Abstract Aim: According to World Health Organization, prostate cancer is one of the increasing malignancies in men worldwide. This paper aims to describe the epidemiological, clinical, diagnostic, therapeutic, and evolutionary aspects of patients with early metastatic prostate cancer in a urology center in the city of Douala in Cameroon. Materials and Methods: It is a retrospective and descriptive study of 110 patients with prostate cancer that was immediately metastatic at diagnosis over a period of six years (from January 2014 to December 2020). Results: The average age of patients at diagnosis was 67.5 years (range: 45 years to 88 years) and 53.63% of patients had body mass indexes greater than 25. Disorders of the lower urinary tract were the main presenting complaint in 55.45% of cases, followed by bone and joint pain in 46.36% of cases. Digital rectal examination was suggestive of prostate cancer in 96.36% of cases with an average total prostatic specific antigen (PSAT) level of 676.9 ng/ml (range: 21.8 to 8832 ng/ml). The diagnosis was made through prostate biopsy in 57 (51.81%) patients or after palliative endoscopic resection of the prostate indicated for lower urinary tract symptoms or even acute urinary retention in 53 (48.18%) patients. Adenocarcinoma of the prostate was the main histologic type, and in 47.27% of cases, the tumor was poorly differentiated with a Gleason’s score of greater than 7. The sites of metastasis were mainly the lymph node (87.27%), bone (56.36%), and both (44.54%). The treatment was palliative and dominated by bilateral pulpectomy in 60% of cases and luteinizing hormone-releasing hormone agonists (Triptorelin 11.25 mg every 3 months) in 44 (40%) of cases. Conclusion: Prostate cancer is a real public health problem in developed countries but also in Africa, especial ly in Cameroon. It is aggressive cancer that is often diagnosed when metastasis has already occurred. Its management is essentially palliative.

Abstract Objective: To evaluate the role of the laparoscopic approach in the management of pelvic calculi in a urology centre in Douala, Cameroon. Materials and Methods: This was a retrospective study carried out from 2014 to 2019 involving 62 patients with calculi at the renal pelvis managed through laparoscopic pyelolithotomy. Results: We recruited 62 patients (38 men and 24 women) with a median age of 36 [25 - 48] years. Nephritic colic was the most frequently encountered presenting complaint (92% of cases). In 56.45% of cases, the stone was on the left side of the body. Twelve patients had kidney acute failure at the time of diagnosis. Five patients received antibiotics for urinary tract infections before the operation. Before surgery, eight double J stents were placed in 8 patients; in five because of urinary tract infection and in three because of nephritic colic. In all the cases, the definitive diagnosis was made using abdominal CT scans. The median size of the calculi was 22 [17 - 28] mm. Dilatation of the pyelocaliceal cavity was noticed in all the patients. The median surgery duration was 100 [90 - 120] minutes. Drainage of the urinary tract using a double J stent was performed in all the patients, whereas percutaneous drainage was performed only in 9.67% of cases. There was no case of conversion to open surgery. Control ultrasound performed one month after the removal of the double J stent did not reveal any residual stones in the pyelocaliceal cavities. Conclusion: Laparoscopic pyelolithotomy is a mini-invasive technique that is adequate for the management of voluminous pelvic calculi.

Abstract Traumatic ruptures of the bladder are relatively rare lesions. They are associated in more than 80% of cases with a fracture of the pelvic girdle. The lesion mechanism is usually a sudden compression on the full bladder. Hypo gastric pain and macroscopic hematuria suggest the diagnosis, which is confirmed by cystography. This diagnosis can be difficult and delayed in the absence of these call signs. We report a case of isolated traumatic intraperitoneal rupture of the bladder, diagnosed 24 hours after a public road accident in a 44-year-old patient.

