Hydatid Disease of the Liver Presenting as Spontaneous Cutaneous Fistula: A case report.

Hydatid cyst (HC) disease is a parasitic infection produced by cysts containing the Echinococcus granulosus larval phase. Patients with HC disease are typically asymptomatic until incidentally diagnosed or when complications occur. A rare presentation of liver HC is spontaneous cutaneous fistualisation. We report a 63-year-old female patient admitted in a tertiary care hospital in Ibb, Yemen, in 2019 with an infected cutaneous fistula induced by a ruptured HC. The patient underwent laparotomy and partial cystectomy with excision of the fistula tract. Upon 6-month follow-up, there was no HC recurrence. This report highlights the need for physicians to consider this diagnosis when faced with an unusual cutaneous fistula near organs commonly involved in HC, especially in areas where the prevalence of this disease is high.

Totally ultrasound-guided minimally invasive percutaneous nephrolithotomy in children: Is it safe?

OBJECTIVE: The objective of the study was to assess the outcome and feasibility of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL) in children. MATERIALS AND METHODS: Twenty-five children with upper urinary tract stones who had undergone US-guided mini-PCNL from June 2017 to June 2020 were enrolled in this study. Patients' demographic information and post-treatment results were retrospectively gathered and analysed. Pyelocaliceal system was punctured in prone position using US guidance, and the tract was dilated using single-shot dilation technique. All steps of renal access were done using only US. Mini-PCNL in all cases was done by using 15 Fr rigid nephroscope. Stones were fragmented with a pneumatic lithotripter and evacuated. RESULTS: The patients' mean age was 6.30 ± 3.25 years (range: 1.5-15). The mean stone size was 16.04 ± 3.93 mm (range: 10-30). The mean access time to the stone was 1.50 ± 0.62 min (range: 1-4). The mean operation time was 94.66 ± 3.05 min (range: 90-100 min). The final stone-free rate was 96%. Post-operation fever occurred in 4 (16%) patients who were treated successfully with an antibiotic. No major complications occurred. CONCLUSIONS: We recommend US-guided mini-PCNL as a harmless alternative treatment option, in children with renal calculi due to its excellent outcomes and little complications.

Role of tunica vaginalis flap and dartos flap in tubularized incisional plate for primary hypospadias repair: A retrospective monocentric study.

BACKGROUND: In the tubularized incised plate (TIP) procedure, flap interposition between the skin and neourethra is highly recommended to decrease the postoperative fistula rate. However, there is no consensus regarding the ideal flap for this procedure. This study aimed to report our experiences in the one-stage TIP hypospadias surgery utilizing dartos flap (DF) (penile skin subcutaneous tissue) and tunica vaginalis flap (TVF) (parietal layer of the testis) as a tissue coverage of neourethra. METHODS: In a retrospective study from Sep 2018 to May 2021, 16 cases of hypospadias with different types, ranging from midpenile to penoscrotal types, were managed with TIP urethroplasty using DF or TVF as a tissue coverage of neourethra were enrolled. The demographic characteristics of the participants, type of hypospadias, outcome, and complications were analyzed and compared. RESULTS: We used TVF and DF as soft tissue coverage in 11 (68.8%) and 5 (31.3%) patients, respectively. The mean age was 56.38 ± 47.83 months. Mid-penile, proximal, and penoscrotal hypospadias were presented in 3 (18.8%), 8 (50.0%), and 5(31.2%) patients, respectively. The total success rate was 14 (87.5%), while 2 (12.5%) patients developed a urethrocutaneous fistula, which required delayed closure later. In comparison between TVF and DF groups: the TVF was applied in all patients with moderate and severe chordee and all patients with penoscrotal hypospadias, and six patients with proximal hypospadias, while only three patients with mild chordee and two patients with proximal hypospadias used the DF and showed statistical significance between groups (p < 0.001 and 0.012) respectively. The success rate was 90.9% vs. 80.0% in TVF and DF groups, respectively, with no statistical significance between groups (p = 1.000). CONCLUSIONS: In the primary TIP repair, the TVF is a practical option as a DF for the interposition cover of a neourethra, especially in penoscrotal and proximal hypospadias with severe chordee.

