Revising SA-CCR

In this article, Mourad Berrahoui, Othmane Islah and Chris Kenyon propose a comparison for SA-CCR, termed Revisited SA-CCR, which reconstructs SA-CCR in a self-consistent and appropriately risk-sensitive way by cashflow decomposition in a three-factor Gaussian market model identified from SA-CCR itself. This framework can guide banks in resolving ambiguities in their SA-CCR interpretation

Management of encrusted ureteral stent: nine years experience in a single center

lntroduction: Ureteral stent insertion is common in urological practice. However, ureteral stent is not without complications or adverse effects. Stent migration, infection, fragementation and encrustation are among the known complicationso f ureterals tents. Objective: To share our experience in the management of stentse ncrustationi n our centre. Material and methods: We retrospectively studied all patients with ureteral stent encrustation which needed intervention either surgically or by ESWL in our centre (HospitalU niversitiS ainsM alaysia).F or a periodo f 9 years (zooz-zoto)a, ll patientsw ith stent encrustationw ho needed surgical or ESWL interventions were included in the study. Demographic data, risk factors and outcome of treatments were studied.T reatmentd ecisionsw ere made basedo n the clinicala nd imagingf indings. Results: 36 patients were included in the study. Mean age at presentation was 48.47 years. There were 2i males and t5 females. The stents were inserted for stone diseases alone(8o.6%)c, ombination of stone diseasesa nd ureteric strictures('n.'t%u),r eteric strictures alone(5.6%a) nd in a case of malignant disease(2.82). The treatment options were ESWL, vesicolitholapaxy, vesicolithotripsy, ureteroscopy, retrograde intra renal surgery (RIRS) and PCNL. All the stents were successfully removed. 583% of the stents were removed in a singles ession.T he rest of the stents needed additional interventions. Conclusion: Eventhough stent insertion is fundamental in urological practice it is not without complications.S tent should only be inserted in patients who are really in need for the stent insertion. However, stent encrustation could still be successfulltyr eated even in the very severec ase

Case report: isolated glans penis gangrene

Introduction Glans penis gangrene is a rare condition that carries special challenges in managing the problem. It is usually associated with vascular insufficiency and amputation is required to prevent spread of infection from the necrotic tissue. While most penile gangrene presented on top of Fournier's gangrene, this particular case presented with isolated glans penis gangrene. Case Report A 60 year-old man, known case of diabetes mellitus, presented with lethargy and poor oral intake for past 1 month. He denied having any prior urinary symptoms, external device applications or trauma. He was treated as having hyperosmolar hyperglycemic state. At catheterization there was blackish discoloration over the glans penis with erythema of surrounding penile shaft. Foley catheter was successfully inserted. His blood investigations were suggestive of infection and acute renal injury secondary to dehydration. Urine analysis was clear of infection. Parenteral Ampicillin and Metronidazole was given empirically. The glans penis was amputated and penile shaft debrided. It was noted no active bleeder upon debriding the corpora until we reached the base of penis. Adjacent tissue of penile urethra was necrotic until base of penis. The remaining healthy penile stump was 1 cm from the base of penis and successfully reconstructed. Post operatively, he recovered well and the catheter was removed after 2 weeks. The patient was able to urinate in a standing position with good urinary flow. Histopathological report showed ischemic necrosis of the glans and along the corpus cavernosa. Discussion Most penile gangrene occurs on top of a Fournier's gangrene setting, and may extend to the penis along the Buck fascia thus compromising vascularity via local infection. In isolated penile gangrene, thromboembolism to end arterial organ is the main culprit. Underlying disease such as diabetes mellitus, smoking and atherosclerosis may precipitate thromboembolic events that eventually affect end-arteries of digits and penis. Amputation may be required to prevent extension of infection, particularly when wet gangrene component is evident. Preserving the penile stump can be done in this case, as the necrosis had not extended to the base of penis. Severe cases require total amputations and perineal urethrostomy or suprapubic cystostomy urinary diversions