Case Reports in Urology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Adenomatoid Tumor of the Tunica Albuginea in a Boy: A Case Report and Literature Review Wed, 27 May 2015 12:31:18 +0000 http://www.hindawi.com/journals/criu/2015/935193/ Adenomatoid tumors (AT) are the most common paratesticular neoplasms and account for approximately 30% of all paratesticular masses. Most of them occur in the third or fourth decade and present as well-defined firm and painless masses. We report here a case of adenomatoid tumor from tunica albuginea. This patient is a 12-year-old boy with left testicular pain for 6 months. Scrotal ultrasonography revealed a solid mass of paratesticular origin. The histology and immunohistochemistry confirmed the final diagnosis. A right tumor resection was performed. Because of its rarity, the clinical and histopathologic appearance is seldom illustrated. Here we present a case report and a comprehensive literature review with the objective of providing useful information on this entity. Kaimin Guo, Runhui Tian, Lingyun Liu, Congqi Du, Fubiao Li, and Hongliang Wang Copyright © 2015 Kaimin Guo et al. All rights reserved. Midline Prostatic Cyst Marsupialization Using Holmium Laser Tue, 26 May 2015 07:00:20 +0000 http://www.hindawi.com/journals/criu/2015/797061/ Many of the prostatic cysts are asymptomatic and only 5% are symptomatic (Hamper et al., 1990; Higashi et al., 1990). These symptoms include pelvic pain, hematospermia, infertility, voiding dysfunction, prostatitis-like syndrome, and painful ejaculation. Treatment of prostatic cysts includes TRUSG guided drainage, endoscopic transurethral resection, and in some cases even open surgery. In the literature, endoscopic interventions use marsupialization of the midline prostatic cyst with transurethral resection (TUR) or transurethral incision with endoscopic urethrotomy (Dik et al., 1996; Terris, 1995). Holmium: YAG laser was employed for the marsupialization of the cyst wall in midline prostatic cyst treatment for the first time in the present study. Symptoms, treatment, and follow-up are presented in this paper. Mehmet Kilinc, Yunus Emre Goger, Mesut Piskin, Mehmet Balasar, and Abdulkadir Kandemir Copyright © 2015 Mehmet Kilinc et al. All rights reserved. Monophasic Synovial Sarcoma of Prostatic Fascia: Case Report and Literature Review Thu, 14 May 2015 14:56:42 +0000 http://www.hindawi.com/journals/criu/2015/419180/ Synovial sarcoma (SS) primarily occurs in the para-articular soft tissue of the lower extremities in young adults and it is extremely rare in the prostatic region. We report a case of a 46-year-old man who presented with urinary retention. Pelvic ultrasound (US) examination, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated an 8.5 cm mass that appeared to originate in the prostatic fascia of the right lobe. Preoperative prostatic ultrasound transrectal needle biopsy revealed mesenchymal neoplastic tissue. Patient underwent surgery. The final pathologic findings were consistent with the diagnosis of monophasic synovial sarcoma. Lucio Olivetti, Luigi Benecchi, Serena Corti, Carlo Del Boca, Matteo Ferrari, Pietro Sergio, Luisa Bercich, and Giulia Tanzi Copyright © 2015 Lucio Olivetti et al. All rights reserved. A Rare Complication of Extracorporeal Shock Wave Lithotripsy: Intrarenal Hematoma Mimicking Pelvis Renalis Tumor Tue, 12 May 2015 09:24:00 +0000 http://www.hindawi.com/journals/criu/2015/719618/ Extracorporeal shock wave lithotripsy (SWL) is a very commonly used treatment modality for appropriate sized stones. Even though it is a noninvasive treatment technique, major complications may occur following SWL sessions. Herein, we report a 17-year-old male patient, who received 2 sessions of SWL treatment for his left kidney stone, 4 months before his admission. Imaging methods showed an enhanced left renal pelvis mass with contrast-enhanced computerized tomography (CT) and this finding raised a suspicion of pelvis renalis tumor. Diagnostic ureterorenoscopy was planned for the patient and operation revealed a left intrarenal hematoma, which was drained percutaneously during