A rare case of penile fracture with complete urethral rupture during sexual intercourse.

Fracture of the penis during intercourse is a relatively uncommon condition. We report a rare case with laceration of bilateral corpora cavernosa and associated complete urethral rupture. The patient underwent immediate surgical repair of the penile fracture with primary urethroplasty. After 1 year follow-up he presents excellent results with normal sexual function and normal postoperative urethrogram with no voiding problems.

Surgical treatment of ureteral obstruction from endometriosis: our experience with thirteen cases.

Endometriosis is a biologically benign albeit aggressive pathology marked by high local recurrences. Ureteral involvement accounts for only a minority of cases (0.1-0.4%) with often non-specific symptoms at clinical presentation and difficult preoperative diagnosis. Thirteen cases of severe ureteral endometriosis (i.e. causing significant obstruction to the urinary flow) were observed and surgically treated, out of 17 ureteral units affected (three cases of bilateral involvement, one case of complete pyeloureteral duplicity). The initial symptomatology was acute and related to ureteral obstruction in eight cases, silent and non-specific in the other five; a presumptive diagnosis was made only for the seven patients (53.9%) with a positive medical history for pelvic (and in two cases also ureteral) endometriosis. Preoperative drainage of urine proved necessary for eight patients due to the complete functional exclusion of the excretory axis. One patient (7.7%) underwent nephrectomy due to renal atrophy. Segmental ureteral resection and termino-terminal anastomosis were performed in two patients, while seven patients underwent segmental ureterectomy and ureterocystoneostomy, with bladder psoas hitching in four cases and vesical flap according to Casati-Boari in one case. All three cases of bilateral involvement were treated by bilateral segmental ureterectomy and trans-uretero-uretero-cystoneostomy with bladder psoas hitching. Following histological examination, all patients were diagnosed with active ureteral endometriosis, which was found to be intrinsic in five cases (38.5%) and extrinsic in the other eight. One of the two patients that had undergone ureterectomy and termino-terminal anastomosis had to undergo ureteral resection and ureterocystoneostomy 22 months later due to relapsing endometriosis-induced stenosis. Conversely, no ureteral endometriosis relapses occurred in the remaining 12 patients within the mean follow-up time of 41.1 months (range 6-91). Ureteral endometriosis is marked by non-specific symptoms, making preoperative diagnosis often difficult. Therefore, an ultrasound or urographic examination of the urinary tract in case of pelvic endometriosis is absolutely essential. In our experience, terminal ureterectomy with ureterocystoneostomy has provided long-term favourable results as extended ureteral resection can be performed and continuity of the urinary tract can be restored without resorting to the distal pelvic ureter, which is often affected by the disease besides being more subject to relapses.

Myofibroblastic inflammatory tumors of the bladder.

Bladder myofibroblastic inflammatory tumors are rare benign proliferative lesions that can simulate both urothelial and connective tissue malign neoplasms, making a preoperative diagnosis nearly impossible. Conservative treatment appears to be curative, even though local recurrences have been reported, and so malignancy should be ruled out above all by means of an accurate follow-up. Two cases are described, 1 of which with the longest follow-up period reported so far (8 years).

[Ureteral endometriosis: urological features]. / Endometriosi ureterale: aspetti urologici.

Endometriosis affects about 10-20% of premenopausal women but ureteral involvement is an infrequent event occurring only in 0.1-0.4% of cases. Clinical presentation and radiological aspects are non-specific so that preoperative diagnosis is difficult, requiring a high index of suspicion. Intravenous urography is mandatory in all patients with pelvic endometriosis. Between 1995 and 2001, 10 patients with severe endometriosis of the ureter were referred to our center. Bilateral involvement was present in 3 cases. 6 patients showed a significant involvement of other pelvic organs, with subsequent surgical treatment. 1 patient with bilateral ureteral endometriosis was treated by bilateral stenting and medical hormonal therapy, with good results. 2 patients underwent ureteral resection with primary reanastomosis; one of them showed an ureteral relapse 22 months after surgery, with the necessity of a second resection and ureteroneocystostomy. Ureteric resection and ureteroneocystostomy were initially performed in the other 7 patients, without evidence of recurrences in all cases (median follow-up 31 months). Hormonal therapy or hysteroadnexiectomy, when feasible, are necessary to reduce the risks of relapses. In our opinion, ureteral resection associated with ureteroneocystostomy gives the best chances to cure severe ureteral endometriosis.