Purpose of Review: We performed recent literature review with the aim to address the updates in diagnosis and management of sexually transmitted urethro-cystitis.

Recent Findings: There are multiple, recently published studies that collectively lead to an organized stepwise plan for diagnosis and management of sexually transmitted urethro-cystitis.

Summary: Sexually transmitted urethro-cystitis is a common health condition that can be managed efficiently if the appropriate steps are taken in diagnosis and management.

Background: We sought to evaluate rural–urban disparities in patient care experiences (PCEs) among localized prostate cancer (PCa) survivors at intermediate-to-high risk of disease progression.

Methods: Using 2007–2015 Surveillance Epidemiology and End Results (SEER) data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, we analyzed survivors’ first survey ≥6 months post-diagnosis. Covariate adjusted linear regressions were used to estimate associations of treatment status (definitive treatment vs. none) and residence (large metro vs. metro vs. rural) with PCE composite and rating measures.

Results: Among 3779 PCa survivors, 1798 (53.2%) and 370 (10.9%) resided in large metro and rural areas, respectively; more rural (vs. large metro) residents were untreated (21.9% vs. 16.7%; p = 0.017). Untreated (vs. treated) PCa survivors reported lower scores for doctor communication (ß = −2.0; p = 0.022), specialist rating (ß = −2.5; p = 0.008), and overall care rating (ß = −2.4; p = 0.006). While treated rural survivors gave higher (ß = 3.6; p = 0.022) scores for obtaining needed care, untreated rural survivors gave lower scores for obtaining needed care (ß = −7.0; p = 0.017) and a lower health plan rating (ß = −7.9; p = 0.003) compared to their respective counterparts in large metro areas.

Conclusions: Rural PCa survivors are less likely to receive treatment. Rural–urban differences in PCEs varied by treatment status.

Background: One of the commonest pediatric surgeries is hydrocele. There are suggestions to wait for spontane- ous resolution than to operate these cases without harmful adverse events. Herein, we evaluated the outcome of the watchfulness of these cases over 18 months.

Methods: The study included 93 infants with communicating hydrocele for the Pediatric Surgery Department, Fac- ulty of Medicine (Assiut, Egypt). They were planned to be followed up for 18 months, and indications for intervention included hernia, increasing in size, being tense, and completion of 18 months of follow-up without improvement.

Results: The gestational age of the included patients was 38.5 ± 2.2 weeks and the age at the time of presentation was 50 (7, 495) days. Most cases were bilateral, reducible, and had an intermittent course. After 18 months of follow- up, 60.2% of the patients resolved spontaneously and 39.8% were surgically treated. Age at the time of presentation was higher among operated patients. Patients with reducibility criteria on clinical examination and lack of intermittent course had higher frequency among operated patients (89.2%).

Conclusions: It is safe to wait and not to operate on infants with hydrocele up to 18 months as long as there was no hernia. Higher age at presentation and reducibility on examination are indicators that favor the need for surgery.

Introduction: Near-infrared (NIR) fluorescent cholangiography (FC) using indocyanine green (ICG) in laparoscopic cholecystectomy (LC) has been used as a technique for real-time visualiza- tion of bile ducts for approximately ten years; however, no standard protocol has been deter- mined. This study aimed to determine the optimal time of administration of ICG.

Material and methods: In this prospective study, patients (n1⁄430) indicated for LC were div- ided into two groups. The first group received ICG 1 h before anesthesia at a dose of 0.1 mg/kg (1h group), whereas the other group received ICG immediately after anesthesia with the same dose (0 h group).

Results: The rates of identification of the cystic duct (CD) and common bile duct (CBD) using NIR FC before and after dissection of Calot’s triangle were comparable between the two groups. The fluorescence intensity ratios of CD/Liver and CBD/Liver were significantly higher in the 1h group (2.2 vs. 0.49 and 2.1 vs. 0.38, respectively, p < .001) with minimal background liver fluores- cence interference in the 1 h group.

Conclusions: The study illustrates that administration of ICG 1 h before surgery with a dose of 0.1 mg/kg allows superior visualization of the extrahepatic bile ducts with minimal fluorescence interference from the background liver.

