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Introduction and Objectives. The most common cause for Congenital adrenal hyperplasia (CAH) is due to 21- hydroxylase deficiency which can produce disorders of sex development. 46,XX maleness is a rare syndrome with an incidence of 1 in 20000-25000 males, and they are defined by ambiguous genitalia or partially to fully mature male genitalia. Materials and Methods. We present the case of a 49-year-old patient (46,XX) with CAH resulting from 21-hydroxylase deficiency, diagnosed with penoscrotal hypospadias at the age of 3 and a half years for whom multiple corrective surgeries were performed and was referred to our hospital for evaluation of urethrocutaneous fistulas. Results. In 2021, the patient was diagnosed by the endocrinology department with 46,XX Karyotype, male phenotype and congenital adrenal hyperplasia due to 21 hydroxylase deficiency. The urological diagnosis established at "Prof. Dr. Theodor Burghele" Clinical Hospital was of multiple urethrocutaneous fistulas that occurred after penoscrotal hypospadias repair in childhood. The surgical indication consisted of urethroplasty with oral mucosa graft in two steps, the time between interventions being about four months. The surgical evolution was good, without complications. Complications after multiple times operated hypospadias are redoubtable, including strictures of the anterior urethra, urethral fistulas, urethritis, and recurrent urinary tract infections. The treatment of such cases is particularly difficult. Conclusions. The use of extragenital tissues for urethral reconstruction (oral mucosa graft) provides superior functional and aesthetic results compared to the techniques using skin flaps. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Percutaneous nephrolithotomy (PCNL) successfully replaced open surgery more than 30 years ago, and it still represents the gold standard in the treatment of large renal stones. Although nowadays, with advancing technology improving many technical aspects, it is considered a safe procedure with a low complication rate, close postoperative management is mandatory. Colon perforation is a rare but severe complication that can occur in specific cases. Materials and Methods. We analyzed 1146 cases, from June 2015 to May 2017, admitted in "Prof. Dr. Th. Burghele" Clinical Hospital based on medical records identified when searching procedure code. Data referring to risk factors such as age, sex, stone location and type, associated diseases, previous surgical history, and also intra and postoperative details were carefully analysed. All of the cases were primarily assessed with complete blood and urine tests. When diagnosed, urinary tract infections were treated with specific antibiotic agents. All available imagistic details were studied before and after the PCNL session for selected cases. Results. 7 cases met our criteria and were diagnosed with colonic injury after PCNL. All suspected cases were assessed imagistically with an abdominal CT scan and managed conservatively as the first intention. Sex distribution revealed five males and two females with a mean age of 52.3 years old. Colonic injuries were diagnosed intra or postoperatively and were most prevalent on the left side. Accessing the pylocaliceal system was performed by puncturing the lower calyx in 6 cases and the middle calyx for technical reasons in one case. When referring to risk factors, a retrorenal colon was diagnosed in two cases. In one case with previous open renal surgery, the right colon was injured. It was only one case of intraperitoneal lesion in which surgical management with temporary colostomy for three months was preferred. Conclusions. Colon perforation is a rare complication related to PCNL with management key being based on early diagnosis. According to other studies, our results reveal that extraperitoneal colon perforations can be successfully managed conservatively, but surgery with a temporary colostomy is the election treatment for intraperitoneal lesions. [ABSTRACT FROM AUTHOR]

Knowledge of lymph node metastases in patients with urologic tumors is important for clinical management and may help the urologic surgeon in choosing the best treatment for these patients. Accurate nodal staging helps to predict prognosis. Conventional magnetic resonance imaging (MRI) often fails to differentiate between benign and malignant changes in lymph nodes because this technique is reliant on nonspecific features such as size and morphologic criteria. Therefore, there is a need for more accurate non-invasive diagnostic technique to improve nodal assessment. Diffusion-weightedmagnetic resonance imaging (DW-MRI) is a non-invasive functional imaging technique that provides unique information related to tumor cellularity and the integrity of the cellular membrane. DW imaging has the potential to differentiate malignant from benign lymph nodes based on the mean ADC value. Metastatic nodes show, as most primary malignant tumors, lower ADC values due to their impeded diffusion caused by high cellularity. Improved diagnostic of lymph node metastases might guide the surgeon to remove positive nodes only. Although initial results are promising, larger-scale studies will be needed to improve detection and localization of lymph node metastases. Standardizing the technical parameters and improving the image analysis represent major challenges to the widespread adoption of DW imaging. [ABSTRACT FROM AUTHOR]

