Testicular tumors are relatively uncommon urogenital malignancies, accounting for only 1-2% of all cancers in men, with germ cell tumors representing the predominant histopathological subtype. Histiocytic sarcoma (HS) is a rare and aggressive malignancy that typically arises in extranodal sites, and its standard treatment strategy has yet to be established. Here, we report a rare case of testicular histiocytic sarcoma, which has been sparsely documented in previous studies and for which clinical experience remains limited, thereby providing valuable insights into its diagnostic challenges and clinical management. This case describes a 70-year-old male admitted with enlarged left scrotum accompanied by ulceration. Based on the chief complaint, medical history, physical examination and ancillary investigation results, enhanced CT and MRI revealed patchy mixed-density shadows in the left testicular region and with obvious enhancement, which indicated the possibility of neoplastic lesion. The patient had indications for surgery and underwent orchiectomy. Histopathological and immunohistochemical evaluation confirmed a testicular histiocytic sarcoma. The postoperative recovery was uneventful and the follow-up data revealed no recurrence. Testicular histiocytic sarcoma is an uncommon type of tumor that has rarely been reported before. Its diagnosis remains challenging and the standard treatment for this disease is still undetermined. This case could provide valuable clinical experience and contribute to a more comprehensive understanding of testicular histiocytic sarcoma, and indicated surgical resection might be a feasible treatment for selected cases.

This study aimed to evaluate the effect of vacuum-assisted access sheath use during mini-percutaneous nephrolithotomy (mini-PCNL) on early postoperative pain intensity and analgesic requirements in the treatment of renal pelvic stones. A total of 150 patients who underwent mini-PCNL for a single renal pelvic stone ≥ 20mm were retrospectively included. Patients who underwent standard mini-PCNL were classified as Group 1, while those treated with a vacuum-assisted access sheath were assigned to Group 2. Demographic characteristics, perioperative parameters, pain assessed by visual analog scale (VAS), and analgesic requirements were compared between the groups. The two groups were comparable in terms of mean age, body mass index, comorbidity status, ASA scores, degree of hydronephrosis, distance between skin puncture, fluoroscopy time, stone size, and stone density (p > 0.05). Operative time and length of hospital stay were significantly longer in Group 1 (77.97 ± 15.72min and 3.28 ± 1.56 days, respectively) compared with Group 2 (p < 0.001). The incidence of high-grade fever and urinary tract infections requiring additional antibiotic therapy was significantly higher in Group 1 (p = 0.044 and p = 0.032, respectively). Hemoglobin decrease was also more pronounced in Group 1 (p < 0.001). Postoperative VAS scores were significantly lower in Group 2 than in Group 1 (p < 0.001). The absolute between-group differences in VAS at rest were 1.37 points at 1h, 1.68 points at 6h, and 1.81 points at 24h. For dynamic VAS, the corresponding absolute differences were 2.38, 2.09, and 2.05 points, respectively. Furthermore, the number of patients requiring rescue analgesia was markedly higher in Group 1 (p < 0.001). In addition, Group 1 demonstrated a shorter mean time to rescue analgesia and higher analgesic dosage compared with Group 2 (p = 0.002 and p = 0.019, respectively). In multivariate analysis, vacuum-assisted access sheath use remained an independent predictor of both lower postoperative pain scores and reduced analgesic requirement, with an approximately 90% reduction in the odds of rescue analgesia use after adjustment for operative time and intraoperative remifentanil consumption. Vacuum-assisted access sheath use was associated with lower early postoperative pain scores and reduced analgesic requirements; however, prospective controlled studies are needed to confirm these findings.

The optimal graft choice for urethral reconstruction remains debated. This umbrella review synthesised evidence from systematic reviews and meta-analyses on graft materials, focusing on success, complications, and long-term outcomes. PubMed and Scopus were searched to March 2025 for reviews of patients undergoing graft-based urethral reconstruction. Eligible studies reported outcomes including success, donor-site morbidity, complications, stricture recurrence, stricture-free survival, operative efficiency, and postoperative parameters. GRADE assessed certainty, with analyses stratified by graft type and, where available, by sex or indication. Twelve reviews (2012–2025) covering 9,829 patients met criteria. Ten examined males—nine adults (three mixed etiologies, others strictures) and one pediatric hypospadias. Two included both sexes, with female cases limited to anterior strictures. Buccal mucosa grafts (BMG) were most studied, showing success > 80%. Meta-analyses found no significant difference between BMG and penile skin grafts (OR 0.83, 95% CI 0.55–1.23, I²=88%) or lingual mucosa grafts (OR 1.18, 95% CI 0.79–1.77, I²=63%). Low review quality was found in studies involving females, children, and some males, due to small sample sizes, risk of bias, lack of PROSPERO registration, and inconsistencies with meta-analysis methods, resulting in low GRADE certainty. BMG remains most effective, but evidence for women and children is scarce. Future studies should prioritise sex-stratified data, scoping reviews, and clinical algorithms.

We present the case of a 54-year-old woman with an incidentally discovered left renal hilar mass. Imaging examination revealed a large, heterogeneous mass of fat density in the left renal pelvis, accompanied by a tumor thrombus extending into the renal vein and inferior vena cava (IVC), consistent with a Mayo level II thrombus—a finding reported in fewer than 50 cases worldwide. A preoperative diagnosis of renal angiomyolipoma (RAML) was established. Despite the patient’s strong preference for nephron-sparing surgery (NSS), intraoperative findings of extensive hilar invasion and calyceal involvement, along with significant hemorrhage, necessitated conversion to radical left nephrectomy with IVC thrombectomy. Histopathological examination confirmed the diagnosis of classic RAML, as indicated by positive immunohistochemical staining for Human Melanoma Black 45 (HMB45), Melanoma Antigen Recognized by T-cells 1 (Melan-A), and Smooth Muscle Actin (SMA), and negative staining for Cytokeratins (CK), S-100 Protein (S-100), and Desmin. The tumor thrombus was derived from the RAML. The patient recovered well postoperatively, with no recurrence or metastasis observed at the 8-month follow-up. This case underscores the surgical challenges of large hilar RAMLs with venous extension and highlights the importance of preoperative planning and intraoperative adaptability.

Mycotic aneurysms of the transplant renal artery (TRA) are rare but life-threatening complications following renal transplantation, often resulting in graft loss and high mortality. Prompt recognition and timely management are essential to prevent catastrophic haemorrhage and improve patient outcomes. We report two cases of ruptured mycotic aneurysms in cadaveric renal allografts. Both patients were on maintenance haemodialysis and underwent deceased donor kidney transplantation. In the first case, the patient presented two weeks postoperatively with haemodynamic instability and intra-abdominal bleeding. Imaging revealed active contrast extravasation near the arterial anastomosis. Emergency exploration revealed a ruptured mycotic aneurysm, necessitating graft nephrectomy; despite antifungal therapy, the patient succumbed to rebleeding. In the second case, the patient presented with fever and hypotension ten days post-transplant. Imaging revealed absent graft perfusion with peri-graft collection. Graft nephrectomy was performed, and histopathology confirmed fungal arteritis. The patient responded to antifungal therapy and recovered, albeit with graft loss. Ruptured mycotic aneurysms of the transplant renal artery (TRA) can have catastrophic outcomes. Despite early diagnosis and initiation of antifungal therapy, graft nephrectomy may be unavoidable in cases with rupture and hemodynamic compromise. Emphasis should be placed on strict aseptic protocols during organ retrieval and handling. Routine culture of preservation fluid may aid in early detection of fungal contamination, enabling timely intervention and potential graft salvage.