http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 23 May 2013 18:49:11 +0000 http://www.hindawi.com/crim/urology/2013/482098/ We present the case of a penile fracture involving the proximal corpus cavernosum, presenting as a hematoma extending into the scrotum. The presentation, diagnosis, and surgical approach, which differ from the more typical penile shaft fracture, are delineated. A. Darves-Bornoz, M. M. DeBartolo, and A. M. Mishail Copyright © 2013 A. Darves-Bornoz et al. All rights reserved. Thu, 23 May 2013 18:48:48 +0000 http://www.hindawi.com/crim/urology/2013/485165/ Leiomyomas are the second most common tumors of epididymis. Patients with leiomyomas are sometimes misdiagnosed with testicular tumors. A Case of a patient with a scrotal mass presenting with testicular torsion is reported. Concurrent occurrence of testicular torsion and epididymal leiomyoma is an extremely rare condition. E. Arpali and A. Tok Copyright © 2013 E. Arpali and A. Tok. All rights reserved. Thu, 23 May 2013 18:02:54 +0000 http://www.hindawi.com/crim/urology/2013/624096/ Introduction. Von Hippel-Lindau (VHL) syndrome is a pathological condition that causes various clinical symptoms and is difficult to diagnose. The most common pathological lesions are hemangioblastomas of the central nervous system, retinal angiomas, renal clear cell carcinomas, and pheochromocytomas. Case Report. A 23-year-old female had a syncope episode in 2008. Magnetic resonance imaging (MRI) revealed a right temporal hemangioblastoma, which was treated surgically. Genetic screening identified a VHL gene mutation, and computed tomography (CT) revealed a left adrenal mass. Since it was unclear whether the mass was a pheochromocytoma, or another benign or malignant tumors, laparoscopic adrenalectomy was performed. A month after surgery, the patient complained of general fatigue, poor concentration, loss of appetite, and insomnia. After careful clinical investigation, the patient was referred to a psychiatrist due to suspected depression, which was confirmed. Conclusions. VHL genetic screening should be performed in cases of hemangioblastoma. In VHL syndrome cases, pheochromocytoma cannot always be diagnosed by biochemical catecholamine analyses; therefore, CT or MRI scanning of the abdomen must be performed. Due to the long treatment period, some patients may develop episodes of depression, which can simulate VHL syndrome. P. Vaganovs, K. Bokums, E. Miklaševics, J. Plonis, L. Zarina, I. Geldners, J. Gardovskis, and E. Vjaters Copyright © 2013 P. Vaganovs et al. All rights reserved. Thu, 23 May 2013 15:54:46 +0000 http://www.hindawi.com/crim/urology/2013/610312/ Bladder herniation within the inguinal canal is a relatively uncommon finding. We report an even less-common occurrence of transitional cell carcinoma located within a portion of inguinally herniated bladder. Fewer than 20 reports exist in the literature describing this scenario. Matthew A. Uhlman, Nathan A. Bockholt, and Amit Gupta Copyright © 2013 Matthew A. Uhlman et al. All rights reserved. Wed, 22 May 2013 14:22:26 +0000 http://www.hindawi.com/crim/urology/2013/472642/ We report a case of a 33-year-old male with a mixed germ-cell testicular tumor. Postoperative follow-up FDG-PET revealed concentration of FDG in the left inguinal area which is not tumor metastasis or local recurrence but suture reactivity granuloma. In this paper, we reviewed suture granulomas associated with false-positive findings on FDG-PET after surgery. If FDG-PET will be used more frequently in the future, it will be necessary to refrain from using silk thread in order to prevent any unnecessary surgery. Kohei Takahara, Hiroaki Kakinoki, Saya Ikoma, Kazuma Udo, Shohei Tobu, Yuji Satoh, Yuji Tokuda, Mitsuru Noguchi, Shigehisa Aoki, and Jiro Uozumi Copyright © 2013 Kohei Takahara et al. All rights reserved. Tue, 21 May 2013 10:38:42 +0000 http://www.hindawi.com/crim/urology/2013/167635/ Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery. Vinod Kumar Prabhuswamy, Rahul Tiwari, and Ramakrishnan Krishnamoorthy Copyright © 2013 Vinod Kumar Prabhuswamy et al. All rights reserved. Wed, 15 May 