Asian Journal of Research and Reports in Urology

Cumulative Occupational Sunlight Exposure Associated with Oxidative Stress, Thyroid Hormone Alterations and Endocrine Dysregulation among Commercial Motorcycle Riders in a Tropical Setting

Eruotor Ogheneochuko Harrison — 2026-01-13

Commercial motorcycle riders in tropical regions experience prolonged occupational exposure to intense sunlight and heat, which may influence oxidative and endocrine regulation. This study examined the association between cumulative occupational sunlight exposure and oxidative stress, thyroid hormone alterations, and endocrine dysregulation among commercial motorcycle riders in a tropical setting. A comparative cross-sectional design was used to evaluate 100 riders and 50 age-comparable controls. Oxidative stress markers (superoxide dismutase, catalase, malondialdehyde) and endocrine parameters (triiodothyronine, thyroxine, thyroid-stimulating hormone, luteinizing hormone, and prolactin) were measured using standard laboratory methods. Riders exhibited significantly reduced antioxidant enzyme activities and elevated lipid peroxidation compared with controls. Thyroid hormones T3 and T4 were significantly higher among riders, while thyroid-stimulating hormone showed no significant difference. Duration of riding demonstrated strong exposure-dependent associations with oxidative stress markers and thyroid hormone levels, alongside inverse relationships with pituitary hormones. These findings suggest that cumulative occupational sunlight exposure is associated with progressive oxidative stress and endocrine dysregulation, highlighting potential subclinical health risks among outdoor workers in tropical environments.

Impact of Tobacco and Alcohol on Seminal Fluid Parameters: A Focus on Sperm Viability in Rivers State, Nigeria

Okigbeye Danagogo — 2026-03-16

Male infertility contributes substantially to the global burden of reproductive health disorders, with modifiable lifestyle factors such as tobacco smoking and alcohol consumption increasingly implicated in impaired spermatogenesis. Although several studies have evaluated their reproductive effects, region-specific data from the Niger Delta region of Nigeria remain limited.

To assess the impact of tobacco smoking and alcohol consumption on seminal fluid parameters among men undergoing evaluation for infertility in Rivers State, Nigeria.

This cross-sectional analytical study was conducted among 190 men aged 27-52 years attending the urology fertility clinic of Gbeye Hospital. Semen samples were collected following 2-7 days of sexual abstinence and analyzed according to WHO 2021 guidelines. Demographic information, tobacco use, and alcohol consumption history were obtained from medical records. Continuous variables were expressed as mean ± standard deviation. Comparisons between groups were performed using Wilcoxon rank sum and Kruskal–Wallis tests, with statistical significance set at p < 0.05.

The mean age of participants was 40.94 ± 5.73 years, with a mean duration of infertility of 5.75 ± 4.19 years. Alcohol consumption was reported in 46.20% of participants, while 21.98% reported tobacco smoking. Increasing age was significantly associated with longer duration of infertility (p < 0.001) but not with significant changes in conventional seminal parameters. Alcohol consumption did not demonstrate statistically significant differences in semen volume (p = 0.12), sperm concentration (p = 0.7), motility (p = 0.7), morphology (p = 0.9), or percentage of dead sperm cells (p = 0.9). In contrast, tobacco smoking was significantly associated with a higher percentage of dead sperm cells (51.38 ± 36.62% vs. 34.05 ± 36.23%, p = 0.017), while no statistically significant differences were observed in semen volume (p = 0.4), sperm concentration (p = 0.2), motility (p = 0.5), or morphology (p = 0.7).

Tobacco smoking is associated with increased sperm cell death among infertile men in Rivers State, suggesting oxidative stress–mediated impairment of sperm viability. Alcohol consumption did not demonstrate significant effects on conventional seminal parameters in this population. Increasing age was associated with prolonged infertility duration but not with significant alterations in routine semen indices. These findings underscore the importance of lifestyle assessment and smoking cessation counselling in male infertility management.

L-Methionine Improves Sperm DNA Integrity and Functional Semen Quality in Infertile Men: A Randomized Controlled Study

Marwan Abdulaziz Ibrahim — 2026-04-21

Background: Sperm DNA fragmentation index is considered an important marker of male reproductive potential. Increased DNA fragmentation is associated with impaired semen quality and poor reproductive outcomes. However, effective targeted therapies to improve sperm DNA integrity remain limited.

Aims: To evaluate the effect of L-methionine supplementation on sperm DNA fragmentation and conventional semen parameters in infertile men with elevated sperm DNA fragmentation.

Materials and Methods: This prospective randomized double-blind placebo-controlled trial was conducted between May 2024 and May 2025 at the infertility clinic of Diwaniyah teaching hospital in Iraq. A total of 40 infertile men with elevated sperm DNA fragmentation were randomly assigned in a 1:1 ratio to receive either oral L-methionine (500 milligrams twice daily) or matching placebo for 12 weeks (20 participants in each group). In addition, 20 fertile men were included as a reference control group. Conventional semen parameters and sperm DNA fragmentation were assessed before and after intervention using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling assay.

Results: L-methionine supplementation resulted in significant improvement in progressive motility, sperm morphology, and sperm viability, along with a significant reduction in sperm DNA fragmentation compared with placebo. No significant change was observed in sperm concentration. Between-group comparisons showed greater improvement in semen parameters and DNA integrity in the L-methionine group. Correlation analysis showed an inverse relationship between reduction in DNA fragmentation and improvement in progressive motility.

Conclusions: L-methionine supplementation was associated with improvement in sperm DNA integrity and semen quality in infertile men with elevated DNA fragmentation. These findings suggest a potential role for L-methionine in the management of male infertility associated with increased sperm DNA damage.

Mini-percutaneous Nephrolithotomy: What are the Real Benefits Compared to Standard PCNL? Single-center Experience and Comparative Analysis with Literature

M. Belaghzal — 2026-04-28

Introduction: Percutaneous nephrolithotomy (PCNL) is the standard treatment for renal stones ≥ 2 cm. However, the size of the percutaneous tract is associated with non-negligible morbidity, particularly bleeding complications. The miniaturization of instruments has led to the development of mini-PCNL, aiming to reduce parenchymal injury while maintaining satisfactory efficacy.

Objective: To evaluate the efficacy and morbidity of mini-PCNL in our clinical practice and to compare our results with those reported in the literature.

