Case Study in 2008

This Case Study describes a 56-year-old man who initially presented to his urologist with lower urinary tract symptoms. Four years later, a gastrointestinal stromal tumor (GIST) was diagnosed after prostate biopsy. This article discusses the role of immunohistochemistry for diagnosing GIST, and the pharmacologic and surgical management of this unusual prostatic tumor.

This Case Study describes a 60-year-old woman who presented with an enlarging subcutaneous lesion on her right flank, 6 months after having undergone treatment for transitional cell carcinoma (TCC) of the bladder. The article highlights that rare cutaneous TCC metastases can mimic common benign and inflammatory processes, and the authors suggest treatment options for such patients.

In this Case Study, Gao et al. present a 59-year-old man with complete staghorn calculi who had previously undergone ileal ureteral replacement. The patient was successfully treated with percutaneous nephrolithotomy. The authors emphasize the essential role of CT urography in diagnosis and treatment planning in such complex cases.

This Case Study describes a 14-year-old girl with continuous urinary incontinence after resection of a vaginal septum associated with uterus didelphys. The authors discuss the diagnostic procedures undertaken, and show that MRI was effective, both preoperatively and intraoperatively, in detecting an ectopic ureter and ectopic dysplastic kidney.

Urethral carcinoma is a rare malignancy, without validated treatment protocols. In particular, the role of chemotherapy remains poorly defined. In this Case Study, Nicholson and colleagues discuss a 48-year-old woman with a T4N0M0 tumor, who was successfully treated with neoadjuvant TIP (paclitaxel, ifosfamide, cisplatin) chemotherapy followed by consolidative chemoradiation therapy.

In this Case Study, Tu et al. report a 76-year-old man who presented repeatedly with bleeding from an ileal conduit, identified as being caused by an isolated varix secondary to portal hypertension. The authors highlight that portal hypertension should be considered in the differential diagnosis of hematuria from an ileal conduit.

This Case Study by Bedke and colleagues describes a 36-year-old woman who presented to a urology department with a pelvic mass of unknown etiology. The authors highlight the difficulties of diagnosing and treating an inflammatory myofibroblastic tumor of the bladder, which can easily be misdiagnosed as a malignant lesion or sarcoma. In this patient, the authors initially opted for bladder-sparing surgery with planned complete cystectomy if indicated by the final pathologic report.

This article describes the case of a 51-year-old woman with acute renal failure. Bylund and Pais detail the investigations that the patient underwent, the discovery of bilateral, multifocal malacoplakia lesions of the bladder and ureters, and the patient's management with medical therapy and surgery. This case emphasizes that upper urinary tract malacoplakia can present as an aggressive disease, but that renal preservation can be achieved.

Polyarteritis nodosa is a rare systemic necrotizing vasculitis that requires urgent treatment. Asymptomatic scrotal involvement is relatively common, although symptomatic involvement is rarer. In this Case Study, Bush and colleagues highlight how urological evaluation including scrotal biopsy can enable rapid diagnosis of the disease and allow appropriate immunosuppressive therapy to be administered in a timely manner.

In patients with AIDS, urogenital tuberculosis presents both diagnostic and therapeutic challenges. In this Case Study, Figueiredo et al. present a 38-year-old man who was initially misdiagnosed as having a usual urinary tract infection. The authors use the patient to illustrate the unusual presentation and special treatment requirements of immunosuppressed patients with urogenital tuberculosis.

Distinguishing primary bladder adenocarcinoma from metastatic colorectal cancer represents a diagnostic challenge; however, a correct diagnosis can prevent the patient from receiving inappropriate treatment. Here, Izzo et al. use the case of a 71-year-old woman to highlight important issues in the diagnosis of these bladder neoplasms, with particular focus on the role of immunohistochemistry.

The optimum management of patients with low-stage seminoma remains a matter of debate. Here, Resnick et al. detail the case of a 51-year-old man who was diagnosed with bilateral stage I testicular seminoma. The authors discuss the management of bilateral disease, addressing the implications of surgical castration and the possibility of testis-sparing approaches to treatment.

In this Case Study, Masterson and Russo report on a patient with a small renal mass who underwent hand-assisted laparoscopic partial nephrectomy and was subsequently found to have substantial locoregional and port-site recurrence. The authors highlight the importance of adherence to oncologic principles when using minimally invasive techniques to treat renal tumors.

In this Case Study, Tseng and Matlaga report on a 50-year-old man with a 1.5 cm lower pole renal calculus who was successfully treated with percutaneous nephrolithotomy. They discuss the management options for patients presenting with lower pole calculi and highlight the need for studies evaluating quality-of-life outcomes for the different approaches.

In this Case Study, Buchler et al. report the case of 27-year-old man who had undergone right orchiectomy for testicular seminoma and was subsequently diagnosed with intratubular germ cell neoplasia of the contralateral, atrophic, testis. The controversial issue of testicular biopsy is discussed, as is the optimum management approach in the context of fertility therapy.

The iliac-artery–ureteral fistula is a rare, but potentially lethal entity. In this Case Study by Gallo et al. the case of a 66-year-old man who presented with hematuria is used to illustrate the successful diagnosis and management of this condition using only endoscopic techniques.

In this Case Study, Subramanian et al. present a patient who underwent orchiectomy for low-stage nonseminomatous germ cell tumor of the testis. The patient opted for management by surveillance, and subsequently developed a recurrent teratoma of the spermatic cord. The case illustrates the importance of combining imaging and tumor marker measurement in surveillance protocols.

In this Case Study, Phipps et al. describe a 33-year-old woman with severe hypertension resulting from iatrogenic ureteric injury. The authors discuss the underlying mechanisms of hypertension caused by ureteric obstruction, and they use the case to illustrate the effective endourological management of short, completely obliterating, distal ureteric strictures.

Primary lymphoma of the bladder is a rare condition, typically presenting as intermittent hematuria, urinary frequency and dysuria. In this Case Study, Horasanli et al. report the management, using transurethral resection, chemotherapy and radiotherapy, of a 65-year-old woman who presented with urinary symptoms and a right hydronephrosis resulting from this tumor.

In this Case Study, Tu et al. report on a 61-year-old man previously treated for prostatic adenocarcinoma who presented with obstructive urinary symptoms and was subsequently found to have ductal carcinoma of the prostate. The authors discuss the difficulty of diagnosing this tumor, and the correct approach to its management.