The Effects of Varicocelectomy on Sperm DNA Fragmentation and Conventional Semen Parameters in Men with Severe Oligoasthenoteratozoospermia: A Prospective Study.

BACKGROUND: The dilation and torsion of testicular veins in the plexus pampiniformis causes Varicocele, which is a surgically repairable cause of male infertility. This study assessed the impact of varicocelectomy on semen characteristics, total motile sperm count (TMSC) and sperm DNA integrity in patients with severe oligoasthenoteratozoospermia (OAT). MATERIALS AND METHODS: In this prospective study, semen samples of 360 men with severe OAT who underwent varicocelectomy according to World Health Organization (WHO) criteria 2021 were studied (pre-operatively and at 6, 12, and 18 months post-operatively). RESULTS: The average age of our patients was 38.5 years. The mean spermatozoa concentration was found to be 1.60 ± 0.83 million/ml pre-operatively, while the mean post-operative concentration was 5.17 ± 1.23 million/ml at 6 months, 8.32 ± 0.98 million/ml at 12 months, and 13.51 ± 1.48 million/ml at 18 months (P<0.0001). The mean percentage of A+B motile spermatozoa was 2.92 ± 1.17% pre-operatively, 6.10 ± 1.51% at six months, 9.58 ± 1.49% at 12 months and 13.92 ± 1.88% at 18 months postoperatively (P<0.0001). The mean Modified David's morphology score was 3.80 ± 1.43% pre-operatively, 5.95 ± 1.23% at 6 months, 7.94 ± 1.18% at 12 months, and 10.82 ± 1.91% at 18 months post-operatively (P<0.0001). The mean of total motile sperm count (TMSC) was statistically improved after varicocelectomy (P<0.001). The mean of DNA fragmentation index (DFI) of the spermatozoa was 31.40 ± 0.52% pre-operatively, and post-operatively at 28.20 ± 0.32% at 6 months, 25.90 ± 0.31% at 12 months and 20.50 ± 0.40% at 18 months (P<0.001). CONCLUSION: Varicocelectomy was associated with significant improvement of sperm parameters and DNA fragmentation resulting in significant improvement of spermatogenesis quality. We believe that universalization in the routinely used sperm dispersion chromatin (SDC) test could be beneficial in the treatment of infertility.

Acute pancreatitis revealed by right orchi - Epididymitis: A case report and review of the literature.

Orchiepididymitis is a rare complication of acute pancreatitis and leads to misdiagnosis and unnecessary surgery. Abdominal pelvic CT and testicular Doppler ultrasound are the two key examinations in this situation. This is about a 38-year-old patient, seen in the emergency room in an initial picture of right orchiepididymitis secondary to a migration of pancreatic fluid collection treated with antibiotic therapy with monitoring. No consensus as to management has not been established so far. - According to the 2012 Atlanta Consensus: basic antibiotic therapy is recommended in case of suspected infection of these collections.

Bladder papilloma: A rare benign tumor - Case report and literature review.

INTRODUCTION AND IMPORTANCE: Bladder papilloma, a rare benign tumor of the urinary tract, accounts for 1-4 % of bladder tumors. Its distinct features, diagnosed through light microscopy, include architectural and cytological characteristics. Despite its rarity, bladder papilloma is clinically significant due to its distinct traits, low recurrence risk, and potential progression to other urothelial neoplasms. Understanding this condition is crucial for early diagnosis and optimal patient care. CASE PRESENTATION: A 66-year-old male with benign prostatic hyperplasia presented with one month of intermittent hematuria. Physical examination and laboratory tests were unremarkable. Imaging revealed an 11 × 10 × 7 mm echogenic nodular lesion with calcifications on the right bladder wall. Cystoscopy identified a polypoid lesion, leading to transurethral resection. Histopathological examination confirmed bladder papilloma without malignant features. CLINICAL DISCUSSION: Bladder papilloma typically presents with hematuria, mainly in younger patients, with low recurrence and rare progression to aggressive cancers. Diagnosis involves endoscopy and resection, followed by cystoscopic surveillance. Understanding its classification, characteristics, and risk factors aids in accurate management. CONCLUSION: Bladder papilloma diagnosis relies on light microscopy, with hematuria as a primary symptom, often in younger patients. Recurrence risk is low, and progression to aggressive cancers is rare. Diagnosis involves endoscopy, resection, and cystoscopic follow-up. This case enhances our understanding of bladder papilloma, contributing to improved care.

Enterovesical Fistula Revealing Crohn's Disease: A Case Report.

