Segmental renal vein thrombosis: An unusual complication of acute pyelonephritis

Renal vein thrombosis is not a common manifestation in the context of acute pyelonephritis. We report the case of a 29-year-old female diabetic patient that was admitted to our department for an episode of complicated acute pyelonephritis. Initial imaging showed a left lower polar abscess of 27 mm and urine cultures grew community acquired K. Pneumoniae. Two days after the patient was discharged, she was readmitted with worsening symptoms. Repeat imaging showed stability in the size of the abscess and revealed a left lower segmental vein thrombosis. The patient responded favorably to antibiotics and heparin-warfarin therapy.

Pelvic leiomyoma associated with intermediate risk prostate cancer: A case report

Pelvic leiomyoma in male patients is a very rare occurrence and its association with prostate cancer is a unique clinical situation. This study reports a new case of a 9 cm pelvic Leiomyoma associated with intermediate-risk localized prostate cancer in a 68-year-old patient. The leiomyoma was discovered fortuitously after an MRI was performed in the context of prostate cancer work-up. Surgical excision of the pelvic mass along with a radical prostatectomy were performed and the diagnosis of leiomyoma was confirmed by histopathology.

Bilateral renal hydatid disease associated with complex urolithiasis: A case report

INTRODUCTION AND IMPORTANCE

The association of bilateral renal hydatid cysts and complex urolithiasis is unprecedented. We herein report the case of a patient presenting with both diseases.

CASE PRESENTATION

A 56-year-old female patient with a history of chronic kidney disease presented with right flank pain. Imaging revealed bilateral kidney cystic lesions associated with right spontaneous large ureteric streinstrasse and multiple calyceal stones. The right sided mass was exophytic and measured 56 mm and the left sided lesion measured 35 mm. Semi rigid right ureteroscopy was performed along with a right partial nephrectomy and a right pyelotomy which allowed for renal and ureteral stone extraction. Histopathology report concluded to a hydatid cyst. The decision was to monitor the left-sided lesion.

CLINICAL DISCUSSION

The association of bilateral renal hydatidosis and right urolithiasis is unprecedented in literature. The lesion presented a differential diagnosis problem with a cystic malignancy. Thus, the decision was to perform a right partial nephrectomy. The combination of ureteroscopy and a single right flank incision was sufficient to treat the renal lesion as well as to obtain stone free status. Once the histopathological report concluded to a hydatid cyst, the decision was to monitor the left sided lesion. A more aggressive approach could be proposed however it would have been detrimental to the patient's renal function.

CONCLUSION

When presented with an association of bilateral renal masses and urolithiasis, a methodical step-by-step approach is necessary in order to treat both diseases while minimizing patient morbidity.

Adult bladder rhabdomyosarcoma: A case report

Rhabdomyosarcomas (RMS) are mesenchymal tumors that develop at the expense of striated muscle fibers. It accounts for 6% of childhood malignancies. Rhabdomyosarcomas of the genitourinary tract also occur in children but are distinctly uncommon in adults. We report a case of bladder rhabdomyosarcoma in a 72-year-old patient who presented with gross hematuria and discuss difficulties of diagnosis and treatment.

Life-threatening complication due to double-J stent: renal subcapsular hematoma

The double-J ureteral stent is a standard procedure in daily urological practice. Although considered as safe, this approach is fraught with several complications. These complications are of limited severity and resolve with symptomatic treatment. In some cases, serious and life-threatening complications, such as infection and subcapsular hematoma, can occur. In the literature, a few cases of subcapsular renal hematoma secondary to ureteral stent insertion have been reported. Herein, we report a case of renal subcapsular hematoma combined with hemorrhagic shock in a 67-year-old patient who had a ureteral stent insertion one month ago.

An unusual cause of painful ejaculation in a young patient: Zinner syndrome

Introduction

and importance: Zinner syndrome is a rare congenital malformation of the seminal vesicles and the homolateral upper urinary tract. While the majority of patients remain asymptomatic and are discovered incidentally, others present symptoms such as micturition or ejaculatory difficulties, or pain. We report a case of Zinner syndrome in a 32-year-old patient with painful ejaculation and discuss the diagnosis and treatment difficulties.

