Urethral diverticulum with massive lithiasis presenting as a scrotal mass.

Urethral diverticula in men are uncommon clinical entities. Their clinical manifestations include urinary tract infection, hematuria, irritative or obstructive voiding symptoms, ventral bulging and displacement of the penile shaft. Male urethral diverticulum with massive lithiasis presenting as a scrotal mass with stress urinary incontinence as the main symptom is extremely rare. Herein, we present such a case.

Primary leiomyosarcoma of the testis. A case report.

Primary leiomyosarcoma of the testis is an extremely rare disease entity of the genito-urinary tract. Although its clinical presentation does not seem to differ from that of other testicular malignancies, the clinical stage with which patients have been treated, as reported in contemporary literature, has always been stage 1. Diagnosis is achieved by combining histologic and immunohistochemical findings. Histologic findings refer to the presence of a spindle cell component with nuclear pleomorphism, while immunohistochemical findings refer to its reaction to specific antibodies. Although the number of reported cases is not significant and the clinical and biological behaviour of these tumors are very hard to predict, we demonstrate that radical orchidectomy followed by surveillance appears to be the treatment of choice. Retroperitoneal lymphadenectomy, radiotherapy and chemotherapy do not seem to have any place in the treatment of this type of malignancy.

Guided e-MRI prostate biopsy can solve the discordance between Gleason score biopsy and radical prostatectomy pathology.

INTRODUCTION: The aim of this study is to examine if guided prostate biopsies based on abnormalities detected by conventional and functional endorectal magnetic resonance imaging (MRI) yield a more reliable representation of the radical prostatectomy pathology and to identify probable preoperative clinical variables that stratified patients likely to harbor significant upgrading. PATIENTS AND METHODS: From April 2004 to April 2009, a review of N=70 patients records diagnosed with prostate cancer by a 3-6 core guided transrectal ultrasound (TRUS) prostate biopsy based on abnormalities detected by conventional and functional endorectal MRI and who subsequently underwent radical prostatectomy and exhibited a significant upgrading was conducted. Additionally, a multivariate analysis with a significant upgrading as the outcome was performed including the following parameters: prostate specific antigen (PSA) level, clinical stage, prostate size and duration from biopsy to radical prostatectomy. RESULTS: A significant upgrading was noted in only 8.5% of patients, with 1.4% exhibiting a significant downgrading and the rest 90.1% exhibiting an exact Gleason score match. No preoperative clinical variables that stratified patients likely to harbour significant upgrading were identified. CONCLUSIONS: This type of biopsy method seems to solve the discordance between the biopsy Gleason score and radical prostatectomy pathology regardless of known preoperative clinical variables that can affect it.

Empyema of the ureteral stump. An unusual complication following nephrectomy.

A ureteral stump, which is the segment of the ureter left in place after nephrectomy, may occasionally give rise to a pathologic process called ureteral stump syndrome, which is clinically interpreted as febrile urinary tract infections, lower quadrant pain, and hematuria. Empyema of the ureteral stump, which belongs to this syndrome, is an uncommon disease entity presenting with a reported incidence of 0.8-1%. We present a case of empyema of the ureteral stump in a female patient 5 years postnephrectomy for a nonfunctioning kidney, and discuss the clinical presentation, radiologic diagnosis, and therapeutic options of this uncommon disease entity.

Anaplastic sarcoma of the kidney.

Wilms tumor can appear with a wide spectrum of morphologic features and can sometimes cover or delay the recognition of other clinicopathologic entities of the kidney. We present a case of a new tumor entity of the kidney, namely the anaplastic sarcoma of the kidney, a tumor of high malignancy.

The role of conventional and functional endorectal magnetic resonance imaging in the decision of whether to preserve or resect the neurovascular bundles during radical retropubic prostatectomy.

