Management of multiple giant bladder diverticula: a comprehensive approach - a case report.

Introduction and importance: Bladder diverticula are commonly due to obstruction of the bladder outlet and are typically treated conservatively. However, the rarity and complexity of multiple giant diverticula require a tailor-made surgical approach. Case presentation: We report on a 72-year-old male who presented with severe urinary symptoms and lumbar pain, diagnosed with multiple giant bladder diverticula, including one compressing the ureter. The complex presentation of the patient, including his age and comorbidities, added layers of complexity to the clinical decision-making process. Interventions and outcomes: The patient underwent a two-stage surgery consisting of transurethral prostate resection followed by resection of three diverticula. Postoperatively, the patient showed a remarkable improvement in urinary symptoms, resolution of hydronephrosis, and, more importantly, no complications, demonstrating the efficacy and safety of the surgical strategy chosen. Relevance and impact: This case underscores the challenges in managing complex bladder diverticula, highlighting the importance of personalized treatment strategies and further research in atypical urological conditions. Furthermore, this case highlights the need to increase awareness and research on rare urological conditions. By sharing detailed insights from this case, we aim to enrich the clinical knowledge base, ultimately improving patient outcomes in similar challenging scenarios.

Innovative techniques in the treatment of penile strangulation: a case report.

Introduction and importance: Penile strangulation is a medical emergency characterized by the encirclement of the penis by an external object, resulting in circulatory compromise. Case presentation: A 35-year-old male presented with penile pain and urinary obstruction due to the inability to remove the ring. Upon examination, the ring was firmly lodged at the base of the penis, causing significant swelling and discoloration in the distal region. Interventions and outcomes: Initial attempts to cut the ring using standard tools were unsuccessful, leading to the engagement of a rescue team equipped with an air cutter. The cutting procedure, complicated by the ring's thickness and hardness and the significant edema, took ~90 min. Safety measures, including the use of a surgical brain spatula and forceps, were employed to protect the penile skin from damage during the operation. Relevance and impact: This case underscores the necessity for timely intervention in penile strangulation cases and highlights the effectiveness of collaboration with specialized rescue teams equipped with appropriate cutting tools. It also emphasizes the importance of safety considerations when employing nonmedical devices in medical emergencies. The patient experienced a favorable outcome, with significant improvement in swelling and discoloration postprocedure, and no complications during follow-up. This report contributes to the limited but crucial literature on managing penile strangulation, particularly regarding the methods and timeframes for safely removing constricting objects.

Primary adenocarcinoma of the renal pelvis: An uncommon tumor, a case report.

INTRODUCTION AND IMPORTANCE: Primary adenocarcinoma of the renal pelvis is a rare and unique malignancy, representing a small fraction of renal cancers and posing significant diagnostic challenges due to its unusual presentation and similarity in symptoms to more common excretory tract disorders. This case emphasizes the importance of distinguishing this pathology from other renal neoplasms and metastatic adenocarcinomas that originate in the digestive tract. CASE PRESENTATION: We report the case of a 34-year-old man with no significant medical history who presented persistent lower back pain but no hematuria, which is atypical for renal pathologies. Initial imaging identified a 30 × 14 mm enhancement mass in the right renal pelvis. Surgical intervention was performed through right nephroureterectomy, including excision of the bladder cuff. Histopathological examination confirmed the diagnosis of primary intestinal-type adenocarcinoma of the renal pelvis, characterized by necrotic carcinomatous proliferation with varying architectural patterns and occasional signet ring cells. CLINICAL DISCUSSION: The diagnosis of primary renal pelvis adenocarcinoma is complicated by its nonspecific symptomatology and the potential for misdiagnosis as a more common urothelial carcinoma or a metastatic digestive-origin adenocarcinoma. Immunohistochemical staining supported a primary rather than metastatic digestive tract origin. This case underscores the need for a comprehensive diagnostic approach, including advanced imaging and meticulous histopathological analysis, to effectively differentiate this rare entity from other neoplasms. CONCLUSIONS: This case highlights the diagnostic complexities and the critical need to be aware among clinicians about rare renal cancers such as primary adenocarcinoma of the renal pelvis. It also stresses the importance of interdisciplinary collaboration in the diagnosis and management of such rare cases, improving our understanding and requiring timely and accurate treatment.

Idiopathic scrotal calcinosis: Is the cause still unknown? A case report.

INTRODUCTION AND IMPORTANCE: Idiopathic Scrotal Calcinosis (ISC) is a rare and benign dermatological condition, characterized by the formation of calcified nodules on the scrotal skin. CASE PRESENTATION: A 47-year-old man with a 15-year history of painless, chamois-colored nodules on his scrotum. Surgical excision of the affected skin was performed, followed by primary closure, with histopathological examination confirming ISC. The patient recovered well with no recurrence noted at a 14-month follow-up. CLINICAL DISCUSSION: The etiology of ISC remains uncertain, with theories ranging from dystrophic calcification of epidermal cysts to Dartos muscle degeneration. In this case, no signs of epithelial cells or anatomical structure degeneration were observed, supporting the idiopathic nature of ISC. Treatment is typically surgical and aimed at aesthetic or symptomatic relief. While surgery is generally effective, the literature indicates a variable risk of recurrence, underscoring the need for long-term follow-up. CONCLUSION: This report contributes to the understanding of ISC, highlighting its idiopathic nature and the diversity of its etiological theories. It reinforces the effectiveness of surgical treatment for symptomatic relief and underscores the importance of ongoing research to elucidate the condition's etiology and optimize patient care.

