Unusual clinical scenarios in Urology and Andrology


Published: March 22, 2021
Abstract Views: 1362
PDF: 649
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Lucio Dell'Atti Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
  • Andrea Fabiani Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Italy.
  • Erika Palagonia Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
  • Agostini Edoardo Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
  • Maria Pia Pavia Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Italy.
  • Simone Scarcella Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
  • Valentina Maurelli Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Italy.
  • Emanuele Principi Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Italy.
  • Marco Tiroli Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
  • Giulio Milanese Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
  • Lucilla Servi Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Italy.
  • Andrea Benedetto Galosi Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.

This collection includes some unusual cases and how they were diagnosed and treated.

Case 1: A case of a patient with primary hyperthyroidism presenting with a submucosal ureteral stone after endoscopic lithotripsy was described. After multiple endoscopic treatment, the stone was successfully removed by open ureterolithotomy recovering ureteral patency and normal renal function.

Case 2: A case of burned-out testicular cancer with atypical lymphatic spread (stage II A) was presented. After right orchiectomy and complete remission of tumor markers, due to atypical metastases location and uncertain histology, the patient was treated with systemic therapy based on bleomycin, etoposide and cisplatin (PEB). At re-staging after chemotherapy computed tomography showed reduction of all node metastases and an observation protocol was proposed.

Case 3: A patient was readmitted to hospital after 12 days from an uneventful Robot-Assisted Radical Prostatectomy (RARP) for prostate cancer due to lower abdominal pain plus abdominal distension, nausea and constipation not responsive to medical therapy. Computed Tomography showed colon and small bowel dilatation without any evidence of anatomical or mechanical obstruction. Laparoscopic abdominal exploration confirmed bowel distension without evidence of obstructing lesions. Ogilvie’s Syndrome or acute colonic pseudo-obstruction (ACPO) was diagnosed. The patient fully recovered and was discharged six days after the procedure.

Case 4: A case of recurrent Acute Idiopathic Scrotal Edema (AISE) was diagnosed on clinical signs together with the decisive help of pathognomonic ultrasound findings as the “fountain sign”.

Case 5: Small bilateral testicular nodules were diagnosed in a 30-years old patient undergoing scrotal ultrasound in follow up of acute lymphoblastic leukemia. Ultrasound guided testis sparing surgery was performed demonstrating Leydig cell tumors.


Türk C, Petrík A, Sarica K, Seitz C, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016; 69:475-482. DOI: https://doi.org/10.1016/j.eururo.2015.07.041

Cindolo L, Castellan P, Primiceri G, et al. Life-Threatening complications after ureteroscopy for urinary stones: Survey and systematic literature review. Minerva Urol Nefrol. 2017; 69:421-431.

Dell'Atti L, Papa S. Ten-year experience in the management of distal ureteral stones greater than 10 mm in size. G Chir. 2016;37:27-30. DOI: https://doi.org/10.11138/gchir/2016.37.1.027

Angulo JC, González J, Rodríguez N, et al. Clinicopathological study of regressed testicular tumors (apparent extragonadal germ cell neoplasms). J Urol. 2009; 182:2303-2310. DOI: https://doi.org/10.1016/j.juro.2009.07.045

Dell'Atti L, Galosi AB. "Pearl oyster": a new ultrasonographic sign of the regressed testicular tumor. J BUON. 2017; 22:1610-1611

Honecker F, Aparicio J, Berney D, et al. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol. 2018; 29:1658-1686. DOI: https://doi.org/10.1093/annonc/mdy217

Ogilvie H. Large-intestine colic due to sympathetic deprivation; a new clinical syndrome. Br Med J. 1948;2:671-673. DOI: https://doi.org/10.1136/bmj.2.4579.671

Wegener M, Borsh G. Acute colonic pseudo-obstruction (Ogilvie’s Syndrome). Presentation of 14 of our own cases and analysis of 1027 cases reported in the literature. Surg Endosc. 1987; 1:169-174. DOI: https://doi.org/10.1007/BF00590926

Kevin T.McVary, Daniel P. Dalton and Michael D.Blum. Acute Intestinal Pseudo-Obstruction (Ogilvie’s Syndrome) complicating Radical Retropubic Prostatectomy. J Urol. 1989; 141:1210-1212. DOI: https://doi.org/10.1016/S0022-5347(17)41217-1

Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s Syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986; 29:203-210. DOI: https://doi.org/10.1007/BF02555027

Galosi AB, Dell'Atti L, Bertaccini A, et al. Clinical evaluation of the iXip index to reduce prostate re-biopsies. Cancer Treat Res Commun. 2018; 16:59-63. DOI: https://doi.org/10.1016/j.ctarc.2018.07.001

Santi M, Lava SAG, Simonetti GD, et al. Acute Idiopathic Scrotal Edema: Systematic Literature Review. Eur J Pediatr Surg. 2018;28:222-226. DOI: https://doi.org/10.1055/s-0037-1603089

Martino P, Galosi AB, Bitelli M, et al. Imaging Working Group-Societa Italiana Urologia (SIU); Società Italiana Ecografia Urologica Andrologica Nefrologica (SIEUN). Practical recommendations for performing ultrasound scanning in the urological and andrological fields. Arch Ital Urol Androl. 2014; 86:56-78. DOI: https://doi.org/10.4081/aiua.2014.1.56

Lee A, Park SJ, Lee HK, et al. Acute idiopathic scrotal edema: ultrasonographic findings at an emergency unit. Eur Radiol. 2009;19:2075-2080. DOI: https://doi.org/10.1007/s00330-009-1356-z

Dell’Atti L. Successful management of an asymptomatic bilateral synchronous testicular carcinoid tumor with a testicular-sparing surgery. Asian J Androl. 2017; 19:507-508. DOI: https://doi.org/10.4103/1008-682X.181080

Patoulias D, Rafailidis V, Feidantsis T, et al. Fountain's sign as a diagnostic key in acute idiopathic scrotal edema: case report and review of the literature. Acta Medica (Hradec Kralove). 2018;61:37-39. DOI: https://doi.org/10.14712/18059694.2018.22

Galosi AB, Fulvi P, Fabiani A, et al. Testicular sparing surgery in small testis masses: a multinstitutional experience. Arch Ital Urol Androl 2016; 4:320-324. DOI: https://doi.org/10.4081/aiua.2016.4.320

Dell’Atti L. Efficacy of ultrasound-guided testicle-sparing surgery for small testicular masses. J Ultrasound. 2015; 19:29-33. DOI: https://doi.org/10.1007/s40477-015-0171-4

Dell'Atti L, Fulvi P, Galosi AB. Are ultrasonographic measurements a reliable parameter to choose non-palpable testicular masses amenable to treatment with sparing surgery? J BUON. 2018; 23:439-443.

Dell’Atti, L., Fabiani, A., Palagonia, E., Edoardo, A., Pavia, M. P., Scarcella, S., Maurelli, V., Principi, E., Tiroli, M., Milanese, G., Servi, L. ., & Galosi, A. B. (2021). Unusual clinical scenarios in Urology and Andrology. Archivio Italiano Di Urologia E Andrologia, 93(1), 120–126. https://doi.org/10.4081/aiua.2021.1.120

Downloads

Download data is not yet available.

Citations