Ureteral duplicity with a left ureterocele: a case report.

An intravesical ureterocele is a rare condition in which a terminal ureter terminates in a cystic dilation of the bladder. We present the case of a 42-year-old female who presented with irritative lower urinary tract symptoms and left lower back pain. Computed tomography (CT) urography revealed ureteral duplication with a ureterocele complicated by upper tract obstruction. Treatment involved endoscopic ureterocelotomy, which successfully relieved symptoms and resolved renal obstruction.

Primary peripheral neuroectodermal tumor or Ewing's sarcoma of the kidney: A rare case and review of the literature.

Peripheral neuroectodermal tumors (PNET), or Ewing sarcoma, are tumors that generally develop in bone; extraskeletal locations are rare. Renal PNETs are rare and are characterized by an aggressive clinical course and a poor prognosis. We report the case of a young patient who presented with abdominal and lumbar pain with a palpable abdominal mass. The imaging was in favor of a huge renal tumor, and the histological analysis allowed the diagnosis of a renal PNET. The therapeutic attitude was multimodal, including surgery and chemotherapy, allowing complete remission and a favorable outcome.

Tubular ectasia of the rete testis: A benign yet unrecognized condition.

Tubular ectasia of the rete testis (TERT) presents as multiple cystic structures within the rete testis, often incidentally detected on ultrasound as echo-free intratesticular cystic lesions. Despite its benign nature, assessing testicular cystic lesions can sometimes be challenging. The primary importance of identifying this uncommon condition lies in its distinction from cystic testicular malignancies and thus avoiding further radical procedures. We report an instance of TERT within the right testis discovered incidentally in a patient with a medical background of epididymitis, presenting for management of left testis cryptorchidism, and bilateral inguinal hernia.

Primary metastatic melanoma of the female urethra: A case report and literature review.

BACKGROUND: Urethral malignant melanoma is an uncommon and aggressive malignancy, frequently diagnosed at an advanced stage, posing diagnostic and therapeutic challenges. CASE PRESENTATION: We present the case of a 74-year-old North African female diagnosed with primary metastatic urethral melanoma. Initial staging included a thorough physical examination, pelvic MRI, and whole-body CT scan, initially showing no signs of distant metastasis. Subsequent FDG PET/CT revealed unexpected bone metastases, prompting a significant shift in our management approach. The patient received immunotherapy with pembrolizumab, resulting in sustained metabolic stability at the six-month follow-up. DISCUSSION: We present recent epidemiological data and risk factors for this uncommon melanoma site. Additionally, we delve into the diagnostic challenges, underlining the expanding role of PET/CT. The discussion also covers managing options in the absence of a consensus. CONCLUSION: Despite several treatment choices, metastatic urethral melanoma still has a poor prognosis. This reality reflects the complexity of the disease and emphasizes the need for further research to unravel its underlying mechanisms and to establish more effective therapeutic approaches.

Renal cell carcinoma with massive cavo-atrial tumor thrombus leading to pulmonary embolism: Case study and literature review.

INTRODUCTION: Renal cell carcinoma (RCC) occasionally involves the inferior vena cava (IVC), but intra-atrial extension is very rare, with the most dreaded complication being thrombi migration into pulmonary arteries. CASE PRESENTATION: A 52-year-old male with rheumatoid arthritis and a smoking history presented with dyspnea, weight loss, and a previous episode of hematuria. Echocardiography revealed an intra-atrial thrombus with signs of pulmonary embolism (PE). Subsequent evaluation found a massive right renal tumor with an extensive thrombus extending into the right atrium, causing PE. Multidisciplinary management included surgery involving nephrectomy and thrombectomy via cavotomy and open-heart surgery along with pre- and postoperative anticoagulation. DISCUSSION: Intra-caval tumor thrombus (TT) in RCC is infrequent, especially when extending into the right atrium. Accurate diagnosis involves imaging modalities, with echocardiography and MRI playing pivotal roles. Multidisciplinary and personalized management is mandatory to ensure a successful outcome. Surgery remains the primary treatment for RCC with TT but carries significant risks. CONCLUSION: Managing RCC with cavo-atrial tumor thrombus is a complex situation that requires a collaborative approach. Accurate staging and tailored treatment are crucial. Surgical intervention remains pivotal in the absence of alternative effective modalities. Ongoing research into adjuvant therapies is crucial for optimal outcomes.

Endothelial cyst of the adrenal gland: A surgical case report.

