Case Reports in Urology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Radical Cystectomy with Ileal Conduit Urinary Diversion in a Patient with a Left Ventricular Assist Device Tue, 28 Jul 2015 09:05:32 +0000 Left ventricular assist device (LVAD) is an option for the surgical management of severe heart failure, and radical cystectomy remains the standard of care for muscle-invasive bladder cancer. Given a complicated population in terms of comorbidities and management for patients with an LVAD, there is little experience with major urologic procedures, which require balancing the benefits of surgery with considerable perioperative risks. We report our experience performing the first radical cystectomy with ileal conduit in a patient with an LVAD and muscle-invasive bladder cancer. Joseph J. Pariser, Adam B. Weiner, and Gary D. Steinberg Copyright © 2015 Joseph J. Pariser et al. All rights reserved. Papillary Renal Cell Carcinoma Seeding along a Percutaneous Biopsy Tract Tue, 28 Jul 2015 08:52:24 +0000 We report a case of tumour seeding caused by percutaneous biopsy of a papillary renal cell carcinoma detected on pathological assessment of the partial nephrectomy specimen in a 50-year-old male. Whilst percutaneous biopsy of renal masses is considered to be safe and can be a valuable tool in the assessment of certain renal lesions, it is not without risks. This rare complication should be taken into consideration before contemplating its use in a patient. Deanne Soares, Nariman Ahmadi, Oana Crainic, and John Boulas Copyright © 2015 Deanne Soares et al. All rights reserved. Prelaminated Gracilis Flap with Buccal Mucosal Graft for Salvage of Devastated Urethra Thu, 16 Jul 2015 10:17:07 +0000 In patients with devastated bulbous urethra, that is, bulbar necrosis, failed fasciocutaneous repairs and “watering can perineum” repair options are limited by paucity of reliable local tissue suitable for reconstruction. In this case report we demonstrate a novel variation of a two-stage technique for reconstruction of a devastated bulbous urethra in a 57-year-old male who suffered penetrating trauma to his previously reconstructed urethra. Because of extensive loss of local tissue from the prior reconstruction and subsequent trauma and infection a 2-stage technique with use of gracilis was employed. This technique involved creation of two independently vascularized urethral hemi-plates prelaminated with buccal mucosa graft (BMG). In the first stage the dorsal plate was created by quilting buccal graft onto corpora cavernosa to create a temporary augmented perineal urethrostomy. In the same stage the future ventral neourethral plate was created by grafting another BMG onto the exposed distal gracilis muscle. Eight weeks later the two prelaminated plates were anastomosed by tunneling the gracilis-BMG composite into the perineum. At 8-month follow-up patient has normal voiding and continence. To our knowledge this is the first report of reconstructing an entire segment of devastated urethra in such a manner. Dmitriy Nikolavsky Copyright © 2015 Dmitriy Nikolavsky. All rights reserved. Sarcomatoid Renal Cell Carcinoma Metastasis to the Penis Tue, 14 Jul 2015 11:51:12 +0000 Secondary cancers of the penis are extremely uncommon with less than 300 cases reported in the past 100 years. These cancers are most frequently a result of an aggressive or poorly managed primary prostate or bladder cancer and rarely a metastasis from a primary kidney tumor. Currently, there is no published literature which describes the spread of sarcomatoid renal cell carcinoma (SRCC) to the penis. In this report, we present a 55-year-old-man who presented with a large right-sided SRCC which metastasized to the base of his penis within 1 month of symptom onset. We also discuss the possible route of metastasis based on primary tumor size and location within the retroperitoneum. Victor D. Liou, Oussama M. Darwish, Mary M. Henry, Ik C. Jun, and Sameer A. Siddiqui Copyright © 2015 Victor D. Liou et al. All rights reserved. A Major Complication in Micropercutaneous Nephrolithotomy: Upper Calyceal Perforation with Extrarenal Migration of Stone Fragments due to Increased Intrarenal Pelvic Pressure Tue, 14 Jul 2015 07:37:08 +0000 