Case Reports in Urology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . 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. Dabigatran Induced Hemorrhagic Cystitis in a Patient with Painful Bladder Syndrome Thu, 13 Mar 2014 13:35:20 +0000 An 82-year-old female presented with longstanding history of both painful bladder syndrome and atrial fibrillation. She underwent hydrodistension remarkable for hematuria without temporary discontinuation of Dabigatran. Subsequently, patient was admitted to the hospital secondary to anemia and hemorrhagic cystitis. Helen Otteno, Erica Smith, and R. Keith Huffaker Copyright © 2014 Helen Otteno et al. All rights reserved. A Rare Case of Paratesticular Leiomyosarcoma Tue, 11 Mar 2014 08:46:47 +0000 Paratesticular leiomyosarcomas are rare and can lead to significant morbidity and mortality, if inadequately diagnosed or treated. We present a case of paratesticular leiomyosarcoma in an 88-year-old man presenting with a left scrotal mass with ultrasound revealing that the mass is extratesticular. Left radical orchidectomy was performed and pathological examination of the resected specimen confirmed the diagnoses of high grade leiomyosarcoma with surgical margins clear of tumour. The patient was free of metastatic disease on further imaging and has been disease-free for 18 months. A review of the literature regarding paratesticular leiomyosarcoma presentation, diagnosis, and treatment is also discussed. Shankar Haran, Vikram Balakrishan, and Greg Neerhut Copyright © 2014 Shankar Haran et al. All rights reserved. Primary Leiomyosarcoma of the Adrenal Gland: A Case Report with Immunohistochemical Study and Literature Review Tue, 04 Mar 2014 12:56:22 +0000 Primary adrenal leiomyosarcoma is extremely rare tumor. We report a case with adrenal leiomyosarcoma. Our case was a 48-year-old man who presented with lower urinary tract symptoms. Ultrasonography and magnetic resonance imaging revealed approximately 9 cm solid mass originating from right adrenal gland. He underwent right adrenalectomy. Pathology of the specimen showed histologic and immunohistochemical features of adrenal leiomyosarcoma. Murat Tolga Gulpinar, Asif Yildirim, Berrin Gucluer, Ramazan Gokhan Atis, Cengiz Canakci, Cenk Gurbuz, and Turhan Caskurlu Copyright © 2014 Murat Tolga Gulpinar et al. All rights reserved. Distant Ureteral Metastasis from Colon Adenocarcinoma: Report of a Case and Review of the Literature Tue, 04 Mar 2014 09:00:40 +0000 Carcinomas arising from organs neighbouring the ureter can directly infiltrate the ureter. Distant ureteral metastasis from colon adenocarcinoma is extremely rare and usually an incidental finding in performed autopsies. We report a case of a right ureteral metastasis in a 65-year-old Caucasian male with a history of rectal cancer for which he had been treated 4 years before. He presented with asymptomatic moderate right hydronephrosis. The patient underwent a right nephroureterectomy. Histology of the ureter revealed transmural adenocarcinoma with infiltration of the mucosa. Infiltration of the muscular coat of the bladder was found 2 years later. Thus, cystectomy and left ureterocutaneostomy were performed. The patient died 6 months later due to toxic megacolon during chemotherapy. The differential diagnosis of ureteral adenocarcinoma, especially in patients with previous history of colon adenocarcinoma, should include the possibility of distant metastasis from the primary colonic tumor. Ferakis Nikolaos, Anastasopoulos Panagiotis, Bouropoulos Konstantinos, Samaras Vassilios, and Poulias Iraklis Copyright © 2014 Ferakis Nikolaos et al. All rights reserved. Complete Renal Artery Embolization in a Comorbid Patient with an Arteriovenous Malformation Tue, 04 Mar 2014 08:45:45 +0000 Renal arteriovenous malformations are uncommon and are rarely a cause for presentation. However, they can occasionally pose life-threatening problems. We present a case of an elderly female who underwent a complete left renal artery embolization, following a difficult presentation complicated by advanced dementia and multiple comorbidities. This is the first documented case of complete renal artery embolisation used to treat a renal AVM. Anthony Thayaparan, Tarik Amer, Eamon Mahdi, Omar Aboumarzouk, and Owen Hughes Copyright © 2014 Anthony Thayaparan et al. All rights