Asian Journal of Research and Reports in Urology

An Unusual Presentation of Penile Fracture: A Report of Two Cases

Tue, 20 Jan 2026 00:00:00 +0000

Penile fracture is a rare condition that is easily identified by its classical clinical features. However, its features and course of the condition could be altered by the timing of presentation and the occurrence of complications. Delayed presentation is directly associated with delayed intervention with attendant poor clinical outcome. The occurrence of concomitant injuries like urethral rupture is associated with morbidities such as urethral stricture and urethra-cutanous fistula if not promptly and primarily repaired. We present two rare case reports of a delayed presentation of penile fracture and penile fracture with concomitant urethral injury. The patient in the first case report presented with localized right sided penile swelling and painful erection while the patient in the second case report presented with diffuse penile swelling, pain and urethral bleeding following trauma to the erect penis during intercourse. Both cases had immediate repair with good anatomical and functional outcome. This article highlights the invaluable role of primary repair in the management of penile fracture irrespective of the pattern of presentation.

Primary Isolated Testicular Tuberculosis in an Elderly Male: A Rare Case Report from Sekadau General Hospital as Rural Accessibility

Rendy Franiko, Edward Julio Suhendra — Tue, 27 Jan 2026 00:00:00 +0000

Introduction: Pulmonary tuberculosis represents the predominant clinical manifestation of tuberculosis. Extra-pulmonary involvement accounts for approximately 10–15% of cases, with lymph nodes being the most frequently affected site in Asian.

Presentation of Case: A 60‑year‑old male presented with a painful, right-sided testicular swelling without any discharging sinus or scrotal ulceration for 1 month. There was no history of any respiratory symptom. On examination, the general survey revealed no abnormality, Ultrasonography examination of testes showed the right side of scrotum was enlarge (3.38 x 3.34 x 5.0 cm) sized heteroechoic space occupying lesion with hypoechoic components and small cystic areas were seen at the lower pole of the right testis, lobulated with clear line, On Color Doppler Ultrasound (CDUS) showed intralesional vascularization. For the left side was within normal range. From Ultrasonography (USG) examination concluded that Solid mass with cystic component in right testes, suggestive for malignancy with hydrocele on the right side, with normal of left testes. The patient was informed to surgery procedure such as orchiectomy.

Discussion: Tuberculosis (TB) remains one of the leading causes of mortality worldwide, particularly in developing countries within TB-endemic regions such as Indonesia. Among these, isolated genital involvement is observed in nearly 28% of patients with genitourinary TB and occurs more frequently in males. Scrotal ultrasonography plays a pivotal role in the evaluation and diagnosis of tuberculous orchitis. Standard anti-tubercular chemotherapy remains the cornerstone of treatment for tuberculous orchitis. A six-month regimen consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol during the intensive phase for two months, followed by rifampicin and isoniazid for an additional four months, is generally effective in achieving complete resolution of testicular lesions. Surgical intervention is reserved for selected cases with complications or poor response to medical therapy.

Conclusion: Primary isolated testicular tuberculosis is an uncommon clinical entity and is frequently underrecognized because of its nonspecific presentation. Consequently, a high index of suspicion supported by thorough history taking, detailed physical examination, and appropriate diagnostic investigations is essential.

Medial Thigh Fasciocutaneous Flap for Perineoscrotal Reconstruction after Fournier’s Gangrene

Fri, 30 Jan 2026 00:00:00 +0000

Fournier’s gangrene is a rare and potentially serious necrotizing fasciitis of the perineal and external genital area which warrants urgent, multidisciplinary management. Even with the availability of advanced intensive care, antibiotic therapy, and aggressive surgical debridement, survivors often have massive perineoscrotal tissue lesions, which represents an intricate reconstructive problem. We report a 31-year-old male with no previous medical history who developed advanced Fournier’s gangrene, leading to extensive scrotal loss of skin with bilateral exposed testicles. Management initially consisted of hemodynamic stabilization, broad-spectrum antibiotics, and surgical debridement which was repeated until complete control of the infection was reached. A definitive reconstruction was made with a long-pedicle medial thigh fasciocutaneous flap, resulting in stable coverage in a single phase. Partial donor-site dehiscence was observed in the postoperative period and controlled conservatively. A second operative procedure was then conducted with flap division and scrotal reconstruction with purse-string method, as well as split-thickness skin grafting of the donor site. The postoperative outcome after surgery was favourable and acceptable in terms of aesthetics and function. Erectile function was intact and sperm analysis was normal at follow-up. This case illustrates the reliability and functional advantages of the long-pedicle medial thigh fasciocutaneous flap in perineoscrotal reconstruction for Fournier’s gangrene.

