Genome Sequencing of Multiple Primary Lung Cancers Harbouring Mixed Histology and Spontaneously Regressing Small-Cell Lung Cancer.

Up to 15% of lung cancer patients present two or more anatomically separate primary lung lesions, known as multiple primary lung cancers (MPLCs). While surgical resection or stereotactic body radiation therapy (SBRT) is the standard of care for most early-stage lung cancer cases, this may not be an option for patients with widespread tumours, highlighting the need for the improved targeted management of MPLC patients, which remains challenging. Moreover, the spontaneous regression (SR) of small-cell lung cancer (SCLC) is rare, with only four cases accounted for between 1988 and 2018. We report a rare MPLC case harbouring the mixed histology of non-small-cell lung cancer adenocarcinoma (NSCLCa) and SCLC and the SR of SCLC without treatment. The patient was diagnosed in 2015 with MPLCs, identified as NSCLCa and SCLC. In 2016, a restaging PET/CT scan prior to the start of treatment showed SCLC SR. In 2018, a further tumour was detected in the patient's mandible, and a re-biopsy of the SCLC revealed histology consistent with NSCLCa. Whole-genome sequencing (WGS) analysis identified a high expression of programmed death ligand-1 (PDL-1) in the NSCLCa, which was treated with pembrolizumab. WGS revealed distinct genomic profiles and mutational mechanisms in MPLCs, suggesting the need for distinct targeted therapies to improve the management of MPLC patients and highlighting the importance of precision evaluation.

Assessment of brain tumor detection techniques and recommendation of neural network.

OBJECTIVES: Brain tumor classification is amongst the most complex and challenging jobs in the computer domain. The latest advances in brain tumor detection systems (BTDS) are presented as they can inspire new researchers to deliver new architectures for effective and efficient tumor detection. Here, the data of the multi-modal brain tumor segmentation task is employed, which has been registered, skull stripped, and histogram matching is conducted with the ferrous volume of high contrast. METHODS: This research further configures a capsule network (CapsNet) for brain tumor classification. Results of the latest deep neural network (NN) architectures for tumor detection are compared and presented. The VGG16 and CapsNet architectures yield the highest f1-score and precision values, followed by VGG19. Overall, ResNet152, MobileNet, and MobileNetV2 give us the lowest f1-score. RESULTS: The VGG16 and CapsNet have produced outstanding results. However, VGG16 and VGG19 are more profound architecture, resulting in slower computation speed. The research then recommends the latest suitable NN for effective brain tumor detection. CONCLUSIONS: Finally, the work concludes with future directions and potential new architectures for tumor detection.

Challenges of Retrograde Ureteroscopic Procedures in Overweight Patients.

BACKGROUND: Obesity and urolithiasis are both prevalent conditions that have an impact on the healthcare system. The ureteric diameter and accessibility play a crucial role in the management of urolithiasis in both overweight and normal weight patients. Studies have shown that obesity can lead to changes in ureter diameter where excessive body fat can exert pressure on the kidneys, causing them to enlarge in size and this enlargement can result in a compression of the adjacent structures, including the ureter. The aim of this study is to assess the incidence of intraoperative challenges faced during retrograde ureteroscopic procedures in overweight patients with ureteric and renal calculi. METHODS: We retrospectively reviewed patients who underwent retrograde ureteroscopic surgery (RURS) for urolithiasis from 1st January 2021 until 30th August 2023. The outcome and any complications were documented and compared with the patient's Body Mass Index (BMI). All patients who undergo RURS in our facility have to have a Non-Contrast CT scan prior to surgery. Procedural success was determined by the ability to obtain access to the stone site intraoperatively and stone-free status in kidney, ureter, and bladder (KUB) X-ray post-operatively. Post-operative complications were recorded up to two weeks post-operatively and classified according to the Calvein Dindo Classification. RESULTS: Our total sample size was 146 patients out of which 75 were overweight and 71 were normal weight patients. In 34 (45%) of overweight patients' access to the ureter was restricted due to a narrow ureteric orifice with ureteroscopy not successful; on the contrary 13 (18%) of normal weight patients faced this same issue. This was statistically significant with a p-value of .004. The stone clearance rates were 91% and 95% in overweight and normal weight patients respectively, which is higher in normal weight patients however this difference was not found to be a statistically significant finding (p-value .028). Overweight patients had 12% Grade I and 8% Grade II complications whereas normal weight patients had 11% Grade I complications and 1.4% Grade II with no higher-grade complications. CONCLUSION: Retrograde ureteroscopic procedures are a safe treatment modality for patients with urolithiasis in both overweight and normal weight populations. They are shown to have similar success rates between both populations once ureteric access is obtained. However, access failure rates are shown to be slightly higher in overweight patients. Hence, further preoperative patient counselling and technical considerations should be undertaken.

