Dislocation of the penis: a rare case of genital trauma

Traumatic dislocation of the penis is one of the rarest types of genital trauma. This type of injury is accompanied by a violation of the integrity of the skin and the penile ligamentous apparatus, with the dislocation of the penis into the scrotum under the skin of the thigh, or the area of the pubic joint. The low occurrence frequency of such injuries and the small number of observations described in the literature entails the absence of generally accepted treatment tactics for this category of patients. The article describes a clinical case of successfully treated traumatic dislocation of the penis with penile transposition into the pubic joint area and the formation of subcutaneous urinary leakage after late treatment of the patient for medical care.

En-Bloc Transplantation of Dual Adult Kidneys with Multiple Vessels

Background. To provide optimal nephron mass, two adult kidneys with suboptimal function can be transplanted into one single recipient. All techniques described to date are based on the lengthy sequential transplantation of one allograft after the other, in each iliac fossa, or through one long incision in the right iliac quadrant. Material and Methods. We report on a novel shorter and simpler operative technique allowing the en-bloc transplantation of seven dual adult kidneys with multiple vessels into a single iliac fossa, with revascularization through the donor aorta and vena cava. A proposal for the identification, allocation, procurement, and placement of the dual adult kidneys is presented. Results. There was no primary non-function, no thrombosis, and no urinary leakage. No urosepsis and hydronephrosis were noted during the follow-up. The operative time was 180 min. At 36 months, serum creatinine levels averaged 1.8 mg/dL (range 1.4–1.9 mg/dL). Conclusions. The procedure described permits converting two complex vascular kidneys into one en-bloc graft, which then can be transplanted into a single iliac incision, using only one arterial and one venous anastomoses. It avoids extensive dissection, shortens the operative time, and reduces the complications rate for the elderly recipients. It is applicable to the transplantation of dual kidneys with single or multiple arteries.

Utilizing Synergism between the Transverse Abdominal and Pelvic Floor Muscles at Different Postures in Nulliparous Women: A Randomized Case-Control Study

<b><i>Introduction:</i></b> The aim of the study was to determine the effects of the pelvic floor muscle (PFM) training (PFM-T) in combination with transverse abdominal (TRA) muscle activation (cPFM-T) in female urinary incontinence. <b><i>Methods:</i></b> We enrolled nulliparous women in supine (SUG) (<i>n</i> = 22), sitting (SIG) (<i>n</i> = 19), and control (COG) (<i>n</i> = 14) groups. We conducted an 8-week cPFM-T programme. We examined the effect of training on the parameters with the Kruskal-Wallis test, the pairwise comparisons with the Mann-Whitney U test, and the Wilcoxon rank test with the Bonferroni correction. <b><i>Results:</i></b> Before training, 15 participants reported occasional urinary leakage. After cPFM-T, 7 participants reported that urinary leakage had disappeared. Maximal isometric contraction of the PFMs until fatigue improved significantly in the SUG (<i>p</i> &#x3c; 0.001) and SIG (<i>p</i> = 0.015) groups but not significantly in the COG group (<i>p</i> = 0.499). Holding time increased in the SUG (<i>p</i> = 0.972) and the SIG (<i>p</i> = 0.717) groups and decreased in the COG group (<i>p</i> = 0.132). The dynamic endurance of the PFM improved significantly in the SUG group (<i>p</i> &#x3c; 0.001) but not in the SIG (<i>p</i> = 0.798) and the COG (<i>p</i> = 0.153) groups. The number of maximal fast contractions within 1 min increased in both the SUG (<i>p</i> &#x3c; 0.001) and SIG (<i>p</i> = 0.813) groups and decreased in the COG group (<i>p</i> = 0.257). Relaxation improved significantly in the SIG group (<i>p</i> = 0.011). TRA mucle thickness increased in both training groups. <b><i>Conclusion:</i></b> Slow-twitch fibres of the PFM can be trained effectively with PFM-T in both the body positions.

DOUBLE J STENTING IN A DELAYED URETER INJURY DUE TO THERMAL NECROSIS FOLLOWING LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY

The presenting symptom to a gynecologist for postoperative vaginal discharge, which may or may not be related to the gynecologic diagnosis. A 40-year-old woman with abnormal uterine bleeding came to ObGyn Opd. The diagnosis was simple endometrial hyperplasia for which laparoscopic assisted vaginal hysterectomy with bilateral salphingo oophorectomy was done. Post-Operative Day 18 patient developed vaginal discharge suggestive of urinary leakage. The postoperative delayed ureter injury is an unusual association with laparoscopic assisted vaginal hysterectomy. The management was ureter stent insertion. This case report could be guidance to surgeons about the postoperative management of ureter injury. Gynecologists should consider the presenting symptom of vaginal discharge in formulating their differential diagnosis.

