Using machine learning models to predict synchronous genitourinary cancers among gastrointestinal stromal tumor patients.

Objectives: Gastrointestinal stromal tumors (GISTs) can occur synchronously with other neoplasms, including the genitourinary (GU) system. Machine learning (ML) may be a valuable tool in predicting synchronous GU tumors in GIST patients, and thus improving prognosis. This study aims to evaluate the use of ML algorithms to predict synchronous GU tumors among GIST patients in a specialist research center in Saudi Arabia. Materials and Methods: We analyzed data from all patients with histopathologically confirmed GIST at our facility from 2003 to 2020. Patient files were reviewed for the presence of renal cell carcinoma, adrenal tumors, or other GU cancers. Three supervised ML algorithms were used: logistic regression, XGBoost Regressor, and random forests (RFs). A set of variables, including independent attributes, was entered into the models. Results: A total of 170 patients were included in the study, with 58.8% (n = 100) being male. The median age was 57 (range: 9-91) years. The majority of GISTs were gastric (60%, n = 102) with a spindle cell histology. The most common stage at diagnosis was T2 (27.6%, n = 47) and N0 (20%, n = 34). Six patients (3.5%) had synchronous GU tumors. The RF model achieved the highest accuracy with 97.1%. Conclusion: Our study suggests that the RF model is an effective tool for predicting synchronous GU tumors in GIST patients. Larger multicenter studies, utilizing more powerful algorithms such as deep learning and other artificial intelligence subsets, are necessary to further refine and improve these predictions.

Neurofibroma of the external genitalia, extreme enlargement of the clitoris.

Neurofibromatosis of the genitourinary tract is rare, with a prevalence of 0.65%, and it is exceedingly rare to involve the external genitalia. Involvement of the clitoris, labia majora, and prepuce was reported with clitoromegaly being the most frequently occurring. Herein, we are reporting the case of a 6-year-old girl who was diagnosed with a neurofibroma of the clitoris; measuring 9.4 cm in its largest dimension. To the best of our knowledge, this is the largest clitoral neurofibroma reported in the literature. Due to the rarity of such cases and reports limitations in the literature, the diagnosis of neurofibroma of the external genitalia requires a high index of suspicion by health-care providers. Surgical excision and postoperative follow-up for possible recurrence remain the gold standard of management.

Bidirectional Intraoperative Chemotherapy Using Cisplatin and Ifosfamide for Intraperitoneal Mesothelioma in Severe Renal Impairment: A Case Report.

BACKGROUND Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm with a poor prognosis. Bidirectional intraoperative chemotherapy (BDIC) using concurrent intraperitoneal and intravenous chemotherapy in combination with cytoreductive surgery (CRS) is an emerging treatment option for selected cases of MPM. It is a locoregional treatment that involves intraoperative chemoperfusion of heated chemotherapy. The administration of systemic along with intraperitoneal chemotherapy allows for a bidirectional chemotherapy gradient in peritoneal tumor cells. The aim of this treatment is eradication of microscopic residual cancer cells after major removal of macroscopic tumor nodules. To date, there is no consensus on the chemotherapeutic regimen that can be used in BDIC to manage MPM in patients with severe renal impairment. Administering intravenous ifosfamide with hyperthermic intraperitoneal cisplatin and doxorubicin is a promising regimen in treating peritoneal mesothelioma. Nephrotoxicity is a dose-limiting adverse effect of cisplatin and ifosfamide. Therefore, dose adjustment is required in patients with renal impairment. CASE REPORT In this report, we describe a 46-year-old female patient with recurrent MPM and severe renal impairment. Her treatment was managed with hyperthermic intraperitoneal cisplatin and doxorubicin along with intravenous ifosfamide following CRS. The cisplatin dose was reduced to 50% and the ifosfamide dose was reduced by 25%. The patient tolerated the procedure well, without deterioration in her renal function. At her 9-month follow-up, she did not report experiencing chemotherapy-related adverse effects, and her kidney function remained stable. CONCLUSIONS Severe renal impairment might not be a contraindication to using potentially nephrotoxic chemotherapeutic agents in CRS-BDIC.

A comparison of the perineal and penoscrotal approaches in artificial urinary sphincter implantation for the control of male stress urinary incontinence.

