Purpose: To compare the rate of post-flexible ureteroscopy urinary tract infection (UTI) in patients subjected to the standard antibiotic prophylaxis alone versus enhanced prophylactic measures. Methods: A prospective randomized controlled study included 256 patients subjected to flexible ureteroscopy (FURS) for ureteral or renal stones from March 2018 to July 2022. Treatment groups included the standard antibiotic prophylaxis group (group 1, n=128) and the enhanced prophylaxis group (group 2, n=128). Patients in group 1 were injected with intravenous fluoroquinolone one hour preoperatively, and oral antibiotics were used for 24 h postoperatively. Patients in group 2 had urine culture ten days before the procedure; antibiotic-culture based was given for positive asymptomatic cases, while the procedure was deferred for active UTI. Results: The study groups were comparable regarding patient demographics, stone characteristics, operative time, and intraoperative complications. The overall hospitalization time was 1.68 ± 0.81 days. Postoperative, and overall complications were significantly higher in group 1 (15.6% vs. 6.3%, p = 0.04 and 26.6% vs. 17.2%, p = 0.047), respectively. Twenty patients (15.6 %) in the standard prophylaxis group were diagnosed with UTI in comparison to 8 patients (6.3 %) in the enhanced prophylaxis group (p = 0.047). Conclusions: Urinary tract infection after FURS could be reduced significantly by utilizing the suggested enhanced prophylactic approach.

Objectives To determine the utility of serum copeptin and urinary aquaporin‐2 (AQP2) levels in diagnosing primary monosymptomatic nocturnal enuresis (PMNE) in children. Methods This study comprised 58 children (30 males and 28 females), aged 9.7 (±2.9) years with PMNE enuresis. Another 29 children (16 males and 13 females) aged 10.2 (±3.3) without nocturnal enuresis (NE) were recruited as a control group. History taking, clinical examination, and assessment of serum copeptin (blood) and AQP‐2 levels (urine) were performed in all participants. Results Serum levels of copeptin, potassium and urinary AQP‐2, and urine creatinine levels were lower in the PMNE group compared to the control group (p < 0.001 for all). No significant differences in body mass index, urine specific gravity, serum sodium, serum creatinine, or estimated glomerular filtration rate were observed between groups. This study evaluated both serum copeptin and AQP‐2 levels in healthy and enuretic children. Conclusions In this study, serum levels of copeptin (blood) and AQP2 (urine) were significantly lower in enuretic patients compared to healthy controls. Further, the measurement of urinary AQP‐2 levels is more practical than serum copeptin levels due to lower invasiveness.

Background About one in 200 to one in 300 male births has hypospadias. The prevalence of this congenital anomaly varies worldwide. The meatus is located distally in approximately 70% of cases. Several surgical techniques were described for distal hypospadias repair; despite this, there is no ideal approach. This study compares urethral advancement &glanuloplasty, and TIP techniques in terms of feasibility, duration of operation, and complications. Patients and. Methods This prospective randomized comparative study was conducted at Al-Azhar University Hospitals from April 2022 to October 2022. Fifty-seven cases with different types of hypospadias were assessed for eligibility. Among them, seven cases were excluded due to the presence of severe chordee (n = 3), proximal variant (n = 2), and recurrent cases of hypospadias (n = 2). Fifty cases were randomly divided into two groups using a 1:1 ratio (computer-generated randomization). Twenty-five cases were subjected to urethral advancement and glanuloplasty, and the rest were subjected to tubularized incised plate (TIP) urethroplasty. Results The mean age of all studied cases was 4.2 years. Approximately 52% had coronal or sub-coronal meatus, whereas 48% had glandular meatus. Both groups were matched according to age and meatus location (p > 0.05). No statistically significant difference was observed between the two groups regarding duration of operation, postoperative pain, and postoperative hospital stay. In addition, both groups did not differ significantly in late complications (meatal stenosis, meatal retraction, fistula, and glans dehiscence). Conclusions Both urethral advancement &glanuloplasty, and TIP urethroplasty have comparable short-term outcomes. Urethral advancement and glanuloplasty is preferred in certain conditions, especially in circumcised children or those with a narrow urethral plate. Trial registration The study protocol was approved by the Pan African Clinical Trials Registry (number for the registry is: PACTR202211757905870) on (29/11/2022). All procedures were performed per the Helsinki Declaration.