Abstract Introduction: Percutaneous nephrolithotomy (PCNL) is a standard minimally invasive urological procedure for the treatment of large renal calculi. It is also associated with complications arising from absorption of irrigation fluid and intravenous fluid injection. We evaluated the changes occurring in vital and blood parameters during PCNL using 0.9% normal saline (NS) as an irrigation fluid. Materials and Methods: We prospectively studied 71 patients who underwent PCNL in our hospital between 2016 and 2018. NS(0.9%) was used as irrigation fluid in all patients. Changes in hemodynamics, hemogram, renal function tests and serum electrolytes were noted and assessed for significance using paired t-test. These changes were correlated with ASA grade, BMI, total operating time, total irrigation fluid used and total intravenous fluid used using Pearson’s correlation test. Results: A significant fall in serum creatinine was present (1.30 ± 0.96 vs. 1.24 ± 0.93) along with a rise in eGFR (85.39 ± 24.10 vs. 90.18 ± 22.58). A significant rise in serum potassium (4.34 ± 0.45 vs. 4.5 ± 0.56) and chloride levels (104.79 ± 3.51 vs. 106.69 ± 3.14) post-operatively was noted. A significant rise in pulse rate (80.84 ± 10.13 vs. 87.76 ± 13.12) and systolic blood pressure (127.67 ± 15.90 vs. 136.88 ± 19.56) post-operatively was noted. There was no significant change noted in hemoglobin, PCV, platelets and serum sodium levels. Total operating time and irrigation fluid volume showed a positive correlation with changes in eGFR, serum chloride, post-operative pulse rate and blood pressure values. Intravenous fluids volume correlated positively with changes in serum potassium, chloride, post-operative pulse rate and blood pressure val ues. Conclusion: High amount of irrigation fluid absorption can cause early post-operative changes in patients’ hemodynamics and blood indices. Over zealous hydration during PCNL with potassium containing fluids can also lead to hyperkalemia and hyperchloremic acidosis. Thus, early post-operative monitoring of serum electrolytes should be done in all patients after PCNL to prevent complications arising from dyselectrolytemia.

Abstract Background: IgG4-related disease is a rare autoimmune condition that presents with lympho plasma cytic infiltrate and fibrosis in the organ affected. Isolated testicle involvement is uncommon and there are only a few cases reported in the literature. Case Presentation: We report a case of isolated chronic orchitis due to IgG4 hypersecretion in a 61-year-old patient that evolved with asymptomatic tumor-like mass growth and was treated with left orchiectomy. Histopathological study revealed orchitis related to IgG4 hypersecretion disease. Conclusion: IgG4-related disease can be manifested as a multi or single organ disorder. Most diagnoses are made after surgery with histopathological analysis. Most of the cases in literature stand out the difficulty in diagnosis and necessity of high suspicion due to this condition’s similarity with neoplasm presentation.

Abstract Background: Benign prostatic hypertrophy is the non-malignant stromal and epithelial proliferation of the prostate gland, with or without associated anatomical enlargement of the gland and clinical symptoms. Symptomatic Benign prostatic hypertrophy may cause obstructive symptoms, irritative symptoms or both obstructive symptoms include a sensation of incomplete bladder emptying, straining to void, urinary hesitancy and weak stream while irritative symptoms include dysuria, nocturia, urinary frequency and urinary urgency. A quantitative measure of the severity of lower urinary tract symptoms due to benign prostatic hypertrophy can be obtained using the International Prostate Symptoms Score. Ultrasonography is useful for helping to determine bladder and prostate size in patients with urinary lower urinary tract symptoms. Uroflowmetry is a non-invasive test that assesses voiding function. It provides valuable data on the voided volume, time is taken to reach maximum flow rate and average flow rate. The goal of this study was to improve the follow up of patients with benign prostatic hypertrophy by providing simple, available, affordable and non-invasive that best predict bladder outlet obstruction and the quality of life in these patients. Method: This was a cross-sectional analytic study carried out over a period of five months from May 2020 to September 2020 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, which is a tertiary hospital in Cameroon. Were included in the study, adult males who presented with lower urinary tract symptoms and prostatic enlargement suggestive of benign prostatic hypertrophy taking into account clinical, uroflowmetry and ultrasound findings. Results: A study population of 103 participants was recruited. The mean age of patients was 63.17 ± 10.26 years. Concerning the International Prostate Symptoms Score, the mean total, voiding (obstructive) and storage (irritative) scores were 14.6 ± 6.2, 8.5 ± 4.1 and 6.05 ± 2.7 respectively. The mean maximum flow rate was 13.44 ± 3.88 mL/s. The mean prostate volume was 53.71 ± 16.46 ml. A majority of patients have an enlarged prostate 1.5 to 2 times (46 to 60 mL) the up per limit for normal value. The intravesical prostatic protrusion was present in eighty-three (80.58%) and absent in 20 (19.42%). Above a prostate volume of 60 mL, 91% to 100% of our patients had intravesical prostatic protrusion. There was strong evidence (p < 0.001) that a change from no intravesical prostatic protrusion to intravesical prostatic protrusion grade 1 increased the chances of having a low maximum flow rate with a crude odds ratio of 7.98. The adjusted odds ratio after multivariate analysis was 5.26 and this remained statistically significant (p = 0.03). Conclusion: the measure of intravesical prostatic protrusion is superior to the prostate volume in the assessment of maximum flow rate and thus the follow up of patients with benign prostatic hypertrophy. This measure which is non-invasive, easy to measure, easily accessible, and cost effective may be a useful tool in predicting voiding dysfunction and acute urinary retention.

