Persistant Mullerian duct syndrome with intra-abdominal seminoma.

Persistent Mullerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism; it is defined by the presence of the Mullerian duct derivatives (the uterus, the fallopian tubes, and the upper vagina) in genotypically and phenotypically males. Seminoma is the most common type of testicular tumor in the third and fourth decade of life. We report a case of intra-abdominal seminoma in a patient with bilateral undescended testes and persistent Mullerian duct syndrome.

Management of Idiopathic Retroperitoneal Fibrosis, a Retrospective Study at Prince Hussein Urology and Organ transplantation center (PHUO), Jordan.

INTRODUCTION: to study the presentation, clinical course, laboratoryresults, imaging findings, medical and urological treatments ofidiopathic retroperitoneal fibrosis at our institution. METHODS: Between January 2006 and December 2017, medical recordsand operatives' notes of 116 patients with idiopathic retroperitonealfibrosis (IPRF) were reviewed retrospectively. Diagnosis was doneby clinical and radiological imaging that fulfilled a strict criterion.All patients were initiated on Prednisolone 60 mg for two months,and reduced until reaching 10 mg daily, with a total duration of24 months in the responding patients. Renal drainage was done incases of obstructed kidneys. To assess response, both laboratoryresults and imaging studies at initiation and after 4 months werereviewed and compared. RESULTS: Of 116 patients diagnosed with IRPF, eighty five (73.3%)were male and thirty one (26.7%) female, with mean ± SD age atpresentation was (50.5 ± 10.6) years. 79% of the patients complaintof abdominal and low back pain, 27% uremic symptoms, 10.3% hada new onset of hypertension, 3.4% presented with anejaculation,and 13.8% were totally asymptomatic. Uretric obstruction hadbeen resolved in 132 ureters after a mean of 152 days of treatment.Almost 30 % reduction in the fibrotic mass size was achieved in82 % of patients. CONCLUSION: Glucocorticoids is the the mainstay of treatment. Therenal function tests, of the vast majority of patients, normalizedwith treatment. Relapse may occur, so a follow-up over a longperiod of time is required. A high index of suspicion is neededfor diagnosis in asymptomatic patients.

Monopolar transurethral resection of the big prostate, experience at Prince Hussein Bin Abdullah Urology Center.

OBJECTIVE: To evaluate and review our experience in management of patients with big size prostate using monopolar transurethral resection of the prostate (TURP). METHODS: Between January 2005 and March 2010, TURP was performed on 198 patients with prostate size between 80 and 120 grams. The patients were subjected to standard urologic pre-operative evaluation and they were given 5 alpha reductase inhibitor for two weeks before surgery. TURP was performed using 27F continuous-flow resectoscope, Otis urethrotomy and suction cystostomy were done, and 500 ml normal saline with 20mg furosomide was given intraoperatively. Catheterization time, hospital stay, peri-operative and late complications were recorded. All patients were seen at 6 weeks and 6 months post surgery in the outpatient clinic. Symptoms and complications were evaluated and histopathological diagnoses were recorded. RESULTS: The mean age was 67 +/- 3.7 years (range 57-80 years). Of these, 102 patients presented with retention and obstructive uropathy, 36 with recurrent haematuria, 12 with urinary bladder stones, 11 with recurrent urinary tract infection and 37 patients with moderate to severe international prostate symptom score (IPSS) and not responding to medical treatment. The mean prostate volume was 88 +/- 8.22 grams (range 80-120 grams) with an average residual urine of 160 ml (range 20-1500 ml). The mean Qmax was 6.8 +/- 1.7 ml/sec (range 2.1-11.7 ml/sec) and the mean IPSS score was 20.2 +/- 6.2 (range 15-30). The average operative time was 72 +/- 6.2 minutes (range 58-92 minutes). The mean drop in haemoglobin was 3.2 +/- 0.6 mg/dl (range 2.1-6.1 mg/dl) and immediate post-operative mean sodium drop was 3 +/- 1.36 mmol/l (range 0.9-13 mmol/l). Blood transfusion was needed in 17 patients (8.6%), two patients developed TURP syndrome (1%), and clot retention occurred in two patients (1%). The average time of hospital stay was 2.3 +/- 0.25 days, catheterization time was 48-72 hours, and re-catheterization was needed in three patients (1.5%). The mean IPSS score six weeks after surgery was 9.9 +/- 1.7 (range 6-21) and the mean Qmax was 18.1 +/- 2.1 ml/sec (range 6-22). Urethral stricture and bladder neck contracture occurred in 12 and 3 patients respectively (6 and 1.5%). Completion TURP was needed in four patients (2%). CONCLUSIONS: Standard monopolar TURP with some modification in resection technique in addition to perioperative care will allow the urologist to treat benign prostate hyperplasia with prostate size between 80-120 grams successfully in centers where new laser technology is not available.

Sonographic spectrum of scrotal abnormalities in infertile men.

PURPOSE: To use sonography to detect scrotal abnormalities in infertile men. MATERIAL AND METHODS: Two hundred thirty-four infertile men, including 176 oligospermic (sperm count < 10 x 10(6)/ml), 58 azoospermic, and 150 normospermic men (control group) were evaluated prospectively for the presence of intra- and extratesticular abnormalities using high-frequency transducers and color Doppler imaging. Medical and surgical history, testicular volume, semen parameters, and hormonal levels were recorded. RESULTS: A statistically significant increase in the prevalence of abnormal scrotal findings detected with sonography was observed in the study group compared with controls. These included varicocele in 35.5% versus 16% (p < 0.01), hydrocele in 16.7% versus 8.7% (p < 0.05), testicular microlithiasis in 9.8% versus 2% (p < 0.01), epididymal enlargement in 9% versus 2.6% (p < 0.05), and epididymal cyst in 7.7% versus 2% (p < 0.05). Testicular tumor was not seen in either group. A statistically significant decrease in testicular volume, sperm concentration, normal morphology, and forward motility of the sperm was noted in the study group compared with controls (p < 0.01). CONCLUSION: The various intra- and extratesticular abnormalities were demonstrated in infertile men. Sonography should be used routinely in the work-up of male infertility.

Isolated renal hydatid disease: experience at the queen rania urology center, the king hussein medical center.

In this retrospective study, we present our experience on the diagnosis and management of isolated Hydatid disease of the kidneys. Between January 1999 and January 2003, eight patients were diagnosed to have Hydatid disease of the kidney and constituted the subjects of this study. Their age ranged between 20 and 63 years age (mean 40); there were five males and three females. Loin pain was the commonest mode of presentation in these patients. Investigations performed included urine analysis, serological tests, eosinophil count and relevant radiological studies. Urine analysis showed hydatiduria in one patient, the Casoni's test was positive in two, Ghedini skin test was positive in three and eosinophilia was noted in two other patients. All patients were treated surgically using loin supracostal extra-peritoneal approach. Total nephrectomy was performed in five patients, partial nephrectomy in one while excision of the cyst was performed in two patients. Our report suggests that a combination of various investigative modalities with a high index of suspicion is necessary in establishing the correct diagnosis. Surgery remains the main option of treatment for renal hydatid disease.