The optimal management of primary renal leiomyosarcomas is unknown owing to its rarity and minimal available information about their primary, adjuvant treatment and clinical outcomes. This study systematically reviews treatment evidence and effects in terms of survival for leiomyosarcomas arising primarily from kidney, renal pelvis and renal vessels. PubMed and Embase databases were searched from inception to March 2023, with manual searches of reference lists. Two investigators independently reviewed the studies reporting management and survival outcomes of renal leiomyosarcomas. A total of 85 publications met inclusion criteria, reporting on 188 cases. The median age was 55.5 years, predominantly female [52.7%]. Pain was the most common presenting symptom [41.5%], and most tumors were high grade [45.8%]. Complete surgical resection with negative margins forms definitive treatment. The median disease-free survival and overall survival (OS) for all reviewed patients were 24 months [95%CI 4.1–43.9] and 42 months [95%CI 32.5–51.4], respectively. The OS of 1 year, 2 year, 3 year and 5 year was 78.8%, 64.4%, 53.8% and 38.9%, respectively. On univariate analysis, favorable factors for OS included tumor size ≤ 5 cm, low-grade histology, tumors of renal vascular origin and non-metastatic disease at presentation. Neoadjuvant or adjuvant treatment with either radiotherapy or chemotherapy has been shown to improve OS (NR vs. 36 months, p < 0.001), especially for high-grade tumors > 5 cm in size. Radical nephrectomy with en bloc tumor resection with negative margins forms the mainstay of treatment for renal leiomyosarcomas. Adjuvant radiotherapy or chemotherapy appears to improve OS. To validate this treatment strategy, prospective multicentric efforts are required to acquire reliable data from randomized trials.
{"title":"Primary renal leiomyosarcoma in adult patients: a systematic review and individual patient data analysis","authors":"Kannan Periasamy, Treshita Dey, Shikha Goyal, Renu Madan, Santosh Kumar, Sudheer Kumar Devana, Thiraviyam Elumalai, Prashanth Giridhar, Sushmita Ghoshal, Rakesh Kapoor, Chandan K. Das","doi":"10.1186/s12301-024-00418-1","DOIUrl":"https://doi.org/10.1186/s12301-024-00418-1","url":null,"abstract":"The optimal management of primary renal leiomyosarcomas is unknown owing to its rarity and minimal available information about their primary, adjuvant treatment and clinical outcomes. This study systematically reviews treatment evidence and effects in terms of survival for leiomyosarcomas arising primarily from kidney, renal pelvis and renal vessels. PubMed and Embase databases were searched from inception to March 2023, with manual searches of reference lists. Two investigators independently reviewed the studies reporting management and survival outcomes of renal leiomyosarcomas. A total of 85 publications met inclusion criteria, reporting on 188 cases. The median age was 55.5 years, predominantly female [52.7%]. Pain was the most common presenting symptom [41.5%], and most tumors were high grade [45.8%]. Complete surgical resection with negative margins forms definitive treatment. The median disease-free survival and overall survival (OS) for all reviewed patients were 24 months [95%CI 4.1–43.9] and 42 months [95%CI 32.5–51.4], respectively. The OS of 1 year, 2 year, 3 year and 5 year was 78.8%, 64.4%, 53.8% and 38.9%, respectively. On univariate analysis, favorable factors for OS included tumor size ≤ 5 cm, low-grade histology, tumors of renal vascular origin and non-metastatic disease at presentation. Neoadjuvant or adjuvant treatment with either radiotherapy or chemotherapy has been shown to improve OS (NR vs. 36 months, p < 0.001), especially for high-grade tumors > 5 cm in size. Radical nephrectomy with en bloc tumor resection with negative margins forms the mainstay of treatment for renal leiomyosarcomas. Adjuvant radiotherapy or chemotherapy appears to improve OS. To validate this treatment strategy, prospective multicentric efforts are required to acquire reliable data from randomized trials.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"157 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140196751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the feasibility of partial penectomy under local anesthesia and penile nerve blocks. A total of 45 patients underwent partial penectomy under local anesthesia over the last 15 years at our institute. These patients were included in group A. We took 45 age-matched controls for comparison in group B. All patients underwent partial penectomy with the standard technique. The control group underwent partial penectomy under general or spinal anesthesia, and the intervention group underwent partial penectomy under local anesthesia. Patients’ tolerance to anesthesia and surgery was compared, and postoperative pain and other complications were assessed. Mean age was 53.5 years in group A (case) and 52.8 years in group B (controls). Out of 45 patients in group A, 9 were ASA I, 16 were ASA II, 8 were ASA III, and 12 were ASA IV patients. Out of control patients, 35 underwent surgery under spinal and 10 underwent surgery under general anesthesia. All patients tolerated the anesthesia and surgery well. The duration of anesthesia and surgery was shorter in group A (p < 0.05). Postoperative pain scores between the two groups were comparable after 6 h. Postoperative recovery was comparable in both groups, and hospital stays were shorter in local anesthesia/nerve block group but were statistically insignificant. There was no positive margin in any group. Partial penectomy under local anesthesia is a satisfactory alternative in selected cases or with limited availability of anesthesia services.
