The Penile Perception Score after distal hypospadias repair with tubularized incised plate and Mathieu

Objective: The aim of this study was to evaluate the Penile Perception Score (PPS) after repair of distal penile hypospadias using tabularized incised plate (TIP) and Mathieu procedures.Methods: A randomized controlled study was conducted at urology department from October 2013 to May 2014. It included 60 children who were divided into three groups: group A included 20 patients with distal hypospadias corrected using TIP; group B included 20 patients with distal hypospadias corrected using Mathieu; and group C included 20 children with normal male genitalia who were circumcised and considered as a control group.Results: There were no statistically significant differences between group A and group B in urologists’ and parents’ average sum of PPS evaluation, but urologists’ satisfaction was more than parents’ satisfaction. The PPS for TIP was 8.43 and 7.80 for urologists and parents, respectively. The difference was significant. The PPS for Mathieu were 8.04 and 7.89 for urologists and parents, respectively, with no significance. There were no statistically significant differences between group A and group B in the postoperative evaluation by urologists and by parents in meatus, glans, shaft skin, and general appearance. There were complications in 10% of cases from group A in the form of fistula, in 30% of cases from group B in the form of fistula in 25% and meatal stenosis in 5%, and no complication in group C.Conclusion: TIP showed better PPS score compared with Mathieu in hypospadias repair. However, the results of this study were not statistically significant. PPS was a good scale to evaluate hypospadias repair after surgery.Keywords: hypospadias, parents and urology, Penile Perception Scor

Gonadal infection: a risk factor for the development of adolescent varicocele

Objective: The aim of this study was to determine whether a relationship between previous gonadal infections and adolescent varicocele occurrence exists.Patients and methods: All adolescents who presented with varicocele at Tanta Urology Department during the period from January 2006 to March 2011 were included in this study. Patients were evaluated for age, clinical presentation, previous history of epididymitis or epididymoorchitis, laterality, and grading of varicocele. Examination of testicular consistency and ultrasound measurement of testicular volume were carried out for all patients to define those with testicular atrophy.Results: Sixty-three boys were included in this study. The mean patients’ age was 15.6 years (range: 10–18, SD; 1.6 years). Twenty-nine (44.4%) boys had signs of testicular atrophy (testes are soft in consistency with ultrasounddetected volume smaller than that normal for age) either unilateral or bilateral. About 28.6% of patients (18 boys) had a history of epididymitis or epididymo-orchitis either associated with mumps or of unknown etiology. Of those patients, six boys had previous history of single attack, 10 boys had two attacks, and two boys had more than two attacks of epididymo-orchitis. A significant positive correlation was seen between the incidence of epididymo-orchitis attacks and the grade of varicocele (rs=0.63, 95% confidence interval: 0.21–0.85, P<0.05). Patients with past history of epididymo-orchitis were significantly more liable (4.1 times) of developing testicular atrophy as compared with those without a history of epididymo-orchitis (95% confidence interval: 1.517–11.097, P<0.05).Conclusion: History of epididymo-orchitis is significantly a potential risk factor for the development of adolescent varicocele with subsequently higher risk for testicular atrophy. We advise routine ultrasonographic examinations in patients with previous history of epididymo-orchitis both for possible early detection of varicocele and to avoid testicular atrophy in this cohort of patients. However, more studies on a larger scale are still warranted.Keywords: adolescent varicocele, epididymo-orchitis, testicular atroph

Urinary and sexual functions after surgical treatment of penile fracture concomitant with complete urethral disruption

