oxide and lipid peroxidation, and decreased the anti-oxidant enzymes activities significantly compared with the control group. The tramadol group showed decreased sperm count and motility, and numbers of primary spermatocytes, rounded spermatid and Leydig cells. Immunohistochemical examinations showed that tramadol increased the expression of endothelial nitric oxide synthase in testicular tissues. The present study showed that tramadol treatment affects the testicular function of adult male rats, and these effects might be through the overproduction of nitric oxide and oxidative stress induced by this drug.

Introduction: Penile fracture is the most common presentation of acute penis. Rupture of the superficial dorsal penile vein (s) may mimic penile fractures with similar clinical presentation but with intact corporeal bodies. Our aim of the study is to highlight superficial dorsal penile vein (s) injury as true emergency with better prognosis. Subjects and Methods: Sixty-eight patients with suspected penile fractures presented to our hospital between June 2007 and January 2013. Out of these, 11 patients showed intact tunica albuginea on exploration with injured dorsal penile vein (s) identified. Records of such 11 cases were reviewed regarding age, etiology, symptoms, physical signs, findings of surgical exploration and post-operative erectile function. Results: All 11 patients were injured during sexual intercourse and presented with penile swelling and ecchymosis and gradual detumescence. Mild penile pain was encountered in 5 cases and the "snap" sound was noted in 2 cases. Examination revealed no localized tenderness, or tunical defect. All the patients regained penile potency without deformity after surgical ligation of the severed vessels. One patient developed penile hypoesthesia. Conclusion: Although the classic "snap" sound and immediate detumescence are usually lacking in the symptomology of dorsal penile vein rupture, its clinical presentation can be indistinguishable from true penile fracture. Surgical exploration is still required to avoid missing tunical tear with possible future complications. The long-term outcome and prognosis are excellent.