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Iliac artery injuries from gunshot wounds are very rare and lethal injuries associated with high mortality rate. Concurrent ballistic external iliac artery and bladder injuries resulting in an acute ilio-vesical shunt or fistula and discovered at the time of presentation are extremely rare.

Penile self-mutilation is an infrequent form of self-harming behavior seen primarily in patients with schizophrenia spectrum disorders and rarely reported in those with major depressive disorders. We herewith present a major depression related case of penile self-mutilation successfully managed by macroscopic penile re-implantation performed 8 hours after the incident.

Background Angiomyolipoma with epithelial cysts is a rare variant of an angiomyolipoma that typically occurs sporadically. Patients with pre-existing kidney lesion or disease have significantly increased risk of morbidity and mortality associated with trauma. Abnormal and diseased kidneys are frequently injured by low or insignificant velocity impacts. The vulnerability of these kidneys is related to the type of pathology. However, cystic or hydronephrotic kidneys are more susceptible to trauma. Recent studies have shown an association of this rare entity with tuberous sclerosis complex. Despite the rarity of genetic association of Angiomyolipoma with epithelial cysts and tuberous sclerosis, the emerging findings raise the necessity of genetic testing of these lesions to confirm a remote possibility of tuberous sclerosis complex. Case presentation We report a case of a 38-year-old male patient who sustained a right renal injury as a result of a gunshot to the abdomen and underwent an emergency nephrectomy due to hemodynamic instability. A grossly looking shattered kidney was surgically removed. The morphology in conjunction with immunohistochemistry of the specimen favoured a diagnosis of Angiomyolipoma with epithelial cysts. Conclusion This is the first reported case of angiomyolipoma with epithelial cysts diagnosed on a nephrectomy specimen from renal trauma. We aim to highlight an approach to renal trauma on a kidney with pre-existing AMLEC as well as an approach to adult cystic renal neoplasms and to propose the importance of genetic testing for Tuberous Sclerosis.

Xp11.2 translocation renal cell carcinoma is an uncommon and distinctive subtype of renal neoplasm. Osseous metaplasia with renal cell carcinoma is extremely rare and only less than 20 cases have been reported in the literature distinctly in clear cell, papillary and chromophobe subtypes. There has only been one report of Xp11.2 translocation renal cell carcinoma with osseous metaplasia in an elderly woman. We present the first case of this unusual renal neoplasm associated with osseous metaplasia in an adolescent male with no history of previous exposure to chemotherapy who presented with symptomatic anemia due to painless haematuria. Level of evidence: Level 4.

Background The study was carried out to determine the trend of referrals with testicular torsion; the pre-surgery duration of symptoms; the rate of orchidectomy; as well as the seasonality and the age-related laterality of testicular torsion. Methods This was a retrospective study conducted at Chris Hani Baragwanath Academic Hospital using patients’ records from 2006 to 2018 from which data were obtained and analyzed. Results A total of 308 patients with testicular torsion were included in this study; the mean age was 17.2 ± 4.12 (10–33) years. The median (IQR) time from onset to hospital was 47 h, and 194/308 (63%) underwent orchidectomy. Although the orchidectomy rate was higher (95%) in those who had surgery beyond 72 h, 3.6% had reperfusion after detorsion in theater followed by orchidopexy. In the 112 patients who underwent a bilateral orchidopexy, the time from onset of symptoms to surgery was significantly shorter at a median (IQR) of 13 (9–26) h, compared to 144 (40–264) h in the 194 patients who had an orchidectomy (p p = 0.047) for every 1-year increase in age. Conclusion This study shows that there is a significant association between the pre-surgery duration of symptoms and the testicular salvage rate. Testicular salvage is possible beyond 72 h from the onset of symptoms, although the salvage rate reduces from 75% within 24 h to 3.6% beyond 72 h. In addition, it also shows that older patients tend to present with right-sided torsion.

This clinical image presents an unusual association of pneumoscrotum and pneumothorax in a trauma setting. Clinicians managing chest trauma patients need to be aware of such association. The etiology of pneumoscrotum must be clarified through history, physical examination, and investigations as necessary considering that its management targets the primary cause.

Adult type granulosa cell tumours are extremely rare. Albeit mostly benign, 10% have malignant potential associated with unfavorable pathological features. The present case with the longest history duration, shows that size alone may not necessarily be unfavorable prognosticator when not associated with other factors., Adult‐type granulosa cell tumors are extremely rare. Albeit mostly benign, 10% have malignant potential associated with unfavorable pathological features. The present case with the longest history duration shows that size alone may not necessarily be unfavorable prognosticator when not associated with other factors.

