Case Reports in Urology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Huge Trombus including Left Renal Vein, Ovarian Vein, and Inferior Vena Cava Mimicking Renal Colic Tue, 22 Jul 2014 07:26:20 +0000 A 31-year-old female presented with acute left flank pain; she had a C/S at the postpartum day 24. Ureteral stone was suspected but ultrasound examination was normal. Then Doppler ultrasound revealed a trombus in left renal vein and inferior vena cava. Contrast enhanced MDCT scan showed swelled and nonfunctional left kidney, a trombus including distal part of left ovarian vein, left renal vein, and inferior vena cava. We started anticoagulation treatment. Further examination revealed diagnosis of chronic myeloproliferative disease. The trombus was completely recanalized at 3-month followup. Sakir Ongun, Sermin Coban, Abdullah Katgi, Funda Obuz, and Aykut Kefi Copyright © 2014 Sakir Ongun et al. All rights reserved. A Case of the Nutcracker Syndrome Developed after Delivery Tue, 22 Jul 2014 06:38:47 +0000 We report a case of nutcracker syndrome that developed after delivery. A 32-year-old woman visited our clinic complaining of gross hematuria 4 months after delivery. Urethrocystoscopic examination failed to show hematuria coming from the ureteral orifice; however, enhanced computed tomography revealed the compression of the left renal vein between the aorta and superior mesenteric artery. Therefore, we diagnosed her with nutcracker syndrome and conservatively observed her. The macrohematuria disappeared by itself after 1 month. This is the first report to describe a case of nutcracker syndrome that developed after delivery. Koji Tsumura, Kanae Yoshida, Sachi Yamamoto, Sayuri Takahashi, Katsuyuki Iida, and Yutaka Enomoto Copyright © 2014 Koji Tsumura et al. All rights reserved. SIMPLE Technique of Laparoscopic Nephrectomy for Ectopic Nonfunctioning Pelvic Kidney Secondary to Pelviureteric Junction Obstruction: A Feasible and Safe Technique Mon, 21 Jul 2014 09:10:47 +0000 Ectopic kidneys are rare developmental anomalies. Anomalous blood supply of the pelvic ectopic kidneys poses a problem for a minimally invasive surgery. Although laparoscopic nephrectomies have been described for symptomatic nonfunctioning pelvic ectopic kidney, this is the first case report that highlights the safety and feasibility of SIMPLE technique of laparoscopic nephrectomy in a pelvic kidney. Santosh Kumar, Kalpesh Mahesh Parmar, Sriharsha Shankaregowda Ajjoor, Nitin Garg, Kumar Jayant, and Shrawan Kumar Singh Copyright © 2014 Santosh Kumar et al. All rights reserved. Spontaneous Postmenopausal Urethral Prolapse Treated Surgically and Successfully Mon, 21 Jul 2014 07:51:17 +0000 Urethral prolapse (UP) is a circular complete eversion of the distal urethral mucosa through the external meatus. It is a rare condition seen mostly in African-American premenarcheal girls. Both a medical and a surgical approach to this condition have been described. We present a case of a spontaneous urethral prolapse in a 60-year-old postmenopausal Caucasian woman, who failed medical management and underwent successful surgical management. The patient is asymptomatic 18 months following the procedure. I. Klein, Y. Dekel, and A. Stein Copyright © 2014 I. Klein et al. All rights reserved. Forgotten Kirschner Wire Causing Severe Hematuria Thu, 17 Jul 2014 06:29:21 +0000 Kirschner wire (K-wire) is commonly used in the treatment of hip fracture and its migration into pelvis leading to bladder injury is a very rare complication. Nonremoval of these devices either because of lack of followup or because of prolonged requirement due to disease process is associated with this complication. We report a case of a patient who presented with acute onset severe hematuria with clot retention secondary to perforation of bladder by a migrated K-wire placed earlier, for the treatment of hip fracture. Initial imaging showed its presence in the soft tissues of the pelvis away from the major vascular structures. Patient was taken for emergency laparotomy and wire was removed after cystotomy. Postoperative period was uneventful and patient was discharged in satisfactory condition. K-wires are commonly used in the management of fracture bones and their migration has been reported in the literature although such migration in the intrapelvic region involving bladder is very rare. Early diagnosis and prompt removal of such foreign bodies are required to avert potentially fatal involvement of major structures. Santosh Kumar, Shrawan Kumar Singh, Kumar Jayant, Swati Agrawal, Kalpesh Mahesh Parmar, and