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Penile Mondor disease (MD) is a palpable, painful, subcutaneous induration resulting from thrombosis of the superficial dorsal penile vein. In this report, we present a 53-year-old case of Mondor disease following prolonged, vigorous sexual activity. He had engaged in sexual activity the previous night after taking sildenafil. Physical examination revealed penile swelling and tenderness over the protruding dorsal penile vein with no evidence of penile fracture. An in-color Doppler ultrasound was promptly performed, revealing hyperechoic thrombosis in the dilated superficial dorsal penile vein accompanied by soft tissue swelling and the absence of a detectable flow signal within the thrombotic lesion. The patient was diagnosed with penile Mondor disease. The patient received conservative treatment. This case highlights the association between prolonged vigorous sexual activity, oral sildenafil uses and the development of penile Mondor disease.

Actinomycosis is a rare bacterial infection characterized by nonspecific clinical and radiological manifestations. It often presents in cervicofacial, abdominopelvic, and thoracopulmonary forms, with cervicofacial being the most common. The extensive differential diagnosis and vague clinical and radiological features contribute to diagnostic challenges. Cancer, tuberculosis (TB), and nocardiosis are commonly considered in differential diagnoses. This report presents a biopsy-confirmed case of cervicocranial actinomycosis with intracranial extension.

Objective: To determine the utilization of barley and parsley for managing urolithiasis among the Saudi Arabian population. Methods: This is a prospective cross-sectional survey-based study. The survey comprised questions about the use of barley, parsley, and other therapies for managing urolithiasis. A WhatsApp® message with the link to the study survey was sent out to family, friends, patients, and other acquaintances residing in the Kingdom of Saudi Arabia (KSA). Results: A total of 1014 respondents completed the survey, of which 44.8% indicated that they utilized barley, 38.3% stated that they used parsley, and 4.2% indicated that they utilized other non-medical remedies to treat or prevent kidney stones. In contrast, only 29.5% stated that they utilized potassium citrate and/or magnesium citrate, and only 14.4% indicated that they consumed greater amounts of water to treat or prevent kidney stones. Conclusion: Our study findings indicate that among the Saudi Arabian population, non-conventional therapies such as barley and parsley are more commonly utilized for managing urolithiasis rather than established therapies such as increasing water intake and the use of potassium-citrate/ magnesium-citrate. There is a need to conduct large-scale clinical studies to evaluate the efficacy and safety of barley, parsley, and other non-conventional therapies for treating urolithiasis.

Abstract. Background. Atypical Congenital Obstructive Urethral Lesions (ACOUL) are uncommon causes of urethral obstruction in children. They include Cobb’s collar or Moorman’s ring, Type III posterior urethral valve (PUV), congenital urethral narrowing and anterior urethral valves. This study is aimed to evaluate the knowledge and current practice amongst clinicians attending to ACOUL. An international online case based questionnaire was performed. Materials and methods. A survey was administered to members of international urological societies. It included 22 clinical questions on cases with ACOUL (14 questions suitable for statistical analysis) using cases of Type I PUV as controls. Two sets of paired questions evaluated change in opinion(s) after additional information was provided. Results. One hundred twenty-one participants responded with 71% reporting exposure of less than 5 cases per annum. In questions regarding diagnosis between 11.6% (14/121) and 21.5% (26/121) of participants identified the ACOUL as PUV. Among them, 66% of respondents agreed on ACOUL’s causative role in urethral obstruction. Gini coefficient was consistently lower for ACOUL compared to PUV: diagnosis (mean 0.33 vs. 0.44) and prognosis (0.23 vs. 0.43). High intra-rater concordance (kappa 0.420.57) was observed for paired questions–a mean of 5.79% (7.44% and 4.13% for questions 10 and 12, 16 and 17, respectively) of participants changed their answers from an alternate diagnosis to the correct diagnosis of ACOUL after viewing endoscopic images. High variation in management of ACOUL was noted (Gini 0.51). Conclusions. This global snapshot survey identified substantial inconsistency among clinicians dealing with ACOUL. Although rarely encountered in clinical practice, better overall education of ACOUL is warranted.