Abbreviations: BDI: bile duct injury; BMI: body mass index; CBD: common bile duct; CD: cystic duct; CHD: common hepatic duct; CVS: critical view of safety; FC: fluorescent cholangiography; FI: fluorescence intensity; GB: gallbladder; ICG: indocyanine green; IOC: intraoperative cholangi- ography; LC: laparoscopic cholecystectomy; NIR: Near-infrared; WL: white light

Objective: To evaluate and compare the effectiveness and safety of holmium laser enucleation of prostate (HoLEP) in relieving either voiding or storage lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH) patients.

Materials and methods: The charts of patients with BPH who underwent HoLEP for either predominant voiding or predominant storage LUTS at University of Cincinnati hospitals in the period between February 2015 and December 2020 were retrospectively reviewed and analyzed for changes in voiding symptomatology, storage symptomatology, hematuria, International Prostate Symptom Score (IPSS), peak flow rates (Qmax), presence of detrusor overactivity (DO), and post-voiding residual urine (PVR) from baseline to up to 6 months postoperatively.

Results: A total of 132 patients were included in the analysis. Patients were divided into two groups: Group 1 included BPH patients with predominant voiding LUTS (68 Patients) while group 2 involved those with predominant storage LUTS (64 Patients). HoLEP was equally effective in management of both groups with significant improvement in urodynamics study (UDS) parameters, patient voiding and storage symptomatology, and IPSS from preoperatively to up to 6 months postoperatively with relatively low procedure complication rate and postoperative need for medication or procedure.

Conclusions: HoLEP is a safe, effective, and reliable minimally invasive surgical modality that can be relied on for BPH patients with either predominant voiding or predominant storage symptoms with relatively low procedure complication rate and postoperative need for medication or procedure.

Background

Infants with recurrent vomiting and respiratory tract infection since birth constitute a challenging diagnosis for pediatric surgeons. The surgeon must put in mind a congenital microgastria (CM) as a differential diagnosis.

Case reports

A five-month-old male infant complained of non-bilious vomiting since birth. A gastrografin swallow had referred to the dilated esophagus, small capacity stomach, and the contrast flows easily distally to the duodenum. A gastric augmentation was created through a Hunt-Lawrence (HL) pouch with a good outcome.

Discussion

Diagnosis of CM can be discovered during the intrauterine life through the absence of visualization of the gastric gas. CM may be associated with other anomalies or may be isolated. The isolated anomaly should operate early, as soon as possible because the stomach will not spontaneously enlarge with the conservative management.

Conclusions

HL pouch is a suitable gastric augmentation for the infant with isolated CM. The dilated esophagus returns to its normal size after increasing the stomach reservoir.

Introduction: Splenic tumours are relatively rare and include malignancies such as lymphomas, angiosarcomas,

plasmacytomas, primary malignant fibrous histiocytomas, and splenic metastases. Benign tumours of the spleen

such as hemangiomas, cysts, and inflammatory pseudotumours are very rare (Kaza et al., 2010, PisaniCeretti

et al., 2012) [1,2]. There are fewer than 160 cases of splenic hamartoma or splenomas having been reported in

the literature (Basso et al., 2012) [3]. Only 20% of the cases were detected in children (Abramowsky et al., 2004)

[4]. Although multi-modality imaging findings were described preoperatively, the final diagnosis was splenic

hamartoma based on histology and immunohistochemistry.

Case report: Here, we report a case of a14 year old child left upper quadrant abdominal pain and worsening

sickness. Multi-modality imaging detected a solid lesion of the spleen, who required splenectomy and was

pathologically diagnosed as a splenic hamartoma. The postoperative course was uneventful.

Discussion: Splenic hamartoma is very rare. Only 20% of hamartomas occur in children. They are commonly

found incidentally on imaging with no symptoms.

Conclusion: Splenic hamartoma is a benign vascular proliferative lesion that requires a multi-modality imaging

studies for diagnosis and confirmed by histopathology. It must be included in the differential diagnosis of splenic

mass forming lesions.

Objective: To evaluate the early and late outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction (LUTD).

