Outcomes of surgical correction of Peyronie's disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft.

Objective: Peyronie's disease (PD) is an abnormal wound healing in the penile tunica albuginea. After fibrotic plaque excision, different graft materials have been used to repair the defects, but the optimal graft remains unknown. This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD. Methods: A retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021. The patients were divided into two groups depending on the type of graft used. For 15 patients in Group B, testicular tunica vaginalis grafts were used to repair the defect, while for 18 patients in Group A, bovine pericardium grafts were used. Data of the patient's age, comorbidities, sexual function, penile curvature, postoperative complications, need for further treatment, change in penile length, and satisfaction were gathered and compared between the groups. Sexual function was evaluated using the 5-item version of the International Index of Erectile Function (IIEF-5), and a functional less than 20-degree penile curvature after surgery was considered a successful intervention. Results: There was no difference in age, comorbidities, degree of curvature, perioperative IIEF-5, operative time, plaque size, or complication rates. After surgery, a statistically significant improvement in curvature degree (p<0.05) and satisfactory penile appearance (p<0.05) were seen in both groups without any superiority between the two groups (p=0.423 and p=0.840, respectively). With a 30-month follow-up, the IIEF-5 was consistent in both groups, with no statistical significance between the groups (p=0.492). The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance (p=0.255 and p=0.101, respectively). Conclusion: Partial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.

Giant asymptomatic left renal oncocytoma in a 40-year-old man: a case report.

Renal oncocytoma is a benign tumor that arises from epithelial cells of the distal renal tubules. It is naturally presented with a small-sized mass, and giant oncocytoma is uncommon. Renal oncocytoma is frequently asymptomatic and challenging to distinguish preoperatively from renal cell carcinoma (RCC). We present a 40-year-old man who presented with intermittent abdominal pain in the last two years. Abdominal computed tomography (CT) scan showed a large, heterogenous left renal mass measured 15 x 16 x 19.5 cm and associated with central calcifications suspected of RCC. The patient underwent a left radical nephrectomy without complication. The histopathological study revealed typical oncocytoma features. There was no detected recurrence or distant metastasis on six months follow-up. In conclusion, it is challenging to distinguish renal oncocytoma from RCC via preoperative radiology images, especially when a giant mass is present. The only histopathology examination of the removed specimen can provide a definitive diagnosis.

Repair of total penile skin loss after ritual circumcision using a scrotal flap: a case report.

Ritual circumcision is associated with a high rate of complications, mainly if performed by an untrained practitioner. Furthermore, excessive skin removal is a rare complication of this procedure that results in penis "trapping" underneath the skin and future sexual dysfunction. Here, we presented a 45-day-old Yemeni newborn with a trapped penis due to total loss of penile skin during a ritual circumcision performed by a traditional untrained practitioner using the guillotine technique one month ago. The patient underwent surgical exploration, and the penis was deliberated, released, and the skin defect was repaired with a single-step scrotal flap advancement over the penile shaft. At the six-month follow-up, the outcome was both functional and cosmetically satisfying. In conclusion, we recommend that the circumcision procedure be performed at the very least by an educated and skilled health professional. Additionally, a scrotal advancement flap is still an option in significant penile skin loss cases.

Pentalogy of Cantrell Associated with Ectopia Cordis: A Case Report.

Pentalogy of Cantrell is a congenital anomaly of the median mesodermal constructions with a poor prognosis. It is characterized by defects of the anterior diaphragm, the lower sternum, the abdominal wall, pericardium, and various congenital heart malformations. We present a case of ectopia cordis and Pentalogy of Cantrell in a newborn of a healthy 35-year-old woman with no history of embryotoxic exposure or smoking. The infant was first diagnosed with the anomaly in the second trimester of pregnancy and was delivered at 35 weeks of gestational age via a caesarian section. Shortly after birth, he was transferred to the neonatal intensive care unit (NICU) due to progressive respiratory failure, which ultimately, along with septicemia, led to infant death on the second day. In conclusion, the Pentalogy of Cantrell should be appropriately assessed for effective prenatal counseling and postnatal management with a multidisciplinary team; since infant survival assessment and early diagnosis give the parents the option of terminating the pregnancy.

Sarcomatoid variant of urothelial carcinoma in the renal pelvis with brain metastasis: a case report.

Sarcomatoid urothelial carcinoma (UC) of the renal pelvis is rare. It is a high-grade malignant tumor that contains both epithelial and mesenchymal elements. Brain metastases from renal pelvis UC are infrequent and represented in few cases. We report a 68-year-old female with a right renal mass diagnosed as a UC with a sarcomatoid variant. The patient underwent a right radical nephroureterectomy and received chemotherapy. She developed brain metastasis in the left temporal area two months later. Therefore, metastasectomy and palliative brain radiotherapy were performed for her. Sadly, her general condition worsened, and she passed away after one month. Brain metastasis in patients with UC is rare and poorly understood. Therefore, we describe the clinico pathological characteristics, including the clinical follow-up of our case with a focus on the treatment and outcome.

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.

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.