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.

Pleomorphic spermatic cord liposarcoma: A case report and review of management.

Liposarcoma of the spermatic cord is very rare, representing about 7% of para testicular sarcomas. It is considered to be one of the highest malignancy grades. We present a case of a liposarcoma of the spermatic cord in a 45-year-old male complaining of a progressive painless swelling in the right inguinoscrotal region. Ultrasonography and computed tomography findings were compatible with liposarcoma of the spermatic cord. We performed a right radical orchiectomy with a wide resection of the mass. Histological examination confirmed the diagnosis and showed a pleomorphic subtype. The mainstay of management of spermatic cord liposarcoma is wide excision with radical orchiectomy. The most important factors for prognosis are the histologic subtype and surgical margin status. Adjuvant radiotherapy should be considered in cases at high risk for local recurrence. Long-term surveillance is mandatory. Liposarcoma of the spermatic cord is an uncommon para testicular tumor which should be part of the differential diagnosis of inguinoscrotal mass. A radical inguinal orchiectomy with wide resection of the soft tissue mass and the spermatic cord are the key to longest local and systemic disease-free survival.

Isolated Penile Fournier's gangrene: A very rare entity.

Comparatively to scrotal gangrene, isolated penile gangrene is very rare due to the rich blood supply of the organ. It is thought to be initiated by a traumatic or vascular insult to the penis. This condition requires parenteral antibiotic therapy and serial debridement of necrotic tissue. Split thickness skin graft is thought to be the best approach to cover penile skin loss. We share our experience on the presentation of an isolated penile gangrene in a 35-year-old male. In the light of this case, we review the predisposing factors and the management of this entity.

Unusual presentations of urogenital tuberculosis.

Urogenital tuberculosis is a rare and severe disease since it causes serious consequences. Often, diagnosis may be delayed because of its multiple presentation forms and clinical features. Usually, the recognition is easy to hold, but in certain cases the presentation form can be misleading which can exclude the diagnosis. We present two cases of unusual form of urogenital tuberculosis from which clinical features were taken for a malignant cancer at the beginning. The first case is about a young woman with renal lesions then proceeding to radical nephrectomy. The second case is about a 48 years old patient who had a radical cystectomy to treat an urothelial carcinoma (classified as pT1G3) along with squamous metaplasia (25 %). In both cases, the histologic investigation revealed the presence of a granulomatous reaction with giant cells and caseous necrosis which confirms the diagnosis of tuberculosis. Through the study of these two cases and literature review, we mark the different diagnosis and treatment difficulties handling these unusual presentation forms.

Predictive factors of bleeding and fever after percutaneous nephrolithotomy.

AIM: Percutaneous nephrolithotomy (PCNL) remains the standard procedure for large (≥2 cm) renal calculi; however, up to one quarter of PCNL patients experience some perioperative complications. The aim of the present study was to investigate the factors that may influence bleeding and fever following percutaneous nephrolithotomy. METHODS: In total, 170 patients, who underwent percutaneous nephrolithotomy between January 2012 and January 2016 in our Urology department, were retrospectively evaluated for postoperative bleeding and fever. Preoperative, operative and postoperative factors were assessed using univariate followed by multivariate regression. RESULTS: The mean patient age was 49.41 ± 15.07 years (14-83). The overall stone-free rate was 83.5%. We recorded 48 postoperative complications (28.2%): 34 cases of fever and 14 cases of bleeding. Univariate analyses showed an association between diabetes and postoperative bleeding (p=0.002). Staghorn calculus (p=0.0001), prone position (p=0.009), operative time (p=0.0001) and presence of residual stones ≥  7 mm were associated to postoperative fever (p=0.01). Multivariate stepwise regression analyses showed that diabetes was the only independent predictive factor of postoperative bleeding (OR=7.6). Staghorn lithiasis (OR=5.9), prone position (OR=3.7) and operative time > 95 minutes (OR=6.2) were the predictive factors of postoperative fever. CONCLUSIONS: To our knowledge, this study is the first to report that prone position was significantly associated with fever after percutaneous nephrolithotomy. Further studies are necessary to confirm our results in a greater number of patients.

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.