Sriharsha Ajjoor Shankargowda Copyright © 2014 Santosh Kumar et al. All rights reserved. Fahr Syndrome Unknown Complication: Overactive Bladder Wed, 16 Jul 2014 13:03:23 +0000 A 38-year-old male patient was admitted to our outpatient department because of frequency and urgency incontinence. During evaluation it was detected that the patient was suffering from frequency which was progressive for one year, feeling of incontinence, and urgency incontinence. There was no urologic pathology detected in patient’s medical and family history. Neurologic consultation was requested due to his history of boredom, reluctance to do business, balance disorders, and recession for about 3 years. Brain computerized tomography (CT) scan revealed that amorphous calcifications were detected in the bilaterally centrum semiovale, basal ganglia, capsula interna, thalami, mesencephalon, pons and bulbus, and the bilateral cerebellar hemispheres. We have detected spontaneous neurogenic detrusor overactivity without sphincter dyssynergia after evaluating the voiding diary, cystometry, and pressure flow study. We consider the detrusor overactivity which occurred one year after the start of the neurological symptoms as the suprapontine inhibition and damage in the axonal pathways in the Fahr syndrome. Devrim Tuglu, Ercan Yuvanç, Fatih Bal, Yakup Türkel, Ersel Dağ, Erdal Yılmaz, and Ertan Batislam Copyright © 2014 Devrim Tuglu et al. All rights reserved. Concomitant Urothelial Cancer and Renal Tuberculosis Mon, 14 Jul 2014 11:08:00 +0000 We report a case of coexisting urothelial cancer and renal tuberculosis in the same kidney. The patient is a 72-year-old female with a remote history of treated pulmonary tuberculosis who presented with haematuria, initial investigation of which elucidated no definitive cause. Almost 1 year later, a diagnosis of metastatic urinary tract cancer was made. The patient received chemotherapy for advanced collecting duct type renal cell carcinoma, based on histological features of renal biopsy. Subsequent confirmatory immunostains however led to a revised diagnosis of urothelial cancer, necessitating a change in chemotherapy regimen. A diagnosis of ipsilateral renal tuberculosis was made based on TB-PCR testing of renal biopsy tissue and anti-TB therapy was coadministered with chemotherapy. The patient died 9 months after diagnosis of metastatic urothelial cancer. Sheray N. Chin, Tanya Foster, Gurendra Char, and Audene Garrison Copyright © 2014 Sheray N. Chin et al. All rights reserved. A Rare Cause of Testicular Metastasis: Upper Tract Urothelial Carcinoma Sun, 13 Jul 2014 00:00:00 +0000 Metastatic testicular cancers are rare. Primary tumor sources are prostate, lung, and gastrointestinal tract for metastatic testicular cancers. Metastasis of urothelial carcinoma (UC) to the testis is extremely rare. Two-thirds of upper tract urothelial carcinoma (UTUC) is of invasive stage at diagnosis and metastatic sites are the pelvic lymph nodes, liver, lung, and bone. We report a rare case of metastatic UTUC to the testis which has not been reported before, except one case in the literature. Testicular metastasis of UC should be considered in patients with hematuria and testicular swelling. Alper Nesip Manav, Ercan Kazan, Mehmet Şirin Ertek, Akın Soner Amasyalı, Nil Çulhacı, and Haluk Erol Copyright © 2014 Alper Nesip Manav et al. All rights reserved. A Giant Case of Pyonephrosis Resulting from Nephrolithiasis Thu, 03 Jul 2014 06:55:17 +0000 Pyonephrosis is an uncommon disease that is associated with suppurative destruction of the renal parenchyma in adults. Upper urinary tract infection and obstruction play a role in its etiology. Immunosuppression from medications (steroids), diseases (diabetes mellitus, AIDS), and anatomic variations (pelvic kidney, horseshoe kidney) may also be risk factors for pyonephrosis. Fever, shivering, and flank pain are frequent clinical symptoms. On physical examination, a palpable abdominal mass may be associated with the hydronephrotic kidney. Septic shock and death can occur if the disorder is not treated with urgent surgery. After the acute phase, most patients are treated with nephrectomy. In this paper, we share the etiology, clinical features, diagnosis and treatment of pyonephrosis using the background of a case with giant pyonephrosis developing due to a kidney stone, the most common cause of upper urinary tract obstruction. Ali Erol, Soner Çoban, and Ali Tekin Copyright © 2014 Ali Erol et al. All rights reserved. Contralateral Renal Cell Carcinoma Ureteric Metastases Can Arise on Tyrosine