Case Reports in Urology最新文献

A 50-year old male patient with morbid obesity was admitted for removal of large staghorn calculi and multiple small stones in the left kidney. The patient was managed by Percutaneous Nephrolithotomy (PCNL). Surgery was carried out in prone position and Alken's metal dilators were used for tract dilation. Alken dilators were inserted without any challenges, and the procedure was completed in a shorter span of time than anticipated with total operative time of 2 hours, including the change of positioning from lithotomy to prone. No intra-operative or post-operative complications were encountered. The patient has been followed up for 6 months post-operatively, without any complications or any evidence of stone recurrence.

Herein, we reported a duodenal perforation case as an intestinal injury during a percutaneous nephrostomy procedure. A 73-year-old woman with bilateral nephrostomy catheters was applied to the emergency service with right flank pain. Early in the day, her bilateral nephrostomy catheters had been changed. On physical examination, she had a defense and rebound at her right quadrant, and costovertebral angle tenderness was also positive. In the contrast-enhanced abdominal computed tomography scan, the right nephrostomy catheter was located in the second part of the duodenum, and the contrast agent did not leak into the peritoneum from the injury area. We decided on conservative management of the case with active surveillance using daily blood tests and physical examinations. The nephrostomy catheter in the duodenum was left to prevent fistula between the duodenum and the skin, and a new one was placed in the right kidney. The broad spectrum antibiotherapy regime was applied, and the patient was followed up closely. The catheter in the duodenum was removed on the 20th day, uneventfully, and the patient was discharged successfully on the 24th day with her permanent bilateral nephrostomy tubes. On the first follow-up, one month later, the patient had no active medical complaint.

Urinary diversion following radical cystectomy and neoadjuvant chemotherapy is the gold standard for the management of muscle-invasive bladder cancer. Urinary diversions are at an increased risk of urolithiasis as a result of various factors. Traditional surgical intervention has included open cystolithotomy which has given way to minimally invasive techniques as of late. We describe a case of a robotic-assisted cystolithotomy from a neobladder in a 54-year-old female patient with muscle-invasive bladder cancer. This is the first description of a robotic-assisted removal of a stone in an orthotopic neobladder. This approach has many advantages, especially in the removal of larger stones. Further study is needed to investigate the efficacy and success of this approach.

Urachal carcinoma is a very rare tumor, commonly found in the urachal remnant connecting the bladder dome to the umbilicus. Diagnosis is often challenging due to the location of the tumor and its late presentation. We hereby report the case of a 49-year-old female where the diagnosis of urachal carcinoma was made and a robotic partial cystectomy associated with en bloc resection of the umbilicus was performed. We aim to present the clinical aspects, presentation, and diagnosis of this rare entity along with a review of the literature.

A 73-year-old man visited our hospital with chief complaints of fever of unknown origin and bilateral shoulder and hip joint pain. He was initially diagnosed with polymyalgia rheumatica (PMR). Although the patient was treated with prednisolone 15 mg/day, his PMR-related symptoms did not improve. Further examination was performed as the patient was suspected of having paraneoplastic syndrome. Assessment results showed prostate cancer without metastases. After undergoing robot-assisted radical prostatectomy, the patient's PMR-related symptoms dramatically improved. Hence, the prednisolone dose was decreased to 4 mg/day. PCa may have triggered the development of PMR through the activation of immune-mediated systemic inflammatory responses.

Transverse testicular ectopia is a rare anomaly characterized by testicular descent into the scrotum through the same inguinal canal. Here, we report the case of a 15-year-old boy diagnosed with transverse testicular ectopia wherein both testes descended through separate inguinal canals. He underwent a diagnostic laparoscopy which helped to identify both spermatic cords entering both inguinal canals separately. During scrotal exploration, both testes were found in the same side. Transseptal orchidopexy was performed. The short-term follow-up is uneventful.

In this paper, we describe two cases of Fournier's gangrene (FG) in which Integra grafting was used for reconstruction. FG is a progressive necrotizing infection occurring in the perineal region and on the external genitalia. Reconstructive options using local tissue are limited due to the destruction this infection imposes on the soft tissue. Integra graft is a bilaminate artificial dermis made of shark chondroitin 6-sulfate and bovine collagen. It is applied to the wound bed after debridement and establishment of a healthy, well-vascularized wound base. The patients in this case series had large defects which could not be closed primarily with tissue beds and would not have been appropriate for skin grafting. Therefore, an Integra graft was placed. In both patients, the wound beds were appropriate for skin grafting after three weeks. Without the Integra graft, both of our patients would have needed to wait a considerable amount of time prior to reconstruction. Our case series further illustrates and supports the use of Integra grafts in such a scenario following Fournier's gangrene which has only previously been published on three occasions, all of which demonstrated successful outcomes.

