Penile fracture is a rare urological emergency resulting from rupture of the tunica albuginea during blunt trauma to an erect penis, typically during sexual intercourse. While immediate surgical repair is associated with superior outcomes compared with conservative management, delayed treatment can lead to significant long-term complications including penile curvature in 30% of cases and erectile dysfunction in 50%-62% of cases. We present the case of a 22-year-old patient who sustained a penile fracture while manipulating his erect penis. Clinical examination revealed penile swelling, bruising, and a 60° leftward curvature. Intraoperative ultrasound (IO-USG) with a linear probe precisely localized a tunica albuginea defect in the right corpus cavernosum, enabling a minimally invasive 1.5-cm transverse incision directly over the fracture site. This approach avoided complete penile degloving, reduced operative time and blood loss, and facilitated complete clot evacuation and defect closure using interrupted 3-0 PDS sutures. Postoperative recovery was uneventful, with the patient discharged the following day and reporting normal erectile function and no penile deformity at the 3-month follow-up. A literature review confirms that while preoperative imaging is commonly utilized for surgical planning, IO-USG guidance for real-time fracture localization and incision placement remains rarely reported. Although MRI and CT offer superior soft tissue resolution, they are limited by availability, time constraints, and radiation exposure. IO-USG is readily accessible and noninvasive; although operator-dependent, it provides high-resolution real-time guidance that enables smaller incisions, minimizes postoperative complications such as glans numbness, and optimizes functional outcomes. We conclude that IO-USG-guided repair of penile fracture facilitates rapid identification of the injury site, accurate assessment of hematoma burden, and targeted surgical approach that avoids penile degloving while ensuring complete repair.
Hematuria in children often presents a diagnostic puzzle, especially when cystoscopic findings are unexpected-such as the appearance of worm-like structures. We report the case of a 13-year-old male with recurrent hematuria, initially suspected of having a parasitic bladder infection based on endoscopic findings. Ultimately, histopathology identified the structure as a fibrin clot. This case emphasizes the importance of including fibrin clots in the differential diagnosis of pediatric hematuria and highlights the essential role of pathology in guiding management when visual impressions might mislead.
Background:Retrocaval ureter is an uncommon congenital condition caused by abnormal development of the inferior vena cava. The resulting posterior displacement of the ureter may produce compression, impaired urinary drainage, and hydronephrosis. Case Presentation:A 35-year-old man was referred following the detection of a right-sided Type I retrocaval ureter during evaluation of right renal colic. Laboratory investigations and physical examination were unremarkable. Computed tomography urography and retrograde pyelography demonstrated the characteristic abnormal ureteral course with associated proximal obstruction. The patient underwent laparoscopic retroperitoneal mobilization, transposition, and reconstruction of the ureter. The operative steps are presented in an accompanying video. Recovery was uncomplicated, and follow-up imaging demonstrated resolution of the obstruction. Conclusion:Laparoscopic retroperitoneal reconstruction provides direct access to the affected ureter while avoiding entry into the peritoneal cavity. In appropriately selected patients and experienced hands, it represents an effective minimally invasive option for the treatment of retrocaval ureter.
Extranodal marginal zone lymphoma involving the urinary system is a rare manifestation of lymphoma. Ureteric obstruction by this subtype of lymphoma can mimic other more common genitourinary or retroperitoneal conditions. The current case describes a 42-year-old female who presented with abdominal pain and hydronephrosis without findings supportive of renal or ureteric calculus. Diagnostic work-up was unremarkable, even with the employment of endoscopic evaluation. The patient's ureter was dilated and she underwent both stenting and eventual percutaneous nephrostomy tube placement. Ultimately, she underwent surgical intervention with ureteral reimplantation and associated histopathological analysis was able to definitively diagnose a low-grade B-cell extranodal marginal zone lymphoma. The present case highlights the diagnostic challenges associated with this rare etiology of urinary obstruction. It also emphasizes the importance of considering atypical malignancy in the differential diagnosis of recurrent ureteral obstruction, especially when traditional radiological imaging and clinical assessment are unrevealing.
