Case Reports in Urology最新文献

Primary signet ring cell carcinoma (SRCC) of the bladder is an exceptionally rare and aggressive malignancy, accounting for only 0.12%-0.6% of all bladder cancers. This case report describes a 54-year-old female who presented with urinary incontinence and abdominal pain, initially misdiagnosed as a urinary tract infection. Imaging revealed suspicious bladder findings, and subsequent cystoscopy with transurethral resection identified SRCC, later confirmed by immunohistochemistry (PD-L1 positive, CDX-2/ER negative). Despite peritoneal carcinomatosis, the patient responded to cisplatin/gemcitabine chemotherapy and immunotherapy, demonstrating tumor shrinkage on follow-up imaging. This case highlights the diagnostic challenges of SRCC due to its nonspecific symptoms and potential histological overlap with other metastatic gastrointestinal tumors. Early recognition and a multidisciplinary approach are critical for improving patient outcomes.

Spontaneous bladder rupture during vaginal delivery is a rare yet serious complication that requires prompt recognition and management to prevent life-threatening consequences. We report the case of a 32-year-old woman with a previous cesarean section who developed concurrent uterine and bladder rupture following vaginal delivery after labor induction, a highly unusual occurrence. The presence of hematuria right before delivery, which worsened postpartum, raised suspicion for a bladder injury. Diagnosis was confirmed intraoperatively through laparotomy. Timely surgical repair was performed, leading to a favorable outcome and full recovery.

Mixed epithelial and stromal tumor (MEST) of the kidney is a rare and distinctive neoplasm accounting for 0.2% of all renal tumors. The general treatment for MEST typically involves radical nephrectomy or partial nephrectomy. We report a rare case of MEST successfully treated with robot-assisted partial nephrectomy (RAPN), which, to our knowledge, represents the first documented instance of this approach. The patient is a 53-year-old woman with an incidental right renal tumor. The patient visited a primary care physician for chest pain. Computed tomography (CT) scan revealed a 3.5-cm lesion in the upper pole of the right kidney and was suspected of renal cell carcinoma. The patient was subsequently referred to the department and was admitted to our department for RAPN. We experienced the first case of RAPN performed for MEST of the kidney. Histopathological and immunohistochemical analyses confirmed the diagnosis of MEST. This case highlights the feasibility of robot-assisted laparoscopic surgery as a minimally invasive treatment option for MEST.

Background: Renal foreign bodies are rare clinical entities that may result from iatrogenic injury, ingestion, or trauma. They often present with nonspecific symptoms, making diagnosis challenging.

Case presentation: We report the case of a 42-year-old woman with right flank pain of 2 months and a surgical history of Burch colposuspension and laparoscopic cholecystectomy. Computed tomography revealed a 6-cm linear hyperdense object, representing a needle-like foreign body that penetrated the posterior cortex of the right kidney. She underwent successful transperitoneal laparoscopic retrieval, with an uneventful postoperative course and complete recovery.

Conclusion: This case underscores the importance of maintaining a high index of suspicion and supports minimally invasive retrieval as a safe and effective approach, yielding favorable clinical outcomes.

Purpose: Ureteral strictures are a well-documented pathology in urology, commonly resulting from congenital anomalies, iatrogenic injury, or other acquired conditions such as infection, trauma, or radiation. While ischemic and nonischemic strictures are recognized, bilateral idiopathic ureteral strictures remain rare, particularly when associated with systemic thrombotic microangiopathy. This case report describes a 25-year-old female with a history of IgA deficiency and atypical hemolytic uremic syndrome (aHUS), who developed bilateral ureteral strictures following envenomation by a brown recluse spider. The purpose of this report is to highlight an unusual cause of ureteral stricture formation, discuss its underlying pathophysiology, and evaluate long-term surgical outcomes, including the failure of a Yang-Monti neoureter and the subsequent necessity for left renal autotransplantation.

Results: The patient initially developed bilateral ureteral ischemia and subsequent stricture formation, requiring percutaneous nephrostomy tubes for urinary drainage. The left ureter exhibited an 8-9 cm occlusion, leading to the decision to perform a Yang-Monti neoureter using a jejunal interposition graft. Despite initial surgical success, the patient later presented with left-sided hydronephrosis and recurrent urinary tract infections, revealing complete stricture of the neoureter. After thorough evaluation, she underwent left renal autotransplantation with ureteral reimplantation. Postoperative outcomes were favorable, with stable renal function, although complicated by transient ileus. This case underscores the challenges of managing extensive ureteral stricture disease, particularly when secondary to systemic microangiopathic processes triggered by envenomation.

Conclusions: To our knowledge, this is the first documented case of long-segment ureteral stricture as a sequela of brown recluse spider envenomation. The venom's prothrombotic and endothelial-damaging effects likely contributed to progressive ischemic injury and fibrosis, leading to bilateral stricture formation. While the Yang-Monti technique provided temporary urinary diversion, its long-term viability was limited, necessitating a definitive solution via renal autotransplantation. This case highlights the need for increased awareness of envenomation-related ischemic complications, particularly in patients presenting with delayed-onset ureteral obstruction. Future research should further explore envenomation-induced microangiopathy and optimal surgical management strategies for complex ureteral stricture disease.

