Background: Storage lower urinary tract symptoms (LUTS) are prevalent in men and have historically been linked to bladder outlet obstruction (BOO) as a result of benign prostatic enlargement. However, this paradigm fails to adequately account for the persistence of symptoms in the aftermath of surgical procedures, including transurethral resection of the prostate (TURP). This review aimed to evaluate the present understanding of the pathophysiological mechanisms underlying storage LUTS and to assess their persistence, predictors, and evaluation following bipolar TURP. A narrative review of the literature was done focusing on the role of bladder dysfunction, metabolic factors, and postoperative changes contributing to storage LUTS after TURP. In addition, bladder dysfunction including detrusor overactivity and impaired contractility—plays a central role, particularly in the persistence of symptoms after surgical relief of obstruction. Conclusion: A complex clinical entity, storage LUTS following bipolar TURP are influenced by both systemic factors and pre-existing bladder dysfunction. It is essential to have a thorough comprehension of the underlying mechanisms and predictors in order to guide individualized management strategies, enhance postoperative outcomes, and optimize patient selection. Keywords: Benign Prostatic Hyperplasia, Lower Urinary Tract Symptoms, Bipolar Transurethral Resection of the Prostate.

Background Iatrogenic ureteral injury (IUI) is a severe complication in surgery for deep pelvic malignancies. The utility of prophylactic ureteral stenting (PUS) to mitigate this risk remains controversial. This study aimed to prospectively evaluate the clinical value of PUS on intraoperative outcomes, including ureteral injury rates, blood loss, and the ease of surgical dissection and repair. Methods A retrospective review of 108 patients undergoing open surgery for deep pelvic malignancies. Patients were divided into two groups: the PUS group (n = 56), who received a preoperative ureteral stent, or the non-stented control group (n = 52). The primary outcome was the incidence of IUI. Secondary outcomes included operative time, estimated intraoperative blood loss, and postoperative complications. Data were analyzed using t-tests and Chi-square tests, with p < 0.05 considered significant. Results IUI was identified in 20/56 (35.7%) patients in the PUS group and 10/52 (19.2%) in the non-stented group. All injuries in the PUS group were identified and repaired intraoperatively. The PUS group demonstrated significantly lower mean intraoperative blood loss than the non-stented group (823.21 vs. 1232.08 ml; p = 0.002). There was no significant difference in mean operative time between the groups (241 min vs. 237 min; p = 0.769). The stented group also had significantly fewer patients with positive lymph nodes (p = 0.009) and required less adjuvant therapy (p = 0.0006), suggesting baseline differences in case complexity. Conclusion Prophylactic ureteral stenting did not reduce the incidence of iatrogenic ureteral injury; a higher injury rate was observed in the stented group, likely reflecting a selection bias for higher-risk cases. However, PUS was associated with a significant reduction in intraoperative blood loss and facilitated immediate injury recognition and repair. These findings support a selective, rather than routine, application of PUS, reserving it for patients with complex pelvic anatomy where ureteral identification is anticipated to be challenging. Clinical Trials registration number is NTC05183334

The hallmark of refractory ischemic priapism (RIP) is increasing tissue necrosis and hypoxia due to blocked venous outflow caused by unrelieved tissue pressure inside a confined compartment. inside six hours of start, irreversible changes to corporal tissue take place as a result of RIP, which causes time-dependent alterations inside the corpora cavernosa. While 50% of patients can maintain their erectile function if their priapism is treated within 24 hours, the maintenance of erectile function and the response rate to distal shunt procedures progressively decrease as priapism lengthens. Guidelines from the American Urological Association state that once more conservative methods have failed, a distal penile shunt surgery is usually part of the management of RIP. Distal shunts, such as intracavernosal tunneling, have poor results for protracted ischemic priapism, with just 30% of priapic episodes lasting more than 48 hours successfully treated. Penoscrotal corporal decompression is a simple technique in the management of RIP with fewer complications & less cost with the restoration of erectile function than other techniques. PSD has favorable results in maintaining adequate sexual function as If PSD does not produce a long-lasting new shunt from the corpora cavernosa to the glans or spongiosum, there may be a greater chance of restoring physiological erectile function.