Micropercutaneous nephrolithotomy is a safe and efficient technique for appropriate sized stones. It is performed through a 4.85 Fr all-seeing needle and stones are fragmented into dust, without the need for tract dilatation, unlike other percutaneous nephrolithotomy types. Even though micropercutaneous nephrolithotomy has many advantages, increase in intrapelvic pressure during surgery may cause rare but serious complications. Herein we report a case of micropercutaneous nephrolithotomy in a 20-year-old woman with a 20 mm right renal pelvis stone and present an undesired outcome of this complication, upper calyceal perforation. Right lower calyceal access was performed with 4.85 Fr all-seeing needle and 2 cm renal pelvis stone was fragmented by 272 μm Holmium-Yag laser system. Upper calyceal perforation and infrahepatic accumulation of stone fragments were detected by fluoroscopy during the surgery. Postoperative imagings revealed perirenal urinoma, perirenal and infrahepatic stone fragments, and lower calyceal stone fragments inside the system. On second postoperative day, minipercutaneous nephrolithotomy and double J catheter insertion procedures were applied for effective drainage and stone clearance. Risk of calyceal perforation and urinoma formation, due to increased intrapelvic pressure during micropercutaneous nephrolithotomy, should be kept in mind. Fatih Akbulut, Burak Ucpinar, Metin Savun, Onur Kucuktopcu, Faruk Ozgor, Abdulmuttalip Simsek, and Gokhan Gurbuz Copyright © 2015 Fatih Akbulut et al. All rights reserved. Intravesical Migration of Missed Intrauterine Device Associated with Stone Formation: A Case Report and Review of the Literature Mon, 13 Jul 2015 06:36:48 +0000 Intrauterine device is the most widely used method of reversible contraception. It may cause various complications including perforation of uterus. In this case, 44-year-old woman was presented with lower urinary tract symptoms after six years of insertion. Patient has no remarkable physical or laboratory finding but abdominal ultrasound revealed a 27 mm hyperechogenicity, suggestive of foreign body or calculus on the posterior bladder wall which was removed endoscopically. This case highlights the need of immediate and periodic evaluation of women with intrauterine device to avoid missing serious complications. Mücahit Kart, Turgay Gülecen, Murat Üstüner, Seyfettin Çiftçi, Ufuk Yavuz, and Cüneyd Özkürkçügil Copyright © 2015 Mücahit Kart et al. All rights reserved. Adult Patient with Synchronous Gastrointestinal Stromal Tumor and Xp11 Translocation-Associated Renal Cell Carcinoma: A Unique Case Presentation with Discussion and Review of Literature Mon, 13 Jul 2015 05:56:54 +0000 Gastrointestinal stromal tumor (GIST) is the most common primary mesenchymal tumor of the gastrointestinal tract. This entity comprises a wide spectrum of tumors that vary from benign to overtly malignant, with the majority of these tumors harboring oncogenic mutations of the KIT receptor tyrosine kinase that can aid in diagnosis as well as in targeted therapy. Although the majority of GISTs are sporadic, there are forms that are associated with a variety of syndromes including Carney-Stratakis syndrome and neurofibromatosis type 1, as well as a subset of familial GIST syndromes that are caused by germline mutations in KIT or PDGFRA. Here, we describe an unusual case of a patient who was found to have a large abdominal GIST with an incidentally found Xp11 translocation-associated renal carcinoma. The karyotype of the renal carcinoma revealed an unbalanced rearrangement involving an (X;22) translocation at Xp11.2 and 22p11.2, which has not been reported in the literature. Although GISTs have shown an association with other primary malignant neoplasms, including simultaneous presence with unilateral clear cell renal cell carcinoma and bilateral papillary renal cell carcinomas, we describe the first reported case of synchronous GIST and Xp11 translocation-associated renal cell carcinoma. Vanda Farahmand Torous, Albert Su, David Y. Lu, and Sarah M. Dry Copyright © 2015 Vanda Farahmand Torous et al. All rights reserved. Huge Pyogenic Granuloma of the Penis Thu, 02 Jul 2015 10:21:51 +0000 Pyogenic granulomas are benign vascular disorders of