reserved. Asymptomatic Bladder Metastasis from Breast Cancer Tue, 04 Mar 2014 07:39:08 +0000 Introduction. Breast cancer is the most common nondermatologic cancer in women. Common metastatic sites include lymph nodes, lung, liver, and bone. Metastases to the bladder are extremely rare, with all reported cases presenting with urinary symptoms. Case Report. Herein, we report the first case of completely asymptomatic bladder metastasis from breast cancer, occasionally revealed, 98 months after the initial diagnosis of lobular breast carcinoma, by a follow-up computed tomography scanning showing thickening of left bladder wall and grade II left hydronephrosis. A positive staining for estrogen and progesterone receptors was confirmed by immunohistochemistry. Discussion. The reported case confirms that bladder metastases from breast cancer tend to occur late after the diagnosis of the primary tumor and, for the first time, points out they can be asymptomatic. Conclusion. Such data support the need for careful follow-up and early intervention whenever such clinical situation is suspected. Luigi Cormio, Francesca Sanguedolce, Giuseppe Di Fino, Paolo Massenio, Giuseppe Liuzzi, Nicola Ruocco, Pantaleo Bufo, and Giuseppe Carrieri Copyright © 2014 Luigi Cormio et al. All rights reserved. Stone Formation from Nonabsorbable Clip Migration into the Collecting System after Robot-Assisted Partial Nephrectomy Sun, 23 Feb 2014 13:18:15 +0000 We describe a case in which a Weck Hem-o-lok clip (Teleflex, Research Triangle Park, USA) migrated into the collecting system and acted as a nidus for stone formation in a patient after robot-assisted partial nephrectomy. The patient presented 2 years postoperatively with left-sided renal colic. Abdominal computed tomography scan showed a 10 millimeter renal calculus in the left middle pole. After using laser lithotripsy to fragment the overlying renal stone, a Weck Hem-o-lok clip was found to be embedded in the collecting system. A laser fiber through a flexible ureteroscope was used to successfully dislodge the clip from the renal parenchyma, and a stone basket was used to extract the clip. Ziho Lee, Christopher E. Reilly, Blake W. Moore, Jack H. Mydlo, David I. Lee, and Daniel D. Eun Copyright © 2014 Ziho Lee et al. All rights reserved. Laparoscopic Repair of a Ureteric Sciatic Hernia: Report of a Case Sun, 23 Feb 2014 12:00:19 +0000 Ureteric sciatic hernias are extremely rare. Here we report a case of a 78-year-old woman presented with colicky left abdominal pain. Computed tomography revealed a ureteric sciatic hernia, and drip infusion pyelography revealed dilated left ureter with herniation of the ureter into the sciatic foramen. The hernia was successfully repaired laparoscopically. We have described the diagnosis and management of the patient, followed by a review of the literature on sciatic hernias. Yasuo Tsuzaka, Kazuhiro Saisu, Nobuo Tsuru, Yukio Homma, and Hiroyuki Ihara Copyright © 2014 Yasuo Tsuzaka et al. All rights reserved. Nephron Sparing Surgery for Renal Angiomyolipoma with Inferior Vena Cava Thrombus in Tuberous Sclerosis Sun, 23 Feb 2014 10:52:50 +0000 Introduction. Angiomyolipoma is a common benign renal tumor. It is associated with Tuberous Sclerosis Complex (TSC) in 20% of patients. Angiomyolipomas are classically multiple, bilateral, and growing; they may lead to complications such as Wunderlich syndrome or, in rare cases, to venous extension. Observation. a 74-year-old woman with TSC presented with an angiomyolipoma of the right kidney with inferior vena cava (IVC) fatty thrombus. She underwent partial nephrectomy and thrombectomy. After a 7-year follow-up there was no evidence of recurrence or metastasis and her renal function was preserved. Review of Literature. It is the 44th reported angiomyolipoma associated with IVC thrombus. The mean size of angiomyolipomas was 86.1 mm and 67.4% of patients were symptomatic. Pulmonary embolism was found in 6 patients. There were 2 cases of recurrence/metastatic outcome after radical nephrectomy and thrombectomy. They were associated with epithelioid form. The mean size of epithelioid tumors was significantly bigger than in classical angiomyolipomas (127.1 mm versus 82.6 mm, ). With a median follow-up of 12 months, 91.3% of patients were recurrence and metastasis free, with 3 cases of nephron sparing