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Recurrent Xanthine Stones in a Young Patient with Lesch-Nyhan Syndrome. 年轻Lesch-Nyhan综合征患者复发性黄嘌呤结石1例。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0046
Margaret F Meagher, Seth K Bechis

Background: Lesch-Nyhan syndrome results from a rare X-linked inborn error of metabolism leading to a total body accumulation of uric acid. Clinical manifestations include self-mutilating behavior, poor muscle control, intellectual disability, gout, and kidney disease. Unfortunately, life expectancy is limited to the second or third decade of life because of symptoms associated with hyperuricemia, particularly renal failure. Patients with this condition frequently necessitate urologic intervention as the buildup of lithogenic substances predispose individuals to the development of kidney and bladder stones. Case Presentation: We present the case of a 23-year-old white man with known Lesch-Nyhan syndrome and recurrent bilateral xanthine stones despite repeated urologic interventions. Conclusion: Therapy for Lesch-Nyhan syndrome consists of reduction of uric acid achieved through allopurinol. However, excess allopurinol dosing can lead to development of xanthine kidney and bladder stones. Thus, the treating clinician must maintain a delicate balance between managing hyperuricemia and avoiding xanthine urolithiasis.

背景:Lesch-Nyhan综合征是一种罕见的先天性x连锁代谢错误,导致全身尿酸积累。临床表现包括自残行为、肌肉控制不良、智力残疾、痛风和肾病。不幸的是,由于与高尿酸血症相关的症状,特别是肾衰竭,预期寿命被限制在生命的第二或第三个十年。这种情况的患者经常需要泌尿外科干预,因为产石物质的积累使个体易患肾结石和膀胱结石。病例介绍:我们提出的情况下,23岁的白人男子与已知的Lesch-Nyhan综合征和复发双侧黄嘌呤结石,尽管多次泌尿外科干预。结论:治疗Lesch-Nyhan综合征的方法是通过别嘌呤醇降低尿酸。然而,过量的别嘌呤醇可导致黄嘌呤肾结石和膀胱结石。因此,治疗临床医生必须在管理高尿酸血症和避免黄嘌呤尿石症之间保持微妙的平衡。
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引用次数: 2
Robot-Assisted Nephron-Sparing Surgery of Renal Hydatid in Pregnancy: A Predicament in Management. 机器人辅助妊娠期肾包囊保留肾的手术:一个管理困境。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0124
Deepak Prakash Bhirud, Sunil Kumar, Satish Kumar Ranjan, Ravimohan Suryanarayan Mavuduru, Ankur Mittal

Background: Hydatid disease is a parasitic zoonosis caused by Echinococcus granulosus. Dog and other carnivores are the definitive hosts, which harbor adult worm. Humans are the accidental and dead-end hosts that acquire the infection by ingestion of eggs released from the intestinal tract of these carnivores, mainly dogs. The primary organ of echinococcosis in humans is the liver and lung, while the kidney is the third most commonly involved organ. Occurrence of hydatid disease of kidneys in isolation or with multiple organ involvement and their management has been reported and well described. The concurrent hydatidosis and pregnancy are an unusual clinical condition and poses a clinical challenge. Case Details: In this study, we present a case of 36-year-old woman with symptomatic hydatid disease of the right kidney during the first trimester of pregnancy. A multidisciplinary team discusses the pros and cons of hydatid during pregnancy with the patient. After taking informed consent from the patient, she was effectively managed by medical termination of pregnancy followed by robot-assisted laparoscopic pericystectomy. Conclusion: The co-occurrence of symptomatic renal hydatid and pregnancy is quite unusual. Medical or surgical management of hydatid during pregnancy can have some detrimental effect on the fetus. Hence these patients could be managed with medical termination of pregnancy followed by robot-assisted nephron-sparing surgery. Robot-assisted surgery for the renal hydatids is safe and effective, and has a shorter learning curve.

