Suprapubic Research Articles

Risk factors for local recurrence of keloids and hypertrophic scars after postoperative electron beam radiotherapy.

Keloids and hypertrophic scars are benign fibroproliferative lesions that occur as a result of skin injury. Postoperative radiation therapy is used to reduce the recurrence rate because of the high recurrence rate with surgical treatment alone. This study aimed to identify the risk factors for recurrence after postoperative electron beam radiotherapy. Patients with keloid or hypertrophic scars with at least one lesion and who underwent postoperative electron beam radiotherapy at our institution from June 2013 to March 2022 were included in the study, while patients with a follow-up period of fewer than three months were excluded. A retrospective analysis was performed on 94 lesions in 81 patients. Exactly two years after the treatment, the actuarial local control rate was 86.4%. The chest wall, shoulder, and suprapubic area were identified as high-risk recurrence sites. Compared to other body sites, these sites had significantly lower local control rates (two-year local control rates: 75.5% vs. 95.2%, P = 0.005). After multivariate analysis, treatment site (P = 0.014), male gender (P = 0.019), and younger age (P = 0.029) were revealed to be statistically significant risk factors for local recurrence. Risk factors for keloid recurrence after postoperative electron beam radiotherapy were therefore identified. This result could be used for follow-up and as a determinant for the optimal dose/fractionation of postoperative radiotherapy.

MP03-12 FUNCTIONAL MRI EXPLORATION OF THE SACRAL SPINAL CORD: A BULBOCAVERNOSUS REFLEX TASK-BASED STIMULATION

You have accessJournal of UrologyCME1 Apr 2023MP03-12 FUNCTIONAL MRI EXPLORATION OF THE SACRAL SPINAL CORD: A BULBOCAVERNOSUS REFLEX TASK-BASED STIMULATION Charles Mazeaud, Betsy Salazar, Kris Hoffman, Christof Karmonik, and Rose Khavari Charles MazeaudCharles Mazeaud More articles by this author , Betsy SalazarBetsy Salazar More articles by this author , Kris HoffmanKris Hoffman More articles by this author , Christof KarmonikChristof Karmonik More articles by this author , and Rose KhavariRose Khavari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract (LUT) is under the control of the central nervous system. Functional MRI (fMRI) is designed to explore neuronal activity, however, its application at the level of the spinal cord has been challenging and not explored. The bulbocavernosus reflex (BCR) is a reliable means of assessing the integrity of the spinal cord, particularly at the sacral level of the LUT control. The BCR is usually triggered by a gentle squeezing of the penis glans or the clitoris, especially with a full bladder. A similar and more convenient method is to tap on the midline of the suprapubic region when the bladder is full. The objectives of this project are twofold: (1) to establish a feasible and MRI compatible BCR assessment within the MRI scanner, (2) to assess the feasibility of spinal cord fMRI during a full bladder BCR in regard to LUT control in healthy individuals. METHODS: An MRI compatible hammer was designed and generated to deliver the stimulation within the MRI tunnel to elicit BCR. Two healthy males with no previous history of LUT symptoms or spinal cord injury were recruited for this trial. The participants were instructed to consume 500 ml of water and empty their bladder immediately before entering the MRI. When they reported a full bladder, they underwent a task-based fMRI of four blocks of 40 seconds of tapping (BCR) and 40 seconds of control (rest). The regions of interest (ROIs) involved in the BCR, were defined as the area of the terminal cone (S1-S4 roots) known to be involved in LUT control. The blood level oxygen-dependent (BOLD) signal within ROIs was analyzed with the FSL software. RESULTS: The ROIs identified in the sacral spinal cord showed a significant increase in signal upon BCR stimulation. BOLD activations were present and time-related to the stimulation period (Figure 1). CONCLUSIONS: This is the first study to demonstrate that: There is a feasible and modest approach to elicit BCR within the MRI to assess spinal cord integrity in regard to LUT control. The activity of the sacral spinal cord during the BCR stimulation can be revealed in fMRI. These preliminary results pave the way for further study of the functional role of the spinal cord in larger cohorts of healthy individuals and in individuals with spinal cord injury. Source of Funding: Funding provided by the National Institute of Health, NIDDK R03DK126994-01 award and the CAIRIBU Core collaboration award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e26 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Mazeaud More articles by this author Betsy Salazar More articles by this author Kris Hoffman More articles by this author Christof Karmonik More articles by this author Rose Khavari More articles by this author Expand All Advertisement PDF downloadLoading ...