Bilobed testis is a rare anomaly of testicular development. Although its etiology remains uncertain, this condition may represent a variant of polyorchidism. We herein describe the case of an 18-year-old patient who presented with a painless scrotal nodule located in the upper pole of the left testis. We report this case to highlight the rarity of this entity and to delineate relevant issues such as radiologic features, differential diagnosis, and possible clinical implications.
Eosinophilic cystitis (EC) is an inflammatory disease characterized by eosinophilic bladder infiltrate. It is primarily seen in adults with presenting symptoms of dysuria and gross hematuria, and diagnosis is confirmed with bladder biopsy. Possible etiologies include allergies, prior bladder trauma, or parasitic infections and management involves nonsteroidal anti-inflammatory drugs, antihistamines, corticosteroids, and occasionally immunologic agents. EC is rare and especially uncommon in the pediatric population. We present a case series of five pediatric patients diagnosed with EC over a 20-year review at a single institution, including how they presented and their management. This case series highlights the first pediatric case of EC requiring an immunologic agent for symptom control as well as several cases uniquely associated with schistosomiasis.
Pleomorphic giant cell carcinoma (PGCC) of the prostate is an extremely rare and aggressive malignancy with limited treatment options. We present a case report of metastatic PGCC patients treated with 177Lu-PSMA-617 radioligand therapy (Pluvicto) after progression on standard therapies. Both patients had PSMA-avid tumors on imaging. Molecular profiling revealed mutations in hallmark tumor suppressors including TP53, RB1, and PTEN. Both patients initially experienced partial radiographic response, in which one patient achieved stable disease for 9 months posttherapy. These findings suggest that PSMA-radioligand therapy may be a reasonable treatment for PGCC patients, but underscore the need for additional therapeutic options.
We report robotic-assisted partial nephrectomy for isthmic clear cell renal cell carcinoma in a horseshoe kidney with aberrant aortic arterial supply. Intraoperative management utilized indocyanine green-guided near-infrared fluorescence imaging, intraoperative ultrasonography, and ligation of aberrant arterial branches supplying the mass. Pathology demonstrated a 4.6-cm WHO/ISUP grade 3 clear cell RCC, pathologic stage pT1b with negative surgical margins. Postoperative recovery was uncomplicated with preserved renal function and no recurrence at 6 months. This case highlights the importance of detailed anatomic delineation during nephron-sparing surgery in complex horseshoe kidney anatomy.
Background:Penile melanoma is an extremely rare malignancy, representing less than 0.1% of all melanomas. It most commonly arises from the glans, foreskin, or urethral meatus. Deep cavernosal involvement without clinically evident cutaneous, mucosal, or urethral disease is an unusual presentation and poses significant diagnostic and therapeutic challenges. Case Presentation:A 23-year-old male presented with progressive penile induration and pain. MRI revealed a lesion predominantly involving the corpus cavernosum, with no clinically evident cutaneous, mucosal, or urethral involvement. An excisional biopsy established the diagnosis of malignant melanoma; however, the initial specimen showed tumor involvement of the resection margin and did not include epidermal sampling. Systemic staging with whole-body CT and PET-CT showed no evidence of metastatic disease. The patient subsequently underwent partial penectomy with bilateral sentinel lymph node dissection, showing negative sentinel lymph nodes and free final surgical margins. One year later, 18F-FDG PET-CT demonstrated nodal and osseous metastatic disease, with hypermetabolic lymphadenopathies in the distal retroperitoneal, left iliac, and left inguinal regions, osseous lesions in the sternal manubrium, and a new right upper-lobe pulmonary micronodule. The patient received immunotherapy with a limited clinical response. Conclusion:This case describes an unusual presentation of melanoma predominantly involving the corpus cavernosum without clinically evident cutaneous, mucosal, or urethral involvement. The absence of epidermal sampling prevents definitive histological exclusion of a regressed or deeply invasive mucosal/cutaneous primary lesion. This report highlights the aggressive behavior of deeply located penile melanoma and the need for careful clinicopathological correlation and individualized multidisciplinary management.
