Journal of Endourology Case Reports最新文献

Background: The inability to remove an indwelling urethral catheter in a postrobot-assisted laparoscopic radical prostatectomy (RALP) patient constitutes a serious problem to the urologist. If the proper deflation of the catheter balloon is not observed, forcible extraction can lead to devastating consequences such as urethral disruption and subsequent stricture formation. Case Presentation: A 60-year-old male patient developed lower urinary-tract symptoms 20 months after robotic prostatectomy for early prostate cancer. Cystourethroscopy revealed a migrated Hemo-lok clip that was extracted near the anastomotic site, followed by insertion of an indwelling Foley catheter. Two weeks later, the patient accidentally pulled the catheter into the urethra. Several attempts were done to deflate the catheter, which failed. Subsequently, a transrectal ultrasound (TRUS)-guided transperineal puncture was done to deflate the catheter balloon followed by effective catheter removal. Conclusion: TRUS-guided transperineal puncture (under local anesthesia) of an indwelling catheter balloon is a viable alternative for patients who have a history of RALP.

Background: Localized urinary extravasation is a known complication after partial nephrectomy; however, rarely it forms a nephrocutaneous fistula. Nephrocutaneous fistula after partial nephrectomy is a management challenge for the treating surgeon. It is typically managed with indwelling ureteral stent placement. Persistent fistula after indwelling ureteral stent can be managed with percutaneous nephrostomy drainage. However, persistence after all these measures is a real therapeutic dilemma. Few reports are available on effective management of persistent urine leak by percutaneous obliteration of leak site using glue. Case Presentation: We report one such rare case of persistent nephrocutaneous fistula in a 41-year-old man of Indo-Aryan ethnicity. He was managed effectively with percutaneous cyanoacrylate glue application, when all the conservative methods failed. At 6 months follow-up he is doing well clinically and radiologically. Conclusion: Persistent nephrocutaneous fistula after partial nephrectomy is a rare and highly morbid condition, which leads to multiple intervention and prolonged hospital stay. Percutaneous glue application is a potential therapeutic approach to tackle such cases with good results.

Background: Mitomycin C (MMC) extravasation after transurethral resection of bladder tumor (TURBT) is a rare and highly morbid complication. Management of these cases may require a multidisciplinary approach with strategies ranging from conservative management to surgical intervention. Case Presentation: We present a 48-year-old woman who received a TURBT for a 5 mm bladder tumor. Procedure was uneventful and no bladder perforation was noticed. A single dose of instillation of MMC was performed after surgery resulting in extravasation, consequent ipsilateral pudendal neuralgia, and ureterohydronephrosis. Treatment included a second TURBT, Double-J stent placement, and multiple pain management schemes. After 8 months the patient had complete resolution of pain and ureterohydronephrosis. Conclusion: Perioperative chemotherapy is the standard of care in low-risk bladder cancer. Extravasation of MMC, although rare, can produce severe complications, sometimes irreversible. Other treatment options, such as gemcitabine, are less frequently used despite being less irritant and having similar efficacy. Further studies are needed to compare single-dose instillation regimens.

Background: Renal cell carcinoma (RCC) recurrence can present in nearly any location. Rarely, recurrence is within the venous system. Previous reports of such recurrent tumor thrombectomy have all used an open approach. For the first time, we present robotic excision of recurrent RCC tumor thrombus. Case Presentation: This is a 59-year-old man who was referred to us 3 years after right robotic radical nephrectomy and renal vein tumor thrombectomy with positive margins. He had been lost to follow-up after 1 year. He presented again 3 years after surgery and was found to have recurrence with inferior vena cava (IVC) tumor thrombus to the caudal margin of the liver. He was taken for robotic tumor thrombectomy, which was completed with 900 mL of estimated blood loss, requiring a single unit of packed red blood cells. The surgery was complicated by increased bleeding caused by an undiagnosed arteriovenous fistula between the right renal artery and vein remnants. Conclusion: Robotic excision of recurrent RCC IVC thrombus is a potential treatment for selected patients under the care of experienced robotic surgeons.

Background: Chronic pain in the region of varicocele embolization is not well described and can be a challenging symptom to manage, with limited options for treatment after failing conservative measures. It is important to counsel patients of this potential complication when determining the best option for varicocele repair. To our knowledge, there are no reported cases of gonadal vein excision for chronic abdominal pain after coil embolization. Case Presentation: A 63-year-old Caucasian male presented to our urology clinic after coil embolization. His testicular pain resolved but he reported new left-sided abdominal pain after coil embolization for a large left varicocele. After failing conservative measures including nonsteroidal anti-inflammatory drugs, antibiotics, and prednisone, he was referred for further work-up and to discuss treatment options. On presentation, the patient reported pain on the left side of his abdomen consistent with the location of gonadal vein. After extensive counseling that surgical removal may not alleviate his pain, robotic gonadal vein excision was offered, and the patient elected to proceed. Intraoperatively, the coils were easily seen through the wall of the vessel. This segment of the gonadal vein containing the coil was excised in its entirety. The patient was discharged on postoperative day 1 with only nonsteroidal pain medications. Six weeks postoperatively, the patient reported no complications, and almost complete resolution of his preoperative pain. Conclusions: To our knowledge, this is the first case report demonstrating the surgical removal of the gonadal vein for treatment of chronic abdominal pain after varicocele embolization. After failing conservative measures, this may present another viable treatment option to address this difficult complication in a select group of patients.

