Nonabsorbable polymer clip as a cause of chronic perineal pain after radical prostatectomy: Description of a case treated by transperineal approach

The occurrence of persistent perineal pain caused by surgical clips has rarely been described after radical prostatectomy (RP). We describe the case of a patient complaining of chronic perineal pain occurred soon after robotic RP, refractory to conventional medical therapy and exacerbated by the sitting position. Pain was related to a nonabsorbable polymer clip used to secure lateral pedicles. A transpeerineal approach was used to perform an hydrodissection of the rectovesical space at the level of the surgical clip combined with local injection of mepivacaine and betametasone. The patient experienced a clinically significant reduction of pain that remained stable at three months' follow-up

Seminal vesicle abscess causing unilateral hydroureteronephrosis: A case report

Seminal vesicle abscess (SVA) is a rare urologic entity. It mainly occurs in subjects with predisposing factors and may be associated with other urogenital infections. We describe the case of a diabetic subject with SVA associated with funiculitis, epididymitis and obstructive pyelonephritis. Treatment consisted of laparotomic surgical drainage of the abscess and ureteral stent placement

Incidentally discovered pelvic paraganglioma: A case report

Paragangliomas (PGL) are rare neuroendocrine tumors of the autonomic nervous system originating from paraganglia. Although PGL may arise at any site where physiologic paraganglionic tissue exists, the localization in the small pelvis is extremely rare. PGL may be hormonally active and release surplus catecholamines into the blood or inactive. The asymptomatic cases pose a diagnostic dilemma. We describe the case of an asymptomatic PGL arising in the small pelvis sidewall presenting as an incidentally discovered asymptomatic mass in a male subject

Transperineal repair of a persistent rectourethral fistula using aporcine dermal graft

INTRODUCTION: Rectourethral fistula (RUF) is a rare major complication after radical prostatectomy (RP). Management of patients with persistent RUFs after primary repair is controversial and technically challenging. PRESENTATION OF CASE: We describe the case of a patient with history of RUF secondary to rectal injury during laparoscopic RP and failed trans-abdominal repair. A further attempt to repair the persistent RUF was done through a perineal approach. The fistula was excised, the anterior rectal wall was closed in two layers and the defect at the level of the urethrovesical anastomosis (UVA) was repaired with an interrupted suture. A porcine dermal graft was interposed between the UVA and the rectum and was sutured to the rectal wall. There were neither clinical nor radiological evidences of fistula recurrence at one-year follow-up after transperineal surgical repair. DISCUSSION: We used, for the first time, a porcine dermal collagen allograft as interposition tissue in a persistent RUF secondary to rectal injury during laparoscopic RP. The use of this allograft allows the potential advantage of less surgical invasivity if compared to gracilis muscle graft. CONCLUSIONS: Transperineal repair of persistent RUFs with porcine dermal graft interposition is a safe and feasible surgical procedure

Giant primary scrotal lipoma: A case report

Lipomas are benign mesenchymal tumours that are rarely seen in the scrotum. Few cases of primary scrotal lipomas originating from the scrotal wall have been reported in the literature. We describe the case of a giant primary intrascrotal lipoma presenting as scrotal swelling and discomfort. Findings from scrotal magnetic resonance imaging were highly suspicious for lipoma. The mass was completely excised and histological examination confirmed the diagnosis of lipoma

Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin

Objectives: To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET) of distal ureteric stones. Patients and methods: Observational data were collected retrospectively from patients who received silodosin (N = 50) or tamsulosin (N = 50) as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Results: Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant). Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant). Mean number of pain episodes were 1.6 and 1.7 in the silodosin and tamsulosin group, respectively (p not significant). The mean number of analgesic requirement was 0.84 and 0.9 for the silodosin and tamsulosin group, respectively (p not significant). Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced an higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Subgroup analysis demonstrated significantly lower mean expulsion times and pain episodes in patients with stones ≤ 5 mm in both groups. Conclusions: Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associatd with a lower incidence of side effects related to peripheral vasodilation but an higher incidence of retrograde ejaculation when compared to tamsulosin

A case of highly aggressive anaplastic seminoma of the testis presenting as fungating scrotal lesion

Anaplastic seminoma (AS) is an uncommon histological variant of classical seminoma of the testis and account for 5%-15% of cases. It is poorly described in the scientific literature. We present the case of a 50-years-old homeless man presenting with fever, marked left scrotal hardness and a fungating left scrotal lesion. He underwent left orchiopexy 40 years before. A computed tomography with contrast media showed a suspect testis cancer with scrotal involvment, extensive intralesional necrosis and multiple systemic metastases. A wide excision of the left hemiscrotum including the testis was performed in order to prevent severe local and systemic infectious complications. Histological examination revealed an AS. General conditions showed a rapid deterioration and the patient died on post operative day 10

A rare case of male pelvic squamous cell carcinoma of unknown primary origin presenting as perineal abscess and urethral stenosis

Carcinomas of unknown primary origin (CUP) represent a diagnostic and therapeutic challenge. Squamous cell CUP located in the male pelvis are very rare. We describe a case of a locally advanced squamous cell CUP occurring in the male pelvis presenting as perineal abscess and urethral stenosis and diagnosed by means of transperineal needle biopsy

Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin-induced chemical cystitis: Preliminary experience with one-year follow-up

Objective: We investigated the efficacy of intravesical instillations of combined hyaluronic acid (HA) and chondroitin sulphate (CS) in patients with bacillus Calmette-Guérin (BCG)-induced chemical cystitis unresponsive to first-line therapies. Patients and methods: We retrospectively reviewed the clinical records of patients with grade 2 BCG-induced chemical cystitis unresponsive to first line therapeutic options performed according to the International Bladder Cancer Group guidelines who underwent intravesical instillations of HA/CS. Bladder pain, urinary urgency, voiding volume and number of voids/24 hours recorded prior to treatment, at the end of the treatment, at six months and at one-year follow-up were recorded and analyzed. Results: The records of 20 patients were identified. All patients underwent eight weekly instillations of HA/CS. Mean baseline visual analogue scale (VAS) scores ± Standard Deviation (SD) for urinary urgency and bladder pain were 7.8 ± 0.5 and 7.2 ± 1.0, respectively. Mean number of voids/24 hours ± SD was 15.4 ± 2.3 and mean urine volume per void ± SD was 85.8 ± 21.0 mL. At the end of the treatment, mean VAS scores ± SD for urgency and pain significantly decreased to 4.7 ± 1.1 and 4.2 ± 0.9, respectively (p < 0.05 in both cases). Mean number of voids/24 hours ± SD decreased to 9.6 ± 1.4 (p < 0.05) and mean urine volume per void ± SD significantly increased to 194.1 ± 59.5 mL (p < 0.05). At six months and one-year followup, all outcome measures remained stable. Conclusions: Bladder instillations of HA/CS provide significant and durable improvement of bladder pain, urinary urgency, urinary volume per void and urinary frequency in patients with refractory BCG-induced chemical cystitis