Unusual clinical scenarios in Urology and Andrology

Abstract

This collection includes some unusual cases and how they were diagnosed and treated.
 Case 1: A case of a patient with primary hyperthyroidism presenting with a submucosal ureteral stone after endoscopic lithotripsy was described. After multiple endoscopic treatment, the stone was successfully removed by open ureterolithotomy recovering ureteral patency and normal renal function.
 Case 2: A case of burned-out testicular cancer with atypical lymphatic spread (stage II A) was presented. After right orchiectomy and complete remission of tumor markers, due to atypical metastases location and uncertain histology, the patient was treated with systemic therapy based on bleomycin, etoposide and cisplatin (PEB). At re-staging after chemotherapy computed tomography showed reduction of all node metastases and an observation protocol was proposed.
 Case 3: A patient was readmitted to hospital after 12 days from an uneventful Robot-Assisted Radical Prostatectomy (RARP) for prostate cancer due to lower abdominal pain plus abdominal distension, nausea and constipation not responsive to medical therapy. Computed Tomography showed colon and small bowel dilatation without any evidence of anatomical or mechanical obstruction. Laparoscopic abdominal exploration confirmed bowel distension without evidence of obstructing lesions. Ogilvie’s Syndrome or acute colonic pseudo-obstruction (ACPO) was diagnosed. The patient fully recovered and was discharged six days after the procedure.
 Case 4: A case of recurrent Acute Idiopathic Scrotal Edema (AISE) was diagnosed on clinical signs together with the decisive help of pathognomonic ultrasound findings as the “fountain sign”.
 Case 5: Small bilateral testicular nodules were diagnosed in a 30-years old patient undergoing scrotal ultrasound in follow up of acute lymphoblastic leukemia. Ultrasound guided testis sparing surgery was performed demonstrating Leydig cell tumors.

The value of contrast-enhanced ultrasonography in differential diagnosis of primary testicular germ cell tumors and non-germ cell tumors over 50 years old

“…Since lymphoma is a combination treatment requiring surgery, chemotherapy and radiotherapy, intraoperative frozen sections are more difficult to diagnose, so preoperative puncture biopsy for immunohistochemistry can clarify the diagnosis ( 8 ). Since Leydig cell tumors are mostly benign, enucleation is the first choice ( 9 , 10 ). Pathological diagnosis of Leydig cell tumors by preoperative biopsy can reduce the operation time and protect testicular tissue.…”

Staghorn Calculus with Adenomatoid Tumor: A Case Report

“…In the present case, imaging showed a staghorn calculus occupying the renal collecting system with a 3.9 cm epididymal mass. Small and not palpable testicular lesions are often benign and can be followed clinically with ultrasound routinely or even intraoperatively, as testicular sparing surgery is the mainstay in case of benign lesions [ 15 , 16 ]. However, orchiectomy can be diagnostic as well as therapeutic when clinical suspicion of malignancy is expected.…”

“…testicular sparing surgery is the mainstay in case of benign lesions [15,16]. However, orchiectomy can be diagnostic as well as therapeutic when clinical suspicion of malignancy is expected.…”

Neglected pelvic viscera prolapse complicated by irreducible cystocele containing a large vesicle calculus

“…This case is an unusual presentation of the large vesical calculus in the prolapsed part of the cystocele, which is further complicated by the neglected middle and posterior compartment, making it necessary because the surgical approach needs to be modified based on complications and age of the patients 11…”