Oral Propranolol in a Child with Infantile Hemangioma of the Urethra
Infantile hemangiomas (IH) are the most common in the head and neck region.1 They can occur anywhere in the skin, however, urethral hemangiomas are very rare.We describe a case report of a three years old boy with extensive lesions of IH in the anterior urethra. Urethral IH were disappeared during one year of oral administration of propranolol though it brought on urinary retention.This is the first report about oral propranolol treatment in a child with urethral IH. Oral administration of propranolol may be effective for urethral IH and beneficial especially for lesions requiring extensive surgical resection and reconstruction.
Complications of Delivery Among Mothers with Spina Bifida : To determine rates and types of peripartum morbidity among delivering women with spina bifida (SB) compared to those without SB. The rates of pregnancy and delivery among women with SB have been significantly increasing. Current knowledge of peripartum outcomes for these women is limited.
Cowper's Gland Syringocele Cowper's gland syringoceles are rare cystic dilations of the Cowper's gland duct. They are typically diagnosed in childhood but occasionally occur in adults. We report the case of a 28-year-old man who presented with a painful perineal and inferior scrotal mass and was found to have a large Cowper's gland syringocele extending into the scrotum associated with a scrotal abscess. Treatment consisted of surgical excision. The magnetic resonance imaging findings of this case are described.
Robot Assisted Vesico - Vaginal Fistula Repair: A compilation Vesico - vaginal fistulae (VVF) are the most common type of urinary tract fistulae. 1 These fistulae (VVF) represent a complication that generally occurs after an iatrogenic injury during hysterectomy and lower segment cesarean section, obstructed labor, radiation necrosis, pelvic malignancies as well as other radical pelvic surgery. 1 The incidence varies between 0.3 and 2%.2 Due to its iatrogenic nature, and symptomatology VVF is associated with considerable emotional and psychologic distress.
Paradoxical Exam and Imaging Findings in a Case of Paratesticular Cutaneous Angioyxoma
Angiomyxomas are rare soft tissue neoplasms rich in myxoid matrix and blood vessels that typically present as nodules on the trunk, head, and limbs in adults. They are classified as either cutaneous or aggressive based on histological findings and extent of local growth. There are less than 150 reported cases in the literature. In this case report we describe the first paratesticular case of a cutaneous angiomyxoma in a pediatric patient, who presented with a transilluminating paratesticular mass consistent with a hydrocele, but showed solid and vascular features on ultrasound.
Nephrolithiasis in a 17 Year Old Male with Seckel Syndrome and Horseshoe Kidneys: Case Report and Review of the Literature We report the case of a 17 year old male with Seckel syndrome and horseshoe kidneys which had a 7 mm kidney stone in the lower pole calyx of the right moiety. The patient had a history of rotoscoliosis with 60° dextroconvex curvature and hepatic steatosis. Attempted ureteroscopy was unsuccessful due to stone location and anatomy. Percutaneous nephrolithotomy was ultimately required. This case highlights the difficulties of endoscopic treatments of renal calculi in patients with abnormal renal anatomy and dysmorphia.
Aggressive Renal Angiomyolipoma in a Patient with Tuberous Sclerosis Resulting in Pulmonary Tumor Embolus and Pulmonary Infarction, Renal angiomyolipoma (AML) is the most commonly encountered mesenchymal tumor of the kidney which can present spontaneously or in association with tuberous sclerosis complex. Rarely, renal AMLs may demonstrate aggressive features such as renal vein invasion. This common entity and its uncommon complications are diagnosed based on physical examination and computed tomography results. Here we report imaging findings of a renal AML with renal vein and inferior vena cava invasion resulting in pulmonary tumor embolus and pulmonary infarction.
Editorial Comment The authors have studied MRI scans of men prior to laser enucleation of the prostate gland. They have measured the distance from the verumontanum to the distal end of the prostatic adenoma, as well as the distance from the prostate adenoma to the apex of the prostate. They note a correlation between the length of the urethra from the verumontanum to the prostate adenoma to the overall prostate volume in patients over the age of sixty nine.1
Reply We thank Dr. Lotan for his editorial comment1 and for raising the critical issue of adherence to intravesical therapy. Our study intended to evaluate compliance with intravesical therapy outside of a clinical trial and in fact, rates of completion of maintenance therapy were lower than reported in a well controlled environment. Unfortunately, despite the substantial evidence in favor of BCG therapy for NMIBC,2,3 data show that its use is not nearly as optimal.4,5
Editorial Comment Intravesical therapy is the standard of care for high risk non-muscle invasive bladder cancer (NMIBC).1 There is considerable evidence that maintenance therapy improves outcomes in patients with high risk disease.2,3 Unfortunately, many patients do not receive the standard of care despite guideline recommendations.3,4 This study in Urology evaluated compliance with intravesical therapies and found that the rate of completion of 6 weeks induction therapy with BCG and mitomycin C was similar (86% and 87%, respectively).
