Journal of Endourology Case Reports最新文献

Background: In selected cases cryoablation is a valid treatment option for small renal masses. The procedure is generally considered oncologically efficient with a low rate of severe complications. We report here a case of a 62-year-old man who after percutaneous cryoablation develops severe gangrene in the treated kidney. Case Presentation: A 62-year-old man was incidentally diagnosed with a 45-mm renal cell carcinoma. The tumor was found on a CT scan performed on the suspicion of diverticulitis. An abscess in relation to the sigmoid was found and he was treated with aspiration and antibiotics. The tumor was treated with percutaneous cryoablation 20 days later. On the third postoperative day, he was readmitted with urosepsis. A CT scan revealed gangrene at the ablation site, and a nephrectomy was performed. Clinical progress was slow, and a new CT scan showed reformation of the abscess at the sigmoid and a suspicion of a colonic tumor was raised. This was confirmed by coloscopy and biopsy. The patient had a right hemicolectomy, and the pathology report described a T4 adenocarcinoma with positive margins. After 4 months follow-up, metastases to the lungs was found and the patient was referred to further oncologic treatment. Conclusion: Renal cryoablation is generally a very safe procedure, but severe complications may occur. This case report highlights that attention should be given to recent abdominal infections and that delayed intervention might be in place in selected cases.

Background: Continent urinary diversion is a procedure commonly performed in patients after cystectomy who wish to not have a urostomy. Well-documented complications after continent urinary diversion include urinary tract infections and formation of urinary stones. However, these are typically late complications, and few reports have described the onset of these urinary symptoms within 12 months of initial continent urinary diversion. Case Presentation: Herein we report a case of a 41-year-old woman with history of cystectomy with continent urinary diversion who presents with recurrent infections and a calculus in the pouch 10 months after the initial procedure. Upon surgical exploration for removal of the stone, it was discovered that the stone was in fact a calcified retained catheter tip. Conclusion: This case further highlights that stone formation within 12 months of a urinary diversion is unusual and should prompt additional work-up for foreign body.

Background: Renal cell carcinoma (RCC) has a propensity to metastasize with the most common sites of metastasis being the lungs and bones. Cutaneous metastasis of RCC to the eyelid is exceedingly rare, with only six cases reported in the past decade. We are reporting a case of metastatic renal cell carcinoma (mRCC) that presented with a painless eyelid mass. Case Presentation: We describe a case of a 66-year-old man with a history of chronic kidney disease stage III presenting with a rapidly growing left lower eyelid lesion thought to be a capillary hemangioma. Biopsy revealed polygonal clear cells with small central nuclei with thin-walled vasculature and strong immunostaining with PAX8 consistent with mRCC, clear cell type. Subsequent abdominal CT scan revealed a 5.1 × 4.7 × 4.3 cm heterogeneously enhancing mass with central necrosis in the upper pole of the left kidney. The patient was treated with excision of the eyelid lesion followed by robotic partial nephrectomy of the primary tumor. Follow-up CT scan at 3 and 6 months showed no evidence of recurrence. Conclusion: Isolated eyelid metastasis is an extremely rare form of presentation of mRCC. Interestingly, that patient did not have any other site of metastasis. Cytoreductive partial nephrectomy has been previously reported to be oncologically safe in selected patients.

Percutaneous nephrolithotomy (PCNL) has become the standard of care for the removal of kidney stones >2 cm. Major complications, although rare, are between 1% and 7%. Splenic injury during PCNL is rare and can often be managed conservatively, but has the potential to be devastating, necessitating the importance of early diagnosis. Our team describes two cases of splenic injury during PCNL with emphasis on diagnosis and management. Although both cases were managed conservatively through close monitoring and prolonged nephrostomy tube presence, one case had a concurrent pneumothorax. Both cases were diagnosed primarily through postprocedure CT imaging. Risk factors primarily include supracostal access and splenomegaly. Splenic injury is a rare complication that can often be managed conservatively; however, prompt recognition of injury is important. We present in this study two cases of conservative splenic injury management sustained during PCNL.

Background: Calcium-based urinary stones rarely grow bacteria on stone culture. The presence of an anaerobic bacteria is even more uncommon. We present a case of Veillonella growth from a primarily calcium phosphate-based urinary stone culture. Case Presentation: A 56-year-old Caucasian woman presented with urosepsis and bilateral nephrolithiasis. A nephrostomy tube was emergently placed in the left kidney. After resolution of her urosepsis, she underwent a left percutaneous nephrolithotomy. The stone culture grew Veillonella, a gram-negative anaerobe. Conclusion: Growth of anaerobic bacteria, such as Veillonella, on stone culture of a calcium-based stone is a rare occurrence; the mechanism of this association remains unexplained.

Background: Periureteral venous rings are a rare congenital anomaly involving the inferior vena cava (IVC) and the right ureter, where the ureter courses through a venous ring made by the duplication of the IVC during embryogenesis. This anatomic anomaly is also referred to as a transcaval ureter. Although most patients are asymptomatic and radiographic findings are incidental, some patients can be symptomatic. We present the first reported case of asymptomatic obstructive ureterolithiasis at the level of a periureteral venous ring that was effectively treated with endoscopic management. Case Presentation: A 47-year-old woman was found to have right hydroureteronephrosis on MRI. Further CT imaging showed an obstructing ureteral stone at the level of a periureteral venous ring. After initial decompression with ureteral stenting, she underwent ureteroscopy that revealed the ureteral stone at the level of the venous anomaly. The stone was fragmented and removed with laser lithotripsy and stone basket manipulation. After a period of ureteral stenting and removal, she had improved hydroureteronephrosis, no symptoms of ureteral obstruction, and stable renal function. Given these findings, she elected for surveillance with imaging in lieu of any reconstructive procedure to transpose the ureter around the venous anomaly. Conclusions: We present the first reported case of obstructive ureterolithiasis at the level of a periureteral venous ring. Our experience suggests that, with preoperative ureteral stenting, obstructing ureteral stones in the setting of an IVC anomaly can be managed with retrograde flexible ureteroscopy. Conservative laser settings and minimal torqueing of the ureteroscope are advised given adjacent vascular anomaly. Cases wherein the affected ureteral segment is too constricted or tortuous to allow for stone passage or for ureteroscopy may require management by percutaneous antegrade intervention. Surgical reconstruction of the ureter should also be considered.

