Purpose: Renal colic due to urinary system stone disease is one of the main complaints in emergency department (ED) admissions. The STONE score is the most used model. The “race” item in the nomogram is not useful for communities where the Black race is not dominant. Therefore, we aimed at investigating the diagnostic value of a new modified scoring system, in which we replaced the “race” item in the original nomogram by “obstruction = pelvicalyceal dilation.” Materials and Methods: The study included patients who were admitted to a tertiary university ED with flank pain and underwent ultrasonography (US) from June 2017 to November 2017. Patients' demographic data such as US findings and the STONE score parameters were recorded. “Obstruction (pelvicalyceal dilation)” replaced the “race” item of the original STONE score. The diagnostic value of the modified system was investigated by categorizing the scores as low risk (0–5 points), moderate risk (6–9 points), and high risk (10–13). Results: The study included 305 patients who met the inclusion criteria. The mean age was 39.45 ± 13.83 years, and 170 patients (55.7%) were male. Pelvicalyceal dilation was detected on US at a statistically significantly higher percentage in patients with stones compared to stone-free patients (P < 0.001). The modified STONE score was statistically significantly higher in patients with stones compared to stone-free patients (P < 0.001). Conclusion: We suggest that the replacement of the race parameter of the original STONE score by the US finding of pelvicalyceal dilation will enhance the diagnostic value of scoring in societies mostly comprising a non-Black population.

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Webbed penis may be congenital or acquired in etiology. Treatments are indicated for reasons such as cosmetic concerns and erection pain. This study aims at reviewing the etiology, symptoms, types of surgical correction, and outcomes of webbed penis. We searched Medline/PubMed for “webbed penis” and “inconspicuous penis” from 1956 through 2019. In this study, we discuss the advantages, drawbacks, and outcomes of each surgical method. We also explain the postoperative cosmetic outcomes and complications of the previously proposed surgical methods. Since the isolated congenital webbed penis is uncommon, there is a paucity of large-scale studies for the treatment of webbed penis. A variety of methods are proposed to correct webbed penis, including traditional transverse incision and vertical closure, Z-plasty, V-Y advancement technique, Byars preputial flap method, and other methods. Preoperative design is essential and is based on not only the degree of penoscrotal fusion but also the surgeon's experience and preference of the surgical methods. Some methods call for elaborate skin flaps that may be technically complicated. The immediate outcomes of surgical correction for webbed penis are good. However, studies on long-term cosmetic results and patient satisfaction remain scarce. Hence, surgical correction of the webbed penis generally yields good results. Long-term follow-up of postoperative cosmetic outcomes, patient satisfaction, and the impact of surgery on the psychological development of children are indicated.

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Renal aspergillosis is a fungal infection caused by Aspergillus, which develops in immunocompromised patients. We report the case of a patient with acquired immunodeficiency syndrome (AIDS), who developed renal aspergillosis. He underwent abdominal tomography (computerized tomography) which showed an abscess in his left kidney. A nephrectomy was performed, and pathology revealed Aspergillus conidia.

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Purpose: Infective complications such as fever, systemic inflammatory response syndrome (SIRS), septicemia, and shock are common and preventable complications after retrograde intrarenal surgery (RIRS). Patients with positive urine and stone cultures have a greater risk of SIRS. Infection stones (carbonate apatite) are bacteria-harboring stones that predispose to sepsis. A pilot study is conducted to establish the role of stone analysis in predicting SIRS after RIRS compared to urine and stone cultures. Materials and Methods: Sixty patients who underwent RIRS from January 2018 to June 2018 were prospectively evaluated with respect to preoperative urine culture, stone burden and location, operative time, postoperative clinical course, residual stone size, stone culture, stone analysis, and occurrence of septicemia-related events. Results: 5 out of 60 patients who underwent RIRS developed SIRS (8%). Sensitivity levels of predicting SIRS were different, where urine culture (20%), stone culture (20%), and carbonate apatite on the stone analysis (60%). Positive urine culture and stone culture had no significant relation to the prediction of SIRS (P = 1). Carbonate apatite was present in 12 samples (20%) in varying proportions. The presence of apatite >50% of the total sample was in 5/60 samples (8%), which are referred to as infection stones. Three out of these 5 patients with infection stones developed SIRS (60%). Thus, the presence of carbonate apatite in the stone analysis had a statistically significant relation to SIRS (P < 0.01). Conclusion: The presence of carbonate apatite >50% on stone analysis has higher sensitivity than urine and stone culture in predicting SIRS after RIRS.

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Purpose: A stented Foley's catheter was designed to combine two catheters into a single catheter to reduce the postureteroscopy (URS) pain and complications. This study evaluated the pain score and complications associated with the use of stented Foley's catheter in double J (DJ) stenting compared to the use of infant feeding tube (IFT) or a ureteric catheter in patients undergoing DJ stenting. Materials and Methods: A randomized parallel-group study was conducted in patients undergoing DJ stenting along with URS and stone fragmentation with pneumatic lithotripsy/LASER. The patients were randomized to be managed with either stented Foley's catheter or IFT along with Foley's catheter. The postoperative pain and complications were recorded. Results: A total of 200 patients were randomized (1:1) into Group A (100 patients with stented Foley's catheter) and Group B (100 patients with IFT). Male preponderance was observed in Group A (73%) and Group B (69%). A significantly higher number of patients from Group B (n = 20) had pericatheter leakage compared to Group A (n = 2). In Group B, the pericatheter leakage resolved in three males and three females, whereas six males and eight females continued to leak, which is managed by diapers. The number of patients with no pain was higher in Group A (52%) than Group B (36%), whereas none of the patients from both groups had severe pain scores (V or VI). Conclusion: The patients undergoing DJ stenting were tolerant to the use of stented Foley's catheter compared to those with the IFT.

