Urology Case Reports最新文献

Background

Valveless trocars like AirSeal system are maintain a stable pneumoperitoneum and reduce instrument friction.

Case presentation

A 65-year-old man's robotic radical cystectomy was complicated by a missing needle while using AirSeal system. The needle was detected via backward inspection using the endo camera inserted through the trocar, tip at its most distal end let the visualization of the needle within the air channels and confirmed with a trocar X-ray.

Conclusion

Our findings suggest that retrograde inspection and targeted radiography of the trocar, prior to patient imaging, can be helpful in locating the lost needle and prevent prolongation of surgeries.

Renal infarction is a rare pathology, which can be life-threatening for the kidney. Its low incidence and non-specific clinical manifestations make it difficult to diagnose, often resulting in delayed or misdiagnosis. Contrast-enhanced CT has a role to play in early positive diagnosis, enabling rapid and effective management. We report the case of a right renal infarction simulating renal colic, with a review of the literature.

We present the case of a 64-year-old patient with metastatic renal cell carcinoma, who experienced disease progression despite undergoing multiple lines of systemic therapy, including immune checkpoint inhibitors (ICI). Two months after stereotactic radiosurgery to his brain lesions and while the patient was not on any systemic therapy, restaging scans demonstrated a dramatic near complete regression of the primary renal lesion and metastatic sites, which was attributed to the abscopal effect, mediated by the exposure to ICI and radiotherapy. While its mechanisms are not fully understood, it is believed to stem from the tumor immunosuppression and immunogenicity induced by radiation.

A primary seminal vesicle leiomyoma (PSVL) is a rare male genitourinary tract tumor. No previous reports have utilized a robotic-assisted laparoscopic posterior approach (RALPA) for surgical management. A 76-year-old man was incidentally found to have a 5cm lobulated mass posterior to the bladder in an abdominal/pelvic computed tomography scan. Biopsy confirmed leiomyoma. RALPA was utilized to excise the mass without complications. PSVLs are benign tumors with obstructive and minimal metastatic potential. Robotic-assisted surgery provides high fidelity, low risk, and an accelerated postoperative course compared to open surgery. The RALPA should be considered when surgical excision of PSVLs is required.

Ureteral metastasis of prostate cancer is extremely rare, with less than 50 cases at present. Kidney cancer with prostate cancer is also rare, and ureteral metastasis with prostate cancer is difficult to diagnose. Especially if there are no symptoms of hematuria, the ureteral mass should be clearly understood. Although there is no error in the diagnosis and treatment process in this case, there are still many points worth considering, such as whether unilateral nephroperectomy should be performed if there is no kidney cancerHere, we report a case of renal cancer complicated with prostate cancer and ureteral metastasis.

We present the case of a 75 year old transgender woman 18 months post gender-affirming vaginoplasty found to have unfavorable, intermediate risk prostate cancer. She elected a robotic radical prostatectomy with bilateral pelvic lymph node dissection. Postoperatively, the patient resumed neovaginal dilation without difficulty, and had improvements on International Prostate Symptom Score when compared to post-vaginoplasty, pre-prostatectomy. Incontinence measured by Revised Urinary Incontinence Scale remained mild. Robotic prostatectomy can, under appropriate circumstances, allow preservation of the neovaginal vault, but requires considerable experience and multidisciplinary intraoperative collaboration.

Ureteral endometriosis accounts for about 5 % of urologic endometriosis, with a peak incidence in the age group of 30–35 years, usually with unilateral onset. Because of its insidious onset, often combined with asymptomatic loss of renal function, and the ineffectiveness of medications, surgery is the gold standard of treatment.Thus, here we report a case of ureteral endometriosis with severe hydronephrosis to raise awareness of this condition.

Fournier's gangrene is a life-threatening fascial infection. We report a case of a 65-year-old diabetic man with a history of obstructive prostate growth who developed ischemic penile gangrene following traumatic transurethral catheterization. Despite initial debridement, progressive necrosis necessitated total penectomy and cystostomy. This case highlights the potential for devastating consequences of failed catheterization and the importance of early urologic intervention.

Prostate cancer rarely metastasizes to the stomach and kidneys. We report a 73-year-old male with such spread, highlighting significant clinical challenges. Initially diagnosed via biopsy and imaging, he received hormone therapy and cytoreductive radical prostatectomy. Despite initial management, the cancer progressed to metastatic castration-resistant prostate cancer, with gastric and renal metastases confirmed by imaging and biopsy. This case emphasizes the need for awareness of rare metastatic sites, comprehensive diagnostic evaluations, and further research into these atypical metastases to improve patient outcomes and develop better treatment strategies for managing advanced prostate cancer effectively.

Zinner Syndrome (ZS) is a rare congenital genitourinary abnormality defined by seminal vesicle cysts, ejaculatory duct obstruction, and unilateral renal dysplasia or agenesis. Patients can be asymptomatic, while others experience pain, urinary or ejaculatory symptoms and infertility. A patient that presented with painless gross hematuria was found to have a large pelvic cystic structure, an absent left kidney, multiple fluid collections in the region of the left seminal vesicle and right hydronephrosis. Hydronephrosis is atypical in ZS. This patient eventually developed right flank and pelvic pain treated with robotic-assisted laparoscopic excision of the pelvic cystic structure and extravesical ureteral reimplantation.