Purpose: To demonstrate the various antegrade and retrograde endourologic approaches that may be required for effectively treating kidney transplant recipients presenting with ureteral obstruction caused by urolithiasis. Materials and Methods: We prospectively evaluated endoscopic management techniques of renal transplant recipients referred to a national kidney transplant center with obstructing transplant ureteral calculi for a 12-month period (April 2019-April 2020). Results: Four kidney transplant recipients presented with ureteral obstruction caused by urolithiasis and the mean age was 66.6 (range: 62-71) years. The mean duration from renal transplantation was 16 (range: 6-25) years. Three patients presented with acute urosepsis and one patient presented with malaise and recurrent urinary tract infections. Two patients were definitively treated with percutaneous antegrade flexible ureteroscopic lithotripsy through a 16F minipercutaneous nephrolithotomy sheath. Two patients were definitively treated with retrograde flexible ureteroscopy (7F single-use disposable ureteroscope) and laser lithotripsy. Full stone clearance was achieved in all four patients and no perioperative complications occurred. Conclusion: Management of ureteral calculi in renal transplant recipients is challenging. A multimodal approach involving antegrade and retrograde endoscopic techniques may be required to achieve full stone clearance.

Background: Irreversible electroporation (IRE) is a soft tissue ablation technique using electrical pulses without thermal energy to create pores in the cell membrane, resulting in death from apoptosis rather than necrosis. Advantages include protection of blood vessels, nerves, and surrounding structures. Documented complications include periprocedure nausea/vomiting, infection, and severe pain. Ureteral stents are frequently used in management of hydronephrosis caused by malignant obstruction. We describe what is to our knowledge the first documentation of stent fragmentation secondary to IRE and subsequent management. Case Presentation: This is a 61-year-old male with history of metastatic rectal adenocarcinoma treated initially with chemotherapy and surgery. Follow-up imaging revealed hydronephrosis and enlarged right iliac lymph node. Ureteral stent was placed for management of the hydronephrosis and the patient was referred to undergo IRE for management of metastatic disease. After treatment, the patient had imaging performed that showed fractured right ureteral stent with proximal portion in the ureter and distal portion floating freely in the bladder. This complication was managed with staged endoscopic procedure involving adjacent ureteral stent placement and subsequent ureteroscopy and stent removal using delta grasper. Conclusion: We describe to our knowledge the first incidence as well as subsequent management of ureteral stent fracture from an increasingly common treatment modality for metastatic disease. Given the frequency of malignant ureteral obstruction managed with ureteral stents, knowledge of potential complications pertaining to the urologist is imperative.

Introduction: Amplatz sheaths are hollow tubes that serve as the portal for the insertion of the nephroscope during percutaneous nephrolithotomy (PCNL). Breakage of this tube during the procedure is rare, but when it does occur it should be recognized and addressed promptly. Case Presentation: A 46-year-old Caucasian male patient was scheduled for PCNL. The Amplatz sheath was inserted in the usual manner over a balloon dilator and nephroscopy was performed. Profuse bleeding was encountered early. Upon meticulous endoscopic navigation, the broken Amplatz tube was recognized and replaced. This allowed us to identify and remove the fragment of the Amplatz tube, followed by stone fragmentation and removal. Conclusion: Our experience highlights the importance of recognizing this rare complication of a broken Amplatz sheath that should be managed promptly and effectively through endoscopic means without the need to abort the planned PCNL.

Background: Inflammatory pseudotumor of the kidney is a rare disease of unknown etiology. There are no specific clinical or radiologic findings. The lesion can mimic renal cell carcinoma or transitional cell carcinoma depending on the site of involvement. These tumors, if diagnosed correctly, may respond to medical management. We present a case in which an inflammatory pseudotumor of the renal pelvis was misdiagnosed as a transitional cell carcinoma and unwarranted surgical intervention was performed. Case Presentation: A 39-year-old man presented with left flank pain and gross hematuria. On MRI, there was a hypointense 2.4 × 1.8 cm lesion involving the left renal pelvis. The urine cytology and biopsy of the lesion were inconclusive. On follow-up cans the lesion increased in size and patient had repeated hematuria. The lesion was clinically presumed to be a transitional cell carcinoma of the left renal pelvis. A laparoscopic left side nephroureterectomy along with bladder cuff excision and para-aortic lymphadenectomy was performed. The histology report revealed the lesion to be inflammatory pseudotumor of the renal pelvis. Conclusion: Inflammatory pseudotumor should always be considered in differential diagnosis of pelvic tumors, especially when image findings and biopsies are inconclusive.

Background: Nephrolithiasis is increasingly becoming one of the most prevalent and costly urologic conditions in the United States. The most common type of kidney stone in humans is calcium oxalate, accounting for 75% of idiopathic stones in first-time stone formers. Stone formation is typically a gradual process; however, certain factors can accelerate stone development and recurrence. Case Presentation: We present two cases of adult white men who were found to have rapidly recurrent symptomatic kidney stones that were ultimately determined to be comprised of an outer mineral shell with an inner core of blood clot. Both patients had a history of nephrolithiasis and recent hematuria. Urine supersaturation values at time of presentation supported formation of kidney stones. Conclusion: Thrombi within the urinary tract can serve as a nidus for formation of multiple types of kidney stones, including calcium oxalate and uric acid stones. Stones arising from such a nidus may exhibit unusually rapid growth.