Journal of Endourology Case Reports最新文献

Background: Ureterosciatic hernia (USH) is a rare benign disease. We report a case of USH treated with laparoscopic intraperitonization of the ureter. Case Presentation: A 70-year-old woman was admitted to our hospital with right abdominal pain lasting for 2 months. CT showed right hydronephrosis and invagination of the right ureter into the right sciatic foramen. She underwent retrograde ureterography, which revealed abnormal tortuosity of the right lower ureter, and was found to have USH. We performed laparoscopic intraperitonization of the ureter and she presented good postoperative course. Conclusion: Laparoscopic intraperitonization of the ureter can be a useful treatment for USH.

Background: Inguinal lymph node dissection is performed in penile cancers and has a high complication rate with mostly wound-related complications. This case study demonstrates the use of robotic technique, tissue perfusion assessment, and negative pressure wound dressing to minimize wound-related complications. Case Presentation: A 67-year-old Maltese man was diagnosed with squamous cell carcinoma (SCC) in situ on biopsy of a self-detected penile lump. The patient underwent a partial penectomy and histopathology report confirmed moderately differentiated SCC with clear surgical margins. A positron emission tomography/CT scan was performed preoperatively, which showed several nodes in the right inguinal region with increased metabolic activity and nonspecific findings in the left inguinal region. The patient had a robotic right inguinal node dissection the following month. Assessment of the skin flap was performed using indocyanine green (ICG) angiography with the SPY system and there was excellent vascularity. Further treatment was performed 3 months later with a robotic left inguinal node dissection. Again, assessment of the skin flap was performed using the SPY system but showed an area of poor perfusion in the left femoral triangle, which suggested a high risk of inadequate wound healing and tissue necrosis. The clinical decision to use the negative pressure PICO dressing was made intraoperatively to enhance perfusion of the skin. When the PICO dressing was removed it revealed excellent tissue viability and vascularity of the skin flap. Histopathology analysis showed no evidence of malignancy in the nodes removed and patient was discharged to the outpatient care of their urologist. Conclusion: This case study demonstrates that the use of a tissue perfusion assessment tool avoided a potentially poor clinical outcome for the patient. Robotic inguinal lymph node dissection was performed in coordination with ICG angiography to guide the use of negative pressure wound therapy and facilitate good wound healing.

Introduction and Background: The Cook Resonance^® metallic ureteral stent's unique configuration allows adequate urine drainage while providing improved resistance to external ureteral compression. We report a case in which a stent broke and subsequently uncoiled during stent removal under cystoscopy. Case Presentation: A 46-year-old woman with a history of cervical carcinoma treated with radiation therapy and chemotherapy and bilateral ureteral strictures presented for cystoscopic removal of bilateral Cook Resonance ureteral stents. During removal of the right ureteral stent, a snap was felt with subsequent uncoiling of the stent. Firm tension to the inner wire and outside curls allowed eventual complete removal of the stent without any retained fragments. Discussion: The all-metal Cook Resonance stent is an attractive alternative to polymeric stents because of reduced frequency of stent exchange and resistance to external compression. However, the metal stent possesses risks such as increased urothelial hyperplasia and stent embedment.

Objective: To highlight the unusual complication of subcapsular renal hematoma (SRH) after a seemingly simple ureteroscopic lithotripsy (URSL), to try and identify the predisposing factors that lead to this complication, and steps that can be taken to further decrease the incidence of this rare but potential life-threatening complication. Methods: We highlight two cases of obstructed ureteral stones with upstream hydronephrosis who presented with colicky pain. Both underwent URSL with 8F/9.8F semirigid ureteroscope and were found to have postprocedure SRH. Results: Both our patients were managed conservatively with culture-directed intravenous antibiotics. One patient needed intervention in the form of aspiration of the hematoma. Follow-up ultrasound revealed complete resolution of the hematoma in both the cases and are doing fine on follow-up. Conclusion: Various risk factors have been identified, which predispose an individual to this complication and all endourologists must take certain precautionary measures such as decreased operative time and perfusion pressures, treating urinary tract infections and preoperative optimization of hypertension, diabetes, and chronic kidney disease (CKD) to further decrease the incidence of SRH. Management is conservative in majority of cases with percutaneous drainage and antibiotics, with surgery being reserved for hemodynamically unstable patients.

We report the case of a 49-year-old woman affected by bilateral urinary stones. Bilateral semirigid ureteroscopy was performed followed on the left side by a flexible ureteroscopy, caused by localization of the stone. Unfortunately, disinsertion of the left ureter occurred during the intervention. Open conversion was performed in the same single procedure for left ureteral reimplant. After an easy recovery, the patient was rehospitalized on day 9 postintervention for left pyelonephritis. This case report discusses the management of this rare but serious complication, including the necessity for quick thinking and decision making.