Kinase Adjuvant Therapy and Be Effectively Treated by Endoscopic Laser Excision and Ablation Tue, 01 Jul 2014 08:55:39 +0000 Renal cell carcinoma (RCC) uncommonly metastasizes to the ureter and rarely to the contralateral ureter. We describe the presentation of 2 successive contralateral ureteric metastases from RCC in our institution. The first represents the only reported metachronous ureteric deposit on adjuvant sorafenib after laparoscopic radical nephrectomy for RCC. The other presented with a synchronous lesion after radiological work-up. Both lesions were treated with endoscopic excision and laser ablation with preservation of the renal unit and no local recurrence. We report these cases and discuss the literature. Sarah L. Reid, Nikolas J. Arestis, Craig McIlhenny, and Gavin W. A. Lamb Copyright © 2014 Sarah L. Reid et al. All rights reserved. Conservative Management of a Delayed Neovesicocutaneous Fistula Sun, 29 Jun 2014 11:32:43 +0000 A neovesicocutaneous fistula is a rare complication after orthotopic bladder reconstruction, particularly in the late postoperative period. We report the case of a 59-year-old man who had undergone ileal neobladder construction 17 months previously. He presented with urinary retention concomitant with urinary tract infection due to a neovesicourethral anastomotic stricture. After a combination of transurethral catheter drainage and broad-spectrum antibiotic therapy for 3 weeks, the fistulous tract completely closed. Therefore, conservative treatment may be regarded as a valid option for a delayed neovesicocutaneous fistula. Koichi Kodama, Yasukazu Takase, and Isamu Motoi Copyright © 2014 Koichi Kodama et al. All rights reserved. Giant Nephrothoracic Abscess: A Misleading Disease, a Surgical Challenge, and an Unexpected Complication Thu, 26 Jun 2014 00:00:00 +0000 A rare case of perinephric abscess with unilateral secondary pulmonary involvement that was further complicated by spillover of purulent content into the contralateral lung is reported here. Its diagnosis, treatment, and evolution are described and discussed along with certain features of nephropulmonary fistulas. The diagnosis of these abscesses is difficult, largely because of the paucity of primary symptoms and the frequent presence of misleading secondary symptoms. Deceptive cases like this one highlight the importance of its contemplation in every physician’s differential diagnosis. Peter Kronenberg, Bruno Graça, and Manuel Ferreira Coelho Copyright © 2014 Peter Kronenberg et al. All rights reserved. Primary Vesical Actinomycosis in a 23-Year-Old Man Tue, 17 Jun 2014 11:21:32 +0000 Introduction. Actinomycosis can affect any organ of the body, although cutaneous fistulas are common in actinomycotic infections, and other organs such as the bladder are only rarely involved. Case Presentation. Herein we report and discuss a young male patient with primary vesical actinomycosis. A 23-year-old man was hospitalized complaining of intermittent gross hematuria over a 6-month duration. The patient underwent a cystoscopic examination under general anesthesia; an edematous, hyperemic, wide-based mass, which protruded from the dome of the bladder, was seen and incompletely resected. The histopathological examination of the material showed Actinomyces organisms surrounded by inflammation and a photomicrograph showed the microorganism. After confirmation of bladder actinomycosis, the patient received penicillin. A CT scan of the abdomen and pelvis showed no evidence of the mass at the postoperative 6th month. Cystoscopic examination showed complete healing of the transurethral resection area at the dome of the bladder. Conclusion. In conclusion, we believe that the gold standard treatment for vesical actinomycosis should include the combination of a transurethral resection of the mass and long-term penicillin treatment. Tevfik Ziypak, Senol Adanur, Fatih Ozkaya, Muhammet Calık, Ozkan Polat, Yilmaz Aksoy, and Isa Ozbey Copyright © 2014 Tevfik Ziypak et al. All rights reserved. A 55-Year-Old Man with Stage IV Squamous Cell Carcinoma of the Right Groin after External Beam Radiation for Testicular Cancer Sun, 15 Jun 2014 11:55:49 +0000 Treating testicular cancer with adjuvant radiation has been associated with a number of second malignancies affecting the genitourinary tract and retroperitoneal structures; however, there have been few reported cases of cutaneous second malignancies. We report the case of a man who developed stage IV squamous cell carcinoma (SCC) of a condyloma after orchiectomy and adjuvant radiation for testicular