Crohn's disease is an inflammatory bowel disease of unknown etiology. It is characterized by intra- and extra-intestinal complications. It is a frequent cause of uroenteric fistulas. They are mostly symptomatic and occur after several years of the evolution of Crohn's disease. The pneumaturia and fecaluria are the most significant symptoms for their presence. They are usually poorly tolerated and require surgical treatment. We report the case of an enterovesical fistula revealing Crohn's disease during endoscopic resection of a bladder pseudotumor in a generally impaired patient. Crohn's disease should be evocated when histology is not relevant for a bladder pseudotumor or a rectovesical fistula. The discovery of an isolated bladder pseudotumor should suggest the diagnosis in the context of weight loss and chronic diarrhea. Enterovesical fistulas are uncommon but potentially dangerous complications of Crohn's disease. Abdominal CT scans and cystoscopy are the most commonly used diagnostic modalities. Surgical treatment seems to be unavoidable in most cases although medical treatment could also benefit a small cohort of patients.

Unusual presentation of a seminomatous tumor of the testis by acute pyelonephritis: An exceptional case report.

Cancer of the testis is the most common malignant tumor in men aged 14-44 years. Genetic and environmental factors contribute to the development of testicular cancer, for which cryptorchidism is the most common risk factor. It is potentially curable and has a long life expectancy, requiring long-term observation of survivors. Radical orchiectomy is the procedure for the diagnosis and treatment of these tumors. We report the case of a young man whose testicular tumor was discovered fortuitously by pyelonephritis because he did not consult us for the large bursa.

An etiological assessment of a deep vein thrombosis led to the discovery of a renal tumor collision: Case report.

INTRODUCTION AND IMPORTANCE: The thromboembolic complication of kidney's tumor is rare, and they can be the reason for the discovery of those tumor. Also the collision kidney tumor, such as a simultaneous occurrence of different histological types of adjacent neoplasms in the same organ is rare. CASE PRESENTATION: We report a patient diagnosed with a kidney tumor discovered in the context of an etiological assessment of thrombosis, presenting with pulmonary embolism and deep vein thrombosis of the lower limb. This tumor treated by a cytoreductive nephrectomy. The histologic diagnosis of PRCC (Papillary Renal Cell Carcinoma) associated with a chromophobe cell carcinoma and sarcomatoid component was rendered. CLINICAL DISCUSSION: The development of the tumor process and its progression to the metastatic stage is largely favored by the hypercoagulable state, and the cancer itself promotes the appearance of thrombo-enmbolic phenomena due to this phenomenon. Two major studies recommend that immediate cytoreductive nephrectomy should be offered to metastatic patients with a good general condition. CONCLUSION: A renal tumor collision is rare, whereas the risk factors for a renal tumor collision are the same as a renal tumor without collision, just as the management of a metastatic renal tumor is the same. Understanding the thromboembolic physiopathology in the case of kidney cancer has made it possible to optimize management.

Hormonal, clinical, and genetic profile of infertile patients with azoospermia in Morocco.

Introduction: azoospermia affects more than 10%-15% of infertile male subjects attending the infertility center. In Morocco, there have been no studies on male infertility with azoospermia. Thereby, our objective was to evaluate the clinical, hormonal, and genetic characteristics of infertile men with azoospermia in Morocco. Methods: we conducted a retrospective descriptive study performed with a convenience sample of 80 infertile men from 2021 to 2022, in the Assisted Reproductive Technology Unit of the Mohammed VI University Hospital Center in Oujda-Morocco. All patients with azoospermia were subjected to a quantitative hormone assay to evaluate the functionality of the sertolic and leydigial compartments. Human karyotyping and AZF microdeletion analysis are routinely performed in azoospermic patients. Results: the results show that the mean age of patients in the study was 45.7 ± 3.5 years. Primary infertility accounts for the majority, with a rate of 96% (n=77). There were 12 cases of azoospermia of secretory origin, 22 cases of excretory origin, and 3 of undetermined origin. Azoospermia was associated with hydrocele in 29% (n=27) of cases. The average levels of FSH, LH, testosterone, and inhibin B were 15.54 ± 5.5 mIU/mL, 7.71 ± 2.7 mIU/mL, 405.09 ± 6.13 ng/dl and 38.44 ± 5.13 pg/ml, respectively. The prevalence of chromosomal abnormalities was 30.7%. Of these, the sex chromosome aneuploidy with 47, XXY karyotype (Klinefelter syndrome) accounted for 11% (n=9). The incidence of microdeletions of azoospermia factors (AZF) was 9%, and AZFc deletion was the most common at the rate of 3%. Conclusion: our research shows that hydrocele, varicocele, and chromosomal abnormalities are the leading causes of azoospermia. In the Moroccan population, azoospermia is essentially of excretory origin.

Klippel-Trenaunay Syndrome Associated With Urinary Tract Hemangiomas: A Case Report.

