Molecular Biophysics
Lip Metastasis After Radical Cystectomy
An 86-year-old male who underwent radical cystectomy with ileal conduit for bladder cancer (pT3aN0) presented with rapidly growing lesion of the lip 18 months after surgery. Physical exam demonstrated a 1 cm poorly circumscribed, dark, raised and tender lesion on the upper lip (Fig. 1). Surveillance CT chest, abdomen and pelvis was negative for recurrence.Tuberous Sclerosis Complex
A 38-year-old woman arrived at the emergency department complaining of left lower back pain, nausea, malaise, and mild chest discomfort. On physical examination she was pale and had multiple skin fibromas. Her abdominal exam was benign, and she was vitally stable. Her heart rate was 90 beats per minute. Labs were notable with a reported hemoglobin level of 9 mg/dl. Given her symptoms, a CT of her chest, abdomen and pelvis was performed. A bleeding angiomyolipoma on the left kidney was identified (Fig.Rhabdomyosarcoma of the Urinary Bladder Occurring in an Adult
A 78-year-old female was referred to urology for hematuria and dysuria. Her urine culture was negative, however, urine cytology showed malignant cells with scant cytoplasm and stippled chromatin (Fig. 1). They were negative for pancytokeratin, CD45, and Melan A, thus making carcinoma, lymphoma or melanoma unlikely. Additional tissue procurement was requested. Cystoscopy revealed a 6 cm bladder mass composed of a small, blue cell tumor, with involvement of the muscularis propria. The tumor expressed skeletal muscle markers (desmin and myogenin) consistent with rhabdomyosarcoma (Fig.Corrigendum to ‘Opioid Free Ureteroscopy: What is the True Failure Rate?’ [Urology Vol. 154 (2021) pp. 89-95]
The authors regret that there is a typo in the Results section of the Abstract. “In the total cohort, benzodiazepine users had a lower risk of OF-URS failure on multivariate analysis” should read “benzodiazepine users had a higher risk of OF-URS failure”.The R Frank Jones Urology Interest Group: An Intentional and Strategic Pipeline Program to Increase Diversity in Urology
To address the low numbers of urologists who are ethnically and racially underrepresented in medicine (URiM), the nonprofit organization Urology Unbound developed the R. Frank Jones Urology Interest Group (RFJUIG), a pipeline program that provides mentorship, research opportunities, and professional development for URiM students. Students complete a questionnaire as part of the registration process for the RFJUIG. This questionnaire collects demographic information and asks about their experience pursuing urology and goals for participation in the program.A Male With a “Uterus-like” Mass in Pelvic Cavity
A 65-year-old man presented to our clinic for physical examination. He reported no obvious symptoms. Abdominal examination revealed a well-defined mass in the pelvic area, approximately 12 cm × 8 cm in size. During the digital rectal examination, the upper boundary of the prostate cannot be touched clearly. Laboratory tests showed slightly elevated levels of testosterone (13.00 ng/mL) and carbohydrate antigen 19-9 (35.40 U/mL). The free prostate specific antigen and total prostate specific antigen is 0.26 ng/mL and 1.12 ng/ml, both in the normal range.Metastatic Penile Adenocarcinoma in the Context of Rectal Cancer
The presence of penile metastatic lesions proceeding from primary rectal tumors is a rare entity usually associated with a poor prognosis. Clinical presentation and localization may vary. There exists no consensus gold standard treatment for penile metastatic lesions, and there is continuous debate on whether lesions should undergo surgical, chemotherapeutic or palliative management.Juxtaglomerular Cell Tumor: A Rare Cause of Hypertension
A 39 year-old young woman was referred to the cardiology department because of 'dizziness for 1 week'. She had a history of hypertension for 3 years, which was treated with irbesartan, but had poor blood pressure control for 1 week. The laboratory examination revealed an elevated renin level of 1000 uIU/ml. An enhanced computed tomography (CT) scan of the abdomen demonstrated a soft-tissue mass in the upper pole of the left kidney. The patient was admitted for further evaluation. Admission labs were notable for a serum potassium of 2.93 mmol/L.Utilization of the Glue-clot Technique for Removal of Small Lower Pole Calculi in Pediatric Patients: Case Series
Glue-clot technique has been described as a method to remove small stone fragments in adults undergoing endourological management of renal calculi. In this case series, we share our experience of using this technique for retrieval of stone fragments in 4 children who underwent ureterorenoscopy. The fragments were mainly located in the lower calyces rendering stone extraction challenging. We were able to achieve complete clearance in all patients. This series represents the first use of glue-clot technique in pediatric ureterorenoscopy.Congenital Bilateral Wilms Tumor: A Case Report
