Abstract Background Penile fracture is a rare urological emergency involving a traumatic rupture of the tunica albuginea of the corpora cavernosa. This study aims to describe the epidemiological, diagnostic, therapeutic, and prognostic aspects of this condition at a university teaching hospital in Burkina Faso. Patients and methods A descriptive retrospective study was conducted over 3 years (2021–2023) at the Yalgado Ouédraogo University Teaching Hospital (CHU-YO). Data from 19 patients managed for a confirmed penile fracture were collected from clinical files, operative registers, and via telephone interviews. Data were analyzed using Epi Info 7.2.1 and Excel software. Results The mean annual incidence was 6.3 cases. The mean patient age was 34.16 years. The main mechanism was a coital misstep (73.68%). The mean time to consultation was 12.95 h. Diagnosis was purely clinical in all cases. All patients underwent immediate surgical repair. Early postoperative complications (surgical site infection) were rare (10.52%). Long-term, 89.47% of patients had normal erectile function (IIEF-6 score ≥ 26). Conclusion Penile fracture, although rare, is a recognized entity in Burkina Faso. Early surgical treatment, based on reliable clinical diagnosis, offers excellent functional outcomes and a low complication rate, confirming its position as the therapeutic gold standard.

Abstract Background Implantation of penile prosthesis in cases of fibrotic scarred corporeal tissue is one of the most challenging procedures in prosthetic urology. We present our work with implantation of semirigid penile prostheses in cases of severe scarred corporeal fibrosis using two types of cavernotomes, Uramix cavernotome (Uramix USA) and Shaeer`s coring cavernotome (ShC) either separately or combined. Methods Fourteen cases with severe scarred penile fibrosis underwent semirigid penile prosthesis implantation from September 2021 to May 2023. The institutional ethical committee approved the work that conforms to Helsinki declaration 2013. All participants were fully counseled about their condition and the necessity to redo the implantation with the possibility of postoperative complications together with cancelling the operation in case of dilatation failure. Results In most cases, proximal dilatation was more difficult than distal dilatation. In thirteen patients, penile prosthesis implantation was inserted bilaterally. In one post-priapism patient, dilatation was successful on one side only, and a single rod was implanted. Failure of dilatation of the contralateral side was due to atrophy and thinning-out of the corpus cavernosum. Urethral injury, distal perforation or crossing-over was not encountered. Proximal perforation was encountered in three cases, two by Uramix and one by ShC. Corporotomies were then extended, and the rear tip extender was sutured to the tunica albuginea by prolene sutures. In two cases, distal side perforations happened due to misdirection of ShC. In those two cases, penile degloving through the penoscrotal incision was done and the corporeal side perforations were sutured by absorbing sutures under vision. In only four patients, Uramix dilator was used alone to dilate the corpora. In the Uramix group, two patients had girth 12 mm implanted and two had girth 11 mm. In another four patients, the Uramix could not dilate the fibrotic corpora, so ShC was used to excavate the sclerotic cavernosal tissue. Conclusion It is recommended to start first with the Uramix dilators. If corporeal fibrosis is severe, ShC can then be used owing to the higher risk of corporeal perforation that is induced by ShC.

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 Purpose Ureterocele is a congenital malformation characterized by cystic dilatation of the distal ureter. Endoscopic decompression is the standard initial treatment in symptomatic cases. This study evaluates the efficacy and safety of the suprapubic transvesical grasper-assisted technique (SATUP) for endoscopic drainage of ureterocele in children . Materials and methods A retrospective review was conducted of pediatric patients who underwent SATUP drainage for ureterocele between 2016 and 2022. Patients were followed for a mean duration of 22 months (18 till 48 months). Outcomes assessed included improvement in hydronephrosis, development of vesicoureteral reflux (VUR), incidence of urinary tract infections (UTIs), and need for re-intervention. Procedural safety was evaluated by assessing operative time and complications, such as urinary leakage, bleeding, or bladder perforation. Results Nineteen ureterocele moieties in 16 patients were treated using the SATUP technique. Transurethral incision was performed at a mean age of 16 months in single-system ureteroceles and 7 months in duplex systems. Hydronephrosis improved in 83% of single-system and 68% of duplex-system cases. De novo reflux developed in 14% and 53% of these groups, respectively. No single-system cases required further surgery. Two patients with bilateral duplex-system ureteroceles underwent bilateral ureteric reimplantation 36 months post-procedure due to recurrent UTIs. Mean operative time was 25 min, and no procedure-related complications, such as bladder wall hematoma or urinary leakage were reported. Conclusions SATUP appears to be a safe and effective adjunct to conventional endoscopic treatment for pediatric ureterocele, offering improved surgical control without added morbidity.

