Introduction. Liposarcoma is a rare pathological entity. By far it is the most common histological subtype of genitourinary sarcomas in adults. Approximately two hundred cases were reported in the literature. We are hereby presenting a case with a typical clinical scenario of paratesticular liposarcoma. Case report. A 75-year-old gentleman presented with a painless right hemiscrotal swelling that was progressively increasing in size over the last 6 years. Testicular tumour markers were negative. Imaging showed a heterogenous mass with fat component. Subsequently he underwent wide local excision that included the paratesticular mass along with the right testicle and all right inguinal canal contents up to the deep inguinal ring with the sparing of right illioinguinal nerve. Histopathological examination showed a well differentiated liposarcoma of the spermatic cord. He remained recurrence-free so far after 18 months of followup. Conclusion. Radical orchidectomy with wide local excision comprises the cornerstone of treatment of paratesticular liposarcoma. Due to the rarity of the disease there is no definite universal consensus of opinion as regards the role of radiotherapy and chemotherapy.

ObjectiveTo assess the diagnostic accuracy and safety of photodynamic diagnosis (PDD) in upper urinary tract urothelial carcinoma (UUTUC).Materials and methodsA systematic literature search was conducted. Included studies were assessed for the risks of bias and quality using appropriate tools. Dedicated data extraction forms were used. Diagnostic accuracy in terms of sensitivity and specificity were quoted whenever provided by individual studies. A combined toxicity profile of 5-aminolevulinic acid (5ALA) was given after reviewing individual studies.ResultsIn all, 17 studies were identified. After screening seven studies were included involving a total of 194 patients. None of the studies were randomised. All the available studies were of low-to-moderate quality. The largest available study, with 106 patients, reported a sensitivity of 95.8% and 53.5% for PDD and white-light (WL) ureterorenoscopy (URS) respectively, with a statistically significant difference. The specificity was 96.6% for PDD and 95.2% for WL-URS with no statistical significance. PDD showed better ability in detecting carcinoma in situ and dysplasia. One study compared PDD to computed tomography urogram (CTU) and found PDD to have better sensitivity and statistically significantly better specificity. 5ALA-associated toxicity was minor in nature and hypotension was the most common adverse event.ConclusionPDD in UUTUC appears to be more accurate than WL-URS and CTU, with no significant toxicity. Larger scale randomised trials are needed.

ObjectiveTo review the mode of presentation and clinical course of patients with prostate cancer during a specified period, as the detection rate is tending to increase, with most patients presenting at an advanced stage, and yet the overall incidence and prevalence rates are low.Patients and methodsWe retrospectively reviewed all aspects of care for patients who were diagnosed between May 2006 and July 2010.ResultsIn all, 76 men had a histologically confirmed prostatic adenocarcinoma diagnosed between May 2006 and July 2010 (mean age 71.1 years, SD 8). The median (range) prostate-specific antigen level at diagnosis was 52 (1.2–16,230) ng/mL. Of the patients, 74% had a Gleason grade of ⩾ 7 on diagnosis, and 64% had extraprostatic disease on presentation. Active surveillance was adopted in four patients, and four others were maintained on watchful waiting. Six patients had a radical prostatectomy, in one of whom it was a salvage procedure. Six patients received external-beam radical radiotherapy, five of whom had neoadjuvant, concurrent and adjuvant hormonal therapy. All remaining patients were treated primarily with androgen-deprivation therapy (ADT). Of the patients on hormonal manipulation, in 56% the cancer became castrate-resistant within the mean (SD) follow-up of 17.2 (15) months. Of patients treated primarily with ADT, 34% died. The death rate among the whole group was 23%. Both percentages include both prostate cancer-specific and non-specific mortality.ConclusionAn advanced stage of disease at presentation mandates an early-detection, hospital-based screening programme. Further research should include many more patients and be based in several centres.

Renal cell carcinoma (RCC) is a common tumor of the urinary tract. It is known to have variable presentations due to the extremely vascular nature of the organ. RCC are known to metastasize to lungs, bone, and brain commonly but atypical metastasis to various sites are reported in literature but as very rare pathology. We report a case of a 60-year-old female who presented with multiple inguinal and axillary lymph node enlargements which on excision biopsy showed metastatic RCC. RCC can present with synchronous metastatic deposits in the various organs. RCC can metastasize to some atypical sites as well such as thyroid, orbit, and neck as mentioned earlier in literature. The patient presenting with extra-regional lymph nodes like inguinal and axillary is extremely rare, and so far only one clinical case could be found from India in 2008. A 61-year-old female presented in the emergency department with left flank pain and hematuria. Imaging showed left swollen kidney but multiple lymph nodes in retroperitoneum, left inguinal and axillary region. Excisional biopsy confirmed metastatic renal clear cell carcinoma. The case was referred to an oncologist after left radical nephrectomy for further treatment. Renal cancer is quite common aggressive disease. Due to its vascular nature, it may present quite atypically as evident from literature. Although treatment of metastatic carcinoma is still controversial surgery is the mainstay of treatment and guidelines consider metastasectomy and cytoreductive nephrectomy as valid option followed by targeted systemic therapies. RCC has quite a high potential to metastasize in the versatile pattern, in our case, it is evident that valid management is still surgery but needs support from the multidisciplinary team.

