Kyle R. Joseph, Parul Garg, Romanthi Madawala, Bushra Othman, Femi E. Ayeni, Ewan MacDermid
Introduction
Colovesical fistula is a recognized complication of diverticulitis, but progression to testicular ischaemia is, to our knowledge, an unreported phenomenon. While colovesical fistulas occur in diverticular disease, the spread of infection to the testes is rare.
Case Presentation
A 47-year-old male with recurrent diverticulitis presented with abdominal pain and was found to have a pelvic abscess. Despite conservative management, the patient developed pneumaturia, dysuria, and right testicular pain. Preoperative scrotal ultrasonography with color Doppler demonstrated globally reduced but present intratesticular arterial flow; a decision was made to prioritize definitive source control of the colovesical fistula with laparoscopic anterior resection and defunctioning ileostomy. Repeat Doppler on Day 7 demonstrated complete absence of arterial flow to the right testis, necessitating orchiectomy for inflammatory necrosis.
Conclusion
We report what is, to our knowledge, the first documented case. This case highlights the need for vigilance for genitourinary symptoms in diverticulitis. Prompt recognition is vital to prevent irreversible testicular loss.
{"title":"Testicular Ischaemia Following Diverticulitis Complicated by Colovesical Fistula: A Case Report","authors":"Kyle R. Joseph, Parul Garg, Romanthi Madawala, Bushra Othman, Femi E. Ayeni, Ewan MacDermid","doi":"10.1002/iju5.70143","DOIUrl":"10.1002/iju5.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Colovesical fistula is a recognized complication of diverticulitis, but progression to testicular ischaemia is, to our knowledge, an unreported phenomenon. While colovesical fistulas occur in diverticular disease, the spread of infection to the testes is rare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 47-year-old male with recurrent diverticulitis presented with abdominal pain and was found to have a pelvic abscess. Despite conservative management, the patient developed pneumaturia, dysuria, and right testicular pain. Preoperative scrotal ultrasonography with color Doppler demonstrated globally reduced but present intratesticular arterial flow; a decision was made to prioritize definitive source control of the colovesical fistula with laparoscopic anterior resection and defunctioning ileostomy. Repeat Doppler on Day 7 demonstrated complete absence of arterial flow to the right testis, necessitating orchiectomy for inflammatory necrosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We report what is, to our knowledge, the first documented case. This case highlights the need for vigilance for genitourinary symptoms in diverticulitis. Prompt recognition is vital to prevent irreversible testicular loss.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12826882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Humoral hypercalcemia of malignancy (HCM) caused by parathyroid hormone–related peptide (PTHrP) is a common paraneoplastic syndrome, and renal cell carcinoma (RCC) is one of the main causes. However, initial presentation with rapidly progressive cognitive decline is rare.
Case Presentation
A 68-year-old woman was presented with a rapidly progressive cognitive impairment. Laboratory tests revealed severe hypercalcemia with elevated PTHrP and suppressed parathyroid hormone levels. Thoracoabdominal computed tomography revealed an 8-cm left renal mass, which was pathologically diagnosed as a sarcomatoid RCC. She underwent left radical nephrectomy, after which serum calcium normalized and cognitive function improved markedly (Hasegawa Dementia Scale-Revised score 7→28).
Conclusion
This case demonstrates that an unexplained cognitive decline may be the first sign of PTHrP-producing RCC. Checking serum calcium levels is essential, and surgical removal of the tumor can reverse both metabolic and neurological symptoms.
{"title":"PTHrP-Producing Renal Cell Carcinoma Presenting as Rapidly Progressive Cognitive Impairment: A Case Report","authors":"Fumiakira Yano, Norifumi Sawada, Norikazu Tanaka, Koshiro Hikawa, Keiichiro Hirose, Yuko Ohtake, Takahiko Mitsui","doi":"10.1002/iju5.70142","DOIUrl":"10.1002/iju5.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Humoral hypercalcemia of malignancy (HCM) caused by parathyroid hormone–related peptide (PTHrP) is a common paraneoplastic syndrome, and renal cell carcinoma (RCC) is one of the main causes. However, initial presentation with rapidly progressive cognitive decline is rare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 68-year-old woman was presented with a rapidly progressive cognitive impairment. Laboratory tests revealed severe hypercalcemia with elevated PTHrP and suppressed parathyroid hormone levels. Thoracoabdominal computed tomography revealed an 8-cm left renal mass, which was pathologically diagnosed as a sarcomatoid RCC. She underwent left radical nephrectomy, after which serum calcium normalized and cognitive function improved markedly (Hasegawa Dementia Scale-Revised score 7→28).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case demonstrates that an unexplained cognitive decline may be the first sign of PTHrP-producing RCC. Checking serum calcium levels is essential, and surgical removal of the tumor can reverse both metabolic and neurological symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The incidence of renal complication following BCG treatment is rare. Few previous studies have reported a solitary renal granuloma distinct from the renal pelvis following BCG treatment.