Compare to congenital mesoblastic nephroma in fetus, congenital wilms tumor is extremely rare. Herein we report a case of congenital bilateral solid masses on antenatal ultrasound. The mass was evaluated by ultrasonography and contrast computed tomography scan in postnatal period, and the patient was undergoing tumor enucleation separately in short period after neoadjuvant chemotherapy. The diagnosis was confirmed by histology analysis for each side, and the treatment was taken according to the International Society of Pediatric Oncology.Spontaneous Pubertal Onset in a Male Patient With Mixed Gonadal Dysgenesis With Mosaicism 45,X/ 46, X, mar (Y)/ 47,X,mar(Y),+mar(Y) - Pediatric Case Report
This report describes an adolescent with Mixed Gonadal Dysgenesis and unexpected mosaicism [karyotype 46,X,mar(Y)/ 47,X, mar(Y),+mar(Y)].). Diagnosis with 1 month of age due to atypical genitalia. He presented a right streak gonad, which was removed due to the risk for germ cell tumor, and a left testis with epididymis barely connected and without vas deferens. Left testis maintenance was sufficient for him to undergo spontaneous puberty. The patient was non-responsive to growth hormone. Webbed neck was the only dysmorphic feature.Persistent Genital Arousal and Major Depressive Disorder in an Adolescent Male: Case Report and Discussion
Persistent genital arousal disorder [PGAD] is a distressing physiologic arousal condition with no psychologic etiology. We highlight identification and treatment of PGAD and associated mental comorbidities in a 15-year-old male who presented to Pediatric Urology with PGAD with pain, and resultant depression and suicidal ideation. After failure of conservative pharmacologic management, MRI of the lumbosacral spine demonstrated an L5-S1 annular tear and herniation of the nucleus pulposus. The patient underwent transforaminal steroid injection with reduction in symptoms, and eventually lumbar discectomy with near complete resolution of symptoms.Vena Cava Tumor Thrombus Associated With Renal Angiomyolipoma in a Jehovah's Witness Patient
We present a case of a young premenopausal female patient who was found to have a left-sided renal mass consistent with angiomyolipoma (AML) with Mayo Level IIIa vena caval tumor thrombus. The patient is of Jehovah's witness faith and would not accept blood transfusion. The following case report discusses workup and treatment for AML with tumor thrombus extension, as well as pre-operative optimization and intra-operative techniques during nephrectomy and thrombectomy to minimize blood loss in a patient unaccepting of blood transfusion.Management of Giant Groin Mass
A 66-year-old male presented with intermittent cardiac ischemia and underwent evaluation for revascularization. Preoperatively, he was discovered to have a 33 × 16 cm locally invasive groin mass that had been present for ∼20 years. He was disqualified from CABG due to his giant, purulent mass, and underwent immediate coronary stenting with drug eluting stents, requiring chronic dual-antiplatelet therapy (DAPT). He continued to suffer recalcitrant purulent infection with chronic leukocytosis and developed intermittent bleeding that required recurrent transfusions and unsuccessful angioembolizations with profound impacts on his quality of life (Fig.Ectopic Vas Deferens Causing Recurrent Epididymo-Orchitis
Vasal ectopia is a rare congenital anomaly arising from the close embryonic relationship between the proximal vas precursor and the common mesonephric duct. We present a case of an adolescent male with recurrent epididymitis with scrotal and inguinal abscesses found to have right ectopic vas draining into the bladder.Thinking of Draining a Renal Abscess? Wait! – Could Be Acute Lobar Nephronia
Acute Lobar Nephronia (ALN) is a rare infective condition of the kidney currently described only in case reports and small case series. The diagnosis of ALN is made by characteristic clinico-radiological findings. Differentiation from acute pyelonephritis, renal abscess and renal tumor is crucial for proper management and to avoid unnecessary diagnostic interventions. Herein, we report a 58-year-old woman with an uncontrolled diabetes mellitus, who was diagnosed clinically as acute pyelonephritis and treated with standard duration of antibiotics but had recurrence of symptoms.Surgical Correction of True Diphallia in a Newborn Male
Diphallia is an exceedingly rare anomaly characterized by partial or complete duplication of the phallus. Approximately 100 cases have been reported worldwide since its initial documentation, and incidence is estimated at 1 in 5 to 6 million live births. Therapeutic management is dependent on the extent of the anomaly, ranging from phallic excision to complex reconstructive procedures in cases of broader systemic involvement. We present the case of congenital true diphallia with associated penoscrotal transposition, bifid scrotum, partial urethral duplication, ventral chordee, large scrotal lipoma and sacral dimple.A Bosniak IV Cystic Renal Mass with Mixed Epithelial and Stromal Tumor Features
