Combined on-demand sildenafil citrate and tramadol hydrochloride is an effective and safe treatment for premature ejaculation: A randomized placebo-controlled double-blind clinical trial.

Background: Premature ejaculation (PE) is a common sexual dysfunction that harms both sex partners. Aim: To evaluate the safety, efficacy and impact on sexual satisfaction scores of the combined use of tramadol HCl and sildenafil citrate for the treatment of PE. Methods: One hundred and sixty otherwise healthy males complaining of PE (primary/secondary) were enrolled in this randomized, double-blind, placebo-controlled study. Only 155 patients (age range 22-48 years) completed the study. Of them, 81 patients had primary PE, and 74 had secondary PE. The comparative groups included the placebo group (n = 34), sildenafil citrate 50 mg group (n = 39), tramadol HCl 100 mg group (n = 40), and the combination therapy group (n = 42). The treatment duration for all groups was 10 weeks. Outcomes: This combination is safe and effective. Results: Five patients discontinued the study, all from the placebo group, due to a lack of improvement over the treatment course. No significant differences were reported between groups before treatment as regards Intravaginal ejaculatory Latency Time (p = 0.8), satisfaction score (p = 0.7), age (p = 0.9), or duration of marriage (p = 0.9). There was a significant improvement in IELT after treatment with a placebo (p = 0.0001), associated with an insignificant improvement in satisfaction score (p = 1.0). In the other three groups, there was a significant improvement in IELT after treatment (p = 0.0001 for all), which coincided with a significant improvement in satisfaction scores in all three groups (p = 0.0001 for all). Clinical Implications: We recommend this combination in the treatment of premature ejaculation. Strengths: It is a prospective randomized double-blind placebo-controlled clinical trial. Limitations: Limited number of participants. Conclusion: Combined therapy of PE, whether primary or secondary, with sildenafil citrate 50 mg and tramadol HCl 100 mg is safe and effective; and its therapeutic effect is superior to the utilization of either agent alone.

Effect of Heat Treatment on the Microstructure and Mechanical Properties of 18Ni-300 Maraging Steel Produced by Additive-Subtractive Hybrid Manufacturing.

The present work investigates the effectiveness of two heat treatment cycles-solution treatment + aging (STA) and direct aging (DA)-on optimizing the microstructure and enhancing the mechanical properties of 18Ni-300 maraging steel (300 MS) produced by additive-subtractive hybrid manufacturing (ASHM). The STA treatment led to a fully martensitic microstructure with minor remnants of the cellular substructures associated with the solidification conditions in ASHM. DA resulted in some reverted austenite and partial dissolution of the cellular morphologies into shorter fragments. Despite the contrasting microstructures, the tensile strength and the macro- and micro-hardness were comparable between STA and DA conditions. By contrast, the potential for improving the ductility was higher with the DA heat treatment. This is attributed to the higher reverted austenite content in the samples treated by DA, i.e., up to a maximum of 13.4% compared to less than 3.0% in the STA samples. For the DA sample with the highest reverted austenite content of 13.4%, the highest local and global fracture strain values of 30.1 and 5.9 ± 0.6% were measured, while the respective values were 23.4 and 4.4 ± 0.1% for the corresponding STA sample. This work suggests that DA of 300 MS produced by ASHM is sufficient to achieve comparable hardness and tensile strength to STA, whilst maintaining reasonable ductility. Avoiding the solution treatment cycle, with its appreciably higher temperatures, could benefit the dimensional stability and surface quality that are important for ASHM of 300 MS parts.

A breakthrough effect of gene replacement therapy on respiratory outcomes in children with spinal muscular atrophy.

