Here we describe the first case of paratesticular epithelioid sarcoma in an adolescent male. Paratesticular epithelioid sarcoma is an exceedingly rare entity with an aggressive clinical course and poor prognosis. The patient underwent wide hemiscrotectomy with radical inguinal orchiectomy and adjuvant chemoradiotherapy for inguinal nodal metastasis. Subsequent retroperitoneal lymph node dissection revealed metastasis to the para-aortic lymph nodes. Paratesticular sarcomas can be challenging to diagnose and treat. This report outlines the pathology and management of the first pediatric paratesticular epithelioid sarcoma in the English literature and highlights the need for multidisciplinary collaboration.
Bladder hemangiomas are rare benign vascular tumors that may cause severe hematuria. We report a 66-year-old man with Glanzmann thrombasthenia who presented with life-threatening hematuria, clot retention, and severe anemia. Histopathological examination revealed multiple capillary bladder hemangiomas, while contrast-enhanced CT failed to clearly identify the lesions due to their small size. Despite intensive hematological support, including transfusions, recombinant activated factor VII, and transurethral electrocoagulation, bleeding recurred. Given the prohibitive hemorrhagic risk of repeat surgery, super selective vesical artery embolization was performed, achieving complete and durable hemostasis. No complications or recurrence occurred during six months of follow-up.
Renal cell carcinoma is the most common adult renal malignancy but is rare in children, where Wilms tumor predominates. A 10-year-old boy presented with intermittent gross hematuria for two years, worsening with clot retention. Imaging revealed a right renal solid mass without metastasis (cT1bN0M0). After cystoscopic clot evacuation, open radical nephrectomy was performed. Histopathology confirmed RCC with lymphovascular invasion and negative margins (pT2aN0Mx). Because clinical and radiologic findings overlap with other pediatric renal tumors, definitive diagnosis relies on histopathology. Surgical resection is the primary treatment, as pediatric RCC responds poorly to chemo-and radiotherapy. Early-stage disease generally has favorable outcomes.
Extramedullary hematopoiesis (EMH) is a compensatory process associated with chronic bone marrow failure and rarely involves the adrenal gland. We present a 63-year-old woman with abdominal pain and a large heterogeneous right suprarenal mass with calcifications and central necrosis raising suspicion for adrenocortical carcinoma. Laboratory evaluation revealed severe anemia and bone marrow examination confirmed primary myelofibrosis. Due to radiologic and core needle biopsy suspicion of malignancy, surgical resection was performed. Histopathological examination demonstrated extramedullary hematopoiesis composed of erythroid and myeloid precursors with scattered megakaryocytes. This case highlights adrenal EMH as a diagnostic pitfall mimicking adrenal malignancy clinically, radiologically, and histopathologically.
Anatomical variations may result from errors during embryologic development. Specifically, variations in gonadal vasculature can arise from atypical persistence of subcardinal -supracardinal anastomoses, which can result in duplicated gonadal veins. We present a rare case of a partially duplicated left ovarian vein bisected by the left renal artery that was discovered in a female anatomical donor during dissection of twenty human cadavers at Creighton University School of Medicine. To our understanding, the anteroposterior duplication with a bisecting renal artery has not been previously reported. Proper documentation of anatomical variations can help enhance clinician awareness, therefore mitigating procedural and clinical complications.
Primary myeloid sarcoma arising in the prostate is an exceptionally rare extramedullary manifestation of acute myeloid leukemia. Its nonspecific clinical presentation frequently leads to diagnostic delay or misdiagnosis. This report aims to enhance clinical awareness and diagnostic accuracy through a detailed analysis of a representative case and a systematic review of the existing literature. We report a 74-year-old male initially misdiagnosed as benign prostatic hyperplasia, confirmed post-PKRP by MPO-positive pathology. He received AML-directed systemic chemotherapy after transfer to hematology. Normal PSA and MPO positivity aid diagnosis; obstruction relief plus AML-regimen chemotherapy is core. Lysozyme testing was not performed.
High-pressure intrapelvic instillation of povidone-iodine may result in catastrophic systemic complications, although such events are rarely reported. We describe a 52-year-old woman with genitourinary tuberculosis and a solitary functioning kidney who underwent augmentation cystoplasty with ureteric reimplantation. During surgery, dilute povidone-iodine was instilled through a percutaneous nephrostomy under high pressure to identify the ureteric orifice. Within minutes, she developed a catastrophic systemic reaction followed by disseminated intravascular coagulation, refractory shock, and death despite aggressive resuscitation and re-exploration. This case highlights the potential hazards of high-pressure intrapelvic antiseptic instillation and discusses possible underlying mechanisms.
