Challenging Clinical Case

Bilateral testicular torsion in an adolescent: a case with challenging diagnosis

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0371


CHALLENGING CLINICAL CASES

Lorenzo 1, E. Martínez-Cuenca 1, E. Broseta 1
1 Hospital Universitario y Politécnico La Fe, Valencia, Espanha

ABSTRACT

Bilateral testicular torsion is a very uncommon emergency, with a challenging dif­ferential diagnosis. We describe the case of a 15-year-old patient with a left testicular torsion of 48 hours of duration and a sudden onset of right scrotum pain during his stay at the emergency area. Bilateral testicular torsion was diagnosed after repeat physical examination and doppler ultrasound, which had been normal for right testis in a first evaluation. Surgical exploration was performed with orchiectomy in left testis and fixation in right testis. In previous literature, there are reported bilateral torsion only in four adolescents and five adults. With this case, we demonstrate that bilateral spermatic cord torsion may be easily overlooked in a patient with acute scrotum and we emphasize the importance of bilateral exploration in testicular torsion.

Keywords: Testis; Spermatic Cord Torsion; Adolescent

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A case of retroperitoneal fibrosis responding to steroid therapy

Vol. 43 (6): 1185-1189, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0520


CHALLENGING CLINICAL CASES

Ryuta Watanabe 1, Akira Ozawa 1, Tokuhiro Iseda 1
1 Department of Urology, Matsuyama Shimin Hospital, Ehime, Japan

ABSTRACT

A 69-year-old man presented at the hospital with complaints of prolonged stomach pain extending from the week prior. Enhanced computed tomography (CT) revealed a low density area in the retroperitoneal space. A radiologist diagnosed the patient with retroperitoneal fibrosis. One week later, an enhanced CT revealed an exponential increase of the low density area and slight right hydronephrosis. Upon admission, prednisolone administration was initiated at a dose of 40mg/day. The size of the retroperitoneal soft tissue mass decreased gradually. Although the dose of prednisolone was tapered to 5mg, the patient is doing well without any sign of recurrence.

Keywords: Retroperitoneal Fibrosis; Therapeutics; Steroids

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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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