Abstract Background: Prostate cancer is a common disease in men over 50 years. Only early detection by screening can guarantee a favourable outcome. Objective: The objective of the study is to report on the practice of prostate cancer screening by general practitioners in Lomé. Material and Method: This was a practice survey. A questionnaire administered to general practitioners al lowed to examine the following parameters: the practitioner’s years of practice, the screening criteria, the screening tools and the factors motivating the request for urological advice. The data were analysed using the software Epi info 7.1.5. The P value was considered significant below 0.05. Results: One hundred and eighty (180) physicians average-aged 29 were administered among whom one hundred and fifty-seven (157) males and twenty-three (23) females. The average duration of the medical practice was 35.2 months (6months - 204 months). The screening criteria were age (47.2%), family history of cancer (17.8%), and age over 50 years associated with symptoms of the low urinary tract (35%). The practitioner’s experience did not affect these criteria (p = 0.12). The screening tools were the digital rectal examination (DRE) associated with prostate specific antigen (PSA) assay (20.5%), PSA alone (29.5%), DRE alone (6.6%), suprapubic ultrasound (32.3%) and endorectal ultrasound (11.1%). The choice of the screening tool was related to the practitioner’s experience (p = 0.03). The determining factor for a urological consultation was a high PSA (>4 ng/ml) independent of the DRE. Conclusion: Prostate cancer screening is largely done by general practitioners in Lomé. However, the use of some criteria and tools for the screening is not optimal.

Abstract The study aimed to determine the effect of microsurgical sub-inguinal varicocelectomy on semen parameters among men seeking infertility treatment in Ghana. This was an intervention study conducted at Tamale Teaching Hospital in the Tamale Metropolis from September 2017 to August 2021. The study involves two groups; the surgery group (n = 75) and the observed group (n = 63). Duplicate semen samples (mean values adopted) were collected at the onset and assessed according to the criteria established by World Health Organization (WHO), 2010. Varicocelectomy was performed for the surgery group and no intervention was given to the observed group. The two groups were followed for 180 days and repeated semen samples were collected and analyzed. The data was computed using Graph Pad Prism (v8.0) at an alpha of 0.05. All the men had varicocele and were aged between 46.0 and 67.0 years old. There was no difference between semen parameters among the two groups before the surgery. However, after 180 days of follow-up, all of the semen parameters significantly improved in the surgery group (p < 0.0001), while sperm concentration (p = 0.0068), progressive motility (p = 0.0281), and normal sperm morphology (p = 0.0015) decreased in the observed group. The surgery group had an overall percent increase in total sperm count (840.7%; p = 0.0197), sperm concentration (582.1%; p = 0.0125), total viable sperms (155.2%; p < 0.0001), and normal sperm morphology (110.9%; p < 0.0001) while immotile sperms (−51.71%; p < 0.0001) reduced. A pregnancy rate of 25.3% (19/75) was reported among the surgery group but none was reported among the observed group after 180 days. Microsurgical sub-inguinal varicocelectomy improves semen parameters and hence effective treatment of infertile men with a clinically palpable varicocele. It is recommended to use this choice for similar patients, however, further studies with a larger sample size are needed to provide more evidence to recommend this therapy.

