African Journal of Urology <p>The <em> African Journal of Urology</em> is the official journal of the Pan African Urological Surgeons‘ Association (PAUSA) The journal is a bilingual publication - publishing articles in English and French. The <em>African Journal of Urology</em> covers the whole scope of urology as well as the related basic sciences. In allignment with the objectives of PAUSA, it has a special concern with urologic diseases and problems related to Africa. The scope of the AFJU includes, urinary tract related oncology, endourology, female and reconstructive urology, genitourinary medicine, andrology, uro-pharmacology, uro-radiology, and voiding dysfunctions.</p><p>Other websites related to this journal include: <a title="" href="" target="_blank"></a></p> en-US Copyright for articles published in this journal is retained by the journal. (Ismail Khalaf, M.D) (Mrs. Ingrid El-Damanhoury) Tue, 22 Jan 2019 14:04:25 +0000 OJS 60 Role of MMP-2, MMP-9 and VEGF as serum biomarker in early prognosis of renal cell carcinoma <p><strong>Introduction</strong>: Renal cell carcinoma epitomizes a diversified group of tumors which contributes more than 15,000 deaths annually worldwide. In spite of tremendous efforts to identify prognostic factors apart from grade, histology and tumor size, they are not so obvious yet to fulfill the requirement. In this study, the prognostic role of serum matrix metalloproteinase (MMP)-2, 9, and vascular endothelial growth factor (VEGF) levels in patients with pre and postoperative renal cell carcinoma are evaluated to use as biomarker.<br /><strong>Patients and methods</strong>: A total of 100 patients with a diagnosis of renal cell carcinoma included in the study. Additionally, hundred healthy kidney donors enrolled as control, serum MMP-2, MMP-9, and VEGF levels were analyzed in the serum of post and preoperative patients and parallel in control serum samples by ELISA method.<br /><strong>Result</strong>: Most of the patients with RCC were found to have high concentrations of serum MMP-2, MMP-9, and VEGF. The levels of MMP-2 in the serum of preoperative patients ranged from 627 to 1117 ng/ml (833.90 ± 111.91), postoperative MMP-2 range 302–913 (553.02 ± 150.08), control range 122–384 (228.33 ± 72.52). In MMP-9 pre-operative range 619–1233 (862.32 ± 119.77), post-operative range 124–909 (552.88 ± 151.91) and control range 42–467 (245.44 ± 116.52 and in VEGF preoperative range was 0.792–2.214 (1.35 ± 0.36), postoperative range was 0.315–1.917 (0.81 ± 0.46) and in control it was 0.01–0.39 (0.10 ± 0.09). We observed that preoperative levels of all three markers, were significantly increased if compared with postoperative and control levels (P = 0.001) however, no any significant correlation found when the levels correlated with grade, stage, size, and type for MMP-2 and MMP-9, but VEGF shows some significance in comparison.</p> S. Ahmad, V. Singh, R.J. Sinha, A. Srivastava, A. Mandhani Copyright (c) Sensitivity and specificity of 47 kDa polyclonal antibody for detection of bladder cancer cells in urine of hematuria patients <p><strong>Objective</strong>: To investigate the performance analysis of immunocytochemistry using 47 kDa polyclonal antibody compared with cytology in urine of patients hematuria symptom.<br /><strong>Patients and methods</strong>: Patients with a suspicion of bladder tumor based on workup of hematuria were prospectively collected. The voided urine was performed for cytology and test with 47 kDa polyclonal antibody.<br /><strong>Results</strong>: This study involved 39 patients consisting of 35 (89.74%) male and 4 (10.25%) female patients. For male patients, they showed 6 (17.14%) of positive cytology cases and 25 (71.42%) of positive immunocytochemistry cases. For female patients, they showed 0 (0.00%) of positive cytology cases and 2 (50.00%) of positive immunocytochemistry cases. The sensitivity and specificity value for immunocytochemistry using polyclonal antibody to the 47 kDa were 100.00% (95% CI = 54.07%–100.00%) and 36.36% (95% CI = 20.40%–54.88%), respectively. The positive and negative predictive value for immunocytochemistry of polyclonal antibody to the 47 kDa were 22.22% (95% CI = 8.62%–42.26%) and 100.00% (95% CI = 73.54%–100.00%), respectively. In conclusion, urine detection with 47 kDa polyclonal antibodies has higher sensitivity value and negative predictive value (100.00%) than urine cytology.