Hungarian Society of Urology
  
  

2017-1 — Summary

Scrotal lymphangiomatosis: a case report of a multilocular scrotal cutaneous benign tumour

DOI: 10.22591/magyurol.2017.1.damasdim.13

Authors:
Damásdi Miklós dr.1, Rózsa Annamária dr.2
1PTE KK, Urológiai Klinika, Pécs (mb. igazgató: Szántó Árpád dr.)
2PTE KK Bőr-, Nemikórtani és Onkodermatológiai Klinika, Pécs (igazgató: Gyulai Rolland dr.)

Summary

Objective: Lymphangiomas are benign tumours of the lymphatic system, and there are several reported cases of scrotal lymphangioma in the literature to date. We report a rare case of multilocular cutaneous scrotal lymphangiomatosis treated with surgical excision (partial scrotal skin excision and reconstruction).
Case report: In the clinical case presentation unidentified, progressive scrotal skin lesions appeared in a 21-year-old-male. During the diagnostic studies the abnormal lymphatic network of the scrotal skin was confirmed. After the diagnostic tests on treatment options scrotum skin removal and reconstruction was performed. After the intervention, the patient’s condition improved locally, so far recurrences were not observed.
Conclusion: For the diagnosis of lymphatic malformations localised to male external genitalia, tissue sampling is essential. This case demonstrates that complete excision is an effective course of treatment for chronic scrotal lymphangiomatosis.

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ACQUIRED MALE URETHRAL DIVERTICULUM FOLLOWING RADICAL PERINEAL PROSTATECTOMY

DOI: 10.22591/magyurol.2017.1.muranyim.9

Authors:
Murányi Mihály dr., Farkas Antal dr., Kiss Zoltán dr., Flaskó Tibor dr. Debreceni Egyetem Klinikai Központ, Urológiai Klinika, Debrecen (igazgató: Flaskó Tibor dr.)

Summary

Objective: Urethral diverticula of the male urethra are uncommon clinical entities which may be either acquired or congenital. Acquired diverticula can be caused by urethral trauma, infection, urethral stricture, prolonged urethral catheterization, substitution urethroplasty, hypospadias repair and artificial urinary sphincter placement. A patient with urethral diverticulum after radical perineal prostatectomy is reported. To our knowledge, our case is the second in a patient after radical prostatectomy.
Case presentation: The 76-year-old male patient had a past medical history of radical perineal prostatectomy in 2002. Postoperative cystography showed large extravasation; therefore the urethral catheter was left for 4 weeks. 9 months later the patient was admitted with perineal pain and swelling caused by perineal abscess and urethroperineal fistula. Drainage of the abscess was performed besides insertion of an indwelling urethral catheter and antibiotic treatment. Three weeks later the abscess was healed and cystography revealed no fistula or extravasation, but the fistula came back thus transurethral resection of the diverticular neck was performed. 2 weeks later the catheter was removed and the fistula was closed. Thereafter patient had no urinary symptoms except mild stress urinary incontinence. 13 years after the radical perineal prostatectomy, in 2015, patient was admitted with perineal pain and swelling again. Retrograde urethrography and urethroscopy revealed a 45×20 mm urethral diverticulum just proximal to the external urinary sphincter. Diverticulectomy and urethral reconstruction was performed by perineal approach. Postoperative period was uneventful. Urethral catheter was removed three weeks later. Follow up retrograde urethrography showed no extravasation. Histopathological examination revealed diverticulum lined by keratinized stratified squamous epithelium and granulation tissue. Repeated urinary and perineal symptoms were not observed during 18 months follow-up period, but his urinary incontinence became more intense.
Conclusion: Due to the rarity of male urethral diverticula, there is no consensus on the optimal management. Treatment of urethral diverticula is selected based on patient’s complaint, size of the diverticulum and extent of involvement of the urethra. Small asymptomatic urethral diverticula generally do not require surgery, while small symptomatic diverticula can be treated by transurethral resection. Patients with large, complicated diverticula are candidates for complete diverticulectomy, while if the urethral defect is large, diverticulectomy with urethroplasty might be necessary

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Elimination of recurrent bulbar urethral stricture with urethroplasty after inserting wallstent

DOI: 10.22591/magyurol.2017.1.széllt.5

Authors:
Széll Tamás dr., Kelemen Zsolt dr., Nyirády Péter dr. Semmelweis Egyetem ÁOK, Urológiai Klinika, Budapest (igazgató: Nyirády Péter dr.)

