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Objective: To develop and validate an artificial intelligence (AI)-based algorithm for capturing automated measurements of Penile curvature (PC) based on 2-dimensional images. Materials and methods: Nine 3D-printed penile models with differing curvature angles (ranging from 18 to 88°) were used to compile a 900-image dataset featuring multiple camera positions, inclination angles, and background/lighting conditions. The proposed framework of PC angle estimation consisted of three stages: automatic penile area localization, shaft segmentation, and curvature angle estimation. The penile model images were captured using a smartphone camera and used to train and test a Yolov5 model that automatically cropped the penile area from each image. Next, an Unet-based segmentation model was trained, validated, and tested to segment the penile shaft, before a custom Hough-Transform-based angle estimation technique was used to evaluate degree of PC. Results: The proposed framework displayed robust performance in cropping the penile area [mean average precision (mAP) 99.4%] and segmenting the shaft [Dice Similarity Coefficient (DSC) 98.4%]. Curvature angle estimation technique generally demonstrated excellent performance, with a mean absolute error (MAE) of just 8.5 when compared with ground truth curvature angles. Conclusions: Considering current intra- and inter-surgeon variability of PC assessments, the framework reported here could significantly improve precision of PC measurements by surgeons and hypospadiology researchers. Special thanks for Dr. Carlos Villanueva for providing us with the 3D printed penile models with pre-defined angulations utilized in -. Open Access Fund fees were supported by Qatar National Library. Scopus

Tariq O Abbas,1–3 Mohammed Abdelkareem,4 Abdelrahman Alhadi,4 Vishwanatha Kini,5 Prem Chandra,6 Abdulla Al-Ansari,4 Mansour Ali1 1Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar; 2College of Medicine, Qatar University, Doha, Qatar; 3Weill Cornell Medical College-Qatar, Doha, Qatar; 4Urology Department, Hamad General Hospital, Doha, Qatar; 5Radiology Department, Hamad General Hospital, Doha, Qatar; 6Medical Research Center, Hamad Medical Corporation, Doha, Qatar Purpose: Testicular torsion (TT) represents a clinical challenge that needs emergency surgical assessment. It is common to have negative scrotal exploration due to confounding symptoms and signs which makes it sometimes difficult to differentiate from similar surgical emergencies that do not warrant surgery. At the same time, several occasions of misdiagnoses or late interventions occur with devastating effects. We aim at delineating the significance of the different clinical, laboratory, and radiological variables in the detection of TT.Methods: We retrospectively reviewed the charts of 52 patients who were surgically explored with a preoperative working diagnosis of suspected TT in our center over the period from 2011 to 2015. All the patients were examined by pediatric surgeons in the emergency room and had undergone ultrasound imaging of the testes. The ultrasound images were retrospectively reviewed by a pediatric radiologist who was blinded to the intraoperative findings. Univariate and multivariate and logistic regression analyses were performed.Results: Of the studied group of patients, the majority (84.6%) had TT upon surgical exploration. The most frequently presented symptom was pain (80.8%), and only a minority (11.5%) presented with vomiting. Radiological findings with the highest sensitivity were heterogeneous echogenicity in favor of TT and enlarged epididymis indicating that TT is unlikely. However, the predictability of TT by any of the assessed clinical and imaging factors was statistically insignificant.Conclusion: It is important to gather all relevant data from clinical, laboratory, and imaging sources when assessing pediatric patients with suspected TT given the inaccuracy of each single one of them if used alone. Keeping this in mind, Doppler ultrasound has a significant role to aid in the accuracy of the diagnosis and hence the appropriate decision-making thereafter. However, we found no single clinical or imaging sign that is sensitive enough to prove or rule out TT. Therefore, surgical exploration should take place in a timely manner. Moreover, further research is necessary to construct scoring systems where different predictors collectively have higher reliability. Keywords: testicular torsion, Doppler ultrasound, children, spermatic cord torsion, diagnosis

Hypospadias is a common birth defect of the male external genitalia. However, there are conflicting arguments about the optimal classification approach and ideal surgical technique. We have introduced the Plate Objective Scoring Tool (POST) to define critical glanular phenotypic landmarks of the urethral plate. We propose that POST can objectively, reproducibly, and accurately determine urethral plate quality, thus permitting robust comparison between the different surgical techniques commonly utilized in hypospadias repair. Furthermore, the POST scoring system represents a versatile tool that can objectively quantify key variables in hypospadiology that are currently not well defined. Further validation of POST should lead to better identification and management of postoperative complications., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/yy_2-OaaCVw, Graphical Abstract

In order to reconstruct injured urinary tract tissues, biodegradable scaffolds with autologous seeded cells are explored in this work. However, when cells are obtained via biopsy from individuals who have damaged organs due to infection, congenital disorders, or cancer, this can result in unhealthy engineered cells and donor site morbidity. Thus, neo-organ construction through an alternative cell source might be useful. Significant advancements in the isolation and utilization of urine-derived stem cells have provided opportunities for this less invasive, limitless, and versatile source of cells to be employed in urologic tissue-engineered replacement. These cells have a high potential to differentiate into urothelial and smooth muscle cells. However, urinary tract reconstruction via tissue engineering is peculiar as it takes place in a milieu of urine that imposes certain risks on the implanted cells and scaffolds as a result of the highly cytotoxic nature of urine and its detrimental effect on both growth and differentiation of these cells. Both of these projections should be tackled thoughtfully when designing a suitable approach for repairing urinary tract defects and applying the needful precautions is vital.

Several congenital and acquired conditions may result in severe narrowing of the urethra in men, which represent an ongoing surgical challenge and a significant burden on both health and quality of life. In the field of urethral reconstruction, tissue engineering has emerged as a promising alternative to overcome some of the limitations associated with autologous tissue grafts. In this direction, preclinical as well as clinical studies, have shown that degradable scaffolds are able to restore the normal urethral architecture, supporting neo-vascularization and stratification of the tissue. While a wide variety of degradable biomaterials are under scrutiny, such as decellularized matrices, natural, and synthetic polymers, the search for scaffold materials that could fulfill the clinical performance requirements continues. In this article, we discuss the design requirements of the scaffold that appear to be crucial to better resemble the structural, physical, and biological properties of the native urethra and are expected to support an adequate recovery of the urethral function. In this context, we review the biological performance of the degradable polymers currently applied for urethral reconstruction and outline the perspectives on novel functional polymers, which could find application in the design of customized urethral constructs.

Congenital mid ureteric valve (MUV) stenosis is a very rare entity. Definitive preoperative diagnosis is clinically challenging, and most patients are misdiagnosed preoperatively. Intraoperative identification is therefore very important. Curative treatment consists of excision of the involved ureteric segment and anastomosis. This report describes the clinical findings in a patient with congenital mid ureteric valve stenosis, including radiological and histological workup and operative management. Routine intraoperative retrograde pyelography is important in the diagnosis of such rare pathologies.

Perinatal testicular torsion is a relatively rare event that remains unidentified in many situations and managed only after an avoidable delay of time. Its current management approaches include watchful observation, delayed contralateral orchiopexy, and emergent contralateral orchiopexy. On the other hand, bilateral torsion is now being more frequently reported. However, the assessment of the contralateral testis through physical examination and imaging can be inaccurate in cases of perinatal torsion. We report a case of prenatal testicular torsion with incidentally discovered metachronous contralateral extravaginal testicular torsion. Therefore, immediate surgical intervention is recommended both when uni- or bilateral testicular torsion is suspected. Whenever possible, affected testes should be preserved as some endocrine function may be retained.