Catastrophic Complications of Circumcision by Traditional Circumcisers.

Circumcision is one of the important public surgeries performed globally. It is a popular non-therapeutic procedure that can be performed by people of various abilities and skills, ranging from trained medical practitioners to non-specialists, depending on their cultural and social backgrounds. Consequently, this surgery may cause varying types and frequencies of complications. Glans amputation and death due to severe bleeding, as a complication of this procedure, are rare, and the patients are left with morbidity and life-long complications. Here, we describe two cases of catastrophic complications due to ritual circumcision (one penile glans amputation and one death).

Optimal clamping time in meatotomy procedure for children with meatal stenosis: Experience with 120 cases.

OBJECTIVE: During meatotomy procedure for children with meatal stenosis (MS), a straight clamp used as a hemostat on the ventrum of the meatus before incised with scissors for clamping and holding bleeding from the site of operation. The aim of this study was to evaluate the optimum clamping time for meatotomy in children with MS. MATERIALS AND METHODS: All the patients with MS between 2014 to 2019 were enrolled in this retrospective study. Patients with uncircumcised penis, traumatic catheterization, any kind of penile abnormality such as hypospadias or penile curvature, and active urinary tract infection (UTI) were excluded. The indication of meatotomy was a pinpoint meatus that develops with dorsal or lateral deflection of the urinary stream and high-velocity urine flow. During meatotomy procedure, clamping time was examined in different groups such as 2, 3, and 4 minutes. The main symptoms of presentation and ultrasonography (US) findings were recorded and compared between groups. To assess the optimum time clamping, postoperative bleeding was noted carefully in all groups. The success rate was recorded at onemonth postoperative follow-up in the clinic. RESULTS: Of the 120 patients with MS who underwent a meatotomy procedure, there were 40 (33.3%) participants in each group. The main symptoms were painful urination and urine stream deviation that represented in 54 (46%) patients. Bladder wall thickness was the main pre-operation finding in the US which was observed in 67 (55.8%) patients. In comparison between the groups related to clamping time, bleeding was observed and required suturing when clamping was applied for 2 minutes in 4 (3.3%) patients (p = 0.016). With a minimum follow-up of 12 months, no recurrent meatal stenosis was reported. CONCLUSIONS: Clamping time for more than 2 minutes may prevent bleeding during and after meatotomy.

Isolated Giant Primary Splenic Hydatid Cyst in a 10-Year-Old Boy: A Case Report.

Hydatid cyst (HD) disease is a parasitic infection produced by cysts containing the larval stage of Echinococcus granulosus. It occurs worldwide, but its prevalence is higher in the rural communities of some developing countries like Yemen, where sheep and cattle raising constitute a crucial component of the agricultural industry. This zoonotic disease spreads due to close contact humans with sheep and dogs. The most involved organs with HC are the liver and lungs. However, other organs may also foster it, such as the spleen, with an incidence rate of between 0.5% and 6%. To the best of our knowledge, primary involvement of the spleen by HC is very rare, and a few cases with isolated spleen HC in children were reported. In this study, a ten-year-old boy with a huge primary splenic HC is reported with chief chief complaint of pain and non-tender bulging in his abdomen's left upper quadrant. A 20×16×18 cm splenic cystic mass was detected by ultrasonography (US) and confirmed by abdominal computed tomography (CT) scan without macroscopic involvement in other organs. Total splenectomy was carried out for hem. Pathological examinations revealed cystic hydatidosis. We describe this case of an isolated huge spleen HC, which was successfully treated with total splenectomy, focusing on the management and outcome of this disease.

Outcome of Transperitoneal Laparoscopic Ureterolithotomy (TPLU) for proximal ureteral stone > 15 mm: Our experience with 60 cases.