INTRODUCTION: Spinal muscular atrophy (SMA) is an inherited progressive neuromuscular disorder characterized by generalized hypotonia, respiratory failure and early death. The introduction of gene replacement therapy (GRT) modified the natural history of the disease. However, more data is needed to understand the long-term effect of GRT on measurable respiratory outcomes. We report the respiratory outcomes in our cohort of patients with SMA post-GRT in 2-year period. METHODS: A retrospective chart-review of genetically confirmed children with SMA who received GRT between 2019 and 2021 in Qatar. The evaluated respiratory outcomes were chronic respiratory support, respiratory hospitalizations, escalation of respiratory support and polysomnography results before and after GRT. Nonrespiratory outcomes; nutritional status, swallowing, and motor functions; were also assessed. RESULTS: A total of 11 patients (9 patients with SMA-1 and 2 patients with SMA-2) received GRT at a median age of 12 months and 22 months in patients with SMA-1 and SMA-2, respectively. All patients were successfully weaned off Noninvasive ventilation (NIV) except one patient who remained on mechanical ventilation through tracheostomy tube. The annualized hospitalization rate dropped by half after GRT. The average length of stay (LOS) in intensive care unit (ICU) decreased by 17.32 days/patient/year after GRT. Duration of required escalation of respiratory support during acute hospitalizations has dropped by 18.56 days/patient/year post-GRT. CONCLUSION: We report favorable respiratory outcomes of GRT in our cohort. GRT resulted in discontinuation of chronic respiratory support in majority of ventilated patients. GRT also resulted in decreased respiratory hospitalization rate, hospital-LOS, ICU-LOS, and need for escalation of ventilatory support.

Functional evaluation of a spiral neobladder with an angled chimney; A prospective randomized comparative study.

OBJECTIVES: to assess the functional outcome of performing ureteric re-implantation to an angled short chimney in a modified spiral orthotopic ileal neobladder. PATIENTS AND METHODS: From January 2018 to December 2020, 90 male patients with bladder cancer underwent radical cystectomy and spiral ileal neobladder reconstruction with a chimney. Patients were randomly divided in two groups according to the position of the chimney [straight and angled] to which the ureters will be implanted. Postoperative evaluation included clinical, laboratory, radiographic and urodynamic studies. RESULTS: There were no perioperative deaths. The mean operative time for the procedure was 4.7 ± 1.2 h in group I and 4.9 ± 1.3 h in group II (p 0.456). No intraoperative complications occurred. Early postoperative complications occurred in 8 patients. In group I, according to the modified Clavien system, GII complication occurred in 2 (5%) patients in the form of DVT in 1 (2.5%) and surgical site infection in 1 (2.5%). GIIIa occurred in 3 (7.5%) patients in the form of wound dehiscence. In group II, GII occurred in 2 (4.8%) patients in the form of prolonged urinary leakage and myocardial infarction, each occurred in one patient. GIIIb occurred in 1 (2.4%) patient in the form of intestinal leak. Poucho-ureteral reflux occurred in 10 patients [3 (7.5%) in group I and 7 (16.8%) in group II (p 0.001)]. CONCLUSIONS: The preliminary results of the right sided angled chimney during neobladder reconstruction are safe, acceptable, without an extra time to develop an anti-reflux technique and without an increased incidence of reflux.

Predictors of successful emergency shock wave lithotripsy for acute renal colic.

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6-12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

Inoculation with Azospirillum brasilense and/or Pseudomonas geniculata reinforces flax (Linum usitatissimum) growth by improving physiological activities under saline soil conditions.