Materials and Methods: This is a retrospective single-center study including 48 patients who underwent mini-PCNL between 2023 and 2026. The analyzed parameters included demographic data, stone characteristics (size, location, density in Hounsfield units), operative time, stone-free rate, complications according to the Clavier–Dindo classification, transfusion rate, and length of hospital stay.

Results: The mean age was 53.6 years (range: 24–75 years), with a female predominance (59%). Stones were radiopaque in 94% of cases, with a density >1000 Hounsfield units in 52.6% of cases. Stones larger than 20 mm accounted for 58.8% of cases. Operative time ranged between 100 and 120 minutes in 97% of cases. The mean length of hospital stay was 2–3 days. The initial stone-free rate (SFR) was 79.4%. Additional treatment (flexible ureteroscopy or extracorporeal shock wave lithotripsy) was required in 20.6% of patients. Hemorrhagic complications and transfusion rate were 4.2%, while infectious complications occurred in 2.1% of cases.

Conclusion: Mini-percutaneous nephrolithotomy (mini-PCNL) is an effective and less invasive technique, allowing a reduction in hemorrhagic morbidity and length of hospital stay.

The stone-free rate remains satisfactory despite a high proportion of large and dense stones.

Careful patient selection remains essential to optimize outcomes. Standard PCNL still retains its role in the management of large and complex stones.

School-Based Intervention on Testicular Cancer Awareness and Self-examination Behaviour among Male Secondary School Students in Lagos State, Nigeria

Onyedibe Josephine — 2026-05-08

Testicular cancer (TC) is the most common malignancy among young males aged 15 to 50 years. Despite its high survival rate when detected early, awareness and engagement in preventive practices, such as testicular self-examination (TSE), remain low, particularly among adolescents in Nigeria. This study assessed the effectiveness of a school-based educational intervention in improving knowledge and practices related to TC and TSE. The study used a quasi-experimental design with pre and post-test interventions. A total of 130 male students from public and private secondary schools were selected via multi-stage sampling. The intervention was delivered in four modules(Understanding testicular cancer; importance of TSE; How to preform TSE(practical); Health and lifestyle practices)with teaching methodologies such as interactive lectures, group discussions and role play.Data were collected using structured questionnaires on knowledge (20-point scale) and self-reported TSE practice (10-point scale). Descriptive statistics and paired t-test were applied for analysis at p ≤ 0.05 significance level. All questionnaires were returned. The study found significant improvements in knowledge and self-reported practices regarding testicular cancer (TCS). Mean knowledge scores increased from 5.39 ± 1.78 to 18.93 ± 2.34. Participants aged 18-25 showed the highest improvement, with knowledge rising from 0.0% to 76.9%. The school-based intervention significantly improved knowledge, with a highly significant effect size of -4.93 (p=0.001). However, 88.5% of participants had poor perceived benefits of TCS, and only 1.5% had poor self-reported practice of TSE. The school-based intervention improved testicular cancer knowledge and TSE practices among male students in Lagos State, Nigeria. It highlighted the effectiveness of structured health education in early detection. Recommendations include integrating TC education into school curricula for sustained engagement in TSE and preventive behaviors.

Correlation of Prevoid and Postvoid Urine Volumes with International Prostate Symptom Score among Men with Lower Urinary Tract Symptoms

Melifonwu Ikenna O. — 2026-05-16

Background: Males, 50 years and above, often suffer from lower urinary tract symptoms (LUTS). International Prostate System Score (IPSS) is used clinically to assess LUTS. Urodynamic studies are the gold standard for its investigation, but are invasive, costly, time consuming and require expertise, and are not readily accessible, especially in low and middle income countries (LMICs). Transabdominal ultrasound comes in handy. It can be used to assess prevoid and postvoid urine volumes. Postvoid residual (PVR) urine volume is widely used in ultrasound evaluation of lower urinary tract symptoms (LUTS), but its interpretation without reference to prevoid urine volume (PrVR) may be limited. PrVR reflects bladder filling status and may provide important physiological context. This study aims to evaluate the relationship between PrVR, PVR, and IPSS in adult males with LUTS.

Methodology: This was a prospective cross-sectional study carried out over a period of six months. Institutional ethical clearance and patients’ consent were obtained as required. Transabdominal ultrasound was used to measure PrVR and PVR. Symptom severity was assessed using IPSS. Data analysis was with the Statistical Package for Social Sciences (SPSS), version 20.0. Simple frequencies, measures of central tendencies and dispersion, paired sample t-tests and Pearson correlation tests were carried out. P-values < 0.05 were considered statistically significant. Assumptions of linearity was assessed. Effect sizes and 95% confidence intervals (CI) were reported where applicable.

Results: A total of 273 subjects were studied, mean age was 67.2 years. The IPSS scores were: moderate (38.83%), severe (31.50%) and mild (29.67%). Prevoid urine volume was statistically greater than that of the postvoid (t = 21.356, p < 0.001), with a very large effect size (Cohen’s d = 1.29). The PrVR demonstrated a weak but statistically significant positive correlation with IPSS (r = 0.120, 95% CI: 0.002–0.234, p = 0.047); and PVR showed a moderate positive correlation with IPSS (r = 0.288, 95% CI: 0.175–0.392, p < 0.001). Regression analysis demonstrated linear relationships with low coefficients of determination (PVV: R² = 0.0145; PVR: R² = 0.0832).

Conclusion: PrVR and PVR show weak-to-moderate associations with symptom severity. While PVR demonstrates a relatively stronger relationship, both parameters explain only a small proportion of symptom variability, reflecting the multifactorial nature of LUTS. The PrVR provides important physiological context that enhances interpretation of bladder function. Incorporating PrVR improves the clinical relevance and interpretability of LUTS assessment.

Prevalence of Urinary Tract Infection Pathogens Detected in Children at a Hospital in Colombo, Sri Lanka

D. N. Wickremasinghe — 2026-06-22

Introduction: Urinary tract infections (UTIs) are among the commonest bacterial infections in children, with Escherichia coli and Klebsiella spp. reported as predominant causative agents. Several studies have shown that at least 8% of children aged between 1 month and 11 years have at least one UTI.

Objective: This study aimed to determine the prevalence of pathogens causing UTI detected in children under 12 years of age at a paediatric hospital in Colombo, Sri Lanka.

