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OBJECTIVE: To investigate whether the length of ileum used for ileal orthotopic neobladder (ONB) reconstruction (60 cm vs. 40 cm) after radical cystectomy (RC) for bladder cancer (BC) impacts on bowel function, postoperative complications or survival outcome. MATERIAL AND METHODS: In this retrospective study, we included 56 patients who received an ONB (Studer (S)-Pouch: 23 patients; I-Pouch: 33 patients) after RC for BC between 2003 and 2011. Preoperative comorbidities were assessed by the Charlson Comorbidity Index (CCI) and surgical complications as graded by the Clavien-Dindo classification. Changes of perioperative bowel habits were retrospectively evaluated by the validated Gastrointestinal Quality of Life Index (GIQLI). Kaplan-Meier analyses calculated survival outcomes between both ONB types. RESULTS: Preoperative CCI was comparable between S- and I-pouch patients. No significant differences were observed for 30-day major- (p = 0.33) and minor (p = 0.96) complication rates between both neobladder types. S-Pouch patients reported higher preoperative stool frequencies (S-pouch: mean 2.7; I-pouch: mean 3.4; p = 0.049) and tended to suffer from urgency (S: mean 2.9; I: mean 3.4; p = 0.059). No significant differences in postoperative bowel disorders were found between both neobladder types (S-Pouch: 15.9, IQR; I-Pouch: 16.6 IQR; p = 0.84). Furthermore, we observed no overall-, cancer specific- or recurrence free survival advantage for either of both ONB variants (p = 0.81; 0.65 and 0.78), respectively. CONCLUSION: Comorbidities, perioperative complication rates and bowel habits were similar between both ONB substitutes and did not influence survival outcomes. These stratified data suggest that the length of ileum used for ONB reconstruction (60- vs. 40 cm) does not impact per se on postoperative bowel function

At experienced centers, laparoscopic partial nephrectomy (LPN) can achieve similar results to those of open surgery (OPN). However, the role of LPN for complex tumors and imperative indications is under debate. PATIENTS AND METHODS: A total of 356 cases (186 LPN and 170 OPN) between 2005-2012 were reviewed. Clinical, surgical, pathological and radiological data, including PADUA classification were analyzed. RESULTS: In overall analysis, OPN was associated with higher tumor complexity (p≤0.03). Subgroup analysis of PADUA >8 tumors (n=85) showed no significant difference between LPN and OPN. In patients with unfavorable treatment characteristics (imperative indication/multifocal tumors, n=71) LPN was beneficial. In this subgroup, LPN led to better perioperative (p≤0.02) and postoperative (p≤0.04) outcome. CONCLUSION: Use of LPN is associated with favorable tumor characteristics. Although no advantage was shown for LPN for tumors with higher complexity (PADUA>8), this large series confirmed the superiority of LPN for imperative indication or multifocal tumors.

Objective: To compare the expulsion rate of Nova-T380, Multiload 375, and Copper-T380A intrauterinecontraceptive devices (IUCDs) inserted during cesarean delivery. Methods: A comparative randomized study wasconducted between January 1, 2013, and June 30, 2014, in three maternity centers in Egypt and Saudi Arabia. Allwomen scheduled for an elective cesarean and accepting intraoperative insertion of an IUCD were randomly allo-cated to receive the Nova-T380 (group 1), Multiload 375 (group 2), or Cu-T380A (group 3) using a computer-generated table. Researchers and participants were not masked to the type of IUCD. Follow-up was for 1 year.The primary outcome was IUCD expulsion (complete or partial [i.e. displacement] ). Results: Each group contained40 participants. At 1 year, expulsion had been reported for 5 (13%) women in group 1, 2 (5%) in group 2, and 6(15%) in group 3 (P N 0.05 for all). The frequency of displacement was significantly lower in group 2 (5 [13%] par-ticipants) than in group 1 (15 [38%]; P = 0.001) and group 3 (14 [35%]; P =0.008).Conclusion: Despite a compa-rable risk of expulsion following IUCD insertion during cesarean delivery, the Multiload 375 device showed thelowest risk of displacement.

Objective: To compare the expulsion rate of Nova-T380, Multiload 375, and Copper-T380A intrauterinecontraceptive devices (IUCDs) inserted during cesarean delivery. Methods: A comparative randomized study wasconducted between January 1, 2013, and June 30, 2014, in three maternity centers in Egypt and Saudi Arabia. Allwomen scheduled for an elective cesarean and accepting intraoperative insertion of an IUCD were randomly allo-cated to receive the Nova-T380 (group 1), Multiload 375 (group 2), or Cu-T380A (group 3) using a computer-generated table. Researchers and participants were not masked to the type of IUCD. Follow-up was for 1 year.The primary outcome was IUCD expulsion (complete or partial [i.e. displacement] ). Results: Each group contained40 participants. At 1 year, expulsion had been reported for 5 (13%) women in group 1, 2 (5%) in group 2, and 6(15%) in group 3 (P N 0.05 for all). The frequency of displacement was significantly lower in group 2 (5 [13%] par-ticipants) than in group 1 (15 [38%]; P = 0.001) and group 3 (14 [35%]; P =0.008).Conclusion: Despite a compa-rable risk of expulsion following IUCD insertion during cesarean delivery, the Multiload 375 device showed thelowest risk of displacement.

We aimed to investigate effect of adding sildenafil vaginal gel to clomiphene citrate (CC) in infertile women with prior CC failure. Methods: This is a self- controlled clinical trial. Women with CC failure (in prior 5 cycles) and thin endometrium were recruited (N = 42). In their 6th (CC only) cycle, women continued on CC 100 mg/ day for 5 days, and had measurement of endometrial thickness and Doppler assessment of uterine arteries on day of HCG administration. In 7th cycle, women (N = 36) were given usual dose of CC supplemented with sildenafil vaginal gel (5 gm, containing 50 mg sildenafil) twice daily from cycle day 8 to day of HCG administration. Endometrial thickness and uterine artery Doppler were measured on day of HCG injection. Results: In the 7th (CC + sildenafil vaginal gel) cycle, endometrial thickness was significantly higher than in the 6th (CC only) cycle (9.3 mm +/- 3.1mm versus 6.6 mm +/- 1.4 mm, respectively, P = 0.001). Uterine artery pulsatility index dropped from 2.4 +/- 0.8 in 6th cycle to 1.6 +/- 1.3 in 7th cycle (P = 0.002). Clinical pregnancy rate increased but numbers were too small (only 3 pregnancies). Conclusion: Sildenafil vaginal gel significantly increased endometrial thickness and uterine blood flow, and may improve pregnancy rate in patients with CC failure due to thin endometrium. Mucoadhesive vaginal gel formulation allowed shorter duration of sildenafil application, and less frequent daily dosing