Testicular swellings simulating malignancy. Clinical pitfalls, sonographic and histopathological correlation

The final diagnosis of twenty-eight consecutive male patients presented with unilateral testicular swelling, underwent inguinal orchiectomy due to suspected testicular malignancy was correlated with the results of the clinical and sonographic examinations. A high index of suspicion arose primarily from the patients history, clinical examination of the swelling and its appearance on scrotal ultrasonography. Histopathological examination proved the existence of testicular malignancy in 2 cases [7.1%]. The final diagnosis of the remaining 26 cases, based on histopathological examination, was tuberculosis in one case [3.6%], testicular infarction in 2 cases [7.1%], neglected torsion in 6 cases [21.4%], filariasis in one case [3.6%], chronic nonspecific orchitis in 9 cases [32.1%] and granulomatous orchitis in 7 cases [25%]. All were found to simulate malignant tumors either in their clinical presentation, local examination or ultrasonographic appearance. Benign testicular swellings simulating malignancy are not rare and hence differential diagnosis of testicular tumors should be expanded to include chronic and granulomatous orchitis, testicular infarction, neglected torsion as well as tuberculosis and filariasis. The decision of orchiectomy should be properly judged in view of the under-estimated incidence of benign swellings simulating malignancy

Intra-operative ureteroscopy: a valuable addition during ureterolithotomy

This study comprised 30 patients [23 males and 7 females] with a mean age of 42.6 years in whom an unexpected difficulty and/or complication occurred during ureterolithotomy. Patients included 12 with migrated stones, 10 with densely impacted stones in the lower ureteral segment, 6 in whom ureteral patency could not be assessed with confidence after stone extraction and 2 with suspected ureteral injury during stone manipulation. Sixty percent of patients had undergone previous surgery on the same segment of the ureter. In order to avoid further dissection or extra-ordinary ureteral manipulations, intra-operative ureteroscopy was done by the rigid ureteroscope; through the original ureterotomy in 53.3% and via an additional one in 46.7% of patients. Taken together, intra-operative ureteroscopy showed an overall diagnostic accuracy of 90% and therapeutic efficiency of 70.8%. Successful retrieval of migrated stones, extraction of those impacted in the lower ureter and antegrade dilatation of ureteral strictures could be achieved in 77.8%, 70%, and 60% respectively. When indicated, intra-operative ureteroscopy proved to be a safe procedure that could be done without complications. It offers definite advantages and successful outcome, at least in some patients, than alternative traditional methods which might add to patients' discomfort and morbidity

Ureteral reconstruction by bladder flaps

A total of 22 patients [20 bilharzial and 2 nonbilharzial] underwent ureteral reconstruction by bladder flaps. Of the patients, 14 were treated by Boari flap and 8 by the spiral bladder flap ureteroneocystostomy. The indications included long segment stricture in the pelvic ureter, ureteral fistula and gynaecological injuries. The procedure was successful in restoring ureteral continuity and preservation of renal function in 20 patients. Our results showed that bladder flap can be used in bilharzial patients without appreciable difficulty or completions provided that the posterior bladder wall was not the site of previous surgery. Moreover, Spiral bladder flap is a good alternative to ileal replacement of longer ureteral defects are to be reconstructed