Case presentation

A 32-year-old married patient was consulted for pelvic pain associated with painful ejaculation that had been evolving for six months. The clinical examination was normal. Routine laboratory studies of blood and urine were normal. The patient was explored by ultrasound which showed the absence of the right kidney and the presence of a 7 cm right lateral prostatic cystic mass. On MRI, the right kidney was not visualized. Multiple cysts were seen in the right seminal vesicle. Surgical excision of the cyst by laparotomy was performed. The patient had an uneventful recovery and was discharged on the third postoperative day.

Clinical discussion

Congenital malformations of the seminal vesicles are often associated with those of the ipsilateral upper urinary tract, as the ureteral and seminal vesicle buds originate from the mesonephric duct. The syndrome often occurs in the second and third decades of life, especially after the onset of sexual activity. The most common symptoms were dysuria, perineal pain, epididymitis, and painful ejaculation. Diagnostic modalities include ultrasound, MRI, and cystoscopy. In patients with symptoms, the therapeutic management of the cyst includes ultrasound-guided aspiration and laparoscopic or open surgical excision.

Conclusion

Seminal vesicle cysts associated with homolateral renal agenesis or hypoplasia are a rare urologic anomaly. The treatment depends on the patient's symptoms. surgical excision of seminal vesicle cysts may be needed for large cysts causing obstructive symptoms.

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Zinner syndrome is a rare congenital malformation of the seminal vesicles and the homolateral upper urinary tract.

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The most common symptoms were dysuria, perineal pain, epididymitis, and painful ejaculation.

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Diagnostic modalities include ultrasound, MRI, and cystoscopy.

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Surgical excision of seminal vesicle cysts may be needed for large cysts causing obstructive symptoms.

Unusual association between testicular tuberculosis and microdeletion of the Y chromosome in an infertile patient with azoospermia

Introduction

and importance: Infertility affects approximately 10–15% of couples worldwide. Several causes are incriminated such as hormonal abnormalities, infections, genetic disorders, testicular cancer, varicocele, and others. Herein, we report a case of an unusual association between testicular tuberculosis and microdeletion of the Y chromosome in an infertile patient and we discuss the diagnostic and therapeutic difficulties.

Case presentation

A 36-year-old patient, a smoker, with no previous history consulted our department for primary infertility for 2 years. The clinical examination was normal. The sperm count showed azoospermia. karyotype analysis confirmed the diagnosis of a microdeletion of the Y chromosome. A testicular biopsy was performed. The microscopic analysis did not find any sperm cells. However, the histopathological examination was in favor of testicular TB. The patient received 6 months of anti-TB treatment. He remained azoospermic.

Clinical discussion

Azoospermia is defined as the absence of sperm in the ejaculate in two different samples. This condition is classified as obstructive and non-obstructive. The etiology of this condition is either an intrinsic testicular deficiency or an insufficient production of gonadotropins. Genetic and chromosomal abnormalities should be investigated due to the higher incidence in azoospermic patients compared to the normal population. Testicular causes are dominated by infections, trauma, ischemia, and iatrogenic causes such as chemotherapy and radiotherapy. Genetic causes are dominated by Klinefelter syndrome and Y-chromosome microdeletions.

Conclusion

Azoospermia is a frequent cause of male infertility. Several causes are incriminated such as hormonal abnormalities, infections, genetic disorders, and others. In some cases, this condition can be multifactorial.

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Infertility affects approximately 10–15% of couples worldwide.

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Several causes are incriminated such as hormonal abnormalities, infections, genetic disorders, and others.

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In some cases, this condition can be multifactorial.

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We report a case of an unusual association between a microdeletion of the Y chromosome and testicular tuberculosis.

An unusual association between renal tuberculosis and urothelial carcinoma of the upper urinary tract; a case report

The occurrence of urothelial carcinoma and tuberculosis in the same kidney is exceptional. To our knowledge, a few cases have been reported in the literature. Herein, we report a case of an unusual association between renal tuberculosis and urothelial carcinoma of the upper urinary tract in a 61-year-old patient and discuss the diagnosis and treatment difficulties.

Functional outcomes of surgical treatment of varicocele in infertile men: Comparison of three techniques

Introduction

Among identified causes of male infertility, varicocele holds an important place and is significantly associated with sperm quality deterioration. Surgical management of this condition leads to an improvement in the sperm count and an increase in the spontaneous pregnancy rate.

Objective

The goal of this study was to compare different surgical techniques in terms of morbidity and fertility results.

