Complications following biopsy of an intraabdominal or retroperitoneal mass compared with a renal mass.

INTRODUCTION: This study aimed to assess the short-term complication rate after US-guided core needle biopsies with an 18-gauge needle of retroperitoneal or intraabdominal masses (non-kidney group) compared with complications after biopsy from a renal mass (kidney group). METHODS: This was a retrospective analysis of 330 consecutive patients in the non-kidney group and 330 control patients in the kidney group. We recorded baseline characteristics, diagnostic yield, complications graded as Clavien-Dindo (CD) and readmissions within one and seven days. RESULTS: In all, 245 patients in the non-kidney and 281 patients in the kidney group had a biopsy performed. A total of 54 (22%) patients in the non-kidney group had a complication registered. However, 47 were minor complications (minor bleeding or localised pain, CD 1). In the kidney group, 47 (17%) patients had a complication, with 44 being graded as CD 1. No major complications (CD 3 or higher) were associated with the biopsies. Only 0.8% of patients in the non-kidney group and 0.7% in the kidney group had a treatment-requiring CD 2 complication (i.e. blood transfusion) directly caused by the US-guided biopsy. These complications were recognised less than 30 minutes or more than four hours after the procedure. We found no significant difference in the complication rate, diagnostic yield or risk of re-admission between the two groups. CONCLUSION: The observation period for patients who undergo an uncomplicated US-guided biopsy from an intraabdominal or retroperitoneal mass can safely be reduced to 30 minutes. FUNDING: None TRIAL REGISTRATION. Not relevant.

Challenging the Urologist of the Future: Time for a Change?

Physicians need both medical expertise and diverse skills for effective patient care. Adaptability is also key in embracing advances in technology and new techniques. We outline six thought-provoking points to guide the new generation of urologists.

[Pregnant woman with renal cancer treated with simultaneous section and partial nephrectomy].

This is a case report of a 43-year-old pregnant woman, who in 26+0 was referred to a department of urology on suspicion of a kidney tumor. A CT scan of chest and abdomen showed a 7 cm tumor in the right kidney without signs of metastases. Biopsy revealed a clear cell renal cell carcinoma. The patient was treated in week 32+0 by a joint venture between a department of urology and a department of obstetrics with a midline incision caesarean followed by a right-sided open partial nephrectomy. The delivery of the baby was uncomplicated. The patient showed no signs of relapse in her control regiment after 1,5 years of observation.

[Tumour of the ureter surprisingly turned out to be localised amyloidosis].

Localised amyloidosis in the urinary tract is a rare and often benign condition, which is usually clinically mistaken for malignancy. I this case report, a 48-year-old man was referred to the hospital with left flank pain, and CT-urography showed a tumour with calcification in the distal ureter. During transurethral procedure, the tumour was resected macroscopically. Histology revealed the diagnosis of amyloidosis. Follow-up was without signs of systemic involvement or recurrence. This case underlines the significance of preoperative diagnostic biopsy, thus saving the patient from unnecessary major surgery.

Left sided flank pain due to Bochdalek hernia with intrathoracic kidney.

A 40 year old woman had undergone surgery as a newborn due to a left sided congenital Bochdalek hernia with the ventricle, spleen, left kidney and adrenal gland located intrathoracically. After three pregnancies, she developed left sided flank pain and dyspnea. A CT scan showed a diaphragmatic hernia with a malrotated intrathoracic placed left kidney with minimal hydronephrosis. The spleen was located caudally in the left iliac fossa; there were no other abnormalities. The patient underwent a thoracotomy with a small resection of the diaphragm in order to replace the kidney in the abdominal cavity and closure of the diaphragmatic defect with a Gore-Tex patch.

[An ordinary condom can be used for removing encircling metallic objects around penis].

We describe a new method for removing encircling objects from penis. A 69-year-old male was admitted with a ratchet spanner stuck at the penile base. A condom was applied to the penile shaft and manoeuvred in between the ratchet spanner and the penis. A lot of lubrication was applied, and the ratchet spanner was removed. Later the same method was tried when a 66-year-old male had a tap aerator stuck under glans penis. However, the method was unsuccessful because of a very narrow diameter of the tap aerator. Instead, the tap aerator was cut in two by using an angle grinder.

