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Case Reports in Urology
Number of Followers: 12

This is an Open Access Journal

Open Access journal
ISSN (Print) 2090-696X - ISSN (Online) 2090-6978
Published by Hindawi

[340 journals]

Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report
and Literature Review
- Abstract: Acquired hemophilia A (AHA) is an acquired bleeding disorder caused by neutralizing antibodies (inhibitors) against Coagulation Factor VIII (FVIII:C), causing sudden hemorrhagic symptoms (i.e., subcutaneous bleeding, intramuscular bleeding, and hematuria). Herein, this study is aimed at presenting a case of AHA diagnosed based on hematuria and reviewing patients who were diagnosed with AHA due to hematuria. A 67-year-old woman was referred to Atsugi City Hospital with painless gross hematuria that began 4 weeks before presentation. Contrast-enhanced computed tomography (eCT) revealed an approximately 2 cm mass in the right renal pelvis, and the patient’s activated partial thromboplastin time (APTT) was elevated (61.4 s). The day after the endoscopic biopsy, the patient was in shock due to a large retroperitoneal hematoma. Although her condition stabilized after intravenous radioembolization, she underwent emergency surgeries several times because of rebleeding within the next 3 weeks. At that time, APTT was more prolonged at 106.4 s, and the FVIII:C level was 2%. Mixing tests showed an upwardly convex curve after 2-h incubation, indicating the presence of an inhibitor. Factor VIII inhibitor titer was ≥5.1 Bethesda unit (BU)/mL. A combined product of Plasma-Derived Factors VIIa and X (pd-FVIIa/FX), as second-line hemostatic therapy, as well as cyclophosphamide (CYP), were administered after Recombinant Activated Factor VIIa (rFVIIa) had been ineffective. Following this, the Factor VIII inhibitor titer was undetectable, FVIII:C levels were restored, and APTT decreased to within the normal range. Gross hematuria was significantly alleviated. However, the patient died of cytomegalovirus and fungal infections due to prolonged immunosuppressive therapy. Although AHA diagnosed based on hematuria may have a better prognosis than others, there have been occasional cases with severe outcomes. APTT, detected upon initial hematological testing in patients with hematuria, may be a potential indicator of an existing AHA.
  PubDate: Mon, 12 Aug 2024 13:48:21 +000
Penetrating Posterior Urethral Injuries: Case Report and Management
Strategies
- Abstract: Penetrating posterior urethral trauma from gunshot wounds (GSW) is rare and requires prompt treatment to minimize complications. Data regarding the management of such cases is scarce in the literature and poorly addressed in the guidelines. Different management approaches exist, including urinary diversion with immediate versus delayed urethroplasty/fistula repair. We present our case series to add to our experience to the literature. Three patients aged 18–44 presented with ballistic posterior urethra injuries from GSW. Initial management involved urethral catheter placement, with one patient requiring operative placement of urethral and suprapubic catheters (SPTs). Complications included recurrent membranous stricture, urinary retention, rectourethral fistula, and erectile dysfunction (ED). Posterior urethral injuries from GSW are complex as they can be either isolated or affect adjacent organs. Bladder, ureteral, and urethral injuries must be ruled out. Unlike bladder neck injuries, immediate urethroplasty/fistula repair would be very challenging and not advised for standard prostatic or membranous injuries. Urethral catheter or suprapubic tube is recommended and can result in fistula closure and urethral patency. It is critical to maintain close follow-up with the patient due to the possibility of stricture recurrence. Urethroplasty in a delayed fashion can be very successful.
  PubDate: Fri, 26 Jul 2024 09:20:01 +000
Robot-Assisted Laparoscopic Radical Prostatectomy for Prostatic Metastatic
Recurrence from Testicular Cancer
- Abstract: Introduction. Treatment evidence for malignancies metastatic to the prostate in young patients is scarce. Herein, we present a case of prostatic metastasis from testicular cancer treated with induction chemotherapy followed by robot-assisted radical prostatectomy. Case Presentation. The patient is a 34-year-old male who underwent radical orchiectomy for a left testicular tumor two years ago and was diagnosed with a mixed germ cell tumor. He was followed up without adjuvant therapy, but symptoms of dysuria lead to suspicion of a prostate tumor, which was diagnosed by prostate biopsy as seminoma of the prostate. After four cycles of chemotherapy, normalization of tumor markers, and tumor shrinkage on imaging, he underwent robot-assisted radical prostatectomy. No recurrence has been observed nine months after treatment. Conclusion. In men with a history of testicular cancer presenting with lower urinary tract symptoms, it is important to consider recurrent prostate metastases.