Editorial Comment The Michigan Urological Surgery Improvement Collaborative (MUSIC) program has transformed both population management and quality improvement in urology. In the current study,1 the authors address an important and timely question: do men on active surveillance pursue confirmatory testing after diagnosis of favorable-risk prostate cancer and, when they do, do they persist on active surveillance? In addition to delineating current practices in Michigan of confirmatory testing—the most common being the use of molecular classifiers (55%), followed by magnetic resonance imaging (MRI, 34%) and repeat biopsy (11%), the study also captures a snapshot of how these confirmatory tests are affecting the landscape of active surveillance.
Wilms Tumor after Orthotopic Liver Transplant in a Patient with Alagille Syndrome,,✰✰✰ We present a case of Wilms Tumor in a patient with Alagille syndrome ten months after liver transplant. We explore a suggested genetic connection between these two diseases. In children with Wilms Tumor, we propose a patho-embryologic explanation for not just the tumor, but also for the cause of associated benign ureteral and renal parenchymal aberrancies that are commonly seen in the Alagille population. We also discuss the diagnostic and therapeutic challenges that can arise in a liver transplant patient with Alagille syndrome who subsequently develops a renal mass.
Reply The primary objective of our analysis was to demonstrate that patients with simultaneous bilateral ureteral calculi (SBUC) do not all have exactly the same initial clinical presentation. Therefore, a tailored approach should be applied to their management just as in any other clinical condition. Traditionally, patients with SBUC undergo immediate upper tract drainage and deferred definitive stone treatment. As emphasized in our study and the Editorial Comment,1 this staged approach remains the standard of care in patients with SBUC who present with true emergencies including infection, significant renal injury, or electrolyte abnormalities.
Editorial Comment Simultaneous bilateral ureteral calculi (SBUC) represent roughly 1% of all stone patients, as documented in the current study and prior work from multiple authors. SBUC, although rare, presents a distinct risk of acute kidney injury (AKI), oliguria, anuria, and hyperkalemia. In the current study, 30% of patients had AKI with a creatinine rise over 0.5 mg/dL and of the patients with AKI, 9/13 had either oliguria or anuria. Such patients clearly need decompression and time for renal function and electrolytes to stabilize; these are not patients whom primary bilateral URS is appropriate.
Renal Pelvic Hemangioma in a 3-Year-Old Boy: a Rare Pediatric Case Report Renal pelvic hemangioma is a rare benign tumor that is difficult to diagnose preoperatively. In the past there are rarely reported cases in children. Here a case of left renal pelvic hemangioma in a 3-year-old boy managed nephrectomy is reported.
Re: Cohen et al.:Impact of Statin Intake on Kidney Stone Formation (Urology 2018) We have read the article “Impact of statin intake on kidney stone formation” by Cohen et al, with utmost interest. The authors presented the effects of statins on nephrolithiasis risk and higher lipids correlation with risk of stone formation.1 We would like to request the authors to elucidate the following points for our better understanding.
Reply The commentator underscores several important points. First, since the United States Preventive Services Task Force recommendation to eliminate PSA screening, there has been an increased incidence of more clinically aggressive prostate cancers. Second, although the current data shows that with PSA screening at 12-18 months intervals, prostate cancer morbidity can be substantially reduced, it is critically important to mitigate the impact of unnecessary treatment by utilizing active surveillance, and various newer methods for risk stratification of patients with low-grade, low-stage disease.
Editorial Comment Prostate cancer (PCa) is the most common non-skin cancer and the second leading cause of cancer death for men in the United States.1 Strategies for managing PCa are mainly aimed at early detection because 68% of PCa mortality takes place under the age of 75 (the average life expectancy for men in the US). This is substantiated by scientific literature that demonstrates that early detection can play a vital role in the survival of individuals affected by cancer.2 Despite the evidence surrounding early detection, differences of opinion abound on the screening recommendations for PCa because of the high false positive rate and the over-detection of indolent disease.
Growing Teratoma Syndrome of Testicular Origin A 20-year-old Hispanic male semi-professional soccer player with no prior medial history presented to the emergency department with one month of abdominal distension, and four days of left lower extremity swelling. During initial interview, the patient offered that his testicle had been enlarged for approximately 4-6 years, without any workup or intervention. A firm non-tender abdomen, enlarged left hemi-scrotum, and left lower extremity swelling was noted on physical examination. A left supraclavicular lymph node was also palpable.
A Rare Case of Ureteral IgG4 Disease Masquerading as Urothelial Carcinoma The present paper described a rare case of ureteral IgG4-related disease (IgG4-RD) that mimicked urothelial carcinoma. An otherwise healthy patient presented with computed tomography, ureteroscopic, and biopsy findings that were suspicious of urothelial carcinoma. The patient received a right nephroureterectomy. Histopathology showed ureteral IgG4-RD, without evidence of urothelial carcinoma. Accurate diagnosis of this rare entity should be based on clinical, biochemical, and histopathological findings.