Bilateral supernumerary kidneys and associated urinary stone disease are rarely seen in clinical practice, and only three cases have been reported in the literature to date. We report a 15-year-old male patient having a bilateral supernumerary kidney with an obstructive left ureteric stone successfully managed with retrograde intrarenal surgery. Stones in such anomalous kidneys pose a challenge for the urologist, and imaging is essential for surgical intervention planning. RIRS with holmium laser lithotripsy is a safe and effective treatment with a high single-stage stone-free rate and low complication rate in experienced hands.

Abstract. Background. To determine the impact of pre-transplant diabetes mellitus (DM) and post-transplant hypertension (HT) at 1 year on renal allograft survival in all adult first kidney-only (FKO) transplant recipients at a single transplant center in Johannesburg, South Africa. Materials and methods. A retrospective review was conducted of all adult FKO transplant procedures at the Charlotte Maxeke Johannesburg Academic Hospital transplant unit between 1966 and 2013. Results. During the stipulated timeframe, 1685 adult FKO transplant procedures were performed. Of these, 84.1% were from deceased donors (n = 1413/1685). The prevalence of pre-transplant DM transplant recipients with no missing or incomplete records was 6.5% (n = 107/1625). Of the total cohort of 1685 adult FKO transplant recipients, 63.6% of those with no missing data survived to 1 year (n = 1072/1685). The prevalence of HT at 1-year post-transplant was 53.6% (n = 503/1072). HT at 1-year post-transplant, even after adjusted survival analysis, proved a significant risk factor for renal allograft loss (hazard ratio, 1.63; 95% confidence interval, 1.37–1.94) (p < 0.0001). Similarly, after adjusted survival analysis, the risk of renal allograft loss within the pre-transplant DM group was significantly higher (p = 0.043; hazard ratio, 1.26; 95% confidence interval, 1.01–1.58). Conclusions. This study identified pre-transplantation diabetes mellitus and post-transplantation HT as significant risk factors for graft loss within the population assessed in this region of the world. These factors could potentially be used as independent predictors of renal graft survival.

Abstract. Newer modalities for treating upper tract urinary stones focus on maintaining and improving outcomes, reducing complications, and optimizing patient care. This narrative review aims to outline novel miniaturized endourological innovations for managing upper tract calculi.

Abstract. Background. Ureteral stents play a major role in maintaining ureteral patency. Various innovations are advocated in the design and subsequent removal of traditional double-J ureteral stents, such as the magnetic-end double-J ureteral stent (MEDJUS). This stent facilitates outpatient removal using a magnetic stent removal device. This systematic review was conducted to analyze the published role, efficacy, and outcomes of MEDJUS. Materials and methods. After PROSPERO registration (CRD42021235739), an electronic database search (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) was performed on December 31, 2020. The search terms were as follows: “magnetic,” “ureteric,” “stent,” “double-J,” “urotech,” and “Black-Star.” Results. Nine studies with a total of 685 patients were included in the systematic review. The total number of MEDJUS procedures used was 498 (73%) compared to the 187 (27%) traditional double-J stent method. Magnetic-end double-J ureteral stent extraction failure was reported in 8 cases (1.61%). Compared with traditional stents, MEDJUS showed a cost benefit in 5/5 studies. Better pain scores (during stent in situ) and (at stent removal) were observed in 2/3 and 3/4 of the studies, respectively. Conclusions. Magnetic-end double-J ureteral stent may serve as a viable alternative to traditional double-J stents, offering cost and pain benefits with similar rates of complications. Magnetic-end double-J ureteral stent also offers relative ease of extraction and a reduced need for inpatient removal. This ambulatory stent removal technique has forged its use in modern urological practice.