Introduction:Immune checkpoint inhibitors, such as pembrolizumab, are increasingly used in high-grade urothelial carcinomas. Immune checkpoint inhibitors are known to cause immune-related adverse events (irAEs), often involving the skin. Case Presentation:Reported is a 59-year-old woman with metastatic high-grade urothelial carcinoma of the right renal pelvis previously treated with chemoradiation and surgery. She developed morphea 1.5 years after initiating pembrolizumab therapy. The patient presented with violaceous, indurated plaques and paresthesias of the lower extremities. Biopsies revealed thickened collagen bundles and perivascular inflammation. MRI excluded eosinophilic fasciitis. She was diagnosed with pembrolizumab-induced morphea and treated with methotrexate and topical corticosteroids, leading to partial improvement. Conclusion:As immunotherapy becomes more widely used in urologic oncology, recognition of rare cutaneous irAEs such as morphea is crucial for timely diagnosis and management.
Background:Penile venous abnormalities are an uncommon cause of erectile dysfunction and are rarely implicated in isolated glans tumescence impairment. We report what may be the first successful surgical treatment of glandular tumescence dysfunction caused by an anomalous venous communication between the deep dorsal vein of the penis and the left great saphenous vein. Case Presentation:A 42-year-old man presented with lifelong inadequate glans tumescence and mild erectile maintenance difficulty (International Index of Erectile Function-5 score, 18). Physical examination and hormonal evaluation were unremarkable. Dynamic penile color Doppler ultrasonography after intracavernosal prostaglandin E1 demonstrated normal cavernosal arterial inflow and preserved cavernous veno-occlusive function but showed markedly increased flow in the deep dorsal vein despite rigid shaft erection and persistent poor glans engorgement. Dynamic cavernosography identified an isolated anomalous collateral vessel connecting the deep dorsal vein to the left great saphenous vein, with no additional venous leakage sites. Surgical correction consisted of ligation and excision of the anomalous collateral vein, excision of the deep dorsal vein through an anterograde penile skin degloving approach, and selective ligation of cavernous veins. Conclusions:The patient reported complete restoration of glans tumescence at 1 month, sustained at 1 year, with improvement of the International Index of Erectile Function-5 score from 18 to 23. This case highlights the diagnostic value of cavernosography in selected patients with discordant findings between shaft rigidity and glans engorgement and suggests that targeted surgical correction may be effective when a highly localized venous shunt is identified.
Primary melanoma is a very rare malignancy arising from the kidney. We present a case of a 78-year-old female who presented with locally advanced primary kidney melanoma requiring complex surgical intervention and multidisciplinary management. The patient underwent an open left radical nephrectomy with distal pancreatectomy, splenectomy, and colonic resection, followed by adjuvant immunotherapy. We additionally review the literature regarding the diagnosis and management of primary renal melanoma.
Bilobed testis is an extremely rare congenital anomaly considered an incomplete form of polyorchidism, resulting from incomplete division of the genital ridge during embryogenesis. Fewer than 250 cases of polyorchidism have been reported worldwide, and bilobed variants represent only a small proportion of these cases. Recognition of this benign anatomical variant is important to avoid unnecessary surgical intervention. We report the case of a 37-year-old asymptomatic male in whom a left scrotal mass was detected incidentally on clinical examination. Scrotal ultrasonography demonstrated a well-defined ovoid nodule adjacent to the posterior-inferior aspect of the left testis measuring 14 × 15 × 8 mm. The lesion demonstrated identical echogenicity and internal architecture to the adjacent testicular parenchyma, consistent with a bilobed testis. Follow-up ultrasonography at 18 months showed no interval change, confirming stability. Given the benign imaging features, absence of symptoms and stability on serial imaging, the patient was managed conservatively with reassurance and education regarding testicular self-examination. This case highlights the importance of recognising bilobed testis as a rare but benign congenital variant. Accurate radiological diagnosis can prevent unnecessary surgical exploration, reduce patient anxiety and preserve fertility.