Extra-adrenal Pheochromocytoma Associated With Segmental Renal Artery Compression and Pseudostenosis Classically, pheochromocytomas and paragangliomas result in hypertension secondary to an excess release of catecholamines. However, when the tumor arises near the renal hilum, hypertension may also be secondary to renal artery stenosis, which can occur via several purported mechanisms. We describe an unusual case of a hereditary, extra-adrenal pheochromocytoma causing right lower pole renal artery pseudostenosis, pertinent radiologic signs, relevant surgical findings, and subsequent resolution after extirpative surgery.
Robotic Management of Rectourethral Fistulas After Focal Treatment for Prostate Cancer To describe our management strategy for rectourethral fistula (RUF) after focal treatment for prostate cancer (PCa) using 2 cases as an example. Almost 50% of RUFs are associated with energy treatment modalities for PCa. The adjacent damage to healthy tissue along with limited pliability of it makes the success of the repair troublesome. There is no standardized approach for these scenarios.
Author Reply An optimal definition for urethroplasty success should include both anatomic and functional outcomes.1 To objectively assess anatomic success, ideally all patients should undergo cystoscopy at follow up. However, previous data show that about half of the patients will not return for a cystoscopic follow-up at 1 year.2 Factors such as lack of symptoms, being remote from the clinic, lack of time, and unwillingness to undergo another cystoscopy are among the reasons for low follow-up rates.1 Lack of cystoscopic follow-up in 12 of 35 (34%) patients in our study is in line with this.
Editorial Comment The authors reviewed the quality of life as well as the occurrence or persistence of perineal pain in a series of men who are underwent urethroplasty, with primary anastomosis or using single-stage buccal graft repair, for bulbar urethral strictures.
Author Reply This retrospective study provides a window of a group of patients who rarely present to the large academic medical centers, where almost all prostate cancer research is carried out. Despite a dearth of literature regarding the majority black and low socioeconomic background patients in this study, physicians and allied health professionals who work in America's Essential Hospitals know that a substantial number present with remarkably elevated prostate-specific antigen (PSA) values.1 When patients do present, often it is via the Emergency Department, where the presentations are often signs and symptoms of disseminated prostate cancer.
Editorial Comment The authors describe their study on a group of predominantly lower socio-economic status African-American men who presented to their public hospital with PSAs > 100, and conclude that the lack of PSA screening may be exacerbating advanced disease in a similar population of men.
Bladder Agenesis and Associated Pelvic Arterial Anomaly in Two Female Pediatric Patients Bladder agenesis is an extremely rare congenital anomaly of the genitourinary tract. Two female patients with known diagnoses of bladder agenesis presented for pre-renal transplant evaluation and neobladder creation. Similar unique pelvic arterial malformations were identified through pre-operative imaging and intraoperative examination. With these similar findings, it could be proposed that such anatomical variants are products of the same insult or involve a causal relationship, with vascular aberrancies potentially provoking pelvic organ maldevelopment.
Simultaneous Bilateral Ureteral Calculi: A New Paradigm for Management To define the need for emergent intervention between patients with simultaneous bilateral ureteral calculi (SBUC) compared to unilateral ureteral calculi (UUC). Patients with SBUC represent a potential urological emergency due to possible anuria or electrolyte imbalance. While conventional practice mandates immediate intervention in these patients, little data exist to define the rate of these events.
The Application of Suctioning Flexible Ureteroscopy with Intelligent Pressure-Control in Treating Upper Urinary Tract Calculi on Patients with a Solitary Kidney The position of the end of the ureteral sheath during surgery should be determined based on the location of the stone and the range of flexible motion of the ureteroscope at the time of lithotripsy. In lithotripsy for ureteral calculus, the sheath should be as close as possible to be beneath the ureteral calculus; in lithotripsy for kidney stones, the front end of the sheath should be as close as possible to the outlet of the renal pelvis but should not limit the moving activity of the bendable part of the flexible ureteroscope.
Retrograde Ureteral Catheterization: A Possible New Treatment for Renal Fungal Balls in Very Low Birth Weight Infants Invasive candidiasis is a serious pathogen of late-onset sepsis in very low birth weight infants. Kidney is the most common organ involved, and it causes morbidity and mortality, especially when fungal balls are formed. We report a 34-day-old female infant (born at 28 weeks' gestation, 1152 g) with systemic fungal infection complicated obstructive uropathy. On sonography, the fungal balls filled the entire pelvis without hydronephrosis. Percutaneous nephrostomy was not feasible. In addition to systemic antifungals, we successfully performed cystoscopy-assisted retrograde ureteral catheterization to decompress the pelvis, which also provided a route for local amphotericin B irrigation to achieve therapeutic concentration without nephrotoxicity.