Insights from the molecular docking analysis of GRP78 with natural compound inhibitors in the management of cancers.

Cancer is regarded as one of the world's most serious health issues. Glucose regulated protein (GRP78) exhibits a vital role in the proliferation, invasion, and metastasis of numerous cancer cells. Based on that, this study screened the 390 natural compounds targeting the GRP78 catalytic site. Among them, corynanthin, toyocamycin, and nanaomycin were found to strongly bind with GRP78 and possess the binding affinities of -8.4, -8.9, and -8.7 kcal/mol, respectively. In addition, these compounds interacted with key residues of GRP78 and have several amino acid residues interaction in common with the cocrystal ligand (ATP). Based on physicochemical parameters and ADME evaluations, these compounds were found to have good drug-like properties. These compounds could be used as possible GRP78 inhibitors in the fight against cancers. Albeit, exhaustive experimental studies would be required to confirm the findings described here.

An observational study of dose dense chemotherapy with lipegfilgrastim support in early breast cancer.

PURPOSE: Breast cancer is one of the most prevalent malignant diseases in women. The development of dose dense chemotherapy regimens has improved clinical outcomes but has been associated with increased hematological toxicity. Currently there is a paucity of data on the use of lipegfilgrastim in dose dense AC treatment in early breast cancer. The purpose of this study was to assess the use of lipegfilgrastim in the treatment of early breast cancer and to examine the incidence of treatment-related neutropenia during the dose dense AC phase and subsequent paclitaxel treatment. METHODS: This was a single arm, non-interventional, prospective study. The primary endpoint was to determine the rate of neutropenia defined as ANC of < 1.0 × 109/L, during four cycles of dose dense AC with lipegfilgrastim support. The secondary endpoints were the incidence of febrile neutropenia, (temperature > 38 °C and ANC < 1.0 × 109/L), treatment delays, premature treatment cessation and toxicity. RESULTS: Forty-one participants were included in the study. Of the 160 planned dose dense AC treatments, 157 were administered, and 95% (152/160) of these were given on time. The rate of treatment delay was 5% (95% CI 2.2 to 9.9%) due to infection (4) and mucositis (1). Four (10%) patients developed febrile neutropenia. The most frequently occurring adverse event was grade 1 bone pain. CONCLUSION: Lipegfilgrastim is an effective option in the prophylaxis of chemotherapy-induced neutropenia, and its use in everyday anti-cancer treatment can be considered.

Degrees of Testicular Atrophy Following Orchidopexy for Testicular Torsion.

