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Urotoday International Journal Volume 5 - August 2012 Table of Contents: August, 2012

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Urotoday International Journal Volume 5 - August 2012 Table of Contents: August, 2012 ® UIJ UroToday International Journal www.urotodayinternationaljournal.com Volume 5 - August 2012 Table of Contents: August, 2012 Review • Retroperitoneum Beyond the Kidney: Retroperitoneal Sarcomas in a Urology Department BJ Pereira, R Borges, R Leão, V Grenha, H Coelho, A Brandão, P Temido Erectile Dysfunction • Penile Fractures: Tertiary Center Experience and a Review of the Literature Avinash T Siddaiah, Madhumohan R Prabhudessai, Prashant R Lawande, Nilesh B Talwadker, Rajeev N. Palvia, Elphiston Fernandes, Pravin Govardhane, Pankaj D Chari, Prashant TN Mandrekar Endourology • Memokath 044 Stent for the Treatment of Recurrent Bulbar Urethral Strictures Magdy Ahmad Alsayed El-Tabey Reconstruction • Pyeloplasty in Ureteropelvic Junction Obstruction: Laparoscopic or Open? Siavash Falahatkar, Ali Roushani, Hamidreza Nasseh, Ehsan Kazemnezhad, Keivan Gholamjani Moghaddam, Seyedeh Mahboobe Raoofi, Mani Mohiti Asl, Ahmad Enshaei, Alireza Farzan Stone Disease • A Multi-institutional Study Demonstrating the Safety and Efficacy of Holmium Laser Ureterolithotripsy Ahmed S Safwat, Nabil K Bissada, Udaya Kumar, Mahmoud M Osman, Toulupe Bakare, Ehab Eltahawy, Samy Heshmat Case Reports • A Case Report of Foot Drop Following Visual Internal Uretherotomy In the Lithotomy Position: Is Prolonged Surgery In the Lithotomy Position the Only Important Risk Factor? NH Nagaraja, Satyam Sharma, GB Manjuprasad • A Rare Case of Fungus Balls of the Urinary Bladder Due to Candida Tropicalis Sivaneswaran Lechmiannandan, Eng Hong Goh, Boon Wei Teoh, Kah Ann Git • Metastatic Breast Carcinoma Masquerading as Obstructive Uropathy: A Rare Clinical Presentation Waleed Mansour Shabana, Tariq Tassadaq, Hosam Al-Oudah, Syed Gillani, Hisham Abu-Taha, Sameh Barayan ©2012 Digital Science Press, Inc. / UIJ / Vol 5 / Iss 4 / August http://www.urotodayinternationaljournal.com ISSN 1944-5792 (print), ISSN 1944-5784 (online) ® UIJ UroToday International Journal • Ovarian Dermoid Cyst Perforating Into the Urinary Bladder Sanjay Kumar Gupta, Manoj Kumar, Mahendra Singh, Vijoy Kumar, Rajesh Kumar Tiwari, Sanjay Kumar Suman, Vijayanand Choudhary • Penile Carcinoma with Umbilical Metastasis: A Rare Case Report Simanta Jyoti Nath, Rajeev T Puthenveetil, Saumar J Baruah, Sasanka K Barua, Puskal K Bagchi, Bikash Bawri • Post-cesarean Vesicouterine Fistulae: A Report on a Case and an Update of the Literature Benatta Mahmoud, Sallami Satáa • Renal Cell Carcinoma Presenting with Inguinal Metastasis: A Rare Presentation Amit Attam, Arun Kerketta, Sameer Trivedi, Udai Shankar Dwivedi • Ureteric Endometriosis with Adenomyosis: A Rare Association Leading to the Death of a Kidney Dheeraj Kumar Gupta, Vishwajeet Singh, Rahul Janak Sinha, Pushp Lata Sankhwar ©2012 Digital Science Press, Inc. / UIJ / Vol 5 / Iss 4 / August http://www.urotodayinternationaljournal.com ISSN 1944-5792 (print), ISSN 1944-5784 (online) ® UIJUroToday International Journal www.urotodayinternationaljournal.com Volume 5 - August 2012 Retroperitoneum Beyond the Kidney: Retroperitoneal Sarcomas in a Urology Department BJ Pereira, R Borges, R Leão, V Grenha, H Coelho, A Brandão, P Temido Submitted April 4, 2012 - Accepted for Publication April 23, 2012 ABSTRACT Primary adult soft tissue sarcomas represent 1% of all cancers and represent a treatment challenge for surgeons and oncologists. Of these sarcomas, 15% are located in the retroperitoneum. Randomized series that have examined both radiation therapy and chemotherapy have not shown a survival benefit. Conversely, radiotherapy may delay the time to local recurrence but not overall survival. Our review presents medical records of 5 consecutive patients undergoing retroperitoneal sarcoma excision from May 2004 through February 2006. Images were obtained from the patients’ exams and during their surgical procedures. Surgery is the only potential curative treatment. As “retroperitoneal surgeons,” urologists are completely able to approach these kinds of tumors. BACKGROUND Surgery seems to be the only potentially curative treatment [4,7,9]. However, since retroperitoneal sarcomas are generally Primary adult soft tissue sarcomas represent 1% of all cancers and large with locally advanced presentation, and are adjacent to represent a treatment challenge for surgeons and oncologists vital organs and major vascular structures, complete surgical [1]. Of these sarcomas, 15% are located in the retroperitoneum. resection is possible only in 67% of patients presenting with In most surveys, their incidence increases between the fourth primary disease [10]. Therefore, the outcome is characterized and the sixth decade, and there’s a distinct male predominance by a high local recurrence