Issue 5: October 2010

UIJ Volume 3 Issue 5 2010

Prostate Cancer Presenting With Neurologic Deficits and Visual Symptoms: Uncommon Presentation of a Common Malignancy


Intracranial metastases from prostate adenocarcinoma are very unusual, and initial presentation with symptomatic brain involvement is especially rare. We describe a 65-year-old male who presented with blurred vision and was found to have abducent nerve involvement and high-grade metastatic prostate cancer. Computed tomography of his head revealed a destructive lesion involving the clivus. He was started on hormonal treatment and his visual symptoms improved. Repeat scans after 6 months revealed resolution of the clivus lesion. Prostate cancer can occasionally present with neurologic manifestations, predominantly due to metastatic involvement of the skull bone. Awareness of this possibility could lead to accurate diagnosis. Initiation of appropriate therapy can successfully reverse the neurologic deficits.

Ashish Bhargava,1 Hussein Aoun,2 Mehsati Herawi,3 Ulka Vaishampayan1

1 Department of Internal Medicine, Wayne State University, Karmanos Cancer Institute, Detroit Michigan, USA

2Department of Radiology, Wayne State University, Karmanos Cancer Institute, Detroit Michigan, USA

3 Department of Pathology, Wayne State University, Karmanos Cancer Institute, Detroit Michigan, USA

Submitted July 8, 2010 - Accepted for Publication September 15, 2010

KEYWORDS: Prostate adenocarcinoma; Brain metastasis; Hormonal therapy

CORRESPONDENCE: Ashish Bhargava, MD, Department of Internal Medicine, 2E University Health Center, 4201 St. Antoine, Detroit, MI 48201, USA ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.11

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; MRI, magnetic resonance image; PSA, prostate-specific antigen.



Encysted Urachal Abscess Associated With a Premalignant Lesion in an Adult Male


Congenital anomalies of the urachus are uncommon in adults. If these anomalies persist into adulthood, they very frequently present as complications of the anatomical entity. Encysted urachal abscesses with associated premalignant urothelium of the bladder wall have been very rarely reported. A 56-year-old male presented with infraumbilical pain and swelling. He was diagnosed as having an infected urachal cyst. The cyst did not communicate with the bladder or the umbilicus. On surgical exploration, the interior of the bladder wall near the urachal connection showed an exophytic mass. Histopathological analysis revealed that it was an exophytic papillomatous metaplasia of the bladder urothelium. The remnants of urothelium within the urachal cyst demonstrated normal transitional epithelium. Long-term follow-up was recommended because the features of papillary urothelial neoplasm exhibit a low malignancy potential. The present case is unique because it presents a rare combination of: (1) an encysted urachal abscess, (2) a blind urachal diverticulum, and (3) an exophytic, potentially malignant papillomatous lesion of the bladder epithelium close to its apex.

Niladri Kumar Mahato,1 Mukesh M. Mittal,1 Rajeev Aggarwal,2 Kavita M. Munjal3

1 Department of Anatomy, Sri Aurobindo Institute of Medical Sciences (SAIMS), Indore, Madhya Pradesh, India

2 Department of Surgery, Sri Aurobindo Institute of Medical Sciences (SAIMS), Indore, Madhya Pradesh, India

3 Department of Pathology, Sri Aurobindo Institute of Medical Sciences (SAIMS), Indore, Madhya Pradesh, India

Submitted July 10, 2010 - Accepted for Publication July 30, 2010

KEYWORDS: Adenocarcinoma; Pappilaoma; Urachus; Urothelium

CORRESPONDENCE: Dr. Niladri Kumar Mahato, Associate Professor, Department of Anatomy, Sri Aurobindo Institute Of Medical Sciences (SAIMS), Indore-Ujjain Highway, Bhawrasala, Indore, Madhya Pradesh, India. Pin – 452 010 ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.01



Scrotal Schwannoma: A Case Report


INTRODUCTION: Schwannoma is a benign, encapsulated neoplasm with an overall low incidence. It typically occurs in the head and neck regions and seldom develops in the scrotum. Histology shows 2 distinctive patterns (Antoni type A or type B) and several variants including cellular, ancient, glandular, and epithelioid. A 45-year-old male presented with a 1-year history of a painless, slowly growing, left-sided scrotal mass. Ultrasonography revealed an intrascrotal, extratesticular, soft-tissue mass without local invasion. The mass was successfully and totally excised without opening it and without remnant. Histopathology revealed an Antoni type A, cellular variant schwannoma of the scrotum.

