Case Reports in Urology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Laparoscopic Treatment of a Spontaneously Ruptured Kidney (Wunderlich Syndrome) Thu, 26 Feb 2015 17:20:39 +0000 Spontaneous, nontraumatic retroperitoneal hemorrhage or Wunderlich syndrome (WS) is a rare but potential life-threatening condition. In most patients a bleeding renal neoplasm is the cause of the retroperitoneal hematoma. The management of this condition includes a conservative approach in the hemodynamically stable patients and active treatment in the unstable patients. Active treatment includes angioembolization or surgery. If angioembolization is not available open surgery is in most cases the preferred approach. We present a patient with a spontaneously ruptured kidney due to a central renal angiomyolipoma, which was treated by laparoscopic nephrectomy. Katharina Maria Bretterbauer, Dean Markić, Daniela Colleselli, Stephan Hruby, Ahmed Magdy, Günter Janetschek, and Michael Josef Mitterberger Copyright © 2015 Katharina Maria Bretterbauer et al. All rights reserved. 28-Year Survival following Several Metastasectomies, Going through 8th Line Systemic Therapy in a Case of mRCC Wed, 25 Feb 2015 11:38:44 +0000 Metastatic renal cell carcinoma (mRCC) has been one of the most treatment-resistant cancers because of its unpredictable clinical course, resistance to chemo- and radiotherapy, and the limited response to immunotherapy and targeted agents. We present a case of long-term survival, that is, 28 years, after primary diagnosis (longest survival in the literature up to our knowledge) with mRCC after several metastasectomies (from local site recurrence, liver, and lung) and eight lines of systemic targeted therapy. This case report shows how crucial is the regular follow-up of patients with RCC after primary management and positive impact of early metastasectomy and systemic targeted therapy in case of mRCC on patients’ condition and overall survival. A. Magdy, K. Bretterbauer, S. Hruby, T. Kunit, D. Colleselli, G. Janetschek, and M. Mitterberger Copyright © 2015 A. Magdy et al. All rights reserved. Acute Hepatocellular Drug Induced Liver Injury Probably by Alfuzosin Sun, 22 Feb 2015 12:21:27 +0000 Alpha blockers are the drugs that exert their effects by binding to alpha receptors and relaxing smooth muscles and are currently used for treatment of benign prostate hyperplasia (BPH). These drugs are often tolerated well by the patients. However, they also possess some common side effects. Hepatotoxicity, on the other hand, is quite rare. We report herein a case with the rare complication of acute hepatocellular drug induced liver injury (DILI) by administration of Alfuzosin. Tufan Cicek, Huseyin Savas Gokturk, and Gulhan Kanat Unler Copyright © 2015 Tufan Cicek et al. All rights reserved. Bilateral Wünderlich Syndrome Caused by Spontaneous Rupture of Renal Angiomyolipomas Sun, 22 Feb 2015 11:41:24 +0000 Wünderlich syndrome (WS) is a urological emergency characterized by retroperitoneal hemorrhage. In most cases, bleeding occurs from a renal angiomyolipoma (AML) and may be the first manifestation of the disease. We report a female patient with bilateral WS due to the metachronous rupture of renal AMLs. Because the patient was stable and the tumor was not malignant, treatment was conservative. Follow-up revealed the full recovery of kidney function and the resolution of the hematoma. Stanislav Sotošek, Dean Markić, Josip Španjol, Kristian Krpina, Siniša Knežević, and Anton Maričić Copyright © 2015 Stanislav Sotošek et al. All rights reserved. First Reported Case of Isolated Persistent Genital Arousal Disorder in a Male Thu, 12 Feb 2015 10:30:34 +0000 Introduction. Persistent genital arousal disorder (PGAD) is a newly recognized disorder in women. It is described as unwanted, persistent feelings of genital arousal unrelated to sexual desire and not relieved by orgasm. Its prevalence is estimated to approach 1% of young women. Until now, this has not been described in men. Aim. Here we present