Comparison of Outcomes of Kidney Transplantation From Extremely Low Body Weight ≤5kg Versus Larger Body Weight Pediatric Donors

BackgroundKidney transplantation from donors who weigh ≤5 kg is performed at only a few transplant centers owing to the high complication and low graft survival rates associated with this approach.MethodsWe retrospectively compared the results of kidney transplantation at our center between January 2015 and December 2019 based on the following pediatric donor criteria: donor body weight ≤5 kg (n=32), 5 kg&lt; donor weight ≤20 kg (n=143), and donor weight &gt;20 kg (n=110). We also perform subgroup analysis of kidney transplantation outcomes from ≤5 kg donors, using conventional (dual separate and classic en-bloc KTx)/novel (en-bloc KTx with outflow tract) surgical methods and allocating to adult/pediatric recipients.ResultsThe death-censored graft survival rates from extremely low body weight ≤5kg at 1 month, and 1, 3, and 5 years were 90.6%, 80.9%, 77.5%, and 73.9%, respectively, which were significantly lower than that from larger body weight pediatric donors. However, the 3-, and 5-year post-transplantation eGFRs were not significantly different between the pediatric and adult recipient group. The thrombosis (18.8%) and urinary leakage (18.8%) rates were significantly higher in the donor weight ≤5 kg group. Compared with 5 kg&lt; donor weight ≤20 kg group, donor weight ≤5kg group was at elevated risk of graft loss due to thrombosis (OR: 13.4) and acute rejection (OR: 6.7). No significant difference on the outcomes of extremely low body weight donor kidney transplantation was observed between adults and pediatric recipients. Urinary leakage rate is significantly lower in the novel operation (8.7%) than in the conventional operation group (44.4%).ConclusionsAlthough the outcomes of donor body weight ≤5kg kidney transplantation is inferior to that from donors with large body weight, it can be improved through technical improvement. Donors with body weight ≤5 kg can be considered as an useful source to expand the donor pool.

Women’s Awareness linked by Pelvic Floor Muscle Activity

Levator ani is a healthy and fatigue resistant striated muscle. It is stung like a sway around the midline pelvic effluents like the uterus, bladder, and bowel. The pubococcygeus muscle has four fibers; Posterior fibers, Puborectalis, Puboanalis, Pubovaginalis. Here, the Pubovaginalis forms a U-shaped sling, supporting the Pelvic organ-like bladder, uterus. Therefore, during Parturition, weakness or tear of the sling occurs, responsible for the pelvic organ prolapse. Pelvic organ prolapse includes the drop of the vaginal wall or the uterus. The weakness of the pelvic floor also causes urinary incontinence, defined as the involuntary loss of urine when the intravesical pressure exceeds the urethral pressure in the absence of detrusor muscle. So, it is very important to be aware of the pelvic floor exercises, which help in strengthening the pelvic floor and prevent complications. Some women may think the leakage of urine and organ prolapse as a regular phenomenon that may contribute to incontinence and prolapse, study objective was to see the awareness in the women about the complications. This survey highlights the need for awareness. It promotes early education among females about pelvic floor structure, exercise, the importance of early diagnosis, and the correct treatment to avoid complications. Author contribution: Authors have analyzed the data and wrote the paper. The author contributed to manuscript revisions and approved the final version of the manuscript and agreed to the responsibility for the content. Methods. This survey has developed on the basis of analysis of women suffering from urinary leakage and prolapse issues. The date in which the responses have been collected are 2-11-2020 to 3-03-2021.This study comprises a cross-sectional survey, a 3-part questionnaire to 246 females who know the English language, which has three sections where section one, prolapse and incontinence knowledge questionnaire which is made up of 13 questions, to evaluate knowledge of females about urinary incontinence. Section two has 14 questions that contain information about the treatment of the problem and prognosis and the remaining 12 questions in section three including demographic information. It has been distributed among 700 women on which 246 filled this form and answered all the questions which were asked in the questionnaire . Inclusion and exclusion criteria: The following inclusion criteria: age - born between 2003 − 1960, understanding of basic english language it is because this is the common language which is understood by the whole community. As there is no specification in terms of region or nation. The English language is commonly understood by most people. should have a smartphone or computer, should have access to the internet and awareness of the google form. Exclusion criteria are as follows: Women who have gone under surgical intervention, who do not know the english language, who cannot see. Data collection procedure: The conduction of this research involves the questionnaire used by researchers; the difference is of inclusion criteria among females. This form has reliability and validity as per prior check by an expert. The technique to distribute the questionnaire is snowball sampling. Results: The overall awareness level for the sub sample population was calculated to be at 42.67%. Awareness for urinary leakage was 45.12% and pelvic organ prolapse 40.25% Conclusions: More than half of the population is estimated to be unaware of basic knowledge of the subject

