Global viewpoints: proposals for the development of endourology in resource-limited countries in Africa.

Endourology plays an important role in modern urological practice. Compared to open surgery, it offers many advantages. In Africa, endourology is not widely practiced or non-existent in some referral centres. Several factors have been linked to this challenge. This article explores and proposes strategies to improve endourology practice in the African context. Recognising the unique challenges and opportunities in the region, the document discusses key initiatives and recommendations to promote the growth and development of endourological practices, including the identification of local needs, training, technological adaptation, etc. It aims to provide valuable information on the advancement of endourology in Africa.

Rare adrenal incidentaloma: ganglioneuroma.

Ganglioneuroma (GN) is a rare, benign neurogenic tumor that develops from sympathetic ganglion cells. It occurs mainly in the retroperitoneal region. Adrenal localization is rare. We report a case of adrenal ganglioneuroma in a 22-year-old woman with no previous history of the disease. The tumor was discovered incidentally on an entero scan ordered as part of the etiological assessment for chronic diarrhea. The diagnosis was confirmed by pathological examination.

What may an adrenal mass conceal? Adrenal gastrointestinal stromal tumor: a case report.

Extraintestinal gastrointestinal stromal tumors (GISTs) are extremely rare, and adrenal GISTs are even exceptional. Only three cases have been reported in the literature thus far, the current case being the fourth. This case demonstrates the need of including extraintestinal GIST in the differential diagnosis when investigating adrenal tumors. Herein, we present a case of adrenal GIST diagnosed in a 60-year-old female patient who had a left adrenal GIST surgically removed as an adrenal tumor.

A case of extremely rare pathology: Renal malakoplakia.

Malakoplakia is a granulomatous tissue inflammation with a characteristic histological appearance, mainly affecting the urogenital system and morphologically reflecting a macrophage disease. If bladder involvement is the most common, renal involvement is very rare and may be responsible for a differential diagnosis problem with renal cell carcinoma. We present a clinical case of renal malacoplakia mimicking malignant renal cell carcinoma diagnosed after partial nephrectomy in a 58-year-old woman with no history of recurrent urinary infections.

Place of urolithiasis in the spectrum of urological pathologies, practices and use of endourological procedures in the management of calculi of the upper urinary tract: results of a survey of referral centres in Africa.

Our aim was to determine the current trend of endourology in the management of upper urinary tract calculi in Africa reference centres. We conducted an online multiple-choice questionnaire survey involving 46 centres from 27 countries using a structured well-designed Google Form (®) questionnaire. The questionnaires were distributed to the head of service through their emails. The questions collected demographic data about the centre, the epidemiology of urolithiasis, diagnostic means and management of upper urolithiasis, especially access to endourology procedures and their practices. Descriptive analyses were performed. The participation rate was 77.9%. Urinary lithiasis was one of the three main pathologies encountered in 42/46 centres. 33 centres had easy access to CT scanners and 34 had operating theatres equipped with endo-urological surgery equipment. Of these 34 centres, 30 perform endourology for the management of upper urinary tract stones. Rigid ureteroscopy is the main technique used by the centres. It is the only endourology technique used for stone management by 12 centres (40%). 7/30 (23.3%) have the option of performing rigid ureteroscopy, flexible ureteroscopy and percutaneous nephrolithotomy. The frequency of procedures varies widely, with 43.3% rarely performing endourological surgery. Seventeen centres have their operating theatre equipped with a fluoroscope and 6/42 centres have extracorporeal lithotripsy. Open surgery is still used in 29/42 centres (69.1%). Laparoscopy is available in 50% of centres, but none reported performing laparoscopic lithotomy. In Africa, urinary lithiasis plays an important role in the activities of referral centres. Modern management techniques are used to varying degrees (not all centres have them) and with very variable frequency. Open surgery is still widely performed as a management. Rigid ureteroscopy is the main endourological technique. It is essential to develop the practice of modern urology in Africa, mainly endourology.

Hematuria complicated by urinary retention revealing post-radiotherapy gangrenous cystitis with peritoneal involvement: an exceptional case in current urological practice.