Patients and methods

It is a retrospective study of interesting patients followed for infertility related to varicocele between January 2007 and December 2015. Three surgical techniques were compared: open inguinal surgery, antegrade sclerotherapy, and laparoscopy. Morbidity and pregnancy rate were assessed according to different techniques.

Results

Post-operative complication rates were comparable (p = 0,94) between the 3 surgical techniques. An amelioration of sperm parameters has been noted in all operated patients, without statistical difference between the three techniques (p = 0,29 for the sperm concentration and p = 0,49 for the progressive mobility). Spontaneous pregnancy was better (p = 0,03) for patients who have had a varicocelectomy in a sub-inguinal way.

Conclusion

All of the three surgical techniques used in this study showed an improvement of sperm parameters in an equal way with similar morbidity. However, the spontaneous pregnancy rate with open surgery was better.

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A varicocele is found in 15% of the male population and in 35% of men with infertility.

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Surgical treatment of a clinical varicocele improves spermogram parameters as well as the paternity rate.

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Open surgery should not be abandoned at the expense of sclerotherapy and laparoscopy.

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This technique was associated with a better paternity rate.

Calcified double J stent removed at 10 years: a case report

In our current practice, the use of JJ probes has become extremely frequent. However, incrustation and fragmentation of JJ leads are still relatively common and sometimes complicate removal. A 61-year-old woman with a history of hysterectomy ten years ago, she had a double J endo-ureteral stent for preoperative identification of the right ureter. The patient has forgotten the double J stent. She currently has right lower back pain and urinary tract symptoms of urinary. Uroscan revealed a very important right hydronephrosis, a fully calcified right double J stent with a calcification of 6 cm at the level of the lower loop. She had, at first, a cystotomy allowing the extraction of the lower part of the calcified stent and secondly a pyelotomy to extract the rest of the double J stent. The operative follow-up was simple. The use of a double J probe to divert the urinary tract is an effective and generally well tolerated technique. Regular monitoring prevents complications.

OUP accepted manuscript

Carcinosarcoma is a distinct neoplasm consisting of bidirectional differentiation toward epithelial and mesenchymal cells. Bladder localization is rare and the association with a rahbdomyoblastic component is exceptional. Few cases of bladder carcinosarcoma with rhabdomyoblastic differentiation have been reported in the literature. We present a case of a bladder carcinosarcoma in a 68-year-old man who presented with terminal hematuria and discuss difficulties of diagnostic and treatment.

Prostatic lithiasis complicating granulomatous prostatis of tuberculous origin: About a case report

Urogenital tuberculosis remains a frequent disease in our country. It is the most common extra-pulmonary location. Prostatic involvement is extremely rare. We report the observation of a prostatic lithiasis complicating a granulomatous prostatitis of tuberculous origin, revealed essentially by obstructive and storage lower urinary tract symptoms. The diagnosis was suspected on imaging and clinical findings and confirmed by histology. Treatment consisted of endoscopic resection of the prostate associated with endoscopic ballistic lithotripsy. Prostatic lithiasis is a rare condition with a poorly elucidated ethiopathogeny. The origin of tuberculosis should be evoked in front of this affection.

Isolated penile schwannoma: A rare case report

Schwannoma is a benign nerve tumor composed of cells of the schwann nerve sheath. Only about twenty cases have been reported in the literature to our knowledge. We report an isolated case of schwannoma of the penis in a 56-year-old man who presented a nodule of the penis in the balanopreputial groove that had been progressively increasing in size for three years. Anatomopathological and immunohistochemical criteria allowed for a positive diagnosis. Treatment consisted of surgical excision followed by rigorous surveillance.

OUP accepted manuscript

Myelolipoma is a rare, benign, non-secreting tumor and its pathophysiology is of metaplasia of the cells of the adrenal cortex into reticuloendothelial cells. Although they are often small and asymptomatic, some cases of giant adrenal myelolipoma cause symptoms such as chronic pain. Few cases of adrenal myelolipoma have been reported in the literature. We present a case of a large right adrenal myelolipoma in a 26-year-old female patient, who presented with an adrenal mass, and discuss the challenges of diagnosis and treatment.

OUP accepted manuscript

Bladder lymphoepithelioma-like carcinoma is a rare entity. It represents a particular variant of urothelial carcinoma characterized by an important infiltrating power. Therapeutic management of this cancer is not codified. Surgery associated with chemotherapy seems to be the best therapeutic option. Few cases of this tumor have been reported in the literature. We report a case of bladder lymphoepithelioma-like carcinoma in a 52-year-old patient who presented with gross hematuria and discusses difficulties of diagnostic and treatment.