背景:包虫病是由细粒棘球绦虫引起的一种寄生虫性人畜共患病。狗和其他食肉动物是最终的宿主,它们携带成年蠕虫。人类是偶然的死角宿主,通过摄入这些食肉动物(主要是狗)肠道释放的卵而感染。人类包虫病的主要器官是肝脏和肺,而肾脏是第三个最常见的器官。孤立或累及多器官的肾包虫病的发生及其处理已被报道并有很好的描述。同时包虫病和妊娠是一种罕见的临床状况,并提出了临床挑战。病例细节:在这项研究中,我们提出了一个36岁的妇女在怀孕的前三个月有症状的右肾包虫病。一个多学科团队与患者讨论妊娠期间包虫病的利弊。在获得患者的知情同意后,通过药物终止妊娠,然后进行机器人辅助腹腔镜包膜切除术,对她进行了有效的管理。结论:有症状的肾包虫病与妊娠同时发生是很少见的。妊娠期包虫病的医学或外科治疗对胎儿有一定的不利影响。因此,这些患者可以通过药物终止妊娠,然后进行机器人辅助肾保留手术。机器人辅助肾包虫病手术安全有效,学习曲线较短。
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引用次数: 1
Persistent Lower Urinary Tract Symptoms After Prostatic Urethral Lift Successfully Treated with Water Jet Ablation of the Prostate: A Case Report and Review of the Literature. 前列腺水射流消融成功治疗前列腺尿道抬高后持续下尿路症状1例报告及文献复习
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0096
Eric M Ghiraldi, Young Son, David Ambinder, Joshua A Cohn, Steven Sterious

Background: We describe a patient who underwent waterjet ablation of the prostate after an unsuccessful prostatic urethral lift (PUL) procedure. Case Presentation: After PUL, our patient had incomplete bladder emptying with a postvoid residual of 600 mL. Urodynamic study of the bladder suggested detrusor underactivity. Our patient was motivated to undergo a salvage bladder outlet surgery. At 3 months after Aquablation, he reported complete resolution of bothersome lower urinary tract symptoms (LUTS). Conclusion: This case report illustrates return of volitional voiding and significant improvement in LUTS after salvage bladder outlet treatment with waterjet ablation of the prostate.

背景:我们描述了一位在前列腺尿道提升(PUL)手术失败后接受前列腺水射流消融的患者。病例介绍:在PUL后,我们的病人膀胱不完全排空,空后残留600毫升。膀胱尿动力学研究提示逼尿肌活动不足。我们的病人是有动机去接受挽救性膀胱出口手术。在水消融后3个月,他报告了恼人的下尿路症状(LUTS)的完全解决。结论:本病例报告显示,经前列腺水射流切除膀胱出口治疗后,自发性排尿恢复,LUTS有明显改善。
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引用次数: 0
Percutaneous Removal of Retained Metallic Ureteral Stent with a Looped Polytetrafluoroethylene-Coated Guidewire. 用环形聚四氟乙烯包覆导丝经皮切除残留金属输尿管支架。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0115
Jonathan G Pavlinec, Andrew K Rabley, Ashley O Gordon, Jennifer Kuo, Vincent G Bird

Background: Ureteral stricture disease is a troubling urologic issue that can be managed with surgical reconstruction or, more conservatively, with chronic nephrostomy tubes or ureteral stents. These indwelling tubes require exchanges and are prone to complications such as encrustation or stent failure. Metallic ureteral stents are designed to be more resistant to extrinsic compression and allow for exchanges at longer intervals. However, encrustation or tissue ingrowth can occur with these stents as well. The removal of encrusted or embedded metallic ureteral stents poses a difficult clinical scenario. We present a case of an encrusted metallic stent embedded in a proximal ureteral stricture requiring percutaneous endoscopic removal with a novel looped-wire technique. Case Presentation: A 50-year-old Caucasian man with bilateral ureteral stricture disease, managed with chronic indwelling metallic stents, failed retrograde removal on the right during routine exchange. Staged procedures with percutaneous nephrostomy, followed by combined percutaneous antegrade and retrograde endoscopy were required to observe and access the embedded stent. The exposed metallic surface was unable to be grasped by available instruments through flexible endoscopy. Under endoscopic control with fluoroscopic guidance, a polytetrafluoroethylene (PTFE)-coated guidewire was looped around the metallic stent. With gentle traction on the wire loop, the embedded stent curl was delivered out of the stricture and into the renal pelvis from where it was extracted carefully with graspers inserted through a rigid nephroscope. Follow-up antegrade fluoroscopic studies with contrast showed no extravasation. Conclusion: Percutaneous removal of metallic stents retained within the ureter has unique challenges. We present a novel method of extraction of a retained metallic stent with a looped PTFE-coated guidewire, which may safely and effectively be used in complex situations.

