3 30
BRITISH JOURNAL OF UROLOGY
inguinoscrotal mass. The phallus was not visible. On rectal examination the prostate was not palpable. Laboratory studies, including full blood count, blood chemistry studies, urine analysis and urine culture were normal. An intravenous urogram showed good renal function; the distal ureteric segments appeared to extend into the inguinal hernia sac. Cystography demonstrated the entire bladder descending into the scrotum with filling defects (Fig. 1). Urinary cytology revealed a G3 transitional cell carcinoma. CT scan of the scrotum showed an infiltrating bladder tumour (Fig. 2).
Comment
Fig. 2 Large haematoma located behind the undamaged left kidney.
to patients with associated lesions or indirect trauma (Sevitt, 1955; Karli et al., 1978). Hypertension is frequently associated with adrenal haemorrhage but no evidence of pre-existing adrenal pathology was found in this case. Adrenal traumatic lesions, although frequently resolving spontaneously, can cause serious retroperitoneal haematoma and non-function of the kidney.
The urinary bladder is frequently a component of inguinal hernias and has been reported to occur in 10% of all inguinal hernias in men over the age of 50 years; usually, however, only a small portion of the bladder is involved. Bladder hernias extending into the scrotum are extremely rare. Only a few cases of massive bladder herniation combined with bladder cancer have been reported (Croushore and Black, 1979; Bell and Witherington, 1980). Retrograde cystography delineates the bladder protrusion
References Karli,V. P., Steele, A. and Davis, P. (1978). Adrenal hemorrhage in the adult. Medicine, 57, 21 1-221. Sevitt, S. (1955). Post-traumatic adrenal apoplexy. J. Clin. Pathol., 8, 185-194. Requests for reprints to: S. Rocca Rossetti, Department of Urology, University of Turin, Corso Polonia 14, 10126 Turin, Italy.
~~~
Massive Scrota1 Cystocele with Bladder Cancer S. H. PAPADIMITRIOU, M. A. CHLEPAS,C. P. KOKINACOS and C. B. PAPADOPOULOS, Department of Urology, Euagelistria Hospital, Tripolis, Greece
Case Report An 88-year-old man complained of haematuria, dysuria and a long history of left inguinal hernia. Physical examination revealed an obese man with a large left
Fig. 1 Cystogram showing lateral displacement of the lower third of both ureters, the entire bladder descending into a large left inguinal hernia and filling defects in the bladder.
331
CASE REPORTS
Biochemical analysis was normal (ESR, Hb, WCB, liver function tests, renal function tests). Karyotype was 46, X.Y. Abdominal sonography revealed an abnormal structure localised in the mesogastrium, suggesting an ectopic or horseshoe kidney. Further radiological exploration (CT scan, IVU, cavography) confirmed the diagnosis of a horseshoe kidney with a right hydronephrosis on a pelvic junction stenosis. The infrarenal caval vein was situated to the left of the abdominal aorta and crossed under the aorta to the right above the renal veins (Fig.). The parenchymal isthmus was divided and the pelvic junction stenosis was corrected with an AndersonHynes pyeloplasty.
Fig. 2 CT scan cut transversely through the scrotum showing an infiltrating bladder tumour.
accurately and has been recommended as a routine investigation in men over 50 years of age with inguinal hernia.
References Bell,E. D. and Witherington,R. (1980). Bladder hernias. Urology, 15, 127-130. Croushore, J. H. and Black, R. B. (1979). Scrota1 cystocele. J . Urol., 121, 541-542.
Requests for reprints to: S . H . Papadimitriou, Department of Urology, Euagelistria Hospital, Tripolis, Greece.
Horseshoe Kidney Associated with Left Inferior Vena Cava 1. BILLIET, J. MATTELAER,V. HERPELS and H. VERRESEN, Departments of Urology, Radiology, Anatom y and Embryology, Sint-Maarten Hospital and the Catholic University of L euven. Kortrijk. Belgium
We report a second case of the rare association between a horseshoe kidney and an infrarenal left caval vein.
Case Report A 28-year-old patient was investigated for chronic right flank and abdominal discomfort, present for many years. Colicky pain was present in the peri-umbilical region, transfixing the abdomen anteroposteriorly. There was no fever, weight loss, icterus or urinary abnormalities.
Fig. Digital substraction cavography. The left-sided infrarenal vena cava crosses to the right above the level of the renal veins and behind the aorta, ending in a normally positioned right atrium.
