Pelvic leiomyoma associated with intermediate risk prostate cancer: A case report.

Pelvic leiomyoma in male patients is a very rare occurrence and its association with prostate cancer is a unique clinical situation. This study reports a new case of a 9 cm pelvic Leiomyoma associated with intermediate-risk localized prostate cancer in a 68-year-old patient. The leiomyoma was discovered fortuitously after an MRI was performed in the context of prostate cancer work-up. Surgical excision of the pelvic mass along with a radical prostatectomy were performed and the diagnosis of leiomyoma was confirmed by histopathology.

Segmental renal vein thrombosis: An unusual complication of acute pyelonephritis.

Renal vein thrombosis is not a common manifestation in the context of acute pyelonephritis. We report the case of a 29-year-old female diabetic patient that was admitted to our department for an episode of complicated acute pyelonephritis. Initial imaging showed a left lower polar abscess of 27 mm and urine cultures grew community acquired K. Pneumoniae. Two days after the patient was discharged, she was readmitted with worsening symptoms. Repeat imaging showed stability in the size of the abscess and revealed a left lower segmental vein thrombosis. The patient responded favorably to antibiotics and heparin-warfarin therapy.

Bilateral renal hydatid disease associated with complex urolithiasis: A case report.

INTRODUCTION AND IMPORTANCE: The association of bilateral renal hydatid cysts and complex urolithiasis is unprecedented. We herein report the case of a patient presenting with both diseases. CASE PRESENTATION: A 56-year-old female patient with a history of chronic kidney disease presented with right flank pain. Imaging revealed bilateral kidney cystic lesions associated with right spontaneous large ureteric streinstrasse and multiple calyceal stones. The right sided mass was exophytic and measured 56 mm and the left sided lesion measured 35 mm. Semi rigid right ureteroscopy was performed along with a right partial nephrectomy and a right pyelotomy which allowed for renal and ureteral stone extraction. Histopathology report concluded to a hydatid cyst. The decision was to monitor the left-sided lesion. CLINICAL DISCUSSION: The association of bilateral renal hydatidosis and right urolithiasis is unprecedented in literature. The lesion presented a differential diagnosis problem with a cystic malignancy. Thus, the decision was to perform a right partial nephrectomy. The combination of ureteroscopy and a single right flank incision was sufficient to treat the renal lesion as well as to obtain stone free status. Once the histopathological report concluded to a hydatid cyst, the decision was to monitor the left sided lesion. A more aggressive approach could be proposed however it would have been detrimental to the patient's renal function. CONCLUSION: When presented with an association of bilateral renal masses and urolithiasis, a methodical step-by-step approach is necessary in order to treat both diseases while minimizing patient morbidity.

Functional outcomes of surgical treatment of ureteral injury following gynecological and obstetrical surgery.

Introduction: Iatrogenic ureteral lesions represent one of the serious complications that can follow obstetric and gynecological surgery. This condition has a fatal consequence on renal function if it's not promptly diagnosed and managed. Objective: The aim of our study was to report our experience in the management of this pathology. Materials & Methods: This is a retrospective study of 32 patients treated for an iatrogenic ureteral injury after gynecological or obstetrical surgery, collected in the urology department of the Rabta Hospital over a 15-year period (2005-2020). Clinical presentation, investigations, and operative and postoperative details were reviewed from the patients' charts. Results: The average age of the patients was 42.6 (21-61). Multiparity was observed in 90.6% of cases. Hysterectomy was the most common cause (71.87%), followed by cesarean operation (18.75%), mainly for patients with placenta percreta (12.5%), and lastly, cure of prolapse by the upper approach in 9.37% of cases. The symptoms were dominated by low back pain and urinary incontinence. Stenosis was the most frequent lesion in 25 cases, followed by a section in 4 cases. A ureterovaginal fistula was observed in 3 case s. The first-line treatment of the patients was drainage by a ureteral stent (15.6%) or by a percutaneous nephrostomy (84.4%). Ureterovesical reimplantation was performed in 26 cases (81.25%). However, one patient had an Ileal ureter replacement. During follow-up, treatment failure was noted in 7 patients. Four patients developed secondary hydronephrosis treated with a urethral stent while 3 patients required nephrectomy. The type of gynecological and obstetrical procedure (open hysterectomy), history of pelvic surgery, and malignant pathology were predictive factors of treatment failure. Conclusions: Injuries to the ureter during gynecological and obstetrical surgery are generally rare. The diversity of repair techniques and the contribution of endo-urological techniques most often allow renal preservation, knowing that the best treatment remains prevention.

