Ureteral triplication is an extremely rare congenital anomaly, with just over 100 cases reported in the literature. Smith classified this anomaly into four types in 1946. However, variants that do not fit this classification present significant diagnostic and therapeutic challenges. We present the case of a 5-year-old female patient evaluated for recurrent febrile urinary tract infections. Investigations revealed a duplicated left collecting system with high-grade vesicoureteral reflux (VUR). Intraoperatively, a third, blind-ending ureter was unexpectedly identified within the same sheath, exhibiting a unique “rosary-bead-like” morphology not previously described in the literature. The patient was successfully treated with Politano-Leadbetter ureteroneocystostomy, preserving the blind-ending ureter alongside the two functional ureters. This case represents a unique variant of ureteral triplication that does not fit Smith’s original classification due to the absence of associated renal parenchyma and the specific morphology of the third ureter. We highlight the utility of detailed preoperative imaging and intraoperative assessment in managing such unclassifiable variants. Ureteroneocystostomy without excision of the blind-ending ureter is a viable option to avoid vascular compromise to the functional units.

Abstract Background Transurethral resection of the prostate (TURP) is recognized as the gold standard for alleviating bladder outlet obstruction associated with benign prostatic hyperplasia (BPH). Despite its efficacy, TURP can be accompanied by various complications, including acute urinary retention, which undermines the intended outcome. However, there is limited evidence available regarding the factors contributing to post-TURP acute urinary retention. Methods A hospital-based unmatched case-control study assessed patients undergoing transurethral resection of the prostate (TURP). Excluding those with diagnoses like prostatic cancer and Parkinsonism, data were analyzed using SPSS version 23. Bivariate and multivariable logistic regression identified factors for post-TURP acute urinary retention, with p-values under 0.05 deemed significant. Results Among 143 audited cases, 40 fell into the AUR group, while 103 were non-AUR. Variables like age, illness duration, preoperative AUR, prostate volume > 80 ml, and showed increased AUR likelihood but lacked statistical significance. In incompletely resected adenomatous tissue, surgery duration > 60 min, intraoperative urethral injury, prolonged catheterization (> 2 days), and postoperative UTI had significantly higher AUR odds. Multivariate analysis revealed incomplete resection as the sole sustained significant variable (AOR = 8.34, 95%CI (2.21–31.65)). Conclusions Incomplete resection emerged as a significant predictor of post-TURP AUR. Vigilance, thorough preoperative assessments, and consideration of specific factors are crucial for optimal outcomes. Further studies are warranted to validate these findings, given the study’s limitations.

Abstract Background In this study, we aimed to present the imaging and surgical results of our pediatric UPJO patients and to discuss our findings in the context of the current literature. Methods All medical records of children who underwent open pyeloplasty due to UPJO were reviewed retrospectively. Obtained data included patient demographics, clinical symptoms, ultrasonographic and scintigraphic imaging, intraoperative details, length of hospital stay and complications. Results 114 patients underwent 124 open dismembered pyeloplasties for UPJO. Anderson-Hynes dismembered pyeloplasty technique was used except Y–V plasty in a recurrent patient. Significant changes in mean hydronephrosis degree, pelvic anterior–posterior diameter and parenchymal thickness were observed. The mean preoperative ipsilateral differential renal function was 37%, and it was calculated as 36% postoperatively. Pelviostomy catheter was used in 11 kidneys, double-J stent was used in 108 kidneys and no catheter was used in 5 kidneys. The mean operative time was 98 min. The mean length of hospital stay was 4.6 days. The mean postoperative follow-up period was 5.1 years. Recurrent UPJO was seen in 5 of 124 kidneys (4%). Conclusion Open dismembered pyeloplasty remains a highly successful and feasible surgical option in the treatment of pediatric UPJO, and our findings are consistent with outcomes reported in the current literature.