Introduction Testicular torsion is an urological emergency. It is a time-sensitive condition in which twisting of the spermatic cord and testicular blood supply occurs, causing acute onset severe scrotal pain. The incidence of testicular torsion is highest amongst prepubertal males; however, it can occur at any age. Every hour that passes from the onset of symptoms has been shown to decrease the salvageability rate of the torted testis. Another significant factor that impacts testicular salvage is the degree of torsion. Prompt surgical exploration of the scrotum and orchidopexy, if the testis is salvageable, is the mainstay of treatment. A major sequela following orchidopexy for torsion is the decrease in testicular volume. The aim of this study is to assess testicular volume loss post orchidopexy in patients who presented with testicular torsion, as well as to identify the significance of the degree of rotation and duration of torsion in post-fixation volume loss. Methods This is a retrospective study in which all patients who underwent scrotal exploration for a primary diagnosis of testicular torsion between June 1, 2016, to January 15, 2023, were reviewed. The information obtained included the patients' demographics such as age, duration of symptoms, and laterality. Ultrasound images were reviewed for pre- and postoperative findings which included confirmation of testicular torsion as well as testicular volume measurements. Patients were excluded if they underwent an orchidectomy, had a diagnosis other than testicular torsion once scrotal exploration was done, or did not perform a follow-up scrotal ultrasound. Additionally, patients who underwent an orchidopexy for undescended testis earlier in life were also excluded. For statistical analysis purposes, degrees of testicular torsion and time to surgery were classified into mild, moderate, and severe. Results A total of 109 patient records were reviewed within the specific time frame. Of these, 47 patients were excluded as per the exclusion criteria mentioned previously, which gave us a sample size of 62 patients. Our findings showed that increasing severity of the degree of torsion as well as the time for surgery have statistically significant (p-value <0.05) effects on postoperative testicular volume loss. However, it was noted that time to surgery has a more pronounced effect on the mean volume loss than the degree of torsion. Moreover, the analysis also showed that, on average, with every additional hour from the onset of symptoms to surgery, the approximate volume loss is 0.15 ml. However, once time exceeds the 4.5-hour mark, the mean volume loss is 0.4 ml for each additional hour. Conclusion The current study indicates that earlier surgical intervention and correction of torsion are associated with enhanced preservation of postoperative testicular volume. Both the degree of torsion and time to surgery influence mean volume loss; however, time to surgery has a greater impact on the mean volume loss. These results highlight the importance of early diagnosis and intervention in cases of testicular torsion to minimize the risk of long-term testicular volume loss.

Renal Carcinoma Patterns and Prevalence in Bahrain: A Descriptive Study.

Cancer is a major health problem with a significant impact on society and healthcare systems. In 2018, approximately 18.1 million cases of cancer were diagnosed and 9.6 million deaths were documented. Urological cancers account for 12.9% of new cases recorded and 8% of deaths due to cancer worldwide. The latest cancer registries covering the Gulf Cooperation Council (GCC) countries report that 4078 cases of renal cell carcinoma were diagnosed from 1998 to 2012. Urological cancers comprised 9.4% of all cases with an incidence rate of 16.1% in males and 3.2% in females. All renal cancer cases documented in Salmaniya Medical Complex (SMC) from 2014 to 2018 were reviewed. Data collected for all patients from the electronic health record system included age at diagnosis, gender, laterality of cancer (where applicable), histological type, and TNM (tumor, node, metastasis) classification and staging. Furthermore, World Health Organization (WHO) grade and data were collected for kidney cancer cases. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp, Armonk, NY). From 2014 to 2018, there were 65 documented cases of kidney cancer with an average caseload of 13 cases per year. The mean age at diagnosis was 57.6 years. Clear cell carcinoma was the most common histological subtype (37.5%). Stage 1 was the most common stage at diagnosis (35.4%) and the age-standardized mortality rate for males and females were 4.59 and 4.58 in 100,000, respectively. Kidney cancer is a urological malignancy that can pose a burden on both the patient and the healthcare system. There should be a national effort to better understand the etiology and epidemiology of this disease entity with regard to our population. Such efforts would make data regarding diagnosis, management, and follow-up more accessible and would add positively to our healthcare system.

Testicular Germ Cell Tumor Presenting as Torsion in a Young Patient.

Testicular torsion is a relatively common urological emergency, which involves the twisting of the spermatic cord and its contents leading to ischemia to the testes, which usually presents as sudden, severe scrotal pain. In comparison, testicular neoplasms are far less commonly encountered in the emergency department as they often present as painless hard masses that grow slowly over longer periods of time. Extremely rare cases of testicular neoplasms present as sudden scrotal pain that causes a challenging task in the emergency department as physical examinations and ultrasound findings could vary and not be specific enough in confirming the diagnosis. In this case, we report a 22-year-old male who was referred from the emergency department (ED) as a case of testicular torsion from the presenting history; however, his physical examination and Doppler ultrasound findings were suspicious of testicular malignancy. The patient presented with a history of right scrotal pain for a few hours with no predisposing factors; however, examination and imaging were highly suspicious of an underlying neoplasm. The patient underwent an inguinal orchidectomy, and histology confirmed the presence of a germ cell tumor of varying components. In conclusion, a high index of suspicion for testicular torsion should always be present when a patient presents with sudden onset testicular pain; however, the differential diagnosis including testicular neoplasms should not be overlooked as it can change the management and outcome.