In this case series, we describe our approach to the urologic management of ureteral hernias. This is a single-institution, multi-surgeon cohort of patients who presented with an abdominal hernia involving a ureter between 2018 and 2025. Among eight patients, seven male patients (87%) had an inguinal hernia involving the ureter. Six patients underwent urologic intervention at the time of inguinal hernia repair, most commonly preoperative ureteral stent placement (40%). Three patients (50%) experienced inguinal ureteral hernia recurrence, of whom two underwent ureteral reimplantation. Based on our experience, the majority of inguinal ureteral hernias can be managed with a preoperative ureteral stent at the time of hernia repair, although more complex ureteral reconstruction may be required in the setting of recurrence.
Introduction:Metastatic spread of prostate cancer to the epididymis is exceptionally rare. Recognition is challenging because clinical and ultrasonographic findings may mimic benign or primary paratesticular lesions. Case Presentation:We describe a 71-year-old man who developed an isolated epididymal metastasis 12 years after radical prostatectomy for high-risk prostate cancer. After adjuvant treatment and later biochemical recurrence managed with salvage radiotherapy and androgen deprivation therapy, prostate-specific antigen rose to 2.2 ng/mL despite castrate testosterone levels. Choline positron emission tomography/computed tomography identified a suspicious paratesticular lesion. Scrotal ultrasound showed a cystic mass initially suggestive of a benign epididymal lesion. Surgical exploration with hydrocelectomy and excision of the epididymal mass was performed for both diagnostic and therapeutic purposes. Histology and immunohistochemistry confirmed metastatic adenocarcinoma of prostatic origin. After surgery, prostate-specific antigen became undetectable. Conclusion:This case underlines the need to consider epididymal metastasis during follow-up when prostate-specific antigen rises without typical sites of relapse and supports the role of dedicated scrotal evaluation, molecular imaging, and individualized surgical management in selected patients.
Background:Penile fracture is a rare condition characterised by disruption of the tunica albuginea typically caused by blunt trauma to a tumescent penis. It is a urological emergency that requires prompt diagnosis with a view to urgent treatment. The current global consensus on management of penile fractures is urgent surgical exploration and repair of the tunical defect. This is recommended with a view to minimise the risk of long-term functional outcomes, mostly relating to sexual dysfunction. However, the lack of high quality data on 'immediate' versus 'delayed' surgical repair groups in terms of long-term outcomes means that the exact timing of surgical repair is still debatable. Case Presentation:A 50-year-old healthy sexually active male presented after a snapping sound during sexual intercourse 90 minutes before, followed by detumescence and penile pain. A tunical breach in the left proximal penile shaft was diagnosed clinically and confirmed on emergency ultrasound. The patient tested positive for COVID-19 and, given the perioperative risk of morbidity and mortality, it was decided to delay surgical repair. 10 days after the injury, following a negative COVID-19 test, he successfully underwent circumferential degloving, circumcision and closure of the tunical defect. Upon review at 4 and 20 months post-op, there was no scarring or penile curvature, and he was having normal painless erections and penetrative sexual intercourse. Conclusions:This is a case of early presentation of penile fracture in a healthy sexually active male, where surgical repair was delayed by 10 days because of COVID-19 infection, with positive short and medium term outcomes. It reinforces the idea that penile fracture patients who present late should still be offered surgery and that delaying surgery to optimise a patient's condition may be an acceptable approach. However, more research is needed into timing of surgical repair and its effect on long-term functional outcomes.
We report a rare case of a urethral phyllodes tumour. A 58-year-old male presented with urinary retention requiring catheterisation, preceded by a gradual onset of poor urinary flow. He had a prior history of poor urinary flow in 2022, when a urethral fibroepithelial polyp was identified and excised. Histopathology at the time confirmed a fibroepithelial polyp. On recurrence, flexible cystoscopy showed a polyp arising from the prostatic urethra and extending into the bladder neck, while MRI prostate revealed a 63 cc gland with a small median lobe and a PI-RADS 1, Likert 1 lesion. The patient underwent redo transurethral resection of the lesion, and histology revealed a low-grade phyllodes tumour. This case underscores the importance of recognising rare urological tumours in order to guide appropriate management.