Abstract Objective: To investigate the value of the number of circulating tumor cells (CTC) in peripheral blood in the prognosis and coagulation-related indicators of patients with renal cancer. Methods: 65 patients with renal cell carcinoma (RCC) confirmed pathologically were divided into CTC positive group and CTC negative group according to the CTC count (5 pcs/3.5 ml). Com pare the age, gender, tumor location, TNM (clinical stage), pathological grade, tissue type, lymph node metastasis, distant metastasis, prognosis and prothrombin time (PT), fibrinogen (FIB), partial coagulation of the two groups of patients The correlation between the results of zymogen time (APTT) and D-dimer (DD) and the number of CTC. Results: There were significant differences in TNM, lymph node metastasis, and distant metastasis between the two groups (P < 0.05). The number of CTC in patients was correlated with FIB and D-D levels (P < 0.05). Conclusion: The number of CTC in patients with renal cell carcinoma is correlated with some clinical phenotypes (TNM, lymph node metastasis, distant metastasis) and some coagulation indexes (FIB, D-D), and can jointly .

Abstract Background: Dengue virus (DENV) infection is caused by an arboviral strain and is transmitted by the mosquito Aedes aegypti which is found in Sudan especially Red Sea and Kassala states in the east. The disease is known to cause renal disturbances and a thorough understanding of that will potentially help in the prediction, diagnosis and treatment of the disease. Methods: This study is a prospective observational cross sectional study conducted in the Eastern Sudan College of Medical Science and Technology and Port Sudan Teaching Hospital. 200 confirmed Dengue virus infected patients along with 200 healthy appearing adults (control) were enrolled for the study. Statistical analysis was carried out after the collection of patients’ demographic, clinical, and investigational data including serum urea and creatinine values. Ethical approval was obtained from the ministry of health, Red Sea state and informed written consent was obtained from each participant. Results: The highest incidence of DENV infection was observed in individuals of the middle age group (29%). Elevated blood urea levels were detected in 10 (5%) patients while elevated creatinine levels were seen in 17 (8.5%) patients. Although fallen within reference ranges found in the literature, mean blood urea and creatinine values differed significantly between patients and controls and between different categories of the disease. Mean blood urea concentration showed a statistically significant difference between the control (22.3 mg/dl) and the test (28.4 mg/dl) (P value < 0.001). Similarly, mean serum creatinine in the control (0.70 mg/dl) differed significantly (P value < 0.001) from test (0.94 mg/dl). Clinically, fever was present in 97.5% of patients, headache in 95.5%, joints pain in 71%, lethargy in 67%, vomiting in 49%, skin rash in 40%, abdominal pain in 24% and bleeding in 17.5%. Conclusion: We strongly conclude that renal involvement is not uncommon in Dengue fever and that blood urea and creatinine evaluation should be considered in the counseling of DENV infection patients. Patients need to be subjected to necessary laboratory investigations associated with acute kidney injury to decrease the rate of morbidity and mortality associated with the disease.

Abstract Background: Urinary incontinence mainly affects women regardless of age and, as it affects their quality of life, influences work, sex life and independence for activities of daily living. The treatment of stress urinary incontinence including urethral volume injection therapy can provide an intermediate option over non-surgical and surgical therapies. One of the mechanisms for stress continence depends on the effective coaptation of the urethra during the increase in intra-abdominal pressure. The bulking agents can be injected transurethral or periurethral retrogradely, using direct vision from a cystoscope. Purpose: To evaluate the feasibility and preliminary outcome performance of the bacterial polysaccharide gel used as biological bulking agent applied in female patients with stress urinary incontinence. Methods: A prospective clinical pilot study was performed, in a single institution, including female patients who were admitted to the urologic outpatient clinic with Stress Urinary Incontinence (SUI) without previous treatments and they were selected and underwent bulking agent procedure. The evaluation was performed at the time of enrollment and 6 months after treatment. The primary outcome was Quality of Life (QOL) using the ICIQ-SF Questionnaire. The amount of urine leakage measured by the 1-HOUR PAD-TEST was the second outcome. Results: Fifteen women (with an average age of 53 years) were submitted to the application of bacterial cellulose gel and she was analyzed. Only two patients presented unchanged incontinence. The study considered as primary outcome the improvement or disappearance of symptoms after six months of intervention. Post-intervention Quality of Life (QOL) questionnaire indicated that all of these patients related a better quality of life (62.5%). Through the PAD-test it was possible to observe a decrease in urinary leak of 85% comparing the results pre and post-intervention (BCA—Bacterial Cellulose Application) with p-value equal to 0.000009. Conclusions: The results of this pilot study suggest that the use of biological bulking agent is a promising approach to treat stress urinary incontinence in female patients. Trial registration: Registration number and date of registration should be instated in this section.

Abstract Background: With the advancement of technology, prostate resection can be performed nowadays using endoscopic techniques, which include monopolar and bipolar transurethral prostate resection. This study aimed to evaluate the results of bipolar transurethral prostate resection in a single urology center in Cameroon. Materials and Methods: This was a retrospective study carried out over two years (2015-2017) involving 112 patients with symptomatic prostate diseases who underwent transurethral prostate resection with the help of a bipolar Olympus generator. Results: The ages of the participants ranged from 44 years to 85 years, with a mean age of 64.41 ± 9.5 years. Fifty-six (50%) patients presented with only obstructive symptoms, five (4.46%) had only irritative symptoms, twenty (17.86%) presented with both obstructive and irritative symptoms, eight (7.14%) presented with macroscopic hematuria, seven (6.25%) with urinary tract infections, and sixteen (14.29%) with acute urinary retention. Digital rectal examination was unremarkable in 74 (66.07%) findings and was positive in 38 (33.93%) patients. The median prostate diameter was 70 [59 - 86.5] mm. The mean preoperative IPSS was 24.46 ± 5.68. The mean surgery duration was 77.61 ± 23.87 minutes. The mean volume of irrigation fluid used during surgery was 24.84 ± 6.40 ml. The differences between the preoperative and postoperative mean IPPS score, maximum urine flow rate, and quality of life were statistically significant (allP < 0.001). Only 4 (3.57%) of the study participants experienced postoperative complications. Conclusion: Bipolar transurethral prostate resection is a viable alternative to open surgery or laparoscopic surgery for large prostate glands. This technique is also associated with a reduction in prostate-related morbidity.

Abstract Objectives: To clarify the clinical, histological and therapeutic features of prostatic tuberculosis. Methods: We conducted a single-centre retrospective descriptive study of all patients presenting with prostatic tuberculosis between January 2002 and December 2020. Patients who were lost to follow-up, could not be reached by telephone or whose records were not usable were excluded from this study. Results: 240 patients were treated for urogenital tuberculosis, including 13 for isolated prostatic tuberculosis. The average age of the patients was 75 years. None of our patients had a history of tuberculosis. The average of international prostate symptom score (IPSS) was 27. Lower urinary tract symptoms in the filling phase were predominant. The digital rectal examination was suspicious in only one patient. The mean preoperative PSA was 9.24 ng/ml.46.15% of patients underwent transurethral resection of the prostate and 53.85% underwent ultrasound-guided prostate biopsy. Histological examination showed epithelioid gigantocellular granuloma with isolated caseous necrosis in 61.53% of patients and associated adenomyomatous hyperplasia in 38.47% of patients. Antituberculosis treatment was given for 6 months. The average of follow up was 15 months. All patients reported an improvement in clinical signs with a mean post operative IPSS score of 17 and a normalisation of PSA levels. Conclusion: Isolated prostatic tuberculosis is a rare entity, it can simulate a cancer. In front of the symptoms of the lower urinary tract, the clinicians must think of it especially in the developing countries where tuberculosis still prevails in an endemic state.

