Gonzalez Orión Erenhú Rodriguez, Castro Edgar Ivan Bravo, Salcedo José Gadú Campos
Escuela Militar de Graduados de Sanidad, Mexico.
Department of Urology of Hospital Central Militar, Mexico.
Int J Surg Case Rep. 2022 Dec;101:107799. doi: 10.1016/j.ijscr.2022.107799. Epub 2022 Nov 23.
The most common causes of hematuria are lower urinary tract infections, especially of the bladder, urolithiasis, urogenital tumors or benign prostatic hyperplasia; consequently, this condition presents the greatest clinical challenge due to its broad clinical spectrum, hematuria is an atypical form of presentation of testicular tumors, with very few cases reported in the literature, reaffirming the importance of a complete examination when approaching hematuria in the emergency department.
We present a case of a 31-year-old patient who presented to the emergency department with macroscopic hematuria of 5 weeks of evolution, showing on examination a mass in the left testicle. Imaging studies showed bilateral pulmonary metastatic lesions and retroperitoneal lymph node activity with a retrocaval conglomerate infiltrating the left ureter, for which a radical left orchiectomy and multiple procedures were performed to resolve the hematuria.
Macroscopic hematuria in adolescents or young adults is an infrequent cause of admission to the Emergency Department with a large list of differential diagnoses both benign and malignant so it is necessary to perform exhaustive studies in its approach, when young patients present with a painless testicular mass, it is important to keep testicular cancer within the differential diagnoses, metastatic disease is a rare form of presentation in this type of tumors. The relevance of this clinical case lies in the fact that hematuria was the main symptom that brought the patient to the emergency department, so we must not forget that macroscopic hematuria should be extensively studied.
When approaching a patient with macroscopic hematuria, the clinical history and physical examination is extremely important to provide the best possible care and focus the treatment properly.
血尿最常见的病因是下尿路感染，尤其是膀胱感染、尿路结石、泌尿生殖系统肿瘤或良性前列腺增生；因此，由于其广泛的临床谱，这种情况带来了最大的临床挑战，血尿是睾丸肿瘤的一种非典型表现形式，文献报道的病例很少，这再次强调了在急诊科处理血尿时进行全面检查的重要性。
我们报告一例31岁患者，因持续5周的肉眼血尿就诊于急诊科，检查发现左侧睾丸有肿块。影像学检查显示双侧肺部转移灶以及腹膜后淋巴结活动，有一个腔静脉后肿物浸润左侧输尿管，为此进行了左侧根治性睾丸切除术及多项手术以解决血尿问题。
青少年或青年患者的肉眼血尿是急诊科较少见的入院原因，有大量良性和恶性的鉴别诊断，因此在处理时必须进行详尽的检查，当年轻患者出现无痛性睾丸肿块时，在鉴别诊断中考虑睾丸癌很重要，转移性疾病在这类肿瘤中是一种少见的表现形式。本临床病例的相关性在于血尿是促使患者前往急诊科的主要症状，所以我们绝不能忘记应对肉眼血尿进行广泛的检查。
在处理肉眼血尿患者时，临床病史和体格检查对于提供最佳护理和正确聚焦治疗极为重要。
