Case Reports in Urology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. First Report of the Stapled Mesh Stoma Reinforcement Technique in a Urologic Context Wed, 22 Oct 2014 11:27:27 +0000 Parastomal hernia is a common complication of ileal conduit formation. Mesh repair of parastomal hernia has lower rate of recurrence than nonmesh techniques but can be time-consuming to perform. The stapled mesh stoma reinforcement technique (SMART) is a novel method of rapidly constructing a reinforced stapled stoma. We report the first case utilising this technique in a urologic context. The procedure was performed on a middle-aged female with recurrent parastomal hernia of her ileal conduit. There were no perioperative complications. The resited stoma remained healthy and functioned normally. Longer term data is clearly desirable though this technique deserves consideration in the treatment of urologic parastomal hernias. This case demonstrates that SMART is an easy and convenient procedure for parastomal hernia repair. Dwayne Tun Soong Chang, Isaac Andrew Thyer, John Oliver Larkin, Marina Helen Wallace, and Dickon Hayne Copyright © 2014 Dwayne Tun Soong Chang et al. All rights reserved. Inflammatory Pseudotumor Containing Necrotizing Granulomatous Lesions of Kidney: A Hitherto Undescribed Entity Tue, 14 Oct 2014 07:48:51 +0000 Herein reported is a case of inflammatory pseudotumor (IPT) of kidney. It is not described in WHO, AFIP, and other books. A review of the literature revealed about 35 cases. A 76-year-old man underwent nephrectomy under clinical diagnosis of renal pelvic carcinoma. Grossly, a solid tumor was seen in renal parenchyma. Microscopically, it was composed of spindle cell tissue with inflammation and many necrotizing granulomas. Epithelioid histiocytes were abundant but giant cells were few. Lymphocytes and plasma cells were also seen. The features suggested tuberculosis (TB), but Ziehl-Neelsen stains and PCR revealed no TB bacillus. Immunohistochemistry showed that the tumor spindle cells were positive for vimentin, CD68, CD45, and Ki-67 (labeling = 18%), α-smooth muscle antigen, and NSE. Focal staining of KIT (mast cells), S100 protein (Langerhans cells), and CD10 (spindle cells) was present. IgG4 was negative. The tumor spindle cells were negative for other antigens examined. Tadashi Terada Copyright © 2014 Tadashi Terada. All rights reserved. Urethrogluteal Fistula Developing Secondary to the Use of Clean Intermittent Self-Catheterization: First Case Report in the Literature Thu, 02 Oct 2014 09:29:03 +0000 Clean intermittent self-catheterization is the standard method for bladder evacuation in these patients today. The patient was diagnosed with urethrogluteal fistula and gluteal-perineal abscess by radiological evaluation. Gluteal drainage decreased after cystostomy. In our paper, a case of urethrogluteal fistula and pelvic urinoma that developed as a result of the use of clean intermittent self-catheterization (CISC), which is rarely found in the literature, is presented. Aliseydi Bozkurt, Mehmet Karabakan, Mehmet Soyturk, Erkan Hirik, and Barış Nuhoglu Copyright © 2014 Aliseydi Bozkurt et al. All rights reserved. Autopsy Report with Clinical and Pathophysiologic Discussion of Autosomal Dominant Adult Polycystic Kidney Disease Wed, 17 Sep 2014 07:35:00 +0000 The average weight of a kidney is approximately 135 gm, measuring on average 10 × 6 × 4 cm. In hereditary conditions, autosomal dominant and autosomal recessive polycystic kidney disease, the shape, size, and the weight can be significantly abnormal, causing progressive renal failure, often necessitating dialysis or renal transplant for survival. We report a case of adult polycystic kidney disease in a 50-year-old female without a family history, who died of complications of the disease which included accelerated hypertension, and renal and cardiac failure. Anup Hazra, Richard Siderits, Cheryl Rimmer, and Noah Rolleri Copyright © 2014 Anup Hazra et al. All rights reserved. Basal Cell Carcinoma of the Penis: A Case Report and Review of the Literature Sun, 14 Sep 2014 08:46:41 +0000 Basal cell carcinoma of the penis is an extremely rare entity, accounting for less than 0.03% of all basal cell carcinomas. Fortunately, wide local excision of such lesions is generally curative. Fewer than 25 cases have been reported in the literature describing penile basal cell carcinoma. Here we report a case of penile basal cell carcinoma cured with