Isolated renal mucormycosis masquerading as emphysematous pyelonephritis.

Mucormycosis is an acute, life-threatening infection and isolated renal involvement is rare. Due to the angioinvasive nature of the disease, it is rapidly progressive and can be lethal if not managed expeditiously. In patients with underlying conditions of immunosuppression, diabetes mellitus, transplantation, COVID-19, intravenous drug and substance use and pyelonephritis, which is unable to be controlled via regular antibiotics, mucormycosis must be considered on the differential and antifungals must be empirically started. Most cases are often diagnosed on histopathology, which causes delayed treatment and resolution. We present a case of emphysematous pyelonephritis diagnosed on imaging and was later found to have mucormycosis on histopathological examination.

Bilateral renal aspergillosis with a fungal cast masquerading as renal malignancy.

Invasive isolated renal aspergilloma in an immunocompetent host is rare, and few cases have been reported in the literature. It is a unique entity encountered by a urologist that can lead to catastrophic complications like end-stage renal disease. Infective pathology may closely resemble renal mass, and timely, appropriate investigations are obligatory for early intervention. This case report highlights the importance of strong consideration of renal fungal infections in the differential diagnosis of a renal mass with atypical radiological findings in an immunocompetent host. Meticulous decision-making and appropriate management help to prevent disastrous sequelae.

A comparison of the impact of the COVID-19 pandemic on urological surgeries in Japan and Taiwan.

OBJECTIVE: We report the impact of the COVID-19 pandemic on urological surgeries and hospital policies at two hospitals in Japan and Taiwan. METHODS: We retrospectively surveyed the number of surgeries every 3 months in the Urology Department of Kobe University Hospital (KUH), Kobe, Japan before (January 2019-March 2020) and after (April 2020-September 2021) the COVID-19 outbreak, and in the Urology Department of Shuang Ho Hospital, Taipei Medical University (SHH-TMU), Taiwan before (January 2021-March 2021) and after (April 2021-September 2021) the outbreak, and compared the averages and types of surgery. RESULTS: In Kobe, COVID-19 patients were stratified such that other regional hospitals gave priority to treating COVID-19 while KUH gave priority to treating non-COVID-19 patients. In KUH, the number of surgeries did not change significantly, 237.2 ± 29.6 versus 246.3 ± 20.8 (p = 0.453). In Taiwan COVID-19 patients increased sharply in May 2021, and teaching hospitals in Taiwan were obliged to provide 20% of their total beds for COVID-19 patients. At SHH-TMU, there was a 33.3% drop in the number of surgeries during April-June 2021 compared to the pre-pandemic average. However, no significant changes were observed, 423.4 ± 68.4 versus 373 ± 91.0 (p = 0.298), because of the subsequent success in controlling the COVID-19 infection. CONCLUSIONS: The comparison of infection control measures between the two countries revealed that while both KUH and SHH-TMU successfully maintained the number of surgeries, the reasons for this were different for each.

Evaluation of the impact of COVID-19 pandemia on pediatric urological operations and the number of outpatient clinic patients in a province with, the highest birth rate Turkey

Investigation of the effect of Covid-19 pandemic on pediatric urology operations in Şanliurfa province, where the birth rate is the highest in Turkey : Objective: The aim of this study is to investigate the effect of the COVID-19 pandemic on pediatric urology operations. Materials and Methods: Hospital records of pediatric patients who applied to Harran University Medical Faculty Pediatric Urology Clinic during the pandemic period (19 March-22 December 2020) and pre-pandemic period (19 March-22 December 2019) and were operated with precautions were retrospectively analyzed. The number of outpatient clinic patients during and before the pandemic period, the number of operations and indications, and the types of surgery were compared. The names and numbers of surgical procedures are listed according to the European Association of Urology (EAU) priority classification. Results: During the COVID-19 pandemic period, the number of pediatric patients admitted to the outpatient clinic was 2361, while it was 5214 in the same period before the pandemic. It was observed that the number of patients who applied to the outpatient clinic decreased by 54.8% during the pandemic period. While the total number of pediatric operations was 316 during the pandemic period, it was 741 before the pandemic period. When the pandemic period was compared with the pre-pandemic period, a 58.4% reduction was observed in pediatric urology operations. The number of emergency operations was 69 during the pandemic period and 85 in the pre-pandemic period. During the pandemic period, the reduction in emergency operations was 18.8%. No complications were observed due to COVID-19 in any of the operated patients. Conclusion: During the COVID-19 epidemic, it was observed that the number of pediatric urology outpatient clinic admissions and surgeries in our hospital decreased. In cases where urgent interventions were required, adequate precautions were taken, and surgical operations could be applied without any contamination and mortality. Keywords: Coronavirus, coronavirus disease 2019, pandemic hospital, pediatric urological surgery.Alternate :et Amaç: Bu çalışmada COVID-19 pandemisinin pediatrik üroloji ameliyatlarına etkisini araştırmayı amaçladık. Materyal ve metod: Tıp Fakültesi Pediatrik Üroloji Kliniği’ne pandemi döneminde (19 Mart-22 Aralık 2020) ve pandemi öncesi dönemde (19 Mart-22 Aralık 2019) polikliniğe başvuran ve önlemler eşliğinde ameliyat edilen pediatrik hastaların hastane kayıtları retrospektif incelendi. Pandemi dönemi ve öncesi poliklinik hasta sayıları, ameliyat sayıları ve endikasyonları, ameliyat türleri karşılaştırıldı. Cerrahi prosedürlerin isimleri ve sayılar Avrupa Üroloji Derneği (EAU) öncelik sınıflandırmasına göre listelendi. Bulgular: COVID-19 pandemisi döneminde polikliniğe pediatrik hasta başvuru sayısı 2361 iken pandemi öncesi aynı dönemde 5214 idi. Pandemi döneminde polikliniğe başvuran hasta sayısının % 54,8 azaldığı görüldü. Pandemi döneminde toplam pediatrik ameliyat sayısı 316, pandemi dönemi öncesi 741 idi. Pandemi dönemi, pandemi öncesi ile karşılaştırıldığında pediatrik üroloji ameliyatlarında %58,4 azalma olduğu görüldü. Pandemi döneminde acil ameliyat sayısı 69, pandemi öncesi dönemde 85 idi. Pandemi döneminde acil ameliyatlardaki azalma %18,8 idi. Opere edilen hiçbir hastada COVID-19 nedeniyle komplikasyon izlenmedi. Sonuç: COVID-19 salgını sırasında hastanemizdeki pediatrik üroloji poliklinik başvurusu ve ameliyat sayısının azalmış olduğu görüldü. Acil müdahalelerin gerekli olduğu olgularda yeterli önlemler alınarak, herhangi bir kontaminasyon ve mortalite olmaksızın cerrahi operasyonlarının uygulanabilirliği görüldü.

