Metastatic testicular cancer presenting with hematuria and flank pain

Testicular cancer (TC) represents 1% of male neoplasms and 5% of urological tumors. Most of seminoma patients and about 55% of patients with nonseminoma TC have stage I disease at diagnosis. TC usually presents with a palpable testicular mass incidentally found by the patient himself or its partner by palpation. It shows excellent cure rates based on their chemosensitivity, especially to cisplatin-based chemotherapy, but careful staging at diagnosis, adequate early treatment based on a multidisciplinary approach and strict follow-up are necessary. We present a case of a 25-year-old male patient who was diagnosed of metastatic TC with an atypical presentation: hematuria, hydronephrosis, and direct infiltration of the ureter by the retroperitoneal mass, mimicking a renal colic. After orchiectomy and placement of a double-J stent, the evolution was favorable, with a good response after the first cycle of chemotherapy with quick resolution of hematuria. After the treatment, a retroperitoneal lymph node dissection was performed. The patient remains disease-free after 3 years of follow-up.