背景:输尿管狭窄疾病是泌尿系统的一个困扰问题,可以通过手术重建或更保守的慢性肾造口管或输尿管支架治疗。这些留置管需要更换,并且容易出现结痂或支架失效等并发症。金属输尿管支架被设计成更能抵抗外部压迫,并且允许更长的交换间隔。然而,这些支架也可能发生结痂或组织向内生长。金属输尿管支架包覆或嵌入的移除是一个困难的临床场景。我们提出了一例金属支架嵌套在输尿管近端狭窄,需要经皮内镜下去除与新的环丝技术。病例介绍:一名50岁的白人男性,患有双侧输尿管狭窄疾病,采用慢性留置金属支架治疗,在常规交换过程中右侧逆行取出失败。需要分阶段进行经皮肾造口术,然后进行经皮顺行和逆行联合内窥镜检查,以观察和接近嵌入的支架。通过柔性内窥镜,现有仪器无法捕捉暴露的金属表面。在内镜控制下,在透视引导下,将聚四氟乙烯(PTFE)涂层的导丝绕在金属支架上。在钢丝环的轻微牵引下,嵌入的支架卷被送出狭窄并进入肾盂,在那里通过刚性肾镜插入抓手小心地将其取出。随访顺行造影检查未见外渗。结论:经皮取出输尿管内金属支架具有独特的挑战。我们提出了一种新型的环形ptfe涂层导丝提取保留金属支架的方法,该方法可以安全有效地用于复杂情况。
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引用次数: 0
Endourologic Management of Stent Retained Over 22 Years in Patient with Duplicated Collecting System. 重复收集系统患者保留支架超过22年的腔内管理。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0032
William C Daly, Johann P Ingimarsson

Background: Retained and subsequently encrusted stents can lead to a number of complications, the most dire being deterioration of renal function. Limited literature exists concerning endourologic management of stents retained for extreme durations and few that concerns patients with abnormal renal anatomy. Case Presentation: A 70-year-old man with history of Crohn's disease and partially duplicated collecting system presented with rising creatinine and was found to have bilateral retained Double-J stents, originally placed before small bowel resection 22 years prior. The patient underwent staged bilateral percutaneous nephrolithotomy with ultimate effective removal of both stents. The patient has had subsequent improvement in renal function and has not required dialysis. Conclusion: Removal of ureteral stents in a timely manner is paramount to prevent long-term retention and complication, but when required retained stents can be safely managed with a well-planned endourologic approach, even if significant deterioration in renal function has occurred.

背景:保留和随后的支架包覆可导致许多并发症,最可怕的是肾功能恶化。目前关于超长时间保留支架的泌尿系统管理的文献有限,而关于肾脏解剖异常患者的文献则很少。病例介绍:一名70岁男性,有克罗恩病病史,部分收集系统重复,肌酐升高,发现双侧保留双j支架,最初于22年前在小肠切除术前放置。患者接受了分阶段的双侧经皮肾镜取石术,最终有效地取出了两个支架。患者后来肾功能有所改善,不需要透析。结论:及时取出输尿管支架对于防止长期留置和并发症是至关重要的,但当需要时,即使发生肾功能明显恶化,也可以通过精心规划的尿内入路安全地处理留置支架。
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引用次数: 0
Right Renal Pelvis Renal Cell Carcinoma Mimicking Transitional Cell Carcinoma: Case Report. 右肾盂肾细胞癌模拟移行细胞癌1例。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0180
Fahad Sheckley, Craig Nobert, Michael Stifelman

Background: Renal cell carcinoma (RCC) originates from the renal parenchyma, whereas transitional cell carcinoma (TCC) originates from the renal urothelium. Although renal pelvis TCC is relatively rare in terms of urologic malignancies, it is the most common tumor originating in renal pelvis. Case presentation: A 75-year-old woman presented with gross hematuria found to have a filling defect in the renal pelvis with retrograde pyelogram and cytology showed clusters of urothelial cells, with imaging suspicious for TCC. Patient underwent robotic nephroureterectomy with partial cystectomy. Pathology analysis revealed RCC. Conclusion: RCC may occur in the renal pelvis mimicking TCC. Extensive preoperative evaluation to accurately diagnose tumor is key to avoid unnecessary procedures. Intraoperative pathologic evaluation is emphasized with inconclusive preoperative results.