评估在局部麻醉和阴茎神经阻滞下进行阴茎部分切除术的可行性。在过去的 15 年中，共有 45 名患者在我院接受了局部麻醉下的阴茎部分切除术。所有患者均采用标准技术进行了阴茎部分切除术。对照组在全身或脊髓麻醉下进行阴茎部分切除术，干预组在局部麻醉下进行阴茎部分切除术。比较了患者对麻醉和手术的耐受性，并对术后疼痛和其他并发症进行了评估。A组（病例）的平均年龄为53.5岁，B组（对照组）的平均年龄为52.8岁。A 组 45 名患者中，9 人为 ASA I 级，16 人为 ASA II 级，8 人为 ASA III 级，12 人为 ASA IV 级。在对照组患者中，35 人接受了脊髓麻醉手术，10 人接受了全身麻醉手术。所有患者都能很好地耐受麻醉和手术。A 组的麻醉和手术时间较短（P < 0.05）。两组术后恢复情况相当，局麻/神经阻滞组住院时间较短，但无统计学意义。各组均无阳性边缘。在局部麻醉下进行阴茎部分切除术是一种令人满意的替代方法，适用于部分病例或麻醉服务有限的病例。
{"title":"Feasibility of partial penectomy under local anesthesia: a case–control study","authors":"Madhur Anand, Apul Goel, Bhupendra Pal Singh, Swati Aggarwal, Manoj Kumar, Vivek Kumar Singh, Vishwajeet Singh","doi":"10.1186/s12301-024-00416-3","DOIUrl":"https://doi.org/10.1186/s12301-024-00416-3","url":null,"abstract":"To assess the feasibility of partial penectomy under local anesthesia and penile nerve blocks. A total of 45 patients underwent partial penectomy under local anesthesia over the last 15 years at our institute. These patients were included in group A. We took 45 age-matched controls for comparison in group B. All patients underwent partial penectomy with the standard technique. The control group underwent partial penectomy under general or spinal anesthesia, and the intervention group underwent partial penectomy under local anesthesia. Patients’ tolerance to anesthesia and surgery was compared, and postoperative pain and other complications were assessed. Mean age was 53.5 years in group A (case) and 52.8 years in group B (controls). Out of 45 patients in group A, 9 were ASA I, 16 were ASA II, 8 were ASA III, and 12 were ASA IV patients. Out of control patients, 35 underwent surgery under spinal and 10 underwent surgery under general anesthesia. All patients tolerated the anesthesia and surgery well. The duration of anesthesia and surgery was shorter in group A (p < 0.05). Postoperative pain scores between the two groups were comparable after 6 h. Postoperative recovery was comparable in both groups, and hospital stays were shorter in local anesthesia/nerve block group but were statistically insignificant. There was no positive margin in any group. Partial penectomy under local anesthesia is a satisfactory alternative in selected cases or with limited availability of anesthesia services.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"110 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140127817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-12DOI: 10.1186/s12301-024-00417-2
Reginald Rustandi, Fakhri Rahman, Raga Manduaru, Chaidir Arif Mochtar
To evaluate burnout syndrome among Indonesian urologists by describing its prevalence and risk factors. This is a cross-sectional study conducted from February to April 2020. A validated Indonesian version of the Maslach Burnout Inventory that consists of 22 questions addressing emotional exhaustion, depersonalization, and personal achievement was utilized. The questionnaire was constructed using Google Forms (Google, Inc.) and was distributed via e-mail and WhatsApp Messenger (Facebook, Inc.). Burnout was defined as either high score on emotional exhaustion, or high score on depersonalization, or low score on personal achievement. Several variables were analyzed as risk factors to burnout using multivariate analysis. All statistical analyses were carried out using Statistical Software for Social Science (SPSS) version 23. From 486 eligible members of IUA, 184 (37%) respondents completed the questionnaire. Burnout syndrome was detected in 43 respondents (23.4%). From the results, most of the respondents have low EE (54.9%), low DP (77.7%), and moderate PA (45.7%). Bivariate analysis showed that age of less than 44 years old and being single were associated with increased risk of burnout with OR 2.2 (1.0–5.1, 95% CI, p-value 0.04) while being married decreases risk of burnout with OR 0.2 (0.1–0.8, 95% CI, p-value < 0.01). Lower work load in COVID-19–19 era was related to protective results with OR 0.4 (0.2–0.9, 95% CI, p-value 0.03). Multivariate analysis showed that being married decreases risk of burnout with OR 0.3 (0.1–0.9, 95% CI, p-value 0.04). Multivariate analysis showed that being married was the only significantly protective factor from burnout. Burnout syndrome among majority of urologists in Indonesia has a moderate degree of burnout, with being married the only significant factor influencing burnout in this study.