Extratesticular leiomyoma of the epididymis is a rare benign extratesticular tumor that may mimic malignancy clinically and radiologically. This a case report of a 64-year-old male presenting with painless, left scrotal swelling of six years duration. Imaging demonstrated a well-circumscribed extratesticular epididymal mass suspicious for a fibrous neoplasm. Due to inability to exclude malignancy pre and intra-operatively, left high inguinal orchiectomy was performed. Histopathology confirmed benign leiomyoma composed of spindle cells without atypia or mitosis. This case highlights the diagnostic challenges posed by extratesticular masses and emphasizes considering benign differentials to potentially avoid unnecessary radical surgery in patients preoperatively.
Ureteral lithiasis in renal allografts can quickly compromise graft function, particularly as the transplant kidney often serves as a solitary functioning unit. A 45-year-old male renal allograft recipient presented with acute graft dysfunction four years post-transplantation, with imaging revealing a 5-mm proximal ureteral stone and hydronephrosis. Retrograde ureteroscopic access and stent placement failed due to severe ureteral tortuosity. The procedure was converted to endoscopic combined intrarenal surgery(ECIRS), successfully removing the stone via a rendezvous-assisted approach. Postoperative outcomes were favorable, with improved serum creatinine and stable graft function at six months, demonstrating ECIRS as a salvage approach when retrograde methods fail.
Renal aspergillosis is an uncommon complication of urological instrumentation. We report a 40-year-old immunocompetent male who developed upper ureteric Aspergillus flavus fungal ball obstruction one month following left partial nephrectomy for Papillary Renal Cell Carcinoma Type 1. Prior history included DJ stenting and ureteroscopic stone clearance. He presented with left loin pain, malaise, and decreased urine output. CT demonstrated left hydroureteronephrosis without a discrete calculus. Emergency ureteroscopy successfully extracted the fungal ball. The patient completed three months of oral itraconazole 200 mg twice daily, with therapeutic serum trough levels confirmed, achieving complete clinical and radiological resolution.
Horseshoe kidney (HSK) with a duplicated collecting system and a bifid ureter is a unique surgical challenge. We report the case of a 43-year-old male patient with a left HSK, duplicated collecting system, bifid ureter, staghorn calculus in the lower moiety, and proximal ureteral stone. The procedure of mini-endoscopic combined intrarenal surgery (mECIRS) with mini-percutaneous nephrolithotomy (mini-PCNL) was successfully performed, resulting in minimal blood loss and no intraoperative complications. This case exemplifies the feasibility of employing mECIRS with a single-tract, tubeless mini-PCNL, combined with flexible ureteroscopy, to achieve complete stone clearance in a rare and challenging anatomical context.
Congenital anterior urethrocutaneous fistula (CAUF) is an uncommon penile malformation characterized by the urethra's connection to the skin on the ventral aspect of the penis. It can occur alone or with genitourinary or anorectal anomalies. Due to the scarcity of reported cases, treatment strategies vary, prompting a systematic review to evaluate their clinical presentation, surgical outcomes, and recurrence rates. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, ScienceDirect, EBSCO, Cochrane, and Google Scholar for studies published up to December 12, 2024. Eligible studies focused on CAUF, its variants, surgical interventions, complications, and recurrence rates. Data were extracted and analyzed, including fistula location, associated anomalies, surgical techniques, and patient outcomes. Seventy-eight patients from 46 studies were reviewed. The most common fistula sites were subcoronal (42.3%) and mid-penile (39.7%), followed by penoscrotal (8.9%), proximal penile to subcoronal (5.1%), and scrotal/perineal (3.8%). Chordee occurred in 11 cases, while 19.2% had associated genitourinary anomalies and 16.7% systemic anomalies, mainly anorectal malformations. Surgical repair, especially with a ventral dartos flap, showed high success. Recurrence was 8.9%, with 5.4% closing spontaneously. CAUF is a rare anomaly with variable presentations and frequent associations with other anomalies. Surgical repair generally achieves good outcomes with low recurrence, though spontaneous resolution is possible in select cases. Larger multicenter studies are needed to standardize management and clarify genetic and embryologic factors.
Prostatic calculi are frequently detected on transrectal ultrasound (TRUS) and computed tomography (CT), yet their clinical relevance in prostatitis remains uncertain. To systematically evaluate the association between prostatic calculi and prostatitis-related outcomes in adult men. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted. PubMed, Ovid Embase, CINAHL, and Google Scholar were searched for studies published between January 1, 2015 and October 31, 2025. Eligible studies assessed prostatic calculi by presence, burden, location, or density and compared outcomes with men without calculi or with lower burden. Outcomes included prostatitis diagnoses, validated symptom measures (National Institutes of Health-chronic prostatitis symptom index [NIH-CPSI], International Prostate Symptom Score [IPSS], International Index of Erectile Function - 5), inflammatory markers, and treatment response. Risk of bias was assessed using the Critical Appraisal Skills Programme tool. A total of 198 records were identified, of which 10 studies were included. Most were cross-sectional, with one prospective CP/chronic pelvic pain syndrome cohort. Greater calcification burden and peri-urethral distribution were associated with higher NIH-CPSI and IPSS scores and less favorable symptom improvement following medical therapy. CT-based cohorts reported associations between higher-density calculi and worse lower urinary tract symptoms, erectile dysfunction, pelvic pain, and reduced quality of life. A prostatectomy series demonstrated bacterial biofilm within calcifications, providing biological plausibility. Prostatic calculi - particularly when extensive or peri-urethral - are associated with increased symptom burden and may identify men with more refractory disease. However, current evidence is observational and heterogeneous, with incomplete confounder control. Standardized imaging classifications and prospective studies are required to clarify causal relationships and inform management strategies.
