Detection and Identification of Gonococci Resistance to Cephalosporin and Determination the Most Effective Empirical Treatment for Gonococcal Urethritis in Male Human in Egypt

Introduction: Gonorrhoeae and antimicrobial resistance AMR of gonococci is a major health problem today, because emerged resistance to last line empirical treatment for gonorrhoeae cephalosporins in many countries is predictable to be untreatable disease in near future. WHO GASP, WHO GLASS and WHO’s global action plan on AMR recommends to expand nationally and internationally to collect data to monitor AMR of gonococci for public health policies. Objective: Our aim is to detect resistance of gonococci to Cepha- losporins and determine the most effective empirical treatment for un-com- plicated gonococcal urethritis in males in Egypt. Methods: We depended in our methodology on selected gonococci from male urethral discharge specimens on Thyer Martien medium;collected 33 isolates during three years from 2017 to 2020;used antibiotics with MIC according to international standards and measuring IZD according to antimicrobial susceptibility testing reference ranges in international standards. Results: By statistical studies, resistance to cephalosporins was as follows: Cephradine 97%, Cefaclor 87.9%, Cefoxitin 97%, Ceftriaxone 90.9% and 42.4% to Cefepime, that shows hetero-genecity in resistance inside cephalosporin group;while resistance to Macrolides group represented by Azithromycin and Tetracyclins group represented by Doxycycline was as follows: Azithromycin 39.4%, Doxycycilne 27.3%;finally fluoroquinolones, the most effective group, resistance, was as: Levofloxacin 15.2%, Ciprofloxacin 15.2% and Ofloxacin 24.2%. Conclusion: The most effective empirical treatment for uncomplicated gonococcal urethritis in males in EGYPT is Fluoroquinolone;especially Levofloxacin ranks first susceptibility as 78.8% and 15.2% resistance followed by Ciprofloxacin susceptibility as 69.7% and 15.2% resistance, finally Ofloxacin susceptibility as 66.7% and 24.2% resistance;for Ceftriaxone not more recommended in EGYPT as empirical treatment for uncomplicated gonococcal urethritis, it is susceptibility as 6.1% and 90.9% resistance;in addition, we can use combination therapy of Fluoroquinolones with Azithromycin or Doxycycline, whose susceptibility is 30.3% for Azithromycin and 42.4% for Doxycycycline, while resistance is 39.4% for Azithromycin and 27.3% for Doxycycline. It is worth noting that only Cefepime in Cephalosporins group represents 42.4% susceptibility and 42.4% resistance;in addition to the Carbapenems group, it represents as 42.4% susceptibility for Imipenem and 45.5% resistance, then 42.2% susceptibility for Meropenem and 48.5% resistance, which can play role in combination therapy.

Male Urethral Stricture: Epidemiological, Clinical, and Therapeutic Aspects in Kara

Background: Urethral stricture is a pathology frequently encountered in urological practice. Management is often surgical, with possible recurrences. What about this pathology in Kara, a semi-urban city? Objective: Assess the management of male urethral stricture in Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department of the teaching hospital of Kara, from December 2020 to December 2022. All cases of male urethral stricture, surgically treated at the teaching hospital of Kara, were listed. The inclusion criteria were as follows: any patient who had been treated surgically for male urethral stricture in the urology department of the teaching Hospital of Kara. The operating theater register and hospital records were used to collect the data. The diagnosis of urethral stricture had been made with retrograde urethrogram. A total of 24 patients were treated for male urethral stricture during the study period. The following variables were studied: age, reason for consultation, location, length, and etiology of the stricture;the type of treatment received: optical internal urethrotomy, or anastomotic urethroplasty, and the results. The result was considered good if, after removal of the urethral catheter, the patient regained his micturition without the need for dilatation;the result was considered average if, after removal of the urethral catheter, the patient needed one or more dilatation sessions to regain urination;the result was considered poor if, after removal of the catheter, the patient did not regain good micturition despite the urethral dilatation sessions. Microsoft excel and epi info 7 software were used for data processing. Results: The average age of our patients was 43.7 years ± 10.18 with extremes ranging from 27 to 70 years. The most represented age groups were that of 40 to 50 years, with 37.5% of cases;and that of 30 to 40 years with 33.3% of cases. The patients had consulted for urine retention in 66.6% of cases;the location of urethral stricture was bulbar in 45.8% of cases. The most found etiology was infectious in 58.3% of cases. Among our patients, 58.3% had received optical internal urethrotomy as treatment, while 41.6% of our patients had received anastomotic urethroplasty as treatment. Postoperatively, after removal of the urinary catheter, 87.5% of patients had benefited from one or repeated dilatation. In terms of results, we had a good result in 20.8% of patients;the result was average in 45.8% of patients, and poor in 33.3% of patients. The average duration of follow-up was 14.3 +/- 7.2 months (3-27). Conclusion: Male urethral stricture mainly affects young adults in Kara. Surgical management is done by optical internal urethrotomy and/or anastomotic urethroplasty.

Orgasm-associated urinary in continence(climacturia)following radical prostatectomy:a review of pathophysiology and current treatment options

Orgasm-associated urinary incontinence,or climacturia,is a common side effect after radical prostatectomy(RP)that is gaining more attention due to the distress it causes to patients.A range of treatment options have been reported in the literature and are outlined in this review.The goal of our study is to review the pathophysiology and current management options for climacturia following RP.A PubMed search was used to review the current literature relating to the pathophysiology and the treatment of postprostatectomy climacturia.We reviewed the currently available treatment options and their success rates for climacturia.Several techniques were found to subjectively help improve the amount and bother of patients'climacturia.These include pelvic floor muscle training(PFMT),penile variable tension loop,soft silicone occlusion loop,artificial urethral sphincter,male urethral sling,and the Mini-Jupette graft.Success rates ranged from 48%to 100%depending on the modality used.For patients with erectile dysfunction and climacturia,the Mini-Jupette graft could be a valuable option.Given the lack of validated measurement tools and management options,climacturia has become a challenge for urologists.Albeit a condition that has not garnered much attention,there are several management options from conservative to invasive treatments that have shown a hopeful promise for the treatment of climacturia.These options should be discussed with patients to determine the best treatment for each individual.More clinical trials are n eeded to assess the efficacy and impact of the d iff ere nt treatme nt options before a defi nitive recommendation regarding management can be made.