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Introduction: The main problem after Radical Nephroureterectomy (RNU) for localized non-metastatic upper urinary tract urothelial cancer (NM-UUT-UC) is bladder recurrence., Aim: To identify factors of bladder recurrence of localized NM-UUT-UC after radical treatment., Methods: It is an analytical and observational study that was conducted in the department of urology of La Rabta Hospital in Tunis. We collected the data of patients diagnosed with localized NM-UUT-UC who had RNU between 2005 and 2019., Results: The mean age of the 73 eligible patients was 68 years (±11). The sex ratio was 5/2. Macroscopic hematuria was the revealing clinical sign in 66% of patients, while low back pain was the most frequent sign in 88% of patients. The most frequent tumor stage was pT1 in 20 patients while 32% of them had a pT2-T3 stage. Bladder recurrence was reported in 22% of patients with a median time of nine months [4-27] and extremes of three and 69 months. Factors of bladder recurrence in the univariate analysis were smoking, tumor localization in the ureter and the extravesical excision of the intramural ureter and bladder cuff. On multivariate analysis, the only independent predictor of bladder tumor recurrence was ureteral location (OR=3.65; CI95%=[1.02-13.1] ; p=0.047)., Conclusion: Tumor localization in the ureter was an independent predictor of bladder recurrence after radical treatment for localized NM-UUT-UC.

Background: Fournier's gangrene is a rare, fulminant, and usually localized necrotizing soft tissue polymicrobial infection of the perineum, with occasional extension up to the abdominal wall., Case Presentation: We describe an unusual case of penile gangrene in a 64-year-old Tunisian man suffering from urinary incontinence secondary to cerebrovascular accident. Gangrene developed due to continuous tourniquet effect on the penis caused by a condom catheter. Although source control was achieved with aggressive debridement, careful wound care, and wide-spectrum antibiotherapy, the patient died due to septic shock., Conclusion: Use of condom catheters is not without complications. Careful placement, strict hygiene, and regular monitoring of the local condition are necessary., (© 2023. The Author(s).)

Hydatid cyst is a major health problem in developing countries. The kidney is in third position of organs affected by hydatid cyst. One of the complications of renal hydatid cyst is a urinary fistula. The purpose of this study is to identify preoperative predictive factors of urinary fistula in renal hydatid cyst and to develop a scoring system for this disorder. We retrospectively analyzed all patients operated for renal hydatid cysts between January 2000 and December 2020. We divided our patients into two groups according to whether or not the renal hydatid cysts opened in the urinary tract. Predictive factors of the presence of a urinary fistula have been studied to obtain a simple score to predict the presence of a urinary fistula. Differences were considered significant if p < 0.05. Urinary fistula was detected in 33 of 96 patients. Univariate analyses showed significant differences in patient age, cyst size, location, hydaturia, eosinophil count, and platelet count between patients with and without urinary fistula. In multivariate analyses, hydaturia (p < 0.005), eosinophil count >500/mm 3 , (p = 0.01), cyst diameter >5 cm (p = 0.02), and upper or lower renal pole location (p = 0.003) were significant and independent predictors of urinary fistula. A score was developed to predict the opening of the cyst in the urinary tract. The total score varies between 0 and 15. The resulting area under the receiver operator characteristic curve was 0.798 (95% CI, 0.726-0.866; p = 0.023). At a cutoff point ≥8, the specificity achieved was 100%. Preoperative detection and management of urinary fistula are important issues in the treatment of renal hydatid cyst. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with renal hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice.

