Polymicrobial bacterial infections are commonly found in cases of Fournier gangrene (FG), although fungal growth may occur occasionally. Solitary fungal organisms causing FG have rarely been reported. The authors describe a case of an elderly man with a history of diabetes who presented with a necrotizing scrotal and perineal soft tissue infection. He underwent emergent surgical debridement with findings of diffuse urethral stricture disease and urinary extravasation requiring suprapubic tube placement. Candida albicans was found to be the single causative organism on culture, and the patient recovered well following antifungal treatment. Fungal infections should be considered as rare causes of necrotizing fasciitis and antifungal treatment considered in at-risk immunodeficient individuals.
Bladder neck sling cystourethropexy is a common procedure used to correct intrinsic sphincter deficiency in children with neurogenic bladders. Various modifications of the procedure have been made, but all involve circumferential dissection of the bladder neck and proximal urethra. The posterior dissection may be difficult and can result in injury to the rectum, urethra, and vagina. Using the principles of the posterior approach to the bladder neck as originally described by Lottman et al., one may perform a robotic-assisted laparoscopic placement of a bladder neck sling.
Reconstruction of the umbilicus has cosmetic and functional value in the surgical treatment of the child with bladder exstrophy. We report on 12 patients who underwent creation of a neoumbilicus as part of genitourinary reconstruction.
Purpose: To describe our initial experience with laparoscopic robot-assisted appendicovesicostomy (LRAA). Materials and Methods: We have performed the LRAA in three patients, aged 9, 17, and 45 years. The underlying medical conditions were myelomeningocele, prune-belly syndrome, and multiple sclerosis. Adjuvant procedures consisted of extensive lysis of adhesions and a bladder-neck fascial sling. Results: All procedures were completed intracorporeally. The mean blood loss was 50 mL. The mean operative time was 301 minutes (range 203–362 minutes). The mean hospital stay was 3 days (range 2–4 days). Follow-up ranges from 1 to 8 months. All patients currently catheterize without difficulty and are continent. Conclusions: In our initial experience, LRAA is a safe and effective option for creating a continent catheterizable channel into the urinary bladder.
Most hypospadias patients undergo 1 surgical procedure and go on to live normal lives. However, there is a small subset of patients who have remaining functional complications after their repair. Patients presenting with diffuse scarring of the urethral plate and a shortage of penile skin for closure are referred to as "hypospadias cripples." We present our experience using tissue expanders in the treatment of reoperative hypospadias with skin deficiency.We retrospectively reviewed hospital records from 2009 to 2019. Five hypospadias cripple patients were encountered. A multidisciplinary team involving plastic surgery and pediatric urology collaborated a 3-stage reconstructive plan:Stage 1-Scar excision and buccal mucosal graft harvestStage 2-Dorsal tissue expander placementStage 3-Tissue expander explantation, creation of neourethra, and skin closure.Successful skin closures were achieved in all patients. There were no cases of expander explanation. Average time between tissue expander placement and final reconstruction ranged from 3 to 4 months. Complications included 2 cases of penile cellulitis, 1 with an associated abscess, and 2 limited urethrocutaneous fistulas, which were addressed with an additional operative procedure.The 3-stage approach is advantageous in treating hypospadias cripple patients. This population can benefit greatly from tissue expander placement after buccal result with an acceptable complication rate. Using a multidisciplinary approach is beneficial in treating these complex patients.
Kidney cancer is the ninth most common malignancy in the United States. Most kidney cancers are clear cell renal cell carcinoma (RCC) and arise as solid tumors from kidney parenchyma. In the setting of metastatic disease, a primary renal tumor is usually identified, and metastases are often to lung, bone, liver, and brain. Metastatic RCC without an identifiable solid kidney tumor is exceedingly rare. We report the case of a 52 year old male with a rare cutaneous RCC metastasis without an identifiable primary renal tumor.