surgery. Conclusion. Nephron sparing surgery for angiomyolipoma with IVC fatty thrombus can be safely performed in TSC, even in sporadic angiomyolipoma. Adrien Riviere, Thomas Bessede, and Jean-Jacques Patard Copyright © 2014 Adrien Riviere et al. All rights reserved. Removal of a Penile Constriction Device with a Large Orthopedic Pin Cutter Thu, 20 Feb 2014 13:50:20 +0000 Penile strangulation is an infrequent clinical condition that has widely been reported. It usually results following placement of a constriction device to enhance sexual stimulation. Early treatment is essential to avoid potential complications, including ischemic necrosis and autoamputation. We describe the use of a Large Orthopedic Pin Cutter to remove a metal penile constriction device in the Emergency Department (ED). This case report describes the relatively safe technique of using an instrument available in many hospitals that can be added to the physician’s arsenal in the removal of metal constriction devices. Avinash Chennamsetty, David Wenzler, and Melissa Fischer Copyright © 2014 Avinash Chennamsetty et al. All rights reserved. Medullary Sponge Kidney and Testicular Dysgenesis Syndrome: A Rare Association Tue, 18 Feb 2014 12:41:38 +0000 The medullary sponge kidney is also known as Lenarduzzi’s kidney or Cacchi and Ricci’s disease from the first Italian authors who described its main features. A review of the scientific literature underlines particular rarity of the association of MSK with developmental abnormalities of the lower urinary tract and genital tract such as hypospadias and bilateral cryptorchidism. The work presented is the only one in the scientific literature that shows the association between the medullary sponge kidney and the testicular dysgenesis syndrome. A question still remains unanswered: are the MSK and TDS completely independent malformation syndromes occurring, in this case, simultaneously for a rare event or are they different phenotypic expressions of a common malformative mechanism? In the future we hope that these questions will be clarified. Stefano Masciovecchio, Pietro Saldutto, Giuseppe Paradiso Galatioto, and Carlo Vicentini Copyright © 2014 Stefano Masciovecchio et al. All rights reserved. A Case of Malignant Pheochromocytoma Detected during Fertility Treatment Wed, 05 Feb 2014 13:57:50 +0000 We report a case of malignant pheochromocytoma in a 35-year-old Japanese woman during fertility treatment, successfully treated with surgical excision. The patient recovered without any postoperative problems, and plasma catecholamine levels normalized. At present, 18 months after the operation, there are no signs of relapse. Kazuhisa Hagiwara, Itsuto Hamano, Ayumu Kusaka, Hiromi Murasawa, Noriko Tokui, Kengo Imanishi, Akiko Okamoto, Hayato Yamamoto, Atsushi Imai, Shingo Hatakeyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, and Chikara Ohyama Copyright © 2014 Kazuhisa Hagiwara et al. All rights reserved. Robotic Assisted Laparoscopic Prostatectomy in Men with Proctocolectomy and Restorative Ileal Pouch-Anal Anastomosis Wed, 05 Feb 2014 07:16:21 +0000 We conducted a retrospective chart review of robotic prostatectomies done by a single surgeon between 2003 and 2012. During that time period, we identified two patients within the year 2012, with ileal pouch-anal anastomosis (IPPA) who also underwent robotic prostatectomies. The demographics and postoperative characteristics of the two patients were assessed. In both patients, prostatectomy, bilateral nerve sparing, and pelvic lymphadenectomy were successfully performed and the integrity of ileal pouch was maintained. There was a mean surgical time of 144.5 minutes, and an average estimated blood loss was 125 mL. Both patients were discharged on the second day postoperatively. In both patients there was a Gleason upgrade to 3 + 4, with negative margins, and preservation of fecal and urinary continence by their six-month followup. Owing to surgical modifications, these two surgeries represent the first successful robotic prostatectomies in patients with a J-pouch. Michael Leapman, Young Suk Kwon, Shemille A. Collingwood, Edward Chin, Maria Katsigeorgis, Adele R. Hobbs, and David B. Samadi Copyright © 2014 Michael Leapman et al. All rights reserved. Metastatic Mucinous Adenocarcinoma of the Prostate with PSA Value of 8.6 ng/mL at 5-Year-Followup after