Objective: Prostate cancer is one of the most common cancers worldwide. Its histological diagnosis is based on prostate biopsy. The transrectal procedure is one of the most common procedures performed by urologists. Although it is considered safe, post-biopsy infectious complications are frequently observed in practice. The aim of this study is to investigate the value of urine culture before the transrectal biopsy. Secondly, we assessed potential risk factors for infectious complications following TR-PB., Methods: We performed a retrospective analysis of all patients who underwent urine culture tests before transrectal prostate biopsy between January 2019 and July 2020. The inclusion criteria for the study were all indications for prostate biopsy (PSA>4ng/mL or abnormal digital rectal examination). Baseline characteristics and the incidence of post-biopsy urinary tract infection were compared between patients showing positive pre-biopsy culture results and those showing negative findings. Multivariate logistic regression analyses were used to determine risk factors for infectious complications following TR-PB., Results: Out of 163 patients included in our study, 19 patients (11.65%) had positive urine culture results before the biopsy. Age (P=0.068); history of hospitalization (P>0.999), history previous of quinolone use (P=0.75), history of UTI (P=0.64); median PSA level at diagnosis (P=0.267); prostate volume (P=0.78); post-void residual volume (P=0.374); percentage of patients testing positive for cancer on biopsy (P=0.81); and percentages of patients with a history of biopsy (P=0.889), diabetes mellitus (P=0.524), hypertension (P=0.714) and immunosuppressive medication use (P>0.999) were similar between the two groups. One patient in the positive urine culture group had post-biopsy prostatitis. However, 3.24% (five patients) of the negative urine culture group had the disease (P=0.789) (four patients with prostatitis and one with epididymitis). Among them, four patients were diagnosed by urine culture at the time of post-biopsy urinary tract infection. Multivariate logistic regression analysis demonstrated that history of hospitalization and history of previous quinolone use were risk factors for infection after transrectal prostate biopsy., Conclusion: Our study suggests that systematically performing urine cultures before transrectal prostate biopsy does not reduce the rate of infectious complications after biopsy. Positive pre-biopsy cultures were not associated with the development of post-biopsy infectious complications., (Copyright © 2022 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Introduction Radical retropubic prostatectomy is one of the standard treatments for localized prostate cancer. Evaluating the severity of postoperative urinary incontinence is primordial to guiding the treatment choice, and it still lacks standardization, hence the value of assessing the quality of life. Methods We conducted a retrospective study between January 2014 and December 2018 in the Urology Department of La Rabta Hospital, involving 30 patients followed for localized prostate cancer treated with radical prostatectomy for at least one year. Our work aimed to study urinary incontinence after radical retropubic prostatectomy and to evaluate the quality of life of patients who underwent surgery for localized prostate cancer by three validated questionnaires: The International Prostate Symptom Score (IPSS), The International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and the International Continence Society (ICS) scores. Results The preoperative IPSS score ranged from 5-22, averaging 11.13. After the surgery, it ranged between four and 23, with an average of 14.13. This increase was significant, with p = 0.001. The average preoperative ICIQ-SF score was 10.03, and the mean postoperative score was 14.23. The first question dealing with the frequency of episodes of urinary leakage has not demonstrated variation after surgery. In the second question, which deals with the amount of urine loss, we found a significant increase in this parameter with p=0.003. In the third question inherent to perceived discomfort, operated patients reported significant deterioration with p <0.001. We observed an increase in patients with urinary stress incontinence and enuresis on the ICS score after radical retropubic prostatectomy. Wearing protection or padding was required in 23.3% of patients. Conclusion IPSS, ICIQ-SF, and ICS scores are helpful to perform before and after radical retropubic prostatectomy. It helps to study urinary incontinence better, propose to each patient with postoperative complications the appropriate treatment option, and improve the quality of the urinary status., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ouanes et al.)

