Background: Clear cell renal cell carcinoma (ccRCC) is the most common malignant renal neoplasm and exhibits heterogeneous biological behavior. Prognosis is influenced by histopathological factors such as nuclear grade, tumor necrosis, and vascular invasion, even in small tumors. The development of robotic platforms such as the Hugo™ RAS system has expanded the role of nephron-sparing surgery. Case presentation: We report a 42-year-old male with an incidentally detected left renal mass measuring approximately 4 cm, with solid-cystic features with a 5p R.E.N.A.L Score. The patient underwent Hugo™ RAS-assisted partial nephrectomy without intraoperative complications. Histopathological evaluation revealed clear cell renal cell carcinoma, WHO/ISUP grade 3, with 30 % tumor necrosis and vascular invasion, confined to the kidney, with negative surgical margins (pT1a). Immunohistochemical analysis showed positivity for CAIX and negativity for CK7, TFE3, and ALK, supporting the diagnosis. Discussion: Despite its early stage, the presence of tumor necrosis, high nuclear grade, and vascular invasion suggests a potentially aggressive biological behavior. This case highlights the importance of integrating histopathological findings with advances in robotic surgery to achieve accurate prognostic stratification and optimize clinical management.
The male prepuce is the skin that covers and protects the glans. This structure has been underestimated, stigmatized and even ablated for non-medical reasons. The main aim of this review is to summarize existing literature on male prepuce neurobiology and secondary to it, to discuss the potential effect of circumcision and the associated axotomy on neuroplasticity and male urogenital physiology. It was found that the prepuce ontogeny and innervation include prenatal and postnatal development. Since its separation from the glans penis is androgen dependent, the physiological phimosis at birth is resolved during childhood and adolescence. In contrast to the glans penis, the prepuce is innervated by a dense network of corpuscular sensory receptors, specialized nerve endings that are essential for the perception of various tactile sensations, including light touch, pressure, vibration, and stretch. Thus, the foreskin is a specialized sensory tissue, with potential roles in sexual perception and modulation of genital reflexes. Its ablation may induce peripheral and central neural reorganization, but little is known about the neuroplasticity associated with genital nerve axotomy. Preclinical research will allow elucidating the mechanisms and their long-term implications, understanding these aspects is essential for interpreting clinical findings.
Introduction: Giant bladder leiomyomas are rare benign tumors that may clinically and radiologically mimic malignant neoplasms. When large or located near the bladder neck, they are traditionally managed through open or laparoscopic approaches due to concerns regarding incomplete resection and significant bleeding. Case presentation: A 41-year-old man presented with a three-year history of intermittent hematuria. Imaging revealed a 61.6 × 54.9 × 43 mm intravesical mass. Endoscopic thulium laser vaporresection was performed, revealing an approximately 8 × 7 × 7 cm pedunculated tumor occupying 90 % of the bladder lumen and attached to the bladder neck by a broad pedicle. Complete resection was achieved without intraoperative or postoperative complications. Histopathological analysis confirmed bladder leiomyoma (actin and desmin positive; CD117 and S100 negative). No recurrence was observed at six-month follow-up. Conclusion: To our knowledge, reports of giant bladder leiomyomas successfully treated endoscopically with thulium laser are scarce. This case suggests that, in carefully selected patients, endoscopic management may expand traditional treatment boundaries and potentially avoid more invasive surgical approaches.
The identity of gender in transgender people calls for integrated, multidisciplinary care. In Mexico, about 316,192 transgender individuals may require specialized medical attention. Gender-affirming treatment brings together hormonal therapy and surgical options, with the urologist serving as a key member of a coordinated team of specialists. Research supports that this approach is safe and effective when provided by a multidisciplinary group and followed over the long term, improving both physical health and overall quality of life for patients.
Objective: to evaluate the clinical and functional outcomes of single-stage urethroplasty using the Kulkarni technique in patients with panurethral stricture disease treated at a national military referral center between 2020 and 2024. Methods: an observational retrospective study was conducted including male patients with panurethral strictures measuring ≥8 cm who underwent urethroplasty with the Kulkarni technique. Demographic data, comorbidities, etiology, uroflowmetry parameters, quality-of-life scores (EQ-VAS, EQ-5D-3L, IIEF-5, MSHQ-EjD, ICIQ-MLUTS, ICIQ-UI SF), and postoperative complications were analyzed. Continuous variables were summarized using medians and interquartile ranges. Paired differences in quality-of-life scores were assessed using the Wilcoxon test. Recurrence-free survival was evaluated with Kaplan–Meier analysis. Results: eighteen patients were included (median age 62 years). The most frequent etiology was iatrogenic injury (61.1 %), followed by lichen sclerosus and trauma (16.7 % each). The preoperative Qmax was 8 mL/s, increasing to 14.4 mL/s at three months and remaining stable at 12 and 24 months. EQ-VAS scores improved from 70 to 95 points at follow-up (p < 0.001). Sexual-function and urinary-symptom scores demonstrated significant improvement across all instruments. Postoperative complications were infrequent and mild, with no reoperations or infections recorded. Median follow-up was 27 months, and no recurrences were identified, yielding a recurrence-free survival of 100 %. Conclusions: single-stage urethroplasty using the Kulkarni technique demonstrated favorable clinical and functional outcomes in patients with panurethral strictures, with sustained symptom improvement, low complication rates, and no recurrences during follow-up. These findings support its use as an effective and safe reconstructive option for extensive anterior urethral disease.