Abstract. Objective. The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH) treated with prostatic Aquablation. Materials and methods. We performed a literature search of clinical trials using the MEDLINE, Embase, and Cochrane Library databases and retrieved published works on Aquablation for the treatment of BPH up to August 2021. Unpublished works, case reports, conference proceedings, editorial comments, and letters were excluded. Risk of bias was assessed using the ROBINS-I tool. Raw means and mean differences were meta-analyzed to produce summary estimates for pre- versus post-International Prostate Symptom Scores, maximum flow rate, and male sexual health questionnaire value changes. An inverse-variance weighted random effects model was used. Results. Seven studies were included in this review (n = 551 patients) that evaluated various urological parameters. At 3 months, the International Prostate Symptom Scores raw mean difference from baseline was −16.475 (95% confidence interval [CI], −15.264 to −17.686; p < 0.001), with improvements sustained for 12 months. Similarly, maximum flow rate improved by +1.96 (95% CI, 10.015 to 11.878; p < 0.001) from pre to 3 months postoperatively. In addition, the male sexual health questionnaire change pooled effect size was −0.55 (95% CI, −1.621 to 0.531; p = 0.321) from preintervention to postintervention at 3 months. Meta-analyses of some outcomes showed large statistical heterogeneity or evidence of publication bias. Conclusions. Aquablation seems to improve lower urinary tract symptoms in men with BPH while providing relatively preserved sexual function. Further research is required to confirm these preliminary results.

Background: Diabetes is a major health concern that has grown to alarming proportions. With more than 500 million sufferers globally, diabetes is one of the most prevalent metabolic diseases. The aim of the study is to find the prevalence of impaired fasting glucose (IFG) and undiagnosed diabetes mellitus (DM) in patients presented to our outpatient department at Mogadishu Somali Turkey Training and Research Hospital. Methods: In this cross-sectional study conducted in the largest referral hospital in Mogadishu Somalia, all adult patients who volunteered to give consent have participated in the study. We excluded pregnant women, individuals taking medications that could affect glucose metabolism (e.g., steroids, beta-blockers, and thiazide diuretics), and confirmed diabetic patients from our study. Results: Seven hundred and twenty-two adults with a mean age of 42.85 ± 18.23 years were included. Most of the participants were female 432 (59.8%), aged 20–40 years 329 (45.6%). The prevalence of IFG was common among males (22.4%) and those 60 years and above (30.6%), while the prevalence of undiagnosed DM was high among males (9.7%), aged 40–60 years (13.4%). In the bivariate analysis, total cholesterol, high-density lipoprotein, triglycerides, systolic blood pressure, and comorbidities were found to be significantly associated with the prevalence of IFG in all age groups. Conclusions: IFG was common among outpatient adults. Increased urbanization, the rise of the middle class, and population aging will lead to considerable rises in IFG, undiagnosed diabetes, and diabetes in Somalia in the next years. To limit the growth of diabetes in Somalia, public health interventions must be implemented soon. Promoting the health system and providing education can help.

Abstract. Background:. Coronavirus disease 2019 (COVID-19) has an established impact on multiple organ systems, including the vascular and urogenital systems. Vascular effects may include venous thromboembolic disease, which could theoretically be a precursor to priapism—a urological emergency defined as an abnormal condition of prolonged penile erection lasting >4 hours. To better explore this association, we critically appraised all the published COVID-19 cases associated with priapism. Materials and methods:. After PROSPERO registration (CRD42021245257), a systematic search of Google Scholar, Scopus, Embase, Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Index Medicus, and Cochrane Database of Systematic Reviews was performed using specific search terms. The following study metadata were extracted: age, requirement for respiratory support, cavernous blood gas findings, management of priapism, and patient outcomes. Results:. Fifteen single-patient case reports were included in this review. Of these, all of the patients presented with ischemic priapism, 9 patients (60.0%) were >60 years of age, 4 (26.7%) reported more than a single episode of priapism, 11 (73.3%) presented with pneumonia, 8 (53.3%) required mechanical ventilation, D-dimer was elevated in 5 of the 6 (83.3%) patients in whom this was reported, and among the 13 patients in whom mortality was reported, 4 (30.8%) died. Conclusions:. Early reports suggest a prognostic relationship between COVID-19 and coexisting priapism. However, owing to commonalities in their pathophysiology and the small dataset reported in the literature, the probable association between COVID-19 and priapism is still theoretical. Further research is needed to confirm this association.