OBJECTIVE: Because the recovery of erectile function and the avoidance of positive surgical margins are important but competing outcomes, the decision whether to preserve or resect a neurovascular bundle (NVB) during radical prostatectomy (RP) is based on information concerning mostly the presence and location of extracapsular extension (ECE). Conventional endorectal magnetic resonance imaging (e-ctMRI) and functional endorectal MRI (e-ftMRI) of the prostate provide an excellent depiction of the pelvic and prostate anatomy, and are also useful in predicting the presence of prostate cancer as well as ECE, seminal vesicle invasion (SVI) and NVB involvement. Their predictive qualities, however, have shown significant interobserver variability. The aims of this study are to report on accuracy using e-ctMRI and e-ftMRI, and to assess their value in making the decision whether to preserve or resect the NVBs during RP. MATERIAL AND METHODS: From 2004 to 2007, 75 consecutive patients with a biopsy-proven prostate cancer and satisfactory erectile function, who were scheduled to undergo RP, were subjected to e-ctMRI and e-ftMRI before surgery. Interpretation was performed by a highly experienced radiologist blinded to patient clinical data. All patients underwent RP and a nerve-sparing (NS) procedure was considered appropriate if the tumour did not extend outside the capsule in the posterolateral region of the prostate as assessed by the images. RESULTS: An NSRP was performed in 78.7% of patients. Based on the e-ctMRI and e-ftMRI findings, the operative strategy was changed in 44% of patients. The findings favoured NVB preservation in 67% of patients with a high clinical probability of ECE, and opposed NVB preservation in 33% of patients with a low clinical probability of ECE. Based on the final histopathological findings, the surgical plan was successfully changed in all patients. The sensitivity, specificity and accuracy rate were 92%, 100% and 100% for ECE, SVI and NVB involvement, respectively, results which are higher than all other published international standards in this matter. CONCLUSIONS: e-ctMRI and e-ftMRI comprise a sufficient modality in detecting prostate cancer, ECE, SVI and NVB involvement. This technique seems to one of the most sensitive preoperative clinical staging methods for selective patients, and extremely useful for identifying candidates for an NSRP.

Dry gangrene of the penis induced by a bullring for sexual stimulation purposes.

Dry gangrene of the penis is a critical clinical condition provoked by vascular compromise that can lead to severe complications. Although usually caused by diabetes mellitus or due to end-stage renal disease, in these last years, there has been an increase of penile gangrene incidents induced by penile strangulation due to constricting devices for sexual stimulation purposes. We present such a case and discuss the correct approach for treatment of this unusual condition.

A case of a large seminal vesicle cyst associated with ipsilateral renal agenesis.

The diagnosis of seminal vesicle cysts is often delayed or missed as a result of both their rarity and wide spectrum of potentially confusing clinical and imaging findings they can produce. Although rare, they should be considered in men, especially with a history of renal agenesis, who exhibit o inexplicable irritable voiding symptoms, perineal discomfort or other genitourinary complaint of unclear etiology. We introduce such a case, and discuss its symptoms, radiological findings and its therapeutic approach.

Spontaneous rupture of the urinary bladder 10 years after curative radiotherapy.

It has been reported that the rate of clinically relevant side effects following curative radiotherapy for primary carcinoma is about 3% for urologic complications. Such complications include hematuria, fibrosis, and cystitis. An extremely rare, but dangerous, medical complication following curative radiotherapy that can also be noted is spontaneous bladder perforation. We present such a case of a 27-year-old patient with spontaneous bladder perforation, who was initially misdiagnosed because of its rarity as well as unspecific clinical and laboratory findings.

Urinary bladder leiomyosarcoma in adults.

INTRODUCTION: Non-urothelial neoplasms of the bladder account for fewer than 5% of all bladder tumors. Sarcoma constitutes the most usual mesenchymal malignancy of the bladder, with leiomyosarcomas being the most common type of sarcoma in adults. PATIENTS AND METHODS: The records of seven patients presenting to two different institutions with bladder leiomyosarcomas between 2003 and 2007 and between 2000 and 2007, respectively, were examined. Cystoscopy, with transurethral resection of the bladder tumor was initially performed in all patients, with leiomyosarcoma being initially diagnosed on the basis of examination of the transurethral specimen. RESULTS: There were N = 5 men and N = 2 women with a median age of 64.8 years at presentation. All seven patients underwent a definitive surgical procedure. Complete resection with negative surgical margins was achieved in all seven patients (100%). MSKCC stage included 86% of patients with stage 3 (N = 6) and 14% with stage 2 (N = 1). A low-grade tumor was evident in one patient only, with the remaining 86% exhibiting a high-grade tumor. DISCUSSION: Leiomyosarcomas of the bladder have always been considered as a highly aggressive entity and little is known about their origin, clinicopathologic presentation, and the survival factors associated with them. Contemporary studies suggest that these tumors may have a better prognosis than once believed. Leiomyosarcomas require aggressive surgical extirpation and, when surgical resection is possible, radical cystectomy with wide margins is the rule and should be performed. Strict adherence to standard surgical technique has resulted in low rates of positive surgical margins and low rates of local tumor recurrence.