INTRODUCTION AND IMPORTANCE: Advances in medical imaging have led to increased detection of rare adrenal cysts, typically asymptomatic. The article emphasizes their silent nature and the evolving diagnostic methods. CASE PRESENTATION: Woman underwent successful laparoscopic removal of a 9 cm left adrenal cyst. Histological analysis identified it as an endothelial cyst. CLINICAL DISCUSSION: Adrenal cysts, mostly unilateral, have diverse histological types. Diagnosis relies on imaging, and surgical intervention is required for symptomatic cases or those exceeding 5 cm. Minimally invasive techniques have improved outcomes. CONCLUSIONS: Adrenal cysts, generally benign and asymptomatic, pose diagnostic challenges. Surgical intervention is recommended for larger or symptomatic lesions, with advancements in minimally invasive options improving outcomes.

Penoscrotal elephantiasis: A severe form of genital lymphedema.

Penoscrotal lymphedema is a manifestation of disrupted lymphatic drainage, causing a significant increase in scrotal volume. impacting both aesthetics and quality of life. Elephantiasis, classified as stage III by the International Society of Lymphology, represents the advanced stage of scrotal lymphedema, often linked to parasitic diseases. The diagnosis is clinical, and the treatment involves mass excision. The lymphatic reconstruction is an innovative therapeutic approach that improves postoperative results and better quality of life. In this case report, we present the case of massive genital elephantiasis managed surgically, and we will focus on surgical techniques and reconstructive approaches.

Isolated prostate tuberculosis: A rare condition.

Tuberculosis remains a global health threat, notably with a considerable burden of extrapulmonary cases. Prostate tuberculosis stands out as a rare and challenging diagnosis, often resulting in substantial management delays. In this report, we present the case of a 55-year-old man in whom initial suspicion of prostate cancer resulted in the diagnosis of prostate tuberculosis. The diagnostic methods, progressive features, and therapeutic tools of this rare condition are discussed.

Retrovesical hydatid cyst: A rare presentation of echinococcosis - A case report.

This case details a 42-year-old farmer experiencing ten months of lower abdominal pain, diagnosed with a retrovesical hydatid cyst (RVHC). Imaging, including ultrasound and CT scans, categorized the cyst as Gharbi type 3. Serological tests confirmed echinococcal antibodies. Surgical intervention comprised the resection of the cyst's prominent dome, following one month of albendazole therapy. The importance of a multidisciplinary approach is highlighted, emphasizing collaboration among urologists, radiologists, and parasitologists for optimal outcomes. This case discussion contributes to the existing literature, providing insights into the management of this rare manifestation of echinococcosis.

Generalized peritonitis secondary to a renal forniceal rupture in an obstructed pelvic kidney - A case report.

Peritoneal fistulization of pyonephrosis is an uncommon condition, leading to a generalized peritonitis, considered as extreme life-threatening emergency. Secondary to an obstructive uropathy, increasing intra-renal pressure. In most cases, ureteral stones represent the underlying causes followed by stenosis, tumor, or connective tissue disease. Through this case report, we present a 60-year-old patient with a history of urolithiasis, admitted for an atypical instance of spontaneous renal pelvis rupture in an ectopic right kidney managed surgically. This case emphasizes the importance of considering renal etiology in cases of peritonitis and underscores the rarity of such occurrences.

Hybrid Management of a Wünderlich's Syndrome Secondary to a Giant Ruptured Renal Angiomyolipoma: A Case Report.

Wünderlich's syndrome, a rare and life-threatening condition involving spontaneous renal hemorrhage, is commonly associated with renal angiomyolipoma (rAML). Management options for rAML include surveillance, mTOR inhibitors, selective arterial embolization (SAE), and surgery. When complicated by Wünderlich's syndrome, prompt and adequate interventional treatment is necessary to prevent fatal outcomes. We present a unique case of a young female patient with Tuberous Sclerosis Complex who experienced a massive ruptured rAML, leading to Wünderlich's syndrome. Our approach involved a multidisciplinary hybrid strategy, combining SAE and nephrectomy, highlighting SAE's valuable role even when radical treatment is required.

Testicular lymphoma: Atypical presentation of acute scrotal swelling.

INTRODUCTION: Primary testicular lymphoma (PTL) rarely presents as acute scrotal swelling. It is a very aggressive form of extra nodal non-Hodgkin's lymphoma. It accounts for less than 9 % of all testicular tumours. There are limited data characterizing this entity and this case report aim to add to existing literature. CASE PRESENTATION: A 40-year-old patient, with a history of a pulmonary tuberculosis declared cured, presented a scrotal swelling that set rapidly in less than a week evolving in a context of weight loss and fever. The clinical examination was tender and hard on palpation while ultrasound revealed a suspicious oval formation not taking colour in Doppler. The patient underwent a right inguinal orchidectomy due to suspicious clinical presentation. CLINICAL DISCUSSION: MHNL are very rare causes of acute scrotal swelling representing approximately 1 %. It's an aggressive tumour and remains rare in young men. Diagnosis is purely histological. Standard treatment includes orchidectomy, chemotherapy with a poor prognosis. CONCLUSION: PTL can reoccur years after complete remission. It's related to an expression of diffuse lymphomatosis suggesting an aggressive approach. Its management is multidisciplinary based on the tumour's stage according to Ann Arbor classification.