[Colorenal fistula complicating renal tuberculosis: a case report]

Urogenital tuberculosis is little suspected and known by clinicians. Colorenal fistulas, although rare, are complex forms of renal tuberculosis occurring in patients with advanced-stage disease. They generally occur in the ascending and descending colon. We here report the clinical case of a 58-year-old female patient presenting to the Emergency Department with severe acute left pyelonephritis. Abdominal CT scan objectified left pyonephrosis with left colorenal fistula. The patient had poor clinical, biological outcome despite resuscitation measures and antibiotic treatments. Urgent left nephrectomy was performed with disconnection and drainage of colorenal fistula. Histology showed renal tuberculosis. The patient received antibacillary drugs according to 2ERHZ/4RH guidelines. The treatment of this type of TB should be adequate to avoid recurrences that could be more complicated to manage.

Bilateral renal abscess fusing with the psoas on the right: A case report

Renal abscess is a medical and surgical urological emergency whose diagnosis has been improved by modern imaging.

It often poses a problem of therapeutic management between antibiotic therapy or the association of a drainage. Most abscesses are unilateral, the bilateral nature of the abscessed lesions suggests a hematogenous diffusion.

We report a case of a bilateral renal abscess fusing to the psoas muscle on the right that progressed well with antibiotic treatment and percutaneous drainage.

An unusual association of adenocarcinoma and isolated tuberculosis of prostate gland

Adenocarcinoma of prostate is the most common primary prostatic malignancy in the world. Isolated prostate tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. We report two cases of adenocarcinoma and tuberculosis of the prostate. The patients were 83 and 74 years old, respectively. They presented obstructive and irritative symptoms of the lower urinary tract. The prostatic finding and prostate-specific antigen were abnormals. The diagnosis of prostatic tuberculosis and adenocarcinoma was made by histologic analysis after transurethral resection of prostate. The treatment is based on chemotherapy anti-tuberculosis and hormonotherapy. Tuberculosis and malignancy may co-exist in some cases and clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

Isolated prostatic tuberculosis and review of literature

Tuberculosis (TB) is one of the most important infectious diseases, particularly in the world. Amongst the genitourinary organs, prostatic TB is less common. We report an 68 year old patient, immunocompetent who presented obstructive and irritative symptoms of the lower urinary tract. A history of pulmonary tuberculosis was not present. The digital rectal examination was suspicious and PSA was a normal. The biopsy results did not reveal any malignant lesions but the transurethral resection of the prostate performed for voiding purposes showed prostatic tuberculosis. A very good clinical and biological improvement was observed after chemotherapy anti-tuberculosis.

A case report of testicular diffuse large B-cell malignant lymphoma with cutaneous metastasis: A rare entity

Introduction and importance

Primary testicular lymphoma (PTL) is a variety of extra-nodal lymphoma taking origin from testis. It accounts 5% of all testicular tumors. Metastasis may occur in contralateral testis, bone, central nervous system and rarely in skin. Herein, we present the case of testicular diffuse large B-cell malignant lymphoma with cutaneous metastasis.

Case presentation

A 60-year-old male presented with swollen painless solid right testis, with homolateral inguinal nodes. Testicular tumors markers were within normal range. Right radical orchidectomy was performed. Histopathological examination concluded to the diagnosis of Diffuse Large B Cell Lymphoma. Four weeks later, the patient presented alteration of general condition and multiples cutaneous centimetric lesions located in the right inguinal region. Biopsy of this lesion confirmed the diagnosis of metastases from the testicular lymphoma. The patient deceased three days later, before starting further treatment.

Clinical discussion

Primary testicular lymphoma is a rare variety of testicular tumors. The prognosis is poor. Metastasis may occur in different sites such as contralateral testis, central nervous system, and skin. The prognosis is usually poor in the rare case of cutaneous metastasis.

Conclusion

Primary testicular tumor is an aggressive rare variety of testicular tumors with poor prognosis. Cutaneous metastasis is rarely reported. Cutaneous lesions should be explored and suspected to be malignant. Early treatment with rapid multidisciplinary management is the key for adequate approach.

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Primary testicular lymphoma is rare, aggressive testicular tumor.

