Case Reports in Urology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Hematospermia and Cloacogenic Transitional Cell Carcinoma: A Twist on Significance and Meaning Mon, 08 Feb 2016 08:05:37 +0000 http://www.hindawi.com/journals/criu/2016/8050459/ A 52-year-old gentleman presented with recurrent hematospermia. Further history revealed recent onset of constipation and difficulty voiding. Rectal examination revealed a firm, polypoid mass and colonoscopy showed suspicious, ulcerated lesions of the rectal mucosa with narrowing of the rectal vault. Pathology demonstrated transitional cell carcinoma of the rectum. While transitional cell carcinoma is a common genitourinary cancer, its presence in the anus and rectum is exceedingly rare. Furthermore, hematospermia is generally not associated with malignancy. This case is a remarkable example of two pathologic processes presenting in rare form and underscores the value of a thorough investigation of hematospermia when associated with other clinical symptoms. Alex M. Hennessey, Jessica M. Clement, Faripour Forouhar, and John A. Taylor III Copyright © 2016 Alex M. Hennessey et al. All rights reserved. Scrotal Abscess Precipitating Late Infection of a Malleable Penile Prosthesis: The Risk Never Evanesces Thu, 04 Feb 2016 11:12:35 +0000 http://www.hindawi.com/journals/criu/2016/3280418/ Although infrequent, infections represent the dreadful complication of penile prosthesis implantation. The incidence substantially decreases after a few infection-free postoperative months. We report herein a case of a very late penile prosthesis infection from a fistualizing scrotal abscess in a 67-year-old man. The patient presented with a one-month history of persistent penile-base discharge from a right hemiscrotal swelling. On examination, mild penile tenderness and a discharging penoscrotal-junction sinus were noted. Microbiological wound culture was positive for Staphylococcus epidermidis. Magnetic resonance imaging revealed this multiloculated fluid collection’s communication with the right corporal body. Removal of the prosthesis was performed. Pathological evaluation of the dissected fistula was suggestive of acute on top of chronic inflammatory reactions. To our knowledge, this is the first report of a scrotal abscess leading to penile prosthesis infection 15 years after an uneventful implantation. Osama Mustafa, Sultan Althakafi, Said Kattan, Mohamed Kattan, and Naif AlHathal Copyright © 2016 Osama Mustafa et al. All rights reserved. Duplicated Renal System with H Shaped Ureter: An Extraordinary Anomaly Thu, 28 Jan 2016 15:04:22 +0000 http://www.hindawi.com/journals/criu/2016/4062515/ Duplex collecting systems are the most commonly encountered anomaly of the urinary system. Complete duplex system with an H shaped ureter is a very rare situation. There are only two reported H ureter cases in the literature. Herein, we aimed to present an H shaped ureter case, which was identified while performing ureterorenoscopy to a 48-year-old female patient due to a right distal ureteral stone. Fatih Akbulut, Metin Savun, Burak Ucpinar, Murat Sahan, Burak Arslan, Faruk Ozgor, Abdulmuttalip Simsek, Ahmet Yalcın Berberoglu, Murat Baykal, and Murat Binbay Copyright © 2016 Fatih Akbulut et al. All rights reserved. Salvage Procedure in Case of Urethrocavernous Fistula after Revision Surgery for Malfunctioning Three-Piece Penile Prosthesis Wed, 27 Jan 2016 06:11:23 +0000 http://www.hindawi.com/journals/criu/2016/4179862/ Urethrocavernous fistula is a rare complication of penile prosthesis. Literature lacks any materials regarding this complication’s treatment. We report our experience with a 66-year-old man who developed urethrocavernous fistula after penile prosthesis implant. Our technique involves the careful closure of urethral and corpus cavernosum defects with application of TachoSil above the sutures. After the salvage procedure, no recurrence of fistula occurred and patient was able to have sexual intercourse. We believe that