Methodology: A retrospective cross-sectional study was conducted using laboratory records from January 2024 to June 2024 at a major women’s and children’s hospital in Colombo. Urine samples from 619 paediatric patients were analysed according to standard microbiological methods, including urine culture, Gram staining and biochemical identification tests. The collected data were sorted in a prepared spreadsheet and entered into SPSS version 29.0.10 for statistical analysis. Discrete variables were expressed as frequencies and percentages.

Results: Of the 619 urine samples tested, 111 (17.93%) showed significant bacterial growth. Gram-negative bacteria (96.26%) were the predominant uropathogens, whereas Gram-positive pathogens were less frequently reported. E. coli (55.86%), Proteus spp. (15.32%) and Klebsiella spp. (14.41%) were the most frequently isolated organisms. Pseudomonas spp. (3.60%), other coliforms (3.60%), Enterococcus spp. (3.60%) and coagulase-negative staphylococci (2.70%) were also reported. There was no difference between males and females with regard to the types of pathogens isolated. Males (57.66%) had a higher prevalence of infection than females (42.34%), and 44.14% of cases were from children aged less than 1 year. In contrast, in the 9–12-year age group, 66.67% (n = 8) were females and 33.33% (n = 4) were males.

Conclusion: This study highlights the microbial profile and demographic distribution of UTIs among a paediatric population. However, the study does not provide insights into resistance patterns, which limits its direct application in guiding antibiotic therapy. The findings emphasise the importance of identifying uropathogens that cause UTIs in paediatric patients to support the initiation of antibiotic treatment and reduce the burden of UTIs.

Uretero-Ileal Anastomotic Strictures Following Bricker Urinary Diversion: A Retrospective Study

Y. Rharmili — 2026-06-23

Aims: This study evaluated the incidence, clinical presentation, management strategies, and risk factors associated with uretero-ileal anastomotic strictures (UIAS) after radical cystectomy with Bricker ileal conduit urinary diversion and compared the findings with published data.

Study Design: Retrospective single-centre observational study.

Place and Duration of Study: Department of Urology, Mohammed VI University Hospital, Tangier, Morocco, January 2021 to January 2026.

Methodology: Medical records of patients who underwent radical cystectomy with Bricker ileal conduit diversion were reviewed retrospectively. Patients operated on at the study institution were included; those with incomplete records, insufficient postoperative follow-up, loss to follow-up, or surgery performed elsewhere were excluded. Demographic, clinical, perioperative, and postoperative variables were analysed.

Results: Among 88 patients, 10 developed UIAS, corresponding to an incidence of approximately 12%. The mean age of affected patients was 62 years, and 80% were male. No statistically significant association was identified between stricture occurrence and age, sex, or smoking status. Strictures were detected incidentally on surveillance imaging in 50% of cases, while deterioration of renal function, acute pyelonephritis, and flank pain accounted for 30%, 10%, and 10% of presentations, respectively. The mean time to diagnosis was approximately 12 months, with most strictures diagnosed between 6 and 12 months after surgery. Left-sided strictures were most frequent (50%), followed by right-sided and bilateral strictures (25% each). Mono-J drainage was successful in 40% of patients.

Conclusion: UIAS remains a clinically relevant complication after Bricker urinary diversion. Early detection, decompression when required, and structured long-term surveillance are important for preserving renal function.

Isolation and Diagnosis of Bacteria Causing Urinary Tract Infections in Diabetic Patients

Dhafer Rahman Abed Al-Janabi — 2026-07-01

Background: Urinary tract infections (UTIs) are important bacterial infections in diabetic patients because diabetes mellitus may promote bacterial growth and recurrent infection. This study aimed to isolate and identify bacterial species associated with UTIs in diabetic patients and to evaluate the susceptibility of the isolates to selected antibiotics. Methods: The study was conducted in the laboratories of the College of Medical Technologies, Department of Medical Laboratory Analysis, Al-Islamic University, Najaf, Iraq, from December 2024 to March 2025. A total of 31 midstream urine samples were collected from diabetic patients diagnosed with UTIs by specialist physicians at Al-Sadr Teaching Hospital, Najaf. Samples were processed by centrifugation and cultured on MacConkey agar, Mannitol Salt Agar and blood agar. Isolates were identified using colony morphology, Gram staining and standard biochemical tests. Antibiotic susceptibility testing was performed by the Kirby-Bauer disk diffusion method using amikacin, gentamicin, amoxicillin/clavulanic acid, clindamycin and erythromycin. Results: Twenty-three bacterial isolates were recovered. Gram-negative bacteria accounted for 16 isolates (69.57%), whereas Gram-positive bacteria accounted for 7 isolates (30.43%). The identified species were Escherichia coli (7 isolates; 30.4%), Staphylococcus aureus (6 isolates; 26.1%), Pseudomonas aeruginosa (4 isolates; 17.4%), Proteus spp. (3 isolates; 13.0%) and Staphylococcus saprophyticus (3 isolates; 13.0%). Among Escherichia coli isolates, the highest susceptibility was observed to amikacin (85.71%), followed by gentamicin (71.43%), while complete resistance was recorded to amoxicillin/clavulanic acid. Conclusion: The findings indicate that Gram-negative bacteria, particularly Escherichia coli, were the predominant bacterial pathogens in diabetic patients with UTIs in this study. Routine bacterial identification and susceptibility testing remain important for guiding appropriate antimicrobial selection.

Evaluation of the Effect of Diazepam on Prostate of Animals Administered with Elaeis Guineensis

O. H. Blackie — 2026-07-20

The prostate gland is a hormonally regulated accessory reproductive organ whose structural integrity is essential for normal male reproductive function. Exposure to certain pharmacological agents may alter prostatic tissue through oxidative stress, vascular disruption, or endocrine imbalance. This study evaluated the effect of diazepam on the prostate of adult mice administered Elaeis guineensis. Sixteen adult mice weighing 25–40 g were acclimatised for two weeks and randomly assigned to four groups (n = 4). Group A served as the control and received water and feed only. Group B received E. guineensis, followed by diazepam (18.75 mg/mL) two hours later. Group C received diazepam, followed by E. guineensis two hours later, whereas Group D received diazepam only. The experiment lasted 28 days. At the end of the study period, prostate tissues were harvested under chloroform anaesthesia and fixed in 10% formalin for histological processing and haematoxylin–eosin staining. Microscopic examination showed that the control group maintained normal prostate architecture with well-distributed connective tissue. Group B exhibited generally preserved tissue architecture but showed stromal haemorrhage, suggesting partial protection by E. guineensis when administered before diazepam exposure. Group C showed near-normal histology with mildly distorted connective tissue distribution, indicating some recovery following post-treatment. In contrast, Group D demonstrated stromal haemorrhage despite relatively preserved connective tissue, indicating diazepam-induced vascular instability in prostatic tissue. The protective and ameliorative effects observed in the treated groups may be associated with the antioxidant constituents of E. guineensis, including tocotrienols, tocopherols, and carotenoids, which may reduce oxidative stress and support tissue repair. In conclusion, E. guineensis exhibited protective and restorative potential against diazepam-associated prostatic alterations, although the extent of protection may depend on the timing of administration.