背景:肾细胞癌(RCC)起源于肾实质,而移行细胞癌(TCC)起源于肾尿路上皮。尽管肾盂TCC在泌尿系统恶性肿瘤中相对罕见,但它是最常见的起源于肾盂的肿瘤。病例介绍:一名75岁女性患者,肾盂内发现血尿充盈缺损,肾盂肾盂造影逆行,细胞学检查显示尿路上皮细胞聚集,影像学怀疑为TCC。患者接受机器人肾输尿管切除术和部分膀胱切除术。病理分析为肾细胞癌。结论:肾小细胞癌可能发生于肾盂,与肾小细胞癌相似。广泛的术前评估以准确诊断肿瘤是避免不必要手术的关键。术中病理评估强调术前结果不确定。
{"title":"Right Renal Pelvis Renal Cell Carcinoma Mimicking Transitional Cell Carcinoma: Case Report.","authors":"Fahad Sheckley,&nbsp;Craig Nobert,&nbsp;Michael Stifelman","doi":"10.1089/cren.2020.0180","DOIUrl":"https://doi.org/10.1089/cren.2020.0180","url":null,"abstract":"<p><p><b><i>Background:</i></b> Renal cell carcinoma (RCC) originates from the renal parenchyma, whereas transitional cell carcinoma (TCC) originates from the renal urothelium. Although renal pelvis TCC is relatively rare in terms of urologic malignancies, it is the most common tumor originating in renal pelvis. <b><i>Case presentation:</i></b> A 75-year-old woman presented with gross hematuria found to have a filling defect in the renal pelvis with retrograde pyelogram and cytology showed clusters of urothelial cells, with imaging suspicious for TCC. Patient underwent robotic nephroureterectomy with partial cystectomy. Pathology analysis revealed RCC. <b><i>Conclusion:</i></b> RCC may occur in the renal pelvis mimicking TCC. Extensive preoperative evaluation to accurately diagnose tumor is key to avoid unnecessary procedures. Intraoperative pathologic evaluation is emphasized with inconclusive preoperative results.</p>","PeriodicalId":36779,"journal":{"name":"Journal of Endourology Case Reports","volume":"6 4","pages":"536-539"},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803192/pdf/cren.2020.0180.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38829012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
A Rare Retrograde Intrarenal Surgery Complication: Hemophagocytic Syndrome. 一种罕见的逆行肾内手术并发症:噬血细胞综合征。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0066
Murat Akgül, Cenk Yazıcı, Hüseyin Ateş, Enes Altın, Burhan Turgut

Background: Hemophagocytic syndrome (HS) is a syndromic complex that is categorized in the group of histiocytic disorders associated with macrophages. Case Presentation: A 39-year-old male patient was admitted to the outpatient clinic with complaint of left flank pain. A 1 cm kidney stone was found in the upper pole of left kidney at radiologic imaging. The patient underwent retrograde intrarenal surgery (RIRS) with no peroperative complication. High fever and increasing of acute-phase reactants were observed at postoperative first day. Besides resistant fever, pancytopenia developed despite the appropriate antibiotherapy. The urine and blood cultures were sterile. After multidisciplinary consultation, bone marrow sampling was performed. Microscopic examination of the bone marrow material revealed that the macrophage cells phagocyted the erythrocytes, which was compatible with HS. Unfortunately despite the appropriate medical HS treatment, the patient died due to multiorgan failure at the 21st day of RIRS. Conclusion: HS is a significantly rare complication after RIRS, which was presented initially with postoperative fever. HS should be kept in mind if the patient had resistant fever and pancytopenia despite the appropriate antibiotherapy.

