Case Reports in Urology https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Forty-Three-Year-Old Female with Dopamine Secreting Pheochromocytoma of the Adrenal Gland Thu, 31 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/1736326/ We report on a 43-year-old, asymptomatic female who presented with incidental finding of left adrenal mass. MRI gave concerns for possible pheochromocytoma but markers for pheochromocytoma were not elevated as expected. 24-hour urine dopamine levels (6988 μg/day) were significantly elevated. The patient successfully underwent robotic assisted radical left adrenalectomy and was diagnosed with a dopamine secreting pheochromocytoma. Pathology revealed increased malignant potential associated with the tumor. The patient underwent full metastatic workup, which was negative. At two years of follow-up there was no recurrence and normalization of lab values. Tyler Haden, Marcin Zuberek, and Naveen Pokala Copyright © 2017 Tyler Haden et al. All rights reserved. Chondroma of the Bladder: An Atypical Localization Thu, 24 Aug 2017 07:20:27 +0000 http://www.hindawi.com/journals/criu/2017/6548314/ Chondroma is a benign tumour of mesenchymal origin that is composed of cartilage and rarely located in soft tissues, being described so far only in four cases, as located in the bladder, according to our knowledge. We describe the fifth case of a 67-year-old woman who consulted for microscopic haematuria, with an endoscopic finding of submucosal nodular image in the anterior wall of the bladder, which after resection and the histologic study shows cartilage and fibroconnective tissue, in part hyalinised, and positive immunohistochemical staining of cells with vimentin and S-100; this fact can support the diagnosis of bladder chondroma. M. Tamayo-Jover, A. Nazco-Deroy, R. González-Álvarez, H. Álvarez-Argüelles Cabrera, B. Padilla-Fernández, and T. Concepción-Masip Copyright © 2017 M. Tamayo-Jover et al. All rights reserved. Primitive Neuroectodermal Tumor and Wegener’s Granulomatosis of the Kidney: A Curious Combination of Two Rare Entities Tue, 01 Aug 2017 07:53:23 +0000 http://www.hindawi.com/journals/criu/2017/1750694/ Wegener’s granulomatosis (WG) is characterized by necrotizing polyangiitis involving the respiratory tract and kidneys. It causes segmental necrotizing glomerulonephritis in the kidneys. In rare cases, a renal pseudotumor may be seen because of the granulomatous process. Association of WG with renal malignancy, however, is very uncommon. We report a case of a patient who presented several years after being treated for WG with malignant hypertension and an infiltrating mass in the right kidney. The histopathology of radical nephrectomy specimen showed presence of primitive neuroectodermal tumor (PNET). Association of renal cell carcinoma (RCC) with WG has been documented in a few cases, but PNET in such circumstances has not been reported. Long-term immunosuppressive treatment is a known risk factor in the development of malignancies, so it is proposed that the occurrence of RCC in WG may have been a side effect of cyclophosphamide treatment. It is not clear whether the same mechanism for PNET holds true in the present case. It is important to make a differential diagnosis between true malignancy and pseudotumors in WG as these entities cannot be distinguished based solely on imaging. We suggest a need to routinely screen the WG patients for increased risk of urologic malignancies. Rugvedita Parakh, Satyajeet Parakh, and Maria Tretiakova Copyright © 2017 Rugvedita Parakh et al. All rights reserved. Use of Diagnostic Laparoscopy for Identification of Bilateral Noncommunicating Hydroceles in an Infant with Right-Sided Abdominoscrotal Mass and Left-Sided Scrotal Mass Mon, 31 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/8602584/ Infantile abdominoscrotal hydrocele (ASH) is a rare condition characterized by a dumbbell-shaped cystic mass extending from the scrotum to the abdomen. We present the case of a 4-month-old infant who presented with progressively enlarging bilateral scrotal swelling and a tense, ballotable right-sided abdominal mass with