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Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Vesico-vaginal fistula (VVF) is one of the most important diseases related to quality of life in women's diseases and postoperative complications. We aimed to identify preoperative predictive factors of fistula repair failure and to develop a predictive model for this disorder., Patients and Methods: The data from patients who underwent VVF repair from January 2010 and December 2020 were recorded and analyzed. The therapeutic results were assessed after a follow-up of at least six months. A successful VVF repair was defined as: closed VVF as noted on visual inspection of both the bladder and the vagina, no subjective complaints of vaginal leakage, no evidence of leakage during Valsalva and cough from the vaginal closure area using a half-speculum. Variables associated with fistula repair failure in the univariate analysis were included in a multivariate model using binary logistic regression to determine the independent factors of this disorder. All statistical analyses were performed using SPSS, and significance was set at 0.05%., Results: Ninety-eight patients were identified. The median age of patients was 50 (interquartile range: 42 - 55) years. Failure of surgical treatment of VVF has been reported in 32 (32.7%) cases. Patients with failed surgical treatment had the higher size of fistula (p = 0.03), supratrigonal fistula (p = 0.02) and vaginal fibrosis (p = 0.001). On multivariate analysis, vaginal fibrosis (Adjusted OR = 4.2; 95% CI = 1.398 - 12.739; p = 0.01) and supratrigonal VVF (Adjusted OR = 3.3; 95% CI = 1.18 - 9.26; p = 0.02) were independent factors of fistula repair failure. These two predictors were used to calculate the probability of combined success given by the following formula:ⅇ b 1+ⅇ b , where b = -0.195 + 1.436*(for the vaginal fibrosis) +1.196*(for a supratrigonal VVF). The model had a sensitivity of 50% and a specificity of 86.36%., Conclusion: Treatment failure was, in our series, correlated with the quality of the vaginal tissue and the seat of the fistula. This study demonstrated that vaginal fibrosis and supratrigonal fistula location are independent risk factors for failure of surgical treatment of VVF., (Copyright © 2025. Published by Elsevier Masson SAS.)

Background: Horseshoe kidneys are often considered a typical and frequently occurring type of kidney fusion anomaly when compared to other anomalies. Surgery for tumors that appear in horseshoe kidneys can challenging due to the abnormal vasculature and the potential need for isthmectomy. In such cases, open surgery remains a viable treatment option., Case Presentation: A 65-year-old African male patient hospitalized for total hematuria evolving for 6 months, and right lumbar pain without fever. The patient underwent a computed tomography scan, which revealed the presence of a solid mass occupying the junction of the isthmus and the inferior pole of left renal of a horseshoe kidney wish measured 30 mm. Tumorectomy was done by open lobotomy. The histological examination of the surgical specimen showed the presence of a clear cell carcinoma of the left kidney. After 52 months of clinical and radiological check-up, there was no functional complaint or any sign of recurrence., Discussion: Horseshoe kidneys are the most common fusion anomaly. These patients have an increased risk of malignant tumors, including renal cell carcinoma. Many studies indicate that horseshoe kidney tumors can be treated with partial nephrectomy, if feasible, with generally acceptable morbidity., Conclusion: This report presents a successful case where open surgery was used to partially remove a horseshoe kidney affected by renal carcinoma. We believe that, in certain circumstances, such as the presence of complex vascularization or an unfavorably located tumor, open surgery remains a reliable option for nephron-sparing procedures., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interests., (Copyright © 2025. Published by Elsevier Ltd.)