a case of a 27-year-old male with symptoms consistent with PGAD and describe successful treatment. Methods. A 27-year-old male presented to urology clinic with the chief complain of persistent feelings of impending orgasm. He reported a sensation similar, but not identical, to sexual arousal that did not occur in the setting of sexual thoughts or desire. Orgasm alleviated the arousal for only a short time after which the symptoms would return. This had become quite bothersome to him. Results. After assessing for a neurological cause and finding none, the patient was started on paroxetine daily with complete resolution of symptoms. Conclusions. PGAD is a disorder previously described only in females. Although symptoms of PGAD have been described in a male as part of another disorder complex, this report describes the first reported isolated case in a male and the successful treatment. Bradford J. Stevenson and Tobias S. Köhler Copyright © 2015 Bradford J. Stevenson and Tobias S. Köhler. All rights reserved. Hair Coil Penile Tourniquet Syndrome in an Unusual Age Wed, 11 Feb 2015 13:51:09 +0000 Penile tourniquet syndrome (PTS), a rare urologic emergency, may lead to undesirable results including necrosis and amputation of penis, if not diagnosed and treated appropriately. Sometimes these injuries may be accepted as a forensic case. Miscellaneous objects used for strangulation can be metallic or nonmetallic. Of all ages, the most vulnerable period is infancy. Telogen effluvium is the most common cause of PTS in infants who are 0–6 years old. In the literature, telogen effluvium as a reason of PTS was not found except for this age group. Therefore, we aimed to present a boy who is 8 years old diagnosed as PTS because of his mother’s hair coil. Kursad Zengin, Mustafa Yasar Ozdamar, Sebahattin Albayrak, Serhat Tanik, Muhittin Atar, Hasan Bakirtas, Muhammed Abdurrahim Imamoglu, and Mesut Gurdal Copyright © 2015 Kursad Zengin et al. All rights reserved. Primary Carcinoid Tumor of the Testis Wed, 11 Feb 2015 09:27:18 +0000 Primary carcinoid tumors of the testis are a rare entity comprising less than 1% of all testicular neoplasms. Their presence should be considered particularly when evaluating a testicular lesion in an older male patient. Immunohistochemical studies may aid in diagnosis and radiographic evaluation is important to rule out metastatic origin. Primary carcinoid tumors of the testis are associated with an excellent prognosis; however, surveillance is important given rare reports of delayed metastases. Albert A. Petrossian, Joseph Habibi, David E. Rapp, and Dharamdas Ramnani Copyright © 2015 Albert A. Petrossian et al. All rights reserved. A Case of True Hermaphroditism Presenting as a Testicular Tumour Tue, 03 Feb 2015 08:57:22 +0000 True hermaphroditism represents only 5% cases of all of disorders of sexual differentiation (DSD) and usually present in early childhood with ambiguous genitalia. Occasionally, cases might present later on in adolescence with problems of sexual maturation. Our case report presents a true hermaphrodite with normal male phenotype that presented as a left testicular mass, two years after being diagnosed with Sertoli cell only syndrome in the contralateral testis. Histological examination of the left testis showed ovarian, fallopian tube, myometrial, endometrial, and epididymal tissue. This combination of findings is found in approximately one-third of true hermaphrodites, but it is very rare to present clinically as an inguinoscrotal mass. Michelle Ceci, Edward Calleja, Edith Said, and Noel Gatt Copyright © 2015 Michelle Ceci et al. All rights reserved. Management of Metachronous Bilateral Testis Cancer in a Patient with Pre-B Cell ALL Tue, 03 Feb 2015 07:05:13 +0000 We present a patient with a metachronous, second testicular cancer after being diagnosed with pre-B cell ALL and receiving induction chemotherapy for a bone marrow transplant. We discuss the management of bilateral testis masses in a young patient with a hematologic malignancy as well as the role of immunosuppressive chemotherapy in developing a second cancer. This case illustrates the importance of recognizing bilateral testicular cancer early, as well as the importance of follow-up care in oncology patients including routine measurements of tumor markers. A multidisciplinary approach between medical oncology and urology, including close monitoring of the contralateral testis, remains paramount to patient care. Kelly T. Harris, Shakil A. Shaikh, Mark W. Ball, Mohamad E. Allaf, and Phillip M. Pierorazio Copyright © 2015 Kelly T. Harris et al. All rights reserved. Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi Sat, 31 Jan 2015 14:29:07 +0000 We report a rare case of iliac vein compression syndrome caused by urethral calculus. A 71-year-old man had a history of urethral stenosis. He complained of bilateral leg edema and dysuria for 1 week. Physical examination revealed bilateral distention of the superficial epigastric veins, so obstruction of both common iliac veins or the inferior vena cava was suspected. Plain abdominal computed tomography showed a calculus in the pendulous urethra, distention of the bladder (as well as the right renal pelvis and ureter), and compression of the bilateral common iliac veins by the distended bladder. Iliac vein compression syndrome was diagnosed. Bilateral iliac vein compression due to bladder distention (secondary to neurogenic bladder, benign prostatic hyperplasia, or urethral calculus as in this case) is an infrequent cause of acute bilateral leg edema. Detecting distention of the superficial epigastric veins provides a clue for diagnosis of this syndrome. Akiko Ikegami, Takeshi Kondo, Tomoko Tsukamoto, Yoshiyuki Ohira, and Masatomi Ikusaka Copyright © 2015 Akiko Ikegami et al. All rights reserved. Clear Cell Papillary Renal Cell Carcinoma: A Potential Mimic of Conventional Clear Cell Renal Carcinoma on Core Biopsy Thu, 29 Jan 2015 11:12:25 +0000 Clear cell papillary renal cell carcinoma (CCP-RCC) is a recently described, relatively uncommon variant of renal cell carcinoma (RCC) with a reported incidence of 4.1%. Thought to only arise in those with end stage renal disease, CCP-RCC is increasingly identified in those without renal impairment. CCP-RCCs have unique morphologic, genetic, and immunohistochemical features distinguishing them from both conventional clear cell renal cell carcinomas and papillary renal cell carcinomas. Immunohistochemically, these tumors are positive for CK7 and negative for CD10 and racemase. This is in contrast to conventional cell renal cell carcinomas (CK7 negative, CD10 positive) and papillary cell carcinomas (CK7, CD10, and racemase positive). These tumours appear to be indolent in nature, with no current documented cases of metastatic spread. We present the case of a 42-year-old female who presented with an incidental finding of a renal mass that on a core biopsy was reported as clear cell carcinoma, Fuhrman grade 1. She subsequently underwent a radical nephrectomy and further histological examination revealed the tumor to be a clear cell papillary renal cell carcinoma, Fuhrman grade 1. Heath Liddell, Anton Mare, Sean Heywood, Genevieve Bennett, and Hin Fan Chan Copyright © 2015 Heath Liddell et al. All rights reserved. Life-Threatening Bleeding from Peristomal Varices after Cystoprostatectomy: Multimodal Approach in a Cirrhotic, Encephalopathic Patient with Severe Portal Hypertension Thu, 29 Jan 2015 09:50:41 +0000 The bleeding of peristomal varices due to a portosystemic shunt is rare but potentially life-threatening in cirrhotic patients with portal hypertension. The scarce case reports in the literature recommend transjugular intrahepatic portosystemic shunt (TIPS) to prevent further bleeding. We report on a 72-year-old man who was referred to our hospital because of life-threatening bleeding from peristomal varices, three years after radical cystoprostatectomy for invasive bladder cancer. CT imaging showed liver cirrhosis with a prominent portosystemic shunt