extension into the scrotum. Scrotal ultrasound revealed bilateral hydroceles but exam and ultrasound could not rule out communication. At the time of planned hydrocelectomy, initial diagnostic laparoscopy was used to identify a massive right-sided ASH extending from the internal ring to the umbilicus and a large noncommunicating left-sided hydrocele that was visible with application of pressure to the left side of the scrotum. Following confirmation of anatomy with diagnostic laparoscopy, a scrotal approach to hydrocelectomy was performed as well as bilateral orchidopexy. Kian Asanad, Pooya Banapour, and Monica Metzdorf Copyright © 2017 Kian Asanad et al. All rights reserved. Scrotal Abscess Drained by Iatrogenic Urethral Fistula in an Adult Diabetic Male Mon, 17 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/9820245/ A 46-year-old Caucasian male has been transferred to our urology department with a history of septic fever, uncompensated diabetes, pain, and scrotal swelling. On clinical examination, the left inguinal and scrotal area was swollen, tender, and painful; scrotal MR had been performed, showing the catheter tip in scrotal cavity and presence of gas. The case was diagnosed as scrotal abscess with urethroscrotal fistula. He was successfully treated with scrotal incision, drainage, catheter repositioning under fluoroscopic control, antibiotics, and insulin. This patient developed an infection of scrotum, which led to subcutaneous abscess getting worse by a poorly controlled glycemia. In this case, an iatrogenic fistula, caused by wrong catheterization, stops the evolving to a Fournier’s Gangrene. Early detection and intervention provide opportunities to improve outcome of this disease. Marco Stizzo, Davide Arcaniolo, Carmelo Quattrone, Raffaele Balsamo, Marco Terribile, Celeste Manfredi, Vincenzo Mirone, Paolo Verze, and Marco De Sio Copyright © 2017 Marco Stizzo et al. All rights reserved. Multiple Acrometastases in a Patient with Renal Pelvic Urothelial Cancer Mon, 03 Jul 2017 06:34:09 +0000 http://www.hindawi.com/journals/criu/2017/7830207/ Metastasis may occur in any bone but more commonly occurs in the spine, pelvis, or other axial bones. Metastasis in peripheral bones located distal to the elbow or knee, so-called acrometastasis, is rare. Although the mechanism of acrometastasis development is not completely understood, it is thought to be the result of a massive dissemination of cancer cells; thus the prognosis of patients with acrometastasis is relatively poor. Here, we report the case of renal pelvic cancer with multiple acrometastases in both the upper and lower extremities without axial bone metastasis in a 68-year-old man. After two regimens of chemotherapy, he suffered from pain on his wrist and ankle and swelling and hemorrhage of his toe. He had no axial bone metastasis by CT but was diagnosed with multiple acrometastases by plain radiographs. Radiation therapy and disarticulation of the left big toe at the metacarpal-phalangeal joint were performed and his pain and hemorrhage were successfully controlled. Although acrometastasis from renal pelvic cancer is very rare, we should recognize that acrometastasis might occur which exists outside of the CT scanning field. Ryoko Sawada, Yusuke Shinoda, Aya Niimi, Tohru Nakagawa, Masachika Ikegami, Hiroshi Kobayashi, Sakae Tanaka, Yukio Homma, and Nobuhiko Haga Copyright © 2017 Ryoko Sawada et al. All rights reserved. Marker-Negative Pheochromocytoma Associated with Inferior Vena Cava Thrombosis Thu, 15 Jun 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/6270436/ Pheochromocytoma associated with inferior vena cava (IVC) thrombosis is very rare. A 27-year-old female presented with right flank pain and hypertensive urgency. Contrast-enhanced CT abdomen and gadolinium-contrast MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Her routine laboratory investigations including 24-hour urine fractionated metanephrines, vanillylmandelic acid, and cortisol were normal. Right adrenalectomy with IVC thrombectomy was done. Perioperative period was uneventful. Histopathology of the mass turned out to be pheochromocytoma