Unusual presentation of extended iliofemoral deep vein thrombosis caused by giant retroperitoneal abscess: a rare case report.

Secondary deep vein thrombosis due to a mass effect on the venous system has been reported in the literature. Venous thrombosis is frequently seen in the lower extremities; however, when seen at the iliac level, the mass effect of an underlying pathology must be considered. Identifying such etiologies guides the management and reduces the risk of recurrences. Case Presentation: In this report, the authors present a case of an extended iliofemoral vein thrombosis caused by a giant retroperitoneal abscess (RA) in a 50-year-old woman with underlying type 2 diabetes mellitus, presenting with painful left leg swelling and fever. Color venous Doppler ultrasonography and computed tomography scan of the abdomen and pelvis findings were compatible with a left voluminous RA compressing the left iliofemoral vein with an extended deep vein thrombosis. Conclusions: The mass effect on the venous system is rare in RAs, but it must be kept in mind. In light of this case and literature review, the authors highlight the diagnosis and management difficulties in handling this unusual presentation form of a RA.

Neoplasm of a supernumerary undescended testis: A case report and review of the literature.

INTRODUCTION: Polyorchidism, defined as the presence of more than two testicles, is a rare congenital abnormality of the male genital tract. There is no consensus regarding the management of supranumerary testis (SNT) due to its rareness. To the best of our knowledge, this is the first report of leiomyoma in SNT. PRESENTATION OF CASE: We report the case of a 41-year-old man with two right testes sharing a common vas deferens and separate epididymides. Orchiectomy of right testes was performed. Pathology examination found that the superior testis was the site of a leiomyoma and the lower tesits was the site of an intratubular germ cell neoplasia (IGCN). Orchiopexy and biopsy were later performed for the left testis. Histology was compatible with IGCN. We opted for follow-up to avoid risks of hypogonadism. DISCUSSION: Polyorchidism is usually asymptomatic and found incidentally during surgery for inguinal hernia, undescended testes as in our case, torsion, hydrocele or testicular tumor. If the SNT is scrotal, and there is no other indication for surgery, most authors recommend conservative management with regular ultrasound follow-up. If nonscrotal SNT is found incidentally during surgery, orchiectomy could be performed because of increased risk of malignancy. Treatment of IGCN includes surveillance, orchiectomy, or low-dose external radiation. CONCLUSION: Different factors come into account for polyorchidsm management: the drainage system, the fertile potential of the supernumerary gonad, and its localization. In cases of uncomplicated polyorchidism, a conservative treatment, with US or MRI follow-up seems to be a rational choice without surgical complications.

[Ureteral injuries complicating gynecologic surgery]. / Les traumatismes urétéraux compliquant une chirurgie gynécologique.

Iatrogenic ureteral lesions may occur after any pelvic surgery. They are severe and can affect renal function and even vital prognosis. This study aimed to determine the clinical aspects and the therapeutic approaches of this injury. We conducted a retrospective study of six patients with iatrogenic ureteral lesions following gynecologic or obstetric surgery whose data were collected in the Department of Urology in Kairouan on a period of 4 years (2012-2016). The average age of our patients was 46 years. They were all multiparous. Clinical symptoms were variable depending on the type of lesion. Intravenous urography is very useful for diagnosis. It was performed in 4 cases showing abnormalities. Treatment was based on the insertion of a catheter in one case and on 5 uretero-vesical reimplantations. The postoperative course was marked by a nephrectomy. Iatrogenic ureteral lesions have become a rarity. They are correlated with the degree of medicalization in the country. Gynecological and obstetric surgery is the main cause of iatrogenic ureteral lesions. Prognosis is conditioned by early diagnosis and the anatomic condition of the ureter.

Predictive factors of extracorporeal shock wave lithotripsy success for urinary stones.

Objective To review with our experience the predictors of stone-free status after extracorporeal shock wave lithotripsy (ESWL) on urinary stones. Methods The records of 68 consecutive patients with urinary stones treated with ESWL were reviewed. Patient age, sex, body mass index (BMI), stone dimension, stone Hounsfield density (HD) and stone composition determined by infrared spectroscopic analysis were studied as potential predictors. Results Stone Hounsfield density and stone composition were found to be the only predictors of treatment outcome. Stones with lower mean HU levels were more successfully fragmented. The stone density threshold that best distinguished between the outcome groups was 1000 HU. Higher ESWL success rates were found with uric acid and calcium oxalate dihydrate stones. Conclusions The results of our study have shown that stone Hounsfield density and stone composition predict for ESWL success.

[Solitary fibrous retroperitoneal tumour: report of two cases]. / La tumeur fibreuse solitaire rétropéritonéale: a propos de deux observations.

Solitary fibrous tumours are benign tumours, described for the first time by Klemperer and Rabin in 1931. They are mesenchymal tumours which usually arise in the pleura, while retroperitoneal sites have been rarely described. The authors report two cases of very large retroperitoneal tumours in two men aged 58 and 47 years, respectively, who consulted for abdominopelvic vaulting associated with gastrointestinal and urinary disorders. Ultrasound-guided biopsy suggested the diagnosis preoperatively in one case. In the light of these cases, the authors present a review of the main extrapleural sites described to date, as well as the most characteristic radiological, histological and immunohistochemical features in order to facilitate the diagnosis.