Background: Uretero-pelvic junction obstruction is the most common form of congenital anomaly of the kidney and urinary tract with an incidence of about 1/1.000-1.500 of births and the aetiology and pathogenesis of this anomaly are still unclear until now. Methods: This is a prospective randomized comparative study conducted from March 2022 to December 2022. Thirty children with uretero-pelvic junction obstruction were included and randomly divided into two groups according to a 1:1 ratio (computer-generated randomization, single blind). Fifteen cases (12 males and 3 female) were subjected to ureter first approach pyeloplasty, and another fifteen (9 males and 6 female) were subjected to conventional Anderson Hynes pyeloplasty. Results: The mean age of all patients was 6.7 ± 5.4 years in ureter first approach group and 5.1 ± 4.3 years in conventional Anderson-Hynes pyeloplasty group. There were no significant differences between the two groups regarding age, gender, presentation, side, preoperative renogram and post-operative renogram. Also, there were no significant differences between the two groups regarding operative time (in first group 110.3 ± 12.4 and in the second group 111.2 ± 12.0 with p < 0.836), pre and post-operative complication rate. Two cases of urinary tract infections in the first group, one of them having fever, and four cases in the second group, two of them having fever (p < 0.651); four cases of loin pain in the first group and one case in the second group (p < 0.330); one case in the first group having pro- longed leakage of urine for 7 days in post-operative period (p < 0.309). However GFR and t 1⁄2 improved significantly after operation in both groups (p < 0.001). Conclusions: Ureter first approach is a simple and effective procedure in children with good short term outcomes and could be done safely especially for beginners and less expert surgeons. Finally, it can overcome the problem of long ureteric stricture that may be found intraoperatively because you can shift easily to a flap procedure and complete a tension free anastomosis.

Background: About one in every 300 male births has hypospadias, and the meatus is located distally in approximately 65% of cases. Hypospadias is defined as a maldevelopment of the urethral fold and ventral foreskin, with or without the penile curvature. Any recent classification must include the urethral meatus site, prepuce (complete or incomplete), urethral plate width, glans (flat, cleft, or incomplete cleft), and other associated anomalies if present. Methods: This prospective randomized comparative study was conducted at Al-Azhar University Hospitals from April 2022 to October 2022. Fifty-seven cases with different types of hypospadias were assessed for illegibility. Among them, seven cases were excluded due to the presence of chordee (n = 3), proximal variant (n = 2), and recurrent cases of hypospadias (n = 2). Fifty cases were randomly divided into two groups according to a 1:1 ratio (computer-generated randomization). Twenty-five cases were subjected to modified meatal advancement and glanuloplasty (MAGPI), and the rest were subjected to tubularized incised plate (TIP) urethroplasty. Results: The mean age of all studied cases was 4.2 years. Approximately 52% had coronal or subcoronal meatus, whereas 48% had glandular meatus. Both groups were matched according to age and meatus location (p > 0.05). No statistically significant difference was observed between the two groups in terms of time of operation, postoperative pain, and postoperative hospital stay. In addition, late complications (meatal stenosis, meatal retraction, fistula, and breakdown of the repair) did not differ significantly between both groups. Conclusions: Modified MAGPI and TIP urethroplasty have comparable short-term outcomes; however, TIP urethroplasty has a lower incidence of postoperative complications. Modified MAGPI is preferred in certain conditions, especially in circumcised child or those with a narrow urethral plate. Trial registration: The study protocol was approved by the Pan African Clinical Trials Registry (number for the registry is: PACTR202211757905870) at (29/11/2022). All procedures were performed in accordance with the Helsinki Declaration.