Thrombosed urethral prolapse is a rare clinical condition. In this context, we describe our experience and compare our findings with the literature, following presentation of five consecutive cases over 2 years. This will hopefully improve awareness and appropriateness of specialty referrals as a correct diagnosis is rarely established prior to the patient being seen by a urologist. We also wish to highlight a case presentation of thrombosed urethral prolapse outside the bimodal age distribution which has been recorded in the literature. Level of Evidence: Level 4
Background and Objective: There are many evolving prostatic biopsy sampling techniques aimed at improving diagnostic accuracy, localization, prognostication and dictating prostate cancer treatment options. This study analysed the histomorphology, spatial distribution and prognostic implications of site-specific core biopsies of the prostate gland.
Methods: Double-sextant prostate biopsy cores, representing the medial and lateral aspects of the left and right apices, mid-gland and bases of the glands, were microscopically examined prospectively over an 18-month period. These were obtained by transrectal ultrasound guidance. H&E stained slides were examined for the presence, volume, Gleason score and ISUP grade-group of cancer.
Results: Ninety-one patients aged 48 to 88 years (median age 70 years) were seen. In 68.1% of cases all anatomical zones of an examined prostate gland (apices, mid-gland and bases) had cancer. Overall, the apical region of the prostate gland had cancer in 35.6% of cases, the mid-gland portion 33.8% of the time while the basal region was positive in 30.6% of the cases. Tumour was restricted to mid-gland in 5.5% of cases, the apex in 4.4%, whilst it was restricted to the base in 2.2% of the cases. At least a core from all sextant biopsy sites had cancer in 42.9% of cases. Carcinoma volume was least in basally located cancers. ISUP grade group 5 was most frequently seen and grade group 2 was the least seen.
Conclusion: Prostatic carcinomas in our region have poor prognostic indicators such as poor differentiation, high tumour volume, and in most cases involves biopsy cores from all anatomical zones of the prostate.
The lower urinary tract (LUT), in particular the prostate, has been theoretically recognized as a target for SARS-CoV-2. Moreover, common pathophysiological mechanisms have been described for BPE/LUTS and COVID-19, including RAS dysregulation, androgen receptors, and MetS-related factors. These factors raise concerns about the possibility of worse urological outcomes due to BPE/LUTS progression in COVID-19 patients. The available results suggest a correlation between SARS-CoV-2 infection, exacerbation or new onset of LUTS, and semen impairment. BPE patients’ care and management have been deeply affected by COVID-19. In the midst of the pandemic, the main urological guidelines suggested postponement of BPH-related deferrable medical examinations and surgery. Telemedicine, therefore, gained attention and interest. Clinical evidence of impaired QoL or complications expedited surgical intervention. An informed consent covering the risk of COVID-19 and a negative molecular PCR within 72 hours of surgery were mandatory. A reduction in procedures under general anaesthesia was recommended. Long waiting lists accrued worldwide during the pandemic, leading to regular review of the BPE waiting lists and patients’ clinical status, encouraging the increase of minimally invasive office-based procedures, even in the post-COVID-19 era, and the improvement of telemedicine. Prospective studies are still needed to assess the course of LUTS/BPE patients after COVID-19.
BackgroundTyphoid fever afflicts people of low socioeconomic status in developing nations. Although ileal perforation is a common complication of typhoid fever in tropical Africa, caecal perforations related to typhoid fever are uncommon. They present atypically in children under of five years old. Such presentation could include cough and caecal perforation.Clinical DescriptionWe report a two-year old girl with intraoperative and histopathological evidence of a perforated typhoid caecitis who had right hemicolectomy.ConclusionCaecal perforations may occur in children as young as two years of age following enteric fever. High index of suspicion is needed for early detection.
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