Case Reports in Urology最新文献

We described two patients diagnosed with rare bladder metastasis (BM) from pancreatic adenocarcinoma, a prevalent neoplastic disease primarily associated with ductal adenocarcinoma. The overall prognosis for those patients with metastasis is very poor, with a 5-year survival rate of < 3%. The scarcity of cases in the literature makes this series a significant contribution as it presents the first documented instance of BM originating from pancreatobiliary ampullary cancer and a rare case associated with the Krukenberg tumor. Additionally, we extensively reviewed the literature on the infrequent metastasis of pancreatic cancer to the bladder and provided details of those nine previously reported cases. Given its unusual nature, this report highlights the importance of considering BM in patients with a history of pancreatic carcinoma who present with new-onset hematuria or upper tract obstruction, stressing the need for comprehensive evaluation and timely management.

Transperineal prostate biopsy is becoming a popular approach in the diagnosis of prostate cancer. Urethral bleeding and urinary retention are the most common complications. We report a case of intraperitoneal bleeding after transperineal prostate biopsy in a patient with history of focal therapy for prostate cancer. The patient presented with dizziness, abdominal pain, and tenderness a few hours after the procedure. A computed tomography (CT) scan showed intraperitoneal bleeding. He was managed conservatively without needing any interventions or blood transfusion. Intraperitoneal bleeding is a possible, rare, and unexpected complication after transperineal biopsy especially in smaller prostates with prior procedures and scarring.

Background: The penis is a relatively uncommon organ for metastases. Secondary lesions often originate from the bladder, prostate, or rectosigmoid cancers. Only a few cases have described penile lesions secondary to lung cancers, mostly as a later complication. Case Description: We hereby report the case of an 86-year-old male patient who presented with a 3-week-long nonpainful priapism. A penile Doppler ultrasound and a chest and abdominal CT scan were performed, showing a left hilar lung mass as well as lesions in the liver, the adrenal glands, the pancreas, bone structures, and the penis. Penile metastasis is associated with a poor prognosis because of the frequent disseminated malignant lesions in other sites. Conclusion: Malignant priapism should be suspected, especially in patients with no evident risk factors for priapism (hematological diseases, drugs, alcohol, neurological diseases, or metabolic disorders).

Erectile dysfunction (ED), the impairment of achieving and maintaining an erection for satisfactory sexual intercourse, is a common pathology that men experience for a variety of different factors. Conservative treatment for ED includes changing medications, lifestyle modifications, and psychotherapy. Pharmaceutical and nonsurgical interventions include phosphodiesterase-5 inhibitors(PDE-5i), intracavernosal medication injections, and vacuum devices. Surgical treatment options for ED have evolved over time and currently include the use of inflatable penile prosthesis (IPP) and malleable penile prosthesis. IPP insertion is usually met with good patient satisfaction. However, complications of device insertion can include corporal perforation, urethral injury, cylinder erosion or extrusion, infection, and mechanical failure, to name a few. Our patient presented with device malfunction and intraoperative assessment showed the IPP tubing twisted at the levels of the reservoir on the first operation and the level of the cylinder and scrotal pump on the second operation. The twisting of the tubing resulted in a nonfunctioning IPP as the fluid was unable to fill the cylinders resulting in an erection. The patient was managed with complete device explanation and reinsertion of a new three-piece IPP per the patient and partner's request. This is the first case report highlighting this specific complication, and we hope to provide clinicians with the resources to recognize this rare complication.

Crossed-fused renal ectopia (CFRE) is a rare congenital anomaly where both kidneys are fused on the same side. We report a case of a 52-year-old male patient who presented with central abdominal pain associated with hematuria and dysuria, with a history of left open ureterolithotomy. Abdominal computed tomography (CT) showed an 18-mm left distal ureteric stone and a CFRE with a bilateral duplex-collecting system. Left ureteroscopy and laser lithotripsy with magnetic double-J stent insertion were carried out successfully, and the patient was discharged on the same day in fair general condition.

We encountered a case of metastatic renal cell carcinoma in which the serum level of KL-6, a therapeutic marker, was exceptionally high and fluctuated with the progression of treatment. A 74-year-old man was diagnosed with right renal cystic cancer and multiple metastases in October 2022. The KL-6 level was 27490 U/mL. He started treatment with lenvatinib and pembrolizumab. KL-6 decreased to 3885 U/mg in February 2023. The patient's proteinuria worsened, leading to the discontinuation of lenvatinib. KL-6 increased to 25950 U/mL in April. He discontinued pembrolizumab and started taking cabozantinib. In September, drug-induced bilateral inflammatory pneumonitis developed. He discontinued cabozantinb and began taking axitinib. KL-6 decreased; however, he suffered from severe diarrhea and subsequent renal insufficiency. He discontinued axitinib in November. KL-6 increased to 29640 U/mL in December.

