Deep Vein Thrombosis: A Rare Cause of Acute Testicular Pain. Case Report: Literature Review.

INTRODUCTION: Thrombosis is defined as the formation of a clot in a blood vessel that obstructs the flow of blood to the peripheral tissues. The incidence of thromboembolic disease ranges from 0.7 to 1.2% within urology. CASE REPORT: A 40-year-old warehouse worker male presented to the emergency department with worsening of a month's lasting scrotal pain. Physical examination showed the presence of an enlarged and painful left testicle with no other findings. Right testicle, penis and abdominal examination showed no abnormalities whatsoever. Bilateral varicocele with a partial thrombosis of the left one associated with left inguinal hernia was diagnosed by performing an urgent testicular ultrasound test. Conservative treatment was first given. However, since pain was not relieved, surgery was indicated with left varicocelectomy and a left inguinal hernia repair procedure leading to complete symptoms control and normal testicular flow in the control Doppler ultrasound study 2 months after the surgery. CONCLUSION: Spontaneous thrombosis of the pampiniform plexus is a rare entity where the management remains controversial. The clinical case we report here shows that surgery may be considered an effective option.

[Prognostic factors in renal cancer with venous thrombus survival analysis.] / Factores pronósticos en cáncer renal con trombo en vena. Análisis de supervivencia.

OBJECTIVES: To analyze surgery for renal cancer with venous thrombus at different levels, perioperative complications and prognostic factors associated to overall, cancer-specific and disease-free survival. MATERIAL AND METHODS: Retrospective analysis of 42 cases of renal cancer with venous thrombus performed between 2005 and 2015. The level reached by the thrombus was established according to the Mayo Clinic classification. Postoperative complications were staged according to Clavien-Dindo classification. RESULTS: Most frequent in males. Mean age 65.7 years. 16.6% were tumors with level II thrombus. Subcostal approach was performed in 58.9%. Extracorporeal circulation with cardiac arrest and hypothermia was established in 2 patients. Resection of metastatic disease was performed in 3 patients during radical nephrectomy. Reoperation was 2.3% while, perioperative mortality was 4.7%. 30% presented with metastases at diagnosis. Twenty patients progressed at 15.5 months (3-55). Overall survival was 60 months. The cancer-specific mortality was 75%. Disease-free survival was 30% at 55 months. CONCLUSIONS: Surgical treatment of renal cancer with venous thrombus requires a multidisciplinary management. The surgical technique varies according to the level reached by the venous thrombus. Tumor stage is the most important prognostic factor. Thrombus level influences prognosis, with longer survival for patients with tumor thrombus confined to the renal vein (pT3a) in comparison to tumors with thrombus in the atrium (pT3c).