Metastatic Renal Cell Cancer Instigating Paraplegia in a Male Patient.

Renal cell carcinoma (RCC) constitutes about 2% of all adult malignancies and is the most common malignant renal neoplasm with bony metastases occurring in up to 50% of patients with RCC. In this case, we report a 42-year-old male who presented with chronic back pain and had a sudden episode of paraplegia. The patient was initially referred to the orthopedics service. He had a lumbar X-ray done followed by a CT of the spine that showed a burst fracture of the L1 vertebra with incidental finding of a right renal mass suspicious of RCC. Upon further investigations, the patient was found to have a large heterogeneous renal cortical mass with multiple cystic changes and necrosis invading the Gerota's fascia as well as a tumor thrombus extending into the right renal vein and inferior vena cava. Although it has been well established that RCC metastasizes to bones and it is not uncommon for vertebral column involvement, sudden paraplegia and incontinence resulting from lumbar fracture due to metastatic RCC has not been widely published. Conclusively, RCC is a common malignancy in which a significant number of patients have metastatic disease upon presentation and this can lead to initial confusion and delay in diagnosis, hence it should be part of the differential diagnosis when investigating chronic bony pain and pathological fractures.

Early-Onset Bilateral Severe Valvular Regurgitation After Mediastinal Radiotherapy in Hodgkin Lymphoma Survivors: Should We Screen Prior to 10 Years After Mediastinal Radiotherapy?

Background: Radiation-induced valvulopathy (RIV) is a common complication of mediastinal radiotherapy and usually occurs at least 10 years after exposure to radiotherapy. Case Report: We report the case of a 37-year-old female with a history of stage IIIB Hodgkin lymphoma who was diagnosed with RIV after all other potential causes of shortness of breath and valvular dysfunction were excluded. The patient's presentation, 6 years after receiving chemotherapy and radiotherapy for Hodgkin lymphoma, was earlier than expected after mediastinal radiotherapy. The patient was started on a regimen of lisinopril, nifedipine, and metoprolol, and her symptoms improved significantly within 4 days of starting medical therapy. We review the literature, discuss the risk factors and determinants of developing RIV, and suggest the ideal timing to screen patients. Conclusion: This case is of educational value for internal medicine, oncology, and cardiology healthcare providers who should consider RIV as a cause of shortness of breath in patients who underwent mediastinal radiotherapy for Hodgkin lymphoma.

Impella RP Support and Catheter-Directed Thrombolysis to Treat Right Ventricular Failure Caused by Pulmonary Embolism in 2 Patients.

Right ventricular failure secondary to pulmonary embolism is associated with morbidity and death. The Impella RP System has often been used for percutaneous mechanical circulatory support in patients with right ventricular failure from other causes, including myocardial infarction, cardiac surgery, and left ventricular assist device implantation. We report 2 cases of massive pulmonary embolism in which combined Impella RP use and ultrasound-assisted catheter-directed thrombolysis effectively treated shock caused by right ventricular failure and contributed to successful outcomes. To our knowledge, only one other patient with this indication had been treated with the Impella RP device.

Preliminary Report on the Safety and Efficacy of Staged versus Complete Revascularization in Patients with Multivessel Disease at the Time of Primary Percutaneous Coronary Intervention.

This study aims to determine the safety and efficacy of complete versus staged-percutaneous coronary intervention (PCI) of nonculprit lesions at the time of primary PCI in patients with multivessel disease. Recent trials had suggested that revascularization of nonculprit lesions at the time of primary PCI is associated with better outcomes, however; the optimum timing and overall safety of this approach is not well known. An observational prospective study was conducted, including 50 patients who presented with ST-segment elevation myocardial infarction and found to have at least an additional nonculprit significant (> 70%) type A or B lesion. According to the operator's discretion, patients either underwent complete revascularization of nonculprit significant lesions during primary PCI procedure or within 60 days of primary PCI (staged-PCI). Safety outcomes evaluated were contrast-induced nephropathy (CIN), the amount of contrast used, and fluoroscopy time. Efficacy outcome assessed was major adverse events (MACE) at 1 year. The fluoroscopy time and amount of contrast used were increased in complete revascularization group (35.3 ± 9.6 vs. 26.3 ± 6.7 minutes, p < 0.001, and 219.5 ± 35.1 vs. 187.5 ± 45.5 mL, p = 0.01, respectively); while incidence of CIN remained similar ( p = 0.73). The incidence of MACE at 1 year was similar in both groups (23% in the complete revascularization group vs. 25% in the staged-PCI group, p = 0.43). Complete revascularization and staged-PCI of nonculprit type A or B lesions at the time of primary PCI were associated with similar long-term outcomes and safety profile. Larger studies are needed to further validate these results.

