Abdullah Waleed Aldughiman

Polyorchidism is a very rare embryological anomaly characterized by the presence of extra number of testes with the usual presentation of two homolateral and one contralateral testis and no clear guidelines for management. Herein, we present a 14yearold case with left supernumerary testes presented with discomfort and painless mass, diagnosed by US and confirmed by magnetic resonance imaging. Conservative treatment was implemented, in the form of ultrasound followup imaging (every 6–12 months) with selfscrotal examination every month.

Introduction: Giant hydronephrosis (GH) is a rare urological entity, described as more than 1 L of fluid contained in the renal collecting system. Ureteropelvic junction obstruction (UPJO) is the most common cause. GH if not discovered and managed early can result in long term complications. We present our experience in the late presentation of adult Giant hydornephrosis. Presentation of cases: We reviewed all the cases of patients with giant hydronephrosis who presented to our institute from December 2017–December 2019 at our institute. Pre-operative renal ultrasound, computed tomography with contrast and MAG-3 were performed on all patients to establish their diagnoses. The patients' demographic data, clinical presentation, preparatory investigations, indications for intervention, type of intervention, pre- and post-operative complications and durations of hospital stay were reported. Laparoscopic transperitoneal nephrectomy was completed in three cases without open conversion. One case proceeded to open conversion owing to a lack of space and severe adhesions. The mean operating time was 79.7 min (range: 65–95 min), estimated blood loss was 75 mL and the mean hospital stay was 4 days (range: 2–6 days). Discussion: The first case of GH was described in 1746. Since then, few cases have been described in the literature. A radiological definition, is the occupation of the hemi-abdomen by the kidney with a midline cross which is the height of five vertebral bodies. GH may be congenital or acquired. The most common presentation of GH is abdominal distention followed by fever and flank pain. Conclusion: When nephrectomy is indicated in giant hydronephrosis, the laparoscopic trans-peritoneal approach is feasible. Pre-operative decompression using a nephrostomy tube and suspension stitch use facilitate the surgery. Highlights:

Introduction: Renal cell carcinoma (RCC) classically presents as a triad of hematuria, loin pain, and a palpable mass. However, Renal cell carcinomas (RCCs) nowadays are more commonly present as incidental findings rather than symptomatic. Wunderlich syndrome is a rare first presentation of RCC. Presentation of case: We present a clinical case of spontaneous renal hemorrhage with unclear etiology that was treated with therapeutic embolization and was found to have renal mass after long follow up. Discussion and conclusion: In regards to treating Wunderlich syndrome, some authors favor angioembolization and follow up. Others proposed radical nephrectomy in conditions with no apparent etiology and normal contralateral kidney because of the high incidence of small renal tumors. Spontaneous perinephric hematoma of unknown etiology should be followed up regularly with a CT image for concerning of impending renal tumor Highlights:

Renal leiomyomas are rare benign tumors of the kidney originating from muscle cells. They are usually found by an autopsy, whether the patient is asymptomatic or has symptoms (i.e., abdominal/flank pain, hematuria, and palpable mass). Today the widespread use of ultrasonography and CT has increased the detection of clinically asymptomatic renal leiomyomas. The differential diagnosis between leiomyomas and other malignant lesions (above all renal cell carcinoma or leiomyosarcoma) is still possible by histologic examination. Radiologic examinations are not sufficient for the differential diagnosis. Renal leiomyomas have no aggressive behavior and they usually do not metastasize. The prognosis, after surgery, is excellent without recurrence. We report a case of leiomyoma in a 78-year-old man who presented with hematuria and flank pain. We also review the literature and provide a summary of clinical, radiologic, and histologic features of renal leiomyomas.