Unusual case of urothelial carcinoma disguised as xanthogranulomatous pyelonephritis and causing reno-colic fistula: Case report and review of literature.

Xanthogranulomatous pyelonephritis is a rare and aggressive form of chronic pyelonephritis, it can occur at all age groups but is more common in women than in men, supposedly relating to the increased incidence of urinary tract infections and chronic nephrolithiasis in woman. Computed tomography (CT) findings are very helpful in making the correct diagnosis, but the definitive diagnosis is still based on histology, as there are many differential diagnoses such as renal cell carcinoma and renal tuberculosis. The complications of this type of pyelonephritis are due to the involvement of adjacent organs. The most frequent ones are Psoas abscess, perinephric abscess, and sepsis. Nephrocutaneous and renocolic fistulas are less common. We report a case of a 61-year-old male, who presented to emergency for left-sided lumbar pain for whom radiological investigations confirmed a renocolic fistula complicating xanthogranulomatous pyelonephritis. The diagnosis of XGP was proven by histopathological examination of the nephrectomy specimen slides, but there was also association with an underlying malignant squamous differentiation consistent with urothelial carcinoma, which was not evident on CT. XGP is a rare variant of chronic pyelonephritis with known imaging features. The treatment of choice is nephrectomy and histopathological examination is required for final diagnosis, as there may be associated renal malignancy.

[Prevalence and severity of erectile dysfunction in patients with type 2 diabetes in the Department of Urology at the University Hospital Center Hassan II, Fez, Morocco: a cross-sectional study of 96 cases]. / Dysfonction érectile chez les patients diabétiques type 2, prévalence et gravité au Service d´Urologie du Centre Hospitalier Universitaire de Fès, Maroc: à propos de 96 cas (étude transversale).

INTRODUCTION: type 2 diabetes is a very common condition which, in some patients, may cause erectile dysfunction. The purpose of this study is to determine the prevalence and severity of erectile dysfunction in patients with type 2 diabetes attending the Department of Urology. METHODS: we conducted a cross-sectional and descriptive study in the Department of Urology at the University Hospital Center Hassan II in Fez using a self-administered questionnaire encompassing an "International Index of Erectile Function-5" test based on 5 questions with routine blood test results in diabetic patients. RESULTS: a total of 96 anonymous questionnaires were distributed over a 12-month period. The average age of patients was 53.5 years, 35% (n=34) of them were active smokers. Diabetes had progressed for over 10 years in 54% (n=52) of cases. Three patients were treated with diet alone, 32% (n=31) with oral antidiabetic drugs, 31% (n=30) with insulin therapy alone and 31% (n=30) with insulin and oral antidiabetic drugs. Only 11% (n=11) of patients had HbA1c below 7%. Patients reporting erectile dysfunction accounted for 70% (n=67) of surveyed patients. The proportion of patients with erectile dysfunction according to the International Index of erectile function-5 was 88% (n=84). The onset of erectile dysfunction had started more than 3 years earlier in 63% (n=60) of patients. Disorders started progressively in 90% (n=86) of patients. Screening rate was 37.5% (n=36), only 30% (n=29) of patients received phosphodiesterase type 5 inhibitors, then intracavernous injection or both. Forty-two per cent (n=40) of patients had either macro or micro-angiopathic complications. CONCLUSION: erectile dysfunction is a common but little suspected condition in diabetic men. Hence, the importance of systematic screening in any diabetic patient and of adequate treatment for sexual and cardiovascular disorders.

[Multiple stones of the prostatic urethra associated with anejaculation revealing spinal dysraphism such as tethered cord syndrome at the base of the spinal canal in a young man: about an exceptional case]. / Multiples lithiases de l'urètre prostatique associées à une anéjaculation révélant un dysraphisme spinal à type de syndrome de moelle bas attachée chez un jeune homme: à propos d'un cas exceptionnel.

Spinal dysraphism (or spina bifida) is a neurological disorder representing the first cause of congenital urological disability. It has several clinical manifestations, vesicosphincteric and sexual disorders are frequent and rarely isolated, belonging to motor disorders, orthopedic, sensory, digestive or even cognitive impairments. Tethered cord syndrome at the base of the spinal canal is a complication of spinal dysraphism. This disorder is often detected in children, may be asymptomatic and found in adults. Bladder sphincter disorders are the main cause of morbi-mortality due to uronephrologic complications with a significant alteration in quality of life. This justifies specific management and multidisciplinary and strict monitoring. We here report an exceptional case of spinal dysraphism such as tethered cord syndrome at the base of the spinal canal found incidentally in an adult patient during an etiological assessment of lithiasis of the prostatic urethra associated with anejaculation .

[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.

[Metastatic bladder metachrone to a kaposi sarcoma cancer at a therapeutic impasse: about a case]. / Impasse thérapeutique pour une tumeur de la vessie métastatique métachrone à un sarcome de kaposi: à propos d'un cas rare.

Chemotherapy is the treatment of choice for a metastatic urothelial bladder cancer. We here report a rare case of metastatic bladder cancer associated with Kaposi sarcoma posing a serious risk of aggravation of the new neoplasia. It was necessary to entrust the patient to his family.