Materials and methods: The charts of patients with refractory non-malignant LUTD who underwent continent or incontinent external urinary diversion at University of Cincinnati hospitals in the period between March 2012 and December 2019 were retrospectively reviewed. The demographic and baseline characteristics, surgery indications, operative data, early and late outcomes were collected, analyzed, and compared.

Results: A total of 78 patients including 55 patients with neurogenic bladder (NGB) and 23 patients with non-neurogenic bladder (non-NGB) refractory non-malignant LUTD were included. Fifty-three patients underwent incontinent urinary diversions (IUD), while 25 patients underwent continent urinary diversions (CUD). During the first 4 postoperative weeks, 53.85% (n=42) of patients developed complications, and the incidence was non-significantly higher in patients with NGB than those with non-NGB (56.36% vs 47.83%, p-value=0.490). Fever was exclusively encountered in patients with NGB earlier, while stomal retraction occurred only in patients with non-NGB later. More non-NGB patients had early wound infection. There was an overall improvement of urological symptoms in 52 patients (66.67%), and the rate was non-significantly higher in non-NGB patients than NGB patients (78.26% vs 61.82%, p-value=0.160). Late complications were reported in 47 patients and were more encountered in those with non-NGB than those with NGB (65.22% vs 58.18%). Stomal leakage and stenosis occurred more with CUD than with IUD (52% vs 0% and 28% vs 3.77%, respectively).

Conclusions: External urinary diversion can achieve a reasonable level of urological symptoms control in patients with refractory non-malignant LUTD, but with associated adverse outcomes. Although non-significantly, these complications tend to be higher in patients with IUD and/or NGB during the early postoperative period and higher with CUD and/or non-NGB on the long-term.

Introduction: We aimed to compare the effectiveness and safety of transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), and photoselective vaporization of the prostate (PVP) in management of storage and overactive bladder (OAB) symptoms complicating benign prostatic hyperplasia (BPH) in patients with moderately enlarged prostates.

Methods: The charts of patients with moderately enlarged prostates and BPH complicated by storage and OAB symptoms who were treated by TURP, HoLEP, and PVP at University of Cincinnati hospitals between March 2012 and December 2020 were retrospectively reviewed and analyzed for changes in storage and OAB symptomatology, International Prostate Symptom Score (IPSS), peak flow rates (Qmax), presence of detrusor overactivity (DO), and postvoid residual (PVR) from baseline to up to six months postoperatively. 

Results: A total of 204 patients with moderately enlarged prostates and BPH complicated by storage and OAB symptoms were divided into three groups: group 1 (patients who underwent TURP, 89 patients), group 2 (those who underwent HoLEP, 64 patients), and group 3 (those who underwent PVP, 51 patients). TURP, HoLEP, and PVP were associated with significant improvement in urodynamics study (UDS) parameters, patient storage and OAB symptomatology, and IPSS from preoperatively to both three and six months postoperatively in BPH patients with moderately enlarged prostates, with relatively low procedure complication rate and postoperative need for either anticholinergic or procedure.

Conclusions: TURP, HoLEP, and PVP are effective and reliable surgical procedures that can be relied upon for BPH patients with moderately enlarged prostates and storage or OAB symptoms, with comparable efficacy and relatively low procedure complication rate and postoperative need for anticholinergic or additional procedure.

Mucormycosis is a life-threatening opportunistic angioinvasive fungal infection. We aimed to describe the frequency, presentations, predictors, and in-hospital outcome of mucormycosis patients in the scope of CoronaVirusDisease-19 (COVID-19) during the third viral pandemic wave. This cross-sectional retrospective study included all patients who fulfilled the criteria of mucormycosis with concurrent confirmed covid19 infection admitted to Assuit University Hospital between March 2021 and July 2021. Overall, 433 patients with definite covid-19 infection, of which 33 (7.63%) participants were infected with mucormycosis. Mucormycosis was predominantly seen in males (21 vs. 12; p = 0.01). Diabetes mellitus (35% vs. 63.6%; p < 0.001), hypertension (2% vs.45.5%; p 0.04), and Smoking (26.5% vs. 54.5%; p < 0.001) were all significantly higher in mucormycosis patients. Inflammatory markers, especially E.S.R …