Case Reports in Urology最新文献

This case series presents four cases of extreme proximal internal corpus cavernosum (EPICC) penile fractures. Patients, aged 33-53, presented with penile trauma primarily during sexual intercourse, exhibiting atypical symptoms sparing the penis but with significant perineal and scrotal bruising. Diagnosis was confirmed via penile magnetic resonance imaging (MRI), revealing fractures at the penile base. All patients underwent surgical repair through a midline perineal incision, with no long-term complications reported. This series highlights the value of MRI for diagnosing atypical fractures and supports a perineal surgical approach for optimal exposure and repair in EPICC fractures.

Patient selection for focal therapy (FT) of prostate cancer requires the assessment of MRI and biopsy results. However, there is currently little guidance for the utility of PSMA PET/CT in FT planning. We describe the case of a man originally considered an ideal candidate for FT based on biopsy and MRI who was found to have a contralateral lesion-harboring cancer detected only on PSMA PET/CT. Trial Registration: ClinicalTrials.gov identifier: NCT05852041.

This case report presents a compelling instance of Wunderlich syndrome (WS), a rare and nontraumatic medical condition characterized by spontaneous renal hemorrhage into the subcapsular and perirenal spaces. WS poses unique diagnostic and management challenges due to its sudden and substantial hemorrhage presentation that is life-threatening, often accompanied by acute flank pain, hemodynamic instability, and the presence of a flank mass. While the exact pathogenesis remains debated, WS can arise from various renal pathologies, including neoplastic and nonneoplastic conditions. In this case, a 65-year-old male with a complex medical history, including polycystic kidney disease, presented to the emergency room with massive hematuria leading to an abrupt severe drop in hemoglobin levels and hemodynamic instability. Despite aggressive management, including transfusions, the patient ultimately underwent an urgent open left radical nephrectomy due to the severity of the condition and distorted anatomy. Additionally, the report draws attention to the potential use of tranexamic acid in WS cases, stressing the importance of balancing its benefits against associated risks. This case highlights the critical importance of recognizing and promptly addressing WS, highlighting the diverse etiology of this condition, the role of tranexamic acid in controlling bleeding, and the lifesaving role of nephrectomy in cases of significant bleeding and hemodynamic instability.

Background: Staghorn calculi are large renal stones which occupy most of the renal pelvis and are commonly associated with chronic or recurrent upper urinary tract infections (rUTIs). They often require more aggressive management, such as percutaneous nephrolithotomy (PCNL) or nephrectomy, although conservative management may be a safer option for select patients, particularly those with significant comorbidities. The presence of chronic stones or recurrent infections in the kidney increases the risk of complications, including fistula and abscess formation. Case Presentation: A 68-year-old female presented to the emergency department with signs of urosepsis. Computed tomography (CT) imaging revealed a left-sided staghorn calculus with concurrent smaller renal calculi. Due to worsening kidney function during hospitalization, repeat imaging was done, which revealed a staghorn calculus in the rectum. The staghorn calculus migrated to the colon through a renocolic fistula, and the patient subsequently passed the large staghorn through the rectum spontaneously. Conservative management was pursued due to her high surgical risk. Several months after discharge, she represented with signs of infection, and a large left-sided psoas abscess was identified. Conclusion: As the patient had severe comorbidities, our options to manage the staghorn calculi were very limited. She responded well to conservative management initially, but then was found to have another complication associated with the staghorn. It is acceptable to manage uncomplicated staghorn calculi conservatively in a small selection of patients, who are not good candidates for more invasive procedures, though in healthier and younger people, aggressive management is recommended to prevent further complications or deterioration. It is crucial to highlight the importance of early recognition and individualized treatment for renocolic fistulas, as timely intervention can significantly improve patient outcomes.

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.