Abstract Background Although oral opioid agonist therapies (OATs), buprenorphine and methadone, are effective first-line treatments, OAT remains largely underutilized due to low retention rates and wide variation across programs. This rapid review therefore sought to summarize the retention rates reported by randomized controlled trials (RCTs) and controlled observational study designs that compared methadone to buprenorphine (or buprenorphine-naloxone). Methods We searched four electronic databases (EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, up to April 2018) for RCTs and controlled observational studies that compared oral fixed-dose methadone to buprenorphine versus methadone (or buprenorphine-naloxone). Data were extracted separately for two different definitions of retention in treatment: (1) length of time retained in the study and (2) presence on the final day of a study. Separate random effects meta-analyses were performed for RCTs and controlled observational studies. Data from controlled observational studies where retention was measured as the length of time retained in the study were not amenable to meta-analysis. Results Among 7603 studies reviewed, 10 RCTs and 3 observational studies met inclusion criteria (n = 5065) and compared fixed-dose oral buprenorphine with methadone. Across studies, the average retention rate was highly variable (RCTs: buprenorphine 20.0–82.5% and methadone 30.7–83.8%; observational studies: buprenorphine 20.2–78.3% and methadone 48.3–74.8%). For time period retained in the study, we observed no significant difference in treatment retention for buprenorphine versus methadone in RCTs (standardized mean difference [SMD] = − 0.07; 95% CI − 0.35–0.21, p = 0.63; quality of evidence: low). For presence on the final study day, we observed no significant difference between buprenorphine and methadone treatment retention in RCTs (risk ratio [RR] = 0.89; 95% CI 0.73–1.08, p = 0.24; quality of evidence: low) and controlled observational studies (RR = 0.75; 95% CI 0.36–1.58, p = 0.45). Conclusion Meta-analysis of existing RCTs suggests retention in oral fixed-dose opioid agonist therapy with methadone appears to be generally equal to buprenorphine (or buprenorphine-naloxone), with wide variation across studies. Similarly, a meta-analysis of three controlled observational studies indicated no difference in treatment retention although there was significant heterogeneity among the included studies. The length of follow-up did not appear to affect the retention rate. Systematic review registration PROSPERO CRD42018104452 .

Abstract Background Tizanidine, an α-2 adrenoceptor agonist, is widely prescribed for the management of spasticity in adults. Case reports on pediatric tizanidine overdose are limited. Here, we report a case of pediatric tizanidine toxicity that was reversed with naloxone. Case presentation A 3-year-old male presented to the emergency department with lethargy, bradycardia, and bradypnea after accidental ingestion of multiple tizanidine tablets. Improvements in the level of consciousness and respiratory and heart rates were observed after two intravenous administrations of naloxone at a dose of 0.05 and 0.1 mg/kg, respectively. Conclusions This case report provides further evidence regarding the use of naloxone as a viable antidote for centrally acting α-2 receptor agonists and presents additional epidemiologic data on childhood tizanidine poisoning.

Abstract. Objective:. The objective of this study was to conduct a pilot study to determine the prevalence and patterns of emergency urological presentations and to evaluate their relationship with the lunar cycle and seasonal variation. Methods:. Medical records of subjects that presented with urological pathology to the Emergency Department during the 2017 calendar year were retrospectively reviewed. The data extracted included demographic details, date and day of presentation, presenting complaints, investigations, radiological findings, and final diagnosis. Associations between emergent presentations and the lunar phase and seasonal variation were determined. Results:. A total of 199 subjects were enrolled. The median participant age was 49 (interquartile range 31–64) years with the majority (n = 136, 68.3%) being male. Cystitis (n = 55, 27.6%), prostate cancer (n = 30, 15.1%), benign prostatic hypertrophy (n = 29, 14.6%), and urolithiasis (n = 29, 14.6%) were the most common clinical diagnosis. There were 96 (48.2%) patients who presented during the waxing moon phase, whereas 85 (42.7%) presented during the waning moon phase, 11 (5.6%) presented on the day of full moon, and 7 (3.5%) patients presented on the day of the new moon. Most patients presented during the summer months (n = 61, 30.7%). There was no significant association between the lunar cycle and emergent urological presentations (p = 0.99). Conclusion:. In this pilot study, there was no significant association between the lunar cycle and emergent urological presentations. However, during the summer months more urology-related emergency presentations to the Emergency Department were observed.

