Urinary bladder rupture years after excision of urachal remnant.

A 13-year-old boy presented with acute kidney injury, abdominal discomfort, and distention secondary to urinary ascites. He had undergone a robotic-assisted laparoscopic excision of a urachal cyst 5 years prior to presentation. Further examination revealed decreased urine output, elevated serum creatinine, and hyperkalemia. He was diagnosed with rapidly progressive glomerulonephritis requiring hemodialysis. Further investigation of ascites fluid demonstrated significantly elevated creatinine consistent with urine. A computed tomography cystogram demonstrated an intraperitoneal bladder rupture. He underwent an emergent surgical cystorrhaphy with significant improvement.

Acute management of Fournier's gangrene in the setting of massive lymphedema.

Chronic, massive lymphedema of the scrotum can pose therapeutic challenges to the urologist. Uncommonly encountered in developed countries, this dilemma can be amplified in the emergent setting. Along with voiding limitations and pain, lymphedema can lead to recurrent subcutaneous infections. Recurrence of infections can lead to a cycle of worsening lymphedema. We report a case of Fournier's gangrene complicated by massive lymphedema of the scrotum and right leg in a 43 year-old man from Panama, presumably filarial. This case highlights the surgical management of a patient requiring emergent intervention and multidisciplinary approach of reconstructive repair in the acute care setting.