Re: Dawidek et al: Assessing Time of Full Renal Recovery Following Minimally Invasive Partial Nephrectomy (Urology 2018;112:98-102) In an interesting article, Dawidek et al reported that the optimal global renal function recovery in 92 adult patients with unilateral renal tumor occurred 6-12 weeks after minimally invasive partial nephrectomy. Global renal function “did not differ significantly from 1 year post-operatively.” Following surgery, 9 patients (13%) developed de novo stage ≥3 chronic kidney disease (estimated glomerular filtration rate ≤60 mL/min/1.73 m2).1
Photoselective Vaporisation of the Bladder for the Management of Radiation Cystitis – Technique and Initial Outcomes. ObjectiveTo describe our technique utilising photoselective vaporisation of the bladder (PVB) for the management of haemorrhagic cystitis and initial results of 12 patients.Materials and MethodAn audit of theatre records of a single surgeon was performed to identify patients who had undergone PVB for management of radiation-cystitis. Technique: Rigid cystoscopy was performed. Ureteric catheters were placed and active bleeding sites targeted to optimise vision. Ablation was commenced using the vaporize function.
Reply by the Authors: Assessing Time of Full Renal Recovery Following Minimally Invasive Partial Nephrectomy In adults, renal function recovery following partial nephrectomy plateaus, with no significant long-term recovery. Our study emphasizes the timing of this plateau, indicating that it occurs at 6-12 weeks, even earlier than previously suspected. Factors such as age and renal disease, although not investigated in our study, may impact the recovery trajectory. As highlighted, our results cannot be generalized to the pediatric population, where the evidence suggests a greater capacity for long-term recovery of renal function.
Laparoscopic Yang-Monti Ureteral Reconstruction in Children To investigate the clinical outcome of surgical treatment for long ureteral defect in children, we evaluated our experience of managing 6 children with the long defect utilizing laparoscopic ureteral reconstruction technique using Yang-Monti technique.
Nationwide Increase in Cryptorchidism After the Fukushima Nuclear Accident To estimate the change of discharge rate after cryptorchidism surgery between pre- and postdisaster in Japan. Cryptorchidism cannot be diagnosed before birth and is not a factor that would influence a woman's decision to seek an abortion. Therefore, this disease is considered suitable for assessing how the Great East Japan Earthquake and the subsequent Fukushima Daiichi nuclear accident (2011) influenced congenital diseases.
A Novel Calculator for Estimating Prostate Volume in Daily Urology Services To develop a simple prostate volume (PV) calculator that can aid in managing patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement at daily urology services in developing Asian countries.
The Role of Imaging in Prostate Cancer Care Pathway: Novel Approaches to Urologic Management Challenges Along 10 Imaging Touch Points We map out a typical prostate cancer care pathway through discussion of updates on modern imaging. Multiparametric magnetic resonance imaging is the most sensitive and specific imaging tool for diagnosis and local staging, but transrectal ultrasound remains the most widely used technique for prostate biopsy guidance. Computed tomography and bone scan are useful in initial staging and recurrence detection. Novel imaging techniques in ultrasound elastography and multiparametric magnetic resonance imaging allow for increased lesion detection sensitivity and have the potential to enhance biopsy, while the development of new positron emission tomography radiotracers has great promise for improved detection of local and metastatic disease in patients with biochemical recurrence.
Magnet Before the Needle Commentary on: MRI-targeted or Standard Biopsy for Prostate-cancer Diagnosis (PRECISION Trial) Systematic transrectal ultrasound (TRUS)-guided prostate biopsy has been the standard of care for the diagnosis of prostate cancer for many decades.1 In recent years, the utility of magnetic resonance imaging (MRI) for targeted biopsy of prostate cancer has been on the rise with the aim of detecting clinically significant cancers while avoiding overdetection of cancers that do not require treatment.2
Priapism Throughout the Ages Long-lasting penile erections are closely associated with the god Priapus. He was regarded as the son of Dionysus, god of the vine, and Aphrodite, goddess of beauty. When Aphrodite was pregnant, the story was that her mother Hera was jealous, had put her hands on the belly of her daughter and pronounced a curse. As a result, Aphrodite gave birth to Priapus, a misshapen dwarf with a large erect penis,1 who, as a result, was subjected to ridicule and assumed to lack intelligence.2 Since antiquity, long-lasting erections have been the object of scientific interest.
Genital Lichen Sclerosus Et Atrophicus: A Benign Skin Disorder With Malignant Aftermath Genital lichen sclerosus et atrophicus (LSA) is an uncommon genital dermatosis. Its resemblance to vitiligo, especially during the earlier stages, leads to delay in its diagnosis. Apart from the common complications such as meatal stenosis, balanoposthitis, phimosis, and painful erections, squamous cell carcinoma is a rare but ominous complication of genital LSA. Herein, we present a case of long-standing penile LSA complicated by squamous cell carcinoma, stressing upon the requirement of early diagnosis and management of LSA.