Urethroplasty for treatment of long anterior urethral stricture: buccal mucosa graft versus penile skin graft-does the stricture length matter?

PURPOSE: To investigate the surgical outcomes of dorsal onlay urethroplasty (DOU) using buccal mucosa graft (BMG) or penile skin graft (PSG) and to assess the effect of stricture length in men with anterior urethral strictures. METHODS: A prospective cohort included men with anterior urethral strictures between 2008 and 2015. Patients underwent DOU using PSG or BMG. Patients had urethrography and uroflowmetry at 0, 3, 6, 12 months, and urethroscopy when needed. Student's t test, Mann-Whitney U tests, and Pearson's Chi-square test were used for analysis. RESULTS: Sixty-nine patients (43 ± 14 year) were included, 31 received BMG, and 38 received PSG. Mean stricture length was 8 ± 3 cm, mean operative time was 145 ± 31 min, and mean follow-up was 56 ± 10 mo. Success rate was 87 % (90 % BMG vs. 84 % PSG, p = 0.4). Mean operative time was significantly shorter in PSG group (136 ± 29 min vs. 256 ± 58 min, p = 0.0005). Complications of grade I developed in 36 % (wound infection = 10 %, postvoiding dribbling = 18.8 %). Thirty of 69 patients (43 %) had strictures ≥8 cm, and 39 (57 %) had strictures <8 cm-success rate was equal for both subgroups (87 %). Mean blood loss, mean operative time, and incidence of postvoid dribbling were significantly lower in strictures <8 cm. CONCLUSION: BMG and PSG have comparable success rates in treatment of long anterior urethral strictures. Operative time is significantly longer in BMG. Long-segment strictures are associated with longer operative time, more blood loss, and more occurrence of postvoid dribbling. However, the length of the stricture has no influence on the success rate and functional outcomes of DOU.

Spontaneous Distal Right Coronary Artery Dissection in a Patient With Massive Pulmonary Embolism: Thrombolyze or Not?

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischemia, myocardial infarction, and sudden cardiac death. We report a case with SCAD of distal right coronary secondary to pulmonary thromboembolism. Reported treatment options for SCAD include medical therapy, thrombolysis, balloon angioplasty, and coronary artery bypass surgery. The decision as to which one depends on the clinical and angiographic factors. The benefit of thrombolysis in these patients is controversial. The prognosis in patients surviving the initial event is generally believed to be favorable. In patients who remain stable, conservative management seems to be safe and is compatible with a good long-term outcome.

Myoepithelial carcinoma in the mediastinum involving the left atrium.

We report a case of a 56-year-old male who presented with typical atrial flutter and was diagnosed with a large mediastinal mass, posterior to the ascending aorta, noted within the left atrium, compressing the superior vena cava and right superior pulmonary vein, and measuring >9.0 cm at its greatest diameter. Histopathological studies showed a myoepithelial carcinoma. The patient underwent tumor debulking and radiation therapy. This is the first report of a mediastinal myoepithelial carcinoma involving cardiac chambers.

Accuracy of Sentinel Node in Detecting Lymph Node Metastasis in Primary Endometrial Carcinoma.

BACKGROUND: Endometrial carcinoma is the most common gynecological cancer and its treatment is still controversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneal lymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment. Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selective lymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simple and seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy of sentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staging laparotomy. MATERIALS AND METHODS: Ninety-three women with endometrial carcinoma at high-risk for nodal metastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, then retroperitoneal spaces were opened and blue lymph nodes within pelvic and para-aortic regions were removed as separate specimens for histopathological examination (sentinel lymph nodes=SLNs). Hysterectomy and selective lymphadenectomy then performed for all women included in this study. RESULTS: Deposition of methylene dye into at least one lymph node was observed in 73.1% (68/93) of studied cases. 18.3% (17/93) of studied women had positive lymph node metastasis and 94.1% (16/17) of them had positive metastasis in SLNs. In this study, SNLs had 94.4% sensitivity and 100% specificity in prediction of lymph node metastasis. Mean number of lymph nodes removed from each case decreased when SLNs biopsy were taken. CONCLUSIONS: SLNs are the key lymph nodes in endometrial tumor metastasis and their involvement could be an indicator for whether or not complete systematic lymphadenectomy is needed during staging laparotomy.

