Secondary localization of urothelial carcinoma after cystectomy or total cystoprostatectomy (CPT) on the penis (metastasis) is rare, representing 1 to 8%. Occurring within 18 months of the diagnosis of the primary lesion in about 65% according to the literature. The prognosis is often poor with survival rarely exceeding 20 months. The treatment of cavernous metastases of the penis is multidisciplinary, essentially based on surgery (emasculation or penectomy) and chemotherapy, which provide the best results in terms of overall survival. The authors report a case of metastasis, cavernous location of the penis after cystoprostatectomy in 2016 for high-grade urothelial carcinoma of the bladder, whose anatomy-pathology of the surgical specimen is classified pT3a. The patient underwent emasculation (penectomy plus bilateral total orchiepidymectomy involving the entire scrotum). The authors also discuss the diagnostic, therapeutic and prognostic problems that this secondary location poses.

Introduction Peyronie's disease is a widespread and potentially disabling condition affecting patients’ quality of life. Practitioners and researchers should explore the different approaches proposed to optimize management and tailor it to the patient. Objective To evaluate the efficacy and reproducibility of a semi-invasive protocol for Peyronie's disease made of "optimized" platelet-rich plasma (PRP) injections + penile traction + Phosphodiesterase type 5 (PDE5) inhibitors. Methods The study selected 12 patients who presented with the typical symptomatology of Peyronie's disease for less than 18 months with a curvature of less than 60° and had not received any other medical therapy. The average age was 49 years. 8 patients had a single plaque while 4 had multiple locations. The protocol consisted of 6 sessions of PRP injection, associated with a stretching of the penis and a daily intake of 5mg of Tadalafil. The parameters collected before and after the protocol were: Angulation of the penis, pain Visual Analogue Scale (VAS) on intercourse, International Index of the erectile function-5items (IIEF5), plaque size on ultrasound as well as the Peyronie Disease's Questionnaire scale (PDQ). Protocol description: - PRP injections: 6 injection sessions at one-week intervals. Each session is performed as follows: 1) Autologous collection of 10ml of blood which will be centrifuged at a force of 1500g RCF for 10min, only the supernatant plasma will be taken, avoiding the buffy coat which will only maintain an inflammatory reaction and will considerably reduce the activity of the PRP. 2) Performing a penile block with pure lidocaine 7ml on each side, avoiding peri-platelet injections which will lead to a significant decrease in platelet functionality. 3) Mechanical fragmentation of the plaques with an 18G or 25G needle depending on the sensitivity of the subject, after manual or ultrasound identification, is an essential time of the protocol conditioning the result. 4) Plasma injection around and inside fibrous plaque of the albuginea - Penile traction therapy (PTT): Throughout the protocol, the patient will stretch his penis for one hour, three times a day minimum. - Daily intake of 5mg of Tadalafil. Results The patients were well informed and followed the same protocol during the 6 weeks. The evaluation was done 3 months after the first injection: - Improvement in mean angulation: from 34° to 16°. - Significant decrease in pain during intercourse: from 57% to 22%. - Improvement of the average IIEF5 score: from 14 to 18.75 - Decrease in average plaque size: from 15mm to 6.7mm (55% reduction) - Improvement of PDQ scale in 91% of subjects. No infectious complications were noted. Only one subject reported a minimal hematoma at the injection site during a single session. Conclusions This study requires confirmation in a longer series of cases, but the preliminary results of this safe, reproducible, and very inexpensive protocol are promising and should encourage practitioners to adopt it, especially in low and middle-income countries. Disclosure No

Chromophobic renal cell carcinoma with sarcomatoid differentiation is a rare tumor characterized by a biphasic tumor with both classic epithelial components and sarcomatoid components with poor prognostic factors, usually in association with the rhabdoid contingent which has the potential to behave aggressively and metastasize. We report a particular case of recurrence of this entity in a male patient in which the diagnosis was suspicious preoperatively for the tumor evolution time and the size of the mass and the imaging data performed. The patient underwent extensive left total nephrectomy and lymph node dissection. The postoperative follow up was marked by early appearance of recurrence within 6 weeks after surgery.

Tuberculosis is a real public health problem still rampant in an endemic fashion in developing countries. Multifocal forms are observed in immunocompromised patients but can also be observed in immunocompetent subjects. Often misleading aspects, and which can mislead the diagnosis. The authors reported the case of a 32-year-old young man with no particular medical history, immunocompetent, received with acute obstructive renal failure from the outset anuric associated with orchiepididymitis, pulmonary and vertebral involvement on CT scan without physical signs, progressing well under treatment. This form of multifocal tuberculosis can be life-threatening and requires early diagnosis and urgent management.