NECROTIZING CELLULITIS OF THE PERINEUM COMPLICATING A SURGICAL CURE FOR BARTHOLINITIS: A CASE REPORT

We report a very rare and serious complication of a surgically treated batholinitis. The patient was a 62-year-old woman who developed significant infiltration of the soft tissues in the perineal area extending to the hypogastric region and left thigh in the postoperative period, consistent with necrotizing fasciitis.

Epidemiology and healthcare utilization for rectal foreign bodies in United States adults, 2012–2021

IntroductionPresentations to the emergency department for rectal foreign bodies are common, but there is little epidemiologic information on this condition. This limits the ability to provide evidence-based education to trainees regarding the populations affected, the types and frequency of foreign bodies, and factors associated with hospitalization. To address this, we analyzed national estimates of emergency department presentations for rectal foreign bodies from 2012 to 2021 in the US. MethodsWe queried the National Electronic Injury Surveillance System for any injury to the ‘pubic region’ or ‘lower trunk’ with an accompanying diagnosis of foreign body, puncture, or laceration. Two authors manually reviewed all clinical narratives to identify cases of rectal foreign bodies. National estimates were determined using weighting and strata variables, incidence rates calculated using census data, trends assessed by linear regression, and factors associated with hospitalization identified by multivariable logistic regression. ResultsFrom 885 cases, there were an estimated 38,948 (95% CI, 32,040-45,856) emergency department visits for rectal foreign bodies among individuals ≥15 years from 2012 to 2021. The average age was 43, 77.8% were male, 55.4% of foreign bodies were sexual devices, and 40.8% required hospitalization. The annual incidence of presentations for rectal foreign bodies increased from 1.2 in 2012 to 1.9 per 100,000 persons in 2021 (R2 = 0.84, p < 0.01). Males have a bimodal age distribution peaking in the fifth decade, while females have a right-skewed age distribution peaking in the second decade. Female sex (odds ratio [OR] 0.4; 95% confidence interval [CI], 0.2–0.6) and, compared to sexual devices, balls/marbles (OR 0.2; 95% CI, 0.05–0.6) or drugs/paraphernalia (OR 0.1; 95% CI, 0.05–0.4) are associated with a reduced odds of hospitalization. ConclusionsPresentations to the emergency department for rectal foreign bodies increased for males and females from 2012 to 2021 in the United States. These epidemiologic estimates for a complex form of anorectal trauma provide preclinical information for emergency medicine, surgery, and radiology trainees.

A rare case report of tuberculosis osteomyelitis of pubic symphysis

Less than 2% of all hematogenous osteomyelitis occurs in the pubic symphysis, making it a very uncommon condition. 10-15% of all instances of extra-pulmonary tuberculosis are caused by skeletal TB. We describe a rare instance of pubic osteomyelitis caused by tuberculosis in a 58-year-old woman who initially complained of discharge in the suprapubic region for 8 months. Patient was admitted due to suspected pubic symphysis osteomyelitis caused by TB. Based on preoperative studies, surgery was planned. Due to a suspicion of tuberculosis, debridement was performed and stimulan antibiotic beads were inserted. CB-NAAT and histopathology samples were sent. When CB-NAAT tested positive for multidrug-resistant tuberculosis (MDR-TB) and started on antitubercular therapy (ATT), HPR indicated granulomatous inflammation. After receiving MDR-TB treatment, there was no discharge from the location. Following surgery, there was a year of follow-up. Patient made a full recovery without any site discharge. This example serves to illustrate our approach to treating pubic symphysis osteomyelitis caused by TB. Osteomyelitis of the pubic symphysis, stimulating antibiotic cement beads, CB-NAAT, MDRTB, ATT.

