Incidental Finding of Pyeloureteral Junction Syndrome during Extension Workup for Prostatic Adenocarcinoma

Introduction: Prostate cancer is one of the most common cancers in men. In cases of suspected locally advanced disease or lymph node or bone metastases, thoraco-abdomino-pelvic CT is still useful for detecting visceral metastases. In the course of this extension work-up, other abnormalities may be discovered by chance, which had previously remained silent, and which could be diagnosed and managed in childhood, hence the interest of presenting a case of incidental finding of pyeloureteral junction syndrome during extension workup for prostatic adenocarcinoma at Yaounde Central Hospital. Observation: A 72-year-old patient presented to the department with acute urinary retention. The clinical examination, with an empty bladder, and in particular the digital rectal exam (DRE), was in favor of malignant prostatic hypertrophy. A workup was ordered, including a total PSA returned to 61.3 ng/ml (PSA performed one week after the episode of acute urinary retention) with cytobacteriological examination of sterile urine. Renal function was slightly impaired, with creatinemia at 14 ng/ml. Renal and vesico-prostatic ultrasound revealed a 57 g prostate with regular, clean contours and a polycystic right kidney. A prostate biopsy was indicated, which revealed a histopathological aspect in favor of a prostatic adenocarcinoma ISUP 1. An extension work-up including a thoraco-abdomino-pelvic CT scan revealed no signs of local or distant secondary localization, but a pyeloureteral junction syndrome with significant hydronephrosis, parenchymal destruction and compensatory hypertrophy of the contralateral kidney was found. Conclusion: The prostate cancer extension work-up revealed a pathology that can be diagnosed early. It is therefore important to reinforce prenatal and natal screening, which will enable malformative uropathies to be identified early and corrected in time to preserve patients’ renal function. Furthermore, we must be careful in the ultrasound diagnosis of pyeloureteral junction syndrome.

Retrocaval ureter presenting at 6 years of age in a girl child e An extreme rarity

Retrocaval ureter is one of the very rare congenital anomalies.We report a case of retrocaval ureter in a 6-year-old girl who presented with right flank pain and hydronephrosis.The diagnosis was made on intravenous urography which showed typical“J”shape deformity in the proximal dilated ureter with moderate hydronephrosis.CT scan delineated the course of ureter.The patient was operated and findings were confirmed.The ureter was transected near the pelvis and a pyeloureteric anastomosis with pre-caval transposition of the ureter was performed and the patient was discharged in fair health.

Transperitoneal Laparoscopic Nephrectomy for Non-Functional Kidneys: A Report of 25 Cases

Background and Aim: Ever since the first-ever laparoscopic nephrectomy performed in 1991 by Clayman, laparoscopy has become the technique of choice for benign renal pathologies and also for cancerous lesions. In this paper, we present and evaluate the results of laparoscopic nephrectomy carried out on patients with non-functional kidneys at the Centre medico-chirugical d’urologie in Douala, Cameroon. Materials and Methods: This was a retrospective study carried out from 2016 to 2020. We included 25 patients with non-functional kidneys who underwent transperitoneal laparoscopic nephrectomy. Results: We included 25 patients (15 males and 10 females) with a mean age of 32.80 ± 9.76 years. Twenty (80%) patients presented with low back pain, four (16%) presented with acute pyelonephritis, and one (4%) presented with both low back pain and hematuria. The right kidney was damaged in 10 (40%) patients and the left kidney in 15 (60%) patients. The kidney failure requiring nephrectomy was due to stones in 16 (64%) patients and upper pyeloureteric junction obstruction in nine (36%) patients. The mean surgery duration was 111.08 ± 31.95 minutes. The median perioperative blood loss was 100 [70 - 120] ml. Percutaneous drainage was required in 13 (52%) patients. Only two (8%) patients developed postoperative complications. The mean follow-up duration was 64 ± 24.48 days. All patients survived the surgical intervention. Conclusion: Laparoscopic nephrectomy is a mini-invasive technique that is suitable for the surgical removal of non-functional kidneys due to either ureteropelvic junction obstruction or massive kidney stones.