  PubDate: Tue, 11 Jun 2024 08:18:28 +000
Chondroma in the Urinary Bladder: An Extremely Rare Finding
- Abstract: Chondroma, commonly observed in the bones, has limited documentation when found in soft tissues. To date, only 8 chondromas in the urinary bladder have been reported, all in females. Here, we describe a 54-year-old female who presented with a chondroma located at the anterior wall of the urinary bladder. An incidental 5 mm enhanced focus was identified on the right bladder wall during a contrast-enhanced computerized tomography (CT). Subsequent cystoscopy did not reveal any abnormalities, and both urinalysis and urine cytology were unremarkable. However, a CT urogram reconfirmed suspicions of malignancy, which a cystoscopy validated. The patient underwent a transurethral resection of the bladder tumor, which was identified as a bladder chondroma. During the surgical incision, a submucosal lesion was found, which was further confirmed with histopathological evaluation. Over a year-long follow-up using imaging and urine cytology, no recurrence was observed. This case reinforces earlier findings and underscores the predilection for females between their 5th and 7th decades with a positive prognosis.
  PubDate: Thu, 06 Jun 2024 11:49:19 +000
Bladder Cancer Invading the Prostate and Penis and Multiple Bone
Metastases Showing Significant Improvement after a Short-Term
Pembrolizumab Therapy following Radiation and Gemcitabine and Cisplatin
Therapy Leading to a Pathologically Complete Remission
- Abstract: A 65-year-old man was diagnosed with bladder cancer invading the prostate and penis and multiple bone metastases. He underwent palliative radiation (30 Gy/10 fr) through vertebral bones (Th3 and Th12-L5) and pelvic bones for pain control. The patient received pembrolizumab therapy after three courses of gemcitabine and cisplatin therapy. CT four weeks after starting pembrolizumab therapy showed that both the primary and metastatic lesions had notably reduced in size, and no new lesion was detected. He subsequently fell, resulting in a femoral neck pathological fracture, and underwent hemiarthroplasty. Pathological examination of the pathological fracture site revealed no residual tumor tissue.
  PubDate: Mon, 27 May 2024 12:05:00 +000
The Management of Inflatable Penile Prosthesis Erosion and Infection
following Iatrogenic Aspiration
- Abstract: This case report presents a unique and previously unreported case of malfunction, infection, and erosion of an inflatable penile prosthesis (IPP) resulting from iatrogenic injury during a priapism aspiration procedure performed by an emergency medicine physician. The patient, a 75-year-old male with a history of IPP placement for erectile dysfunction, presented with urinary retention and priapism, leading to inadvertent deflation of the IPP during aspiration. Subsequent evaluation revealed a pinhole opening on the scrotum, indicating infection and erosion of the prosthesis tubing. The patient underwent emergent explantation of the infected IPP, washout, cystoscopy, and insertion of a suprapubic tube. Intraoperative cultures identified Escherichia cloacae as the causative pathogen. This case highlights the importance of thorough chart review to identify patients with IPPs before aspiration procedures and emphasizes the need for healthcare provider education regarding potential complications in this patient population. Early recognition and management of such complications are crucial for optimal patient outcomes. While IPP placement remains a highly satisfactory treatment for erectile dysfunction, this case highlights the importance of vigilance to ensure the best care for patients with penile prostheses. It is noteworthy that ultimately, a new IPP was not placed in this patient due to the patient’s significant medical comorbidities.
  PubDate: Sat, 20 Apr 2024 07:35:00 +000
Urethral Caruncle in Pediatrics: A Northern Tanzania Experience
- Abstract: Urethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in postmenopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present a case series of three pediatric patients with a urethral caruncle.
  PubDate: Wed, 03 Apr 2024 06:50:00 +000
A Rare Variant of Zinner Syndrome Involving Ectopic Ureteral Implantation
into the Seminal Vesicle Causing Recurrent Epididymitis
