Background and Objectives: Giant hydronephrosis refers to a hugely dilated kidney containing more than 1 L of fluid. It is usually due to congenital pelvi-ureteral junction obstruction in children. In adults, however, urolithiasis is the main cause and may result in bilateral conditions mimicking ascites. We aimed to present a case of bilateral giant hydronephrosis causing huge abdominal distention. Case Report: A 73-year-old male patient presented with diffuse abdominal pain and distention. His abdomen was massively distended with pendulous and irregular contour. Bilateral renal masses were expected due to the smooth surface and cystic consistency. Urine analysis showed 40-70 pus cells/HPF and serum creatinine level was 3.4 mg/dl. Abdominal ultrasonography revealed hugely dilated kidneys with lost renal parenchyma due to bilateral ureteral stones. Bilateral nephrostomy tubes were inserted under local anesthesia with gradual drainage and produced 4.8 L and 5.2 L from the right and left kidneys, respectively. After improvement of serum creatinine and hemoglobin values, ureteral stones were treated endoscopically. Follow up ultrasonography showed decompressed kidneys and serum creatinine around 2 mg/dl. Conclusion: Bilateral giant hydronephrosis is a cause of massive abdominal distention. It could be promptly diagnosed by ultrasonography. Initial percutaneous nephrostomy is recommended to save any potential residual functions.

Acute presentation of ureteral stump empyema after pretransplant nephrectomy has not been reported so far. We report on a 25-year-old male patient with end-stage renal disease due to congenital vesicoureteral reflux and a longterm history of management of infected kidneys including the last step of pretransplant right native nephrectomy. Within 2 weeks after operation, he presented with clinically visible ureteral stump empyema. Computed tomography and surgical exploration confirmed the diagnosis of a huge retentive stump of obstructive-refluxing megaureter which was excised with a smooth postoperative course. So, ureteral stump empyema may develop after a pretransplant nephrectomy and threaten the transplant process and the patient’s life. Consecutive nephrectomy and ureterectomy procedures to keep the iliac fossa fresh for kidney transplantation do not outweigh the risks of ureteral stump infections. Therefore, simultaneous nephroureterectomy is mandatory in the case of obstructive-refluxing megaureter.

Introduction: Unintentional self-inflicted injuries mainly refer to those injuries which are inflicted by the patient himself with benign intentions. In urology, they may vary and result in significant morbidities. Patients and Methods: A retrospective search of our patients’ data records for the reported cases of patient’s side-inflictor urological injuries during the period July 2006 – June 2016 was made. Each case was studied for age, gender, primary diagnosis, injury inflictor, involved organ, motivating factor, mechanism, diagnosis, management, and final outcome. Results: Of more than 55,000 urological procedures, 26 patients (0.047%) were involved in unintentional patient’s side-inflictor urological injuries. The age range was 8–76 years and included 23 Rabea A. Gadelkareem Elgamaa Street, Faculty of Medicine, Assiut University EG–71515 Assiut (Egypt) E-Mail dr.rabeagad@yahoo.com Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. II. Urological Self-Inflicted Harms: 1. Unintentional Patient’s Side-Inflictor Urological Injuries Rabea A. Gadelkareem Ahmed A. Shahat Mohamed F. Abdelhafez Ahmed Reda Mahmoud Khalil Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt Original Paper Received: November 9, 2017 Accepted: January 10, 2018 Published online: March 8, 2019 males and 3 females. Fifteen patients (57.7%) had urological disorders before the injury. They could be differentiated into direct organ involvement injuries (53.8%) and catheter involvement injuries (46.2%). External male urogenital organs were involved in 69.3% of cases which were diagnosed on physical examination. The inflictor of the injury was the patient himself, a relative, and another patient in 73.1, 19.2, and 7.7% of cases, respectively. Motivating factors were relief of painful conditions (34.6%), psychiatric disorders (38.5%), and sexual purposes (27%). Final outcomes were short-term harm, long-term harm, and permanent disability in 50, 11.5, and 38.5% of cases, respectively. Conclusion: Unintentional patient’s side-inflictor urological injuries are very rare events and mainly involve the external male urogenital organs under different motivating stressors. They could be differentiated into direct organ and catheter manipulation injuries with variable final outcomes from mild short-term harms to permanent disabilities.