cancer. We also review relevant literature available to date. A 55-year-old Caucasian man presented to the hospital with a large growth at the right groin which had grown into his right thigh preventing ambulation. His past medical history was significant for right testicular cancer of unknown pathology treated with orchiectomy and adjuvant radiation twenty years ago. Punch biopsy of the lesion revealed superficially invasive squamous cell carcinoma. He underwent excision of the growth with subsequent Cisplatin, radiation boost, and Paclitaxel regimens. Despite an aggressive treatment regimen and an initial good response, the patient’s cancer progressed requiring palliative care. It is unclear whether or not therapeutic radiation in this case promoted the conversion of the patient’s condyloma to a malignant lesion. Further studies are required at this time to clarify the clinical implications of these findings. Christine Ibilibor, Jeremy Wells, Sravan Kavuri, and Kelvin A. Moses Copyright © 2014 Christine Ibilibor et al. All rights reserved. A Case of Recurrent Renal Aluminum Hydroxide Stone Mon, 09 Jun 2014 08:56:44 +0000 Renal stone disease is characterized by the differences depending on the age, gender, and the geographic location of the patients. Seventy-five percent of the renal stone components is the calcium (Ca). The most common type of the stones is the Ca oxalate stones, while Ca phosphate, uric acid, struvite, and sistine stones are more rarely reported. Other than these types, triamterene, adenosine, silica, indinavir, and ephedrine stones are also reported in the literature as case reports. However, to the best of our knowledge, aluminum hydroxide stones was not reported reported before. Herein we will report a 38-years-old woman with the history of recurrent renal colic disease whose renal stone was determined as aluminum hydroxide stone in type. Aluminum mineral may be considered in the formation of kidney stones as it is widely used in the field of healthcare and cosmetics. Basri Cakıroglu, Akif Nuri Dogan, Tuncay Tas, Ramazan Gozukucuk, and Bekir Sami Uyanik Copyright © 2014 Basri Cakıroglu et al. All rights reserved. Metachronous Primary Adenocarcinoma of Distal and Proximal Ureter within Two Years Mon, 02 Jun 2014 00:00:00 +0000 Primary adenocarcinoma of the upper urinary tract, particularly of the ureter, is an extremely rare entity. We are reporting on the first case of metachronous appearance in one patient. The 71-year-old man underwent partial ureterectomy (R0 resection) for primary adenocarcinoma of the left distal ureter. 3 years later, nephroureterectomy had to be performed because of metachronous primary adenocarcinoma of the left proximal ureter. Extensive examinations revealed no evidence for further malignancies at both times. Primary adenocarcinoma of the upper urinary tract is rare but should be kept in mind, especially in patients with chronic inflammation and urinary tract obstruction. Due to the low incidence, there is a lack of data regarding its pathogenesis, diagnosis, and optimal treatment. Dominik Abt, Gautier Müllhaupt, Livio Mordasini, Pierre André Diener, and Hans-Peter Schmid Copyright © 2014 Dominik Abt et al. All rights reserved. Idiopathic Scrotal Hematoma in Neonate: A Case Report and Review of the Literature Tue, 27 May 2014 08:11:13 +0000 Neonatal scrotal hematoma is a rare genitourinary emergency. Some cases have underlining aetiologic factors such as testicular torsion, adrenal hemorrhage, or birth trauma, and others are idiopathic. Previously, immediate scrotal exploration was considered imperative for diagnosis and treatment. With good imaging techniques, some patients are managed nonoperatively. We report a case of idiopathic scrotal hematoma in a neonate. He was managed conservatively with clinical and radiological follow-up. There was complete resolution of hematoma within two months, thus, avoiding unnecessary exploration. Bioku Muftau Jimoh, Eziechila Bessie Chinwe, Adewumi Oluwafemi Adebisi, Igwilo Chinwe Ifeoma, Maduka Ogechi, and Aiyekomogbon Joshua Oluwafemi Copyright © 2014 Bioku Muftau Jimoh et al. All rights reserved. Multiple Urethral Stones Causing Penile Gangrene Sun, 18 May 2014 00:00:00 +0000 Penile urethral stones are a rare occurrence resulting from a number of causes including migration of stones within the urinary tract, urethral strictures, meatal stenosis, and obstructing tumours such as adenomatous metaplasia of the uroepithelium, hypospadias, urethral diverticulum, and very rarely primary fossa navicularis calculi. We report the case of a 