ObjectiveTo evaluate the outcome of using commercially available (SIS) grafts for repairing hypospadias. Collagen-based acellular matrices, including SIS and bladder submucosa matrix, have been used to repair urethral strictures, with varying success, and patients with hypospadias and with inadequate or no genital skin need a substitute tissue for urethroplasty.Patients and methodsThis pilot study included 12 patients (mean age 8 years, range 1.5–15) with hypospadias (distal in six, mid-shaft in four and proximal in two). They underwent a repair with four layers of prefabricated SIS as an onlay graft. The outcome was assessed for cosmetic appearance, urinary stream and the postvoid residual volume. The chi-squared and Mann–Whitney U-tests were used to assess the relationship between preoperative factors and the outcome of the repair with SIS grafting.ResultsThe mean (range) follow-up was 23 (6–36) months. Nine patients ultimately voided normally, with a good cosmetic appearance and no postvoid residual urine. Six patients had a successful repair with no further intervention, whilst three had small fistulae that were treated by simple closure. In three patients the graft failed, by complete disruption or stricture. Graft infection adversely affected the outcome of SIS grafting.ConclusionsThe prefabricated SIS graft can be used as an alternative substitute for urethral reconstruction when genital skin is insufficient or lacking, as in circumcised patients or a repeat hypospadias repair. Graft infection is the chief reason for graft failure and should be prevented. Further studies with more patients are needed to confirm these preliminary results.

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Background:The increased rate of resistance among Gram-negative bacteria to 𝛽lactam, quinolone, or aminoglycoside antibiotics has resulted in increased use of colistin antibiotic with the unavoidable risk of emerging resistance and spreading of colistin resistant strains. Objectives: Our study aimed to investigate urinary tract infections for detection of colistin resistance among E. coli strains causing urinary tract infections and isolated from two University hospitals in Upper Egypt; Assiut and Minia University hospitals. Methodology: One hundred isolates of E. coli strains were collected from urine specimens at both Assiut and Minia University Hospitals. Antibiotic sensitivity test was carried out using disc diffusion method. For analysis of colistin resistance, the broth microdilution technique was employed. In addition, the mcr-1 gene encoding an enzyme phosphoethanolamine transferase which has been identified recognized as a source of acquired resistance of colistin was detected by PCR assay. Results: The high resistance pattern among E. coli strains, as most strains were resistant to 13 antibiotics. mcr-1 gene was detected in (20.8%) and ( 23.1%) of Assiut and Minia University Hospital respectively E. coli isolates. In addition, in this report, we describe the detection of mcr-1 in E. coli isolates causing urinary tract disorders infections in Upper Egypt. Conclusion:Our study revealed a high rate of mcr-1 gene encoding a phosphoethanolamine transferase in E. coli isolates as a source of acquired resistance to colistin. The Emergence of mcr-1 in our isolates of E. coli is alarming. Therefore, broader surveillance of this resistance determinant would be recommended even among other members of Gram-negative bacilli.

Background: Testicular ectopia is defined as a testis which is located away from the normal pathway of testicular descent and outside its ipsilateral hemiscrotum. Controversies have been raised about considering the abdominal and inguinal ectopic testes as undescended ones. Our purpose was to review our center's experience with the diagnosis and management of testicular ectopia focusing on the inguinal ectopic testis. Retrospectively, we studied the clinical and surgical characteristics of a case series of testicular ectopia which was managed in our center during July 2001-June 2016. Results: Out of 1132 patients with undescended testes, 44 cases (3.9%) had testicular ectopia. Twenty-three cases (mean age = 5.15 ± 5.79 years) fulfilled the criteria of inguinal ectopic testis. Clinically, testes were relatively mobile and superficial. Surgically, they were located in the superficial inguinal pouch, had relatively long spermatic cords, and commonly had average rather than small sizes. The other ectopic 21 cases (mean age = 10.56 ± 6.92 years) were perineal, anterior abdominal wall, femoral, prepubic, and transverse testes in 7 (33.3%), 4 (19%), 4 (19%), 3 (14.3%), and 3 (14.3%) cases, respectively. Congenital inguinal hernia was the commonest associated anomaly (22.7%). All cases were treated surgically with only 1 case of testicular atrophy (2.3%). Conclusions: Testicular ectopia is rare with relatively delayed presentations. Different anatomical sites have been reported including the superficial inguinal pouch and anterior abdominal wall with variable complexities and controversies. The inguinal ectopic testis is the most controversial, but it might be characterized from other entities based on certain clinical and surgical criteria.

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