No abstract

Renal arteriovenous fistulae (AVF) are a rare condition that can be acquired, congenital, or idiopathic. Idiopathic AVF are the rarest type of renal AVF. Traditionally, renal AVF were treated with surgery, but the mainstay of treatment has shifted to an endovascular approach by coil embolization. Embolization procedures are often difficult secondary to the "high flow" of the AVF, and there is the substantial risk of distal embolization of coils. We present a case in which an idiopathic renal AVF was successfully embolized with an Amplatzer vascular plug.

High-grade spindle cell sarcomas are rare undifferentiated pleomorphic cancers that present a treatment challenge to urological practices, especially when they present in the pelvis. We report a 46-year-old male patient who presented to our urology clinic with urinary retention after having a Foley catheter placed at an outlying facility. A voiding trial was attempted, but the patient failed this trial. This failure resulted in cystoscopy with bilateral retrograde pyelograms, which revealed a compressed bladder due to extrinsic compression. This finding had been evaluated with a computed tomography (CT) scan with and without intravenous contrast that showed a 14 cm pelvic mass with bladder displacement and compression. A fine needle aspiration was done at this outlying facility, prior to referral to our office, and it confirmed spindle cell pathology. The mass was surgically excised with the histology revealing a pelvic spindle cell sarcoma with positive surgical margins. Further, metastatic work-up with CT/positron emission tomography revealed bone and lung metastasis. The patient is currently undergoing chemotherapy and radiation. In this case study, we will review staging, management, differential diagnosis, chemotherapy, and radiation.

Prostate cancer is the most common intrinsic cancer in men and the 2nd most common cause of cancer related death in men over fifty years of age. The benefit of early screening for prostate cancer is yet to be proven. Multiple organizations currently offer recommendations regarding prostate cancer screening. Prostate Specific Antigen (PSA) testing was introduced into widespread use in the late 80’s and its role in screening is debatable. We surveyed by mail every primary care physician in West Virginia who has a state license. Results from 438 respondents indicated that the American Cancer Society (ACS) guidelines were most commonly used and that PSA testing does seem to be a good screening test. We present the results and discuss the different points of view regarding prostate cancer screening