Comparison of intraoperative neurophysiological monitoring methods for lumbosacral lipoma surgery in infants.

Stable intraoperative neurophysiology monitoring of infants, especially very young infants, is challenging. In this study, motor evoked potentials (MEPs), the bulbocavernosus reflex (BCR), and somatosensory evoked potentials (SEPs) were simultaneously monitored in infants with lumbosacral lipomas, and these methods were compared retrospectively. A total of 21 surgeries performed for lumbosacral lipoma in patients less than 1year old were studied. The mean age at surgery was 133.8days (range 21-287days; ≤ 120days: 9 cases, > 120days: 12 cases). Transcranial MEPs were measured in the anal sphincter and gastrocnemius, and tibialis anterior and other muscles were added as needed. The BCR was measured by the electromyogram of the anal sphincter muscle with stimulation of the pubic region, and SEPs were measured from the waveforms of stimulation of the posterior tibial nerves. For the BCR, stable potentials could be recorded for all 9 cases at ≤ 120days of age. In contrast, for MEPs, stable potentials could be recorded in only 4 of 9 cases (p < 0.05). For all patients > 120days of age, MEPs and the BCR were measurable. SEPs were undetectable in some patients regardless of age. The BCR could be more consistently measured than MEPs in infant patients with lumbosacral lipoma at ≤ 120days of age.

Efficacy of Five Days Nitrofurantoin Therapy versus Fosfomycin Stat Dose in Clinical Resolution of Uncomplicated Urinary Tract Infections

Objective: To compare the efficacy of 5-days Nitrofurantoin therapy versus Fosfomycin stat dose in clinical resolution of uncomplicated urinary tract infections in females of reproductive age group.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2019 to Mar 2020.&#x0D; Methodology: A total of 498 females of reproductive age (18 years to 40 years) with lower urinary tract infection symptoms(increased urinary hesitancy, frequent micturition, tenderness at suprapubic region) and positive urine dipstick test for nitrates/leukocyte esterase test were incorporated in the study. Patients were randomly assigned to Group-A and Group-B,comprising 249 patients. Group-A was given tablet Nitrofurantoin 100mg every six hourly. Group-B was given Fosfomycin 3gstat dose. Patients were advised to follow up on days 14 and 28 of treatment to observe the clinical resolution of urinary tractinfection symptoms and bacteriologic response.&#x0D; Results: Clinical resolution of urinary tract infection on the 28th day of treatment was attained in 172(69.1%) patients of the Nitrofurantoin-Group versus 140(56.2%) patients receiving Fosfomycin (p-value 0.003). Baseline urine cultures were positive in 286(57.4%) patients. Microbiologic resolution was achieved in 109 of 140(77.9%) and 100 of 146(68.4%) (p- value=0.026).&#x0D; Conclusion: Among the females of reproductive age, five days of Nitrofurantoin therapy is superior to stat dose Fosfomycin in the clinical and microbiologic resolution of uncomplicated urinary tract infections.

Thoracolaparoscopic radical resection of esophagogastric junction cancers with a NOSE-like approach to extract large specimens.