Prostatectomy, Radiotherapy, and Androgen Deprivation Wed, 29 Jan 2014 12:35:25 +0000 Introduction. Mucinous adenocarcinoma of the prostate is a rare variant of prostate cancer. Its malignant potential and the clinical course of the affected patients remain, by and large, controversial. No data exist about the course of metastatic mucinous adenocarcinoma of the prostate. Case Presentation. This case report describes the excellent clinical course of a 68-year-old patient with metastatic mucinous adenocarcinoma of the prostate, treated by radical prostatectomy, irradiation, and androgen deprivation. Conclusion. In our case, mucinous adenocarcinoma of the prostate does not appear to behave differently than acinar prostate cancer. Its malignant potential is dependent on its Gleason score. Christos Kalaitzis, Michael Koukourakis, Stilianos Giannakopoulos, Alexandra Giatromanolaki, Efthimios Sivridis, Athanasios Bantis, and Stavros Touloupidis Copyright © 2014 Christos Kalaitzis et al. All rights reserved. Completely Intracorporeal Robotic-Assisted Laparoscopic Ileovesicostomy Wed, 29 Jan 2014 00:00:00 +0000 We present a report of a completely intracorporeal robotic-assisted laparoscopic ileovesicostomy with long term follow-up. The patient was a 55-year-old man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction. The procedure was performed using a da Vinci Surgical system (Intuitive Surgical, Sunnyvale, CA) and took 330 minutes with an estimated blood loss of 100 mL. The patient recovered without perioperative complications. He continues to have low pressure drainage without urethral incontinence over two years postoperatively. MaryEllen T. Dolat, Greg Wade, B. Mayer Grob, Lance J. Hampton, and Adam P. Klausner Copyright © 2014 MaryEllen T. Dolat et al. All rights reserved. Subpubic Cartilaginous Pseudocyst: Orthopedic Feature with Urological Consequences Thu, 16 Jan 2014 13:46:46 +0000 Introduction. Masses arising from structures adjacent to the female urethra can cause obstructive urinary symptoms. Subpubic cartilaginous pseudocyst is a rare degenerative lesion of pubic symphysis that may cause these symptoms. Materials and Methods. A 61-year- and 57-year-old women presented with symptoms of difficult micturition and dyspareunia. Physical examination revealed a painless smooth, rounded, firm, and cystic mass, at the anterior vaginal wall of about 4 cm width. The mass caused inward deviation of the external urethral meatus. Cystoscopy and MRI were done. Results. Cystoscopy of case 1 (61 y) demonstrated anterior external urethral compression with normal urethral mucosa. Cystoscopy was not possible in case 2 (57 y) because the urethra could not be entered under local anesthesia. MRI showed almost the same findings in both cases: midline, rounded, and cystic mass  cm, anterosuperior to the urethra, and posteroinferior to the pubic symphysis, with normal features of the urinary bladder. Open surgical excision of theses lesions was performed in both patients. Histopathologic assessment of the specimen obtained from both patients showed degenerated hyaline with areas of fibrinous and mucoid degeneration, a picture suggestive of cartilaginous subpubic pseudocyst. After 11-month and 4-month followup of patients numbers 1 and 2, respectively, there is no evidence of local recurrence of the lesion, either clinically or radiologically and both patients void empty. Conclusions. Subpubic cartilaginous pseudocysts are rare benign lesions with only 13 cases were reported in the literature. Patients present with a spectrum of gynecological and/or urological manifestations. Sizable lesions severely compressing the urethra need surgical excision to restore the voiding function. Fawzy Farag, Ingrid van der Geest, Christina Hulsbergen-van de Kaa, and John Heesakkers Copyright © 2014 Fawzy Farag et al. All rights reserved. Cystosarcoma Phyllodes of the Seminal Vesicle: A Case Report and Literature Review Thu, 02 Jan 2014 10:07:14 +0000 Cystosarcoma of the seminal vesicle is a very rare malignant tumor; in the literature only four cases are reported. We present a case of cystosarcoma phyllodes arising in the right seminal vesicle of a 49-year-old man without any urinary symptom but with persistent constipation. Ultrasound examination showed a mass at the right superior base of the prostate subsequently studied