Factors influencing bacterial colonization of double J ureteral stents: a prospective study.

Background: To investigate the microorganisms responsible for double J stent (DJS) colonization, bacteriuria, and the drug susceptibility of the isolates. We also tried to determine factors associated with stent colonization, such as indwelling time, sex, age, and comorbidities. Materials and methods: This study is a prospective analysis of patients following DJS ablation. A total of 155 patients from our institution were enrolled in this study between January 2023 and May 2023. Bladder urine was collected in a sterile container prior to stent removal for bacteriological exam. The removed stents were divided into three parts: top (Renal), middle (Ureteral), and bottom (Bladder); 3 cm pieces from each part were taken and placed in a sterile test tube for bacteriological investigation. Results: The mean age of patients with positive stent culture was 61.17±12.82 versus 55.94±10.32 when stent culture is negative, which is statistically significant P=0.016. Diabetes and bacteriuria are both correlated with DJS contamination with P<0.001 in the two cases. The mean duration of the use of DJS in patients with colonized stent culture is 6.45±2.98 months versus 4.06±2.20 months for the other patients; the difference is statistically significant P<0.001. The most commonly isolated pathogens on stents were Gram-negative bacilli (53.2%), dominated by Enterobacteriaceae in 19 cases (55.2%). Conclusion: Indwelling time is the only unanimous factor of stent colonization in literature, so we recommend using DJS only if necessary and to remove it as soon as possible.

HPLC-DAD Analysis and Investigation of Biological Properties of the Leaves of Globularia alypum (L.), Infusion Extract.

Globularia alypum L. (GA) belonging to the Globulariaceae family is a Mediterranean plant which is widely used in traditional Tunisian medicine. The aim of this study was to investigate the phytochemical composition, antioxidant, anti-arthritic, antiproliferative, antibacterial and antibiofilm potential of aqueous GA leaf extracts (AGAL). Quantitative analyses of the different constituents of extracts were evaluated by high-performance liquid chromatography with photodiode-array detection (HPLC-DAD). Spectrophotometric methods and chemical tests were used for antioxidant and anti-arthritic activities. The antiproliferative study was evaluated using colorectal cancer SW620 cells, while the antibacterial assessment and analysis of the antibiofilm effects were determined by the microdilution method and the crystal violet assay, respectively. AGAL extracts presented several components, mainly Nepetin-7-Glucoside and trans-ferrulic acid. The results showed that they had an important antioxidant (IC50 = 0.34; 0.38 and 1.20 mg/mL) and anti-arthritic (IC50 = 2.94 mg/mL) properties, and these effects are displayed in a dose-dependent manner. In addition, this extract demonstrated significant antiproliferative (IC50 = 50 µg/mL), antibacterial (MIC = 6.25 mg/mL and MBC = 6.25 mg/mL), and antibiofilm (59.70% at 25 mg/mL) properties especially against S. aureus. The results achieved confirm the important role of this plant as a source of therapeutic activities.

Analysis of Pathogens of Urinary Tract Infections Associated with Indwelling Double-J Stents and Their Susceptibility to Globularia alypum.

Ureteral double-J stents are frequently used to prevent urinary obstruction. They can develop bacterial colonization and encrustation, which leads to persistent infections that seldom respond to antibiotic treatment. Thus, the goal of this study was to evaluate the local spectrum of bacterial pathogens and their susceptibility to natural compounds. A total of 59 double-J ureteral stents from 59 consecutive patients were examined. The samples were inoculated on agar culture mediums. Extracts of Globularia alypum L. were evaluated for their antibacterial activity with the diffusion and broth dilution methods; for antibiofilm activity, the crystal violet assay was used. The identification and the quantification of the different constituents of extracts were determined by reverse-phase high-performance liquid chromatography (RP-HPLC). Bacterial growth was found in three patients (5.1%). Enterococcus faecalis (1.7%), Acinetobacter baumanii (1.7%), and Pseudomonas putida (1.7%) strains were more commonly detected. They were resistant to several common antibiotics. All extracts presented several components, mainly nepetin-7-glucoside and trans-ferulic-acid, and they had antibacterial activity (MIC = 6.25 mg/mL and MBC = 6.25 mg/mL), and antibiofilm (59.70% at 25 mg/mL) properties, especially against Acinetobacter baumanii. The results achieved confirm the important role of this plant as a source of therapeutic activities.