背景:噬血细胞综合征(Hemophagocytic syndrome, HS)是一类与巨噬细胞相关的组织细胞疾病综合征。病例介绍:一名39岁男性患者因左侧腰痛就诊于门诊。影像学检查发现左肾上极有1厘米的肾结石。患者行逆行肾内手术(RIRS),无术中并发症。术后第1天出现高热,急性期反应物增多。除了耐药发热外,尽管进行了适当的抗生素治疗,仍会出现全血细胞减少症。尿液和血液培养是无菌的。多学科会诊后进行骨髓取样。骨髓材料镜检显示巨噬细胞吞噬红细胞,与HS相容。不幸的是,尽管进行了适当的医疗HS治疗,但患者在RIRS第21天因多器官衰竭而死亡。结论:HS是RIRS术后罕见的并发症,最初表现为术后发热。如果患者在接受了适当的抗生素治疗后仍出现了耐药性发热和全血细胞减少症,则应注意HS。
{"title":"A Rare Retrograde Intrarenal Surgery Complication: Hemophagocytic Syndrome.","authors":"Murat Akgül,&nbsp;Cenk Yazıcı,&nbsp;Hüseyin Ateş,&nbsp;Enes Altın,&nbsp;Burhan Turgut","doi":"10.1089/cren.2020.0066","DOIUrl":"https://doi.org/10.1089/cren.2020.0066","url":null,"abstract":"<p><p><b><i>Background:</i></b> Hemophagocytic syndrome (HS) is a syndromic complex that is categorized in the group of histiocytic disorders associated with macrophages. <b><i>Case Presentation:</i></b> A 39-year-old male patient was admitted to the outpatient clinic with complaint of left flank pain. A 1 cm kidney stone was found in the upper pole of left kidney at radiologic imaging. The patient underwent retrograde intrarenal surgery (RIRS) with no peroperative complication. High fever and increasing of acute-phase reactants were observed at postoperative first day. Besides resistant fever, pancytopenia developed despite the appropriate antibiotherapy. The urine and blood cultures were sterile. After multidisciplinary consultation, bone marrow sampling was performed. Microscopic examination of the bone marrow material revealed that the macrophage cells phagocyted the erythrocytes, which was compatible with HS. Unfortunately despite the appropriate medical HS treatment, the patient died due to multiorgan failure at the 21st day of RIRS. <b><i>Conclusion:</i></b> HS is a significantly rare complication after RIRS, which was presented initially with postoperative fever. HS should be kept in mind if the patient had resistant fever and pancytopenia despite the appropriate antibiotherapy.</p>","PeriodicalId":36779,"journal":{"name":"Journal of Endourology Case Reports","volume":"6 4","pages":"339-342"},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/cren.2020.0066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38829938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Cystoscopically Placed Pancreatic Duct Stent for Management of Bladder-Drained Pancreas Transplant with Pancreatic Duct Leak. 膀胱镜下放置胰管支架治疗膀胱引流胰腺移植伴胰管渗漏。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0042
Ahmad M El-Arabi, Stephen P Pittman, Charlene Dekonenko, Nathan J Locke, David A Duchene

Background: Historically, exocrine pancreas secretions during pancreas transplant were commonly managed by bladder drainage. Although this technique has fallen out of favor because of significant rates of urologic complications, urologists must still be prepared to assist when they arise. We describe the first reported case of a cystoscopically placed pancreatic duct stent for management of a pancreas transplant duodenocystostomy leak in the setting of normal bladder function. Case Presentation: A 63-year-old male with a history of type 1 diabetes mellitus complicated by end-stage renal disease underwent a simultaneous bladder-drained pancreas and kidney transplant 25 years ago. He developed hematuria and acute rejection of his pancreas, with CT showing large volume ascites concerning for pancreatic leak. Cystoscopy revealed an intact and patent duodenal-cystostomy anastomosis; however, intraperitoneal extravasation on intraoperative cystogram raised concern for pancreatic head necrosis. The patient underwent intraperitoneal drain placement and Foley catheter bladder decompression, but drain output and drain amylase and lipase remained markedly elevated. He was taken back to the operating room for attempted cystoscopic stenting of the pancreatic duct, which was effective using a 5F × 4 cm Zimmon® pancreatic stent. His drain output normalized in the following days and the pancreatic stent and intraperitoneal drain were removed 4 and 5 weeks after discharge, respectively. Outpatient urodynamics revealed no signs of obstruction and his catheter was removed with minimal postvoid residuals on follow-up. Conclusion: Anastomotic leak after duodenocystostomy during pancreas transplant is a complication typically related to elevated intravesical pressures, managed with bladder decompression and subsequent bladder outlet procedure. We present a novel technique for cystoscopic pancreatic duct stenting in the setting of intact anastomosis and normal bladder function with delayed leak secondary to necrotic pancreatic head. Endoscopic stent placement, intraperitoneal drainage, and bladder decompression with Foley catheter are an effective technique to avoid unnecessary reconstructive surgery.