Introduction: Unintentional self-inflicted injuries mainly refer to those injuries which are inflicted by the patient himself with benign intentions. In urology, they may vary and result in significant morbidities. Patients and Methods: A retrospective search of our patients’ data records for the reported cases of patient’s side-inflictor urological injuries during the period July 2006 – June 2016 was made. Each case was studied for age, gender, primary diagnosis, injury inflictor, involved organ, motivating factor, mechanism, diagnosis, management, and final outcome. Results: Of more than 55,000 urological procedures, 26 patients (0.047%) were involved in unintentional patient’s side-inflictor urological injuries. The age range was 8–76 years and included 23 Rabea A. Gadelkareem Elgamaa Street, Faculty of Medicine, Assiut University EG–71515 Assiut (Egypt) E-Mail dr.rabeagad@yahoo.com Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. II. Urological Self-Inflicted Harms: 1. Unintentional Patient’s Side-Inflictor Urological Injuries Rabea A. Gadelkareem Ahmed A. Shahat Mohamed F. Abdelhafez Ahmed Reda Mahmoud Khalil Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt Original Paper Received: November 9, 2017 Accepted: January 10, 2018 Published online: March 8, 2019 males and 3 females. Fifteen patients (57.7%) had urological disorders before the injury. They could be differentiated into direct organ involvement injuries (53.8%) and catheter involvement injuries (46.2%). External male urogenital organs were involved in 69.3% of cases which were diagnosed on physical examination. The inflictor of the injury was the patient himself, a relative, and another patient in 73.1, 19.2, and 7.7% of cases, respectively. Motivating factors were relief of painful conditions (34.6%), psychiatric disorders (38.5%), and sexual purposes (27%). Final outcomes were short-term harm, long-term harm, and permanent disability in 50, 11.5, and 38.5% of cases, respectively. Conclusion: Unintentional patient’s side-inflictor urological injuries are very rare events and mainly involve the external male urogenital organs under different motivating stressors. They could be differentiated into direct organ and catheter manipulation injuries with variable final outcomes from mild short-term harms to permanent disabilities.

Introduction: Unintentional self-inflicted injuries mainly refer to those injuries which are inflicted by the patient himself with benign intentions. In urology, they may vary and result in significant morbidities. Patients and Methods: A retrospective search of our patients’ data records for the reported cases of patient’s side-inflictor urological injuries during the period July 2006 – June 2016 was made. Each case was studied for age, gender, primary diagnosis, injury inflictor, involved organ, motivating factor, mechanism, diagnosis, management, and final outcome. Results: Of more than 55,000 urological procedures, 26 patients (0.047%) were involved in unintentional patient’s side-inflictor urological injuries. The age range was 8–76 years and included 23 Rabea A. Gadelkareem Elgamaa Street, Faculty of Medicine, Assiut University EG–71515 Assiut (Egypt) E-Mail dr.rabeagad@yahoo.com Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. II. Urological Self-Inflicted Harms: 1. Unintentional Patient’s Side-Inflictor Urological Injuries Rabea A. Gadelkareem Ahmed A. Shahat Mohamed F. Abdelhafez Ahmed Reda Mahmoud Khalil Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt Original Paper Received: November 9, 2017 Accepted: January 10, 2018 Published online: March 8, 2019 males and 3 females. Fifteen patients (57.7%) had urological disorders before the injury. They could be differentiated into direct organ involvement injuries (53.8%) and catheter involvement injuries (46.2%). External male urogenital organs were involved in 69.3% of cases which were diagnosed on physical examination. The inflictor of the injury was the patient himself, a relative, and another patient in 73.1, 19.2, and 7.7% of cases, respectively. Motivating factors were relief of painful conditions (34.6%), psychiatric disorders (38.5%), and sexual purposes (27%). Final outcomes were short-term harm, long-term harm, and permanent disability in 50, 11.5, and 38.5% of cases, respectively. Conclusion: Unintentional patient’s side-inflictor urological injuries are very rare events and mainly involve the external male urogenital organs under different motivating stressors. They could be differentiated into direct organ and catheter manipulation injuries with variable final outcomes from mild short-term harms to permanent disabilities.

