The current state of prostate cancer in Antigua & Barbuda-2021.

Antigua and Barbuda is a twin-island nation within the Caribbean where the men are predominantly of African descent. The burden of prostate cancer is therefore expected to be similar to regional counterparts. There has been very little research done on prostate cancer in this nation. Few published peer-reviewed and non-peer reviewed documents exist to guide prostate cancer management and policy. A review of the available literature and the author's experience managing prostate cancer in the country was used to provide a synopsis of prostate cancer management in the country. All aspects of the prostate cancer care pathway exist in Antigua and Barbuda from public awareness and screening campaigns to external beam radiotherapy, abiraterone acetate and hospice care. There are still limitations to accessing some aspects of the care pathway such as prostate biopsies, radical prostatectomies and newer imaging modalities for staging. Data collection and analysis will help to provide objective and quantitative evidence of the nation's prostate cancer management capabilities. Other developing nations will face many of the same challenges managing prostate and other cancers and this shared experience may be particularly useful for comparing and contrasting purposes. It also provides a documented milestone on which future plans can be made to improve care and shape national policy.

Open Pyelolithotomy in the Presence of a Retro-Renal Colon: A Safe Alternative in Resource-Limited Settings.

A retro-renal colon (RRC) is a rare but important anatomical variant to consider when planning percutaneous stone surgery. CT scanning of the abdomen is critical to detect this and to plan the surgical approach to avoid injury to the colon. In this case report, a 38-year-old woman with large obstructing bilateral symptomatic renal stones was found to have a left retro-renal colon on image review prior to left percutaneous nephrolithotomy. An open pyelolithotomy was performed to surgically remove the stone and to prevent any injury to the colon. An RRC can occur in up to 16% of patients undergoing percutaneous renal access. A CT scan is important to rule out this anatomical variant and to allow for surgical planning to avoid injury to the colon. The modern era of endourology has brought a significant reduction in open stone surgery. An open pyelolithotomy is still a safe option for stone removal if an RRC is detected preoperatively. Injury to the colon during percutaneous access can most commonly be managed conservatively. Occasionally open intervention may be required. An RRC detected on a preoperative CT scan may influence surgical planning and an open pyelolithotomy can be performed to safely remove renal stones and prevent colonic injury, especially in resource-limited settings.

Malignant transformation of a urachal cyst-a case report and literature review.

Urachal remnant diseases are very uncommon pathologies which are mostly benign. Rarely they can progress to a very aggressive form of Urachal cancer. The rarity of this condition has precluded large studies to help guide the diagnostic and therapeutic management of these potentially malignant lesions. In this case, a urachal cyst was discovered and conservative management was employed after a biopsy proved the lesion was benign. Unfortunately this patient represented several years later with a locally advanced urachal cancer. To date, this is the first clearly documented case of malignant transformation. The available literature surrounding these urachal cysts and cancers will be reviewed to determine if anything could have been done differently in this case and in the future should a similar case present.

The role of the multiparametric MRI in the diagnosis of prostate cancer in biopsy-naïve men.

PURPOSE OF REVIEW: To review the role of prebiopsy multiparametric MRI in biopsy-naïve men for the detection of clinically significant prostate cancer. RECENT FINDINGS: Recent level 1 evidence shows that multiparametric MRI has high sensitivity and negative predictive value for the detection of clinically significant prostate cancer in biopsy-naïve men. Concurrent developments include important work in the standardization of MRI reporting. The low specificity and positive predictive value of MRI means that biopsy is still necessary following MRI. MRI-targeted prostate biopsy has emerged as an alternative diagnostic test to transrectal ultrasound guided prostate biopsy, though its exact role in biopsy-naïve men and the optimal technique remain to be defined. SUMMARY: There is the potential for MRI to be used as a triage test to allow a proportion of men to avoid biopsy and remain on prostate-specific antigen surveillance. MRI-suspicious areas can be sampled more intensively using MRI-targeted biopsy that can be carried out in a variety of ways. Future work should focus on the cost-effectiveness of introducing a prebiopsy MRI pathway in biopsy-naïve men and addressing the training needs for such a change. VIDEO ABSTRACT: http://links.lww.com/COU/A11.

Epididymo-orchitis causing testicular infarction: a serious complication of a common disorder.

One of the most common differentials for the acute scrotum is an epididymo-orchitis (EO), which can mimic the presentation of testicular torsion. We present a case of a 37-year-old man presented to the Emergency department with a 3-day history of progressive left testicular pain. A Doppler ultrasound was done which revealed increased flow to the left testicle with no evidence of testicular torsion and he was discharged. He was re-admitted with worsening pain and a repeat scan showed that the penile arterial diastolic flow had reversed, indicating testicular infarction. This was confirmed at exploration and an orchidectomy was performed. EO causing severe complications is an uncommon manifestation of a common disorder. Features suggesting a lack of response to antibiotics include sepsis, pronounced scrotal oedema, severe testicular pain and scrotal wall inflammation. The presence of a positive urine culture has also been highlighted as a poor prognostic factor.