Case Reports in Urology最新文献

Background: Ureteric small bowel fistulas are rare entities, with limited reports in the literature. These pathological connections between the ureter and small bowel can lead to recurrent upper urinary tract infections and pose significant diagnostic and therapeutic challenges. The primary cause of ureteric small bowel fistula formation is iatrogenic intervention, such as percutaneous nephrolithotomy (PCNL) or abdominal surgery involving tissue resection. However, they can also arise spontaneously due to local chronic inflammation and infection. Given their rarity, there is no standardised management pathway, and the treatment approach should be individualised. Case Presentation: We present the case of a 57-year-old man presenting with a history of extensive locally advanced distal sigmoid carcinoma, managed with Hartmann's procedure with end colostomy followed by adjuvant radiotherapy and chemotherapy. He later developed a mid-ureteric small bowel fistula, presenting with urosepsis, a high-output stoma, deteriorating renal function and severe metabolic acidosis. Conservative management with regular ureteric stent exchanges every 3-4 months has successfully preserved renal function and improved his quality of life. Surgical closure was not pursued due to high operative risk, and repeat imaging has shown no evidence of persisting fistula, suggesting possible spontaneous closure. Conclusion: The treatment options for this ureteric small bowel fistula were limited. A lifelong nephrostomy was deemed unsuitable due to incompatibility with the patient's profession, and surgical intervention was associated with significant complexity due to the patient's history of malignancy and radiotherapy-related tissue changes. Therefore, a conservative strategy involving serial ureteric stent exchanges was pursued. Early recognition and individualised treatment of ureteric-enteric fistulas are essential, as timely intervention can significantly enhance prognosis and quality of life.

Malignant priapism secondary to a genitourinary malignancy is a rare and late-stage oncological finding. A 72-year-old man with a past medical history of muscle-invasive bladder cancer treated with trimodal therapy presented with altered mental status, white discharge from his Foley catheter, and bilateral corporal rigidity. Initial pelvic magnetic resonance imaging demonstrated engorgement of the corporal bodies without obvious tumor invasion. The patient eventually underwent penile exploration and bilateral decompression, and a biopsy revealed high-grade urothelial carcinoma invading the corporal tissues. Despite current guidelines for priapism, we present a three-tiered approach to the management of malignant priapism.

Objective: Spontaneous intravesical knotting is a highly infrequent complication of urinary catheters. We present a novel endoscopic treatment approach to managing a spontaneously knotted urinary catheter around a ureteric stent. Subject: A 79-year-old man presented to the Emergency department with confusion and acute renal failure. His background was significant for metastatic castrate-resistant prostate cancer. His associated obstructive uropathy was managed with a long-term right 7-Fr Rüsch ureteric stent, last changed 1 month prior and a long-term 18-Fr indwelling catheter. A CT intravenous pyelogram clearly demonstrated his indwelling catheter knotted around and through the distal intravesical portion of an appropriately positioned right ureteric stent. Results: Following decompression of the left kidney via percutaneous nephrostomy, attempts were made to remove the urinary catheter under fluoroscopy with a variety of wires and introducers. The patient then underwent a general anesthesia, and the knot was successfully removed piecemeal with a Mauermayer stone crusher via 25-Fr access sheath. Conclusion: Endoscopic techniques such as the use of a stone crusher may be beneficial for the removal of difficult and complex catheter knots as demonstrated in this case. Catheter knotting should always be considered if the functioning or attempted removal of the catheter is abnormal and timely referral to a urologist is made.

The COVID-19 pandemic affected millions worldwide. While mainly regarded as a respiratory process, there may be both direct and indirect urologic consequences that are sparsely discussed. This case report describes a patient with a severe COVID-19 infection resulting in a kidney and liver transplant. After recovery, the patient was found to have de novo erectile dysfunction and Peyronie's disease. We suspect the systemic inflammation and vasculopathy leading to liver and renal failure also caused severe atherosclerotic erectile dysfunction. Furthermore, the prone positioning likely represents an iatrogenic etiology of Peyronie's disease. This unique case demonstrates some important considerations from a men's health perspective when caring for patients following a severe COVID-19 infection.

Duplex renal collecting system is a relatively common congenital abnormality affecting equally both pelvicalyceal systems. Although usually it is an incidental finding, it can cause significant problems to the patients such as recurrent urinary tract infections, hydronephrosis, and lithiasis. In this study, we describe an interesting surgical management option for a patient with upper moiety hydronephrosis and lithiasis of the aberrant ureter, achieving resolution of the hydronephrosis and complete removal of the calculus. A 49-year-old female patient presented with symptoms of left colicky pain. During the initial investigation, a left-sided duplex renal collecting system with severely hydronephrotic upper pole moiety and grossly dilated tortuous ureter with distal calculus and ectopic insertion to urinary bladder was identified. On cystoscopy, the upper moiety ureteric opening was identified distally to the urethral sphincter. Under ultrasound guidance, endoscopic transvesical resection was performed distal to the stented lower moiety ureteric orifice, resulting in the identification of the stone and extraction. Short- and long-term follow-up demonstrated no recurrence of the stone and significant resolution of the hydronephrosis. In conclusion, in this case report, we describe an unusual anatomical variation of the upper moiety outflow, and we introduce a new technique of intravesical ultrasound-guided removal of an obstructive calculus.