Comment Horseshoe kidneys occur in 0.25%of the population. In nearly one-third of these patients other congenital abnormalities are present that involve the urogenital, skeletal, central nervous or cardiovascular systems. An increased incidence of horseshoe kidney is found in trisomy 18 and Turner’s syndrome (Perlmutter et al., 1987). The associated anomaly of a left infrarenal vena cava has been reported only once (Boyden, 1931). The development of a horseshoe kidney and formation of the inferior vena cava both occur in the seventh week of gestation and can be the result of the same disturbance in embryogenesis. The
BRITISH JOURNAL OF UROLOGY
inguinoscrotal mass. The phallus was not visible. On rectal examination the prostate was not palpable. Laboratory studies, including full blood count, blood chemistry studies, urine analysis and urine culture were normal. An intravenous urogram showed good renal function; the distal ureteric segments appeared to extend into the inguinal hernia sac. Cystography demonstrated the entire bladder descending into the scrotum with filling defects (Fig. 1). Urinary cytology revealed a G3 transitional cell carcinoma. CT scan of the scrotum showed an infiltrating bladder tumour (Fig. 2).
Comment
Fig. 2 Large haematoma located behind the undamaged left kidney.
to patients with associated lesions or indirect trauma (Sevitt, 1955; Karli et al., 1978). Hypertension is frequently associated with adrenal haemorrhage but no evidence of pre-existing adrenal pathology was found in this case. Adrenal traumatic lesions, although frequently resolving spontaneously, can cause serious retroperitoneal haematoma and non-function of the kidney.
The urinary bladder is frequently a component of inguinal hernias and has been reported to occur in 10% of all inguinal hernias in men over the age of 50 years; usually, however, only a small portion of the bladder is involved. Bladder hernias extending into the scrotum are extremely rare. Only a few cases of massive bladder herniation combined with bladder cancer have been reported (Croushore and Black, 1979; Bell and Witherington, 1980). Retrograde cystography delineates the bladder protrusion
References Karli,V. P., Steele, A. and Davis, P. (1978). Adrenal hemorrhage in the adult. Medicine, 57, 21 1-221. Sevitt, S. (1955). Post-traumatic adrenal apoplexy. J. Clin. Pathol., 8, 185-194. Requests for reprints to: S. Rocca Rossetti, Department of Urology, University of Turin, Corso Polonia 14, 10126 Turin, Italy.
~~~
Massive Scrota1 Cystocele with Bladder Cancer S. H. PAPADIMITRIOU, M. A. CHLEPAS,C. P. KOKINACOS and C. B. PAPADOPOULOS, Department of Urology, Euagelistria Hospital, Tripolis, Greece
Case Report An 88-year-old man complained of haematuria, dysuria and a long history of left inguinal hernia. Physical examination revealed an obese man with a large left
Fig. 1 Cystogram showing lateral displacement of the lower third of both ureters, the entire bladder descending into a large left inguinal hernia and filling defects in the bladder.
331
CASE REPORTS
Biochemical analysis was normal (ESR, Hb, WCB, liver function tests, renal function tests). Karyotype was 46, X.Y. Abdominal sonography revealed an abnormal structure localised in the mesogastrium, suggesting an ectopic or horseshoe kidney. Further radiological exploration (CT scan, IVU, cavography) confirmed the diagnosis of a horseshoe kidney with a right hydronephrosis on a pelvic junction stenosis. The infrarenal caval vein was situated to the left of the abdominal aorta and crossed under the aorta to the right above the renal veins (Fig.). The parenchymal isthmus was divided and the pelvic junction stenosis was corrected with an AndersonHynes pyeloplasty.
Fig. 2 CT scan cut transversely through the scrotum showing an infiltrating bladder tumour.
accurately and has been recommended as a routine investigation in men over 50 years of age with inguinal hernia.
References Bell,E. D. and Witherington,R. (1980). Bladder hernias. Urology, 15, 127-130. Croushore, J. H. and Black, R. B. (1979). Scrota1 cystocele. J . Urol., 121, 541-542.
Requests for reprints to: S . H . Papadimitriou, Department of Urology, Euagelistria Hospital, Tripolis, Greece.
Horseshoe Kidney Associated with Left Inferior Vena Cava 1. BILLIET, J. MATTELAER,V. HERPELS and H. VERRESEN, Departments of Urology, Radiology, Anatom y and Embryology, Sint-Maarten Hospital and the Catholic University of L euven. Kortrijk. Belgium
We report a second case of the rare association between a horseshoe kidney and an infrarenal left caval vein.
Case Report A 28-year-old patient was investigated for chronic right flank and abdominal discomfort, present for many years. Colicky pain was present in the peri-umbilical region, transfixing the abdomen anteroposteriorly. There was no fever, weight loss, icterus or urinary abnormalities.
Fig. Digital substraction cavography. The left-sided infrarenal vena cava crosses to the right above the level of the renal veins and behind the aorta, ending in a normally positioned right atrium.
Comment Horseshoe kidneys occur in 0.25%of the population. In nearly one-third of these patients other congenital abnormalities are present that involve the urogenital, skeletal, central nervous or cardiovascular systems. An increased incidence of horseshoe kidney is found in trisomy 18 and Turner’s syndrome (Perlmutter et al., 1987). The associated anomaly of a left infrarenal vena cava has been reported only once (Boyden, 1931). The development of a horseshoe kidney and formation of the inferior vena cava both occur in the seventh week of gestation and can be the result of the same disturbance in embryogenesis. The