Background: Intraoperative imaging for endourologic procedures is generally limited to single-plane fluoroscopic X-ray. The O-arm™ is a mobile cone-bean CT scanner that may have applications in urologic surgeries. Case Presentation. We present a case of an 85-year-old male with radiation cystitis and recurrent gross hematuria who was identified to have a bladder perforation on cystoscopy during emergent clot evacuation. Single-view fluoroscopic evaluation was inconclusive as to whether an intraperitoneal bladder perforation occurred. A portable cone-beam CT scan was used to acquire a 3-D CT cystogram, which demonstrated intraperitoneal contrast extravasation, confirming the diagnosis of an intraperitoneal bladder perforation.

Conclusion: We report the first use of a portable cone-beam CT scanner to perform an intraoperative CT cystogram to diagnose an intraperitoneal bladder perforation and guide surgical management.

Malignant bladder neoplasms represent a significant disease burden not only for urologists but also the broader medical community. While the majority of bladder tumors are urothelial in origin, up to two percent are found to be adenocarcinomas. Among bladder adenocarcinomas, roughly one-tenth are urachal and are frequently located at the dome of the bladder where urachal remnants can often be found. We describe a case of bladder adenocarcinoma that presented at the dome of the bladder but ultimately exhibited a nonurachal histology. A 65-year-old male with a history of myocardial infarction and cerebrovascular accident with residual right-sided hemiparesis and aphasia was referred to our clinic for evaluation of a bladder mass discovered in the setting of painless gross hematuria. Diagnostic cystoscopy demonstrated a large mass at the dome of the bladder, and subsequent transurethral resection revealed stage T1 mucinous adenocarcinoma arising in a villous adenomatous lesion without the presence of muscle in the specimen. The patient underwent a robotic-assisted laparoscopic partial cystectomy with extended bilateral pelvic lymph node dissection. Postoperatively, the patient experienced short-lived paralytic ileus and was discharged on postoperative day 5. Follow-up surveillance imaging at 6 months with CT chest, abdomen, and pelvis, repeat office cystoscopy, and negative tumor markers postoperatively indicated no evidence of disease recurrence. Characterization of bladder adenocarcinomas into urachal and nonurachal subtypes is critical in differentiating the operative management and oncologic outcomes of the respective neoplasms. However, given the paucity of literature describing treatment approaches to bladder adenocarcinoma in general, existing methods have largely mirrored genetically similar neoplasms, including ovarian and colon adenocarcinomas. Although there is still much to be understood regarding the potential mechanisms of carcinogenesis of nonurachal adenocarcinomas, further investigation may pave the way for a more standardized treatment paradigm and provide insight into the potential utility of modern immunotherapies.

Introduction: The genitourinary system is a recognized site for multiple primary malignant neoplasms even without syndromic anomalies. However, to the best of our knowledge, a case of upper tract urothelial carcinoma (UTUC) with contralateral renal cell carcinoma (RCC) is not reported in surgical literature so far. Case Presentation. A 52-year-old Sri Lankan male patient was found to have a right lower ureteric tumour and a left renal mass together upon investigating for painless visible hematuria. The right ureteric tumour measured 32 × 22 mm resulting in moderate hydronephrosis and cortical thinning of the right kidney, and the left renal mass measured 43 × 38 mm involving the lower pole. The biopsy of the right ureteric lesion revealed a high-grade transitional cell carcinoma with focal nested pattern and that of the left renal mass revealed a clear cell carcinoma. Right nephroureterectomy followed by a left partial nephrectomy was performed in six weeks' interval. The histology of both the resected specimens confirmed the biopsy findings. Discussion. A high-risk upper tract urothelial carcinoma such as the right ureteric tumour of this patient required a nephroureterectomy which makes the management of the contralateral renal cell carcinoma more complex. An adequate functional renal remnant was ensured after offering oncologically sound surgical treatment for both the malignancies of this patient.

Conclusion: A UTUC when associated with a contralateral RCC poses challenges in patient management. The preservation of renal excretory function has to be considered as an important determinant in addition to oncologically sound surgical resection when managing complex cases of genitourinary malignancies involving both sides of the upper urinary tract.