Inflammatory pseudotumor of the Kidney.

BACKGROUND: Inflammatory pseudotumor of the kidney or inflammatory myofibroblastic tumor (IMT) is composed of spindle cells admixed with variable amount of proliferating myofibroblasts, fibroblasts, extracellular collagen, lymphocytes and plasma cells. This mainly affects the urinary bladder or prostate. Renal involvement is rare. CASE PRESENTATION: A 56 year-old man was diagnosed with asymptomatic left sided hydronephrosis while being investigated for rheumatoid arthritis. CT scan imaging showed ill defined fascial plains around the kidney and thickening around the renal hilum suggestive of localized inflammatory change. Worsening intermittent left loin pain with increasing hydronephrosis, significant cortical thinning and marked deterioration of renal function necessitated nephrectomy. Macroscopy showed a hydronephrotic fibrotic kidney with microscopy and immunohistochemistry consistent with a histological diagnosis of IMT. CONCLUSION: We report a case of an inflammatory pseudotumor of the kidney. It is unique in that the patient presented with painless hydronephrosis followed two years later with progressive deterioration in renal function and worsening loin pain.

Ejaculatory-duct calculus causing secondary obstruction and infertility.

OBJECTIVE: To report on a patient with ejaculatory-duct calculi that caused secondary obstruction and infertility. DESIGN: Case report. SETTING: Clinical. PATIENT: A 32-year-old man. INTERVENTIONS: Magnetic resonance imaging, vasography, transurethral resection of the veru, and a review of similar cases. RESULT(S): A 32-year-old man with ejaculatory-duct obstruction because of calculi that caused infertility is described. Diagnosis was via vasography and magnetic resonance imaging. Management of this condition involves transurethral veru resection. CONCLUSIONS: Calculus causing ejaculatory-duct obstruction and leading to infertility is a rarely reported phenomenon. Transurethral resection of the veru and calculi extraction is the optimal management.

Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility?

OBJECTIVE: To report clinical findings associated with an increased incidence of mumps orchitis in Liverpool, UK, as in the last 2 years there has been a four-fold increase in the number of notified viral mumps cases in the UK. PATIENTS AND METHODS: In the 8 months before April 2005, patients presenting to the Accident and Emergency/Urology Departments of the Royal Liverpool University Hospital with a diagnosis of epididymo-orchitis were identified from the emergency urological admission database. RESULTS: Of 195 males presenting with an acute history of testicular pain and swelling, 25 gave a history of mumps parotitis 4-11 days earlier. Three had bilateral orchitis and two needed scrotal exploration to exclude torsion. Scrotal ultrasonography findings varied from increased vascularity to abnormal testicular echo texture. Treatment included analgesia, scrotal support, re-hydration and broad-spectrum antibiotics. Of the 10 patients followed-up to date, four had testicular abnormalities; one had persistent testicular pain, one a change in testicular consistency, one a noticeably reduced size of one testis, and one significant testicular atrophy. CONCLUSION: As postpubertal mumps in males is associated with a 40% incidence of orchitis, parents should be made aware that failing to immunize their children threatens the future fertility of their sons. Young men not immunized as children should be counselled and offered urgent vaccination. Clinicians should be aware that epididymo-orchitis may be secondary to mumps infection even with no history or clinical evidence of parotitis.