with thrombus revealing fibroadipose tissue with fibrin. Pheochromocytoma may present with IVC thrombus as well as normal serum and urinary markers. Thus, clinical suspicion is imperative in perioperative management of adrenal mass. S. Poudyal, M. Pradhan, S. Chapagain, B. R. Luitel, P. R. Chalise, U. K. Sharma, and P. R. Gyawali Copyright © 2017 S. Poudyal et al. All rights reserved. Primary Signet-Ring Cell Carcinoma of the Urinary Bladder Successfully Managed with Radical Cystectomy in a Young Patient Mon, 05 Jun 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/9121078/ Primary signet-ring cell adenocarcinoma of bladder is a rare neoplasm, usually seen in middle age adults. We report the case of an 18-year-old man who presented with intermittent gross hematuria. Computed tomography imaging showed multifilling defects in the bladder. The patient underwent a transurethral resection of the bladder tumor. Histological findings were consistent with poorly differentiated mixed mucinous and signet-ring cell adenocarcinoma. We ruled out other possible origins of tumor by gastrointestinal endoscopy and colonoscopy. The patient was treated with radical cystectomy with prostate and seminal vesicle sparing technique and orthotopic diversion using “W” ileum pouch with pelvic lymphadenectomy to the bifurcation of the aorta was done. Six-month follow-up of patient showed normal conditions without metastatic spread or any recurrence. Farzad Allameh, Morteza Fallah Karkan, Yalda Nilipour, and Azadeh Rakhshan Copyright © 2017 Farzad Allameh et al. All rights reserved. Female Urethral Diverticulum Carcinoma: A Case Report and Literature Review Thu, 25 May 2017 07:08:02 +0000 http://www.hindawi.com/journals/criu/2017/8918492/ A 48-year-old woman with a history of voiding difficulty visited our hospital. Magnetic resonance imaging revealed a periurethral tumor, which was pathologically diagnosed as an adenocarcinoma via transperineal needle biopsy. Radical cystectomy and urethrectomy were performed, and the urinary tract was reconstructed using an ileal conduit. Pathological examination of a resected specimen confirmed adenocarcinoma of the urethral diverticulum. The patient received adjuvant gemcitabine and cisplatin chemotherapy. She is alive at 5 months since the operation. Ryo Kasahara, Tadashi Tabei, Yukio Tsuura, and Kazuki Kobayashi Copyright © 2017 Ryo Kasahara et al. All rights reserved. Propionibacterium acnes Is an Unusual Cause of Acute Scrotal Abscess in a Preterm Infant Tue, 23 May 2017 10:02:26 +0000 http://www.hindawi.com/journals/criu/2017/7942707/ Acute scrotal abscess is an extremely rare condition in neonates and may mimic testicular torsion. Most of these abscesses have reportedly been due to Staphylococcus and Salmonella spp. infections. We herein report a unilateral acute scrotal abscess in a preterm infant born at 26 weeks in whom Propionibacterium acnes was isolated from the collected scrotal fluid culture. To our knowledge, this is the first case report implicating P. acnes as a causative agent of neonatal scrotal abscess. Based on such findings, P. acnes infection should be considered in differential diagnosis of acute scrotal abscess in neonates, particularly in preterm infants. Naoto Nishizaki, Tadaharu Okazaki, Yu Adachi, Kaoru Obinata, Hiromichi Shoji, and Toshiaki Shimizu Copyright © 2017 Naoto Nishizaki et al. All rights reserved. Hyper IgE Syndrome and Renal Cell Carcinoma Thu, 18 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/7083451/ Hyper IgE Syndrome (HIES) is an immunodeficiency disorder characterized by increased serum levels of IgE, eczema, and recurrent cutaneous and pulmonary infections. In this report, we present, to our knowledge, the first documented case of renal cell carcinoma (RCC) found in a patient with HIES. The patient received infectious disease clearance prior to obtaining a partial nephrectomy which revealed clear cell histology. Both HIES and RCC have an immunological basis for their pathophysiology and may involve common pathways. Further studies may provide insight into any possible link and clinicians should be mindful of