Volume 23, Number 4Case ReviewExceptional Response to Radiation Therapy to the Primary Tumor in a Patient With de Novo Metastatic Prostate Cancer With High Tumor Mutation BurdenBenjamin MercierAndrew TamDaniela V. CastroSalvador Jaime-CasasAbhishek TripathiYun Rose LiRegina Barragan-CarrilloWe present the case of a patient diagnosed with de novo, low-volume metastatic prostate cancer who received first-line treatment with androgen-deprivation therapy in combination with darolutamide. The patient presented with symptoms derived from local growth from the primary tumor and received pelvic radiation therapy to the primary tumor and pelvic nodes. He experienced complete tumor regression, with high serum prostate-specific antigen declining to nondetectable levels. Next-generation genomic analysis indicated high tumor mutation burden and high microsatellite status instability. Here, we contextualize this patient’s case regarding the importance of precision genomics in radiation oncology and its potential importance for optimizing treatment.Prostatic neoplasmsRadiation therapyNeoplasm metastasisAndrogen antagonistsprostate neoplasmcastration resistant
Volume 9, Number 4Case ReviewBilateral Testicular Infarction and Orchiectomy as a Complication of Polyarteritis NodosaCase ReviewSean P StroupShannon R HerreraDonald S CrainWe report an unusual case of a 28-year-old male with constitutional symptoms and bilateral testicular pain. After diagnosis of cytomegalovirus (CMV) hepatitis, his constitutional symptoms and testicular pain worsened despite treatment for epididymoorchitis. Ultrasound was concerning for infarction. Exploration in the operating room revealed bilateral testicular infarction requiring bilateral orchiectomy with subsequent androgen hormone replacement. Pathologic diagnosis was polyarteritis nodosa (PAN). PAN is a rare systemic vasculitis that affects multiple organs. There are no previous reports of PAN-induced vasculitis leading to bilateral testicular infarction and bilateral orchiectomy. [Rev Urol. 2007;9(4):235-238]Testicular infarctionPolyarteritis nodosaAndrogen replacement therapy
Volume 9, Number 3Case ReviewSpontaneous Renal Artery DissectionCase ReviewJamie A KanofskyHerbert LeporSpontaneous renal artery dissection (SRAD) is a rare event, and thus may be a challenge for physicians to diagnose and treat. We report a case of SRAD in a healthy 56-year-old male who presented with flank pain, fever, and elevated white blood cell count. The patient was initially diagnosed with nephrolithiasis versus pyelonephritis and was admitted for observation. Multiple imaging modalities, including non-contrast computed tomography (CT), magnetic resonance imaging (MRI) with gadolinium, CT angiogram, and intraoperative angiogram, were used to make the final diagnosis of SRAD. The patient was treated with endovascular stent placement and is currently free of pain with normal laboratory values and blood pressure. [Rev Urol. 2007;9(3):156-160]KidneyRenal arteryDissectionAngiogramEndovascular stenting
Volume 10, Number 4Case ReviewManagement of Localized Prostate Cancer and an Incidental Ureteral Duplication With Upper Pole Ectopic Ureter Inserting into the Prostatic UrethraCase ReviewHerbert LeporBachir TaouliMichael D StifelmanTracy P MarienEllen ShapiroJonathan MelamedEctopic ureters are rare congenital malformations of the renal system that most commonly present in females. It is extremely rare to encounter an ectopic ureter in an older man undergoing radical prostatectomy. We report herein a case of a 66-year-old man with prostate cancer and a complete duplication of the left renal collecting system, with an upper pole ectopic ureter and associated normal functioning renal parenchyma entering into the prostatic urethra. This anomaly was incidentally discovered on preoperative magnetic resonance imaging of the prostate. Open radical retropubic prostatectomy and a left ureteroureterostomy were performed. [Rev Urol. 2008;10(4):297-303]Prostate cancerProstatectomyEctopic ureterProstatic urethra
Volume 10, Number 3Case ReviewShock Wave Lithotripsy and Renal HemorrhageCase ReviewCharles M LakinJonathan SilbersteinJ Kellogg ParsonsAlthough shock wave lithotripsy is a safe and efficacious treatment for nephrolithiasis, the most common acute complication is renal hemorrhage. Shock wave–induced renal hemorrhage is a potentially devastating injury if not promptly recognized and treated appropriately. The authors report a large perirenal hematoma occurring after shock wave lithotripsy and review the causes, prevention, and treatment of shock wave–induced renal hemorrhage. [Rev Urol. 2008;10(3):236-241]NephrolithiasisShock wave lithotripsyHematoma