Gangrenous cystitis is a pathology that is rarely encountered in current urological practice. It is due to necrosis of the bladder wall, which may be superficial or involve the entire wall. Its exact pathogenesis is unknown, but several factors make its diagnosis based on cystoscopy or imaging. Its surgical treatment depends on the operative finding. In this report, the authors report a case of gangrenous cystitis in a 73-year-old patient with a history of prostatectomy and radiotherapy whose main manifestation was urinary retention. The diagnosis was made by computed tomography scan. Surgical exploration confirmed the diagnosis, thus imposing a partial cystectomy with an omentum base plasty. Despite a good postoperative clinical and biological evolution, the patient died in the intensive care unit following respiratory distress and ventricular tachycardia. This case reminds once again the high mortality associated with this pathology.

A large dedifferentiated retroperitoneal liposarcoma extended to the testis: a rare case report.

Liposarcomas are neoplasms of mesodermal origin representing less than 1% of all malignant tumors and 1 to 2% of urogenital lesions. Primary retroperitoneal liposarcomas extending into the inguinal canal are rare. We present the case of a large retroperitoneal liposarcoma invading the left testicle and its spermatic cord. It was diagnosed by imaging as a large mass that compresses surrounding abdominal structures and communicating with the inguinal canal. A surgical intervention consisting of en bloc resection of the tumor and the left testicle with its cord was performed by 2 routes, intercostal and inguinal. Histology showed a dedifferentiated liposarcoma, which is a rare entity with a high rate of malignancy and a poor prognosis. The treatment of choice is wide surgical resection with clear margins; chemotherapy and radiotherapy are less sensitive. The patient did not manifest any particular complaints during the first six months after surgery.

Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation: a case report.

Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation is a very extremely rare tumor and only few cases have been reported in the literature. Here we report a case of a 37-year-old woman who presented with a pain and a palpable mass in the right flank. The abdominal computed tomography (CT) scan found a renal tumor and the patient underwent a right radical nephrectomy with adrenal gland resection. After the histological examination of the specimen completed by immunohistochemical and molecular study, a diagnosis of chromophobe renal cell carcinoma with liposarcomatous dedifferentiation was made. The patient received adjuvant chemotherapy. Afterwards, she developed bone metastasis and died 13 months after the surgery. Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation is a rare tumor associated with a poor prognosis and a metastatic potential.

Primary renal lymphoma in an immunocompetent patient.

Renal lymphoma is rarely primary, but its diagnosis is critical because it requires specialized medical treatment. We present the case of a 59-year-old man who was admitted to the hospital for a painful left renal mass revealed by isolated chronic low back pain. A clinical examination revealed left lumbar tenderness. A non-lymphoma Hodgkin's type B was discovered during a renal biopsy. As part of the extension workup, a PET scan was performed, which revealed no secondary location, and the patient underwent chemotherapy. Following the start of chemotherapy, a complete remission was observed, as well as a reduction in the size of the kidney.

Acute renal failure and bladder tumors, about 106 cases.

OBJECTIVES: The overall objective of the study was to determine the prevalence of acute renal failure due to bladder tumors by describing the clinical, paraclinical, therapeutic, histological and clinical evolution parameters. MATERIALS AND METHODS: Retrospective study over a period of 2 years dating from the first of September 2017 to the 31 of October 2019 on a number of patients with acute renal failure due to bladder tumors treated at the department of urology in the Ibn Roch teaching Hospital in Casablanca. RESULTS: In a series of 597 cases of bladder tumors, the prevalence of acute renal failure was 17.8%. The mean age was 69.5 years [51-88], with a male predominance (97%). The main clinical signs were hematuria (87%), lower back pain (62%), oligo-anuria (31%) and acute urine retention (12%). The mean serum creatinine on admission was 1316µmol/L (extremes: 155-2477) and The mean serum urea was 2.4g/L (0.8-4). Renal ultrasound showed hydronephrosis in 96% of cases, which was bilateral in 69% of cases. Hemodialysis was indicated in 23.6% of the cases, due to hyperkalemia (14.1%), metabolic acidosis (6.6%) and acute pulmonary oedema in (2.8%). Percutaneous nephrostomy was performed in 77% of cases, bladder catheterization in 21% of cases and double J-stenting in 2% of cases. As to the treatment of bladder tumors, endoscopic trans-urethral bladder resection was the main treatment and was performed in (71%) of cases. Meanwhile, 21% of the patients benefited from a cystoprostatectomy and combined radio-chemotherapy was indicated in 9% of cases. The main histological finding was transitional cell carcinoma (98%). The evolution of renal function was favorable in 87% of cases. CONCLUSION: Acute renal failure is a frequent and severe complication of bladder tumors that can be life-threatening and makes it difficult to treat bladder tumors requiring multidisciplinary management.