leading to massively enlarged peristomal varices. TIPS was taken into consideration, but not possible due to hepatic encephalopathy (HE). Medical therapy with lactulose and the nonselective beta-blocker carvedilol was initiated to treat HE and portal hypertension. In a second step, the portosystemic shunt was percutaneously embolized. Here, we present a multimodal approach to treat intractable bleeding from peristomal varices in a patient with ileal conduit urinary diversion, not suitable for TIPS. Sergej E. L. Staubli, Tobias Gramann, Christoph Schwab, David Semela, Lukas Hechelhammer, Daniel S. Engeler, Hans-Peter Schmid, Dominik Abt, and Livio Mordasini Copyright © 2015 Sergej E. L. Staubli et al. All rights reserved. Seminoma Presenting as Renal Mass, Inferior Vena Caval Thrombus, and Regressed Testicular Mass Thu, 29 Jan 2015 07:33:13 +0000 Testicular cancer is the most common malignancy of men aged 15–40. Metastatic spread classically begins with involvement of the retroperitoneal lymph nodes, with metastases to the liver, lung, bone, and brain representing advancing disease. Treatment is based on pathologic analysis of the excised testicle and presence of elevated tumor markers. We report a case of a 34-year-old male presenting with back pain who was found to have a right renal mass with tumor extension into the inferior vena cava. Subsequent biopsy was consistent with seminoma. We review this rare case and discuss the literature regarding its diagnosis and management. Valary T. Raup, Michael H. Johnson, Jonathan R. Weese, Ian S. Hagemann, Stephen D. Marshall, and Steven B. Brandes Copyright © 2015 Valary T. Raup et al. All rights reserved. Squamous Cell Carcinoma of Kidney and Its Prognosis: A Case Report and Review of the Literature Thu, 29 Jan 2015 07:07:51 +0000 Primary squamous cell carcinoma of the renal parenchyma is an extremely rare entity. The diagnosis of squamous cell carcinoma of the renal pelvis is usually unsuspected due to the rarity and inconclusive clinical and radiological features. Most of the patients are diagnosed at an advanced stage and are with poor outcome. Radical nephrectomy is the mainstay of the treatment. We reported a case of squamous cell carcinoma of the kidney in a 50-year-old female who presented with the right sided abdomen pain. The patient was treated with radical nephrectomy. Tapan Kumar Sahoo, Saroj Kumar Das, Chandraprava Mishra, Ipsita Dhal, Rohani Nayak, Iftekhar Ali, Debashis Panda, Saroj Kumar Das Majumdar, and Dillip Kumar Parida Copyright © 2015 Tapan Kumar Sahoo et al. All rights reserved. Torsion of Undescended Third Testis, as Rare Cause of Painful Inguinal Mass Mon, 26 Jan 2015 08:32:20 +0000 Twenty years old young was referred to our department due to painful inguinal mass. The mass was diagnosed as torsion of third testis which was treated by orchiectomy. Polyorchidism is a rare entity with increased risk for malignancy and torsion. Suheil Artul, Faozi Artoul, Basel Fahoum, William Nseir, Najib Nasrallah, and George Habib Copyright © 2015 Suheil Artul et al. All rights reserved. A Case of Primary Renal Carcinoid Tumor Thu, 22 Jan 2015 09:46:13 +0000 Primary renal carcinoid tumors are extremely rare kidney lesions, with fewer than 100 reported cases previously. We describe a 75-year-old man with an incidentally detected cystic renal mass. Computed tomography showed a 3 cm tumor with a cystic component enhanced with contrast. No evidence of metastasis was detected. We treated the patient with radical nephrectomy. Pathological examinations revealed a cellular arrangement specific to carcinoid tumor and positive for chromogranin A, neural cell adhesion molecule, and somatostatin receptor type 2. The tumor cells had a mitotic count of 4 mitoses/10 high-power fields, and the level of the proliferation marker Ki-67 was 5%. The pathological diagnosis was renal neuroendocrine tumor grade 2. No local recurrence and no systemic metastasis were detected during the 18-month follow-up period. To our knowledge, this is the 