背景:历史上,胰腺移植过程中外分泌的胰腺分泌物通常通过膀胱引流来处理。尽管由于泌尿系统并发症的显著发生率,这种技术已经失宠,但泌尿科医生仍然必须准备好在出现并发症时提供帮助。我们描述了第一例膀胱镜下放置胰管支架治疗胰腺移植十二指肠膀胱造口漏的病例,膀胱功能正常。病例介绍:一名63岁男性,有1型糖尿病合并终末期肾脏疾病病史,25年前接受了膀胱引流胰腺和肾脏移植手术。他出现血尿和胰腺急性排斥反应,CT显示大量腹水,可能是胰腺渗漏。膀胱镜检查显示十二指肠-膀胱吻合口完整通畅;然而,术中膀胱造影显示的腹腔外渗引起了对胰头坏死的关注。患者接受了腹腔内引流管放置和Foley膀胱减压,但引流量和引流淀粉酶和脂肪酶仍然明显升高。患者被带回手术室,尝试膀胱镜下胰管支架置入,使用5F × 4cm Zimmon®胰腺支架有效。术后数日引流液量恢复正常,出院后4周和5周分别取出胰腺支架和腹腔内引流管。门诊尿动力学显示没有梗阻迹象,他的导尿管在随访中被移除,术后残留极小。结论:胰腺移植十二指肠膀胱造口术后吻合口漏是一种典型的并发症,与膀胱内压力升高有关,可通过膀胱减压和随后的膀胱出口手术加以控制。我们提出了一种新的膀胱镜下胰管支架置入术,在吻合完好和膀胱功能正常的情况下,胰头坏死后继发的延迟泄漏。内镜下支架置入、腹腔内引流和Foley导尿管膀胱减压是避免不必要的重建手术的有效技术。
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引用次数: 0
First Report of a Symptomatic Calculus of the Ampulla of the Ductus Deferens. 输尿管壶腹症状性结石一例报告。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0024
Magdalena Wiesmayr, Daniel Meyer, Frederik König, Daniel Engeler, Hans-Peter Schmid, Gautier Müllhaupt

Background: Similar to other secretory organs, the male spermatic ducts may develop calculi. However, this condition is described as rare in literature and usually affects the seminal vesicles. As far as we know, no cases of calculi in the ampulla of the ductus deferens have been published so far. Patients with seminal vesicle calculi usually complain of hematospermia, painful ejaculation, perineal or testicular discomfort or pain, and often experience significant impairment of quality of life. Case Presentation: We present a case of a 39-year-old patient who presented himself in an external urologic practice with recurrent hematospermia and painful ejaculation. According to the diagnosis of a seminal vesicle calculus of 1 cm in length on the right side, the patient underwent a transurethral vesiculo- and ampulloscopy with a semirigid ureteroscope whereby the stone could be located in the ampulla of the ductus deferens and removed in toto. Conclusion: Lithiasis should be kept in mind when examining patients with hematospermia and ejaculation pain. Transurethral ampulloscopy is an efficient, safe, and minimally invasive method for stone removal from the ampulla of the ductus deferens.