Case Presentation
An 85-year-old male underwent transurethral resection of the bladder tumor. A 6-week induction of intravesical BCG instillation therapy was planned; however, the sixth instillation was canceled owing to fever. Regular follow-up revealed no recurrence. However, 4 years later, CT revealed a right renal mass. With a clinical diagnosis of renal cell carcinoma, robot-assisted partial nephrectomy was performed. The pathological diagnosis was epithelioid cell granuloma with caseating necrosis. Stress cystography revealed no vesicoureteral reflux.
Conclusion
A renal granuloma caused by BCG is one of the differential diagnoses for solitary renal mass following BCG treatment, even if the mass is not adjacent to the renal pelvis.
{"title":"Renal Granuloma Distinct From the Renal Pelvis Following Bacillus Calmette–Guérin Treatment for Bladder Cancer: A Case Report","authors":"Ryuji Oka, Yusuke Goto, Kosuke Mikami, Hiroto Kato, Ken Wakai, Kyokushin Hou, Kazuhiro Araki, Takashi Fujino, Kazuto Yamazaki, Yukio Naya","doi":"10.1002/iju5.70141","DOIUrl":"10.1002/iju5.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The incidence of renal complication following BCG treatment is rare. Few previous studies have reported a solitary renal granuloma distinct from the renal pelvis following BCG treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 85-year-old male underwent transurethral resection of the bladder tumor. A 6-week induction of intravesical BCG instillation therapy was planned; however, the sixth instillation was canceled owing to fever. Regular follow-up revealed no recurrence. However, 4 years later, CT revealed a right renal mass. With a clinical diagnosis of renal cell carcinoma, robot-assisted partial nephrectomy was performed. The pathological diagnosis was epithelioid cell granuloma with caseating necrosis. Stress cystography revealed no vesicoureteral reflux.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A renal granuloma caused by BCG is one of the differential diagnoses for solitary renal mass following BCG treatment, even if the mass is not adjacent to the renal pelvis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kaoru Ito, Ko Kobayashi, Kohei Hashimoto, Wakako Yorozuya, Ko Okabe, Seisuke Nofuji, Yasuyuki Sakai, Yuki Kyoda, Toshiaki Tanaka, Noaya Masumori
Introduction
Postorgasmic illness syndrome is a rare condition occurring after ejaculation. This syndrome can significantly affect the quality of life of patients.
Case Presentation
A 17-year-old boy suffered from annoying fatigue, headache, photophobia and the sensation of a flu-like state. He did not know the trigger of these symptoms. He visited a psychiatry clinic where he was diagnosed with depression. Although he received administration of selective serotonin reuptake inhibitors, his symptoms continued. Then he noticed that his symptoms occurred after ejaculation by masturbation or wet dreams. He visited our outpatient clinic when he was 19 years old. We administered desloratadine. One month later the general malaise after ejaculation improved. Thereafter, all symptoms after ejaculation disappeared.
Conclusions
A Japanese teenager suffering from postorgasmic illness syndrome was successfully treated with desloratadine. We believe that our experience will contribute to elucidating and treating this condition in the future.
{"title":"Administration of Desloratadine for Postorgasmic Illness Syndrome in a Japanese Teenager","authors":"Kaoru Ito, Ko Kobayashi, Kohei Hashimoto, Wakako Yorozuya, Ko Okabe, Seisuke Nofuji, Yasuyuki Sakai, Yuki Kyoda, Toshiaki Tanaka, Noaya Masumori","doi":"10.1002/iju5.70128","DOIUrl":"10.1002/iju5.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Postorgasmic illness syndrome is a rare condition occurring after ejaculation. This syndrome can significantly affect the quality of life of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 17-year-old boy suffered from annoying fatigue, headache, photophobia and the sensation of a flu-like state. He did not know the trigger of these symptoms. He visited a psychiatry clinic where he was diagnosed with depression. Although he received administration of selective serotonin reuptake inhibitors, his symptoms continued. Then he noticed that his symptoms occurred after ejaculation by masturbation or wet dreams. He visited our outpatient clinic when he was 19 years old. We administered desloratadine. One month later the general malaise after ejaculation improved. Thereafter, all symptoms after ejaculation disappeared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A Japanese teenager suffering from postorgasmic illness syndrome was successfully treated with desloratadine. We believe that our experience will contribute to elucidating and treating this condition in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fumihiro Ito, Koki Kobayashi, Gaku Hayashi, Shunsuke Kamijo, Takashi Fujita
Introduction
Direct liver invasion by renal cell carcinoma (RCC) is rare and often precludes margin-negative resection. Herein, we report a case where neoadjuvant treatment with avelumab plus axitinib downstaged the disease, enabling complete surgical resection.
