Background: Fournier’s gangrene (FG) is an acute progressive necrotizing fasciitis of the genital area and perineum with possible extension to the abdominal wall. Surgical debridement is the gold standard management modality of established patients. Equivocal (early) FG represents a challenge in diagnosis. The objective of this study was to compare conservative management and early exploration in cases of equivocal (early) FG. Methods: This was an observational study where data of all patients diagnosed as early FG in our departments over 4 years (2011–2015) were enrolled. Patients were divided into two groups: group 1 with conservative treatment, and group 2 managed with urgent exploration with longitudinal hemiscrotal incision starting from external inguinal ring. All patients’ demographics, vital signs, laboratory finding and clinical findings were reported. Results: A total of 28 patients were enrolled in the study. Group 1 was managed with conservative treatment (17 patients) and group 2 underwent urgent exploration (11 patients). Overall, four patients (23.5%) out of 17 patients of group 1 showed a good response to conservative management without any surgical debridement. A total of 13 patients (76.5%) developed gangrenous discoloration and needed surgical debridement later. In group 2, four patients (36.4%) underwent scrotal exploration and release incision only without debridement and showed an excellent clinical outcome. A total of four patients (36.4%) underwent debridement with excision of doubtful deep subcutaneous and fascial tissues. The remaining three patients (27.2%) underwent debridement of necrotic fascia. The hospital stay was significantly shorter in group 2 patients than group 1 (7.5 ± 3.75 versus 13.4 ± 5.19 days p < 0.05). The mean number of debridement sessions was 3.74 ± 0.69 in group 1 versus 1.82 ± 0.34 in group 2. Conclusions: Early exploration and debridement in equivocal (early) FG has a better clinical outcome with reduced hospital stay and number of debridement sessions than conservative treatment with delayed debridement.

ObjectiveTo evaluate the detailed vascular anatomy of the spermatic cord during subinguinal microscopic varicocelectomy and to assess the outcome of the cases with regard to varicocele recurrence and hydrocele formation.Patients and methodsIn all, 100 varicocele cases including 74 left-sided and 26 bilateral, comprising 126 spermatic cord units with clinically palpable varicoceles underwent microscopic subinguinal varicocelectomy. Detailed description of vascular anatomy of the spermatic cords was reported. The number of spermatic, cremasteric, and inguinal veins was recorded. A record of testicular arteries and lymphatics was noted. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, as well as scrotal Doppler ultrasonography, to detect varicocele recurrence and hydrocele formation. The mean (range) postoperative evaluation period was 6 (3–12) months.ResultsThe mean number of spermatic veins was 14 on both sides. The mean number of spermatic arteries on both sides was 1.3. For lymphatics, the mean number was around three on both sides. The gubernacular veins were noted in 75% of the cases on the left side (mean number of 1.2) and in 85% on the right-side, (mean number of 1). The mean number of cremasteric veins on the left and right sides was 1.4 and 1.2, respectively. Finally, inguinal floor vessels were noted in 9% on the left-side and were not seen in the right-side cases. The incidence of varicocele recurrence was 2% and for hydrocele that was not clinically significant was 0.07%.ConclusionMicroscopic subinguinal varicocelectomy accurately evaluated the detailed vascular anatomy of the spermatic cord, achieving excellent surgical outcome with minimal varicocele recurrence and hydrocele formation. Microscopic subinguinal varicocelectomy should be the ‘gold standard’ for varicocelectomy.