PURPOSE: We aim to review our experience of transperitoneal laparoscopic ureterolithotomy (TPLU) for proximal ureteric stone more than 15 mm. PATIENTS AND METHODS: Between June 2017 to December 2020, sixty patients with a history of unsuccessful Extracorporeal shock wave lithotripsy (ESWL) and/or failed ureteroscopy for impacted ureteral calculi more than 15 mm who accepted TPLU were enrolled in our study. The patients' demographic information and post-treatment results were gathered and analyzed, retrospectively. RESULTS: The patients' mean age was 46.25 ± 12.56 years. The mean size of the stone was 20.11 ± 4.76 mm. 37 (61.7%) patients had severe hydronephrosis (HDN) and 46 (76.7%) stones were radio-opaque. Almost all of the patients underwent TPLU by a single urologist. The mean operation time was 72.86 ± 6.07 minutes without intraoperative complication (only 3 stones had upward migration to the pyelocaliceal system). The main operative blood loss was 88.86 ml. The average length of stay in the hospital was 45.8 ± 8.11 hours. The stone free rate (SFR) at discharge was 57 (95%). The overall complication rate was 27 (45%). Regarding early complications, fever was found in 8 (13.3%) patients, and 3 patients (5%) had paralytic ileus. The rate of urine leak was 8.3%, and 8 (13.3%) patients required blood transfusions. In multivariate analysis, the multiple stones, bigger stone in size, incomplete SFR, longer duration of hospital admission, and severe HDN were associated with a high early complication rate (p = 0.05, 0.04, < 001, 0.03, and 0.01, respectively). CONCLUSIONS: TPLU is a harmless option for managing proximal ureteric stone as a primary procedure or salvage procedure with good outcomes and acceptable complication rates.

Minimal invasive percutaneous nephrolithotomy (Mini-PCNL) in children: Ultrasound versus fluoroscopic guidance.

BACKGROUND: Miniaturization of endoscopic instruments in percutaneous nephrolithotomy (PCNL) allowed less invasive procedures with low complication rates, especially in children. This study was conducted to evaluate the safety and efficacy of ultrasonography-guided (USG) versus fluoroscopy-guided (FG) mini-PCNL in children. MATERIALS AND METHODS: This is a retrospective comparative study conducted from June 2015 to June 2020. The sample included 70 children (35 pateints underwent USG mini-PCNL and 35 pateints underwent FG mini-PCNL). They were compared mainly by the patients' demographic characteristics, procedural information, and post-treatment outcomes. In the USG mini-PCNL group, puncturing was performed using a 3.5 MHz US probe, whereas fluoroscopy was utilized in the FG mini- PCNL group. RESULTS: Both groups were comparable in terms of gender, previous history of failed ESWL, and hydronephrosis grade. The mean stone burden was 15.94 ± 3.69 mm and 19.20 ± 7.41 mm in USG and FG groups, respectively (p = 0.024). The stonefree rate (SFR) was 97.1% in the USG group and 94.3% in the FG group, which was not statistically significant (p = 0.16). Mean operative time in the USG group and FG group was 69.00 ± 13.33 minutes and 63.48 ± 16.90 minutes, respectively. Four (11.4%) patients in the FG group required blood transfusions to restore the hemodynamic state (p = 0.039). Fever was detected in 4 (11.4%) patients in the USG group and 15 (31.4%) patients in the FG group (p = 0.041). CONCLUSIONS: In children, mini PCNL under USG is safe and as effective as fluoroscopy.

Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report.

BACKGROUND: Major pelvic trauma (MPT) with traumatic hemipelvectomy (THP) is rare, but it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton, which is associated with a high incidence of intra-abdominal and multi-systemic injuries. THP is generally performed as a lifesaving protocol to return the patient to an active life. CASE REPORT: A 12-year male patient exposed to major pelvic trauma with bilateral THP survived the trauma and multiple lifesaving operations. The anterolateral thigh flap is the method used for wound reconstruction. The follow-up was ended with colostomy and cystostomy with wheelchair mobilization. To the best of our knowledge, there have been a few bilateral THP reports, and our case is the second one to be successfully treated with an anterolateral thigh flap. CONCLUSION: MPT with THP is the primary cause of death among trauma patients. Life-threatening hemorrhage is the usual cause of death, which is a strong indication for THP to save life.