Introduction: The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. In urology, there is limited literature on the impact of frailty on percutaneous nephrolithotomy (PCNL) outcomes. We aimed to compare the predictive value of the modified 5-item frailty index (mFI-5) to identify high risk patients prior to PCNL., Methods: A database of patients undergoing PCNL, between 2015 and 2022, was analyzed. Patient frailty was assessed using the mFI-5 index. The mFI-5 index was calculated based on the presence of the five co-morbidities: congestive heart failure within 30 days prior to surgery, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Patients were grouped as not frail (mFI-5 = 0), intermediate (mFI-5 = 1), and severely frail (mFI-5 ≥ 2). Primary outcomes were 30-day postoperative complications. Secondary outcomes were hospitalization: total hospital length of stay, reoperation, and unplanned readmission., Results: From a total of 320 PCNL patients included for analysis, 54.06% (n = 173) were not frail, 17.81% (n = 57) were intermediate, and 28.12% (n = 90) were severely frail. Frail patients were likely to be older (p = 0.002) and have a higher American Society of Anesthesiologists score (p = 0.001), chronic kidney disease (p < 0.001). Patients of intermediate or severe frailty were more likely to exhibit postoperative sepsis (p = 0.042), significant blood loss (p = 0.036) and require intensive care units admissions (p = 0.0015). Frail patients had a longer hospital length of stay (p < 0.001) and tended to require reoperation (p = 0.001), and unplanned readmission (p = 0.02)., Conclusion: Frailty assessment appears useful in stratifying those at risk of extended hospitalization, septic and hemorrhagic complications, readmission, or reoperation after PCNL. Preoperative assessment of frailty phenotype may give insight into treatment decisions and assist surgeons in counselling patients on expected course and hospital stay following PCNL., Competing Interests: Declarations. Conflict of interest: The authors declare that there are no competing interests., (© 2024. The Author(s).)

Introduction: Penile fracture is a post-traumatic condition affecting the tunica albuginea of the corpora cavernosa when erect. Clinical diagnosis and urgent surgical intervention are crucial to avoid severe functional complications, particularly erectile dysfunction. We aimed to evaluate male sexual function after surgical treatment in patients with penile fracture and to identify predictive factors of postoperative erectile dysfunction., Methods: We underwent a hospital-based retrospective study on patients who underwent surgical repair for fractures of the corpora cavernosa between 2012 and 2023. Included in this study were all patients who have a postoperative follow-up of at least 12 months. Patients were clinically evaluated for the presence of erectile dysfunction and the presence of postoperative penile curvature. The patients were asked to answer the structured questionnaire of the International Index of Erectile Function (IIEF-15)., Results: We included 87 patients. The mean age was 38 ± 12 years. Fourteen patients (16%) developed a fibrous plaque, with a median onset time of 30 days postoperatively. Erectile dysfunction was noted in forty-four patients (51%). Active smoking (p < 0.002), the surgical approach (p = 0.02), a consultation time > 7.5 h (p = 0.01), a length of the discontinuity of the corpora cavernosa > 2.5 cm (p = 0.01) and the use of an erection inhibitor postoperatively (p = 0.021) were independent predictive factors of erectile dysfunction at 1 year postoperatively., Conclusion: Considering the results of our study, we propose rapid and urgent surgical management for penile fractures, and an elective surgical approach may be considered. We emphasize the fundamental role of sexual education, especially for young people, in preventing this sexual accident that could negatively impact their sexual life., Competing Interests: Declarations Conflict of interest The authors declare no competing interests. Ethical approval and consent to participate The study was approved by the ethics committee of THE RABTA UNIVERSITY HOPITAL, TUNIS. Approval was granted by THE RABTA UNIVERSITY HOPITAL LOCAL ETHICS COMMITTEE (ID: 19011989) (Approval date: 20/03/2023). All methods were performed in accordance with the relevant guidelines and regulations set out by the Declaration of Helsinki. An informed consent was obtained from all participants. Proof of consent to participate can be requested at any time., (© 2024. The Author(s).)

Para-testicular liposarcoma develops from the fatty tissue surrounding the spermatic cord and covers the testicle and epididymis. It is an extremely rare pathological entity. We report the case of a 58-year-old african man who presented with a tumor mass developed from the right spermatic cord. Right orchidectomy with wide excision of the tumor was challenging due to the significant size of the mass. The histological examination of the surgical specimen favored a paratesticular liposarcoma., Competing Interests: The authors declare that they have no competing interests., (© 2024 Published by Elsevier Inc.)