Objectives: Penile fracture with concomitant complete urethral disruption is an uncommon urologic disorder. Data about the treatment and outcome measurements of this condition are scarce in the literature. The aim of the present study is to evaluate the long term urinary and sexual functions of patients with penile fracture associated with complete urethral injury after immediate surgical reconstruction. Patients and methods: Twelve patients met our inclusion criteria and were included in this retrospective case series study; however, one was lost during follow-up. Patient's medical records were reviewed and all patients were interviewed for clinical evaluation. Urinary function was assessed by history, uroflometry and retrograde urethrography, while, sexual function was assessed by questionnaire (Sexual Health Inventory for Men) and penile Doppler for patients with erectile dysfunction. Results: Patients’ mean age was 32.3 ± 7.5 years (range 21-43) and the mean follow-up period was 72.6 ± 45.4 months (range 14-187). Vigorous sexual intercourse was the main cause in 91% of our patients. No serious long term complications was found. Only 1 patient (9%) suffered from anterior urethral stricture, 1 patient (9%) complained of weak erection, 3 patients (27%) had a palpable fibrosis and 2 patients (18%) reported a slight penile curvature during erection. Ninety one percent of all our patients maintained their normal urinary and sexual functions. Conclusion: On the long term follow-up, most of the patients maintained their normal erectile and voiding functions with no harmful long-term complications. We advocate immediate surgical intervention and reconstruction of both corpora cavernous and urethra as a first line treatment for those patients

Clinical significance of prostatic-urethral angulation on the treatment outcome of patients with symptomatic benign prostatic hyperplasia treated with tamsulosin hydrochloride

Objectives: To evaluate the impact of the prostatic-urethral angulation (PUA) on the treatment efficacy of selective alpha-1A receptor blocker in male patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Materials and methods: A total of 80 patients with LUTS/BPH and with mean age 53.3 ± 6.3 (range 47-70) were included in our prospective comparative study. The patients were classified into 2 groups as a consecutive cases 40 in each one depending on the PUA either ≤ 35° (group A) or > 35° (group B). PUA and different prostatic parameters were measured using transrectal ultrasound. Prostate-specific antigen (PSA), the International Prostate Symptom Score and quality of life score (IPSS/QoL score), maximum flow rate (Qmax), and postvoid residual (PVR) volume were compared between the groups. The clinical significance of PUA was evaluated after 8 weeks of medical treatment with tamsulosin hydrochloride 0.4 mg daily. Results: Baseline evaluation (pre-treatment) for both groups were comparable to each other with no clinically significant difference regarding age, PSA, IPSS/QoL score, Qmax and PVR volume (P-value > 0.05). Comparison of parameters after 8 weeks showed that tamsulosin hydrochloride improved the total IPSS and all subscores (P < 0.001), QoL (P = 0.001), Qmax (P = 0.002), and PVR (P = 0.04) in group A (Table 1). Conclusion: Tamsulosin hydrochloride appears to be less effective in improving IPSS/Qol score, Qmax and PVR in patients with lager PUA. The PUA might be a predictor for the treatment efficacy of α-blockers and more studies are warranted in the future before the final conclusion

Monoclonal Antibody Treatment of RSV Bronchiolitis in Young Infants: A Randomized Trial.

BACKGROUND: Monoclonal antibody to respiratory syncytial virus (RSV; palivizumab) is recommend for prophylaxis of high-risk infants during bronchiolitis seasons but not for RSV bronchiolitis treatment. Our aim was to determine if palivizumab would be helpful in young infants with acute RSV bronchiolitis. METHODS: Eligible infants ≤3 months old presenting to the pediatric emergency service with RSV-positive bronchiolitis requiring inpatient admission underwent double-blind random assignment to single-dose intravenous palivizumab (15 mg/kg) or placebo. The primary efficacy outcome was the need for inpatient readmission in the 3 weeks after discharge. Secondary outcomes were time to readiness for hospital discharge, need for PICU on the initial admission, and need for revisit not requiring readmission for the same illness during 3-week follow-up. RESULTS: A total of 420 infants (median age 49 days) diagnosed with RSV bronchiolitis were randomly assigned; 417 received treatment, and 413 completed follow-up. Readmission during follow-up was needed for 23 (11%) patients on palivizumab and 19 (9.3%) patients in the placebo group (difference 1.8%; 95% confidence interval -4.4% to 7.7%; CONCLUSIONS: Intravenous palivizumab did not appear to help or harm young infants with acute RSV-positive bronchiolitis