Case Presentation
A 67-year-old woman presented with gross hematuria. Computed tomography revealed a 70-mm right renal mass with direct liver invasion. Core biopsy confirmed clear-cell RCC and clinical stage cT4N0M0. She received ten cycles of avelumab (10 mg/kg, biweekly) plus axitinib (10 mg/day), resulting in tumor shrinkage to 35 mm. She underwent open radical nephrectomy with partial hepatectomy, achieving negative surgical margins. Histological examination revealed hepatic parenchymal invasion, with no viable tumor at the inked hepatic margin. Adjuvant therapy was not administered. The patient has remained disease-free for 24 months.
Conclusion
In select cases of organ-invasive non-metastatic RCC, short-term neoadjuvant therapy with avelumab plus axitinib may allow for complete resection and prolonged disease control.
{"title":"Neoadjuvant Avelumab Plus Axitinib Enabling Curative Resection of Renal Cell Carcinoma With Direct Liver Invasion: A Case Report","authors":"Fumihiro Ito, Koki Kobayashi, Gaku Hayashi, Shunsuke Kamijo, Takashi Fujita","doi":"10.1002/iju5.70124","DOIUrl":"10.1002/iju5.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Direct liver invasion by renal cell carcinoma (RCC) is rare and often precludes margin-negative resection. Herein, we report a case where neoadjuvant treatment with avelumab plus axitinib downstaged the disease, enabling complete surgical resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 67-year-old woman presented with gross hematuria. Computed tomography revealed a 70-mm right renal mass with direct liver invasion. Core biopsy confirmed clear-cell RCC and clinical stage cT4N0M0. She received ten cycles of avelumab (10 mg/kg, biweekly) plus axitinib (10 mg/day), resulting in tumor shrinkage to 35 mm. She underwent open radical nephrectomy with partial hepatectomy, achieving negative surgical margins. Histological examination revealed hepatic parenchymal invasion, with no viable tumor at the inked hepatic margin. Adjuvant therapy was not administered. The patient has remained disease-free for 24 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In select cases of organ-invasive non-metastatic RCC, short-term neoadjuvant therapy with avelumab plus axitinib may allow for complete resection and prolonged disease control.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12782775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Multiple cranial neuropathy is a rare manifestation of immune-related adverse events. To date, no cases have been reported during immune checkpoint blockade for metastatic renal cell carcinoma. This report describes a case of multiple cranial neuropathy that developed during lenvatinib and pembrolizumab combination therapy.
Case Presentation
A 66-year-old man with metastatic clear cell renal cell carcinoma involving the maxilla received lenvatinib and pembrolizumab. After two months, he developed a rash and facial nerve palsy that resolved with corticosteroids. Pembrolizumab rechallenge later caused diplopia due to multiple cranial neuropathies, which improved after steroid pulse therapy. Two years after treatment initiation, disease control and pembrolizumab maintenance have continued without neurological recurrence.
Conclusions
We report a rare case of multiple cranial nerve palsies that developed during lenvatinib–pembrolizumab therapy. Such neuropathies typically occur early, respond to corticosteroids, and require careful monitoring, as retreatment may lead to recurrence or new adverse events.