Emergency Management of Obstructive Uropathy in Resource-constrained Settings: Current Concepts and Surgical Perspectives

Rudraksh Kesharwani — 2026-04-30

Background and Aim: Obstructive uropathy is a common urological emergency and an important reversible cause of acute kidney injury. Delayed recognition and inadequate management may lead to irreversible renal damage, sepsis, and increased mortality. Although standardized guidelines exist for the management of urinary obstruction, their implementation remains challenging in many healthcare systems, particularly in resource-constrained settings where access to imaging and specialist care may be limited. A practical, clinically oriented synthesis of current management principles is therefore necessary to guide decision-making in diverse clinical environments.

Methods: A structured narrative review of the literature was conducted using electronic databases including PubMed/MEDLINE, Scopus, and Google Scholar. Relevant articles addressing etiology, pathophysiology, clinical presentation, diagnostic strategies, emergency decompression techniques, complications, and management approaches in resource-limited settings were identified. Priority was given to guideline-based evidence, randomized trials, systematic reviews, and clinically relevant observational studies. Selected findings were synthesized into clinically oriented sections supported by summary tables and a management algorithm.

Results: Obstructive uropathy arises from multiple etiologies, with urolithiasis, malignancy, benign prostatic hyperplasia, and ureteric strictures representing the most common causes in emergency practice. Early recognition of high-risk features—including infection, bilateral obstruction, solitary kidney involvement, and acute kidney injury—is essential in guiding urgent intervention. Both ureteric stenting and percutaneous nephrostomy remain effective methods of decompression, with procedure selection influenced by patient condition, anatomical factors, and resource availability. In resource-constrained environments, ultrasound-based evaluation, early stabilization, and timely referral play a critical role in improving outcomes. Advances in portable imaging, training programs, and referral networks have the potential to further enhance patient care in underserved settings.

Conclusion: Emergency management of obstructive uropathy requires timely diagnosis, prompt decompression, and careful follow-up to prevent irreversible renal injury. Adaptation of established management principles to local resource availability remains essential for improving outcomes. Strengthening diagnostic capacity, procedural training, and referral systems may reduce morbidity and mortality associated with obstructive emergencies, particularly in low-resource healthcare settings.

Prostate Cancer in Cameroon: Epidemiological Trends, Diagnostic Challenges, Therapeutic Constraints, and Emerging Opportunities: A Systematic Review

Jean Paul Engbang — 2026-06-09

Background: Prostate cancer is the most frequently diagnosed solid malignancy among men in many regions of the world and remains one of the leading causes of cancer-related death. More than 1.4 million new cases and nearly 400,000 deaths are estimated to occur globally each year, making this disease a major and growing public health challenge. Men of African ancestry appear to be disproportionately affected, with higher incidence rates, more aggressive pathological features, and poorer survival outcomes than those reported in many other populations. In sub-Saharan Africa, demographic expansion, increasing life expectancy, and progressive improvements in diagnostic capacity have contributed to a steady rise in the number of newly diagnosed cases.

Although some prostate cancers follow an indolent clinical course, a large proportion of patients in low- and middle-income countries are diagnosed only after the disease has become locally advanced or metastatic. Delayed diagnosis is commonly associated with limited public awareness, low uptake of prostate-specific antigen testing, inadequate access to prostate biopsy and advanced imaging, and restricted availability of specialized urological and oncological services. As a consequence, many men first present with severe lower urinary tract symptoms, bone pain, spinal cord compression, pathological fractures, or obstructive renal failure.

In Cameroon, prostate cancer has emerged as one of the most frequently encountered male malignancies and constitutes an increasingly important cause of cancer-related morbidity and mortality. Hospital-based studies suggest that most patients are diagnosed after the age of 60 years and that a substantial proportion present with markedly elevated prostate-specific antigen levels, high Gleason scores, and metastatic disease at the time of initial evaluation. Structural barriers such as delayed consultation, cultural perceptions of cancer, limited diagnostic infrastructure, high out-of-pocket expenditures, and unequal geographic distribution of specialized services continue to compromise early detection and optimal treatment.

Major therapeutic advances over the past two decades have transformed the management of prostate cancer. Curative treatment is possible for localized disease through active surveillance, radical prostatectomy, and radiotherapy, while androgen deprivation therapy remains the cornerstone of treatment for advanced stages. More recently, androgen receptor–targeted agents, taxane-based chemotherapy, and novel radioligand therapies have substantially improved survival. However, access to these innovations remains limited in many African countries, where cost and infrastructure constraints continue to restrict their implementation.

This systematic review was undertaken to synthesize the available evidence on the epidemiology, risk factors, clinicopathological characteristics, diagnostic pathways, treatment patterns, and health system challenges associated with prostate cancer in Cameroon, and to identify strategic priorities that may improve prevention, early diagnosis, and patient outcomes.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies published between January 2010 and April 2026 were identified through PubMed/MEDLINE, Scopus, African Journals Online, and Google Scholar. Eligible publications reported epidemiological, clinical, pathological, therapeutic, economic, or health system data related to prostate cancer in Cameroon. When national data were limited, studies from comparable sub-Saharan African settings were used to provide contextual interpretation. Methodological quality was assessed using the Newcastle–Ottawa Scale, and findings were synthesized narratively because of substantial heterogeneity across study designs and outcome measures.

Results: The reviewed literature consistently shows that prostate cancer in Cameroon is predominantly diagnosed in men aged 60–75 years and that a substantial proportion of patients present with high-risk or metastatic disease. Median prostate-specific antigen concentrations at diagnosis are frequently markedly elevated, often exceeding 20–100 ng/mL, and Gleason scores of 8–10 are common. Acinar adenocarcinoma accounts for the overwhelming majority of tumors. Delayed consultation, limited screening, inadequate access to multiparametric magnetic resonance imaging and image-guided biopsy, scarcity of radiotherapy facilities, restricted availability of modern androgen receptor–targeted therapies, and high out-of-pocket costs are the principal factors associated with poor outcomes. These health system constraints frequently result in late diagnosis, treatment interruption, and reduced survival.