<br /><strong>Conclusion</strong>: This technique becomes an alternative early detection of bladder cancer for high-risk populations which can be easily and specifically carried out in primary care in Indonesia.</p> H. Prasetya, B.B. Purnomo, K. Mintaroem, S.R. Prawiro Copyright (c) Effect of smoking on pathological grade and stage in clinically low-risk patients <p><strong>Objective</strong>: To investigate the potential effect of smoking on pathological staging in clinically low-risk patients.<br /><strong>Subjects and methods</strong>: Data of 59 patients who were diagnosed with a bladder tumor for the first time and had a single lesion radiologically and endoscopically smaller than 3 cm were investigated, retrospectively. A total of 33 patients who currently smoke or smoked were classified as Group I and 26 patients who did not ever smoke were classified as Group II. Pathological diagnoses of the patients in both groups were compared.<br /><strong>Results</strong>: A total of 9 patients (27.3%) in Group I and 18 patients (69.2%) in Group II had Ta disease (p &lt; 0.05). Moreover, 19 patients (57.6%) in Group I and 5 patients (19.2%) in Group II had stage T1 disease (p &lt; 0.05). The number of patients with low grade (LG) tumor were 8 (24.2%) and 19 (73.1%) in Group I and in Group II, respectively (p &lt; 0.05). The number of patients with high grade (HG) tumor were 25 (75.8%) and 7 (26.9%) in Group I and in Group II, respectively (p &lt; 0.05). Ta high grade (TaHG) was detected in 9 (27.3%) patients in Group I. In contrast, no patients in Group II had Ta HG disease (p &lt; 0.05). The number of patients with T1 high grade (T1HG) was 17 (51.5%) in Group I and 2 (7.69%) in Group II (p &lt; 0.05).<br /><strong>Conclusion</strong>: Smoking seems to associate with pathologically worse stage and grade in patients with primary, single, &lt;3 cm bladder cancer.<br /><br /></p> E. Ogreden, U. Oguz, E. Demirelli, O. Yalcın Copyright (c) Pattern and clinical management of penile cancer in Rwanda <p><strong>Introduction</strong>: Penile cancer is rare in developed countries but has a high prevalence in some developing countries. Surgery includes inguinal lymphadenectomy, which remains the mainstay treatment of the disease.<br /><strong>Objective</strong>: This study reports on the epidemiological profile of penile cancer and clinical management options in Rwanda. <br /><strong>Patients and methods</strong>: From January 2015 to June 2016, a multicenter cross-sectional, prospective cohort study was conducted involving all male patients presenting with penile cancer after two national radio campaigns and a Ministry of Health instruction to all district hospitals. All patients with positive biopsy were included. Surgical treatment aligned with published guidelines. Clinical characteristics, surgery, pathology, and early follow-up data were collected.<br /><strong>Results</strong>: Over 18 consecutive months, 30 male patients were enrolled. The mean age was 60 years [range 33–83]. All patients were uncircumcised before symptom onset; 50% had phimosis and 20% were HIV- positive. The estimated prevalence of penile cancer in Rwanda was 0.37 per 100,000 men. At presentation, 96.7% of patients had a T2-4 disease and 43.3% were with clinically non-palpable inguinal lymph nodes (cNO). After penectomy, bilateral inguinal lymphadenectomy was performed in 10 (33.3%) patients (modified and radical in 16 and 4 limbs, respectively). Complications included surgical site infection (10%), lymphocele (10%), urethral meatus stenosis (6.7%), skin necrosis (3.3%) and two (6.7%) patients with metastatic disease died in hospital.<br /><strong>Conclusion</strong>: Penile cancer is a rare but significant disease in Rwanda. Patients present with advanced disease. After treatment of the primary tumor, modified inguinal lymphadenectomy appears to be a safe method of cure and staging for patients with clinically impalpable inguinal lymph nodes. Our early results provide a compelling insight into this rare but serious disease.</p> E. Ngendahayo, M. Nzayirambaho, A. Bonane, G.A. Gasana, R. Ssebuufu, F. Umurangwa, E. Muhawenimana, A. Nyirimodoka, I. Nzeyimana, B. Rugwizangoga, T.Z. Muvunyi, E. Musoni, S. Bwogi, T. Hategekimana, R. Kalengayi, E. Rwamasirabo Copyright (c) Case report Primary extragonadal seminoma arising from the pelvis: A case report <p><strong>Introduction</strong>: Extragonadal germ cell tumors (EGCT) are relatively rare tumors with an incidence of 2–5% among all germ cell tumors and commonly seen in males. They appear mostly in midline locations, commonly in the retroperitoneum, mediastinum and central nervous system but the origin of EGCTs remain controversial.