Unilateral Testicular Infarction a Very Rare Complication of Genital Tuberculosis: A Case Report and Literature Review.

Background: Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis in developing countries. Isolated genital TB is rare, but testicular infarction is an unusual complication of delayed management, in which surgical intervention is warranted. Case Presentation: A 29-year-old male non-smoker presents with painful left scrotal pain of 21 days. Initially managed with intravenous antibiotics, the disease progressed and resulted in testicular infarction. Left orchiectomy was performed, and the specimen was sent for histopathological examination, which revealed features consistent with a testicular tuberculous abscess. Conclusion: Tuberculous epididymo-orchitis (TBEO) with testicular infarction was unusual. It is prudent to consider this in patients presenting with long-standing urinary symptoms, particularly in those unresponsive to the initial antibiotic therapy. It requires a high index of suspicion, especially in TB endemic areas.

Pilimiction, a Rare Presentation of Ovarian Teratoma: A Case Report.

Background: Adnexal teratoma involving the urinary bladder is a very rare condition. Presentation is variable ranging from irritative LUTS (lower urinary tract symptoms) to pilimiction or trichiuria (passage of hair in the urine). Case Presentation: We report a case of a 42-year-old woman who presented with pilimiction and lower abdominal pain. Contrast-enhanced computed tomography scan (CECT) and cystoscopy were used for the diagnosis. Tumor markers were negative. Right side salpingo-oophorectomy and partial bladder wall excision were performed. Histopathology of the specimen showed features consistent with mature teratoma. The patient reported improvement of symptoms in the subsequent follow-up visits. Conclusion: Pilimiction is a pathognomonic sign of bladder teratomas. This case represents a rare complication of ovarian teratoma. Therefore, a high index of suspicion is required in patients with ovarian teratoma presenting with urinary complaints. Transurethral resection is associated with a high recurrence rate and is not recommended for secondary bladder teratomas.

Bilaterally Fused Supernumerary Kidneys: A Very Rare Case Report and Review of Literature.

Supernumerary kidney is a rare anomaly of number where commonly a third extra kidney exists with its own collecting system, blood supply, and encapsulated parenchyma. However, an extremely rare and unique diagnosis of bilateral supernumerary kidneys is also reported in few instances where two extra kidneys exist on each side of the body. Parenchymal fusion and the presence of good excretory function make the supernumerary kidneys even rarer as many of the reported cases are rudimentary organs. We present a 35-year-old man with a sudden onset of agonizing right flank pain and tenderness. Radiologic assessment with computed tomography showed bilaterally fussed and malrotated supernumerary kidneys with an obstructive stone and good contrast uptake. The patient has four fully functional kidneys (two on each side) with their own arterial supply, venous drainage, collecting system and incompletely duplicated ureters bilaterally. An open pyelolithotomy is performed to relieve pain and hydronephrosis. The patient's symptoms improved after surgery and during subsequent follow-up.

Emergency Decompression of Obstructive Uropathy Using Percutaneous Nephrostomy: Disease Pattern and Treatment Outcome at Two Urology Centers in Ethiopia.

PURPOSE: Obstructive uropathy (OU) is a potentially life-threatening urologic emergency that requires urgent decompression. Percutaneous nephrostomy (PCN) is a commonly performed procedure to decompress OU. The objective of this study is to assess disease patterns and treatment outcome at two urologic centers in Ethiopia. METHODS: A cross-sectional study was conducted on 110 patients who underwent emergency PCN from October 1, 2019 to September 30, 2020. Data were collected by a retrospective chart review. SPSS 25 was used for analysis. Descriptive statistics and logistic regression were utilized to assess disease pattern and significant predictors. A p-value of <0.05 on multivariate logistic regression was considered statistically significant. RESULTS: Females accounted for 70% of cases and mean age at presentation was 48 ± 12.9 years. Bilateral OU was diagnosed in 60% of patients and 77.3% of obstructions occurred at the level of the ureter. Malignancies were diagnosed in >80% of patients among which cervical cancer was the commonest (37.3%) followed by bladder cancer (17.3%). Acute kidney injury (AKI) accounted for 70% of the presenting indications for PCN. Success rate after emergency PCN was 75.5% and 41.8% of the cases developed post-procedure complications. Factors that predicted successful outcome include male gender [AOR = 5.72 (1.13-28.92), 95% CI; p = 0.035], severe hydronephrosis pre-operatively [AOR = 7.12 (1.32-38.45), 95% CI; p = 0.022], and use of combined imaging (ultrasound and fluoroscope) to guide PCN [AOR = 12.91 (1.13-46.54), 95% CI; p = 0.039]. On the other hand, postoperative complication is a negative predictor [AOR = 0.26 (0.08-0.86), 95% CI; p = 0.027]. CONCLUSION: In this study, overall success of emergency PCN is low. Presence of severe hydronephrosis predicts technical ease and better outcome of PCN. Procedures performed under ultrasound and fluoroscope guidance also improve outcome. Postoperative complication rate is high in this study and mandates strict preventive measures as it predicts unfavorable outcome.

Giant bladder stone resulting in acute kidney injury; A case report and review of literature.

A giant bladder stone is very rare in adults. We report a case of giant bladder stone causing acute kidney injury in a 23-year-old male, who presented with lower urinary tract symptoms (LUTS) characterized by both irritative and obstructive LUTS. In addition, he also had episodes of reddish urine for the past decade. A non-contrast-enhanced CT scan was used for the diagnosis. Open cystolithotomy was performed and a 500g weighing stone was removed. He developed a superficial surgical site infection which was treated with wound care. He was discharged improved. Improvement in symptoms and serum creatinine was noted on follow-up.

Giant hydronephrosis secondary to ureteropelvic junction obstruction, a rare occurrence, case report.

Giant hydronephrosis (GH) is very rare in adults. We report a case of a 46-year-old man who presented with progressively increasing abdominal swelling. A contrast-enhanced CT scan of the abdomen and pelvis was used for the diagnosis. Left side open nephrectomy was performed and 22 L fluid was evacuated. UPJ obstruction was noted intraoperatively. No recurrence of abdominal swelling was noted on follow up examination.

Fused Supernumerary Kidney with Single Pelvis and Ureter; Presenting with Stones: A Case Report and Literature Review.

INTRODUCTION: A supernumerary kidney is an extremely rare congenital anomaly, defined as the presence of one or more extra kidneys. Thus far, there have been less than 100 cases reported in the medical literature. It has its capsule, vascular supply, and collecting system. It frequently causes diagnostic challenges in clinical practice. The supernumerary kidney can be symptomatic due to the presence of stone. CASE PRESENTATION: We present a case of a 19-year-old male patient who came to our clinic with the complaint of abdominal pain. On computed tomography urography (CTU), he was found to have a caudally located left fused supernumerary kidney with a separate vascular supply. Both left kidneys had a separately draining calyceal systems uniting at the left renal pelvis and drained by a single ureter. Multiple left renal stones (largest measures 4cm x 2.2cm) in both kidneys were also seen. The stones were removed surgically by doing pyelolithotomy and radial nephrolithotomy. The patient was doing well during follow-up visits with the improvement of abdominal pain. CONCLUSION: Supernumerary kidney is a very rare congenital renal anomaly. This case is even unique, because of the fused supernumerary kidney and the presence of a single left renal pelvis and ureter. Imaging is very essential for planning surgical intervention. Stones in such kidneys can be managed with nephrolithotomy and/or pyelolithotomy.