OBJECTIVE To review our 15‐year experience with ureteroscopic treatment of distal ureteric calculi and to determine the impact of improved technology and techniques on the efficacy, success and complications of the procedure. PATIENTS AND METHODS We retrospectively reviewed the medical records of 4512 patients who underwent 5133 ureteroscopic procedures for the treatment of distal ureteric calculi at our institution from January 1991 to December 2005. The patient and stone characteristics, treatment variables and clinical outcomes were assessed. Factors such as type of ureteroscope, procedure duration, procedure success, complication rate and hospital stay were evaluated. Data obtained from a cohort of patients that underwent the procedure from 1991 to 1995 (group 1) were statistical compared with those obtained from a cohort of patients from 1996 to 2005 (group 2). Logistic regression analysis was used to identify associated factors with the major complications of ureteroscopy. RESULTS Overall, the stone‐free rate after the procedure was 94.6%, the mean (sd; range) operative duration was 43 (15.0; 25–120) min, the intraoperative complication rate was 6.67%, the postoperative complication rate was 9.9%, and the mean (sd) hospital stay was 1.7 (1.1) days. The clinical and radiological follow‐up (mean 36.8 months) for 71.3% of eligible patients detected only 12 ureteric strictures (0.23%). On comparing group 1 with group 2, the overall success of ureteroscopic stone extraction improved from 85.7% to 97.3% (P < 0.001), significant ureteric perforation decreased from 3.3% to 0.5% (P = 0.05), ureteric avulsion decreased from 1.3 to 0.1% (P < 0.05), ureteric stricture decreased from 0.7% to 0.1% (P < 0.007), the mean (sd) procedure time significantly decreased from 75 (42.9) min to 36.5 (12.5) min (P < 0.001), and the mean hospital stay significantly decreased from 2.5 (1.6) days to 0.5 (1.2) days, with a trend toward outpatient treatment. Logistic regression analysis showed a significant association of the major ureteroscopic complications with increased operative duration, type of ureteroscope used, stone impaction, stone size and surgeon experience. CONCLUSION The present series shows the high success rate, with minor complications, that can be achieved with ureteroscopic treatment of distal ureteric calculi. Improvements in ureteroscope design, accessories, technique and experience have led to a significant increase in the success rate and decrease in the complication rate.

Attribute reduction is the process of removing a subset of attributes from the dataset. One of the most famous tools used for solving the attribute reduction problem is rough set theory. The current attribute reduction methods in rough set theory are failed for finding the optimal reduction because of no perfect heuristic can ensure optimality. In this paper, we consider a novel rough set approach to attribute reduction based on heuristic genetic algorithm. The proposed method, called accelerated genetic algorithm attribute reduction (AGAAR). The proposed method uses new suitable crossover and mutation operators that fit the considered problem. Moreover, an acceleration technique is also invoked in order to accelerate the search process for the optimal reduction. The experiment is archived to AGAAR through 13 well-known datasets from UCI machine learning repository. The experiment proves that the algorithm is more effective, it has improved the global search ability to avoid falling into local optimum, and it can get relative minimum attribute reduction.

Aims: To evaluate the results of staged surgical repair of proximal forms of hypospadias according to Bracka’s method using preputial or buccal grafts in the department of urology, Tanta university hospital between January 2019 and January 2022. Study Design: Prospective comparative randomized study. Place and Duration of Study: Urology department, Tanta university hospital, between January 2019 and January 2022. Methodology: Fifty male patients with severe proximal hypospadias associated with moderate to severe chordee and or poor urethral plate underwent two-stage repair with buccal mucosal or preputial graft in the department of urology, Tanta university hospital between January 2019, and January 2022 cosmetic and functional outcomes were assessed. Results: Native meatus was at proximal penile in 1, penoscrotal in 13, scrotal in 19, and perineal in 17 cases.  25 patients underwent staged hypospadias repair using preputial graft in the 1st stage and 25 patients underwent staged hypospadias repair using buccal mucosal graft. The mean age of the patients at the 1st stage was 9.5 and 8.7 months in the preputial and buccal mucosal groups respectively. The graft take was successful except only in 5 patients needed graft redo after the 1st stage. Success rate was 54.5% with preputial group and was 62% in buccal mucosal group. Conclusions: Two-stage repair with Bracka’s technique is safe and feasible for repair of primary cases of sever proximal hypospadias. Both preputial and buccal mucosal grafts are reliable and suitable urethral substitutes in staged hypospadias repair with comparable results and complications rate.

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