Nephroblastoma in Pediatric Urinary Retention: A Rare Clinical Presentation in Sekadau General Hospital

Rendy Franiko, Edward Julio Suhendra — Mon, 09 Feb 2026 00:00:00 +0000

Introduction: Wilms’ tumor (WT) is the most common malignant renal neoplasm in children and classically presents as an asymptomatic abdominal mass in early childhood. Urological manifestations related to urinary tract obstruction are rare and may obscure the underlying diagnosis, particularly in older children and in settings where delayed presentation is common.

Presentation of Case: A 7-year-old boy presented with acute urinary retention caused by extrusion of necrotic soft tissue through the urethral meatus. The patient had a four-month history of progressive abdominal distension without hematuria, trauma, or prior urinary instrumentation. Physical examination revealed a necrotic mass protruding from the urethra and a palpable left-sided abdominal mass. Emergency extraction of the obstructing tissue resulted in immediate relief of urinary retention; histopathological evaluation demonstrated necrotic material. Abdominal ultrasonography identified a solid left renal mass with associated pelvicalyceal system dilatation. The patient subsequently underwent radical nephrectomy. Histopathological examination of the nephrectomy specimen confirmed nephroblastoma with extensive tumor necrosis and capsular infiltration. The postoperative course was uneventful, with complete resolution of obstructive urinary symptoms, and the patient was commenced on risk-adapted adjuvant chemotherapy.

Discussion: Urinary tract obstruction in Wilms’ tumor is most commonly associated with intrapelvic extension, while gross hematuria remains an uncommon feature. Necroturia resulting in acute urinary retention has not previously been reported as a presenting manifestation of WT. This extreme clinical phenotype likely reflects advanced intrapelvic tumor necrosis with migration of devitalized tissue into the urinary tract, underscoring the biological and anatomical heterogeneity of Wilms’ tumor.

Conclusion: Wilms’ tumor may rarely present with necroturia and acute urinary retention. Recognition of such atypical presentations broadens the clinical spectrum of WT and highlights the importance of thorough abdominal examination in children presenting with unusual lower urinary tract symptoms.

Aggressive Primary Adrenal Leiomyosarcoma with Pancreatic and Gastric Involvement: Lessons from a Rare Case

Tue, 17 Feb 2026 00:00:00 +0000

Background: Primary adrenal leiomyosarcoma (PAL) is an exceedingly rare malignant neoplasm arising from smooth muscle elements of the adrenal gland or its associated vasculature. Fewer than 60 cases have been reported in the literature, and presentation with contiguous multivisceral invasion is exceptionally uncommon, posing significant diagnostic and surgical challenges.

Case Presentation: A 74-year-old male presented with left flank pain. Cross-sectional imaging revealed a large left adrenal mass measuring 13 × 13 cm with obliteration of surrounding fat planes and direct invasion into adjacent organs, including the pancreas, spleen, gastric muscularis, and left diaphragmatic crus. The mass caused compression of the splenic vessels with associated splenic vein thrombosis. Given the locally advanced nature of the disease, the patient underwent multivisceral “en-bloc” resection comprising left adrenalectomy, distal pancreatectomy, splenectomy, and distal gastrectomy. Histopathological examination confirmed primary adrenal leiomyosarcoma with infiltration into the pancreatic parenchyma and gastric muscularis propria. All surgical margins were free of tumour.

Discussion: PAL with direct multiorgan involvement is extremely rare, and preoperative diagnosis is often difficult due to nonspecific clinical and radiological features. Complete surgical excision with negative margins remains the cornerstone of treatment and offers the best chance for durable local control in the absence of distant metastasis.

Conclusion: This case highlights an exceptionally rare presentation of primary adrenal leiomyosarcoma with extensive contiguous organ invasion. Radical “en-bloc” resection, when technically feasible, can achieve clear margins and may offer curative potential. Reporting such cases contributes to the limited existing literature and helps guide surgical decision-making in this rare malignancy.