Introduction:Bladder paraganglioma is a rare tumour of chromaffin cell origin. Few cases have been reported in the literature.Case report:A 59-year-old female with no known co-morbidities presented with catecholamine-related symptoms, haematuria, elevated blood pressures and raised urine metanephrines. A sonar and computed tomography scan confirmed a bladder mass shown to be active on iodine-131 meta-iodobenzylguanidine. Partial cystectomy was performed.Conclusion:Although bladder paraganglioma is rare, clinicians need to be aware of how such cases may present and the necessary work-up to confirm the diagnosis. Surgery is the treatment of choice, and long-term follow-up of these patients is necessary to detect recurrence or metastases.Level of evidence:4.

Emphysematous cystitis is a rare potentially life‐threatening condition and a distinct type of complicated lower urinary tract infection generally associated with diabetes mellitus and diagnosed radiologically. This case report presents a case of emphysematous cystitis as post hiatal hernia repair infectious complication incidentally found on CT abdomen/pelvis.

Bilateral epididymal cysts are infrequent particularly in children. They commonly arise from the epididymal head. Cysts arising from the epididymal tails are very rare. Spontaneous resolution may occur with no need for surgical excision of cysts and can take up to 50 months.

A 70-year-old black male presented with a 2-month history of obstructive lower urinary tract symptoms. He had no current or previous proven history of urinary tract infections and was not on any antibiotics, steroids or immunosuppressive drugs. A tender, firm and non-nodular prostate was noted on digital rectal examination and his prostate-specific antigen level was 32.4 ug/L. Histopathological analysis following transrectal ultrasound-guided prostate biopsy showed an unusual finding, malakoplakia associated with severe chronic active prostatitis. Only a limited number of cases of prostatic malakoplakia have ever been reported in the literature. We present the first ever case of malakoplakia without any evidence of urinary tract infection associated with severe chronic active prostatitis in a black African male. Level of evidence: Level 5.

Testicular cancer is less common in black males. The highest incidence of these neoplasms worldwide has been reported in white males.1 Tumors of the testis constitute a variety of neoplasms with wide‐ranging biological behaviors, histopathological, and clinical findings.2 Mixed germ cell tumors include combinations of seminomatous and nonseminomatous histological types, with the most common types being mixed embryonal carcinoma and teratoma, mixed teratoma and seminoma, as well as choriocarcinoma and teratoma.3, 4 The combination of seminoma and choriocarcinoma is noted to be an exceptionally rare occurrence.2 We report the first ever case of this unusual combination associated with spinal cord compression in the immediate post radical orchidectomy period in a black patient from a possible choriocarcinoma syndrome on epidural spinal metastasis. A brief review on pathology and management is herein discussed.

Background Cytomegalovirus-related infections are commonly seen in immunocompromised patients. However, haemorrhagic cystitis is an exceptionally rare associated manifestation. We present an unusual case of cytomegalovirus-related haemorrhagic cystitis in a patient with acquired immune deficiency syndrome (AIDS). Case presentation A 33-year-old HIV-positive female presented with acute gross haematuria and suprapubic pain. Cystoscopy revealed features suggestive of haemorrhagic cystitis with clots in the bladder and an ulcerative lesion on the left lateral wall which was biopsied. Histology demonstrated the presence of enlarged cells containing eosinophilic intranuclear and ill-defined amphophilic intracytoplasmic inclusions. Immunohistochemistry was positive for cytomegalovirus. Conclusion This case appears to be the first of its kind reported in South Africa highlighting the importance of considering cytomegalovirus as a potential infectious aetiology in AIDS patients with haematuria. Bladder irrigation with normal saline with or without clot evacuation combined with Ganciclovir are associated with good outcome.

In bilharzia-endemic areas, schistosomiasis is a common infection. Prostate cancer is also a common urological condition affecting people in both bilharzia and non-bilharzia-endemic areas. The association of these familiar conditions is infrequent and the relationship between these entities still controversial. We are adding to the literature a rare case of prostatic bilharzia on needle biopsy, and the subsequent finding of prostatic adenocarcinoma on transurethral resection of prostate specimens. Level of evidence: 4

Xanthogranulomatous prostatitis as mimicker of prostate adenocarcinoma can cause a diagnostic dilemma, as presented in this case. Therefore, alongside histopathology analysis, multiparametric magnetic resonance imaging (mpMRI) would be useful in this situation by identifying and characterizing suspicious prostatic lesions before biopsy thereby supporting current recommendations on the use of mpMRI.

