Penile Mondor's disease after anterolateral retroperitoneal approach for lumbar fracture.

This is a rare case of thrombosis of the dorsal vein of the penis (Mondor's disease) occurred after an anterior-lateral retroperitoneal approach for a vertebral stabilisation in thoracolumbar vertebral fracture. Potential causes are traumatism, neoplasms, excessive sexual activity or abstinence. Although penile Mondor's disease is a clinical diagnosis, ultrasound imaging is the gold standard to confirm it. In the reported case, 1 week after neurosurgical retroperitoneal procedure of vertebral stabilisation, the patient complained of a painful cord-like mass midshaft of penis. The diagnosis was made by clinical evaluation and ultrasound images. After 2 weeks of therapy with enoxaparin sodium, the patient recovered. The authors report this case evaluating the possible correlation between the anterior-lateral retroperitoneal approach and the development of the rare Mondor's disease.

Distant subcutaneous spreading of Fournier's gangrene: An unusual clinical identification by preoperative ultrasound study.

We present here the first case of successful management via preoperative ultrasonographic (US) study to detect a distant spreading of Fournier's gangrene (FG), which was happened in a 75-year-old man. US study showed the necrotizing infection in the periumbilical region distant 22 cm from the genital tract. A target incision of this periumbilical area and debridement of necrotic tissues was made. Computed tomography (CT) is superior to ultrasonography to confirm the diagnosis of FG and support in surgical management, but a CT evaluation in patients with FG may be limited by the frequent presence of concurrent acute renal failure or patient hemodynamic instability. Ultrasonography is an ideal technique for evaluating patients in bedside settings and can be routinely used in an emergency.

Blue light cystoscopy with hexylaminolevulinate: Our 7 years experience.

AIM: The objective of the present study is to evaluate the diagnostic accuracy of hexylaminolevulinate (HAL) blue light cystoscopy compared with standard white light cystoscopy (WLC) in daily practice. MATERIALS AND METHODS: An observational, comparative, controlled (within patient) study was carried out at our Center. 61 consecutive patients with suspected or confirmed bladder cancer were recruited for the study from January 2008 until January 2015. Patients with suspected bladder cancer (positive cytology with negative WLC) or history of previous high-grade NMIBC or CIS were included in the study. Biopsies/resection of each positive lesion/suspicious areas were always taken after the bladder was inspected under WLC and BLC. Diagnoses of bladder tumor or CIS were considered as positive results, and the presence of normal urothelium in the biopsy specimen as negative result. RESULTS: 61 BLC were performed. 15/61 (24.5%) with suspected initial diagnosis of NMIBC and 46/61 (75.5%) with a history of high-risk non-muscle invasive bladder cancer (NMIBC). We performed a total of 173 biopsies/TURBT of suspicious areas: 129 positive only to the BLC and 44 both positive to WLC and BLC. 84/173 biopsies/TURBT were positive for cancer. All 84 NMIBC were positive to the BLC, while 35/84 were positive to the WLC with a sensitivity of BLC and WLC respectively of 100% and 41.7%. Sensitivity of WLC for highgrade NMIBC and CIS was 34.1% and 39% respectively while sensitivity of BLC for high-grade NMIBC and CIS was 100%. The specificity of the WLC was 79.9% compared to 48.5% of the BLC. The positive predictive value of BLC and WLC were respectively 48% (95% CI: 0.447-0.523) and 79% (95% CI: 0.856-0.734). CONCLUSIONS: Our data confirm those reported in the literature: BLC increases the detection rate of NMIBC particularly in high risk patients (history of CIS or high grade). BLC is a powerful diagnostic tool in the diagnosis of bladder cancer if malignancy is suspected (positive urine cytology) and if conventional WLC is negative.

Safety and efficacy of percutaneous nephrolithotomy in the Galdakao - Modified Supine Valdivia position: A prospective analysis.

OBJECTIVE: Aim of the present study was to evaluate the safety and efficacy of Percutaneous Nephrolithotomy (PCNL) in the Galdakao- Modified Supine Valdivia (GMSV) position in order to predict operative time, stone-free rate and onset of complications taking into account comorbidity, stone-related parameters and anatomic upper urinary tract abnormalities. MATERIAL AND METHODS: A prospective evaluation of patients who underwent to PCNL in GMSV position for renal stones > 2 cm, from January 2009 to February 2015 was performed. According to the technique, upper urinary tract abnormalities, stone chemical and morphological characteristics, and patients' history were matched with operative outcome, in terms of stone-free, intervention time and incidence of perioperative complications. RESULTS: Seventy-two cases were collected; mean operative time was 105 minutes (DS 41): staghorn stones and the presence of comorbidity resulted statistically significant variables. The complication-rate resulted in line with data showed in literature: hyperpyrexia and hemorrhage were the more frequently complications found. The overall stone-free was reached in 48 patients (67%), and it was influenced by patients' anatomic abnormalities. CONCLUSIONS: In the treatment of renal stones, PCNL may be a safe and effective choice; nevertheless, patients' anatomic abnormalities or staghorn-stones may influence the outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Pseudoaneurysm with arteriovenous fistula of the prostate after pelvic trauma: Ultrasound imaging.