Introduction: The aim of this study was to investigate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio in non-metastatic renal cell carcinoma., Patients and Methods: We retrospectively analyzed the records of patients with non-metastatic renal cell carcinoma who were operated between 2004 and 2020 at our institution. The Kaplan-Meier method was utilized to graphically display survivor functions. Univariate and multivariate Cox's proportional hazards regression models were utilized to analyze the association between neutrophil-to-lymphocyte ratio and oncological outcomes., Results: We included 202 patients. Patients with higher neutrophil-to-lymphocyte ratio had larger tumors (P=0.03), higher ASA score (P=0.014), clinical symptoms (P=0.04), sarcomatoid differentiation (P=0.03) and tumor necrosis (P=0.02). The rates of recurrence-free survival and metastasis-free survival were significantly lower in patients with a high neutrophil-to-lymphocyte ratio than in those with a low ratio (P=0.017; P=0.036 respectively). Multivariate analysis identified the neutrophil-lymphocyte ratio as an independent predictor of recurrence-free and metastasis-free survival (P=0.021; P=0.001 respectively)., Conclusion: A higher neutrophil-to-lymphocyte ratio has been associated with a symptomatic renal cancer with a significant prognostic factor for both recurrence-free and metastasis-free survival., Level of Proof: 3., (Copyright © 2022 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Introduction: Iatrogenic ureteral lesions represent one of the serious complications that can follow obstetric and gynecological surgery. This condition has a fatal consequence on renal function if it's not promptly diagnosed and managed., Objective: The aim of our study was to report our experience in the management of this pathology., Materials & Methods: This is a retrospective study of 32 patients treated for an iatrogenic ureteral injury after gynecological or obstetrical surgery, collected in the urology department of the Rabta Hospital over a 15-year period (2005-2020). Clinical presentation, investigations, and operative and postoperative details were reviewed from the patients' charts., Results: The average age of the patients was 42.6 (21-61). Multiparity was observed in 90.6% of cases. Hysterectomy was the most common cause (71.87%), followed by cesarean operation (18.75%), mainly for patients with placenta percreta (12.5%), and lastly, cure of prolapse by the upper approach in 9.37% of cases. The symptoms were dominated by low back pain and urinary incontinence. Stenosis was the most frequent lesion in 25 cases, followed by a section in 4 cases. A ureterovaginal fistula was observed in 3 case s. The first-line treatment of the patients was drainage by a ureteral stent (15.6%) or by a percutaneous nephrostomy (84.4%). Ureterovesical reimplantation was performed in 26 cases (81.25%). However, one patient had an Ileal ureter replacement. During follow-up, treatment failure was noted in 7 patients. Four patients developed secondary hydronephrosis treated with a urethral stent while 3 patients required nephrectomy. The type of gynecological and obstetrical procedure (open hysterectomy), history of pelvic surgery, and malignant pathology were predictive factors of treatment failure., Conclusions: Injuries to the ureter during gynecological and obstetrical surgery are generally rare. The diversity of repair techniques and the contribution of endo-urological techniques most often allow renal preservation, knowing that the best treatment remains prevention., Competing Interests: Authors do not report any conflict of interest., (© 2022 The Author(s).)

Introduction: Among identified causes of male infertility, varicocele holds an important place and is significantly associated with sperm quality deterioration. Surgical management of this condition leads to an improvement in the sperm count and an increase in the spontaneous pregnancy rate., Objective: The goal of this study was to compare different surgical techniques in terms of morbidity and fertility results., Patients and Methods: It is a retrospective study of interesting patients followed for infertility related to varicocele between January 2007 and December 2015. Three surgical techniques were compared: open inguinal surgery, antegrade sclerotherapy, and laparoscopy. Morbidity and pregnancy rate were assessed according to different techniques., Results: Post-operative complication rates were comparable (p = 0,94) between the 3 surgical techniques. An amelioration of sperm parameters has been noted in all operated patients, without statistical difference between the three techniques (p = 0,29 for the sperm concentration and p = 0,49 for the progressive mobility). Spontaneous pregnancy was better (p = 0,03) for patients who have had a varicocelectomy in a sub-inguinal way., Conclusion: All of the three surgical techniques used in this study showed an improvement of sperm parameters in an equal way with similar morbidity. However, the spontaneous pregnancy rate with open surgery was better., Competing Interests: Authors do not report any conflict of interest., (© 2022 The Authors.)

