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.

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

OBJETIVO: Analizar el tratamiento quirúrgico en el cáncer renal con trombo venoso a distintos niveles, así como las complicaciones perioperatorias y los diversos factores pronósticos relacionados a supervivencia global, cáncer específica y libre de enfermedad. MÉTODOS: Estudio descriptivo retrospectivo de 42 casos de cáncer renal con trombo venoso entre 2005 y 2015. El nivel alcanzado por el trombo se estableció según la clasificación de la Clínica Mayo. Las complicaciones postoperatorias se estadificaron según la clasificación de Clavien-Dindo. RESULTADOS: Predominio masculino con media de edad de 65,7 años. El 16,6% correspondieron a tumores con trombo de nivel II. En el 58,9% se realizó un abordaje subcostal. En 2 pacientes se estableció hipotermia con parada cardíaca y circulación extracorpórea. En 3 pacientes se realizó resección de lesiones metastásicas durante la nefrectomía radical. La necesidad de reintervención fue del 2,3% mientras que, la mortalidad perioperatoria fue del 4,7%. El 30% debutaron con metástasis al diagnóstico. Veinte pacientes progresaron a 15,5 meses (3-55). La supervivencia global fue de 60 meses. La mortalidad cáncer específica fue del 75%. La supervivencia libre de enfermedad fue del 30% a 55 meses. CONCLUSIONES: El tratamiento quirúrgico del cáncer renal con trombo venoso precisa un manejo multidisciplinar. La técnica quirúrgica seleccionada varía en función del nivel del trombo tumoral. El estadiaje tumoral es el factor pronóstico de mayor importancia. El nivel del trombo influye en el pronóstico, teniendo una supervivencia mayor aquellos pacientes con trombo confinado en vena renal (pT3a) frente a los tumores con trombo en aurícula (pT3c)

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)

[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).