Unilateral Papillary Cystadenoma of the Epididymis as a First Presentation of Von Hippel-Lindau Disease Association between papillary cystadenoma of the epididymis (PCE) and Von Hippel-Lindau Disease (VHLD) is well known and stronger for bilateral tumors. Unilateral PCE occurs either as a sporadic tumor without evidence of VHLD or in the context of a known diagnosis of VHLD, indeed it has never been reported as the first manifestation of VHLD. In contrast, we report the case of a boy with an apparently isolated, unilateral PCE that resulted to be the first manifestation of an unknown VHLD. Thus, we recommend screening for VHLD in patients with a new diagnosis of unilateral PCE, especially if the patients are young.
Bilateral Ureteroenteric Strictures: A Case of the “Reverse 7” Anastomotic stricture is a well-known complication of the urinary diversion that accompanies radical cystectomy. Management options range from endoscopic procedures to open surgeries, with a subset of the latter employing bowel as the interposing segment. In this report, we describe a rare patient, who successfully underwent a “Reverse 7” procedure, bypassing strictures at both anastomotic junctions between ureters and neobladder.
Unclassifiable CD20-negative Testicular Diffuse Large B-cell Lymphoma CD20-negative diffuse large B-cell lymphoma (DLBCL) is a very uncommon neoplasm, and very rare unclassifiable cases that did not meet the criteria for well-established subtypes of CD20-negative DLBCLs have been reported. CD20-negative DLBCLs often present an aggressive clinical course with important chemoresistance and poor prognosis. Here, we report a case of CD20-negative DLBCL presented as a testicular mass. To the best of our knowledge, this is one of the first reported cases of testicular unclassifiable CD20-negative DLBCL.
Arterial Fistula With Severe Hematuria After Ileal Conduit Diversion Iliac-urinary fistula is a rare cause of severe hematuria after urinary diversion. Indwelling stents and advanced atherosclerosis may be risk factors. Angiography with embolization is usually resolutive.
Frequent Penile Erection in a Boy With Autism-spectrum Disorder: Case Report Risperidone is commonly prescribed by pediatricians for a variety of behavioral and psychological disorders. We report a boy with autism-spectrum disorder, who developed frequent penile erections after an increase in risperidone dosage for a month. The patient fully recovered 2 days after risperidone discontinuation. This report concerns the youngest case of psychotropic medication-induced sexual disorders, which illustrates the differences in presentation between children and adults. Moreover, this case can serve as evidence that discontinuation should be recommended for the management of drug-induced sexual disorders.
Concurrent Robotic Pyelolithotomy and Partial Nephrectomy: Tips and Tricks With the evolution of robot-assisted surgery in the urology field, this technology is being applied to treat many genitourinary conditions.1 Although incidence of urolithiasis and renal neoplasm has increased, encountering both entities in a single kidney is noteworthy. Our video exhibits the concurrent management of a renal calculus and an ipsilateral renal neoplasm using a robotic platform.
Case Report: Nephron-sparing Surgery in a Patient With Bilateral Multifocal Wilms Tumor We present a case of bilateral multifocal Wilms tumor in a nonsyndromic 12-month-old male. Our management approach included 12 weeks of preoperative chemotherapy for maximal tumor shrinkage and, despite the central location of the tumors, successful staged bilateral nephron-sparing surgery. We advocate for a broader application of nephron-sparing surgery in Wilms tumor cases with the goal of preserving renal function without compromising oncologic outcomes.
Efficacy and Safety of Ureteroscopy for Stone Disease in a Solitary Kidney: Findings From a Systematic Review Management of stone disease in solitary kidney remains a difficult treatment entity for the urologist. The challenge exists to deliver high clearance while maintaining strong safety profile. Twelve eligible studies were included, comprising a total of 693 patients with a male:female ratio of 2:1. Overall, 114 (16.4%) complications were reported. No fatalities were reported in any of the studies. Clavien III complications were recorded in less than 0.5% of the patients. This review confirms the effectiveness, safety, and reliability of this technique for this unique cohort of patients.
Re: Morris and Krieger: Does Circumcision Increase Meatal Stenosis Risk?—A Systematic Review and Meta-analysis (Urology 2017;110:16-26) We thank Van Howe for his letter.1 He posits, without evidence, that meatal stenosis (MS) typically develops 3-5 years after circumcision.1 A recent study that monitored MS onset by repeated examination following neonatal circumcision found that most MS developed in the first 2 months after circumcision: on average 2.3 and 3.8 weeks in the 2 groups studied.2 Symptoms were not reported in 36 of the 38 cases (95%). The authors suggested that this may be due to parents paying less attention to the urination of young babies than of older boys.
Pediatric Robotic Prostatectomy and Pelvic Lymphadenectomy for Embryonal Rhabdomyosarcoma We present the first published case of a pediatric robot-assisted prostatectomy and pelvic lymphadenectomy for refractory prostatic embryonal rhabdomyosarcoma. The patient is a 7-year-old male who had been treated with 3 cycles of chemotherapy and radiation, who underwent prostatectomy and lymphadenectomy for a recurrent mass. Surgery was uncomplicated and yielded negative surgical margins. We highlight the surgical technique and feasibility of utilizing robotic surgery for pediatric prostatectomy.
