A 27-year woman presented with irritative lower urinary tract symptoms and alleged small right distal ureteric stone that had been diagnosed with KUB and non-contrast spiral CT.Patient was scheduled for ureteroscopic lithotripsy, revealing absence of the presumed stone, while cystoscopy showed unexpected 2 cm pedunculated grayish white lesion, situated on the right lateral wall of the bladder with sparse hairs covering it.An incomplete TURBT was done; the histological findings correlated with the gross picture seen on cystoscopy.Following CT urography, the patient went an open partial cystectomy and right oophorectomy; the histopathology was consistent with mature bladder teratoma.

Objectives Penile prosthesis insertion is a well-established therapeutic option in refractory ischemic priapism but there is a lack of standardization regarding the timing of surgery, the type of prosthesis (malleable or inflatable), as well as the possible complications. In this study, we retrospectively compared early versus delayed penile prosthesis insertion in patients with refractory ischemic priapism. Methods 42 male patients who presented with refractory ischemic priapism during the period between January 2019 and January 2022 were included in this study. All patients had malleable penile prosthesis insertion by four highly experienced consultants. Patients were divided into two groups based on the time of the prosthesis insertion. 23 patients had immediate insertion of the prosthesis within the first week of the onset of priapism while the remaining 19 patients had delayed prosthesis insertion three months or later after the onset of priapism. The outcome as well as the intra- and the postoperative complications were recorded. Results Postoperative complications such as prosthesis erosion and infection were higher among the early insertion group while the delayed insertion group had higher incidence of intraoperative complications such as corporal perforation and urethral injury. The insertion of the prosthesis was much more difficult among the delayed insertion group due to fibrosis which made dilatation of the corpora very difficult. The length and the width of the penile implant were significantly higher among the early insertion group as compared to the delayed insertion group. Conclusions Early penile prosthesis insertion for refractory ischemic priapism is a safe and effective treatment option as delayed prosthesis insertion is more difficult and challenging due to corporal fibrosis and is associated with higher complication.

transurethral resection (TUR) and additional adjuvant instillation in intermediate risk non-muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence. Pirarubicin (THP), an anthracycline analogue, is widely used reagent for intravesical instillation chemotherapy. Several studies have showed that THP can rapidly penetrate tumor tissue after intravesical instillation. Therefore long instillation time (e.g. 120 min) may not be required for its prophylactic effect against recurrence since it may reduce the risk of adverse events such as cystitis and hematuria without compromising its efficacy. However, there is no high level evidence regarding optimized intravesical THP instillation time in terms of both toxicity and efficacy.METHODS: This randomized, prospective, open-label trial intended to enroll 160 pts with primary NMIBC with intermediate risk based on EORTC criteria. All pts received initial THP instillation within 24 hr after TUR and then intended to continue weekly repetitive THP instillation for a total of 9 treatments. Pts who seemed likely to be at intermediate risk were provisionally registered and then randomized into two groups with different intravesical THP retention times before TUR, (a) 30 min versus (b) 120 min. Follow-up period is 4 years. Primary endpoint is change from baseline in quality of life (e.g. OABSS and I-PSS), which will be evaluated prior to THP intravesical instillation. Secondary endpoint is recurrence-free survival.RESULTS: 126 pts were enrolled for provisional registration in this trial and randomized before TUR-B. After excluding pts due to the result of pathology by TUR-B such as benign disease, T1 G3 tumor and concomitance of CIS, 29 pts were assigned to group (a) (30 min), and 26 pts to group (b) (120 min). There is a trend that group (a) is less prone to increase in OABSS after 3rd instillation compared to group (b), which is not statistically significant. Log-rank test shows that there is no significant difference in recurrence-free survival between the groups during follow-up period (HR¼2.161, 95% C.I.: 0.4317-10.82, p¼0.3484).CONCLUSIONS: Shortening intravesical instillation period to 30 min has little effect on reducing the adverse effect of THP. However, it does not compromise the prophylactic effect on recurrence in intermediate risk NMIBC pts.

Background: Percutaneous nephrolithotomy (PCNL) is the first choice for treatment of large renal stone >2 cm. The prone position is the classical position preferred by most surgeons. Aiming to improve patient anesthesia and surgery-related inconveniences of the prone position, Valdivia et al ., 1987, described the performance of PCNL with the patient in the supine position. Hence, we aimed to study the safety and efficacy of flank-free modified supine position in PCNL compared to the standard prone position. Patients and Methods: This is a prospective randomized study for 60 patients with large renal stones planned for PCNL operation during the period from November 2017 to May 2019. Patients were divided into two groups (30 patients each group): Group A – patients underwent PCNL in the prone position and Group B – patients underwent PCNL in the modified flank supine position. Patients’ demographics, stone size, Hounsfield unit with intraoperative details as fluoroscopy time, operative time, and complications were recorded. Postoperatively, need for or not to blood transfusions, hospital stay, stone-free status, and postoperative complications were assessed. Results: There was no statistically significant difference between the prone and supine positions regarding stone size (4 cm vs. 4.5 cm, P = 0.16), Hounsfield unit (940 HU vs. 955 HU, P = 0.78), body mass index (31.2 kg/m 2 vs. 32.5 kg/m 2 , P = 0.49), fluoroscopy time (6.9 min vs. 7.3 min, P = 0.5), operative time (89.5 min vs. 90.4 min, P = 0.9), residual stones (10% vs. 20%, P = 0.8), and hospital stay (45.6 h vs. 48.6 h, P = 0.5). Fever occurred in 3.3% of cases in each group and urine leakage observed in one patient with prone position. No blood transfusion was needed in both the groups. Conclusions: PCNL in the modified supine position proved to be a safe and effective choice compared to the prone position for adult patients with large renal calculi.