Delayed surgical repair in double penile fracture: Insights and outcomes: A case report.

INTRODUCTION AND IMPORTANCE: Penile fractures, though rare, demand urgent surgical attention due to their potentially severe consequences. This case report illustrates the significance of prompt and comprehensive imaging with surgical exploration in managing a delayed presentation of a double penile fracture. CASE PRESENTATION: A 27-year-old male sustained a penile injury during sleep, presenting to our department 36 h post-trauma. His clinical symptoms included significant penile swelling, deviation, and the characteristic 'eggplant' deformity. Ultrasonography revealed extensive subcutaneous edema and a substantial hematoma at the penile base, with a disruption in the tunica albuginea. Surgical exploration identified two distinct fractures in the corpora cavernosa, which were successfully repaired. The patient experienced a rapid and complication-free recovery, regaining full erectile function within four days. CLINICAL DISCUSSION: This case underlines the anatomical complexity of penile fractures. Despite the delay in seeking medical attention, the outcome was favorable, challenging the notion that immediate surgery is crucial for avoiding long-term complications. The literature suggests that delayed surgery might not significantly impact long-term outcomes, especially in the absence of urethral involvement, a perspective supported by our case findings. CONCLUSION: Penile fracture requires a nuanced approach to diagnosis and treatment. The case demonstrates that while immediate surgical intervention is ideal, delayed repair can also result in positive outcomes under certain conditions. This report contributes to the growing body of evidence suggesting the potential for re-evaluating current clinical guidelines for penile fracture management.

Isolated Penile Fournier's gangrene: A very rare entity.

Comparatively to scrotal gangrene, isolated penile gangrene is very rare due to the rich blood supply of the organ. It is thought to be initiated by a traumatic or vascular insult to the penis. This condition requires parenteral antibiotic therapy and serial debridement of necrotic tissue. Split thickness skin graft is thought to be the best approach to cover penile skin loss. We share our experience on the presentation of an isolated penile gangrene in a 35-year-old male. In the light of this case, we review the predisposing factors and the management of this entity.

Unusual presentations of urogenital tuberculosis.

Urogenital tuberculosis is a rare and severe disease since it causes serious consequences. Often, diagnosis may be delayed because of its multiple presentation forms and clinical features. Usually, the recognition is easy to hold, but in certain cases the presentation form can be misleading which can exclude the diagnosis. We present two cases of unusual form of urogenital tuberculosis from which clinical features were taken for a malignant cancer at the beginning. The first case is about a young woman with renal lesions then proceeding to radical nephrectomy. The second case is about a 48 years old patient who had a radical cystectomy to treat an urothelial carcinoma (classified as pT1G3) along with squamous metaplasia (25 %). In both cases, the histologic investigation revealed the presence of a granulomatous reaction with giant cells and caseous necrosis which confirms the diagnosis of tuberculosis. Through the study of these two cases and literature review, we mark the different diagnosis and treatment difficulties handling these unusual presentation forms.

Predictive factors of bleeding and fever after percutaneous nephrolithotomy.

AIM: Percutaneous nephrolithotomy (PCNL) remains the standard procedure for large (≥2 cm) renal calculi; however, up to one quarter of PCNL patients experience some perioperative complications. The aim of the present study was to investigate the factors that may influence bleeding and fever following percutaneous nephrolithotomy. METHODS: In total, 170 patients, who underwent percutaneous nephrolithotomy between January 2012 and January 2016 in our Urology department, were retrospectively evaluated for postoperative bleeding and fever. Preoperative, operative and postoperative factors were assessed using univariate followed by multivariate regression. RESULTS: The mean patient age was 49.41 ± 15.07 years (14-83). The overall stone-free rate was 83.5%. We recorded 48 postoperative complications (28.2%): 34 cases of fever and 14 cases of bleeding. Univariate analyses showed an association between diabetes and postoperative bleeding (p=0.002). Staghorn calculus (p=0.0001), prone position (p=0.009), operative time (p=0.0001) and presence of residual stones ≥  7 mm were associated to postoperative fever (p=0.01). Multivariate stepwise regression analyses showed that diabetes was the only independent predictive factor of postoperative bleeding (OR=7.6). Staghorn lithiasis (OR=5.9), prone position (OR=3.7) and operative time > 95 minutes (OR=6.2) were the predictive factors of postoperative fever. CONCLUSIONS: To our knowledge, this study is the first to report that prone position was significantly associated with fever after percutaneous nephrolithotomy. Further studies are necessary to confirm our results in a greater number of patients.

Giant urethral diverticulum calculus revealed by peri-urethral abscess.

Urethral diverticulum of the male is uncommon. We report a case of bulbar urethraldiverticulum with contained giant calculus presenting as left inguino-scrotal swellingsecondary to peri-urethral abscess in a 40 year-old male. In the light of this case Weemphasize the importance of investigation for the presence of urethral diverticulum in youngmale individuals presenting with voiding disturbances to preventrelated complications.

Training of Tunisian future urologists: how to improve it ?