Percutaneous Tibial Nerve Stimulation for Neurogenic Detrusor Overactivity after Spinal Cord Injury: A Case Report

Sat, 07 Mar 2026 00:00:00 +0000

Introduction: Neurogenic detrusor overactivity (NDO) is characterized by spontaneous or provoked involuntary detrusor contractions during the storage phase in urodynamic investigation secondary to neuro-urological disorders. Percutaneous tibial nerve stimulation is a minimally invasive neuromodulation technique for treating overactive bladder symptoms.

Case: We report the case of a 53-year-old male, who came with DO secondary to spinal cord injury (SCI) since November, 2023. The patient had an inadequate response to oral anticholinergic drugs (tolterodine, propiverine and solifenacin). Therefore, the patient adopted weekly percutaneous tibial nerve stimulation (PTNS) and continued anticholinergic therapy with clean intermittent catheterization (CIC). At 3 months,12 months and 18 months from baseline, urodynamic assessments indicated normalized bladder compliance. At 3 months from baseline, the patient had no incidence of DO and complete dryness. Significant changes were already present in Incontinence-Specific-Quality-of-Life Instrument (59 vs 19) and mean voiding volume (400 ml vs. 70 ml), respectively. The outcomes had still yielded significant improvements until 18 months from baseline. Besides, the patient reported no related adverse event.

Conclusion: PTNS was effective and safe as the treatment for NDO secondary to SCI.

Primary Localised Urinary Bladder Amyloidosis: A Mimicker of Malignancy

Ravi V. Patel, Bunty A. Patel, Prathan N. Joshi — Wed, 11 Mar 2026 00:00:00 +0000

Aim: To study clinical features of primary urinary bladder amyloidosis, to identify it, to differentiate it from urinary bladder malignancy and to treat the disease.

Case Presentation: We present a case of 51-year-old gentleman presented with painless gross hematuria who was a known case of Nonalcoholic SteatoHepatitis (NASH) associated chronic liver disease. Ultrasound revealed a large blood clot without any evidence of mass or lesion. Cystoscopy revealed a flat lesion near trigone and biopsied. Lesion completely respected and surprisingly histopathology turned out to be localised amyloidosis which was confirmed with immunohistochemistry (IHC) profile. Within 6 months patients had recurrence and repeat trans urethral resection was performed. After that patients remained asymptomatic for 18 months and still under follow up without recurrence.

Discussion: The aetiology of bladder amyloidosis is poorly understood. There are two different schools of thoughts. Most researchers think that it is abnormal metabolism of protein which causes amyloidosis. While others think that it is a sequela of chronic urinary tract infection or repeated inflammation of mucosa and submucosa. Investigation protocol includes basic blood investigations, urine for cytology, ultrasound and CT-IVP and cystoscopic resection and Histopathological examination conclude the diagnosis. As the recurrence is known phenomenon, strict cystoscopic follow up is necessary.

Conclusion: Primary urinary bladder amyloidosis mimics bladder malignancy clinically. Thus, it is of utmost importance to distinguish between both of them and to treat them accordingly.

Double Inferior Vena Cava with Renal Angiomyolipoma in a Living Kidney Donor: A Rare Vascular and Parenchymal Anomaly with Surgical Implications

Nripesh Sadasukhi, Abdul Basit — Sat, 04 Apr 2026 00:00:00 +0000

Background: Duplication of the inferior vena cava (IVC) and renal angiomyolipoma (AML) are uncommon findings in living kidney donors and rarely coexist. Both anomalies may influence donor nephrectomy and graft implantation strategy.

Case Presentation: We report a 72-year-old female living kidney donor who underwent ABO-incompatible transplantation for her 32-year-old son with end-stage renal disease (donor: B positive; recipient: A negative). Preoperative contrast-enhanced CT angiography demonstrated a duplicated IVC with a left-sided cava crossing anterior to the aorta and joining the right IVC (pre-aortic confluence), along with an accessory left renal vein. A small lower pole AML measuring 8 × 7.5 × 12 mm was identified in the donor kidney. Bilateral single renal arteries were present. The anticipated technical challenge was reduced left renal vein length due to early drainage into the duplicated cava, potentially complicating venous anastomosis. Following multidisciplinary evaluation and immunological optimization, donor nephrectomy and transplantation were completed successfully without vascular compromise or graft-related complications.

