High-grade undifferentiated pleomorphic sarcoma of the pelvis: A case report and review of literature.

High-grade spindle cell sarcomas are rare undifferentiated pleomorphic cancers that present a treatment challenge to urological practices, especially when they present in the pelvis. We report a 46-year-old male patient who presented to our urology clinic with urinary retention after having a Foley catheter placed at an outlying facility. A voiding trial was attempted, but the patient failed this trial. This failure resulted in cystoscopy with bilateral retrograde pyelograms, which revealed a compressed bladder due to extrinsic compression. This finding had been evaluated with a computed tomography (CT) scan with and without intravenous contrast that showed a 14 cm pelvic mass with bladder displacement and compression. A fine needle aspiration was done at this outlying facility, prior to referral to our office, and it confirmed spindle cell pathology. The mass was surgically excised with the histology revealing a pelvic spindle cell sarcoma with positive surgical margins. Further, metastatic work-up with CT/positron emission tomography revealed bone and lung metastasis. The patient is currently undergoing chemotherapy and radiation. In this case study, we will review staging, management, differential diagnosis, chemotherapy, and radiation.

Postprostatectomy erectile dysfunction: the role of penile rehabilitation.

Radical prostatectomy has become the gold standard for the treatment of prostate cancer in patients who have a longer than 10-year life expectancy. Surgical treatment has led to severe quality-of-life issues in these patients, especially urinary incontinence and erectile dysfunction (ED). This article reviews the etiology and pathophysiology of postprostatectomy ED, and current management strategies for these patients.

Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for moderate sized kidney stones.

OBJECTIVE: To compare the outcomes of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) for moderate sized (1-2 cm) upper and middle pole renal calculi in regards to stone clearance rate, morbidity, and quality of life. METHODS: All patients diagnosed with moderate sized upper and middle pole kidney stones by computed tomography (CT) were offered enrollment. They were randomized to receive either ESWL or PNL. The SF-8 quality of life survey was administered preoperatively and at 1 week and 3 months postoperatively. Abdominal radiograph at 1 week and CT scan at 3 months were used to determine stone-free status. All complications and outcomes were recorded. RESULTS: PNL established a stone-free status of 95% and 85% at 1 week and 3 months, respectively, whereas ESWL established a stone-free status of 17% and 33% at 1 week and 3 months, respectively. Retreatment in ESWL was required in 67% of cases, with 0% retreatment in PNL. Stone location, stone density, and skin-to-stone distance had no impact on stone-free rates at both visits, irrespective of procedure. Patient-reported outcomes, including overall physical and mental health status, favored a better quality of life for patients who had PNL performed. CONCLUSION: PNL more often establishes stone-free status, has a more similar complication profile, and has similar reported quality of life at 3 months when compared with ESWL for moderate-sized kidney stones. PNL should be offered as a treatment option to all patients with moderate-sized kidney stones in centers with experienced endourologists.

Use of an amplatzer vascular plug for transcatheter embolization of a renal arteriovenous fistula.

Renal arteriovenous fistulae (AVF) are a rare condition that can be acquired, congenital, or idiopathic. Idiopathic AVF are the rarest type of renal AVF. Traditionally, renal AVF were treated with surgery, but the mainstay of treatment has shifted to an endovascular approach by coil embolization. Embolization procedures are often difficult secondary to the "high flow" of the AVF, and there is the substantial risk of distal embolization of coils. We present a case in which an idiopathic renal AVF was successfully embolized with an Amplatzer vascular plug.

Selective renal artery embolization following blunt renal trauma: case report and current treatment recommendations for renal trauma.

Management of renal trauma has become more conservative as newer techniques evolve. In 2004, the Renal Trauma Subcommittee modified their algorithms for the management of renal injuries to include selective angiography and embolization for grade III and IV lacerations for both blunt and penetrating renal lacerations. These algorithms are based on the renal organ injury scale defined by The American Association for the Surgery of Trauma (AAST) and whether the patient is hemodynamically stable or unstable (Table 1). Historically, grade III and IV renal injuries would have been managed by renal exploration. The goals of treating patients with severe renal injuries are to prevent significant hemorrhage and retain sufficient functional nephrons to prevent end-stage kidney failure. Selective arterial embolization provides a minimally invasive treatment option for renovascular injuries and potentially obviates the need for surgical exploration with its higher incidence of nephrectomy. We present a case of grade IV renal laceration following blunt renal trauma, which was successfully treated with selective renal arterial embolization.