The association between Klippel-Trenauney syndrome (KTS) and bladder hemangiomas is rare. The most common clinical manifestation is hematuria. The diagnosis is made from the characteristic cystoscopic appearance of the tumor. We report the case of a patient presenting recurrent macroscopic hematuria in the context of KTS. A cystoscopic evaluation revealed bladder hemangiomas. A conservative approach consisting of bladder irrigation and close follow-up was chosen as therapy. Conservative treatment of bladder irrigation and close follow-up is the recommended initial treatment of moderate and infrequent episodes of hematuria in this context. The more invasive therapeutic options have to be considered especially for frequent or life-threatening episodes of hematuria. This case suggests that conservative treatment may be effective in treating moderate and infrequent episodes of hematuria due to bladder hemangioma in the context of KTS. Further studies are required to adequately establish the effectiveness, limitations, and complications of each approach.

Acute pyelonephritis revealing an exceptional form of horseshoe kidney: A case report.

INTRODUCTION: The horseshoe kidney is a malformation of the upper urinary tract where the kidney is U-shaped. This condition results the fusion of the lower poles of the right and left kidneys on the midline. CASE PRESENTATION: We report a case of pyelonephritis revealing a rare form of horseshoe kidney with fusion of the lower pole of the right kidney with the upper pole of the left kidney, initially treated with urine drainage. DISCUSSION: Multiple etiological conditions may contribute to the development of a horseshoe kidney, in particular: the genetic/chromosomal predisposition, intrauterine environment and structural factors affecting kidney development and migration. CONCLUSION: Horseshoe kidneys reveal a veritable range of anatomical and embryological peculiarities, always suspect pyelonephritis on a horseshoe kidney in the presence of febrile abdominal pain in a patient with malformations.

Infertility revealing intratubular germinal cell neoplasia of the testis: Case report and review of the literature.

INTRODUCTION: Testicular cancer is the most frequent solid tumor in young people. Most germ cell tumors of the testis, with the exception of vitelline tumors and teratomas in children, and spermatocytic seminoma in the elderly, derive from a common precursor. This precursor, initially described as carcinoma in situ (CIS), is now referred to as intratubular Germinal Cell Neoplasia (ITGCN). CASE PRESENTATION: We report the case of a 37-year-old man with intratubular Germinal Cell Neoplasia (ITGCN) on a testis already treated for cryptorchidism in a context of infertility. We proposed active surveillance, but the patient preferred radiotherapy. DISCUSSION: The origin of ITGCN is still not fully understood. The detection of ITGN is often incidental since it typically does not present with noticeable symptoms, and clinical examination may appear normal. The standard treatment for ITGCN is scrotal radiotherapy. CONCLUSION: The standard treatment for ITGCN is scrotal radiotherapy. However, for patients who desire to preserve fertility, regular observation may be considered as an alternative.

Acute urine retention following medullary compression of metastatic breast cancer in the spinal cord: Rare symptomatlogic presentation and management.

The management of locally advanced and metastatic breast cancer has evolved since 2021, with confirmation of the role of cell cycle inhibitors. The discovery of breast cancer is often the result of self-examination through the discovery of a nodule, but may also be due to symptoms at the metastatic site. The spinal cord is one of the rare sites of metastatic breast cancer involvement. We report the management of a rare case of metastatic breast cancer in the spinal cord, discovered following acute urinary retention.

Management of a localized prostatic adenocarcinoma despite the very high rate of PSA and the large tumor mass: Does PSA level indicate the stage of prostate cancer?

Prostate-specific antigen (PSA) is a marker specific to the prostate gland, and it is, therefore, possible to observe an increase in PSA above 4 ng/mL in cases of benign prostatic hypertrophy and cancer. But according to studies, a very high PSA level is most likely synonymous with metastatic prostate cancer. Our rare case concerns the management of a localized prostatic adenocarcinoma despite a very high PSA level of over 3000 ng/mL, with an enormous volume of prostate without invasion or distant metastasis. A very high PSA level can probably be a sign of metastatic prostatic adenocarcinoma, but not necessarily.

Fournier's gangrene revealing an aggressive squamous cell carcinoma of the penis: An exceptional case report.

Fournier's gangrene is a fast progressive necrotizing fasciitis of the perineum and external genitals, It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with synergistic action. The origin of the infection is either cutaneous, urogenital or colorectal. There are age, diabetes and immunosuppression, are frequently present in affected patients. Fluid and electrolyte management, combined with broad-spectrum antibiotic therapy followed rapidly by surgical debridement, is the standard of treatment. we report in this article a very rare case of cancer of the penis manifested by fournier's gangrene.

Management of an accidental mass in a monorchidic patient discovered during infertility: a case report.