Conclusion: This case underscores the importance of meticulous preoperative vascular mapping and individualized operative planning in donors with complex venous anatomy. Small, asymptomatic AMLs should not represent an absolute contraindication to donation when appropriately assessed. Even in the presence of ABO incompatibility and dual anatomical anomalies, successful transplantation is achievable with structured multidisciplinary management.

Ureteral Strictures after Intravesical BCG Therapy: Should Antituberculous Treatment Always be Initiated?

O. Tnibar, E. El Hichou, Z. Bakkali Aissaoui, Y. Retal, A. Khallouk — Mon, 06 Apr 2026 00:00:00 +0000

Objectives: Intravesical Bacillus Calmette–Guérin (BCG) therapy is the standard adjuvant treatment for intermediate- and high-risk non-muscle-invasive bladder cancer. Although generally well tolerated, severe complications may occur, while involvement of the upper urinary tract remains exceptional. We report a rare case of bilateral ureteral strictures following BCG therapy and discuss the diagnostic challenge between active infection and inflammatory reaction.

Case Presentation: A 74-year-old woman with a history of pT1 low-grade non-muscle-invasive bladder cancer developed acute renal failure during maintenance intravesical BCG therapy. The delay between initiation of BCG therapy and onset of renal failure was approximately 7 months. Pre-treatment imaging showed no dilatation of the pyelocaliceal systems, and ureteral orifices were consistently patent on surveillance cystoscopy. Subsequent imaging revealed bilateral uretero-hydronephrosis due to distal ureteral strictures associated with inflammatory bladder wall thickening. A comprehensive microbiological workup, including urine cultures and GeneXpert testing, as well as thoracic imaging, was negative. Bladder and peri-meatal biopsies demonstrated chronic fibro-inflammatory changes without evidence of mycobacterial infection. BCG therapy was discontinued, and bilateral double-J stenting with periodic replacement allowed stabilization of renal function at 6 months of follow-up.

Discussion: Bilateral ureteral strictures following BCG therapy are extremely rare. The main diagnostic challenge lies in distinguishing active Mycobacterium bovis infection from an immune-mediated inflammatory reaction. In the absence of microbiological and histological evidence of infection, an inflammatory mechanism is more likely.

Conclusion: Careful diagnostic evaluation is essential in such cases. When no evidence of active infection is found, conservative management with urinary drainage and discontinuation of BCG therapy may avoid unnecessary antituberculous treatment.

Beyond the Pelvis: Atypical Presentations of Prostate Cancer Mimicking Neurological and Head Neck Pathologies-selected Case Series from India

Mon, 20 Apr 2026 00:00:00 +0000

Background: Prostate cancer is one of the most common malignancies among elderly men worldwide. Prostate carcinoma typically metastasizes to bone and regional lymph nodes. Cranial or extrathoracic metastases as initial presentations are exceedingly rare and can mimic neurological or head-and-neck pathologies, leading to diagnostic delay. Such cases are sparsely reported, and to our knowledge, no dedicated case series from India exists.

Methods: We retrospectively analysed five patients who presented with atypical cranial or extra- thoracic manifestations and were subsequently diagnosed with metastatic prostate adenocarcinoma between 2020 and 2025 at our centre. Clinical, radiological, and histopathological data were reviewed.

Results: Presentations included sudden-onset bilateral blindness due to optic canal metastasis (n=1), unilateral facial nerve palsy with skull base involvement (n=1), petrous bone lesion with facial nerve palsy (n=1), Sudden onset memory loss (n=1) and supraclavicular lymphadenopathy (n=1). Serum PSA ranged from 185–420 ng/mL. Imaging (MRI and PET-CT) demonstrated corresponding metastatic lesions. Biopsy or FNAC confirmed metastatic adenocarcinoma with PSA immunopositivity in all cases (insert result). All patients received androgen deprivation therapy, with selected cases receiving palliative radiotherapy. Partial neurological recovery was observed in two patients.333--

Conclusion: Cranial and extrathoracic metastases may rarely represent the initial manifestation of prostate carcinoma. Awareness of such presentations is crucial, as early prostate specific antigen testing and immunohistochemistry can facilitate prompt diagnosis and management. This represents the largest reported Indian case series describing these unusual initial manifestations of prostate cancer.