2013 14:08:39 +0000 http://www.hindawi.com/crim/urology/2013/482320/ Renal injuries are a common occurrence in many trauma cases. The management of these cases varies, but, currently, a conservative, nonoperative approach is the norm. In cases where an operative intervention may be necessary, emergency total nephrectomies are the most commonly performed procedure reported in the literature. There is a dearth in the reporting of other surgical approaches, especially the delayed nephron sparing approach. Here, we present a unique case of a 29-year-old male that underwent a delayed nephron sparing nephrectomy for a persistent urinoma despite appropriate noninvasive therapy. Parth K. Shah, Ryan W. Frieben, and Rowena A. DeSouza Copyright © 2013 Parth K. Shah et al. All rights reserved. Wed, 08 May 2013 16:49:06 +0000 http://www.hindawi.com/crim/urology/2013/915874/ Primary signet-ring cell carcinoma of the urinary bladder is extremely rare and patient survival is very poor. The disease usually presents at advanced stages because the cancer progresses rapidly. The only option for effective treatment is radical cystectomy, and no effective chemotherapy has been established for this variant. We report a case of signet-ring cell carcinoma of the urinary bladder with a long-term survival of 90 months owing to radical cystectomy and combination adjuvant chemotherapy with S-1 and cisplatin. To our knowledge, this is the first report to demonstrate the long-term therapeutic activity of combination S-1 and cisplatin adjuvant chemotherapy against invasive signet-ring cell carcinoma of the urinary bladder. Takashi Hamakawa, Yoshiyuki Kojima, Taku Naiki, Yasue Kubota, Takahiro Yasui, Keiichi Tozawa, Yutaro Hayashi, and Kenjiro Kohri Copyright © 2013 Takashi Hamakawa et al. All rights reserved. Tue, 07 May 2013 09:05:19 +0000 http://www.hindawi.com/crim/urology/2013/194690/ Primary urethral squamous cell carcinoma is rare. Its management is particularly challenging owing to the paucity of evidence from randomised trials to inform practice. We report two male and female cases of squamous cell carcinoma of the urethra, which were treated with concomitant cisplatin and radiotherapy. These cases add to the body of case reports that have shown benefit for concomitant chemoradiotherapy in urethral squamous cell carcinoma. They also illustrate that single agent chemotherapy, namely, cisplatin, may be used successfully with limited toxicities. H. Coop, L. Pettit, C. Boon, and P. Ramachandra Copyright © 2013 H. Coop et al. All rights reserved. Thu, 02 May 2013 14:37:29 +0000 http://www.hindawi.com/crim/urology/2013/913953/ Ahmad Alkhasawneh and Robert W. Allan Copyright © 2013 Ahmad Alkhasawneh and Robert W. Allan. All rights reserved. Thu, 02 May 2013 10:33:33 +0000 http://www.hindawi.com/crim/urology/2013/812475/ Endometriosis is a chronic gynaecological disorder characterized by the presence of endometrial tissue outside the uterus. The disease most often affects the ovaries, uterine ligaments, fallopian tubes, and cervical-vaginal region. Urinary tract involvement is rare, accounting for around 1%-2% of all cases, of which 84% are in the bladder. We report a case of isolated lumbar ureteral stenosis due to endometriosis in a 37-year-old patient. The patient came to our observation complaining from lumbar back pain and presented with severe fever. The urological examination found monolateral left positive sign of Giordano. Blood tests evidenced marked lymphocytosis and increased valued of C-reactive protein. Urologic ultrasound showed hydronephrosis of first degree in the left kidney and absence of images related to stones bilaterally. Uro-CT scan evidenced ureteral stenosis at the transition between the iliac and pelvic tracts. We addressed the patient to surgery, and performed laparoscopic excision of the paraureteral bulk, endoscopic mechanical ureteral dilation, and stenting. The histological examination evidenced glandular structures lined by simple epithelium and surrounded by stroma. Immunohistochemical test of the glandular epithelium showed positivity for estrogen and progesterone receptors and