Giant intravesical prostatic protrusion mimicking bladder carcinoma: Navigating diagnostic and management challenges.

INTRODUCTION AND IMPORTANCE: Benign prostate hyperplasia is common condition among elderly men, but giant intravesical prostatic protrusion is rare and may be confused with bladder carcinoma. CASE PRESENTATION: We report an unusual case of giant intravesical prostatic protrusion mimicking bladder carcinoma. A diagnosis of giant intravesical prostatic protrusion was confirmed with the assistance of cystoscopy and patient was managed by transvesical simple open prostatectomy where he had uneventfully recovery. CLINICAL DISCUSSION: Both bladder carcinoma and benign prostate hyperplasia are more prevalent in elderly men and they all present with lower urinary tract symptoms. Ultrasound and computer tomography may all suggest bladder carcinoma. The two conditions are treated differently, and therefore having correct diagnosis is mandatory. Cystoscopy is an important investigation that can act as a tiebreaker in differentiating giant intravesical prostatic protrusion from bladder carcinoma. Transvesical simple open prostatectomy is the preferred surgical approach with good postoperative outcome. CONCLUSION: This case report reminds urology surgeons on the possibility of having giant intravesical prostate mimicking bladder carcinoma and the importance of cystoscopy in differentiating the two. Transvesical simple open prostatectomy has promising result.

Urethral Caruncle in Pediatrics: A Northern Tanzania Experience.

Urethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in postmenopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present a case series of three pediatric patients with a urethral caruncle.

Distal penile pyogenic granuloma: A case report.

Key Clinical Message: The mainstays of treatment for granuloma pyogenicum include careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, and close monitoring to check relapse and management. Abstract: Pyogenic granuloma is an acquired noncancerous vascular proliferation that arises from the mucosa and skin, seldom subcutaneously or intravascularly. It is also referred to as telangiectasis granuloma or lobular capillary haemangioma. The risk factors include vascular abnormalities, medicines, hormones, and microtrauma. We discussed the case of a 24-year-old man who had a poorly managed ventral distal penile polypoid lesion at a peripheral hospital. Upon further histopathological examination, the diagnosis of pyogenic granuloma was made. Histopathologically speaking, the term "pyogenic granuloma" is misleading because the illness is not linked to the production of granulomas. Pyogenic granuloma's etiopathogenesis is still unknown; true hemangioma is thought to be a reactive hyperproliferative of the vasculature brought on by a variety of stimuli; pyogenic granuloma may be caused by uneven angiogenic factor production in response to minor local trauma or cutaneous disease. Histopathological analysis and surgical excision are the methods used for diagnosis and treatment. The mainstay of treatment for granuloma pyogenic granuloma includes careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, close follow-up to check for relapse, and early management.

Hydrometrocolpos in an infant with urological complications: a rare case and review of literature.

Hydrometrocolpos is a rare congenital anomaly characterized by gross distension of the uterus and vagina with fluid, which may result in obstruction to the urine flow. The insertion of Foley catheter into the uterus can relieve the obstruction to the flow of urine and improve renal function. Herein we present a case of infant who was diagnosed with an abdominal mass and renal insufficiency that was managed by the placement of Foley catheter into the dilated uterus and the renal function recovered.

Primary scrotal lipoma posing a diagnostic quandary: Experience from northern Tanzania, a case report.

Primary scrotal lipoma is a rare urological diagnosis. It is usually diagnosed incidentally as most of time initial diagnosis may be confused with other common etiology of scrotal masses. A rare case of scrotal lipoma with initial misdiagnosis of hydrocele at primary health facility is presented in this article.

Intravesical textiloma mistook for bladder stone: A case report.

Key Clinical Message: Intravesical textiloma is a rare surgical complication, that may cause nonspecific lower urinary tract symptoms. Clinicians should consider it in patients with a history of bladder surgery and persistent or new-onset urinary symptoms. Abstract: Intravesical textiloma is a rare condition usually presents asymptomatic or with non specific symptoms. A 72 years old man with prior open prostatectomy presented lower urinary tract symptoms and diagnosed with bladder stones, explorative laparotomy revealed semi calcified gauze. Similar history should prompt suspicion of this condition.