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Skin metastasis is extremely rare, and if present, compromises the prognosis.

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Diagnosis may be comforted by 18F-PET-CT.

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Orchidectomy followed by chemotherapy is the recommended therapeutic options.

Primary tuberculosis of the glans penis: A rare presentation and review of literature

Tuberculosis poses a real public health problem inTunisia.We report an 80-year old patient, immunocompetent, who has initial presentation of a painless ulcerative lesions of the glans penis. A history of pulmonary tuberculosis was not present.The physical examination revealed an indurated glans penis covered with blackish crusts and small ulcerations. A biopsy of the lesion was undertaken and histological examination was confirmed the diagnosis of tuberculosis of glans.Others investigations was performed without finding any abnormalities He responded well to anti-tubercular treatment with complete resolution of lesions in six months.

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Tuberculosis poses a real public health problem in endemic countries.

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Tuberculosis of the glans penis is an uncommon presentation of tuberculosis.This is the first case to be reported in Africa.

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Clinical presentation is extremely varied.

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Diagnostic confirmation is based on histological study aided by culture.

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Antibiotic therapy for tuberculosis is the basis of treatment.

Inguinal bladder hernia: a case report

Inguinal hernia is a common disorder that requires urgent and adequate surgical management. Multiple organs may be associated with inguinal hernias, but bladder involvement is rarely seen. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or intravenous urography confirms the diagnosis. We report a case of inguinal hernia involving the bladder at the right side with a 72-year-old man. We performed a hernia repair after reintegration of the bladder.

Double retroperitoneal hydatid localization: About a case report

The hydatid cyst is a parasitic pathology which is endemic in Tunisia and presents a public health problem.Hydatid cysts located in the retroperitoneum, especially around or in the kidney, are rare and only represent 5% of visceral locations. The kidney is the most commonly affected organ of the urinary tract.The psoas muscle is an uncommon location and not less than 70 cases have been cited. We report the Case of an unusual presentation of a right kidney hydatid cyst associated with a psoas muscle location. To our knowledge, this association of double retroperitoneal location has not been reported in the literature.

A case report of non-functional ectopic left kidney obstructing the right kidney in crossed fused kidneys: A rare entity

Introduction and importance

Crossed fused renal ectopia is a rare congenital condition that might pose some diagnostic and therapeutic challenges to clinicians. We report a patient with a non-functional crossed fused ectopic left kidney that obstructed the orthotopic kidney in a rarely observed situation.

Case presentation

A 68-year-old male presented a right flank pain with fever. The diagnosis of right obstructive pyelonephritis was dressed, after biological and radiological investigations. The obstacle was a crossed ectopic left kidney in its inferior variety. The ectopic kidney was non-functional as result of an obstructive ureteral calculus. The patient had right ureteral stenting with a double-J catheter. Three months later, left nephrectomy was performed by lumbotomy. Per operative difficulties were mainly the infiltration of peri renal fat, the anarchic vascularization and the multiple small pedicles of the ectopic kidney that was also malrotated with the hilum facing anteriorly. Postoperative recovery was uneventful and the patient left the hospital after three days.

Clinical discussion

Crossed Fused renal ectopy is rare. As shown in this case, the ectopic kidney might cause damage to the orthotopic kidney, by compression to urinary ducts. Surgery is the main treatment option. Some difficulties related to aberrant vascularization and possible malrotation is to preview.

Conclusion

Crossed fused renal ectopia is uncommon renal anomaly, mostly asymptomatic. However, it may be responsible of some complications, sometimes severe. Surgery can be delicate due to vascular complexity.

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Crossed renal fused ectopy is rare and asymptomatic congenital condition. Association to other malformations is possible.

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The ectopic kidney may be responsible of the obstruction and the mal function of the orthotopic kidney.

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This is the first case to be reported in literature.

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Surgery might be difficult due to aberrant vascularization and possible malrotation of the kidney.

Mediastinopulmonary sarcoidosis mimicking metastatic renal cell carcinoma: About a case report

There is a well-established association between sarcoidosis and many solid and hematologic malignancies, but it is less commonly described in patients with renal cell carcinoma. The majority of the cases described presented local sarcoid-like reactions in the immediate vicinity of the tumor with comparatively few reports of the disease further away. In view of the relatively small number of cases, there remains great uncertainty about the clinical behavior of sarcoidosis in renal cell carcinoma. In this observation, we illustrate a case of mediastinopulmonary sarcoidosis, which behaved like a true paraneoplastic syndrome of a renal tumor.