6th case of renal neuroendocrine grade 2 tumor reported thus far. Toshikazu Tanaka, Hayato Yamamoto, Atsushi Imai, Hatakeyama Shingo, Takahiro Yoneyama, Takuya Koie, Yasuhiro Hashimoto, and Chikara Ohyama Copyright © 2015 Toshikazu Tanaka et al. All rights reserved. Persistent High Level of Urinary Tumor Marker Carbohydrate Antigen 19-9 in Prenatally Diagnosed Dysplastic Kidney Wed, 31 Dec 2014 00:10:43 +0000 Tumor marker carbohydrate antigen 19-9 (CA 19-9) level has gained clinical significance in gastrointestinal malignancies and in various solid and cystic diseases. Dysplastic kidney is a congenital abnormality resulting from atresia of the ureteral bud during the embryogenesis which can be unilateral or bilateral. We report unilateral dysplastic kidney with extremely large cyst diagnosed by routine ultrasonography in the 32nd week of gestational age with high levels of CA 19-9 in cystic and amniotic fluid, as well as persistent high urinary levels of this tumor marker during the 1-year follow-up. Persistent high urinary CA 19-9 level even after cyst aspiration may be attributable to remained function of dysplastic kidney due to remained epithelial lining. Reza Khorramirouz, Maryam Ebadi, Fatemeh Rahimi Sherbaf, and Abdol-Mohammad Kajbafzadeh Copyright © 2014 Reza Khorramirouz et al. All rights reserved. Possible Complications of Ureteroscopy in Modern Endourological Era: Two-Point or “Scabbard” Avulsion Sun, 28 Dec 2014 00:10:24 +0000 Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple types of complications. Severe complications are possible including ureteral perforation or avulsion. Ureteral avulsion has been described as an upper urinary tract injury related to the action of blunt trauma, especially from traffic accidents, being the mechanism of injury, the result of an acute deceleration/acceleration movement. With the advent of endourology, that term is also applied to the extensive degloving injury resulting from a mechanism of stretching of the ureter that eventually breaks at the most weakened site, or ureteral avulsion is referred to as a discontinuation of the full thickness of the ureter. The paper presents a case report and literature review of the two-point or “scabbard” avulsion. The loss of long segment of the upper ureter, when end-to-end anastomosis is not technically feasible, presents a challenge to the urological surgeon. In the era of small calibre ureteroscopes these complications, due to growing incidence of renal stones will become more and more actual. Our message to other urologists is to know such a complication, to know the ways of treatment, and to analyse ureteroscopic signs, when to stop or pay attention. Andrius Gaizauskas, Marius Markevicius, Sergejus Gaizauskas, and Arunas Zelvys Copyright © 2014 Andrius Gaizauskas et al. All rights reserved. Delayed Migration of Embolized Coil with Large Renal Stone Formation: A Rare Presentation Wed, 24 Dec 2014 08:58:13 +0000 Delayed bleeding following percutaneous nephrolithotomy (PCNL) usually occurs due to development of the pseudoaneurysm which can be successfully managed with coil embolization. However very few cases of such complications have been reported in the literature. Here we are reporting a case of delayed post-PCNL bleeding that occurred in a 53-year-old diabetic patient operated on for renal stone. Computed tomography scan revealed a presence of the pseudoaneurysm in the segmental branch of right renal artery, which was successfully managed with coiling. Patient remained asymptomatic for the next 9 years after which he again presented with similar complaints. X-ray KUB was done which revealed a 2.7 cms renal pelvic calculus with the migrated coil in its center and a left upper ureteric calculus. His routine haemogram, coagulogram, serum electrolytes, and liver function tests, renal function tests, vitamin D3, and PTH (parathyroid hormone) were within normal limits. He underwent left laparoscopic ureterolithotomy and right percutaneous nephrolithotomy (PCNL). Intraoperatively