Role of irbesartan in prevention of post-coronary artery bypass graft atrial fibrillation.

BACKGROUND AND OBJECTIVE: Atrial fibrillation (AF) is a common complication of cardiothoracic surgery (CTS). Existing evidence about the potential protective role of angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) for post-CTS AF has been limited and conflicting. In this single-blind, open-label, randomized prospective pilot study, we evaluated the potential protective role of irbesartan (an ARB) in post-coronary artery bypass graft (CABG) AF. METHODS: A total of 100 consecutive patients undergoing CABG were randomly assigned to irbesartan (n = 50) versus no irbesartan (n = 50) for 5 days prior to the scheduled surgery. Data were collected for imaging studies, laboratory values, and peri-operative details. Patients were monitored post-operatively for in-hospital AF episodes. Unadjusted and adjusted logistic regression analysis was performed to assess the effect of irbesartan on the incidence of post-CABG AF. RESULTS: A total of 14 patients developed AF during their post-operative hospital stay. The incidence of AF in patients who received irbesartan was 6% (n = 3) compared with 22% (n = 11) in patients who did not receive irbesartan (p = 0.021). Univariate logistic regression analysis identified irbesartan and age as statistically significant variables. An adjusted multivariate logistic model identified irbesartan as an important protective factor against development of post-CABG AF (adjusted odds ratio [OR] 0.20; 95% confidence interval [CI] 0.04, 0.94; p = 0.04). Increasing age (adjusted OR 1.09, 95% CI 1.01, 1.17; p = 0.03) was also identified as an independent risk factor for development of post-CABG AF. CONCLUSION: Pretreatment with irbesartan tends to have a significant protective effect against the occurrence of AF during the post-operative period in patients undergoing CABG.

The use of penile skin graft versus penile skin flap in the repair of long bulbo-penile urethral stricture: a prospective randomized study.

OBJECTIVES: To evaluate the use of penile circular skin graft versus flap as a ventral onlay for bulbo-penile stricture urethra. MATERIAL AND METHODS: Between 2003 and 2009, 37 patients with bulbo-penile stricture were randomized to penile methods circular skin graft (PCG = 18) or flap (PCF = 19). Inclusion criteria included postinstrumentation or idiopathic stricture. Exclusion criteria were unhealthy skin and previous urethrotomy/urethroplasty. Patients had urethrogram at three weeks, three months, one year, and urethroscopy when needed. Any subsequent urethrotomy/urethroplasty was considered a failure. Chi-square and Student's t test were used for analysis. RESULTS: Patients' ages were 45.3 (range: 30-65) and 45.5 (35-60) yr in PCG&PCF respectively. Stricture length was 15.2 (10-22) &14.1 (9-21) cm in PCG&PCF respectively. The stricture was postinstrumentation in 9 and 11 and idiopathic in 9 and 8 patients in PCG&PCF respectively. Mean follow up was 36.2 (12-60) and 37.1 (range: 13-24) months in PCG and PCF respectively. Operative time was significantly shorter in PCG than in PCF (203.3 and 281.6 min, respectively; P = .000). Early postoperative complications were similar in both groups. Superficial skin necrosis occurred only in the PCF group (3 cases). Late complications of mild postvoid dribbling occurred similarly in both groups. One patient in PCF had a urethro-cutaneous fistula at the level of fossa navicularis that was repaired later. Stricture recurred in 5 (27.7%) and 4(21%) patients in PCG and PCF, respectively (P = .249). Four patients had visual internal urethrotomy (2, 2), four needed anastomotic urethroplasty (2, 2) in PCG and PCF, respectively, and one needed buccal mucosal graft in the PCG group. CONCLUSIONS: At intermediate follow-up, both penile circular graft and flap had similar and high success as a ventral onlay for repair of long bulbo-penile stricture with a low rate of complications.