Management of Fournier's gangrene in a newborn: A rare case report and literature review.

INTRODUCTION: Fournier's gangrene (FG) in neonates is less common than in adults, but this case can lead to a poor prognosis. FG is a disease of the genital, perianal, and perineal areas characterized by necrotizing infections. Here, we report a case of a 24-day-old male infant diagnosed with Fournier's gangrene involving the scrotum. CASE PRESENTATION: The patient presented with scrotal swelling, fever, erythema, and insect bites on the penile tip that had gradually extended to the proximal area and bilateral scrotum. On physical examination, indurated grayish and blackish-brown scrotal skin with sharp distinction from the surrounding normal skin, erythema, purulence, ulceration, and necrotic tissue were observed. Abdominal X-ray and scrotal ultrasonography revealed gaseous distension of the scrotal region, free fluid on bilateral testes, and enlargement of bilateral testicles. Immediate surgical debridement, along with broad-spectrum antibiotics, was initiated, and a microbiological culture identified the presence of Pseudomonas aeruginosa. The patient demonstrated the completed healing of the surgical wound after thirty days of surgical intervention. DISCUSSION: Fournier's gangrene in neonates is a sporadic case. Our patient presented with multiple predisposing factors, including insect bites and poor hygiene, underscoring the need for heightened clinical suspicion in vulnerable populations. Prompt recognition and intervention are critical, given the rapid progression of FG. CONCLUSION: This case underscores the importance of timely diagnosis and early initiation of surgical and medical interventions in neonatal Fournier's gangrene, particularly in cases involving the scrotum.

Giant paratesticular liposarcoma: A rare case report and literature review.

INTRODUCTION: Paratesticular liposarcoma is a rare variant of genitourinary malignancy. This malignancy accounts for less than 12 % of all liposarcomas. Approximately 200 cases of paratesticular liposarcoma have been reported. Giant paratesticular liposarcoma sizing over 10 cm is rarer, with only a few reported cases. Due to the rarity of this disease, there are no standardized guidelines regarding its incidence, diagnostic, recurrence, and treatment. CASE PRESENTATION: A 73-year-old male came to the hospital with a painless left scrotal mass three years ago. The patient had an ultrasound examination of the left scrotal, which proved a solid mass and hypervascular on the left testicular. Abdominopelvic computed tomography (CT) showed a solid-cyst masses, size ±16,6 × 9,6 × 18,2 cm, lobulated, contrast enhancement with no sign of metastatic disease. The patient had radical orchiectomy without any complications. Histopathological and immunohistochemistry examination (Vimentin, MDM2, dan CDK4) showed well-differentiated liposarcoma. CLINICAL DISCUSSION: Radical orchiectomy is the best curative therapy. Adjuvant chemotherapy and radiotherapy benefit is still inconclusive. The patient had followed up for two years after surgery found no recurrent mass and metastatic. The well-differentiated type has a better prognosis but has a high incidence of local recurrence if incompletely excised. The result showed that this approach produces excellent outcomes without any relapse. CONCLUSION: Giant Paratesticular Liposarcoma is a rare condition that can be managed by radical. Long-term follow-up is importance to observe the relapse of this malignancy.

Endoscopic combined intrarenal surgery for successful removal of an encrusted ureteral stent and multiple renal stones in solitary kidney: A case report.