{"title":"Multiple Cranial Neuropathies After Lenvatinib–Pembrolizumab Therapy for Metastatic Renal Cell Carcinoma: A Case Report","authors":"Hideyuki Minagawa, Tomoyuki Kaneko, Keiichi Hokkoku, Ayano Miyashima, Inoue Hazuki, Ono Tenei, Risako Yagi, Kenjiro Kishitani, Kazuki Takei, Tohru Nakagawa","doi":"10.1002/iju5.70136","DOIUrl":"10.1002/iju5.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Multiple cranial neuropathy is a rare manifestation of immune-related adverse events. To date, no cases have been reported during immune checkpoint blockade for metastatic renal cell carcinoma. This report describes a case of multiple cranial neuropathy that developed during lenvatinib and pembrolizumab combination therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 66-year-old man with metastatic clear cell renal cell carcinoma involving the maxilla received lenvatinib and pembrolizumab. After two months, he developed a rash and facial nerve palsy that resolved with corticosteroids. Pembrolizumab rechallenge later caused diplopia due to multiple cranial neuropathies, which improved after steroid pulse therapy. Two years after treatment initiation, disease control and pembrolizumab maintenance have continued without neurological recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We report a rare case of multiple cranial nerve palsies that developed during lenvatinib–pembrolizumab therapy. Such neuropathies typically occur early, respond to corticosteroids, and require careful monitoring, as retreatment may lead to recurrence or new adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12779414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vaginal pessaries are a widely used treatment for pelvic organ prolapse. They are considered minimally invasive, effective, and easy. However, pessary-related adverse events are sometimes underestimated. Here, we report on an important case of vaginal mesh exposure as a pessary complication.
Case Presentation
A patient underwent transvaginal mesh surgery for pelvic organ prolapse, and after 10 years, had a mild recurrence. Gynecologists recommended that she use a pessary. After 3 years, she had vaginal bleeding and malodor. Gynecologists detected mesh exposure, but they downplayed the finding and continued pessary use. Two years after that, she came to our hospital and underwent mesh excision surgery. She had an uneventful postoperative course with no complications in the 2 years after the surgery.
Conclusion
We propose that pessary use after mesh surgery can cause mesh exposure, which must not be ignored because it may lead to mesh infection and intra-abdominal abscess.
{"title":"Vaginal Mesh Exposure Following Pessary Use After Transvaginal Mesh Surgery: A Case Report","authors":"Yukiko Tsunoda, Kumiko Kato, Hidemori Araki, Masashi Kato, Masahiro Narushima","doi":"10.1002/iju5.70135","DOIUrl":"10.1002/iju5.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vaginal pessaries are a widely used treatment for pelvic organ prolapse. They are considered minimally invasive, effective, and easy. However, pessary-related adverse events are sometimes underestimated. Here, we report on an important case of vaginal mesh exposure as a pessary complication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A patient underwent transvaginal mesh surgery for pelvic organ prolapse, and after 10 years, had a mild recurrence. Gynecologists recommended that she use a pessary. After 3 years, she had vaginal bleeding and malodor. Gynecologists detected mesh exposure, but they downplayed the finding and continued pessary use. Two years after that, she came to our hospital and underwent mesh excision surgery. She had an uneventful postoperative course with no complications in the 2 years after the surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We propose that pessary use after mesh surgery can cause mesh exposure, which must not be ignored because it may lead to mesh infection and intra-abdominal abscess.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12778300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report the case of a patient with severe uterine prolapse who underwent successful vaginal pessary removal after pelvic floor muscle training.
Case Presentation
A 63-year-old woman presented with urinary dysfunction and residual urine. She was diagnosed with stage III pelvic organ prolapse by an obstetrician-gynecologist, and a vaginal pessary was inserted. The patient underwent pelvic floor muscle training for 4 months while the vaginal pessary remained in situ. M-mode ultrasonography revealed improved pelvic floor function, necessitating vaginal pessary removal. The patient's uterine prolapse improved to pelvic organ prolapse-quantification stage II without recurrence of pelvic organ prolapse, urinary dysfunction, or residual urine after 2 years.
Conclusions
In patients with severe uterine prolapse who use a vaginal pessary, appropriate pelvic floor muscle training guided by a physical therapist may eliminate the need for continued pessary use.
{"title":"Severe Pelvic Organ Prolapse Managed Without Surgery: Pessary Discontinued After Pelvic Floor Muscle Training With M-Mode Ultrasound","authors":"Yukimasa Ide, Nobutaka Shimizu, Rio Ninomiya, Tomoko Ogawa, Tetsuya Fukumoto, Shinji Hyodo, Rie Yoshimura, Yoshitaka Kurano, Satoshi Fukata, Keiji Inoue","doi":"10.1002/iju5.70138","DOIUrl":"10.1002/iju5.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We report the case of a patient with severe uterine prolapse who underwent successful vaginal pessary removal after pelvic floor muscle training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 63-year-old woman presented with urinary dysfunction and residual urine. She was diagnosed with stage III pelvic organ prolapse by an obstetrician-gynecologist, and a vaginal pessary was inserted. The patient underwent pelvic floor muscle training for 4 months while the vaginal pessary remained in situ. M-mode ultrasonography revealed improved pelvic floor function, necessitating vaginal pessary removal. The patient's uterine prolapse improved to pelvic organ prolapse-quantification stage II without recurrence of pelvic organ prolapse, urinary dysfunction, or residual urine after 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with severe uterine prolapse who use a vaginal pessary, appropriate pelvic floor muscle training guided by a physical therapist may eliminate the need for continued pessary use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12778299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madelung disease is a rare disorder characterized by symmetrical fat accumulation, typically around the neck, shoulders, and trunk.
