[Conservative therapy after self-mutilation of the scrotum resulting in bilateral testicular underperfusion]. / Konservative Therapie nach Automutilation des Skrotums mit Folge einer beidseitigen testikulären Minderperfusion.

We report the case of a patient with massive penile and scrotal swelling due to use of a compression ring with auto-erotic intent and under the influence of addictive substances. Based on the patient history, the mechanical pressure on the scrotum was about 30 hours (h). The Doppler sonogram showed no central perfusion in either testicle. Conservative treatment with antibiotics and analgesics was initiated with a slight increase in inflammatory parameters and local edema and necrosis formation. Follow-up showed regression of swelling, healing of necrosis and improvement of laboratory parameters. Testosterone substitution therapy was necessary due to the bilateral testicular atrophy that developed.

Bladder carcinoma during pregnancy.

INTRODUCTION: We report 3 cases of bladder cancer during pregnancy and give a review of the literature in an attempt to evaluate tumor at presentation, characteristics, maternal and fetal outcome. MATERIALS AND METHODS: The case history of 3 pregnant women treated for bladder cancer in 2001 together with the results of a MEDLINE search from 1966 to 2003. RESULTS: Out of 27 cases of nonbilharzial bladder carcinoma, 74% presented with transitional cell carcinoma. Five patients had muscle-invasive tumors. Major symptom was hematuria in 81%, which was initially mistaken as vaginal bleeding in 22%. Only half of the tumors were identified by ultrasonography. Although superficial bladder carcinoma was transurethrally resected alone, outcome and prognosis are good. But the prognosis of locally advanced bladder carcinoma is poor. None of the fetuses delivered before 30 weeks of gestation survived. Two of the 5 patients died from the disease and follow-up is only short in the rest. CONCLUSION: Any doubtful genital bleeding during pregnancy without definite proof of vaginal/cervical origin should be investigated by both ultrasonography of the upper urinary tract and urethrocystoscopy. Superficial bladder tumors can be most effectively treated by transurethral resection followed by cystoscopy, whereas the prognosis of muscle-invasive bladder carcinoma is poor and demands more radical treatment, depending on the stage of pregnancy.