Conclusion: The growing burden of prostate cancer in Cameroon reflects the convergence of demographic transition, heightened genetic susceptibility among men of African ancestry, and persistent weaknesses in cancer care delivery. Although major advances in diagnosis and treatment have transformed outcomes in high-resource settings, many Cameroonian patients continue to present when curative options are no longer feasible. Strengthening public awareness, expanding access to early detection, improving pathology and imaging capacity, decentralizing oncology services, and reducing financial barriers should be considered national priorities. Without coordinated and sustained reforms, prostate cancer will remain a major and increasingly important cause of preventable morbidity and mortality among men in Cameroon.

An Unusual Presentation of Penile Fracture: A Report of Two Cases

Ugochukwu Ikedichi Alili — 2026-01-20

Penile fracture is a rare condition that is easily identified by its classical clinical features. However, its features and course of the condition could be altered by the timing of presentation and the occurrence of complications. Delayed presentation is directly associated with delayed intervention with attendant poor clinical outcome. The occurrence of concomitant injuries like urethral rupture is associated with morbidities such as urethral stricture and urethra-cutanous fistula if not promptly and primarily repaired. We present two rare case reports of a delayed presentation of penile fracture and penile fracture with concomitant urethral injury. The patient in the first case report presented with localized right sided penile swelling and painful erection while the patient in the second case report presented with diffuse penile swelling, pain and urethral bleeding following trauma to the erect penis during intercourse. Both cases had immediate repair with good anatomical and functional outcome. This article highlights the invaluable role of primary repair in the management of penile fracture irrespective of the pattern of presentation.

Primary Isolated Testicular Tuberculosis in an Elderly Male: A Rare Case Report from Sekadau General Hospital as Rural Accessibility

Rendy Franiko — 2026-01-27

Introduction: Pulmonary tuberculosis represents the predominant clinical manifestation of tuberculosis. Extra-pulmonary involvement accounts for approximately 10–15% of cases, with lymph nodes being the most frequently affected site in Asian.

Presentation of Case: A 60‑year‑old male presented with a painful, right-sided testicular swelling without any discharging sinus or scrotal ulceration for 1 month. There was no history of any respiratory symptom. On examination, the general survey revealed no abnormality, Ultrasonography examination of testes showed the right side of scrotum was enlarge (3.38 x 3.34 x 5.0 cm) sized heteroechoic space occupying lesion with hypoechoic components and small cystic areas were seen at the lower pole of the right testis, lobulated with clear line, On Color Doppler Ultrasound (CDUS) showed intralesional vascularization. For the left side was within normal range. From Ultrasonography (USG) examination concluded that Solid mass with cystic component in right testes, suggestive for malignancy with hydrocele on the right side, with normal of left testes. The patient was informed to surgery procedure such as orchiectomy.

Discussion: Tuberculosis (TB) remains one of the leading causes of mortality worldwide, particularly in developing countries within TB-endemic regions such as Indonesia. Among these, isolated genital involvement is observed in nearly 28% of patients with genitourinary TB and occurs more frequently in males. Scrotal ultrasonography plays a pivotal role in the evaluation and diagnosis of tuberculous orchitis. Standard anti-tubercular chemotherapy remains the cornerstone of treatment for tuberculous orchitis. A six-month regimen consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol during the intensive phase for two months, followed by rifampicin and isoniazid for an additional four months, is generally effective in achieving complete resolution of testicular lesions. Surgical intervention is reserved for selected cases with complications or poor response to medical therapy.

Conclusion: Primary isolated testicular tuberculosis is an uncommon clinical entity and is frequently underrecognized because of its nonspecific presentation. Consequently, a high index of suspicion supported by thorough history taking, detailed physical examination, and appropriate diagnostic investigations is essential.

Medial Thigh Fasciocutaneous Flap for Perineoscrotal Reconstruction after Fournier’s Gangrene

H. Lahmidi — 2026-01-30

Fournier’s gangrene is a rare and potentially serious necrotizing fasciitis of the perineal and external genital area which warrants urgent, multidisciplinary management. Even with the availability of advanced intensive care, antibiotic therapy, and aggressive surgical debridement, survivors often have massive perineoscrotal tissue lesions, which represents an intricate reconstructive problem. We report a 31-year-old male with no previous medical history who developed advanced Fournier’s gangrene, leading to extensive scrotal loss of skin with bilateral exposed testicles. Management initially consisted of hemodynamic stabilization, broad-spectrum antibiotics, and surgical debridement which was repeated until complete control of the infection was reached. A definitive reconstruction was made with a long-pedicle medial thigh fasciocutaneous flap, resulting in stable coverage in a single phase. Partial donor-site dehiscence was observed in the postoperative period and controlled conservatively. A second operative procedure was then conducted with flap division and scrotal reconstruction with purse-string method, as well as split-thickness skin grafting of the donor site. The postoperative outcome after surgery was favourable and acceptable in terms of aesthetics and function. Erectile function was intact and sperm analysis was normal at follow-up. This case illustrates the reliability and functional advantages of the long-pedicle medial thigh fasciocutaneous flap in perineoscrotal reconstruction for Fournier’s gangrene.

Nephroblastoma in Pediatric Urinary Retention: A Rare Clinical Presentation in Sekadau General Hospital

Rendy Franiko — 2026-02-09

Introduction: Wilms’ tumor (WT) is the most common malignant renal neoplasm in children and classically presents as an asymptomatic abdominal mass in early childhood. Urological manifestations related to urinary tract obstruction are rare and may obscure the underlying diagnosis, particularly in older children and in settings where delayed presentation is common.

Presentation of Case: A 7-year-old boy presented with acute urinary retention caused by extrusion of necrotic soft tissue through the urethral meatus. The patient had a four-month history of progressive abdominal distension without hematuria, trauma, or prior urinary instrumentation. Physical examination revealed a necrotic mass protruding from the urethra and a palpable left-sided abdominal mass. Emergency extraction of the obstructing tissue resulted in immediate relief of urinary retention; histopathological evaluation demonstrated necrotic material. Abdominal ultrasonography identified a solid left renal mass with associated pelvicalyceal system dilatation. The patient subsequently underwent radical nephrectomy. Histopathological examination of the nephrectomy specimen confirmed nephroblastoma with extensive tumor necrosis and capsular infiltration. The postoperative course was uneventful, with complete resolution of obstructive urinary symptoms, and the patient was commenced on risk-adapted adjuvant chemotherapy.