Renal hydatidosis masquerading as xanthogranulomatous pyelonephritis: a new case report

Human hydatid disease is still endemic in pastoral and rangeland areas, with temperate climate, mainly in the southern shore of the Mediterranean, particularly in the Maghreb countries. Renal localization is rare although it is the most frequent site of the urinary tract. Its clinical evolution remains silent for long time, and the diagnosis is often elusive for years. Renal hydatid cysts may pose a problem of differential diagnosis. Our case concerns a renal hydatidosis misdiagnosed as a xanthogranulomatous pyelonephritis, treated by total nephrectomy.

Xanthogranulomatous pyelonephritis presenting as a cystic mass: a rare case report

Xanthogranulomatous pyelonephritis may, rarely, occur as a renal cystic mass. We report a case report of a 50-year-old with a history of medically treated renal lithiasis, who consults for left low back pain. Imaging findings concluded to a Bosniak type-3 hemorrhagic cystic mass of the left kidney. The diagnosis of xanthogranumolatous pyelonephritis on its focal form was made histologically. The diagnosis of xanthogranulomatous pyelonephritis is often difficult even with surgical findings and frequently a histological surprise. This points out the importance of identifying it in pre-operative staging; the diagnosis may be suggested by the association of chronic pyelonephritis, renal stones and hypovascular renal tumor syndrome without specificity at sonography and CT.

Sexual Function Outcomes After Surgical Treatment of Penile Fracture

Introduction

Penile fracture is a urologic emergency and is defined as the rupture of the tunica albuginea of the cavernous body in erection.

Aim

Our study aims to evaluate patients with penile fracture and to identify the factors that may influence the sexual function after surgical repair.

Methods

A total of 138 patients who were diagnosed with penile fracture between January, 1999 and December, 2018 were reviewed. Clinical features, perioperative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed.

Main Outcome Measures

Sexual function was evaluated by three parameters six months after surgical repair: International Index of Erectile Function-5 (IIEF-5) questionnaire, penile curvature and the presence of a painful intercourse. All factors that could potentially influence these parameters were analyzed.

Results

The mean age was 31.2 years (19-55). Presentation delay ranged from 1 to 5 days (mean = 16.8 hours) while surgery delay was 14.3 hours ().The most common cause of penile fracture in our patients was forcefully bending of the erect penis to achieve detumescence in 62 cases (44.9%). On multivariate analysis, we found that the presentation delay and the fracture site located in the proximal shaft of the penis showed significant difference in the occurrence of postoperative ED (P = 0.03 and P = 0.015 respectively). Presentation delay, elective incision and tuncial leak located in the proximal shaft (P = 0.045; P = 0.018 and P = 0.022 respectively) were associated with higher penis curvature.

Conclusion

Immediate surgical repair and circumferential degloving incision for tunical leaks located in the proximal shaft of the penis are recommended in order to decrease the incidence of ED after surgical repair of penile fractures. Ouanes Y, Saadi MH, Alouene HH, et al. Sexual Function Outcomes After Surgical Treatment of Penile Fracture. Sex Med 2021;9:100353.

Retroperitoneal cystic mass: a rare form of adrenal pheochromocytoma

Adrenal cysts are usually non-functional and asymptomatic. Cystic pheochromocytomas are a rare clinical entity and difficult to differentiate from simple cysts in the absence of classic clinical symptoms. Few cases of cystic pheochromocytomas have been reported in the literature. We present a case of a huge cystic pheochromocytoma in 70-year-old men who presented with a large retroperitoneal cystic mass and discuss difficulties of diagnostic and treatment.

Rupture of urinary bladder secondary to bladder carcinoma with extensive abdominal gangrene: A case report

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Spontaneous Urinary bladder rupture secondary to transitional cell carcinoma is a very rare entity.

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Abdominal gangrene is a severe necrotizing infection which is usually an extension of Fournier gangrene.

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Management of urinary bladder rupture with underlying transitional cell carcinoma of the bladder is not standardized.

Introduction and importance

Spontaneous rupture of the urinary bladder is rare but potentially severe. It is unusually related to bladder tumours. The morbidity and mortality rate are very high in these groups of patients.