Background: Ureteroceles containing stones present as a unique challenge to the urologist. When a calculus has to be removed from within the ureterocele, a large opening leads to de novo vesicoureteral reflux (VUR), which may result in recurrent infections and renal parenchymal damage. Case Presentation: We present a case of a 13-mm stone in the ureterocele in an 11-year-old boy. He was asymptomatic but presented with abnormal urinalysis results and unilateral hydronephrosis. To avoid de novo VUR, we performed minimally invasive transvesical laparoscopic ureterolithotomy, which included partially suturing the incision at the roof of the ureterocele so that a small opening is maintained for drainage of urine. The surgery was performed with no complications and with normal postoperative urinalysis results. The patient's hydronephrosis resolved, and postoperative voiding cystourethrography showed no VUR. Conclusion: Transvesical laparoscopic ureterolithotomy with partial suturing of the incision at the roof of the ureterocele is a good treatment option, particularly for asymptomatic patients.

Background: Heterotopic ossification (HO) is the presence of bone in soft tissue where bone normally does not exist. This can be acquired or inherited with the acquired form most often seen with either trauma, spinal cord injury, or central nervous system injury. HO most commonly affects the flexors and abductors of the hip, medial knees, and the shoulders and rarely affects the genitourinary (GU) system. Case Presentation: We discuss a 67-year-old Caucasian male patient who presented with left-sided ureteral obstruction. He was involved in an airplane accident in 2001 resulting in a spinal cord injury. This ultimately led to heterotopic bone growth within the retroperitoneal space involving the left psoas muscle and encasing the ureter. Owing to the ureteral obstruction, a nephrectomy was performed to treat the patient's urinary symptoms. Conclusion: Although HO is relatively common after spinal cord injuries and trauma, it rarely infiltrates the GU system. Management ultimately involves treating the symptoms that arise because of the complications from the abnormal bone formation. For this case, because of extensive ossification resulting in obstruction of the ureter and inability to separate the kidney from the psoas, the ultimate outcome was a nephrectomy.

This case report describes the novel use of ultrasound-guided MRI-fusion biopsy to sample an extraluminal perirectal mass. This is a 64-year-old man with a history of pT3N2b mucinous adenocarcinoma of the right colon with metastatic disease to the mesocolic lymph nodes. Two years after initial resection he was found on restaging CT to have a mass measuring ∼4.0 × 4.8 cm superior to the seminal vesicles. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed a moderately FDG avid soft tissue mass interposed between the prostate and the rectum. Multiparametric MRI revealed a 6.2 × 4.6 × 2.8 cm heterogeneous lobulated T2 hyperintense mass with enhancement just superior to the seminal vesicles. This mass was unable to be viewed using sigmoidoscopy. Using UroNAV technology, we were able to biopsy the mass in the clinic setting. Biopsy was confirmed as recurrent mucinous adenocarcinoma.

Introduction and Background: Urosepsis is commonly predicted by the systematic inflammatory response syndrome (SIRS) criteria. We report a case of urosepsis preceded only by thrombocytopenia. Case Presentation : An 80-year-old Caucasian female presented with recurrent urinary tract infections, type 1 second-degree heart block (Mobitz I), and chronic deep venous thrombosis for which she was taking apixaban. Computed tomography (CT) revealed a 1.3 cm right upper pole calculus (Hounsfield units (HU) = 704) and a left 5 mm nonobstructing interpolar calculus (HU = 904). A preoperative urine culture was sterile as the patient was on antibiotics. While on antibiotic coverage, the patient underwent bilateral retrograde intrarenal surgery with bilateral stent placement: the procedure time was 188 minutes. She was continued on vancomycin and gentamicin immediately postoperatively. On postoperative day (POD) 1, she was feeling well; her vital signs were within normal limits. However, the hemoglobin and the platelet counts declined from 12.4 to 10.0 g/dL and from 215 to 58/mm³, respectively. Because of the unexplained thrombocytopenia, the patient was kept at the hospital. In the afternoon, she became hypotensive (78/37 mm Hg) and a rapid response was called. She was admitted to the surgical intensive care unit and antibiotics were broadened. On POD 2, the patient met sepsis SIRS criteria with white blood cell (WBC) of 2.9/mm³ and heart rate of 92 bpm. Stone culture was positive for methicillin-resistant Staphylococcus aureus (MRSA). On POD 3, her blood pressure had returned to 116-142/47-84. On POD 5, platelet count recovered to 94/mm³ and WBC to 3.8/mm³. She was discharged on POD 6 with a 2-week ongoing course of intravenous vancomycin. On follow-up 7 weeks postoperatively, she was asymptomatic with WBC of 6.5/mm³ and platelet count of 206/mm³. Follow-up CT demonstrated normal renal anatomy with subcentimeter calculi clustered within the left renal parenchyma and no stones on the right side. Conclusion: This case shows an uncommon non-SIRS presentation of postoperative urosepsis signaled only by thrombocytopenia.