with CT and MRI. The patient underwent vesiculectomy; his postoperative course was uneventful. The patient is still well, without evidence of recurrent disease. Lucio Olivetti, Francesco Laffranchi, and Vincenzo De Luca Copyright © 2014 Lucio Olivetti et al. All rights reserved. Laparoscopic Nephroureterectomy for Adult Patient with Primary Obstructive Megaureter Sun, 22 Dec 2013 14:01:56 +0000 A 29-year-old female with a complaint of abdominal distension was referred to our hospital. She had a history of being treated for pyelonephritis three times. By computed tomography and retrograde pyelography, she was diagnosed with adult left primary megaureter. Her left renal function was severely deteriorated. She hoped for surgical intervention before becoming pregnant. Laparoscopic nephroureterectomy for megaureters seems to be difficult due to the large size. By sucking urine from an inserted ureteral catheter and setting trocar positions, we successfully performed laparoscopic nephroureterectomy for megaureter. Kimito Osaka, Kazuhide Makiyama, Shinji Ohtake, Hiroyuki Yamanaka, Futoshi Sano, Noboru Nakaigawa, and Yoshinobu Kubota Copyright © 2013 Kimito Osaka et al. All rights reserved. Renal Cell Carcinoma Associated with Xp11.2 Translocation/TFE3 Gene Fusion: A Rare Case Report with Review of the Literature Sun, 22 Dec 2013 11:06:38 +0000 Introduction. The recently recognized renal cell carcinomas associated with Xp11.2 translocations are rare tumors predominantly reported in children. Chromosome Xp11.2 translocation results in gene fusion related to transcription factor E3 (TFE3) that plays an important role in proliferation and survival. Case Report. Herein, we present two cases of a TFE3 translocation-associated RCC in young female adults, one detected incidentally and the other one presenting with gross hematuria. Tumor is characterized by immunohistochemistry and a literature review with optimal treatment regimen is presented. Discussion. Xp11.2 translocation RCCs in adult patients are associated with advanced stages, large tumors, and extracapsular disease and usually have an aggressive clinical course. Conclusion. In TFE3 RCC, the genetic background may not only contribute to tumorigenesis, but also determine the response to chemotherapy and targeted therapy. Therefore it is necessary to diagnose this tumor entity accurately. Because of the small number of TFE3 gene fusion-related renal tumors described in the literature, the exact biologic behavior and impact of current treatment modalities remain to be uncertain. Puneet Ahluwalia, Balagopal Nair, and Ginil Kumar Copyright © 2013 Puneet Ahluwalia et al. All rights reserved. Squamous Upper Tract Carcinoma Presenting as a Perinephric Abscess Sun, 15 Dec 2013 14:47:59 +0000 Perinephric abscesses are life-threatening conditions, which are rarely associated with neoplasms of the kidney or upper tract collecting system. We report, to our knowledge, the first case of squamous carcinoma of the upper tract presenting as a perinephric abscess, diagnosed after radical nephrectomy. M. Lopes, D. Rauber, F. Carvalho, M. Nicodem, J. A. Noronha, and G. F. Carvalhal Copyright © 2013 M. Lopes et al. All rights reserved. The Case of the Wandering Kidney Wed, 11 Dec 2013 13:46:19 +0000 Nephroptosis is a controversial phenomenon well described in the literature. In this case report, we present a patient whose right kidney had “wandered” from its normal anatomic position in the retroperitoneum anteriorly and was in a fixed position anterior to the liver secondary to hydronephrosis. As opposed to the suspected mechanism of nephroptosis, we offer a hydraulic theory as to the origin of the energy required to cause this translocation. The work required to move the patient's kidney was generated by her cardiac output. David W. Sobel and Brian M. Jumper Copyright © 2013 David W. Sobel and Brian M. Jumper. All rights reserved. Unusual Presentation of Renal Cell Carcinoma: Gluteal Metastasis Wed, 11 Dec 2013 09:33:06 +0000 Renal cell carcinoma (RCC) has widespread and unpredictable metastatic potential. The most common sites of metastatic RCC are the lungs, lymph nodes, bones, liver, and brain; however the soft tissue metastasis is rare (2,3). Here we report a 76-year-old male patient who had renal cell carcinoma presented with gluteal metastasis. To our knowledge