Surgical Treatment of an Exuberant Case of Penoscrotal Elephantiasis.

Lymphedema is a manifestation of lymphatic system disturbance and deranged lymph transport, with resultant swelling, a proliferation of parenchymal and stromal elements, and excess deposition of the extracellular matrix. It may occur in any part of the body, most frequently in the limbs. Staging ranges from inconspicuous lymphatic system derangement to lymphatic elephantiasis. Surgical treatment is the preferred modality. This case report is of a 36-year-old male patient with morbid obesity with a five-year-long history of penoscrotal volume increase without any apparent trigger. Patient observation revealed a frankly enlarged scrotum involving the penis, with distortion and an increase in urinary meatus diameter. The penis was palpable but hardly observable. Neither testicle was palpable. Scrotal tissue was hardened and sclerotic. We performed surgical excision of all swollen tissue while identifying and preserving the penis and both testicles. Local advancement flaps were used to create a neoscrotum. Resurfacing of the penis was accomplished with split-thickness skin grafting harvested from a small part of healthy skin included in the excised tissue and held in place during the first week with negative pressure therapy. There are no signs of local or distant relapse, and the patient mentions a dramatic improvement in urinary flow, quality of life in terms of ambulation, everyday tasks, and self-esteem. We present a very rare clinical case of exuberant penoscrotal lymphedema in a young patient with very few risk factors. Given the extent and time of presentation, microsurgery of the lymphatics was not indicated, and thus, a Charles procedure was undertaken. Even so, patient quality of life was significantly improved, and no recurrences have been reported so far.

Intestinal adenocarcinoma in an augmented ileocystoplasty.

We present a case of a 67-year-old patient with a history of augmentation ileocystoplasty 31 years ago following genitourinary tuberculosis. Radiological investigations performed due to asymptomatic microscopic haematuria revealed three contrast-enhancing polyps within the neobladder. The patient had enterocystoprostatectomy and histopathological examination of the neobladder revealed mucinous adenocarcinoma in all three polyps, together with a prostatic adenocarcinoma Gleason 7 (3+4). After adjuvant chemotherapy and 1 year of follow-up, he had no sign of clinical or radiological recurrence. Taking into consideration this rare case, we discuss the development of malignant tumours after the incorporation of intestinal segments in a urinary tract reconstruction, showing what relationship exists between secondary neoplastic growth, the primary disease and the type of urinary diversion utilised.

[Strangulated urethral prolapse. Case report]. / Prolapso uretral encarcerado. A propósito de un caso clínico.

OBJECTIVE: We report a case of strangulated urethral prolapse. METHOD/RESULTS: A 62-year-old female patient presents to the emergency department with complaints of a bleeding vaginal mass, pain referred to the vaginal introitus and dysu-ria. After being diagnosed with a strangulated urethral pro-lapse, surgical excision of the prolapsed urethra was performed. Pathologically, vascular proliferation of the angioma-tous type with thrombosis and focal recanolization (Masson) and inclusion of rare muscular fibers were recognized. Her postoperative course was uneventful, without any recurrence or abnormal micturition. CONCLUSION: For the treatment of strangulated urethral prolapse, surgical excision has been widely applied with successful results.

[Bladder adenocarcinoma. Case report]. / Adenocarcinoma vesical. Aportación de un caso clínico.

OBJECTIVE: Primary bladder adenocarcinoma is a rare entity. We performed a review of the literature on this subject and present a clinical case. METHOD/RESULTS: A 74 year old female patient presents to the emergency department with complaints of gross hematúria not accompanied by lower urinary tract symptoms. Diagnostic work-up included renal and bladder ultrasound, cistoscopy and abdomino-pelvic C. T. scan. Metastatic disease was excluded. Trans-urethral resection revealed an invasive adenocarcinoma. A gynaecologic origin was excluded by further gynaecologic examination and an anterior pelvic exanteration was performed. The bladder specimen showed primary bladder adenocarcinoma, pT3aNO. At 6 months of follow-up, the patient does not present disease progression or surgical complications. CONCLUSION: Primary bladder adenocarcinoma is rare. Unlike urothelial carcinoma, it responds poorly to chemotherapy or radiotherapy Radical Cistectomy offer the best chance of long-term survival.