Primary diffuse large B-cell lymphoma of the kidney: A rare case report and review of literature.

INTRODUCTION AND IMPORTANCE: Lymphoma can either be Hodgkin or non-Hodgkin (NHL) with diffuse large B cell lymphoma (DLBL) being a type of the latter with an aggressive behavior. Although it is common for NHL to involve the kidney in its advanced stages, disease that primarily originates from the kidney is rare and therefore poses a diagnostic challenge. CASE PRESENTATION: We presented a case of NHL that was initially thought to be Renal Cell Carcinoma (RCC) but later confirmed histologically to be diffuse large B cell Lymphoma. The patient was kept on doxorubicin, cyclophosphamide and dexamethasone. However, on day five of the treatment he succumbed. CLINICAL DISCUSSION: Lymphoma can be broadly grouped into Hodgkin and non-Hodgkin Lymphoma. Primary kidney lymphoma accounts for <1 % with non-specific symptoms hence can be challenging in the diagnosis. Biopsy yields in the diagnosis and management is primarily chemotherapy. CONCLUSION: This case reminds health care professional on the possibility of having primary Lymphoma of the kidney in a patients with renal mass. Treatment of lymphoma is different from RCC, a common renal malignancy in adult. Therefore, tissue biopsy for definitive diagnosis is mandatory before initiation of treatment.

Triple penile fracture: A rare case report and review of literature.

INTRODUCTION AND IMPORTANCE: Penile fracture is uncommon entity that rarely involves all the three erectile bodies (the two corpora carvenosa and corpus spongiosum). The diagnosis is clinical as most cases presents with typical signs and symptoms. CASE PRESENTATION: We present a case of young man who sustained penile fracture involving the two corpora cavernosum and corpus spongiosum with associated urethral injury that was successfully repaired primarily. CLINICAL DISCUSSION: In this case apart from MRI confirming the diagnosis it showed the injury to involve all the three corpora bodies as well as the urethral. Although MRI is reserved for controversial cases, when available, apart from just confirming the diagnosis, it can help in showing the extent of the injury and assist surgeon in management. Primary repair of the erectile bodies as well as the urethral gives excellent outcome. CONCLUSION: This case reminds surgeons the possibility of having such extensive injury with promising outcome if properly managed.

Giant perineal epidermoid cyst in adult man: a rare case report and review of literature.

An epidermoid cyst is a common benign cutaneous mass that mostly occurs on the neck, face and trunk. The majority of epidermoid cysts are small and asymptomatic with the giant perineal epidermal cyst being rare and more liable to develop complications such as malignant transformation. The treatment of an epidermal cyst involves total excision of the cyst along with its wall to prevent recurrence. We present an unusual case of a giant perineal epidermal cyst in a 52-year-old male.

Huge primary retroperitoneal mature cystic teratoma mimicking adrenal incidentaloma: A case report and literature review.

INTRODUCTION: Teratomas originating from extra-gonadal account for 15 % of all teratomas, while retroperitoneal site being the least site for teratoma 1-11 %, extremely rare adrenal teratoma is less than 4 % of the retroperitoneal teratomas. Usually, patients are asymptomatic and the tumours are detected incidentally during imaging. PRESENTATION OF CASE: A case of a 29 years old female, presented with intractable pain for four weeks. Computed tomography scan study of the abdomen showed an avascular septate cystic lesion measuring 11.6 × 11.4 14.5 cm (cranial-caudal x transverse x anterior-posterior) with central fat density and large punctate calcification in the right suprarenal region displacing the inferior vena-cava laterally, abutting the gall bladder, pancreas and duodenum. Impressions of right adrenal teratoma and less likely adrenal myelipoma were suggested. She remarkably improved one day post operation. During clinic visit a month later, she was completely recovered and resumed her daily activities. DISCUSSION: In adults primary retroperitoneal mature cystic teratoma are uncommon, mostly are secondary tumours and very rare will occur in adrenal gland. Adrenal incidentaloma have been seldom reported mimicking primary mature cystic teratoma. Biochemical and Imaging studies are of great importance in diagnosing and showing relationship of the tumour and other organs. This work has been reported in line with the SCARE criteria (Agha et al., 2018 [1]). CONCLUSION: Primary retroperitoneal tumours are rare and surgery is the main stay of treatment whether it be open or laparoscopic, the latter being best for small lesion for it offers early recovery and complete excision gives excellent prognosis of 100 %.