[Transurethral prostate resection prior to kidney transplantation leading to urethral cicatricial tissue]. / Transuretral prostataresektion forud for nyretransplantation medførende uretral arvævsdannelse.

In Denmark, kidney transplantations in patients above 50 years have increased during the last decade. Consequently, the number of patients with lower urinary tract symptoms due to prostate hypertrophy increases accordingly. We describe two patients, who both had a resection of the prostate while having anuria and waiting for a kidney transplantation from a deceased donor. In both cases it was impossible to place a urethral catheter during the following transplantation due to total urethral occlusion, so a suprapubic catheter was inserted until the scar tissue was dilated or resected by a later transurethral intervention.

[Perforation of the appendix and observation of Enterobius vermicularis]. / Perforeret appendicitis med fund af Enterobius vermicularis.

A nine-year-old girl was admitted to the paediatric ward due to fever and lower abdomen pain through a day. Acute laparoscopic exploration showed a large necrotic perforation at the distal end of the appendix. During the appendectomy multiple small, live Enterobius vermicularis (pinworms) were observed. The patient was admitted for three days of observation and received relevant treatment with intravenous antibiotics and antihelminthic treatment. The histology showed numerous pinworms in the lumen of the appendix and invasion of the pinworms of the submucosal layer and the wall of the appendix.

[Prolonged penile strangulation can cause serious problems].

A 45-year-old male fell asleep with a plastic ring around both scrotum and penis after intake of 100 mg of Viagra. He woke up several hours later with pain and oedema of the external genitalia. He was able to cut off the ring, but a concentrically wound around the base of scrotum had already been formed. He went to see a doctor ten days later and was referred to an urological department. The wound was purified and sutured in general anaesthesia, because the cremaster muscle was exposed. The patient was discharged the next day.

Prostate stent is an option for selected patients who are unsuitable for transurethral resection of the prostate.

INTRODUCTION: Transurethral resection of the prostate (TUR-P) is the gold standard for treatment of severe lower urinary tract symptoms (LUTS) or urine retention. Some patients are unfit for surgery due to much co-morbidity and need alternative treatment. Intraprostatic stents are one example of minimally invasive treatment for LUTS. We present our results for 27 consecutive intraprostatic stents. MATERIAL AND METHODS: A retrospective chart review of all patients who had received an intraprostatic stent between January 2012 and December 2013 by the same surgeon at the Department of Urology, Roskilde Hospital, Denmark. RESULTS: A total of 27 consecutive intraprostatic stents placed in 25 patients were reported. In all, 14 stents were still functioning at the end of follow-up after a mean 432.5 days. Four patients had died of reasons unrelated to the stent with a functioning stent in situ after an average of 102 days. A total of nine stents (33%) were removed in seven patients after a mean 165 days due to migration in two cases, infection in two cases, incontinence in two cases and retention in three cases. Residual urine was significantly reduced after placement of the stents. 72% of the patients avoided surgery or an indwelling catheter. CONCLUSION: An intraprostatic stent can be an important option in highly selected patients with considerable co-morbidity who are unsuitable for TUR-P. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Amyloidosis in the bladder: three cases with different appearance.

Amyloidosis refers to a number of diseases characterized by extracellular deposition of misfolded proteins, called amyloid fibrils, in the tissues and organs of the body. Amyloidosis in the bladder is a generally localized, rare condition, with approximately 200 cases reported in the literature. This report presents three cases of amyloidosis in the bladder, two of which had coexisting transitional cell carcinoma. Evaluation for systemic disease is recommended in patients with newly discovered amyloidosis, even if first recognized in an area with the localized form, as in the bladder.

[Successful conservative treatment after accidental stab wound to the chest]. / Vellykket konservativ behandling efter knivtraume mod hjertet.

A five year-old girl was admitted to hospital following an accidental stab wound to the chest, inflicted by a knife placed in a dishwasher's cutlery tray. Investigations revealed a traumatic ventricular septum defect of the heart, with a pericardial effusion. Since the patient remained haemodynamically stable, surgical intervention was considered unnecessary. At the first follow-up, an echocardiogram showed no visible pericardial effusion. At ten month follow-up, she showed initial symptoms of cardiac failure, and a renewed echocardiogram revealed a new pericardial effusion. It is important to perform long-term follow-up on patients with traumatic chest wounds.