Attitude and perception of urology by medical students at the end of their medical school: an appraisal from Saudi Arabia

To evaluate the attitude and perception of the graduates of King Saud University [KSU] College of Medicine regarding the quality of their urology rotation, urology exposure during this rotation, confidence about managing common conditions, and career prospects. In 2013, a questionnaire regarding the students' perceptions of urology rotation was developed and E-mailed to all final [5[th]] year medical students and interns of KSU College of Medicine, Riyadh, Saudi Arabia. Individual responses were recorded, tabulated and compared using descriptive statistics. The overall response rate was 67.7%. Respondents included 101 [49.8%] males and 102 [50.2%] females. All the respondents but 18 [8.9%] were enrolled in a urology rotation during undergraduate years. Only 27 [13.3%] were willing to choose urology specialty as a future career. Significant gender differences were found regarding choice of urology as a future career [P = 0.002] and the need for more urology exposure during surgical rotation [P = 0.002]. Knowledge of medical school graduates is insufficient in many urologic subjects, and there is a need for more urology exposure. Social reasons and lack of knowledge about urology hinder the choice of urology specialty as a future career. Clearance of learning objectives, immediate and prompt feedback on performance and adequate emphasis of common problems and ambulatory care are some aspects that should be taken into account by curriculum planners as they consider improvements to urology rotation program

Clinical, endocrinological and histopathological patterns of infertile Saudi men subjected to testicular biopsy: a retrospective study from a single center

To evaluate the outcome of testicular biopsies as well as the etiology of azoospermia and severe oligospermia in Saudi men referred for tertiary care. To correlate testicular histology with patients' clinical and hormonal profiles. Charts of men subjected to testicular biopsies in the last 10-year period were retrospectively reviewed. Relative history and physical examination findings were reported. Results of male fertility profile tests and semen analysis of at least two ejaculates were collected. Reported histopathology was obtained. Reports of 229 patients were included; 199 [86.9%] with azoospermia and 30 [13.1%] with severe oligospermia. The mean [SD] age was 30.6 [6.4] years. A small right or left testis was reported in 88 [38.4%] and 87 [38%] of the patients, respectively. The mean [SD] testosterone and follicle stimulating hormone [FSH] values were 17.2 [7.2] nmol/L and 13.1 [10.9] IU/L, respectively. Hypospermatogenesis was the most common histology encountered [36.5%], followed by Sertoli cell-only [SCO] histology [31.5%]. Low testicular volume [P = 0.000], high FSH [P = 0.001] and high leutenizing hormone [LH] [P = 0.001] were found to be of significantly adverse effect on spermatogenesis. Despite having bilateral small testes, high serum FSH and LH, 24.3% of our patients showed active spermatogenesis. Hypospermatogenesis was the most common pattern of spermatogenic defect in our patients. SCO histology was the most common pattern in patients with small testes, primary testicular failure, primary infertility and azoospermia. Low testicular volume, high FSH and LH are significantly associated with impaired spermatogenesis. Even with severe male factor infertility disorders, infertile men can have some spermatogenesis

Penile abscess and necrotizing fasciitis secondary to neglected false penile fracture

Penile infection and abscess formation have been described in association with priapism, cavernosography, intracavernosal injection therapy, trauma and penile prosthesis. We report a case of penile abscess and necrotizing fasciitis of penile skin in a 37-year-old male, presented 3 weeks after neglected false penile fracture

Large orthotopic reservoir stone burden: Role of open surgery

To present our experience in open poucholithotomy as a primary management of large orthotopic reservoir stone burden and discuss different management options. Records of men underwent radical cystectomy and orthotopic urinary diversion were retrospectively reviewed as regards pouch stone formation. Patients with large reservoir stone burden managed by open poucholithotomy were further selected. Large reservoir stone burden was encountered in 12 post radical cystectomy men. All underwent open poucholithotomy as a primary management of their reservoir stones. Median age at cystectomy was 46 [range: 32-55] years with a median total follow up period of 214.15 [range: 147-257] months and a median interval to stone detection of 99 [range: 63-132] months. The median stone burden was 5260 [range: 3179-20410] mm2. All patients were continent during the day while 5 showed nocturnal enuresis; 2 of them became continent after removal of the stones. Post poucholithotomy, all patients had sterile urine cultures except one who showed occasional colonization. None of the 12 patients showed stone recurrence after poucholithotomy. Two patients underwent revision of a dessuscepted nipple valve in association with stone removal. Open poucholithotomy for large reservoir stone burden is a feasible and safe option. It saves the reservoir mesentery and adjacent bowel. It allows complete removal of the stone[s] leaving no residual fragments. Furthermore, it permits correction of concomitant reservoir abnormalities

Trans-perineal VS. trans-rectal repair of rectocele in obstructed defecation: a prospective randomized trial

To evaluate functional outcome of transperineal [TP] versus transrectal [TR] repair of rectocele presented with obstructed defecation. 48 multiparous females with obstructed defecation due to rectocele were randomly allocated into 3 groups: Group A [16 patients]: TP repair with levatorplasty [LP].Group B [16]: TP repair without LP.Group C [16]: TR repair. The study included defecographic assessment, anal manometry / /[Maximum anal resting pressure [MARP], maximum reflex volume [MRV] and urge to defecate volume [UTDV] and functional score [0 -26]. These were done preoperative and 6 months postoperative. Defecography showed significant reduction in size of rectocele in all groups. Constipation improved significantly in the groups of transperineal but not in transrectal repair. We had significant reduction in MARP, UTDV and MRV only in transperineal approach. Functional score was significantly improved in group A [P<0.001] and B [P<0.001] while the improvement was insignificant in group C. LP significantly improved the overall functional score in group A compared to group B and C [P= 0.032] Rectocele repair improves anorectal function by improving the rectal urge sensitivity. TP repair of rectocele is superior to TR repair in both the structural and functional outcome. Levatorplasty improves functional outcome, but should be avoided in young sexually active females