Introduction Percutaneous nephrolithotomy (PCNL) is considered a clean-contaminated surgical procedure. The American Urological Association has recommended different preoperative antimicrobial prophylaxis for various urological procedures to prevent surgical site infections, postoperative fever, and possible sepsis. The European Association of Urology (EAU) antibiotic guidelines endorse giving either a second or third-generation cephalosporin, trimethoprim-sulfamethoxazole, fluoroquinolone or aminopenicillin with a β-lactamase inhibitor. The aim of the present study is to prospectively compare two different protocols of antibiotic prophylaxis in PCNL. Material and methods Successfully consented patients with sterile urine preoperatively who were awaiting percutaneous nephrolithotomy were randomized into two groups. The first group (n = 41) was given a single dose of 200 mg ciprofloxacin infusion, while group two (n = 43) was given 2 mg of cefotaxime divided into 2 doses; during induction of anesthesia and 12 hours later. The occurrence of perioperative infection-related events would be compared in both groups. Results Both groups had similar age, sex, Body Mass Index, and stone composition. No statistical difference was found regarding stone size, stone culture, irrigation fluid volume, operative time and urine pelvis culture result in both groups (Table 2). Two patients (5%) developed postoperative fever in the 1 st group compared to 12 patients (28%) in the second group (p = 0.02). Conclusions A prophylactic regimen consisting of a single dose ciprofloxacin infusion during induction of surgery showed a higher efficacy as a preoperative antibacterial preparation, compared to cefotaxime, in protection against postoperative fever in patients undergoing PCNL.

Objective: Tamoxifen was not used earlier in clinical practice to decrease the urethral re-stricture rate after visual internal urethrotomy (VIU). In this study, we are the first to report the use of Tamoxifen as an adjuvant therapy to decrease the re-fibrosis and stricture recurrence post-VIU. Patients and Methods: Between 2015 and 2017, 60 patients underwent VIU for post-traumatic bulbar urethral stricture ≤1 cm. They were randomly divided into 2 groups (30 patients each). The Tamoxifen group cases received Tamoxifen 10 mg twice daily for 6 months post-VIU. The control group did not receive any medications. All patients were evaluated using the IPSS score, uroflowmetry, and perineal ultrasonography preoperatively at 3 and 6 months. Results: At presentation, there was no significant difference between patients of both groups in terms of IPSS score, Qmax, stricture width, and length. At 6 months follow-up, the mean IPSS score for the Tamoxifen group was 12.3 (8–19) in comparison with 20 (12–26) in the control group (p < 0.001). The Tamoxifen group had mean Qmax 11.1 mL/s (9–14), while those of the control group had mean Qmax 8.2 mL/s (6–10; p < 0.001). Using perineal ultrasound, only stricture width showed to be significantly smaller in the Tamoxifen group (p = 0.001). Conclusion: Tamoxifen seemed to be effective in reducing the recurrence of urethral stricture post-VIU. There was a significant improvement of the clinical outcome regarding Qmax and IPSS score after Tamoxifen adjuvant therapy.

BACKGROUND: We evaluated the e cacy of bladder ultrasound to predict resolution of vesicoureteral re ux after subureteral endoscopic Hyaluronic acid/dextranome (De ux) injection. METHODS: Between 2010 and 2018, 120 patients (220 ureters) underwent Subureteral De ux injection for re ux in children. Male/female ratio was 1: 5. All patients had voiding cystourethrography and bladder ultrasound at 3 months and one year after surgery. Outcome analysis included: Success rates and presence/ absence of De ux mount by bladder ultrasound.RESULTS: Mean follow-up was 48 months. Mean age at surgery 72 months. Grades of re ux were grade II in 100 ureters (45.4%), III in 90 ureters (41%) and IV-V in 30 ureters (13.6%). Bilateral surgery was performed in 40 patients. Single De ux injection cured re ux (Success rate) in 85% (187 ureters) at 3 months which improved to 88.2% (194 ureters) at last follow-up. Ultrasound was able to detect De ux mounts at the base of the bladder in 200 ureters (91%). Sensitivity and speci city of ultrasound was 92.68% and 20% of the correction of re ux at the last follow up. Positive Predictive Value of bladder ultrasound was 94 % and accuracy was 87.7 % at the last follow up. Ultrasound did not detect the mount in 20 ureters (9 %) and 8 of these ureters (3.6%) had persistence of their re ux. Ultrasound was able to detect bilateral mounts as well as unilateral mounts.CONCLUSION: Bladder-US was highly sensitive for detection of De ux implants and can predict resolution of re ux in 82.7% of re uxing ureters. Postoperative bladder-US could be adjusted as a screening tool in the follow-up of patients with primary low-grade VUR patients treated by De ux injection, while VCUG could be preserved for follow-up of high-grade VUR patients.