BACKGROUND

Penile squamous cell carcinoma (SCC) is rare in high-income regions but remains a significant oncologic burden worldwide. Nodal involvement is the most important prognostic factor, and early identification is critical.

THE CASE

A 56-year-old circumcised male presented with a six-month history of a progressively enlarging, foul-smelling fungating penile mass and bilateral inguinal lymphadenopathy. Biopsy confirmed moderately differentiated SCC. Imaging showed large bilateral inguinal nodal disease without distant metastasis. Laboratory findings revealed leukocytosis, thrombocytosis, and mildly deranged coagulation parameters. The patient underwent total penectomy with perineali urethrostomy, followed by bilateral inguinal and pelvic lymph node dissection through single-curvilinear incisions. Frozen-section analysis confirmed extensive bilateral nodal metastasis. Postoperatively, a localized left inguinal surgical site infection was treated conservatively. He was discharged on postoperative day seven with drains in situ and was recommended adjuvant chemoradiotherapy in accordance with NCCN Guidelines.

CONCLUSION

This case highlights the challenges of managing advanced penile SCC with bulky bilateral inguinal metastasis and demonstrates the utility of single-curvilinear inguinal incisions for comprehensive lymphadenectomy. Early recognition, accurate staging, and guideline-based multimodal treatment remain essential for optimizing outcomes.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Carcinoma, Squamous Cell ; Lymph Node Excision

Pantaloon hernias are a subset of abdominal hernias wherein both indirect and direct components of inguinal hernias are present on one side. Inguinoscrotal hernia of the urinary bladder is a rare condition involved in less than 4% of inguinal hernias and more so if they are part of a direct component of a pantaloon hernia. This is a case of a 65-year-old male who presented a non-reducible right inguinoscrotal mass. Inguinoscrotal herniation of the urinary bladder was preoperatively diagnosed through imaging. Intra-operatively a pantaloon hernia was noted with the herniated urinary bladder as the direct component and omentum as the indirect component. The patient underwent cystourethroscopy, inguinal exploration right, and mesh hernioplasty. The patient had an unremarkable post-operative course and was discharged with improved conditions. Awareness of this clinical condition will aid in the diagnosis, and proper management and prevent post-operative complications.
Herniorrhaphy

Vesico-utero-sigmoid fistula secondary to an encrusted, transmigrated intrauterine contraceptive device (IUCD) to the urinary bladder is a rare urogenital occurrence. Reported here is a case of a 42-year-old female with 13 years of IUCD presenting with a two-year history of terminal dysuria, occasional hematuria and urinary dribbling. In the interim, she complained of persistent wet stools, pneumaturia, fecaluria and occasional urinary incontinence. Imaging revealed an encrusted IUCD with a concomitant vesico-utero-sigmoid fistula. Patient underwent a single setting colonoscopy, vagino-hysteroscopy, cystoscopy with cystostomy and extraction of encrusted foreign body (IUCD), excision and primary repair of vesico-utero-sigmoid fistula was done. The surgery proved successful, greatly improving the patient’s quality of life. This is the first reported case of a vesico-utero-sigmoid fistula caused by a foreign body both in local and international literature.

Complications arising from simple surgical procedures such as circumcision are uncommon. When a person devoid of surgical training performs these procedures, severe problems usually occur. This is a rare case of a 23-year-old, Filipino male with severe penile shaft erosion secondary to chronicpenile strangulation from complications of circumcision. A two-stage procedure was planned for this patient involving removal of the constricting object, debridement and anastomosis of the penile shaft. Postoperatively, there was good penile erectile function and an aesthetically acceptable form.

Horseshoe kidney is a rare form of congenital renal malformation. It occurs in 0.25 to 3% of the population and is usually asymptomatic. Occurrence of symptoms is usually related to infection, lithiasis, and rarely, malignancy. Presented is a case of a 62-year old male with a one-year history of occasional painless hematuria associated with epigastric discomfort. On physical examination, a palpable mass was noted on the right periumbilical area, 10cm x 10cm in size and was non-tender. CT-scan with IV contrast showed 10cm x 7cm x 12cm mass on the right side of a horseshoe kidney. He underwent Radical Nephrectomy, right with Isthmusectomy. Post-operative course was unremarkable. Histopathology result showed Renal Cell Cacrcinoma, clear cell type.. Although malignancy was present in an anomalous kidney, the prognosis is the same as with normal kidneys. To date, this is the first reported case of malignancy on a horseshoe kidney in the Philippines.
Fused Kidney ; Carcinoma, Renal Cell