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Background Benign prostatic hyperplasia (BPH) prevalence varies by ethnicity, with risk increasing in aging men. The visual prostate symptom score (VPSS) offers a practical alternative to the International Prostate Symptom Score (IPSS), especially for elderly patients, but its validation in Tanzania and correlation with IPSS remain underexplored. Objectives This study conducted a comparative analysis of IPSS and VPSS in Tanzanian patients, assessing lower urinary tract symptoms (LUTS) and BPH severity before and after treatment at Muhimbili National Hospital’s Urology Department. Methodology This longitudinal observational study included both inpatients and outpatients at MNH in Dar es Salaam, examining the correlation between VPSS and IPSS for grading LUTS in BPH patients aged 40 years and above. Prostate volume was measured using transabdominal ultrasound. Participants completed Swahili versions of the 7-item IPSS and 4-item VPSS. Data were collected before treatment and at the six-month follow-up, with surgical patients and deceased patients excluded from follow-up analysis. Statistical analysis was performed using SPSS version 27. Results In a study of 137 BPH patients with LUTS, aged 62–76 years (median 70), prostate volume significantly decreased from 49.0 mL before treatment to 35.0 mL after treatment. Most patients (94.2%) were literate in Swahili, with significant differences in completing IPSS on the basis of literacy ( p  = 0.042) but no difference in completing VPSS ( p  = 0.999). Both the IPSS and VPSS improved significantly after treatment, with strong correlations before ( r  = 0.648) and after treatment ( r  = 0.732), confirming their reliability in assessing LUTS severity. Conclusion This study showed that VPSS effectively evaluates LUTS severity in BPH patients, correlating well with IPSS, even in illiterate patients. VPSS’s reliability suggests its utility in routine practice, enhancing symptom monitoring and treatment outcomes in BPH management.

Background Advanced prostate cancer leads to many symptoms, notably bone pain and lower urinary tract symptoms (LUTs); however, the degree and duration of pain relief, changes in LUTs severity and underlying factors associated with the extent of symptom relief remain inadequately understood. Surgical castration has proven effective in relieving both bone pain and urinary symptoms for metastatic prostate cancer patients. Objective To determine the extent and pattern of symptom relief in advanced prostate cancer patients following surgical castration at Muhimbili National Hospital (MNH). Methods We conducted a prospective cohort study for a period of 6 months involving men with advanced Prostate cancer (PCa) undergoing surgical castration at MNH and followed them for 30 days. The international prostate symptoms score tool was used to assess changes in LUTs, and the pain rating scale was used for assessing changes in bone pain symptoms before and after surgery. Logistic regression model was used to determine factors associated with complete bone pain relief. Results A total of 210 participants with a mean age of 72.3 years were recruited. The LUTS score showed a decrease of 7.1 points after surgical castration (95% CI: 6.4 to 7.7, p  < 0.001). The bone pain score showed an absolute decrease of 39.8% (95% CI: 34.7 to 44.9, p  < 0.001) after surgical castration, with more than half of the patients (111, 52.9%) reporting bone pain relief within the first two weeks. Among the factors associated with greater pain relief were being in a marital union (aOR 2.73, 95% CI: 1.26 to 5.89, p < 0.011). Normal BMI was also linked to pain relief in bivariate analysis (OR 1.92, 95% CI: 1.03 to 3.61, p < 0.035). Additionally, patients with severe bone pain before surgical castration were more likely to achieve complete pain relief compared to those with mild or moderate pain (odds ratio 8.32, 95% CI: 3.63 to 19.1, p < 0.001). Conclusion Surgical castration improves both bone pain and lower urinary tract symptoms in patients with advanced prostate cancer. Notably, patients experiencing severe bone pain reported resolution of bone pain symptoms within the first and second weeks, respectively, indicating the prompt effectiveness of the surgery on these symptoms.

Background The retrocaval ureter is a rare congenital anomaly resulting from abnormal development of the inferior vena cava. The obstruction is usually at the retrocaval segment of the ureter, as it lies between the inferior vena cava and the body of the third lumbar vertebra. Computed tomography intravenous urography is the gold standard for investigating this condition and can reveal ipsilateral hydronephrosis and the fishhook sign or sickle sign of the proximal ureter, depending on the type of retrocaval ureter. Case presentation We present the case of a 30-year-old African female who presented with intermittent dull right flank pain for 3 years. Computed tomography intravenous urography revealed isolated moderate right hydronephrosis with a fishhook sign in the proximal ureter. Surgical correction was performed, and the patient was followed for 6 months with improved renal function. Conclusion Surgery remains the sole definitive management of the retrocaval ureter for symptomatic patients and those with worsening hydronephrosis or differential renal function.