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Purpose: Complete urethral mobilization may endanger the lateral vascularity of the urethra in buccal mucosal graft (BMG) urethroplasty in stricture urethral disease. The present study aimed to evaluate the outcomes of BMG urethroplasty by dorsolateral onlay technique in patients with anterior urethral stricture. Materials and Methods: This was a prospective interventional study conducted at the Department of Urology at PSG Institute of Medical Sciences and Research between January 2015 and December 2018. Patients diagnosed with anterior urethral stricture who underwent dorsolateral onlay urethroplasty were included in this study. Results were considered satisfactory with the Qmax between 8 mL/s and 15 mL/s. Failed outcome was defined as persistent lower urinary tract symptoms, stricture on retrograde urethrogram, Qmax <8 mL/s, and requiring repeated urethra intervention. Results: A total of 54 patients underwent BMG urethroplasty by dorsolateral onlay graft with a mean age of 47.6 years. The patients with a range of stricture length 3–14 cm were included in this study. Short-term success rate (Qmax >15 mL/s) was achieved in 42 patients, while satisfactory results (Qmax 8–15 mL/s) were observed in nine patients and failure (Qmax <8 mL/s) occurred in three patients. Oral and perineal complications were treated conservatively with oral antibiotics and analgesia. None of the patients in this study had a postoperative perineal hematoma, graft infection, and scrotal swelling. Conclusion: Overall observations suggest that dorsolateral onlay BMG urethroplasty with unilateral urethral mobilization for an anterior urethral stricture is a feasible and effective option with favorable outcomes.

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Purpose: Direct vision internal urethrotomy (DVIU) is the most common surgical intervention for anterior urethral strictures. We evaluated the long-term outcome and success rate of optic urethrotomy in patients treated in our hospital who had recurrent anterior urethral strictures, according to different predisposing causes and stricture sites. The aim is to find the success rate of optic urethrotomy in patients treated who had recurrent anterior urethral strictures. Materials and Methods: This study is a retrospective chart review. From January 2000 to August 2017, 232 patients received internal optic urethrotomy for anterior urethral strictures in our hospital. A retrospective chart review of all patients involved in the study was performed. Median follow-up period after receiving the first urethrotomy procedure was 91 months (range: 8–204 months). The Kaplan–Meier method was used to analyze the success rate of the first, second, third, fourth, and fifth urethrotomy procedures. Results: Of the 232 patients who underwent at least two procedures of urethrotomy, 150 (64.65%) were included in the study. The success rate of the first urethrotomy procedure was 0%, with a mean time to recurrence of 20 months. For the second urethrotomy, the success rate was 53%, with a mean time to recurrence of 22.5 months. For the third urethrotomy, the success rate was 40%, with a mean time to recurrence of 16.1 months. For the fourth and fifth urethrotomy procedures, the success rate was 39% and 18%, with a mean time to recurrence of 17.9 and 10.2 months, respectively. Patients who had anterior urethral stricture related to previous surgery (surgery-related) had a better outcome (success rate, 87.3%) than patients with strictures stemming from other causes (P = 0.003). No association was found between preoperative infection, the age of the patient, and the site of the strictures and the success rate of the procedure. Conclusion: The patient population was older and had a longer-term follow-up, compared with previous studies, but even with repeated DVIU, the surgery-related stricture group had a higher success rate of urethrotomy than the groups with different etiology. In patients with pelvic fracture or infection, repeated urethrotomy may not be recommended as first-line treatment for recurrent anterior urethral stricture.

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Purpose: The objective of this study was to evaluate the efficacy of antibiotic prophylaxis in patients with a tentative diagnosis of ureteral stones undergoing ureterorenoscopic surgery. Materials and Methods: This is a single-surgeon, open-label randomized controlled trial, which enrolled 109 patients from May 2014 to September 2018. The patients were equally randomized into three groups: a group with a single dose of intravenous cefazolin (1g), a group with oral cefuroxime (500 mg), and a control group with no prophylactic antibiotics. The primary end points were the rate of febrile urinary tract infections (UTIs) and postoperative pyuria. Results: The rate of postoperative fever was 9.4% in the cefazolin group (3 in 32), 0% in the cefuroxime group (0 in 29), and 6.9% in the control group (2 in 36). There was no statistically significant difference between the cefazolin and control groups (P = 0.1). The rate of postoperative pyuria was 64.3% in the cefazolin group, 58.3% in the cefuroxime group, and 33.3% in the control group, without statistically significant differences between the groups. Conclusion: Antibiotic prophylaxis could not reduce the incidence of postoperative febrile UTI and pyuria in ureterorenoscopic lithotripsy.

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