Prolapso uretral encarcerado. A propósito de un caso clínico / Strangulated urethral prolapse. Case report

Objetivo: Presentar un caso clínico de prolapso de la mucosa uretral encarcerado. Métodos/Resultados: Paciente del sexo femenino de 62 años de edad. Acude al Servicio de urgencias por masa vaginal sangrante acompañada de dolor, localizada en el introioto vaginal y disuria. Después del diagnóstico de prolapso de la mucosa uretral encarcerado, se sometió a exéresis quirúrgica del mismo. El examen histológico reveló uretra con proliferación vascular de tipo angiomatoso con trombosis y recanalización focal (Masson) e inclusión de raros fascículos de fibras musculares. El postoperatorio recorre sin incidencias, no recurrencias o problemas miccionales. Conclusión: Para el tratamiento del prolapso uretral encarcerado, la exéresis quirúrgica es el «gold stardard» (AU)

Objective: We report a case of strangulated urethral prolapse. Method/Results: A 62 year old female patient presents to the emergency department with complaints of a bleeding vaginal mass, pain referred to the vaginal introitus and dysuria. After being diagnosed with a strangulated urethral prolapse, surgical excision of the prolapsed urethra was performed. Pathologically, vascular proliferation of the angiomatous type with thrombosis and focal recanalization (Masson) and inclusion of rare muscular fibers were recognized. Her postoperative course was uneventful, without any recurrence or abnormal micturition. Conclusion: For the treatment of strangulated urethral prolapse, surgical excision has been widely applied with successful results (AU)

Adenocarcinoma vesical. Aportación de un caso clínico / Bladder adenocarcinoma. Case report

Objetivo: El adenocarcinoma primario de vejiga es una entidad rara. Realizamos una revisión de la literatura y presentamos un caso clínico. Métodos/Resultados: Se trata de una paciente del sexo femenino de 74 años de edad que acude al servicio de urgencias por hematuria macroscópica, sin otra sinto matología acompañante. Se sometió a varios exámenes auxiliares de diagnóstico, incluyendo ecografía renal y vesical, cistoscopia y TAC abdominal y pélvico. Después de la realización de resección transuretral de pólipo vesical y frente al diagnóstico de adenocarcinoma músculo invasivo, se somete a una evaluación ginecológica completa, excluyendo enfermedad ginecológica. Se procede a exanteración pélvica anterior. El informe anatomo patológico muestra un adenocarcinoma vesical primario, pT3aN0, con ganglios linfáticos regionales negativos. Después de 6 meses de seguimiento, la paciente no presenta complicaciones resultantes de la cirugía o evidencia de evolución de su enfermedad. Conclusión: El Adenocarcinoma vesical primario es una entidad rara. Al contrario del carcinoma urotelial, responde mal a la quimioterapia y radioterapia, por lo que el único tratamiento eficaz es la cirugía radical (AU)

Objective: Primary bladder adenocarcinoma is a rare entity. We performed a review of the literature on this subject and present a clinical case. Method/Results: A 74 year old female patient presents to the emergency department with complaints of gross hematúria not accompanied by lower urinary tract symptoms. Diagnostic work-up included renal and bladder ultrasound, cistoscopy and abdomino-pelvic C.T. scan. Metastatic disease was excluded. Trans-urethral resection revealed an invasive adenocarcinoma. A gynaecologic origin was excluded by further gynaecologic examination and an anterior pelvic exanteration was performed. The bladder specimen showed primary bladder adenocarcinoma, pT3aN0. At 6 months of follow-up, the patient does not present disease progression or surgical complications. Conclusion: Primary bladder adenocarcinoma is rare. Unlike urothelial carcinoma, it responds poorly to chemotherapy or radiotherapy. Radical Cistectomy offer the best chance of long-term survival (AU)