To investigate the efficacy and safety of combined thoracoscopic and laparoscopic radical resection of esophagogastric junction cancers using a natural orifice specimen extraction-like approach for extraction of large surgical specimens. Patients who had esophagogastric junction cancers treated with thoracolaparoscopic resection using the natural orifice specimen extraction-like approach for specimen extraction were retrospectively enrolled. A 5-cm transverse incision on the abdominal wall at the middle of the superior pubic symphysis was made for surgical specimen extraction. The clinical, surgical, complications, and follow-up data were analyzed. A total of 162 patients were enrolled, and the surgery was successful in all patients (100%). The total surgical duration ranged 165 to 270 minutes, with blood loss 20 to 150 mL, hospital stay 8 to 22 days, first flatus time 2 to 7 days, extubation time of drainage tubes 1 to 26 days, first oral feeding time 5 to 10 days, number of lymph nodes resected 15 to 39, postoperative ambulation time 1 to 2 days, and postoperative residual rate of cancerous cells at the surgical margins 0. Postoperative complications occurred in 14 (8.6%), including anastomotic leakage in 4 (2.5%), anastomotic stenosis in 3 (1.9%), hydrothorax in 4 (2.5%), and incision infection in 3 (1.9%). At follow-up (mean 12 months), all patients were alive, and the transverse incision was a linear scar concealed in the suprapubic pubic hair area. The combined laparoscopic and thoracoscopic surgery for radical resection of carcinomas at the esophagogastric junction is safe and effective, and a transverse incision at the suprapubic symphysis for specimen extraction results in improved minimal invasiveness and cosmesis.

Morbidity following suprapubic line insertion for videourodynamics in children

Previously in our unit, urodynamics were delayed after insertion of suprapubic (SP) lines. We postulated that performing urodynamics on the same day as SP line insertion would not result in increased morbidity. We retrospectively compared complications in those having urodynamics on the same day against those who had delayed urodynamics. Notes were reviewed for patients undergoing urodynamics via SP lines from May 2009 until December 2018. In 2014 we modified our practice to allow urodynamics on the same day as SP line insertion in some patients. Patients undergoing videourodynamics would have two 5 Fr (mini Paed) SP lines inserted under general anaesthesia. Patients were divided into two groups: those that had urodynamics on the same day as SP line insertion and those that had urodynamics after an interval of more than one day. The outcome measure was the number of problems affecting those in each group. The two groups were compared using Mann-Whitney U tests and Fisher's Exact tests. There were a total of 211 patients with a median age of 6.5 years (range three months to 15.9 years). Urodynamics were performed on the same day in 86. Delayed Urodynamics were performed at an interval of more than one day in 125. Adverse events included pain or difficulty with voiding, increased urinary frequency, urinary incontinence, leak from catheter site, extravasation, extension of in-patient stay, visible haematuria, urethral catheterisation, and urinary tract infection. Problems affected 43 (20.4%) children. In the same day group, 11 (13.3%) patients had problems, in the delayed group 32 (25.6%) had problems; this was statistically significant (p=0.03). The difference in combined incidence of important problems (requiring urethral catheterisation, extended admission or abandonment of urodynamics) was not statistically significant between the two groups. When using suprapubic catheters for urodynamics there is no additional morbidity when catheters are inserted on the same day as the urodynamics study compared to when urodynamic are delayed.

Changes in nerve growth factor signaling in female mice with cyclophosphamide-induced cystitis.

IC/BPS is a chronic inflammatory pelvic pain syndrome characterized by lower urinary tract symptoms including unpleasant sensation (pain, pressure, or discomfort) in the suprapubic or bladder area, as well as increased urinary frequency and urgency, and decreased bladder capacity. While its etiology remains unknown, increasing evidence suggests a role for changes in nerve growth factor (NGF) signaling. However, NGF signaling is complex and highly context dependent. NGF activates two receptors, TrkA and p75NTR, which activate distinct but overlapping signaling cascades. Dependent on their coexpression, p75NTR facilitates TrkA actions. Here, we show effects of CYP treatment and pharmacological inhibition of p75NTR (via LM11A-31) and TrkA (ARRY-954) on NGF signaling-related proteins: NGF, TrkA, phosphorylated (p)-TrkA, p75NTR, p-ERK1/2, and p-JNK. Cystitis conditions were associated with increased urothelial NGF expression and decreased TrkA and p75NTR expression as well as altering their co-expression ratio; phosphorylation of ERK1/2 and JNK were also altered. Both TrkA and p75NTR inhibition affected the activation of signaling pathways downstream of TrkA, supporting the hypothesis that NGF actions during cystitis are primarily TrkA-mediated. Our findings, in tandem with our recent companion paper demonstrating the effects of TrkA, TrkB, and p75NTR inhibition on bladder function in a mouse model of cystitis, highlight a variety of potent therapeutic targets and provide further insight into the involvement of NGF signaling in sustained conditions of bladder inflammation.

