INTRODUCTION

Testicular torsion is a true urologic emergency. It occurs when the blood supply to the testis is compromised as the vessels twist along the spermatic cord. Early diagnosis and prompt treatment are critical to prevent prolonged ischemia time which is crucial to its prognosis. This paper aimed to present cases of testicular torsion who underwent testis sparing surgery for torsion.

Cases of testicular torsion admitted at the institution from January 2023 to July 2024 were reviewed. Demographic data, scrotal ultrasound findings, intraoperative findings and ischemia time were documented. Patients who underwent tunica albuginea fasciotomy with tunica vaginalis flap were monitored post-surgery via scrotal ultrasound, documenting testicular size.

Twenty seven (27) cases of testicular torsion were reviewed. Of these cases, 4 improved after detorsion and orchidopexy, 12 cases with > 72 hours ischemia time and failed detorsion underwent orchiectomy, 11 cases with < 72 hours of ischemia time, tunica albuginea fasciotomy were performed. Five (5) of these 11 cases showed no improvement in appearance and no bleeding was observed and subsequent orchiectomy was performed. Six cases demonstrated improvement in appearance and bleeding after tunica albuginea fasciotomy, tunica vaginalis flap used to cover the resulting defect. Of these 6 cases, 2 cases showed intact testicular size, 1 case had testicular atrophy on monitoring and 3 cases were lost to follow-up.

Testicular torsion remains to be a critical urologic emergency. Prompt diagnosis and immediate surgery required to improve salvage rates. Tunica albuginea incision, with subsequent tunica vaginalis flap may be an option for the urologist to improve salvage, although not consistently prevent testicular atrophy.

Pelvic kidneys are anatomical abnormalities that occur when the kidney does not rise from the pelvis during embryogenesis. The majority of cases are asymptomatic, though they are associated with higher risks for traumatic injury, infections, renal calculi, and other urological issues. Because of its advantages of flexion and deflection, retrograde intrarenal surgery (RIRS) employing flexible ureterorenoscopy (fURS) is an alternative treatment method for small- to medium-sized calculi in anatomically aberrant kidneys. Presented here is a case of a 43-year-old male with a renal stone in a pelvic left kidney with the ureter crossing the midlineand is located at the prevertebral region at the level of L4 to S1.

Wilms tumor is very rare in adults. Even more infrequent is an adult Wilms tumor with an extensioninto the central nervous system.Reported here is a case of an adult Wilms tumor in a 38-year-old female. She was referred to theJRRMMC with a 2 month history of intermittent hematuria associated with a rapidly enlargingabdominal mass and right-sided facial asymmetry. Abdominal computed tomography revealed a largemass inthe rightkidney. CranialMRI showedmultiple brainmetastases. Thepatient underwentrightradicalnephrectomy.Pathologicalanalysisdemonstratednephroblastoma.Thepatientwasdischargedunremarkable and underwent adjuvant chemotherapy. After 2 months, the patient succumbed to thedisease.Adult Wilms tumor presents almost similarly with renal cell carcinoma and there is no definitivediagnostictesttoconfirmitpre-operatively.Eventhoughit’sararetumor,itshouldalwaysbeincludedin the differential diagnosis for any renal tumor.

In the Philippines, data on testicular rupture due to a firecracker-related accident is sparse, and to the best of the authors’ knowledge, there is only one published report in international literature on firework-related genitourinary injury. Most published data on testicular rupture are associated with blunt trauma, which are mostly sports-related. The objectives of this clinical case report were to describe a rare case of a firecracker-related injury to the groin, and to discuss the approach to its evaluation and management.A 13-year-old male presenting with scrotal avulsion following a blast injury from a firecracker to his groin is described. After confirmation of right testicular rupture by ultrasonography, the patient underwent scrotal exploration and right testicular repair. The patient had an uneventful recovery and he was discharged on the second post-operative day. This case report highlights the importance of ultrasonography and early surgical exploration for a successful testicular salvage.

Inflammatory myofibroblastic tumors (IMT) are rare, benign spindle cell neoplasms of the urinary bladder with a presentation similar to that of a malignant disease. Oftentimes, these tumors pose a diagnostic dilemma because of a significant overlap with malignant spindle cell tumors in terms of clinical presentation, gross findings and immunohistopathologic profile. Due to its rarity, there are no guidelines regarding treatment and follow up. Reporting cases of IMT will bring awareness to the features of these rare tumors, and will help in overcoming limitations in diagnosis, and treatment protocols. Presented here is a case of a 28-year-old female who presented with gross hematuria. Upon work up, revealed the presence of a bladder mass. Patient underwent transurethral resection, then a partial cystectomy, and pathology demonstrated an IMT.

OBJECTIVE: Specimen retrieval bags were used to remove cysts and masses in minimally invasiveurologic surgeries for more than 3 decades. This study aims to describe the steps in making a home-made specimen retrieval bag named JuRoLap and its safety and resiliency. MATERIALS AND METHODS: The bag’s name was taken from the initials of the institution combined withthe department's short-name (uro) and laparoscopy (Lap). The bag is composed of a non-toxicpolyvinyl chloride (PVC) urine bag custom fitted according to the expected specimen size. The sideswere sealed using an impulse sealer leaving one side open. The bag ways rolled and introducedintracorporeally via the 12mm port. It was opened followed by specimen placement using standardlaparoscopic instruments. Purse-string suture at the one-side opening was tightened and extractedthrough the umbilical port extending the incision as necessary. RESULTS: JuRoLap was used in 33 cases removing various organs such as adrenals, kidney, ureter,bladder and prostate. It was easily prepared, safe, resilient and economical costing approximatelyUSD 0.68. It was essential to routinely check its durability by doing a leak test prior to sterilization.Proper rolling, transparent plastic component of the bag and the use of two laparoscopic graspersprovided ease in bag deployment and specimen entrapment. It was also observed that smaller incisionon extraction site as compared to the specimen size was needed due to the resiliency of the bag.Despite the required learning curve in organ entrapment and extraction, there were no complicationsand specimen leakage noted. CONCLUSION JuRoLap specimen retrieval bag is organ size specific, safe, resilient and low cost specimenretrieval bag innovation.
Laparoscopy

Crossed Testicular Ectopia (CTE), is a rare congenital anomaly in which both gonads migrate towardthe same hemiscrotum. This may be due to a deviation of testicular descent resulting in unilaterallocation of both testes. Reported is a case of crossed testicular ectopia in a 1-year-old boy whopresented with undescended testis. On exploration, both testes were present in the right hemiscrotum.Subsequently, transseptal orchidopexy was performed. CTE should be considered in patientspresenting with undescended testis, unilateral hernia and concurrent cryptorchidism of the contralateralside. In suspected cases, laparoscopy and ultrasonographic evaluation may be helpful in diagnosingthis condition.