Objective: To assess safety and efficacy of emergency ureteroscopy (URS) with intracorporeal lithotripsy for management of distal ureteral stones in highly selected cases presented with urinary tract infection (UTI) with mild sepsis. Patients and Methods: Patients presenting with a solitary distal ureteral stone £20 mm with UTI with mild sepsis at two tertiary care centers between January 2016 and December 2018 were included. Patients were randomly assigned into one of two groups; Group I (GI) managed by direct emergency definitive URS and Group II (GII) managed by Double-J ureteral stent insertion. Both groups were compared regarding operative time, time to normalization of leukocytosis and temperature, analgesic consumption, length of hospital stay, and any perioperative complications. Stone-free status was defined as complete stone removal or residual nonobstruction fragments of £2 mm. Results: A total of 124 patients were included; 55 in GI and 69 in GII. Both groups were comparable regarding demographic and baseline data, length of hospital stay (2.0 -0.14 vs 1.99 -0.12 days, p = 0.78), time to normalization of total leukocytic count and body temperature, and analgesic consumption. Patients in GII had significantly lower operative time, compared to those in GI (22.2 -6.7 vs 44.6 -8.7 minutes, p < 0.001). Stone-free rate in GI was 98.1%. Both groups were comparable in postoperative adverse events [5 (9.1%) vs 8 (11.6%), p = 0.76], respectively, in GI and GII. Most complications were low grade, without reported mortality rate. Conclusion: Emergency URS with intracorporeal lithotripsy seems to be safe and efficient definitive alternative to temporary ureteral stenting in highly selected patients presenting with UTI with mild sepsis secondary to obstructing distal ureteral stones. Abbreviations Used BMI ¼ body mass index CT ¼ computed tomography NECT ¼ nonenhanced spiral computed tomography PCN ¼ percutaneous nephrostomy SD ¼ standard deviation SEM ¼ standard error of mean SIRS ¼ systemic inflammatory response syndrome TLC ¼ total leukocytic count URS ¼ ureteroscopy UTI ¼ urinary tract infection 266 BAKR AND ABDELHALIM Downloaded by 44.224.250.200 from www.liebertpub.com at 08/05/20. For personal use only.

The long-term development of any mature field requires a fresh perspective of long MRC (Maximum reservoir contact) wells and increased well accessibility. To improve well accessibility the deployment of lower completion has been a mandate. Onshore UAE Field demands drilling Slim hole (6″ /6-1/8″ ) laterals and Slim Hole ERD (Extended reach drilling) wells with 4.5″ Uncemented Lower Completion. This paper highlights the innovative wellbore cleanout procedure prior installation of Lower Completions. Conventionally, using Water Based Mud (WBM) with high friction factors in 6″ Horizontal Hole (HH), two trips were required to reduce the friction factor prior running the Lower Completion. The optimized solution allowed wellbore clean-up and displacement of brine in one trip with drilling assembly (BHA). This innovative technique eliminated one dedicated trip for wellbore cleanout and thus saved millions in CAPEX and Business Plan days. The T&D data for 5 wells with dedicated cleanout trip were compared to clean-out with 6″ drilling BHA with viscous-lubricated brine. The 6″ BHA was optimized to fit with innovative dormant drilling scrapper and lubricated viscous brine was displaced in the Open Hole. A thorough hole cleaning procedure was formulated and was applied to all the wells. After analyzing over 5 wells, it was observed that in both runs, the one with 6″ BHA compared to dedicated cleanout-trip, the torque and drag values were similar and the effective reduction in friction factor was similar. This supported the elimination of planned dedicated cleanout trip and saved average 2 days/well and 27MM$ for year 2022. This optimized BHA design with enhanced hole cleaning procedure was a keystone in deploying slim 4-1/2″ lower completion in WBM system. This practice led to successful deployment of First Slim Hole ERD in UAE with 15000ft of 4-1/2″ lower completion with WBM system. This was a one-of-a-kind achievement in UAE.

No abstract

Objective: To evaluate the correlation between maternal age and anogenital distance (AGD) in patients with hypospadias. Patients, subjects and methods: A total of 82 participants were divided into two groups, Group 1 included 52 male children with different types of primary hypospadias and Group 2 included 30 normal controls. In both groups, child age and weight, maternal age, and AGD were recorded. In Group 1, the Glans-Urethral Meatus-Shaft score was used to categorise the patients into mild (score 3-6), moderate (score 7-9) and severe (score 10-12) hypospadias. Results: Both groups were similar for maternal age, child age and child weight (P = 0.308, P = 0.283 and P = 0.664, respectively). The mean (SD) AGD was 4.64 (1.23) and 5.33 (1.01) cm for groups 1 and 2, respectively (P = 0.011). Patients in Group 1 were subdivided regarding severity of hypospadias into mild (40.4%), moderate (38.5%) and severe (21.1%). There was a significant relationship between older maternal age and short AGD in both groups (P < 0.001 for Group 1 and P = 0.001 for Group 2). In Group 1, there was a significant correlation between both short AGD and older maternal age, and severe hypospadias (both P < 0.001). Maternal age of ≥34 years significantly predicted a severe hypospadias score (10-12) (sensitivity 100% and specificity 68.3%). Conclusion: Older maternal age is associated with a shorter AGD in patients with hypospadias and controls. Maternal age of ≥34 years is significantly correlated with patients with severe hypospadias.

Background Several preoperative factors affect the outcome of Tabularized Incised Plate (TIP) repair. Our aim was to collect and analyze all these factors to define what the most important predictive factors are. Methods Hundred patients (1–5 years old) with primary distal hypospadias were included. Exclusion criteria included previous penile operations and hormonal treatment or associated congenital anomalies. Anogenital distance (AGD), stretched penile length (SPL), meatal site, glanular shape, chordee and torsion degree, plate width and glans meatus shaft (GMS) score were assessed. TIP repair was done to all patients and followed up for one year. The outcome was correlated with the above parameters. Results Mean ± SD of age of patients was 3.5 ± 1.5 years, while weight was 14.1 ± 3.0 kg. Complication rate was 18% including urethrocutaneous fistula (UCF) and meatal stenosis 14%, repair breakdown 1% and urethral stricture 3%. Patients with chordee degree < 30° and distal penile meatal location were associated with increased risk for complications by 11.6 and 8.2 times; 95% CI was (1.46–91.75) and (1.02–66.52), respectively (p < 0.05 for each). Plate width ≥ 9 mm, AGD > 5 cm, GMS score ≤ 7 (p < 0.001 for each), age of patient ≤ 2 years old, and SPL > 3.5 cm (p < 0.01 for each) were associated with successful outcome of repair. Conclusion The proposed successful criteria of TIP repair were absent chordee, coronal/subcoronal penile meatal location, plate width ≥ 9 mm, AGD > 5 cm, age of patient ≤ 2 years old, GMS score ≤ 7, SPL > 3.5 cm and grooved glanular shape.