54-year-old male presenting with penile gangrene and sepsis resulting from impaction of multiple stones within the penile urethra. This paper summarises the topic and discusses the pathophysiology of this unusual condition. Michael J. Ramdass and Vijay Naraynsingh Copyright © 2014 Michael J. Ramdass and Vijay Naraynsingh. All rights reserved. A Rare Case of Continuous Type Splenogonadal Fusion in a Young Male with Primary Infertility Wed, 14 May 2014 09:38:58 +0000 Splenogonadal fusion is a rare developmental anomaly in which an abnormal connection between splenic tissue and gonads or mesonephric derivatives is present. Here we present a case of young man with the complaint of primary infertility for 3 years. On evaluation (USG and MRI abdomen and pelvis), his right scrotal testis was atrophied and left intra-abdominal undescended testis. On laparoscopic assessment, a mass was seen on the left side due to continuous type of splenogonadal fusion for which excision and left orchidectomy were done. Postoperative period was uneventful and he was discharged under satisfactory condition. Splenogonadal fusion is a rare entity and it is commonly mistaken for testicular tumour. It should be considered in the differential diagnosis of testicular masses especially when there are associated congenital anomalies and preoperative laparoscopic assessment, should be done to avoid unnecessary radical surgery. Santosh Kumar, Kumar Jayant, Swati Agrawal, Kalpesh Mahesh Parmar, and Shrawan Kumar Singh Copyright © 2014 Santosh Kumar et al. All rights reserved. Paratesticular Inflammatory Myofibroblastic Tumor in a Pediatric Patient Mon, 12 May 2014 06:33:31 +0000 Although rare, paratesticular inflammatory myofibroblastic tumor (IMT) represents the second most common paratesticular mass after adenomatoid tumor and comprises roughly 6% of such lesions. Only approximately four cases have been reported in patients younger than 18 years of age. We report an incidentally discovered paratesticular IMT in a 17-year-old male successfully treated with wide excision and testis sparing. To our knowledge, no recurrence has been reported after complete excision of paratesticular IMT; however, continued follow-up is recommended. Miriam Harel and John H. Makari Copyright © 2014 Miriam Harel and John H. Makari. All rights reserved. Abiraterone Acetate and Castration Resistant Ductal Adenocarcinoma of the Prostate Wed, 07 May 2014 13:33:22 +0000 Ductal adenocarcinoma of the prostate is a rare histological variant that only represents 1% of prostate tumors. This histological variant has several important clinical implications with respect to their evolution, clinical prognosis, and treatment. We report the case of a 64-year-old patient with ductal adenocarcinoma of the prostate, which progresses to castration-resistant prostate cancer, that was treated with abiraterone acetate with good clinical response, to our knowledge, the first case of ductal adenocarcinoma of the prostate in treatment with abiraterone acetate. Edgar Linden-Castro, Marcela Pelayo-Nieto, Alejandro Alias-Melgar, Daniel Espinosa-Perezgrovas, Ivan Ramirez-Galindo, and Gabriel Catalan-Quinto Copyright © 2014 Edgar Linden-Castro et al. All rights reserved. Metachronous Bilateral Granulocytic Sarcoma of the Testis in a Young Adult: A Report of an Unusual Entity Tue, 06 May 2014 00:00:00 +0000 Granulocytic sarcomas are rare tumors composed of neoplastic blood cells, typically occurring during the course of acute nonlymphoblastic leukemia or before its onset. We present a case of a 23-year-old young adult man with metachronous granulocytic sarcoma of the testis without hematologic manifestations who was diagnosed with granulocytic sarcoma (GS). The patient was treated with right orchiectomy but relapsed with a left testicular mass 16 months later when a left orchiectomy was performed. The patient has been free of disease for 13 months following the left orchiectomy. This case highlights a rare hematologic cancer that urologists and pathologists should be aware of since it can present as a testicular mass. Only 3 cases of testicular GS without an associated hematologic disorder have been described. To the best of our knowledge, our patient is the first reported case in the English literature of metachronous GS of the testis with no evidence of hematologic disorder. Fatih Hızlı, Hakan Aksüt, Aslı Mengeloğlu, İbrahim Sarı, Eşref Oğuz Güven, and Halil Başar Copyright © 2014 Fatih Hızlı et al. All rights reserved. Renal Paraganglioma: Report of a Case Managed by Robotic Assisted Laparoscopic Partial