the same operation. Careful history should be taken from patients with renal pelvis masses and intrarenal hematoma formation should be kept in mind, especially if the patient has a previous SWL history. Fatih Akbulut, Onur Kucuktopcu, Burak Ucpinar, Metin Savun, Faruk Ozgor, Erkan Sonmezay, Abdulmuttalip Simsek, and Gokhan Gurbuz Copyright © 2015 Fatih Akbulut et al. All rights reserved. Bilateral Ureteral-Iliac Artery Fistula in a Patient with Chronic Indwelling Ureteral Stents: A Case Report and Review Tue, 05 May 2015 07:31:42 +0000 http://www.hindawi.com/journals/criu/2015/826760/ Ureteral-arterial fistula (UAF) is an exceedingly rare but life-threatening condition warranting emergent intervention. Prompt recognition and management of UAF in suspect patients presenting with gross hematuria are required for a successful outcome. We report a rare subset of UAF involving the bilateral common iliac arteries. The patient underwent successful endovascular stent-grafting to correct the arterial defect and delayed open repair of the ureteral strictures. Timely management has benefited from the collaboration of the involved medical teams, which included emergency medicine, urology, and interventional radiology. Arash Rafiei, Timothy A. Weber, Michael Kongnyuy, and Raul Ordorica Copyright © 2015 Arash Rafiei et al. All rights reserved. Laparoscopic Nephrectomy with Adrenalectomy for Synchronous Adrenal Myelolipoma and Renal Cell Carcinoma Wed, 29 Apr 2015 14:03:54 +0000 http://www.hindawi.com/journals/criu/2015/635072/ Introduction. Adrenal myelolipomas are uncommon nonfunctioning tumors of the adrenal. Synchronous renal cell carcinomas with adrenal myelolipomas are very rare. We present the case report of adrenal myelolipoma with synchronous RCC managed laparoscopically. Case Report. A 60-year-old old gentleman presented with incidental right upper polar mass with right adrenal mass. Metastatic work-up was negative. Laparoscopic radical nephrectomy with adrenalectomy was done under general anesthesia. The biopsy report was right kidney clear cell adenocarcinoma (T1b) with right adrenal myelolipoma. Conclusion. This is the first case report of laparoscopic adrenalectomy with nephrectomy for ipsilateral synchronous renal cell carcinoma with adrenal myelolipoma. Kallappan Senthil, Manickam Ramalingam, Karpagam Janardhan, Anandan Murugesan, and Mizar Ganapathy Pai Copyright © 2015 Kallappan Senthil et al. All rights reserved. Synchronous Bilateral Testicular Tumors with Different Histopathology Tue, 28 Apr 2015 06:34:58 +0000 http://www.hindawi.com/journals/criu/2015/492183/ A 40-year-old male presented to our outpatient department with the chief complaint of a painless mass on his right testis with gradual size increase over the past two months. Physical examination and ultrasound revealed a firm and nontender mass both on the right and on the left testis. The only elevated biomarker was b-hcG (24,7 mIU/mL) and computer tomography (CT) did not reveal any pathology. Bilateral high orchiectomies were performed, without previous frozen storage of the sperm. Histology proved typical seminoma of the left testis and embryonal carcinoma of the right testis. He received two cycles of adjuvant combination chemotherapy with bleomycin, etoposide, and cisplatin. Six months after the operation no residual tumor or recurrence was observed. Ioannis Anastasiou, Dimitrios Deligiannis, Ioannis Katafigiotis, Ioannis Skarmoutsos, Georgios Karaolanis, Viktoria-Varvara Palla, Afrodite Nonni, Dionysios Mitropoulos, and Constantinos A. Constantinides Copyright © 2015 Ioannis Anastasiou et al. All rights reserved. Unusual Presentation of Testicular Cancer with Tumor Thrombus Extending to the Inferior Vena Cava Mon, 27 Apr 2015 08:03:49 +0000 http://www.hindawi.com/journals/criu/2015/160560/ A 45-year-old man with a left testis tumor with a 25 mm para-aortic lymph node swelling, multiple bilateral pulmonary metastases, bilateral pulmonary embolism, and inferior vena cava (IVC) thrombus underwent a radical orchidectomy in our institution. The thrombus extended from the left gonadal vein to the left