Giant Pyelic Stone: Clinical Image

The management of giant stones of the upper urinary tract remains a challenge for the urologist because of the potential risk of treatment-related complications [1]. We report as a clinical picture the case of a 42-year-old patient received for chronic right lumbar pain in whom the CT scan performed revealed the presence of a giant pyelic stone (Figure 1a and 1b) whose dimensions on the sagittal plane are 43.1mmx41.5mm. The patient underwent an open pyelolithotomy in our department, which allowed the extraction of a giant pyelic calculus of 12cm (Figure 1c). The postoperative course was simple.

Urachal Sinus Surgery: Clinical Picture

The urachus is a fibrous cord, a remnant of the duct, which in the embryo, connects the bladder with the allantois duct [1]. The urachus can be the site of two types of lesions: on the one hand, congenital anomalies resulting from a defect in the obliteration of the allantois duct (diverticula, fistulas, cysts, sinus), and on the other hand, acquired lesions, essentially of a tumoral nature and most often malignant (urachus carcinoma) [2]. We report the clinical picture of a 28-year-old patient, with a history of uropathology since childhood (hypospadias), chronic renal failure since 2017 under dialysis, neobladder type Mitrofanoff since 2009, admitted for the management of an umbilical abscessed collection. Abdominal MRI revealed a superinfected urachus sinus. The treatment consisted of complete open excision of the sinus (Figure 1) from the umbilicus to the urinary bladder. The postoperative course was simple. Figure 1: The resected specimen (urachal sinus (black arrow), bladder wall (white arrow). A purulent umbilical discharge is often indicative of the presence of a urachus sinus; ultrasound and fistulography are sufficient for the diagnosis [3]. Excision of the urachus sinus by surgery is the standard treatment in this clinical situation [4].

Radical Nephroureterectomy: A Clinical Image

Upper Urinary Tract Urothelial Carcinoma (UTUC) remain rare. Radical Nephroureterectomy (RNU) is the Gold standard for management of these tumours. We are reporting a clinical image of a 45-year-old patient admitted in emergency for left lumbar pain (nephritic colic). The checkups requested computed tomography scanner showed a nephromegaly and left hydronephrosis upstream of a suspicious parietal thickening of the lumbar ureter with cortical and functional repercussion, neighborhood infiltration, and atypical lateral-aortic ganglia. Left lower calicial lithiasis of stasis, pancreatic nodular lesion and the left adrenal gland. The patient was a candidate for an open Radical Left Nephroureterectomy (RNU) (Figure 1). Figure 1: Radical Nephroureterectomy (RNU) picture U (Ureter) R (Renal). There are prognostic factors of tumors of the upper urinary excretory tract, which are the patient’s status, the preoperative, the operation and the anatomopathology [1]. According to current literature data, the oncology outcomes of radical nephrouretrectomy by laparoscopic are lower than those of open RNU surgery [2].

Comparison of Modified Mathieu versus Standard Tubularised Incised-Plate Urethroplasty for Distal Hypospadias Repair

Objective: To compare the outcomes of modified Mathieu versus standard tubularised incised-plate urethroplasty for distal hypospadias repair. Materials and Methods: This prospective comparative study was conducted on 54 cases affected by distal hypospadias presenting to Institute of Kidney Disease, Hayatabad, Peshawar form February 2015 to June 2020. The inclusion criteria was patients with distal hypospadias (coronal, sub-coronal, or distal penile), age range of 15 to 60 months. Cases with severe chordee/ventral curvature, history of previous hypospadias repair, and poorly developed urethral plate were excluded. The patients with distal hypospadias were divided into two equal groups: in-group I repair done with Mathieu procedure plus incision of the urethral plate (modified Mathieu) and in-group II repair was performed with Tubularized Incised Plate (TIP). The principal author performed functional and cosmetic assessment at follow up visits which includes; denvo meatus; size and pressure of the stream; and complications like meatal stenosis, urethral cutaneous fistula. Fisher Exact test was used to compare categorical variables between the two groups and student t test for continuous variables. Results: The mean age of the study was 38.13±12.55 months. The operating time was less in TIP than modified Mathieu procedure statistically (P=0.036, 95% CI=0.315, 9.02). In modified Mathieu procedure the sprayed stream of micturition was higher (n=4, 14.8%) while in TIP procedure the frequency of narrow stream was higher (n=4, 14.8%). The difference was statistically significant (P=0.054). Only in modified Mathieu procedure the meatus shape was round in 4 (14.8%) cases and the results were statistically different (P=0.038). Post-operative fistula was higher TIP (n=6, 22.2%) than modified Mathieu (n=1, 3.7%) statistically (P=0.043). Only in TIP procedure postoperative meatal stenosis was found in 5 (18.5%) and the difference was statistically significant (P=0.019). Conclusion: The modified Mathieu technique can improve the cosmetic outcome through creation of slit-like meatus, low incidence of fistula and meatal stenosis than tubularized incised plate urethroplasty in the repair of distal hypospadias.