An unusual presentation of penetrating bladder injury with vesicocutaneous fistula: a case report.

BACKGROUND: Blunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms. CASE PRESENTATION: We present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis. CONCLUSION: Fistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management.

Concomitant squamous cell carcinoma of the bladder and renal tuberculosis: A case report from northern Tanzania.

Concomitant squamous cell carcinoma (SCC) and renal tuberculosis (TB) are a rare presentation. It is associated with poor prognosis and poses a challenge in the management. To the best of our knowledge, we present a challenging first document case of locally advanced SCC of the bladder with coactive renal tuberculosis.

Perineal ectopic testis in adult: Experience from tertiary hospital, northern Tanzania.

INTRODUCTION AND IMPORTANCE: Perineal ectopic testis is a rare congenital abnormality mostly diagnosed during childhood period. The diagnosis can be easily reached by physical examination. The treatment of choice is either orchidopexy or orchiectomy through scrotal or inguinal approach. CASE PRESENTATION: We report a case of 30 year old male with painful perineal mass and empty right hemiscrotum. Ultrasound of the mass was done prior to operative procedure and the ectopic testis was the working diagnosis ever since. At exploration there was no abnormality found on the testis; thus, orchidopexy was done with uneventful postoperative period. CLINICAL DISCUSSION: Ectopic testis is rare congenital anomaly with perineal ectopic testis accounting for only 1% of all cases. Most cases of ectopic testis are diagnosed during childhood period. Our case presented at the age of 30 years, the reason could be either late diagnosis by physician or lack of insight of parents/care takers or both. The late presentation might pose a diagnostic challenge but also the testis may be atrophic or undergo malignant changes. In this case the testis was normal and therefore it was successfully relocated surgically through trans-inguinal approach. CONCLUSION: It is suggested to make perineal ectopic testis one of the differential diagnoses on painful perineal swelling without ipsilateral testis on any man.

An uncommon presentation of a large vulval wart in a child.

INTRODUCTION AND IMPORTANCE: Ano-genital warts are rare presentation in children. The main route of transmission is by sexual intercourse however horizontal transmission, self-inoculation and vertical transmission are also documented. Establishing the route of transmission when there is no evidence of sexual abuse may be difficult in pediatric and female virgins such as in our case report. Surgical excision remains one of the best options for treatment of large warts in pediatrics. To the best of our knowledge, this is the first report of novel case of large genital warts in pediatrics in Tanzania. CASE PRESENTATION: We present a case of female child of one year and 10 months old with large ano-genital cauli-flower masses admitted at Kilimanjaro Christian Medical Centre. The child's hymen was intact and with no evidence of sexual abuse identified. The masses were excised under general anesthesia and histology confirmed Condyloma acuminata. CLINICAL DISCUSSION: Ano-genital warts are rare presentation in pediatrics and female virgins. Sexual abuse should be ruled out in pediatrics patients. Self-inoculation is described as a possible route of transmission in pediatrics and in female virgins. Horizontal and vertical transmissions are also possible route of transmission of HPV. It might be difficult to establish the route of transmission as in our case report. The warts were successful treated by surgical excision and cauterization. CONCLUSION: Condyloma acuminata are rare in pediatrics and establishing the route of transmission may be difficult. Sexual abuse should be ruled out in pediatrics.