BACKGROUND: The lack of continuous evaluation of training tools in medicine, especially in developing countries, represents a brake to the development of the latter. AIM: To establish an inventory of the training facilities available to residents in urology in Tunisia, to assess their satisfaction and their expectations, and to propose solutions to improve residents training. METHODS: An anonymous questionnaire was sent by E-mail in 2015 to all residents in urology in Tunisia. The questionnaire addressed demographic characteristics, educational resources used and desired, the current medical and university curriculum and evaluation of the training. RESULTS: Among 33 residents, 66.6% responded to the survey. Medical staff, courses organized by the national college of urology, reading french-language articles and daily activity in operating room were the most used pedagogic resources. Training was judged unsatisfactory by 59.1% of respondents because of a lack of theoretical training in 18.1% of cases, a lack of practical training in 13.6% of cases and both of them in 27.2% of cases. Training on animals and simulator, creation of an educational booklet, use of online course materials, and the institution of a mentoring process during residency were rated favorable by the majority of respondents. CONCLUSION: The majority of residents in urology in Tunisia believe their training is unsatisfactory. The E-learning, improved access to surgical training in animals and simulator, better information on existing resources and strengthening of companionship through tutoring should enhance satisfaction.

Testicular torsion in undescended testis: A persistent challenge.

OBJECTIVE: To evaluate the management and outcomes of patients who presented with torsion of an undescended testis and review the reported series in the literature. METHODS: The case records of 13 patients operated for testicular torsion involving undescended testis were retrospectively reviewed. The medical records included age at presentation, medical history, physical examination, operative findings and the results of follow-up. The diagnosis of torsion of undescended testis was made clinically and confirmed by inguinal exploration. RESULTS: In six cases the testis was preserved and orchiopexy was performed, while in seven cases orchidectomy was performed due to testicular gangrene in six patients and testicular tumor discovered peroperatively in one case. Mean duration of symptoms at time of surgery in the orchiopexy group was 6.5 h and in the orchidectomy group was 21.2 h. From six patients treated by orchiopexy, two patients suffered from testicular atrophy at a mean of 24 months. CONCLUSION: Testicular torsion in undescended testis is still diagnosed with delay which may affect testicular salvage. The importance of examination of external genital organs is highlighted which should be routinely included by emergency physicians in physical examination for abdominal or groin pain.

Testicular tumors of adrenogenital syndrome: From physiopathology to therapy.

Testicular tumor of adrenogenital syndrome is a rare and benign anomaly usually presenting as bilateral testicular masses. It is the most important cause of infertility in adult male congenital adrenal hyperplasia. Distinction between testicular tumors of adrenogenital syndrome and Leydig cell tumors can be problematic; it is based on clinical, histopathologic, immunohistochemical and endocrine features. Biopsy is advised in cases of longstanding tumors in infertile patients and when surgery is indicated. Fertility preservation is a key management goal in testicular tumor of adrenogenital syndrome. In stages 2 and 3, intensified glucocorticoid treatment is recommended as a first step treatment. Sparing surgical approach is preferred for tumors of stage 4 and steroid unresponsive masses. Magnetic resonance imaging is recommended before surgery. The only indication of surgery in stage 5 is testicular pain.

Spontaneous rupture into the peritoneal cavity: Unusual presentation of prostatic abscess.

INTRODUCTION: Prostatic abscess is a rare but relatively serious infectious disease; its association with spontaneous rupture is extremely unusual. PRESENTATION OF CASE: We present a case of peritonitis secondary to a rupture of prostatic abscess in a 87-year-old man. The diagnosis was made on computed tomography. Emergency laparotomy, transrectal ultrasonography guided aspiration of the residual abscess and antibiotics permitted a full recovery. DISCUSSION: Delay in diagnosis of prostatic abscess can have grave sequelae, including spontaneous rupture into the urethra, perineum, bladder or rectum and the development of septic shock. Only one case of spontaneous rupture into the peritoneal cavity has been reported in the literature. CONCLUSION: This case highlights the importance of early diagnosis of prostatic abscess and close monitoring of patients, with diabetes or immunosuppression, treated for acute prostatitis.

[Not Available]. / Les torsions sur testicules cryptorchides.

PURPOSE: Cryptorchidism is a rather frequent pathology in urology. It is associated with a high risk of infertility and degeneration. It also seems to be associated with a high risk of torsion. This entity is poorly studied in the literature. We studied the cases of torsion on cryptorchid testicles hospitalized at our service, to better characterize this pathology and reduce the rate of orchidectomy. METHODS: We underwent a retrospective study of all the cases of torsion on a cryptorchid testicle hospitalized in our service of urology between 1999 and 2007. RESULTS: The age of patients was between 7 months and 39 years. Torsion touched the right testicle in 53% of the cases. Patients experienced a brutal pain of the inguinal area with an under cutaneous mass inflammatory and a painful and empty homolateral scrotum. In 60% of the cases, the diagnosis was late and an orchidectomy was carried out. In the other cases, a lowering of the testicle was done with the controlateral orchidopexy. CONCLUSION: Even though torsions on a cryptorchid testicle are rare, we should not ignore them. The early diagnosis will make it possible to save and lower the testicle, and track a possible degeneration.

[Scrotal elephantiasis]. / L'éléphantiasis scrotal.

Scrotal elephantiasis (scrotal lymphoedema) is essentially observed in filaria endemic zones. It is very rare outside of these zones and is usually idiopathic, and rarely congenital or secondary. The authors report two cases of scrotal elephantiasis treated by wide resection of the pathological scrotal wall and penoscrotal repair with a good functional and cosmetic result.