{"title":"Prevalence of burnout among urologist and its risk factors in Indonesia","authors":"Reginald Rustandi, Fakhri Rahman, Raga Manduaru, Chaidir Arif Mochtar","doi":"10.1186/s12301-024-00417-2","DOIUrl":"https://doi.org/10.1186/s12301-024-00417-2","url":null,"abstract":"To evaluate burnout syndrome among Indonesian urologists by describing its prevalence and risk factors. This is a cross-sectional study conducted from February to April 2020. A validated Indonesian version of the Maslach Burnout Inventory that consists of 22 questions addressing emotional exhaustion, depersonalization, and personal achievement was utilized. The questionnaire was constructed using Google Forms (Google, Inc.) and was distributed via e-mail and WhatsApp Messenger (Facebook, Inc.). Burnout was defined as either high score on emotional exhaustion, or high score on depersonalization, or low score on personal achievement. Several variables were analyzed as risk factors to burnout using multivariate analysis. All statistical analyses were carried out using Statistical Software for Social Science (SPSS) version 23. From 486 eligible members of IUA, 184 (37%) respondents completed the questionnaire. Burnout syndrome was detected in 43 respondents (23.4%). From the results, most of the respondents have low EE (54.9%), low DP (77.7%), and moderate PA (45.7%). Bivariate analysis showed that age of less than 44 years old and being single were associated with increased risk of burnout with OR 2.2 (1.0–5.1, 95% CI, p-value 0.04) while being married decreases risk of burnout with OR 0.2 (0.1–0.8, 95% CI, p-value < 0.01). Lower work load in COVID-19–19 era was related to protective results with OR 0.4 (0.2–0.9, 95% CI, p-value 0.03). Multivariate analysis showed that being married decreases risk of burnout with OR 0.3 (0.1–0.9, 95% CI, p-value 0.04). Multivariate analysis showed that being married was the only significantly protective factor from burnout. Burnout syndrome among majority of urologists in Indonesia has a moderate degree of burnout, with being married the only significant factor influencing burnout in this study.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140106367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1186/s12301-024-00414-5
Daria S. Dolgasheva, Marina K. Ibragimova, Matvey M. Tsyganov, Nikolai V. Litviakov
The aim of this study was to evaluate data over the past 25 years to assess the prevalence of the virus in patients with bladder cancer and to evaluate the association between human papillomavirus (HPV) and bladder cancer risk. Major databases were searched for published studies from October 1995 to May 2022. The present study evaluated the prevalence of HPV in patients with bladder cancer and the prevalence according to patients' ethnicity. The incidence of HPV in bladder cancer patients varies widely, ranging from complete absence of the virus in tissues to 64.6%. The meta-analysis was performed using Meta-Essentials_1.5 software. Begg’s and Egger’s methods were used to assess publication bias. Cochran’s Q test was used to assess heterogeneity and the I2 index was employed for calculating the variation in the pooled estimations. A weak association of HPV infection with the risk of bladder cancer was found. The risk of bladder cancer with HPV infection has clear ethnic characteristics and is statistically significant in Arabs and Asians.