our technique may be successfully used in case of urethrocavernous fistula after penile prosthesis implant. Enrico Caraceni, Angelo Marronaro, and Luca Leone Copyright © 2016 Enrico Caraceni et al. All rights reserved. A Rare Case of the Simultaneous, Multifocal, Metastatic Renal Cell Carcinoma to the Ipsilateral Left Testes, Bladder, and Stomach Thu, 21 Jan 2016 12:08:42 +0000 http://www.hindawi.com/journals/criu/2016/1829025/ We describe the rare case of a 68-year-old gentleman with the history of a hand-assisted laparoscopic left radical nephrectomy for a T2bN0M1 clear cell renal cell carcinoma (RCC). Seven years after surgery and with clean surveillance imaging for metastasis/recurrence the patient presented with three separate tumors suspicious for malignancy. A bladder lesion was found during workup for hematuria, a stomach lesion during diagnostic endoscopy, and a testicular lesion during self-exam. He underwent transurethral resection of bladder tumor, left inguinal orchiectomy, and upper endoscopic ensnarement. All specimens surprisingly showed RCC by histology and immunostaining. These three sites are rare for RCC metastasis and simultaneous presentation is even rarer, further emphasizing the importance of continuous and careful follow-up in this patient population, despite what could appear as complete remission. Michael Kongnyuy, Samuel Lawindy, Daniel Martinez, Justin Parker, and Mary Hall Copyright © 2016 Michael Kongnyuy et al. All rights reserved. Synchronous Renal Cell Carcinoma and Gastrointestinal Malignancies Tue, 19 Jan 2016 18:26:17 +0000 http://www.hindawi.com/journals/criu/2016/7329463/ While renal cell carcinoma is the most commonly diagnosed neoplasm of the kidney, its simultaneous diagnosis with a gastrointestinal malignancy is a rare, but well reported phenomenon. This discussion focuses on three independent cases in which each patient was diagnosed with renal cell carcinoma and a unique synchronous gastrointestinal malignancy. Case explores the diagnosis and surgical intervention of a 66-year-old male patient synchronously diagnosed with clear cell renal cell carcinoma and a carcinoid tumor of the small bowel. Case describes the diagnosis and surgical intervention of a 61-year-old male found to have clear cell renal cell carcinoma and a mucinous appendiceal neoplasm. Lastly, Case focuses on the interventions and management of a 36-year-old female diagnosed with synchronous clear cell renal carcinoma and hereditary nonpolyposis colorectal cancer. This case series examines each distinct patient’s presentation, discusses the diagnosis, and compares and contrasts the findings while discussing the literature on this topic. Tamer J. Dafashy, Cameron K. Ghaffary, Kyle T. Keyes, and Joseph Sonstein Copyright © 2016 Tamer J. Dafashy et al. All rights reserved. Spontaneous Retroperitoneal Haematoma due to Polyarteritis Nodosa: Report of a Case and Literature Review Mon, 18 Jan 2016 16:27:01 +0000 http://www.hindawi.com/journals/criu/2016/7592563/ Retroperitoneal haematoma is a rare clinical entity with variable etiology. It can happen spontaneously, without any obvious precipitating factors, the so-called spontaneous retroperitoneal haematoma. There is no general consensus as to the best management plan for patients with retroperitoneal haematoma. Polyarteritis nodosa (PAN) is a rare cause of retroperitoneal haematoma. Here we report relationship between PAN and retroperitoneal haematoma and treatment approaches. However, an accepted and clearly defined treatment has not been established due to its rarity. Emrah Simsek, Hasan Yilmaz, Kerem Teke, Ali Kemal Uslubas, and Mustafa Yuksekkaya Copyright © 2016 Emrah Simsek et al. All rights reserved. Incidental Finding of a Rare Urachal Pathology: Urachal Mucinous Cystic Tumour of Low Malignant Potential Sun, 03 Jan 2016 11:17:38 +0000 http://www.hindawi.com/journals/criu/2016/5764625/ Urachal mucinous cystic tumours are rare pathological findings with only 23 previously reported cases in the