renal vein to the IVC. The fluorine-18 fluorodeoxyglucose (f-FDG) positron emission tomography (PET) computerized tomography (CT) demonstrated a hypermetabolic focus in the retroperitoneum and in the IVC thrombus. Before orchidectomy only lactate dehydrogenase (LDH) was high but all the serum tumor markers increased postoperatively. The tumor was staged pT1N2M1aS1, which was an intermediate prognosis, based on the International Germ Cell Cancer Collaborative Group consensus (IGCCCG). After 4 courses of bleomycin, etoposide, and cisplatin (BEP) chemotherapy the patient’s tumor markers normalized and the thrombus disappeared. There was only one residual retroperitoneal lymph node M1. Retroperitoneal lymph node dissection was performed. The pathological examination revealed only necrotic tissues. The patient has been disease-free since surgery. Marie Dusaud, Younes Bayoud, François-Régis Desfemmes, Benoît Molimard, and Xavier Durand Copyright © 2015 Marie Dusaud et al. All rights reserved. Idiopathic Bilateral Adrenal Hemorrhage in a 63-Year-Old Male: A Case Report and Review of the Literature Mon, 20 Apr 2015 11:26:52 +0000 http://www.hindawi.com/journals/criu/2015/503638/ Adrenal hemorrhage is a largely uncommon condition typically caused by a number of factors including infection, MI, CHF, anticoagulants, trauma, surgery, and antiphospholipid syndrome. Yet, idiopathic bilateral hemorrhage is rare. The authors present a case of a 63-year-old male who presented with abdominal pain that was eventually diagnosed as bilateral adrenal hemorrhages due to an unknown origin. Abdominal CT revealed normal adrenal glands without enlargement, but an MRI displayed enlargement due to hemorrhage in both adrenals. There was no known cause; the patient had not suffered from an acute infection and was not on anticoagulants, and the patient’s history did not reveal any of the other known causative factors. The case underscores the importance of keeping bilateral adrenal hemorrhages on the list of differentials even when a cause is not immediately clear. It also raises the question of whether CT is the most sensitive test in the diagnosis of adrenal hemorrhage and whether the diagnostic approach should place greater weight on MRI. The case highlights the need for prompt therapy with steroids once bilateral hemorrhage is suspected to avert the development or progression of adrenal insufficiency. Naveen Dhawan, Vijay Kumar Bodukam, Kshitij Thakur, Amandeep Singh, Donald Jenkins, and Jaya Bahl Copyright © 2015 Naveen Dhawan et al. All rights reserved. Dedifferentiated Paratesticular Liposarcoma with Osseous Metaplasia Thu, 16 Apr 2015 06:21:34 +0000 http://www.hindawi.com/journals/criu/2015/965876/ Paratesticular liposarcoma is a rare tumour of the genitourinary track but the most common of all sarcomas in adults. The dedifferentiated variation occurs only in 10% of liposarcoma cases. The typical clinical presentation is similar to an inguinal hernia or a benign lipoma. We present the case of a dedifferentiated paratesticular liposarcoma with osseous metaplasia of the spermatic cord, in a male presented with acute scrotum. Kostas Chondros, Ioannis Heretis, Michael Papadakis, Vasiliki Bozionelou, Emmanouil Mavromanolakis, Nikolaos Chondros, and Charalampos Mamoulakis Copyright © 2015 Kostas Chondros et al. All rights reserved. Urethrovaginal Fistula in a 5-Year-Old Girl Sun, 12 Apr 2015 07:43:17 +0000 http://www.hindawi.com/journals/criu/2015/202059/ Urethral fistulas are rare in girls. They occur most of the time during trauma. The case presented here is an iatrogenic fistula. The treatment was simple and consisted of a simple dissection and suture of urethra and vagina. Noël Coulibaly and Ibrahima Séga Sangaré Copyright © 2015 Noël Coulibaly and Ibrahima Séga Sangaré. All rights reserved. Symptomatic Infundibulopelvic Dysgenesis in an Adolescent Thu, 09 Apr 2015 14:21:19 +0000 http://www.hindawi.com/journals/criu/2015/307319/ Infundibulopelvic dysgenesis is a rare condition characterized by congenital malformation of the pelvicalyceal system. We present the case of an 18-year-old boy with