A Literature Review and Two Case Reports: Is Traumatic Dislocation of the Testes a Surgical Emergency?

Traumatic dislocation of the testes (TDT) is a rare sequela of blunt scrotal and perineal trauma. TDT can easily be overlooked during concomitant trauma due to other injuries, The damage to the testis appears to be not severe in dislocation and may be corrected by repositioning even if it is delayed. However, delayed intervention might be associated with pain and discomfort and may lead to abnormal sperm parameters and possible infertility. The urgency of surgical intervention increases whenever there is associated testicular torsion, rupture, or bilateral testicular TDT. We report two cases of unilateral traumatic testicular dislocation following motorcycle crashes with different presentations and approaches to treatment. We also engage in a review of the relevant literature.

Combined percutaneous and transurethral cystoscopy for large urethral foreign bodies: A case report and literature review.

Since early reports in the literature, cases with urethral foreign bodies have been extremely variable and interestingly challenging. Various presentations have been reported, including self-insertion for sexual pleasure, assaults, trauma, and foreign bodies migration. Management by endoscopic surgery is usually a preferred option for small foreign bodies. Open surgery is reserved for large objects with difficult access. We present a case of self-insertion of a large urethral foreign body with a caliber of 45F in a young gentleman. Endoscopic extraction of the foreign body was safely successful using combined percutaneous and transurethral cystoscopy.

Percutaneous nephrolithotomy: critical analysis of unfavorable results.

OBJECTIVE: To identify the risk factors of unfavorable results of percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: A total of 602 patients were subjected to 616 PCNL procedures. Patients were divided into two groups according to the results of treatment. Group 1 with favorable results includes patients who became stone free after a single PCNL procedure without major complications. Group 2 with unfavorable results includes three subgroups: a) Patients who developed major complications, b) Those who required second major intervention to complete stone removal, and c) Patients with residual stones > 4 mm at 3 month. Risk factors for unfavorable outcome were studied by univariate and multivariate analyses. RESULTS: Unfavorable results were documented in 176 patients (28.6%) due to major complications in 40 (6.5%), need for second intervention in 124 (20%), and presence of residual stones > 4 mm at 3 month in 12 (1.9%). The remaining 440 patients (71.4%) were considered of favorable outcome. Independent risk factors of unfavorable results on multivariate analysis were staghorn stones, multiple stones and stone largest diameter > 50 mm. CONCLUSION: To optimize the results of PCNL, urologists should consider careful patient selection. Patients with staghorn stones, multiple stones or large stone burden are more susceptible to unfavorable outcome.

Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients.

OBJECTIVE: To study the impact of tamsulosin on the rate of spontaneous passage of distal ureteral stones. METHODS: A total of 100 patients with stones sized 10 mm or smaller, located in the distal part of the ureter were included. Patients were randomly assigned to 2 equal groups. Group 1 received 0.4 mg tamsulosin once daily and group 2 received placebo. The investigators and the patients were masked to the type of treatment. Patients were followed-up until passage of the stone, or for a maximum of 4 weeks. The number of pain episodes, need for analgesia, stone expulsion rate and time, and possible side effects of medications were observed in both groups. RESULTS: Apart from 4 patients in the placebo group who were lost to follow-up, all patients complied with the prescribed medications and continued the study. Stone expulsion occurred in 41 of 50 patients (82%) in group 1 and in 28 of 46 patients (61%) in group 2 (P = .02). The chance of stone expulsion was 3 times higher in the tamsulosin group (relative risk [RR] = 2.93; 95% CI, 1.152-7.45). In group 1, patients with stones sized < or = 5 mm showed a significantly higher expulsion rate compared to those with larger stones (> 5 mm). Age, gender, and stone laterality had no significant impact on the expulsion rate. The expulsion time was significantly shorter in the tamsulosin group (6.4 +/- 2.77 days vs 9.87 +/- 5.4 days for groups 1 and 2, respectively). Moreover, the frequency of pain episodes, the need for diclofenac, and its total dosage were significantly lower in the tamsulosin group. Side effects observed in both groups were comparable and mild, and no patient withdrew because of them. CONCLUSIONS: Tamsulosin is a safe and effective drug that enhances spontaneous passage of distal ureteral stones sized 10 mm or smaller.