Background Horseshoe kidney is the most common renal fusion anomaly, occurring in approximately 1 in 500 individuals worldwide. It is characterized by abnormalities in kidney position, rotation, and vascular supply. While often asymptomatic, horseshoe kidneys can lead to urological complications, primarily due to ureteric obstruction and impaired urinary drainage.Although ureteropelvic junction obstruction (UPJO) is uncommon in horseshoe kidneys, its occurrence presents unique diagnostic and management challenges. This case explores the etiology, clinical presentation, and surgical management of UPJO in a patient with a horseshoe kidney, highlighting the critical role of urologists in addressing these anatomical and functional complexities. Case presentation We report the case of a 3-month-old African male infant who presented with a two-month history of excessive crying and symmetrical abdominal distension. Radiological evaluation revealed a horseshoe kidney with decreased parenchymal thickness in the left kidney and marked hydronephrosis of the pelvis and calyces, with abrupt cessation at the left ureteropelvic junction. Surgical correction of the obstruction was performed successfully. The patient was followed for six months, during which he remained symptom-free with normal renal function tests. Conclusion Ureteropelvic junction obstruction in a horseshoe kidney presents unique anatomical challenges. Symptomatic cases require thorough imaging for diagnosis and surgical planning. Pyeloplasty is the typical surgical intervention, meticulously planned to address these complexities. This ensures effective relief of obstructions and proper urinary drainage.

To assess medical and nursing students' intentions to migrate abroad or practice in rural areas. We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students' intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models. Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25-2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21-6.29) and rural (OR: 4.84; 95% CI: 3.52-6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19-1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50-0.96). A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.

Neuroblastoma (NB) is a rare solid tumor of the sympathetic nervous system, primarily occurring in children and rarely in adults. Its extracranial origin stems from the medullary region of the adrenal gland or sympathetic ganglia. We report an 18‐year‐old female who presented with a 6‐month history of abdominal swelling and tenderness. Imaging revealed a large retroperitoneal mass causing significant displacement of adjacent structures. Following multidisciplinary optimization, a huge tumor was successfully resected surgically. Histopathology confirmed the diagnosis of adrenal NB. The patient underwent adjuvant chemotherapy and remained symptom‐free with favorable outcomes during a 9‐month follow‐up. This case underscores the importance of comprehensive diagnostic evaluation and multimodal management in treating rare adult adrenal NB.

In this Policy Forum, the Bellagio Essential Surgery Group, which was formed to advocate for increased access to surgery in Africa, recommends four priority areas for national and international agencies to target in order to address the surgical burden of disease in sub-Saharan Africa.

Key Clinical Message Early diagnosis and aggressive treatment of testicular rhabdomyosarcomas including surgery and chemotherapy significantly reduce local recurrence and improve survival rates in young adults with metastases. Adjuvant chemotherapy is highly recommended to enhances prognosis and survival outcomes.

Wilms' tumor (WT), also known as nephroblastoma, is a malignant embryonal kidney tumor composed of embryonic cells and is the most prevalent tumor among children, but isolated cases occur infrequently in the adult population. Adult WT is defined according to the criteria of Kilton, Matthews, and Cohen, which comprise age above 15 years and histological patterns characteristic of WT. We report a case of an adult WT with venous thrombus on an incomplete duplex collecting system. To the best of our knowledge, this is the first case of adult WT with such a presentation. A 28‐year‐old female patient presented to our department with a 4‐month history of right flank pain and flank mass and was diagnosed by abdominal contrasted CT to have a right renal tumor with tumor thrombi in the renal vein and the inferior vena cava. The CT scan also revealed a bilateral duplex collecting system with a partial (ureter fissus proximalis) on the tumor side and a complete duplex system on the contralateral side. Right radical nephrectomy with complete tumor thrombectomy via venacavotomy was performed successfully. Histopathological examination of the specimen revealed a triphasic nephroblastoma with immunohistochemistry confirmation. Postoperatively, adjuvant chemotherapy was initiated. The increasing incidence of non‐syndromic WT cases associated with duplex collecting systems suggests a potential shared pathogenesis, necessitating further research.

Key Clinical Message Conservative nonsurgical therapy ensures that the resolution is nearly 80% for vesicoureteral reflux grades I and II and 30%–50% for vesicoureteral reflux grades III and V within 4–5 years of follow‐up. Open surgical reimplantation of ureters of grades IV and V is a highly successful procedure, with reported correction rates ranging from 95% to 99% regardless of the severity of vesicoureteral reflux. Patients with vesicoureteral reflux present with a wide range of severity. With an incidence of approximately 1%, vesicoureteral reflux is a relatively common urological abnormality in children. Postnatal diagnosis of vesicoureteral reflux is typically made following a diagnosis of a urinary tract infection and less frequently following family screening. Voiding cystourethrograms remain the gold standard for diagnosing vesicoureteral reflux. To preserve the kidney and prevent the need for potential renal replacement therapy, infants with a single kidney require significantly more assessments and prompt decision‐making. Surgical correction is advised for patients with vesicoureteral reflux grades IV and V, while vesicoureteral reflux grades I, II, and III are managed conservatively.