rate leading to poor overall survival [2]. Retroperitoneal sarcomas may have diverse histopathology; [7,11]. Distant metastatic dissemination is rare due to poor liposarcomas and leiomyosarcoma are the most common (31 vascularization [6]. Randomized series that have examined and 24%) [3,4], and their progression depends on the tumor both radiation therapy and chemotherapy have not shown a grade, size, and the presence of metastasis. Despite its size, it survival benefit [4,7,9,10]. Conversely, radiotherapy may delay is often considerably ab initio and the presenting symptoms the time to local recurrence but not overall survival [11]. might be vague and unspecific, including abdominal or lumbar pain or mass, weight loss, gastric repletion sensation, nausea, or MATERIAL AND METHODS vomiting [2,4-7]. Thus, in about 80% of the cases, retroperitoneal sarcomas may simulate symptoms from contiguous organs Medical records of 5 consecutive patients undergoing or may compromise them (by involvement or invasion) [6,8]. retroperitoneal sarcoma excision from May 2004 through Abdominal computed tomography (CT) is the gold-standard February 2006 were reviewed. Images were obtained from the examination for the diagnosis of a retroperitoneal mass [7]. patients’ exams and during their surgical procedures. KEYWORDS: Retroperitoneal sarcomas, liposarcoma, angiosarcoma, rhabdomyosarcoma, pararenal mass, retroperitoneal surgery CORRESPONDENCE: Bruno Jorge Pereira, MD, Urology Department, Centro Hospitalar de Coimbra, Hospital dos Covões, Quinta dos Vales, São Martinho do Bispo, Coimbra, Protugal ([email protected]) CITATION: UroToday Int J. 2012 August;5(4):art 35. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08 ©2012 Digital Science Press, Inc. http://www.urotodayinternationaljournal.com UIJ / Vol 5 / Iss 4 / August / http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08 ISSN 1944-5792 (print), ISSN 1944-5784 (online) ® UroToday International Journal review UIJ Retroperitoneum Beyond the Kidney: Retroperitoneal Sarcomas in a Urology Department Figure 1a. An abdominal CT showing a retroperitoneal RESULTS liposarcoma; 26.4 cm x 12 cm x 1 cm. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08f1a Clinical Case 1 JCG, a 48-year-old male, presented with pain and right abdominal swelling, a solitary hydronephrotic right kidney, and a right varicocele. He had a personal history of left renal agenesis, a gastric ulcer, and hyperuricemia. He underwent an abdominal CT that showed a retroperitoneal mass and a right hydronephrotic kidney (Figure 1a, Figure 1b). The first biopsy of the retroperitoneal mass revealed an undetermined soft tissue malignant neoplasm (liposarcoma, myxoma, or other). He underwent a second ultrasonography-guided biopsy that confirmed a well-differentiated liposarcoma. Surgical excision of the retroperitoneal sarcoma on May 2004 confirmed the diagnosis of a well-differentiated sarcoma (217 g), completely removed. The patient died during chemotherapy with doxorubicin. The histopathology showed a neoplastic mass containing adipocytes of variable dimensions (Figure 1c) and a collagenous and myxoid stroma (Figure 1d) beside atypical cells with a pleomorphic nucleus (Figure 1d, Figure 1e). Figure 1b. An abdominal CT showing a heterogeneous Figure 1c. Microscopy: A neoplastic mass with adipocytes in mass (retroperitoneal liposarcoma). a collagenous and myxoid stroma (H&E, magnified 50 x). http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08f1b http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08f1c ©2012 Digital Science Press, Inc. http://www.urotodayinternationaljournal.com UIJ / Vol 5 / Iss 4 / August / http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08 ISSN 1944-5792 (print), ISSN 1944-5784 (online) ® UroToday International Journal review UIJ Retroperitoneum Beyond the Kidney: Retroperitoneal Sarcomas in a Urology Department Figure 1d. Microscopy: A neoplastic mass with adipocytes in Figure 1e. Atypical stromal cells with a pleomorphic a collagenous and myxoid stroma (H&E, magnified 400 x). nucleus (H&E, magnified 400 x). http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08f1d http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08f1e Clinical Case 2 Figure 2a. Microscopy: A neoplastic mass with adipocytes in a collagenous and myxoid stroma (H&E, magnified 400 x). LJSC, a previously healthy 70-year-old male, presented with http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08f2a pain and a palpable left stony lumbar mass. Renal angiography showed that the mass had fat and was independent from the left kidney (Figure 2a). He was submitted for surgical excision on November of 2004. Pathologic analysis of the retroperitoneal mass (1.026 g; 14 cm x 12 cm x 11 cm) revealed a sarcoma containing fusiform cells in beams (Figure 2b), areas of pleomorphic patterns (Figure 2c), and areas with myxoid configuration (Figure
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