Recurrent testicular torsion after previous orchiopexy is rare and needs high index of suspension to avoid misdiagnosis and delayed management. This case showed that this diagnosis can occur even when the testis is still fixed to the scrotal wall. A 31-year-old male who had previous testicular fixation for testicular torsion with a single stitch to the lower pole before 6 years presented with recurrent testicular torsion and missed diagnosis. This case confirm that recurrent testicular torsion after previous fixation should be included in the differential diagnosis of acute scrotum and emphasis on the testicular fixation with nonabsorbable suture in at least two points to prevent recurrent torsion.

Patient: Male, 60Final Diagnosis: Renal fungal ballSymptoms: FeverMedication: —Clinical Procedure: Fluconazole instillation through nephrostomy tubeSpecialty: UrologyObjective:Unusual setting of medical careBackground:Urinary tract candida infection can be due either to hematogenous dissemination of the organism or a retrograde infection. In debilitated or immunosuppressed septic patients, who have upper urinary tract obstruction with renal filling defect, fungal infection should be considered.We report on a patient with sepsis and renal fungal ball who was treated with percutaneous nephrostomy and intravenous antifungal agent, but the patient did not respond so instillation of fluconazole through nephrostomy was given.Case Report:A 60-year-old male patient with a known case of diabetes mellitus with refractory urine retention underwent transurethral resection of the prostate. Postoperatively, the patient developed recurrent high-grade fever with left loin pain, and elevated septic parameters; urine and blood culture were positive for Candida albicans. Computed tomography urography showed left hydronephrosis with filling defect in the left renal pelvis with suspected renal fungal ball. Left percutaneous nephrostomy was performed and intravenous fluconazole started but the fever did not subside, therefore, the treatment was changed to anidulafungin. The patient improved but urine from both the bladder and the nephrostomy remained positive for candida. Instillation of fluconazole at 300 mg in 500 mL normal saline was applied through the nephrostomy tube over 12 hours at 40 mL/hour for 7 days.Conclusions:Renal fungal ball is rare but can be serious, especially in immunocompromised patients. Management options for renal fungal ball include intravenous antifungal agents and percutaneous nephrostomy with antifungal instillation of antifungal agents. The objective of this case report was to document treatment success with the use of fluconazole instillation through a nephrostomy tube.

Penile fracture is not uncommon blunt trauma to the penis. Here, we present a rare case of penile fracture during sexual intercourse. The patient presented with penile swelling, bleeding per urethra, and inability to pass urine. Retrograde urethrogram showed significant extravasation of contrast from anterior penile urethra and no contrast passing to proximal urethra. Surgical exploration showed complete urethral rupture and bilateral cavernosal rupture. This case represents the value of urethrogram to evaluate the urethral injury and the association of complete urethral injury with bilateral ventral cavernosal injury.

The technological advancements of flexible ureteroscopy (FURS) and its accessories have resulted in broadening its indications to include the management of complex renal stones, with long operative time. The surgeon’s understanding about the ergonomics of the ureteroscopes and their cognizance of the operation theatre layout helps to improve their performance, including the surgical outcomes. This paper will describe the ergonomics that are involved in conducting FURS which in turn will aid in developing a more conducive surgical environment for the surgeon during the procedure, based on scientific literature review and expert opinions in high-volume centres. Proper surgeon position, well-arranged operation theatre layout, monitor and pedal position, anaesthesia type, and surgical team are important factors to decrease musculoskeletal strains for surgeons and increase work efficiency. Different types of flexible ureteroscope have different characters and knowing these special characters leads to better ergonomics during surgery. Robotic-assisted FURS have shown good safety and ergonomics in clinical application.

Purpose: The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD). The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities. Methods: We retrieved the records of all patients ( n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence. Results: A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases. The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample. Conclusion: Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.