the skin and mucose membranes, generally developed by trauma and irritation. The lesions are generally small. They are most commonly seen in the skin and oral mucosa and rarely seen on penis. We present the case of a huge pyogenic granuloma on the penis. Fatih Akbulut, Tugba Akbulut, Faruk Kucukdurmaz, Erkan Sonmezay, Abdulmuttalip Simsek, and Gokhan Gurbuz Copyright © 2015 Fatih Akbulut et al. All rights reserved. Delayed Recognition of an Ureteropelvic Junction Obstruction in a Young Adult Female Sun, 28 Jun 2015 06:57:26 +0000 A percentage of ureteropelvic junction obstruction cases are clinically silent in childhood and manifest symptoms in adults. Herein we present a 25-year-old female with several years of intermittent flank pain and abdominal symptoms with prior inconclusive diagnostic workup including abdominal imaging without hydronephrosis. Ultimately, a CT scan performed during an acute pain crisis clearly identified right-sided hydronephrosis. The keys to diagnosis are awareness of this entity, a detailed history, and obtaining imaging studies during a crisis. The patient subsequently underwent a right robotic-assisted laparoscopic pyeloplasty with preservation of a lower pole crossing vessel. We highlight noteworthy features of the clinical presentation and surgical repair. Ariel Schulman, Jean Paul Wuilleumier, and Ervin Teper Copyright © 2015 Ariel Schulman et al. All rights reserved. Epinephrine Injection Associated Scrotal Skin Necrosis Mon, 22 Jun 2015 14:18:53 +0000 Male circumcision is among the most frequent surgical interventions throughout history. Although considered as a minor intervention, it may have complications ranging from insignificant to catastrophic. These complications can be attributed to the surgical procedure and anesthesia. In this report we present two cases of scrotal skin necrosis after lidocaine with epinephrine injection using subcutaneous ring block technique prior to circumcision. Murat Gul, Mehmet Kaynar, Tamer Sekmenli, Ilhan Ciftci, and Serdar Goktas Copyright © 2015 Murat Gul et al. All rights reserved. A Rare Case of a Renal Cell Carcinoma Confined to the Isthmus of a Horseshoe Kidney Mon, 22 Jun 2015 06:45:56 +0000 Horseshoe kidney (HSK) is the most common renal anomaly. Reports of the incidence of renal cell carcinoma (RCC) in HSK are conflicting. Very few cases of isthmus-located RCC have been reported in the literature. We report a unique case of an isthmus-located RCC. Proper vascular and tumor imaging prior to surgery is key to successful tumor removal. Michael Kongnyuy, Daniel Martinez, Anthony Park, Barrett McCormick, Justin Parker, and Mary Hall Copyright © 2015 Michael Kongnyuy et al. All rights reserved. Chikungunya Virus Infection and Acute Elevation of Serum Prostate-Specific Antigen Wed, 17 Jun 2015 12:49:35 +0000 A man with prostate cancer on a regime of active surveillance had a laboratory-confirmed acute Chikungunya virus infection. The patient experienced a sudden increase in serum Prostate-Specific Antigen (PSA) during the acute illness that caused him anxiety and confounded interpretation of the PSA test. Six weeks after the onset of Chikungunya Fever symptoms, the elevated serum PSA returned to baseline. The association of Chikungunya Fever and elevated serum PSA may result in misinterpretation of the PSA test, triggering unnecessary prostate biopsy or other management errors. William Derval Aiken and Joshua J. Anzinger Copyright © 2015 William Derval Aiken and Joshua J. Anzinger. All rights reserved. Necrotizing Urethritis due to Aerococcus urinae Thu, 11 Jun 2015 16:48:18 +0000 A 49-year-old male presented to the emergency with hematuria and pain in the shaft of the penis for one day. The patient was found to be in a state of shock. The shaft of the penis and the scrotum were swollen and tender. No skin necrosis was observed and no crepitus was palpable. Serum white count (WBC) was 29.5 × 103/μL. A CT scan showed gas in the corpus spongiosum. Antibiotics were started with IV metronidazole, vancomycin, and piperacillin/tazobactam. Metronidazole was then replaced by clindamycin. Exploration was performed but no necrotic tissue was identified. Cystourethroscopy revealed dusky looking urethra. A suprapubic tube and a