Plasmacytoid bladder cancer: a rare case report.

Plasmacytoid carcinoma of the bladder is a rare histological variant of urothelial carcinoma associated with late presentation. This pattern of disease may portend an extremely poor prognosis and significant challenges for treatment with curative intent. Case presentation: The authors report a case of a patient with locally advanced plasmacytoid urothelial carcinoma (PUC) of the bladder. A 71-year-old man with a history of chronic obstructive pulmonary disease presented with gross hematuria. The rectal examination revealed a fixed bladder base. A computed tomography scan showed a pedunculated lesion arising from the anterior and left lateral bladder wall and extended to the perivesical fat. The patient underwent transurethral resection of the tumor. The histologic examination revealed the presence of muscle-invasive PUC of the bladder. The decision of the multidisciplinary consultation meeting was to do palliative chemotherapy. Thus, the patient could not receive systemic chemotherapy and died 6 weeks after transurethral resection of the bladder tumor. Clinical discussion: A plasmacytoid variant of urothelial carcinoma is a rare subtype of urothelial carcinoma that has a poor prognosis with a high mortality rate. The disease is usually diagnosed at an advanced stage. Given the rarity of plasmacytoid bladder cancer, treatment guidelines are not clear; therefore, more aggressive treatment may be required. Conclusion: PUC of the bladder is characterized by high aggressiveness, an advanced stage at the time of diagnosis, and a poor prognosis.

Primary extragastrointestinal stromal tumor of the prostate: review of the literature and case report.

The extragastrointestinal stromal tumor (EGIST) is defined as a mesenchymal neoplasm arising from soft tissues outside the gastrointestinal tract, and the prostate is a rare presentation site. Case presentation: A 58-year-old man was presented with lower urinary tract symptoms for 6 months. A digital rectal examination revealed a markedly enlarged prostate with a smooth, bulging surface. Prostate-specific antigen density was 0.5 ng/ml. MRI of the prostate showed an enlarged prostatic mass with hemorrhagic necrosis. Transrectal ultrasound-guided prostate biopsy was performed and pathological reports suggested a gastrointestinal stromal tumor. The patient refused radical prostatectomy and received only imatinib treatment. Clinical discussion: The diagnosis of EGIST of the prostate is extremely rare and depends on the histopathologic features with immunohistochemical results. The treatment is essentially based on radical prostatectomy, but there are other therapeutic modalities associating surgery with adjuvant or neoadjuvant chemotherapy. For patients refusing surgery, treatment with imatinib alone appears to be a therapeutic solution. Conclusion: Despite the rarity, EGIST of the prostate should be included in the differential diagnosis of patients presenting with lower urinary tract symptoms. There is no consensus regarding the treatment of EGIST, and the patients are treated as per the risk stratification.

Crossed-fused renal ectopia with renal calculi and its management, a case report.

INTRODUCTION AND IMPORTANCE: Crossed fused renal ectopia is a rare congenital anomaly characterized by both kidneys being fused together on one side of the spine. Herein, we present an atypical subtype of this disease. To our best knowledge, in the current literature, there is few cases reported with superior crossed fused renal ectopia of the right kidney. CASE PRESENTATION: A 40-year-old man with diabetes type 1 presented to our hospital with diabetic ketoacidosis and abdominal pain initially taken care of in an endocrinology department then transferred to our urology department after discovery on the CT scan of a staghorn calculus in the solitary right kidney is later discovered during the therapeutic management that it is a superior CFRE. CLINICAL DISCUSSION: Unilateral fused renal superior ectopia is extremely rare and the management of urinary calculi in this disease is technically challenging for urologists. The choice of treatment for urinary calculi in cases of crossed renal ectopia should be made depending on the size and position of the urinary calculi and the patient's anatomy. CONCLUSION: Before proceeding to surgery, a preoperative assessment with contrast computed tomography is necessary to explore a solitary kidney with calculi so as not to miss the diagnosis of crossed fused renal ectopia because the management of renal stone in this rare malformation is complicated.

