Purpose: To present our center's experience with the implications of the unusual presentation of renal pain as the first presenting clinical symptom. Material and methods:A retrospective search of the patients' records during the period July 2001 -June 2016 was done in our center for the reported cases of isolated unusual (ectopic) first clinical presentation of renal pain or colic. Cases with abnormal underlying anatomy in the upper urinary tract and those who did not present firstly with isolated unusual renal pain were excluded. Each case was studied for the relevant demographic and clinical variables from the site of pain to the management approach.Result: Of more than 135,000 cases of loin pain, only 24 patients (15 males and 9 females) presented with unusual renal pain between July 2001 and June 2016. They were classified into distant-site referral of pain in 15 cases (62.5%) and renal pain due to unusual extra-urological causes in 9 cases (37.5%). The former group included contralateral renal pain in 3 cases (12.5%), epigastric cramps in 3 cases (12.5%), low-back pain in 4 cases (16.7%), and contralateral testicular pain in 5 cases (20.8%). The latter group included cases of refractory acute ischemic renal pain as the first presentation of other system pathologies in 5 cases (20.8%) and referred biliary pain in 4 cases (16.7%). All cases warranted multiple medical visits and most of them indicated extra laboratory and/or imaging examinations till the final diagnosis. Conclusion:Ectopic renal pain could be either an isolated distant-site referred pain which is mostly served by common innervation between nerve plexuses or pain due to unusual renal involvement by other system pathology. It may delay the original diagnosis and indicate undue diagnostic works up.

Aposthia or natural circumcision is a very rare preputial anomaly that should be differentiated from hypospadias. Here, we report on a 3-day-old male neonate who presented with a congenitally deficient prepuce and normal development of the urethra and external urethral meatus. Physical examination and abdominal ultrasonography revealed no other abnormalities. Relatives were assured about the anomaly, where no further interventions were needed.