The present study aimed to investigate the anti-proliferative effect of the ionic liquid-Graviola fruit (IL-GFE) extract on colon adenocarcinoma (HT29) cell lines and their kinetics behaviour to assess the Graviola fruit potential as a therapeutic alternative in cancer treatment. The phytoconstituents content of IL-GFE was identified using GC-TOFMS apparatus and measured its cytotoxicity on HT29 by tetrazolium bromide. Then the cytokinetic behaviour of the treated HT29 cells with IL-GFE was illustrated using the cells' growth curve. Besides, the cell cycle phase perturbation for the treated HT29 was applied using a flow cytometry technique. Qualitative identification of phytoconstituents of IL-GFE showed that Graviola fruit contains acetogenins, alkaloids, flavonoids, tannins and saponins compounds. IL-GF extract displayed a cytotoxicity effect on HT29 cells with the IC50 value of 10.56 µg/mL, while Taxol showed an IC50 value of 1.22 µg/mL. IL-GFE also decreased the cell generation number from 3.93 to 2.96 generations compared to Taxol-treated cells 2.01 generations. The microscope observation of the HT29 cells treated with the crude IL-GFE displayed loss of density and cell detachment. The extract's growth inhibition was related to the cell cycle arrest at the G0/G1 phase. IL-GFE inhibited colon adenocarcinoma HT29 cells' proliferation and affected their kinetic behaviour by lowering cell viability, inducing apoptosis, and arresting the cell cycle at the G0/G1 phase. ABSTRAK: Kajian ini bertujuan untuk mengkaji kesan anti-proliferatif ekstrak buah-ion Graviola (IL-GFE) pada garis sel adenokarsinoma kolon (HT29) dan tingkah laku kinetik mereka untuk menilai potensi buah Graviola sebagai alternatif terapi untuk barah rawatan. Kandungan fitokonstituen IL-GFE dikenal pasti menggunakan alat GC-TOFMS dan mengukur sitotoksisitasnya pada HT29 oleh tetrazolium bromida. Kemudian tingkah laku sitokinetik sel HT29 yang dirawat dengan IL-GFE digambarkan menggunakan keluk pertumbuhan sel. Selain itu, gangguan fasa kitaran sel untuk HT29 yang dirawat diaplikasikan menggunakan teknik sitometri aliran. Pengenalpastian kualitatif fitokonstituen IL-GFE menunjukkan bahawa buah Graviola mengandungi asetogenin, alkaloid, flavonoid, tanin dan sebatian saponin. Ekstrak IL-GF memperlihatkan kesan sitotoksisiti pada sel HT29 dengan nilai IC50 10.56 µg/mL, sementara Taxol menunjukkan nilai IC50 1.22 µg/mL. IL-GFE juga menurunkan jumlah penjanaan sel dari 3.93 hingga 2.96 generasi berbanding sel yang dirawat Taxol 2.01 generasi. Pemerhatian mikroskop sel HT29 yang dirawat dengan IL-GFE kasar menunjukkan kehilangan ketumpatan dan detasmen sel. Perencatan pertumbuhan ekstrak berkaitan dengan penangkapan kitaran sel pada fasa G0/G1. IL-GFE menghalang percambahan sel HT29 adenokarsinoma kolon dan mempengaruhi tingkah laku kinetik mereka dengan menurunkan daya maju sel, mendorong apoptosis, dan menghentikan kitaran sel pada fasa G0/G1.