Rupture of Dorsal Vein Mimicking Penile Fracture: a Case Series Report and Literature Review

Penile fracture is a rare and traumatic emergency in andrology. Immediate surgical repair is widely accepted as the therapy of choice in penile fracture. But some situations mimic penile fracture such as superficial dorsal vein rupture. There are few cases reported in the literature. Aim: To present a case series of injuries of the penile dorsal vein that occurred during sexual intercourse. Methods: A 48-year-old and 45-year-old patients both received in emergency for suspected penile fracture after one hour of vigorous sexual intercourse, the clinical examination and ultrasound were performed and the penile fracture was suspected. Surgical management in an emergency was indicated. Results: Per-operative diagnosis was a dorsal vein injury. The surgical management which consisted of early exploration, evacuation of hematoma, and ligation of the bleeding vessel in this case was good with preserving erectile function after surgery, without abnormal curvature erection. Conclusions: Vascular injuries of the penis can mimic perfectly penile fractures. The medical history and clinical examination can lead to prompted exploration for suspected penile fracture. The ultrasound exploration can be limited for detection of penile vascular injury and final surgical exploration offers final diagnosis and repairment of the trauma. Clinical evolution is favorable, without painful nocturnal erections or deviation of the penis or hypoesthesia of the glans.

Augmentation Cystoplasty in Children: Institute of Kidney Diseases Peshawar Experience

Objective: The aim of this study is to share our single-center experience of Augmentation Cystoplasty (AC) in children regarding indications, bowel segment used, associated procedures, and its complications. Materials and Methods: We analyzed data of all pediatric patients who underwent AC at Institute of Kidney Diseases (IKD), Peshawar between July 2017 and March 2020. Results: A total of 18 pediatric patients are included in the study who underwent Bladder augmentation (BA) either isolated in 1 (5.5%), or along with other associated procedures like Mitrofanoff 17 (94.4%), Antegrade Continent Enema (ACE) 6 (33.3%), Bladder Neck Reconstruction (BNR) 5 (27.7%) and Bilateral ureteric Re-implantation (B/L UR) in 3 (16.6%). Indication for Bladder augmentation were Neurogenic bladder (NGB) 13 (72.2%), Exstrophy Epispadias Complex (EEC) 3 (16.6%) and Posterior urethral value with small functional capacity bladder 2 (11.1%). Small gut used in 15 (83.3%) and large gut in 3 (16.6%) for BA. For Mitrofanff associated with bladder augmentation, Appendix was used in 14 (82.35%) and small gut (Monti) in 3 (17.6%) cases. For ACE associated with BA, in 4 (66.6%) Appendix used as right-sided ACE and in 2 (33.3%) small gut (Monti) as left-sided ACE. No intraoperative complications noted, while early post-op complications, 2 wound infection and 1 urinary leakage from wound, were noted in 3(16.6%) cases and late post-op complications (stomal stenosis) in 4(22.2%) patients.

Giant Testicular Cancer: Clinical Picture

Testicular tumour is the most malignant cancer in young males 15 to 34 years of age. Its accounts for 1% of all male cancer and 5% of urological malignancy [1]. The management of this type of cancer is radical inguinal orchiectomy which is the gold standard for the diagnosis and initial management of a suspected testicular cancer. Trans -scrotal orchiectomy is discouraged because scrotal violation is associated with higher rates of local recurrence and altered pathways of metastatic dissemination [2]. We report a young patient 23 years old. History: Chronic smoking, cannabis. Admitted for large bursa evolving for 14 months. The history of the disease dates back to 14 months by the gradual increase in the volume of the bursa with an alteration of the general status with a weight loss estimated at 10kgs. Clinical examination showed: right hemi-scrotum increased in volume with a hard consistency with a left testicle repressed in extreme lateral and some inflammatory lesions. Right testis was not palpable with a cord repulsed and glued to the inguinal orifice. The ultrasound of the scrotal content showed: large right testis hypervascularized with moderate anterior cloisonnae hydrocele, bilateral testicular microlithiasis. Tumor markers: Lactate Dehydrogenase (LDH) 229IU, beta-Human Chorionic Gonadotropin (beta-hCG) 29.73mUI/ ml, Alpha-Foetoprotein (AFP) 400IU/ml. Patient benefited from a complete pre-operative assessment that did not object to any abnormality. Programmed for a right inguinal orchiectomy and reduction scrotoplasty (Figure 1).

Prevalence of Stress Urinary Incontinence in Women from a Rural Community in the Brazilian Amazon

Introduction: Stress urinary incontinence affects a significant number of women and causes great loss of Quality of Life (QoL). Its prevalence varies from 15 to 41.5%. Objective: To assess the prevalence of Stress Urinary Incontinence (SUI) in women living in a rural community in Amapá, the main risk factors and quality of life assessment using a standardized questionnaire. Methodology: A screening questionnaire was applied to 235 women residing in Igarapé da Fortaleza, in the city of Macapá, in 2015. Patients with SUI complaints were submitted to the King’s Health Questionnaire (KHQ) questionnaire. For statistical processing, BioEstat software version 5.3 was used. Results: The prevalence of SUI was 28.9% (68 women). A significant age difference was found between women with SUI (44.2) and without SUI (37.9 ± 12.5 years). Childbirth, birth interval, smoking and Body Mass Index (BMI) showed to be statistically significant differences between groups. Variables such as number of deliveries, birth weight, menopause, education and race did not express a real difference. Conclusion: The prevalence of SUI was 28.9%. There was a significant difference in the group with SUI in terms of age, smoking, parity, interval between births and BMI. In assessing QoL in patients with SUI using KHQ, we found the worst results in general health perception, impact of incontinence, personal relationships, sleep/mood and severity of symptoms.