Pseudoaneurysm (PA) associated with an arteriovenous fistula (AVF) of the internal pudendal artery branches are very uncommon. We report a case of post-traumatic PA with AVF connected to Santorini plexus. Diagnosis was made with trans-rectal ultrasound (TRUS) after recurrent hematuria. TRUS reported a 1.7 × 1.4 × 1.5 cm anechoic area, on anterior prostate apex close to Santorini plexus. The use of color Doppler in this area revealed high flow velocity that was indicative for AVF. The feeding artery was a distal branch of the left pudenda artery. After selective embolization was observed complete occlusion of the feeding branches and disappearance of PA with AVF. Prostate PA with concomitant symptomatic AVF detected with TRUS has not yet described in literature after pelvic trauma and represents complex diagnostic challenges. This case report suggests that the use of TURS and color Doppler can provide an important diagnostic and follow-up to address the clinical suspicion of occult vascular injuries using a noninvasive approach.

Transrectal ultrasound (TRUS) and TRUS-biopsy accuracy in potential candidates for PRIAS active surveillance protocol.

AIM: Evaluate the transrectal ultrasound (TRUS) and TRUS-guided Biopsy (TRUS-Bx) accuracy in patients with low risk prostate cancer (PCA) that were potential candidate for PRIAS active surveillance (AS) protocol but underwent to immediate radical prostatectomy (RP). METHODS: 616 men were extracted from our institutional RP database. We selected the patients who met PRIAS inclusion criteria. The primary outcome was to evaluate the positive predictive value (PPV) and the specificity of suspected lesions at TRUS. The secondary outcome was to evaluate the TRUS-Bx accuracy in term of pathological upstaging and pathological upgrading with respect of RP specimen pathology report. RESULTS: 147 men of 616 (23.8%) in our RP database met PRIAS criteria; in this group we found 66 suspected lesions at TRUS examination (66/147: PPV 44.8%). Prostate cancer was really present in the biopsy specimen in only 32/66 of suspected lesions; in 28/66 the suspect lesion at TRUS was in the same position of the index lesion at final pathology. TRUS/biopsy specificity was 48% and TRUS/surgical specimen specificity 39%. TRUS-Bx staging accuracy: upgrading between biopsy and RP was recorded in 57/147 (38%) whereas 30/147 (20%) were upstaged on final pathology up to N1. CONCLUSIONS: TRUS and TRUS-Bx are insufficient tools to detect the grade, the location and the extent of PCA. New emerging techniques, such as US-MRI fusion biopsy and 3D template-guided transperineal saturation biopsy are promising to minimize the risk of misclassification and therefore to better select the best option of treatment (radical treatments or focal therapies or active surveillance) in each patient with low risk prostate cancer.

[Isolated hydatid cyst of the kidney]. / Fistola cutanea da cisti idatidea isolata del rene: case report.

BACKGROUND: A hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. Kidney involvement represents 4% of all cases, and is rare compared to that in the liver or lung, even more as an isolated site of infection. We present a case report of a woman with septic status, cutaneous fistula and a renal cystic mass revealed to be a solitary hydatid cyst of the kidney. METHODS: A 60-year-old woman was referred acutely by another hospital to our department because of septic fever, cutaneous lumbar fistula and a left kidney cystic mass of 10 x 8 cm. We suspected a renal abscess and the patient underwent immediate left nephrectomy. RESULTS: We performed an extraperitoneal nephrectomy with a lumbar access under the 12th rib with complete resection of the fistula. The histopathological examination revealed it to be a hydatid cyst involving 2/3 of the kidney. After surgery a medical therapy with albendazol was administrated for 6 months, and the patient did not have any other localization 24 months after surgery. CONCLUSIONS: An isolated renal hydatid cyst presenting as cutaneous fistula with a septic status is a very rare condition. A pre-surgical diagnosis is not always possible as in this case. The surgical therapy (nephron-sparing or radical) is the key of the success and a medical therapy after surgery is recommended to prevent other localizations of this parasitic disease.