Introduction: Emphysematous pyelonephritis (EPN) is a severe form of life-threatening renal infection. Conservative treatment represents the gold standard in the management of EPN, but nephrectomy remains appropriate in certain situations., Objective: The aim of our study was to report our experience in the conservative management of emphysematous pyelonephritis and to identify the predictive factors of failure of conservative treatment., Patients and Methods: This is a retrospective study including all patients treated for emphysematous pyelonephritis in our department between January 2015 and December 2020. The first-line treatment was conservative based on antibiotic therapy and drainage in case of an obstructive cause. A nephrectomy was performed in case of failure of the conservative approach. Epidemiological, clinical, biological, therapeutic, and evolutionary data were collected from the patients' files. Statistical analysis was made using SPSS version 28., Results: 41 patients were included in our study. The mean age was 64.4 years old [28-91] with gender ratio of 0.46 (13H/28F). Diabetes mellitus was present in 75.6% of cases. The mean presentation delay was 3.28 days (Kaiser and Fournier, 2005; Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007; Dutta et al., 2007; Dutta et al., 2007; Deoraj et al., 2018 Sep; Rahim et al., 2021 Mar; Maheshwari, 2021 Jul-Sep) [1-11]. In CT scan, 21 patients had class 1 EPN, 9 had class 2 EPN, 8 had class 3 EPN and 3 had class 4 EPN. The obstructive origin was found in 24 cases. Initially, 25 patients (60.9%) presented with severe sepsis and 7 patients (17.07%) developed a septic shock. Seven patients required nephrectomy with a mean delay of 2.12 days (Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007) [2-6]. Five patients with septic shock refractory to conservative treatment and two patients whose evolution was marked by the occurrence of secondary septic shock. In the univariate analysis, thrombocytopenia, initially septic shock, and the need for hemodialysis were the predictive factors of failure of conservative management in patients with emphysematous pyelonephritis., Conclusion: Emphysematous pyelonephritis is a serious condition with significant mortality. The optimal management is based on conservative treatment in most cases. However, patients requiring hemodialysis and with thrombocytopenia and initially septic shock should be considered candidates for emergency nephrectomy., Competing Interests: Authors do not report any conflict of interest., (© 2022 The Author(s).)

Introduction: Ischemic Priapism is defined as an abnormally prolonged state of erection, exceeding 6 h, often and irreducible, occurring without any sexual stimulation. Ischemic priapism has a fatal consequence on the sexual function of men if it's not promptly managed. This pathology can cause erectile dysfunction and this can alter the quality of life of patients., Objective: The aim of our study was to determine the factors influencing erectile function after treatment of ischemic priapism., Patients and Methods: This is a ten-year retrospective, descriptive and analytic study of 40 patients who consulted the urology department at the university hospital center for treatment of ischemic priapism (2010-2019)., Results: We included 40 patients in our study. The mean age was 35.2 [18-62]. Duration of priapism varied from 20 to 360 h (mean 76.6). The most common etiology of priapism was sickle cell disease in 65% of cases. The mean preoperative IIEF-5 score was 23 [21-26]. All patients underwent corporal aspiration with an injection of ephedrine, but detumescence was observed in only 10% of cases. Thirty-six patients had a distal shunt with detumescence in approximately 70% of cases. Eleven patients underwent a distal shunt but seven patients had definitive fibrosis. After the episode of priapism, only eight patients retained normal erectile function. The mean postoperative IIEF-5 score was 14 [ 7-26]. We noted an improvement in erectile function in 8 patients treated with tadalafil. In multivariate analysis, we have demonstrated that a treatment delay exceeding 48 h, fibrosis and the necessity of a distal shunt significantly affects postoperative erectile function (p = 0.001; p = 0.002; p = 0.002 respectively)., Conclusion: According to our study, delayed management exceeding 48 h, fibrosis and the necessity of a surgical distal shunt are three independent factors affecting erectile function after treatment of ischemic priapism., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Background: Although the