Renal cell carcinoma with atypical metastases sites revealed by diabetes mellitus: A case report.

Introduction and importance: Lung, bone, lymph nodes and liver are the most common metastatic sites. This observation presents a metastatic renal cell carcinoma (RCC) with atypical secondary sites and a rare mode of revelation corresponding to diabetes mellitus. Case presentation: We report the case of a 64-year-old woman recently diagnosed with diabetes mellitus. A thoracic parietal nodule was palpated. An uro-CT scan had shown a renal tumor with unusual metastatic sites: pleura, pancreas, and contralateral kidney. The patient underwent a biopsy of the pleural nodule. The pathology report concluded to the diagnosis of clear cell RCC. She had a targeted therapy. Three months after admission, the patient had altered general condition and total hematuria. Clinical discussion: RCC commonly metastasizes haematogenously via renal veins. Atypically, secondary lesions may involve pleura. Such a metastatic site may be of particular interest for percutaneous biopsy, as in our case. The rare metastatic invasion of the pancreas is most likely the cause of the inaugural diabetes in our patient. The controlateral kidney was involved in 1.4% of secondary lesions. For patients with poor prognosis, according to International Metastatic RCC Database Consortium classification, anti-angiogenic treatment is recommended. The median overall survival of patients with poor prognosis is 8 months. Conclusions: Pancreas and contralateral kidney are rare secondary sites of RCC. The clinical expression of pancreas metastatic invasion can rarely fit with diabetes. Metastatic dissemination to these organs is most often associated with an unfavorable prognosis.

Recurrent hematuria: A rare presentation of leiomyosarcoma of the prostate.

Introduction and Importance: Prostatic leiomyosarcoma is a rare aggressive tumor. The presentation came with non-specific signs and symptoms likewise other forms of prostatic pathology like benign prostatic hyperplasia. Case presentation: A 64 years old man presented to the emergency with a recurrent macroscopic hematuria, he was a heavy smoker and has reported lower urinary tract symptoms. On the physical examination, the patient was hemodynamically stable and afebrile. However, the digital rectal exam revealed an enlarged homogeneous prostate without any palpable nodule. Pelvic transabdominal ultrasound showed an enlarged prostate and a thickening of the bladder's left lateral wall. The CT-scan showed a large and heterogeneous mass arising from the left bladder wall measuring 100 mm, which extends through almost the entire bladder wall. Furthermore, the patient performed cystoscopy, performed by a Urology Professor, showing a normal urethra, a normal prostate gland, and a large solid bladder mass with multiple clots. Subsequently, multiple masses' biopsies were performed. The diagnosis of a primary protatic leomyosarcoma was based on the clinical findings and on the histopathological exam. The patient was prepared for a radical cystoprostatectomy, which would be performed by a Urology Professor, but he died of cardiac arrest before undergoing surgery. Clinical discussion: There are no specific clinical presentations of prostatic sarcoma, patients normally complain of urinary frequency and urinary urgency. Due to the lack of typical clinical symptoms, the tumor is easily overlooked or misdiagnosed as benign prostatic hyperplasia. In this case, the first symptom was a recurrent hematuria in a 64 years-old heavy smoker, which is a relatively rare obvious symptom according to literature. As showed in this case, recurrent hematuria may delay the diagnosis. Concerning the management of prostatic leiomyosarcoma, there are no standard recommendations. Multimodality combination treatments including surgery, pre or postoperative radiotherapy and neo or adjuvant chemotherapy have been used in the management of leiomyosarcoma of prostate. Conclusion: Prostatic leiomyosarcoma poses a unique diagnostic challenge, as clinical presentation alone may not always be suggestive, an unsual clinical presentation as recurrent hematuria must suggest a prostatic leimyosarcoma when associated with urinary frequency and urinary urgency. Histopathological examination and the FNCLCC grading system are essential for the definitive diagnosis. Multimodality treatment regimens including surgery, radiotherapy and chemotherapy are recommended.