Background: Secondary penile cancer, despite the region's rich vascularization, is a rare phenomenon with only around 500 cases ever reported, typically of genitourinary origin and in even rarer cases, of colorectal adenocarcinoma. Unfortunately, the underlying mechanisms are not well elucidated, and prognosis remains poor with a late onset and median overall survival of 9 months for colon adenocarcinoma. Secondary penile cancer often presents alongside concurrent metastases months or years following successful treatment of the primary tumor. However, we report a case of an isolated penile metastasis as the presenting symptom of colon adenocarcinoma with no identifiable primary lesion or history of malignancy. Case Summary: A 67-year-old African-American male presented with a 1-month history of voiding symptoms, whereupon follow-up revealed a penile mass near the left base of the penis. Postoperative histopathological, immunohistochemical, and genomic analyses revealed characteristics of invasive and metastatic colorectal adenocarcinoma. Initial diagnostic testing revealed elevations in serum tumor markers CA 19-9 and carcinoembryonic antigen, while whole body PET/CT scan and colonoscopy failed to identify any tumorigenic lesions or primary colorectal malignancy. Although hypermetabolic activity was noted near the base of the penis and bilateral inguinal lymph nodes, the patient is currently on chemotherapy with a modified FOLFOX-6 regimen with active surveillance and no adverse effects. Conclusion: Here, we report a rare case of isolated penile metastasis as the first presentation of colon adenocarcinoma with no primary lesion. Regardless of origin, secondary penile cancer is a rare phenomenon with a poor prognosis. While the exact mechanism of spread is uncertain, the most probable mode of dissemination is through venous networks. There is also no standard of treatment relying on surgical, therapeutic, and palliative management. Although unclear, our unique presentation may portend a more favorable prognosis with continued treatment and observation.

Urologists are commonly referred patients with retroperitoneal lesions and masses arising from or involving the kidney. In this case, the patient had a retroperitoneal mass identified on imaging which was initially concerning for a cystic renal neoplasm, but it was clearly distinct from all surrounding structures. Pathology found the very uncommon and unexpected diagnosis of a mucinous cystic neoplasm (MCN) with ovarian-type stroma suspected to have arisen from the pancreas. MCNs are lesions that most commonly arise in the ovaries, but less often can arise in extraovarian tissues. Of these extraovarian MCNs, primary retroperitoneal MCNs are exceedingly rare masses with some similarity to their pancreatic and ovarian counterparts. We present a case of an MCN found in the retroperitoneum and initially mistaken for a cystic renal mass, with histological markers and a concomitant pancreatic cyst that suggests possible pancreatic origin. Interestingly, no literature has described pancreatic MCNs without invasive features that have been found in the retroperitoneum without any formal tissue connection to the pancreas. The pathogenesis of retroperitoneal MCNs is still unknown, and as a result, the optimal treatment strategy is unclear.

Abdominoplasty is a frequently performed elective procedure, often indicated for patients after substantial weight loss resulting in significant redundant skin. Closing techniques and the lifting of the mons pubis during abdominoplasty have been proposed to alleviate symptoms of stress urinary incontinence by elevating and supporting the urethra. Despite these observations, the impact of abdominoplasty on pelvic anatomy and subsequent endoscopic procedures remains underexplored and underreported. We present a case where cystoscope passage as part of endoscopic laser lithotripsy for nephrolithiasis was impeded by altered anatomy in a patient with a history of Fleur-de-Lis abdominoplasty.

Urosepsis, a severe infection originating from the urinary tract, can be life-threatening. We present the case of a 56-year-old female who developed urosepsis twice within 15 days, each episode occurring shortly after stent removal. Ureteroscopy with stent placement was initially performed to treat a 12-mm stone in the distal left ureter. Although the stent was removed only after imaging showed no residual stones, sepsis developed shortly after, leading to another ureteroscopy and stent placement. Before the removal of the second stent, imaging again confirmed no stones were present, yet she experienced sepsis once more following the second stent removal. Further imaging studies during hospital admission for both episodes of sepsis revealed stone fragments and hydronephrosis which were missed during office evaluations. This case highlights the need for more effective imaging techniques to detect residual stones. The decision to place a stent after ureteroscopy for ureteral stone treatment should also be carefully considered, even for low-risk patients, to reduce infection risk.

Background: The self-insertion of superglue into the male urethra is an uncommon and challenging cause of urethral obstruction, with only five reported cases to date. These cases demonstrate diverse clinical presentations and treatment approaches. This report presents the sixth documented case, reviews the existing literature, and proposes a structured treatment approach for superglue-induced urethral obstruction. Case Presentation: A 51-year-old male instilled superglue into his urethra to secure a pintail comb inserted for self-stimulation. Upon forcefully removing the comb, hardened superglue fragments remained stuck in the urethra, causing urinary retention. Endoscopic extraction using rigid cystoscopy and forceps under local anesthesia successfully removed all fragments from the penile urethra and bladder. Conclusion: Early endoscopic extraction using rigid cystoscopy under local anesthesia represents a safe and effective treatment option for nonadherent superglue fragments in the urethra.