Why do we miss isolated male genital tuberculosis diagnosis?

Tuberculosis remains a worldwide health problem. It can affect the entire genitourinary tract. Tuberculosis of male genital tract still presents a diagnostic dilemma because of its varied presentations and the unavailability of sensitive and specific investigations. "Urogenital tuberculosis" is the most common term used in the literature. Male genital tuberculosis (MGTB) is usually reviewed together with urinary tract tuberculosis because often both sites are involved simultaneously; however, this is not always the case and current terminology may need to be modified. Until now, little importance has been given to isolated MGTB diagnosis. The current methods used for diagnosis are not adequate and the optimal strategy warrants further studies with a special attention on the evaluation of sperm investigations. In this review, we aim to establish a summary on the type of tuberculosis affecting only the male genital tract. We recommend that the diagnosis of MGTB should be made taking into consideration the epidemiological data, the clinical presentation, and performance of latest molecular or immunological tools from urine, sperm, blood, other fluids or tissue specimens.

Male genital damage in COVID-19 patients: Are available data relevant?

Over the past few weeks, we have observed increasing concern about the possible impact of coronavirus disease 2019 (COVID-19) which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) on male fertility. Precise mechanisms of male reproductive damages are still unclear, but it seems that high temperature resulting from persistent fever and triggering a secondary autoimmune response leading to an autoimmune orchitis are the most likely involved mechanisms. Also, angiotensin conversion enzyme 2 (ACE2) plays a highly important role in cellular entry for SARS-CoV-2 and male genital system presents high ACE2 expression. All these preliminary findings suggest that COVID-19 could impact men's reproductive health. Thus, we examined available data including published and unpublished articles to assess the potential risk of COVID-19 in particular on the male reproductive system.

Pregnancy management in laparoscopic promontofixation patients: a challenging situation with no clear recommendations.

Uterine-sparing prolapse surgery offers fertility preservation; however, available data on the safety of pregnancy after surgery and the effects of pregnancy on surgical outcome are limited. Authors report herein reflections on the case of a 39-year-old woman with pelvic organ prolapse who underwent laparoscopic promontofixation. Pregnancy was diagnosed 2 weeks post-surgery. The main target of this research is to focus on pregnancy management before and after promontofixation due to the lack of data on the safety of pregnancy following surgery and the effect of pregnancy on surgical outcome. It seems preferable to us to operate patients in the first part of the cycle, if not after a dosage of beta-HCG and to provide effective contraception for at least 12 months.

Ovarian adenocarcinoma metastasis mimicking psoas abscess on imaging: a case report.

Malignant psoas syndrome (MPS) is very rare with poor prognosis, and usually occurs in patients with advanced and recurrent cancer. Authors report herein the case of a 48-year-old female with history of neoadjuvant chemotherapy has been performed before hysterectomy with bilateral adnexectomy and ovariectomy for ovarian adenocarcinoma. She presented 18 months posttreatment with MPS due to a psoas abscess mimicking metastasis confirmed on computed tomography guided fine needle aspiration cytology.

[Tuberculous vesicovaginal fistula complicated by bladder stones: about an exceptional case]. / Calculs vésicaux multiples compliquant une fistule vésico-vaginale d'origine tuberculeuse: à propos d'un cas exceptionnel.

Vesicovaginal fistula (VVF) continues to be a major public health problem in developing countries. Given the particular association of VVF with stones, the question that arises is whether the fistula is primary or secondary to bladder stone and then whether to use single-stage or two-stage treatment. But what is special about this study is that these rare clinical features are due to tuberculosis. We here report the case of a 62-year old female patient with a history of treated tuberculous spondylodiscitis. The patient had been declared cured 4 years before. For the previous 2 years she had been suffering from continuous urinary incontinence. Clinical examination showed almost complete vaginal synechia. Complementary scannography and cystography showed the presence of 3 stones on the way to the VVF. The largest stone measured 6cm along its longer axis with passage of contrast material into the uterovaginal cavity through the fistula. The patient was admitted to the operating room where she underwent cystolithotomy with ablation of the stones that were on the way to the fistula, biopsy of the fistulous tract and single-stage closure of the VVF in two layers without interposition of the autologous tissue. Anatomopathological results confirmed the presence of active tuberculosis on the way to the fistula, requiring resumption of antibacillary treatment for 9 months. During the follow-up visit at 3, 6 and 9 months the patient showed good clinical status with absence of urinary incontinence. VVF secondary to tuberculosis associated with urinary stones appears very little in literature. Our case demonstrates the feasibility of antibacillar medical treatment associated with single-stage surgical treatment with very satisfactory results despite the history of our patient and the duration of his disease.

Myxoma of the kidney - an unusual benign renal tumor: a case report.

BACKGROUND: Myxomas are rare benign soft tissue tumors. The kidney is an unusual location for this tumor. For this reason, less than 15 cases of renal myxoma have been reported in the English literature. There are no specific clinical and radiological features reported for this tumor that allow a preoperative diagnosis enabling a conservative treatment. CASE PRESENTATION: We report another case of renal myxoma found in a 50-year-old Moroccan woman who presented with a right dull flank pain. An abdominal computed tomography scan objectified a suspected malignant renal mass. Thus, radical nephrectomy was performed. Histopathology of the specimen revealed the typical appearance of a myxoma. CONCLUSIONS: The objective of this report is to add another case report of this rare benign renal tumor to the literature. This benign tumor with excellent prognosis has no specific preoperative features that could justify a conservative management; a radical approach remains the therapeutic option for now.

