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Objective: To compare the outcome of microscopic subinguinal varicocelectomy versus oral antioxidants for the management of male infertility due to isolated teratozoospermia. Material and methods: Clinical patients’ database of a tertiary infertility referral center was retrospectively reviewed to collect data on male infertility due to isolated teratozoospermia from July 2014 to January 2019. Seventy-two patients who underwent microscopic subinguinal varicocelectomy for their clinically palpable varicoceles were considered as a study group, while 60 patients who were treated with antioxidants (l-carnitine, vitamin C, and vitamin E) were included as controls. The improvement in the sperm morphology, sperm DNA fragmentation (SDF), and the achievement of natural pregnancy were compared between the two groups. Results: In the varicocelectomy group, all sperm parameters and SDF statistically improved 6 months after the operation (P-value

To assess the effect and outcome of percutaneous nephrolithotomy (PNL) versus extracorporeal shock wave lithotripsy (SWL) in patients with renal insufficiency. A prospective randomized clinical study of 104 renal insufficiency patients with renal stones (serum creatinine 2–4 mg/dl and eGFR

Objective: To evaluate the outcome of microscopic subinguinal varicocelectomy on sperm DNA fragmentation (SDF) and pregnancy rate in men with normal semen parameters. Patients and methods: A pilot study that included male patients with a minimum of a 1-year history of male subfertility, normal semen parameters, a high percentage of SDF, and clinically palpable varicoceles. Microscopic subinguinal varicocelectomy was carried out for 45 patients (study group), while 40 patients had no intervention (control group). Semen analysis and SDF were measured before and at 6 months after the varicocelectomy. The pregnancy rate was assessed at the 6- and 12-month follow-ups. Results: Between July 2014 and January 2019, 85 subfertile men were included in the study and completed 12 months of follow-up. The two groups were comparable in terms of their age, body mass index, infertility duration, infertility type, varicoceles laterality, and varicoceles grade (P values = 0.84, 0.34. 0.35, 1, 0.39, and 0.46, respectively). At 6 months after varicocelectomy, the mean SDF was reduced in both groups, and this reduction was statistically higher in the varicocelectomy group (P

Background: The incidence of stone formation in patients with renal insufficiency 17.5%, complete clearance of stone in these patients need least invasive procedure with safety of kid-ney parenchyma and kidney function.Objectives:To analyze outcomes of percutaneous nephrolithotomy (PNL) and shock wave lithotripsy (SWL) and their effect on kidney function for patients with renal insufficiency.Materials and methods: 52 renal insufficiency patients with renal stones presented to our de-partment randomized into two groups group A (25 patients) underwent PNL and group B (27 patients) underwent SWL and all results recorded and analyzed with Statistical Package for Social Science® (SPSS) and Microsoft Excel 2010.Results: Stone free rate was about 84% of patients in group A (25 patients) and about 26.6% of patients in group B with first session, while it`s about 88.9% for all patients in group B (27 patients) with some degree of improvement of kidney function.Conclusion: This study shows that both PNL and SWL are safe on patients with renal insuffi-ciency with improvement of kidney function.

Background: addiction is still an increasingly social and health issue worldwide, despite all attempts to overcome it. Analgesics are of the most prevalent substances that are abused. In Egypt and the Middle East, tramadol abuse is highly increasing. This can be correlated to its inexpensive cost, large availability, accessibility and illegal trafficking. Tramadol is a centrally-acting synthetic opioid analgesic that is commonly used to treat different intensities of pain varying from mild to extreme pain conditions. Prolonged administration of tramadol can result in abnormalities of the hypothalamic-pituitary function and decrease in testosterone production. Many experimental studies were done and showed that tramadol affects the level of luteinizing hormone, follicular stimulating hormone, testosterone, estradiol, and prolactin. It also affects sperm quality and motility. We aimed in this review: is to delineate these issues. Conclusion: There is a significant correlation between tramadol abuse and impaired gonadal and male sex hormone and sperm quality parameters.

Objective: To compare the outcome of flexible ureteroscopy (F-URS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of renal stone burden less than 2 cm in children. Patients and methods: A randomized comparative study was conducted at our hospital between December 2013 and May 2015. Seventy two children with renal stone burden less than 2 cm were assessed for eligibility. Our primary outcome is to assess the stone free rate after the first session. The secondary goal is to assess the operative outcome and the associated postoperative complications. Results: Finally, 57 children were completed the treatment and follow up; 27 patients in F-URS group and 30 patients in ESWL group. Patient’s demographics and stone characteristics were comparable between both groups. F-URS group was associated with significantly longer operative time and hospital stay versus ESWL group. Overall complications occurred in 29.6% and 33.3% in F-URS groups and ESWL group, respectively ( p value = 0.1) and most of them were of minor degree. F-URS was associated with significantly higher stone free rate after the first session which reached 81.4% versus 53.3% for ESWL group ( p value = 0.00). The overall success was 92.5% and 90% in F-URS and ESWL group, respectively ( p value = 0.5). Conclusion: Stone free rate after one session of F-URS is higher than ESWL with comparable rates of complications. F-URS could be offered to children who are less likely to respond completely after ESWL monotherapy. Keywords: Pediatric urolithiasis; Minimal invasive stone management; Flexible URS; ESWL

Purpose To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. Patients and methods Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. Results Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.