<br /><strong>Observation</strong>: In this case report, we present a young male with prior history of right orchidectomy for undescended testis, presented as retroperitoneal mass arising from the true pelvis. Imaging studies revealed a large mass arising in the pre-sacral region within the pelvis. Fine Needle Aspiration Cytology and Immunocytochemistry studies revealed Seminoma of classical type. The patient was treated with chemotherapy and radiotherapy, presently no evidence of disease and on routine followup.<br /><strong>Conclusion</strong>: This is a unique case because to the best of our knowledge, only a few cases have been reported in the literature on EGCT (seminoma in present case) presenting as a pelvic mass. Seminoma in true pelvis should be considered as a differential diagnosis when pelvic mass is detected, even in post orchidectomy cases. Tumor markers, histology, and immunohistochemistry examinations are important in making an accurate diagnosis and providing appropriate treatment.</p> C. Drachama, A. Elangovan, R. Madana, N. Gupta Copyright (c) Metastatic basal cell carcinoma of prostate in a young adult: A rare aggressive entity <p><strong>Introduction</strong>: Prostate cancer is one of the commonest, malignancies affecting elderly males. Prostatic basal cell carcinoma, (PBCC) accounts for less than 0.01% of all prostate cancers.<br /><strong>Observation</strong>: A 32-year-old man presented with hematuria and lower urinary tract symptoms. Clinical examination showed hard, nodular enlarged prostate with multiple penile hard nodules. His prostate-specific antigen (PSA) level was 0.91 ng/mL. Histopathological examination of the fingerguided prostate biopsy revealed a malignancy with features of basal cell carcinoma. Further imaging studies were performed and metastases were found in both lungs, penis, pelvic lymph nodes and right ischium.<br /><strong>Conclusion</strong>: The current case highlights PBCC as a diagnostic pitfall which presented in a young adult with a normal PSA level.</p> G. Kapatia, V.S. Attri, U.K. Mete, P. Rastogi Copyright (c) Carcinome rénal à cellules chromophobes : à propos de 16 cas et une revue de la littérature <p><strong>Objectifs</strong> : Déterminer les caractéristiques histocliniques,pathologiques,thérapeutiques et pronostiques des carcinomes chromophobes rénaux.<br /><strong>Patients et méthodes</strong>: Il s’agitd’une étude rétrospective incluant 16 cas de carcinomes chromophobes parmi 86 cancers rénaux de diagnostiqués au sein du service d’urologie B du CHU de Rabat entre janvier 2011 et août 2017.<br /><strong>Résultats</strong> : Il s’agit de 12 femme set 4 hommes. L’âge moyen de découverte est de 57,5 ans. Elles se répartissent en 62,5% àprédominance éosinophile, 37,5% de stumeurs mixtes. Les noyaux sont irréguliers et incisurés. Les stades tumoraux T1 (31,5%) et T2 (56,25%) sont les plus fréquents. La majorité des patients présentent un grade bas de Fuhrman ,43,8% grade 2 et 31,2% grade 3. Un es eulepatiente a eu une récidive locale.Le taux global de survie à 5 ans est de 92%. Un décès lié à la maladie a été rapporté. La néphrectomie est le traitement de référence pour 100% despatients.Le taux moyen de survie globale est à34,4 mois.<br /><strong>Conclusion</strong> : Le cancer chromophobe du rein est une entité anatomoclinique particulière, caractérisé par un pronostic favorable grâce à un gradede Fuhrman basetsalimitationaurein.</p> O. Yddoussalah, A. Saouli, H. Elouazzani, T. Karmouni, K.E. Khader, A. Koutani, N. Mahassini, A.I.A. Andaloussi Copyright (c) Cancer de la prostate localisé à haut risque de récidive:résultats de la prise charge <p>No Abstract</p><p> </p> S. Babacar, B.N. Aissatou, Z.O. Cyrille, T. Amath, S. Alioune, S. Yaya, F. Boubacar, B. Denis, Z.A.R. Hamidou, F.S. Thiapato, N. Modou, N.N. Seck, D. Babacar, F.P. Ahmed, N.A. Khassim, B. Mamadou Copyright (c) Dérivation du haut appareil urinaire par une sonde JJ: indications et résultatsdansuneétude rétrospective et monocentrique No Abstract A.R.H. Zakou, M. Ndoye, L. Niang, M. Jalloh, I. Labou, S.M. Gueye Copyright (c) Is multiple tracts percutaneous nephrolithotomy (PCNL) safe modality in management of complex renal stones? A prospective study: Single center experience <p><strong>Objectives</strong> : To evaluate and analyze the efficacy and the safety of multiple tracts PCNL in management of complex renal calculi.