BACKGROUND: Salinized soils negatively affect plant growth, so it has become necessary to use safe and eco-friendly methods to mitigate this stress. In a completely randomized design, a pot experiment was carried out to estimate the influence of the inoculation with endophytic bacterial isolates Azospirillum brasilense, Pseudomonas geniculata and their co-inoculation on growth and metabolic aspects of flax (Linum usitatissimum) plants that already grown in salinized soil. RESULTS: The results observed that inoculation of salinity-stressed flax plants with the endophytes A. brasilense and P. geniculata (individually or in co-inoculation) increases almost growth characteristics (shoot and root lengths, fresh and dry weights as well as number of leaves). Moreover, contents of chlorophylls and carotenoids pigments, soluble sugars, proteins, free proline, total phenols, ascorbic acid, and potassium (K+) in flax plants grown in salinized soil were augmented because of the inoculation with A. brasilense and P. geniculata. Oppositely, there are significant decreases in free proline, malondialdehyde (MDA), hydrogen peroxide (H2O2), and sodium (Na+) contents. Regarding antioxidant enzymes, including superoxide dismutase (SOD), peroxidase (POD), and ascorbate peroxidase (APX), the inoculation with the tested endophytes led to significant enhancements in the activities of antioxidant enzymes in stressed flax plants. CONCLUSIONS: The results of this work showed that the use of the endophytic bacterial isolates Azospirillum brasilense, Pseudomonas geniculata (individually or in co-inoculation) could be regarded as an uncommon new model to alleviate salinity stress, especially in salinized soils.

Enhancement of Seawater Stress Tolerance in Barley by the Endophytic Fungus Aspergillus ochraceus.

Symbiotic plant-fungi interaction is a promising approach to alleviate salt stress in plants. Moreover, endophytic fungi are well known to promote the growth of various crop plants. Herein, seven fungal endophytes were screened for salt tolerance; the results revealed that Aspergillus ochraceus showed a great potentiality in terms of salt tolerance, up to 200 g L-1. The indole acetic acid (IAA) production antioxidant capacity and antifungal activity of A. ochraceus were evaluated, in vitro, under two levels of seawater stress, 15 and 30% (v/v; seawater/distilled water). The results illustrated that A. ochraceus could produce about 146 and 176 µg mL-1 IAA in 15 and 30% seawater, respectively. The yield of IAA by A. ochraceus at 30% seawater was significantly higher at all tryptophan concentrations, as compared with that at 15% seawater. Moreover, the antioxidant activity of ethyl acetate extract of A. ochraceus (1000 µg mL-1) at 15 and 30% seawater was 95.83 ± 1.25 and 98.33 ± 0.57%, respectively. Crude extracts of A. ochraceus obtained at 15 and 30% seawater exhibited significant antifungal activity against F. oxysporum, compared to distilled water. The irrigation of barley plants with seawater (15 and 30%) caused notable declines in most morphological indices, pigments, sugars, proteins, and yield characteristics, while increasing the contents of proline, malondialdehyde, and hydrogen peroxide and the activities of antioxidant enzymes. On the other hand, the application of A. ochraceus mitigated the harmful effects of seawater on the growth and physiology of barley plants. Therefore, this study suggests that the endophytic fungus A. ochraceus MT089958 could be applied as a strategy for mitigating the stress imposed by seawater irrigation in barley plants and, therefore, improving crop growth and productivity.

Wuxal amino (Bio stimulant) improved growth and physiological performance of tomato plants under salinity stress through adaptive mechanisms and antioxidant potential.

In the present study, ameliorative capabilities of wuxal amino (bio stimulant) under salt stress has been investigated through adaptive mechanisms and antioxidant potential in tomato plants. In the experiment, two different concentrations (2 cm L-1 and 3 cm L-1) of wuxal amino through foliar application and soil irrigation were applied to the salt (150 mM) treated tomato plants and then morphological traits, photosynthetic pigments, osmolytes, secondary metabolites, oxidative stress and antioxidant enzymes activity were assessed at 60 days after planting. The results revealed that salt stress decreased the growth parameters, photosynthetic pigments, soluble sugars and soluble protein whereas, content of proline, ascorbic acid, total phenols, malondialdehyde, hydrogen peroxide and the activity of antioxidant enzymes activity increased under salt stress. Moreover, Wuxal amino application through foliar or soil to salt stressed plants improved morphological traits, photosynthetic pigments, osmolytes, total phenol and antioxidant enzymes activity. Interestingly, the deleterious impact of salinity on tomato plants were significantly reduced and it can be evident from reduced MDA and H2O2 levels. These responses varied with the mode (foliar or soil) of application of Wuxal amino under different concentrations (2 cm L-1 and 3 cm L-1). It was concluded that application of Wuxal amino (2 cm L-1, foliar) and (3 cm L-1; soil) proved best and could be commercially used as eco-friendly tool for the protection of tomato plants grown under salinity stress.

