Uretero-iliac Artery Fistula: A rare, life-threatening condition.

Uretero-iliac artery fistula is an uncommon finding, which typically occurs following abdominal surgery, trauma, radiation, or ureteral stent placement. This usually presents in a patient with intermittent hematuria, making it difficult to diagnosis. Computed tomography angiography (CTA) is gold-standard for diagnosis, but a high-degree of clinical suspicion must be present to make the diagnosis. This often does not occur until there is massive hemorrhage leading to anemia and, not uncommonly, can be fatal. There are multiple proposed mechanisms of fistula formation, which are discussed here. We present a case of nonfatal fistula formation and the difficulties of diagnosing the condition.

Upper tract urothelial carcinoma presenting at a bifurcation of a partially duplicated left ureter: A minimally invasive approach.

Urothelial carcinoma is the fourth most common solid organ malignancy. Rare cases arise from the upper urinary tract. A 78-year-old male presents with a chief complaint of hematuria, burning, urinary incontinence, and passing clots. The patient appeared to have a partial duplication of the left ureter. During the ureteroscopy, a mass was seen at the bifurcation of the partially duplicated left ureter. The mass in the ureter was classified as a T1 upper tract urothelial carcinoma. Minimally invasive endoscopic approaches were chosen to manage the patient and he presented to the operating room for laser ablation of the UTUC.

Small-cell neuroendocrine tumor of the bladder: A rare disease in a low-risk woman.

Bladder cancer is the fourth most common malignancy in men and ninth most in woman. Most bladder cancers are urothelial, and the neuroendocrine sub-types make up 0.5-1.0% of cases. Here we present a 70-year-old female with poorly differentiated small cell carcinoma of the bladder who complains of an extensive history of gross hematuria. She was started on a neoadjuvant chemotherapy regimen of 21-day Etoposide with Carboplatin and radical cystectomy. More work needs to be done when it comes to the best treatment method for this rare cohort of patients.

Ureteral Polyp Managed by Endoscopic Techniques.

Fibroepithelial polyps (FEPs) are rare benign tumors of mesodermal origin. They are found in the ureters 85% of the time, with the remainder located in the renal pelvis and occasionally the bladder. FEPs can present as flank pain, lower abdominal pain, and/or gross hematuria. Previous literature reports management of these benign lesions using open surgical techniques, laparoscopic techniques, and endoscopic management. In this article, the authors present their pure endoscopic management of a large ureteral polyp and a review of the current literature outlining the etiology, clinical presentations, and management techniques for FEP of the ureter.

Case report of metastatic prostate cancer to testicles: An ominous sign of advanced disease.

Prostate cancer is the most common cancer in men in the United States and the second leading cause of mortality in this population. Those diagnosed may undergo a variety of treatments ranging from radiation to chemotherapy to surgery. Although metastases commonly first appear in bone, it is important to consider rare locations of metastasis such as the testicles. We present the case of a 56 year old male who presented with diffusely worsening back pain along with scrotal swelling who was ultimately diagnosed with metastatic prostate cancer to the bilateral testicles.

A Unique Case of Testicular Compromise in a Patient with Ovotesticular Disorder of Sexual Development and a Solitary Testicle.

Ovotesticular disorder of sexual development (OT-DSD), previously true hermaphroditism, is a condition in which one or both gonads contain testicular and ovarian tissue. A 23-year-old OT-DSD male patient presented with continuous pain in his right testicle which had been previously intermittent over the past five days. The patient had a prior history of left ovotestis removal with prosthesis placement, a right undescended testicle with aberrant anatomy, and hypospadias repair, all of which were corrected shortly after birth. A lack of blood flow to the testicle on Doppler ultrasound warranted immediate surgical intervention. Intraoperatively, an aberrant tunica vaginalis space with a compressive hematoma secondary to epididymal abscess rupture was identified as the causation for testicular compromise. Return of vascular flow to the testicle was confirmed with intraoperative Doppler after hematoma and epididymis excision, and the testicle was left in situ. It is imperative to consider epididymal etiologies with acute testicular pain, especially in a patient with a medical history that carries an increased risk for gonadal anomalies.

Bladder cancer that metastasized to the skin: A unique presentation that signifies poor prognosis.

In the United States in 2015, an estimated 74,000 new cases of bladder cancer were diagnosed and approximately 16,000 deaths were due to bladder cancer. We present a rare case of a patient with aggressive bladder cancer who presented with multiple inguinal and scrotal skin lesions that were proven to be metastatic urothelial malignancy. Bladder malignancy can involve the skin by direct tumor invasion, hematogenous routes, lymphatic spread, and direct seeding due to iatrogenic implantation. The cutaneous lesions have an extremely variable appearance, are resistant to therapies, and signify a dismal prognosis.

Tethered cord syndrome in a 24-year-old woman presenting with urinary retention.

We discuss a case of newly diagnosed tethered cord syndrome (TCS) in a 24-year-old woman who presented with dysuria, hematuria, and urinary retention. Physical exam revealed hyperreflexic lower extremity deep tendon reflexes. MRI showed filum terminale terminating in a lipoma, consistent with TCS. We discuss the role of MRI in the workup of adults with bladder dysfunction.