<br /><strong>Patients and Methods</strong> : The study was conducted during the period between March 2016 till January 2017 on 265 patients with complex renal stones, all patients underwent multiple tracts PCNL, either with double or triple punctures, preoperative and postoperative laboratory and radiological results were compared together in correlation to the stone size, shape and site.<br /><strong>Results</strong>: The results of our study have shown that increased size and complexity of stones is associated with increased number of punctures needed to achieve stone clearance, and the aggressive approach to complex renal calculi using multiple tracts PCNL is a safe and effective modality in management of complex renal calculi with acceptable complications.<br /><strong>Conclusion</strong>: Number of percutaneous tracts needed for stone clearance was increased with the increase in stone size and complexity. Surgeon experience, accurate choosing puncture site and carefully performed multiple tracts will decrease the intra-operative and postoperative complications or transfusion requirements.</p> H. Elawady, D.E. Mostafa, M.A. Mahmoud, M. Abuelnaga, A. Farouk, A. Tawfick, T. Elzayat, A. Ahmed Copyright (c) Comparison of efficacy and safety of ESWL in paediatric and adolescent versus adult urolithiasis: A single center 5-year experience from a tertiary care hospital <p><strong>Objective</strong>: To retrospectively compare the efficacy and safety of extra-corporeal shock wave lithotripsy (ESWL) for renal/upper ureteric calculi in pediatric/adolescents (group 1) vs adults(group 2).<br /><strong>Subjects and methods</strong>: Medical records of 948 patients who underwent ESWL for renal/upper ureteric calculi at a tertiary care center in North India from January 2012 to December 2017 (five years). The Dornier compact alpha-K1025163 (Dornier Med Tech) equipment was used for ESWL. We evaluated the stonefree rates, the number of ESWL sessions, use of ancillary procedures and complications between the two groups.<br /><strong>Results</strong>: A total of 110 patients were in group 1 and 838 patients were in group 2. The mean stone size in group 1 patients was 1.20 ± 1.18 cm<sup>2</sup> while in group 2 it was 1.49 ± 0.37 cm<sup>2</sup>. The stone clearance rate was 85/110 (77%) for the group 1 and 545/838(65%) for group 2 patients. In group 1, a second session was required in 28/110 (25.4%) patients and the third session was required in 5/110 (4.5%) patients while in the adult group two sessions were required in 175 (20.8%) and three sessions were required in 24 (19.2%) patients. The overall complication rate in group 1 was 15/110 (13.63%) and in the group, II was 105/838 (12.5%). No statistical difference was found between post-ESWL complications and use of ancillary procedures (DJ stenting/PCNL) (p = 0.067).<br /><strong>Conclusion</strong>: In renal/upper ureteric calculi ESWL has got better efficacy, comparable safety and requires equivalent ancillary procedures in children and adolescents compared to adults.</p> G. Garg, A. Aggarwal, M. Singh, S.N. Sankhwar, D. Sharma, S. Pandey Copyright (c) La lithotripsie extracorporelle: expérience d’un centre Sénégalais <p>No Abstract</p> C. Ze Ondo, B. Fall, Y. Sow, A. Thiam, A. Sarr, H. Ghazal, B. Diao, P.A. Fall, A.K. Ndoye, M. Ba Copyright (c) Early outcome of pediatric pyeloplasty in kidneys with split renal function less than 10%: A prospective study of 25 cases <p><strong>Objectives</strong>: To detect the outcome of pyeloplasty in kidneys with split renal function (SRF) less than 10% in the pediatric age group.<br /><strong>Subjects and methods</strong>: We prospectively analyzed the data from 25 cases of ureteropelvic junction obstruction (UPJO) candidate for pyeloplasty with SRF less than 10%. Abdominopelvic ultrasonography and diuretic renogram using technetium-99 m diethylenetriamine Penta acetic acid (DTPA) were done in all cases. We studied the improvement in pelvic anteroposterior diameter (APD) postoperatively. We compared pre and postoperative SRF after six months and one year.