title: Urogenital manifestations in Wegener granulomatosis: a study of 11 cases and review of the literature.
abstract: We describe the main characteristics and treatment of urogenital manifestations in patients with Wegener granulomatosis (WG). We conducted a retrospective review of the charts of 11 patients with WG. All patients were men, and their median age at WG diagnosis was 53 years (range, 21-70 yr). Urogenital involvement was present at onset of WG in 9 cases (81%), it was the first clinical evidence of WG in 2 cases (18%), and was a symptom of WG relapse in 6 cases (54%). Symptomatic urogenital involvement included prostatitis (n = 4) (with suspicion of an abscess in 1 case), orchitis (n = 4), epididymitis (n = 1), a renal pseudotumor (n = 2), ureteral stenosis (n = 1), and penile ulceration (n = 1). Urogenital symptoms rapidly resolved after therapy with glucocorticoids and immunosuppressive agents. Several patients underwent a surgical procedure, either at the time of diagnosis (n = 3) (consisting of an open nephrectomy and radical prostatectomy for suspicion of carcinoma, suprapubic cystostomy for acute urinary retention), or during follow-up (n = 3) (consisting of ureteral double J stents for ureteral stenosis, and prostate transurethral resection because of dysuria). After a mean follow-up of 56 months, urogenital relapse occurred in 4 patients (36%). Urogenital involvement can be the first clinical evidence of WG. Some presentations, such as a renal or prostate mass that mimics cancer or an abscess, should be assessed to avoid unnecessary radical surgery. Urogenital symptoms can be promptly resolved with glucocorticoids and immunosuppressive agents. However, surgical procedures, such as prostatic transurethral resection, may be mandatory in patients with persistent symptoms.
authors.affiliation: From Hospices Civils de Lyon (JFD, CB, PS), Hôpital de la Croix-Rousse, Department of Internal Medicine, Lyon, and Université Claude Bernard Lyon 1, Lyon; CHU de Caen (TLG, JB, BB), Department of Internal Medicine, Caen, and Université de Caen Basse-Normandie, UFR de Médecine, Caen; Hospices Civils de Lyon (JFC), Department of Pneumology, Hôpital Louis Pradel, Lyon,and Université Claude Bernard Lyon 1, Lyon; CHU de Clermont-Ferrand (OA), Hôpital Gabriel-Montpied, Department of Internal Medicine, Clermont-Ferrand; Clinique Protestante (LP), Department of Internal Medicine, Lyon; Hôtel-Dieu (EA), Assistance publique-Hôpitaux de Paris, Department of Internal Medicine, Paris; Descartes University Medical School (EA), Paris; Hôpital Cochin (CP, AM, LG), Assistance publique-Hôpitaux de Paris, Department of Internal Medicine, Paris, and Université Paris V, Paris; CHU de Rouen (IM), Department of Internal Medicine, Rouen; CH Le Mans (XP), Centre de compétences Maladies systémiques et auto-immunes rares, LeMans; CHU de Rennes (OD), Hôpital Sud, Department of Internal Medicine, Rennes; Clinique Beau Soleil (AD), Montpellier; CHU de Nantes (CA), Hôtel-Dieu, Department of Internal Medicine, Nantes; and CHU de Caen (FC), Department of Pathology, Caen; France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
authors.forename: Thomas
authors.initials: T
authors.lastname: Le Gallou
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cordier
authors.forename: Olivier
authors.initials: O
authors.lastname: Aumaître
authors.forename: Laurent
authors.initials: L
authors.lastname: Pinède
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Aslangul
authors.forename: Christian
authors.initials: C
authors.lastname: Pagnoux
authors.forename: Isabelle
authors.initials: I
authors.lastname: Marie
authors.forename: Xavier
authors.initials: X
authors.lastname: Puéchal
authors.forename: Olivier
authors.initials: O
authors.lastname: Decaux
authors.forename: Alain
authors.initials: A
authors.lastname: Dubois
authors.forename: Christian
authors.initials: C
authors.lastname: Agard
authors.forename: Alfred
authors.initials: A
authors.lastname: Mahr
authors.forename: François
authors.initials: F
authors.lastname: Comoz
authors.forename: Jonathan
authors.initials: J
authors.lastname: Boutemy
authors.forename: Christiane
authors.initials: C
authors.lastname: Broussolle
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
authors.forename: Pascal
authors.initials: P
authors.lastname: Sève
authors.forename: Boris
authors.initials: B
authors.lastname: Bienvenu
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D003559:Cystostomy; D005500:Follow-Up Studies; D005832:Genital Diseases, Male / Q000209:etiology* / Q000628:therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006104:Granuloma, Plasma Cell / Q000209:etiology* / Q000628:therapy; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000209:etiology* / Q000628:therapy; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009392:Nephrectomy; D011241:Prednisone / Q000627:therapeutic use; D011468:Prostatectomy; D012008:Recurrence; D012189:Retrospective Studies; D012883:Skin Ulcer / Q000209:etiology / Q000628:therapy; D015607:Stents; D020728:Transurethral Resection of Prostate; D014515:Ureteral Diseases / Q000209:etiology*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate