Life-threatening complication due to double-J stent: renal subcapsular hematoma.

The double-J ureteral stent is a standard procedure in daily urological practice. Although considered as safe, this approach is fraught with several complications. These complications are of limited severity and resolve with symptomatic treatment. In some cases, serious and life-threatening complications, such as infection and subcapsular hematoma, can occur. In the literature, a few cases of subcapsular renal hematoma secondary to ureteral stent insertion have been reported. Herein, we report a case of renal subcapsular hematoma combined with hemorrhagic shock in a 67-year-old patient who had a ureteral stent insertion one month ago.

Giant adrenal myelolipoma in a young female patient: a case report.

Myelolipoma is a rare, benign, non-secreting tumor and its pathophysiology is of metaplasia of the cells of the adrenal cortex into reticuloendothelial cells. Although they are often small and asymptomatic, some cases of giant adrenal myelolipoma cause symptoms such as chronic pain. Few cases of adrenal myelolipoma have been reported in the literature. We present a case of a large right adrenal myelolipoma in a 26-year-old female patient, who presented with an adrenal mass, and discuss the challenges of diagnosis and treatment.

Bladder carcinosarcoma with rhabdomyoblastic differentiation: a rare case report.

Carcinosarcoma is a distinct neoplasm consisting of bidirectional differentiation toward epithelial and mesenchymal cells. Bladder localization is rare and the association with a rahbdomyoblastic component is exceptional. Few cases of bladder carcinosarcoma with rhabdomyoblastic differentiation have been reported in the literature. We present a case of a bladder carcinosarcoma in a 68-year-old man who presented with terminal hematuria and discuss difficulties of diagnostic and treatment.

Bladder lymphoepithelioma-like carcinoma: a case report.

Bladder lymphoepithelioma-like carcinoma is a rare entity. It represents a particular variant of urothelial carcinoma characterized by an important infiltrating power. Therapeutic management of this cancer is not codified. Surgery associated with chemotherapy seems to be the best therapeutic option. Few cases of this tumor have been reported in the literature. We report a case of bladder lymphoepithelioma-like carcinoma in a 52-year-old patient who presented with gross hematuria and discusses difficulties of diagnostic and treatment.

Calcified double J stent removed at 10 years: a case report.

In our current practice, the use of JJ probes has become extremely frequent. However, incrustation and fragmentation of JJ leads are still relatively common and sometimes complicate removal. A 61-year-old woman with a history of hysterectomy ten years ago, she had a double J endo-ureteral stent for preoperative identification of the right ureter. The patient has forgotten the double J stent. She currently has right lower back pain and urinary tract symptoms of urinary. Uroscan revealed a very important right hydronephrosis, a fully calcified right double J stent with a calcification of 6 cm at the level of the lower loop. She had, at first, a cystotomy allowing the extraction of the lower part of the calcified stent and secondly a pyelotomy to extract the rest of the double J stent. The operative follow-up was simple. The use of a double J probe to divert the urinary tract is an effective and generally well tolerated technique. Regular monitoring prevents complications.

[Colorenal fistula complicating renal tuberculosis: a case report]. / Fistule réno-colique compliquant une tuberculose rénale: à propos d'un cas.

Urogenital tuberculosis is little suspected and known by clinicians. Colorenal fistulas, although rare, are complex forms of renal tuberculosis occurring in patients with advanced-stage disease. They generally occur in the ascending and descending colon. We here report the clinical case of a 58-year-old female patient presenting to the Emergency Department with severe acute left pyelonephritis. Abdominal CT scan objectified left pyonephrosis with left colorenal fistula. The patient had poor clinical, biological outcome despite resuscitation measures and antibiotic treatments. Urgent left nephrectomy was performed with disconnection and drainage of colorenal fistula. Histology showed renal tuberculosis. The patient received antibacillary drugs according to 2ERHZ/4RH guidelines. The treatment of this type of TB should be adequate to avoid recurrences that could be more complicated to manage.

A case report of testicular diffuse large B-cell malignant lymphoma with cutaneous metastasis: A rare entity.

INTRODUCTION AND IMPORTANCE: Primary testicular lymphoma (PTL) is a variety of extra-nodal lymphoma taking origin from testis. It accounts 5% of all testicular tumors. Metastasis may occur in contralateral testis, bone, central nervous system and rarely in skin. Herein, we present the case of testicular diffuse large B-cell malignant lymphoma with cutaneous metastasis. CASE PRESENTATION: A 60-year-old male presented with swollen painless solid right testis, with homolateral inguinal nodes. Testicular tumors markers were within normal range. Right radical orchidectomy was performed. Histopathological examination concluded to the diagnosis of Diffuse Large B Cell Lymphoma. Four weeks later, the patient presented alteration of general condition and multiples cutaneous centimetric lesions located in the right inguinal region. Biopsy of this lesion confirmed the diagnosis of metastases from the testicular lymphoma. The patient deceased three days later, before starting further treatment. CLINICAL DISCUSSION: Primary testicular lymphoma is a rare variety of testicular tumors. The prognosis is poor. Metastasis may occur in different sites such as contralateral testis, central nervous system, and skin. The prognosis is usually poor in the rare case of cutaneous metastasis. CONCLUSION: Primary testicular tumor is an aggressive rare variety of testicular tumors with poor prognosis. Cutaneous metastasis is rarely reported. Cutaneous lesions should be explored and suspected to be malignant. Early treatment with rapid multidisciplinary management is the key for adequate approach.

