Case Reports in Urology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Delayed Diagnosis of Iatrogenic Bladder Perforation in a Neonate Mon, 26 Sep 2016 12:01:23 +0000 Iatrogenic bladder injuries have been reported in the neonate during umbilical artery/vein catheterization, voiding cystourethrogram, urinary catheterizations, and overwhelming hypoxic conditions. Patients with iatrogenic bladder perforations can present with acute abdomen indicating urinary peritonitis, septic-uremic shock, or subtle symptoms like abdominal distension, pain, hematuria, uremia, electrolyte imbalances, and/or difficulty urinating. The following neonatal case report of perforated bladder includes a review of the signs, symptoms, diagnostic tools, and management of bladder injury in neonates. Antoinette S. Birs, Jose A. Perez, Mark A. Rich, and Hubert S. Swana Copyright © 2016 Antoinette S. Birs et al. All rights reserved. A Unique Case of Intraabdominal Polyorchidism: A Case Study Sun, 18 Sep 2016 13:39:34 +0000 Background. Polyorchidism, alternatively supernumerary testes (SNT), is a condition where an individual is born with more than two testicles. This congenital anomaly is quite rare and the literature has described various presentations. Questions/Purposes. To our knowledge, this presentation of polyorchidism has yet to be described in the literature. The goal of this case study is to add to the pediatric, general, and urologic surgery’s body of knowledge of the subject matter. Case Study. A nine-month-old boy was admitted for an impalpable right testis and phimosis. At the time of surgical exploration, there appeared to be polyorchid testis on the right-hand side, with three masses that potentially appeared to be undescended testes. Discussion. Proponents of a conservative approach argue that infertility is common in patients with polyorchidism and, by preserving a potentially functional SNT, there may be improved spermatogenesis. When performing definitive surgical treatment, meticulous intra-abdominal and intrainguinal exploration must be undertaken. Orchiopexy should be performed to reduce the chances of torsion, malignancy, and infertility. Conclusion. Our case is important to the literature as it is the first known case of polyorchidism with 3 SNT on the right side, located intra-abdominally, and in a patient less than 1 year of age. Javier Otero, Natalie Ben-Yakar, Biruk Alemayehu, Steven D. Kozusko, Frank Borao, and Thomas S. Vates III Copyright © 2016 Javier Otero et al. All rights reserved. A Prolapsed Cecoureterocele in an Adult Treated Conservatively: Highly Rare, but Existent Wed, 14 Sep 2016 14:03:11 +0000 Ectopic ureteroceles are one of the most common human urinary tract anomalies. They tend to be recognized and treated in early childhood, especially when they have prolapsed. In most cases surgical therapy is inevitable. In this case report, however, we present the unusual case of a 26-year-old woman suffering from a prolapsed cecoureterocele without any known history of an ectopic ureterocele so far. She was successfully treated without the need for a surgical procedure. Löcherbach Florian, Preusser Stefan, and Meier Mark Copyright © 2016 Löcherbach Florian et al. All rights reserved. Levator Ani Necrosis: An Exceptional Complication Occurring after “High Intensity Focused Ultrasound” of the Prostate Thu, 08 Sep 2016 17:39:01 +0000 High intensity focused ultrasound (HIFU) is a minimally invasive treatment option that might be considered in the management of localized prostate cancer. It is a well-tolerated treatment with few minor urologic complications and no major toxicities. In this paper, we report to our knowledge the first case of levator ani necrosis in a patient treated with HIFU, manifesting as sturdy perineal pain, which took years of NSAID intake and serial MRIs to demonstrate partial improvement. Therefore, we regard HIFU as a serious potential treatment option that still requires longer follow-up data before its approval in the personalized treatment panel of prostate cancer. Danny Badawy, Elie El Rassy, Fouad Aoun, and Roland Van Velthoven Copyright © 2016 Danny Badawy et al. All rights