Tarek A Salem

Urology Department, Suez Canal University, Ismailia, Egypt

Submitted July 20, 2010 - Accepted for Publication July 30, 2010

KEYWORDS: Schwann cell; Schwannoma; Neurolemmal sheath.

CORRESPONDENCE: Dr. Tarek Salem, Department of Urology, Suez Canal University, Faculty of Medicine, Ismailia 31911, Egypt ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.02




Fournier's Gangrene in a Man Who Was HIV-Positive With a High CD4 Count: An Unusual Presentation of a Complex Rectoscrotal Fistula


Fournier's gangrene is a potentially life-threatening, necrotising fasciitis of the perineal and/or genital region. Known risk factors include diabetes, alcoholism, and immunosuppression. Often described as idiopathic, a cause can usually be found such as trauma, catheterization, or anorectal fistula. We report a case of Fournier's gangrene in a 52-year-old man who was HIV-positive but had an underlying complex fistula that was discovered during the course of his treatment. He was successfully treated with surgical intervention and antibiotics. This patient was not typical of most previously described cases because: (1) he had a low viral load and previously high CD4 count; (2) there was no initial evidence of traditional portals of entry for organisms; (3) there was no evidence of sexually-transmitted infection found in surgical specimens; and (4) the complex fistula was the likely nidus of infection.

Sandra Chika Ndirika,1 Rex Melville,2 James Green1

1 Department of Urology, Whipps Cross University Hospital, London

2 Department of Sexual Health, Whipps Cross University Hospital, London

Submitted July 22, 2010 - Accepted for Publication September 16, 2010

KEYWORDS: Fournier's gangrene; Necrotising fasciitis; HIV/AIDS infection

CORRESPONDENCE: Miss S. C. Ndirika, Department of Urology, Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London, E11 9LR; ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.12

ABBREVIATIONS AND ACRONYMS: AIDS, acquired immune deficiency syndrome; CD4, cluster of differentiation 4; FG, Fournier's gangrene; HIV, human immunodeficiency virus.



Tension-Free Vaginal Tape Versus Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A 2-Year Follow-Up Investigation


INTRODUCTION: The purpose of the study was to compare intraoperative, perioperative, and long-term (2-year) safety and efficacy of procedures using tension-free vaginal tape (TVT) versus transobturator tape (TOT) for the treatment of female stress urinary incontinence (SUI).

METHODS: Participants were 120 female patients with SUI. They were randomly assigned to 2 equal groups, receiving either TVT or TOT. All patients were evaluated by history, physical examination, urine culture, pelviabdominal ultrasound, and urodynamics; they also completed the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF). Patients were followed for 2 years. The groups were compared for operative outcomes, complications, maximum flow rates (Qmax) before surgery and at 3-month follow-up intervals, cure rates, and ICIQ-SF scores.

RESULTS: Patients receiving TVT had significantly higher intraoperative blood loss (P < .001) and longer operative times (P < .001). There was no significant group difference in length of hospital stay. Qmax levels decreased after surgery, with no group differences at any follow-up evaluation. Minor complications occurred in < 10% of all patients, with no significant group differences. The success rate was 93.3 % (cure 83.3%; improved 10%) following use of TVT and 96.6% (cure 86.6%; improved 10%) following use of TOT; group differences were not significant. All patients with failed procedures had VLPP < 60 cmH20 and grade III SUI. Mean preoperative ICIQ-SF scores, a quality of life measure, were significantly lowered for all patients following surgery with no significant group differences.

CONCLUSION: Use of TVT and TOT in surgery result in similar outcomes, including cure rates. Based on the results of this 2-year study, both procedures have similar morbidity and should be considered safe and effective.