Penile strangulation by a metallic nut in an 8-year-old male: A rare case report of urological emergency.

INTRODUCTION AND IMPORTANCE: Penile strangulation due to metallic objects in pediatric age groups is a rare urological emergency that warrant emergency management. Removal of metallic ring from strangulated penis poses a great challenge to urologist as it may require industrial gadgets. Multidisciplinary management involving psychiatrist is required. To the best of our knowledge, this is the first reported novel case of penile strangulation by a metallic nut in children in Tanzania. Furthermore, this case report shows that Industrial Manual Scissor metal (IMSMC) cutter offers a safe way of removing metallic nut from strangulated penis with few complications. CASE PRESENTATION: We report a case report of penile strangulation in an 8 year-old boy by a metallic nut which stayed for 11 h prior to arriving at a tertiary hospital in Northern Tanzania. The reason for insertion of nut by a child was not clear. CLINICAL DISCUSSION: On arrival to the hospital the child was clinically stable but in pain. Local examination revealed a metallic nut at proximal penis with grossly edematous penis. A diagnosis of penile strangulation by metallic nut was reached and the child was planned for emergency surgery to remove the metallic nut. The metallic nut was successful removed by IMSMC. This technique has been used in adult with success with few complications and therefore opted in our setting. The child was also diagnosed with oppositional defiant disorder. CONCLUSION: Industrial Manual Scissor Metal cutter is a safe way of managing penile strangulation by a metallic nut in children.

Xanthogranulomatous pyelonephritis in an eight year old male child: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Xanthogranulomatous pyelonephritis is an extremely rare but known form of chronic pyelonephritis resulting from prolonged suppuration of the kidney. Pre-operatively, it may mimic renal tuberculosis or neoplastic lesions including renal cell carcinoma due to its vague clinical presentation, equivocal laboratory and radiological investigations. Due to its rarity and academic interest, herein we report such a rare case we recently encountered in our clinical practice. CASE PRESENTATION: An-eight-year old male child patient resented to our hospital with three months history of abdominal distension associated with progressive left flank pain. Preoperative investigations including CT-scan were suggestive of nephroblastoma with differential diagnosis of clear cell sarcoma. Radical nephrectomy was performed and histopathology of the specimen confirmed the diagnosis of Xanthogranulomatous pyelonephritis. The patient fared well postoperatively and he had no symptoms in the subsequent follow up visits. CLINICAL DISCUSSION: Xanthogranulomatous pyelonephritis is a rare, severe and atypical form of chronic pyelonephritis due to infection (E. coli, Proteus) or stones. The disease may resemble renal cell carcinoma preoperatively. Thus, high index of suspicion is necessary for preoperative diagnosis. CONCLUSION: Preoperative diagnosis of Xanthogranulomatous pyelonephritis may be a daunting task related to the rarity of its presentation. Thus, scrupulous histopathological evaluation is essential for the definitive diagnosis. Radical nephrectomy is the mainstay treatment of choice especially in diffuse cases.

Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report.

INTRODUCTION AND IMPORTANCE: Advanced prostate cancer often presents with lower urinary tract symptoms together with features of cancer on digital rectal examination. The commonest sites of metastasis include bone, liver and lungs. Metastasis to axillary lymph nodes is extremely unusual particularly as initial presentation of the disease. CASE PRESENTATION: We report an atypical case of a 40-year male patient presented with left axillary mass and normal initial urological evaluation. Histopathology and immunohistochemistry of the biopsies from the axillary mass and prostate confirmed the diagnosis of prostate adenocarcinoma. The patient declined anti-androgen monotherapy treatment and succumbed two months after establishment of the diagnosis. CLINICAL DISCUSSION: Prostate cancer contributes significantly to the overall global cancer burden. Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer and only a few cases have been reported in the literature. Therefore, clinical diagnosis of patients presenting with axillary lymphadenopathy may cause diagnostic delay. Careful physical and imaging examinations combined with pathological analysis are essential in the diagnosis of advanced prostate cancer with unusual presentation. CONCLUSION: In theory, prostate cancer can cause metastatic spread to any part of the body. However, metastasis to axillary nodes has not been frequently noticed. Our report highlights the importance of considering prostate cancer among differential diagnoses in Afro-Caribbean males presenting with symptoms suggestive of chest and abdomino-pelvic cancer.