Double-J placement complicated by endogenous endophthalmitis: A rare and serious outcome.

Endogenous endophthalmitis (EE) is a rare intraocular infection resulting from hematogenous microorganism spread, typically associated with underlying risk factors. We present a 52-year-old female with poorly-controlled diabetes and urolithiasis who developed EE following double-J stent placement for obstructive pyelonephritis. EE may occur due to increased intrarenal pressure during urological procedures. Timely recognition and intervention for rare complications like EE in urological patients are essential. This case highlights the importance of vigilance and collaboration between urologists and ophthalmologists in managing such cases.

Blepharoptosis revealing a metastatic renal cell carcinoma: A rare case report.

INTRODUCTION: Renal cell carcinoma (RCC) is a relatively rare malignancy often discovered incidentally. Approximately 15 % of cases are metastatic at diagnosis, commonly affecting the lungs, bones, lymph nodes, and liver. We present an exceptional case of RCC metastasizing to the eyelid. CASE PRESENTATION: A 67-year-old female with no prior cancer history exhibited rapidly progressing left blepharoptosis. Examination revealed a painless, solid eyelid mass. Immunohistochemistry of the eyelid mass biopsy identified a carcinoma potentially of renal origin. A thorax, abdomen, and pelvis CT scan confirmed the presence of a right renal mass. Following a multidisciplinary discussion, we decided to proceed with an upfront cytoreductive nephrectomy and surgical excision of the eyelid metastasis. DISCUSSION: Eyelid metastasis revealing a renal cell carcinoma is exceedingly rare. Immunohistochemistry plays a pivotal role in detecting primary renal tumors. Prognostic models, particularly the IMDC, guide therapeutic decisions. In the era of immune checkpoint inhibitors, cytoreductive nephrectomy remains a safe option for well-selected patients with favorable risk mRCC. CONCLUSION: Recognizing unusual metastatic sites of RCC is vital due to its asymptomatic nature and the potential impact of delayed diagnosis on prognosis. Immunohistochemistry plays a critical role in diagnosis. Multidisciplinary tumor board discussions are essential for tailored management of favorable risk mRCC patients.

Scrotal Trauma in a Hemophiliac: A Noisy Picture With a Minimalist Treatment.

Post-traumatic hematoma is often associated with severe, extensive injuries. In patients with blood coagulation disorders, hematoma can occur even after innocuous injuries. Among these coagulation disorders is hemophilia, an X-linked recessive disorder characterized by hemorrhagic manifestations. The aim of this article is to report a case of massive scrotal hematoma following trauma in a 24-year-old hemophiliac with no signs of severity who benefited from medical treatment with infusion of coagulation factors with a good clinico-biological evolution.

Emphysematous cystitis: A rare and life-threatening condition in patients with uncontrolled diabetes mellitus.

Emphysematous cystitis is a rare and potentially life-threatening condition characterized by gas formation within the bladder due to bacterial infection. This article presents a case study of emphysematous cystitis in a 74-year-old male patient with uncontrolled diabetes mellitus and recurrent urinary tract infections. The patient had lower abdominal pain, signs of infection, and urinary symptoms. Imaging revealed bladder wall thickening and gas bubbles. Prompt diagnosis and broad-spectrum antimicrobial therapy were initiated, with intensive care monitoring. After a 14-day treatment, significant improvement occurred, leading to the patient's discharge after 20 days. This case emphasizes early recognition and aggressive management for optimal outcomes.

Next generation sequencing identifies a pathogenic mutation of WFS1 gene in a Moroccan family with Wolfram syndrome: a case report.

BACKGROUND: Wolfram syndrome is a rare autosomal recessive neurodegenerative disorder that affects 1/200,000 to 1/1,000,000 children. It is characterized by juvenile onset diabetes, optic nerve atrophy and other systemic manifestations. Symptoms of the disease arise mostly in early childhood with a high mortality rate due to severe neurological complications. Two causative genes have been identifed in this syndrome; the classical form is caused by autosomal recessive mutations of the WFS1 gene, and a smaller portion of patients has mutations in the CIDS2 gene, which are responsible for autosomal recessive Wolfram syndrome 2. CASE PRESENTATION: We report the case of a 28-year-old Moroccan boy born from consanguineous parents referred to the department of medical genetics at the National Institute of Health in Rabat. The diagnosis of Wolfram syndrome was made based on insulin-dependent diabetes, optic nerve atrophy, sensorineural deafness, urological abnormalities and psychiatric illness. To establish the diagnosis at a molecular level, we performed next-generation sequencing in the index patient, which revealed compound heterozygous WFS1 mutations: c.1113G > A (p.Trp371Ter) and c.1223_1224insGGAACCACCTGGAGCCCTATGCCCATTT (p.Phe408fs). This second variant has never been described in patients with Wolfram syndrome. CONCLUSION: The identification of the genetic substrate in our patient confirmed the clinical diagnosis of Wolfram syndrome and allowed us to provide him an appropriate management and genetic counseling to his family.