wide local excision. R. J. Roewe, Matthew A. Uhlman, Nathan A. Bockholt, and Amit Gupta Copyright © 2014 R. J. Roewe et al. All rights reserved. Penile Gangrene with Abscess Formation after Modified Al-Ghorab Shunt for Idiopathic Ischemic Priapism Mon, 08 Sep 2014 09:15:08 +0000 Penile gangrene is a rare but unfortunate complication of surgical intervention and priapism shunts. The literature regarding penile gangrene following surgical correction of priapism is sparse, the majority of which dates back to thirty to forty years. Here, we present the case of a 60-year-old man who presented with priapism that required operative management with a modified Al-Ghorab shunt and eventually suffered from complete necrosis of the penis with abscess formation in both corpora cavernosa. Beneranda S. Ford-Glanton, Parth Patel, and Sameer Siddiqui Copyright © 2014 Beneranda S. Ford-Glanton et al. All rights reserved. Surgical Reconstruction of the Urinary Sphincter after Traumatic Longitudinal Disruption Tue, 02 Sep 2014 12:17:03 +0000 The question is whether the urethral sphincter may be reconstructed after longitudinal injury similar to anal sphincter injuries. Analogue to obstetric, anal sphincter repair, an approximation repair of the sphincter may be feasible. An overlap repair is possible in anal sphincter repair, but because of the little tissue available in the urethral sphincter this is not an option. We describe three cases of urethral sphincter injury of different aetiologies. All resulted in a total longitudinal disruption of the muscular components of the urethral sphincter complex. After making the diagnosis of urethral sphincter injury, a primary approximation repair was done. Follow-up of at least two and up to three years is promising with one male patient being completely continent and the two female patients needing one safety pad per day. Longitudinal disruption of the muscular elements of the sphincteric urethra may be primarily reconstructed with good success using an approximation technique with simple interrupted sutures. Peter Rehder, Florian Schillfahrt, and Viktor Skradski Copyright © 2014 Peter Rehder et al. All rights reserved. Robot-Assisted Excision of a Pararectal Gastrointestinal Stromal Tumor in a Patient with Previous Ileal Neobladder Mon, 01 Sep 2014 05:36:59 +0000 Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract with surgical resection remaining the cornerstone of therapy. Pararectal lesions are considered to be technically difficult and pose in some cases a challenge. We report, to the best of our knowledge, the first robotic-assisted pararectal GIST excision. A 43-year-old man was referred to our center with pararectal GIST recurrence, despite treatment with targeted therapy. Eleven years ago, he underwent extensive abdominal surgery including cystoprostatectomy with ileal neobladder diversion due to GIST resection in the rectoprostatic space. Robot-assisted surgical resection was successfully performed without the need for temporary colostomy. The postoperative course of the patient was uneventful, and the pathology report confirmed a GIST recurrence with negative surgical margins and pelvic lymph nodes free of any tumor. Robotic-assisted pelvic surgery can be extended to incorporate excision of pararectal GISTs, as a safe, less invasive surgical alternative with promising oncological results and minimal injury to adjacent structures. A. Ploumidis, A. Mottrie, A. F. Spinoit, M. Gan, V. Ficarra, and R. Andrianne Copyright © 2014 A. Ploumidis et al. All rights reserved. IgG4-Related Disease in a Urachal Tumor Mon, 18 Aug 2014 07:48:33 +0000 IgG4-related disease is a newly recognized fibroinflammatory disorder that has the ability to affect nearly every organ system. It is characterized by tumefactive lesions and fibrosis and closely mimics neoplasms. Only one case of IgG4-related bladder mass has been reported in the literature, but there are no reports of IgG4-related disease in a urachal mass. Herein, we report a 26-year-old male who initially presented with symptoms of recurrent UTI. Work-up revealed a 6 cm urachal tumor, a 1.4 cm pulmonary lesion, and mediastinal lymphadenopathy; all metabolically active on PET scan and suspicious for urachal adenocarcinoma. Lung lesion fine needle aspiration and TURBT pathology revealed inflammation but no evidence of malignancy. The patient underwent a partial cystectomy and umbilectomy with pathology demonstrating dense