moreover stromal cells were positive for CD10. The finding suggested a very rare diagnosis of isolated lumbar ureteral endometriosis. Salvatore Butticè, Antonio Simone Laganà, Valeria Barresi, Antonino Inferrera, Giuseppe Mucciardi, Antonina Di Benedetto, Carmela Emanuela D'Amico, and Carlo Magno Copyright © 2013 Salvatore Butticè et al. All rights reserved. Tue, 30 Apr 2013 08:16:21 +0000 http://www.hindawi.com/crim/urology/2013/459618/ Introduction. Hemolytic uremic syndrome (HUS) is characterized by endothelial dysfunction, consumption thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure. HUS generally has a dismal prognosis, except when associated with gastroenteritis caused by verotoxin-producing bacteria. Cancer associated HUS is uncommon, and there are only scarce reports on prostate cancer presenting with HUS. Case Presentation. A 72-year-old man presented to the emergency department with oliguria, hematuria, and hematemesis. Clinical evaluation revealed acute renal failure, hemolysis, normal blood-clotting studies, and prostate-specific antigen value of 1000 ng/mL. The patient was started on hemodialysis, ultrafiltration with plasma exchange, and androgen blockade with bicalutamide and completely recovered from HUS. The authors review the 14 published cases on this association. Conclusion. The association of HUS and prostate cancer occurs more frequently in patients with high-grade, clinically advanced prostate cancer. When readily recognized and appropriately treated, HUS does not seem to worsen prognosis in prostate cancer patients. R. Ramos, F. Lopes, T. Rodrigues, N. Rolim, I. Rodrigues, and H. Monteiro Copyright © 2013 R. Ramos et al. All rights reserved. Wed, 24 Apr 2013 13:18:48 +0000 http://www.hindawi.com/crim/urology/2013/874035/ Urachal remnant disease is uncommon in adults and can present with symptoms ranging from drainage near the umbilicus to a severe abdominal infection. Most cases are referred for treatment once diagnosed either clinically or radiographically with ultrasound or computerized tomography. We present a unique case of an infected urachal cyst visualized on a series of CT scans in an adult patient with abdominal pain over a period of years. Seong K. Lee, Chauniqua Kiffin, Rafael Sanchez, Eddy Carrillo, and Andrew Rosenthal Copyright © 2013 Seong K. Lee et al. All rights reserved. Tue, 23 Apr 2013 08:19:32 +0000 http://www.hindawi.com/crim/urology/2013/356576/ Lymphoepithelioma-like carcinoma (LELC) in the bladder is uncommon with a reported incidence of 0.4%–1.3% of all bladder carcinomas. In Japan, some occurrences of LELC have been reported in the renal pelvis and ureter but only two in the bladder. A bladder tumor was identified in a 70-year-old man suffering from macroscopic hematuria for 2 months. Sections of the transurethral tumor resection showed invasive high-grade urothelial carcinoma. The patient was diagnosed with local invasive bladder tumor, and cystectomy with ileal conduit formation was performed. The final pathological evaluation was predominant LELC with urothelial carcinoma. We present a new case of LELC in the bladder and performed a review of all published cases of LELC in the urinary tract to obtain its characteristics and prognostic guide. Kenichi Mori, Tadasuke Ando, Takeo Nomura, Fuminori Sato, and Hiromitsu Mimata Copyright © 2013 Kenichi Mori et al. All rights reserved. Tue, 16 Apr 2013 11:24:09 +0000 http://www.hindawi.com/crim/urology/2013/120383/ This paper reports the case of 34-year-old woman who presented with bilateral renal angiomyolipomas (AMLs). On the right side, there was a large AML with a fatty thrombus extending to the right atrium. The treatment consisted of right nephrectomy and complete thrombectomy with extracorporeal circulation and right atriotomy. Postoperatively, the patient was septic and died on postoperative day 7 because of septic shock. Yassine Nouira, Yousri Kallel, Mourad Gargouri, Ahmed Sellami, Rami Boulma, Jalel Ziedi, Mohamed Chelif, Sami Ben Rhouma, Taoufik Kalfat, and Adel Khayati Copyright © 2013 Yassine Nouira et al. All rights reserved. Mon, 15 Apr 2013 15:34:20 +0000 