reserved. Acute Bladder Necrosis after Pelvic Arterial Embolization for Pelvic Trauma: Lessons Learned from Two Cases of Immediate Postembolization Bladder Necrosis Tue, 30 Aug 2016 15:40:32 +0000 We report two cases of acute bladder injury with bladder neck necrosis identified during the initial operative evaluation and within the early postprocedural period in patients with significant pelvic trauma requiring pelvic vascular embolization. To our knowledge, this is the first report of bladder neck necrosis found during the initial intraoperative surgical evaluation or early postoperative setting. Samuel Washington, E. Charles Osterberg, Sean P. Elliott, Adam B. Hittelman, and Benjamin N. Breyer Copyright © 2016 Samuel Washington et al. All rights reserved. Neurogenic Bladder Repair Using Autologous Mesenchymal Stem Cells Tue, 30 Aug 2016 08:40:33 +0000 The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion, the activity of which is regulated by the central and peripheral nervous systems. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury. This report describes a case of neurogenic bladder following laminectomy procedure and long-standing diabetes mellitus with neuropathy treated with autologous cellular therapy. The differentiation potential and paracrine effects of mesenchymal stem cells on bladder function have been highlighted. Pradeep V. Mahajan, Swetha Subramanian, Amit Danke, and Anand Kumar Copyright © 2016 Pradeep V. Mahajan et al. All rights reserved. Skeletal Muscle Metastases to the Flexor Digitorum Superficialis and Profundus from Urothelial Cell Carcinoma and Review of the Literature Sun, 28 Aug 2016 08:03:56 +0000 Urothelial cell carcinoma (UCC) metastases to skeletal muscle are extremely rare and usually found in patients with advanced stage cancer. The most common sites of bladder cancer metastases are lymph nodes, lung, liver, and bones. Muscle is an unusual site of metastases from a distant primary cancer, due to several protective factors. We present a rare case of 76-year-old patient with metastases in the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) muscles, 2 years after a radical cystectomy for invasive UCC of the bladder. This case is the first description of a forearm lesion, with an extensive infiltration of the volar compartments of the forearm, and the first one with a clear functional impairment. Marco Guidi, Cesare Fusetti, and Stefano Lucchina Copyright © 2016 Marco Guidi et al. All rights reserved. Minimally Invasive Approach of a Retrocaval Ureter Sun, 21 Aug 2016 09:55:12 +0000 The retrocaval ureter is a rare congenital entity, classically managed with open pyeloplasty techniques. The experience obtained with the laparoscopic approach of other more frequent causes of ureteropelvic junction (UPJ) obstruction has opened the method for the minimally invasive approach of the retrocaval ureter. In our paper, we describe a clinical case of a right retrocaval ureter managed successfully with laparoscopic dismembered pyeloplasty. The main standpoints of the procedure are described. Our results were similar to others published by other urologic centers, which demonstrates the safety and feasibility of the procedure for this condition. Nuno Fidalgo, Hugo Pinheiro, Frederico Ferronha, Jorge Morales, and Luís Campos Pinheiro Copyright © 2016 Nuno Fidalgo et al. All rights reserved. Severe Hypotension, Hypoxia, and Subcutaneous Erythema Induced by Indigo Carmine Administration during Open Prostatectomy Tue, 16 Aug 2016 09:41:28 +0000 Indigo carmine (also known as 5,5′-indigodisulfonic acid sodium salt or indigotine) is a blue dye that is administered intravenously to examine the urinary tract and usually is biologically safe and inert. Indigo carmine rarely may cause adverse reactions. We treated a 66-year-old man who had general anesthesia and radical retropubic prostatectomy for prostate cancer. He had a previous history of allergy to bee sting with nausea, vomiting, and dizziness. Within 1 minute after injection of indigo carmine for evaluation of the ureters, the patient developed hypotension to 40 mmHg, severe hypoxia (the value of SpO2 (peripheral capillary oxygen