It is a known fact that the retroperitoneum is the commonest metastatic site for testicular germ cell tumours. Contrary to this we are hereby reporting a case of an advanced testicular non-seminomatous germ cell tumour (NSGCT) presenting with a huge anterior abdominal wall metastatic mass and no evidence of retroperitoneal lymphadenopathy. A 36 yearold gentleman who underwent bilateral orchidopexies as a child, presented with a huge anterior abdominal wall mass engulfing the external genitalia. Incisional biopsy showed a yolk sac tumour. He was treated primarily with immediate chemotherapy with a dramatically good response. This was followed by right radical orchidectomy. Unfortunately, a few months later he developed recurrences into the anterior abdominal wall as well as brain metastasis. We conclude with two main messages. Firstly, previous inguino-scrotal procedures can significantly alter the lymphatic drainage from the testicles. Secondly, primary chemotherapy before orchidectomy can have a very favourable outcome in selected patients.

Urinary tract duplication anomalies have a variety of anatomical and clinical manifestations. In broad terms, duplication anomalies are divided into complete and incomplete (partial). We are hereby reporting a case of a 26 year-old man, who presented acutely with right sided loin pain. Subsequent investigations showed right sided complete duplication with a single left ureter, with all three ureters harboring obstructing stones. He underwent urgent bilateral semi-rigid ureteroscopy with LASER lithotripsy with satisfactory outcome. There are no similar case reports in the English literature to the best of our knowledge. Keywords Lithotripsy; Urinary tract diverticula; Ureteric duplication CaseA 26-year-old man with no co-morbidities, presented with severe right loin pain. There is no associated lower urinary tract symptoms, fever or decreased urine output. Physical examination was unremarkable. His laboratory investigations showed microscopic haematuria with sterile pyuria. His renal function test, serum calcium and uric acid were all within normal limits.Figure 1: Plain X-Ray KUB, showing all three calculi. The red arrow pointing to the calculus in the upper third of the right inferior moiety ureter, the yellow arrow pointing to the calculus in the mid third of the right superior moiety ureter, while the green arrow is pointing to the calculus in the upper third of the left single uréter.Plain spiral Computerized Tomography scan (CT scan) of the abdomen and pelvis, showed a duplex system of the right kidney with 1.5 × 0.8 cm calculus in the upper third of the inferior moiety ureter.Another calculus measuring 1 × 0.6 cm was seen in the mid third of the upper moiety ureter. On the left side there was a single ureter with a 1.7 × 0.9 cm calculus in its upper third along with a 5 mm × 3 mm lower calyceal stone. All ureteric calculi (Figures 1 and 2) were obstructing with at least grade III proximal hydro-ureteronephrosis and mild to moderate perinephric fat stranding. He was admitted and adequately prepared for urgent intervention. Intra-operatively, the left ureter was intubated first and retrograde pyelogram was performed (Figure 3), followed by ureteroscopy using 4.5-6.5 F semi-rigid ureteroscope with one working 3F channel (Richard Wolf -Germany).Lithotripsy using Holmium LASER 365 Micron fibre was done. The stone was partially fragmented and a double J stent was inserted. In the right side, retrograde pyelography showed a partial duplex with a very short distal confluence of both ureters measuring around two to three centimetres. Ureteroscopy was carried out in both limbs of the duplex right ureter.

8Acute presentations to the emergency department with ureteric stones represent a significant proportion of daily hospital admissions. It has a genuine impact on productivity in general as the affected group of patients is usually within the working age. Ali et al found that ureteroscopy is safe as a day-case procedure in selected cases; however, it focused on the need for double J insertion after the procedure 1 . There are no published data regarding the remaining aspects of ureteroscopy, nor there are any comparative studies about any international or regional results.A recent systematic review confirmed the association between the metabolic syndrome and the increased incidence of kidney Background: Urolithiasis, in general, constitutes a significant volume of the daily clinical activities in our institution. Objective: To evaluate the outcome of ureteroscopies performed in patients admitted acutely with symptomatic ureteric calculi compared with elective ureteroscopies. Design: A Retrospective Review. Setting: Department of Urology, King Hamad University Hospital, Bahrain. Method: All ureteroscopy (URS) procedures performed for symptomatic ureteric calculi between 1 January 2013 to 31 December 2013 were reviewed. These procedures were divided into two groups: urgent URS and elective URS group. Both groups were comparable in personal and stone characteristics. Result: One hundred ninety-five procedures were performed on 167 patients. One hundred twenty-seven (65.1%) procedures were urgent and 68 (34.9%) were elective. The cohort included 131 males and 36 females with a mean age of 41.5 years, a range of 19 to 74. One hundred fortynine (76.4%) procedures were performed on male patients, while 46 (23.5%) were performed on female patients. The mean stone size for patients undergoing urgent URS was 7.7 mm and 8.3 mm for elective procedures; approximately one-third of patients had more than one stone. Eighty-one stones in the urgent group were distally located; fifty-seven were in the elective group. The most common indication for urgent URS was pain refractory to injectable analgesia. LASER was used in 182 (93.3%) procedures, 179 (91.7%) procedures were urgent. Seventeen (8.7%) complications were documented for urgent URS and 8 (4.1%) for elective cases, no statistical significance, P value = 0.74. Conclusion: Urgent URS procedure is a safe and cost effective option compared with Elective URS. It should be the preferred option when resources and expertise are available.

Hydatid disease caused by the tape worm Echinococcus granulosus is a rare occurrence in the urinary system in general. We are hereby presenting a case of a gentleman in his fourth decade with a giant right renal hydatid cyst. The clinical manifestations, radiological features, and serology were all not suggestive of hydatid disease; however, typical Echinococcus scolices were detected histologically following cyst aspiration. The giant cyst was successfully treated laparoscopically.