背景:与其他分泌器官相似,男性精管也可能发生结石。然而,这种情况在文献中是罕见的,通常影响精囊。据我们所知,到目前为止,还没有关于尿管壶腹结石的报道。精囊结石患者常以血精、射精痛、会阴或睾丸不适或疼痛为主诉,生活质量常显著下降。病例介绍:我们提出一个病例39岁的病人谁提出了自己在泌尿外科门诊反复血精和射精疼痛。根据右侧1厘米长的精囊结石的诊断,患者接受了经尿道膀胱壶腹镜和半硬质输尿管镜检查,结石位于输尿管壶腹,并全部取出。结论:对血精伴射精痛患者进行检查时应注意是否有结石。经尿道壶腹镜是一种有效、安全、微创的取石方法。
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引用次数: 1
Periureteral Marginal Zone Lymphoma Resulting in Hydronephrosis and Flank Pain in the Absence of Disseminated Disease: Case Report of Two Patients Presenting with Rare But Important Differential. 无弥散性疾病的输尿管周围边缘带淋巴瘤导致肾积水和侧腹疼痛:两例罕见但重要的差异病例报告。
Q4 Medicine Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI: 10.1089/cren.2020.0184
Bristol B Whiles, David A Duchene

Background: Extrinsic compression of the ureter can result from multiple different malignancies, typically in the presence of known or disseminated disease. Rarely, hydroureteronephrosis and flank pain can occur as the presenting sign and symptom of lymphoma. In this study, we present two cases of primary ureteral obstruction in patients without a prior diagnosis of lymphoma and without bulky retroperitoneal lymphadenopathy. Case Presentation: Case #1 was a healthy 58-year-old man who presented with acute left flank pain. He was found to have left hydroureteronephrosis secondary to a proximal periureteral mass. Diagnostic ureteroscopy demonstrated this to be an extrinsic compression on the ureter and preoperative imaging was negative aside from one enlarged periaortic node. Laparoscopic ureterolysis and biopsy were remarkable for periureteral dystrophic tissue concerning for lymphoma. Case #2 was a 47-year-old woman with a solitary kidney secondary to prior left nephrectomy who presented with hydronephrosis of her solitary kidney and acute kidney injury. Retrograde pyelogram showed high-grade obstruction at the junction of the mid- and distal ureter. Periureteral thickening was noted, but no definitive masses were seen on cross-sectional imaging. Robotic ureterolysis showed dense fibrosis around the ureter. Pathology report from Cases #1 and #2 were both remarkable for marginal zone lymphoma and both patients received bendamustine and rixuximab with resolution of ureteral obstruction and their lymphoma. Conclusion: Ureteral compression as the primary presentation of periureteral lymphoma is a rare but important etiology of extrinsic malignant ureteral obstruction. These cases emphasize that malignant obstruction can occur even in the absence of disseminated disease.

背景:输尿管外源性压迫可由多种不同的恶性肿瘤引起,通常存在已知或播散性疾病。极少情况下,肾盂积水和侧腹疼痛可作为淋巴瘤的表现和症状。在这项研究中,我们报告了两例原发性输尿管梗阻患者,他们之前没有诊断为淋巴瘤,也没有腹膜后肿大的淋巴结病。病例介绍:病例1是一名健康的58岁男性,表现为急性左侧疼痛。他被发现有继发于近端输尿管周围肿块的左侧输尿管积水。诊断性输尿管镜检查显示这是输尿管的外源性压迫,术前成像除一个增大的主动脉周围淋巴结外为阴性。腹腔镜输尿管溶解和活检对输尿管周围的营养不良组织有显著的影响。病例2是一名47岁的女性,先前左肾切除术继发于孤立肾,表现为孤立肾积水和急性肾损伤。逆行肾盂造影显示输尿管中远端交界处高度梗阻。输尿管周围增厚,但横断面影像未见明确肿块。机器人输尿管溶解术显示输尿管周围致密纤维化。病例1和病例2的病理报告均显示边缘带淋巴瘤,两例患者均接受苯达莫司汀和利须昔单抗治疗,输尿管梗阻及其淋巴瘤得到缓解。结论:输尿管压迫为输尿管周围淋巴瘤的主要表现,是一种罕见但重要的外源性恶性输尿管梗阻病因。这些病例强调,即使没有播散性疾病,也可能发生恶性梗阻。
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引用次数: 2
期刊
Journal of Endourology Case Reports
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