Introduction: Our study aimed to evaluate the performance of Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Systemic Inflammatory Response Syndrome (SIRS), and Global Research in the Emphysematous Pyelonephritis group (GREMP) in predicting the need of admission in intensive care units (ICU) for emphysematous pyelonephritis (EPN) patient., Patients and Methods: In this retrospective study, we reviewed 70 patients admitted to our department from January 2008 to October 2022. Data on clinical presentation and EPN management were noted. The five scoring systems were calculated by one investigator. Univariate and multivariate analyses were used to assess predictive factors of severe sepsis and mortality. Statistical analysis was made using SPSS version 22., Results: Mean age was 61.83 years with 65.7% diabetes. As per Huang and Tseng classification, 41 patients had class I EPN, 7 had class II EPN, 8 had class IIIa, 6 class IIIB EPN, and 8 had class IV EPN. Seventeen patients (24.28%) were admitted to ICU with an 18.57 mortality rate. Univariate analysis showed that ICU admission was significantly associated with higher respiration rate and heart rate, lower systolic blood pressure, confusion, CRP, lactate and creatinine serum (p = 0.0001, p = 0.0001, p = 0.001, p = 0.007, p = 0.004, p = 0.001, p = 0.001, respectively). All five scores and Huang and Tseng classification were significantly predictive of admission to ICU. All five scores showed good results under the area curves to predict ICU entry with 0.915, 0.895, 0.968, 0.887, and 0.846 for qSOFA, MEWS score, NEWS score, SIRS, and GREMP score, respectively., Conclusion: NEWS score seemed to be the best performing physiologic score among the five scoring systems studied and may help with biological and radiological findings to quickly identify EPN patients that need intensive care unit., (© 2023. The Author(s).)

Introduction: Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury., Patients and Methods: We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up., Results: Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25)., Conclusion: Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms. Concurrent pheochromocytoma in pregnant women can lead to severe complications and death due to associated catecholamine excess., Case Presentation: A 37-year-old pregnant woman, without medical or surgical history, gravida 1 para 0, was diagnosed with pheochromocytoma through biochemical and imaging tests at 20 weeks of gestation. Perioperative management included a multidisciplinary approach, symptom stabilization with medical treatment. An open right adrenalectomy was than performed at 23 weeks of gestation., Discussion: Pheochromocytoma is a rare but important cause of hypertension in pregnancy. It should be included and investigated as a differential diagnosis in cases of labile hypertension in pregnant women with or without associated symptoms., Conclusion: A correct diagnosis in all pregnant women with severe hypertension and a multidisciplinary management are mandatory to obtain optimal results and avoid deleterious effects at delivery., Competing Interests: Conflicts of interest The authors declare that they have no competing interests., (Copyright © 2023. Published by Elsevier Ltd.)

Background: A pyosalpinx is the acute inflammation of the fallopian tube, which fills up and swells with pus. It commonly results from inadequate or delayed treatment of pelvic inflammatory disease., Case Presentation: We report the case of a 54-year-old Africain female patient, who presented with sustained high-grade fever, right flank pain, and severe acute storage low-urinary-tract symptoms. Computed tomography showed signs of acute obstructive pyelonephritis with a right tubular juxtauterine mass with complex internal fluid and thick enhancing walls exerting a mass effect on the right ureter. A drainage of the right excretory cavities by a JJ stent was performed. An ultrasound-guided aspiration of the collection was also performed., Conclusion: A pyosalpinx can then exert a mass effect on the excretory cavities, thus causing an acute obstructive pyelonephritis. A double drainage coupled with an effective antibiotic therapy is then necessary., (© 2023. The Author(s).)

Having a kidney disease is a major risk factor of renal injury during blunt traumas. We present a case of abdominal blunt trauma due to motor-vehicle accident in a 48 year old male patient. Abdominal computed tomography scan showed a high-volume retroperitoneal hematoma with rupture in the isthmus of the horseshoe kidney with active contrast-enhanced extravasation. He underwent a partial nephrectomy of the left lower pole., Competing Interests: The authors declare that they have no competing interests., (© 2023 Published by Elsevier Inc.)