A rare pure embryonal rhabdomyosarcoma of the urinary bladder in an adult successfully managed with neoadjuvant chemotherapy and surgery: a case report.

BACKGROUND: Rhabdomyosarcoma of the urinary bladder in adults is an extremely rare malignant neoplasm that develops from the bladder wall. CASE PRESENTATION: We report our experience of a rare case of rhabdomyosarcoma of the bladder in a 45-year-old Moroccan man who was successfully managed with neoadjuvant chemotherapy and surgical excision of the mass; he was disease free at 24-month follow up. CONCLUSIONS: To the best of our knowledge, this is the first reported case of a rare embryonal rhabdomyosarcoma of the bladder that was managed with neoadjuvant chemotherapy and surgery. This is why further studies using a large number of patients with a greater longitudinal follow up will be required.

[Neglected scrotal trauma revealing embryonic paratesticular rhabdomyosarcoma: about a case]. / Un traumatisme scrotal négligé révélant un rhabdomyosarcome embryonnaire para-testiculaire: à propos d'un cas.

Embryonic paratesticular rhabdomyosarcoma is a rare mesenchymal tumor constituting a diagnostic and therapeutic emergency. Localized forms have a favorable prognosis. Multimodal treatment is the gold standard and it is based on surgery, multidrug chemotherapy and radiotherapy, with excellent overall survival rate. We here report the case of a 17-year old patient treated in our Department for embryonic fusiform cell paratesticular rhabdomyosarcoma causing clinical confusion. This study aims to highlight the specific features of this disease.

[Unusual intraurethral foreign body in a schizophrenic adolescent: about a case]. / Corps étranger intra urétral inhabituel chez un adolescent schizophrène: à propos d'un cas.

Self- insertion of foreign body is a common practice for self-injure or erotic purpose in patients with chronic psychosis. The diagnosis is sometimes difficult if it is reported late or if the patient does not cooperate; hence the interest of complementary imaging assessment. Treatment was based on two steps: the extraction of the foreign body by endoscopy or open surgery and psychiatric treatment of the mental illness. We report the uncommon case of a 16-year old schizophrenic adolescent who had introduced a needle into the urethra 2 years before. Diagnosis was based on retrograde and mictional uretrocystography. The needle was removed with endoscopy as well as with technical artifices, without using open surgery despite the length of time the incident had occurred. The patient underwent complementary psychiatric treatment.

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.

Synchronous malignant renal mass in patient with a Lung cancer: case report and literature review.

The finding on imaging (computed tomography scan or magnetic resonance imaging) of synchronous malignant renal mass in patient with an active nonrenal malignancy without renal specific symptoms is not frequent and diagnostic evaluation can be challenging. We describe a 54-year-old Moroccan male former chronic smoker who presented to our hospital with dry cough and impairment of the performance status. The imaging found a tumor mass in the left upper lobe of the lung associated to mediastinal lymph node and a scanno-guided biopsy of this tumor showed a non small cell lung cancer. The radiological staging revealed a solitary renal mass in the right kidney. The patient received firstly two cycles of a lung cancer chemotherapy with a partial response in the lung and a stability of the renal mass. Consequently, he underwent a scanno-guided biopsy of this mass which confirmed a synchronous clear cell renal carcinoma. The patient got chemo radiotherapy for the lung cancer and then after that he got a partial nephrectomy. He is still under a good control with more than 2 years after the initial diagnosis.

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.

Successful replantation of an amputated penis: a case report and review of the literature.

INTRODUCTION: Amputation of the penis is a rare traumatic injury reported from various parts of the world as isolated cases. A complete reconstruction of all penile structures should be attempted in one stage which provides the best chance for full rehabilitation of the patient. CASE PRESENTATION: We report the case of a 35-year-old Berber man who was admitted at the Emergency Department for incomplete criminal amputation of his penis, which was successfully reattached by using a macrosurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capability of erection and near normal sensitivity, were observed. CONCLUSIONS: The importance of using macrosurgical reimplantation in incomplete penile amputation in order to achieve better functional and cosmetic results is discussed. In addition, we also highlight the potential anatomical role of corpus spongiosum in the arterial and venous blood supply to the penis.

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.

A huge renal cyst mimicking ascites: a case report.

BACKGROUND: Renal cysts are common in old patients, and usually remain untreated. Giant renal cyst measuring more than 15 cm in diameter and containing more than 1500 mls of serous fluid are rarely seen. We report a case of a 75-year-old man with a giant right renal cyst. CASE PRESENTATION: A 75-year-old man presented with a five years history of suprapubic pain, abdominal distension. He had no urological symptoms. Physical examination revealed a distended abdomen with shifting dullness. Routine hematology, biochemistry, and serum tumor markers were within normal limits. Erroneously diagnosed as ascites on ultrasonographic examination. Abdominal paracentesis of supposed ascites was performed. The diagnosis of giant renal cyst was finally made by Computed tomography (CT) and patient underwent continuous percutaneous catheter drainage with negative pressure, whereby 8 liters of fluid were removed with negative cytology. Subsequent Computed tomography after 6 months revealed disparition of the cysts, and the patient remained asymptomatic. CONCLUSION: Giant renal cysts are uncommon; we conclude that the CT remains the best exam in patients evaluated for giant renal cyst. This to the best of our knowledge is the largest renal cyst in the medical literature. Studies are needed with particular attention to the factors associated with renal cyst enlargement.