Abstract Background Fournier’s gangrene is a rare Urologic emergency with high fatality rate, as high as 88%. It is preponderant in males with a male female ratio of 10:1, diagnosis is clinical, requiring timely and aggressive intervention as this improves clinical outcome. It is pertinent to identify prognostic factors to improve outcome of management. Methods It is a retrospective cohort study. Data of patients managed for Fournier’s gangrene from January 2019 to December 2024 were retrieved from medical records and theatre records. This includes sociodemographic, anthropometry, risk factors, etiological factors, laboratory parameters. Patients with incomplete medical records were excluded from the study. Fournier’s gangrene severity index score was calculated. Data was analyzed using Statistical package for social sciences (SPSS) version 27.0. Categorical data such as age, BMI, ethnicity, level of education was presented in proportion while continuous data were presented in mean with standard deviation. Association between independent and dependent variable were assessed with Fisher’s exact and Pearson chi square where appropriate, means of laboratory parameters was compared with outcome using t-test. Level significance set at p < 0.05. Results The study includes 39 male patients, with mean age of 51.26 ± 14.37, majority of patients were above 60 years, majority (56.4%) had secondary level of education. Using international standard classification of occupation 64.1% had skill level 2, while most of the patient 82.1% belonged to the lower socioeconomic class. A mortality of 16.7% was recorded, Fournier’s gangrene severity score index was statistically significant in predicting outcome of Fournier’s gangrene management, Fishers exact test = 32.416; p < 0.001. Mean Fournier’s gangrene severity index score between survivors and non survivors was 6.06 ± 2.30 and 18.50 ± 3.56 respectively, p < 0.001. AUC ROC with cut-off value of 9.50 in determining outcome of Fournier’s gangrene showed a sensitivity of 100% and specificity of 97.0%. p value < 0.001. Using t-test there was an association between serum bicarbonate and serum total bilirubin in determining outcome of Fournier’s gangrene t = 5.648; 0.579 respectively; p < 0.001. Conclusion The study highlights the sensitivity and specificity of Fournier’s gangrene severity index score in determining outcome of Fournier’s gangrene, it also revealed that there is a statistically significant association between serum bicarbonate and total serum bilirubin in determining severity and outcome of Fournier’s gangrene.

Abstract Objective To evaluate the benefit of using platelet-rich plasma (PRP) covering layer in decreasing urethrocutaneous fistula rate post-distal penile hypospadias repair using the STAR technique. Methods This prospective randomized controlled trial included 44 boys with primary distal penile hypospadias. Patients were randomized into two groups: Group A ( n = 22) underwent repair using the STAR technique with an additional PRP layer over the neourethra, while Group B ( n = 22) received the STAR repair without PRP. PRP was prepared from autologous blood and applied as an intermediate layer before skin closure. Patients were followed for at least 4 weeks. The primary outcome was the incidence of urethrocutaneous fistula (UCF). Secondary outcomes included postoperative complications (edema, infection, meatal stenosis), operative time, and cosmetic outcome using the Hypospadias Objective Scoring Evaluation (HOSE). Results The two groups (22 patients per group) were similar in age (median ~ 20 months in each, p = 0.96) and other preoperative characteristics. The incidence of urethrocutaneous fistula was significantly lower in the PRP group (4.5% [1/22]) compared to the non-PRP group (27.3% [6/22], p = 0.039). Other postoperative complication rates showed no statistically significant differences: edema occurred in 4.5% of Group A vs 0% of Group B ( p = 1.00), meatal stenosis in 4.5% vs 0% ( p = 1.00), and no wound infections occurred in either group. Mean operative time was slightly longer with PRP (70.2 ± 16.5 min vs 61.1 ± 15.7 min without PRP) but did not reach statistical significance ( p = 0.068). Conclusion Incorporating PRP as a biological layer in distal hypospadias repair using the STAR technique significantly reduced urethrocutaneous fistula rates without increasing complications. PRP is a safe autologous adjunct that may improve surgical outcomes.

Abstract Background Eosinophilic cystitis is a rare disease of the bladder which is difficult to distinguish from other causes of haematuria, and is often misdiagnosed number of times. Diagnosis is made with bladder biopsy. Early diagnosis is important as it is life threatening condition secondary to ongoing hematuria. Case presentation We report the case of a 26-year-old female presents with sudden onset of gross haematuria since 1 day and hypovolemic shock at time of presentation. Cystoscopy showed bladder clots and patchy areas of cystitis with diffuse urothelial erythema. Bladder biopsy revealed lamina propria with inflammatory infiltrate rich in eosinophils. After diagnosis she was commenced on medical treatment with complete resolution of symptoms. Conclusion Early diagnosis is important as it is life threatening condition secondary to ongoing hematuria and is done through a combination of surgical and nonsurgical methods such as bladder biopsy. Once diagnosed, the treatment is by the combination of conservative management and operative interventions. Natural history of this entity is difficult to predict as there are number of other common causes of hematuria which if not treated may result in bladder damage, upper tract damage and can be life threatening as in our case. This case highlights the importance of investigating hematuria that is unresponsive to initial hydration and bladder irrigation. It is important for urologist to think of this entity and also obtain a diagnosis, leading to definitive treatment.