{"title":"Human papillomavirus and bladder cancer: literature review and meta-analysis","authors":"Daria S. Dolgasheva, Marina K. Ibragimova, Matvey M. Tsyganov, Nikolai V. Litviakov","doi":"10.1186/s12301-024-00414-5","DOIUrl":"https://doi.org/10.1186/s12301-024-00414-5","url":null,"abstract":"The aim of this study was to evaluate data over the past 25 years to assess the prevalence of the virus in patients with bladder cancer and to evaluate the association between human papillomavirus (HPV) and bladder cancer risk. Major databases were searched for published studies from October 1995 to May 2022. The present study evaluated the prevalence of HPV in patients with bladder cancer and the prevalence according to patients' ethnicity. The incidence of HPV in bladder cancer patients varies widely, ranging from complete absence of the virus in tissues to 64.6%. The meta-analysis was performed using Meta-Essentials_1.5 software. Begg’s and Egger’s methods were used to assess publication bias. Cochran’s Q test was used to assess heterogeneity and the I2 index was employed for calculating the variation in the pooled estimations. A weak association of HPV infection with the risk of bladder cancer was found. The risk of bladder cancer with HPV infection has clear ethnic characteristics and is statistically significant in Arabs and Asians.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"34 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140098577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1186/s12301-024-00415-4
Norshuhada Amat, Lim Jeffery, Chai C. Ann, Yeoh W. Sien, Ahmad N. Fadzli, Shanggar Kuppusamy, Marniza Saad, Ong T. Aik
Multidisciplinary team meeting (MDTM) has become an increasingly important part of disease management model, particularly in cancer care. MDTM consists of a group of doctors to provide independent opinions on diagnostic and treatment decisions, as well as personalized therapeutic plan for patients. By selecting the most suitable treatment for patients from multiple perspectives, management by multidisciplinary team (MDT) have been shown to have advantages over traditional treatment models. The objective of this study is to determine the impact of MDTM on the management of uro-oncological cases and adherence to MDTM plans. We retrospectively collected patients’ clinical information discussed in MDTM from 1st January 2021 to 31st December 2022 at our institution. The pre-MDTM treatment plan by the clinicians and the MDTM consensus plans were compared to assess the overall MDTM impact on patient management. Adherence to MDTM recommendations was also analyzed. Data on 432 patients discussed in MDTM from 1st January 2021 to 31st December 2022 were collected and analyzed. Prostate cancer was the most common type of cancer discussed (n = 212, 48.8%). MDTM had a significant impact on decision-making in 276 (63.6%) cases, with changes to patient management being observed in more than half of all cases. Adherence to MDTM outcomes was high with 383 (90.5%) of patients eventually had treatment according to the MDTM recommendation. The study highlights the importance of MDTM in the management of genitourinary malignancies, particularly in cases where no original plan exists. Patient’s compliance and adherence to the MDTM consensus plan are also very encouraging.
{"title":"The impact of uro-oncology multidisciplinary team meeting (MDTM) on clinical decision-making and adherence to MDTM recommendation: experience from a tertiary referral centre in Malaysia","authors":"Norshuhada Amat, Lim Jeffery, Chai C. Ann, Yeoh W. Sien, Ahmad N. Fadzli, Shanggar Kuppusamy, Marniza Saad, Ong T. Aik","doi":"10.1186/s12301-024-00415-4","DOIUrl":"https://doi.org/10.1186/s12301-024-00415-4","url":null,"abstract":"Multidisciplinary team meeting (MDTM) has become an increasingly important part of disease management model, particularly in cancer care. MDTM consists of a group of doctors to provide independent opinions on diagnostic and treatment decisions, as well as personalized therapeutic plan for patients. By selecting the most suitable treatment for patients from multiple perspectives, management by multidisciplinary team (MDT) have been shown to have advantages over traditional treatment models. The objective of this study is to determine the impact of MDTM on the management of uro-oncological cases and adherence to MDTM plans. We retrospectively collected patients’ clinical information discussed in MDTM from 1st January 2021 to 31st December 2022 at our institution. The pre-MDTM treatment plan by the clinicians and the MDTM consensus plans were compared to assess the overall MDTM impact on patient management. Adherence to MDTM recommendations was also analyzed. Data on 432 patients discussed in MDTM from 1st January 2021 to 31st December 2022 were collected and analyzed. Prostate cancer was the most common type of cancer discussed (n = 212, 48.8%). MDTM had a significant impact on decision-making in 276 (63.6%) cases, with changes to patient management being observed in more than half of all cases. Adherence to MDTM outcomes was high with 383 (90.5%) of patients eventually had treatment according to the MDTM recommendation. The study highlights the importance of MDTM in the management of genitourinary malignancies, particularly in cases where no original plan exists. Patient’s compliance and adherence to the MDTM consensus plan are also very encouraging.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"34 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140098578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1186/s12301-024-00411-8
Marzuki Panji Wijaya, Ahmad Zulfan Hendri
The laparoscopic approach is the standard of care for living-donor nephrectomy. A rare postoperative complication is small bowel obstruction due to a retroperitoneal hernia. We present a case of an incidental finding of a retroperitoneal hernia in a patient with a history of laparoscopic donor nephrectomy. An adult male presented with diffuse abdominal pain, vomiting, and obstipation for 12 h. He had undergone laparoscopic donor nephrectomy two months prior. Plain abdominal radiograph revealed a dilated small bowel with homogenous opacity in the left lumbar region. Due to worsening diffuse abdominal pain and a high clinical suspicion of intestinal strangulation and ischemia after conservative management, an exploratory laparotomy was performed. Intraoperatively, an incarcerated small bowel segment herniating through an 8 cm descending mesocolon defect into the retroperitoneal space was discovered, forming a closed-loop obstruction. The bowel segment was reduced, and the mesocolon defect was repaired. The patient was discharged five days postoperatively with good recovery. Retroperitoneal hernia following laparoscopic living-donor nephrectomy is a rare but significant complication. Mitigation to prevent mesenteric defect creation, routine inspection, and closure of the defect can reduce the risk of hernia. Non-specific abdominal pain in patients with a history of laparoscopic donor nephrectomy prompts rapid imaging evaluation to aid in the early diagnosis of possible retroperitoneal hernia and its intervention.