AbstractIntroduction: Muscle-invasive bladder cancer is common in Egypt. Trimodality chemoradiation post transurethral resection of bladder tumor proved high benefits. Our aim is to show our institute’s experience in using gemcitabine concurrent with radiotherapy post-TURB in an old frail group of patients diagnosed with MIBC regarding efficacy and tolerability. Materials and Methods: This prospective study included 47 patients diagnosed with de novo MIBC in the period between October 2016 and October 2020. Eligible patients underwent maximal TURBT followed by radiation therapy with 65 GY in two phases concomitant weekly gemcitabine (100 mg/m2). Results: The median age was 65.9 years. Males were more common (80.9%) than females. The Median follow-up was 24 months. A complete response was achieved in 34 patients (72.3%). Salvage cystectomy was done for 3 patients who did not achieve CR. chemotherapy was given to another 5 patients of those who did not achieve CR (gemcitabine plus cisplatin /carboplatin). While 5 patients refused any further treatment, only for follow-up regimens. Survival: Median PFS and OS were 40 months and 42 months, respectively. Three-year progression-free survival (PFS) and overall survival (OS) were 66.6% and 75.4%, respectively. Conclusion: Chemoradiation with low dose Gemcitabine is well tolerated and effective post-TURT. It provides an alternative organ-preserving strategy in invasive TCC for old fragile patients.

Objectiveto compare the results of using Dapoxetine and HA (hyaluronic acid) gel injection by Five puncture technique in the treatment of premature ejaculation (PE).Methods100 sexually active heterosexuals circumcised males with lifelong PE were included in the study. Group A patients were treated with on-demand Dapoxetine, while group B was treated with HA gel glans penis injection using a five-puncture technique. Both groups were evaluated at 1(st),3(rd) and 6(th) months post-treatment using IELT.ResultsThere were no significant differences between both groups regarding patient demographic. Mean pretreatment IELT in groups A and B were 45.82 & PLUSMN; 7.44 and 46.18 & PLUSMN; 7.82 receptively. There was no significant difference between both groups. After treatment, both groups show significant ILET improvement during the 1(st),3(rd), and 6(th) months follow-up with a P value < 0.001. However, when comparing the improvement of ILET in group A (Dapoxetine) and group B (HA injection), there were high significance differences in favor of group B in the 1st,3rd, and 6th-month follow-up.ConclusionAlthough both treatment modalities have improved IELT and premature ejaculation, but HA injection with five punctures technique was significantly better than oral Dapoxetine with self-limited side effects.

Abstract. Background. The lifetime occurrence of urinary stones is approximately 1%–15%, and the peak age of occurrence is 30 years. Approximately one fifths of urinary tract stones are found in the ureter, of which two thirds are in the distal ureter. Many drugs, including phosphodiesterase-5 inhibitors (PDE5Is) and α-blockers, are used to relax the smooth muscles in medical expulsive therapy (MET). We aimed to compare the combination of tadalafil and tamsulosin versus tadalafil alone as MET for stones in the L1/3 ureter of 10 mm or less. Materials and methods. A total of 150 patients with L1/3 ureteric stones measuring 10 mm or less were enrolled in the study and randomly assigned to one of 3 equal groups using a computer-generated random number. Patients in group A prescribed tadalafil 10 mg/d. However, those in group B were prescribed tamsulosin 0.4 mg and tadalafil 10 mg/d, whereas those in group C received a placebo once daily. Stone expulsion rate and pain recurrence were evaluated after 14 days. Results. The stone expulsion rate was significantly higher in the tadalafil and tamsulosin groups and the tamsulosin group than in the placebo group in the current study by 68% in the combination group, 64% in the tadalafil alone group, and 42% in the placebo group (p = 0.019). In the current study, a combination was associated with lower pain recurrence than tadalafil alone or placebo, with means of 1.06, 1.9, 2.98 (with a p value of 0.001). Stone size was not effective in any group. Conclusions. The combination of PDE5Is and α-blockers effectively increases the expulsion of lower ureteric stones (5–10 mm), but with the same effect as PDE5Is alone, with the advantage of decreasing pain recurrence. Stone size did not affect the expulsion rate in patients who received MET for stones less than 1 cm in size.