INTRODUCTION AND IMPORTANCE: Several endoscopic procedures have been performed to clear stones in the kidney. A potential technique called endoscopic combined intrarenal surgery (ECIRS) is a practical option for treating complex kidney stones. Hereby, we report a neglected double j (DJ) stent and recurrent multiple kidney stones treated by ECIRS. CASE PRESENTATION: A 56-year-old female complained of right flank pain one week ago, which worsened within one day before hospital admission. She underwent DJ stent insertion one year ago because of residual stones after right percutaneous nephrolitothomy (PCNL) but was lost to follow-up. There was a history of left nephrectomy, leaving the patient with only a right kidney. A x-ray kidney ureter bladder (KUB) evaluation showed multiple irregular radiopaque shadows. A computed tomography (CT) scan detected numerous stones in the right kidney. The patient underwent ECIRS to remove the DJ stent and clear multiple stones in the right kidney. Following the surgery, the patient was discharged from the hospital on the fourth postoperative day with no complications and residual stone. CLINICAL DISCUSSIONS: ECIRS is a technique that combines a simultaneous antero-retrograde approach to the kidney and aims to resolve nephrolithiasis in one step and with one access. The ECIRS procedure could be considered in cases of complex multiple stone nephrolithiasis. ECIRS could widen the operative vision, thus helping to clear difficult kidney stones. CONCLUSIONS: The ECIRS technique could provide successful and safe management of recurrent multiple kidney stones and encrusted, neglected DJ stents in a solitary kidney patient.

A Thorough Analysis of The Effects and Complications of Two Different Suturing Techniques in Hypospadias Repair Using Tubularized-Incised Plate Urethroplasty: a Meta-Analysis.

Background: Hypospadias is a male congenital anomaly that requires urethroplasty via the tubularized-incised plate (TIP) technique. This technique is simple, and the results are promising, although it has few postoperative complications, including the associated suture technique. Objective: Comparing the continuous and interrupted suturing techniques on the TIP procedure for hypospadias repair. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors thoroughly searched electronic databases of PubMed, Scopus, ScienceDirect, and Web of Science. The compared endpoints were the total complication, wound infection, meatal stenosis, glans dehiscence, and urethral stricture presented as risk ratio (RR), with mean operating time as mean difference (MD), in 95% confidence intervals (CIs). All statistical analyses were performed using Revman 5.4. Results: Ten eligible studies were included, totalling 1,894 patients. Pooled RR showed no significant difference in overall complication, surgical site infection, meatal stenosis, glans dehiscence, and urethral stricture between continuous and interrupted sutures. In subgroup analysis, the interrupted suture had fewer complications when using polyglactin material (RR: 1.51, 95% CI 1.07 to 2.14; p = 0.02). The continuous suture showed lesser mean operative time than the interrupted suture (MD: -6 .67, 95% CI -12.52 to -0.82; p = 0.03). Discussion and Conclusion: No significant complication difference existed between continuous and interrupted suturing techniques. Fewer complications were obtained when using interrupted sutures with polyglactin material. However, continuous suture required less mean operative time.

The use of antibiotic prophylaxis in patients undergoing urologic procedures in an academic hospital Surabaya: A retrospective study.

INTRODUCTION: Prophylactic antibiotics in urological procedures are essential to prevent postoperative infections. A different approach in selecting antibiotic prophylaxis according to the type of procedure is needed. METHODOLOGY: A retrospective study was carried out at an academic hospital in Surabaya, Indonesia, by collecting medical records of patients who underwent urologic procedures within 2019- 2020, including microbiological data. RESULT: One hundred seventy-nine urological procedures were assessed. Antibiotic prophylaxis was administered in the clean-contaminated and clean procedures (93.2% and 6.8%, respectively). Ceftriaxone was commonly used (69.3%), single-dose, one day before the surgery. Gram-negative bacteria were widely found in the urinary culture of patients (75.2%). E. coli, K. pneumoniae, and P. aeruginosa were dominating with low susceptibility to cephalosporins. ESBL-producing bacteria were E. coli (64%) and K. pneumoniae (89%). CONCLUSIONS: The 3rd generation cephalosporins (ceftriaxone) are mostly used in urological procedures despite the low susceptibility against this antibiotic in cultured E coli, P. aeruginosa, and K. pneumonia. The aminoglycosides have relatively good activity and have been suggested in several guidelines for urologic procedures, such as prostate and urinary tract stone procedures. It is crucial to consider the incision site, type of procedure, and bacterial profile in the hospital to propose antibiotic prophylaxis guidelines.