Unusual presentation of a periurethral abscess following infection with Neisseria gonorrhoea.

We describe an unusual case of a male patient presenting with penile and testicular swelling following an unprotected and traumatic sexual encounter. It was suspected that an isolated penile injury occurred during intercourse; however, ultrasound imaging identified an intact tunical layer and right-sided epididymo-orchitis. Following screening for sexually transmitted infections (STIs), he was discharged with antibiotics and advice to attend the Sexual Health Centre for contact tracing. He represented with a periurethral abscess and an antimicrobial-resistant (AMR) strain of Neisseria gonorrhoea was identified. Appropriate antibiotic treatment was initiated. Examination-under-anaesthesia, following abscess drainage, revealed a contained collection with no urethral fistula; however, a flat urethral lesion was seen during urethroscopy. Repeat urethroscopy and biopsy of the lesion indicated polypoid urethritis. Periurethral abscess secondary to gonococcal urethritis is a rare complication, but one that we should be suspicious of, especially with the growing incidence of AMR-STIs.

Large and rapid local recurrence of clear cell renal cell carcinoma.

After radical nephrectomy, clear cell renal cell carcinoma (ccRCC) recurs locally in <3% of patients. Recurrences typically occur 1-2 years postoperatively and grow at 5-20 mm per year. In contrast, this patient's recurrence was unexpectedly large and swift. A 71-year-old woman was initially found on workup for recurrent urinary tract infections to have a 12 cm left renal tumour. After negative staging scans, she progressed to left open radical nephrectomy. Histology revealed a stage T2b 12 cm ccRCCwith sarcomatoid differentiation, International Society of Urological Pathology (ISUP) grade 4, with clear margins. Only 3 months later, the patient developed left-sided abdominal pain, and CT scans revealed a 15 cm left retroperitoneal local recurrence, as well as widespread peritoneal tumours. In discussion with her treating team, the patient and her family elected not to undergo biopsy or systemic therapy. The patient was palliated and passed away 8 days after re-presentation.

The dramatic COVID 19 outbreak in Italy is responsible of a huge drop of urological surgical activity: a multicenter observational study.

OBJECTIVE: To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID-19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID-19. METHODS: A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo-Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month. RESULTS: The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID-19 cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. CONCLUSION: Italy, a country with a high fatality rate from COVID-19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre-planning in other countries not so drastically affected by the disease to date.

A Snapshot from the Department of Urology in Bergamo Evaluating the Timeline of the SARS-CoV-2 Outbreak: Which Patients Are We Missing?

The province of Bergamo in Italy and in particular Papa Giovanni XXIII Hospital was one of the first areas to be hit by the SARS-CoV-2 outbreak and experience firsthand all the different phases of the crisis. We describe the timeline of the changes in overall urological workload during the outbreak period from lockdown to the slow reopening of activities. We sought to compare the 2020 hospital scenario with normality in the same period in 2019, highlighting the rationale behind decision-making when guidelines were not yet available. While we focus on the changes in surgical volumes for both elective (oncological and noncancer) and urgent cases, we have still to confront the risk of untreated and underdiagnosed patients. PATIENT SUMMARY: We present a snapshot of changes in urology during the peak of the COVID-19 outbreak in our hospital in Bergamo, Italy. The effect of medical lockdown on outcomes for untreated or underdiagnosed patients is still unknown.