A randomized controlled trial study on effectiveness between tadalafil versus combination mirabegron and solifenacin on treatment of ureteral stent-related symptoms.

Introduction: ureteral stents have common complications like ureteral stent-related symptoms (SRSs). This study investigated the effectiveness of tadalafil compared to mirabegron and solifenacin combination therapy in patients with ureteral SRSs after double-J (DJ) stent insertion. Methods: this double-blind, randomized clinical trial used consecutive random sampling in participants with SRSs after double-J stent insertion. The study was conducted at four different hospitals in Makassar, Indonesia, from July to December 2020. Ureteral stent-related morbidity indices which analyzed include urinary symptoms, pain, general health, quality of work, and sex scores. All of the indices were measured by ureteral symptom score questionnaire for the first, second, third, and fourth weeks after drug consumption, either tadalafil 10 mg/day (group A, n=25) and a combination of mirabegron 25 mg/day and solifenacin 5 mg/day (group B, n=28). Results: before the treatment procedure, the groups were comparable in age, gender, body mass index, DJ stent procedures, type, and indication. In general, the score in all parameters declined over the follow-up time for both groups. Group A had a lower urinary symptom score than group B at week III and week IV (all p-value < 0.001). In addition, group A had a lower pain score, general condition, work activity, and other complaints than group B at week II, week III, and week IV (all p-value <0.001). The sexual activity score is comparable between the group, except in week I. Conclusion: according to our results, we suggest tadalafil to minimize stent-related urinary symptoms and improve general health in patients with double J stent.

Traumatic Kidney Injury: A 6-Year Retrospective Study in Childhood and Adolescence.

Background: Traumatic kidney injuries are the most common urinary tract injuries. Pediatric patients are more susceptible to renal injury from blunt trauma than adults because of anatomic factors. The aim of this publication was to provide a reference for traumatic kidney injury in the pediatric group based on the study in our center. Methods: A retrospective study was conducted from January 2014 to December 2019 to review medical records of children admitted with renal trauma. Relevant findings including demographics, mechanisms and grades of injury, clinical parameters, interventions, and outcomes were recorded. Results: Thirty-three pediatric patients were investigated. Males experienced traumatic kidney injury more often than the females with a ratio of 10:1. Most cases occurred during the adolescent (12-18) years (81.82%). Left-side kidney injury (63.64%) was more frequent than right side (36.36%). Most cases (96.97%) were caused by blunt trauma, mainly traffic accidents (81.82%). Most patients (90.91%) had stable hemodynamics. Grade IV kidney injury was the most frequently found injury (39.39%). The cause of renal function disturbance was based on the blood urea nitrogen/creatinine (BUN/Cr) ratio with 21.87% of patients suffering from intra-renal causes and 12.5% from pre-renal causes. No significant association between different grades and BUN/creatinine ratio was found. Isolated renal injuries were found in 54.54% of patients. Most patients were treated conservatively (87.88%), and survival was 96.97%. Conclusion: Non-operative management is safe and yields good outcomes in kidney trauma patients with stable hemodynamics. Renal trauma severity is not associated with the BUN/Cr ratio.

Torsion in a right undescended testis: A case report.

Testicular torsion in undescended testicles (UDTs) is a rare clinical combination. Symptoms can be ambiguous and misinterpreted as indications of other common conditions. Moreover, late identification of a UDT may significantly delay the diagnosis and lead to adverse outcomes. Here, we report a case of a 16-year-old boy with progressive pain in the right inguinal region and a history of right UDT. Intraoperatively, he was diagnosed with testicular torsion, and an orchiectomy was performed. This report also underscores the importance of an early UDT torsion diagnosis.

Encysted hydrocele of spermatic cord: A rare case report with review of literature.