Abstract Introduction: Fracture of the penis is a rare uro-andrological emergency defined as the rupture of the tunica albuginea of the erect penis most often during sexual intercourse. Surgical exploration and repair of the albuginea breach as soon as possible are the standard treatment. However, in our African context, early diagnosis and management are negatively influenced by the delay in consultation due to modesty. Our objective was to describe the clinical and therapeutic aspects of the fracture of the penis seen late in the African context and to compare it with the literature review. Presentation of the case: Our aim was to report our experience in the management of late-onset fracture of the penis, after more than 48 hours of evolution, by reporting the observation of a 54-year-old patient, who had a false coitus, treated in the urology department of the Nianankoro Fomba Hospital. The physical examination revealed a deformation of the penis following the formation of a large hematoma with a characteristic eggplant appearance. Therapeutically, a suture of the albuginea was performed with simple follow-up. Conclusion: This case study shows a delay in the management of this emergency due to the reluctance of the patient to be consulted as soon as possible for reasons of modesty. A delayed emergency surgical management was the only therapeutic alternative and the coronal incision with degloving was the only way to approach the voluminous hematoma related to the delay in management.

Abstract Introduction: Penile fracture is a urological emergency that occurs when the penis in an erect state suffers a blunt trauma resulting in a rupture of the tunica albuginea of either one or both corpora cavernosa. It is often caused by vigorous sexual intercourse, hence the incidence of penile fracture is under-reported. We therefore present our experience of the clinical presentation and surgical management of penile fracture. Presentation of Cases: We report three cases of penile fracture and all were diagnosed based on their clinical presentation and examination findings. The patients include two middle aged men and one young man, all with history of hearing a popping sound and experiencing sudden onset pain with detumescence of the penis. No radiological investigations were carried out. An emergency surgical repair was done for all patients. Discussion: All the patients had no urethral injury on presentation and underwent immediate surgical repair. The erectile and voiding function of each patient was preserved. Conclusion: The management of penile fracture involves early diagnosis and immediate surgical repair. Early interention is necessary to preserve penile function.

Abstract Background: Benign prostatic hyperplasia (BPH) is characterized by the abnormal proliferation of cells, leading to structural changes. It is one of the most common diseases in ageing men. Its clinical presentations are dominated by lower urinary tract symptoms (LUTS). The therapeutic methods can be grouped into two options: the medical option and the surgical option in which prostate enucleation is found. In recent years many studies have reported the onset of urinary incontinence (UI) after prostate enucleation. The management of UI occurring after prostate enucleation is embarrassing for both the practitioner and the patient, and generates additional costs. Purpose: Cite the causes of UI after prostate enucleation for BPH, as well as ways to prevent the onset of UI after this surgery, specifically by the study of the vesicosphincteric system aimed at improving the technique of enucleation;our review will also deal with the therapeutic means of UI. Method: We retrieved studies from Science Direct, Wiley and Pubmed. Results: There are multiple etiologies of UI after prostate enucleation including urethral sphincter insufficiency (USI) and bladder dysfunction (BD). The management of UI after surgery could be conservative, surgical, or use new technologies. Urodynamic assessment before prostate enucleation for BPH is relevant. Conclusion: UI is a common post-operative complication of prostate enucleation. The study of the vesicosphincteric system leads us to believe that prostate enucleation for BPH, partially sparing the mucosa and the external urethral sphincter could decrease the incidence of UI after surgery.

Abstract Background: In low incomes country, management and follow up of prostate cancer were hard due to difficult to earn drug and difficult access of new test imaging. We explore the epidemiological and diagnostic aspects of prostate cancer at regional university hospital of Parakou from 1st January 2017 to 1st January 2019. Objective: To study diagnostic and clinical aspects of prostate cancer at regional university hospital of Parakou. Methodology: This study was descriptive with prospective data collection (1st January 2017 to 1st January 2019). Patients who were admitted to the department were included. Demographic, clinical and anatomopathological variables were studied. Result: Eighty-one patients were included; the hospital prevalence is 1.6%. The mean year old of patients was sixty-nine years old ± 10 years old (farthest 45 years old and 95 years old). More than half patients were seventy years old. The medical past history of family cancer were found in 6.1% of cases. The complaints were voiding difficult in 54.3% of cases, urinary frequency in 46.9% of cases, complete urine retention in 28.4% of cases and bones pain in 14.8% of cases. The average time of consultation was 24.3 months (farthest 2 months and 48 months). The mean of prostate specific antigen (PSA) was 93.1 ng/ml (farthest 4 ng/ml and 1000 ng/ml). Adenocarcinoma was found in 84.1% of cases. Classic X-ray imaging was used in most cases to detect metastasis. Five patients had done thoracic-abdominal-pelvis tomography. Sixty-six patients (81.5% of cases) were prostate cancer metastasis. Conclusion: Prostate cancer was frequently disease in seventy years old patients. Diagnostic was late in this study. Awareness campaign of patients for early consult was recommended.

