Case Reports in Urology最新文献

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.

Prostate cancer (PCa) is the most commonly diagnosed cancer in Australia with almost 25,000 cases being diagnosed each year. Treatment for PCa varies depending on stage, patient preferences and the general health of the patient. PCa most commonly spreads to lymph nodes and bones. We present a case of a 66-year-old male who presented with PSA elevation post salvage radiation and was diagnosed with oligometastatic PCa to the right testis. This patient subsequently underwent a right orchidectomy resulting in a rapid fall in PSA.

Background and aim: Postpartum urinary retention (PUR) is a well-recognized complication of childbirth. The prolonged duration and exceptionally large residual bladder volume of 4000 mL observed in this case, despite the patient's report of spontaneous voiding on the first postpartum day, is rare.

Case report: A 21-year-old primiparous woman presented on Postpartum Day 16 with abdominal distension. She reported no urinary symptoms. Her condition had previously been misattributed to postpartum infection during an earlier admission. She was diagnosed with covert PUR, and catheterization drained 4000 mL of urine. However, after 4 days of catheterization, the patient remained unable to void spontaneously. She was then managed with clean intermittent catheterization (CIC) for 2 weeks, and urinary tract function gradually recovered.

Conclusion: This case report stands out due to the extraordinary bladder volume and protracted course, providing a unique perspective on the spectrum of PUR severity. While routine postpartum discharge protocols rely on spontaneous voiding, this case emphasizes the importance of thorough subjective assessment of lower urinary tract symptoms (LUTSs) for early recognition of PUR to prevent such extreme presentations.

Introduction: Sporotrichosis is an endemic fungal infection in Brazil, caused by a dimorphic fungus of the genus Sporothrix. Transmission occurs through traumatic inoculation from soil, contaminated plants, and zoonotic sources, mainly from cats, as well as through inhalation of conidia. It commonly presents as localized, lymphocutaneous, disseminated, or systemic forms. The testicles are among the organs that can be affected, often manifesting as a testicular mass. This work is aimed at analyzing a clinical case along with a bibliographic review on the testicular involvement of sporotrichosis.

Case report: A 35-year-old male with positive HIV serology and a history of psychoactive substance use presented with disseminated ulcerated lesions that progressed over 1 month, with a positive blood culture for sporotrichosis. Upon hospitalization, a painless lump in the right testicle was diagnosed upon palpation and peripheral vascularization. An orchiectomy was performed, and anatomopathological analysis revealed the presence of Sporothrix.

Discussion: Few reports on testicular sporotrichosis were found in the literature. Systemic forms are rare and are often associated with immunosuppression, particularly in cases of HIV and chronic alcoholism. This immunosuppression can favor the prevalence and dissemination of the fungus. The fungus also produces melanin, which aids in evading the immune system. The gold standard for diagnosis is culture. Furthermore, the treatment of choice is prolonged therapy with Amphotericin B, followed by itraconazole.

Conclusion: Given the suspicion of disseminated sporotrichosis and the presence of a testicular nodule, the possibility of testicular sporotrichosis should be evaluated while maintaining attention to the differential diagnosis for neoplasia.

Secondary malignancy of the penis is a rare clinical entity. Nearly three-quarters of metastatic lesions in the penis originate from genitourinary and pelvic organs (such as the bladder, prostate, and colon). Less than 25% of penile metastases arise from extrapelvic primary sites and are usually associated with disseminated disease. Fewer than 50 cases of renal cancer metastasis to the penis have been described in the literature to date. We present the case of a 47-year-old male patient with a single metastasis of papillary renal cell carcinoma (pRCC) in the left corpus cavernosum. The patient had a history of left radical nephrectomy in 2004 and two lung wedge resections for unique metastases in 2007 and 2009. The patient complained of a growing, painless mass at the base of his penis. No other sites of metastasis were identified at staging. We performed a complete excision of the mass, and the final histopathological report confirmed the metastasis of pRCC with negative surgical margins. The patient remains treatment-free 8 years later.

Juxtaglomerular cell tumors (JCTs), also known as reninomas, are rare masses with an extremely low risk of malignancy, but their endocrine activity can lead to medication-resistant hypertension and electrolyte imbalances, which may harm patients. Approximately 150 cases have been documented in the literature. In this report, we describe the case of a 40-year-old male with a complex cystic renal mass, prior hemorrhagic strokes, and hypertension who underwent surgical resection. The final pathology confirmed a JCT, marking the first case on record diagnosed at our institution in 20 years. Following surgery, the patient's hypertension improved, and his need for medication decreased. We suggest that physicians managing renal masses that are otherwise suitable for surveillance should include JCT in their differential diagnosis and consider surgical removal if hypertension is present.

Polyorchidism, or supernumerary testes (SNTs), is a rare congenital condition, management of which remains debated, particularly in paediatric cases with other concomitant features. We report a case of intrascrotal polyorchidism in a 14-year-old boy managed surgically due to parental preference and the need for histological confirmation. The patient presented with a 2-week history of painless heaviness in the scrotum. Physical examination and Doppler ultrasonography revealed a 1.8 cm mass fused to the inferior pole of the left testicle with associated Grade 1 varicocele, hydrocele and testicular appendix. Although MRI of the scrotum was initially offered, the family declined in favour of timely histological confirmation. Surgical exploration confirmed a fused supernumerary testicle and a biopsy showed normal spermatogenesis; this was consistent with Type A3 triorchidism. The patient had no complications or recurrence of symptoms at 12-month follow-up. This case highlights the use of surgical exploration in selected intrascrotal polyorchidism cases where imaging can be inconclusive or histological confirmation is required. Parental concerns and long-term reassurance may also reasonably influence management decisions.