literature. We present the case of a 54-year-old man with an incidentally found urachal mucinous cystic tumour laparoscopically excised. With its known potential to cause pseudomyxoma peritonei, complete surgical excision is important. Long-term cystoscopic and radiological surveillance is also required. Luke L. Wang, Heath Liddell, Sharman Tan Tanny, Briony Norris, Sree Appu, and David Pan Copyright © 2016 Luke L. Wang et al. All rights reserved. Intrathoracic Kidney after Blunt Abdominal Trauma: A Case Report and Review of the Literature Thu, 31 Dec 2015 09:24:17 +0000 http://www.hindawi.com/journals/criu/2015/682649/ Abdominal trauma is responsible for most genitourinary injuries. The incidence of renal artery injury and intrathoracic kidney is quite low in patients who present with blunt trauma experiencing damage. There are four defined etiologies for intrathoracic kidney, which include real intrathoracic ectopic kidney, eventration of the diaphragm, congenital diaphragmatic herniation, and traumatic diaphragmatic rupture. The traumatic intrathoracic kidney is an extremely rare case. We presented intrathoracic kidney case after traumatic posterior diaphragmatic rupture. Fikret Halis, Akin Soner Amasyali, Aysel Yucak, Turan Yildiz, and Ahmet Gokce Copyright © 2015 Fikret Halis et al. All rights reserved. A Case of In-Bore Transperineal MRI-Guided Prostate Biopsy of a Patient with Ileal Pouch-Anal Anastomosis Wed, 30 Dec 2015 11:43:33 +0000 http://www.hindawi.com/journals/criu/2015/676930/ Ulcerative colitis (UC) is an inflammatory disease that specifically affects the colon. Ulcerative colitis is primarily treated medically and refractory disease is treated with proctocolectomy and ileal pouch-anal anastomosis (IPAA). Gastroenterologists advise against digital rectal exams, pelvic radiation therapy, and transrectal ultrasound (TRUS) biopsies of the prostates of ileal pouch-anal anastomosis patients. Any form of pouch manipulation can lead to severe bleeding, inflammation, and pain. Urologists are therefore faced with the challenge of doing a prostate biopsy without a transrectal ultrasound. We report the rare case of a patient with an ileal pouch-anal anastomosis who underwent in-bore transperineal MRI-guided biopsy of the prostate. Michael Kongnyuy, Thomas Frye, Arvin K. George, Amichai Kilchevsky, Amogh Iyer, Meet Kadakia, Akhil Muthigi, Baris Turkbey, Brad J. Wood, and Peter A. Pinto Copyright © 2015 Michael Kongnyuy et al. All rights reserved. Prostatic Stromal Tumor of Uncertain Malignant Potential Which Was Difficult to Diagnose Tue, 29 Dec 2015 09:14:52 +0000 http://www.hindawi.com/journals/criu/2015/879584/ Here, we report a case of stromal tumor of uncertain malignant potential (STUMP) that was difficult to diagnose. A 53-year-old male was found to have a hard nodule on digital rectal examination; magnetic resonance imaging revealed a large nodule on the left side of the prostate, indicating prostate cancer. However, pathological diagnosis of the biopsy specimen was benign prostatic hyperplasia. Although a papillary tumor in the prostatic urethra was also seen on urethrocystoscopy, the tumor specimen obtained from transurethral resection was not malignant. The tumor in the prostatic urethra recurred only 3 months after transurethral resection, and pathological findings revealed benign hyperplasia not only in the stromal tissue but also in the epithelium; therefore, the prostate tumor was suspected to be STUMP. It took many prostate pathologists a long time to reach the final diagnosis of STUMP. STUMP is a rare benign tumor, difficult to diagnose, and sometimes transforms into stromal sarcoma. Thus, we should consider radical resection in such cases. Satoko Matsuyama, Takahiro Nohara, Shohei Kawaguchi, Chikashi Seto, Yuko Nakanishi, Akio Uchiyama, and Shin Ishizawa Copyright © 2015 Satoko Matsuyama et al. All rights reserved. A 14-Year-Old Boy with Torsion of the Epididymal Cyst Mon, 21 Dec 2015 11:21:56 +0000 http://www.hindawi.com/journals/criu/2015/731987/ Epididymal cyst is a benign mass in the scrotum that is relatively common in adults but it is rare in children. In routine experience the treatment of such cysts is conservative. Torsion of these cysts is extremely rare and the diagnosis is made by exploration of the scrotum. Our patient was a 14-year-old boy who has been referred to hospital with scrotal pain followed by a minor trauma 3 days ago. Exploration of the scrotum to rule out testicular rupture was performed and a large black cyst connected to the head of the epididymis with 720-degree rotation was found. The cyst was resected and pathologic examination revealed an acquired epididymal cyst (spermatocele). The patient has normal physical exam after 3 months’ follow-up. Mojtaba Ameli, Samaneh Boroumand-Noughabi, and Leila Gholami-Mahtaj Copyright © 2015 Mojtaba Ameli et al. All rights reserved. Gluteal Necrosis and Lumbosacral Plexopathy in a Diabetic Patient after Renal Transplantation Thu, 17 Dec 2015 09:43:13 +0000 http://www.hindawi.com/journals/criu/2015/976912/ A 34-year-old diabetic patient underwent a renal transplant which was complicated by right side lower extremity paresis and numbness with gluteal necrosis. The main reason was ligation of internal iliac artery of the same side as a result of extensive microvascular obstruction due to severe atheromatous plaque. This is a rare complication which is mostly reported in aneurysmal patients after bypass surgery. The gluteal necrosis is a serious complication which, as in our patient, resulted in patient’s death in most of the reported cases. Because of catastrophic nature of this condition, identifying preventive measures is extremely important. M. A. Asgari, N. Masoumi, and H. Argani Copyright © 2015 M. A. Asgari et al. All rights reserved. “Looks Can Be Deceiving”: Adrenal Teratoma Causing Diagnostic Difficulty Wed, 16 Dec 2015 08:02:43 +0000 http://www.hindawi.com/journals/criu/2015/232591/ Teratomas are unusual tumours that derived from totipotent cells with their origin from more than one or usually all three germ cells. Here authors are presenting a case of primary retroperitoneal tumour that is a rare clinical entity. A 19-year-old male presented with right lumbar pain and was found to have complex cyst with large calcification in right adrenal gland on imaging. Intraoperatively, he was found to have a solid mass with areas of soft consistency, which was excised en bloc. On gross examination, the cyst contained pieces of bone, few teeth, and hairs entangled in mucinous material. On histological evaluation, it was confirmed to be mature teratoma arising from the right adrenal gland. He made uneventful recovery and was kept well on annual follow-up. Mehwash Nadeem, Muhammad Hammad Ather, M. Nasir Sulaiman, and Shahid Pervez Copyright © 2015 Mehwash Nadeem et al. All rights reserved. Primary Small Cell Carcinoma in Urinary Bladder: A Rare Case Tue, 15 Dec 2015 05:59:04 +0000 http://www.hindawi.com/journals/criu/2015/789806/ Small cell carcinoma of bladder, which does not have a common and accepted treatment protocol, is a rare and highly aggressive tumor. It is mostly pulmonary originated; however, it can rarely be seen in extrapulmonary sites. We presented an interesting and uncommon case, in which the transitional cell tumor was found in the transurethral resection specimen, but the small cell carcinoma was detected in the final radical cystectomy material. Ahmet Çamtosun, Huseyin Çelik, Ramazan Altıntaş, and Nusret Akpolat Copyright © 2015 Ahmet Çamtosun et al. All rights reserved. Incidental Bladder Cancer Detected on Multiparametric Magnetic Resonance Imaging of the Prostate Gland Sun, 13 Dec 2015 10:22:31 +0000 http://www.hindawi.com/journals/criu/2015/503154/ The increased use of axial imaging in various fields of medicine has led to an increased frequency of incidental findings, specifically incidental cancer lesions. Hence, as the use of multiparametric magnetic resonance imaging (MP-MRI) for prostate cancer