<br /><strong>Results</strong>: The median age was 24 months (3 months–11 years), male to female 2:1. The median preoperative SRF was 5% (range: 0%–10%) and the median APD of the renal pelvis was 3 cm (range: 2.2–5). There was significant improvement of median APD 0.8 cm (range: 0.5–1.9) (P value &lt;0.05). There was a significant postoperative improvement in the median SRF (P-value &lt;0.05) as the median SRF after 6 months and 1 year were 21% and 20%, respectively but there was no significant difference between SRF at six months and one year (P value 0.174).<br /><strong>Conclusion</strong>: Pyeloplasty provides high rates of functional success even in very poorly functioning kidneys with SRF ≤10% by DTPA renogram in pediatric age group.</p> A.Y. Abdelaziz, H. Shaker, H. Aly, H. Aldaqados, E.M. Hussein Copyright (c) Intérêt de la technique de Koyanagi dans le traitement de l’hypospadias posterieurchez l’enfant No Abstract S. Ben Youssef, A. Ksia, M. Ben Fredj, M. Messaoud, R. Laamiri, S. Belhassen, S. Mosbahi, B. Bouzzaffara, L. Sahnoun, M. Mekki, M. Belguith, A. Nouri Copyright (c) Precoccygeal epidermoid cyst in a child — A unique case report <p><strong>Introduction</strong>: Epidermoid cyst is a benign tumour frequently observed throughout the body. It can grow in size and may get infected over a period of time.<br /><strong>Observation</strong>: We are reporting a case of precoccygeal epidermoid cyst in a six year old female child which was managed successfully.<br /><strong>Conclusion</strong>: Precoccygeal epidermoid cyst in female children has not been reported in the English literature so far. Hence, we are reporting this case.</p> J.S. Aihole, G. Aruna, J. Deepak, S. Supriya Copyright (c) Benign prostatic hyperplasia in a 23 year old man with progeroid syndrome <p><strong>Introduction</strong>: Progeroid syndromes are characterized by accelerated aging and early development of diseases typically associated with aging. Premature development of tumors including BPH, maybe observed in these patients, which can lead to significant bladder outlet obstruction.<br /><strong>Observation</strong>: The index patient was a 23 year old man who presented to us with lower urinary tract symptoms (LUTS), features of obstructive nephropathy and was noticed to have been aging rapidly. He had features of premature aging, bilateral cataract and enlarged benign prostate (BPH). He eventually succumbed to obstructive nephropathy and urosepsis.<br /><strong>Conclusion</strong>: Progeroid syndromes may be associated with premature development of obstructive BPH.</p> M. Ahmed, A.T. Lawal, A. Bello, A. Abubakar, H.Y. Maitama Copyright (c) The value of intravesical prostatic protrusion in evaluation of bladder outlet obstruction from benign prostatic enlargement in Nigeria <p><strong>Objective</strong>: To determine the significance of intravesical prostatic protrusion in evaluation of bladder outlet obstruction from benign prostatic enlargement in Jos, Nigeria.<br /><strong>Patients and Method</strong>: A hospital based cross-sectional prospective study that included patients who presented to the Urology clinic of Jos University Teaching Hospital, Jos, Nigeria with clinical features of BPE. Each had IPSS, Qmax, IPP, PV, PVR and PSA measured. IPP was measured through transabdominal ultrasound scan along mid sagittal view in millimetre using a curvilinear probe 3.5 MHz. IPP was divided into three grades (grade I: &lt;5 mm; grade II: 5–10 mm; grade III: &gt;10 mm). Statistical analysis was done using SPSS® version 20 (SPSS, IBM, Chicago, IL, USA). Appropriate test statistics were used with p-value &lt; 0.05 considered as significant.<br /><strong>Results</strong>: Eighty-seven patients aged 40–86 years were enrolled in the study. The means of age, IPSS, IPSS-v, IPSS-s, Qmax, IPP, PV, PVR and PSA – were 64.6 ± 10.2 years, 16.7 ± 7.6, 9.8 ± 3.5, 6.9 ± 3.3, 8.2 ± 3.8 ml/s, 12.9 ± 7.0 mm, 70.1 ± 50.3 mls, 78.3 ± 69.3 mls and 7.2 ± 1.9 ng/ml respectively. IPP correlated positively with IPSS (r = 0.808, p = 0.000), IPSS-S (r = 0.799, p = 0.000), IPSS-V (r = 0.717, p = 0.000), and PVR (r = 0.306, p = 0.004) but negatively with Qmax (r =−0.519, p = 0.000).<br /><strong>Conclusion</strong>: The IPP correlates significantly with IPSS, Qmax and PVR. Therefore, it is a valuable parameter – for evaluation of patients with BOO due to BPE.