Adoption of Prebiopsy Magnetic Resonance Imaging for Men Undergoing Prostate Biopsy in the United States To assess adoption of prebiopsy prostate magnetic resonance imaging (MRI) in the United States and to evaluate factors associated with magnetic resonance imaging-guided prostate biopsy (MRI-Bx) use. Prior reports have shown improved cancer detection with MRI-Bx vs transrectal ultrasound-guided methods (transrectal ultrasound-guided biopsy [TRUS-Bx]). Population-based trends of their use and outcomes have not been previously characterized.
Perinephric Urinoma Secondary to Malignancy in a Pediatric Patient Perinephric urinomas commonly arise following traumatic injury or high-grade obstruction from kidney stones or lower urinary tract disorders. Not only are spontaneous urinomas rare in the pediatric population, but malignancy presenting with perinephric urinomas have only been described in the adult population. In this case report, we report flank pain from a spontaneous perinephric urinoma as the presenting symptom of lymphoma in a pediatric patient.
Giant Renal Hemangioma in an Adolescent Girl: A Very Rare Entity Hemangiomas are benign vascular tumors of childhood and they usually tend to be located in the upper parts of the body (head and neck). However, renal hemangiomas are very rare and usually occur to be small (1-2 cm) in size. Here, we report an adolescent girl with a giant renal hemangioma of 15 cm diameter.
Erosion of Polytetrafluoroethylene (Gore-tex) Sling Over 20 Years After Placement for Stress Urinary Incontinence As synthetic material has evolved to improve both the efficacy and biocompatibility of suburethral slings, soft polypropylene slings are currently the gold standard for treatment of stress urinary incontinence. However, reports of complications beyond 10 years are limited and patients can nevertheless present with erosion and other complications from other sling materials that have been used in the past. We present a case of synthetic sling erosion 21 years after placement of a polytetrafluoroethylene sling (Gore-tex).
Prepubertal Malignant Large Cell Calcifying Sertoli Cell Tumor of the Testis An otherwise healthy 7-year-old boy was diagnosed with malignant large cell calcifying Sertoli cell tumor (LCCSCT) of the testis. He underwent attempted partial orchiectomy with conversion to radical orchiectomy due to suspected malignancy on intraoperative frozen section. There was no lymph node or visceral metastases. To our knowledge, this is the first report of malignant LCCSCT in the prepubertal population.LCCSCT of the testis is an extremely rare neoplasm, with low malignant potential. Malignant cases are exclusively reported previously in the adult population.
A Voice From the Past: Rediscovering the Virchow Node With Prostate-specific Membrane Antigen-targeted 18F-DCFPyL Positron Emission Tomography Imaging More than 150 years ago, German pathologist Rudolf Ludwig Karl Virchow (1821-1901) described the finding of the involvement of the left supraclavicular node in gastric cancer.1 It is now known that a number of abdominal and thoracic malignancies have a propensity to metastasize to this anatomic site, which is commonly referred to as Virchow node. Cancers known to spread to Virchow node include malignancies of the lung, pancreas, and esophagus, and adenocarcinoma of the gastric corpus, kidney, ovary, testicle, stomach, corpus uteri, cervix uteri, colon, and rectum.
What Is the Role of α-Blockers for Medical Expulsive Therapy? Results From a Meta-analysis of 60 Randomized Trials and Over 9500 Patients Use of α-blockers for medical expulsive therapy (MET) has been the subject of huge debate in urology. Moreover, there have been a number of randomized controlled trials with differing results. We conducted a systematic review and meta-analysis of randomized controlled trials investigating the efficacy of α-blockers for MET. This review confirms there is a role for α-blockers in MET for ureteric stones specifically in stones >5 mm and distal ureteric stones, which is associated with improved stone expulsion.
Sensitivity of Noncontrast Computed Tomography for Small Renal Calculi With Endoscopy as the Gold Standard To compare the sensitivity of noncontrast computed tomography (CT) with endoscopy for detection of renal calculi. Imaging modalities for detection of nephrolithiasis have centered on abdominal x-ray, ultrasound, and noncontrast CT. Sensitivities of 58%-62% (abdominal x-ray), 45% (ultrasound), and 95%-100% (CT) have been previously reported. However, these results have never been correlated with endoscopic findings.
Urinary Ascites Secondary to Bilateral Mid-ureteral Stenosis in a Neonate Urinary ascites is most commonly seen in fetuses and newborns with obstructive uropathy. The majority of cases are associated with lower urinary tract obstruction, such as posterior urethral valves. In this report, we present a unique case of neonatal urinary ascites caused by congenital supravesical obstruction. To date, neonatal urinary ascites secondary to bilateral mid-ureteral stenosis without a history of antenatal diagnosis has not been reported.