A 60-year-old male with a past medical history of aortic valve replacement, well-managed hypertension, hyperlipidemia, and bilateral inguinal herniorrhaphy presented to the emergency room with worsening right lower abdominal pain and gross hematuria. He was subsequently admitted due to leukocytosis (24.35 k/uL), pyuria, and elevated serum creatinine (1.37 mg/dL). Contrast-enhanced CT abdomen/pelvis demonstrated an enlarged prostate with peri-prostatic inflammatory fat stranding suspicious for acute prostatitis.An Unusual Complication of Retropubic Midurethral Sling Placement: Obturator Neuralgia
Midurethral sling placement is a common treatment for female stress urinary incontinence. We report a case of a woman with a 9-month history of significant pelvic and right lower extremity pain following synthetic retropubic sling placement at an outside facility. On evaluation, she had unilateral obturator neuropathy and underwent combined vaginal, and robotic excision of the right arm of the sling. During surgery, the sling was adherent to the obturator nerve and passed laterally through the obturator fossa.Epidural blockade for alternative management of priapism: A case report of child with T-cell acute lymphoblastic leukemia
Priapism is a clinical condition that rarely presents with leukemia in childhood. Management of priapism treatment can become more complex and difficult when accompanied by acute leukemia. We presented a 16 years old child with t-cell acute lymphoblastic leukemia (ALL) who developed priapism. Due to the failure of conservative methods and intracavernosal drainage, we performed epidural blockade which has limited data reported with successful results in the literature before shunt surgery.Female Urethral Clear Cell Adenocarcinoma: A Case Report
A 67-year-old female is referred from gynecology due to irritative voiding symptoms, urethral pain, and a vaginal bulge. On exam, a friable lesion can be seen protruding from the urethral meatus, and can be palpated transvaginally to extend proximal to the bladder neck. Transvaginal biopsy demonstrates clear cell adenocarcinoma.Plexiform Penile Neurofibroma: A Case Report of a Rare Entity in a Pre-Pubertal Child
Neurofibromatosis is a group of genetic disorders and consists of 2 forms: Neurofibromatosis type 1 (NF-1) and Neurofibromatosis type 2. The most common is the NF-1 which is also known as von Recklinghausen's disease. The presentation and clinical manifestations of this condition vary greatly. It is usually characterized by café-au-lait spots and neurofibromas. In this report, the case of a 12-year-old boy with NF-1 is presented. The boy has several café-au-lait spots along with inguinal and axillary freckles.Clinical Challenge: A Rare Testicular Tumor
We present the case of a 22-year-old male that comes to the Urology clinic with the incidental finding of a testicular mass. Typical findings in echography will guide us towards the diagnosis of an epidermoid cyst.1,2 This type of infrequent benign tumor is responsible for only around 2% of all testicular tumors.1 Because of this low incidence literature regarding epidermoid cysts is scarce. Treatment has been susceptible to change throughout the years.6 In this clinical case we challenge readers to review a rare tumor and to choose the most appropriate treatment for our patient.Penile Calciphylaxis
A 66-year-old male presented with five days of penile pain and ulceration. The patient had a history of stage 5 chronic kidney disease and repeatedly declined hemodialysis. Wound and urine cultures were unrevealing. CT of the abdomen and pelvis did not reveal any evidence of Fournier's gangrene but identified diffuse severe calcific vasculopathy. Urology and dermatology agreed on the diagnosis of penile calciphylaxis. While diagnosis of calciphylaxis often includes histologic evidence of obstructive vasculopathy, biopsy of penile calciphylaxis is contraindicated due to increased morbidity and mortality.First Case of a Term Male Born with Aphallia and Complete Urethral Atresia
Aphallia is an exceedingly rare condition often associated with an array of genitourinary anomalies. Classically, aphallia was thought to have to co-exist with a urethral fistula for adequate urine outflow to avoid the sequelae of oligohydramnios, while the absence of a fistula has historically been incompatible with life. We report the first case of a prenatally unrecognized aphallia with complete urethral atresia in a full-term baby, without an associated fistula or ectopic urethra. We postulate a urachal cyst noted on prenatal ultrasound resolved into a patent urachus providing sufficient outflow to avoid sequelae of oligohydramnios and allowed for term birth.