</p> C.A. Agbo, V.M. Ramyil, N.K. Dakum, S.I. Shuaibu, V.E. Onowa, L.E. Nabasu, Z.Z. Galam, B.C. Ukaonu Copyright (c) microRNA-141 as a diagnostic and prognos- tic biomarker for prostate cancer in Egyptian population: Pilot study <p><strong>Introduction</strong>: microRNAs are a family of small non protein-coding RNAs. They are involved in posttranscriptional gene regulation of their target genes. The deregulation of microRNAs has been linked to cancer development and tumor progression. The aim of out study was to look for microRNA-141 as a diagnostic and prognostic biomarker for prostate cancer.<br /><strong>Patients and methods</strong>: The study prospectively recruited 30 patients newly diagnosed with prostate cancer; including 13 and 17 patients without and with metastases, respectively. Another 30 patients without prostate cancer diagnosis were included as a control group. Real-time polymerase chain reaction analysis was done for relative quantification of microRNA-141.<br /><strong>Results</strong>: The present study showed that microRNA-141 was significantly upregulated in cancerous patients compared to control group. Also it was significantly upregulated in patients with metastatic disease compared to non-metastatic patients. Moreover, it was significantly correlating with serum PSA and Gleason score.<br /><strong>Conclusion</strong>: Serum microRNA-141 could be a promising diagnostic and prognostic biomarker for prostate cancer and a good indicative of disease aggressiveness.</p> R. Ali, S. El Tabbakh, W. El Delgawy, A. Kot, M.N. Desouky Copyright (c) Morbidité et mortalité après adénomectomies prostatiques par voie transvésicale au CHU Kara (Togo) No Abstract G. Botcho, T.M. Kpatcha, K. Tengue, T. Dossouvi, E.V. Sewa, K. Simlawo, E. Leloua, K.H. Sikpa, T. Anoukoum, E.D. Dosseh Copyright (c) Is unilateral varicocelectomy as effective as bilateral varicocelectomy in management of subfertile patients with bilateral varicocele <p><strong>Objectives</strong>: To compare the results of unilateral and bilateral subinguinal varicocelectomy for patients with primary infertility, including sperm parameters and pregnancy rate.<br /><strong>Patients and method:</strong> This a retrospective study including 91 men with primary subfertility with bilateral varicocelectomy. The patients were divided into two groups. Group A (46 patients) were subjected to bilateral varicocelectomy. Group B (45 patients) subjected to left varicocelectomy. Patients with unilateral, recurrent, subclinical, secondary varicocele and azoospermia were excluded. All Patients were evaluated with at least two semen analyses with 15 days apart. Follow up schedule for all patients includes physical examination and semen analysis 3, 6, and 12 months postoperatively.<br /><strong>Results</strong>: Subinguinal varicocelectomy with loup magnification was successfully performed in all 91 patients, with no intra-operative complications occurred. The age ranged between 25 and 39 years (average 32 years),which was not significantly different within the 2 groups. The mean follow up was 7 months. Neither definite hydrocele nor testicular atrophy was detected. Despite considerable changes were noted in sperm concentration, percentage of motility and normal sperm morphology postvaricocelectomy in both groups, there was not a statistically significant difference between the two groups, (P = 0.139, 0.922, and 0.825, respectively and also pregnancy rate (P = 0.14).<br /><strong>Concolusions</strong>: The semen parameters and pregnancy rate improved significantly in patients who underwent unilateral and bilateral varicocelectomy, with no significant difference between the two groups.</p> M.S. Abdel-Kader, A.M. Hassan, M. AbdelRazek Copyright (c) Role of sequential semen samples in infertile men candidates for assisted reproduction: A prospective study <p><strong>Objective</strong>: To study the beneficial effect of repeated sequential ejaculation in infertile men who are candidates for assisted reproduction.<br /><strong>Materials and methods:</strong> The study included a total of 237 infertile males attending our infertility and IVF center from January 2016 till December 2017. All patients were asked to provide two semen samples (1–3 h apart) after an abstinence period of 3–7 days. The two consecutive semen samples were analyzed according to the 2010 WHO criteria for semen analysis and their parameters were compared.