Journal of Endourology Case Reports最新文献

Background: Renal mass biopsy (RMB) is an increasingly utilized modality in the work-up of patients with suspicious renal masses. Recurrence of renal cell carcinoma (RCC) from biopsy tract seeding is exceedingly rare in the literature. We report a case of such a phenomenon. Case Presentation: Our patient is a 75-year-old Caucasian man and former smoker with a functionally solitary left kidney, initially worked up for gross hematuria and left flank pain. Imaging revealed hydronephrosis and a left renal mass, which was biopsied. Pathology analysis demonstrated clear cell RCC, and a left robotic radical nephrectomy was performed with negative surgical margins. Sixteen months postoperatively, imaging revealed multiple small masses along the biopsy tract, suspicious for recurrence. These were biopsied and pathology analysis confirmed recurrent clear cell RCC. Conclusion: Despite its rarity, biopsy tract seeding is a serious complication of RMB. This warrants thorough counseling and shared decision making between providers and all patients with renal masses planning to undergo a RMB.

Background: The standard treatments for muscle-invasive bladder cancer with no metastasis are total cystectomy and urinary diversion. Although robot-assisted radical cystectomy (RARC) was covered from April 2018 by the Japanese National Health Insurance system, and the number of RARC is increasing, there has been no pediatric case report on RARC in Japan. Case Presentation: We report the case of a 6-year-old Japanese girl who was referred to our hospital with the chief complaint of a vulvar tumor protrusion during defecation. We resected the tumor from her external urethral meatus, and transurethral resection for the residual partial bladder neck tumor was performed for both a definitive diagnosis and as a possible curative therapy. The pathologic diagnosis was an embryonic type of rhabdomyosarcoma. Although she was treated by chemotherapy combined with proton therapy, a residual tumor at the neck and a new lesion at the top of bladder were observed 2 years after initial treatment. Thus, RARC was performed. The surgical specimen was placed in an end-pouch and was then removed through the incised vaginal wall, with cosmetic consideration. A bilateral cutaneous ureterostomy was performed at the sites of the working ports for urinary diversion. In the future, we plan to perform abdominal wall catheterization. Postoperatively, she was treated with adjuvant chemotherapy. There was no recurrence for 19 months. Conclusion: Because she was a child, particularly a girl, the wounds should be small and inconspicuous considering the cosmetic aspect. Although the posterior aspect of the bladder seemed difficult to detach because of the adhesions, it was possible to safely perform RARC.

Background: Transurethral resection of the prostate (TURP) syndrome is a rare, but extremely dangerous complication. We present an even rarer case of a spinal cord injured patient who developed "TURP-like syndrome" after cystoscopy with Double-J replacement, under general anesthesia. Case Presentation: A 39-year-old man, American Society of Anesthesiologists III, tetraplegic, was scheduled for cystoscopy with bilateral Double-J replacement. Preoperative values of serum sodium were 133 mmol/L and potassium 5 mmol/L. To prevent autonomic dysreflexia, we performed general anesthesia. During cystoscopy, 0.9% NaCl irrigating fluid reservoir was fixed 50 cm above patient level and pressure was applied at urologist's request. The balance between inflow and outflow of irrigation fluids showed no significant difference. Procedure lasted 25 minutes, without any complications. Patient was transferred, awake, to postanesthesia care unit and discharged 1 hour later to the ward. Four hours later, patient referred nausea, headache, and abdominal pain. Acetaminophen and ondansetron were administered. Arterial blood gas sample revealed metabolic acidosis, hyponatremia, and hyperkalemia. A fluid resorption syndrome was assumed, furosemide was given, 0.9% NaCl was loaded, followed by 3% NaCl, and 1.4% NaHCO₃ for metabolic acidosis. A 5% glucose solution with 10 U insulin was started for hyperkalemia correction. In 24 hours, patient's clinical state improved and serum sodium and potassium values returned to baseline levels. A week after surgery, patient was discharged home, without neurologic damage. Conclusion: Excessive absorption of irrigation fluids during cystoscopy may occur and manifestations may be delayed in up to 24 hours postoperatively. Anesthesiologists and urologists must be aware of this life-threatening situation. Preventive measures, rapid detection, and treatment are imperative and may prevent complications and, ultimately, death.