Unusual association between testicular tuberculosis and microdeletion of the Y chromosome in an infertile patient with azoospermia.

Introduction: and importance: Infertility affects approximately 10-15% of couples worldwide. Several causes are incriminated such as hormonal abnormalities, infections, genetic disorders, testicular cancer, varicocele, and others. Herein, we report a case of an unusual association between testicular tuberculosis and microdeletion of the Y chromosome in an infertile patient and we discuss the diagnostic and therapeutic difficulties. Case presentation: A 36-year-old patient, a smoker, with no previous history consulted our department for primary infertility for 2 years. The clinical examination was normal. The sperm count showed azoospermia. karyotype analysis confirmed the diagnosis of a microdeletion of the Y chromosome. A testicular biopsy was performed. The microscopic analysis did not find any sperm cells. However, the histopathological examination was in favor of testicular TB. The patient received 6 months of anti-TB treatment. He remained azoospermic. Clinical discussion: Azoospermia is defined as the absence of sperm in the ejaculate in two different samples. This condition is classified as obstructive and non-obstructive. The etiology of this condition is either an intrinsic testicular deficiency or an insufficient production of gonadotropins. Genetic and chromosomal abnormalities should be investigated due to the higher incidence in azoospermic patients compared to the normal population. Testicular causes are dominated by infections, trauma, ischemia, and iatrogenic causes such as chemotherapy and radiotherapy. Genetic causes are dominated by Klinefelter syndrome and Y-chromosome microdeletions. Conclusion: Azoospermia is a frequent cause of male infertility. Several causes are incriminated such as hormonal abnormalities, infections, genetic disorders, and others. In some cases, this condition can be multifactorial.

An unusual cause of painful ejaculation in a young patient: Zinner syndrome.

Introduction: and importance: Zinner syndrome is a rare congenital malformation of the seminal vesicles and the homolateral upper urinary tract. While the majority of patients remain asymptomatic and are discovered incidentally, others present symptoms such as micturition or ejaculatory difficulties, or pain. We report a case of Zinner syndrome in a 32-year-old patient with painful ejaculation and discuss the diagnosis and treatment difficulties. Case presentation: A 32-year-old married patient was consulted for pelvic pain associated with painful ejaculation that had been evolving for six months. The clinical examination was normal. Routine laboratory studies of blood and urine were normal. The patient was explored by ultrasound which showed the absence of the right kidney and the presence of a 7 cm right lateral prostatic cystic mass. On MRI, the right kidney was not visualized. Multiple cysts were seen in the right seminal vesicle. Surgical excision of the cyst by laparotomy was performed. The patient had an uneventful recovery and was discharged on the third postoperative day. Clinical discussion: Congenital malformations of the seminal vesicles are often associated with those of the ipsilateral upper urinary tract, as the ureteral and seminal vesicle buds originate from the mesonephric duct. The syndrome often occurs in the second and third decades of life, especially after the onset of sexual activity. The most common symptoms were dysuria, perineal pain, epididymitis, and painful ejaculation. Diagnostic modalities include ultrasound, MRI, and cystoscopy. In patients with symptoms, the therapeutic management of the cyst includes ultrasound-guided aspiration and laparoscopic or open surgical excision. Conclusion: Seminal vesicle cysts associated with homolateral renal agenesis or hypoplasia are a rare urologic anomaly. The treatment depends on the patient's symptoms. surgical excision of seminal vesicle cysts may be needed for large cysts causing obstructive symptoms.

Functional outcomes of surgical treatment of varicocele in infertile men: Comparison of three techniques.