The present study is on Acacia seyal gum (ASG), which is an exudate from Talha tree. It provides a rich source of polyphenolics compounds that are used traditionally in folk medicine. The study aims to determine the antioxidant capacity (AC) and functional groups of ASG and Prebio-T-commercial (PTC) samples. The methanol crude extracts of both ASG and PTC have fractioned into chloroform (CHF), hexane (HF), acetone (AF) and methanol (MF) using solvent-solvent portion. Both ferric reducing antioxidant power (FRAP), and cupric reducing antioxidant capacity (CUPRAC) assays for each fraction examined. Crude methanol extracts (CME) and its active compositions also analysed carefully using Fourier Transform Infrared Spectroscopy (FTIR) technique. The findings presented a wide variety of functional groups provided by the FTIR spectra (eights bands approximately. Regarding cupric reducing antioxidant capacity (CUPRAC), the methanol crude extracts values are 888.6±4.57 mg TE/100g extract, for PTC as compared to 474.3± 2.23 mg TE/100g of extract for ASG. However, both methanol and acetone fractions revealed significantly (p ≤ 0.05) high FRAP values ranged between 599.8±7.5 and 741.8±5.8 mg TE/100g fraction; for PTC and ASG, respectively. While CUPRAC showed insignificant (p ≥ 0.05) same values 356.1±2.62 mg TE/100g of fraction; for MF of both PTC and ASG respectively. Therefore, in this study, methanolic fractions (MFs) are found to be more effective than acetone fractions (AFs), except for CHF and HF. Finally, the antioxidant activity of the active fraction has provided some evidence regarding its functional groups which may have used in traditional medicine.

The recently introduced 6-dyes Yfiler® Plus multiplex kit which includes 27 Y-STR loci has been used to study 436 UAE Arab male individuals. In addition to the 17 Y-STRs traditionally used in Yfiler® multiplex kit, Yfiler® Plus has ten additional Y-STRs. It includes seven rapidly mutating Y-STRs (RM Y-STRs) namely DYS560, DYS576, DYS627, DYS518, DYS449 and DYF387S1ab, and three moderately mutating Y-STRs namely DYS481, DYS533 and DYS460. The RM Y-STRs were already proven to be powerful for discriminating closely related and unrelated males’ individuals. As a result, a total number of 419 haplotypes were observed out of 436 samples analysed of UAE Arab males’ population, whereas 15 haplotypes were shared between two individuals and one haplotypes were shared between three individuals. The discrimination capacity (DC) for the 27 loci was found to be 0.9618 whereas haplotype diversity (HD) was found to be 0.99982. AMOVA results showed that UAE population clustered along with Saudi Arabia East [Arab] population which indicates that they have a closer genetic relation. While it was standing away compared to other relevant populations. In conclusion, Yfiler® Plus multiplex kit showed higher power of discrimination than all previous studies conducted on the same population. This study considered the first study conducted using 27 Y-STR loci in this population. Geographic distribution of the populations analysed in this study are well reflected in the genetic distance results.

Background: The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. Objectives: We aimed to review the role of the ‘ideal’ ratio on predicting residual PUV post-ablation. Methods: A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included ‘Urethral Ratio and Posterior urethral valve ablation’. All cited reference lists were further evaluated for additional inclusive studies. Results: Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 (p = 0.001), 2.5–3 and 3.5. Conclusion: Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2–3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.

Background: Substance use disorders represent a significant social and economic burden globally. Accurate diagnosis and treatment by early career professionals in addiction medicine (ECPAM) falls short, in part, due to a lack of training programmes targeting this career stage. Prior research has highlighted the need to assess the specific training needs of ECPAM. Therefore, this focused review assessed self-reported training needs of ECPAM. Methods: Medical and medical education databases (Medline, EMBASE, CINAHL, ERIC, PSYCHInfo, BEI, and AEI) were searched to June 2018 for studies reporting self-reported training needs of ECPAM (trained at most five years before assessment occurred). Retrieved citations were screened for eligibility; two independent researchers reviewed included studies, assessed quality and extracted data. Experts reviewed study findings. Results: Of 1364 identified records, three cross-sectional studies were included, originating from China, USA and England. All studies surveyed ECPAM using self-reported questionnaires, with one study including face-to-face interviews. Participants included residents, physicians and social workers. All studies had a low risk of bias, and reported a wide range of training needs including rehabilitation, relapse prevention, buprenorphine treatment and risk assessment. Conclusions: There is little evidence for and substantial heterogeneity of training needs of ECPAM found in this review, particularly at the level of skills and knowledge. Study quality varies greatly. ECPAM training needs assessments are a priority.