Testicular cancer is the most frequent type of cancer in the young adult men, it is relatively rare. Infertility is an important risk factor for testicular cancer, with a doubled risk of developing cancer compared to the general population. The standard treatment for testicular cancer is the radical orchiectomy, but partial orchiectomy or testicular sparing surgery (TSS) is indicated for small masses, as many experiences, have shown that many small masses found incidentally turn out to be benign. Case presentation: The authors report the case of a patient presented for primary infertility, a clinical examination for left-sided gynecomastia without inflammatory signs. A testicular MRI revealed a 7 mm suspicious nodule in the posterior-inferior aspect of the right testicle, with contrast enhancement in the juxta-tumoral area corresponding to a heterogeneous area on ultrasound. Due to the lesion described on MRI, monorchidism, and azoospermia, a TSS combined with testicular biopsy and testicular sperm extraction was indicated. Clinical discussion: The reference treatment for testicular cancer is the radical orchiectomy, but in some selected situations, partial orchiectomy or TSS is indicated, as many experiences have shown that many small masses found incidentally turn out to be benign. Conclusion: This case suggests that TSS or partial orchiectomy for small nonpalpable testicular masses in monorchidic patients can provide an excellent outcome for the patient.

Urinary bladder metastasis from primary lung cancer, a rare and challenging diagnosis: a case report.

Bladder metastases are rare, representing only 2% of all bladder tumors, secondary bladder localization from a primary lung is exceptional. Case presentation: The authors describe the case followed for lung adenocarcinoma with an exceptional metastatic site, which is the bladder. A computed tomography scan showed a left suprahilar bronchial tumor with pleurisy (Fig. 1A), which biopsies concluded to a moderately differentiated adenocarcinoma. The patient is treated with palliative cisplatin-based chemotherapy. And died 11 months after diagnosis. Clinical discussion: Bladder metastases are rare, representing only 2% of all malignant bladder tumors. Metastatic lesions of the bladder are generally revealed by hematuria. Confirmation of bladder invasion is immunohistochemical, facilitated by knowledge of the primitive. Conclusion: In the presence of any adenocarcinoma of the bladder, a thoracic-abdominal-pelvic computed tomography scan must be requested in search of a primary extra-vesical cancer who can facilitate the diagnosis.

A rare case report of bile duct compression by a polycystic kidney treated by total nephrectomy after embolization.

INTRODUCTION AND IMPORTANCE: Polycystic kidney disease is a cillopathy characterized by the formation of numerous cysts in the kidneys, sometimes associated with extra-renal forms. Diagnosis is often by chance, or by other complications such as hematuria, urinary tract infections or, rarely, compression of neighboring organs. CASE PRESENTATION: We report the case of a patient consulted for a symptomatology similar to that of acute pancreatitis, whose investigation objectified compression of the main bile duct by a voluminous right kidney polycystic in a CT scan. CLINICAL DISCUSSION: For this compressive complication of the polycystic kidney, a nephrectomy was performed after embolization of the renal artery, given the haemorrhage risk. CONCLUSION: A polycystic kidney should be removed in the event of a compressive complication and, given the risk of haemorrhage, should preferably be preceded by embolization.

Acute hepatic colic led to the discovery of an adrenal myolipoma without a hemorrhagic component: About a rare symptomatologic presentation - Case report.

The discovery of an adrenal myolipoma is often fortuitous, or due to the effects of hypersecretion of the adrenal gland. A large tumor can exert a mass effect on neighbouring organs, as in our case where the myolipoma leads to compression of the main bile duct and causes hepatic colic, which is rare to explain the discovery of an adrenal myolipoma on CT.

Rectorrhagia revealing synchronous colonic adenocarcinoma and papillary renal cell carcinoma type 1, an exceptional case report.

Colorectal cancer (CRC) is the most prevalent type of cancer affecting the gastrointestinal tract. The synchronous occurrence of CRC and renal cell carcinoma is rare, and even rarer when the renal cell carcinoma is of papillary origin, with only two cases reported in the literature. The synchronous detection of colon cancer and other primary tumors has been extensively studied and reported in the literature, either falling within the framework of well-defined clinical syndromes such as Lynch syndrome or occurring sporadically. This article aims to report and expose a literature review of the synchrony of colorectal cancer and renal carcinoma.

Gangrene of the anterior abdominal wall secondary to urinary bladder rupture due to emphysematous cystitis: A case report.

INTRODUCTION AND IMPORTANCE: Emphysematous cystitis is a rare form of urinary tract infection that can cause the bladder wall to rupture. It is more prevalent in patients with diabetes. CASE PRESENTATION: We report the case of an 86-year-old man who developed gangrene of the anterior abdominal wall secondary to urinary bladder rupture. We performed a radical cystectomy preceded by an antibiotic treatment. CLINICAL DISCUSSION: Computed tomography is the key to positive and etiological diagnosis. This is particularly observed among diabetic or immunocompromised patients. Empirical antibiotic therapy and surgical treatment are the major components of management. CONCLUSION: Management of this rare condition is not standardized but involves surgery in most cases.