Challenging Clinical Case

Acquired Hemophilia presenting as Gross Hematuria following Kidney Stone – A Case Report and Review of the Literature

Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0172


CHALLENGING CLINICAL CASES

Max Schmidt-Bowman 1, Lael Reinstatler 2, Eric P. Raffin 2, Joseph E. Yared 2, John D. Seigne 2, Einar F. Sverrisson 2
1 Geisel School of Medicine at Dartmouth, Hanover, NH; 2 Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH

 

ABSTRACT

A rare condition in itself, acquired hemophilia A, seldom presents as isolated gross he­maturia. It is a serious condition with a high mortality rate and thus clinical suspicion followed by prompt diagnosis is imperative (1). In fact, only 8 cases of such presen­tation of this condition have been reported thus far in the literature. Of these, none describe the initial presentation of hematuria with the inciting event of a kidney stone. We present a case of a 67-year-old man with signs and symptoms of nephrolithiasis accompanied by profuse hematuria, who was subsequently found to have developed expression of factor VIII inhibitor leading to acquired hemophilia A.

Keywords: Hematuria; Nephrolithiasis; Factor 8 deficiency, acquired [Supplementary Concept]

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Prostate cancer recurrence in vas deferens – fusion image guide as an important tool in dignosis

 Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0071


CHALLENGING CLINICAL CASES

Leonardo Guedes Moreira Valle 1, Antônio Rahal Jr. 1, Priscila Mina Falsarella 1, Juliano Ribeiro de Andrade 1, Oren Smaletz 2, Akemi Osawa 3, Rodrigo Gobbo Garcia 1
1 Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil; 2 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil; 3 Departamento de Medicina Nuclear e Radiologia, Hospital Israelita Albert Einstein, São Paulo, Brasil

ABSTRACT

The biochemical recurrence after local treatment for prostate cancer is an often chal­lenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites.

An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA- 68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence.

The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously.

High resolution acquired in PET / MR associated with image fusion allows orienta­tion procedures, even in areas of...

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Synthetic mesh repair of an anterior perineal hernia following robotic radical urethrocystectomy

Vol. 43 (5): 982-986, September – October, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0534


CHALLENGING CLINICAL CASES

Horacio J. Alvarez Garzón 1,2, Thomas Maubon 3, Camille Jauffret 3, Pierre Vieille 2, Brigitte Fatton 2, Renaud de Tayrac 2
1 Department of Urology, Hospital Privado Centro Medico de Córdoba, Argentina; 2 Department of Obstetrics and Gynaecology, Nîmes University Hospital, Nîmes, France; 3 Department of Urology and Surgical Oncology, Institut Paoli Calmettes, Marseille, France

ABSTRACT

Introduction: Perineal hernia is a protrusion of intra-abdominal viscera through a defect in the pelvic floor and is a rare but challenging complication after extensive abdominoperineal surgery. There have been small series published after colorectal exenteration, but no cases have been reported after radical cystectomy and urethrectomy.

Case Presentation: A 68 years old woman developed an anterior perineal hernia, with no vaginal prolapse, after an anterior exenteration for bladder cancer. A perineal approach with the use of a synthetic polypropylene mesh was chosen to resolve the condition. After 6 months of follow-up, the patient has no symptoms or recurrence of the anterior perineal hernia.

Conclusion: To our knowledge, this case is the first report of perineal hernia after radical urethrocystectomy. Although being a case report, this article describes a potential and challenging complication after extensive anterior pelvic surgery, that could increase its incidence in the future. Literature review shows that whether perineal, abdominal or combined approach is chosen, surgery must respect hernia repair principles.

Keywords: Perineum; Pelvis; Cystectomy

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Spermatozoa retrieval for cryopreservation after death

Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0249


CHALLENGING CLINICAL CASES

Fernando Lorenzini 1, Eduardo Zanchet 1, Gustavo M. Paul 1, Ricardo T. Beck 1, Mariana S. Lorenzini 1, Elisângela Böhme 1

1 Centro de Reprodução Humana Curitiba, PR, Brasil

ABSTRACT

Objectives: To describe the retrieval spermatozoa technique for cryopreservation after death, including the proximal part of vas deferens.
Material and Methods: A 28-years old man, with previous history of infertility, who died 12 hours ago, was submitted to spermatozoa retrieval for cryopreservation, with surgical bilateral resection in bloc of the proximal part of vas deferens, testicle and epididymis. At the laboratory, by milking the epididymis and vas deferens, the ex¬tracted fluid was collected; also, three samples of each testicle parenchyma were also harvested.
Results: The fluid from the vas deferens showed spermatozoa, mostly with in situ motility. Testicular fragments also presented spermatozoa, mostly with small tail movements or immobile.
Conclusion: The inclusion of the proximal part of vas deferens during spermatozoa retrieval after death must be performed, since it contains high concentration of sper¬matozoa, and even in the presence of previous infertility, as was with this patient, it is possible to retrieve spermatozoa.

Keywords: Cryopreservation; Spermatozoa; Vas Deferens; Testis

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Vaginal evisceration related to genital prolapse in premenopausal woman

Vol. 43 (4): 766-769, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0249


CHALLENGING CLINICAL CASES

Lucas Schreiner 1, Thais Guimarães dos Santos 1, Christiana Campani Nygaard 2, Daniele Sparemberger Oliveira 2
1 Departamento de Obstetrícia e Ginecologia do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brasil; 2 Serviço de Uroginecologia do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brasil

 

ABSTRACT

Background: Vaginal evisceration is a rare problem, usually related to a previous hys­terectomy. We report a case of spontaneous rupture of the cul-de-sac in a premeno­pausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythe­matosus (SLE), with uterine prolapse that occurred during evacuation.

Case Report: A 40-year-old woman with SLE, using glucocorticoids, with uterine pro­lapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evis­ceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation.

Case hypothesis: This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.

Keywords:  Prolapse; Vagina; Lupus Erythematosus, Systemic

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Ten cases with 46,XX testicular disorder of sex development: single center experience

Vol. 43 (4): 770-775, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0505


CHALLENGING CLINICAL CASES

Akinsal, Emre Can 1, Baydilli, Numan 1, Demirtas, Abdullah 1, Saatci, Cetin 2, Ekmekcioglu, Oguz 1
1 Department of Urology, Erciyes University Medical Faculty, Kayseri, Turkey; 2 Department of Genetics, Erciyes University Medical Faculty Medical, Kayseri, Turkey

 

ABSTRACT

Objective: To present clinical, chromosomal and hormonal features of ten cases with SRY-positive 46,XX testicular disorder of sex development who were admitted to our infertility clinic.

Cases and Methods: Records of the cases who were admitted to our infertility clinic between 2004 and 2015 were investigated. Ten 46,XX testicular disorder of sex development cases were detected. Clinical, hormonal and chromosomal assessments were analized.

Results: Mean age at diagnosis was 30.4, mean body height was 166.9cm. Hormonal data indicated that the patients had a higher FSH, LH levels, lower TT level and normal E2, PRL levels. Karyotype analysis of all patients confirmed 46,XX karyotype, and FISH analysis showed that SRY gene was positive and translocated to Xp. The AZFa, AZFb and AZFc regions were absent in 8 cases. In one case AZFb and AZFc incomplete deletion and normal AZFa region was present. In the other one all AZF regions were present.

Conclusion: Gonadal development disorders such as SRY-positive 46,XX testicular disorder of sex development can be diagnosed in infertility clinics during infertility workup. Although these cases had no chance of bearing a child, they should be protected from negative effects of testosterone deficiency by replacement therapies.

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