Involvement of urinary tract in IgAV was reported in several cases, including scrotum, testicle, ureter, bladder, prostate, and penis. Common testicular manifestations of IgAV include acute scrotum, epididymitis, orchitis, and spermatic cord complications
[50]. It may require assessment by an experienced pediatric surgeon to exclude a testicular torsion, which requires surgical emergency instead of conservative management. Orchitis is usually gradual in nature with associated nausea and vomiting, whereas scrotal involvement due to IgAV presents with instantaneous pain, typically without nausea or vomiting
[51]. Hematomas and edema of the spermatic cord are rare urological complications of IgAV and they could be also confused with testicular torsion and acute scrotum. Some patients with spermatic cord involvement suffer from thrombosis of the spermatic veins; however, it is not typically seen in children
[52]. Penile manifestations of IgAV include thrombosis, priapism, and purpuric lesions on the penis. Such lesions may appear before or after the onset of IgAV
[53]. Ureteral involvement often results in ureter obstruction. Obstruction is either unilateral or bilateral and may be partial or complete depending on the severity of the case
[54]. Residual stenotic lesions and subsequent urinary tract obstruction frequently require surgical intervention
[55]. Bilateral and unilateral ureteritis are other complications reported in IgAV, and they appear about 1–2 months after the onset of the disease
[56]. In some cases, ureteritis is accompanied by nephritis, which results in delayed diagnosis and an increased risk of complications
[57].
IgAV could also affect the urinary bladder. Hirayama et al. described an 83-year-old man who developed IgAV in the course of Bacillus Calmette–Guerin (BCG) intravesical therapy. Following the BCG maintenance, purpura appeared on the lower region of the patient’s legs
[58]. Ishigaki et al. described a 70-year-old male with bladder cancer diagnosed with IgAV following neoadjuvant chemotherapy and a radical cystectomy. Twenty-three days after radical cystectomy, the patient presented with purpura, and the diagnosis of IgAV was made based on a skin biopsy
[59].
In adults, IgAV has been linked to PCa. The relationship between the development of IgAV and PCa remains unknown, but it is postulated that tumor antigens or irregular IgA production may be contributing factors
[60].