Background: Circumcision is a commonly practiced surgical procedure particularly in Islamic countries. As any other surgical procedure, it is attended by some complications of either early (e.g., bleeding) or late (e.g., meatal stenosis [MS]). Objectives: This study was designed to study the different clinical pictures, age at presentation, and management and outcome of postcircumcision MS. Patients and Methods: This is a retrospective study involving 86 children diagnosed with symptomatic MS and underwent meatotomy during the period from January 2010 to December 2018 at Hawari Center for Urology and Otolaryngology, Benghazi. The medical records of the patients reviewed included age at presentation, different clinical pictures, management, and outcomes. All patients were circumcised during the neonatal or infancy period. Results: Patients' age ranged between 3 and 13 years with a mean age of 5.14 years. More than three-quarters of the patients (84.8%) were between 3 and 8 years of age. Forty-six patients (53.4%) presented with pain (burning) during micturition; 17 patients (19.7%) with thin casting stream; 13 patients (15.11%) with thin dorsally deviated stream; five patients (5.8%) with sudden urge to micturiate; 3 (3.40%) patients with frequency of micturition; and only two patients (2.3%) with prolonged voiding time. All our patients operated by meatotomy as a day case procedure under general anesthesia, and there were no recurrences of MS symptoms in any case during the follow-up period. Conclusion: MS is a frequent late complication of neonatal circumcision; it should be excluded by careful meatal examination in any child who is circumcised particularly at the neonatal or nappy period and presented with abnormal micturition or even lower abdominal pain.

Background and Aim: Penile fracture is a relatively rare urological emergency. The aim of this study was to review the experience with 69 consecutive cases in Benghazi, Libya. Patients and Methods: Records of 69 penile fracture cases who presented between January 1997 and December 2018 to Hawari Center for Urology, Benghazi, Libya were retrospectively reviewed. Penile fracture diagnosis was based on classic history and typical physical signs. Surgical exploration was performed for all patients under spinal anesthesia. Results: The most common mechanism of penile fracture was self-inflicted forceful bending (manipulation) of erected penis which account for 39 (56.5%) patients, followed by vigorous sexual intercourse in 19 (27.5%) patients, masturbation in five (7.2%) patients, rolling over an erect penis in bed in five (7.2%) patients, and slipping in WC in one (1.5%) patient. Clinical features at presentation include intense pain in 97%, sudden audible popping sound in 87%, rapid de tumescence in 94.2%, followed by development of swelling and ecchymosis in all patients (100%). All patients were treated surgically and no intraoperative or immediate postoperative complications were encountered. During the follow-up period, all patients had normal urinary steam and normal sexual function was experienced by 97.1% of the patients. Five patients (7.2%) had long-term complications: penile hypoesthesia (one patient), painful erection (one patient), penile curvature of <15o on erection (one patient), and mild erectile dysfunction (two patients). Most patients were discharged home on postoperative day 1. Conclusion: Penile fracture occurred mainly due to forceful sexual manipulation of erected penis, and diagnosis can be made clinically. Immediate surgical repair is the only option to avoid complications.

No abstract

Background: Fournier's gangrene (FG) is a fulminant aggressive necrotizing fascitis affecting the external genitalia, perineum and anterior abdominal wall with significant mortality rate. The aim of the present study was to describe the associated risk factors, presentation, diagnosis, management and outcome of this condition in Benghazi, Libya. PATIENTS & METHODS: Over a period of twenty years (from January 1997 to October 2016) a series of 54 consecutive patients who were admitted to Urology Department, Hawari Center for Urology and Otolaryngology, Benghazi-Libya were evaluated retrospectively to assess the risk factors, etiology, management and outcome of this fatal disease. Results: It was found that 37 (68.5%) of patients were diabetics and 24 patients (44.4%) had perianal abscess as predisposing factor. Mortality rate was 14.8% (8 patients). All cases diagnosed on clinical basis. The patients operated promptly by extensive debridement. Reconstructive surgery done by flap or graft in plastic department to close the skin defect in most of our patients (41 patients, 75.9%). Conclusion: The main co-morbidity and predisposing factors of FG are diabetes mellitus and perianal abscess respectively. Prompt aggressive debridement is the only management to save the patient's life.

Vesical explosion during transurethral resection of the prostate (TURP) is an extremely rare, serious and dreadful complication, which should be considered as a blast injury requiring urgent exploratory laparotomy and repair. Until 2019, only 38 cases have been reported in the International English literature. The underlying mechanism for this rare intravesical explosion is the generation and trapping of explosive gases under the dome of the bladder, which eventually detonates by sparks from the cutting electrode during TURP. Herein, we report a case of a 67- years- old man where an explosion occurred during TURP, resulting in a large intraperitoneal rupture of the urinary bladder. After confirmation of the diagnosis clinically, endoscopic ally and radio logically the patient underwent a successful emergency laparotomy to repair the bladder tear. He had uneventful postoperative recovery and he is symptoms free at 6months and one year of follow-up. Although uncommon, vesical explosion during TURP may occur and some preventive measures, discussed here, can be carried out to avoid this dreadful complication. In addition to the discussion of its mechanism, we will discuss the preventive measures of this dreadful event. To the best of our knowledge, this is the first case of a Vesical explosion reported in our department.