Percutaneous nephrolithotomy (PCNL) remains the recommended intervention for large kidney stones, major complications, although rare, are between 1% and 7%. Literature regarding liver injury during PCNL is sparse, and many incidences occur unnoticed. In general, most liver injuries can be treated conservatively when compared with other organ injury sustained during PCNL. Despite this, there is still significant potential for intraperitoneal bleeding as well as possible hemodynamic instability that may result secondary to the inadvertent access. Our team describes two cases of liver injury during PCNL with focus on presentation and injury management. Both cases were treated conservatively through close clinical monitoring and delayed removal of nephrostomy tube. Both liver injuries were diagnosed primarily through postprocedure axial CT imaging. In general, risk factors include supracostal access, particularly at or above the 11th rib, as well as hepatomegaly. Despite that liver injury is a rare complication of right-sided PCNL, outcomes can result in significant blood loss not diagnosed. We present in this study two instances of effective conservative management of liver injury after PCNL.

Background: Vesical paraganglioma is rare and accounts for <0.1% of all urinary bladder tumors. They are mostly functional because of secretion of catecholamines and clinical presentation may mimic like a hyperfunctioning adrenal pheochromocytoma. They are easily misdiagnosed as urothelial malignancy and adequate perioperative attention is not provided. Case presentation: We hereby report a case of 55-year-old Indian lady with silent vesical paraganglioma at anatomically difficult location of bladder neck managed with robot-assisted excision of mass and bladder preservation. Conclusion: Surgery is the mainstay of the treatment that requires total excision of mass. However, minimally invasive bladder-preserving approach should be always kept as an option, if feasible. Robot assistance can help in bladder preservation even in difficult anatomic locations.

Background: Intraoperative indocyanine green (ICG) near-infrared fluorescence guidance is a type of optical imaging technology now available to facilitate a better understanding of surgical landmarks. This case describes use of this technique during lower-pole heminephrectomy for a patient with duplex kidney. Case Presentation: A 50-year-old woman with a left duplex system and lower-pole kidney infection underwent a laparoscopic transperitoneal lower-pole heminephrectomy. After exposing the left renal pedicles, ICG was administered through a ureteral stent inserted into the upper calix; the nonaffected ureter could be viewed, which enabled us to dissect the affected ureter connected to the lower-pole pelvis. Next, intravenous ICG administration revealed that the lower-pole kidney blood flow was not reduced. This finding prompted us to clamp the main renal artery. Furthermore, ICG injection through a nephrostomy tube helped to observe the lower-pole kidney collecting system and predict the parenchymal dissection plane location between the upper- and lower-pole kidneys. We effectively performed a lower-pole heminephrectomy through complete lower-pole urinary tract resection and maximal upper-pole parenchyma preservation. Conclusion: ICG fluorescence by intravenous and intraureteral administration observes relevant anatomy intraoperatively and is beneficial in patients who undergo a lower-pole heminephrectomy for duplex kidney.

Background: Drainage tubes are almost always routinely used after a laparoscopic or robot-assisted radical prostatectomy and pelvic lymphadenectomy to prevent urinoma formation and lymphoceles. They are seldom of any consequence. We present our unique experience of bowel obstruction resulting from the use of pelvic drains. Case Presentation: We are reporting on two prostate cancer cases with rare postoperative complications. Each of them received robot-assisted laparoscopic radical prostatectomy and bilateral pelvic lymph node dissection and subsequently developed ileus and bowel obstruction. Series follow-up images suggested the bowel obstruction was related to their drainage tube. No evidence of urine leakage or intestine perforation was found based on drainage fluid analysis. We performed exploratory laparotomy in the first patient and found drainage tube kinking with the terminal ileum and adhesion band. The drainage tube was removed and patient recovery occurred over the following days. In the second case, the patient experienced bowel obstruction for 4 days after surgery. Based on our experience in the first case, and a drainage fluid survey showing no evidence of urine leakage, we removed the drainage tube on the morning of the 4th day, giving the patient a dramatic recovery with flatus and stool passage occurring in the afternoon. Both of the patients recovered well in hospital and during regular follow-up. Conclusion: To best of our knowledge, despite there being certain case reports regarding drainage tube ileus in colorectal and bowel surgery, we have reported here on the first two cases of small bowel obstruction as a complication arising from the abdominal drainage tube used in robot-assisted urology surgery.