Impact of Foliar Application of Chitosan Dissolved in Different Organic Acids on Isozymes, Protein Patterns and Physio-Biochemical Characteristics of Tomato Grown under Salinity Stress.

In this study, the anti-stress capabilities of the foliar application of chitosan, dissolved in four different organic acids (acetic acid, ascorbic acid, citric acid and malic acid) have been investigated on tomato (Solanum lycopersicum L.) plants under salinity stress (100 mM NaCl). Morphological traits, photosynthetic pigments, osmolytes, secondary metabolites, oxidative stress, minerals, antioxidant enzymes activity, isozymes and protein patterns were tested for potential tolerance of tomato plants growing under salinity stress. Salinity stress was caused a reduction in growth parameters, photosynthetic pigments, soluble sugars, soluble proteins and potassium (K+) content. However, the contents of proline, ascorbic acid, total phenol, malondialdehyde (MDA), hydrogen peroxide (H2O2), sodium (Na+) and antioxidant enzyme activity were increased in tomato plants grown under saline conditions. Chitosan treatments in any of the non-stressed plants showed improvements in morphological traits, photosynthetic pigments, osmolytes, total phenol and antioxidant enzymes activity. Besides, the harmful impacts of salinity on tomato plants have also been reduced by lowering MDA, H2O2 and Na+ levels. Chitosan treatments in either non-stressed or stressed plants showed different responses in number and density of peroxidase (POD), polyphenol oxidase (PPO) and superoxide dismutase (SOD) isozymes. NaCl stress led to the diminishing of protein bands with different molecular weights, while they were produced again in response to chitosan foliar application. These responses were varied according to the type of solvent acid. It could be suggested that foliar application of chitosan, especially that dissolved in ascorbic or citric acid, could be commercially used for the stimulation of tomato plants grown under salinity stress.

Strategy of Salt Tolerance and Interactive Impact of Azotobacter chroococcum and/or Alcaligenes faecalis Inoculation on Canola (Brassica napus L.) Plants Grown in Saline Soil.

A pot experiment was designed and performed in a completely randomized block design (CRBD) to determine the main effect of two plant growth-promoting rhizobacteria (PGPR) and their co-inoculation on growth criteria and physio-biochemical attributes of canola plants (Brassica napus L.) plant grown in saline soil. The results showed that inoculation with two PGPR (Azotobacter chroococcum and/or Alcaligenes faecalis) energized the growth parameters and photosynthetic pigments of stressed plants. Moreover, soluble sugars' and proteins' contents were boosted due to the treatments mentioned above. Proline, malondialdehyde (MDA), and hydrogen peroxide (H2O2) contents were markedly declined. At the same time, antioxidant enzymes, viz. superoxide dismutase (SOD), ascorbate peroxidase (APX), and peroxidase (POD), were augmented due to the inoculation with Azotobacter chroococcum and/or Alcaligenes faecalis. Regarding minerals' uptake, there was a decline in sodium (Na) and an increase in nitrogen (N), potassium (K), calcium (Ca), and magnesium (Mg) uptake due to the application of either individual or co-inoculation with the mentioned bacterial isolates. This study showed that co-inoculation with Azotobacter chroococcum and Alcaligenes faecalis was the most effective treatment and could be considered a premium tool used in facing environmental problems, especially saline soils.

Primary versus deferred ureteroscopy for management of calculus anuria: a prospective randomized study.