{"title":"Retroperitoneal hernia following laparoscopic living-donor nephrectomy: a case report and review of literature","authors":"Marzuki Panji Wijaya, Ahmad Zulfan Hendri","doi":"10.1186/s12301-024-00411-8","DOIUrl":"https://doi.org/10.1186/s12301-024-00411-8","url":null,"abstract":"The laparoscopic approach is the standard of care for living-donor nephrectomy. A rare postoperative complication is small bowel obstruction due to a retroperitoneal hernia. We present a case of an incidental finding of a retroperitoneal hernia in a patient with a history of laparoscopic donor nephrectomy. An adult male presented with diffuse abdominal pain, vomiting, and obstipation for 12 h. He had undergone laparoscopic donor nephrectomy two months prior. Plain abdominal radiograph revealed a dilated small bowel with homogenous opacity in the left lumbar region. Due to worsening diffuse abdominal pain and a high clinical suspicion of intestinal strangulation and ischemia after conservative management, an exploratory laparotomy was performed. Intraoperatively, an incarcerated small bowel segment herniating through an 8 cm descending mesocolon defect into the retroperitoneal space was discovered, forming a closed-loop obstruction. The bowel segment was reduced, and the mesocolon defect was repaired. The patient was discharged five days postoperatively with good recovery. Retroperitoneal hernia following laparoscopic living-donor nephrectomy is a rare but significant complication. Mitigation to prevent mesenteric defect creation, routine inspection, and closure of the defect can reduce the risk of hernia. Non-specific abdominal pain in patients with a history of laparoscopic donor nephrectomy prompts rapid imaging evaluation to aid in the early diagnosis of possible retroperitoneal hernia and its intervention.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"213 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-28DOI: 10.1186/s12301-024-00413-6
Alper Simsek, Salih Butun, Mesut Berkan Duran, Kursat Kucuker, Sinan Celen, Yusuf Ozlulerden, Omer Levent Tuncay
The European Association of Urology (EAU) defines primary urethral carcinoma (PUC) as a carcinoma that arises in the urethra without a previous diagnosis of carcinoma elsewhere in the urinary system. It is considered as a rare cancer, accounting for less than 1% of all malignant tumors and 5% of malignant tumors of the urinary system. The difficulty in diagnosis and its rarity can lead to delayed diagnosis and decreased survival. We think that a case report to be made in the literature for this rare disease with no consensus on treatment will contribute to disease management. In this article, we describe the diagnosis and treatment process of a 75-year-old patient who was diagnosed with primary urethral cancer and had urethral discharge and difficulty in urination. The biopsy result from the suspected hyperemic area in the urethra in cystourethroscopy was primary urethral cancer. Urethrectomy followed by urethroplasty was performed on the patient's 2-cm primary urethral cancerous tissue. In the postoperative first month, an F-18 FDG whole-body PET scan for oncological evaluation showed increased pathological F-18 FDG uptake in the periphery of the mass in the penile urethra and indistinguishable boundaries from the prostatic urethra. After this, adjuvant gemcitabine and carboplatin therapy was planned by the oncology team. Based on our outcome in this case, we believe that chemotherapy combined with surgery increases the chance of successful treatment in locally advanced urethral cancer.