saturation) was 75% on 40% inspired oxygen concentration), poor air movement and bilateral diffuse wheezing on auscultation, and marked subcutaneous erythema at the upper extremities. After treatment with 100% oxygen, epinephrine (total, 1.5 mg), hydrocortisone (100 mg), diphenhydramine (50 mg), albuterol nebulizer (0.083%), and continuous infusion of epinephrine (0.15 μg/kg/min), the vital signs became stable, and he recovered completely. In summary, indigo carmine rarely may cause life-threatening anaphylactic or anaphylactoid reaction that may necessitate rapid treatment to stabilize cardiovascular, hemodynamic, and pulmonary function. Koichiro Nandate and Bryan B. Voelzke Copyright © 2016 Koichiro Nandate and Bryan B. Voelzke. All rights reserved. A Case of Cryptorchidism with Ipsilateral Congenital Unilateral Absence of the Vas Deferens and Contralateral Renal Agenesis Thu, 11 Aug 2016 11:52:53 +0000 Introduction and Aims. Congenital absence of the vas deferens is an uncommon anomaly and this clinical condition is responsible for up to 1-2% of male infertility. It can be either unilateral or bilateral and the associated anomalies include cryptorchidism, seminal vesicles and ejaculatory ducts anomalies, and renal anomalies such as renal agenesis. We hereby present a case of congenital unilateral absence of vas deferens, which was found incidentally during an evaluation of undescended testis in a patient with ipsilateral renal agenesis. Case Presentation. A 10-month-old boy was referred to the urology clinic with an undescended right testis. Preoperative abdominal ultrasonography showed agenesis of the right kidney and the absence of right vas deferens and epididymis was confirmed during laparoscopic orchiectomy performed due to short right spermatic cord. There were no other concomitant anomalies of the genitourinary system observed in evaluation. Conclusion. Congenital unilateral absence of the vas deferens with cryptorchidism and renal agenesis is a rare diagnostic entity. Cryptorchidism or absent vas deferens found incidentally should lead the physician to evaluate the status of the contralateral vas deferens and conduct a renal tract ultrasound study. Young Dong Yu and Young Kwon Hong Copyright © 2016 Young Dong Yu and Young Kwon Hong. All rights reserved. Spontaneous Subcapsular Renal Hematoma: Strange Case in an Anticoagulated Patient with HWMH after Aortic and Iliac Endovascular Stenting Procedure Mon, 08 Aug 2016 12:43:42 +0000 Spontaneous subcapsular renal hematoma is a rare condition in clinical practice. It is caused by renal cysts, benign and malignant renal tumors, vascular lesions, and antiplatelet or anticoagulant therapy. In this paper we report an unusual case of rupture of a renal cyst of a 66-year-old male patient during an aortic and iliac endovascular procedure for a massive calcified atheroma above the iliac bifurcation. We suspected that the bolus of high weight molecular heparin given during the procedure caused the rupture of the cyst. According to the literature, this is the first case of renal cyst rupture during an endovascular aortic procedure after administering a high weight molecular heparin bolus. Michele Greco, Salvatore Butticè, Filippo Benedetto, Francesco Spinelli, Olivier Traxer, Tzevat Tefik, Rosa Pappalardo, and Carlo Magno Copyright © 2016 Michele Greco et al. All rights reserved. Severe Hydronephrosis and Perinephric Urinoma with Rupture of Renal Fornix Secondary to Postoperative Urinary Retention following Laparoscopic Umbilical Hernia Repair Sun, 31 Jul 2016 07:08:11 +0000 Postoperative urinary retention (POUR) is a known complication following a variety of procedures, with a reported incidence of 2.1–3.8% in general surgery and up to 52% in anorectal surgery. We report a case of POUR in a female resulting in severe unilateral hydronephrosis with a perinephric urinoma due to a ruptured fornix. The extent of hydroureter caused an axial rotation upon itself producing further outflow obstruction. This phenomenon of an anatomical ureter deformity secondary to urinary retention resulting in a ruptured fornix is an unusual occurrence. The patient underwent a percutaneous