Background: Stress Urinary incontinence (SUI) is a public health condition that affects women worldwide, Patient satisfaction after stress incontinence surgery is influenced by many factors, patient-specific expectations, postoperative continence status, and complications. Traditionally treatment success has been defined by cure rate and symptom improvement, patient-reported outcomes, particularly satisfaction, have been recognized as complementary measures of success, This study amid to evaluate patient satisfaction post sling surgery for stress urinary incontinence. Methods: It is a retrospective study including 30 female patients, 15 underwent Transobturator Vaginal Tape (TOT) operation and 15 underwent Tension-free vaginal tape (TVT) for stress urinary incontinence between Jan 2019 to Jan 2020 in Urology Department, Faculty of Medicine, Zagazig University. Patients were evaluated 12 month post MUS for complications and satisfactions by(ICIQ-SF) score, quality of life score , female sexual function index, and Global response assessment scale.Results: Marked improvement in International consultation on incontinence Questionnaire –Short Form and quality of life (ICIQ-SF) score dropped from (12.20±2.27) to (1.40±0.51) TOT group and from (11.26±2.15) to (1.06±0.23) in TVT group. The Quality of life score improved by dropping from (5.26±1.22) to (0.48±0.11) and from (5.06±1.09) to (0.51±0.11) in TVT group with no significant difference between both groups. All items of (FSFI) score were improved from pre to post-management without difference between both groups. Conclusions: Mid urethral slings have high patient satisfaction rates regarding the improvements in ICIQ-SF scores and FSFI on short-term and are relatively safe procedures

Objective: The objective of this study is to compare the outcome of percutaneous nephrostomy by ultrasound (US) versus fluoroscopy including access time, volume of anesthesia required, success rate, and complications. Methods: One hundred patients were enrolled in a prospective randomized study. Patients were divided into two groups, 50 cases each. Comparing the two groups was done regarding the need for dye, radiation effect, time taken, trial number, rate of complication, volume of anesthesia, and success rate. Results: Patient demographics were comparable between both groups with no statistically significant difference. According to the modified Clavien–Dindo classification, the complications were Grade I (pain and mild hematuria) in each group. Procedural pain was present in 41 (82%) patients in Group I and in 48 (96%) patients in Group II. It was treated in both groups with a simple analgesic. Mild hematuria was present in 5 (10%) patients in the US group and 13 (26%) in the fluoroscopic group and treated by hemostatic drugs only. There was a statistically significant difference between both groups regarding the volume of required local anesthesia, the trial numbers, the puncture numbers, bleeding, extravasation, and change in the hemoglobin level. Conclusion: US percutaneous renal access is a safe and effective modality with a high success rate, less operative time, and complication rate. However, a minimum of 50 cases with some pelvicalyceal system dilation may be preliminary requisites to achieve good orientation and competence in achieving safe US percutaneous renal access for future endourological procedures.

To report the safety and efficacy of holmium laser and compare its results with cold knife visual internal urethrotomy (VIU) in the management of short segment urethral stricture. This prospective randomized study included 66 male patients aged more than 18 years, with short segment bulbar urethral strictures < 2 cm from March 2020 to March 2022. The patients were randomized into two groups each containing 33 patients. In group A (Cold knife group), Sachse cold knife was used for stricture treatment. In group B (Holmium group), internal urethrotomy was done with Ho:YAG laser. Patients were evaluated before the operation and followed up after the operation at 1, 3, 6 and 12 months by physical examination, IPSS, PVR, Qmax and retrograde urethrography. There was significant improvement in the mean values of IPSS, PVR and Qmax in both groups. There was no significant difference between both groups in the mean values of IPSS, PVR and Qmax during follow-up visits. However, at the end of follow-up at one year there was statistically significant difference between both groups in the mean values of IPSS, PVR and Qmax due to higher recurrence rate in cold knife group than laser group. The overall complication rate is significantly lower in laser group (p = 0.014). Holmium laser VIU is an effective and safe treatment option for short segment urethral stricture with shorter operative time, less complication rate and less recurrence than cold knife VIU.

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 .