Case presentation

We present a case of a 62-year-old man who was known to have a bladder tumour who presented with extensive gangrene of the anterior abdominal wall. Imaging showed an extraperitoneal urinoma extended to the anterior abdominal wall secondary to a bladder rupture with posterior bladder wall thickening suggesting a bladder tumour. After optimization of the patient’s condition, urinoma drainage and upper urinary tract drainage by bilateral nephrostomy, excision of all necrotic tissues and a biopsy of the bladder lesion was performed. At a multidisciplinary meeting, we opted for a transurethral resection of the bladder followed by palliative chemotherapy considering that the tumour was locally advanced and depending on the disease course and patient’s condition.

Clinical discussion

Gangrene secondary to urinary bladder rupture caused by transitional cell carcinomas is a very rare disease with poor oncological and infectious prognoses. For these reasons, treatment is often palliative.

Conclusion

Urinary bladder rupture secondary to bladder carcinoma could rarely be complicated with abdominal gangrene. No standardized treatment is recommended seeing the extreme rarity of this disease and management should be discussed on a case-by-case basis.

Symptomatic bladder metastasis of malignant melanoma: a case report

Bladder metastasis of cutaneous malignant melanoma is an extremely rare condition, with less than 10 cases reported in the last 30 years in the English literature. Bladder localization is most often asymptomatic, explaining the frequency of cases discovered during autopsy in multi-metastatic patients. We report a case of symptomatic malignant melanoma metastasis to the bladder in a 31-year-old patient.

Spontaneous bladder diverticulum rupture due to a squamous cell carcinoma of the bladder: a case report

While bladder rupture is most of the time secondary to external injury such as trauma or iatrogenic events, spontaneous bladder rupture (SBR) is a rare condition which is mostly associated with bladder cancer, neurologic bladder or radiotherapy. We report a case of a 63-year-old patient with an invasive squamous cell bladder carcinoma who presented acute peritonitis caused by a SBR while being prepared for radical surgery. CT-scan helped to confirm diagnosis and emergency cystectomy was performed. SBR should be considered in differential diagnosis of peritonitis. On time diagnosis and adequate surgery could improve its prognosis.

Carcino-sarcoma of the urinary bladder with cartilaginous differentiation: About a case report

Carcinosarcoma of the bladder is a very rare and aggressive tumor with poor prognosis. We report a case of a 61 year-old-male who presented a terminal hematuria. Ultrasounds revealed a mass at the dome and the right of urinary bladder. A transurethral resection of the bladder tumor was performed. A pathological examination revealed a pT1 hight grade carciono-sarcoma of the urinary bladder with cartilaginous differentiation. Cystoprostatectomy with Bricker diversion and lymph node dissection were performed. The pathological examination of the surgical specimen revealed no residual tumor lesion.

Unexpected skin lesions secondary to metastasis of urothelial carcinoma

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Skin metastases of urothelial bladder carcinoma are rare.

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The inflammatory presentation, as seen in our case, is exceptional.

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Diagnosis requires immunohistochemical study of a skin biopsy.

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The prognosis after the appearance of cutaneous metastasis is poor.

Introduction

Metastatic spread of urothelial bladder carcinoma (UBC) rarely involves the skin which is associated with a poor prognosis. We present a rare case of UBC with cutaneous metastases which is exceptional by its inflammatory clinical form.

Presentation of case

A 62-year-old male was diagnosed with a non-metastatic muscle invasive transitional cell bladder carcinoma invading the anterior wall of the rectum. Cisplatin-based chemotherapy was indicated but refused by the patient. Three months later, he developed cutaneous lesions in the left axilla and the right inguinal fold. These lesions were budding, nodular and inflammatory corresponding to carcinomatous metastasis on skin biopsy which urothelial origin was confirmed by immunohistochemical analysis. The patient died four weeks later after multi-organ failure.

Discussion

Skin metastasis of transitional cell carcinoma of the bladder are uncommon, representing 0.84% of all cutaneous metastases. The inflammatory presentation, as seen in our case, is rarer than the other types and is usually due to a lymphatic extension. The clinical appearance of cutaneous metastases might mimic other common dermatologic disorders; Thus, diagnosis requires histological confirmation by microscopic examination and immunohistochemical study of a skin biopsy. The prognosis after the appearance of cutaneous metastases is generally poor with a median disease-specific survival of less than 12 months Treatment is palliative and is principally based on chemotherapy, analgesics and psychological support.