nephrogram where a stiff guidewire was successfully passed into the bladder by interventional radiology (IR) and allowed for placement of an indwelling ureteral stent. The case presentation, diagnostic evaluation, and therapeutic intervention are discussed. Anthony Dakwar, James Wysock, and James Satterfield Copyright © 2016 Anthony Dakwar et al. All rights reserved. Alveolar Soft Part Sarcoma of Urinary Bladder Occurring as a Second Primary Malignancy: A Case Report and Literature Review Thu, 28 Jul 2016 11:26:44 +0000 We report a case of bladder alveolar soft part sarcoma in an 18-year-old Thai male patient who had been treated with testicular radiation and systemic chemotherapy for acute lymphoblastic leukemia with testicular relapse. He presented with recurrent dysuria and gross hematuria. Cystoscopy revealed a 2-centimeter irregular sessile mass at the bladder base adjacent to left ureteral orifice. Transurethral resection of the tumor was performed. The histopathological diagnosis was alveolar soft part sarcoma. Chest and abdominal computed tomography showed no evidence of metastasis. He was treated with partial cystectomy and left ureteral reimplantation with negative surgical margin. No evidence of recurrence was found during a 28-month follow-up period with surveillance cystoscopy and computed tomography of the chest and abdomen. Manint Usawachintachit, Piyada Sitthideatphaiboon, Voranuch Thanakit, Sulada Pukiat, Kamol Panumatrassamee, Julin Opanuraks, and Apirak Santi-Ngamkun Copyright © 2016 Manint Usawachintachit et al. All rights reserved. Corrigendum to “A Case of In-Bore Transperineal MRI-Guided Prostate Biopsy of a Patient with Ileal Pouch-Anal Anastomosis” Wed, 27 Jul 2016 12:27:14 +0000 Michael Kongnyuy, Thomas Frye, Arvin K. George, Amichai Kilchevsky, Amogh Iyer, Meet Kadakia, Akhil Muthigi, Baris Turkbey, Bradford J. Wood, and Peter A. Pinto Copyright © 2016 Michael Kongnyuy et al. All rights reserved. Adrenal Neuroblastoma in an Adult: Effect of Radiotherapy on Local Progression after Surgical Removal Wed, 27 Jul 2016 07:35:08 +0000 Here, we report the case of a 62-year-old man with neuroblastoma, which is extremely rare in adults. His tumor was resected, but it recurred four months later. Radiotherapy reduced tumor size, and the patient remained in good health three years after surgical tumor removal. The residual tumor and the treatments administered to this patient were evaluated. We have also reviewed the literature. Satoshi Kurokawa, Kentaro Mizuno, Akihiro Nakane, Yoshinobu Moritoki, Hidenori Nishio, Hideyuki Kamisawa, Yasue Kubota, Atsushi Okada, Noriyasu Kawai, Yutaro Hayashi, and Takahiro Yasui Copyright © 2016 Satoshi Kurokawa et al. All rights reserved. Presence of an Isolated Hydatid Cyst in the Left Kidney: Report of a Case of This Rare Condition Managed Surgically Mon, 27 Jun 2016 14:26:00 +0000 Introduction. Hydatid cyst disease caused by Echinococcus granulosus is rarely presented in the kidneys, whereas isolated renal occurrence is estimated to be about as low as 2–4% of all cases. We present a case of a female patient suffering from this condition that was treated successfully in our department. Case Presentation. A 44-year-old woman was incidentally diagnosed with a 14 cm left renal cystic mass through ultrasound imaging performed during upper abdominal pain investigation. Laboratory examinations were normal and CT imaging set the diagnosis of an isolated left renal hydatid cyst. The cyst was excised and the postoperative period was uneventful. Discussion. Isolated renal hydatid cyst is a very rare condition and could possibly be misdiagnosed with other renal masses. The clinical history, laboratory tests, and thorough radiologic imaging are crucial for the accurate preoperative diagnosis. Daniel Paramythiotis, Petros Bangeas, Konstantinia Kofina, Vassileios Papadopoulos, and Antonios Michalopoulos Copyright © 2016 Daniel Paramythiotis et al. All rights reserved. A Case of Strangulated Urethral Prolapse in a Premenopausal Adult Female Mon, 20 Jun 2016 13:56:07 +0000 Urethral prolapse in a premenopausal adult female is exceedingly rare. This paper describes a case of