Introduction: In Egypt, bladder cancer (BC) represents about 8.7% of cancers in both sexes. In Egyptian men, it ac-counts for over 30% of all cancers, which makes it the second most fre-quent cancer. The standard curative treatment for patients with muscle -in-vasive bladder cancer (MIBC) has been radical cystectomy (RC) with urinary diversion and pelvic lym phadenec-tomy. Concomitant chemoradiation therapy (CCRT) in MIBC appears to produce results that are comparable to those of RC.Material and methods: Between Jan-uary 2018 and March 2021, 34 BC -diagnosed patients, who refused RC, were enrolled. They received trans -urethral resection of the bladder tu-mour (TURBT) followed by 3 cycles of neoadjuvant chemotherapy (NACT) with gemcitabine, cisplatin, and CCRT. Concomitant chemoradiation therapy with cisplatin, as a chemosensitizer, was administered to patients who experienced a complete response (CR) and a partial response (PR) symbolscript 50%.Results: Following NACT, CCRT was given to 27 patients (79.45%) who had either a PR > 50% or CR. Seven patients (20.5%) showed PR below 50%, stable disease, or progressive disease; 4 of them underwent RC followed by postoperative radiation. The average follow-up period was 46 months (range: 6-52 months). Twenty-three patients (67.6%) were still alive at the last check-up. Disease-free survival and 3-year over-all survival were 70.8% and 65.1%, respectively.Conclusions: Bladder preservation provides survival rates comparable to those of MIBC patients, but with a higher quality of life. The findings show good survival rates without metastasis; nevertheless, more mul-ticentre trials with larger sample sizes and longer follow-up periods are re-quired to confirm these findings.

Purpose of Review We performed recent literature review with the aim to address the updates in diagnosis and management of interstitial cystitis/bladder pain syndrome (IC/BPS). Recent Findings There are multiple recently published studies that collectively lead to an organized stepwise plan for diagnosis and management of IC/BPS. Summary IC/BPS is a common health condition that can be managed efficiently if the appropriate steps are taken in diagnosis and management.

Introduction:We aimed to evaluate the outcome of treatment with docetaxel plus androgen deprivation therapy (ADT) in newly diagnosed patients with metastatic high tumor burden hormone-sensitive prostate cancer (mHSPC) and correlated the outcome with hemoglobin, albumin, lymphocyte and platelets (HALP) score. Material and methods:Six cycles of docetaxel plus ADT were given to 50 patients with high burden mHSPC. Baseline HALP score was calculated and disease outcome was tabulated; moreover, the prognostic impact of the HALP score in response to treatment and survival was calculated. Results:We found a significant association between high HALP score and response to treatment where a higher rate of complete response occurred in patients with a high HALP score than in patients with a low HALP score (53.8% vs. 5.4% respectively, p-value = 0.001). Patients with ≥ 12-month-duration castration-resistant prostate cancer (CRPC) had a significantly higher HALP score compared to patients with a lower HALP score (84.6% vs. 35.1% respectively, p-value = 0.002); 18-month-duration CRPC-free survival was significantly greater in patients with higher HALP score than patients with a lower HALP score (23.1% and 5.4% respectively, p-value < 0.001). Patients with a high HALP score had insignificantly higher mean overall survival than patients with a low HALP score (mean: 22.91 and 20.66 months respectively, p-value = 0.230). Conclusions:Our results confirmed the benefits of treatment with docetaxel plus ADT in high-burden mHSPC with accepted tolerance. HALP score was found to be an independent predictive factor for benefit from therapy; we can apply it as an easy way to stratify patients for appropriate selection of treatment for better tolerance and outcome.

Objective:To assess safety and efficacy of hyaluronic acid (HA) gel injection in glans penis for treatment of premature ejaculation (PE) using our new five puncture technique. Patients and methods:This is a prospective, non-randomized clinical trial on HA gel injection in glans penis for all patients with lifelong PE; all patients were circumcised having heterosexual normal marital life and sexually active. Patients with history of ejaculatory medication use within the previous 3 months, psychiatric disorders, erectile dysfunction, lower urinary tract symptoms (LUTS) due to prostatitis and acquired PE were excluded from the study. A local anesthetic was applied to the skin of glans penis for 30 minutes before the injection of 2 ml HA in glans penis via 30-gauge needle using our new Five-puncture technique. Intra-vaginal ejaculatory latency time (IELT) was measured at 1, 3, 6 and 12 months after injection. Results:Thirty patients completed our study follow up schedule. Mean age of the patients was 41.72 ± 8.50, while mean age of female partner was 37.23 ± 8.54 years. IELT was highly significantly increased (P-value < 0.001) after HA gel injection from baseline, which was in maximum 37.83 ± 11.01 sec at baseline to 323.03 ± 42.06, 281.07 ± 41.05, 241.03 ± 43.09 and 235.6 ± 41.87 sec after 1, 3, 6 and 12 months, respectively, after injection. Three patients complained from discomfort at the site of injection, two from bullae formation at the site of injection and one from ecchymosis, and all resolved spontaneously after 1 week to 10 days after injection. Conclusion:HA gel injection in glans penis using our new five-puncture technique is a safe and effective method that ensures a modest long-term significant increase in IELT and improves ejaculatory control.