<br /><strong>Results</strong>: The mean age for our study group was 35.7 years (20–56 year). Of the 237 subjects, 157 showed oligoasthenozoospermia on their initial semen sample while the remaining 80 were azoospermic. A statistically significant difference was detected between the 2 sequential semen samples regarding all semen parameters except grade A motility. Despite the significant decrease in seminal volume by sequential sampling, there was a statistically significant increase in sperm concentration in the second ejaculate compared to the first (6.2 ± 0.61 versus 3.4 ± 0.52 million/mL, respectively, p = 0.016). The mean normal sperm morphology also demonstrated a significant increase (2.1 ± 1.8–5.1 ± 2.6%, p &lt; 0.002). Mean progressive sperm motility increased from 1.13 ± 0.31 to 1.7 ± 0.31% (p = 0.010) on repeated sampling. Also, we were able to retrieve viable sperm in 15% of the azoospermic patients whom were known to be azoospermic on previous occasions.<br /><strong>Conclusions</strong>: Obtaining consecutive semen samples leads to improvements in the quality of many semen parameters (sperm concentration, motility and morphology) which may be of special importance for management of infertile couples especially those attempting assisted reproductive techniques.</p> A.M. Ragheb, R.M. Ibrahim, A.M. Elbatanouny, A.S. Moussa, A.M. Abdelbary, O.M. Sayed, M.S. Eladawy, H.A. Shaker, S.O. Hamdi Copyright (c) Prevalence and risk factors for urinary and anal incontinence in Tunisian middle aged women <p><strong>Objectives</strong>: To estimate the prevalence of urinary incontinence and anal incontinence in Tunisian women and to identify their risk factors.<br /><strong>Subjects and methods</strong>: A cross-sectional study was conducted among 402 female doctors and nurses randomly selected from 3 large hospitals in the center of Tunisia. The prevalence of urinary incontinence and anal incontinence were measured using validated questionnaires.<br /><strong>Results</strong>: Overall 45.3% of women experienced incontinence (urinary incontinence or anal incontinence). The overall prevalence of urinary incontinence, anal incontinence and double incontinence were 45%, 6.3% and 6%, respectively. Factors associated with incontinence were postpartum urinary incontinence (OR 11.91, CI 4:72–30:04, P &lt; 0.001), menopausal status (OR 11.72, CI 3:8–36:07, P &lt; 0.001), arterial hypertension (OR 4.17, CI 1:61–10.81, P = 0.003), nurse occupation (OR 3.22, CI 1:62–6:36, P = 0.001) and constipation (OR 1.71, CI 1:02–2:87, P = 0.041). Medical help seeking was taken only by 21% of the incontinent women.<br /><strong>Conclusion</strong>: Forty five percent of Tunisian women suffered from urinary or anal incontinence. A primary prevention for modifiable risk factors, such as postpartum pelvic floor physiotherapy and hypertension control, should be advised to women in order to optimize their quality of life.</p> S. Gallas, S. Frioui, H. Rabeh, M. Ben Rejeb Copyright (c) A guidewire on your fingertip: A novel innovative technique <p><strong>Objective</strong>: 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.<br /><strong>Subjects and methods:</strong> 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.<br /><strong>Results</strong>: An easily manipulated system of guidewire insertion, with fingertip mobility and dexterity is obtained utilizing everyday consumables in a simple to perform fashion.<br /><strong>Conclusion</strong>: 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.</p> Ahmed Adam Copyright (c) The superiority of the analgesic effect of intraurethral Bupivacaine during outpatient flexible cystoscopy in male patients <p><strong>Objective</strong>: Flexible cystoscopy (FC) has become a frequently applied outpatient prosedure. Dysuria with an incidence of 30–54% is the main complaint of patients. As our hypothesis was, lower pain scores during and after cystoscopy would be achieved with bupivacaine application we aimed to compare the analgesic efficacy of intraurethral bupivacaine and lidocaine.<br /><strong>Subjects and methods</strong>: Files of 90 patients who underwent FC in our clinic, between August 2015 and November 2015 were retrospectively scanned. Patients were evaluated in 2 groups according to the local anesthetic they were applied intraurethrally. The first group consisted of 45 patients who received 10 mL of %2 lidocaine gel; the second group consisted of 45 patients who received 10 mL of 0.5% bupivacaine. A numerical visual analog scale (VAS) from 0 to 10 was used to assess pain scores during and after the procedure.