{"title":"Combined surgical and chemotherapy treatment for invasive primary urethral cancer: a case presentation","authors":"Alper Simsek, Salih Butun, Mesut Berkan Duran, Kursat Kucuker, Sinan Celen, Yusuf Ozlulerden, Omer Levent Tuncay","doi":"10.1186/s12301-024-00413-6","DOIUrl":"https://doi.org/10.1186/s12301-024-00413-6","url":null,"abstract":"The European Association of Urology (EAU) defines primary urethral carcinoma (PUC) as a carcinoma that arises in the urethra without a previous diagnosis of carcinoma elsewhere in the urinary system. It is considered as a rare cancer, accounting for less than 1% of all malignant tumors and 5% of malignant tumors of the urinary system. The difficulty in diagnosis and its rarity can lead to delayed diagnosis and decreased survival. We think that a case report to be made in the literature for this rare disease with no consensus on treatment will contribute to disease management. In this article, we describe the diagnosis and treatment process of a 75-year-old patient who was diagnosed with primary urethral cancer and had urethral discharge and difficulty in urination. The biopsy result from the suspected hyperemic area in the urethra in cystourethroscopy was primary urethral cancer. Urethrectomy followed by urethroplasty was performed on the patient's 2-cm primary urethral cancerous tissue. In the postoperative first month, an F-18 FDG whole-body PET scan for oncological evaluation showed increased pathological F-18 FDG uptake in the periphery of the mass in the penile urethra and indistinguishable boundaries from the prostatic urethra. After this, adjuvant gemcitabine and carboplatin therapy was planned by the oncology team. Based on our outcome in this case, we believe that chemotherapy combined with surgery increases the chance of successful treatment in locally advanced urethral cancer.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"37 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140008418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-16DOI: 10.1186/s12301-023-00406-x
Babasaheb Dhakne, Venkat Arjunrao Gite
Xanthogranulomatous pyelonephritis (XGP) is common in middle-age female, involved kidney usually is hydronephrotic, non-functioning and associated with stones but giant hydronephrotic presentation is a very rare. We report a case of 25-year-old female presented as huge cystic abdominal lump involving left hemi-abdomen and crossing midline associated with pain. On radiological evaluation, she had giant left non-functioning hydronephrotic kidney pushing small and large bowel on right side for which she underwent open simple nephrectomy. To our surprise, her histopathology report was Xanthogranulomatous pyelonephritis. Only one case reported till date of Xanthogranulomatous pyelonephritis presented as giant hydronephrosis in adult. Xanthogranulomatous pyelonephritis is very rare cause of giant hydronephrosis with a varying clinical and radiological presentation and difficult to diagnose preoperatively. Diagnosis of XGP should be entertained in case long-standing gross hydronephrotic obstructed, infected kidney with stone disease.
{"title":"Xanthogranulomatous pyelonephritis presenting as giant hydronephrosis in young women: a very rare case report","authors":"Babasaheb Dhakne, Venkat Arjunrao Gite","doi":"10.1186/s12301-023-00406-x","DOIUrl":"https://doi.org/10.1186/s12301-023-00406-x","url":null,"abstract":"Xanthogranulomatous pyelonephritis (XGP) is common in middle-age female, involved kidney usually is hydronephrotic, non-functioning and associated with stones but giant hydronephrotic presentation is a very rare. We report a case of 25-year-old female presented as huge cystic abdominal lump involving left hemi-abdomen and crossing midline associated with pain. On radiological evaluation, she had giant left non-functioning hydronephrotic kidney pushing small and large bowel on right side for which she underwent open simple nephrectomy. To our surprise, her histopathology report was Xanthogranulomatous pyelonephritis. Only one case reported till date of Xanthogranulomatous pyelonephritis presented as giant hydronephrosis in adult. Xanthogranulomatous pyelonephritis is very rare cause of giant hydronephrosis with a varying clinical and radiological presentation and difficult to diagnose preoperatively. Diagnosis of XGP should be entertained in case long-standing gross hydronephrotic obstructed, infected kidney with stone disease.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"94 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139754056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1186/s12301-024-00408-3
Sahin Gokhan, Dundar Mehmet, Senturk Taskin
Retroperitoneal fibrosis (RPF) is a rare disease characterized by the development of a fibroinflammatory mass in the retroperitoneum. Immunoglobulin-G4 related RPF was suggested as a secondary form of RPF and thought to be part of the spectrum of Immunoglobulin-G4 related diseases (IgG4-RD). Patients often present to the clinic because of flank pain. Ranging from mild to end-stage renal failure can be observed. The main purpose of treatment is to preserve renal function. As it is a rare condition, there is no definite treatment strategy. We report a case of 39-year-old man with left flank pain and diagnosis of IgG4-related RPF mimicking a renal pelvis tumor. A 39-year-old male patient presented with left flank pain. MRI suggested solid retroperitoneal mass associated with hydronephrosis in the left kidney collecting system. Upon identifying the retroperitoneal origin of the mass during nephroureterectomy, the procedure was concluded following the acquisition of frozen section and routine pathological samples from the lesion. In the histopathological examination, inflammatory cells were observed and specific immunohistochemistry for IgG-4 was detected focally positive. Following the placement of a DJ stent, immunosuppressive therapy was initiated with Prednol and Azathioprine. After a one-year follow-up period, during which the patient received immunosuppressive treatment and underwent tri-monthly DJ stent replacements, the DJ stent was subsequently removed, revealing complete regression of hydronephrosis. With the correct diagnosis and treatment of IgG4-related RPF, it is possible to prevent irreversible complications of the disease. Because it is a rare disease, case reports in the literature will be useful for treatment.