Background: Wunderlich syndrome (WS) is a rare phenomenon. It was first described by Carl Wunderlich in 1857 as a clinical picture of spontaneous renal bleeding with dissection of blood into either or both the subcapsular and perinephric spaces. Tumours, vascular malformations, coagulopathy and inflammatory states have been shown to be aetiological factors, yet up to 10% of cases remain idiopathic. WS is usually diagnosed on CT imaging due to the variable history and signs on examination which can mimic many other abdominal conditions. Management strategies include conservative treatment, embolisation and surgical nephrectomy.

Case presentation: A 37-year-old female presented to the emergency department with acute onset severe right flank pain after performing deadlift exercises in the gym. She collapsed on arrival. Clinical observations and blood results were indicative of haemorrhagic shock. Computed tomography (CT) with angiography demonstrated an acute right renal haemorrhage with active extravasation and the formation of a large perirenal haematoma. Blood products and vasopressors were administered to resuscitate the patient. Definitive management with embolisation was undertaken by the interventional radiology team.

Conclusion: WS is a rare diagnosis that should be considered in patients presenting with flank pain and evidence of haemorrhagic shock. Weightlifting can act as a trigger for this condition. Early recognition and intervention can enable successful resuscitation and definitive treatment with minimally invasive embolisation.

Objective: An incarcerated gravid uterus (IGU) is a rare condition that occurs when a retroverted gravid uterus becomes trapped between the sacral promontory and pubic symphysis. If untreated, IGU could have devastating consequences including uremia, renal failure, sepsis, peritonitis, uterine wall necrosis/rupture, and ultimately maternal and/or fetal death. Our objective is to provide education on the presentation, diagnosis, and management of a rare diagnosis to assist clinicians in better recognizing and treating IGU.

Methods: We present two cases of gravid females with acute urinary retention (AUR) in the setting of IGU. In this case series, we will discuss patient presentation, workup, and management of both IGU and AUR secondary to IGU.

Results: The first patient represents delayed recognition of IGU and a protracted clinical course resulting in increased morbidity. The second case represents heightened recognition of IGU and appropriate, timely management.

Conclusion: Prompt bladder decompression by urethral or suprapubic catheterization is the mainstay treatment for nearly all etiologies of AUR. In the case of AUR due to IGU, it is imperative to address bladder decompression prior to the reduction of IGU.

Langerhans cell histiocytosis (LCH) is a disease characterized by the excessive proliferation and abnormal differentiation of immune cells, including monocytes, T cells, and dendritic cells. The most affected organs are the bones, skin, lungs, liver, and spleen, while renal involvement is rare. LCH primarily affects children and is seldom diagnosed in adults. In this case report, we describe a 64-year-old man patient with no prior urological history nor history of LCH and presenting with both localized renal LCH and clear cell renal carcinoma (ccRCC). Renal cancer was first discovered fortuitously on an abdominal computed tomography (CT) scan while the patient presented symptoms of a complicated urinary tract infection. Following radical nephrectomy, LCH foci was detected as incidental histological finding within the ccRCC pathological analysis. Immunohistochemical staining confirmed the positivity of S-100 and CD1a markers and PCR analysis identified the BRAF^V600E mutation. Based on these findings, a diagnosis of ccRCC associated with LCH was established.

Background: Close to a quarter of men seek paternity after vasectomy. Microsurgical vasectomy reversal is a common choice for men seeking children after vasectomy, with outcomes dependent on surgical expertise and intraoperative decision-making. Here, we describe the case of a patient with an unexpectedly long vasal gap that necessitated the dissection of the tail and midbody of the epididymis from the testis during a vasoepididymostomy.

Case discussion: We report a case of a 31-year-old male who underwent vasectomy reversal that required a rare surgical approach. During the operation, we discovered a secondary distal obstruction and an additional proximal obstruction on the patient's left side, which resulted in a long vasal gap that did not permit a tension-free vasoepididymostomy. To bridge the long gap, the tail and midbody of the epididymis were carefully dissected and mobilized from the testis. Dissociation of the epididymis from the testis allowed a tension-free vasoepididymostomy. Postoperative semen analysis confirmed patency, and the patient had no concerns.

Conclusion: Dissection of the tail and midbody of the epididymis is discussed in textbooks, but is not readily documented in real-world patients. Here, we provide a case discussion where the dissection of the epididymis from the testis was successfully performed to gain additional length to bridge a long vasal gap.

Clinicians faced with common diagnoses such as pelvic pain or recurrent urinary tract infection (rUTI) may not consider less frequent etiologies, such as a delayed erosion of an intrauterine device (IUD). Given that modern IUDs are not approved for more than 10 years, early or midcareer clinicians unfamiliar with the earlier versions of these devices may not consider that a long-retained foreign object may be the source of symptoms in an older woman. We report a case of an IUD placed 50 years ago that eroded into the bladder, causing recurrent UTI and pelvic pain. Thankfully, minimally invasive laparoscopic techniques available now-to date unreported-enable surgical management while limiting morbidity, which is especially important in an elderly population.