[Transurethral enucleation of bladder paraganglioma]. / Enucleazione transuretrale di paraganglioma vescicale.

Paraganglioma of the urinary bladder is a rare neoplasm that derives from ganglion cells located in the bladder wall and may morphologically simulate a urothelial carcinoma. The authors present the case of a vesical paraganglioma incidentally detected by ultrasound, and entirely removed by transurethral approach from detrusorial wall. Conventional approaches include surgery (partial cystectomy) or laparoscopic procedures, with inspection by transurethral endoscopy; in this case we wanted to avoid the combined approach considering the lesion diameter and the possibility of an easy removal.

[A case of intravesical migration of an intrauterine device detected 14 years later]. / Un caso di un dispositivo intrauterino migrato in sede intravescicale quattordici anni dopo.

We report the case of a patient arrived because of urological symptoms characterized by terminal hematuria, strangury and dysuria due to migration into the bladder of an intrauterine contraceptive device (IUD) placed 14 years before and penetrated into the bladder with formation of lithiasis. These cases have already been described in literature, but the particular feature of this case is that the patient had been pregnant and had a eutocic delivery, she never voluntarily removed the IUD and nor was it found during a gynecologic laparoscopy. The patient underwent the surgical removal of the IUD and of the bladder stone, without detecting adjacent connective routes between uterus and bladder.

[Wunderlich syndrome. Clinical and therapeutic aspects of a long-term experience]. / Sindrome di Wunderlich. Aspetti clinici e terapeutici di una esperienza pluriennale.

INTRODUCTION: Wunderlich's syndrome is defined as a clinical manifestation secondary to sudden spontaneous rupture of renal parenchyma in the absence of injury, resulting in hemoretroperitoneum. This syndrome may occur in patients with benign or malignant neoplasm of the kidney, arterial venous fistulae, immunovasculitis and other phlogosis of the kidney. MATERIALS AND METHODS: We present 19 cases of acute spontaneous hemoretroperitoneum or Wunderlich's syndrome diagnosed from 1996 to 2009, related to the following conditions: 7 renal carcinomas, 4 angiomyolipomas, 2 adrenal hemorrhages, 1 bleeding polycystic kidney, 2 hemorrhagic renal cysts and three cases of immunovasculitis. Overall, 6 patients were treated with acetylsalicylic acid and 4 with dicumarolics for cardiovascular disease, while 13 patients were suffering from hypertension? RESULTS: In 19 cases there was no mortality and the following treatment was performed: 11 nephrectomy, 4 partial nephrectomy, 2 adrenalectomy, 2 selective embolization of intrarenal branches as single treatment, while in three other cases, the embolization was carried out from a surgical procedure, conservative (partial nephrectomy) in one case, ablative (nephrectomy) in two other cases. CONCLUSIONS: The spontaneous hemoretroperitoneum is a rare syndrome associated with acute kidney disease often unknown to the patient and only in selected cases with small hematoma; it is possible to perform arteriography with selective embolization of branches avoiding renal access surgery. So far, it is unknown to which extent anti-platelet and anticoagulant drug treatment contributes to this syndrome but, in our experience, they have increased the morbidity of the clinical condition.