Case Reports in Urology https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . 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. 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. 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. 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. Inflammatory Myofibroblastic Tumor of the Bladder: 2 Rare Cases Managed with Laparoscopic Partial Cystectomy Tue, 15 Nov 2016 13:33:38 +0000 http://www.hindawi.com/journals/criu/2016/4976150/ Two cases of inflammatory myofibroblastic tumor (IMT) of the bladder are reported here. Both patients were male and presented with macroscopic hematuria; in the first case terminal hematuria was associated with irritative voiding symptoms. The second case was a smoker with hematuria unresponsive to medical treatment and anemia. Clinical presentation, pathological features, treatment, and prognosis are discussed. Due to rarity of this pathological condition, there are no guidelines concerning treatment and follow-up. We present our follow-up scheme and highlight the use of laparoscopic partial cystectomy as a successful treatment approach. Sofia Santos Lopes, Andrea Furtado, Rita Oliveira, Ana Cebola, Bruno Graça, Manuel Ferreira Coelho, Fernando Ferrito, and Carrasquinho Gomes Copyright © 2016 Sofia Santos Lopes et al. All rights reserved. Intrascrotal Collection in an Acute Pancreatitis: A Case Report and Review of the Literature Tue, 01 Nov 2016 12:32:49 +0000 http://www.hindawi.com/journals/criu/2016/7534781/ Context. An inguinoscrotal swelling occurring during an acute pancreatitis is very rare. Case Report. We report a case of right inguinoscrotal swelling appearing in connection with an interstitial edematous acute pancreatitis. We have noticed a spontaneous complete reduction of the right inguinoscrotal swelling after 10 days. Conclusion. The management of a scrotal swelling should be the least invasive possible method but also the most complete possible method to avoid unnecessary interventions. The exclusion of a pathology that could affect the vital prognosis of the testis remains the absolute priority. An acute scrotum swelling must be carried out by the clinical management by a professional and must be completed with an ultrasonography of the scrotum. Despite all that, if the original etiology of the acute scrotum remains unknown, an abdominopelvic CT scan could provide more details and so could offer a different diagnosis of exclusion, different from the diagnosis of acute idiopathic scrotal edema (AISE). This rare complication of acute pancreatitis reported could be mistaken for a more common pathology. If that complication is identified, it will not require a surgical intervention if there is a correct management of the acute pancreatitis which could justify a broader CT scan. L. Moens, P. Yengue Yengue, and C. Assenmacher Copyright © 2016 L. Moens et al. All rights reserved. Synchronous Malignant Peripheral Nerve Sheath Tumor and Adenocarcinoma of the Prostate: Case Report and Literature Review Mon, 31 Oct 2016 11:26:29 +0000 http://www.hindawi.com/journals/criu/2016/2457416/ Malignant Peripheral Nerve Sheath Tumors (MPNSTs) of the prostate are extremely rare. A very unusual case of simultaneous adenocarcinoma and MPNST of the prostate is reported. A 60-year-old Caucasian male presented for annual urologic examination. Digital rectal examination revealed a painless, toughish, and asymmetrically enlarged prostate. Serum prostate-specific antigen was 1 ng/mL. Radiologic examinations demonstrated a large mass, which was arising from the left peripheral lobe of the prostate. The patient underwent transrectal ultrasound-guided biopsy of the prostate which revealed a smooth muscle tumor of uncertain malignant potential. Radical retropubic prostatectomy with en bloc removal of the mass and the seminal vesicles was performed and histology demonstrated low-grade MPNST and adenocarcinoma of the prostate. To the best of our knowledge, this is the first report of simultaneous prostatic adenocarcinoma and MPNST in the English literature. Nikolaos Ferakis, Antonios Katsimantas, Konstantinos Bouropoulos, and Antonios Farmakis Copyright © 2016 Nikolaos Ferakis et al. All rights reserved. Concomitant Laparoscopic Burch Urethropexy and Combined Vaginal-Laparoscopic Mesh