- Abstract: Zinner syndrome is a rare congenital anomaly characterized by a triad of renal dysgenesis/agenesis, cysts in the ipsilateral seminal vesicle, and ejaculatory duct obstruction. Though often diagnosed in infancy, the diagnoses can be incidentally found in adults who present with nonspecific genitourinary symptoms including dysuria, ejaculatory dysfunction, or genital pain. We present an unusual case of a 29-year-old male patient who presented to the emergency department with recurrent testicular pain and hematospermia and was found to have an atrophic right kidney with an ectopic ureter implanting into a cystic seminal vesicle. These findings were consistent with a rare subvariant of Zinner syndrome only previously described four times in the literature. We performed a robotic-assisted laparoscopic ectopic nephroureterectomy with sparing of his seminal vesicle. To our knowledge, this is the first report to describe the safe and effective use of robotic surgery in this setting to remove affected anatomy while preserving the patient’s seminal vesicle.
  PubDate: Mon, 18 Mar 2024 08:05:00 +000
Metastatic Melanoma to the Urinary Bladder: A Rare Cause of Visible
Haematuria
- Abstract: Bladder metastasis from cutaneous melanoma is a rare pathology. A 79-year-old woman presented to the haematuria clinic on account of painless visible haematuria. Ten years prior to this index presentation, she was diagnosed with melanoma on her right thigh following a total excision of the skin lesion. Cystoscopy showed a pigmented bladder tumour, and the histology report following a transurethral resection was consistent with metastatic melanoma, and further imaging revealed metastasis to the lungs, adrenals, and lymph nodes.
  PubDate: Fri, 01 Mar 2024 06:35:00 +000
Pelvic Abscess Caused by Ureteral Calculus and Abscess Treatment through
Aspiration by Transperineal Puncture
- Abstract: Pelvic abscess is mostly caused by gynecological inflammation or digestive system diseases such as appendicitis or Crohn’s disease. This case of pelvic abscess originates from ureteral calculus and is not commonly seen in clinical practice. This is mainly due to the patient’s ureteral stones not being actively treated. After local puncture and pus extraction, as well as the application of effective antibiotics, the patient recovered. Therefore, this case provides clinical doctors with experience that ureteral stones may cause serious complications and should be actively treated after detection.
  PubDate: Thu, 25 Jan 2024 09:50:00 +000
Pembrolizumab Therapy Leading to Complete Remission for Recurrence of
Pulmonary Metastases after their Resection and Radical Cystectomy
following Gemcitabine and Cisplatin Therapy
- Abstract: A 64-year-old man was diagnosed with invasive bladder and right lower ureteral urothelial cancer with right pelvic lymph node and lung metastases. He received four courses of gemcitabine and cisplatin therapy. He underwent lung metastasectomy and radical cystoprostatectomy, with not only primary lesions but also metastatic lesions showing a complete response. New multiple lung metastases were revealed five months after adjuvant chemotherapy. On starting pembrolizumab therapy, the metastatic lesions are notably reduced in size. He is currently receiving pembrolizumab therapy, and no recurrence has been observed for over one year.
  PubDate: Wed, 17 Jan 2024 05:05:01 +000
Malignant Epithelioid Mesothelioma of the Tunica Vaginalis Testis
Presenting as Hydrocele in a Kidney Transplant Recipient
- Abstract: Mesotheliomas of the tunica vaginalis testis are rare malignant tumors that can present as a scrotal mass or hydrocele. These tumors are typically aggressive with high rates of recurrence and metastasis. Suspected risk factors for malignant mesothelioma include asbestos exposure, chronic inflammation, trauma, and persistent hydrocele. We report the case of a malignant epithelioid mesothelioma of the tunica vaginalis testis that presented as a finding at hydrocelectomy and was ultimately treated with radical inguinal orchiectomy. This patient was on chronic immunosuppression therapy with tacrolimus and mycophenolate mofetil secondary to a kidney transplant but had none of the common risk factors for mesothelioma formation. To our knowledge, this is the first case describing a possible connection between chronic immunosuppression and mesothelioma of the tunica vaginalis. However, future studies are needed to investigate this association and discern whether this could have played a role in our patient or if his mesothelioma formation was coincidental.
  PubDate: Wed, 10 Jan 2024 10:50:00 +000

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