Third-Generation Dynamic Anterior Plate-Screw System for Quadrilateral Fractures: Digital Design Based on 834 Pelvic Measurements.

Background and Objectives: To investigate the digital measurement method for the plate trajectory of dynamic anterior plate-screw system for quadrilateral plate (DAPSQ), and then design a third-generation DAPSQ plate that conforms to the needs of the Chinese population through collating a large sample anatomical data. Materials and Methods: Firstly, the length of the pubic region, quadrilateral region, iliac region, and the total length of the DAPSQ trajectory were measured by a digital measurement approach in 22 complete pelvic specimens. Then, the results were compared with the direct measurement of pelvic specimens to verify the reliability of the digital measurement method. Secondly, 504 cases (834 hemilateral pelvis) of adult pelvic CT images were collected from four medical centers in China. The four DAPSQ trajectory parameters were obtained with the digital measurement method. Finally, the third-generation DAPSQ plate was designed, and its applicability was verified. Results: There was no statistically significant difference in the four trajectory parameters when comparing the direct measurement method with the digital measurement method (p > 0.05). The average lengths of the pubic region, quadrilateral region, iliac region, and the total length in Chinese population were (60.96 ± 5.39) mm, (69.11 ± 5.28) mm, (84.40 ± 6.41) mm, and (214.46 ± 10.15) mm, respectively. Based on the measurement results, six models of the DAPSQ plate including small size (A1,A2), medium size (B1,B2), and the large size (C1,C2) were designed. The verification experiment showed that all these six type plates could meet the requirement of 94.36% cases. Conclusions: A reliable computerized method for measuring irregular pelvic structure was proposed, which not only provided an anatomical basis for the design of the third-generation DAPSQ plate, but also provided a reference for the design of other pelvic fixation devices.

Quantitative analysis of the innominate bone for sex estimation utilising the Phenice method

BackgroundThe Phenice method is a reliable qualitative analysis of the pubis and ischium region of the innominate bone to assess an individual’s sex. Geometric morphometric provides methods of quantitative analysis of the region for identification purposes, which may be affected by environmental changes. This study analysed the Phenice method by utilising 3D (3 dimensional) CT (computed tomography) scans by geometric morphometrics for sex estimation. The CT scans of 231 adult individuals (148 males and 83 females) of the Malaysian population were landmarked by IDAV Landmark software and analysed by MorphoJ and SPSS.ResultsThe first four principal components (PCs) accounted for 41.9% of the total changes when utilising the Phenice method. Widening in pubic symphysis in a U shape with a general widening of the border of the true pelvis, which is typically seen in females, accounted for 21.8% of the eigenvalues.ConclusionsIt was possible to quantify the changes seen in the ventral arc, subpubic concavity and the medial aspect of the ischio-pubic ramus for sex estimation utilising the Phenice method, and most of the changes were seen in PC1 at the pubic region, which accounted for 21.8%.

Pelvic Pain in Transgender People Using Testosterone Therapy.

Purpose: This descriptive study aimed to assess the characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Methods: An online cross-sectional survey was open between August 28, 2020, and December 31, 2020, to trans people presumed female at birth, using testosterone for gender affirmation, living in Australia, and >16 years of age. The survey explored characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual, gynecological, and mental health experiences. Logistic regression was applied to estimate the effect size of possible factors contributing to pain after starting testosterone. Results: Among 486 participants (median age = 27 years), 351 (72.2%)* reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as "cramping." Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No association was observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.

