BACKGROUND: Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico, placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient\'s collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula.
METHODS: A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate.
RESULTS: A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100). A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001).
CONCLUSIONS: Guy\'s Score Grade IV showed a higher incidence of residual lithiasis, seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.

Colovesical fistulas present a diagnostic and therapeutic challenge, commonly arising from complications of diverticular disease. In our case, a 71-year-old male with colovesical fistula symptoms underwent robotic-assisted surgery for complicated sigmoid diverticulitis. Intraoperatively, meticulous adhesiolysis and fistula repair were performed. Histopathology confirmed diverticular disease. Postoperatively, the patient recovered well. Colovesical fistulas may indicate underlying malignancy in diverticulitis. With a lack of standardized protocols, our case suggests that robotic-assisted surgery offers improved outcomes, better vision, and ergonomics. To conclude, robotic-assisted colovesical fistula repair and sigmoidectomy demonstrated excellent outcomes, suggesting a promising approach for enhanced postoperative recovery.

Inflammation of the vas deferens, or vasitis, is a rarely reported condition that can manifest as either acutely painful infectious vasitis or predominantly asymptomatic vasitis nodosa. Acute vasitis is usually presented with ambiguous clinical findings, and a scan is required for a definitive diagnosis. Retrograde urinary pathogens are typically the cause, and it is treatable conservatively. We present a male in his 40s with a one-day history of right groin pain and a history of right indirect inguinal hernia. On examination, there was an impression of an incarcerated inguinal hernia. A CT scan revealed thickening and inflammatory changes associated with the inguinal canal and a picture of the rare inflammatory condition, acute vasitis. This case report illustrates the significance of understanding the wide range of possible diagnoses associated with acute groin pain and swelling and the importance of imaging in the diagnosis, which might help avoid needless operation.

Scrotal epidermoid cysts are rare. Intratesticular epidermoid cysts are more common than extra scrotal cysts and are the most commonest benign tumors of the testicles. Midline scrotal raphe cysts are reported, but only a few have intrapelvic extensions deep into the pelvis. A nine-year-old boy presented with a painless scrotal swelling. Magnetic resonance imaging (MRI) of the pelvis confirmed the cystic nature with an extension of the swelling up to the base of the prostate. On surgical exploration, the cyst had a tapering stalk with cranial extension up to the base of the prostate. The patient underwent an excision of the cyst and made an uneventful recovery and was asymptomatic at the end of three months of surgery. The histopathology of the lesion was typical of an epidermoid cyst. Extratesticular scrotal epidermoid cysts with pelvic extension are a rarity with less than five cases reported in the literature. Our case stands to be the youngest reported case of a scrotal epidermoid cyst based on our knowledge. Scrotal epidermoid cysts are a very rare and benign entity, and upon recognition and confirmation of the extent of spread, extratesticular scrotal cysts can safely be removed. No other management may be required with no recurrences reported.

Hereditary leiomyomatosis and renal cell cancer (HLRCC) is a rare genetic disorder, and individuals tend to develop multiple cutaneous leiomyomas, uterine leiomyomas, and renal cell cancer (RCC). In our study, we report the first case in Saudi Arabia, to our knowledge - a 28-year-old male with a history of right leg leiomyosarcoma post excision two years back who was referred to us with incidental finding of right kidney mass measuring 1.8x2x2.2 cm who underwent right laparoscopic radical nephrectomy, and histopathology reported it as HLRCC and RCC.

Dermoid cysts are subcutaneous swellings that are usually congenital and originate from the sequestration of embryonic epithelium along the lines of embryonic closure. They are composed of a mixture of sebaceous fluid, keratin, cholesterol crystals, calcium, hair follicles, sweat glands, and sebaceous glands. They present as a non-tender mass that is well-circumscribed, firm in consistency, and usually asymptomatic. Occasionally, dermoid cysts can get infected and form an abscess. Surgical excision remains the linchpin of treatment for dermoid cysts. Dermoid cysts are most common on the head, face, neck, and thoracoabdominal region and are very rare on the prepuce (foreskin). We report the case of a 27-year-old male who presented with a midline penile mass, difficulty in retracting his prepuce, and painful intercourse. A basic hematological and radiological workup was done to rule out the other differentials. Surgical excision of the swelling was done, and a histopathology report proved it to be dermoid. This case report highlights the possibility of the presence of a dermoid at rare anatomical locations such as the penis.