Background Dorsal penile frenulum is noted to be an extremely rare congenital penile abnormality. Only two cases have been reported in the literature. Case presentation A 31-year-old male was involved in a motor vehicle accident and sustained a pelvic fracture and a scrotal laceration which was the main reason for urology consult. Genital examination revealed a circumcised penis, the presence of two frenula and a right scrotal laceration. Scrotal laceration was cleaned and closed. Orthopaedic surgeon took over the patient for the pelvic fracture. Conclusion This is the third reported case of a dorsal penile frenulum incidentally found in a circumcised male and completely asymptomatic. A brief review of relevant embryology and anatomy is herein discussed.

Renal arteriovenous malformations are rare renal vascular abnormalities. More commonly, the term refers to the congenital type of malformation. Only a few cases have ever been presented and reported in the literature, mostly with a nidus. We present the clinical, ultrasound and computed tomography findings and discuss the management related to a 63-year-old male with a right congenital renal arteriovenous malformation without a nidus that was successfully managed with coil embolisation. Relevant literature is hereby reviewed to highlight characteristic imaging and appropriate treatment.

Introduction: Breast cancer is well known as the stereotypical women's cancer, and prostate cancer represents the well-known stereotypical male counterpart. While prostate cancer carries the potential to metastasize to the breast, the synchronous or metachronous co-occurrence of primary breast and primary prostate cancers is quite unusual. Prostate cancer in men of African descent may have its own behaviour with regards to its relationship with male breast cancer. Case presentation: Case 1: A 64 year old male presented to Chris Hani Baragwanath Hospital (CHBAH) with a 2 years history of a painless left breast lump. A core biopsy was done and confirmed breast carcinoma. Tamoxifen was started but, due to disease progression, he underwent left modified radical mastectomy followed by chemotherapy. Prostate biopsy was done for raised Prostate Specific Antigen (PSA) and suspicious prostate on digital rectal examination. A prostatic adenocarcinoma was subsequently diagnosed with bone metastases on bone scan. He was started on Androgen deprivation therapy and followed up every 3 months. Case 2: A 68 year old male presented to CHBAH with a 1 year history of a painless right breast lump. A core biopsy confirmed breast cancer. Tamoxifen was started, followed by right modified radical mastectomy and chemotherapy for disease progression. A raised PSA and suspicious prostate on digital rectal examination prompted a prostate biopsy revealing a prostatic adenocarcinoma. Bone scan was negative for metastasis. He is currently on 3 monthly Androgen deprivation therapy and awaiting radiation. Conclusion: This clinical practice article not only presents this exceptionally rare duality but highlights that both cancers can coexist either as sporadic conditions, or as a result of genetic mutations. Thus, we suggest that men with prostate cancer be screened clinically, biochemically and genetically for breast cancer and vice versa.

Penile Mondor's disease or thrombophlebitis of the superficial dorsal penile vein is a rare disorder of the penis. Reported cases in the literature are mostly focal thrombus. We present clinical and sonographic images of an extensive superficial dorsal penile vein thrombosis.

This clinical image presents an unusual association of diffuse liver uptake on bone scan and prostate adenocarcinoma. Such association has never been described in the literature. The cause of the hepatic uptake should be identified from thorough history taking, technical factors to anatomical diagnostic workup.

Introduction: Breast cancer is well known as the stereotypical women's cancer, and prostate cancer represents the well-known stereotypical male counterpart. While prostate cancer carries the potential to metastasize to the breast, the synchronous or metachronous co-occurrence of primary breast and primary prostate cancers is quite unusual. Prostate cancer in men of African descent may have its own behaviour with regards to its relationship with male breast cancer. Case presentation: Case 1: A 64 year old male presented to Chris Hani Baragwanath Hospital (CHBAH) with a 2 years history of a painless left breast lump. A core biopsy was done and confirmed breast carcinoma. Tamoxifen was started but, due to disease progression, he underwent left modified radical mastectomy followed by chemotherapy. Prostate biopsy was done for raised Prostate Specific Antigen (PSA) and suspicious prostate on digital rectal examination. A prostatic adenocarcinoma was subsequently diagnosed with bone metastases on bone scan. He was started on Androgen deprivation therapy and followed up every 3 months. Case 2: A 68 year old male presented to CHBAH with a 1 year history of a painless right breast lump. A core biopsy confirmed breast cancer. Tamoxifen was started, followed by right modified radical mastectomy and chemotherapy for disease progression. A raised PSA and suspicious prostate on digital rectal examination prompted a prostate biopsy revealing a prostatic adenocarcinoma. Bone scan was negative for metastasis. He is currently on 3 monthly Androgen deprivation therapy and awaiting radiation. Conclusion: This clinical practice article not only presents this exceptionally rare duality but highlights that both cancers can coexist either as sporadic conditions, or as a result of genetic mutations. Thus, we suggest that men with prostate cancer be screened clinically, biochemically and genetically for breast cancer and vice versa.