Mucosal urinary secretion revealing adenocarcinoma of urachus.

INTRODUCTION: Urachus adenocarcinoma is an extremely rare malignant tumor characterized by its insidious evolution responsible for the delay in diagnosis. Several scientific works have tried to study the indication of adjuvant treatment, therefore the prognosis is still poor. PRESENTATION OF CASE: We report the case of a 50-year-old patient with no pathological history who consulted for an episode of intermittent urinary mucosal secretion aggravated by the appearance of macroscopic hematuria. Without other associated clinical signs. Imaging examinations revealed a mass at the expense of the upper wall of the bladder. The cystoscopy allowed us to visualize the mass and the biopsy. Histological study revealed an adenocarcinoma of urachus. The patient underwent surgical exeresis and adjuvant chemotherapy. The evolution was marked by a deterioration of the general condition despite adequate management. DISCUSSION: Due to its topography, urachus cancer usually manifests as a bladder tumor, exceptionally as much as an anterior umbilical or extraperitoneal tumor. Few studies have been done on this neoplasm; however surgery still has a primary place in therapeutic management. CONCLUSION: The scarcity of cases of urachus cancer makes the publications scarce and the lack of multicenter clinical and randomized trials explains the disagreement about adjuvant treatments.

Malignant pheochromocytoma: A diagnostic and therapeutic dilemma.

INTRODUCTION: Malignant pheochromocytomas are rare endocrine tumors that develop within chromaffin tissue. The diagnosis of malignancy is based on neoplastic recurrence or the presence of metastasis in organs that lack chromaffin tissue. We report a series of four cases because of their diagnostic and therapeutic particularities. PRESENTATION OF CASE: we describe four clinical cases of patients with malignant pheochromocytoma whose Menard triad "headache-palpitations-sweating" was present in three out of four patients, the methoxylated derivatives were measured in 4 patients, 3 of which had high values, all of our patients carried out a CT scan which objectified signs of malignancy, MRI was performed on a single patient; presenting with a neoplastic recurrence; looking for a locoregional invasion. DISCUSSION: Pheochromocytoma (PC) is a rare neuroendocrine tumor derived from the chromaffin cells of the adrenal medulla. Its annual incidence is 2 to 8 per million adults. A peak frequency is observed between 30 and 40 years of age. Approximately 10% of pheochromocytomas are malignant and in 10% of cases, bilateral localization is observed. Criteria for malignancy include the invasion of neighboring organs, a large tumor, the presence of lymphadenopathy on imaging, or fixation on scintigraphy. Surgery for MAP is not always curative. In the case of multiple liver metastases, treatment is based on adrenalectomy, which can be effectively combined with chemoembolization, cryoablation, or radiofrequency techniques. CONCLUSION: The main prognostic factors of the malignant pheochromocytomas are a large tumor volume, the existence or number of visceral metastases, and the presence of a mutation in the SDHB (Succinate dehydrogenase B) gene.

Urachal carcinoma revealed by isolated hematuria.

Urachal carcinoma is an aggressive and rare neoplasia of bladder cancer involving the urachus. The diagnostic failure is due to its insidious development as well as its non-specific clinical signs. Management constitutes a real dilemma for urological surgeons. We describe two pathological cases of urachal adenocarcinoma revealed by isolated hematuria.

Hypercalcemia an exceptional complication in upper urinary tract urothelial carcinoma.

