Purpose: This study determined the clinical impact and causes of loss to follow-up (LTFU) from the patients’ perspective in individuals with proliferative diabetic retinopathy (PDR) who received panretinal photocoagulation (PRP) and/or intravitreal injections (IVIs) of anti-vascular endothelial growth factor (VEGF). Methods: This prospective cohort study included 467 patients with PDR who received PRP and/or IVIs of anti-VEGF between May 2013 and June 2018. LTFU was defined as missing any follow-up visit for any interval exceeding 6 months, provided that patients eventually resumed care. Main outcome measures include rates and causes of LTFU. Results: A total of 391 patients (83.7%) were followed, and 76 patients (16.3%) were LTFU over the study period. Rates of LTFU decreased with age (P = 0.005). Questionnaire analysis conducted for patients LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient’s lack of trust and satisfaction with treatment [rs = 0.458, P 0.001]. There was also a significant positive correlation between treatment unaffordability and number of IVIs of anti-VEGF [rs = 0.55, P 0.001] and lack of social support and age [rs = 0.39, P 0.001]. Conclusions: LTFU threatens vision in PDR patients receiving PRP and/or IVIs of anti-VEGF. Possibly, patient-specific LTFU causes should be addressed before treatment in order to minimize the risk of LTFU.

Purpose: This study determined the clinical impact and causes of loss to follow-up (LTFU) from the patients’ perspective in individuals with proliferative diabetic retinopathy (PDR) who received panretinal photocoagulation (PRP) and/or intravitreal injections (IVIs) of anti-vascular endothelial growth factor (VEGF). Methods: This prospective cohort study included 467 patients with PDR who received PRP and/or IVIs of anti-VEGF between May 2013 and June 2018. LTFU was defined as missing any follow-up visit for any interval exceeding 6 months, provided that patients eventually resumed care. Main outcome measures include rates and causes of LTFU. Results: A total of 391 patients (83.7%) were followed, and 76 patients (16.3%) were LTFU over the study period. Rates of LTFU decreased with age (P = 0.005). Questionnaire analysis conducted for patients LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient’s lack of trust and satisfaction with treatment [rs = 0.458, P 0.001]. There was also a significant positive correlation between treatment unaffordability and number of IVIs of anti-VEGF [rs = 0.55, P 0.001] and lack of social support and age [rs = 0.39, P 0.001]. Conclusions: LTFU threatens vision in PDR patients receiving PRP and/or IVIs of anti-VEGF. Possibly, patient-specific LTFU causes should be addressed before treatment in order to minimize the risk of LTFU.

Purpose: This study determined the clinical impact and causes of loss to follow-up (LTFU) from the patients’ perspective in individuals with proliferative diabetic retinopathy (PDR) who received panretinal photocoagulation (PRP) and/or intravitreal injections (IVIs) of anti-vascular endothelial growth factor (VEGF). Methods: This prospective cohort study included 467 patients with PDR who received PRP and/or IVIs of anti-VEGF between May 2013 and June 2018. LTFU was defined as missing any follow-up visit for any interval exceeding 6 months, provided that patients eventually resumed care. Main outcome measures include rates and causes of LTFU. Results: A total of 391 patients (83.7%) were followed, and 76 patients (16.3%) were LTFU over the study period. Rates of LTFU decreased with age (P = 0.005). Questionnaire analysis conducted for patients LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient’s lack of trust and satisfaction with treatment [rs = 0.458, P 0.001]. There was also a significant positive correlation between treatment unaffordability and number of IVIs of anti-VEGF [rs = 0.55, P 0.001] and lack of social support and age [rs = 0.39, P 0.001]. Conclusions: LTFU threatens vision in PDR patients receiving PRP and/or IVIs of anti-VEGF. Possibly, patient-specific LTFU causes should be addressed before treatment in order to minimize the risk of LTFU.