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.

Objectives: To report the one-year results of ESWT on CPPS patients and the possible clinical characteristics that may affect its efficacy. Patients & methods: A prospective randomized clinical study between January 2017 and January 2021 on 155 adult patients with chronic pelvic pain syndrome. All patients were initially evaluated with a thorough history and physical examination. Baseline symptoms evaluation of each participant was assessed using NIH-CPSI score, IPSS, VAS, and IIEF-5 score. Patients were randomized into two groups: a verum treatment group and a placebo treatment group. Patients of verum group in the lithotomy position received a perineally applied ESWT treatment once a week for four weeks with 3000 impulses each. Patients of placebo group received the same therapy head of the same device with a layer of air-filled microspheres to absorb the shock waves. The previously mentioned validated scores were reassessed on regular follow-up visits at one, three, six, and 12 months after the completion of ESWT. Results: A statistically significant improvement was noticed in the mean values of NIH-CPSI, IPSS, VAS, and IIEF-5 of the patients of verum group over the follow-up period with also statistically significant difference between both groups. At the first visit of follow-up after ESWT, 63 (82.8%) patients had ≥6 points decrease in the NIH-CPSI total score, while 13 (17.2%) patients did not. Univariate and multivariate analyses of the clinical characteristics between the responders and non-responders showed that those patients with history of psychological disorders or had higher initial NIH-CPSI score had a significantly lower response rate to ESWT ( p = 0.005, 0.02 & p = 0.002, 0.004 respectively). ROC curve of NIH-CPSI score showed that a score of 32 was the cut-off point above which the response to ESWT decreased. Conclusion: ESWT is an effective treatment option for CPPS. Its efficacy remained throughout long-term follow up. High initial NIH-CPSI score and history of psychological problems are significant predictors for it.

Objective: To observe changes in sperm parameters after 72 days of infection by COVID-19. Methods: A total of 100 patients had been enrolled in the study by a criteria suggesting good semen analysis. Two sets of semen analysis done, the first after 72 days of first positive swab for COVID-19 to show changes in the cycle of spermatogenesis during infection, the other sample after 72 days from the first to compare it with the first sample. Results: A total number 100 patients first sample show 2% of patient’s oligospermia, 36% of patient’s teratospermia. The second sample shows 4% of patients’ teratospermia. by comparing the two samples there is a significant increase in sperm concentration also a significant increase in motility (A+B), a highly significant increase in the normal forms of sperms. Conclusion: COVID-19 affects spermatogenesis in the form of reversible teratospermia, reversible decrease sperm count but within normal level, reversible decrease in the sperm motility but also within normal level.

Aims: The aim of this study is to compare between transrectal ultrasound (TRUS)-guided aspiration and transurethral (TU) deroofing in the treatment of prostatic abscess regarding safety and efficacy. Settings and Design: This prospective randomized study was done during the period between April 2009 and March 2015 and included 32 patients with prostatic abscess. Subjects and Methods: All patients were enrolled in the study after obtaining a written informed consent and approval of the local ethical committee. The patients were randomly allocated into two groups; Group A treated by TRUS-guided aspiration, saline wash, and local injection of antibiotics and Group B treated by TU deroofing of the abscess. All patients received broad-spectrum antibiotics during the period of treatment, and the follow-up was done on the 5th day by TRUS to ensure complete resolution of the abscess. Statistical Analysis Used: Statistical analysis was done using online social science statistical calculators http://www.socscistatistics.com/Default.aspx using t-test for two independent means, Chi-square test, and Mann–Whitney U-test with P < 0.05 considered statistically significant. Results: The mean age was 59 ± 11.46 and 60 ± 13.65 years for Groups A and B, respectively. Diabetes mellitus was detected in 9 (56.25%) and 6 (37.5%) patients in Groups A and B, respectively, hypertension in 7 (43.75%) and 6 (37.5%) patients in Groups A and B, respectively, and two patients (12.5%) with liver cirrhosis in each group. The mean size of the abscess was 3.36 ± 0.86 and 3.04 ± 0.86 cm in Groups A and B, respectively (P = 0.29). The abscess recurred in five patients (31.25%) and one patient (6.25%) in Groups A and B, respectively (P = 0.08). TRUS-guided aspiration was done for all recurrent cases except for two patients (12.5%) in Group A required trans urethral deroofing of the recurrent abscess. The mean hospital stay was 12.9 ± 4.05 and 7.25 ± 2.40 days for Groups A and B, respectively (P = 0.000). In Group A, one patient (6.25%) was complicated by urethrorectal fistula, whereas in Group B, one patient (6.25%) was complicated by septic shock, three patients (13.75%) with epididymo-orchitis and two patients (12.5%) with urethral stricture. Conclusion: Patients with prostatic abscess treated with TRUS-guided aspiration show less morbidity, higher recurrence rate, and longer hospital stay than those treated with TU deroofing.