Introduction: Unintentional self-inflicted injuries mainly refer to those injuries which are inflicted by the patient himself with benign intentions. In urology, they may vary and result in significant morbidities. Patients and Methods: A retrospective search of our patients’ data records for the reported cases of patient’s side-inflictor urological injuries during the period July 2006 – June 2016 was made. Each case was studied for age, gender, primary diagnosis, injury inflictor, involved organ, motivating factor, mechanism, diagnosis, management, and final outcome. Results: Of more than 55,000 urological procedures, 26 patients (0.047%) were involved in unintentional patient’s side-inflictor urological injuries. The age range was 8–76 years and included 23 Rabea A. Gadelkareem Elgamaa Street, Faculty of Medicine, Assiut University EG–71515 Assiut (Egypt) E-Mail dr.rabeagad@yahoo.com Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. II. Urological Self-Inflicted Harms: 1. Unintentional Patient’s Side-Inflictor Urological Injuries Rabea A. Gadelkareem Ahmed A. Shahat Mohamed F. Abdelhafez Ahmed Reda Mahmoud Khalil Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt Original Paper Received: November 9, 2017 Accepted: January 10, 2018 Published online: March 8, 2019 males and 3 females. Fifteen patients (57.7%) had urological disorders before the injury. They could be differentiated into direct organ involvement injuries (53.8%) and catheter involvement injuries (46.2%). External male urogenital organs were involved in 69.3% of cases which were diagnosed on physical examination. The inflictor of the injury was the patient himself, a relative, and another patient in 73.1, 19.2, and 7.7% of cases, respectively. Motivating factors were relief of painful conditions (34.6%), psychiatric disorders (38.5%), and sexual purposes (27%). Final outcomes were short-term harm, long-term harm, and permanent disability in 50, 11.5, and 38.5% of cases, respectively. Conclusion: Unintentional patient’s side-inflictor urological injuries are very rare events and mainly involve the external male urogenital organs under different motivating stressors. They could be differentiated into direct organ and catheter manipulation injuries with variable final outcomes from mild short-term harms to permanent disabilities.

Introduction: Unintentional self-inflicted injuries mainly refer to those injuries which are inflicted by the patient himself with benign intentions. In urology, they may vary and result in significant morbidities. Patients and Methods: A retrospective search of our patients’ data records for the reported cases of patient’s side-inflictor urological injuries during the period July 2006 – June 2016 was made. Each case was studied for age, gender, primary diagnosis, injury inflictor, involved organ, motivating factor, mechanism, diagnosis, management, and final outcome. Results: Of more than 55,000 urological procedures, 26 patients (0.047%) were involved in unintentional patient’s side-inflictor urological injuries. The age range was 8–76 years and included 23 Rabea A. Gadelkareem Elgamaa Street, Faculty of Medicine, Assiut University EG–71515 Assiut (Egypt) E-Mail dr.rabeagad@yahoo.com Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. II. Urological Self-Inflicted Harms: 1. Unintentional Patient’s Side-Inflictor Urological Injuries Rabea A. Gadelkareem Ahmed A. Shahat Mohamed F. Abdelhafez Ahmed Reda Mahmoud Khalil Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt Original Paper Received: November 9, 2017 Accepted: January 10, 2018 Published online: March 8, 2019 males and 3 females. Fifteen patients (57.7%) had urological disorders before the injury. They could be differentiated into direct organ involvement injuries (53.8%) and catheter involvement injuries (46.2%). External male urogenital organs were involved in 69.3% of cases which were diagnosed on physical examination. The inflictor of the injury was the patient himself, a relative, and another patient in 73.1, 19.2, and 7.7% of cases, respectively. Motivating factors were relief of painful conditions (34.6%), psychiatric disorders (38.5%), and sexual purposes (27%). Final outcomes were short-term harm, long-term harm, and permanent disability in 50, 11.5, and 38.5% of cases, respectively. Conclusion: Unintentional patient’s side-inflictor urological injuries are very rare events and mainly involve the external male urogenital organs under different motivating stressors. They could be differentiated into direct organ and catheter manipulation injuries with variable final outcomes from mild short-term harms to permanent disabilities.