http://www.hindawi.com/crim/urology/2013/986362/ Spontaneous bladder perforation is an uncommon event in childhood. It is usually associated with bladder augmentation. We are presenting a case of bladder rupture in an infant with neurogenic bladder without prior bladder surgery. Three days after lipomyelomeningocele excision the patient showed signs and symptoms of acute abdomen. The ultrasound exploration revealed significant amount of intraperitoneal free fluid and therefore a laparoscopic exploration was performed. A posterior bladder rupture was diagnosed and repaired laparoscopically. Currently, being 3 years old, she keeps successfully dry with clean intermittent catheterization. Neurogenic bladder voiding function can change at any time of its evolution and lead to complications. Early diagnosis of spontaneous bladder rupture is of paramount importance, so it is essential to think about it in the differential diagnosis of acute abdomen. Daniel Cabezalí Barbancho, Felix Guerrero Ramos, Francisco López Vázquez, Adolfo Aransay Bramtot, and Andrés Gómez Fraile Copyright © 2013 Daniel Cabezalí Barbancho et al. All rights reserved. Wed, 10 Apr 2013 16:08:16 +0000 http://www.hindawi.com/crim/urology/2013/147496/ Solitary fibrous tumor is a spindle cell neoplasm mostly originating from pleura; however, it has also recently been reported to be extrapleural. A 57-year-old man presented with left lumbal pain. Ultrasonography and computed tomography showed a cystic lesion of 14 × 11 cm with solid areas and septations in middle and lower poles of the left kidney. Radical nephrectomy was performed. Immunohistochemical studies showed strong reactions with CD34 and CD99. A nuclear positivity with Ki-67 was observed in less than 1% of cells. Despite repeated stainings with vimentin, no clear tumor evaluation could be made due to artifacts. The tumor was negative with Bcl-2, desmin, HMB-45, S100, FVIII, and CD31. Histopathological and molecular studies made the diagnosis of a solitary fibrous tumor. The patient is now currently free of disease at the 26th month of followup. Abdullah Demirtaş, Volkan Sabur, Hülya Akgün, Emre Can Akınsal, and Deniz Demirci Copyright © 2013 Abdullah Demirtaş et al. All rights reserved. Wed, 10 Apr 2013 13:36:50 +0000 http://www.hindawi.com/crim/urology/2013/651081/ Background. Renal cell carcinoma (RCC) has unpredictable and diverse behavior. The classic triad of hematuria, loin pain, and abdominal mass is uncommon. At time of diagnosis, 25%–30% of patients are found to have metastases. Bones, lungs, liver, and brain are the frequent sites of metastases. RCC with metastasis to the head and neck region and thyroid gland is the rarest manifestation and anaplastic carcinoma behaving metastatic thyroid mass is an extremely rare presentation of RCC. Case Presentation. A 56-year-old Saudi man with past history of right radical nephrectomy 5 years back presented with 3 months history of rapid increasing neck mass with dysphagia, presenting like anaplastic thyroid carcinoma. Tru-cut biopsy turned out to be metastatic renal cell carcinoma. Patient was treated with radiation therapy 30 Gy in 10 fractions to mass. Patient died 4 months after the discovery of anaplastic thyroid looking metastasis. Conclusion. Rapidly progressing thyroid metastases secondary to RCC are rare and found often unresectable which are not amenable to surgery. Palliative radiotherapy can be considered for such patients. Khalid Riaz, Mutahir A. Tunio, Mushabbab AlAsiri, Asim Ali Elbagir Mohammad, and Muhammad Mohsin Fareed Copyright © 2013 Khalid Riaz et al. All rights reserved. Sun, 07 Apr 2013 15:12:09 +0000 http://www.hindawi.com/crim/urology/2013/124715/ Ease of sperm retrieval has not been previously described as a goal for patients undergoing radical prostatectomy for prostate cancer; however preservation of fertility is a known concern for some younger prostate cancer patients. We present the first known case of a patient with postejaculatory spermaturia following robotic assisted radical prostatectomy. We hypothesize that this is due to fistula formation between the vas deferens and the urinary