An unusual association of adenocarcinoma and isolated tuberculosis of prostate gland.

Adenocarcinoma of prostate is the most common primary prostatic malignancy in the world. Isolated prostate tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. We report two cases of adenocarcinoma and tuberculosis of the prostate. The patients were 83 and 74 years old, respectively. They presented obstructive and irritative symptoms of the lower urinary tract. The prostatic finding and prostate-specific antigen were abnormals. The diagnosis of prostatic tuberculosis and adenocarcinoma was made by histologic analysis after transurethral resection of prostate. The treatment is based on chemotherapy anti-tuberculosis and hormonotherapy. Tuberculosis and malignancy may co-exist in some cases and clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

Inguinal bladder hernia: a case report.

Inguinal hernia is a common disorder that requires urgent and adequate surgical management. Multiple organs may be associated with inguinal hernias, but bladder involvement is rarely seen. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or intravenous urography confirms the diagnosis. We report a case of inguinal hernia involving the bladder at the right side with a 72-year-old man. We performed a hernia repair after reintegration of the bladder.

Renal hydatidosis masquerading as xanthogranulomatous pyelonephritis: a new case report.

Human hydatid disease is still endemic in pastoral and rangeland areas, with temperate climate, mainly in the southern shore of the Mediterranean, particularly in the Maghreb countries. Renal localization is rare although it is the most frequent site of the urinary tract. Its clinical evolution remains silent for long time, and the diagnosis is often elusive for years. Renal hydatid cysts may pose a problem of differential diagnosis. Our case concerns a renal hydatidosis misdiagnosed as a xanthogranulomatous pyelonephritis, treated by total nephrectomy.

Xanthogranulomatous pyelonephritis presenting as a cystic mass: a rare case report.

Xanthogranulomatous pyelonephritis may, rarely, occur as a renal cystic mass. We report a case report of a 50-year-old with a history of medically treated renal lithiasis, who consults for left low back pain. Imaging findings concluded to a Bosniak type-3 hemorrhagic cystic mass of the left kidney. The diagnosis of xanthogranumolatous pyelonephritis on its focal form was made histologically. The diagnosis of xanthogranulomatous pyelonephritis is often difficult even with surgical findings and frequently a histological surprise. This points out the importance of identifying it in pre-operative staging; the diagnosis may be suggested by the association of chronic pyelonephritis, renal stones and hypovascular renal tumor syndrome without specificity at sonography and CT.

Sexual Function Outcomes After Surgical Treatment of Penile Fracture.

INTRODUCTION: Penile fracture is a urologic emergency and is defined as the rupture of the tunica albuginea of the cavernous body in erection. AIM: Our study aims to evaluate patients with penile fracture and to identify the factors that may influence the sexual function after surgical repair. METHODS: A total of 138 patients who were diagnosed with penile fracture between January, 1999 and December, 2018 were reviewed. Clinical features, perioperative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed. MAIN OUTCOME MEASURES: Sexual function was evaluated by three parameters six months after surgical repair: International Index of Erectile Function-5 (IIEF-5) questionnaire, penile curvature and the presence of a painful intercourse. All factors that could potentially influence these parameters were analyzed. RESULTS: The mean age was 31.2 years (19-55). Presentation delay ranged from 1 to 5 days (mean = 16.8 hours) while surgery delay was 14.3 hours ().The most common cause of penile fracture in our patients was forcefully bending of the erect penis to achieve detumescence in 62 cases (44.9%). On multivariate analysis, we found that the presentation delay and the fracture site located in the proximal shaft of the penis showed significant difference in the occurrence of postoperative ED (P = 0.03 and P = 0.015 respectively). Presentation delay, elective incision and tuncial leak located in the proximal shaft (P = 0.045; P = 0.018 and P = 0.022 respectively) were associated with higher penis curvature. CONCLUSION: Immediate surgical repair and circumferential degloving incision for tunical leaks located in the proximal shaft of the penis are recommended in order to decrease the incidence of ED after surgical repair of penile fractures. Ouanes Y, Saadi MH, Alouene HH, et al. Sexual Function Outcomes After Surgical Treatment of Penile Fracture. Sex Med 2021;9:100353.

Symptomatic bladder metastasis of malignant melanoma: a case report.

Bladder metastasis of cutaneous malignant melanoma is an extremely rare condition, with less than 10 cases reported in the last 30 years in the English literature. Bladder localization is most often asymptomatic, explaining the frequency of cases discovered during autopsy in multi-metastatic patients. We report a case of symptomatic malignant melanoma metastasis to the bladder in a 31-year-old patient.

