Volume 17, Number 2Case ReviewLong-term Survival From Muscle-invasive Bladder Cancer With Initial Presentation of Symptomatic Cerebellar Lesion: The Role of Selective Surgical Extirpation of the Primary and Metastatic LesionGanesh K KarthaJoseph SanfrancescoEsther UdojiHemant Chaparala (4)Donna HanselJ Stephen JonesA 59-year-old man was diagnosed with urothelial carcinoma involving an isolated cerebellar metastasis after presenting to the emergency department for headache complaints. After selective surgical excision of the symptomatic brain lesion and delayed cystectomy due to intractable hematuria, he survived 11 years without evidence of recurrence or subsequent systemic chemotherapy. He eventually expired after delayed recurrence in the lung, supraclavicular lymph node, and brain. To our knowledge, this is the only case of prolonged survival from urothelial carcinoma after selective surgical extirpation of the primary and metastatic lesion without subsequent systemic chemotherapy. [Rev Urol. 2015;17(2):106-109 doi: 10.3909/riu0643] © 2015 MedReviews®, LLCUrothelial carcinomaBladder cancerMetastasisCystectomy
Volume 17, Number 1Case ReviewEn Bloc Robot-assisted Laparoscopic Partial Cystectomy, Urachal Resection, and Pelvic Lymphadenectomy for Urachal AdenocarcinomaChristopher R WilliamsKeyur ChavdaPaul AbramsPrimary adenocarcinomas of the bladder and urachus are extremely rare, accounting for 0.5% to 2.0% of all bladder malignancies. During fetal development, the urachus develops into the median umbilical ligament that stretches from the umbilicus to the bladder. Adenocarcinoma accounts for 90% of all cases of urachal carcinoma. There is no consensus regarding the management of urachal carcinoma. Although the preferred treatment is wide local excision with partial or radical cystectomy, bladder-sparing management is increasing. We report a case of robot-assisted laparoscopic partial cystectomy with en bloc resection of the urachus and bilateral pelvic lymphadenectomy for urachal carcinoma. The robot-assisted laparoscopic approach allowed us to minimize surgical morbidity, postoperative pain, and convalescent time while maintaining the oncologic principle of wide local excision. [Rev Urol. 2015;17(1):46-49 doi: 10.3909/riu0630] © 2015 MedReviews®, LLCUrachal adenocarcinomaRobotic partial cystectomyPelvic lymphadenectomy
Volume 17, Number 1Case ReviewRare Case of Monozygotic Twins Diagnosed With Klinefelter Syndrome During Evaluation for InfertilityYagil BarazaniEdmund S SabaneghAlthough neither Klinefelter syndrome nor monozygotic twins are particularly rare (1/667 male births and 3-4/1000 live births, respectively), the occurrence of both in the same pregnancy (ie, identical twins with Klinefelter syndrome) is exceedingly rare and has only been reported three times previously in the literature. This report describes the fourth ever reported case of monozygotic twins with Klinefelter syndrome (who presented to our male fertility clinic with failure to conceive) and sheds interesting light on the reproductive concordance observed with this rare clinical entity. To our knowledge, this is the first reported case of monozygotic twins with Klinefelter syndrome that describes the infertility workup and outcomes of microsurgical testicular sperm extraction. [Rev Urol. 2015;17(1):42-45 doi: 10.3909/riu0628] © 2015 MedReviews®, LLCKlinefelter syndromeMicrosurgical testicular sperm extractionAzoospermiaSertoli only syndromeGerm cell aplasia
Volume 17, Number 1Case ReviewAdenocarcinoma of the Urethra With Mucinous FeaturesAndrew WrightLucas ReddAnthony DyerJonathan WalkerArthi SatyanarayanPrimary adenocarcinoma of the female urethra is a rare malignancy. Previous studies hypothesize multiple origins, including periurethral glands or intestinal metaplasia. We report a case of a 60-year-old white woman with adenocarcinoma of the urethra who initially presented with obstructive voiding complaints secondary to a urethral mass. Wide local excision revealed invasive adenocarcinoma of the urethra with mucinous features. There was intestinal metaplasia adjacent to the tumor, as well as separate identification of intestinal metaplasia along the urethra. Ultimately, the patient underwent radical cystectomy with ileal conduit urinary diversion with no evidence of recurrence, indicating the role of early identification and surgical intervention for such cases. [Rev Urol. 2015;17(1):38-41 doi: 10.3909/riu0622] © 2015 MedReviews®, LLCUrethraUrethral adenocarcinomaSkene glandGenital tract tumorRadical cystectomy