tract. Chad Reichard, Edmund S. Sabanegh, J. Stephen Jones, and Khaled Fareed Copyright © 2013 Chad Reichard et al. All rights reserved. Thu, 04 Apr 2013 18:11:56 +0000 http://www.hindawi.com/crim/urology/2013/631809/ Sarcomatoid carcinoma of the prostate is among the rarest malignant neoplasm types and has been well known for its aggressive clinical course. Patient was admitted with the symptoms of lower urinary tract. Transurethral resection of prostate (TUR-P) was carried out. Revealing Gleason 5 + 3 = 8 prostate adenocarcinoma in TUR-P material. Thereby, a Radical Prostatectomy procedure was planned. In operation, frozen examination revealed adenocarcinoma metastasis to the obturator lymph node. The operation was terminated. In the postoperative 3rd month, the patient was re-admitted with acute urinary system symptoms. A cystoscopy performed and complete resection of the mass was performed. The pathological examination reported that the tumor was compatible with undifferentiated adenocarcinoma owing to presence of poorly differentiated tumoral cells and detection of adenocarcinoma in a relatively small (1%) focus. 4 month after the operation, the patient underwent another cyctoscopic examination which revealed the prostatic lounge and most of the bladder lumen to be filled with tumoral tissue. The tumoral tissues was resected incompletely. This material was diagnosed to be “Sarcomatoid Malignant Tumor” upon the new evidences of progressive dedifferentiation and predominant sarcomatoid appearance, compared with the former TUR-P materials. Subsequent PET-CT scan depicted multiple metastasis. The patient was referred to oncology department. In conclusion, sarcomatoid carcinoma is a malignant variant that brings along diagnostic and treatment difficulties. Onur Açıkgöz, Eymen Gazel, Neslihan İnci Zengin, Yusuf Kasap, Ahmet Çamtosun, and Ahmet Hamdi Yazıcıoğlu Copyright © 2013 Onur Açıkgöz et al. All rights reserved. Thu, 04 Apr 2013 14:11:01 +0000 http://www.hindawi.com/crim/urology/2013/659582/ Male urethral “play” has been described for centuries. There are serious potential complications in this. We present a bizarre case of a variant of such play. A 49-year-old man presented with abdominal pain and incontinence. He had created a “neovagina” at the perineum for self-pleasure. The handle of a toilet brush was placed in the neovagina for self-pleasure but retracted into the bladder via a vesicoperineal fistula. An open cystotomy was performed to remove the foreign body. Aaron M. Potretzke, Kelvin S. Wong, and Tracy M. Downs Copyright © 2013 Aaron M. Potretzke et al. All rights reserved. Wed, 03 Apr 2013 09:11:14 +0000 http://www.hindawi.com/crim/urology/2013/937689/ Paratesticular tumours are pathologically rare. The vast majority are benign in nature with adenomatoid tumours representing the most common pathological entity. We present the case of a 32-year-old man, from the Indian subcontinent, who presented with a painful scrotal swelling sustained after trauma. The history suggested that the scrotal mass had been present for approximately 12 months, and a preliminary diagnosis of a haemorrhagic cyst caused by trauma was made. Initial management included scrotal support, analgesia, and a follow-up magnetic resonance imaging (MRI) scan. Subsequent imaging and then further histological analysis confirmed a partly necrotic/infarcted adenomatoid tumour of the right epididymis. After scrotal exploration and epididymectomy, the patient made a complete recovery, and, with the histological diagnosis, he was discharged with no further followup. The case is presented as a learning point in the identification and management of such pathologies. A. Gupta, M. Livingston, R. Singh, D. Tansey, and L. Solomon Copyright © 2013 A. Gupta et al. All rights reserved. Thu, 28 Mar 2013 14:03:29 +0000 http://www.hindawi.com/crim/urology/2013/125703/ Background and Aims. This report demonstrates the utility of a pudendal nerve block by pulsed radiofrequency ablation (RFA) for the treatment of male pelvic pain and urinary urgency and hesitancy. Methods. The patient is an 86-year-old gentleman with a 30-year