the migrated stainless steel embolization coil was seen engulfed all around by the multiple stones in the right renal pelvis. Postoperative period was uneventful. Later he was followed in the outpatient department and was doing well. To conclude, this is the only case report of development of a large calculus around a migrated embolization coil which was successfully managed with PCNL. PCNL offers better stone clearance in cases of stones being formed over foreign bodies like fragmented double J stents, fragmented nephrostomies, or migrated embolization coil. Santosh Kumar, Kumar Jayant, Shrawan K. Singh, Kalpesh M. Parmar, Sudheer K. Devana, Gautam R. Choudhari, and Ankur Mittal Copyright © 2014 Santosh Kumar et al. All rights reserved. Bilateral Double Ureters with Bladder Neck Diverticulum in a Nigerian Woman Masquerading as an Obstetric Fistula Tue, 23 Dec 2014 10:16:10 +0000 A 43-year-old woman presented with 20-year history of leakage of urine per vaginam. She had one failed repair attempt. Pelvic examination with dye test showed leakage of clear urine suggestive of ureterovaginal fistula. The preoperative intravenous urogram revealed duplex ureter and cystoscopy showed normally cited ureteric orifices with two other ectopic ureteric openings and bladder diverticula. The definitive surgery performed was ureteric reimplantation (ureteroneocystostomy) of the two distal ureteric to 2 cm superiolateral to the two normal orifices and diverticuloplasty. There was resolution of urinary incontinence after surgery. Three months after surgery, she had urodynamic testing done (cystometry), which showed 220 mLs with no signs of instability or leakage during filling phase but leaked on coughing at maximal bladder capacity. This is to showcase some diagnostic dilemma that could arise with obstetric fistula, which is generally diagnosed by clinical assessment. Imran O. Morhason-Bello, Sikiru A. Adebayo, Rukiyat A. Abdusalam, Oluwasomidoyin O. Bello, Kehinde H. Odubamowo, Olatunji O. Lawal, E. Oluwabunmi Olapade-Olaopa, and Oladosu A. Ojengbede Copyright © 2014 Imran O. Morhason-Bello et al. All rights reserved. Bladder Perforation Secondary to Primary Systemic Amyloidosis Mon, 22 Dec 2014 08:16:17 +0000 Amyloidosis is a disorder of protein folding characterized by extracellular aggregation and deposition of amyloid protein fibrils. Light-chain amyloidosis, also known as primary systemic amyloidosis, is the most common form of the disease. We present a case of an 84-year-old male with a history of systemic primary amyloidosis causing genitourinary, cardiac, and autonomic dysfunction who presented with hematuria and hypotension secondary to bladder perforation. He underwent open repair of a large extraperitoneal bladder defect. He ultimately died as a result of medical complications from his disease. Christopher J. Dru, Tom S. Feng, and Howard H. Kim Copyright © 2014 Christopher J. Dru et al. All rights reserved. Isolated Bilateral Renal Mucormycosis Masquerading as Renal Abscess in an Immunocompetent Individual: A Lesson Learnt Thu, 18 Dec 2014 12:01:34 +0000 Isolated renal mucormycosis is a rare entity in immunocompetent subjects. It is usually a rapidly progressive disease with poor prognosis but it can mimic renal abscess with a protracted course. Somorendro Paonam, Sananda Bag, Ravimohan S. Mavuduru, Mayank Mohan Agarwal, and Arup Kumar Mandal Copyright © 2014 Somorendro Paonam et al. All rights reserved. Intrascrotal Dedifferentiated Leiomyosarcoma Originating from Dartos Muscle Thu, 11 Dec 2014 08:55:57 +0000 A 46-year-old man, who had visited our hospital complaining of a small intrascrotal nodule ten years ago, returned to us because of the rapid growth of the nodule. Computed tomography revealed a heterogeneously enhanced intrascrotal tumor of approximately  cm. The tumor and the right testis were excised with the adhered right scrotal skin. The pathological diagnosis was pleomorphic leiomyosarcoma with dedifferentiation originating from the dartos muscle. Urological