腹膜后纤维化（RPF）是一种罕见疾病，其特征是腹膜后出现纤维炎性肿块。免疫球蛋白-G4相关的腹膜后纤维化被认为是腹膜后纤维化的一种继发形式，也被认为是免疫球蛋白-G4相关疾病（IgG4-RD）的一部分。患者通常因腹部疼痛而就诊。可观察到从轻度到终末期的肾衰竭。治疗的主要目的是保护肾功能。由于该病十分罕见，目前尚无明确的治疗策略。我们报告了一例 39 岁男性左侧腹痛病例，诊断为 IgG4 相关 RPF（模仿肾盂肿瘤）。一名 39 岁男性患者因左侧腹痛就诊。核磁共振成像提示腹膜后实性肿块伴有左肾集合系统肾积水。在肾切除术中确定肿块来源于腹膜后后，在获取病变部位的冰冻切片和常规病理样本后，手术结束。在组织病理学检查中，观察到炎性细胞，IgG-4 的特异性免疫组化检测呈灶性阳性。植入 DJ 支架后，开始使用泼尼松和硫唑嘌呤进行免疫抑制治疗。在为期一年的随访期间，患者接受了免疫抑制治疗，并每三个月更换一次 DJ 支架，随后拆除了 DJ 支架，发现肾积水完全消退。通过对 IgG4 相关 RPF 的正确诊断和治疗，有可能避免该病出现不可逆转的并发症。由于这是一种罕见疾病，文献中的病例报告将有助于治疗。
{"title":"IgG4-related retroperitoneal fibrosis mimicking renal pelvis tumor: a case report and literature review","authors":"Sahin Gokhan, Dundar Mehmet, Senturk Taskin","doi":"10.1186/s12301-024-00408-3","DOIUrl":"https://doi.org/10.1186/s12301-024-00408-3","url":null,"abstract":"Retroperitoneal fibrosis (RPF) is a rare disease characterized by the development of a fibroinflammatory mass in the retroperitoneum. Immunoglobulin-G4 related RPF was suggested as a secondary form of RPF and thought to be part of the spectrum of Immunoglobulin-G4 related diseases (IgG4-RD). Patients often present to the clinic because of flank pain. Ranging from mild to end-stage renal failure can be observed. The main purpose of treatment is to preserve renal function. As it is a rare condition, there is no definite treatment strategy. We report a case of 39-year-old man with left flank pain and diagnosis of IgG4-related RPF mimicking a renal pelvis tumor. A 39-year-old male patient presented with left flank pain. MRI suggested solid retroperitoneal mass associated with hydronephrosis in the left kidney collecting system. Upon identifying the retroperitoneal origin of the mass during nephroureterectomy, the procedure was concluded following the acquisition of frozen section and routine pathological samples from the lesion. In the histopathological examination, inflammatory cells were observed and specific immunohistochemistry for IgG-4 was detected focally positive. Following the placement of a DJ stent, immunosuppressive therapy was initiated with Prednol and Azathioprine. After a one-year follow-up period, during which the patient received immunosuppressive treatment and underwent tri-monthly DJ stent replacements, the DJ stent was subsequently removed, revealing complete regression of hydronephrosis. With the correct diagnosis and treatment of IgG4-related RPF, it is possible to prevent irreversible complications of the disease. Because it is a rare disease, case reports in the literature will be useful for treatment.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"94 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139754118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-23DOI: 10.1186/s12301-024-00409-2
Muzafr Shakir Ali Yousif, Ismail Gareeballah Alhag Mohamad, Mohamed Elimam Mohamed Ahmed, Yassin Mohammed Osman, Ahmed Shakir Ali Yousif, Mustafa Omran
Urogenital fistula can arise from various causes, leading to the development of diverse surgical procedures. The prevention and treatment of obstetric fistula continue to pose challenges in low-income countries. To assess the outcomes and predictors of failure of surgical repair for urogenital fistulas, specifically high vesico-vaginal fistula (VVF) and vesico-uterine fistula (VUF), within our context. Conducted a prospective hospital-based study involving 100 female patients with urogenital fistula (95 VVF and 5 VUF) who underwent abdominal surgical repair at Gezira Hospital for Renal Diseases and Surgery from 2018 to 2023. Collected data encompassing demographics, obstetric history, fistula etiologies, Swab test, cystoscopy findings, urine diversion, ureteric re-implantation, and repair outcomes. The majority of women were aged 20–29 years (39%), illiterate (62%), and had a low socio-economic status (87%). Lack of antenatal