A Primary Epithelioid Angiosarcoma Arising in a Bilharzial Urinary Bladder: A Reappraisal and Case Report.

BACKGROUND: Angiosarcoma (AS) of the urinary bladder is a very rare and aggressive malignancy with a dismal outcome. CASE REPORT: Here, we report a primary epithelioid angiosarcoma (EAS) of the urinary bladder in a forty-nine-year-old male patient who presented with severe hematuria. Cystoscopic examination revealed hemorrhagic ulcerated bladder mucosa but no definite mass lesions. Intractable hematuria raised the initial clinical impression of idiopathic hemorrhagic cystitis. Analysis of the cystoscopic biopsy revealed features of old bilharzial cystitis, markedly atypical epithelioid endothelial cells arranged as primitive anastomosing vascular structures and expressing vascular markers. The diagnosis of EAS was established. The patient developed intractable severe hematuria, and a radical cystoprostatectomy was performed. The patient was started on chemotherapy but suddenly developed widespread distant metastasis (liver, lung, suprarenal glands, and lymph nodes) and succumbed to death two months after the surgery. CONCLUSION: To the best of these authors' knowledge, we presented the first report of primary EAS arising in a bilharzial bladder. The relevant studies were discussed.

Erectile and voiding function outcomes after buccal mucosa graft urethroplasty for long-segment bulbar urethral stricture: ventral versus dorsal onlay technique.

PURPOSE: To compare the impact of dorsal versus ventral onlay buccal mucosa graft bulbar urethroplasty on postoperative erectile function status. MATERIALS AND METHODS: We retrospectively reviewed the records for 232 patients who underwent dorsal and ventral onlay buccal mucosa graft bulbar urethroplasty from March 2012 to April 2021. Outcomes were urinary and erectile function status as assessed by IIEF5-15 score at preoperative, three months, and 12 months post-urethroplasty. We compared the dorsal and ventral only techniques at the different follow-up visits using difference-in-differences analysis. RESULTS: 165 patients met our inclusion criteria; the overall success rate was 87.9% after a mean follow-up of 52.3 ± 18.5 months. Of the patients, 17.6% experienced a 90-day complication. When comparing dorsal and ventral only techniques, there were no significant differences in terms of success rate (88.3% vs. 87.1%, Mantel-Cox test p = 0.68) or postoperative complications (15.5% Vs. 19.4%, p = 0.3). Likewise, there was no significant difference between both techniques regarding postoperative erectile function as assessed by IIEF5-15 score after three months (26.28 ± 2.53 Vs. 26.37 ± 2.41; p = 0.836) and twelve months (26.88 ± 2.45 Vs. 26.48 ± 1.98; p = 0.532). We detected a post-urethroplasty transient ED in (3.9% vs. 1.6%; p = 0.41), and permanent ED in (1.9% vs. 3.2%; p = 0.6) for dorsal and ventral onlay, respectively. CONCLUSIONS: Onlay Buccal mucosa graft urethroplasty is a highly effective surgery in treating long-segment bulbar urethral stricture. The dorsal and ventral only techniques were comparable regarding urinary and erectile function outcomes. Additionally, both techniques have no significant negative impact on post-urethroplasty erectile function status.

Factors predicting successful sperm retrieval in men with nonobstructive Azoospermia: A single center perspective.

Predicting successful sperm retrieval is essential in counseling infertile men with Azoospermia. Objectives: To assess the predictors of successful sperm extraction in men with nonobstructive Azoospermia. Patients and Methods: A retrospective study included all patients with nonobstructive Azoospermia from January 2018 to May 2019. Subdivided into two groups, group I (negative sperm retrieval) and group II (positive sperm retrieval). Results: A total of 108 patients with a mean age of 36.8 ± 10 years were included. The rate of successful sperm retrieval was 47.2%. Group I included 57 patients (52.8%) with a mean age of 33.98 ± 6.18, and group II included 51 patients (47.2%) with a mean age of 40.04 ± 12.22 (p = 0.008). Follicular stimulating hormone (FSH) levels were significantly higher in group I (18.55 ± 13 vs. 7.97 ± 7.11; p < 0.004). Similarly, in group I, luteinizing hormone was significantly higher (11.4 ± 7.45 vs. 5.9 ± 4.4; p < 0.001). Age and FSH were the independent predictors of successful micro-TESE. Additionally, successful pregnancies were 13.7% of patients, 28.6% of which gave rise to living birth. Conclusion: Patients' age and serum FSH are independent predictors of successful sperm retrieval for infertile men with nonobstructive Azoospermia; young patients with high FSH levels could have little chance of sperm retrieval.