INTRODUCTION: Obstructive anuria can be managed by primary ureteroscopy (URS) or deferred URS after initial ureteral stenting. We want to compare the primary URS and deferred URS in the management of calculus anuria regarding the feasibility and clinical outcome. MATERIAL AND METHODS: Between January 2012 and December 2014, 150 patients with anuria due to ureteral calculi were prospectively randomized according to the timing of ureteroscopic intervention into two groups; deferred URS group (69 patients who were treated initially by ureteral stenting) and primary URS group (81 patients who were treated by emergency URS). Follow-up was at least 6 months postoperatively. RESULTS: Complete stone clearance was 87 % and 75.3% for deferred and primary URS groups, respectively (p = 0.097). Renal function normalized in 94.2% of deferred URS vs. 97.5% of primary URS (p = 0.414). Deferred URS group had a 2.9 % overall complication rate in comparison to 9.9 % for the primary URS group (p = 0.109). Ureteral perforation/pyelonephritis was noted in 6.2% of the primary URS group only (p = 0.043). The median number of maneuvers required until stone clearance was one (range 1-5) for primary URS vs. two (range 2-3) for deferred URS (p <0.001). The cost of primary URS was significantly less (p <0.001). On a multivariate analysis, lower ureteral calculi (OR 13.03, 95% CI 4.07- 41.7, p <0.001) and deferred URS (OR 2.84, 95% CI 1.07-7.49, p = 0.035) were independent predictors for an eventless and successful URS. CONCLUSIONS: Primary URS for calculus anuria is feasible and cost-effective. It has a short hospital stay, but is still technically demanding. The perioperative complications are comparable to URS in normouric patients.

Synthesis, modeling and biological evaluation of hybrids from pyrazolo[1,5c]pyrimidine as antileishmanial agents.

AIM: A new series of pyrazolo[1,5-c]pyrimidines were synthesized by different hybridization strategies. METHODOLOGY: All structures were confirmed by IR, 1H, 13C, 1H-13C heteronuclear multiple-quantum correlation (HMQC) spectra and microanalysis. They were evaluated for their in vitro antileishmanial activity against miltefosine and amphotericin B deoxycholate as reference drugs. RESULTS: The most active compounds 2a and 9a demonstrated superior potencies to miltefosine by ten- and six-fold, respectively, for the promastigote form, and by 5.5-fold for the amastigote form. Their binding scenario to Leishmania major pteridine reductase was rationalized by docking experiments. In addition, all compounds were safe for the experimental animals orally up to 150 mg/kg and parenterally up to 75 mg/kg. CONCLUSION: This study provides novel chemotype class for antileishmanial activity. [Formula: see text].

Management of neobladder complications: endoscopy comes first.

OBJECTIVE: The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS: Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS: The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS: Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients.

AIM: To evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients. METHODS: This prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A (TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score (PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. RESULTS: Before LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls (P < 0.001). There was a statistically significant improvement in test values in the patient group after LT; however, their values were still significantly worse than those of the controls (P < 0.001). The PHES detected MHE in 16 patients (80%) before LT with a median value of -7 ± 3.5. The median PHES value was significantly improved following LT, reaching -4.5 ± 5 (P < 0.001), and the number of patients with MHE decreased to 11 (55%). The pre-transplant model for end-stage liver disease (MELD) score ≥ 15 was significantly related to the presence of post-transplant MHE (P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score < 15. CONCLUSION: Reversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score < 15.

Measuring of gastric emptying in Egyptian pediatric patients with portal hypertension by using real-time ultrasound.

BACKGROUND/AIM: Among the various methods for evaluating gastric emptying, the real-time ultrasound is safe, does not require intubation, or rely on either radiologic or radionuclide technique. The aim of our work was to measure the gastric emptying in pediatric patients with portal hypertension by using the real-time ultrasound. PATIENTS AND METHODS: Forty patients with portal hypertension with mean age 7 ± 2.8 years and 20 healthy children as a control group underwent gastric emptying study by using real-time ultrasound. The cross-sectional area of the gastric antrum was measured in the fasting state and then each subject was allowed to drink tap water then calculated by using formula area (π longitudinal Χ anteroposterior diameter/4). The intragastric volume was assumed to be directly proportional to the cross-sectional area of the antrum. RESULTS: The mean gastric emptying half-time volume was significantly delayed in portal hypertension patients (40 ± 6.8 min) compared with the control subjects (27.1 ± 3.6) min (P<0.05). Patients with extrahepatic portal vein obstruction had significant delayed gastric emptying in comparison to patients with portal hypertension due to other etiologies (36.14 ± 4.9 vs 44.41 ± 6.04 min; P<0.01). CONCLUSION: Ultrasound is a noninvasive and a reliable method for measuring gastric emptying in pediatric patients. Gastric emptying was significantly delayed in patients with portal hypertension. Etiology of portal hypertension may influence gastric emptying time in patients with chronic liver disease.