care was noted in 77% of patients. Fistula etiologies were predominantly obstetric (70%), mainly due to spontaneous vaginal delivery (SVD), with the remaining 30% attributed to gynecological causes (hysterectomy). In terms of fistula characteristics, all patients had a high-level fistula, 95% had a single fistula, and 69% had a posterior wall fistula. Successful closure was achieved in 84% of cases, with 11% experiencing ureteric involvements. The analysis of failures pointed to recurrent fistulae (50%), larger fistula size (31%), and the presence of multiple fistulae (19%) as notable predictors of unsuccessful repair. VVF was the prevalent type of urogenital fistula in our population. Risk factors included being in the third decade of life, illiteracy, low socioeconomic status, and a lack of prenatal care. Obstetric causes, particularly prolonged and obstructed labor through SVD, dominated the etiology. Surgical procedures resulted in successful closure in 84% of cases. Recurrent fistulae, larger size, and multiple occurrences emerged as predictors of surgical repair failure.
{"title":"Outcome and predictors of failure of abdominal surgical repair of high vesico-vaginal and vesico-uterine fistulae at Gezira Hospital for Renal Disease and Surgery","authors":"Muzafr Shakir Ali Yousif, Ismail Gareeballah Alhag Mohamad, Mohamed Elimam Mohamed Ahmed, Yassin Mohammed Osman, Ahmed Shakir Ali Yousif, Mustafa Omran","doi":"10.1186/s12301-024-00409-2","DOIUrl":"https://doi.org/10.1186/s12301-024-00409-2","url":null,"abstract":"Urogenital fistula can arise from various causes, leading to the development of diverse surgical procedures. The prevention and treatment of obstetric fistula continue to pose challenges in low-income countries. To assess the outcomes and predictors of failure of surgical repair for urogenital fistulas, specifically high vesico-vaginal fistula (VVF) and vesico-uterine fistula (VUF), within our context. Conducted a prospective hospital-based study involving 100 female patients with urogenital fistula (95 VVF and 5 VUF) who underwent abdominal surgical repair at Gezira Hospital for Renal Diseases and Surgery from 2018 to 2023. Collected data encompassing demographics, obstetric history, fistula etiologies, Swab test, cystoscopy findings, urine diversion, ureteric re-implantation, and repair outcomes. The majority of women were aged 20–29 years (39%), illiterate (62%), and had a low socio-economic status (87%). Lack of antenatal care was noted in 77% of patients. Fistula etiologies were predominantly obstetric (70%), mainly due to spontaneous vaginal delivery (SVD), with the remaining 30% attributed to gynecological causes (hysterectomy). In terms of fistula characteristics, all patients had a high-level fistula, 95% had a single fistula, and 69% had a posterior wall fistula. Successful closure was achieved in 84% of cases, with 11% experiencing ureteric involvements. The analysis of failures pointed to recurrent fistulae (50%), larger fistula size (31%), and the presence of multiple fistulae (19%) as notable predictors of unsuccessful repair. VVF was the prevalent type of urogenital fistula in our population. Risk factors included being in the third decade of life, illiteracy, low socioeconomic status, and a lack of prenatal care. Obstetric causes, particularly prolonged and obstructed labor through SVD, dominated the etiology. Surgical procedures resulted in successful closure in 84% of cases. Recurrent fistulae, larger size, and multiple occurrences emerged as predictors of surgical repair failure.","PeriodicalId":7432,"journal":{"name":"African Journal of Urology","volume":"2017 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139551871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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