Background: During percutaneous nephrolithotomy, retrograde flexible ureteroscopy can be utilized to facilitate repositioning of stones, enable direct vision percutaneous access, minimize radiation exposure, reduce operating times, and improve stone-free rates. Although advancements in technique and flexible ureteroscope technology for the past decades have rendered complications rare, herein we report a case of a retained ureteroscope during percutaneous nephrolithotomy that was effectively managed endoscopically. Case Presentation: A 59-year-old Caucasian gentleman with a history of recurrent bilateral nephrolithiasis presents for a left-sided percutaneous nephrolithotomy for a large stone burden >4 cm. A ureteral access sheath was used and retrograde ureteroscopy was performed to first reposition several stones into the renal pelvis. During manipulation, we were unexpectedly unable to retract the ureteroscope from the access sheath. We describe procedural details leading up to the event and subsequent intraoperative management using an antegrade approach. Conclusion: A retained flexible ureteroscope is a rare but serious intraoperative complication that may require invasive open surgical management. However, careful endoscopic management may be feasible in select cases, allowing for preservation of ureter and instrument.

Background: Bilateral ureteroceles in adult males are a rare occurrence, made even more so with simultaneous presence of bladder calculi. Management strategies for such patients are not well documented in the literature. We present a rare case of bilateral open ureteroceles with large concomitant bladder calculi to contribute to the paucity of literature on management of such patients. Case Presentation: We present the case of a 35-year-old man whose gross hematuria work-up demonstrated right-sided hydroureteronephrosis in the setting of bilateral ureteroceles and multiple large bladder calculi up to 3.8 cm. Conclusion: Bilateral orthotopic single-system ureteroceles in an adult male are a rare finding especially when intraoperatively found to be open secondary to traumatic effects of large calculi. Ultrasonic and pneumatic lithotripsy is a safe, appropriate, and effective option for bilateral ureteroceles contributing to a large bladder stone burden. Our report contributes to the growing body of literature on orthotopic bilateral single-system ureteroceles in the adult population with concomitant significant stone burden.

Background: Paraganglioma of the organ of Zuckerkandl (OZ) is a rare surgically challenging tumor because of its critical location and the nature of catecholamine secretion. We describe the technique of laparoscopic excision as well as provide a literature review to confirm its feasibility. Case Presentation: In a 23-year-old male patient, laparoscopic excision of a 5 × 4 cm tumor located at the aortic bifurcation and indenting the vertebral column was performed. Preoperatively, the patient received α- and β-adrenergic blockers as well as underwent sperm banking. The patient was put in the lateral position, five ports were used: four in the midline and one in the left iliac fossa. The tumor was approached by the reflection of the colon. Ureter, gonadal vein, and sympathetic chain were preserved. Dissection of the tumor from the inferior mesenteric artery was done followed by control of three feeding arteries and two draining veins posteriorly and inferiorly. The procedure was completed laparoscopically with minimal blood loss. Intraoperatively, three episodes of hypertension developed and required stoppage and the administration of vasodilators. The patient recovered on the second day postoperatively and all antihypertensive medications were stopped. At 1 year of follow-up, the patient is tumor-free but developed anejaculation for which he is under current treatment. Conclusion: Laparoscopic excision of paraganglioma located at the OZ is safe and feasible.

Background: Forgotten ureteral stent is frequently observed in urologic practice. It has serious consequences such as encrustation, stone formation, fragmentation, ureteral damage, and sepsis. Panureteral damage by forgotten stent is a major complication requiring complex reconstructive surgery. Case Presentation: We report a case of 66-year-old man with forgotten ureteral stent for 10 years, which caused panureteral damage. Ileal ureteral substitution was done and kidney was salvaged. Conclusion: Prolonged forgotten stent can cause panureteral fibrosis and requires complex surgical procedure such as ileal ureteral substitution.

Background: The prostatic urethral lift (PUL) procedure is a novel therapeutic method to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). Gross hematuria after this procedure has been reported to be mild and transient. This report highlights a case of refractory transfusion-dependent hematuria after the PUL procedure in addition to its management with selective prostatic arterial embolization (PAE). Case Presentation: A 78-year-old Caucasian man with a history of myelodysplastic syndrome, thrombocytopenia, and intermittent urinary retention secondary to BPH underwent a PUL procedure. Before the procedure he received a platelet transfusion making his platelet count 58,000/μL. The day after the procedure he was admitted to a hospital for gross hematuria with clot retention. He was started on continuous bladder irrigation and taken to the operating room for clot evacuation and fulguration of prostate. His thrombocytopenia and anemia were managed with transfusions. He was treated with desmopressin, aminocaproic acid, and intravesical 1% alum without improvement. He returned to the operating room for clot evacuation in addition to photoselective vaporization of the prostate laser ablation of the prostatic fossa. He eventually required a total of four transurethral fulgurations without improvement in transfusion-dependent hematuria. Ultimately, resolution of the hematuria was achieved through bilateral PAE with Embosphere^® Microspheres performed by interventional radiology. He was discharged home 2 days after the embolization procedure without recurrence of hematuria or urinary retention at a 6-month follow-up visit. Conclusion: The PUL procedure has been shown to be an effective alternative to more invasive surgical options for LUTS caused by BPH. Despite careful consideration in an attempt to alleviate urinary retention, PUL still resulted in significant bleeding in this patient with thrombocytopenia. This is the first report to highlight the use of bilateral PAE as a method for achieving control of severe refractory hematuria after PUL.