Sling Removal (x2) for Pain and Persistent Stress Urinary Incontinence Mon, 31 Oct 2016 09:56:46 +0000 http://www.hindawi.com/journals/criu/2016/6180756/ Although midurethral mesh tape slings are considered the standard of care in the treatment of female stress urinary incontinence (SUI), complications such as pain, dyspareunia, or erosion are known to occur in addition to persistent incontinence. The management of these types of mesh sling complications can be very complex, especially when the pain is not just isolated to the vagina but extends into other areas, such as the abdomen which requires a much more extensive dissection. Additionally, if a mesh sling needs to be removed, the patient will most likely have a return of her SUI that often necessitates subsequent treatment. Vaginal and/or laparoscopic removal or revision of mesh tape slings should be considered in patients presenting with complications such as vaginal pain, abdominal pain, dyspareunia, or urinary obstructive symptoms. In those patients who demonstrate persistent SUI, concomitant laparoscopic Burch urethropexy can be considered and can safely be performed at the time mesh removal. In this case report we present a patient who required a dual-approach removal of two painful midurethral slings in addition to concomitant treatment of persistent SUI with a laparoscopic Burch urethropexy procedure. Sarah A. Huber, LaChanda Dunlap-Wright, John R. Miklos, and Robert D. Moore Copyright © 2016 Sarah A. Huber et al. All rights reserved. Malignant Peripheral Nerve Sheath Tumor of Prostate: A Rare Case Report and Literature Review Sun, 30 Oct 2016 08:42:03 +0000 http://www.hindawi.com/journals/criu/2016/9317567/ A mid-aged male presented with progressive lower urinary tract symptoms (LUTS) for years. Huge prostate with low serum prostate-specific antigen (PSA) level was detected. The specimen from transurethral resection revealed surprising pathology finding as malignant peripheral nerve sheath tumor (MPNST). Considering its huge size (more than 300 gm) and location, we prescribed neoadjuvant chemotherapy firstly. The tumor became regressive and then radical surgical resection was achieved. Adjuvant multimodality treatment including concurrent chemoradiotherapy (CCRT) and target therapy was given. However, he expired about one year later. MPNST originating from prostate is very rare and seldom reported before. We here present this extremely rare disease and share our treatment experience. Kun-Lin Hsieh, Chih-Cheng Lu, Chien-Feng Li, Yin-Hsun Feng, and Alex C. Liao Copyright © 2016 Kun-Lin Hsieh et al. All rights reserved. Postrenal Failure due to Urinary Stones Associated with Acute Viral Gastroenteritis: Three Case Reports Wed, 26 Oct 2016 09:11:28 +0000 http://www.hindawi.com/journals/criu/2016/1375923/ Acute gastroenteritis with viral infection in infants causes severe diarrhea and often results in acute renal failure due to severe dehydration. However, a viral infection, particularly rotavirus, rarely induces postrenal failure due to bilateral stones in infants. Herein, we report three cases of postrenal failure in infants due to bilateral ureteral stones induced by acute gastroenteritis with rotavirus. Following immediately nephrostomy, chemical dissolution therapy succeeded to treat postrenal failure. Immediate nephrostomy for the release of upper urinary tract obstruction combined with urinary alkalization as a chemical dissolution therapy should be considered in such cases. Satoru Kira, Takahiko Mitsui, Hidenori Zakoji, Tadashi Aoki, Norifumi Sawada, Tatsuya Miyamoto, and Masayuki Takeda Copyright © 2016 Satoru Kira et al. All rights reserved. Erratum to “Primary Desmoplastic Melanoma of the Penis” Mon, 24 Oct 2016 10:59:36 +0000 http://www.hindawi.com/journals/criu/2016/3181869/ Julia T. Chu, Michael A. Liss, William W. Wu, Atreya Dash, and Di Lu Copyright © 2016 Julia T. Chu et al. All rights reserved. Retroperitoneal Teratoma in an Adult: A Potential Pitfall in the Differential Diagnosis of Adrenal Myelolipoma Thu, 20 Oct 2016 06:03:50 +0000 http://www.hindawi.com/journals/criu/2016/5141769/ We report a 32-year-old female case of a right adrenal gland mass detected on CT scan at medical checkup. CT and MRI showed a mass of 5.1 cm made of fat and calcification in the right adrenal gland, leading