Summary

Objective: In the cases of elimination of urethral strictures the indication of wallstents are doubtful, they usually have only a very small indication range. Spongiofibrosis, which is caused by external or iatrogenic harm, impairs the blood supply of corpus spongiosum, reduces the success rate of wallstents. Initially the wallstents raised hope, because publications supported short term efficiency, but the medium and long term efficiency was not confirmed.
Case report: In our case multiple urethrotomia interna was performed because of recurrent bulbar urethral stricture. Within a short time urethral stricture developed again and – in another institution – metal wallstent was inserted. After 11 years scar tissue caused partial obstruction in the hole of wallstent, which was treated by laser vaporisation. Opioid analgesic claiming perineal pain and total urinary retention evolved after temporary achievement, because of urethroplasty was performed in our institution. The severe scar and hyperplastic tissue growth and the entirely obstructed urethra with the wallstent together were resected until the membranous urethra. After 8 months of undisturbed postoperative period the patient does not have complaint, he has outstanding average and maximum urinary stream and he is continent.
Conclusion: At first sight the wallstent offers an obvious solution of elimination of urethral strictures, but it gets the worst of the long term efficiency over against the success rate of urethroplasty. As a foreign body increases the spongiofibrosis, which aggravates the extant urethral stricture and further on it throws difficulties in the way of the necessary urethroplasty, just like two steps/substitution urethroplasty is required.

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Preserved erectile and ejaculatory function after glansectomy for penile cancer

DOI: 10.22591/magyurol.2017.1.királyi.2

Authors:
Király István dr., Pajor László dr., Bajory Zoltán dr. Szegedi Tudományegyetem, Urológiai Klinika, Szeged (igazgató: Bajory Zoltán dr.)

Summary

Introduction: The glansectomy is an accepted curative method in the therapy of the penile cancer with significant aesthetic and functional defect.
Case report: The 38-year-old patient was operated for biopsy proven penile cancer, which occupied nearly the whole glans. The resected area, the tip of the corpora cavernosa was covered with buccal mucosa graft, and the cut edge of the urethra was inverted against stricture formation. The histopathology revealed squamous cell carcinoma surrounded with 1 cm wide, healthy tissue. No adjuvant oncological therapy was performed. Patient passed urine freely and continued normal sexual life although penis was shortened and its sensitivity slightly diminished. Two years after the operation the patient’s wife delivered a healthy baby.
Conclusion: The aesthetic penis resection is a good solution for young penile cancer case resulting normal urination and preservation of sexual function.

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Late consequence of nephrolithiasis – xanthogranulomatous pyelonephritis with fistula formation

DOI: 10.22591/magyurol.2017.1.szikszaia.17

Authors:
Szikszai Adél dr., Fehér Gabriella dr., Gécs Sándor dr. Csolnoky Ferenc Kórház, Urológiai osztály, Veszprém (osztályvezető: Gécs Sándor dr.)

Summary

Objective: Xanthogranulomatous pyelonephritis is a rare disease. This is a special chronic inflammatory disorder with cholesterol and lipid cell deposits in the kidney. It is 4 times more common in women than in men and is usually noted in the fifth and sixth decades of life. It is most commonly associated with E. coli or Proteus mirabilis infection and urinary tract obstruction.
Case report: There are ESWL therapy and PCNL surgery due to nephrolithiasis in the medical history of our 66-year-old female patient. After these interventions she hasn’t been examined at urology for years. She has been examined at emergency unit in October 2015 with right side pain from kidney area and subfebrile temperature. At the examination at surgery ambulance an abscess size of a chicken egg was incised on her right costovertebral region and at the place of the incision a 5-6 cm long fistula was found by probe. During our urology examination we found a hydronephrotic dilated right kidney and an approximately 2 cm sized stone in the pyelon. We asked for a CT scan to clarify the right kidney’s status. This described a 22×15×25 mm stone at the right side of the pyelouretal junction, significant thinning of the renal parenchyma joining with huge dilation of the renal cavity system. In the pyelon and the middle-lower calyces’ ends an air-liquid level was also observed. During the examination there was no significant contrast agent excretion in the pyelon. Thus we decided for right side nephrectomy which was performed in antibiotic protection after the proper preparation of the patient. Histology described xanthogranulomatous inflammation. In the postoperative period the wound healing was undisturbed. The patient was discharged home in good physical status at the 9th day of the postoperative period.
Conclusion: In case of an inflammation with fistula formation, nephrolithiasis and invasion to the surrounding tissues surgery is necessary as early as possible. In this case radical nephrectomy was needed. We wanted to draw your attention to our patient diagnosed with the rare xanthogranulomatous pyelonephritis, highlighting the importance of looking after the patients with nephrolithiasis.

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