Urethral stones in females are very rare and always associated with genitourinary pathology. We report on a 9-year-old girl with a history of a small left ureteral stone that was diagnosed by abdominal radiograph and ultrasonography and subjected for conserva-tive management. On a follow up visit, she complained of dysuria for a few hours, while the passage of the stone was denied. Exami-nation of the urethral meatus revealed nothing. Follow up abdominal ultrasonography revealed resolution of renal obstruction with free both kidneys and urinary bladder. However, abdominal plain radiograph showed migration of the stone from the course of the left lower ureter into the course of the urethra. The patient was asked to void, where a small stone passed spontaneously. The note here is the transient lodgment of the stone in the normal urethra without urinary retention which represents an unusual scenario of urethral stones in young girls.

Urethral stones in females are very rare and always associated with genitourinary pathology. We report on a 9-year-old girl with a history of a small left ureteral stone that was diagnosed by abdominal radiograph and ultrasonography and subjected for conserva-tive management. On a follow up visit, she complained of dysuria for a few hours, while the passage of the stone was denied. Exami-nation of the urethral meatus revealed nothing. Follow up abdominal ultrasonography revealed resolution of renal obstruction with free both kidneys and urinary bladder. However, abdominal plain radiograph showed migration of the stone from the course of the left lower ureter into the course of the urethra. The patient was asked to void, where a small stone passed spontaneously. The note here is the transient lodgment of the stone in the normal urethra without urinary retention which represents an unusual scenario of urethral stones in young girls.

Introduction:Surgical fires are unique topics that belong to surgical never events and deserve urological attention. Materials and Methods:A retrospective search of our hospital records was done for the states of electrosurgical never events in the period from July 2001 to June 2016. The included events were classified according to the site of occurrence in relation to the patient's body and possibilities of human involvement. The events were studied for the type, extent, damages, personnel involvements, complications, and management. Results:Of more than 82,000 urological interventions, 18 cases (0.022%) of electrosurgical never events were detected. Four subcategories were differentiated: electrosurgical theater fires (33.3%), electrosurgical contact skin burns (38.9%), electrosurgical internal injuries (16.7%), and electrocutions (11.1%). Electrosurgical theater fires included 3 ignition fires with fire skin burns and 3 device explosions. Fires only occurred with the use of alcoholic skin disinfectants. Contact skin burns resulted from inadvertent direct electrosurgical contacts, with 2 burns on the back, 3 burns on the lower limbs, 1 burn at the penile shaft, and 1 burn at the suprapubic region. Only 1 case of contact skin burn required plastic surgery. Electrosurgical internal in-juries involved the intestine, spleen, and urethra and were followed by major complications. Electrocutions involved a doctor and a patient with multiple bone fractures in the former. Conclusion:Urological electrosurgical never events are very rare incidents and were differentiated into 4 clinical subcategories. Human involvements varied from absence to major devastating complications. Reduction of these events depends on the adjusted use of electricity-based armamentarium.

Introduction: Abdominoscrotal hydrocele is a rare hydrocele variant in pediatrics and adults. Besides the historical concerns, controversies in etiology and management of abdominoscrotal hydrocele warrant studying. Subjects and methods: A systematic review was conducted based on a multilingual search of the world liter- ature of abdominoscrotal hydrocele through electronic engines (Google Scholar and MEDLINE/PubMed). The demographic and clinical characteristics are critically addressed and a clinical grading system is proposed. Results: From the 487 delivered articles, 320 articles were eligible to this review including only 21 case series. They delivered 579 abdominoscrotal hydrocele cases. Abdominoscrotal hydrocele affects pediatrics more than adults with significantly increased rate of reporting in the last decades. Full or incomplete case descriptions were found in 558 cases versus 21 cases with deficient description. Abdominoscrotal hydrocele has been reported from 45 countries and India has the highest rate. Eight proposed hypotheses were differentiated for etiology and grouped according to the direction of fluid formation and hydrocele growth. Associated congenital anomalies include contralateral hydroceles and cryptorchidism. Complications result from compression, hemorrhage, infection, torsion, and coincident malignancy. A clinical grading system considering the increased anatomical, pathological or clinical complexities has been proposed and provided two categories; simple and complex abdominoscrotal hydroceles with further sub-classes. Conclusions: Abdominoscrotal hydrocele is rare, but the number of the reported cases is far larger than the previously reported numbers. Etiology follows multiple hypotheses and management is speculative. Proposed clinical grading may support differentiation of severity of the associated cumulative risks.

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.