Introduction: Among identified causes of male infertility, varicocele holds an important place and is significantly associated with sperm quality deterioration. Surgical management of this condition leads to an improvement in the sperm count and an increase in the spontaneous pregnancy rate. Objective: The goal of this study was to compare different surgical techniques in terms of morbidity and fertility results. Patients and methods: It is a retrospective study of interesting patients followed for infertility related to varicocele between January 2007 and December 2015. Three surgical techniques were compared: open inguinal surgery, antegrade sclerotherapy, and laparoscopy. Morbidity and pregnancy rate were assessed according to different techniques. Results: Post-operative complication rates were comparable (p = 0,94) between the 3 surgical techniques. An amelioration of sperm parameters has been noted in all operated patients, without statistical difference between the three techniques (p = 0,29 for the sperm concentration and p = 0,49 for the progressive mobility). Spontaneous pregnancy was better (p = 0,03) for patients who have had a varicocelectomy in a sub-inguinal way. Conclusion: All of the three surgical techniques used in this study showed an improvement of sperm parameters in an equal way with similar morbidity. However, the spontaneous pregnancy rate with open surgery was better.

Predictive factors for failure of conservative management in patients with emphysematous pyelonephritis.

Introduction: Emphysematous pyelonephritis (EPN) is a severe form of life-threatening renal infection. Conservative treatment represents the gold standard in the management of EPN, but nephrectomy remains appropriate in certain situations. Objective: The aim of our study was to report our experience in the conservative management of emphysematous pyelonephritis and to identify the predictive factors of failure of conservative treatment. Patients and methods: This is a retrospective study including all patients treated for emphysematous pyelonephritis in our department between January 2015 and December 2020. The first-line treatment was conservative based on antibiotic therapy and drainage in case of an obstructive cause. A nephrectomy was performed in case of failure of the conservative approach. Epidemiological, clinical, biological, therapeutic, and evolutionary data were collected from the patients' files. Statistical analysis was made using SPSS version 28. Results: 41 patients were included in our study. The mean age was 64.4 years old [28-91] with gender ratio of 0.46 (13H/28F). Diabetes mellitus was present in 75.6% of cases. The mean presentation delay was 3.28 days (Kaiser and Fournier, 2005; Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007; Dutta et al., 2007; Dutta et al., 2007; Deoraj et al., 2018 Sep; Rahim et al., 2021 Mar; Maheshwari, 2021 Jul-Sep) [1-11]. In CT scan, 21 patients had class 1 EPN, 9 had class 2 EPN, 8 had class 3 EPN and 3 had class 4 EPN. The obstructive origin was found in 24 cases. Initially, 25 patients (60.9%) presented with severe sepsis and 7 patients (17.07%) developed a septic shock. Seven patients required nephrectomy with a mean delay of 2.12 days (Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007) [2-6]. Five patients with septic shock refractory to conservative treatment and two patients whose evolution was marked by the occurrence of secondary septic shock. In the univariate analysis, thrombocytopenia, initially septic shock, and the need for hemodialysis were the predictive factors of failure of conservative management in patients with emphysematous pyelonephritis. Conclusion: Emphysematous pyelonephritis is a serious condition with significant mortality. The optimal management is based on conservative treatment in most cases. However, patients requiring hemodialysis and with thrombocytopenia and initially septic shock should be considered candidates for emergency nephrectomy.

Adult bladder rhabdomyosarcoma: A case report.

Rhabdomyosarcomas (RMS) are mesenchymal tumors that develop at the expense of striated muscle fibers. It accounts for 6% of childhood malignancies. Rhabdomyosarcomas of the genitourinary tract also occur in children but are distinctly uncommon in adults. We report a case of bladder rhabdomyosarcoma in a 72-year-old patient who presented with gross hematuria and discuss difficulties of diagnosis and treatment.

Erectile function outcomes following surgical treatment of ischemic priapism.