Cumulative Occupational Sunlight Exposure Associated with Oxidative Stress, Thyroid Hormone Alterations and Endocrine Dysregulation among Commercial Motorcycle Riders in a Tropical Setting

Eruotor Ogheneochuko Harrison, Chinwebudu M. Melford — Tue, 13 Jan 2026 00:00:00 +0000

Commercial motorcycle riders in tropical regions experience prolonged occupational exposure to intense sunlight and heat, which may influence oxidative and endocrine regulation. This study examined the association between cumulative occupational sunlight exposure and oxidative stress, thyroid hormone alterations, and endocrine dysregulation among commercial motorcycle riders in a tropical setting. A comparative cross-sectional design was used to evaluate 100 riders and 50 age-comparable controls. Oxidative stress markers (superoxide dismutase, catalase, malondialdehyde) and endocrine parameters (triiodothyronine, thyroxine, thyroid-stimulating hormone, luteinizing hormone, and prolactin) were measured using standard laboratory methods. Riders exhibited significantly reduced antioxidant enzyme activities and elevated lipid peroxidation compared with controls. Thyroid hormones T3 and T4 were significantly higher among riders, while thyroid-stimulating hormone showed no significant difference. Duration of riding demonstrated strong exposure-dependent associations with oxidative stress markers and thyroid hormone levels, alongside inverse relationships with pituitary hormones. These findings suggest that cumulative occupational sunlight exposure is associated with progressive oxidative stress and endocrine dysregulation, highlighting potential subclinical health risks among outdoor workers in tropical environments.

Impact of Tobacco and Alcohol on Seminal Fluid Parameters: A Focus on Sperm Viability in Rivers State, Nigeria

Okigbeye Danagogo, Esther Ezine Njoku Nwankwo, Nwineh Ambassador Nukpegabari — Mon, 16 Mar 2026 00:00:00 +0000

Male infertility contributes substantially to the global burden of reproductive health disorders, with modifiable lifestyle factors such as tobacco smoking and alcohol consumption increasingly implicated in impaired spermatogenesis. Although several studies have evaluated their reproductive effects, region-specific data from the Niger Delta region of Nigeria remain limited.

To assess the impact of tobacco smoking and alcohol consumption on seminal fluid parameters among men undergoing evaluation for infertility in Rivers State, Nigeria.

This cross-sectional analytical study was conducted among 190 men aged 27-52 years attending the urology fertility clinic of Gbeye Hospital. Semen samples were collected following 2-7 days of sexual abstinence and analyzed according to WHO 2021 guidelines. Demographic information, tobacco use, and alcohol consumption history were obtained from medical records. Continuous variables were expressed as mean ± standard deviation. Comparisons between groups were performed using Wilcoxon rank sum and Kruskal–Wallis tests, with statistical significance set at p < 0.05.

The mean age of participants was 40.94 ± 5.73 years, with a mean duration of infertility of 5.75 ± 4.19 years. Alcohol consumption was reported in 46.20% of participants, while 21.98% reported tobacco smoking. Increasing age was significantly associated with longer duration of infertility (p < 0.001) but not with significant changes in conventional seminal parameters. Alcohol consumption did not demonstrate statistically significant differences in semen volume (p = 0.12), sperm concentration (p = 0.7), motility (p = 0.7), morphology (p = 0.9), or percentage of dead sperm cells (p = 0.9). In contrast, tobacco smoking was significantly associated with a higher percentage of dead sperm cells (51.38 ± 36.62% vs. 34.05 ± 36.23%, p = 0.017), while no statistically significant differences were observed in semen volume (p = 0.4), sperm concentration (p = 0.2), motility (p = 0.5), or morphology (p = 0.7).

Tobacco smoking is associated with increased sperm cell death among infertile men in Rivers State, suggesting oxidative stress–mediated impairment of sperm viability. Alcohol consumption did not demonstrate significant effects on conventional seminal parameters in this population. Increasing age was associated with prolonged infertility duration but not with significant alterations in routine semen indices. These findings underscore the importance of lifestyle assessment and smoking cessation counselling in male infertility management.