RESUMO A espermatocele-cavidade cística contendo fluido e esperma-está entre as condições determinantes mais comuns de massas escrotais não agudas. Geralmente são assintomáticas, porém, quando aumentadas de tamanho, podem trazer desconforto físico e/ou estético. Com o advento da ultrassonografia (USG) cada vez mais se diagnostica esta condição. Na presença de grandes coleções fluidas, a USG pode falhar na determinação da patologia correta. Portanto, relatamos o caso de uma grande espermatocele inicialmente confundida com hidrocele, bem como uma revisão do tópico. Descritores: Espermatocele. Epidídimo. Hidrocele Testicular. Ultrassonografia.
After general anesthesia was achieved we performed cystoscopy and retrograde pyelogram that revealed a significantly dilated and tortuous ureter. We attempted stent placement, but due to tortuosity of the ureter we were unsuccessful and a sensor wire was left in place at the mid-ureter. Three robotic ports were placed and the robot was docked. We carefully mobilized the left distal ureter. A ureterotomy was made proximal to the UVJ obstruction. A cystotomy was made next to the ureterotomy. A ureteral stent was advanced over the pre-placed wire through the native ureteral orifice, proximal ureter, out the ureterotomy, and into the cystostomy. This resulted in both ends of the stent in the bladder. A ureterovesical anastomosis was performed. A JP drain and Foley were left in place.RESULTS: The patient recovered in the hospital for 1 day and drains were discontinued prior to discharge. A post-operative ultrasound at 6 weeks showed resolution of megaureter. A repeat MAG3 at 3 months demonstrated preserved renal function with minimal left hydronephrosis and no evidence of obstruction (T1/2 4 minutes). In the office, the patient reported resolution of flank pain and minimal pain with voiding.CONCLUSIONS: The treatment of primary obstructing megaureter remains controversial, however, with careful patient selection a NUC using the DaVinci is a safe, and viable option.
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