Penile hair coil strangulation in a 9-year-old patient: Surgical management and review of the literature.

INTRODUCTION: Strangulation of the penis is a rare situation that requires urgent treatment for penile decompression. The complications could range from simple edema to severe ones such as urethrocutaneous fistula, complete urethral transection, penile gangrene and penile amputation. This work has been reported in line with the SCARE criteria. CASE PRESENTATION: A 9-year-old patient was presented to the emergency service.During examination of the genitals, the glans was hanging to the penis by a very slim pedicle, its coloration was normal and the urethra was almost cut at the sulcus coronarius. The cause of strangulation was multiple hair coils.We performed single stage reparation which consists of refreshing the edges of the urethra and glans, followed by anastomosing the two cut urethral ends, reinforcement by interposing a well vascularized dartos layer was also performed. At the six months follow-up, the penis had a good cosmetic outcome and the glans sensation was present. DISCUSSION: The penile tourniquet syndrome is one of the major causes of pediatric penile trauma. Ritual circumcision is basically the main cause of the series followed by penile strangulation. Surgical reparation can be performed in one or two stages. It should be performed by a surgeons experienced in hypospadias repair by following the same principles of dissection and applying a second layer coverage for the urethroplasty. CONCLUSION: Hair-coil penile strangulation is an uncommon condition. The repair can be realized in one or two stages but it must be performed by a surgeon experienced in hypospadias surgery. Early surgical repair is required to achieve successful results.

The importance of surgical treatment in encrusted cystitis and pyelitis: A case report.

INTRODUCTION: Encrusted cystitis and Encrusted pyelitis are rare chronic inflammatory diseases. Those conditions are commonly caused by the Corynebacterium spp. especially the type D2 which is a gram positive, aerobic, slow-growing, and urea-sliting bacteria with a multi-antibiotic resistant profile. PRESENTATION OF CASE: We report the case of a 62-year-old man with a past history of chronic obstructive pulmonary disease. He was referred to the department of urology for urosepsis. Bacterial culture results were positive to Corynebacterium urealyticum. The diagnosis of encrusted cystitis and pyelitis were highly considered. An adapted antibiotherapy was undertaken using vancomycin during 3 weeks. The patient presented two acute peritonitis : the first was caused by a spontaneous bladder dome rupture which was surgically repaired and the second was caused by a total bladder rupture which required cysto-prostatectomy and bilateral ureterostomy. The post operative outcomes were uneventful. Bacterial urinalysis was negative and total recovery was obtained. DISCUSSION: In the majority of the reported cases, there were no sepsis or peritonitis conditions. Medical treatment by the glycopeptides and urine acidification was sufficient. However in this case, the sepsis condition and the bladder rupture with acute peritonitis made exclusively medical treatment by antibiotics insufficient. Therefore cystectomy associated to conventional antibiotics were able to limit the systemic dissemination of the bacteria and save the patient's life. CONCLUSION: Glycopeptides antibiotics are currently the preferential treatment of encrusted cystitis. In some complicated conditions such as bladder rupture and urosepsis as in this case, radical surgical treatment by cystectomy must be realized early to avoid peritonea and septic shock.

Intratesticular leiomyoma: A case report and a literature review.