Introduction: Ischemic Priapism is defined as an abnormally prolonged state of erection, exceeding 6 h, often and irreducible, occurring without any sexual stimulation. Ischemic priapism has a fatal consequence on the sexual function of men if it's not promptly managed. This pathology can cause erectile dysfunction and this can alter the quality of life of patients. Objective: The aim of our study was to determine the factors influencing erectile function after treatment of ischemic priapism. Patients and methods: This is a ten-year retrospective, descriptive and analytic study of 40 patients who consulted the urology department at the university hospital center for treatment of ischemic priapism (2010-2019). Results: We included 40 patients in our study. The mean age was 35.2 [18-62]. Duration of priapism varied from 20 to 360 h (mean 76.6). The most common etiology of priapism was sickle cell disease in 65% of cases. The mean preoperative IIEF-5 score was 23 [21-26]. All patients underwent corporal aspiration with an injection of ephedrine, but detumescence was observed in only 10% of cases. Thirty-six patients had a distal shunt with detumescence in approximately 70% of cases. Eleven patients underwent a distal shunt but seven patients had definitive fibrosis. After the episode of priapism, only eight patients retained normal erectile function. The mean postoperative IIEF-5 score was 14 [ 7-26]. We noted an improvement in erectile function in 8 patients treated with tadalafil. In multivariate analysis, we have demonstrated that a treatment delay exceeding 48 h, fibrosis and the necessity of a distal shunt significantly affects postoperative erectile function (p = 0.001; p = 0.002; p = 0.002 respectively). Conclusion: According to our study, delayed management exceeding 48 h, fibrosis and the necessity of a surgical distal shunt are three independent factors affecting erectile function after treatment of ischemic priapism.

An unusual association between renal tuberculosis and urothelial carcinoma of the upper urinary tract; a case report.

The occurrence of urothelial carcinoma and tuberculosis in the same kidney is exceptional. To our knowledge, a few cases have been reported in the literature. Herein, we report a case of an unusual association between renal tuberculosis and urothelial carcinoma of the upper urinary tract in a 61-year-old patient and discuss the diagnosis and treatment difficulties.

[The prognostic value of preoperative neutrophil-to-lymphocyte ratio in patients with non-metastatic renal cell carcinoma]. / Signification pronostique du rapport préopératoire neutrophiles-lymphocytes dans le cancer du rein non métastatique.

INTRODUCTION: The aim of this study was to investigate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio in non-metastatic renal cell carcinoma. PATIENTS AND METHODS: We retrospectively analyzed the records of patients with non-metastatic renal cell carcinoma who were operated between 2004 and 2020 at our institution. The Kaplan-Meier method was utilized to graphically display survivor functions. Univariate and multivariate Cox's proportional hazards regression models were utilized to analyze the association between neutrophil-to-lymphocyte ratio and oncological outcomes. RESULTS: We included 202 patients. Patients with higher neutrophil-to-lymphocyte ratio had larger tumors (P=0.03), higher ASA score (P=0.014), clinical symptoms (P=0.04), sarcomatoid differentiation (P=0.03) and tumor necrosis (P=0.02). The rates of recurrence-free survival and metastasis-free survival were significantly lower in patients with a high neutrophil-to-lymphocyte ratio than in those with a low ratio (P=0.017; P=0.036 respectively). Multivariate analysis identified the neutrophil-lymphocyte ratio as an independent predictor of recurrence-free and metastasis-free survival (P=0.021; P=0.001 respectively). CONCLUSION: A higher neutrophil-to-lymphocyte ratio has been associated with a symptomatic renal cancer with a significant prognostic factor for both recurrence-free and metastasis-free survival. LEVEL OF PROOF: 3.

Bilateral renal abscess fusing with the psoas on the right: A case report.

Renal abscess is a medical and surgical urological emergency whose diagnosis has been improved by modern imaging. It often poses a problem of therapeutic management between antibiotic therapy or the association of a drainage. Most abscesses are unilateral, the bilateral nature of the abscessed lesions suggests a hematogenous diffusion. We report a case of a bilateral renal abscess fusing to the psoas muscle on the right that progressed well with antibiotic treatment and percutaneous drainage.

Isolated penile schwannoma: A rare case report.

