Der Urologe [B] 6•2002 | 515 Die Steinbildung gehört v. a. bei der Verwendung von Staplern mit Metallklammern zu den häufigsten Komplikationen des modernen Harnblasenersatzes. Eine Infektion mit ureasebildenden Bakterien zählt neben einer Hypozitraturie und Hyperphosphaturie zu den wichtigsten Risikofaktoren. Mit einem Durchmesser von 12 cm und einem Gewicht von 780 g handelt es sich bei dem beschriebenen Pouch-Ausguss-Stein um die größte Steinbildung dieser Art in der Literatur. Mögliche Therapieoptionen und Maßnahmen zur Metaphylaxe werden vor dem Hintergrund der im vorliegenden Fall bestehenden Stoffwechselveränderungen diskutiert. Praxisspiegel/Kasuistik Urologe [B] 2002 · 42:515-517
Neurofibromas of the urinary bladder occur as isolated phenomena or as part of generalized neurofibromatosis or von Recklinghausen's disease. This benign mesenchymal tumor can be the cause of subvesical obstruction, hematuria or chronic cystitis. The lesion is rare. Our case of isolated extended neurofibromatosis of the urinary bladder was diagnosed in a 19-year-old girl with an 8-year history of chronic cystitis. Two transurethral resections were successful in relieving symptoms. Possible further therapy was delayed because of the patient's desire for children.
We describe a case of testicular duplication presenting as torsion of the supernumerary distal testis in a 14-year-old boy. Clinical examination showed an unclear mass above the left testis; intraoperatively, the supernumerary testis was linked to the regular testis by a common epididymis and shared a common vas with it. The distal testis was resected due to severe hemorrhagic damage. This condition represents the result of transversal division of the wolffian duct during organogenesis. Review of the literature revealed that testicular torsion, testicular tumor, unclear scrotal masses, or continuing potentia generandi after bilateral vasectomy were the reasons that polyorchidism was detected.
Mesonephric carcinoma is a tumor entity that rarely develops in the neck of the uterus and vaginal wall and is extremely unusual in the urinary bladder or paraurethral tissue. The tumors arise in the remnants of the wolffian or mesonephric duct. The malignant potential is considered to be lower than in tumors of the urethra with different histologic findings. Anterior pelvic exenteration is recommended in the literature as the treatment of choice. In the case described here, the tumor presented as a space-occupying lesion in a urethral diverticulum exhibiting striking clinical features of macrohematuria and urinary retention with subvesical obstruction of the urethra. In accordance with reports in the literature, cystectomy was performed and a Kock pouch constructed for urinary diversion. Tumors occurring in a diverticulum-and in this case manifesting as the rare tumor form of mesonephric carcinoma-should always be included in the differential diagnosis of macrohematuria in women.
Constricting devices placed on the penis to improve sexual performance present a challenge to urologists. Various metallic and nonmetallic objects have been described -- plumbing cuffs, bull rings, wedding rings, plastic or rubber rings -- which usually could be removed by the combination of medical and operative treatment (decompression of the penis and glandular puncture) and craftsmen's techniques. We describe the case of a titanium thumb ring of 2 mm thickness which only could be removed by using an electric cutting tool.
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