Scrotal necrosis is a rare complication following inflatable penile prosthesis (IPP) implantation. However, the management of aseptic ischemic scrotal necrosis following IPP implantation remains controversial. A 60-year-old male patient with a history of diabetes mellitus underwent implantation of a three-piece IPP. Postoperatively, he developed scrotal skin necrosis. Instead of removing the prosthesis, we performed delayed surgical debridement of necrotic tissue and reconstruction with a pedicled superficial circumflex iliac artery perforator (SCIP) flap to preserve the pump. After 8 months of follow-up, the flap remained viable, the prosthesis functioned normally, and the patient reported satisfactory functional and cosmetic outcomes.
A 43-year-old man presented to the emergency department with bleeding from the urethral meatus following sexual intercourse. No penile swelling, hematoma, or detumescence was reported. The patient was able to void spontaneously. Flexible cystoscopy revealed an approximately 2 cm laceration at the 2 o'clock position of the anterior urethra, without evidence of corpus cavernosum involvement. A 16 Fr Foley catheter was inserted and kept for two weeks. Following catheter removal, the patient had normal urination and preserved erectile function. Conservative catheterization for partial anterior urethral injuries without corporal involvement remains a safe and effective management approach.
Abdominopelvic neurofibromas are very uncommon presentations, with only 60 reported cases in literature. We report a sporadic giant abdominopelvic neurofibroma in a 29-year-old male presenting with progressive abdominal distension, urinary frequency, and constipation. Imaging revealed a large heterogeneously enhancing pelvic mass compressing the rectum and urinary bladder, causing bilateral hydroureteronephrosis. Exploratory laparotomy with complete excision was performed successfully. Histopathology confirmed the mass as a neurofibroma. The postoperative course was uneventful, with no recurrence at 6-month follow-up. This case highlights the diagnostic challenges of sporadic pelvic neurofibromas and emphasizes the importance of imaging, histopathological evaluation, and complete surgical excision.
We present the case of primary testicular diffuse large B-cell lymphoma diagnosed at the stage of pectoral skin metastasis in a 40-year-old male patient. He presented with a painless mass in the left scrotum that was complicated by ulcerated gynecomastia. An orchiectomy combined with a pectoral tumorectomy led to this diagnosis. The tumor was of the non-centro-germinative B subtype and classified as pT3NxM1b, Ann-Arbor stage IV E. The patient died while undergoing chemotherapy. This case underscores the poor prognosis associated with this histological type and the value of immunohistochemistry in diagnosis.
Corpus cavernosum thrombosis is rare, and its association with penile malignancy is exceptionally uncommon. Although most penile cancers are squamous cell carcinomas, primary synovial sarcoma is exceedingly rare. We report a 36-year-old man with bilateral corpus cavernosum thrombosis and persistent perineal pain, managed conservatively for two years, during which imaging failed to identify a neoplasm. He later developed a rapidly enlarging penile mass with nodal involvement; total penectomy with lymphadenectomy confirmed synovial sarcoma. Early recurrence with metastatic progression required palliative therapy, and he died eight months postoperatively. Persistent or unexplained corpus cavernosum thrombosis should prompt consideration of malignancy.
A 35-year-old transgender man with history of gender-affirming phalloplasty with radial forearm flap followed by inflatable penile prosthesis (IPP) placement had recurrent urethral stones from hair growth. He presented with pain from his implant and voiding difficulty and was confirmed to have infected IPP. At the time of implant removal, a significant burden of stones and luminal hair were found and treated with laser lithotripsy. For definitive management of hair-related complications, he underwent a staged urethroplasty with a first stage Johanson technique followed by 6 months of electrolysis of hair follicles along urethral plate before second stage repair.
While most kidney stones are made of typical substances like calcium oxalate, patients with uncommon metabolic disorders or exposures/ingestions can crystallize rare materials in their urinary tracts, leading to unusual stone compositions. Six stones in 5 individuals were evaluated when their composition did not match known lithogenic substances. We report the first ever identified human urinary calculi composed of steviol, a metabolite of the no-calorie sweetener, stevia.