progress in diagnosis methods revealed a high incidence of infra-clinical varicocele, the clinical signification of this pathology is controversial. We compared left unilateral varicocelectomy to bilateral surgery in patients with left clinical varicocele associated to an infra-clinical right one., Patients and Methods: It is a retrospective study conducted between January 2007 and December 2015 concerning men followed for a varicocele related infertility (one-year or more primary infertility) with two altered sperm analysis (oligospermia and/or asthenospermia) and had a left clinical varicocele associated to right infra-clinical one detected at Doppler Ultrasound. Surgical techniques used were open surgery (sub-inguinal way), antegrade sclerotherapy and coelioscopy. All patients were reviewed with a 6 month post operatively spermogram and minimum follow up of 1 year., Results: Our study included 95 men. Thirty-five patients have had a unilateral left surgery (Group I) and 60 patients have had a bilateral surgical treatment (Group II). The pre-operative spermatic parameters (concentration and progressive mobility) were comparable for the 2 groups. After the surgical treatment, an improvement of these parameters was noted in all the patients without significant difference between the two groups regarding sperm concentration (24.07±9.36×10 6 /mL Vs 23.29±3.88×10 6 /mL) and their progressive mobility (30.47±9.04% Vs 32.39±9.54%). The spontaneous pregnancy rate was 22.8% for patients in group I and 26.6% for those in group II without any statistically difference (p=0.68)., Conclusion: Treatment of a right s infra-clinical varicocele, when combined with a left clinical varicocele, gave better results in terms of sperm parameters and spontaneous pregnancy than unilateral varicocelectomy but without statistically significant results., Level of Evidence: 3., (Copyright © 2021 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Introduction and Importance: Primary testicular lymphoma (PTL) is a variety of extra-nodal lymphoma taking origin from testis. It accounts 5% of all testicular tumors. Metastasis may occur in contralateral testis, bone, central nervous system and rarely in skin. Herein, we present the case of testicular diffuse large B-cell malignant lymphoma with cutaneous metastasis., Case Presentation: A 60-year-old male presented with swollen painless solid right testis, with homolateral inguinal nodes. Testicular tumors markers were within normal range. Right radical orchidectomy was performed. Histopathological examination concluded to the diagnosis of Diffuse Large B Cell Lymphoma. Four weeks later, the patient presented alteration of general condition and multiples cutaneous centimetric lesions located in the right inguinal region. Biopsy of this lesion confirmed the diagnosis of metastases from the testicular lymphoma. The patient deceased three days later, before starting further treatment., Clinical Discussion: Primary testicular lymphoma is a rare variety of testicular tumors. The prognosis is poor. Metastasis may occur in different sites such as contralateral testis, central nervous system, and skin. The prognosis is usually poor in the rare case of cutaneous metastasis., Conclusion: Primary testicular tumor is an aggressive rare variety of testicular tumors with poor prognosis. Cutaneous metastasis is rarely reported. Cutaneous lesions should be explored and suspected to be malignant. Early treatment with rapid multidisciplinary management is the key for adequate approach., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Crossed fused renal ectopia is a rare congenital condition that might pose some diagnostic and therapeutic challenges to clinicians. We report a patient with a non-functional crossed fused ectopic left kidney that obstructed the orthotopic kidney in a rarely observed situation., Case Presentation: A 68-year-old male presented a right flank pain with fever. The diagnosis of right obstructive pyelonephritis was dressed, after biological and radiological investigations. The obstacle was a crossed ectopic left kidney in its inferior variety. The ectopic kidney was non-functional as result of an obstructive ureteral calculus. The patient had right ureteral stenting with a double-J catheter. Three months later, left nephrectomy was performed by lumbotomy. Per operative difficulties were mainly the infiltration of peri renal fat, the anarchic vascularization and the multiple small pedicles of the ectopic kidney that was also malrotated with the hilum facing anteriorly. Postoperative recovery was uneventful and