detection, staging, and management becomes more widespread, the potential for additional incidental findings in the pelvis increases. Herein, we report the case of a man on active surveillance for low-grade, early-staged prostate cancer who underwent MP-MRI and was incidentally found to have a high-grade bladder cancer lesion. Al Sardari, John V. Thomas, Jeffrey W. Nix, Jason A. Pietryga, Rupan Sanyal, Jennifer B. Gordetsky, and Soroush Rais-Bahrami Copyright © 2015 Al Sardari et al. All rights reserved. Management of Recurrent Rectourethral Fistula by York Mason Posterior Transrectal Transsphincteric Approach Sun, 06 Dec 2015 09:45:15 +0000 http://www.hindawi.com/journals/criu/2015/854365/ Rectourethral fistula (RUF) may develop after ureterovesical and rectal intervention or radiation therapy (RT) rarely, but it is associated with significant morbidity and mortality. The patient will typically present with pneumaturia, faecaluria, and urinary drainage from the rectum. Diagnosis can be easily done with digital rectal examination, cystography, and urethrocystoscopy. Conservative supportive management of RUF does not appear to be successful in most patients, and management with surgical intervention remains the best treatment option. Several surgical techniques have been described including transabdominal, transanal, transperineal, combined abdominoperineal, anterior and posterior transsphincteric, transsacral, laparoscopic, robotic, and endoscopic minimally invasive approaches. There have been very few data about treatment of recurrent RUF. We would like to report the management of recurrent RUF following transurethral resection of prostate and RT for prostate carcinoma in an immunosuppressed, 75-year-old patient by York Mason posterior transrectal transsphincteric approach. Fahri Yetişir, A. Ebru Şarer, H. Zafer Acar, Omer Parlak, Gokhan Osmanoglu, and Gulen Karalova Copyright © 2015 Fahri Yetişir et al. All rights reserved. Metastatic Tumor of the Spermatic Cord in Adults: A Case Report and Review Thu, 03 Dec 2015 13:55:32 +0000 http://www.hindawi.com/journals/criu/2015/747261/ Metastatic spermatic cord (SC) tumor is extremely rare. Recently, we experienced a case of late-onset metastatic SC tumor from cecal cancer. This case is a 68-year-old man presenting with a painless right SC mass. He had undergone a right hemicolectomy for cecal cancer 6 years ago. Radical orchiectomy and adjuvant chemotherapy with S-1 were performed. No recurrence was found after one year of follow-up. We identified a total of 25 cases, including our case, on a literature search via PubMed from January 2000 to April 2015. The most frequent primary sites of the tumors metastasizing to the SC were the stomach (8 cases, 32%) and the colon (8 cases, 32%), next the liver (2 cases, 8%), and kidney (2 cases, 8%). The majority of the cases underwent radical orchiectomy for the metastatic tumors of the SC. Over half of the cases received adjuvant interventions based on the regimens for the primary tumors. Prognosis in the patients with metastatic tumor of the SC was unfavorable except for late-onset metastasis. In patients with a mass in the SC and a history of neoplasm, especially in gastrointestinal tract, the possibility of metastasis from the primary cancer should be considered. Daisaku Hirano, Mizuho Ohkawa, Ryo Hasegawa, Norimichi Okada, Naoki Ishizuka, and Yoshiaki Kusumi Copyright © 2015 Daisaku Hirano et al. All rights reserved. Endoscopic Removal of a Nitinol Mesh Stent from the Ureteropelvic Junction after 15 Years Tue, 01 Dec 2015 17:05:36 +0000 http://www.hindawi.com/journals/criu/2015/273614/ We report a rare case of a patient with a large stone encrusted on a nitinol mesh stent in the ureteropelvic junction. The stent was inserted in the year 2000 after failure of two pyeloplasty procedures performed due to symptomatic ureteropelvic junction stenosis. By combining minimally invasive urinary stone therapies—extracorporeal shock wave lithotripsy, semirigid ureterorenoscopy