plasmacytic cells, a high rate of immunohistochemistry staining positive for IgG4 plasma cells, a storiform pattern of fibrosis, and an obliterative phlebitis. Furthermore, the patient had an elevated serum IgG4 level of 227 mg/dL (range 2.4–121 mg/dL). IgG4-related disease is a newly recognized fibroinflammatory disorder that can mimic neoplastic processes and a high index of suspicion and accurate tissue pathology is necessary for an accurate diagnosis. Travis W. Dum, Da Zhang, and Eugene K. Lee Copyright © 2014 Travis W. Dum et al. All rights reserved. Forgotten DJ Stent with a Large Calculus at Its Distal End in an Ileal Conduit Diversion Mon, 18 Aug 2014 07:41:30 +0000 Calculus formation in an ileal conduit following cystectomy is a known complication. Encrustation and formation of calculus may also occur over a DJ stent retained for a long period; but this is never reported in patients with conduit diversion because of close surveillance of these patients. Here we report first case of a large calculus encrusted over a forgotten DJ stent within an ileal conduit in a man who had undergone urinary diversion following radical cystectomy for carcinoma urinary bladder 8 years earlier. Anurag Puri, Vinod Priyadarshi, Nivedita Raizada, and Dilip Kumar Pal Copyright © 2014 Anurag Puri et al. All rights reserved. Nanoparticle Albumin-Bound-Paclitaxel in the Treatment of Metastatic Urethral Adenocarcinoma: The Significance of Molecular Profiling and Targeted Therapy Mon, 18 Aug 2014 06:59:14 +0000 Primary urethral cancer is rare and accounts for only 0.003% of all malignancies arising from the female genitourinary tract. Due to the rarity of this disease, no consensus exists regarding the optimal therapeutic approach. Nanoparticle albumin-bound-paclitaxel has been shown to be effective in the treatment of a number of malignancies including metastatic breast, pancreatic, and bladder cancer. We present a 67-year-old woman with advanced metastatic urethral adenocarcinoma resistant to two lines of chemotherapy (ifosfamide/paclitaxel/cisplatin and irinotecan/5-fluorouracil/leucovorin) that showed a dramatic response to nanoparticle albumin-bound-paclitaxel. This is the first case report to document the use and efficacy of nanoparticle albumin-bound-paclitaxel in the treatment of unresectable metastatic urethral cancer. Yasmin M. Abaza and Carlos Alemany Copyright © 2014 Yasmin M. Abaza and Carlos Alemany. All rights reserved. Growing Teratoma Syndrome Sun, 17 Aug 2014 11:03:03 +0000 Growing teratoma syndrome (GTS) is a rare clinical entity, which presents with enlarging teratomas masses of the retroperitoneum or other locations, occurring during or after systemic chemotherapy for the treatment of nonseminomatous germ cell of the testis (NSGCT), with normalised tumour markers. Awareness of this syndrome is necessary in order to prevent unnecessary chemotherapy and allow optimal management. Prognosis is excellent after the excision of these tumors, but surgery has to be as complete as possible. Surgical resection of bulky GTS lesions is technically challenging; intraoperative complications may occur; that is, why the treatment must not be delayed. Our experience in the surgical management of these lesions is reviewed in the following work. Anna Scavuzzo, Zael Arturo Santana Ríos, Nancy Reynoso Noverón, and Miguel Angel Jimenez Ríos Copyright © 2014 Anna Scavuzzo et al. All rights reserved. Metastatic Prostate Adenocarcinoma Posing as Urothelial Carcinoma of the Right Ureter: A Case Report and Literature Review Wed, 13 Aug 2014 12:58:07 +0000 This is a case report of a 67-year-old patient with distant metastasis of prostate cancer to the right ureter which caused hydronephrosis. At the beginning, both of the cytology of the morning urine and imaging findings were consistent with urothelial carcinoma. Nephroureterectomy was subsequently performed. Interestingly, the pathological examination of the excised ureter revealed that the malignancy was derived from the prostate. No skeletal metastasis was detected. However, after four months of follow-up, several abnormal signal shadows were reported in skeletal scintigraphy and the prostate specific antigen (PSA) was gradually increasing. We present such a case for its unique presentation. A review of the literature is also provided. Tian-bao Huang, Yang Yan, Huan Liu, Jian-ping Che, Guang-chun Wang, Min Liu, Jun-hua Zheng, and Xu-dong Yao Copyright © 2014 Tian-bao Huang et