Tumors of the upper urinary tract are discovered, either by clinical symptomatology or as part of the evaluation of a bladder tumor. Hypercalcemia is one of the most common paraneoplastic syndromes and an exceptional complication of urothelial carcinoma of the upper tract. Several physiopathological mechanisms have been proposed to explain this rare and serious complication. Hypercalcemia is often correlated with tumors with a poor prognosis.

Retroperitoneal Schwannoma: Case report.

Schwannoma is a rare benign tumor that comes from the SCHWANN cells that sheath the peripheral nerves. Retroperitoneal location is even rarer than the frequency of this neoplasia. The diagnosis is immuno-histochemical and the treatment is surgical. We report the case of a 36-year-old patient with abdominal pain and transit disorders for 4 months. An abdominal CT scan was found a rounded tissue mass of 10 cm long with well-defined borders. The patient was prepared for surgical removal. Per-operatively, a mass was found in the sub hepatic area, pushing the right kidney backwards. Anatomo-pathological examination was in favor of Schwannoma.

Geant adrenal myelolipoma: A case report with literature review.

Adrenal myelolipoma is a rare, benign, non-functioning tumor, composed of mature adipose tissue and hematopoietic cells. We present the case of a 26-year-old woman who presented with abdominal distention and right back pain radiating to the right hypochondrium. Computed tomography of the abdomen revealed a large retroperitoneal mass, which was suspected to be a retroperitoneal liposarcoma. All hormonal studies related to adrenal gland were within normal limits. Open surgery resection was performed. Histopathology showed an adrenal myelolipoma with 39 × 21.5 × 8.5 cm and weighting 4930 g h. The patient evolved with an uneventful postoperative period.

Penile strangulation and amputation in schizophrenic patients: A reports of two cases.

Strangulation or amputation of the penis is the preserve of psychotic patients in the majority of cases. This situation can be the cause of major complications both urinary and sexual. The management is multidisciplinary between urologist and psychiatrist. We report two observations of strangulation and amputation in schizophrenic patients.

Fronto-orbital metastasis of a prostatic adenocarcinoma.

Prostate cancer often spreads to bony sites, but other metastatic sites are exceptional. Brain localization accounts for less than 4% of postmortem cases.The cerebral metastases of a prostatic ADK are rare, the prognosis is unfortunate and the treatment is based on androgen deprivation and radiotherapy. We describe a case of orbital metastasis of prostatic adenocarcinoma and we highlight the diagnostic and therapeutic singularity of this affection.

Spontaneous renal forniceal rupture due to a bladder tumor.

Extravasation of urine following rupture of the renal fornix is a rare complication mostly caused by obstruction secondary to distal ureteric stones. We report the case of a rupture of FORNIX secondary to a bladder tumor.

The ectopic vesical pheochromocytoma a diagnostic and therapeutic challenge case report and literature review.

INTRODUCTION: Extra-adrenal localization of pheochromocytoma is rare. Its clinical revelation is paroxysmal but maybe in the form of permanent hypertension resistant to treatment. The main problem with these tumors is to affirm their benignity or malignancy, ectopic pheochromocytomas have a malignant development once in two. CASE PRESENTATION: We report the observation of a 39-year-old woman hypertensive on Amlodipine. She presents for sweating, headache, and palpation. The dosage of urinary metabolites revealed a marked increase in metanephrine and normetanephrine. Imagery had shown, at the expense of the left lateral wall of the bladder, a budding tissue formation with irregular contours which was significantly enhanced after injection of PDC. The diagnosis of an ectopic pheochromocytoma was accepted. The patient underwent a partial cystectomy, the postoperative consequences of which were unremarkable. DISCUSSION: Threatening secretory syndromes are rare medical situations that require urgent management. Pheochromocytoma can be seen at any age from childhood to old age. The treatment of pheochromocytoma is surgical, once the stages of positive and topographic diagnosis have been carried out, the patient must be immediately entrusted to a team of trained surgeons and anesthetists. The prognosis remains unpredictable, hence the interest in prolonged monitoring. CONCLUSION: Pheochromocytoma is a tumor developed at the expense of chromaffin tissues, extra-adrenal localizations exist, but remain rare. It is a pathology that presents a diagnostic and therapeutic dilemma in which patients require regular and prolonged postoperative monitoring to detect a possible metastasis or recurrence.