A rare case of Fournier's gangrene developing from colon perforation in an infant: A case report.

Fournier's gangrene, a rare and life-threatening soft tissue infection affecting the genitalia and perineum, results from various microorganisms. This rapidly progressing necrotizing fasciitis yields higher mortality and morbidity rates. We report a case of a 1-month-old male infant with Fournier's gangrene due to perforation transverse colon complicated with septic shock and pneumonia also accompanied by patent processus vaginalis. Radiological findings of pneumonia and pneumoperitoneum were exhibited. Early diagnosis and management are demanded to mitigate life-threatening and improve the prognosis. The patient underwent incision drainage, peritoneal lavage, exploratory laparotomy, colostomy, necrotomy debridement, and patent processus vaginalis ligation after hemodynamic status stabilization.

Unusual morphology of isolated male epispadia: A rare case report.

In less than 10% of cases, males may have isolated epispadias, which is caused by failure in the urethral tubularization process, leading to dorsal urethral defect. This case report presents a unique instance where epispadias was associated with ambiguous genitalia. A 5-year-old boy diagnosed with epispadias. The penis resembled external female genitalia, with scrotal skin covering it. He underwent a two-stage operation without complications. The aim of the surgical techniques is to correct these anomalies and restore urinary continence and sexual function. Long-term outcomes of the surgery can vary, which highlights the need for further research.

2,8-Dihydroxyadenine nephrolithiasis with chronic kidney disease in children: A case report and review of literature.

The incidence of nephrolithiasis in children ranges from 5 to 10% in developing countries. Etiology of nephrolithiasis in children remains largely unknown, so metabolic evaluation is indicated in all case, because of potential morbidity and recurrence. We report a case of 2,8-Dihydroxyadenine nephrolithiasis present as bilateral staghorn stone in 11 years old boy with chronic kidney disease. 2,8-Dihydroxyadenine nephrolithiasis is the result of a metabolic abnormality due to the deficiency of the enzyme adenine phosphoribosyltransferase (APRT), it is not only promote stone formation, but also induced nephropathy. Early diagnosis ensure appropriate treatment and favorable prognosis for kidney function and stone management.

Correlation between Motorcycle Riding and Erectile Dysfunction on Online Motorcycle Taxi Drivers.

OBJECTIVE: Erectile dysfunction is a condition in which the patient is unable to achieve or maintain a sufficient erection for sexual intercourse. Transportation usage was believed to have a higher risk of erectile dysfunction. This study aimed to assess the correlation between activity and severity of erectile dysfunction among online motorcycle taxi drivers who use motorbikes. MATERIALS AND METHODS: This research uses an observational analytic method with a cross-sectional approach with primary data collection from the respondents who work as online motorcycle drivers from January 2021 to March 2021. Data analyses were conducted using Mann-Whitney and Spearman statistical test. RESULTS: A total of 149 respondents met the inclusion and exclusion criteria contained in this study. It was found that the prevalence of erectile dysfunction in this study was 57.7%. There was a significant difference in the distance covered (km) by online motorcycle taxi drivers who experienced erectile dysfunction compared to those who did not have erectile dysfunction (P=.050). In addition, there was a significant difference in length of work (year) among online motorcycle taxi drivers who experienced erectile dysfunction (P=.045). CONCLUSION: There was a significant difference in erectile dysfunction incidence based on the distance covered per day and length of work in online motorcycle taxi driver. No significant difference was found in the incidence of erectile dysfunction based on the length of motorbike drive per day. The more distance covered (km) and length of work (year) and the more severe the erectile dysfunction are based on international index of erectile function-5 score.

Comparison between staged laparoscopic technique in children with high intra-abdominal undescended testis: a systematic review and meta-analysis.