Ureteroscopic retrograde intrarenal surgery after previous open renal stone surgery: initial experience.

The management of renal calculi following previous open surgery represents a challenge for urologists. The aim of this study is to evaluate the outcomes and safety of ureteroscopic laser retrograde intrarenal surgery (RIRS) for renal calculi following prior open renal surgery. The charts of 53 patients who underwent RIRS for renal calculi following prior open surgery for urolithiasis were reviewed. Both flexible and semi-rigid ureteroscopes were utilized together with holmium: YAG laser for stone disintegration. Intravenous urography, computed tomography (CT) and ultrasound were used to evaluate the patient, perioperatively. Stone size ranged from 5 to 32 mm (mean 14.3 mm). The mean operative time was 86 min (20-130). The overall stone-free rate was 92.4%. The overall stone-free rates after one and two-procedures were 79.2% (42 cases) and 92.4% (49 cases), respectively. Four patients (7.5%) had larger residual fragments, 2 (3.8%) of them underwent SWL, and 2 (3.8%) cases were followed up conservatively. Major complications were reported in two patients (3.8%). Stone analysis revealed calcium oxalate in 39 patients, uric acid in 5, calcium phosphate in 4, struvite in 3, and cystine in 2 cases. Ureteroscopic retrograde intrarenal surgery for renal calculi following prior open renal surgery was a minimally invasive, safe procedure with a high success rate. It is a viable alternative for PNL in managing recurrent renal calculi efficiently.

Modified N-shaped ileal neobladder after radical cystectomy.

OBJECTIVE: We report on the feasibility and outcomes of the N-shaped pouch with an afferent tubular isoperistaltic segment as a new technique for creating a capacious, low pressure bladder substitute following radical cystectomy. METHODS: Between April 2000 and April 2006, 42 patients (36 male, 6 female) with invasive bladder cancer were considered good candidates for orthotopic urinary diversion. All had radical cystectomy with bilateral pelvic lymphadenectomy and orthotopic bladder substitution by an ileal low pressure reservoir (N-shaped) with an afferent isoperistaltic tubular segment. Of the 42 patients, 36 (86%) had squamous cell carcinoma; 6 had transitional cell carcinoma. None of the patients had positive lymph nodes after pathologic examination of the specimen. The patients were available for a median follow-up period of 24.8 months. Follow-up included clinical and radiographic studies to determine functional and oncological outcomes. RESULTS: Eleven patients (26.2%) had early complications during the period ≤ 3 months following surgery. Seven of these patients had complications such as wound infection, prolonged ileus, persistent urinary leakage, and deep venous thrombosis that were treated conservatively. One female patient developed a pouch-vaginal fistula that required repair. The remaining 3 patients had oncologic failures, 1 of which was isolated urethral recurrence. Late complications occurred in 15 patients (35.7%). These included pouch stones, outflow obstruction, mucus retention, and adhesive bowel obstruction. Daytime and night-time continence was achieved in 92% and 80% of the patients, respectively, and ureteroileal stricture was observed in 5%. The upper tracts remained unchanged or improved in nearly 95% of the patients. CONCLUSIONS: Ileal orthotopic bladder substitution (N-shaped) with an afferent ileal tubular segment offers good functional results with good preservation of the renal units. It is considered a safe and technically feasible surgical procedure.