Volume 18, Number 3Case ReviewA Novel Approach to Mesh Revision After SacrocolpopexyRebecca RinkoKristene E WhitmoreMelissa L DawsonNima M ShahPelvic organ prolapse (POP) is the herniation of pelvic organs to or beyond the vaginal walls. POP affects 50% of parous women; of those women, 11% will need surgery based on bothersome symptoms. Transvaginal mesh has been used for vaginal augmentation since the 1990s. Complications from mesh use are now more prominent, and include chronic pelvic pain, dyspareunia, vaginal mesh erosion, and urinary and defecatory dysfunction. Presently, there is no consensus regarding treatment of these complications. Reported herein are two cases of women with defecatory dysfunction and pain after sacrocolpopexy who underwent mesh revision procedures performed with both urogynecologic and colorectal surgery. [Rev Urol. 2016;18(3):174-177 doi: 10.3909/riu0698] © 2016 MedReviews®, LLCVaginal meshMesh erosionOmental flap mobilization
Volume 18, Number 3Case ReviewA Case of Pelvic Organ Prolapse in the Setting of Cirrhotic AscitesNima M ShahNatasha GinzburgKristene WhitmoreAscites is commonly found in patients with liver cirrhosis. Although conservative therapy is often the ideal choice of care with these patients who also have symptomatic pelvic organ prolapse, this may fail and surgical methods may be needed. Literature is limited regarding surgical repair of prolapse in the setting of ascites. The authors present the surgical evaluation and management of a 63-year-old woman with recurrent ascites from liver cirrhosis who failed conservative therapy. With adequate multidisciplinary care and medical optimization, this patient underwent surgical therapy with resolution of her symptomatic prolapse and improved quality of life. [Rev Urol. 2016;18(3):178-180 doi: 10.3909/riu0702] © 2016 MedReviews®, LLCAscitesCirrhosisProlapseColpocleisis
Volume 18, Number 1Case ReviewUreteral Stone Associated With a Middle Blind Ending of a Bifid UreterSelahattin CaliskanA blind-ending bifid ureter is an anatomic variant of ureteral duplications. There are three forms of blind-ending bifid ureter, classified depending on their location. A proximal blind-ending bifid ureter is the most common subtype of this congenital anomaly. Most patients are asymptomatic and only show symptoms after the complication has occurred. These complications include stone formation, vesicoureteric reflux, and ureteral tumor. Intravenous urography is usually used to diagnose bifid ureter; voiding cystourethrography, photofluoroscopy, cineroentgenography, cystoscopy with retrograde pyelography, computed tomography (CT), multidetector CT, and magnetic resonance urographies are other imaging methods used. This is a case of a ureteral stone associated with a middle blind ending of a bifid ureter. [Rev Urol. 2016;18(1):54-56 doi: 10.3909/riu0688] © 2016 MedReviews®, LLCBlind-ending bifid ureterUreteral duplicationUreteral stoneUreteroscopic
Volume 18, Number 1Case ReviewManagement of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid in AdultsTimothy W StarkJohn M LacyDavid M PrestonA 74-year-old man presented for evaluation after discovery of a left bladder-wall tumor. He underwent transurethral resection of bladder tumor (TURBT) operation for treatment of low-grade, Ta urothelial cancer of the bladder. The patient developed recurrent disease and returned to the operating room for repeat TURBT, circumcision, and administration of intravesical mitomycin C. The patient developed balanitis xerotica obliterans 4 years post-circumcision, requiring self-dilation with a catheter. He subsequently developed 3 consecutive episodes of left-sided pyelonephritis. Further investigation with voiding cystourethrogram (VCUG) revealed Grade 3, left-sided vesicoureteral reflux (VUR). Due to existing comorbidities, the patient elected treatment with endoscopic dextranomer/hyaluronic acid injection. A post-operative VCUG demonstrated complete resolution of left-sided VUR. This patient has remained symptom free for 8 months post-injection, with no episodes of pyelonephritis. [Rev Urol. 2016;18(1):46-50 doi: 10.3909/riu0689] © 2016 MedReviews®, LLCVesicoureteral refluxPyelonephritisDextranomer/hyaluronic acid
Volume 18, Number 1Case ReviewAdenomatoid Tumor of the Testis Arising From the Tunica AlbugineaAndrew Y SunA Scott PolackwichEdmund S SabaneghAdenomatoid tumors are the most common paratesticular tumor. Although they primarily arise from the epididymis, they can rarely occur as an isolated intratesticular mass. These tumors are benign and surgical excision is curative. We present a case of a 36-year-old man diagnosed with an intratesticular adenomatoid tumor. [Rev Urol. 2016;18(1):51-53 doi: 10.3909.riu0690] © 2016 MedReviews®, LLCTesticular neoplasmAdenomatoid tumor
Volume 18, Number 2Case ReviewEndoscopic Management of Bladder DiverticulaClaudio JeldresKhanh N PhamThomas HeftyJohn M CormanA 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. [Rev Urol. 2016;18(2):114-117 doi: 10.3909/riu0701] © 2016 MedReviews®, LLCBladder diverticulumEndoscopicFulguration