Case Presentation
A 56-year-old man presented for 10-month history of dysuria and painless swelling of the lower abdomen and scrotum. A large scrotal mass completely buried the penis, and cranially displaced both testes. Contrast-enhanced magnetic resonance imaging suggested a well differentiated liposarcoma but whole-body computed tomography revealed symmetrical fat accumulation in the upper body trunk, raising suspicion of Madelung disease. Biopsy of the mass confirmed a benign lipoma. Excision of a 664 g lipoma improved the patient's penile configuration, enabling him to urinate in a standing position.
Conclusion
Madelung disease in the scrotal region is rare, only nine cases reported to date. However, it should be considered when bilateral symmetrical fat accumulation is present because a correct diagnosis has a decisive impact on treatment strategy.
{"title":"Madelung Disease of the Scrotal Region: A Case Report","authors":"Kazuki Kokura, Akihiro Kanematsu, Hideki Morisaki, Yasuhiro Shinkai, Takashi Yamasaki, Kenichiro Kawai, Masao Kakibuchi, Seiichi Hirota, Shingo Yamamoto","doi":"10.1002/iju5.70137","DOIUrl":"10.1002/iju5.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Madelung disease is a rare disorder characterized by symmetrical fat accumulation, typically around the neck, shoulders, and trunk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 56-year-old man presented for 10-month history of dysuria and painless swelling of the lower abdomen and scrotum. A large scrotal mass completely buried the penis, and cranially displaced both testes. Contrast-enhanced magnetic resonance imaging suggested a well differentiated liposarcoma but whole-body computed tomography revealed symmetrical fat accumulation in the upper body trunk, raising suspicion of Madelung disease. Biopsy of the mass confirmed a benign lipoma. Excision of a 664 g lipoma improved the patient's penile configuration, enabling him to urinate in a standing position.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Madelung disease in the scrotal region is rare, only nine cases reported to date. However, it should be considered when bilateral symmetrical fat accumulation is present because a correct diagnosis has a decisive impact on treatment strategy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intravesical bacillus Calmette-Guerin (BCG) therapy is a standard treatment for intermediate to high-risk non-muscle invasive bladder cancer. While local side effects are common, systemic complications are rare and can be serious.
Case Presentation
A 69-year-old man presented with episodes of fever, headache, and impaired consciousness. He had undergone intravesical BCG therapy 3 days before presentation. He was initially diagnosed with viral encephalitis and treated with acyclovir, but showed no clinical improvement. Given the lack of response, autoimmune encephalitis was suspected, and steroid therapy was initiated, resulting in marked clinical improvement. Plasmapheresis was performed in addition to steroid therapy, and his condition improved to the level observed prior to BCG treatment. To date, he remains stable and relapse-free.
Conclusion
To our knowledge, this is the first reported case of BCG-induced autoimmune encephalitis after intravesical therapy.
{"title":"The First Case of Bacillus Calmette-Guérin-Induced Autoimmune Encephalitis","authors":"Makoto Ishii, Haruto Honda, Seigo Machiya, Hiromu Horitani, Sayaka Horii, Masao Kobayashi, Yutaka Ono","doi":"10.1002/iju5.70134","DOIUrl":"10.1002/iju5.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intravesical bacillus Calmette-Guerin (BCG) therapy is a standard treatment for intermediate to high-risk non-muscle invasive bladder cancer. While local side effects are common, systemic complications are rare and can be serious.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 69-year-old man presented with episodes of fever, headache, and impaired consciousness. He had undergone intravesical BCG therapy 3 days before presentation. He was initially diagnosed with viral encephalitis and treated with acyclovir, but showed no clinical improvement. Given the lack of response, autoimmune encephalitis was suspected, and steroid therapy was initiated, resulting in marked clinical improvement. Plasmapheresis was performed in addition to steroid therapy, and his condition improved to the level observed prior to BCG treatment. To date, he remains stable and relapse-free.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To our knowledge, this is the first reported case of BCG-induced autoimmune encephalitis after intravesical therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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