BACKGROUND: The two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each method carries its own advantages and disadvantages. The few reports that compare the approaches have disparate outcomes. OBJECTIVE: Compare the outcome of first time AUS implantation by the perineal versus the penoscrotal approach. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS AND METHODS: We included all male patients who underwent primary perineal or penoscrotal AUS placement between June 2004 and October 2018 at our tertiary care hospital. Patients were followed at least one year postoperatively. MAIN OUTCOME MEASURES: Rates of dry, infection, erosion, malfunction, atrophy, revision. SAMPLE SIZE: 44 males who underwent 68 procedures. RESULTS: Twenty-five (56.8%) patients underwent a perineal and 19 (43.2%) underwent a penoscrotal approach. The patients had 68 procedures: 36 (52.9%) perineal and 32 (47.1%) penoscrotal approaches. The median (25th-75th percentiles) age at the time of surgery was 61.0 (51.0-68.0) years (n=68 procedures). The median (25th-75th percentiles) operative time was significantly shorter for the penoscrotal approach, 87 (69-140), vs. 93 (72-210) minutes for the perineal approach (P=.016). The 44 patients were followed up for a mean (SD) of 52.5 (20.3) months for the 68 procedures. Postoperative complications occurred in 16 (36.36%) patients; 11 (44%) perineal approach patients and 5 (26.3%) penoscrotal. There were no significant differences in complications of infection, erosion, malfunction, or urethral atrophy between the two groups. Only removal/revision was significantly more common with the perineal approach (10 patients perineal and two patients penoscrotal, P=.042). At the last follow-up, dryness was comparable among groups. CONCLUSION: The outcomes of AUS placement are comparable between perineal and penoscrotal approaches in terms of complications and one year dryness. The penoscrotal approach however has shorter operative time and less need for revision and removal. LIMITATIONS: Small sample size, single-center. CONFLICT OF INTEREST: None.

Testicular torsion as the initial presentation of testicular tuberculosis.

Testicular tuberculosis (TB) is a rare disease, and it tends to mimic other testicular diseases which are more common. We highlight the case of a 37-year-old male who presented to the emergency department with testicular torsion. Further investigations revealed evidence of TB.

Spontaneous pregnancy post orchidopexy of bilateral retractile testes in an adult: A case report.

Retractile testes have been associated with male factor infertility. However, whether surgical correction is indicated in those males is unknown. Herein, we report a case of a 37 year old male with primary infertile for 7 years with no apparent cause other than retractile testes. Bilateral orchidopexy was done and his wife achieved spontaneous pregnancy and delivery of a healthy girl.

Zinner's syndrome: Case report of a rare maldevelopment in the male genitourinary tract.

Zinner syndrome is a rare congenital malformation of the urogenital tract. It is due anomaly in the developmental of Wolffian duct. Zinner syndrome comprises triad of seminal vesicle cyst, unilateral renal agenesis and ipsilateral ejaculatory duct obstruction. It is frequently associated with infertility. Herein we are highlighting a case of a 35 years-old male, a father of 4 biological children who presented to our clinic due to right hemiscrotal pain, associated with post ejaculation pain.

Male Infertility in Robertsonian Translocation: A Case Report.

BACKGROUND Translocations are the most common type of chromosomal structural anomalies. In balanced translocations, there is not an obvious loss of genetic material; they are usually phenotypically normal adults who present with reproductive issues. Male carriers of Robertsonian (ROB) translocation can have infertility and are shown to have abnormal semen analysis. Some patients have positive sperms in the ejaculate. Therefore, fertility management can be offered to couples to achieve pregnancy and delivery of healthy neonates. CASE REPORT We present 2 cases of 34- and 35-year-old males who presented to our tertiary care hospital because of primary infertility. Semen analysis showed nonobstructive cryptozoospermia and azoospermia, respectively. Genetic tests revealed ROB translocation (13;14). Fertility treatment was offered to both couples. CONCLUSIONS Males with ROB translocation can have positive sperms in the ejaculate. A multidisciplinary approach should be offered to the couples to help them achieve clinical pregnancy, reduce the risk of miscarriage, and increase the rates of delivery of healthy neonates.