Journal of Endourology Case Reports最新文献

Omental wrap is commonly performed after ureterolysis to prevent ureteral obstruction from recurrence of periureteral adhesions and fibrosis. We present the case of a 37-year-old Caucasian woman with a history of two cesarean sections and laparotomy for the treatment of endometriosis. She subsequently developed right flank pain caused by a right distal ureteral stricture requiring a chronic indwelling ureteral stent. Diagnostic laparoscopy revealed extrinsic compression of the ureter for which robot-assisted ureterolysis was performed. Because of inadequate omentum, we report the initial use of a cryopreserved bioregenerative umbilical cord amniotic membrane allograft to perform a ureteral wrap to promote ureteral tissue healing and serve as an adhesion barrier to prevent recurrence of the fibrosis.

Percutaneous nephrolithotomy (PCNL), first described in 1976, is the gold standard for the management of large kidney stones, with stone-free rates as high as 95% in contemporary literature. Colonic injuries during PCNL are a rare complication with an estimated incidence of 0.3%-0.5%. However, given the high morbidity incurred and the necessity of prompt operative intervention, it is imperative that practitioners have a low suspicion threshold for such injuries, particularly in those patients with altered or complex anatomy. This case series addresses peri- and postoperative outcomes of colon perforation during PCNL in patients with complex anatomy and reviews the technical challenges of surgery with potential methods to avoid injury in the future. Herein we review three instances of colonic injuries and their subsequent management to highlight both the presentation and the optimal management of these rare occurrences.

Background: Inguinal herniation of the urinary bladder is rare. Although in most patients it is an incidental finding during hernia repair, some patients present with complications related to herniated bladder. Case Presentation: A 65-year-old man presented with recurrent lower urinary tract infections and multiple episodes of lithuria. He was found to have an incarcerated right inguinal hernia with a large part of the urinary bladder inside the hernial sac. He did not have any features of bladder outlet obstruction. The herniated bladder had multiple small secondary vesical calculi that had probably formed in this hernial sac. He was managed by open surgical mesh hernioplasty followed by cystoscopic stone evacuation. Conclusion: Incarcerated bladder herniation, complicated by intravesical stone formation, is a rare clinical condition. Proper preoperative imaging with CT scan best confirms the diagnosis. Appropriate treatment includes reduction of the bladder, hernia repair, and endoscopic stone management.

Purpose: To report a rare case of secondary adrenal tumor with tumor thrombus in inferior vena cava (IVC) managed by three-dimensional laparoscopy and review the relevant literature. Case Report: A 60-year-old male patient operated for left-sided renal cell carcinoma 7 years ago, presented with asymptomatic secondary right adrenal tumor with tumor thrombus extending into the IVC through the right adrenal vein. A three-dimensional laparoscopic adrenalectomy with en bloc tumor thrombus evacuation from the IVC was performed. Literature Review and Discussion: The available literature was scanned and reviewed. There was a paucity of literature on the secondary adrenal tumors with IVC thrombus and to the best of our knowledge so far there is no reported case of secondary right adrenal tumor with IVC tumor thrombus that has been managed by three-dimensional laparoscopy. Conclusion: Secondary adrenal tumors with IVC tumor thrombus are rare but challenging and can present after many years of primary surgery. The low-level vena cava tumor thrombus can be managed with three-dimensional laparoscopy.

Failure of mature kidney to reach its natural location in renal fossa is termed as renal ectopia. Ectopic kidney can be found in pelvic, iliac, abdominal, and thoracic location. Pelvic ectopia has been estimated to occur in 1 of 2100 to 3000 autopsies. In contrast, ectopic ureters are commonly associated with complete renal duplication. Commonest presentation in females in continuous urinary incontinence with normal voiding habits as ectopic ureter open below the bladder neck in urethra or vagina. An ectopic kidney with ectopic ureter is extremely rare congenital anomaly. We report a 36-year-old woman presenting with left lower abdomen pain with no history of fever, dysuria, or urinary incontinence. On evaluation, she was found to have left nonfunctioning ectopic pelvic kidney with ectopic ureter opening in the vestibule of the vagina, which was managed with laparoscopic nephroureterectomy. One should suspect an ectopic ureter in a female presenting with continuous urinary incontinence since birth. However, diagnosis is challenging when clinical presentation is unusual with no urinary incontinence as seen in the index case. Detailed local examination in correlation with imaging is key for diagnosis and rule out other congenital anomalies. Laparoscopic approach in such clinical scenario is a safe and feasible option.

Background: Delayed persistent urethral hemorrhage caused by pseudoaneurysm of bulbourethral artery after straddle injury is a rare event. In this case report, we underline the cause, diagnostic methods, and image-guided treatment modality of straddle injury-induced symptomatic pseudoaneurysm of bulbourethral artery. Case Presentation: A 44-year-old Indian man, with history of straddle injury, was managed conservatively with per urethral Foley catheter placement. He had an uneventful initial period. One week after the injury, he complained of recurrent episodes of gross urethrorrhagia, which failed to resolve with conservative management. On further evaluation, he was found to have a pseudoaneurysm of bulbourethral artery, which was effectively managed by superselective intra-arterial coiling. Prompt diagnosis and timely management by superselective coiling helped in achieving desirable outcome without any undue complication of the injury and procedure. Conclusion: We report the largest pseudoaneurysm poststraddle injury reported till date. Considering its rarity, the desired diagnostic and treatment protocol has been highlighted. Using novel superselective angioembolization technique, adequate and permanent relief from symptoms and complications was achieved.

