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Background: Bladder cancer is ranked the ninth most common cancer in the world. Locally, the incidence of bladder cancer has increased tenfold over the past 26 years. Radical cystectomy (RC) is considered a gold standard management option for muscle-invasive bladder cancer (MIBC), but trimodal therapy (TMT) has shown comparable oncological outcomes in selected patients. Materials and Methods: This is a retrospective study in which we reviewed medical records of patients diagnosed with MIBC without nodal disease or distant metastasis (cT2N0M0) who underwent either RC or TMT. Demographic data, comorbidities, histopathological and clinical staging, neoadjuvant/adjuvant therapy, and follow-up were analyzed. Results: We included a total of 31 patients in the study, with 10 patients in the TMT group and 21 patients in the RC group. There was no significant difference in recurrence between the TMT and RC groups (P = 0.58). The TMT group had a higher percentage of local recurrence (40% vs. RC 5.2%, P = 0.018) but no significant difference in metastasis (0% vs. 10%, P = 0.420). The difference in overall survival between the TMT and RC groups was not significant (P = 0.25). Conclusion: TMT may be considered an alternative option for patients unwilling to undergo RC due to related complications and prioritize a better quality of life. However, the decision should be made after considering the cost of extensive follow-ups and patient compliance with surveillance.

Introduction and Study Purpose: Renal pedicle control is a crucial period in laparoscopic donor nephrectomy (LDN). Till now, there is no standardized technique for renal pedicle control. Proper evaluation and investigation of the different ways of renal vessel control have to be done to avoid any calamitous event. We aim to prove the safety and reliability of the Hem-o-Lok clips for the renal vascular control in transperitoneal LDN. Methods: All LDNs or hand-assisted LDNs done between January 2016 and December 2018 were collected. The primary outcome was the safety of the Hem-o-Lok clips. The secondary outcomes were blood loss, ischemia time, hospital stay, cost, and operative time. The data were analyzed using SPSS 20, and a statistical package was conducted. Results: The data showed that 238 laparoscopic donor nephrectomies were done. The renal pedicle control during the 1st year was done using a vascular stapler for the artery (63 cases) and two polymer self-locking clips extra-large (XL) for the vein. Two events were reported in the form of mechanical failure. In the following 2 years, the artery was controlled using polymer self-locking clips large (L) few millimeters distal to the aorta and two metallic clips distal to it to increase the safety and stability of the vascular stump (175 cases). However, the vein was controlled by the two polymer self-locking clips XL. There was no reported intraoperative complications or events related to this way of pedicle control; there was no open conversion or blood transfusion required. There was no postoperative complication or collection in ultrasound. Conclusion: Using a combined polymer self-locking clip few millimeters distal to the aorta and two metallic clips distal to it for renal artery control in laparoscopic donor nephrectomies is cost-effective and safe. However, further and broader evidenced base studies are still needed to establish a standard technique for renal pedicle control.

Introduction: About 15% of couples are infertile, with the male factor being responsible for about 50% of these cases of infertility. Idiopathic oligospermia (IO) is a dilemma that faces every andrologist and yet is one of the most common causes of male infertility. Although studies have shed some light on multiple treatment modalities and their effectiveness, one of the most fascinating ones is follicle-stimulating hormone (FSH). Methodology: This is a single tertiary center retrospective study; all patients with severe IO (sperm count of

Varicocele is a common case encountered in urology practice accounting for 15–20% of the general population. We are reporting a rare case of infected inguinal wounds post bilateral microsurgical varicocelectomy which led to persistent bilateral wound sinus formation. After multiple bedside wound debridement and sinus tract excision in operation theater, the patient's wounds were healed. We advise managing post-operative subcutaneous collections very closely to avoid such complications. When it happens and wound debridement is planned, we advise not to leave any dead space behind via using fat flaps.

Hydroceles are one of the most common causes of scrotal swelling affecting around 1% of the adult population. While hydroceles are usually asymptomatic, some hydroceles can lead to infertility. We will present a case of a 34-year-old man who was referred to our center as a case of primary infertility (sever oligospermia 1.1 million/ml) for 4 years and was found to have bilateral hydroceles (infected right hydrocele). At 18 months post bilateral hydrocelectomy, the patient's total sperm count improved to 43 Million/ml. Therefore, we highly recommend considering hydrocele as an etiology in any patient with idiopathic infertility. Keywords: Hydrocele, Infertility, Spermatogenesis

Sex cord tumors of the testis in post pubertal men are rare. Mixed leydig-Sertoli-Granulosa sex cord tumors are exceptionally rare. To the best of our knowledge there is only three reported similar cases in the literature. We reported a case of a 27-year-old male who presented with huge left scrotal mass of 6-years duration. The gross tumor specimen after resection measured 11 cm in diameter. Histological examination revealed mixed sex cord stromal tumor. This case demonstrates the limited ability of accurate diagnostic determination preoperatively, with pathologic examination and immune-histochemical staining post-orchiectomy representing the only definitive means of diagnosis. It also highlights the unique radiological appearances of this tumor, which are not previously reported in literature.