immunocompromised patients who present with risk factors for genitourinary malignancy. Neel H. Patel, Mark Ferretti, and John L. Phillips Copyright © 2017 Neel H. Patel et al. All rights reserved. Urothelial Carcinoma in a 22-Year-Old Female with Angelman Syndrome Tue, 11 Apr 2017 08:29:49 +0000 http://www.hindawi.com/journals/criu/2017/9298565/ A 22-year-old nulligravid white female with Angelman syndrome was noted to have a 4-month history of premenstrual nausea, vomiting, and abdominal pain. She had an echogenic focus in her bladder noted on ultrasound. She was diagnosed with low grade urothelial carcinoma after cystoscopic evaluation with biopsy and was sent to urology for further treatment. Urothelial carcinoma is rare in individuals younger than age 40. Patients may present with gross hematuria. There is often a delay in diagnosis in younger individuals with different genetic mutations noted upon diagnosis. Jessica Pugh and R. Keith Huffaker Copyright © 2017 Jessica Pugh and R. Keith Huffaker. All rights reserved. Arterioureteral Fistula: Treatment of a Hemorrhagic Shock with Massive Hematuria by Placing a Balloon Catheter Wed, 29 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/9453618/ Arterioureteral fistulas (AUF) are serious diseases with increasing incidence. This case report relates the management of AUF in a patient with a history of abdominal oncological surgery, pelvic radiotherapy, and a double J stent in place. The fistula was discovered during a hemorrhagic shock with massive hematuria. The bleeding was controlled by a balloon catheter which led to endovascular treatment consisting of a covered stent. Nicolas Merzeau, Hervé Riquet, Ioannis Nicolacopoulos, Abbas Alame, and Stéphane Larré Copyright © 2017 Nicolas Merzeau et al. All rights reserved. Delayed Infection of a Lymphocele following RARP in a Patient with Nonspecific Symptoms Wed, 15 Mar 2017 07:11:02 +0000 http://www.hindawi.com/journals/criu/2017/3935082/ Pelvic lymphoceles are an infrequent complication after pelvic surgery and develop shortly after the surgery in most cases. We experienced a case of delayed infection of a lymphocele 6 months after robot-assisted radical prostatectomy (RARP) and pelvic lymphadenectomy. In this case, antimicrobial chemotherapy and percutaneous drainage were effective, and there was no recurrence of the disease. Most urologists do not recognize that infected lymphoceles can develop a long time after surgery; thus, infected lymphoceles should be kept in mind in patients with nonspecific infectious symptoms, regardless of the length of time after surgery. Tomoki Taniguchi, Yoshito Takahashi, Mitsuhiro Taniguchi, Toru Yamada, and Kenichiro Ishida Copyright © 2017 Tomoki Taniguchi et al. All rights reserved. PSMA-PET/CT-Positive Paget Disease in a Patient with Newly Diagnosed Prostate Cancer: Imaging and Bone Biopsy Findings Wed, 15 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/1654231/ A 67-year-old man diagnosed with Gleason score clinically localized prostate cancer with 68Ga-labeled prostate-specific membrane antigen-targeted ligand positron emission tomography/computed tomography (PSMA-PET/CT) positive Paget bone disease is described. Immunohistochemical staining revealed weak PSMA positivity of the bone lesion supporting the hypothesis that neovasculature might explain positive PSMA-PET/CT findings in Paget disease. Michael Froehner, Marieta Toma, Klaus Zöphel, Vladimir Novotny, Michael Laniado, and Manfred P. Wirth Copyright © 2017 Michael Froehner et al. All rights reserved. Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma Mon, 13 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/3017501/ Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications. Daniel Benamran, Benedicte de Clippele, Frank Hammer, and Bertrand Tombal Copyright © 2017 Daniel Benamran et al. All rights reserved. Prostate Cancer Presenting with Parietal Bone Metastasis Thu, 09 Mar 2017 07:05:01 +0000 http://www.hindawi.com/journals/criu/2017/1928570/ Bone metastases from prostate cancer are very common. They are usually located on the axial skeleton. However, cranial bone metastases especially to the parietal bone are rare. We report a case of metastatic prostate cancer presenting with left parietal bone metastasis in a patient with no urological symptoms or signs. We should consider prostate cancer in any man above 60 years presenting unusual bone lesions. Brahima Kirakoya, Abdoul Karim Pare, Babagana Mustapha Abubakar, and Moussa Kabore Copyright © 2017 Brahima Kirakoya et al. All rights reserved. Giant Perineal Solitary Fibrous Tumor: A Rare Case Report Thu, 02 Mar 2017 07:48:07 +0000 http://www.hindawi.com/journals/criu/2017/4876494/ Background. Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor that was initially described from the pleura but currently arises at almost every anatomic site. It is usually benign, and surgical resection is curative. SFT involving the perineum is extremely rare. This is the third case report of a perineal SFT in the literature. Case Presentation. We reported an uncommon case of a 64-year-old man presenting with a huge perineal mass that started growing 3 years before his arrival in our service. He was asymptomatic. A contrast-enhanced CT scan revealed a heterogeneous well-circumscribed perineal mass with soft-tissue density. Invasion of the surrounding organs, distal metastasis, and lymph node swelling were absent. The complete resection of mass was done successfully. The specimen was a 23.0 14.0 8.0 cm encapsulated tumor. Mass weight was 1,170 g. After pathological analysis, we confirmed that the mass was a solitary fibrous tumor. The diagnosis was based on clinical findings and histological morphology and immunohistochemistry study. Conclusion. SFTs are usually indolent tumors with a favorable prognosis. The perineal location is extremely rare. Complete resection of the mass is the treatment of choice. Petronio Augusto de Souza Melo, Ana Maria Yoshino Bonifaci, Fabio da Silva Crochik, Claudio Bovolenta Murta, Joaquim Francisco de Almeida Claro, and Joao Padua Manzano Copyright © 2017 Petronio Augusto de Souza Melo et al. All rights reserved. Rare Case of a Well-Differentiated Paratesticular Sarcoma of the Spermatic Cord in a 60-Year-Old Patient Thu, 02 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/7903242/ Introduction. Liposarcomas are tumors that occur mostly in the retroperitoneum. Of all liposarcomas only 3 to 7% are found in the paratesticular region. The spermatic cord is the main site of origin in these cases. The patients ages range from 50 to 60 years. This malignant disease can result in a loss of fertility aside from life-threatening sequelae. Case. We present a case of a liposarcoma of the paratesticular region. A 60-year-old man was referred with a painless mass in the scrotum and the right inguinal region. The patient underwent surgery and the mass was removed along with the right testis, the spermatic cord, and the soft tissues to the internal inguinal ring. Histopathological examination found a well-differentiated liposarcoma of  mm. The surgical margins were negative. The adjuvant treatment consisted in radiation therapy of the right inguinoscrotal area to the dose of 54 Gray, 2 Gy per session, 5 times a week. Conclusion. Paratesticular liposarcomas are rare tumors. Surgery with large margin resections was the main treatment in all reported cases. The adjuvant treatment is still unclear especially when the surgical margins are negative. The main factor that indicated this adjuvant treatment was the size of the tumor and the histologic subtype. Marwen Benna, Semia Zarraâ, Asma Belaïd, Aziz Cherif, Lotfi Kochbati, Mohammed Chebil, and Farouk Benna Copyright © 2017 Marwen Benna et al. All rights reserved. Conversion of Low-Flow Priapism to High-Flow State Using T-Shunt with Tunneling Sun, 26 Feb 2017 07:13:37 +0000 http://www.hindawi.com/journals/criu/2017/7394185/ Introduction. The three types of priapism are stuttering, arterial (high-flow, nonischemic), and venoocclusive (low-flow, ischemic). These are usually distinct entities and rarely occur in the same patient. T-shunts and other distal shunts are frequently combined with tunneling, but a seldom recognized potential complication is conversion