Conclusion

Cutaneous metastases secondary to urothelial bladder carcinoma are exceptional especially in its inflammatory presentation. Diagnosis is based on immunohistochemical study. Treatment is based on chemotherapy and the prognosis is poor.

Infected urachal cyst in an adult: A case report

The urachus is an embryologic remnant which degenerates after the birth. An infected urachal cyst is one of a spectrum of presentations of urachal pathology, all of which are rare in adulthood. Infected urachal cyst is a rare pathology in adult women and it should be considered in the differential diagnosis of acute abdomen. We report here a case of a 50-year-old women with an infected urachal cyst reveled by an acute abdomen.

[Evaluation of protocols on the use of analgesics for pain management in patients with extracorporeal shock wave lithotripsy (ESWL)]

La douleur ressentie au cours d'une séance de lithotritie extracorporelle (LEC) est le facteur limitant le plus important de cette technique. Le but de notre travail était de comparer l'efficacité des différents types d'analgésiques utilisés pour le contrôle de la douleur pendant les séances de LEC. Nous avons mené une étude prospective colligeant 300 patients présentant une lithiase urinaire justifiant un traitement par LEC. Les patients ont été répartis de façon randomisée en trois groupes: le groupe I, incluant 100 patients ayant reçu 2cc de sérum physiologique en IM (intra musculaire) (placebo), le groupe II regroupant 100 patients ayant reçu 100mg de kétoprofène en IM tandis que le groupe III colligeant 100 patients ayant eu une application locale d'une crème contenant la lidocaïne et la prilocaïne. L'échelle visuelle analogique (EVA) a servi à évaluer la douleur à 10 minutes et à la fin de la séance. L'EVA moyenne à 10 minutes et à la fin de la LEC étaient respectivement de 3,7 et 4,91. Aucune différence significative n'a été trouvée entre les trois groupes concernant: les données épidémiologiques (âge, sexe, IMC, antécédents pathologies) et les caractéristiques du calcul (côté, taille, localisation, présence ou non de sonde double J). L'interruption précoce de la séance de LEC a été notée chez 11 patients du groupe I, avec une différence significative par rapport aux autres groupes (p=0,003). L'EVA à 10 minutes et à la fin de séance de LEC, était statistiquement plus élevée dans le groupe I par rapport aux groupes II et III (p < 0,001). Aussi, la LEC était nettement plus efficace dans les groupes (II et III) comparativement au groupe I (p<0,001). L'utilisation d'un traitement antalgique est nécessaire lors de la séance de lithotritie extracorporelle. Les deux molécules antalgiques évaluées ont montré un bon contrôle de la douleur ainsi qu'une augmentation de l'efficacité du traitement par lithotritie.

Interaction Effects of Plasma Vitamins A, E, D, B9, and B12 and Tobacco Exposure in Urothelial Bladder Cancer: A Multifactor Dimensionality Reduction Analysis

The study aimed to examine circulating vitamins A, E, D, and B12 and folate in patients with urothelial bladder cancer (UBC) and detect potential interaction effects of these micronutrients on UBC risk. A case-control study was conducted on 262 UBC patients and 254 matched controls. Vitamins A and E were assessed by ultra performance liquid chromatography, and vitamins D and B12 and folate were assessed by immunological methods. Binary logistic regression models were used to test associations of plasma vitamins tertiles with UBC risk. A multifactor dimensionality reduction method (MDR) was applied to assess interactive effects of the vitamins and tobacco on UBC risk. Higher levels in vitamins A, E, and D were associated with lower occurrence of UBC. No significant association was observed in plasma folate or vitamin B12 with UBC. There were redundancy interactions of plasma vitamin D with tobacco and with plasma vitamin A on UBC risk. Even though the study could not ascertain causality, the findings suggest that vitamins A, E, and D might be protective against UBC. Vitamins A and D interact antagonistically with each other's and with tobacco to modulate UBC risk. These interactions should be taken in consideration for the prevention of UBC.

About a case of paratesticular myxoid liposarcoma

Paratesticular liposarcomas are relatively common sarcomas in the paratesticular region, however, the myxoid variant is considered very rare. Due to the infrequency of this malignant disease, no standard treatment would be available. Multiple treatments have reported in literature with different results. Herein, we presented a case of paratesticular myxoid liposarcoma in a 67-year-old man originating from the right paratesticular soft tissue.