strangulated urethral prolapse presenting as a urethral mass in an unusual demographic and reviews the literature on etiology and management. Only a few cases have occurred in women of reproductive age. The etiology is likely multifactorial. Treatment with surgical excision provides good results in the majority of cases. Morris L. Jessop, Stanley Zaslau, and Osama Al-Omar Copyright © 2016 Morris L. Jessop et al. All rights reserved. Type IV Sacrococcygeal Teratoma Displacing the Urinary Bladder: Unique Magnetic Resonance Imaging Mon, 20 Jun 2016 11:35:31 +0000 Type IV sacrococcygeal teratoma is a rare pediatric tumor that is confined to the presacral area with no external component. The signs and symptoms often arise due to mass effect and compression of adjacent organs. Urinary retention is an uncommon presenting symptom in these patients. A wide spectrum of imaging findings may be encountered in cases with sacrococcygeal teratoma because of variability of tumor size and components. We hereby present a unique magnetic resonance urography finding in a type IV sacrococcygeal teratoma which caused bladder displacement. A meticulous and complete resection of tumor with special attention to the pelvic plexus led to preservation of normal voiding function and normal bowel function in this patient. Sahar Eftekharzadeh, Sorena Keihani, Mehdi Fareghi, Alireza Alamsahebpour, and Abdol-Mohammad Kajbafzadeh Copyright © 2016 Sahar Eftekharzadeh et al. All rights reserved. Ulcerated Scrotal Hemangioma in an 18-Month-Old Male Patient: A Case Report and Review of the Literature Thu, 16 Jun 2016 14:25:37 +0000 Deep scrotal hemangiomas are rare. Less than 50 case reports have been published. After systematic research of the literature, we found less than 5 cases of ulcerated scrotal hemangioma. The aim of this case report is to illustrate the challenges of scrotal hemangiomas pose and their potential therapies based on the successful surgical treatment of an ulcerated scrotal hemangioma in an 18-month-old male patient. Ioannis Patoulias, Konstantinos Farmakis, Christos Kaselas, and Dimitrios Patoulias Copyright © 2016 Ioannis Patoulias et al. All rights reserved. Management of Ureterolithiasis in a Patient with Crossed Unfused Renal Ectopia Tue, 14 Jun 2016 10:05:12 +0000 Crossed renal ectopia is a rare congenital anomaly in which both kidneys are situated on one side and fused together in 85%–90% of cases. The management of urinary calculi in patients with crossed renal ectopia continues to pose challenges to urologists because the aberrant anatomy may make access and clearance of the calculi more difficult to accomplish. Here, we report a case of inferior crossed renal ectopia, without fusion, and a ureteral stone in which the patient was treated successfully by extracorporeal shock wave lithotripsy. Koichi Kodama, Yasukazu Takase, and Hiroki Tatsu Copyright © 2016 Koichi Kodama et al. All rights reserved. Torsion of the Appendix Testis in a Neonate Thu, 09 Jun 2016 09:44:59 +0000 Torsion of the appendix testis is a rare cause of scrotal swelling in the neonatal period. We present a case of torsion of the appendix testis in a one-day-old male. We discuss the physical examination and radiologic studies used to make the diagnosis. Nonoperative therapy was recommended and the patient has done well. Recognition of this condition in the neonatal period can prevent surgical intervention and its associated risks. Arvind Krishnan, Mark A. Rich, and Hubert S. Swana Copyright © 2016 Arvind Krishnan et al. All rights reserved. Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma Tue, 31 May 2016 13:05:49 +0000 We report the first case in Japan of paraneoplastic dermatomyositis with pure seminoma, a tumor that extremely rarely accompanies dermatomyositis. The patient presented to the hospital with muscle weakness and erythema and was diagnosed with dermatomyositis from skin biopsy. Routine radiological screening revealed testicular tumor and massive lymph node metastases. We initially performed orchiectomy along with conventional immunotherapy. However, muscle weakness gradually worsened, and he eventually showed dysphagia and forced respiration and became bedridden. Although he seemed close to being too unstable to tolerate further treatment, we started carefully adjusted chemotherapy comprising 4 courses of etoposide plus cisplatin, which proved highly successful. Lymph node metastases completely disappeared and swallowing and respiration fully normalized after completing chemotherapy. We believe that this clinical success was due to our decision to initiate chemotherapy even in such a weak patient. Hidekazu Yoshie, Ryuto Nakazawa, Wataru Usuba, Hiroya Kudo, Yuichi Sato, Hideo Sasaki, and Tatsuya Chikaraishi Copyright © 2016 Hidekazu Yoshie et al. All rights reserved. Diagnosing and Treating Inflammatory Myofibroblastic Tumor of the Bladder Wed, 18 May 2016 11:52:19 +0000 Inflammatory myofibroblastic tumor (IMT) is an uncommon condition that is rarely encountered in the urinary tract. In this report, we present a case of IMT of the bladder in a woman with multiple previous pelvic surgeries. We further review the relevant literature to highlight this rare but important clinical presentation. Ridwan Alam, Michael H. Johnson, Trevor Caldwell, Christian P. Pavlovich, Trinity J. Bivalacqua, and Jeffrey J. Tosoian Copyright © 2016 Ridwan Alam et al. All rights reserved. Metastatic Granulosa Cell Tumor of the Testis: Clinical Presentation and Management Sun, 15 May 2016 08:01:18 +0000 Granulosa cell tumors (GCTs) of the testis are rare sex cord-stromal tumors that are present in both juvenile and adult subtypes. While most adult GCTs are benign, those that present with distant metastases manifest a grave prognosis. Treatments for aggressive GCTs are not well established. Options that have been employed in previous cases include retroperitoneal lymph node dissection (RPLND), radiation, chemotherapy, or a combination thereof. We describe the case of a 57-year-old man who presented with a painless left testicular mass and painful gynecomastia. Serum tumor markers (alpha fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase) and computed tomography of the chest and abdomen were negative. The patient underwent left radical orchiectomy. Immunohistochemical staining was consistent with a testicular GCT. He underwent a left-template laparoscopic RPLND which revealed 2/19 positive lymph nodes. Final pathological stage was IIA. He remains free of disease 32 months after surgery. Anand Mohapatra, Aaron M. Potretzke, Brent A. Knight, Min Han, and Robert S. Figenshau Copyright © 2016 Anand Mohapatra et al. All rights reserved. Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon Sat, 30 Apr 2016 13:35:19 +0000 Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon. Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012–November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy. Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (), urethral dilatation (), vesicostomy (), and urethral catheterization (). With a median follow-up of 8.2 months (4–16 months) all patients remained symptoms-free. Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered. F. F. Mouafo Tambo, G. Fossi kamga, C. Kamadjou, L. Mbouche, A. S. Nwaha Makon, J. Birraux, O. G. Andze, F. F. Angwafo, and P. Y. Mure Copyright © 2016 F. F. Mouafo Tambo et al. All rights reserved. A Very Rare Complication of Acute Appendicitis: Appendicovesical Fistula Thu, 28 Apr 2016 13:30:36 +0000 Appendicovesical fistula (AVF) is an uncommon type of enterovesical fistula and a very rare complication of acute appendicitis. Herein, we report a case of 39-year-old male patient who presented with persistent urinary tract infection, recurrent abdominal pain, and pneumaturia. Imaging techniques including ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) were performed to identify the abnormality. However, definitive diagnosis of AVF was made by cystoscopy. Deniz Alis, Cesur Samanci, Yesim Namdar, Fethi Emre Ustabasioglu, Elif Yamac, Onur Tutar, Burak Ucpinar, and Bulent Onal Copyright © 2016 Deniz Alis et al. All rights reserved. Solitary Fibrous Tumor of the Kidney Developing Local Recurrence Thu, 28 Apr 2016 11:37:46 +0000 Solitary fibrous tumor (SFT) of the kidney is a rare entity and usually displays