history of urinary hesitancy and urgency. The patient also had pain in the area of the perineum but considered it a secondary issue. The patient was seen by a number of specialists, tried various medications, and underwent a variety of procedures to no avail. Therefore, the patient underwent a pulsed RFA of the pudendal nerve. Results. The patient underwent a pulsed RFA of the pudendal nerve; the patient reported marked improvement in his pelvic pain as well as a drastic reduction in his urinary urgency and hesitancy. Conclusion. Urinary urgency and hesitancy and male pelvic pain are some of the most common symptoms affecting men. Pudendal nerve block by pulsed RFA is an effective treatment of pelvic pain. It may also hold some therapeutic value in the treatment of urinary urgency and hesitancy as our case demonstrated. Further studies are needed to help clarify both the anatomy of the pelvis as well as if pudendal blocks are effective in treating more than pelvic pain. Christopher Bui, Sanjog Pangarkar, and Scott I. Zeitlin Copyright © 2013 Christopher Bui et al. All rights reserved. Tue, 26 Mar 2013 13:21:47 +0000 http://www.hindawi.com/crim/urology/2013/374973/ We present the case of a young man with Klinefelter syndrome, who was admitted to our clinic with renal colic. Shortly after admittance, spontaneous decrease in pain has occurred. Ultrasound and intravenous contrast computed tomography were performed, which showed the evidence of urine extravasation at the level of left renal pelvis and a 4 mm stone in the lower third of the left ureter. The management with a double-J ureteric stent for three weeks was successful. Then, the stent was removed and computed tomography confirmed the absence of urine extravasation. We also analyze the literature related to this case and discuss the main mechanisms of collecting system rupture. Sergey Reva and Yuri Tolkach Copyright © 2013 Sergey Reva and Yuri Tolkach. All rights reserved. Thu, 14 Mar 2013 13:14:40 +0000 http://www.hindawi.com/crim/urology/2013/490373/ Urinary bladder carcinoma is the second most common cancer of the urinary system. The recurrence rate in the upper urinary system (UUS) for urothelial cancers is around 3% following radical cystectomy. The followup generally consists of imaging studies and urinary cytology, although there are no prospective data on the frequency, the mode, and the duration of followup. In patients carefully selected according to risk factors, kidney-sparing minimally invasive methods (ureteroscopic procedures, percutaneous approach, and local drug instillation) appear as contemporary alternatives for low-grade and low-stage primary UUS. In this paper, we present the patient who underwent radical cystectomy with urinary diversion ureterocutaneostomy, was diagnosed with widespread bilateral UUS tumors and recurrent tumor at the urostomy site at active followup, for which he was given local Bacillus Calmette-Guérin (BCG) and cryotherapy, and was followed by disease-free for 2 years thereafter. Abdullah Demirtaş, Yunus Emre Yıldırım, Ayten Ferahbaş, Emre Can Akınsal, Oguz Ekmekçioğlu, and Atila Tatlışen Copyright © 2013 Abdullah Demirtaş et al. All rights reserved. Thu, 14 Mar 2013 13:14:20 +0000 http://www.hindawi.com/crim/urology/2013/247528/ Cohen's technique is the standard treatment of vesicoureteral reflux in children. Its disadvantage is still the classic difficulty in subsequent retrograde ureteral access, requiring the use of percutaneous techniques in the treatment of kidney stones. We describe a novel surgical technique for retrograde catheterization of an adult ureter by a flexible ureterorenoscope, thereby facilitating the treatment of a symptomatic diverticular kidney stone. We compare our technique to other methods described in the literature. Fahd Khalil, Mohamed Tligui, and Olivier Traxer Copyright © 2013 Fahd Khalil et al. All rights reserved. Wed, 06 Mar 2013 15:33:13 +0000 http://www.hindawi.com/crim/urology/2013/194620/ Multiple consecutive cancers involving different organs in a male individual are presented. Case Presentation. Herein, we present a rare case of primary right renal