Background: The type of the stent to be used after endoureterotomy is a matter of discussion and debate. Endopyelotomy stent is commonly used after endoureterotomy for the management of upper and the lower ureteral strictures. For the strictures in the middle segment of the ureter (lower part of upper ureter, midureter, and upper part of lower ureter), the bulbous portion of the endopyelotomy stent may not adequately cover the endoureterotomy site leading to early recurrence. Case Presentation: Presented here is a young man who underwent endoureterotomy for a postureteroscopy stricture at the L4-L5 vertebral level. The endopyelotomy stent that was placed after endoureterotomy upmigrated, and the bulbous portion of the endopyelotomy stent got stuck above the recurrent stricture site. This difficult clinical situation needed a percutaneous access for stent removal. Conclusion: We propose that tandem stents have an advantage over endopyelotomy stent postendoureterotomy for stricture in the middle portion of the ureter as it provides a good splint for healing without any risk of stent migration and complications.

Background: Intraoperative indocyanine green near-infrared fluorescence guidance is an emerging optical imaging technology to facilitate better understanding of surgical landmarks. Herein, this technique was applied during the surgery for urachal carcinoma. Case Presentation: A 50-year-old man with urachal carcinoma underwent laparoscopic partial cystectomy and pelvic lymph node dissection (PLND). Before the laparoscopic surgery, indocyanine green was injected cystoscopically around the tumor at the submucosa level. The tumor location and lymph drainage were clearly viewed. The lymphatic flow was along the superior vesical artery and the umbilical ligament. The obturator and external lymph nodes were not fluoresced. Template PLND was performed. Partial cystectomy was completed with cystoscopic monitoring of the margin and with endoscopic stapler to avoid tumor spillage. Conclusion: Intraoperative indocyanine green fluorescence views lymph drainage and tumor location and is useful to improve the quality of PLND and partial cystectomy.

Background: Endopyelotomy is a minimally invasive option for treatment of ureteropelvic junction (UPJ) obstruction. Although largely supplanted by laparoscopic or robot-assisted laparoscopic pyeloplasty, it retains efficacy and utility in the absence of a crossing vessel in patients not fit for laparoscopy, patients with secondary obstructions or strictures, or those with stones requiring simultaneous treatment. Antegrade endopyelotomy is most commonly performed with scissors, cold knife, or more recently, using a Holmium laser. Herein we present the first reported case of simultaneous antegrade endopyelotomy and percutaneous nephrolithotomy (PCNL) using a thulium fiber laser (TFL). Case Presentation: A 72-year-old male with surgical history of open abdominal aortic aneurysm repair at age 43 years, colon resection, bilateral popliteal artery aneurysms, 5-vessel coronary artery bypass grafting, recent thoracic endovascular aortic repair, and celiac/superior mesenteric artery/bilateral renal stents on Coumadin was referred for gross hematuria and CT urography demonstrating a high-insertion UPJ obstruction without a crossing vessel and 4 caliceal stones, the largest being 2 cm. Given his multiple comorbidities and prior abdominal and retroperitoneal surgeries, he was offered simultaneous PCNL and endopyelotomy to treat both urological conditions with a single procedure. The procedure was accomplished bloodlessly with TFL PCNL and endopyelotomy as an ambulatory procedure with minimal morbidity, immediate resumption of anticoagulation, and rapid convalescence using a special method to convert the high insertion to a dependent insertion. Conclusion: The TFL provides a new effective and efficient tool for the simultaneous endoscopic management of stones and obstructions with minimal bleeding and rapid recovery in select situations.

Background: Autosomal dominant polycystic kidney disease (ADPKD) is most common potentially lethal cystic disease occurring in ∼1 in 1000 live births. It is an important cause of end-stage renal disease, which occurs in 75% of patients by the age of 70 years. APDPKD is a systemic disease with involvement of multiple extrarenal organs. Incidence of renal cell cancer in ADPKD is no more than in normal population. High index of suspicion is required due to gross distortion of renal architecture. Case Presentation: We report a 56-year male, known case of ADPKD on maintenance hemodialysis presenting with hematuria. On evaluation, he was diagnosed with bilateral renal masses on contrast imaging. Bilateral laparoscopic nephrectomy was performed and specimen was retrieved from pfannenstiel incision. Histology showed papillary renal cancer in left kidney and oncocytoma in right kidney with negative margins. Conclusion: Minimally invasive surgery in ADPKD with renal mass is challenging due to space constraints and large size kidneys. However, laparoscopic approach is a feasible option with minimal morbidity, less pain, and speedy recovery, specially in chronic kidney disease patients already immunocompromised status.