Case Reports in Urology最新文献

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.

Ureteric duplication is a variation of the urinary tract which can have significant impact in the urologic reconstructive setting. We present the incidental diagnosis and management of a 68-year-old man who was found to have a double ureter in the context of a radical cystectomy.

Primary signet ring cell carcinoma of the urinary bladder (PSRCCB) is an exceedingly rare subtype of urinary bladder carcinoma, comprising 0.12%-0.6% of cases, with a poor prognosis. This case report details a distinctive case of a 32-year-old woman with PSRCCB, presenting without typical risk factors and posing diagnostic and therapeutic challenges. Initial symptoms included urinary tract infection and lower abdominal pain. Imaging and histological assessments identified a mucinous adenocarcinoma with signet ring cell components. The patient underwent curative open partial cystectomy, given her young age and localized tumor, avoiding lymphadenectomy and adjuvant chemotherapy due to complete tumor resection and absence of metastases. Postoperative follow-up showed no pathological findings, underscoring the importance of individualized treatment strategies in rare cancer cases. This case contributes to the limited data on PSRCCB and its management.

Urofacial syndrome (UFS) is a rare autosomal recessive disorder characterized by voiding dysfunction, inverted facial expressions when smiling, and potential mutations in LRIG2 or HPSE2 genes. We report two sisters diagnosed with UFS who were managed using sacral neuromodulation (SNM). The first, aged 24, had recurrent UTIs, chronic urinary retention, and a trabeculated bladder without vesicoureteral reflux (VUR). Genetic testing identified a homozygous LRIG2 variant. Following SNM, her voiding function improved, reducing the frequency of catheterization. The second patient, aged 27, presented with a Grade 5 left-sided VUR, severe hydronephrosis, and a nonfunctioning left kidney. Urodynamic studies revealed an acontractile bladder. Post-SNM, her postvoid residual decreased to 30 mL, allowing independent voiding. Both displayed the hallmark inverted facial grimace. Diagnostic imaging and urodynamics confirmed neurogenic bladder, excluding spinal anomalies. Management included clean intermittent catheterization (CIC) and SNM, which enhanced bladder emptying and reduced catheter dependence. This case highlights SNM as a promising therapeutic option in UFS, improving voiding efficiency and quality of life. Early recognition of the distinctive facial expression is critical to prevent upper tract damage. Urologists should suspect UFS in patients with voiding dysfunction and abnormal facial expressions, considering SNM as a viable intervention. Further studies on SNM's role in UFS are warranted.

Collagenase Clostridium histolyticum (CCH) injections are the gold standard for nonsurgical management of Peyronie's disease. While generally well tolerated, penis fracture is a known complication. Cases typically occur during intercourse in the weeks following treatment. Because of this, patients are advised to abstain from sexual activity for 4 weeks postinjection. Here, we present a case of corporal rupture occurring 32 days after treatment. This is only the third reported case occurring 30 days after injection. While the risk of penis fracture likely decreases with time, these cases illustrate that the risk may extend beyond 4 weeks.