Testicular Yolk Sac Tumor and Mature Teratoma: Synchronous Bilateral Occurrence in an Infant Yolk sac tumor (YST) is a rare malignancy typically occurring in children. However, bilateral testicular YSTs are a quite rare situation, which can occur metachronously or synchronously with same histologic type, as well as different histology. We present a case of synchronous YST of the left testis and mature teratoma of the right in a 7-month-old infant treated with testis-sparing surgery at right testis and high radical orchiectomy at left. By follow-up of 28th month, no atrophy, or residual tumor in right testis and no recurrence or evidence of disease in left scrotum was found.
Successful Conservative Management of Bilateral Renal Mucormycosis Our patient is a 56-year-old man with medical history of poorly controlled insulin-dependent diabetes, bipolar disorder, and polysubstance abuse. Before presentation at our institution, he had been evaluated at several regional hospitals over the course of the preceding month. His symptoms were recurrent flank pain, fevers, and passage of long filamentous grey strings of material in his urine, which he described as “sea snakes.” Despite several negative urine cultures, he had been diagnosed with presumed pyelonephritis and treated with multiple courses of antibiotics including ceftriaxone, cephalexin, metronidazole, piperacillin-tazobactam, and ciprofloxacin, without any clinical improvement.
Evaluation of Vasectomy Trends in the United States. To use the Truven Health MarketScan® (THM) database to better approximate the annual rate of vasectomies performed in the US population, determine changes over time, regional differences, providers performing this, and if there is any monthly variation in vasectomy rates.
Mucinous Lung Adenocarcinoma Metastasis to Testis in a 29 Year Old—A Case Report Testicular tumors represent 1% of all malignancies in men and are the most common solid tumors occurring in males between the age of 20 and 40 with the majority being primary germ cell tumors.1,2 Metastases to the testes are rare,3 and excluding lymphoma and leukemia, the commonest primary site is the prostate, followed by the lung.2,4,5 Patients with secondaries to the testes are most often over 50 years of age.3,6 We detail a rare case of a young man presenting with a testicular mass, proven to be metastasis from mucinous adenocarcinoma of the lung.
Longitudinal Rupture of Distal Corpus Cavernosum with Concomitant Urethral Injury: an Uncommon Result of a Common Mechanism Fracture of the penis is a well-recognized yet relatively uncommon urologic event. Forceful, blunt trauma with lateral bending of the penis in an erect state typically results in a transverse rupture of the tunica albuginea of the corpus cavernosum. Longitudinal tears of the corpus cavernosum are by themselves considered infrequent. We present a rare case of a patient with longitudinal rupture of the distal corpus cavernosum with concomitant extension to the corpus spongiosum causing partial urethral disruption as a result of trauma during sexual intercourse.
A Rare Case of Pediatric Vaginal Yolk Sac Tumor A 14-month-old girl was evaluated for intermittent vaginal bleeding. Vaginoscopy revealed a friable tumor, and biopsy results confirmed a yolk sac tumor. Alpha-fetoprotein was elevated (1386 ng/mL) at diagnosis but quickly normalized with chemotherapy. The patient remained tumor-free 12 months after diagnosis without the need for radical surgery. Although rare, malignant tumors of the vagina must be included in the differential diagnosis of prepubertal girls who present with vaginal bleeding. Primary yolk sac tumor of the vagina is seen in girls less than 3 years of age and is treated with chemotherapy with or without surgical excision.
Solitary Fibrous Tumor of the Pelvis Involving the Urinary Bladder A 49-year-old man presented to the urology clinic with 1-year history of abdominal swelling and lower urinary tract symptoms, including incomplete bladder emptying and urinary urgency and frequency. Additionally, he complained of thin, loose stools for the past few months but had never had a colonoscopy or other work-up. Immediately on physical exam, a palpable suprapubic mass and a small umbilical hernia were noted with no obvious umbilical abnormalities or drainage.
Metastatic Pheochromocytoma in an Asymptomatic 12-Year-Old With von Hippel-Lindau Disease Pheochromocytoma is a rare chromaffin cell tumor that may be associated with a genetic predisposition, such as von Hippel-Lindau (VHL) disease. VHL is an autosomal dominant disorder that is characterized by a predisposition to multiple tumors, including retinal and central nervous system hemangioblastomas, renal cell carcinoma, and pheochromocytomas. The classic presentation of pheochromocytoma is episodic hypertension, headaches, palpitations, and diaphoresis. In the pediatric population, 40% of pheochromocytomas have a hereditary basis.
A Homeopathic Alternative to Potassium Citrate in Patients with Recurrent Nephrolithiasis The patient is a 55-year-old man with a history of Crohn's disease requiring multiple small bowel resections and a history of uric acid stones. He developed bilateral staghorn calculi and underwent numerous interventions including 3 left percutaneous nephrolithotomies (PCNLs), 2 right PCNLs, and multiple ureteroscopies with holmium laser lithotripsy (URS-HLL). His most recent procedure performed at our institution was a right PCNL in 2013.
