Reinhold Nützel

Guided e-MRI prostate biopsy can solve the discordance between Gleason score biopsy and radical prostatectomy pathology.

INTRODUCTION The aim of this study is to examine if guided prostate biopsies based on abnormalities detected by conventional and functional endorectal magnetic resonance imaging (MRI) yield a more reliable representation of the radical prostatectomy pathology and to identify probable preoperative clinical variables that stratified patients likely to harbor significant upgrading. PATIENTS AND METHODS From April 2004 to April 2009, a review of N=70 patients records diagnosed with prostate cancer by a 3-6 core guided transrectal ultrasound (TRUS) prostate biopsy based on abnormalities detected by conventional and functional endorectal MRI and who subsequently underwent radical prostatectomy and exhibited a significant upgrading was conducted. Additionally, a multivariate analysis with a significant upgrading as the outcome was performed including the following parameters: prostate specific antigen (PSA) level, clinical stage, prostate size and duration from biopsy to radical prostatectomy. RESULTS A significant upgrading was noted in only 8.5% of patients, with 1.4% exhibiting a significant downgrading and the rest 90.1% exhibiting an exact Gleason score match. No preoperative clinical variables that stratified patients likely to harbour significant upgrading were identified. CONCLUSIONS This type of biopsy method seems to solve the discordance between the biopsy Gleason score and radical prostatectomy pathology regardless of known preoperative clinical variables that can affect it.

Dry Gangrene of the Penis Induced by a Bullring for Sexual Stimulation Purposes

Dry gangrene of the penis is a critical clinical condition provoked by vascular compromise that can lead to severe complications. Although usually caused by diabetes mellitus or due to end-stage renal disease, in these last years, there has been an increase of penile gangrene incidents induced by penile strangulation due to constricting devices for sexual stimulation purposes. We present such a case and discuss the correct approach for treatment of this unusual condition.

Spontaneous Rupture of the Urinary Bladder 10 Years after Curative Radiotherapy

It has been reported that the rate of clinically relevant side effects following curative radiotherapy for primary carcinoma is about 3% for urologic complications. Such complications include hematuria, fibrosis, and cystitis. An extremely rare, but dangerous, medical complication following curative radiotherapy that can also be noted is spontaneous bladder perforation. We present such a case of a 27-year-old patient with spontaneous bladder perforation, who was initially misdiagnosed because of its rarity as well as unspecific clinical and laboratory findings.

Urethral Diverticulum with Massive Lithiasis Presenting as a Scrotal Mass

Urethral diverticula in men are uncommon clinical entities. Their clinical manifestations include urinary tract infection, hematuria, irritative or obstructive voiding symptoms, ventral bulging and displacement of the penile shaft. Male urethral diverticulum with massive lithiasis presenting as a scrotal mass with stress urinary incontinence as the main symptom is extremely rare. Herein, we present such a case.

Empyema of the Ureteral Stump. An Unusual Complication Following Nephrectomy

A ureteral stump, which is the segment of the ureter left in place after nephrectomy, may occasionally give rise to a pathologic process called ureteral stump syndrome, which is clinically interpreted as febrile urinary tract infections, lower quadrant pain, and hematuria. Empyema of the ureteral stump, which belongs to this syndrome, is an uncommon disease entity presenting with a reported incidence of 0.8–1%. We present a case of empyema of the ureteral stump in a female patient 5 years postnephrectomy for a nonfunctioning kidney, and discuss the clinical presentation, radiologic diagnosis, and therapeutic options of this uncommon disease entity.

A Case of a Large Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis

The diagnosis of seminal vesicle cysts is often delayed or missed as a result of both their rarity and wide spectrum of potentially confusing clinical and imaging findings they can produce. Although rare, they should be considered in men, especially with a history of renal agenesis, who exhibit o inexplicable irritable voiding symptoms, perineal discomfort or other genitourinary complaint of unclear etiology. We introduce such a case, and discuss its symptoms, radiological findings and its therapeutic approach.