to a high-flow state. Case Presentation. We describe 2 cases of men who presented with low-flow priapism episodes that were treated using T-shunts with tunneling that resulted with both men having recurrent erections shortly after surgery that were found to be consistent with high-flow states. Case was a 33-year-old male with sickle cell anemia and case was a 24-year-old male with idiopathic thrombocytopenic purpura. In both cases the men were observed over several weeks and both men returned to normal erectile function. Conclusions. Historically, proximal shunts were performed only in cases when distal shunts failed and carry a higher risk of serious complications. T-shunts and other distal shunts combined with tunneling are being used more frequently in place of proximal shunts. These cases illustrate how postoperative erections after T-shunts with tunneling can signify a conversion from low-flow to high-flow states and could potentially be misdiagnosed as an operative failure. Neil A. Mistry, Nicholas N. Tadros, and Jason C. Hedges Copyright © 2017 Neil A. Mistry et al. All rights reserved. Solitary Fibrous Tumor of the Prostate Which Was Initially Misdiagnosed as Prostate Cancer Sun, 26 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/3594914/ Solitary fibrous tumor (SFT) of the prostate is a very rare tumor. We report a case of 65-year-old man with SFT of the prostate which was initially misdiagnosed as prostate cancer. Finally, we performed total prostatectomy and the tumor was histologically diagnosed as SFT of the prostate. The patient’s clinical course has progressed favorably with no obvious recurrence 18 months postoperatively. Soma Osamu, Hiromi Murasawa, Atsushi Imai, Shingo Hatakeyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, and Chikara Ohyama Copyright © 2017 Soma Osamu et al. All rights reserved. Extensive Renal Arteriovenous Malformations Treated by Transcatheter Arterial Embolization Thu, 23 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/2376034/ An 84-year-old woman was referred to our department due to gross hematuria. Enhanced computed tomography revealed early enhancement of the right renal vein and multiple tortuous vessels around the right renal hilus, part of which had invaded into the renal parenchyma and renal calix. We diagnosed her with arteriovenous malformations (AVMs) and performed transcatheter arterial embolization (TAE). Angiography showed extensive and complex AVMs located in the central and peripheral areas of her kidney. After TAE, the hematuria resolved and she became hemodynamically stable. Tadashi Tabei, Hironao Tajirika, Jun Yoshigi, and Kazuki Kobayashi Copyright © 2017 Tadashi Tabei et al. All rights reserved. An Extremely Rare Case of Lower Urinary Tract Symptoms: Floating Benign Mesenchymal Mass in Abdomen Thu, 23 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/9854343/ A 48-year-old man admitted to the urology outpatient clinic with major symptoms of right-side pain and intermittent lower urinary tract symptoms (LUTSs) such as low urine flow rate, dysuria, and frequency. Uroflowmetry showed low urine flow, and laboratory tests revealed no pathology. Ultrasound (US) showed a 7 cm calcific mass above the bladder and a kidney cyst with a diameter of 5.3 cm in the upper pole of the right kidney. Enhanced computed tomography confirmed the US findings. Laparoscopic transperitoneal renal cyst decortication was performed. There was no sign of additional tumors. An independent mass in the abdomen was diagnosed, and the mass was removed. Based on the pathology, the diagnosis was a benign mesenchymal calcific mass. This is the first report of LUTSs due to a free benign mesenchymal mass in the published literature. Bulent Kati, Yigit Akin, Eyyup Sabri Pelit, and Mehmet Ogur Yilmaz Copyright © 2017 Bulent Kati et al. All rights reserved. Mycotic Aneurysm after Bacillus Calmette-Guérin Treatment: Case Report and Review of the Literature Mon, 20 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/4508583/ Background. Intravesicular Bacillus Calmette-Guérin (BCG) is an effective adjunctive therapy for superficial bladder cancer