this is the first renal cell cancer case with gluteal metastasis at the initial diagnosis. Yunus Emre Goger, Mehmet Mesut Piskin, Mehmet Balasar, and Mehmet Kilinc Copyright © 2013 Yunus Emre Goger et al. All rights reserved. Surgical Treatment of Adrenal Gland Metastasis Originating from Small Cell Carcinoma of the Urinary Bladder Sun, 08 Dec 2013 14:32:11 +0000 We report a rare case of a solitary adrenal metastasis from small cell carcinoma of the urinary bladder that was successfully treated with surgical resection. A 71-year-old man was suffering from bladder tamponade for hematuria. Computed tomography (CT) revealed a bladder tumor at the left wall. The patients underwent radical cystectomy. Histopathological results were obtained in small cell carcinoma of the bladder with muscle invasion. Thus, he received two courses of adjuvant etoposide and cisplatin chemotherapy, followed by the regimen for small cell lung cancer. Seven months after surgery, follow-up CT showed a gradually enlarged mass enhanced heterogeneously in the right adrenal gland. There was a solitary adrenal metastasis without any other metastasis; therefore, we performed right laparoscopic adrenalectomy. The patient has remained uneventful for four years after the adrenal gland surgery. For patients who have a solitary adrenal metastasis, adrenalectomy may provide a survival benefit. Minekatsu Taga, Hideaki Ito, Naoya Kusukawa, Yoshiji Miwa, Hironobu Akino, Yoshiaki Imamura, and Osamu Yokoyama Copyright © 2013 Minekatsu Taga et al. All rights reserved. Diphallia with Associated Anomalies: A Case Report and Literature Review Sun, 08 Dec 2013 09:45:10 +0000 Diphallia or penile duplication is an extremely rare congenital anomaly. It occurs once in every 5.5 million live births. The extent of penile duplication and the number of associated anomalies vary greatly, ranging from a double glans from a penis with no associated anomaly up to complete penile duplication associated with multiple anomalies. Here, we report a 12-year-old boy with complete bifid diphallia associated with bifid scrotum, epispadia, and pubic symphysis diastasis along with a review of the articles pertaining to this anomaly. Pande Made Wisnu Tirtayasa, Robertus Bebet Prasetyo, and Arry Rodjani Copyright © 2013 Pande Made Wisnu Tirtayasa et al. All rights reserved. Infected Hydrocele of the Canal of Nuck Wed, 04 Dec 2013 14:57:57 +0000 Hydrocele of the canal of Nuck in children is rare. It may present as incarcerated inguinal hernia and necessitates emergency exploration. Risk of infection in hydrocele of the canal of nuck is very rare. We present a case report of a 5-year-old girl who presented with a left tender inguinolabial region swelling with fever, tachycardia, and mild dehydration. The clinical features were suggestive of strangulated left inguinal hernia and further imaging and surgical exploration revealed it to be an infected hydrocele of the canal of Nuck. High ligation and hydrocelectomy were performed. Hydrocele of the canal of Nuck in a female child presenting with an inguinal swelling should be considered in differential diagnosis. Parkash Mandhan, Zaid Raouf, and Khalid Bhatti Copyright © 2013 Parkash Mandhan et al. All rights reserved. Multidrug Resistant Epididymitis Progressing to Testicular Infarct and Orchiectomy Wed, 27 Nov 2013 14:13:05 +0000 Global testicular infarction is a rare sequela of infectious epididymitis, with few reports in the urologic literature since the introduction of fluoroquinolones in the late 1980s. Ischemia occurs secondary to inflammation and edema of the spermatic cord with compression of arterial flow. We report a case of multidrug resistant epididymitis following prostate biopsy that progressed to global testicular infarction requiring orchiectomy. This case highlights the fact that epididymitis does not always follow an indolent pathway to resolution. Progression of pain should prompt early imaging and intervention. It further highlights the potential urologic consequences of the rising prevalence of multidrug resistant bowel flora in the United States, which will increasingly influence the management of presumed uncomplicated epididymitis, whether being primary or postprocedural. Nicholas J. Farber, Rick C. Slater, and Jodi K. Maranchie Copyright © 2013 Nicholas J. Farber et al. All rights reserved.