A 17-year-old patient with acute testicular pain had no blood flow observed on scrotal ultrasound Doppler on either side, suggestive of bilateral torsion. The patient underwent immediate scrotal surgical exploration, and a numerical anomaly was observed during surgery-there were two testicles on each side, and all four exhibited torsion. After detorsion, circulation was recovered, and three of four testicles were kept. One dystrophic testis was removed.

Acquired angioedema with low C1-inhibitor (AAE-C1-INH) is a rare disorder characterized by an acquired deficiency in the C1 esterase inhibitor (C1-INH). This case report describes a 79-year-old patient presenting to the emergency department for painless swelling of his scrotum, penile shaft, and left lower and upper extremities with lab values consistent with acquired angioedema without identifiable lymphoreticular or rheumatic disorder on history, exam, or total body PET scan. Proper diagnosis of AAE-C1-INH is essential to prevent life-threatening airway compromise, ensure proper therapy, and exclude lymphoreticular disorders as the etiology of AAE-C1-INH.

Acquired hemophilia A (AHA) is an acquired bleeding disorder caused by neutralizing antibodies (inhibitors) against Coagulation Factor VIII (FVIII:C), causing sudden hemorrhagic symptoms (i.e., subcutaneous bleeding, intramuscular bleeding, and hematuria). Herein, this study is aimed at presenting a case of AHA diagnosed based on hematuria and reviewing patients who were diagnosed with AHA due to hematuria. A 67-year-old woman was referred to Atsugi City Hospital with painless gross hematuria that began 4 weeks before presentation. Contrast-enhanced computed tomography (eCT) revealed an approximately 2 cm mass in the right renal pelvis, and the patient's activated partial thromboplastin time (APTT) was elevated (61.4 s). The day after the endoscopic biopsy, the patient was in shock due to a large retroperitoneal hematoma. Although her condition stabilized after intravenous radioembolization, she underwent emergency surgeries several times because of rebleeding within the next 3 weeks. At that time, APTT was more prolonged at 106.4 s, and the FVIII:C level was 2%. Mixing tests showed an upwardly convex curve after 2-h incubation, indicating the presence of an inhibitor. Factor VIII inhibitor titer was ≥5.1 Bethesda unit (BU)/mL. A combined product of Plasma-Derived Factors VIIa and X (pd-FVIIa/FX), as second-line hemostatic therapy, as well as cyclophosphamide (CYP), were administered after Recombinant Activated Factor VIIa (rFVIIa) had been ineffective. Following this, the Factor VIII inhibitor titer was undetectable, FVIII:C levels were restored, and APTT decreased to within the normal range. Gross hematuria was significantly alleviated. However, the patient died of cytomegalovirus and fungal infections due to prolonged immunosuppressive therapy. Although AHA diagnosed based on hematuria may have a better prognosis than others, there have been occasional cases with severe outcomes. APTT, detected upon initial hematological testing in patients with hematuria, may be a potential indicator of an existing AHA.

Penetrating posterior urethral trauma from gunshot wounds (GSW) is rare and requires prompt treatment to minimize complications. Data regarding the management of such cases is scarce in the literature and poorly addressed in the guidelines. Different management approaches exist, including urinary diversion with immediate versus delayed urethroplasty/fistula repair. We present our case series to add to our experience to the literature. Three patients aged 18-44 presented with ballistic posterior urethra injuries from GSW. Initial management involved urethral catheter placement, with one patient requiring operative placement of urethral and suprapubic catheters (SPTs). Complications included recurrent membranous stricture, urinary retention, rectourethral fistula, and erectile dysfunction (ED). Posterior urethral injuries from GSW are complex as they can be either isolated or affect adjacent organs. Bladder, ureteral, and urethral injuries must be ruled out. Unlike bladder neck injuries, immediate urethroplasty/fistula repair would be very challenging and not advised for standard prostatic or membranous injuries. Urethral catheter or suprapubic tube is recommended and can result in fistula closure and urethral patency. It is critical to maintain close follow-up with the patient due to the possibility of stricture recurrence. Urethroplasty in a delayed fashion can be very successful.