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Journal: Urology case reports


A 19 year old presented with a progressive decline in ejaculate volume over 2 weeks, followed by a complete absence of ejaculate emission. A post-ejaculatory urine specimen demonstrated spermatozoa confirming a diagnosis of retrograde ejaculation. Investigations revealed a raised blood glucose level of 24.5 mmol/L and HbA1c >15%, with positive tests for anti-GAD antibodies and anti-IA2 antibodies consistent with a diagnosis of Type 1 diabetes mellitus. Retrograde ejaculation in diabetes is associated with autonomic neuropathy and is a late feature of the disease. This case is unique with retrograde ejaculation being the primary presenting symptom of Type 1 diabetes mellitus.

Concepts: Diabetes mellitus, Diabetes, Blood sugar, Semen, Orgasm, Ejaculation, Retrograde ejaculation, Anejaculation


A 68 year old lady presented to urology department suffering from acute urinary retention. The U/S revealed hydronephrosis in left kidney and a mass at the left side of the small pelvis which pushed forward the uterus and the bladder. The CT scan confirmed a mixed (solid and cystic) mass, with diameter of 12 cm with interpretation of the left ovary. The patient underwent laparotomy and the mass was excised after a difficult dissection due to severe adhesion with the bowel. The well-capsulated mass was a retained surgical sponge. The patient had undergone cesarean procedure 29 years ago.

Concepts: Kidney, Urology, Urinary incontinence, Urinary bladder, Urinary system, Ureter, Pelvis, Urinary retention


Human heterophile antibodies may develop after infection or contact with animal tissues or animal serum products. These antibodies have the capacity to bind to the animal immunoglobulins used in immunoassays leading to erroneous results. We here report a case of a testicular germ cell tumor patient who developed heterophile antibodies during the surveillance period of his disease. Following false-positive results of human chorionic gonadotropin (hCG) he received unneeded chemotherapy. This article also stresses the problem of using serum tumor markers without no major imaging abnormalities to diagnose a patients' relapse.

Concepts: Immune system, Cancer, Bacteria, Oncology, Germ cell tumor, Human chorionic gonadotropin, Glycoprotein, Heterophile


Self-mutilation is the deliberate direct injuring of body tissue, often done without suicidal intention. Genital self-mutilation is a very rare event and self-harm of the penis, especially in the genital system is exceedingly rare. Generally, this kind of behavior is related to psychotic disorders but can sometimes be seen in non-psychotic people due to bizarre autoerotic acts, a desire for to change sex or religious beliefs that view sexual intercourse as a sin. Our case was the reported genital self-mutilation as a result of the bizarre sexual arousal of a young man who is employed as an architect.

Concepts: Sexual intercourse, Religion, Vagina, Penis, Erection, Sexual arousal, Sex organ, Masturbation


The ExactVu™ Micro-Ultrasound system is a new high resolution imaging system for visualizing the prostate and has been FDA, CE, and Health Canada approved for visualization and biopsy of the prostate. The PRI-MUS™ (Prostate Risk Identification for Micro-Ultrasound) protocol has previously been demonstrated to correlate with risk of prostate cancer and severity of cancer. Here we present a case where a healthy 50 year old subject with no known risk factors volunteered to test the ExactVu system and was found to harbour multiple PRI-MUS 3-5 lesions. This prompted PSA testing, biopsy and eventual diagnosis of significant prostate cancer.

Concepts: Epidemiology, Cancer, Metastasis, Pathology, Prostate cancer, Radiation therapy, Prostate, Image processing


Clear cell renal cell carcinoma and papillary renal cell carcinoma are the most common types of renal tumors. However, coexistence of both tumors in the same kidney is a rare condition. We report a 56-year old male who was found to have ipsilateral synchronous clear cell and papillary renal cell carcinoma in the left kidney. Review of related literature is provided to estimate the prevalence of similar cases.

Concepts: Kidney, Glucose, Organ, Electrolyte, Case, Renin, Renal cell carcinoma, Nephrectomy


We present a case regarding a 32-year old African male with penoscrotal hypospadias, left cryptorchidism and a left inguinal hernia. There were moderate masculinization characteristics. He underwent a Lichtenstein hernia repair with perioperative biopsies of the left inguinal testis and epididymis. Microscopic examination showed a Sertoli-only left testis with Leydig-cell hyperplasia and the left epididymis consisted of ovarian tissue with corpora albicantia and maturing follicles. Endocrinological evaluation showed a sex-determining region Y (SRY) negative 46,XX karyotype. We successfully performed a two-stage urethroplasty with buccal mucosa graft to reconstruct his penoscrotal hypospadias.

Concepts: Testicle, Reproductive system, Puberty, Endocrine system, Ovary, SRY, Sex-determination system, Androgen insensitivity syndrome


Neurofibromas of the urinary bladder are an exceedingly rare entity and are considered mostly in conjunction with the disease of neurofibromatosis type 1. The fortuitous discovery of vesical plexiform neurofibromas without other stigmata of the disease is presented in a 57-year-old male patient. The course of his condition, modalities of investigation and a non-precedent treatment plan are demonstrated.

Concepts: Urinary bladder, Urinary system, Ureter, Neurology, Neurofibromatosis, Neurofibroma, Dermal and subcutaneous growths, Inferior vesical artery


There are currently several options for tyrosine kinase inhibitor as a systemic therapy for metastatic renal cell carcinoma (mRCC). The successful control of adverse events caused by such drugs, along with eliciting long-term maximum effect, are the major issues with respect to the treatment strategy for mRCC. We herein report the clinical course of mRCC, in which erythema multiforme major was observed on the 13th day of the first course of sunitinib, but the symptoms improved after the immediate withdrawal of sunitinib, as well as the administration of topical steroids and oral antihistamines alone.


This case report presents a unique manifestation of complications in a 71-year-old man following blunt renal trauma. Initially, computed tomography (CT) revealed a traumatic left kidney laceration. Hematuria ceased quickly after ureteral stent placement. One week later, hematuria reoccurred while the patient was treated for pulmonary embolism. Multiphase CT revealed two renal pseudoaneurysms as the underlying cause. Renal pseudoaneurysms are commonly associated with surgery or inflammation and rarely seen after trauma. Selective angiographic embolization successfully stopped hematuria. Thereafter, the patient was hemodynamically stable to continue therapeutic thrombolysis. After discharge, the patient remained symptom-free and had an unremarkable follow up assessment.