Nephrectomy and Review of the Literature Mon, 05 May 2014 00:00:00 +0000 We describe the pathological and clinical presentation of a rare case of renal paraganglioma occurring as an incidental left renal mass in a 58-year-old woman. The patient underwent robotic assisted laparoscopic partial nephrectomy, which is the first one in the literature. Burak Bahar, Stefan E. Pambuccian, Gopal N. Gupta, and Güliz A. Barkan Copyright © 2014 Burak Bahar et al. All rights reserved. Epididymal Polar Dissociation: A Previously Undescribed Anatomical Variant Sun, 04 May 2014 12:57:43 +0000 The normal male external genitalia include the testicles with the epididymis attached posteriorly and the vas deferens arising from this. This case describes an anatomical variation of this normal anatomy not previously reported in the literature. A 17-year-old boy presented with symptoms of intermittent testicular torsion and underwent scrotal exploration. On the left side there was a bell-clapper deformity with the epididymis separated into two parts with the lower pole high in the scrotum and attached to the tunica vaginalis. A normal vas deferens was seen to arise from the isolated lower pole of the epididymis. There was no connection between the vas deferens and the testis or upper pole of epidiymis. This case reminds us of the possibility of anatomical variations and the importance of keeping them in mind to prevent complications at time of surgery. Stephen McCain, Scott McCain, David Mark, and Robin Brown Copyright © 2014 Stephen McCain et al. All rights reserved. Circular Abscess Formation of the Inner Preputial Leaf as a Complication of a Penile Mondor's Disease: The First Case Report Sun, 27 Apr 2014 16:12:59 +0000 Introduction. Mondor's disease of the penis is an uncommon condition characterized by thrombosis or thrombophlebitis involving the superficial dorsal veins. An accompanied lymphangitis is discussed. There is typical self-limiting clinical course. Case Presentation. This paper firstly reports a secondary abscess formation of the preputial leaf two weeks after penile Mondor's disease and subcutaneous lymphangitis as complication of excessive sexual intercourse of a 44-year-old man. Sexual transmitted diseases could be excluded. Lesions healed up completely under abscess drainage, antibiotic, and anti-inflammatory medication. Conclusion. Previous reports in the literature include several entities of the penile Mondor's disease. Our patient is very unusual in that he presented with a secondary preputial abscess formation due to superficial thrombophlebitis, subcutaneous lymphangitis, and local bacterial colonisation. Abscess drainage plus antiphlogistic and antibiotic medication is the treatment of choice. Johann Jakob Wendler, Daniel Schindele, Daniel Baumunk, Uwe-Bernd Liehr, Markus Porsch, and Martin Schostak Copyright © 2014 Johann Jakob Wendler et al. All rights reserved. Autoinflation Leading to Failure of Two-Piece Ambicor Implantable Penile Prosthesis: An Outcome from a Methodical Treatment of Recalcitrant Stuttering Priapism Tue, 22 Apr 2014 00:00:00 +0000 Introduction. We present the case of a patient who received a two-piece Ambicor penile prosthesis for idiopathic recurrent “stuttering” priapism refractory to other treatment options. The patient returned unable to deflate the device due to an interesting anatomically induced mechanical failure. Aims. To describe the method and findings of this inflatable prosthesis failure. Results. Prosthesis failure occurred due to restrictive corporal diameter and the unique characteristics of fluid reservoir location in the two-piece inflatable prosthesis. The patient was successfully converted to a semirigid prosthesis with resolution of the pain that was due to his prosthesis autoinflation. Conclusion. Stuttering priapism remains a challenging clinical problem. Penile implantation is a reasonable long-term solution in a patient refractory to less invasive options. In patients with fibrotic corpora, a malleable device should be considered (at least temporarily) if unable to dilate comfortably to 13 mm. R. Charles Welliver Jr., Adam N. Fonseca, Bradford L. West, Kevin T. McVary, and Tobias S. Köhler Copyright © 2014 R. Charles Welliver Jr. et al. All rights reserved. Diagnosis of Rare Association of Orthotopic Multicystic Dysplasia with Crossed Fused Renal Ectopia Tue, 15 Apr 2014 12:18:50 +0000 Orthotopic multicystic dysplastic kidney with crossed fused ectopia is a rare congenital anomaly. This congenital anomaly may give an appearance of a solitary kidney morphology during the initial