ObjectiveTo evaluate the effect and safety of extracorporeal shockwave therapy (ESWT) on chronic pelvic pain syndrome (CPPS)/chronic abacterial prostatitis after failure of most other modalities of treatment, the maintenance of the treatment effect for up to one year post treatment and whether the patients are in need for further sessions.Materials and methodsIn a follow-up survey of 41 patients, the study inclusion criteria were CPPS patients who failed at least previously 3 modalities of treatment other than ESWT, who were treated by ESWT once a week for one month with a protocol of 2500 pulses at 1 bar over 13 min, Nonaddiction to drugs and narcotics. The exclusion criteria included being under treatment by another method another diagnosis such as prostate cancer, therapy plan alteration, and noninclination to continue this treatment. Then the patients were followed up at 2 weeks, 6 months and 12 months after finishing the course of ESWT. The study was designed as an open-label uncontrolled therapeutic clinical trial which was conducted in Jordan university hospital through the period 2015–2016. Data were compared using paired samples t-test.ResultsOf our total 55 patients 8 of them did not complete the study protocol, 6 of them had missed follow up over the whole follow up period and 41 patients were evaluated. The patient's age group ranged between 18 and 78 years with a mean age of 42 and a median age of 43. The mean of National Institutes of Health -Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptom Score (IPSS), American Urological Association Quality of Life Due to Urinary Symptoms (AUA QOL_US) and International Index of Erectile Function (IIEF) were evaluated pre and post ESWT at 2 weeks, 6 months and 12 months and it showed statistically significant improvement in all parameters with maintenance of the effect without any significant side-effect of the treatment over the 12 months.ConclusionsThe evidence in this study would support the safety and efficacy of ESWT in refractory cases of CPPS at least for one year post treatment.

HighlightsLeydig cell tumor is a testicular tumor with a low incidence accounting for 1–3% of testicular neoplasms.Only about 10% of them show malignant behavior in the form of metastatic disease.When diagnosed and treated early, long-term favorable outcomes are seen even with its potential metastatic behavior.

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Mixed epithelial stromal tumor of the kidney (MESTK) is a newly introduced and rare kidney tumor subtype; approximately 100 cases have been reported. We report a case of MESTK with detailed clinicopathological findings, presented to emergency department with gross hematuria and clot retention managed by radical nephrectomy. Although MESTK are benign tumors, they cannot be distinguished from other malignant neoplasms until after nephrectomy due to lack of typical radiological features. They can cause serious sequelae; including gross hematuria and serious drop in hemoglobin as the case we present here shows. This is why it is important to early diagnose and treat this condition. This case highlights the importance of early introduction of imaging in patients presenting with gross hematuria. Failure to diagnose this lesion as the underlying cause of hematuria may lead to recurrence and malignant transformation.