Volume 10, Number 2Case ReviewLeydig Cell Hyperplasia Revealed by GynecomastiaCase ReviewMohamed Jamal El FassiMoulay Hassan FarihMohamed Fadl TaziSoufiane MellasLeydig cell tumors are rare and represent 1% to 3% of all tumors of the testis. Leydig cell tumors affect males at any age, but there are 2 peak periods of incidence: between 5 and 10 years and between 25 and 35 years. Their main clinical presentation is a testicular mass associated with endocrinal manifestations that are variable according to age and appearance of the tumor. Our patient, a 17-year-old adolescent, presented with an isolated and painless hypertrophy of the right mammary gland. Clinical examination found gynecomastia and no testicular mass. Hormonal levels and tumor markers were normal. Testicular sonography showed an ovular and homogeneous right intratesticular mass 6 mm in diameter. We treated the patient with an inguinal right orchidectomy. The anatomopathological study found a nodule of Leydig cell hyperplasia. The patient recovered without recurrence at 8-month follow-up. The patient opted for mammoplasty 2 months after his orchidectomy rather than wait for the spontaneous gradual regression of his gynecomastia, which requires at least 1 year. Leydig cell hyperplasia manifests in the adult by signs of hypogonadism, most frequently gynecomastia. Although many teams prefer total orchidectomy because of the diagnostic difficulty associated with malignant forms, simple subcapsular orchidectomy should become the first-line treatment, provided it be subsequently followed by close surveillance, as it preserves maximum fertility, and these tumors usually resolve favorably. [Rev Urol. 2008:10(2):164-167]FertilityTesticular tumorLeydig cell hyperplasiaNonseminomatous germ celltumorsGynecomastia
Volume 10, Number 1Case ReviewUse of a Vacuum-Assisted Device for Fournier’s Gangrene: A New ParadigmCase ReviewJonathan SilbersteinJ Kellogg ParsonsJulia GrabowskiFournier’s gangrene is a necrotizing infection of the scrotum or perineum that requires aggressive surgical debridement. Radical debridement of perineal necrotizing fasciitis can leave extensive tissue defects that are difficult to close and often require multiple surgical interventions. Vacuum-assisted closure (VAC) devices have been shown to assist in a more rapid closure of these wounds, but placement of such devices in the perineum can pose significant challenges. We have had success with use of VAC devices and report our techniques for their placement. [Rev Urol. 2008;10(1):76-80]Fournier’s gangreneVacuum-assisted closure devices
Volume 11, Number 4Case ReviewConcurrent Bilateral Renal Angiomyolipoma and Renal Cell Carcinoma in a Patient With Tuberous Sclerosis ComplexMbarek DoublaliAbdelhak KhalloukYounes AhallalMohamed Jamal El FassiMohamed Fadl TaziSoufiane MellasRenal angiomyolipomas (AMLs) are often associated with tuberous sclerosis. These tumors are predominantly benign, although malignant forms do exist and are known to be associated with renal cell carcinoma. This case report describes a patient with tuberous sclerosis and massive bilateral AML. Total right nephrectomy was performed; histopathologic examination revealed the coexistence of AML and clear cell renal carcinoma in the same kidney. Because differentiation between renal cell carcinoma and AML with minimal or no fat component can be difficult, an accurate diagnosis is critical in the management of renal AML.[Rev Urol. 2009;11(4):216-218 doi: 10.3909/riu0436]© 2009 MedReviews®, LLCRenal cell carcinomaAngiomyolipomaTuberous sclerosis
Volume 11, Number 3Case ReviewPlacenta Percreta and the UrologistAsghar AskariJacob RajferRamdev KonijetiPlacenta percreta, the rarest and most severe form of placenta accreta, caninvolve the urinary bladder. Because of its propensity for severe hemorrhage,it is a potentially life-threatening condition. Although commonly discoveredat the time of delivery, antenatal diagnosis may be achieved with ultrasound,magnetic resonance imaging, and/or cystoscopy. Every attempt should bemade to minimize potential for blood loss by avoiding removal of the placentaat the time of delivery and either performing a hysterectomy or usingmethotrexate therapy to ablate the residual placenta in the postpartum period.If hemorrhage does occur during delivery, immediate surgical removalof the uterus should be considered and, depending on the severity of thehemorrhage and the depth of invasion of the placenta into the bladder,excision and/or reconstruction of the bladder may be necessary.[Rev Urol. 2009;11(3):173-176 doi: 10.3909/riu0440]© 2009 MedReviews®, LLCPlacenta percretaPlacenta accretaBladder invasion
Volume 11, Number 2Case ReviewGenitourinary SarcoidosisPravin K RaoEdmund S SabaneghGenitourinary involvement of sarcoidosis can mimic many common urologic conditions. Although sarcoidosis is a benign inflammatory condition, it can present much like malignant or infectious conditions; thus, failed diagnosis can lead to unnecessary medications or surgical procedures. In addition, management choices for patients with scrotal findings have important implications for future fertility. Thus, this uncommon condition should be on the differential diagnosis for any urologic patient. The authors report on a patient with a scrotal mass as his presenting symptom of sarcoidosis and review the diagnosis, implications, and management of sarcoidosis involving all potential sites in the urinary tract.[Rev Urol. 2009;11(2):108-113]UrologySarcoidosisGenitourinaryScrotal mass