urethral catheter were placed in the bladder. WBC trended down to 13.9 × 103/μL on the fourth postoperative day. Urine culture grew Aerococcus urinae and blood cultures grew Alpha Hemolytic Streptococcus. On the sixth day, the patient was feeling worse and WBC increased. MRI revealed absent blood flow to the corpus spongiosum. Urethroscopy revealed necrosis of the urethra. Urethrectomy was performed via perineal approach. The patient immediately improved. The patient was discharged on the sixth postoperative day to continue ampicillin/sulbactam IV every 6 hours for a total of 4 weeks from the day of urethrectomy. Abdulrahman A. Babaeer, Claudia Nader, Vito Iacoviello, and Kevin Tomera Copyright © 2015 Abdulrahman A. Babaeer et al. All rights reserved. Salvage Brachytherapy for Castration-Resistant and External Beam Radiotherapy-Resistant Local Recurrence 17 Years after Radical Prostatectomy Thu, 11 Jun 2015 13:15:18 +0000 A 47-year-old Japanese man was diagnosed with prostate cancer in February 1995 (Initial PSA 77.2 ng/mL, GS3 + 4, cT3N0M0). He underwent radical prostatectomy after androgen deprivation therapy (ADT) in June 1995. Nine years after operation, he was diagnosed with local recurrence of prostate cancer and he received postoperative external beam radiation therapy (EBRT) (70 Gy). By May 2008, the PSA dropped to 0.33 ng/mL, and a CT scan showed that the mass had disappeared. On April 2012, the PSA once again rose to 3.1 ng/mL. CT scan and MRI revealed a mass in the prostatic bed. We diagnosed local recurrence of prostate cancer. We underwent salvage low-dose brachytherapy after obtaining informed consent. The prescribed dose of the salvage brachytherapy was 145 Gy to control the tumor considering the hormone resistant prostatic cancer and high-risk feature. PSA level rapidly decreased to 0.66 ng/mL by 6 months after seed implantation. No adverse events were seen during the follow-up period. Shogo Hosogoe, Osamu Soma, Teppei Matsumoto, Atsushi Imai, Shingo Hatakeyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Chikara Ohyama, and Masahiko Aoki Copyright © 2015 Shogo Hosogoe et al. All rights reserved. The Youngest Korean Case of Urachal Carcinoma Thu, 04 Jun 2015 06:33:09 +0000 Urachal anomalies are relatively uncommon and result from incomplete obliteration of the urachus perinatally. In children, most urachal diseases including urachal cysts and sinuses are benign, and these can sometimes become secondarily infected. Malignant involvement of the urachus is rarely reported, one in 5 million people, accounting for 0.35% to 0.7% of all bladder cancers. There are only five cases of urachal cancer diagnosed at the age of twenties in English written literature. Age at the diagnosis of urachal carcinoma is important to understand pathogenetic transition from benign to malignancy. A 26-year-old man visited our clinic with gross hematuria starting a few months before. CT scan showed a 4.0 6.8 cm sized lobulated cystic mass over the bladder dome. Cystoscopy showed a ball-shaped extrinsic mass from the bladder dome with intact bladder mucosa. With an impression of urachal cancer, laparoscopic partial cystectomy with wide excision of urachus was performed. Final diagnosis was well differentiated mucinous urachal adenocarcinoma invading bladder muscle, staged as pT3a based on Sheldon’s staging system. To our best knowledge, this case is the youngest Korean case of urachal carcinoma (the fourth youngest ever in English written literature). Seung Ryeol Lee, Haeyoun Kang, Moon Hyung Kang, Young Dong Yu, Chang Il Choi, Kyung Hwa Choi, Dong Soo Park, and Young Kwon Hong Copyright © 2015 Seung Ryeol Lee et al. All rights reserved. Megalourethra with Y-Type Duplication of Urethra Presented as Perianal Fistula: A Rare Case Report Wed, 03 Jun 2015 09:56:26 +0000 Megalourethra with Y-type duplication is an extremely rare anomaly. We report here one such case, diagnosed with retrograde urethrogram, which was done from both penile meatus and perianal opening simultaneously. Patient was successfully treated by laser optical internal urethrotomy (OIU), excision of duplicated urethra, and reduction urethroplasty in a single stage. Shashi Verma, Goto Gangkak, Sher Singh Yadav, and Vinay Tomar Copyright © 2015 Shashi Verma et al. All rights reserved. Complete Expulsion of Testicular Prosthesis via the Scrotum: A Case-Based Review of the Preventive Surgical Strategies Tue, 02 Jun 2015 12:25:49 +0000 Testicular prostheses are regularly used in urological surgery and are important for postoperative psychological well-being in many patients undergoing orchiectomy. One of the recognised complications of this procedure is graft extrusion, which can result in significant morbidity for patients and require operative reintervention. Whilst most cases of extrusion involve upward graft migration to the external inguinal ring or direct displacement through the scrotal skin, we present an unusual case of complete expulsion of testicular implant three weeks postoperatively through a previously healthy scrotum. During surgical insertion of testicular prostheses, the urological surgeon must carefully consider the different surgical strategies at each step of the operation to prevent future extrusion of the graft. A stepwise review of the preventive surgical strategies to reduce the risk of graft extrusion encompasses the choice of optimal surgical incision, the technique of dissection to create the receiving anatomical pouch, the method of fixation of the implant within the receiving hemiscrotum, and the adoption of good postoperative care measures in line with the principles of sound scrotal surgery. Jack Donati-Bourne, A. Deb, Suresh Jay Mathias, Mark Fraser Saxby, and Herman Fernando Copyright © 2015 Jack Donati-Bourne et al. All rights reserved. Trisacryl Gelatin Microembolism and Metastases in the Lung after Renal Artery Embolization and Nephrectomy for Renal Cell Carcinoma Sun, 31 May 2015 13:16:07 +0000 This is the first report, to our knowledge, of widespread, histologically confirmed trisacryl gelatin pulmonary microembolism after renal artery embolization (RAE). In addition, this is the first report of lung involvement by both metastatic renal cell carcinoma (RCC) and an embolic agent used for RAE. The patient was a 63-year-old woman who recently presented with both dyspnea on exertion and productive cough. Her past medical history included clear cell RCC, which was treated with preoperative trisacryl gelatin microsphere RAE and right nephrectomy 9 years earlier. Computed tomography of the chest showed multiple lung nodules, a mass-like density in the left lower lobe, and mediastinal and hilar lymphadenopathy. Wedge resections of the lung showed multiple foci of metastatic RCC and extensive involvement of the muscular pulmonary arteries by trisacryl gelatin microspheres. Andres Borja Alvarez, Jack P. Leventhal, Cherise Cortese, Barbara L. McComb, David D. Thiel, and Andras Khoor Copyright © 2015 Andres Borja Alvarez et al. All rights reserved. Unusual Variant of Coronal Bladder Duplication Associated with Glans Diphallia: A Case Report and Review of the Literature Sun, 31 May 2015 08:08:37 +0000 Bladder duplication is a rare congenital anomaly which occurs in the sagittal or coronal plane and it can be associated with other anomalies. It has been previously classified as complete duplication of the bladder and urethra or incomplete duplication with two bladders and common urethra. However, complete duplication of bladder with a single urethra has been rarely reported. Herein, we present a patient with a different variation of bladder duplication in the coronal plane with two urethras originating from the main bladder and associated glans diphallia. Reza Khorramirouz, Amin Bagheri, and Abdol-Mohammad Kajbafzadeh Copyright © 2015 Reza Khorramirouz et al. 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 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 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 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 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 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 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 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 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 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 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 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.