that has been shown to delay recurrence and progression of disease. Serious side effects are relatively rare but are difficult to diagnosis and commonly overlooked. Case Presentation. We report the case of a patient who was found to have mycotic aortic aneurysms secondary to treatment with BCG after a prolonged course with multiple intervening hospitalizations. Conclusion. Through this report, we discuss our present understanding of BCG infection following treatment and review the literature regarding this particular rare manifestation. Nathaniel D. Coddington, Jesse K. Sandberg, Chen Yang, Jennifer K. Sehn, Eric H. Kim, and Seth A. Strope Copyright © 2017 Nathaniel D. Coddington et al. All rights reserved. Robotic Assisted Laparoscopic Prostatectomy after High Intensity Focused Ultrasound Failure Tue, 24 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/criu/2017/5980697/ Background. Prostate cancer is the most common cancer diagnosed in men. As new focal therapies become more popular in treatment of prostate cancer, failure cases requiring salvage therapy with either surgical or other techniques are being reported. Objective. To report the options in treatment of prostate cancer after recurrence or failure of the primary treatment modality. Methods. We report a salvage robotic assisted laparoscopic radical prostatectomy (RALP) for prostate cancer recurrence following high intensity focused ultrasound treatment (HIFU) in the United States. Results. A 67-year-old man who underwent HIFU treatment for prostate adenocarcinoma 2 years prior was presented with a rising prostate specific antigen of 6.1 ng/mL to our clinic. A biopsy proven recurrent disease in the area of previous treatment documented the failure of treatment. The patient elected to undergo a salvage RALP. The operation time was 159 minutes. The patient was discharged from the hospital on postoperative day 1 with no complications. The catheter was removed on post-op day 10. The patient reserved sexual function and urinary continence. The PSA levels on 6 months’ follow-up are undetectable. Conclusions. Salvage RALP is an effective and safe treatment choice for recurrent prostate adenocarcinoma following failed HIFU treatment if operated by an experienced surgeon. Leon Telis, Seyed Behzad Jazayeri, and David B. Samadi Copyright © 2017 Leon Telis et al. All rights reserved. Incidental Presacral Myelolipoma Resembling the Liposarcoma: A Case Report and Literature Review Wed, 28 Dec 2016 09:56:56 +0000 http://www.hindawi.com/journals/criu/2016/6510930/ Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements, but fewer than 50 cases have been reported in the literature. They are usually discovered incidentally during imaging studies and are often misdiagnosed as liposarcoma, which have a malignant nature, because the imaging findings of myelolipoma can be similar to those of liposarcoma. It is challenging to distinguish presacral myelolipomas from other presacral fat-containing tumors without performing a histological examination. We should consider the possibility of a malignant tumor, and imaging-guided biopsy carries a risk of tumor spread along the biopsy tract. Therefore, surgical management might sometimes be required; however, it is not necessary in all cases. We present an incidentally detected case of presacral myelolipoma that was difficult to differentiate from other malignant tumors in a 71-year-old male. Naoto Tokuyama, Hisashi Takeuchi, Isao Kuroda, and Teiichiro Aoyagi Copyright © 2016 Naoto Tokuyama et al. All rights reserved. Primary Mucinous Adenocarcinoma of the Urinary Bladder with Signet-Ring Cells: Description of an Uncommon Case and Critical Points in Its Management Sun, 18 Dec 2016 10:02:41 +0000 http://www.hindawi.com/journals/criu/2016/6080859/ We present an uncommon case of mucinous adenocarcinoma of the bladder (MAB) with signet-ring cells extensively infiltrating prostate gland and pelvic/retroperitoneal lymph node stations and not responsive to usual systemic chemotherapy regimens. This case highlights the important features of MAB including the pattern of tumor spread, the tendency for