Urinary tract infections in women: etiology and treatment options.

Urinary tract infections (UTI) are common among the female population. It has been calculated that about one-third of adult women have experienced an episode of symptomatic cystitis at least once. It is also common for these episodes to recur. If predisposing factors are not identified and removed, UTI can lead to more serious consequences, in particular kidney damage and renal failure. The aim of this review was to analyze the factors more commonly correlated with UTI in women, and to see what possible solutions are currently used in general practice and specialized areas, as well as those still under investigation. A good understanding of the possible pathogenic factors contributing to the development of UTI and its recurrence will help the general practitioner to interview the patient, search for causes that would otherwise remain undiscovered, and to identify the correct therapeutic strategy.

Distal ureter studied with endocavitary end-fire probe: application in adult urology ultrasonographic clinic.

OBJECTIVE: To evaluate the efficacy of transrectal or transvaginal Endocavitary Ultrasound (EU) to depict the juxtavesical and the uretero-vesical junction of the distal ureter. METHODS: We retrospectively examined a series of 80 patients with a variety of urological conditions affecting the distal ureter EU was performed with a 6-10 MHz transrectal/vaginal end-fire probe. In all cases the length of visible ureter was measured. The series included benign and malignant affections as follows: 68 cases of distal ureteral stones and 12 malignancies (10 transitional cell carcinomas, 1 prostate cancer, 1 gastrointestinal stromal tumor). Gray scale and Color Doppler findings were anayzed and images were electronically stored. Every patient also undwent a transabdominal sonography. Definitive diagnosis was made with standard radiological imaging. In 4 patients we performed echo-guided endocavitary guided biopsies to obtain an histological diagnosis of ureteral solid lesions when transurethral biopsies were not feasible or negative. RESULTS: Length of visible ureter was 4 cm (SD 2.1). Ureteral stones were depicted in 80% of cases, however false negative were related to a stone localization above the last 4 cm of the visible distal ureter. The transabdominal approach depicted ureteral stones in 58% of cases. EU showed all the solid lesions located in the last 4 centimeters. Transabdominal approach showed a ureteral mass only in half of the cases. EU with Color Doppler (EUCD) was useful to evaluate the ureteral jet (presence or absence) and changes in the vasculature of solid lesions. Neither body habits, nor bladder fullness affected the reliability of the technique. CONCLUSIONS: Our study shows that EU with end fire probe is a safe, minimally invasive and low cost technique for the investigation of pathological processes involving the lower part of the distal ureter.

Biopsy of the anterior prostate gland: technique with end-fire transrectal ultrasound.

OBJECTIVES: Transperineal approach is considered the best method to biopsy the anterior tissue of the prostate gland that is generally neglected by transrectal approach. We describe a technique of anterior prostate biopsy obtained with transrectal approach using an end-fire probe. MATERIALS AND METHODS: We correlated the images of the video of the diagnostic biopsy, the histology of the biopsy and of the surgical specimen after radical prostatectomy. A 68 years old may previously underwent two biopsies: first biopsy and re-biopsy were performed using the transrectal approach with 12 and 16 cores respectively, including the tranisizion zone (2 per side). Initial histology revealed high grade PIN only. We performed a saturation biopsy (28 samples) under local anesthesia, as outpatient, using endfire ultrasound probe, including anterior zone and fibromuscolar stroma (2 per side). Images of the procedure was stored electronically. Each biopsy core was pre-embedded and inked at one side in order to identify the rectal end (pericapsular side). Surgical specimen of radical nerve sparing prostatectomy was analyzed according to the Stanford protocol (3 mm). All biopsies and surgical specimens were reviewed by the same uro-pathologist. RESULTS: Cancer was detected only by anterior biopsy (left side, 1 core, 3 mm of total cancer extension, Gleason score 3 + 3, placed into the not inked core side). Histology of the surgical specimen confirmed the location of the disease with 0.3 cc tumor volume. Technically, to improve biopsy of the anterior zone the tip of the needle should obtain all the tissue up to the Santorini venous plexus. Postoperative recovery was uneventful after both procedures. CONCLUSION: We showed that end-fire probe makes possible, effective and safe the biopsy of the anterior prostate, which may contain cancer in particular when previous biopsies are negative. The anterior biopsy technique herein described is easy and reliable. Based on our experience, end-fire probe should be used in re-biopsy or saturation biopsy if transrectal approach is preferred. Confirmatory randomized clinical trial should be done in the future.