Introduction and objectives. The aim of this paper is to systematize and illustrate distinct imaging patterns and lesions distribution seen in renal lymphomas and to discuss the differential diagnosis with other renal tumors. Materials and methods. We realized a retrospective study over a period of 12 years from the cases investigated by CT or MRI in our hospital and diagnosed with a lymphoproliferative disease. Of the 3290 patients found, a total of 48 showed renal lymphoma. There was pathological confirmation for all patients, either node biopsy or after nephrectomy. All patients had at least two CT / MRI examinations. Indications for CT examination were: disease staging, follow-up at 6 or 12 months, clinical suspicion of recurrence and evaluation of renal or other organs lesions. Follow-up interval varied from four months to four years. MRI examination was performed only in two patients with iodinated contrast material allergy. Results. The most common imaging appearance of renal lymphomas is that of homogeneous, isodense (non-enhanced CT) and hypoattenuated (contrast-enhanced CT) masses compared with normal parenchyma. We found a wide variety of manifestation: multiple bilateral (52%) or unilateral masses (13%), a solitary nodular lesion (8%) or infiltrative lesions (13%), contiguous retroperitoneal extension (6%) or masses in the perirenal space (8%). Conclusions. Contrast enhanced CT is useful in: detection and characterization of renal involvements in patients with lymphoma, disease staging, follow-up and response after therapy and differential diagnosis with other renal masses. Histological confirmation of disease and the presence of bilateral renal nodular lesions associated with other extra-nodal involvements can establish the diagnosis of renal lymphoma. Otherwise renal biopsy is necessary. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Retroperitoneal mullerian cysts are very rare, usually asymptomatic and are considered to be a subtype of urogenital cysts. We present the clinical and pathological findings in a case of benign retroperitoneal cyst of mullerian type. Materials and Methods. A 50 years old female presented in our department left side abdominal pain and a left side abdominal mass discovered on clinical examination. Physical examination detected a 20x15 cm left side abdominal mass. The CT scan showed a large cyst like structure, 163/160/138 mm in dimensions situated in the left abdominal flank, with its upper pole under the caudal pancreatic region, unilocular with homogenous fluid density. It appears to be separated from the left kidney. Results. Surgery was performed – open laparotomy. We found a large cyst of 17/15 cm situated in the left retroperitoneum. Final histopathological exam described mullerian unilocular cyst, 17/17/13 cm in dimensions, with a thin firm wall, with serosal clear fluid, and the inner surface was without papillary projections. Conclusions. Retroperitoneal mullerian cysts are rare diseases, with a long period of asymptomatic evolution. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to present in a simple concise and clear manner the computer tomography (CT) perfusion technique using a 64-multi-slice CT (MSCT) and to discuss the main clinical applications. Materials and Methods: The CT protocol included: unenhanced CT scan to locate the prostate, intravenous administration of non-ionic iodinated contrast medium using a power injector (volume-100 ml, rate 5ml/s), scanning in CINE mode (cranio-caudal coverage - 40 mm, continuous exposure for 40 seconds) with a 10 seconds delay after beginning of injection, followed by ten additional 1-second scans in axial mode, with a 15-second interval to quantify the amount of contrast medium that filtered into the interstitial compartment. Perfusion CT examination was followed by a standard thoraco-abdomino-pelvic examination; a report was issued according to our daily clinical practice. The patients received doses (DLP - Dose Length Product) ranged between 1000 and 1500 mGy·cm, depending on their age and weight. Analysis of source images was performed on a workstation using a dedicated software. Results: Colored functional maps and quantitative measurements were obtained for the following parameters: Permeability Surface-area product (PS), Blood Volume (BV), Mean Transit Time (MTT), Blood Flow (BF), Contrast Arrival Delay (IRF T0), Time to Peak (TTP), Transit Time to Impulse Residue Function Peak (Tmax). Placing ROI's in femoral artery, normal and abnormal prostate tissue, we obtained graphs with contrast-enhancement curves and tables with specific CT perfusion parameters. Conclusions: Perfusion CT represent an imaging diagnostic tool that may be used in prostate cancer, allowing an easy and quick assessment of the functional changes, providing informations about in vivo tumor vascularity and guidance for histopathological correlation if biopsy is scheduled. Moreover, this technique may be performed in cases where MRI is contraindicated. [ABSTRACT FROM AUTHOR]

Von Hippel Lindau is an multisystem autosomal dominant disorder that causes tumors of the central nervous system (brain, retinal, and spinal cord hemangioblastomas), endolymphatic sac tumors, renal cell carcinomas, renal cysts, pheochromocytomas, pancreatic cysts and tumors, and epididymal cystadenomas. In this review we describe the major semiological computed tomography and magnetic resonance imaging findings of this pathological entity. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)