Background: Superficial bladder cancers (nonmuscle invasive) are commonly faced by urologists and represent a major challenge for urologists and oncologists, especially Grade III carcinomas, whether conservative treatment is sufficient alone or with radical cystectomy is essential. Aim of the Study: We aimed to find a way to avoid recurrences in the nonmuscle-invasive bladder cancer and in the same time avoid radical cystectomy. Patient and Methods: We selected 42 patients with nonmuscle-invasive bladder cancers from those attending to Urology Department, Zagazig University Hospitals, from December 2011 to January 2015. After complete transurethral resection (TUR) bladder resection, diagnosis of biopsy was based on H and E-stained sections. Then, human epidermal growth factor receptor 2 (Her2) immunostaining was performed for all paraffin blocks derived from the patients. Trastuzumab was given to all cases that were positive to Her2, and only one case of them did not receive trastuzumab and left as a control. All cases then underwent follow-up for 20 months. Results: We found a significant relationship (P = 0.05) between Her2 immunostaining positivity and tumor stage, grade, multifocality, and recurrences/progression. Most cases who received trastuzumab did not undergo recurrences (19/22) (P = 0.005). We found also decrease in the immunostaining in cases of recurrences, indicating the presence of other factors affecting the occurrence or recurrences/progression. Conclusions: We concluded that administration of anti-Her2 therapy (like trastuzumab) may be essential for Her2-positive superficial bladder cancer to avoid recurrences after complete TUR bladder (TURB). Recommendation: We recommend for other studies on the significances of recurrences and how to avoid them.

Objectives:To evaluate the possible role of silodosin (a highly selective α1A-adrenoceptor antagonist) in facilitating the passage of distal ureteric stones (DUS) in children, as the role of α-blockers as medical expulsive therapy is well known in adults.Patients and methods:In all, 40 paediatric patients (27 boys and 13 girls) diagnosed with unilateral, single, radiopaque DUS of <10 mm were included in the study. Their mean (SD, range) age was 8.1 (2.7, 5–17) years. The patients were randomly divided into two groups: Group A, received silodosin 4 mg as a single bedtime dose; and Group B, received placebo as a single bedtime dose. Ibuprofen was prescribed to both groups on-demand for pain episode relief. Patients were followed up biweekly for 4 weeks. The stone expulsion time and rate, pain episodes, analgesic use, and any adverse effects were recorded.Results:The mean (SD) stone size in Group A was 6.6 (1.7) mm and in Group B was 6.7 (1.4) mm (P = 0.4). Two patients were lost to follow-up (one from each group), and one patient in Group A refused to complete the study. The stone-free rate at end of the 4-week treatment period was 88.8% in Group A vs 73.6% in Group B (P = 0.4). The mean (SD) stone expulsion time was 7.0 (4.3) vs 10.4 (4.7) days in groups A and B, respectively (P = 0.02). The mean (SD) number of pain episodes requiring ibuprofen was 2.3 (1.4) vs 4.7 (2.6) episodes in groups A and B, respectively (P < 0.001). Adverse effects (headache and dizziness) were recorded in three patients (16.7%) in Group A, which were mild and none of them discontinued treatment, whilst no adverse effects were recorded in Group B.Conclusions:The data in the present study show that silodosin can be safely used in the treatment of DUS in children for decreasing time to stone expulsion, pain episodes, and analgesic requirement.