Background: Hypospadias is one of the commonest congenital penile abnormalities in newborn males. The external urethral opening can be located anywhere from the glans penis along the ventral aspect of the shaft of the penis up to the scrotum or the perineum in extreme cases. The condition has a huge impact on the patient's psychological, emotional and sexual well-being. Aim: To determine the proportion of patients who develop long-term complications after hypospadias repair and its associated risk factors. Methods: This was a hospital-based analytical cross-sectional study, conducted at KCMC Urology Institute from January 2009 to December 2018 and all children were followed up for 1-year post-operatively. A structural data sheet was used to collect information from patients' files. Study parameters include age, location of hypospadias, surgical technique, surgeon experience, chordee, suture size, materials to assess the association with long-term complications. Results: A total of 254 patients were included in the study, the majority were aged more than 2 years (71.83%) with mean age at operation (SD) of 4.74 ± 2.99 years. Distal types were the most common type of hypospadias (125 patients; 50%), and 51 patients (20%) had severe chordee. Tubularized incised plate (TIP) repair was the most common technique (130 patients; 51.59%). The number of patients with long-term complications following hypospadias repair was 156 (61.60%) and urethrocutaneous fistula(UCF) accounted for 40.5%. The surgeon's experience, location of hypospadias, surgical technique and associated chordee were significant predictors of long-term complications of hypospadias repair. Conclusion: Tubularized incised plate urethroplasty is a safe and reliable method of hypospadias repair. Proximal hypospadias with severe chordee still remain a challenge.

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Introduction and importance Xanthogranulomatous pyelonephritis is an extremely rare but known form of chronic pyelonephritis resulting from prolonged suppuration of the kidney. Pre-operatively, it may mimic renal tuberculosis or neoplastic lesions including renal cell carcinoma due to its vague clinical presentation, equivocal laboratory and radiological investigations. Due to its rarity and academic interest, herein we report such a rare case we recently encountered in our clinical practice. Case presentation An-eight-year old male child patient resented to our hospital with three months history of abdominal distension associated with progressive left flank pain. Preoperative investigations including CT-scan were suggestive of nephroblastoma with differential diagnosis of clear cell sarcoma. Radical nephrectomy was performed and histopathology of the specimen confirmed the diagnosis of Xanthogranulomatous pyelonephritis. The patient fared well postoperatively and he had no symptoms in the subsequent follow up visits. Clinical discussion Xanthogranulomatous pyelonephritis is a rare, severe and atypical form of chronic pyelonephritis due to infection ( E. coli , Proteus) or stones. The disease may resemble renal cell carcinoma preoperatively. Thus, high index of suspicion is necessary for preoperative diagnosis. Conclusion Preoperative diagnosis of Xanthogranulomatous pyelonephritis may be a daunting task related to the rarity of its presentation. Thus, scrupulous histopathological evaluation is essential for the definitive diagnosis. Radical nephrectomy is the mainstay treatment of choice especially in diffuse cases.

Prostate cancer is one of the commonest cancers among men contributing significantly to the overall cancer burden globally. Most patients present with lower urinary tract symptoms. Metastasis to supraclavicular lymph nodes is unusual presentation, which has been rarely reported particularly as the primary presentation. We report two rare cases of advanced prostatic adenocarcinoma presenting with firm, non-tender lump in the left supraclavicular region between the two heads of the sternocleidomastoid muscle, (that is Virchow’s node) as initial primary symptom. Examination of the patients revealed an elevated prostatic-specific antigen (PSA) of > 100 ng/ml levels, and the diagnosis was confirmed by histological evaluation and immunostaining with PSA of the supraclavicular lymph nodes and prostate biopsies. This case series emphasizes the importance of considering prostate cancer in the differential diagnosis of male patients with supraclavicular lymphadenopathy.

Highlights Theoretically, prostate cancer can spread to any part of the body. Metastasis to axillary lymph node in a patient with normal urologic examination is rare. It may delay the diagnosis. A high suspicion index is essential in males presenting with symptoms suggestive of chest and abdominal-pelvic cancer.

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Introduction: Benign Prostate Hyperplasia (BPH) is the most common prostatic pathology in elderly men with Trans Urethral Resection of the Prostate (TURP) still being considered as the gold standard surgical management. TURP is the commonest endoscopic surgery performed for BPH in developing countries including Tanzania, however its outcome in this part of the world has not been documented. Therefore, the study aimed to determine the clinical profile, outcome as well as predictors of outcome in patients with clinical BPH undergoing TURP at Bugando Medical Centre (BMC), a tertiary hospital in Mwanza, Tanzania. Methods: This was a cross sectional longitudinal hospital based study to evaluate the clinical profile as well as the outcome of patients with clinical BPH treated by TURP at BMC from November 2018 to April 2019. All participants scheduled for TURP for the diagnosis of clinical BPH who signed informed consent for the study were included, their international prostate symptom score (IPSS) with the 8th question for quality of life (QoL) was scored, social demographic data and clinical profile information were obtained from their files. Participants were followed in the theatre to document any intraoperative complications and other necessary data required by this study. Progress in the ward was recorded and following discharge, patient was scheduled for follow up at 6 and 12 weeks. During follow up, IPSS and QoL scores as well as complication was recorded. Results: A total of 210 participants met the eligibility criteria. The median age was 69 (IQR 63-75) years. Prostate size ranged from 15 – 200 grams with median size of 77 (IQR 51-107) grams. Acute urine retention was the most common indication 69 (33%), followed by lower urinary tract symptoms 52 (25%). Urologist operated most of the patient 122 (58.1%) with the rest operated by either resident alone or finished up by urologist, and the median weight resected was 20 (IQR 13.5 –28.3) grams. About 66 (31.4%) developed perioperative complication with majority having clot retention. During follow up, the median IPSS score was 9 (IQR 7 – 12) and 2 (IQR 0 – 6) and median QoL score of 3 (IQR 1 – 3) and 0 (IQR 0 – 1) with improvement of 93 (45.4%) and 184 (89.8%) on 1st and 2nd follow up visits respectively. There were a total of 9 (4.3%) patients whom developed Trans urethral resection (TUR) syndrome, with overall mortality of 3 (1.4%). Conclusion: BPH is common from 6th decade of life onwards. Though most participants were operated because of either acute urine retention or severe lower urinary tract symptoms (LUTS), some presents late already with renal insufficiency. Despite the fact that most of the participants had severe symptoms and their quality of life was poor at presentation, TURP improved symptoms in most of the participants. The improvement is even better in the hands of experienced surgeon, for the participants with small prostate and in absence of UTI prior to surgery.