to the clinical diagnosis of adrenal myelolipoma. Because of its relatively large size and the patient’s desire, the patient underwent gasless single-port retroperitoneoscopic adrenalectomy using the RoboSurgeon system. Histopathological examination revealed that the cystic tumor is composed of keratinized epidermis, mature fat, nerve, cartilage, bone, and sebaceous glands compressing the normal adrenal gland, leading to the diagnosis of retroperitoneal mature cystic teratoma. The patient remains free of recurrence 29 months after surgery. Retroperitoneal teratoma is relatively rare but clinically important because of high possibility of malignancy. In a case of an adrenal mass difficult to clinically distinguish retroperitoneal teratoma from adrenal myelolipoma, surgical resection via a minimally invasive approach would be the best therapeutic option. Madoka Kataoka, Hiroshi Fukushima, Yasukazu Nakanishi, Minato Yokoyama, Nobuaki Funata, Toru Motoi, Ken-ichi Tobisu, and Fumitaka Koga Copyright © 2016 Madoka Kataoka et al. All rights reserved. A Case of Metastatic Melanoma in the Ureter Wed, 12 Oct 2016 09:36:24 +0000 http://www.hindawi.com/journals/criu/2016/1853015/ Advances in the treatment of melanoma are resulting in patients living for extended periods after being diagnosed with metastatic disease. Metastases to the ureter are rare, but they have been described in the literature on a number of occasions. In this case report, we describe a patient with established metastatic melanoma who, whilst taking and responding to immunomodulatory therapy, was found to have an obstructive mass in the middle of his left ureter. Rather than performing either a nephroureterectomy or partial resection of the ureter, we opted to perform an endoscopic resection of the melanoma. Follow-up imaging at 12 months shows no evidence of local disease recurrence. We submit that primary endoscopic management of metastatic melanoma in the ureter is a viable alternative to a radical approach. James Macneil and Tania Hossack Copyright © 2016 James Macneil and Tania Hossack. All rights reserved. Two Cases of Solitary Fibrous Tumor Involving Urinary Bladder and a Review of the Literature Tue, 04 Oct 2016 07:07:04 +0000 http://www.hindawi.com/journals/criu/2016/5145789/ Solitary fibrous tumor (SFT) is a rare neoplasia of mesenchymal origin, initially described in visceral pleura and lately discovered to have ubiquitous distribution. SFT of the urogenital tract is uncommon and appears to have similar morphologic features and biologic behaviors as SFTs found elsewhere. We present two new cases of SFT of the bladder and review 22 similar cases published in the literature. Due to the general indolent behavior of these lesions, a complete but organ sparing surgical excision should be considered when technically feasible. Therefore, proper identification and characterization of SFT through morphological and immunohistochemical criteria on biopsy specimens are mandatory in the differential diagnosis from other more aggressive spindle-cell tumors, thus avoiding unnecessary radical surgery. Eduardo Yukio Tanaka, Vitor Bonadia Buonfiglio, Joao Padua Manzano, Renée Zon Filippi, and Marcus Vinicius Sadi Copyright © 2016 Eduardo Yukio Tanaka et al. All rights reserved. Delayed Diagnosis of Iatrogenic Bladder Perforation in a Neonate Mon, 26 Sep 2016 12:01:23 +0000 http://www.hindawi.com/journals/criu/2016/1425373/ 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 http://www.hindawi.com/journals/criu/2016/2729614/ 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 http://www.hindawi.com/journals/criu/2016/5049072/ 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 http://www.hindawi.com/journals/criu/2016/3920976/ 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 http://www.hindawi.com/journals/criu/2016/7594192/ 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 http://www.hindawi.com/journals/criu/2016/2539320/ 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 http://www.hindawi.com/journals/criu/2016/2387501/ 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 http://www.hindawi.com/journals/criu/2016/3591832/ 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 http://www.hindawi.com/journals/criu/2016/5237387/ 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.