cell carcinoma (RCC), in which two different organ malignancies of prostate and breast were occurred consecutively. After proper treatment of each organ tumor, the patient experienced metachronous occurrence of its final tumor in his remained left kidney as left side RCC. Discussions. Multiple primary cancers are defined as occurrence of two or more malignancies, synchronous or metachronous, in different organs without any relation to each other. For primary and secondary tumors of the male genitourinary system, the most common occurrence was tumors of bladder and prostate followed by tumors of the kidney. Our case was a rare presentation of consecutive occurrence of multiple organ tumors: right side RCC, adenocarcinoma of prostate, and ductal cell carcinoma of the left breast, followed by left side RCC. Conclusions. In any case of primary malignancy of any organ, not only primary tumor recurrence but also tumoral growth of other nonrelated organs should be evaluated, especially in high risk patients or patients with positive familial history. Mohammad Ali Zargar-Shoshtari, Hossein Saffari, and Mohammad Kazem Moslemi Copyright © 2013 Mohammad Ali Zargar-Shoshtari et al. All rights reserved. Tue, 05 Mar 2013 14:17:11 +0000 http://www.hindawi.com/crim/urology/2013/206078/ Contralateral adrenal metastases from renal cell carcinomas are not commonly seen. To our knowledge, we are presenting the first case of extraadrenal metastasis in the English literature, from the contralateral RCC 6 months after radical nephrectomy. Patient was treated with robotic right adrenalectomy for continuous growing of a de novo right adrenal mass of 6 × 4 × 3 cm in diameter. Tissue between vena cava, renal capsule, and inferior diaphragmatic surface was removed en block. Pathological evaluation revealed renal cell carcinoma within the fatty tissue abutting the adrenal capsule from outside with negative surgical margins. Our experience dictates that removing adrenal tissue only after identifying the adrenal borders may sometimes result in insufficient tumor removal. Therefore, adrenal containing tissue within the anatomic boundaries should be removed en block, if surgical removal is planned for metachronous tumor metastasis in the treatment of renal cell carcinoma. Erdal Alkan, Oguz Ozkanli, and Derya Balbay Copyright © 2013 Erdal Alkan et al. All rights reserved. Sun, 03 Mar 2013 19:27:25 +0000 http://www.hindawi.com/crim/urology/2013/789039/ Primary bladder cancer is the fifth most common malignancy but secondary malignancies of the bladder are rare. Distinguishing primary adenocarcinomas of the bladder from secondary adenocarcinomas is difficult and relies on immunohistochemical staining. Prostate, colorectal, breast, and lung all can produce metastatic adenocarcinomas to the bladder. Further management of the malignancy varies depending on the source, thus making proper diagnosis critical. We present only the fifth documented case of metastatic adenocarcinoma of the lung to bladder and performed a review of the literature. Rishi A. Modh, Katherine A. Corbyons, and Lawrence L. Yeung Copyright © 2013 Rishi A. Modh et al. All rights reserved. Thu, 28 Feb 2013 18:44:40 +0000 http://www.hindawi.com/crim/urology/2013/387931/ Small cell prostate cancer constitutes less than 1% of all prostate cancers and has a poor prognosis. A 60-year-old male patient presented with dysuria, pollakiuria, and nocturia of about 1-year duration.The total PSA level at admission was 47.50 ng/mL. The prostate needle biopsy result was reported as adenocarcinoma Gleason 5 + 3. The patient underwent transurethral prostate resection (TUR-P) and bilateral orchiectomy. The TUR-P pathology result was consistent with small cell neuroendocrine carcinoma. He was offered systemic chemotherapy but refused it. Examinations and tests at the third postoperative month showed diffuse liver metastasis and vertebral bone metastasis. He died at the 6 months after surgery. Abdullah Demirtaş, Nurettin Şahin, Figen Öztürk, Emre Can Akınsal, Türev Demirtaş, Oguz Ekmekçioğlu, and Atila Tatlışen Copyright © 2013 Abdullah Demirtaş et al. All rights reserved.