with laser lithotripsy, and percutaneous nephrolithotomy—it was possible to completely remove the encrusted stone and nitinol mesh stent that was implanted for 15 years, rendering the patient symptom and obstruction free. Tomaž Smrkolj and Domagoj Šalinović Copyright © 2015 Tomaž Smrkolj and Domagoj Šalinović. All rights reserved. Large Genital Cavernous Hemangioma: A Rare Surgically Correctable Entity Sun, 29 Nov 2015 12:15:48 +0000 http://www.hindawi.com/journals/criu/2015/950819/ We report a case of 24-year-old male presenting with painless penoscrotal swelling for 3 years. On examination, a large soft bag of worm-like, superficial, nonpulsatile swelling was present in scrotum and penis. Color Doppler showed dilated tortuous vessels and on angiography no connections to corpora or vessels were seen. So a diagnosis of hemangioma was made and a surgical excision was carried out by circumcoronal and scrotal incisions. Postop course was uneventful. At 6 months of follow-up, no recurrence was seen and wound had healed with excellent cosmetic appearance. Goto Gangkak, Anoop Mishra, Shivam Priyadarshi, and Vinay Tomar Copyright © 2015 Goto Gangkak et al. All rights reserved. “Rosary of Testes”: Splenogonadal Fusion in Association with Bilateral Abdominal Testes Presenting as Polyorchidism Sun, 29 Nov 2015 11:46:55 +0000 http://www.hindawi.com/journals/criu/2015/317189/ Polyorchidism is a rare anomaly where early segmentation in the gonadal ridge can lead to the development of three or less commonly four testes in one individual. Just over 150 reports of this phenomenon exist in English medical literature. However, once confronted by the clinical finding of supernumerary gonads, one must remain mindful of other likely diagnoses involving nontesticular origin. We report on a male patient with bilaterally impalpable testes in whom splenogonadal fusion mimicked polyorchidism. By keeping such differential diagnoses in mind, surgeons are more liable to take the appropriate intraoperative course of action. Pejman Shadpour and Behkam Rezaimehr Copyright © 2015 Pejman Shadpour and Behkam Rezaimehr. All rights reserved. Scrotal Lipomatosis Mimicking Varicocele: A Case Report and Review of the Literature Tue, 17 Nov 2015 11:11:04 +0000 http://www.hindawi.com/journals/criu/2015/695314/ Scrotal lipomatosis is a rarely seen disease with an etiology that is not fully understood. Some information suggests that this disease may be associated with infertility. It is characterized by pain-free scrotal swelling. In this study, we reported a scrotal lipomatosis case presenting due to infertility and pain-free scrotal swelling. It was operated on with the initial diagnosis of varicocele, but once fatty tissue was observed in the scrotum, the case was diagnosed as scrotal lipomatosis. Here, we present this rare case with a literature review. Sadi Turkan, Mehmet Kalkan, and Coşkun Şahin Copyright © 2015 Sadi Turkan et al. All rights reserved. Oncocytic Adrenocortical Neoplasm Diagnosed after Robot-Assisted Adrenalectomy Tue, 17 Nov 2015 06:32:08 +0000 http://www.hindawi.com/journals/criu/2015/515071/ Oncocytic tumors, composed of eosinophilic, mitochondria-rich cells, can occur in several locations throughout the body. These tumors can occur in the adrenal cortex and are rarely malignant. We report a case of a patient presenting with an incidental adrenal mass which was later diagnosed as a oncocytic adrenocortical neoplasm (OAN). The patient is a 53-year-old man found to have a 7.2 cm right adrenal mass, incidentally found by computed tomography (CT). After metabolic workup was negative, a right robotic adrenalectomy (RA) was performed. Pathologic analysis revealed clusters of large cells with abundant eosinophilic and granular cytoplasm, consistent with OAN. This pathology is rare, with only about 150 cases described in the literature. It occurs in females 2.5 times more frequently and more commonly on the left side. Diagnosis is usually made by imaging criteria, typically with