Abstract Background This study aimed to evaluate, for the first time in Iran, the impact of transobturator tape (TOT) and tension-free vaginal tape (TVT) procedures for stress urinary incontinence (SUI) on condition-specific sexual function 2–3 years after these surgeries. Methods A retrospective cohort study was conducted at Ghaem and Imam Reza Hospitals in Mashhad, Iran, involving 200 women who underwent either TOT or TVT surgeries. Sexual function was assessed using the Female Sexual Function Index (FSFI). A random sample of 100 women who had undergone TOT procedure and 100 women who had undergone TVT procedure within the past 2–3 years was selected and completed the FSFI questionnaire online. Results In the TOT group, 69% of women were menopausal, compared to 59% in the TVT group. Additionally, 27% and 31% of women had undergone cesarean deliveries in the TOT and TVT groups, respectively. Nonmenopausal women in the TOT group exhibited significantly better sexual function compared to menopausal and nonmenopausal women in the TVT group. Women with a history of natural delivery in the TOT group demonstrated significantly higher sexual function compared to their counterparts in the TVT group. Similarly, women who had undergone cesarean delivery in the TOT group reported better sexual function than those in the TVT group. Conclusion Minimally invasive surgical procedures such as TOT and TVT not only effectively treat SUI but also may improve aspects of sexual function in selected groups. This improvement is particularly notable among nonmenopausal women and those with a history of natural delivery.

Abstract Background The obliterated strictures in the anterior urethra are not uncommon. We describe a case series of 45 patients of obliterated strictures, their outcome analysis and postulate a management algorithm. Methods Urethral reconstruction was done in all the 45 patients from February 2015 to March 2019 at a single center. The prospectively collected data were evaluated retrospectively with symptom score, uroflowmetry, post void residue (PVR) and urethrogram. The lumen size, length of stricture and the degree of spongio-fibrosis were assessed. The strictures were subclassified into nearly obliterated stricture (NOS) and completely obliterated stricture (COS) based on the urethral lumen size. The patients were followed initially quarterly and yearly after. Any intervention needed was considered as failure. Results The average age was 49 years (IQR 31 to 67). The etiology was iatrogenic in 30 (67%) and Lichen Sclerosus (LS) in 13 (29%) and necrotizing scrotal infection in 2 (4%). There were 24 (53%) COS and 21 (47%) NOS. Seven management categories and their management decision tree are described. The average follow-up was 34 months (IQR 12–58). Overall average symptom score, flow rate and PVR improved from 21 to 7, 6 ml/s to 19 ml/s and 210 ml to 20 ml, respectively. Six patients (13%) developed minor complications. Recurrence was noted in six (13%). Conclusions Obliterated strictures are complex and challenging. A systematic approach as described, may be taken to manage them for a successful outcome with a reasonable complication and recurrence rate.

BackgroundUrethral stricture is a common urological disease, associated with significant morbidity, and often requires urethroplasty for cure. The outcome of urethroplasty, especially substitution urethroplasty, is dependent on specialized surgical training, meticulous tissue handling and good postoperative care. The aim of this study was to report on the impact of specialized training on the outcome of urethroplasty by a single surgeon in a low-income country.MethodsThis is a retrospective study in which we reviewed the electronic medical records of all patients who underwent urethroplasty in Sharab Hospital, The Gambia, West Africa from November 2018 to October 2022. There were two groups of patients, Group 1 (anastomotic urethroplasty) and group 2 (buccal mucosa urethroplasty-BMG). Data analysed includes demographics of the patient, clinical presentation, operation findings of length of stricture, and outcomes in terms of complications and recurrence. They were followed up for one to five years.ResultsFifty-nine (59) urethroplasties were done during the study period. Of which 2 died of cerebral hypoxia and 7 were lost to follow-up. Therefore, 50 (85%) were followed up of which 34(68.0%) and 16 (32.0%) buccal mucosa substitution urethroplasty and anastomotic urethroplasty, respectively. The buccal mucosa was obtained under general anaesthesia in15 patients (42.9%) and local anaesthesia in 20 patients (57.1%). Of those followed up, one patient each of substitution and anastomotic urethroplasty had a recurrence giving a success rate of 97.1% and 93.8%. The median survival for anastomotic and buccal mucosa graft urethroplasty were 36.3 months and 48.2 months with no statistical difference between both groups Chi-square of 0.122, df = 1, and p = 0.727. There was no incidence of wound infection or urethrocutaneous fistula.ConclusionThe specialized training of the urologist contributed significantly to the high success rate of urethroplasty in low-income country such as The Gambia.