initial misdiagnosis, and the importance of immunohistochemical study in order to define its primary origin from the bladder and choose the most appropriate treatment since the beginning. Fabrizio Di Maida, Giuliano Amorim Aita, and Daniele Amorim Aita Copyright © 2016 Fabrizio Di Maida et al. All rights reserved. Multilocular Cystic Renal Cell Carcinoma or Cystic Nephroma? Thu, 15 Dec 2016 08:27:05 +0000 http://www.hindawi.com/journals/criu/2016/5304324/ The incidence of Multilocular cystic renal cell carcinoma (MCRCC) in literature is very low and confounding MCRCC with cystic nephroma (CN) is even more unusual. The aim of this report is to present a case of MCRCC and emphasize the importance of the preoperative radiologic evaluation and immunohistochemical staining confirmation to obtain an accurate diagnosis. A 73-year-old woman presented with a history of 4-month right flank pain. CT showed a Bosniak type III renal mass. After laparoscopic partial nephrectomy the initial report was cystic nephroma. Immunohistochemical staining was performed being positive for Epithelial Membrane Antigen thus changing the diagnosis to MCRCC. Multilocular cystic renal cell carcinoma cannot reliably be distinguished from cystic nephroma neither by physical examination nor by radiologic evaluation; immunohistochemical staining assay is useful to differentiate between these conditions allowing an accurate diagnosis and proper follow-up. Adolfo González-Serrano, Roberto Cortez-Betancourt, Alejandro Alías-Melgar, Pedro Jair Botello-Gómez, Emilio Ramírez-Garduño, Eric Iván Trujillo-Vázquez, Yosimart Torres-Santos, José Antonio Mata-Martínez, and Fernando Carreño- de la Rosa Copyright © 2016 Adolfo González-Serrano et al. All rights reserved. Partial Nephrectomy for a Massive Sporadic Renal Angiomyolipoma: Case Report and Review of the Literature Wed, 14 Dec 2016 06:12:06 +0000 http://www.hindawi.com/journals/criu/2016/3420741/ Introduction. Angiomyolipomas are the most common benign tumor of the kidney, associated with Tuberous Sclerosis in 20% of cases and arising sporadically in 80% of cases. Renal angiomyolipomas are neoplasms of mesenchymal origin with varying proportions of vasculature, smooth muscle spindle cells, and adipocytes, making management of such neoplasms a challenging endeavor. Possible management options include partial or radical nephrectomy and segmental renal artery embolization. Case Presentation. A 61-year-old woman admitted for a large retroperitoneal hemorrhage was discovered to have a giant, sporadic, 3818.3 g, 30.0 × 26.5 × 18.0 cm left perinephric angiomyolipoma. Given her hemodynamic instability upon presentation, she underwent segmental arterial embolization, followed by an open left partial nephrectomy. Ten-month follow-up revealed no noticeable loss of renal function. Discussion. Literature review revealed occasional renal angiomyolipomas of comparable size, with all angiomyolipomas larger than this requiring treatment with radical nephrectomy. Conclusion. We show that nephron-sparing surgery may be considered in the treatment of even the largest of renal angiomyolipomas. Jacob Albersheim-Carter, Molly Klein, Paari Murugan, and Christopher J. Weight Copyright © 2016 Jacob Albersheim-Carter et al. All rights reserved. Surgical Management of Giant Genital Condyloma Acuminata by Using Double Keystone Flaps Wed, 16 Nov 2016 06:09:04 +0000 http://www.hindawi.com/journals/criu/2016/4347821/ Condyloma acuminata in the external genitalia (genital warts) is a sexually transmitted disease that is often caused by human papillomavirus (HPV). We report a case of giant genital condyloma acuminata in a 35-year-old male patient with HIV comorbidity treated by wide surgical excision. Excision defect was covered with split thickness skin graft (STSG) and double keystone flaps. There was no complication after surgery. Ten months following surgery, there was no new condyloma lesion and the patient had normal voiding and erectile functions. Peri Eriad Yunir, Chaidir A. Mochtar, Agus Rizal A. H. Hamid, Chaula L. Sukasah, and Rainy Umbas Copyright © 2016 Peri Eriad Yunir et al. All rights reserved.