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.

Verrucous carcinoma arising in an extended giant condyloma acuminatum (Buschke-Löwenstein tumor): a case report and review of the literature.

INTRODUCTION: Verrucous carcinoma of the external genitalia and perianal region is a rare variant of well-differentiated squamous cell carcinoma. It has been reported to have limited metastatic potential. CASE PRESENTATION: We report the case of a 54 year-old Moroccan man who presented with locally advanced giant condyloma acuminatum (Buschke-Löwenstein tumor) after prolonged intervals of neglect (approximately 10 years). The disease covered his suprapubic, external genitalia and perianal region. It was locally aggressive with extensive tissue destruction. After a biopsy of the lesion, the diagnosis of verrucous carcinoma was confirmed. He initially received chemoradiotherapy, followed by extensive local excision, but he developed septic shock and died a few days later. CONCLUSIONS: The purpose of this case report is to present a case of verrucous carcinoma arising in an extensive giant condyloma acuminatum (Buschke-Löwenstein tumor) and discuss the literature on its diagnosis and management.

Small cell neuroendocrine carcinoma of the urinary tract successfully managed with neoadjuvant chemotherapy.

Introduction. Small cell neuroendocrine carcinomas of the urinary tract is an extremely rare entity and very few cases have been reported in the literature. Small cell neuroendocrine carcinoma of the urinary tract (SCC-UT) is the association between bladder and urinary upper tract-small cell carcinoma (UUT-SCC). It characterized by an aggressive clinical course. The prognosis is poor due to local or distant metastases, and usually the muscle of the bladder is invaded. Case Presentation. We report a rare case of a 54-year-old Arab male native of moroccan; he is a smoker and was referred to our institution for intermittent hematuria. Following a diagnosis of small cell neuroendocrine carcinomas of the ureter and the bladder, thoracoabdominal-pelvic CT was done, and the staging of the tumor was done in the bladder (T2N0M0) and (T1N0M0) in the ureter. Neoadjuvant alternating doublet chemotherapy with ifosfamide/doxorubicin and etoposide/cisplatin was realized, and nephroureterectomy associated to a cystoprostatectomy was carried out. After 24 months of followup, no local or distant metastasis was detected. Conclusion. The purpose of this review is to present a rare case of pure small cell neuroendocrine carcinoma of the urinary tract and review the literature about the place of neoadjuvant chemotherapy in this rare tumors.

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.

Tumor in undescended intrapelvic testis revealed by supraclavicular lymphadenopathy: a case report and literature review.

BACKGROUND: Testicular cancer is a rare disease. The incidence of testicular cancer in undescended testicles is of 3 to 48 times greater than in the general population. In the developed countries, the existence of undescended testicles in the adult population is rare, due to systematic practice of elective orchidopexy before the second year of life and orchiectomy in post adolescent males with undescended testicles. Despite these prevention measures, there are still some isolated cases of intra-abdominal testicular tumors in adults. We report a case of testicular cancer in cryptorchid testis revealed by supraclavicular lymphadenopathy. CASE PRESENTATION: We report a case of a 46 year old fertile man with a history of unilateral cryptorchidism who presented with a palpable left supraclavicular mass and absence of the right testicle. On investigations an intrapelvic testis tumor was diagnosed. Laparotomy and complete excision was carried out. The possible association between the undescended testis and cancer transformations is briefly discussed. CONCLUSION: Testicular cancer in undescended testicles should not be ignored. Only early diagnosis and lower of testis in scrotumprevent such clinical forms.

Polycythemia vera revealed via a bladder tumor in a patient with erectile dysfunction: a case report.

INTRODUCTION: Polycythemia vera is a polyglobular myeloproliferative syndrome related to the mutation of multipotent hemopoietic stem cells. This case report describes a patient whose bladder tumor was associated with polycythemia vera and erectile dysfunction. The association of bladder neoplasia with polycythemia vera and erectile dysfunction has not previously been reported in the literature. CASE PRESENTATION: A 40-year-old Moroccan man was followed up for a bladder tumor which manifested with coagulant hematuria and a facial erythrosis with a hemoglobin level of 20.3g/L suggesting polycythemia vera. The patient also suffered from an erectile disorder. Considering the anesthesia difficulty due to polyglobulia, the patient was treated by bleeding. This treatment enabled the patient's sexual performance to be improved and adjustment of his hemoglobin to a level allowing anesthesia, and hence surgical resection of his bladder tumor. CONCLUSION: Erectile dysfunction associated with polycythemia vera is elucidated by rheological disorders. Bleeding contributed to satisfactory sexual performance and facilitated treatment of polycythemia vera because it enabled anesthesia to be performed and hence the surgical resection of the bladder tumor.