Torção intra-abdominal de testículo criptorquideo sem neoplasia em cão adulto

ABSTRACT: Intra-abdominal or intrascrotal testicular torsion in dogs occurs due to spermatic cord rotation. Dogs with testicular torsion commonly present severe pain and require surgical intervention. Torsion of intra-abdominal retained testicles in cryptorchid adult dogs is often associated with the presence of testicular neoplasia. Herein, we reported the case of a 5-year-old male poodle with uncommon intra-abdominal testicular torsion (ITT) of a non-neoplastic testicle. The dog was referred to the veterinary hospital with acute abdominal pain in the hypogastric region. An intra-abdominal gonad and alterations compatible with testicular torsion were visualized during ultrasound examination. Orchiectomy and histopathological analysis of the testes confirmed the diagnosis of ITT in the absence of neoplasia. The patient recovered uneventfully from the situation. This report showed that ITT can occur in adult dogs in the absence of testicular neoplasia and reinforce the message that it should be included as a differential diagnosis in cases of acute abdominal pain in cryptorchid dogs. Furthermore, the ultrasound examination in this case of pain in the hypogastric region was decisive for the diagnosis of ITT.

Dermatofibrosarcoma Protuberans at Unusual Sites: A Case Series

Dermatofibrosarcoma Protuberans (DFSP) is a rare, locally aggressive malignant subcutaneous soft tissue tumour that often goes undiagnosed due to its indolent nature and non protuberant growth. Recurrences after surgical excision are a common issue. While the trunk and extremities are commonly affected sites, rarer locations such as the genitalia and breast have been reported. The rarity of the lesion, its occasional unusual presentation sites, the indolent yet locally aggressive nature, and the diagnostic and therapeutic challenges are the distinctive features of this tumour. This study presents three unusual sites of DFSP: scrotum, vulva, and pubic region, one of which is an uncommon variant known as pigmented DFSP (Bednar tumour).

Premature pubarche during minipuberty - literature review and two case reports.

Isolated premature pubarche (PP) in infancy may be the reason for many diagnostic difficulties. This is due to the low incidence and, therefore, the limited number of studies on this subject and the lack of strict laboratory standards because of the physiological variability of gonadotropic hormone and androgen concentrations during minipuberty. We aimed to present current knowledge about PP in infancy based on the literature review and 2 cases of male infants with scrotal hair during minipuberty. Isolated hair in the pubic region in aboy during the period of minipuberty requires differential diagnosis. After excluding serious aetiology, it seems to be amild, self-limiting variant of precocious puberty. The phenomenon is probably aresult of increased sensitivity of the hair follicles to transiently increased androgen concentration. Isolated pubic hair in infancy as amild, self-limiting variant of precocious puberty in infants should be adiagnosis of exclusion. The condition resolves spontaneously, but it absolutely requires further follow-up to exclude serious aetiology in the case of puberty progression.

Total Abdominal Hysterectomy for a 36 Weeks Size Fibroid Uterus through a Supra Pubic Transverse Incision

Introduction: Uterine fibroids are the commonest Gynecological benign tumor which affect reproductive age women. Surgical management of large fibroid uterus create multiple challenges to both surgeon and the patient. This is a cases of 36 weeks size fibroid uterus, grown up to the level of xiphisternum which treated with total abdominal hysterectomy through a suprapubic transverse incision. Case: 45-year-old, previously healthy multi-parous women presented with progressive abdominal distention for one to two years. Clinical and Ultrasound scan confirmed the fibroid uterus. She successfully underwent total abdominal hysterectomy through a supra-pubic transverse incision. Conclusion: Management of a fibroid uterus depends on patient’s age, fertility wishes, uterine preserving desires, symptomatology, site and size of the fibroids. Successful hysterectomy can be done through a supra-pubic transverse incision even for a 36 weeks size fibroid uterus in carefully selected cases.