CT or magnetic resonance imaging (MRI). Treatment is generally surgical, since OAN can be malignant in some cases. Differentiation between benign and malignant OAN is done based on the Lin-Weiss-Bisceglia criteria and can be difficult. If malignancy is diagnosed, recurrence is common and close surveillance should be performed. Andrew C. Harbin, Andrew Chen, Siddharth Bhattacharyya, Jasvir S. Khurana, Joshua R. Kaplan, and Daniel D. Eun Copyright © 2015 Andrew C. Harbin et al. All rights reserved. Adenocarcinoma at Anastomotic Site of Ureterosigmoidostomy Potentially of Urothelial Origin Spreading to the Upper Urinary Tract Sun, 15 Nov 2015 07:53:34 +0000 http://www.hindawi.com/journals/criu/2015/564082/ Ureterosigmoidostomy is associated with the risk of several late complications including cancer development at anastomotic sites. We present an unusual case with adenocarcinoma of the anastomotic site associated with multiple adenocarcinoma lesions in the upper urinary tract. A 69-year-old man complained of persistent melena and hematuria. He had undergone radical cystectomy for high-grade bladder cancer and ureterosigmoidostomy 30 years before. Colonoscopy showed a tumor at the right ureterocolonic anastomosis, which was endoscopically resected and histologically diagnosed as adenocarcinoma. Seven years later, a tumor of the left ureterocolonic anastomosis associated with hydronephrosis was found. He underwent temporal percutaneous nephrostomy followed by sigmoidectomy and left ureterocutaneostomy. Eighteen months after the operation, computed tomography (CT) detected left renal pelvic tumor with a mass along the former nephrostomy tract. Left nephroureterectomy and resection of the nephrostomy tract tumor revealed adenocarcinoma with multiple lesions of adenocarcinoma in the ureter. These tumors showed atypical immunohistochemistry as a colonic adenocarcinoma: positive for cytokeratin 7, negative for cytokeratin 20, and negative for β-catenin nuclear accumulation. Anastomotic site adenocarcinoma of the present case is potentially of urothelial origin because of unusual clinical manifestation and immunohistochemistry as a colon cancer. Katsuhiro Makino, Haruki Kume, Teppei Morikawa, Aya Niimi, Tetsuya Fujimura, Tohru Nakagawa, Hiroshi Fukuhara, and Yukio Homma Copyright © 2015 Katsuhiro Makino et al. All rights reserved. Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty Mon, 09 Nov 2015 10:00:38 +0000 http://www.hindawi.com/journals/criu/2015/646784/ Excision with primary anastomosis (EPA) urethroplasty is generally the preferred method for short strictures in the bulbar urethra, given its high success rate and low complication rate compared to other surgical interventions. Bleeding is a presumed risk factor for any surgical procedure but perioperative hemorrhage after an EPA requiring hospitalization and/or reintervention is unreported with no known consensus on the best course for management. Through our experience with three separate cases of significant postoperative urethral hemorrhage after EPA, we developed an algorithm for treatment beginning with conservative management and progressing through endoscopic and open techniques, as well as consideration of embolization by interventional radiology. All the three of these cases were managed successfully though they did require multiple interventions. We theorize that younger patients with more robust corpus spongiosum and more vigorous spontaneous erections, patients that have undergone fewer prior urethral procedures and therefore have more prominent vasculature, and those patients managed with a two-layer closure of the ventral urethra without ligation of the transected bulbar arteries are at a higher risk for this complication. L. A. Bertrand, S. P. Elliott, B. N. Breyer, and B. A. Erickson Copyright © 2015 L. A. Bertrand et al. All rights reserved. Laparoscopic Management of a Complex Adrenal Cyst Sun, 08 Nov 2015 08:32:32 +0000 http://www.hindawi.com/journals/criu/2015/234592/ Adrenal cysts