Suicide attempt by self-stabbing of the bladder: a case report.

INTRODUCTION: The presence of foreign bodies in the bladder often falls within questionable practices in psychiatric settings or in iatrogenic instances such as during endoscopy or migration of foreign bodies around the bladder remaining after surgery on organs close to the bladder. Psychiatric disorders have been reported in patients admitted for self-introduction of foreign bodies in the bladder during an act of sexual satisfaction. However, to the best of our knowledge, no similar case in the context of suicide has been reported in the English-language literature. CASE PRESENTATION: A 56-year-old Moroccan man known to have untreated paranoid schizophrenia and a history of several previous suicide attempts was presented to the emergency unit of our hospital after self-stabbing with a 15 cm sewing needle. His stab wound was located at the hypogastric region of the abdomen, with full penetration of the needle into the abdomen. A computed tomographic scan showed a breach on the dome of the bladder responsible for extravasation of the contrast dye, which revealed a peritoneal cavity effusion of average abundance and a suspected lesion of the left pelvic ureter. An exploratory laparotomy was performed. Approximately 1000 mL of widely dispersed fluid was observed in the abdominal cavity. During exploration of the bladder, two centimetric intrabladder breaches were found, one of which was a breach of the left pelvic ureter without other associated lesions. The breaches were sutured, and a ureteral catheter was mounted. The patient's post-operative follow-up was unremarkable. CONCLUSIONS: The wide variety of ways that foreign bodies are introduced into the lower urinary tract pose diagnostic and therapeutic difficulties for the urologist. Management of these patients is facilitated by the use of endoscopy.

Penile self-mutilation preceded by bizarre delusions: two case reports.

INTRODUCTION: Genital self-mutilation is listed as a symptom of borderline personality disorder. The type of injury varies from simple skin laceration to total amputation of the penis and testicles. These injuries are urological and surgical emergencies. CASE PRESENTATION: We report two cases of penile self-mutilation precipitated by erotic and religious bizarre delusions.Our first patient is a 24-year-old Moroccan man who visited our emergency room with a metallic ring at the root of his penis which had caused marked edema of his entire penis.Our second patient is a 26-year-old Moroccan man evaluated in our emergency unit. A clinical examination revealed a wound at the dorsal side of his penis with complete transection of the dorsal vein and imperfect hemostasis.The two patients were treated in our emergency unit after which a favorable clinical course was observed. CONCLUSION: Cases of genital self-mutilation are urological and psychiatric emergencies, therefore it is important that surgical and psychiatric teams collaborate closely while managing cases of genital self-mutilation.

Bilateral ureteral obstruction revealing a benign prostatic hypertrophy: a case report and review of the literature.

INTRODUCTION: Prostatic hyperplasia is the most frequent tumor in men older than 50 years of age. Bilateral hydronephrosis secondary to benign prostatic hypertrophy is a rare condition most often due to vesicoureteral reflux. Herein we report a case of a patient with bilateral hydronephrosis with distal ureter obstruction caused by detrusor hypertrophy due to prostatic hyperplasia, our analysis of the clinical data and a review of the relevant published literature. CASE PRESENTATION: We report a case of a 65-year-old Berber man with clinically significant storage, bladder-emptying symptoms and bilateral low back pain with renal biologic failure and bilateral ureterohydronephrosis, distal ureteral stenosis, detrusor hypertrophy and prostate hyperplasia without significant post-void residual urine volume visualized by abdominal sonography. The patient underwent bilateral JJ stent insertion with transurethral resection of the prostate. The patient was discharged 3 days after surgery without any obvious complications. At his 3-month follow-up examination, the JJ stent was removed and the patient had comfortable urination without renal failure. CONCLUSION: This is an extremely rare condition that has important diagnostic considerations because of the possibility of comorbid severe obstructive uropathy and chronic renal failure.

Elective gangrene of the corpus spongiosum of idiopathic origin: A case report.

Penile gangrene is rare and associated with significant morbidity and mortality. It can be dry or wet. Treatment for dry gangrene is based on surgery, watchful waiting allowing spontaneous amputation of necrotic tissue or revascularization. It often depends on the general condition of the patient. We report a case of a 54-year-old patient with no significant medical history who presented with necrosis of the glans penis. Upon surgical exploration, we found an elective necrosis of the entire corpus spongiosum for which partial penectomy was performed. No etiology was found. To our knowledge, this is the first such case to be reported in the literature.

Embryonic paratesticular rhabdomyosarcoma: a case report.

INTRODUCTION: An embryonic paratesticular rhabdomyosarcoma is a very rare mesenchymal tumor. It is an intrascrotal tumor that is localized in paratesticular structures such as the epididymis or spermatic cord. Rhabdomyosarcoma is most often observed in children and adolescents, presenting as a painless scrotal mass. CASE PRESENTATION: Our patient was an 18-year-old Moroccan man who presented with a painless left scrotal mass that had evolved over four months. An inguinal orchiectomy was performed. A histological examination of the excised tissue revealed an embryonic rhabdomyosarcoma.Our patient had three sessions of chemotherapy with vincristine, actinomycin C and cyclophosphamide. Each chemotherapy session was conducted over five days, with a cycle of 21 days. Our patient was assessed two months after the last chemotherapy session and demonstrated good clinical improvement. CONCLUSION: Paratesticular rhabdomyosarcoma is a rare aggressive tumor manifesting in children and very young adults. Localized forms have a good prognosis whereas metastatic tumors show very poor results. A well-defined treatment based on surgery and chemotherapy yields good results.