a favorable prognosis. We herein report a second case of renal SFT developing local recurrence. A 50-year-old man was referred to our hospital because of a left renal mass. An abdominal CT detected a large renal tumor and radical nephrectomy was performed with a possible diagnosis of renal cell carcinoma. The resected tumor size was measured at 17 × 11 × 8 cm. Grossly, necrosis was observed in central lesion of the tumor but hemorrhage was not observed. Microscopically, the tumor consisted of spindle-shaped cells with scant cytoplasm accompanied by hyalinized collagenous tissue, which displayed hemangiopericytomatous patterns. The cellularity was normal and nuclear pleomorphism was not observed. Ki-67 labeling index was less than 3%. The pathological diagnosis of SFT was made without obvious malignant findings. Three years after the surgery, a follow-up CT scan detected a mass lesion in the tumor bed. Surgical resection was performed and the resected tumor was compatible with local recurrence of the SFT without obvious malignant findings. Renal SFT should be carefully monitored even in the absence of obvious malignant findings. Wataru Usuba, Hideo Sasaki, Hidekazu Yoshie, Kazuki Kitajima, Hiroya Kudo, Ryuto Nakazawa, Yuichi Sato, Masayuki Takagi, and Tatsuya Chikaraishi Copyright © 2016 Wataru Usuba et al. All rights reserved. Leiomyoma in a Renal Allograft Mon, 18 Apr 2016 09:54:23 +0000 Leiomyomas are smooth muscle tumours that are rarely found in the kidney. There is one report of a leiomyoma in a kidney transplant in a paediatric recipient. Here, we report an adult renal transplant recipient who developed an Epstein-Barr virus-positive leiomyoma in his allograft 15 years after transplantation. The patient was converted to everolimus for posttransplant immunosuppression management and there was no sign of progression over a year. Yan Jun Li, Amila Rohan Siriwardana, James Lawrence Penn Symons, Gordon Francis O’Neill, Min Ru Qiu, and Timothy John Furlong Copyright © 2016 Yan Jun Li et al. All rights reserved. Panniculectomy and Cystectomy: An Approach to the Morbidly Obese Patient Mon, 18 Apr 2016 09:53:35 +0000 The obese patient undergoing radical cystectomy faces a unique set of challenges. We present the case of a 68-year-old gentleman who presented to our institution with Bacillus Calmette-Guerin refractory disease, a body mass index of 38.5, and a large pannus. The present paper describes our technique for performing radical cystectomy with ileal conduit urinary diversion and concomitant panniculectomy. We discuss the impact of obesity on patients undergoing radical cystectomy and how this may be mitigated by panniculectomy. Lee A. Hugar, Robert M. Turner, Jeffrey A. Gusenoff, Andres F. Correa, Bruce L. Jacobs, and Benjamin J. Davies Copyright © 2016 Lee A. Hugar et al. All rights reserved. Posttransurethral Resection of Prostate Recurrent Life Threatening Hematuria: A Rare Cause Tue, 12 Apr 2016 09:11:56 +0000 Herein, we present a case report of post-TURP (transurethral resection of prostate) recurrent severe hematuria due to right internal iliac artery pseudoaneurysm protruding into bladder lumen. A 60-year-old male presented with recurrent massive hematuria following TURP done elsewhere 15 days before. His hemoglobin was 4 gm/dL after 13 units of blood transfusion and repeated clot evacuations. His blood urea, serum creatinine, and coagulation profile studies were normal. Ultrasonography of abdomen showed multiple clots in the bladder. Cystoscopy revealed clots with a right posterolateral wall unhealthy area. After stabilizing the patient, contrast enhanced CT urography revealed intravesical aneurysm. CT angiography showed pseudoaneurysm of a branch of internal iliac artery protruding into urinary bladder lumen. We referred patient to selective embolization of the lesion but the procedure was unsuccessful. At last, ipsilateral internal iliac artery ligation relieved hematuria. But on postoperative day 2, patient suddenly collapsed and deceased, presumably due to cardiomorbidities. MC Arya, Lalit Kumar, Ruchi Mittal, Rajeev Kumar, and Mayank Baid Copyright © 2016 MC Arya et al. All rights reserved.