Discussion: Urinary tract obstruction in Wilms’ tumor is most commonly associated with intrapelvic extension, while gross hematuria remains an uncommon feature. Necroturia resulting in acute urinary retention has not previously been reported as a presenting manifestation of WT. This extreme clinical phenotype likely reflects advanced intrapelvic tumor necrosis with migration of devitalized tissue into the urinary tract, underscoring the biological and anatomical heterogeneity of Wilms’ tumor.

Conclusion: Wilms’ tumor may rarely present with necroturia and acute urinary retention. Recognition of such atypical presentations broadens the clinical spectrum of WT and highlights the importance of thorough abdominal examination in children presenting with unusual lower urinary tract symptoms.

Aggressive Primary Adrenal Leiomyosarcoma with Pancreatic and Gastric Involvement: Lessons from a Rare Case

Aadhar Jain — 2026-02-17

Background: Primary adrenal leiomyosarcoma (PAL) is an exceedingly rare malignant neoplasm arising from smooth muscle elements of the adrenal gland or its associated vasculature. Fewer than 60 cases have been reported in the literature, and presentation with contiguous multivisceral invasion is exceptionally uncommon, posing significant diagnostic and surgical challenges.

Case Presentation: A 74-year-old male presented with left flank pain. Cross-sectional imaging revealed a large left adrenal mass measuring 13 × 13 cm with obliteration of surrounding fat planes and direct invasion into adjacent organs, including the pancreas, spleen, gastric muscularis, and left diaphragmatic crus. The mass caused compression of the splenic vessels with associated splenic vein thrombosis. Given the locally advanced nature of the disease, the patient underwent multivisceral “en-bloc” resection comprising left adrenalectomy, distal pancreatectomy, splenectomy, and distal gastrectomy. Histopathological examination confirmed primary adrenal leiomyosarcoma with infiltration into the pancreatic parenchyma and gastric muscularis propria. All surgical margins were free of tumour.

Discussion: PAL with direct multiorgan involvement is extremely rare, and preoperative diagnosis is often difficult due to nonspecific clinical and radiological features. Complete surgical excision with negative margins remains the cornerstone of treatment and offers the best chance for durable local control in the absence of distant metastasis.

Conclusion: This case highlights an exceptionally rare presentation of primary adrenal leiomyosarcoma with extensive contiguous organ invasion. Radical “en-bloc” resection, when technically feasible, can achieve clear margins and may offer curative potential. Reporting such cases contributes to the limited existing literature and helps guide surgical decision-making in this rare malignancy.

Percutaneous Tibial Nerve Stimulation for Neurogenic Detrusor Overactivity after Spinal Cord Injury: A Case Report

M. X. Guo — 2026-03-07

Introduction: Neurogenic detrusor overactivity (NDO) is characterized by spontaneous or provoked involuntary detrusor contractions during the storage phase in urodynamic investigation secondary to neuro-urological disorders. Percutaneous tibial nerve stimulation is a minimally invasive neuromodulation technique for treating overactive bladder symptoms.

Case: We report the case of a 53-year-old male, who came with DO secondary to spinal cord injury (SCI) since November, 2023. The patient had an inadequate response to oral anticholinergic drugs (tolterodine, propiverine and solifenacin). Therefore, the patient adopted weekly percutaneous tibial nerve stimulation (PTNS) and continued anticholinergic therapy with clean intermittent catheterization (CIC). At 3 months,12 months and 18 months from baseline, urodynamic assessments indicated normalized bladder compliance. At 3 months from baseline, the patient had no incidence of DO and complete dryness. Significant changes were already present in Incontinence-Specific-Quality-of-Life Instrument (59 vs 19) and mean voiding volume (400 ml vs. 70 ml), respectively. The outcomes had still yielded significant improvements until 18 months from baseline. Besides, the patient reported no related adverse event.

Conclusion: PTNS was effective and safe as the treatment for NDO secondary to SCI.

Primary Localised Urinary Bladder Amyloidosis: A Mimicker of Malignancy

Ravi V. Patel — 2026-03-11

Aim: To study clinical features of primary urinary bladder amyloidosis, to identify it, to differentiate it from urinary bladder malignancy and to treat the disease.

Case Presentation: We present a case of 51-year-old gentleman presented with painless gross hematuria who was a known case of Nonalcoholic SteatoHepatitis (NASH) associated chronic liver disease. Ultrasound revealed a large blood clot without any evidence of mass or lesion. Cystoscopy revealed a flat lesion near trigone and biopsied. Lesion completely respected and surprisingly histopathology turned out to be localised amyloidosis which was confirmed with immunohistochemistry (IHC) profile. Within 6 months patients had recurrence and repeat trans urethral resection was performed. After that patients remained asymptomatic for 18 months and still under follow up without recurrence.

Discussion: The aetiology of bladder amyloidosis is poorly understood. There are two different schools of thoughts. Most researchers think that it is abnormal metabolism of protein which causes amyloidosis. While others think that it is a sequela of chronic urinary tract infection or repeated inflammation of mucosa and submucosa. Investigation protocol includes basic blood investigations, urine for cytology, ultrasound and CT-IVP and cystoscopic resection and Histopathological examination conclude the diagnosis. As the recurrence is known phenomenon, strict cystoscopic follow up is necessary.

Conclusion: Primary urinary bladder amyloidosis mimics bladder malignancy clinically. Thus, it is of utmost importance to distinguish between both of them and to treat them accordingly.

Double Inferior Vena Cava with Renal Angiomyolipoma in a Living Kidney Donor: A Rare Vascular and Parenchymal Anomaly with Surgical Implications

Nripesh Sadasukhi — 2026-04-04

Background: Duplication of the inferior vena cava (IVC) and renal angiomyolipoma (AML) are uncommon findings in living kidney donors and rarely coexist. Both anomalies may influence donor nephrectomy and graft implantation strategy.

