Leiomyoma of the epididymis treated with partial epididymectomy.

BACKGROUND: A 56-year-old man presented to a urology clinic with a painless left-testicular mass of unknown duration. On physical examination, a firm mass measuring 2 cm x 2 cm and involving the inferior portion of the left epididymis was found. The left testicle, right testicle, and right epididymis looked normal on examination. INVESTIGATIONS: Assessment of tumor-marker levels, ultrasound examination of the scrotum, Doppler ultrasound examination, surgical exploration, and histologic examination of frozen sections. DIAGNOSIS: Pure leiomyoma arising from the epididymis. MANAGEMENT: Complete excision of the mass with its contiguous epididymis, preserving the left testicle and rest of the epididymis.

Management of the valve-bladder syndrome and congenital bladder obstruction: the role of nocturnal bladder drainage.

Valve-bladder syndrome often develops after the resolution of posterior urethral valves, but is also found after the resolution of congenital bladder obstruction. The features of this syndrome include the persistent dilation of the upper urinary tracts, a thick-walled, noncompliant urinary bladder, urinary incontinence, and polyuria secondary to nephrogenic diabetes insipidus. Nocturnal bladder management, which involves timed emptying of the bladder or continuous drainage, has been recommended in conjunction with diurnal timed voiding therapy as an adjunct to the treatment of valve-bladder syndrome. This treatment is derived from the hypothesis that valve-bladder syndrome is caused by congenital obstruction, and that the resultant changes in detrusor muscle are associated with a persistent bladder dysfunction characterized by chronic overdistention of the urinary bladder. Such overdistention is exacerbated by polyuria, and can be a cause of secondary hydronephrosis. Bladder dysfunction and overdistention is usually treated during waking time, but occasionally this is not effective on its own, and nocturnal therapy is used as well. To date, there are a few sets of data that suggest overnight bladder drainage can bring about profound improvements in the degree of upper-tract hydronephrosis, renal function, or bladder function. Nocturnal bladder drainage seems, in these initial reports, to be a simple and safe therapeutic maneuver. This review discusses the etiology of valve-bladder syndrome and examines each of the studies which have investigated nocturnal bladder drainage in its treatment.