Abstract Introduction The rate of false-negative results for Transrectal Ultrasound-guided prostate (TRUS-TB) biopsy for clinically suspicious carcinoma prostate (CaP) may be as high as 35% depending on used techniques. The objective of this study was to determine the diagnostic yield of Prostate-specific Membrane Antigen Positron Emission Tomography-targeted biopsy (PSMA PET-TB) in suspected carcinoma prostate cases with negative TRUS-guided biopsy. Methods Those cases with high clinical suspicion of CaP with a benign histopathology report following TRUS-TB over a period of 23 months were evaluated using 68 Ga-PSMA PET/CT scan to localize the avid lesion, and PSMA PET-TB was done. Data available from mpMRI studies done during the time of diagnosis were also used. Concordance was calculated for different sites by method of Kappa for test of agreement between 2 modalities, in addition to calculation of various screening test parameters using ROC curves. Results The mean PSA of the cohort (ng/mL) was 20.34 ± 23.90 (95% CI 14.48, 28.20). Of the 50 patients who were negative on TRUS-TB but showed a PSMA-avid lesion, 43 were included; of these, 39 were diagnosed with prostate cancer (CaP), and 20 had a Gleason score of 3 + 3 (Grade Group 1). The sensitivity, specificity, and diagnostic yield of PSMA PET scan were 84.62, 75, and 97.06%, respectively, at an SUVmax > 6.95 on 68 Ga-PSMA scan. 37 out of the 39 CaP cases with anteriorly located lesions missed on TRUS-TB were accurately targeted and diagnosed by PSMA PET-TB. 33 cases with PIRADS score > 3 and SUVmax > 6.95 were diagnosed as CaP by PSMA PET-TB in cases negative on TRUS-TB. Conclusions PSMA PET-TB is a valuable tool to diagnose clinically suspicious prostate cancer in patients with initially negative TRUS-TB.

Abstract Background Since the evolution of flexible ureteroscopy from being reusable to disposable then reused disposable scopes aimed basically to reduce the cost, this study was conducted to evaluate the causes of reused single-use flexible ureteroscope damage in order to extend its longevity and increase the number of procedures per scope. Patients and methods This retrospective study was conducted in a single center between September 2022 and September 2024. Sixty-two reused single-use flexible ureteroscopes after resterilization were used for 202 patients over 235.7 hours. Potential causes of scope damage were observed, recorded and analyzed. Results The observed causes of reused single-use flexible ureteroscope damage were as follows: 32.3% of scopes were damaged by laser fiber related damage (either by sudden withdrawal of fiber during firing or transmitted energy), 27.4% by sustained excessive deflection, 19.4% by scope backloading technique, 9.6% by traumatic ureteral access sheath usage (such as scope withdrawal while deflected over the access sheath and stone fragment lodgment between the sheath and scope) and 11.3% by instrumental working channel damage. On comparing different related causes of damage, fine deflection proved to be superior to excessive deflection (p < 0.001) and access sheath usage proved to be significantly superior to backloading (p = 0.005) while there was no significant difference on comparing laser settings. Conclusion Longevity of single-use flexible ureteroscope can be extended by avoiding potential causes of damage. Cost-effective practice can be achieved through careful scope handling, use of ureteral access sheath instead of backloading, relocation of lower calyceal stones, and proper laser fiber management.

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 Background Hypospadias is the second most common congenital external genital malformation in males, urethrocutaneous fistula (UCF) is the commonest complication of hypospadias repair. This study aimed to assess risk factors of UCF following hypospadias repair in (Khartoum) state, (Sudan), addressing both proximal and distal variants. Materials and methods This is an observational, prospective, multisite cohort study performed at six pediatric surgical centers from September 2021 to April 2023. Although data were abstracted from patient records, all entries were recorded prospectively from admission through follow-up using standardized forms. Children < 18 years undergoing hypospadias repair were included. Patients were followed for 12 months postoperatively. Variables included hypospadias location, surgical technique (including Byars or Bracka for proximal repairs), tissue coverage type, catheter size and duration, and surgeon experience. UCF was defined as any postoperative urethral leakage through the skin, excluding complete dehiscence. Patients were divided into two groups: those who developed UCF and those who did not. Chi-square, t-tests, and binary logistic regression were performed to identify independent risk factors for UCF. Results Among the enrolled patients (n = 152), mean age was 2.5 ± 1.2 years. Forty-two percent had anterior hypospadias, 22% had middle hypospadias, and 36% had posterior hypospadias. Thirty-eight patients (25%) developed UCF; the mean time to development of UCF was 5.0 months. On univariate analysis, posterior hypospadias (p = 0.01), catheter duration >7 days (p < 0.001), and surgery performed by junior surgeons (p = 0.04) were associated with UCF. Logistic regression analysis confirmed these as independent predictors. No patients were lost to follow-up during the study period. Meatal stenosis occurred in 3.3% and urethral stricture in 2.0% of patients, including 2 and 1 case(s), respectively, in the UCF group; no significant correlation was found, and their temporal relationship to UCF was not consistently recorded. Among UCF repairs, tunica vaginalis flap achieved 92% success (11/12) versus 77% (20/26) for skin flap or primary closure. Conclusions Independent risk factors for developing urethrocutaneous fistula include posterior meatal position, longer catheterization >7 days and limited surgeon experience. While stenosis and stricture were rare, their role in fistula formation warrants further study. Understanding these risk factors may help reduce UCF in resource-limited settings.