are rare, and their clinical management remains controversial. We report a case involving an adrenal cyst with a complicated appearance on radiological studies. Unenhanced computed tomography revealed a unilocular, noncalcified, hypoattenuating mass with a thin wall in the left adrenal gland. The lesion gradually increased in size from 10 to 50 mm at two-year follow-up. On contrast-enhanced magnetic resonance imaging, a mural nodule with contrast enhancement was observed. The entire adrenal gland was excised en bloc via a lateral transperitoneal laparoscopic approach without violating the principles of surgical oncology. The pathological diagnosis was an adrenal pseudocyst. Laparoscopic adrenalectomy is a safe option for the treatment of complex adrenal cysts, while maintaining the benefits of minimal invasiveness. Koichi Kodama, Yasukazu Takase, Susumu Niikura, Akiko Shimizu, Hiroki Tatsu, and Katsuhiko Saito Copyright © 2015 Koichi Kodama et al. All rights reserved. Primary Desmoplastic Melanoma of the Penis Tue, 03 Nov 2015 10:18:48 +0000 http://www.hindawi.com/journals/criu/2015/706572/ Desmoplastic melanomas are rare amelanotic melanomas that usually occur on skin with sun exposure. In this report, we present a 72-year-old man who presented with a desmoplastic melanoma of the penis. To our knowledge this represents the first reported case of primary desmoplastic melanoma of the penis. We discuss the pathologic differential and histologic evaluation. Julia T. Chu, Michael A. Liss, William W. Wu, Atreya Dash, and Di Lu Copyright © 2015 Julia T. Chu et al. All rights reserved. Aggressive Angiomyxoma of the Bladder Neck Requiring Local Excision and Mitrofanoff Formation Wed, 28 Oct 2015 11:50:07 +0000 http://www.hindawi.com/journals/criu/2015/819243/ Aggressive angiomyxoma is a rare mesenchymal tumour predominantly affecting the female pelvis and perineum but has also been described in males. This tumour can often present a diagnostic challenge and has a propensity for local recurrence after surgical excision. We present an unusual case of aggressive angiomyxoma arising from the bladder of a female patient which required local excision and Mitrofanoff formation. M. Davari, B. W. Lamb, S. Chowdhury, C. Jameson, J. D. Kelly, and T. Greenwell Copyright © 2015 M. Davari et al. All rights reserved. Femoral Metastasis from Penile Carcinoma: Report of 2 Cases Thu, 22 Oct 2015 13:26:42 +0000 http://www.hindawi.com/journals/criu/2015/583851/ Purpose. Penile cancer rarely gives symptomatic skeletal metastases. Methods. We present 2 patients with squamous carcinoma of the penis who were surgically treated for metastases in the femur. Results. Both patients had pathological fractures and were operated on. In one case, the skeletal metastasis preceded any lymphatic spread of the disease, suggesting early haematogenous dissemination. Conclusions. Endoprosthetic reconstruction resulted in pain relief and restored the ambulatory capacity. Clinicians should be aware of the possibility for symptomatic bone metastases with a risk for pathological fracture in patients with penile cancer. Laura Braumann, Panagiotis Tsagozis, Rikard Wedin, and Otte Brosjö Copyright © 2015 Laura Braumann et al. All rights reserved. The Forgotten Complication of Recurrent Nephrolithiasis: “Squamous Cell Carcinoma of the Renal Pelvis”—A Case and Review of the Literature Thu, 22 Oct 2015 13:24:00 +0000 http://www.hindawi.com/journals/criu/2015/298317/ Squamous cell carcinoma (SCC) of the renal pelvis is an aggressive tumor with insidious onset of unspecific symptoms and advanced stages at diagnosis. It is a rare entity, accounting for 0.5–8% of renal tumors. In this paper, we describe the case of a patient with a history of recurrent nephrolithiasis that presented with an aggressive form of SCC of the renal pelvis with rapid relapse after resection. Tarek Assi, Elie El Rassy, Samah Naderi, Tania Moussa, Maroun Moukarzel, and Joseph Kattan Copyright © 2015 Tarek Assi et al. All rights reserved.