Solo ultrasonography-guided percutanous nephrolithotomy for single stone pelvis.

PURPOSE: To evaluate the success and outcomes of solo ultrasonography (US)-guided percutaneous nephrolithotomy (PCNL) for management of a single stone pelvis. PATIENTS AND METHODS: From April 2008 to April 2010, the procedure was applied to 34 patients (22 men and 12 women) whose ages ranged from 25 to 55 years (mean 29.5 y) with unilateral single stone pelvis in a moderately to markedly dilated pelvicaliceal system (PCS). The stone size ranged from 20 to 30 mm (mean 24 mm). Middle caliceal puncture and dilation were performed in all cases by an experienced urologist under US guidance with a needle-guided system attached to the side wall of the US probe. The evaluation of the procedure included the success of accessing the stones, the occurrence of intraoperative or postoperative complications, the stone-free rate, and the need for auxiliary maneuver. RESULTS: The access was successful in all cases. Minor intraoperative complications occurred in two cases where PCS perforation was detected and was managed conservatively by Double-J stent insertion for 4 weeks. The only reported postoperative complication was fever in five cases that responded to antibiotic treatment. Thirty-two (94%) patients were stone free on postoperative day 2; significant residual stones (8 and 10 mm) were detected in two patients who underwent shockwave lithotripsy, and they became stone free within 10 days. CONCLUSION: Solo US-guided PCNL can be performed safely as an alternative to the fluoroscopy-guided PCNL for single stone pelvis in a moderately to markedly dilated PCS by an experienced urologist.

Penile fracture: long-term results of surgical and conservative management.

BACKGROUND: Penile fracture usually results from direct trauma to the erected penis. We evaluate the outcomes of surgical and conservative treatment. METHODS: Between February 2000 and February 2007, 77 patients with mean age 29 ± 2.5 years (range, 20-57 years) with penile fracture were evaluated retrospectively. A total of 56 patients (group A) were treated with immediate surgical repair and 21 patients (group B) were treated conservatively as they refused surgical intervention. Data on erectile function and any penile sequel were obtained during follow-up using the International Index of Erectile Function (IIEF-15) questionnaire, local examination, and color Doppler ultrasonography reports. RESULTS: Only 69 patients were available for median follow-up period of 20.8 months (range, 17-30 months), 51 patients of the group A and 18 of the group B. Injury involved unilateral and bilateral corporeal rupture in 50 and 6 cases, respectively. Concomitant urethral injury was detected in three cases. During follow-up, 49 cases (96%) of the surgical group (A) and 9 cases (50%) of the conservative group (B) reported erection adequate for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining nine patients (50%) from the conservative group (B) reported erectile dysfunction and penile deviation. CONCLUSIONS: Immediate surgical repair of the penile fracture gave good results and is superior to conservative treatment; however, we cannot distinguish false from true penile fracture accurately to determine on whom we can use the conservative treatment.

Risk factors of hepatitis C infection among Egyptian blood donors.

BACKGROUND: Surveillance of infectious disease markers in the blood donor population is important in recognizing trends in prevalence and incidence of transfusion related infections in asymptomatic volunteer blood donors. SUBJECTS AND METHODS: It was a cross sectional study. Samples were collected from volunteer blood donors and questionnaire was designed to collect the risk factors data. The prevalence of hepatitis C antibodies among 1,000 apparently healthy blood donors were determined. OBJECTIVE: To estimate the prevalence of virus C hepatic infection and to illustrate the various socio-economic, behavioural and medical factors related to infection with Hepatitis C (HCV) among apparently healthy individuals. It contributed to analysis of the particularities of Egyptian blood donors and helped to better understand the challenges and solutions of blood safety. RESULTS: The prevalence of HCV was 16.8%. There was an association of positive anti-HCV test with socio-demographic, medical and behavioural risk factors. CONCLUSION: This study provided comprehensive and reliable information on the possible risk factors affecting spread of Hepatitis C in the area.