Purpose: To study the potential corneal endothelial cell toxicity of Trypan Blue (TB) when used for phacoemulsification to stain the anterior capsule in patients with diabetic retinopathy. Methods: This was a single-center prospective, randomized individual cohort study. One eye in each patient with diabetic retinopathy underwent phacoemulsification without Trypan Blue capsule staining (control eye) while the other eye underwent phacoemulsification with Trypan Blue capsule staining (study eye). Both eyes underwent intraocular lens implantation. Preoperative and four-week postoperative quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed using noncontact specular microscopy. Results: There were no significant differences in endothelial cell density (mean ± SD for the study group: 2506.74 ± 413.99 cells/mm2; for the control eyes: 2466.34 ± 369.12 cells/mm2; P = 0.316) or endothelial cell density (CD) loss% (mean CD loss% was 7.23 ± 13.31 for the study eyes and 9.94 ± 9.36 for the control eyes; P = 0.157) four weeks after the operation. Additionally, no significant differences were seen in the percentage of hexagonal cells, coefficient of variation, or corneal thickness between the two groups pre and 4 weeks postoperatively. Conclusions: Direct administration of Trypan Blue into the anterior chamber for staining of the anterior capsule during cataract surgery did not result in any significant corneal endothelial changes on specular microscopy in patients with severe non-proliferative diabetic retinopathy or high-risk proliferative diabetic retinopathy at 4 weeks postoperatively.

Purpose: To study the potential corneal endothelial cell toxicity of Trypan Blue (TB) when used for phacoemulsification to stain the anterior capsule in patients with diabetic retinopathy. Methods: This was a single-center prospective, randomized individual cohort study. One eye in each patient with diabetic retinopathy underwent phacoemulsification without Trypan Blue capsule staining (control eye) while the other eye underwent phacoemulsification with Trypan Blue capsule staining (study eye). Both eyes underwent intraocular lens implantation. Preoperative and four-week postoperative quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed using noncontact specular microscopy. Results: There were no significant differences in endothelial cell density (mean ± SD for the study group: 2506.74 ± 413.99 cells/mm2; for the control eyes: 2466.34 ± 369.12 cells/mm2; P = 0.316) or endothelial cell density (CD) loss% (mean CD loss% was 7.23 ± 13.31 for the study eyes and 9.94 ± 9.36 for the control eyes; P = 0.157) four weeks after the operation. Additionally, no significant differences were seen in the percentage of hexagonal cells, coefficient of variation, or corneal thickness between the two groups pre and 4 weeks postoperatively. Conclusions: Direct administration of Trypan Blue into the anterior chamber for staining of the anterior capsule during cataract surgery did not result in any significant corneal endothelial changes on specular microscopy in patients with severe non-proliferative diabetic retinopathy or high-risk proliferative diabetic retinopathy at 4 weeks postoperatively.

Purpose: To study the potential corneal endothelial cell toxicity of Trypan Blue (TB) when used for phacoemulsification to stain the anterior capsule in patients with diabetic retinopathy. Methods: This was a single-center prospective, randomized individual cohort study. One eye in each patient with diabetic retinopathy underwent phacoemulsification without Trypan Blue capsule staining (control eye) while the other eye underwent phacoemulsification with Trypan Blue capsule staining (study eye). Both eyes underwent intraocular lens implantation. Preoperative and four-week postoperative quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed using noncontact specular microscopy. Results: There were no significant differences in endothelial cell density (mean ± SD for the study group: 2506.74 ± 413.99 cells/mm2; for the control eyes: 2466.34 ± 369.12 cells/mm2; P = 0.316) or endothelial cell density (CD) loss% (mean CD loss% was 7.23 ± 13.31 for the study eyes and 9.94 ± 9.36 for the control eyes; P = 0.157) four weeks after the operation. Additionally, no significant differences were seen in the percentage of hexagonal cells, coefficient of variation, or corneal thickness between the two groups pre and 4 weeks postoperatively. Conclusions: Direct administration of Trypan Blue into the anterior chamber for staining of the anterior capsule during cataract surgery did not result in any significant corneal endothelial changes on specular microscopy in patients with severe non-proliferative diabetic retinopathy or high-risk proliferative diabetic retinopathy at 4 weeks postoperatively.