INTRODUCTION: Funiculus hydrocele is an uncommon anomaly characterized by obstruction in the closure of the processus vaginalis. The two variations of funiculus hydrocele are the encysted variety that is not related to the peritoneal cavity and the funicular variety that is associated with the peritoneal cavity. We report the clinical investigation and management of a very rare case of encysted spermatic cord hydrocele in a 2-year-old boy. CASE PRESENTATION: A 2-year-old boy came to the hospital with the complaint of a lump in the scrotum for 1 year. The lump had exhibited growth and was not recurrent. The lump was painless, and the parent denied a history of testicular trauma. The vital signs were within normal limits. The left hemiscrotal was observed to be larger than the right. Palpation indicated an oval, soft, well-defined, and fluctuating impression, without tenderness, measuring 4 × 4 cm. The scrotal ultrasound showed a hypoechoic lesion measuring 2.8 × 2.4 × 4.5 cm. The patient underwent a scrotal-approach hydrocelectomy. The 1-month follow-up reported no recurrence. CLINICAL DISCUSSION: An encysted hydrocele is a non-communicating inguinal hydrocele, with a collection of fluid throughout the spermatic cord, which is separate and lies above the testes and epididymis. Diagnosis is clinically important, and if any uncertainty exists, scrotal ultrasound can be used to distinguish it from other scrotal lesions. The treatment for non-communicating inguinal hydrocele in this patient was surgery. CONCLUSION: Hydrocele is usually painless and rarely dangerous so it does not require immediate treatment. The treatment for hydrocele in this patient was surgery because it becomes larger.

A giant intra-abdominal right testicular seminoma in a bilateral undescended testicle: a case report.

Cryptorchidism is the most common congenital malformation of the male genitourinary tract. An undescended testicle has a 10% chance of developing cancer, with an intra-abdominal testicle having the highest risk. We present a 24-year-old man with a history of bilateral cryptorchidism, complaining of lower abdominal mass for two months. An abdominal computed tomography scan showed an intra-abdominal mass lesion measuring 13 x 9 cm and displacing the bladder caudally. Exploratory laparotomy revealed a right intra-abdominal testicular tumor. A right orchiectomy and left orchidopexy was performed. Histopathological examination revealed a testicular seminoma. The patient was discharged without complications and was referred to the oncology department for chemotherapy and further management. Our findings support the early treatment and close monitoring of cases of cryptorchidism due to the risk of malignancy as well as the necessity of routine scrotal examinations in all males presenting with an abdominal mass.

Ureteral avulsion caused by through and through penetrating injury of the pelvis.

Ureteral avulsion is one of the rare cases in urology considering that this structure is well-protected in retroperitoneal location. However, the presence of penetrating pelvis injury should raise high clinical suspicion that ureteral avulsion may present in this case. We report the case of ureteral avulsion in patients caused by through and through penetrating injury of the pelvis. We managed ureteral avulsion by performing end-to-end anastomosis along with ureteral stenting. A multidisciplinary approach was performed to treat other structural damages. Finally, after two months, ureteral stent was removed and ileal-re-anastomosis was performed.

Malignant renal hemangiopericytoma: a case report.

Malignant hemangiopericytoma (HPC) is an uncommon disease first described by Stout and Murray in 1942. Patients with suspected renal HPC on admission sometimes complain of low back pain, hematuria, or hypertension. A combination of histochemical and anatomo-pathologic examinations is necessary to confirm the diagnosis of renal HPC. We report the case of a 41-year-old female patient who had persistent painful nodular lesion at the right lower back and gross hematuria. Based on analyses of clinical symptoms and signs plus radiological a laboratory examination, she was diagnosed with renal cell carcinoma of the right kidney. She subsequently underwent open right radical nephrectomy via transperitoneal approach. The patient was discharged from hospital in good condition on Day 5 of care after surgical intervention. Malignant HPC of the kidney is an uncommon disease that can be diagnosed based on multislice computerized tomography angiography plus histopathological examination using the periodic acid shift method. Management of malignant renal HPC requires radical nephrectomy followed by chemotherapy. This case study provides important preliminary data for further studies of patients with renal HPC in Indonesia.