INTRODUCTION: Leiomyomas are benign tumors that originate from smooth muscles cells. Intratesticular leiomyoma is a very rare type of benign testicular masses. Through the literature, only 11 cases were reported. PRESENTATION OF CASE: A 36 years old man presented with painless right scrotal mass. Clinical examination showed right upper polar testicular mass, well circumscribed and highly vascularized on sonography. Serum tumor markers were normal. Patient was explained the possibility of an organ sparing surgery if frozen section shows no sign of malignancy. Midline incision with frozen section was performed, with wide local excision. Pathological examination of the specimen confirmed intratesticular leiomyoma. Two years after the surgery, patient showed no sign of recurrence. DISCUSSION: Intratesticular Leiomyoma is usually revealed as a non-tender firm scrotal mass that increases in size. Sonography is the imaging modality of choice for assessing intrascrotal pathology, and cannot distinguish benign from malignant tumor. Surgical management is subject of debate. While some authors recommend radical orchiectomy, others suggest the use of frozen section intraoperatively, and perform conservative treatment by mass excision in the absence of signs of malignancy. CONCLUSION: Intratesticular leiomyoma is a very rare finding. When suspected, conservative management using frozen section followed by mass excision can be done, but final diagnosis remains on pathological examination and immunohistochemistry of the specimen.

Bladder hernia complicated with cystolithiasis and bladder tumor: Two cases' analysis.

Inguinal hernia is frequent and reaches up to 8% of the population. It was reported that over 20 million inguinal hernia repairs are performed annually. The bladder may herniate in 1%-3% of the cases through the inguinal canal that can be responsible for various symptoms. The most specific is the classic "two-stage micturition." However, the diagnosis usually remains unspecific, and a surgeon can fall in the trap of a "simple" inguinal hernia and cause accidental damages to an undiagnosed bladder hernia. Therefore, a clear diagnosis must be assessed based on clinical and radiological findings to avoid complications. In these two presented cases, the patients presented cystolithiasis complicating the bladder herniation. One of the patients also developed a bladder tumor which appeared to be urothelial carcinoma.

Acute urinary retention due to benign prostatic hyperplasia associated with cystitis glandularis in a 22-year-old patient.

A 22-year-old man has consulted in emergency for acute urinary retention and left renal colic. Bladder catheterization was performed. Symptomatic treatment was provided with no improvement. MRI showed a pseudotumoral bladder wall thickening associated with vesical floor budding with prostate median lobe infiltration. The patient got an endoscopy that concluded to an inflammatory aspect of the bladder mycosa and a solid mass in the bladder neck arising. The biopsy during examination concluded to a glandular cystitis. Ultrasonography performed six months later still showed an enlarged prostate of 60g volume, post void residue of 280ml and bilateral hydronephrosis. A second cystoscopy showed an obstructive prostate with a median lobe. A transurethral resection of this lobe was performed. The pathological examination concluded to a benign prostate hyperplasia. This case is likely to be the first reported so far about a BPH in a young male associated with Cystitis Glandularis. Neither etiology nor evidence of the cause behind this case has been identified so far. Although Benign Prostate Hypertrophia is rare among young males, its ethiopathogenesis is not well known, its relation with cystitis glanduralis in young patients has never been described before. Both medical and surgical approaches remain similar to the adults.

Interstitial cystitis: elements of diagnosis and place of histopathological examination. About 16 cases.

BACKGROUND: Interstitial cystitis (IC) is a rare disease, of difficult diagnosis. The diagnostic utility of histopathological examination of bladder biopsy remains controversial. AIM: We conducted a retrospective study to assess the frequency of interstitial cystitis, to analyze its clinical presentation and the data from the paraclinical examinations. We discuss the steps and criteria of diagnosis, as well as the place of histopathological examination for diagnosis. METHODS: Sixteen patients diagnosed with IC were followed in the Urology Department of the Sahloul University Hospital between 1996 and 2013. The diagnosis was suggested by clinical history and confirmed on the basis of clinical symptoms and results of the paraclinical explorations: urodynamic assessment, cystoscopy and bladder biopsy. RESULTS: Six men (37.5%) and ten women (62.5%), with an average age of 56 years complained of pelvic pain and urination disorders for two years on average before the diagnosis. The urodynamic study found decreased bladder compliance in 13 cases and bladder instability in nine cases. Cystoscopy demonstrated inflammatory mucosa in 13 patients (81%). Histologically, the classic ulcerative form accounted for 50% of the cases. The number of mast cells was high in both the mucosa and the muscular in 12 cases, both in the classical and non-ulcerative forms. CONCLUSION: The IC remains a diagnosis of exclusion. The first line of diagnosis is patient selection based on symptoms and an exclusion of diseases with similar presentation. Vesical biopsy is useful for confirmation and classification of the disease.

Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control.

INTRODUCTION: Our goal was to investigate the prevalence and antibiogram pattern of extended spectrum beta-lactamase (ESBL) production among uropathogens using isolates from urine samples collected at the Department of Urology in the Sahloul Hospital, Tunisia We also aimed to identify the risk factors for nosocomial urinary tract infections (UTIs) in patients who underwent transurethral resection of the prostate (TURP) and the measures for infection control. METHODS: Laboratory records of a five-year period from January 2004 to December 2008 were submitted for retrospective analysis to determine the incidence of ESBL infections. A total of 276 isolates were collected. A case-control study involving comparisons between two groups of patients who underwent TURP was performed to determine the risk factors for ESBL infection. Group 1, designated case subjects, included 51 patients with nosocomial UTI after TURP. Group 2, designated control subjects, consisted of 58 randomly selected patients who underwent TURP without nosocomial UTI in the same period. Factors suspected to be implicated in the emergence of ESBL infection were compared between the two groups in order to identify risk factors for infection. A univariate regression analysis was performed, followed by a multivariate one. RESULTS: The annual prevalence of ESBL infection ranged from 1.3-2.5%. After performing univariate and multivariate regression analysis, the main risk factors for ESBL infections were identified as: use of antibiotics the year preceding the admission, duration of catheter use, and bladder washout (p=0.012, p=0.019, and p<0.001. CONCLUSIONS: Urologists have to perform a good hemostasis, especially in endoscopic resections, in order to avoid bladder irrigation and bladder washout and to reduce the time of bladder catheterization, which is a strong risk factor of nosocomial UTIs.

Bilateral renal infarction following atrial fibrillation and thromboembolism and presenting as acute abdominal pain: a case report.

INTRODUCTION: Renal infarct is rare and often misdiagnosed because the symptoms are misleading. The mechanisms are various, mainly thrombotic and embolic. CASE PRESENTATION: In this review, we report the case of a 61-year-old Tunisian woman presented to the emergency unit with a 4-hour history of abdominal pain diffused at both flanks, ultrasounds was performed to remove a surgical emergency, showed a peri-renal fluid collection with heterogeneous parenchyma.We followed by a CT scan, which confirmed the diagnosis of renal infarct. The patient was treated by heparin at a curative dose, and the outcome was favorable. CONCLUSION: Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain and with risk factors to this disease. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment.A review of the literature was performed and the case is discussed in the context of the current knowledge of this condition.

Dermaseptins and magainins: antimicrobial peptides from frogs' skin-new sources for a promising spermicides microbicides-a mini review.

Sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), the causative agents of acquired immunodeficiency syndrome (AIDS), are two great concerns in the reproductive health of women. Thus, the challenge is to find products with a double activity, on the one hand having antimicrobial/antiviral properties with a role in the reduction of STI, and on the other hand having spermicidal action to be used as a contraceptive. In the absence of an effective microbicide along with the disadvantages of the most commonly used spermicidal contraceptive worldwide, nonoxynol-9, new emphasis has been focused on the development of more potential intravaginal microbicidal agents. Topical microbicides spermicides would ideally provide a female-controlled method of self-protection against HIV as well as preventing pregnancies. Nonoxynol-9, the only recommended microbicide spermicide, damages cervicovaginal epithelium because of its membrane-disruptive properties. Clearly, there is an urgent need to identify new compounds with dual potential microbicidal properties; antimicrobial peptides should be candidates for such investigations. Dermaseptins and magainins are two classes of cationic, amphipathic alpha-helical peptides that have been identified in the skin extracts of frogs Phyllomedusa sauvagei and Xenopus laevis. Regarding their contraceptive activities and their effect against various STI-causing pathogens, we believe that these two peptides are appropriate candidates in the evaluation of newer and safer microbicides spermicides in the future.