Role of preoperative neutrophil to lymphocyte ratio in prediction of recurrence, progression, and BCG failure in non-muscle invasive bladder cancer: a retrospective study.

Introduction: neutrophil/lymphocyte ratio (NLR), as a biomarker of the systemic inflammatory response, has been studied for diverse tumors. Our study aims to determine whether the NLR can be reliably used as a tool to predict disease course in patients diagnosed with primary non-muscle invasive bladder tumors (NMIBC). Methods: a retrospective study between 2009 to 2014 was conducted on 300 patients newly diagnosed with NMIBC at our institution. The cut-off value of NLR was set at 2.5. Survival curves were compared using the log-rank test. The association between recurrence, progression, and NLR was assessed univariate, and the prognostic significance of high NLR was assessed using multivariate analysis. Results: one hundred and seventy-five patients had an NLR <2.5 and 125 patients had an NLR ≥ 2.5. The survival rate with recurrence at 5 years was higher in the group with an NLR >2.5 (p<0.001, 35 vs 18 months), similarly, the survival rate with progression at 5 years was higher in the group with an NLR > 2.5 (p=0.001, 36 vs. 27 months). The failure rate of immunotherapy using BCG was higher when the NLR was over 2.5. In a multivariate analysis, the factors associated with recurrence were NLR>2.5 (HR=2.03, 95% CI=1.32-3.11, p=0.001), pathologic stage pT1 (HR=2.42, 95% CI=1.52-3.85, p=0.001), high-grade (HR=1.76, 95% CI=1.52-3.92, p=0.01), concomitant CIS lesions (HR=2.31, 95% CI=1.36-3.92, p=0.001), presence of lymphovascular emboli (HR=5.77, 95% CI=1.77-18.78, p=0.004), and BCG immunotherapy failure (HR=5.29, 95% CI=2.88-9.70, p=0.001). With regard to progression, in a multivariate study, the significant factors were NLR>2.5(HR=2.91, 95% CI=1.17-7.23, p=0.01), BCG immunotherapy failure (HR=5.68, 95% CI=3.16-10.22, p=0.001), and the presence of lymphovascular emboli (HR=5.01, 95% CI=1.50-16.05, p=0.001). Conclusion: preoperative NLR value could predict recurrence, progression, and failure of BCG immunotherapy in NMIBC patients.

Secreting retroperitoneal latero-aortic paraganglioma revealed by acute abdominal pain: a case report.

We report the case of a retroperitoneal paraganglioma in a 35-year-old man discovered by abdominal pain. The abdomino-pelvic computed tomography (CT) showed a retro-peritoneal latero-aortic mass compatible with a paraganglioma, confirmed by the 24-hour urinary metanephrines and normetanephrines test. After an adequate pharmacological preparation, we decide to perform a laparoscopic resection of the paraganglioma. The surgery went without any complication. Blood pressure and urinary catecholamines were normal after the surgery. Our observation presents the particularity of the mode of discovery which is atypical, as well as the particularity of the therapeutic management, which is the laparoscopic resection of the mass.

[Thirty-nine cases of suburethral diverticula in women: 30 years single center experience]. / A propos de 39 cas de diverticules sous-urétraux de la femme: expérience monocentrique sur 30 ans.

We here report a retrospective analysis of 30 years´ experience with 39 female patients suffering from suburethral diverticula. The average age of patients was 37 years of age (24-56 years). The average parity was 2 (1-7); 65% of deliveries were complicated by dystocia, with forceps used in 43% of cases. All patients had a history of urological or gynaecological infections. The revealing symptoms were heterogeneous but recurrent urinary tract infections (26 cases), pollakiuria (23 cases), post-micturition urethral discharge (21 cases), vaginal pain (17 cases) and a sensation of vaginal bulge (15 cases) were mostly reported. Radiological assessment were performed, including intravenous urography, retrograde and micturition urethrography, ultrasound, or MRI. Transvaginal diverticulectomy was the treatment of choice for all patients, with no reported intraoperative complications. At 4 years of follow up outcome was satisfactory. Four patients developed recurrence of diverticulitis. These data provide important information about clinical features, diagnostic results and long-term outcomes of transvaginal diverticulectomy, enabling better management of this rare condition.