Priapism due to chronic myelocytic leukemia.

Priapism is defined as a whole or partial penile erection that persists for more than 4 hours without stimulation. Hematologic disorders are a significant risk factor for ischemic priapism. Here, we report a case of priapism due to chronic myelocytic leukemia. This is rare considering that the epidemiology of priapism in hematologic malignancies includes only 1% of patients with chronic myelocytic leukemia. Priapism has a relatively high complication rate, and management generally focuses on prompt treatment. Hematologic screening should be performed to rule out the possibility of these disorders that could underlie priapism.

Neglected double-J stent with giant bladder stone: a case report.

Double-J (DJ) stents have been widely utilized in urological practice. They are commonly used to relieve ureteral obstruction. Serious complications may occur when stents are left in place for long periods of time. In the present paper, we report a patient with a neglected DJ stent that had been inserted for five years after uterus-tumor surgery and led to a bladder stone. We report a case of a female who presented a bladder stone with a right DJ stent in the pelvic cavity. The stone was evident in radiological examination in an incidental finding. The treatment was transurethral cystolithotripsy. This case reminds us of the necessity of providing enough information and appropriate knowledge pertaining to the insertion of a ureteral stent. Transurethral cystolithotripsy is one of the treatment methods and can be suggested as a definitive method in consideration that it is a clinically effective and safe intervention.

Penile Ischemia as a Complication of Epinephrine Use in Penile Nerve Block: Truth or Myth?

The administration of a local anesthetic agent with epinephrine is controversial in penile surgery because of necrosis risk resulting from prolonged vasoconstriction of terminal vessels. We reported a case of an 8-year-old boy suffering from ischemia in the glans of the penis and epidermolysis of the penile skin after circumcision with penile nerve block using anesthetic agents containing epinephrine. The addition of epinephrine to the anesthetic agent (lidocaine) in penile nerve block before circumcision remains controversial. It remains controversial because multiple factors can cause skin necrosis after the circumcision. The adverse effect of epinephrine use in circumcision remains unproven because of a lack of scientific evidence. The administration of epinephrine in penile surgery is the decision of the physician.

Penetrating scrotal injury in childhood.

An 11-year-old boy was referred to the emergency room (ER) because of a stab wound on the scrotum due to a tree trunk. The external genitalia computed tomography (CT) scan revealed a 5-cm long stick that was stuck in his left hemiscrotum; however, the testis was normal. Scrotal exploration and debridement of non-viable tissue was performed, and no testicular or surrounding structure injury was found. At the postoperative evaluation 1 month later, the surgical wound and the patient's general condition were satisfactory.

Primary anastomosis for complete bulbar urethral rupture with rectal laceration caused by straddle injury: A case report.

INTRODUCTION: The initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture's location and length as well as the accompanying trauma. CASE PRESENTATION: A 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. There was a laceration to the perineum 3 cm long to the rectum, with no active bleeding. After the incident, the patient could not void, but the lower abdomen was not painful. Upon retrograde urethrography examination, contrast extravasation of the bulbous urethra was seen through the anorectal laceration. Immediate debridement and repair for the anorectal wound, then primary anastomosis for the bulbous urethra, was performed. DISCUSSION: The likelihood of an injury to the anterior urethra increases with certain clinical features, including blood in the urethral meatus, palpable bladder distention, and a butterfly appearance on the perineum. Immediate exploration and reconstruction of the urethra is recommended in urethral traumas associated with penile fractures and non-life-threatening penetrating injuries. Furthermore, small lacerations are repaired primarily, while total ruptures are treated with anastomosis. CONCLUSION: Proper identification and management of urethral rupture determines the outcome. Initial urethral trauma management is disputed; however, a bulbous urethra rupture with anorectal lacerations can be treated safely and effectively with primary anastomosis.

Partial penile amputation due to Klingsor syndrome: A case report with a successful macroscopic reconstruction.