chronic intermittent right flank pain and cystic dilation with parenchymal thinning on ultrasonography. The left kidney was normal. The patient denied dysuria, constipation, and history of UTIs or renal calculi. Cystoscopy with retrograde pyelogram showed marked stenosis of the right pelvicalyceal system and anatomy unfavorable to stenting. The patient’s symptoms were unresponsive to conservative management. Reconstruction of the right collecting system was unsuccessful and a simple nephrectomy was performed, which led to complete resolution of his symptoms. Daniel Pitts, David Chalmers, and Brian Jumper Copyright © 2015 Daniel Pitts et al. All rights reserved. Leiomyoma of the Renal Vein: A Rare Tumor Presenting as a Renal Mass Sun, 05 Apr 2015 08:53:32 +0000 http://www.hindawi.com/journals/criu/2015/950584/ Leiomyomas are benign mesenchymal tumors that rarely occur in the kidney. Renal leiomyomas usually occur in the renal cortex or capsule. They are less commonly found in the muscularis propria of the renal pelvis and cortical vascular smooth muscle. In this case report, we present a 41-year-old woman who had right flank pain and detected a mass in the right kidney hilum. Cengiz Kocak, Sahin Kabay, and Burak Isler Copyright © 2015 Cengiz Kocak et al. All rights reserved. Giant Abdominoperineal Malignant Schwannoma: An Unusual Presentation and Surgical Challenge Thu, 02 Apr 2015 09:09:28 +0000 http://www.hindawi.com/journals/criu/2015/728062/ Schwannoma is a benign tumor arising from the Schwann cells of peripheral nerves. These are usually benign but malignant transformation can occur in larger lesions. The definitive diagnosis of malignancy can only be made after final histopathological report. The literature reports large pelvic and perineal schwannomas with few being malignant. We report the first case of such giant malignant abdominoperineal schwannoma which was benign on initial biopsy but final histopathology revealed it to be malignant. In view of proximity of perineal and pelvic tumors to urogenital organs and pelvic nerves, such cases represent a challenge to surgical excision. This case brings to highlight another atypical presentation of such tumors. Pankaj Panwar, Santosh Kumar, Shivanshu Singh, Ajjoor Shankargowda Sriharsha, and Kirti Gupta Copyright © 2015 Pankaj Panwar et al. All rights reserved. Congenital Midureteric Stricture: Challenges in Diagnosis and Management Thu, 02 Apr 2015 06:38:23 +0000 http://www.hindawi.com/journals/criu/2015/969246/ Background. Congenital midureteric stricture (MUS) is a rare malformation. We report our experience with five cases seen over a period of 4 years from 2010 to 2014. Materials and Methods. The study was based on the retrospective analysis of five patients diagnosed as having MUS. Diagnosis was suspected after fetal ultrasonography (USG) in one patient and magnetic resonance urography (MRU) in four patients. Retrograde pyelography (RGP) was performed on three patients. The final diagnosis was confirmed during surgical exploration in all the patients. Results. MRU was found to be a good investigation method. It showed the site of obstruction in the ureter in all instances. Intravenous urography detected proximal ureteric dilatation present in two of the patients. RGP delineates the level of stricture and the course of ureter, as shown in our cases. All patients had significant obstruction on the affected side. Four patients underwent ureteroureterostomy, all of whom had satisfactory results. In one patient, ureteric reimplantation was carried out due to distal small ureteric caliber. Conclusion. This rare entity is often misdiagnosed initially as pelviureteric junction obstruction. MRU is an excellent option for the anatomical location and functional assessment of the involved system. At the time of surgical correction of a ureteral obstruction, RGP is a useful adjunct for delineating the stricture level and morphology. Raashid Hamid, Nisar A. Bhat, and Kumar Abdul Rashid Copyright © 2015 Raashid Hamid et al. All rights reserved. Ewing’s Sarcoma of the Kidney Complicated by a Wunderlich Syndrome Wed, 01 Apr 2015 