dedifferentiated leiomyosarcomas are rarely reported and the clinical features are mostly unknown. This is the first report to describe the dedifferentiated leiomyosarcoma of the dartos muscle. Taro Teshima, Sayuri Takahashi, Shoichi Nagamoto, Hideyo Miyazaki, Tohru Nakagawa, Tetsuya Fujimura, Hiroshi Fukuhara, Haruki Kume, and Yukio Homma Copyright © 2014 Taro Teshima et al. All rights reserved. Dystrophic Calcification of the Prostate after Cryotherapy Sun, 07 Dec 2014 00:10:38 +0000 We present a previously undocumented complication of dystrophic calcification of the prostate after cryotherapy. An 87-year-old male presented with recurrent lower urinary tract infections and was found to have an obstructing large calcified mass in the right lobe of the prostate. Subsequently, he underwent transurethral resection of the prostate (TURP) and bladder neck with laser lithotripsy to remove the calculus. We propose that chronic inflammation and necrosis of the prostate from cryotherapy resulted in dystrophic calcification of the prostate. As the use of cryotherapy for the treatment of localized prostate cancer continues to increase, it is important that clinicians be aware of this scenario and the technical challenges it poses. Christopher Dru and Leon Bender Copyright © 2014 Christopher Dru and Leon Bender. All rights reserved. Renal Cell Carcinoma Metastasis from Biopsy Associated Hematoma Disruption during Robotic Partial Nephrectomy Wed, 03 Dec 2014 00:10:15 +0000 We describe a case in which a patient with a past medical history of ovarian cancer received a diagnostic renal biopsy for an incidentally discovered renal mass. During left robotic partial nephrectomy (RPN), a perinephric hematoma was encountered. The hematoma was not present on preoperative imaging and was likely a result of the renal biopsy. The renal cell carcinoma (RCC) and the associated hematoma were widely excised with negative surgical margins. On follow-up imaging at five months postoperatively, a recurrent renal mass at the surgical resection bed and several new nodules in the omentum were detected. During completion left robotic total nephrectomy and omental excision, intraoperative frozen sections confirmed metastatic RCC. We believe that a hematoma seeded with RCC formed as a result of the renal biopsy, and subsequent disruption of the hematoma during RPN caused contamination of RCC into the surrounding structures. Christopher Caputo, Ziho Lee, Andrew Harbin, and Daniel Eun Copyright © 2014 Christopher Caputo et al. All rights reserved. Laparoscopic Nephrectomy, Ex Vivo Partial Nephrectomy, and Autotransplantation for the Treatment of Complex Renal Masses Mon, 24 Nov 2014 13:04:09 +0000 In the contemporary era of minimally invasive surgery, very few T1/T2 renal lesions are not amenable to nephron-sparing surgery. However, centrally located lesions continue to pose a clinical dilemma. We sought to describe our local experience with three cases of laparoscopic nephrectomy, ex vivo partial nephrectomy, and autotransplantation. Laparoscopic donor nephrectomy was performed followed by immediate renal cooling and perfusion with isotonic solution. Back-table partial nephrectomy, renorrhaphy, and autotransplantation were then performed. Mean warm ischemia (WIT) and cold ischemic times (CIT) were 2 and 39 minutes, respectively. Average blood loss was 267 mL. All patients preserved their renal function postoperatively. Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all. All are disease free at up to 39 months follow-up with stable renal function. In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function. Jasmir Gopal Nayak, Joshua Koulack, and Thomas Brian McGregor Copyright © 2014 Jasmir Gopal Nayak et al. All rights reserved. Hormonal Treatment for Severe Hydronephrosis Caused by Bladder Endometriosis Tue, 18 Nov 2014 10:53:29 +0000 The incidence of endometriosis cases involving the urinary system has recently increased, and the bladder is a specific zone where endometriosis is most commonly seen in the urinary system. In the case presented here, a patient presented to the emergency department with the complaint of side pain and was examined and diagnosed with severe hydronephrosis and bladder endometriosis was determined in the etiology. After the patient was pathologically diagnosed, Levonorgestrel-Releasing Intrauterine System (LNG-IUS) was administered to the uterine cavity. At the 12-month follow-up, endometriosis was not observed in the cystoscopy and symptoms had completely regressed. Hydronephrosis may be observed after exposure of the ureter, and silent renal function loss may develop in patients suffering from endometriosis with bladder involvement. For patients with moderate or severe hydronephrosis associated with bladder endometriosis, LNG-IUS application may be separately and successfully used after conservative surgery. Erkan Efe, Murat Bakacak, Salih Serin, Eyüp Kolus, Önder Ercan, and Sefa Resim Copyright © 2014 Erkan Efe et al. All rights reserved. Transitional Cell Carcinoma in Orthotopic Ileal Neobladder Tue, 18 Nov 2014 06:31:16 +0000 Urothelial carcinoma developing in orthotopic ileal neobladder is an extremely rare entity. Fewer than 10 cases have been reported in the literature describing urothelial carcinoma recurrence in orthotopic ileal neobladder. We report a case of transitional cell carcinoma recurrence in orthotopic ileal neobladder after 11 years of surgery. Ozgur Cakmak, Huseyin Tarhan, Orcun Celik, Ulku Kucuk, and Yusuf Ozlem Ilbey Copyright © 2014 Ozgur Cakmak et al. All rights reserved. Ureteroarterial Fistula from Ureteral Stump: A Challenging Case Thu, 13 Nov 2014 09:13:05 +0000 Ureteroarterial fistula (UAF) is a relatively rare condition with about 150 cases reported in the literature. Since it is a potentially life-threatening condition, a prompt diagnosis and treatment are crucial. We present here a rare, challenging case of UAF diagnosed after left nephrectomy, thus involving the ureteral stump. The difficult diagnosis and treatment by contemporary use of endovascular stent placement and ureteral occlusion by mean of metallic coils and Onyx injection are discussed. Pietro Pozzilli, Massimo Lenti, Stefano Mosca, Elisabetta Nunzi, and Luigi Mearini Copyright © 2014 Pietro Pozzilli et al. All rights reserved. Intraneobladder Hem-o-Lok Migration with Stone Formation after Orthotopic Neobladder Cystectomy Mon, 10 Nov 2014 12:49:22 +0000 Introduction. Laparoscopic and robot-assisted laparoscopic surgery are widely performed in urology field, so Hem-o-Lok clips are thus extensively used in the laparoscopic procedures. We describe the first case of Hem-o-Lok clip which migrated into the neobladder with calculus formation 26 months after laparoscopic orthotopic neobladder cystectomy, which causes symptoms of gross hematuria and frequent urination. Case Presentation. A 57-year-old man with T2a muscle invasive bladder cancer underwent laparoscopic orthotopic sigmoid neobladder reconstruction after cystectomy which was complicated by intestinal anastomosis leak and peritoneal abscess requiring transverse colostomy and drainage 15 days postoperatively. Twenty-six months after cystectomy, he complained of gross hematuria and frequent urination. Computerized tomography and plain pelvic X-ray revealed a stone measuring approximately 2.8 cm in diameter in the neobladder. During cystoscopy, a closed whitish Hem-o-Lok clip was seen in the center of the calculi. No anastomotic leak or neoplasm was found during cystoscopy. Conclusion. Hem-o-Lok clip migration into the bladder after laparoscopic orthotopic neobladder cystectomy is a rare complication; the first reported case in the literature. To prevent Hem-o-Lok clip migration, it is recommended to avoid extensive use of Hem-o-Lok clip close to anastomosis site, and any loose Hem-o-Lok clip should be retrieved before closure. Zeng Shu-xiong, Zhang Zhen-sheng, Yu Xiao-wen, Li Hui-zhen, Lu Xin, Sun Ying-hao, and Xu Chuan-liang Copyright © 2014 Zeng Shu-xiong et al. All rights reserved.