A case report of prostate cancer presenting as a symptomatic pelvic mass mimicking lymphoma.

INTRODUCTION: Metastatic prostate cancer is a relatively common condition in elderly men. The aim of this paper is to report a rare case of metastatic prostate cancer presenting as a large pelvic mass mimicking lymphoma and to discuss its management. PRESENTATION OF CASE: An 85-year-old patient was complaining of lower urinary tract symptoms, and significant pelvic swelling. On physical examination, a 15-cm pelvic mass and lumpy prostate were found. Laboratory investigations revealed elevated PSA levels (PSA=300g/mL). CT scan showed a large lobulated necrotic pelvic mass and multiple swollen lymphnodes. The diagnosis of an atypical pelvic lymphoma associated with a metastatic prostate cancer was first evoked. An ultrasonography-guided biopsy of the mass was carried. The immunohistochemical study confirmed prostate adenocarcinoma. A bilateral orchiectomy was performed. A follow up of 3 months showed a decrease of PSA without shrinkage of the mass. DISCUSSION: A metastatic prostate cancer presenting as a compressive pelvic mass mimicking other diagnosis such as lymphomas, is a rare circumstance of discovery. In our case, atypical pelvic lymphoma was evoked based on the association of multiple retroperitoneal enlarged lymphnodes. Histological findings of the biopsy rectified the diagnosis and confirmed prostate adenocarcinoma. The main treatment for such metastatic prostate cancers remains hormone therapy. Some authors reported external beam radiotherapy in order to reduce prostate volume. CONCLUSION: Prostate cancer should be considered in the assessment of large pelvic masses. Digital rectal examination and testing PSA levels can lead to the diagnosis. After histological confirmation, the androgen deprivation is the main treatment.

Unexpected skin lesions secondary to metastasis of urothelial carcinoma.

INTRODUCTION: Metastatic spread of urothelial bladder carcinoma (UBC) rarely involves the skin which is associated with a poor prognosis. We present a rare case of UBC with cutaneous metastases which is exceptional by its inflammatory clinical form. PRESENTATION OF CASE: A 62-year-old male was diagnosed with a non-metastatic muscle invasive transitional cell bladder carcinoma invading the anterior wall of the rectum. Cisplatin-based chemotherapy was indicated but refused by the patient. Three months later, he developed cutaneous lesions in the left axilla and the right inguinal fold. These lesions were budding, nodular and inflammatory corresponding to carcinomatous metastasis on skin biopsy which urothelial origin was confirmed by immunohistochemical analysis. The patient died four weeks later after multi-organ failure. DISCUSSION: Skin metastasis of transitional cell carcinoma of the bladder are uncommon, representing 0.84% of all cutaneous metastases. The inflammatory presentation, as seen in our case, is rarer than the other types and is usually due to a lymphatic extension. The clinical appearance of cutaneous metastases might mimic other common dermatologic disorders; Thus, diagnosis requires histological confirmation by microscopic examination and immunohistochemical study of a skin biopsy. The prognosis after the appearance of cutaneous metastases is generally poor with a median disease-specific survival of less than 12 months Treatment is palliative and is principally based on chemotherapy, analgesics and psychological support. CONCLUSION: Cutaneous metastases secondary to urothelial bladder carcinoma are exceptional especially in its inflammatory presentation. Diagnosis is based on immunohistochemical study. Treatment is based on chemotherapy and the prognosis is poor.

[Evaluation of protocols on the use of analgesics for pain management in patients with extracorporeal shock wave lithotripsy (ESWL)]. / Evaluation des protocoles analgésiques pour la prise en charge de la douleur au cours de la lithotripsie extra corporelle.

Extracorporeal shock wave lithotripsy-related pain is the largest limiting factor in this technique. Our study aimed to compare the effectiveness of different types of analgesics for pain management used during ESWL sessions. We conducted a prospective study of 300 patients with urinary lithiasis justifying ESWL treatment. The patients were randomized to three groups: group I, included 100 patients who received intramuscular injection of 2cc of physiological saline solution (placebo), group II included 100 patients who received intramuscular injection of ketoprofen 100mg while group III included 100 patients who received lidocaine and prilocaine topical cream. Visual Analog Scale (VAS) was used to assess pain 10 minutes after and at the end of the session. Mean VAS score 10 minutes after and at the end of ESWL session was 3.7 and 4.91 respectively. There was no significant difference among the three groups with respect to: epidemiological data (age, sex, BMI, patient's history) and the characteristics of the renal stone (side, size, location, presence or not of double-J ureteral catheter). Eleven patients in the Group I terminated treatment early, with a significant difference compared to the other groups (p=0.003). VAS score 10 minutes after and at the end of ESWL session was statistically higher in Group I compared to Groups II and III (p < 0.001). Moreover, ESWL session was significantly more effective in Groups (II and III) compared to Group I (p<0.001). Pain treatment is necessary during ESWL sessions. Two painkillers molecules were assessed, which showed good pain control as well as an increase in the effectiveness of lithotripsy.