Objective: We aimed to describe a novel method to attain direction and control of the guidewire at the fingertip. This will serve to allow for ease of guidewire placement during open and combined open and endoscopic surgery. Subjects and methods: Over a gloved hand, a ureteric catheter is placed over the index finger, with the distal tip over the distal end of the index finger. Thereafter, adhesive tape is applied over the ureteric catheter (over the proximal, and middle phalanges) to allow for ease of flexion of the index finger. A second glove is then covered over the first one, with care not to rotate or dislodge the fixated ureteric catheter. A small hole is cut at the distal end of the glove, at the tip of the ureteric catheter to allow the guidewire to exit. The guidewire is advanced easily and can now be directed using the ‘loaded’ fingertip. Results: An easily manipulated system of guidewire insertion, with fingertip mobility and dexterity is obtained utilizing everyday consumables in a simple to perform fashion. Conclusion: A simple, novel method to allow flexibility and stress-free maneuvering to pass a guidewire, in open or combined open and endoscopic urological surgery is described. Keywords: Method, Technique, Guidewire, Fingertip, Fistula, Ureteric Orifice

Introduction: Enuresis (or Nocturnal Enuresis) is defined as discreet episodes of urinary incontinence during sleep in children over 5 years of age in the absence of congenital or acquired neurological disorders. Recommendations: Suggestions and recommendations are made on the various therapeutic options available within a South African context. These therapeutic options include; behavioural modification, pharmaceutical therapy [Desmospressin (DDAVP), Anticholinergic (ACh) Agents, Mirabegron (β3-adrenoreceptor agonists), and Tricyclic Antidepressants (TCA)], alternative treatments, complementary therapies, urotherapy, alarm therapy, psychological therapy and biofeedback. The role of the Bladder Diary, additional investigations and Mobile Phone Applications (Apps) in enuresis is also explored. Standardised definitions are also outlined within this document. Conclusion: An independent, unbiased, national evaluation and treatment guideline based on the pathophysiological subcategory is proposed using an updated, evidence based approach. This Guideline has received endorsement from the South African Urological Association, Enuresis Academy of South Africa and further input from international experts within the field. Keywords: Enuresis, Nocturnal Enuresis, South African, Therapeutic options, Mobile Phone Applications (Apps), Treatment guideline, Expert consensus

Introduction: The ‘encrusted and forgotten double J ureteric stent (JJ) phenomenon has always proven to be a challenging dilemma facing the attending urologist. Observation: Herein, we describe the first reported case of 3 encrusted stents within the same ureter, with an overall KUB score of 14 (K = 5, U = 4, B = 5). Complete (stent and stone) clearance was achieved using multiple combined, endo-urological procedures (sequentially) including; bladder stone laser lithotripsy, distal JJ stent coil resections, PCNL and prograde (flexible) ureteroscopy, followed by rigid and flexible retrograde ureteroscopy. The resulting reno-gram confirmed a 45% functioning ipsilateral system. Conclusion: The first report of 3 encrusted stents within the same ureter is presented. The prevention of JJ stent encrustation is crucial via adequate and appropriate patient counselling. In most patients with forgotten encrusted stents who qualify for endoscopic management, a multi-modality approach is required.

This paper investigates the impacts that open-trench drains make on the accuracy of radio propagation prediction in an urban city environment. Compared with conventional prediction styles that assume the ground to be flat, in this paper, we have considered for the first time the real scenario in many Asian cities to make open-trench drains inclusive in radio propagation modeling. The aims of this paper are twofold. First, to scrutinize one narrow L-shaped structure, modeled after an open-trench drain, by means of comparing ray-tracing simulation results with the actual field measurement results at 2.4 and 5.8 GHz. Second, to compare one city model built without and with the inclusion of open-trench drains for running ray-tracing simulation in yielding radio propagation prediction results. The findings from this paper are especially beneficial to the improvement of mobile communications in extraordinary environments such as open-trench drains, caves, coal mines, underground passageway, and others. Besides, they provide a unique insight into how the presence of the open-trench drains may affect radio wave propagation in an urban city environment.