INTRODUCTION: Traumatic penile amputation is a highly uncommon surgical emergency that requires immediate intervention. Most reported cases involve genital self-mutilation induced by underlying psychiatric disorder, especially schizophrenia. The self-mutilation of external genitals in psychiatric patients, also known as Klingsor syndrome, is a rare form of urotrauma. PRESENTATION OF CASE: We present a case of partial penile amputation in a 46-year-old male with Klingsor syndrome admitted to the hospital 3 days after the incident. Urological examination revealed a subtotal cut of the penis, including the distal part of the mons pubis, dorsal and lateral parts of the penile skin, corpus cavernosum, and corpus spongiosum, as well as a partial bulbous urethra rupture. The penis remained suspended by only a thin ventral part of the penile skin. After macroscopic surgical replantation, the patient recovered well and could urinate without any symptoms of urethral stricture. The entire penis remained viable with minimal scarring at the surgical site, and penile erection could be achieved and maintained. CONCLUSION: The case demonstrates a rare instance of the successful proximal penile shaft amputation via macrosurgical techniques by an experienced urologic surgeon.

Bladder stones associated with vesicovaginal fistula: A case report.

INTRODUCTION: The presentation of bladder stones is the most common manifestation of a lower urinary tract stone. In severe cases, it can cause pressure necrosis and lead to vesico-vaginal fistula (VVF). This case reports a female patient diagnosed with a bladder stone accompanied by VVF. PRESENTATION OF CASE: A 56-year-old female came to the hospital with complaints of dysuria accompanied by continual urinary incontinence symptoms dating back about a month. During vaginal examination, we found a fistula and a stone. An ultrasound (US) showed a hyperechoic shadow measuring 1.27 × 1.36 cm in the vesica urinary and plain kidney, ureter, and bladder (KUB) x-ray showed the presence of a radiopaque shadow of about 7.5 × 5 cm in the pelvic area. This stone was removed through an open cystolithotomy. Intraoperatively, a fistula of about 1 cm in diameter was found in the trigonum close to the internal meatus. A fistula repair was performed immediately without complications, and the follow-up results were satisfactory. CONCLUSION: The presentation of a bladder stone is an uncommon condition that can cause VVF. Therefore, it is important to pay attention to its clinical signs.

Risk factors for urethrocutaneous fistula following hypospadias repair surgery in Indonesia.

INTRODUCTION: Hypospadias is one of the most common congenital malformations with a worldwide increasing trend over the years. Despite advancements in hypospadias repair, complications still occur. One of the most common complications of hypospadias repair surgery is Urethrocutaneous fistula. Studies attempting to analyze the association between the complication and risk factors are always beneficial, especially for studies performed in different areas of the world. We hypothesize that several evaluated risk factors among Indonesian hypospadias patients could be associated with the occurrence of urethrocutaneous fistula after the repair procedure. OBJECTIVE: To determine the risk factors associated with urethrocutaneous fistula after hypospadias repair surgery by collecting and analyzing data obtained from multiple centers in Indonesia. MATERIALS AND METHODS: A nationwide, retrospective study with 12 hospitals in Indonesia of children with a diagnosis of hypospadias was conducted. The collected data, taken from patients admitted in 2018, from each center's medical records consisted of patient identity, repair technique used, neourethra length, percutaneous cystostomy, and splint size as independent variables speculated to be possible risk factors correlated to the presence of urethrocutaneous fistulae. Binomial logistic regression analysis was performed using SPSS 21.0 to determine the relationship between urethrocutaneous fistulae as a post-repair complication and possible risk factors. RESULTS: We collected 591 hypospadias cases from 12 centers in 9 cities in Indonesia. Most patients came when they were already at the age of more than four years old (60.4%). The chordee-only and failed urethroplasty groups are excluded from the analysis as they are not classified as true hypospadias. Most repairs were performed by using the Tubular Incised Plate (TIP) with Thiersch-Duplay technique (44.16%). Most of the reconstructed neourethra are 2-3 cm in length (32.13%). The 8 Fr urethral splint (46.41%) was mostly used during the operation. Most surgeons decided not to perform cystostomy throughout the procedure (61.03%) based on personal preferences. Urethrocutaneous fistula was found in 80 patients (15.27%) out of the total patients who underwent the surgery. The binomial logistic regression analysis shows that age (OR = 1.398, p = 0.015), the decision to not perform cystostomy (OR = 2.963, p = 0.014), and splint size (OR = 1.243, p = 0.023) are significantly associated (p < 0.05) with the development of urethrocutaneous fistula. CONCLUSION: Age and splint size are significant risk factors for urethrocutaneous fistula after hypospadias repair in Indonesia, whereas performing percutaneous cystostomy during the repair decreases the risk for urethrocutaneous fistula occurrence.