Abstract Background: Bladder hernias are infrequent and should be treated by the urologist, or an experienced surgeon. An inguinoscrotal hernia of the bladder should be suspected in male patients with voiding symptoms and a fluctuant mass in the scrotum that changes its volume during urination. The most common characteristics found on the series were patients with advanced age, sedentary, and overweight. Case Presentation: We present a case series of 4 patients with inguinoscrotal herniation of the bladder, the surgical management, and outcome. Conclusion: The surgical technique used was inguinal plasty with Lichtenstein technique and either laparoscopic or open surgery mesh-plug placement. None had surgical complications, and none had recurrence at their follow-up.

Abstract We report the first case of a ureteric stone containing gas. This rare stone with gas within it was found during the management of a diabetic patient with urosepsis as the initial presentation. Literature review of cases of renal stone containing gas, mechanisms of gas within the stone, and clinical implications of stone containing gas are discussed. Also, a new terminology is proposed to describe this phenomenon.

Abstract Purpose: As patients with transfusion-dependent thalassemia (TDT) are living longer, novel morbidities are being recognized. The purpose of this review is to summarize the current knowledge regarding the prevalence and risk factors of nephrolithiasis in patients with TDT. Methods: A non-systematic, narrative review of the current literature published up to August 2021 was conducted. Results: Nephrolithiasis has been reported in 18% - 59% of patients with TDT, which is at least twice the prevalence in the general US population. The risk factors for nephrolithiasis can be classified into behavioral (dietary and lifestyle), environmental, metabolic, disease-specific, and genetic factors. While clarifying the true prevalence of nephrolithiasis in different age groups and diagnostic categories of TDT requires further research, prevention, and management of nephrolithiasis is a growing clinical concern. Physicians should be aware of the potential increased risk of stone disease in splenectomized and diabetic patients as well as those treated with certain chelation regimens. Conclusions: The etiology of nephrolithiasis and potential TDT-specific risk factors that may put patients at greater risk are highlighted. There is insufficient evidence at this time to recommend universal screening for nephrolithiasis using ultrasound. Evidence-based recommendations on monitoring, prevention, and management of nephrolithiasis in TDT are provided.

Abstract Introduction: The burden of prostatic cancer is rising in Sudan. Usually, they present late in their disease with urinary tract obstruction, hematuria, bony pain, or cachexia because there is no screening program. Here we present a patient with prostatic cancer who presented with left axillary mass as his main concern. Case Description: 82-year-old Sudanese male presented with a left axillary and left supraclavicular lymphadenopathy of a few months’ duration. He underwent a decisional biopsy which showed metastatic adenocarcinoma. Upper and lower GI endoscopy were performed but the latter was complicated by a sigmoid perforation with peritonitis. During laparatomy, multiple enlarged pelvic lymphnodes were encountered and a biopsy result suggested a metastatic prostatic neoplasm. Later, prostatic biopsy confirmed the diagnosis. The patient was treated with bilateral orchidectomy. Clinical discussion: Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer and only a few cases have been reported in the literature. It can cause diagnostic difficulty since prostate cancer typically metastasis to the pelvic lymph node and very rarely involves he supradiaphragmatic lymph node. Conclusion: Metastatic prostatic carcinoma should be considered among the causes of supra-diaphragmatic lymph adenopathy. Careful physical and imaging examinations combined with PSA and pathological analysis are essential in the diagnosis of advanced prostate cancer with unusual presentation.