Background: This study performed a systematic review and meta-analysis to compare the outcomes of the staged laparoscopic Fowler-Stephens Laparoscopic Orchiopexy (FSLO) and Staged Laparoscopic Traction Orchiopexy (SLTO) in patients with intra-abdominal testes (IAT). Methods: This study reviewed literature published from 2016 to 2024. A systematic literature search was conducted on three databases: PubMed, ScienceDirect, and Google Scholar, using keywords (High intra abdominal testis) AND (("Fowler Stephens laparoscopic orchiopexy" OR (FSLO)) OR (Staged Laparoscopic traction orchiopexy OR (SLTO)). Non-randomized trials and observational studies comparing staged laparoscopic FSLO and SLTO, without any time range restriction are included. Studies without FLSO orchidopexy as a control, case reports, case studies, duplicate publication, no full text and non-English studies are excluded. This study used the PRISMA protocol, the Jadad Scale, and the Newcastle Ottawa Scale (NOS) to evaluate the included studies. To analyze statistical data, the Review Manager (RevMan) software was used. The Chi-squared test was used to calculate statistical heterogeneity in the meta-analysis. Results: There were 240 patients from 5 studies (109 in the SLTO group and 131 FSLO in group). The primary outcome of this study is testicular descent and atrophy. There were no significant differences in testicular descent (RR:1.08[0.96 - 1.23],p<0.20,I 2:0%) and atrophy rate (RR:0.45[0.19 - 1.09],p<0.08,I 2:0%). Secondary outcomes are the duration of operation in both the first and second stages. Statistical analysis reveals a significantly lower first-stage operation time in the FSLO group (MD:9.31[7.08,11.55], p<0.05;I 2:94%). At the same time, lower second-stage operation times are significantly reported in the SLTO group (MD:-4.05[-7.99,-0.12],p<0.05; I 2:60%). Conclusions: In terms of testicular descent and testicular atrophy the SLTO technique yields similar results to the FSLO technique. Both techniques have advantages and disadvantages, and we recommend SLTO as the first choice in children with a high IAT of <4 cm. PROSPERO registration: CRD42023412407.

The Role of Maternal and Environmental Factors During Pregnancy on the Risk of Hypospadias Occurrence.

Introduction and Objectives: Hypospadias is a congenital disorder in boys in which the urethral meatus is located on the ventral penis. The incidence rate of hypospadias is increasing, however, there is still no literature regarding how significant is the role of maternal and environmental factors to the risk of hypospadias, especially in Indonesia. This study aims to analyze the maternal and environmental factors during pregnancy to the risk of hypospadias. Materials and Methods: This study was an analytical observational study with a case control design. The subjects were mothers who gave birth to children with hypospadias, compared to normal, who visited the urology, pediatric-surgery, plastic-surgery, and pediatric clinic at Hasan Sadikin General Hospital. Results: A total of 120 samples (60 cases and 60 control) were included in this study. There were 14 maternal factors, which 5 of them found significantly correlated with hypospadias, including maternal occupation as an industrial worker (P = .003; OR:4.789), pregnancy-enhancing drugs usage (P = .004; OR: 5.783), smoking consumption (P = .034; OR: 2.294), mosquito-repellant usage (P = .0001; OR: 82.600), and preterm birth (P = .013; OR: 2.895). There were 2 environmental factors, and one of them was significant, which was the distance from home to industrial/rice fields/waste areas, approximately 780 m (P = .0001; OR: 6.102). Based on multivariate analysis, we found that maternal occupation, mosquito repellent usage, and the distance from home to industrial area had a strong relationship in predicting hypospadias occurrence. Conclusion: Several maternal and environmental factors were found significantly correlated to hypospadias occurrence. Among these, mosquito-repellant usage was found to be the most significant factor.

Fournier's gangrene in female patient with Turner's syndrome: A case report.

This case reported Fournier's Gangrene (FG) case in 22 year old woman, which is rarely found in young woman, with Turner's Syndrome, vulvar synechiae, uterine agenesis, and voiding disorders. Turner's Syndrome can lead to vulvar synechiae and voiding disorders. This condition is exacerbated by E. coli bacterial infection, causes tissue necrosis and leads to FG. Urgent synechiae incision and necrotomy debridement were successfully performed to remove the necrotic tissue followed by graft closure and flap reconstruction. Rapid administration of broad-spectrum antibiotics is also important. These treatments are considered as the key of successful outcomes of FG.

Polymorphism of PvuII, Xba1, and SNP 12 Estrogen Receptor 1 (ESR1) in Hipospadias Patients at Tertiary Hospital Center.