14:00:02 +0000 http://www.hindawi.com/journals/criu/2015/601038/ The Wunderlich syndrome found after the rupture of primitive renal Ewing’s sarcoma is not a situation that we find often in everyday practice. The clinical findings are not specific, which is why the differential diagnosis must be made with a multitude of benign and malignant renal masses until the correct diagnosis can be made by the pathologist. The CT and MRI images are not characteristic. One treatment option is the multidisciplinary approach; however, the prognosis remains poor for patients with metastatic disease. Mihai Razvan Manescu, Achraf Sahyoun, Nicolas Froment, Nicolae Crisan, and Vincent Girot Copyright © 2015 Mihai Razvan Manescu et al. All rights reserved. Treatment of Symptomatic Lower Pole Stones of a Kidney with Partial Nephrectomy Using Micropercutaneous Nephrolithotomy Technique Tue, 31 Mar 2015 11:56:14 +0000 http://www.hindawi.com/journals/criu/2015/456714/ We present the treatment of lower pole stones of a 62-year-old male patient with a history of open partial nephrectomy due to renal angiomyolipoma and renal stones. He was successfully treated with micropercutaneous nephrolithotomy technique under spinal anesthesia in spite of fibrotic and scar tissue due to previous open surgery. The patient was stone-free and was discharged after a 24-hour hospitalization period. There is not any published report of micropercutaneous nephrolithotomy in a partial nephrectomized kidney before. In this report, we suggest that microperc technique may be considered for challenging conditions in case of failed retrograde intrarenal surgery. Tuna Karatag, Ibrahim Buldu, Mehmet Kaynar, Hakan Taskapu, Erdem Tekinarslan, and Mustafa Okan Istanbulluoglu Copyright © 2015 Tuna Karatag et al. All rights reserved. Long Term Progression-Free Survival in a Patient with Locally Advanced Prostate Cancer under Low Dose Intermittent Androgen Deprivation Therapy with Bicalutamide Only Thu, 26 Mar 2015 12:03:46 +0000 http://www.hindawi.com/journals/criu/2015/928787/ Androgen deprivation is a common treatment option in patients with locally advanced or metastatic prostate cancer. No case of long term treatment with an intermittent approach with only low dose bicalutamide (50 mg daily) has been described yet. We report a 60-year-old patient, initially presenting with a PSA elevation of 19.2 ng/mL in 1996. After diagnosis of well to moderately differentiated prostate cancer by transrectal biopsy, the patient underwent an open radical prostatectomy. Final diagnosis was adenocarcinoma of the prostate, classified as pT3a, pR1, pV0, and pL1. Adjuvant intermittent androgen deprivation therapy with flutamide 250 mg was applied, which was changed to bicalutamide 50 mg once daily when it became available in 2001. Six on-phases were performed and PSA values never exceeded 20 ng/mL. The patient did not experience any serious side effects. To date, there are no clinical or radiological signs of progression. Current PSA value is 3.5 ng/mL. Stefan Latz, Christian Fisang, Wolfram Ebert, Stefan Orth, Dirk G. Engehausen, Stefan C. Müller, and Ralf Anding Copyright © 2015 Stefan Latz et al. All rights reserved. Torsion of a Large Appendix Testis Misdiagnosed as Pyocele Sun, 15 Mar 2015 11:02:37 +0000 http://www.hindawi.com/journals/criu/2015/430871/ Torsion of the appendix testis is not an uncommon cause of acute hemiscrotum. It is frequently misdiagnosed as acute epididymitis, orchitis, or torsion of testis. Though conservative management is the treatment of choice for this condition, prompt surgical intervention is warranted when testicular torsion is suspected. We report a case of torsion of a large appendix testis misdiagnosed as pyocele. Emergency exploration of it revealed a large appendix testis with torsion and early features of gangrene. After excision of the appendix testis, the wound was closed with an open drain. The patient had an uneventful and smooth postoperative recovery. Susanta Meher, Satyajit Rath, Rakesh Sharma, Prakash Kumar Sasmal, and Tushar Subhadarshan Mishra Copyright © 2015 Susanta Meher et al. All rights