<br /><strong>Results</strong>: During the procedure the mean VAS was 4.09 (±1.95) in the %2 lidocaine group and 4.3 (±1.58) in the 0.5% bupivacaine group (p = .5). Therefore, during the first micturition after the procedure the mean VAS was 3.4 (±1.86) in the %2 lidocaine group and 2.09 (±1.19) in the 0.5% bupivacaine group (&lt;0.001).<br /><strong>Conclusions</strong>: With the reason that dyuria is the most annoying complication for the patients undergoing FC, it is worth trying to overcome this issue. By providing significantly decreased levels of dysuria, 0.5% bupivacaine was superior to %2 lidocaine gel for local analgesia especially during first micturiation after out-patient FC in males patients.</p> R. Girgin, E.D. Demirkıran, B. Akduman Copyright (c) A novel technique for removing a metal constriction device causing genital strangulation using a bolt cutter: A case report <p><strong>Introduction</strong>: Strangulation of the genitalia by a metallic device is a rare occurrence. However, such cases present a challenge to any healthcare professional because of the difficulty associated with removing the device.<br /><strong>Observation</strong>: Herein, we present the case of a patient with genital strangulation that was resolved quickly using a bolt cutter.<br /><strong>Conclusion</strong>: Bolt cutters are useful for quickly removing metallic strangulation devices, even those made of thick metal.</p> T. Abe, A. Sasaki, H. Ochiai Copyright (c) The relationship of Charlson comorbidity index and postoperative complications in elderly patients after partial or radical nephrectomy <p><strong>Objectives</strong>: To compare preoperative Charlson comorbidity Index (CCI) and postoperative complications after oncologic kidney surgery in patients aged 70 or older. To compare CCI and need for interdisciplinary evaluation, consults to the emergency department and need of readmission are secondary objectives.<br /><strong>Patients and methods</strong>: This is a retrospective cohort study. Patients aged 70 or older who underwent partial or radical nephrectomy were collected from an institutional database. Period: February 2012–June 2014. Association between CCI and complications was estimated using Chi<sup>2</sup>.<br /><strong>Results</strong>: Final population: 143 (male: 65%). Age median was 75. Minor postoperative complications were 33.88% (n = 41) for patients CCI ≤ 4 versus 9.09% (n = 2) for patients CCI &gt; 4 (p &gt; 0.05), and major postoperative complications were 9.91% (n = 12) versus 45.45% (n = 10), respectively (p &lt; 0.01). Interdisciplinary evaluation was required for 30.6% (n = 37) of patients CCI ≤ 4 versus 59% (n = 13) of patients CCI &gt; 4 (p = 0.01). Readmission was needed for 9.09% (n = 11) and 40.1% (n = 11) respectively (p &lt; 0.01).<br /><strong>Conclusions</strong>: Patients with high comorbidity presented more major postoperative complications. These patients also required more interdisciplinary evaluation after surgery. A higher CCI was not associated with further consults to the emergency department or readmission.</p> E. Becher, P. García Marchinena, J. Jaunarena, D. Santillán, L. Pérez, B. Boietti, A. Jurado, G. Gueglio Copyright (c) Abcès prostatique à staphylococcus Aureus: A propos d’un cas clinique No Abstract A. Saouli, O. Yddoussalah, A. Janane, T. Karmouni, M. Alami, A. Ameur, K. El Khader, A. Koutani, A. Iben Attya Andaloussi Copyright (c) Evaluation de l’antibioprophylaxie en chirurgie urologique au sein de l’Hôpital Militaire Moulay Ismail de Meknès L’antibioprophylaxie en urologie No Abstract A. El kartouti, A. Jaafari, M. Lezrek, M.A. Hachimi Copyright (c) Myiase scrotale chez l’enfant : à propos d’un cas No Abstract P.A. Mbaye, A. Sagna, A. Ndong, N.A. Ndoye, O. Ndour, G. Ngom Copyright (c) Fistule vésico-sigmoïdienne compliquant une bil-harziose vesicale : à propos d’un cas exceptionnel <p>La fistulecolo-vésicale sur une bilharziose vésicale est une entité pathologique exceptionnelle. Nousrap-portons une observation originale ou nous discutons les caractéristiques générales de cette pathologie rare.</p> O. Yddoussalah, A. Saouli, H. El Ouazzani, T. Karmouni, K. Elkhader, A. Koutani, A.I.A. Andaloussia, N. Mahassini Copyright (c)