Augmentation Cystoplasty in Children: Institute of Kidney Diseases Peshawar Experience

Objective: The aim of this study is to share our single-center experience of Augmentation Cystoplasty (AC) in children regarding indications, bowel segment used, associated procedures, and its complications. Materials and Methods: We analyzed data of all pediatric patients who underwent AC at Institute of Kidney Diseases (IKD), Peshawar between July 2017 and March 2020. Results: A total of 18 pediatric patients are included in the study who underwent Bladder augmentation (BA) either isolated in 1 (5.5%), or along with other associated procedures like Mitrofanoff 17 (94.4%), Antegrade Continent Enema (ACE) 6 (33.3%), Bladder Neck Reconstruction (BNR) 5 (27.7%) and Bilateral ureteric Re-implantation (B/L UR) in 3 (16.6%). Indication for Bladder augmentation were Neurogenic bladder (NGB) 13 (72.2%), Exstrophy Epispadias Complex (EEC) 3 (16.6%) and Posterior urethral value with small functional capacity bladder 2 (11.1%). Small gut used in 15 (83.3%) and large gut in 3 (16.6%) for BA. For Mitrofanff associated with bladder augmentation, Appendix was used in 14 (82.35%) and small gut (Monti) in 3 (17.6%) cases. For ACE associated with BA, in 4 (66.6%) Appendix used as right-sided ACE and in 2 (33.3%) small gut (Monti) as left-sided ACE. No intraoperative complications noted, while early post-op complications, 2 wound infection and 1 urinary leakage from wound, were noted in 3(16.6%) cases and late post-op complications (stomal stenosis) in 4(22.2%) patients.

Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study

Background There has been a limited number of reports on the significance and risk factors of urethrovesical anastomotic urinary leakage (AUL) following robot-assisted radical prostatectomy (RARP). We aimed to analyze the clinical significance of AUL and evaluated its risk factors. Methods We conducted a multi-institutional study to review patients with prostate cancer undergoing RARP in three centers (The University of Tokyo Hospital, Mitsui Memorial Hospital, and Chiba Tokushukai Hospital). “Positive AUL” was defined as urinary extravasation at the anastomosis detected by post-operative cystogram and was further categorized into minor or major AUL. Univariate and multivariate analyses were performed to identify predictors of AUL. Postoperative continence rates and time to achieve continence were also analyzed. Results A total of 942 patients underwent RARP for prostate cancer in 3 centers. Of these patients, a cystogram after the RARP procedure was not performed in 26 patients leaving 916 patients for the final analysis. AUL was observed in 56 patients (6.1%); 34 patients (3.7%) with minor AUL and 22 patients (2.4%) with major AUL. Patients with major AUL exhibited a significantly longer time to achieve continence than those without major AUL. Multivariate analysis demonstrated that longer console time (≥ 184 min) was significantly associated with overall AUL, and higher body mass index (≥ 25 g/kg2) was a significant predictor of both major and overall AUL. Conclusions The presence of major AUL was associated with the achievement of urinary continence, suggesting clinical relevance of its diagnosis by postoperative cystogram. A selective cystogram has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.

Laparoscopic treatment of vesicouterine fistula (a literature review and case report)

Urogenital fistulas are common complication of obstetric and gynecological surgery; the most common are vesicovaginal fistulas. Vesicouterine fistulas are rare, which explains the difficulties in diagnosis and treatment. The literature review and own clinical case presented in article. A 43-years-old female patient was consulted with complaint of urinary leakage from vagina, which appeared 1 month after the cesarean section and vesicouterine fistula has been diagnosed. Successful laparoscopic treatment of vesicouterine fistula was performed at the Avicenna Medical Center after 3 months. The urethral catheter was removed 7 days after surgery. At control examination after 1, 3 and 6 months, ultrasound examination of the pelvic organs confirmed the consistency of the scar on the uterus. Urination remained free and painless, the patient did not notice urine leakage. This clinical observation shows the possibility of treating a vesicouterine fistula with a laparoscopic approach with a good result and the possibility of early rehabilitation.