Clinical Characteristics of Basal Cell Carcinomas of the Vulva: An Institutional Retrospective Review.

There are limited data on the etiology, clinical characteristics, and optimal treatment of vulvar basal cell carcinoma (BCC). This retrospective review may aid in treatment decisions for vulvar BCC. A retrospective review of our institutional CoPath database was performed, using search terms to identify cases of vulvar BCCs from 2000 to 2018. A total of 35 cases of vulvar BCC were included. Patient age ranged from 33 to 97 years with a mean age of 70 years. Of the 35 cases, 28 (80%) involved the cutaneous vulva, 6 (17%) involved the suprapubic area, and 1 (3%) involved the clitoris. Most vulvar BCCs were treated by wide local excision (46%) and vulvectomies (37%), with 3 cases treated with Mohs (11%) and 2 with electrodesiccation and curettage (6%). Preoperative tumor sizes were 0.86 cm2 for Mohs, 0.94 cm2 for excision, and 1.54 cm2 for vulvectomy. The mean margins were 3 mm for Mohs, 4.4 mm for wide local excision, and 6 mm for vulvectomy. Most cases (77%) were identified and treated by gynecology. Mohs micrographic surgery should be considered for the advantages of being tissue sparing, evaluating the complete peripheral and deep margin, and avoiding the costs and risks of general anesthesia.

Prostatic bed calcification with [99mTc]Tc-MDP uptake: Easy to miss on planar images.

A 65 years old man with high-risk prostate adenocarcinoma underwent bone scintigraphy with 99mTc-methylene diphosphate ([99mTc]Tc-MDP). The scan revealed a focus of radiotracer uptake in the left pubic region, which was suspicious for metastatic involvement. Additional imaging with single photon emission computed tomography (SPECT/CT) confined the uptake to be extra-osseous and contributed to the calcified zone in the prostate bed. Prostatic bed calcification with [99mTc]Tc-MDP uptake mimics metastasis and can be easily missed on planar images.

Giant seminal vesicle cyst with hemorrhage in Zinner syndrome: A case report

Zinner syndrome (ZS) is a rare congenital malformation of the urogenital tract that is associated with seminal vesicle cysts, ejaculatory duct obstruction, and ipsilateral renal agenesis. This unique condition was first reported by Zinner (1914). ZS is caused by malformation of the distal mesonephric duct during embryogenesis. To our knowledge, no giant seminal vesicle cysts with hemorrhage in ZS have been reported in the current study. A 63-year-old man presented with chronic hypogastralgia with no history of lower urinary tract symptoms, hematuria, or trauma. Physical examination revealed no localized uplift or percussive pain in either kidney. No tenderness in the ureter stroke region, no localized eminence in the suprapubic region of the bladder, and no tenderness in the bladder region was observed. Digital rectal examination revealed a cystic mass with a smooth surface in the anterior wall of the rectum with no tenderness or unclear boundaries. No blood staining was observed in the finger sheaths. Computed tomography scan revealed that the right kidney was absent, with a mass similar to a cord above the right seminal vesicle cyst. Contrast-enhanced pelvic magnetic resonance imaging (MRI) confirmed a short T1 and T2 signal shadow similar to a cord above the right seminal vesicle cyst. The boundary was clear, with the upper part leading to the "renal region" and the lower part connecting to the right seminal vesicle cyst. Contrast-enhanced MRI showed local parenchymal cysts with cyst wall enhancement but no intrathecal enhancement. This suggested a hemorrhagic cyst. A diagnosis of Zinner syndrome was established. The patient was diagnosed with a giant seminal vesicle cyst with hemorrhage in ZS. The patient had no obvious symptoms; therefore, regular follow-ups were performed. MRI of the patient 1 month later showed that the hematoma in the seminal vesicle cyst was not absorbed. Giant seminal vesicle cysts with hemorrhage in ZS are rare. To patients without symptom, regular follow-up can be adopted.