Case Presentation: We report a 72-year-old female living kidney donor who underwent ABO-incompatible transplantation for her 32-year-old son with end-stage renal disease (donor: B positive; recipient: A negative). Preoperative contrast-enhanced CT angiography demonstrated a duplicated IVC with a left-sided cava crossing anterior to the aorta and joining the right IVC (pre-aortic confluence), along with an accessory left renal vein. A small lower pole AML measuring 8 × 7.5 × 12 mm was identified in the donor kidney. Bilateral single renal arteries were present. The anticipated technical challenge was reduced left renal vein length due to early drainage into the duplicated cava, potentially complicating venous anastomosis. Following multidisciplinary evaluation and immunological optimization, donor nephrectomy and transplantation were completed successfully without vascular compromise or graft-related complications.

Conclusion: This case underscores the importance of meticulous preoperative vascular mapping and individualized operative planning in donors with complex venous anatomy. Small, asymptomatic AMLs should not represent an absolute contraindication to donation when appropriately assessed. Even in the presence of ABO incompatibility and dual anatomical anomalies, successful transplantation is achievable with structured multidisciplinary management.

Ureteral Strictures after Intravesical BCG Therapy: Should Antituberculous Treatment Always be Initiated?

O. Tnibar — 2026-04-06

Objectives: Intravesical Bacillus Calmette–Guérin (BCG) therapy is the standard adjuvant treatment for intermediate- and high-risk non-muscle-invasive bladder cancer. Although generally well tolerated, severe complications may occur, while involvement of the upper urinary tract remains exceptional. We report a rare case of bilateral ureteral strictures following BCG therapy and discuss the diagnostic challenge between active infection and inflammatory reaction.

Case Presentation: A 74-year-old woman with a history of pT1 low-grade non-muscle-invasive bladder cancer developed acute renal failure during maintenance intravesical BCG therapy. The delay between initiation of BCG therapy and onset of renal failure was approximately 7 months. Pre-treatment imaging showed no dilatation of the pyelocaliceal systems, and ureteral orifices were consistently patent on surveillance cystoscopy. Subsequent imaging revealed bilateral uretero-hydronephrosis due to distal ureteral strictures associated with inflammatory bladder wall thickening. A comprehensive microbiological workup, including urine cultures and GeneXpert testing, as well as thoracic imaging, was negative. Bladder and peri-meatal biopsies demonstrated chronic fibro-inflammatory changes without evidence of mycobacterial infection. BCG therapy was discontinued, and bilateral double-J stenting with periodic replacement allowed stabilization of renal function at 6 months of follow-up.

Discussion: Bilateral ureteral strictures following BCG therapy are extremely rare. The main diagnostic challenge lies in distinguishing active Mycobacterium bovis infection from an immune-mediated inflammatory reaction. In the absence of microbiological and histological evidence of infection, an inflammatory mechanism is more likely.

Conclusion: Careful diagnostic evaluation is essential in such cases. When no evidence of active infection is found, conservative management with urinary drainage and discontinuation of BCG therapy may avoid unnecessary antituberculous treatment.

Testicular Teratoma with Metastatic Somatic Malignant Transformation: A Rare Case Report

M. Belaghzal — 2026-04-24

Background: Somatic malignant transformation (SMT) in testicular teratomas is a rare phenomenon and is associated with relative resistance to chemotherapy, making therapeutic management particularly challenging.

Case Report: A 69-year-old man presented with a large left testicular mass associated with para-aortic lymphadenopathy. Radical orchiectomy revealed a teratoma with somatic malignant transformation, including adenocarcinomatous, sarcomatous, and neuroectodermal components.

Following BEP chemotherapy (bleomycin, etoposide, and cisplatin), the persistence of a residual lymph node mass led to a retroperitoneal lymph node dissection (RPLND). Histopathological examination revealed a pure residual teratoma.

Conclusion: This case highlights the prognostic value of histological analysis of residual masses and emphasizes the central role of surgery in metastatic forms with somatic malignant transformation.

Lymphocele Following Total Laparoscopic Nephrectomy: A Case Report

Issam Benali — 2026-07-10

Introduction: Lymphocele of the renal fossa is an uncommon postoperative complication after laparoscopic nephrectomy, particularly when no lymph node dissection has been performed. It may arise from disruption of perihilar lymphatic channels during renal surgery and can mimic other postoperative fluid collections or local recurrence during oncological surveillance.

Case Presentation: A 64-year-old male patient with no significant comorbidities underwent total left laparoscopic nephrectomy in December 2024 for a left lower-pole renal mass. The immediate postoperative course was uneventful. Final histopathological examination confirmed clear cell renal cell carcinoma, International Society of Urological Pathology nucleolar grade 2, measuring 6.5 cm, with capsular breach and infiltration of perirenal adipose tissue. Surgical margins were negative, and the final pathological stage was pT3aNx. Ten months after surgery, surveillance abdominal magnetic resonance imaging revealed a well-defined T2-hyperintense cystic lesion measuring 10 cm in the left nephrectomy fossa, without gadolinium enhancement or features suggestive of local tumour recurrence. Ultrasound-guided aspiration yielded 62 mL of clear, yellowish fluid. Biochemical analysis showed a fluid-to-plasma creatinine ratio below 1.0, excluding urinoma, and elevated triglyceride levels consistent with lymphatic fluid. Microbiological cultures were sterile, and cytological examination showed no malignant cells, confirming the diagnosis of lymphocele. Follow-up ultrasound six weeks after aspiration demonstrated complete resolution, and the patient remained asymptomatic.

Conclusion: Post-nephrectomy lymphocele should be considered in the differential diagnosis of renal fossa fluid collections detected during postoperative surveillance. Imaging combined with aspirate analysis is essential for diagnosis. Ultrasound-guided aspiration may be effective in selected cases, although continued follow-up is important to detect recurrence.

When Infection Hides Malignancy: A Rare Case of Testicular Seminoma Presenting as Scrotal Abscess

O. Z. Bakkali Aissaoui — 2026-07-16

Background: Testicular cancer is the most common solid tumour in young men and predominantly comprises germ cell tumours, most commonly seminomas. Although it typically presents as a painless testicular mass, atypical presentations that mimic inflammatory or infectious processes may occur and delay diagnosis.
Case Présentation: We report the case of a 55-year-old man who presented with a one-month history of painful left scrotal swelling, fever, and asthenia and had initially been treated for epididymo-orchitis.

Investigations: Scrotal ultrasonography revealed heterogeneous testicular parenchyma with intraparenchymal and subcutaneous abscess collections. Despite broad-spectrum antibiotic therapy and surgical drainage, the intraoperative findings raised a strong suspicion of malignancy.

Surgical Management: The patient underwent inguinal orchidectomy.