the patient left the hospital after three days., Clinical Discussion: Crossed Fused renal ectopy is rare. As shown in this case, the ectopic kidney might cause damage to the orthotopic kidney, by compression to urinary ducts. Surgery is the main treatment option. Some difficulties related to aberrant vascularization and possible malrotation is to preview., Conclusion: Crossed fused renal ectopia is uncommon renal anomaly, mostly asymptomatic. However, it may be responsible of some complications, sometimes severe. Surgery can be delicate due to vascular complexity., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Penile fracture is a urologic emergency and is defined as the rupture of the tunica albuginea of the cavernous body in erection., Aim: Our study aims to evaluate patients with penile fracture and to identify the factors that may influence the sexual function after surgical repair., Methods: A total of 138 patients who were diagnosed with penile fracture between January, 1999 and December, 2018 were reviewed. Clinical features, perioperative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed., Main Outcome Measures: Sexual function was evaluated by three parameters six months after surgical repair: International Index of Erectile Function-5 (IIEF-5) questionnaire, penile curvature and the presence of a painful intercourse. All factors that could potentially influence these parameters were analyzed., Results: The mean age was 31.2 years (19-55). Presentation delay ranged from 1 to 5 days (mean = 16.8 hours) while surgery delay was 14.3 hours ().The most common cause of penile fracture in our patients was forcefully bending of the erect penis to achieve detumescence in 62 cases (44.9%). On multivariate analysis, we found that the presentation delay and the fracture site located in the proximal shaft of the penis showed significant difference in the occurrence of postoperative ED (P = 0.03 and P = 0.015 respectively). Presentation delay, elective incision and tuncial leak located in the proximal shaft (P = 0.045; P = 0.018 and P = 0.022 respectively) were associated with higher penis curvature., Conclusion: Immediate surgical repair and circumferential degloving incision for tunical leaks located in the proximal shaft of the penis are recommended in order to decrease the incidence of ED after surgical repair of penile fractures. Ouanes Y, Saadi MH, Alouene HH, et al. Sexual Function Outcomes After Surgical Treatment of Penile Fracture. Sex Med 2021;9:100353., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

This cohort study aimed to investigate prognostic significance of plasma folate and cobalamin in non-muscle-invasive bladder cancer (NMIBC). A total of 177 NMIBC patients were followed over a period extending to 6 years. Cox regression models were applied to estimate risks for recurrence and progression according to plasma vitamins tertiles. Compared to first tertile, third tertile of plasma folate [HR (95% CI), 10.5 (1.32-83.4); p  = 0.026] was associated, and of plasma cobalamin [2.12 (0.63-7.25); p  = 0.116] tended to be associated with higher risk for progression. NIMBC patients with high folate/cobalamin statuses should make the physician more alert for a likely poor outcome.

This study aimed to investigate whether plasma 25-hydroxyvitamin D (25-OHD) at diagnosis predicts poor outcomes in patients with urothelial bladder cancer. A total of 177 patients with non-muscle-invasive bladder cancer (NMIBC) were prospectively followed up over a period extending beyond 6 years. Data on poor outcomes (ie., recurrence, progression, and mortality) were collected. Plasma 25-OHD was measured by immunoassay. Cutoff-Finder web application was used to determine the best 25-OHD cutoff point to predict a specific poor outcome. Cox-hazard models were applied to test how plasma 25-OHD affect patients outcome while adjusting for potential confounding factors. During the follow-up period, tumor recurrence and progression occurred in 40.7% and 14.1% of patients, respectively and 11.3% of patients died. Baseline 25-OHD was lower in patients who experienced poor outcome (12.2 ± 7.44 vs. 16.7 ± 10.6 ng/mL; p  < 0.001). Multi-adjusted HR (95% CI) for vitamin D deficiency (25-OHD < 12 ng/mL) was 2.09 (1.27-3.44) for recurrence, 2.63 (1.06-6.49) for progression and 2.93 (1.04-8.25) for mortality in patients with NMIBC. Low plasma 25-OHD in NMIBC patients is associated with higher risk of poor outcome. Future work is required to test whether correction of vitamin D deficiency will improve quality of life and extend survival in these patients.