Schwannoma is a benign nerve tumor composed of cells of the schwann nerve sheath. Only about twenty cases have been reported in the literature to our knowledge. We report an isolated case of schwannoma of the penis in a 56-year-old man who presented a nodule of the penis in the balanopreputial groove that had been progressively increasing in size for three years. Anatomopathological and immunohistochemical criteria allowed for a positive diagnosis. Treatment consisted of surgical excision followed by rigorous surveillance.

Prostatic lithiasis complicating granulomatous prostatis of tuberculous origin: About a case report.

Urogenital tuberculosis remains a frequent disease in our country. It is the most common extra-pulmonary location. Prostatic involvement is extremely rare. We report the observation of a prostatic lithiasis complicating a granulomatous prostatitis of tuberculous origin, revealed essentially by obstructive and storage lower urinary tract symptoms. The diagnosis was suspected on imaging and clinical findings and confirmed by histology. Treatment consisted of endoscopic resection of the prostate associated with endoscopic ballistic lithotripsy. Prostatic lithiasis is a rare condition with a poorly elucidated ethiopathogeny. The origin of tuberculosis should be evoked in front of this affection.

Isolated prostatic tuberculosis and review of literature.

Tuberculosis (TB) is one of the most important infectious diseases, particularly in the world. Amongst the genitourinary organs, prostatic TB is less common. We report an 68 year old patient, immunocompetent who presented obstructive and irritative symptoms of the lower urinary tract. A history of pulmonary tuberculosis was not present. The digital rectal examination was suspicious and PSA was a normal. The biopsy results did not reveal any malignant lesions but the transurethral resection of the prostate performed for voiding purposes showed prostatic tuberculosis. A very good clinical and biological improvement was observed after chemotherapy anti-tuberculosis.

Primary tuberculosis of the glans penis: A rare presentation and review of literature.

Tuberculosis poses a real public health problem inTunisia.We report an 80-year old patient, immunocompetent, who has initial presentation of a painless ulcerative lesions of the glans penis. A history of pulmonary tuberculosis was not present.The physical examination revealed an indurated glans penis covered with blackish crusts and small ulcerations. A biopsy of the lesion was undertaken and histological examination was confirmed the diagnosis of tuberculosis of glans.Others investigations was performed without finding any abnormalities He responded well to anti-tubercular treatment with complete resolution of lesions in six months.

Venous thrombosis of the pampiniform plexus after coronavirus infection (COVID-19): A case report.

Because of an increased hypercoagulable state, a significant proportion of COVID-19 patients develop various and extensive venous thromboembolic complications. We report the case of a young patient with a history of pneumopathy related to COVID-19 disease, in whom the diagnosis of thrombosis of a pampiniform plexus vein was made on color doppler ultrasound data. We adopted a conservative treatment with good clinical and radiological evolution. To our knowledge, this is the second association of venous thrombosis of the pampiniform plexus with COVID-19 disease.

Ureteral diverticulum complicated by urinary lihiasis: About a case report.

Ureteral diverticulum is a rare urinary malformation and can frequently lead to urinary complications. It can be congenital, acquired or an abortive ureteral duplication. Most are treated conservatively. A surgical indication is made in case of symptomatic or complicated diverticulum. It can be congenital, acquired or an abortive ureteral duplication. Most of them are treated conservatively. A surgical indication is given in case of symptomatic or complicated diverticulum. and recurrent total hematuria. Radiological investigations confirmed the diagnosis of congenital ureteral diverticulum complicated with lithiasis.

Double retroperitoneal hydatid localization: About a case report.

The hydatid cyst is a parasitic pathology which is endemic in Tunisia and presents a public health problem.Hydatid cysts located in the retroperitoneum, especially around or in the kidney, are rare and only represent 5% of visceral locations. The kidney is the most commonly affected organ of the urinary tract.The psoas muscle is an uncommon location and not less than 70 cases have been cited. We report the Case of an unusual presentation of a right kidney hydatid cyst associated with a psoas muscle location. To our knowledge, this association of double retroperitoneal location has not been reported in the literature.