Osama Abdelwahab, Hammouda Sherif

Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt

Submitted August 18, 2010 - Accepted for Publication September 24, 2010

KEYWORDS: Stress urinary incontinence; Transobturator tape (TOT); Tension-free vaginal tape (TVT).

CORRESPONDENCE: Osama Abdelwahab, MD, 1st Gameel Street, Makkah Tower, 11513, Benha, Egypt ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.13

ABBREVIATIONS AND ACRONYMS: ICIQ-SF, International Consultation of Incontinence Questionnaire-Short Form; ISD, intrinsic sphincteric dysfunction; PVR, postvoid residual; Qmax, maximum flow rate; SUI, stress urinary incontinence; TOT, transobturator tape; TVT, tension-free vaginal tape; VLPP, Valsalva leak point pressure.



Five-Year Survival After Multimodal Approach in a Patient With Muscle-Invasive Transitional Cell Carcinoma of the Bladder and Adrenal Metastasis


A 59-year-old male presented with painless hematuria. Cystoscopy revealed a 6 cm solid lesion on the bladder wall. Transurethral resection of the mass showed a pT2 G3 transitional cell carcinoma (TCC). Staging computed tomography demonstrated a solitary left adrenal metastasis that was confirmed on fine-needle aspiration. He then underwent 6 cycles of gemcitabine and cisplatin. Postchemotherapy positron emission tomography demonstrated no glucose-avid areas. Left adrenalectomy and radical cystectomy were performed. There is no evidence of disease recurrence 62 months after the procedure. In metastatic TCC, postchemotherapy surgery is controversial but may provide significant survival benefit to patients with limited systemic disease that responds well to chemotherapy. This report adds to the growing body of evidence that supports a more aggressive multimodal approach to metastatic TCC in select patients. Other patient selection criteria are discussed.

Shuo Liu,1 Vincent Tse,1 Martin Stockler,2 Betty Lin3

1 Department of Urology, Concord Repatriation General Hospital, Sydney, Australia

2 Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, Australia

3 Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, Australia

Submitted August 17, 2010 - Accepted for Publication September 10, 2010

KEYWORDS: Adrenal; Bladder cancer; Metastasis; Survival

CORRESPONDENCE: Dr. Shuo Liu, Department of Urology, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney NSW 2139, Australia ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.09

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; GC, gemcitabine and cisplatin; PET, positron emission tomography; TCC, transitional cell carcinoma.



Spontaneous Intraperitoneal Perforation of the Bladder Secondary to Tuberculosis


Spontaneous perforation of the bladder is a rare clinical condition that should be suspected in patients with acute abdomen and a history of tuberculosis. The present case is a 43-year-old male with a history of pulmonary tuberculosis and repeated urinary infections. Based on his presenting symptoms, perforation of the appendix was suspected. Laparotomy revealed several hundred milliliters of urine in the peritoneal cavity. There was also a marked inflammatory response with exudate throughout the peritoneum. A 3 cm defect was found in the posterior wall of the bladder. The bladder was retracted, with very thick and fibrous walls. Laborious radical peritoneal debridement was performed, followed by peritoneal lavage and bladder repair. Postoperatively, the patient was treated with antibiotics. Despite the clinical measures taken, the patient progressed with continuing sepsis and poor clinical course. Rupture of the urinary bladder must be included in the differential diagnosis of an acute abdomen. This is a rare but potentially fatal condition with a high mortality rate if not treated early.

Sataa Sallami,1 Mohamed M Gargouri,1 Mourad Tayeb,1 Mohamed Ben Slima,2 Mounir Makhlouf2

1 Department of Urology, La Rabta Hospital-University, Tunis, Tunisia

2 Department of Surgery, La Rabta Hospital-University, Tunis, Tunisia

Submitted May 17, 2010 - Accepted for Publication June 1, 2010

KEYWORDS: Urinary bladder; Perforation; Spontaneous; Abdomen; Acute; Tuberculosis.

CORRESPONDENCE: Dr. Satâa Sallami, Department of Urology, La Rabta Hospital-University, Tunis 1007, Tunisia ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.06

ABBREVIATIONS AND ACRONYMS: MRI, magnetic resonance image; TB, tuberculosis.



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