reserved. Recurrence of Prostate Cancer with Cutaneous Metastasis after Radical Prostatectomy Thu, 12 Mar 2015 12:20:34 +0000 http://www.hindawi.com/journals/criu/2015/825175/ While cutaneous metastases are already extremely rare in primary metastatic prostatic adenocarcinoma, cutaneous manifestations in recurrent prostate cancer have rarely been described prior to this report. Here we present the case report of a 93-year-old male who underwent radical prostatectomy but eventually suffered from a previously undescribed recurrence of prostatic adenocarcinoma with distant cutaneous metastases to proximal right lower leg. Parth Patel, Jay Patel, and Sameer Siddiqui Copyright © 2015 Parth Patel et al. All rights reserved. Enterovesical Fistula Caused by a Toothpick Sun, 08 Mar 2015 13:31:26 +0000 http://www.hindawi.com/journals/criu/2015/902673/ We present a case of enterovesical fistula caused by an accidental ingestion of a foreign body. A 23-year-old man presented to our hospital with pneumaturia, fecaluria, and abdominal pain but no recent possible causes of enterovesical fistula at anamnesis. Cystoscopy, cystography, and also colonoscopy were not able to detect the fistulous tract. Computer tomography (CT) revealed a fistula between bladder and bowels caused by a toothpick accidentally swallowed 2 years earlier. We tried to remove the foreign body endoscopically by cystoscopy and colonoscopy but with no success. The failure of endoscopic procedures required a surgical treatment. The patient underwent laparoscopic segmental resection of the sigmoid colon to remove the fistulous tract and the foreign body. The cystography revealed no external leakage of contrast from the bladder with complete resolution of the problem. Flavia Tombolini, Vito Lacetera, and Giovanni Muzzonigro Copyright © 2015 Flavia Tombolini et al. All rights reserved. Prostate Cancer Metastatic to the Cervical Lymph Nodes Wed, 04 Mar 2015 11:15:52 +0000 http://www.hindawi.com/journals/criu/2015/263978/ Prostate cancer is the most common cancer in men, often presenting with regional lymph node or bone metastasis and rarely with supradiaphragmatic lymph node involvement. Most metastatic cancers involving the cervical lymph nodes are from cancers of the upper aerodigestive tract. In this report, we describe two cases with cervical lymph node enlargement due to metastatic prostate cancer as the initial clinical presentation: a 43-year-old male, initially misdiagnosed with a tumor of the upper aerodigestive tract and an 87-year-old male with right lobe pneumonia and cervical lymph node enlargement, initially attributed to be an acute inflammatory lymph node reaction. To the best of our knowledge, there are less than 50 cases reported in the literature of adenocarcinoma of prostate metastatic to the cervical lymph nodes and only one case presenting in men younger than 45 years. The authors intend to highlight the importance of digital rectal exam and PSA test in case of persistent left cervical lymph node enlargement, including men younger than 45 years of age. Luis Sepúlveda, Tiago Gorgal, Vanessa Pires, and Filipe Rodrigues Copyright © 2015 Luis Sepúlveda et al. All rights reserved. Laparoscopic Treatment of a Spontaneously Ruptured Kidney (Wunderlich Syndrome) Thu, 26 Feb 2015 17:20:39 +0000 http://www.hindawi.com/journals/criu/2015/701046/ 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 http://www.hindawi.com/journals/criu/2015/523258/ 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 http://www.hindawi.com/journals/criu/2015/101062/ 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 http://www.hindawi.com/journals/criu/2015/316956/ 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 http://www.hindawi.com/journals/criu/2015/465748/ 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 http://www.hindawi.com/journals/criu/2015/642547/ 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 http://www.hindawi.com/journals/criu/2015/687482/ 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 http://www.hindawi.com/journals/criu/2015/598138/ 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.