Objective Cardiovascular disease (CVD) is one of the leading non-AIDS-defining causes of death among HIV-positive (HIV+) individuals. However, the evidence surrounding specific components of CVD risk remains inconclusive. We conducted a systematic review and meta-analysis to synthesise the available evidence and establish the risk of myocardial infarction (MI) among HIV+ compared with uninfected individuals. We also examined MI risk within subgroups of HIV+ individuals according to exposure to combination antiretroviral therapy (ART), ART class/regimen, CD4 cell count and plasma viral load (pVL) levels.Design Systematic review and meta-analysis.Data sources We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews until 18 July 2018. Furthermore, we scanned recent HIV conference abstracts (CROI, IAS/AIDS) and bibliographies of relevant articles.Eligibility criteria Original studies published after December 1999 and reporting comparative data relating to the rate of MI among HIV+ individuals were included.Data extraction and synthesis Two reviewers working in duplicate, independently extracted data. Data were pooled using random-effects meta-analysis and reported as relative risk (RR) with 95% CI.Results Thirty-two of the 8130 identified records were included in the review. The pooled RR suggests that HIV+ individuals have a greater risk of MI compared with uninfected individuals (RR: 1.73; 95% CI 1.44 to 2.08). Depending on risk stratification, there was moderate variation according to ART uptake (RR, ART-treated=1.80; 95% CI 1.17 to 2.77; ART-untreated HIV+ individuals: 1.25; 95% CI 0.93 to 1.67, both relative to uninfected individuals). We found low CD4 count, high pVL and certain ART characteristics including cumulative ART exposure, any/cumulative use of protease inhibitors as a class, and exposure to specific ART drugs (eg, abacavir) to be importantly associated with a greater MI risk.Conclusions Our results indicate that HIV infection, low CD4, high pVL, cumulative ART use in general including certain exposure to specific ART class/regimen are associated with increased risk of MI. The association with cumulative ART may be an index of the duration of HIV infection with its attendant inflammation, and not entirely the effect of cumulative exposure to ART per se.PROSPERO registration number CRD42014012977.

Introduction. Acute urinary retention is a rare occurrence in women necessitating further investigation. Potential underlying causes may be broadly classified into obstructive, neurological, pharmacological, and psychogenic categories. Case. A 36-year-old nulliparous female presented to the Emergency Department with a two-day history of acute urinary retention. Point-of-care ultrasonography and CT scan imaging confirmed the presence of a large uterine mass causing compression of the bladder. The acute retention was relieved with urethral catheterization. A Uterine leiomyoma was confirmed on histology after hysterectomy. Discussion. Once the acute urinary retention has been relieved by insertion of a urethral catheter, the underlying cause of the obstruction must be determined. Although uterine leiomyoma is a fairly common finding in the general population, it is an extremely rare cause of acute urinary retention in women with just a handful of reported cases in the literature.

The bladder hamartoma is an extremely rare entity. We report on its presence in a 5-year-old boy with Goldenhar syndrome. Most probably, this is the first report of a bladder hamartoma presenting with obstruction of the bladder outlet resulting in urinary retention. The obstructive lesion was resected endoscopically. This proved to be curative for the lesion, since the follow-up voiding cysto-urethrogram revealed only a negligible post-void residual volume. Although urogenital anomalies have a well-known correlation with the Goldenhar syndrome, the existence of the bladder hamartoma found in association with this syndrome, according to the best of our knowledge, has not been previously reported in the world literature. With this report being only the 11 th described case of bladder hamartoma, we highlight on the management options for this exceptional histological finding. The incidence, screening, treatment decisions and important urogenital associations of the Goldenhar syndrome are also discussed.