Spermatic Vein Thrombosis A 36-year-old man was transferred from a freestanding emergency department to a nearby tertiary referral center for evaluation of an acute scrotum. He initially experienced midline back and right-sided flank pain in the preceding 24 hours while performing housework, but presented to the outside facility with acute-onset right-sided inguinal and scrotal pain that woke him from sleep. This pain was associated with right hemiscrotum swelling, self-limited gross hematuria, and passage of a small blood clot per urethra.
Impact of Statin Intake on Kidney Stone Formation To determine whether statin intake affects nephrolithiasis risk, and whether higher lipid levels correlate with stone risk. Dyslipidemia is a known independent risk factor for urolithiasis, and emerging evidence suggests common biological pathways. Previous work has suggested that statins protect against new stone formation, but these findings have not been verified by other investigators.
Metallic Ureteric Stents in Malignant Ureteric Obstruction: A Systematic Review The effectiveness of metallic stents in the management of malignant ureteric obstruction is unclear. This systematic review evaluates the use of 4 commercially available metallic stents (Resonance, Memokath 051, Uventa, and Allium URS). Twenty-one studies met eligibility criteria. Overall success rates ranged from 88% for the Allium stent to 65% for Memokath 051. Resonance demonstrated the lowest migration rate (1%). Uventa had the lowest obstruction rate (6%). Metallic ureteric stents offer a viable alternative in the management of malignant ureteric obstruction.
Stem Cells for Urinary Incontinence: Functional Differentiation or Cytokine Effects? Minimally invasive stem cell therapy for stress urinary incontinence may provide an effective nonsurgical treatment for this common condition. Clinical trials of periurethral stem cell injection have been under way, and basic science research has demonstrated the efficacy of both local and systemic stem cell therapies. Results differ as to whether stem cells have a therapeutic effect by differentiating into permanent, functional tissues or exert benefits through a transient presence and the secretion of regenerative factors.
Imprudent Utilization of Partial Nephrectomy A healthy 53-year-old woman presented with a 6.0-cm right renal mass suspicious for kidney cancer (Fig. 1A,B). The tumor demonstrated avid enhancement, extensive necrosis, and calcification, and clear renal cell carcinoma (RCC) was suspected. Hilar tumor location and high tumor complexity were also observed. In retrospect, an infiltrative growth pattern was also evident (Fig. 1B). Renal function was normal and renal scan demonstrated good function in both kidneys (Table 1). Estimated glomerular filtration rate (GFR) in the contralateral kidney was 47 mL/min/1.73 m2.
Bladder and Ureteral Dysfunction Leading to Hydronephrosis and Hydroureteronephrosis in Adults Chronic non–stone-related hydronephrosis from supravesical or bladder dysfunction in adults is often detected incidentally. This study aims to review the literature regarding supravesical obstruction or bladder dysfunction leading to bilateral hydronephrosis in adults and to develop an algorithm to identify patients at risk of renal failure. Cross-sectional studies, retrospective and prospective cohorts, clinical trials, and systematic reviews from 1980 to 2017 were included. From 8115 articles screened, 39 met the inclusion criteria.
Dual Pathology Causing Congenital Bladder Outlet Obstruction Anterior urethral syringocele is an uncommon congenital deformity characterised by cystic dilatation of bulbo-urethral gland ducts and is usually asymptomatic. We present a case on 4-day-old male neonate who presented with bilateral antenatal hydroureteronephrosis and renal impairment and found to have urethral syringocele and posterior urethral valves (PUV).
Author Reply The comments of the editor truly reflect the findings of our study on the surgical treatment of giant penoscrotal lymphedema. All the 19 patients described in the study were to be treated by surgery. Eight patients, however, defaulted, possibly because of their belief in alternative traditional herbal medicine and or financial constraint, because health insurance schemes are yet to be fully established in our environment.
Is Cryotherapy a Genuine Rival to Robotic-assisted Partial Nephrectomy in the Management of Suspected Renal Malignancy? A Systematic Review and Meta-analysis We systematically reviewed the world literature and compare oncological outcomes, morbidity, renal function, and perioperative outcome between cryotherapy and robotic-assisted partial nephrectomy (RAPN) for suspected renal malignancy. There was a statistically significant difference in “recurrence rates” between the 2 techniques, favoring the RAPN cohort. There was no statistically significant difference in overall and ≥Clavien 3a complication rates between the 2 techniques. The quality of evidence for recurrence rates, overall complication, and ≥Clavien 3a were “moderate”, “low,” and “very low,” respectively, on GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
TEMPORARY REMOVAL: New Approach to Guide Target Prostate Biopsy: Technique and Initial Experience The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
WITHDRAWN: Stented or Unstented Distal Hypospadias Repair The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2017.04.057. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
WITHDRAWN: Editorial Comment on “Abnormal Expression of Sg I is Closely Related to Seminal Vesiculitis” The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2015.08.052. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
WITHDRAWN: Reply The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2015.08.053. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
WITHDRAWN: Editorial Comment The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2013.02.086.The duplicate article has therefore been withdrawn.
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