Testicular metastases from prostate carcinoma are exceedingly uncommon, particularly from the ductal histological subtype, which is associated with aggressive clinical behavior and a propensity for atypical metastatic dissemination. We report the case of a 73-year-old male with a history of prostate ductal adenocarcinoma (PDA) treated in 2018 with robot-assisted radical prostatectomy (RARP) and extended pelvic lymphadenectomy. Pathological staging was pT2c R0 N0 (0/53 nodes), and postoperative PSA was undetectable. The patient remained free of recurrence for 5 years. In March 2023, a biochemical recurrence prompted repeated thoracoabdominal computed tomography (CT) and pelvic magnetic resonance imaging (MRI) scans; neither study included dedicated scrotal imaging, and both were negative for recurrence. By March 2024, serum PSA had increased to 5.6 ng/mL, coinciding with the onset of progressive, painless enlargement of the left testicle. Scrotal ultrasonography revealed a solid mass replacing the left testicular parenchyma. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and choline PET/CT showed a hypermetabolic lesion confined to the left testis, with no evidence of extratesticular disease. The patient underwent left inguinal orchiectomy. Histopathological examination revealed metastatic adenocarcinoma with papillary architecture, morphologically consistent with ductal prostate origin. PSA levels declined rapidly postoperatively, reaching 0.07 ng/mL within 40 days. At 13-month follow-up, the patient remained clinically and biochemically free of disease without further treatment. This case represents one of the few documented instances of solitary testicular metastasis from PDA. It underscores the importance of continued PSA monitoring and highlights that isolated testicular involvement, whereas rare, may confer a more favorable prognosis than typically expected in metastatic PDA. In selected cases, orchiectomy may serve both diagnostic and therapeutic roles, supporting a conservative postoperative approach.
Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare congenital disorder characterized by Müllerian duct malformation and ipsilateral renal abnormalities. Variant forms associated with hypoplastic kidneys and ectopic ureteral insertion in the vagina may require nephrectomy because of persistent urinary incontinence. In such cases, urinary drainage through a vaginal opening permits direct ureteral access via vaginoscopy without the size limitations associated with transurethral cystoscopy. Therefore, retrograde catheter placement is technically feasible in patients with OHVIRA syndrome. Consequently, OHVIRA is a particularly suitable indication for ureteral catheterization. Fluorescent ureteral catheters, which were recently introduced in surgery for adults, enable real-time intraoperative visualization of the ureter and may further enhance surgical safety. We report a case involving laparoscopic nephrectomy for OHVIRA syndrome with an ectopic ureter and severely hypoplastic kidney in a pediatric patient. The ectopic ureteral orifice was successfully identified during vaginoscopy when the patient was 5 years of age; therefore, retrograde placement of a fluorescent ureteral catheter was feasible. Intraoperative fluorescence enabled the reliable identification of both the ureter and small renal remnant, thus facilitating safe dissection and resection. This case demonstrates that retrograde placement of a fluorescent ureteral catheter via vaginoscopy is feasible and useful for pediatric patients with OHVIRA syndrome who require nephrectomy. This technique may improve intraoperative ureteral visualization and surgical safety; therefore, it should be considered for selected patients with ectopic ureteral drainage.
The extension of a renal infection to the liver is extremely rare. We present the case of a 70-year-old woman with right hip pain and delayed detection of a perinephric abscess involving her liver. Tomographic and endoscopic contrast studies revealed the presence of a fistulous tract between her liver and right kidney. With minimally invasive intervention, including placement of a ureteral stent, two hepatic drains, a nephrostomy tube, and culture-directed antimicrobial therapy, her infection resolved. Closure of the fistula was subsequently confirmed radiographically. This is the first reported incidence of a pyelo-hepatic fistula resulting from a perinephric abscess.