Background: Radical prostatectomy for de novo prostate cancer (PCa) among kidney transplant (KT) recipients (KTRs) can be challenging because of the location of the renal allograft, which may make robot-assisted radical prostatectomy (RARP) difficult to perform. In this study, we present the first case of RARP in a patient with two renal allografts in both iliac fossae. Case Presentation: A 72-year-old KTR was found to have organ-confined PCa. He had a first KT (in the right iliac fossa) 20 years ago, which he lost because of chronic allograft nephropathy, followed by a second KT (in the left iliac fossa) 8 years ago, which is now functioning well. We performed RARP with a right-nerve sparing technique. The surgical duration was 208 minutes, with an estimated blood loss of 50 mL and no intraoperative complications. The postoperative course was unremarkable. During the 21-month follow-up period, there was no incontinence or biochemical recurrence and the allograft function remained normal. Conclusion: RARP is feasible and can be performed safely in KT patients with two renal allografts in the pelvis.

Background: Alkaline-encrusted pyelitis (AEP) is rare and most often stems from a triad of immunodeficiency, urogenital tract trauma, and alkaline urinary infection. Corynebacterium Group D2 is the most common organism. It results in encrusting calcifications that adhere to most of the urothelial lining of the pelvicaliceal system and ureter. Left unchecked, or unrecognized, the disease process can progress to renal compromise. Studies suggest that management is based on elimination of the bacterium, acidification of the urine, and elimination of calcified plaques and encrustations. Herein, we report a case of a 56-year-old woman who developed AEP in her second transplanted kidney, and detail the diagnosis and treatment of the uncommon, yet potentially devastating, disease. Case Presentation: A 56-year-old woman with a history of lupus, end-stage renal disease, who was on her second renal transplant presented with symptoms of urinary tract infection. Urine was consistently alkaline with cultures repeatedly growing urease-splitting Corynebacterium. Subsequent imaging showed large obstructing ureteral and renal stones concerning for AEP. She was treated with transplant kidney percutaneous nephrolithotomy, culture-specific antibiotics, and urinary acidification. Conclusion: Clinical presentation, urinalysis, culture, and renal imaging, often with CT, are the mainstays for diagnosing AEP. If not addressed, AEP can advance to renal failure. Management often includes a multimodal approach involving treatment and prevention of the underlying infection, urinary acidification, and percutaneous or endoscopic removal of obstructing and large burden stones and encrustation.

Background: Although the prostatic urethral stents are no longer used in the United States for treatment of prostatomegaly, urologists will encounter patients with complications of previously placed permanent prostatic stents. We report two cases of persistent bothersome lower urinary tract symptoms (LUTS) after prostatic stent placement treated with simultaneous holmium laser enucleation of prostate (HoLEP) with endoscopic removal of the prostatic urethral stent using high-power holmium laser. We also reviewed the literature regarding the removal of prostatic stents with holmium laser combined with surgical management of benign prostatic hyperplasia. Case Presentation: A 71-year-old man who presented with LUTS, recurrent gross hematuria, and urinary infection, which developed after placement of a prostatic stent 10 years prior for urinary retention secondary to prostatomegaly (80 g). He underwent combined HoLEP with endoscopic removal of the prostatic stent using 100 W holmium laser at a power setting of 2 J and 30 Hz. The surgical steps comprised fragmentation of the stent in situ by making incisions at 5, 7, and 12 o'clock positions followed by enucleation of the prostate. The stent was then separated from enucleated tissue in the urinary bladder. The remaining prostate adenoma was then morcellated and removed. The patient remained asymptomatic at 10-year follow-up. Another patient was 62-year-old man who developed recurrence of bothersome LUTS, 1 year after placement a prostatic stent for urinary retention. On investigation his prostate was 105 g and stent showed partial migration in the bladder with overlying calcification. HoLEP and stent removal was performed in a manner similar to the first patient. This patient also remained asymptomatic at a 1-year follow-up. Conclusion: Combined HoLEP with removal of a prostatic urethral stent using a high-power holmium laser is safe and effective with long-term durable outcome.