Histopathological Examination: A testicular seminoma infiltrating the scrotal wall was confirmed.

Follow-up: One cycle of carboplatin was administered as adjuvant therapy. At the two-year follow-up, there was no evidence of recurrence or metastasis.

Discussion: Testicular cancer, which predominantly comprises germ cell tumours, can mimic benign scrotal conditions such as abscess or epididymo-orchitis and delay diagnosis. Serum tumour marker assessment is mandatory, but normal results do not exclude malignancy. Scrotal ultrasonography is the first-line imaging modality, with sensitivity exceeding 90%; MRI may provide greater diagnostic accuracy when ultrasonographic findings are inconclusive. Radical inguinal orchidectomy remains the standard surgical treatment; atypical or antibiotic-resistant scrotal presentations warrant consideration of inguinal exploration to exclude malignancy.

Conclusion: This case highlights the diagnostic challenge posed by a testicular tumour presenting as a scrotal abscess. Persistent or atypical scrotal infections that do not respond to antibiotic therapy should raise suspicion of an underlying malignancy. Early imaging and appropriate surgery support accurate diagnosis and favourable outcomes.

Malignant Mesothelioma of the Tunica Vaginalis Testis in a Patient with HIV: A Case Report

Matt Rackemann — 2026-07-17

Background: Malignant mesothelioma of the tunica vaginalis testis (MTVT) is exceptionally rare, comprising less than 1% of all mesotheliomas and often presenting as hydrocele or non-specific scrotal swelling. Asbestos exposure is recognised, but some cases occur without identifiable exposure, suggesting additional pathways, including chronic inflammation and immune dysregulation. We describe MTVT in a patient with HIV infection and no reported asbestos exposure.

Case Presentation: A 73-year-old HIV-positive man presented with a several-month history of progressively enlarging, painless left hydrocele. Examination revealed a transilluminable scrotal swelling without a palpable solid component or inguinal lymphadenopathy. Scrotal ultrasonography demonstrated multiple echogenic, non-mobile solid foci arising from the tunica vaginalis, with increased vascularity on Doppler assessment and preserved testicular parenchyma. Tumour markers were not elevated, and staging imaging showed no lymphadenopathy or metastatic disease. Scrotal exploration identified multiple firm pale-yellow nodules studding the tunica vaginalis. Frozen section raised concern for malignant mesothelial neoplasia, prompting conversion to radical inguinal orchidectomy with high cord ligation. Histopathology confirmed diffuse, multifocal biphasic mesothelioma of the tunica vaginalis, with clear surgical margins, retained BAP-1 expression, and no lymphovascular invasion. Post-operative management consisted of multidisciplinary review, optimisation of HIV care, and structured radiological surveillance.

Conclusion: This case emphasises that MTVT may arise without reported asbestos exposure and should be considered when hydrocele is accompanied by tunica vaginalis nodularity or vascular solid foci. HIV-associated immune dysregulation is biologically plausible but cannot be inferred as causal from a single case.

Life-Threatening Post-Percutaneous Nephrolithotomy Hemorrhage with Negative Renal Angiography Successfully Managed Conservatively: A Case Report

Marwan Abdulaziz Ibrahim — 2026-07-18

Life-threatening haemorrhage following percutaneous nephrolithotomy (PCNL) is an uncommon but serious complication, most commonly resulting from renal vascular injuries such as pseudoaneurysm or arteriovenous fistula, which are usually diagnosed and treated using selective renal angiography with transcatheter embolisation. Management becomes particularly challenging when severe bleeding occurs despite negative angiographic findings. We report the case of a 29-year-old man who developed massive haemorrhage on the first postoperative day after an uncomplicated ultrasound-guided PCNL performed through a single posterior lower calyceal access for a 22-mm solitary renal pelvic stone. The patient presented with severe bleeding from the nephrostomy tract, haemodynamic instability, and a decrease in haemoglobin from 13.5 to 8.1 g/dL. Contrast-enhanced computed tomography demonstrated a large right retroperitoneal haematoma, whereas selective renal angiography revealed no pseudoaneurysm, arteriovenous fistula, or active contrast extravasation. The patient received aggressive resuscitation with four units of packed red blood cells and fresh frozen plasma. Following initial resuscitation and haemodynamic stabilisation, conservative management was continued with intensive monitoring, serial haemoglobin measurements, and repeated imaging, resulting in complete recovery without embolisation or surgery. He was discharged on postoperative day 12 with preserved renal function. This case highlights that negative renal angiography does not exclude clinically significant haemorrhage and that carefully selected, haemodynamically stable patients may be successfully managed conservatively under close clinical surveillance.

Beyond the Pelvis: Atypical Presentations of Prostate Cancer Mimicking Neurological and Head Neck Pathologies-selected Case Series from India

Aadhar Jain — 2026-04-20

Background: Prostate cancer is one of the most common malignancies among elderly men worldwide. Prostate carcinoma typically metastasizes to bone and regional lymph nodes. Cranial or extrathoracic metastases as initial presentations are exceedingly rare and can mimic neurological or head-and-neck pathologies, leading to diagnostic delay. Such cases are sparsely reported, and to our knowledge, no dedicated case series from India exists.

Methods: We retrospectively analysed five patients who presented with atypical cranial or extra- thoracic manifestations and were subsequently diagnosed with metastatic prostate adenocarcinoma between 2020 and 2025 at our centre. Clinical, radiological, and histopathological data were reviewed.

Results: Presentations included sudden-onset bilateral blindness due to optic canal metastasis (n=1), unilateral facial nerve palsy with skull base involvement (n=1), petrous bone lesion with facial nerve palsy (n=1), Sudden onset memory loss (n=1) and supraclavicular lymphadenopathy (n=1). Serum PSA ranged from 185–420 ng/mL. Imaging (MRI and PET-CT) demonstrated corresponding metastatic lesions. Biopsy or FNAC confirmed metastatic adenocarcinoma with PSA immunopositivity in all cases (insert result). All patients received androgen deprivation therapy, with selected cases receiving palliative radiotherapy. Partial neurological recovery was observed in two patients.333--

Conclusion: Cranial and extrathoracic metastases may rarely represent the initial manifestation of prostate carcinoma. Awareness of such presentations is crucial, as early prostate specific antigen testing and immunohistochemistry can facilitate prompt diagnosis and management. This represents the largest reported Indian case series describing these unusual initial manifestations of prostate cancer.