Multiple preputial stones: A case report and literature review.

INTRODUCTION: Preputial stones are a very rare form of urinary tract stone, and only small number cases have been reported in the literature, and tend to occur in uncircumcised males with poor genital hygiene, low socioeconomic status, and phimosis. PRESENTATION OF CASE: Here, we report a case in a male who presented with more than 100 preputial stones. The stones were evident on clinical examination by palpation on the preputial. The patient was treated by dorsal slit circumcision. DISCUSSION: Preputial stones can occur at any age but are far more common in adult males. All cases of preputial stone are associated with severe phimosis in uncircumcised males. The symptoms and signs are due to phimosis, like in these patients, which causes urinary stasis beneath the foreskin. The stone is often palpable on examination of the prepuce, and a plain radiograph can confirm this. Neglected preputial stones can cause serious morbidities. Treatment involves the removal of stone and elimination of the predisposing cause. CONCLUSIONS: This case reminds us of the necessity of circumcision for adult uncircumcised males.

Giant bladder stone formed around sewing-needle in childhood: A case report and literature review.

We present cases of sewing needle as a nidus of the bladder stone in a seven-year-old girl admitted to the hospital with chief complaining burning micturition for 6 months. The Kidney, Ureter, and Bladder (KUB) X-ray revealed the bladder stone was 3.5 cm in length at the pelvic cavity and sewing needle in its center. The bladder stone was removed by open cystolithotomy without any complications.

Common Practice of Hypospadias Management by Pediatric Urologists in Indonesia: A Multi-center Descriptive Study from Referral Hospitals.

BACKGROUND: Hypospadias is the second most common congenital anomalies among human congenital disabilities. There are over 300 surgery techniques being introduced to treat hypospadias. The successful of hypospadias repair is assessed by several outcomes as well as complications following surgery. AIM: This study aims to show the multicenter hypospadias data in Indonesia descriptively. METHODS: All the data were compiled based on questionnaires, which were distributed to Indonesian pediatric urologists. The questionnaire includes several questions containing demographic aspect, preferred techniques being used, and complications being found regarding hypospadias repair. RESULTS: Eighteen Indonesian pediatric urologists from 12 centres involved in this study. The data were collected from June - September 2018 based on the surgeon's experience throughout 2017. From 591 cases based on the returned questionnaire, penile-type hypospadias was the most common type of hypospadias being treated (35.7%) followed by penoscrotal (28.9%) and scrotal-type (12.9%). Moderate severity of chordee was mostly seen among all cases (40.6%). Tubularised incised plate (TIP), + Thiersch Duplay, was the most common technique being used to treat hypospadias (44.3%), followed by onlay island preputial flap (14.9%) and two-stage technique (14%). The incidence of urethrocutaneous fistulae in this study was 13.9%. CONCLUSION: This study showed how Indonesian pediatric urologists dealt with hypospadias cases. TIP + Thiersch Duplay procedure being the preferred technique used by most participants and the rate of urethrocutaneous fistulae as one of the complications was comparable with previous studies.