Virchow's node as the initial presentation of metastatic prostate cancer: a case series of a common cancer in uncommon location.

Prostate cancer is one of the commonest cancers among men contributing significantly to the overall cancer burden globally. Most patients present with lower urinary tract symptoms. Metastasis to supraclavicular lymph nodes is unusual presentation, which has been rarely reported particularly as the primary presentation. We report two rare cases of advanced prostatic adenocarcinoma presenting with firm, non-tender lump in the left supraclavicular region between the two heads of the sternocleidomastoid muscle, (that is Virchow's node) as initial primary symptom. Examination of the patients revealed an elevated prostatic-specific antigen (PSA) of > 100 ng/ml levels, and the diagnosis was confirmed by histological evaluation and immunostaining with PSA of the supraclavicular lymph nodes and prostate biopsies. This case series emphasizes the importance of considering prostate cancer in the differential diagnosis of male patients with supraclavicular lymphadenopathy.

Long-Term Complications of Hypospadias Repair: A Ten-Year Experience from Northern Zone of Tanzania.

BACKGROUND: Hypospadias is one of the commonest congenital penile abnormalities in newborn males. The external urethral opening can be located anywhere from the glans penis along the ventral aspect of the shaft of the penis up to the scrotum or the perineum in extreme cases. The condition has a huge impact on the patient's psychological, emotional and sexual well-being. AIM: To determine the proportion of patients who develop long-term complications after hypospadias repair and its associated risk factors. METHODS: This was a hospital-based analytical cross-sectional study, conducted at KCMC Urology Institute from January 2009 to December 2018 and all children were followed up for 1-year post-operatively. A structural data sheet was used to collect information from patients' files. Study parameters include age, location of hypospadias, surgical technique, surgeon experience, chordee, suture size, materials to assess the association with long-term complications. RESULTS: A total of 254 patients were included in the study, the majority were aged more than 2 years (71.83%) with mean age at operation (SD) of 4.74 ± 2.99 years. Distal types were the most common type of hypospadias (125 patients; 50%), and 51 patients (20%) had severe chordee. Tubularized incised plate (TIP) repair was the most common technique (130 patients; 51.59%). The number of patients with long-term complications following hypospadias repair was 156 (61.60%) and urethrocutaneous fistula (UCF) accounted for 40.5%. The surgeon's experience, location of hypospadias, surgical technique and associated chordee were significant predictors of long-term complications of hypospadias repair. CONCLUSION: Tubularized incised plate urethroplasty is a safe and reliable method of hypospadias repair. Proximal hypospadias with severe chordee still remain a challenge.

Controlling Microarray Feature Spreading and Response Stability on Porous Silicon Platforms by Using Alkene-Terminal Ionic Liquids and UV Hydrosilylation.

In an attempt to develop reversible sensors based on ionic liquid/porous silicon (IL/pSi) platforms, we introduce an approach using task-specific, alkene-terminal ILs (AT-ILs) for direct grafting to the hydrogen-passivated as prepared-pSi (ap-pSi) surface via UV-hydrosilylation to address previous shortcomings associated with IL pattern impermanence (i.e., spread). By employing photoluminescence emission (PLE) and Fourier-transform infrared (FT-IR) imaging measurements, we demonstrate that the covalent grafting of AT-ILs onto the ap-pSi surface via photochemical hydrosilylation not only mitigates such feature spreading but also greatly improves PLE pattern stability. Significantly, we have discovered that, upon hydrosilylation, the resulting contact pin printed IL features remain stable to repeated challenges by toluene vapors, demonstrating the utility of AT-IL hydrosilylation for producing high-fidelity microarray features on pSi toward robust optical sensory microarrays.