Case Reports in Urology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Symptomatic Infundibulopelvic Dysgenesis in an Adolescent Thu, 09 Apr 2015 14:21:19 +0000 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 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 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 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 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 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 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.