imaging evaluation. A solitary kidney should be carefully evaluated for the presence of duplication, horseshoe configuration, or crossed renal ectopy. Vesicoureteral reflux is a common finding associated with a multicystic dysplastic kidney. We present an infant with an orthotopic multicystic dysplastic kidney and an inferiorly placed crossed fused ectopic kidney. The presence of a complex congenital anomaly may warrant further evaluation with cross-sectional imaging to depict the anatomy and structure. Linnan Tang, June Koshy, Melissa R. Spevak, Jane E. Benson, and Thangamadhan Bosemani Copyright © 2014 Linnan Tang et al. All rights reserved. Concealed Enterovesical Fistula Associated with Forgotten Intra-Abdominal Haemostat and Intravesical Towel Mon, 14 Apr 2014 09:27:42 +0000 Introduction. Enterovesical fistula is rare and is often caused by bowel inflammatory diseases and tumours in the urinary bladder or the intestine with local infiltration of bowel or bladder, respectively. The fistula usually presents with lower urinary tract symptoms, pneumaturia, and faecaluria or with food particles in the urine. Intra-abdominal retained surgical foreign bodies have also been reported as causes. Case Presentation. A case of atypical presentation in a woman with enterovesical fistula following abdominal hysterectomy. Investigations confirmed the presence of surgical towel in the urinary bladder and a pair of artery forceps in the abdomen. The towel was removed at cystoscopy after which she presented with food particles in the urine. She later had laparatomy to remove the haemostat and to repair the fistula. Discussion. A typical presentation of enterovesical fistula delayed the diagnosis and treatment in this patient. Conclusion. Managing patients with recurrent urinary tract infection after abdominal operation should include appropriate imaging of the abdomen with emphasis on pelvic organs. Also, surgical operation should always be given the best shot the first time and strict operation room standards and guidelines should always be followed. Ademola Alabi Popoola, J. O. Bello, G. G. Ezeoke, K. T. Adeshina, and A. Fadimu Copyright © 2014 Ademola Alabi Popoola et al. All rights reserved. Amiodarone Induced Hyponatremia Masquerading as Syndrome of Inappropriate Antidiuretic Hormone Secretion by Anaplastic Carcinoma of Prostate Tue, 08 Apr 2014 09:56:11 +0000 Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one of the most common causes of hyponatremia. The usual causes are malignancies, central nervous system, pulmonary disorders, and drugs. Amiodarone is a broad spectrum antiarrhythmic agent widely used in the management of arrhythmias. The different side effects include thyroid dysfunction, visual disturbances, pulmonary infiltrates, ataxia, cardiac conduction abnormalities, drug interactions, corneal microdeposits, skin rashes, and gastrointestinal disturbances. SIADH is a rare but lethal side effect of amiodarone. We describe a 62-year-old male who was suffering from advanced prostatic malignancy, taking amiodarone for underlying heart disease. He developed SIADH which was initially thought to be paraneoplastic in etiology, but later histopathology refuted that. This case emphasizes the importance of detailed drug history and the role of immunohistochemistry in establishing the diagnosis and management of hyponatremia due to SIADH. Pinaki Dutta, Girish Parthan, Anuradha Aggarwal, Santosh Kumar, Nandita Kakkar, Anil Bhansali, Fabio Rotondo, and Kalman Kovacs Copyright © 2014 Pinaki Dutta et al. All rights reserved. Long-Term Results of Combined Tunica Albuginea Plication and Penile Prosthesis Implantation for Severe Penile Curvature and Erectile Dysfunction Tue, 25 Mar 2014 11:39:49 +0000 Penile prosthesis implantation is the recommended treatment in patients with penile curvature and severe erectile dysfunction (ED) not responding to pharmacotherapy. Most patients with mild-to-moderate curvature can expect cylinder insertion to correct both ED and penile curvature. In patients with severe curvature and in those with persistent curvature after corporeal dilation and prosthesis placement, intraoperative penile “modelling” over the inflated prosthesis has been introduced as an effective treatment. We report for the first time the long-term results of a patient treated with combined penile plication and placement of an inflatable penile prosthesis. Luigi Cormio, Paolo Massenio, Giuseppe Di Fino, Giuseppe Lucarelli, Vito Mancini, Giuseppe Liuzzi, and Giuseppe Carrieri Copyright © 2014 Luigi Cormio et al. All rights reserved.