Background Extra-corporeal shock wave lithotripsy (ESWL) is a painful procedure. Sufficient analgesia is mandatory to achieve good treatment results, as well as patient compliance and comfort. Dexmedetomidine, owing to its sedative and its analgesic effects, may be suitable for conscious sedation during ESWL. The aim of this study was to evaluate the use of dexmedetomidine compared with propofol for its safety and efficacy during ESWL. Patients and methods Fifty-two patients were randomly divided into 2 groups that received either dexmedetomidine or propofol for elective ESWL. A dose of 1.5 μg/kg of fentanyl was given intravenously (IV) to all patients 10 min before the ESWL procedure. In the dexmedetomidine group, patient received an initial loading dose of 1 μg/kg of dexmedetomidine infused IV over 10 min, followed by an infusion rate of 0.3 μg/kg/h. In the propofol group, the initial loading dose of 1 mg/kg of propofol was infused IV over 10 min, followed by an infusion rate of 3 mg/kg/h. The Observer’s Assessment of Alertness/Sedation (OOA/S) scores, visual analog scale (VAS), and hemodynamic and respiratory variables were recorded regularly at 5-min interval during ESWL. Hospital discharge time was determined according to Kortilla’s criteria for outpatient surgeries. Results The OOA/S scores in the dexmedetomidine group at the 25- to 45-min assessments were significantly lower than those seen in the propofol group ( P 0.05). The VAS scores for the dexmedetomidine group were significantly lower than those in the propofol group, but only at the 30- to 45-min assessments ( P 0.05). During sedation, the respiratory rate with dexmedetomidine was significantly slower ( P 0.05). Other clinical variables, adverse effects, and hospital discharge times were comparable in both groups ( P > 0.05). Conclusion Dexmedetomidine with fentanyl can be used safely and effectively, and it may be a valuable alternative to propofol with fentanyl for conscious sedation during ESWL.

Although extracorporeal shock wave lithotripsy (ESWL) is the first choice for pediatric renal calculi2 cm, the success rate after the first session is low. This is in contrast to other minimally invasive procedures like percutanous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), which have higher rates of success. Therefore, the present study sought to identify predictors of success after one session of ESWL.A prospective study including 100 children with renal stone burden2 cm who underwent ESWL at the present institution. The success rate after the first session was analyzed, and the predictors of success were investigated. The success of ESWL monotherapy was defined by absence of any residual fragments after 3 months, on non-contrast spiral computerized tomography (NCCT) scan, without need of any additional intervention.Between January 2013 and October 2015, 100 children were treated with a Dornier Gemini lithotripter at the present institution. The mean patients age and stone size were 6 years (range: 1.8-14) and 13.1 mm (range: 6-20), respectively. After one session, 47% of patients showed complete clearance 3 months postoperative, those patients versus those who required an additional session or auxiliary procedures were younger in age, with smaller stone size and lower density. On multivariate analysis, only patient age was an independent predictor of success (odds ratio (OR) 0.9; P0.001).Patient's age was an important predictor for response after ESWL monotherapy: not only did children respond better than adults, but age was also an independent predictor within the pediatric group.

Several techniques have been used to repair mid-penile hypospadias; however, high failure rates and major complications have been reported. In this study, we describe a novel technique using a well-vascularized flap of the inner and outer preputial skin. A total of 110 male children with hypospadias underwent repair by our technique between 2008 and 2015. The inclusion criteria were children with mid-penile or slightly more proximal hypospadias, with or without ventral chordae, and an intact prepuce of the cobra eyes variety. Recurrent cases, patients with other preputial types, and circumcised children were excluded from this study. The prepared flap was sutured in its natural longitudinal orientation to the created urethral plate strip to form a neo-urethra over a urethral catheter. Outcome measures included surgical success without the formation of a urethra-cutaneous fistula, no ischaemia of the flaps, glans dehiscence or infection and functional outcome and cosmetic appearance. The median follow-up duration was 3.3 years. There were 63 cases of mid-penile hypospadias (57.3 %), and in 47 cases (42.7 %), the meatus was slightly more proximal. The age of the patients ranged from 1.1 to 8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was successful in 106 (96.4 %) cases. Minor complications occurred in 11 patients (10 %) and included oedema of glans in ten patients and bluish discoloration on the ventral aspect of the glans close to the suture line in three patients. All patients improved within 2 weeks after surgery. Long-term follow-up revealed a properly functioning urethra with a forward, projectile, single, compact, and rifled urinary stream of adequate calibre and cosmetically acceptable repair. No cases of meatal retraction, meatal stenosis, urethral stricture, or acquired urethral diverticulum occurred. Our technique is different from the split prepuce in situ technique. We create a narrow strip of the urethral plate that facilitates glanular closure, and we use the inner and adjacent outer skin in a vertical manner to preserve excess skin for penile coverage. Prepuce is split at midline to preserve more preputial skin with favourable dartos tissue for penile skin coverage. The glans is closed using a stitch-by-stitch method that has not been described previously. This study presents a novel technique for mid-penile hypospadias repair using a preputial skin flap with excellent results in terms of short- and long-term outcomes.