INTRODUCTION: The prevalence of hypospadias ranges between 1: 250 to 300 per live birth. Estrogen exposure has been associated with the increasing incidence of hypospadias in humans and a significant relationship between Estrogen Receptor 1 (ESR1) polymorphisms and hypospadias was determined from the previous study. This study aims to determine the proportion of ESR1 polymorphism. METHODS: This was a descriptive study aimed to find the incidence of ESR1 gene polymorphism in hypospadias patients visiting the Urology Outpatient Unit of the Hasan Sadikin Bandung Hospital who will undergo hypospadias surgery. Deoxyribonucleic acid (DNA) was performed using foreskin of hypospadias patient during the surgery then being extracted and will be analyzed using polymerase chain reaction (PCR) sequencing. RESULTS: Thirty eight samples of hypospadias were identified, 5 samples were unable to sequence and 33 samples were successfully sequenced using the PCR method. The Pvull ESR1 gene was dominated by the T allele which is a wild-type allele and the genotype containing the T allele, namely TT + TC (57,2%). Normal genotype (TT) were more frequent in distal hypospadias, and Heterozygous polymorphisms (TC) was higher in proximal hypospadias. The ESR1 Xba1 gene polymorphism was dominated by the A allele which is a wild-type allele and the AA + AG genotype (76,1%). Normal genotype (AA) was more frequent in distal hypospadias, and both heterozygous hypospadias (AG) and homozygous hypospadias (GG) were found only in proximal hypospadias. The ESR1 SNP 12 gene polymorphisms were found in the combination of genotypes that played a role, namely GA + AA (81%) and the G allele which is a wild-type allele. Heterozygous polymorphisms (GA) was the most finding genotype and more frequent in proximal hypospadias. CONCLUSION: ESR1 gene polymorphisms (PvuII, XbaI, and SNP 12) were found in hypospadias patients. ESR1 polymorphisms may correlate with the severity of hypospadias. Further research with a larger sample and better hypospadias grouping is needed to confirm.

Urinary Cytochrome C and Caspase-3 as Novel Biomarker of Renal Function Impairment in Unilateral Ureteropelvic Junction Obstruction Model of Wistar Rats.

INTRODUCTION: Prolonged obstruction in UPJO would lead to kidney destruction. It is important to find a non-invasive biomarker for early detection of renal impairment before definitive treatment for UPJO. In this study, we aim to evaluate the role of urinary cytochrome c and caspase-3 as a novel biomarker to predict renal function impairment in a UPJO model in Wistar rats. METHODS: Twenty-five male Wistar rats were separated into 3 groups. Group I consists of 5 rats without any treatment or model, group II consists of 5 rats (sham group), and group III consists of 15 rats with the unilateral partial ureteral obstruction model. After 4, 15, and 21 days of observation, the urine was collected and rats were sacrificed to collect the glomerular count in the kidney. Measurement of cytochrome c and caspase-3 was done using the ELISA method, while the glomerular count was done using a light microscope. Data were analyzed using factorial repeated measures ANOVA test and correlation test with Pearson and processed using SPSS version 20.0. RESULTS: The UPJO group has a significant increase in cytochrome c concentration and caspase-3 concentration compared to the control group and sham group (p<0.05). There was a significant decrease in the normal glomerulus count of the UPJO group (p<0.05). There was a significant relationship between the decrease in glomerulus count with the concentration of cytochrome c and caspase-3 in the UPJO group. CONCLUSION: There was a significant relationship between the decrease in glomerulus count with the increase in the concentration of cytochrome c and caspase-3 in the UPJO group.

Effect of Intracorporeal Human Adipose-Derived Stem Cells (hADSCs) on Corpora Cavernosa Transforming Growth Factor ß1 (TGFß1) and Collagen Type I Concentration in Wistar Rat Priapism Model.

INTRODUCTION: The ischemic process in priapism can lead to displacement of normal tissue with fibrotic tissue, due to collagen deposition, and eventually leads to erectile dysfunction. Many studies have identified that the supernatant of adipose tissue-derived stem cells (ADSCs) significantly ameliorates fibrosis of different tissue, but limited attention has been paid to its efficacy on fibrosis of the corpora cavernosa. METHODS: A total of 22 Wistar rats divided into five groups, with two groups each consisting of five male wistar rats with priapism without human ADSC (hADSC) therapy (group I) and two other groups consisting of five rats with priapism, were given 106 cells' intracorporeal hADSC injection after 12 hours of penile clamping (group II) were euthanized after 2 and 4 weeks of observation. The last group consisted of two rats without any treatment or model (group III). Following euthanasia, penises were harvested for TGFß1 and collagen type I measurement using ELISA. Statistical analysis using independent-sample t-tests was done with SPSS 21.0. RESULTS: Penile TGFß1 concentration in the treatment group was significantly lower in the second and fourth weeks of observation (p 2=0.004, p 4=0.003), and collagen type I was significantly lower in the second and fourth weeks (p 2=0.003, p 4=0.011). CONCLUSION: Intracorporeal hADSC injection limited the fibrosis process in a priapism model. Although the mechanism was unclear, it may be related to the potential of hADSCs to produce various growth factors that could limit TGFß1 and collagen production.