al. All rights reserved. Bladder Endometriosis and Endocervicosis: Presentation of 2 Cases with Endoscopic Management and Review of Literature Tue, 12 Aug 2014 13:07:59 +0000 Urinary tract endometriosis and endocervicosis are an uncommon pathologic finding, with a common embryological origin. We present 2 cases of female patients with bladder mass. The first one was a finding of a nodular formation in the bladder during study of a nonviable foetus and the second was an incidental finding of a neoformation in the fundus of the bladder during the realization of an ultrasound. In both cases, we performed a surgical management with transurethral resection. Histopathological examination revealed a bladder endometrioma in the first case and endocervicosis with associated endometriosis in the second. Javier Fuentes Pastor, Roberto Ballestero Diego, Miguel Ángel Correas Gómez, Eduardo Torres Díez, Alejandro Fernández Flórez, Gerardo Ballesteros Olmos, and Jose Luis Gutierrez Baños Copyright © 2014 Javier Fuentes Pastor et al. All rights reserved. Glanuloplasty with Oral Mucosa Graft following Total Glans Penis Amputation Tue, 12 Aug 2014 00:00:00 +0000 This is a report on the technique of neoglans reconstruction in a patient with amputated glans penis following guillotine neonatal circumcision. A 4 cm long and 2 cm wide lower lip oral mucosa graft was harvested and used to graft the distal 2 cm of the corporal bodies after 2 cm of the distal penile skin had been excised. One edge of the lower lip oral mucosa graft was anastomosed to the urethral margins distally and proximally to the skin. At six months of followup, patient had both satisfactory cosmetic and functional outcomes. Kwaku Appiah, George Amoah, Roland Azorliade, Kofi Gyasi-Sarpong, Ken Aboah, Douglas Arthur, Baah Nyamekye, Kwaku Otu-Boateng, Patrick Maison, Benjamin Twumasi-Frimpong, Issac Opoku Antwi, and Edwin Yenli Copyright © 2014 Kwaku Appiah et al. All rights reserved. Coexisting Papillary and Clear Renal Cell Carcinoma in the Same Kidney Sun, 10 Aug 2014 09:05:55 +0000 Renal cell carcinoma (RCC) is the most common solid lesion of the kidney. Bilateral synchronous benign and malignant renal tumors have been defined in some reports. However, unilateral concordance of malignant renal tumors is very rare and there are only a few cases that had synchronous different subtypes of malignant renal tumors arising within the same kidney. Herein, we describe a 67-year-old male patient who had clear cell RCC and papillary RCC in his right kidney that were successfully treated with radical nephrectomy. We also reviewed the pertinent literature. Murat Ustuner, Busra Yaprak, Kerem Teke, Seyfettin Ciftci, Mucahit Kart, Kursat Yildiz, and Melih Culha Copyright © 2014 Murat Ustuner et al. All rights reserved. Palliative Surgery for Rare Cases of Anterior Urethral Metastasis in Prostate Cancer Tue, 05 Aug 2014 07:20:19 +0000 Penis metastasis from prostate cancer is very rare, and its management varies from case to case as there are very few cases reported in the literature. We describe a patient with prostate cancer treated with radiotherapy and androgen deprivation therapy who presented with urethral bleeding as a symptom of anterior urethral metastasis during followup. We propose a way to manage this and review the literature. Enrique Gómez Gómez, Jose Carlos Carrasco Aznar, Maria del Mar Moreno Rodríguez, José Valero Rosa, and Maria José Requena Tapia Copyright © 2014 Enrique Gómez Gómez et al. All rights reserved. Giant Malignant Pheochromocytoma with Palpable Rib Metastases Sun, 03 Aug 2014 12:52:48 +0000 Pheochromocytoma is a rare and usually benign neuroendocrine neoplasm. Only 10% of all these tumors are malignant and there are no definitive histological or cytological criteria of malignancy. Single malignancy criteria are the presence of advanced locoregional disease or metastases. We report a case, with a giant retroperitoneal tumor having multiple metastases including palpable rib metastases, who was diagnosed as a malignant pheochromocytoma. The patient was treated with surgery. The literature was reviewed to evaluate tumor features and current diagnostic and therapeutic approaches for patients with metastatic or potentially malignant pheochromocytoma. Esat Korgali, Gokce Dundar, Gokhan Gokce, Fatih Kilicli, Sahande Elagoz, Semih Ayan, and Emin Yener Gultekin Copyright © 2014 Esat Korgali et al. 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.