Malignant priapismus induced by adenocarcinoma of the prostate.

Penile metastasis of adenocarcinoma of prostate is an extremely rare clinical entity and even less of such cases presenting with malignant priapism. Management of priapism with penile shunting is recommended in this case. No consensus beyond personal recommendation from other studies found in this case due to the relative rarity of the disease and the associated lack of data. In this study, we present a case of malignant priapism due to penile metastasis of adenocarcinoma of the prostate, an extremely rare clinical entity and a more uncommon site of metastasis.

Complicated Urinary Tract Tuberculosis in a 13-Year-Old Adolescent with Chronic Kidney Disease and Antituberculous Drug-Induced Hepatotoxicity.

Urinary tract tuberculosis (TB) is a rare extrapulmonary manifestation of TB in children. The disease is potentially underdiagnosed because it clinically resembles other urinary tract infections. A 13-year-old adolescent girl presented with pain, difficulty in micturition, and gross hematuria for almost two years before admission, and she had left flank pain since one year ago and significant loss of body weight during the illness. The close TB contact was her grandmother who was on TB treatment. Acid-fast bacilli yielded positive result, Mantoux test was positive (17 mm), urine GeneXpert MTB/Rif was positive; tuberculoma was identified on kidney histopathology, and a diuretic renogram revealed an uncorrected glomerular filtration rate (GFR) of the right and left kidney to be 32.5 mL/min/1.73 m2 and 5 mL/min/1.73 m2, respectively. During the treatment, oral anti-TB drug-induced hepatotoxicity (ADIH) occurred to the patient. This problem was solved with management according to the British Thoracic Society (BTS) guidelines. Screening TB in children is very important for a better outcome. If children complain of some complicated urinary tract infection, TB should be suspected. Optimaly treating children with urinary tract TB exagerrated with ADIH and CKD is very challenging.

AT1 expression in human urethral stricture tissue.

BACKGROUND: Urethral stricture has a high recurrence rate. There is a common doctrine stating that "once a stricture, always a stricture". This fibrotic disease pathophysiology, pathologically characterized by excessive production, deposition and contraction of extracellular matrix is unknown. Angiotensin II type 1 (AT1) receptor primarily induces angiogenesis, cellular proliferation and inflammatory responses. AT1 receptors are also expressed in the fibroblasts of hypertrophic scars, whereas angiotensin II (AngII) regulates DNA synthesis in hypertrophic scar fibroblasts through a negative cross talk between AT1 and angiotensin II type 2 (AT2) receptors, which might contribute to the formation and maturation of human hypertrophic scars. OBJECTIVE: This study was conducted to determine the expression of AT1 receptors in urethral stricture tissues. METHODS: Urethral stricture tissues were collected from patients during anastomotic urethroplasty surgery. There were 24 tissue samples collected in this study with 2 samples of normal urethra for the control group. Immunohistochemistry study was performed to detect the presence of AT1 receptor expression. Data were analyzed using Mann-Whitney U test, and statistical analysis was performed with SPSS version 20. RESULTS: This study showed that positive staining of AT1 receptor was found in all urethral stricture tissues (n=24). A total of 8.33% patients had low intensity, 41.67% had moderate intensity and 50% had high intensity of AT1 receptors, while in the control group, 100% patients had no intensity of AT1 receptors. Using the Mann-Whitney U test, it was found that urethral stricture tissue had a higher intensity of AT1 receptors than normal urethral tissue with a p-value = 0.012. CONCLUSION: The results showed that AT1 receptor had a higher intensity in the urethral stricture tissue and that AT1 receptor may play an important role in the development of urethral stricture.

Hemangioendothelioma of the Bladder: The Youngest Case Report in A Child.

Hemangioendothelioma is a vascular tumor that commonly found in soft tissue, lungs, heart, liver, and bones, but it is very rare in bladder. We report a case of pediatric hemangioendothelioma of the bladder in a 2 years 7 months-old boy that treated with total excision of the bladder and bilateral ureterocutaneoustomy. This case is the second case in pediatric patients, and the youngest case that reported in a child. Our patient is doing well post operatively. But unfortunately interferon a-2b is not available in our hospital. At 3 months follow up, there was progressive progression of the tumor. Recurrent Abdominal mass was confirmed by Abdominal CT-Scan. The patient was died one week later. Interferon a-2b is might be an effective regimen on this tumor but further study is needed to confirm this statement.