Ureteral wall thickness as a predictor for non-invasive treatment success for steinstrasse. Can we save time?

PURPOSE: We aimed to define factors affecting the non-invasive overall treatment success (medical expulsive therapy (MET) ± shock wave lithotripsy (SWL)) for uncomplicated ureteral steinstrasse (SS) clearance. METHODS: We retrospectively evaluated consecutive patients who underwent SWL for renal stones between 2017 and 2021. Patients with uncomplicated SS were included. All patient's demographic and radiological data, e.g., age, gender, pre-SWL stenting, SS site, type, leading stone size in widest diameter (< 10 mm and ≥ 10 mm), ureteral wall thickness (UWT) in mm against the leading stone were collected. If SS was diagnosed, medical treatment was given for 4 weeks. In case of MET failure, either SWL for the leading stones + MET or direct URS was done. Non-invasive treatment success (SFR) was considered if complete clearance of SS occurred with no complications or the need for invasive intervention. RESULTS: A total of 145 patients were included with mean age of 45.9 ± 12.4 years. SFR in case of MET only occurred in 27.9%. Complications happened in 26 patients (17.9%). Non-invasive treatment SFR was achieved in 78 patients (53.8%) totally where SS type I, leading stone size ≤ 10 mm type and decreased UWT around the leading stone increased treatment success. CONCLUSION: Ureteral wall thickness is an important factor predicting SS management success. Besides the decreased UWT, non-invasive management should be offered for type I SS with leading stone ≤ 10 mm.

Male sexual health predictors during the Covid-19 outbreak: a multicenter study.

Background: Pandemic-induced feelings of fear and worry are all psychological implications of the COVID-19 pandemic. The goal of this study was to see how the COVID-19 pandemic affected male Sexual Health and to look for plausible predictors. Methods: Married males were asked to fill out an Arabic Sexual Health questionnaire. Before and during the lockdown. Additionally, generalized Anxiety Disorder-7 and International Index of Erectile Function-5 questionnaires. Results: A multicenter study. The survey was completed by 281 men in total. Only 130 males (47.3%) were satisfied with their Sexual performance before lockdown, compared to 170 males (56.5%) who were not satisfied (P 0.000). Financial issues (P ≤ 0.000), smoking habit prior to lockdown (P ≤ 0.001), spots practice (P ≤ 0.001), smoking during lockdown (P ≤ 0.001), presence of depressive disorder on the PHQ-9 total score (P ≤ 0.001), diagnosis of anxiety on the GAD-7 score (P ≤ 0.001), and presence of ED on the IIEf-5 questionnaire (P ≤ 0.001) were all found to be significant on univariate analysis. On bivariate analysis, financial issues (odds ratio [OR]: 3.56, P ≤ 0.000), presence of anxiety on GAD-7 (OR: 6.40, P ≤ 0.001), PHQ score (OR: 2.50, P ≤ 0.001), and diagnosis of ED on the IIEF-5 scale (OR: 7.50, P ≤ 0.001) were significantly associated with Sexual relationship stress and Sexual Health. Conclusion: During and after COVID-19 lockdown, the presence of anxiety on the GAD-7 scale, PHQ score, and the diagnosis of ED on the IIEF-5 scale were all independent predictors of Sexual Health.

Optimization of shockwave lithotripsy use for single medium sized hard renal stone with stone density ≥ 1000 HU. A prospective study.

PURPOSE: To identify shock wave lithotripsy (SWL) success predictors in hard renal stones (average stone density ≥ 1000 HU). MATERIALS: We prospectively evaluated patients who underwent SWL for hard renal stones between April 2018 and December 2020. Radiological parameters were identified, e.g., stone site, size, the average density in addition to stone core and shell mean density, and renal cortical thickness (RKT). SWL sessions were performed using Doli-S lithotripter till a maximum of 3-4 sessions with 2-4 weeks interval. Initial response to SWL included stone fragmentation and decreased stone size after the first SWL. Treatment success was considered if complete clearance of renal stones occurred or in case of clinically insignificant residual fragments ≤ 4 mm after 12 weeks follow up by NCCT. RESULTS: Out of 1878 patients who underwent SWL, the study included 157 patients with hard renal stones. Treatment overall success was found in 92 patients (58.6%) where 69 patients (43.9%) had complete stone clearance. On multivariate analysis, stone shell density < 901 HU, maximum stone size < 1 cm, RKT > 1.95 cm and initial treatment response were associated with increased the success rate after SWL for hard renal stones (P = 0.0001, 0.009, < 0.0001 and < 0.0001, respectively). CONCLUSION: In hard renal stones, treatment overall success was found in 58.6% where complete stone clearance was found in 43.9%. Stone outer shell fragility, lower stone size, increased RKT and initial response to SWL were associated with a higher success rate at 12-week follow-up.

Critical analysis of pyeloplasty role in adults with late diagnosis of ureteropelvic junction obstruction-a comparative study.

PURPOSE: Due to the data paucity about the functional outcomes post pyeloplasty for patients diagnosed with ureteropelvic junction obstruction (UPJO) with a preoperative age above the age of 45 years and according to the elderly definition (age ≥ 65 years), we conducted this study to clarify the different outcomes in adults presented with late hydronephrosis. METHODS: We included patients who were managed by pyeloplasty with a preoperative age ≥ 45 years. We further subdivided those patients into; group (A) patient's age ≥ 65 years and group (B) patient's age ≥ 45 and < 65 years. Split renal function (SRF) difference was evaluated by the changes between the last follow-up and the baseline renogram, where 5% change was considered a significant change. Functional outcomes and factors predicting the functional recoverability post pyeloplasty were evaluated. RESULTS: A total of 119 patients were included. The mean age was 62.3 ± 16.4 years. Group (A) and group (B) included 47 and 72 patients, respectively. After 24 months, GFR and SRF were increased at the last follow-up (P = 0.32 and 0.57, respectively). No significant functional changes were noted between both groups. Sixty two, 7 and 13 patients showed static, decreased and improved renal function. Lower preoperative SRF was the only predictor for poor functional recoverability in patients with age ≥ 45 years who were managed by pyeloplasty. CONCLUSION: Elderly patients should not be excluded from the corrective surgery for UPJO. Lower preoperative SRF was the only predictor for renal function deterioration post pyeloplasty.

Initial radiological findings associated with active bleeding control necessity and long term functional outcomes after isolated high grade blunt renal trauma.

INTRODUCTION: To assess the predictors for conservative management failure and long term outcomes after isolated blunt high grade renal trauma (HGRT). METHODS:  A retrospective analysis of patients with isolated blunt HGRT (renal trauma grade ≥ IV) was conducted. Patients' demographics, clinical presentation, laboratory and radiological investigations, and different lines of treatment were retrieved. The primary outcome was to assess the predictors of conservative treatment failure (need for active bleeding control e.g.: transarterial angioembolization (TAE) and/or surgical exploration). The secondary outcome was to assess the renal parenchymal volume (RPV) changes post HGRT in correlation with the different lines of management using CT-measured RPV. The difference in RPV ≥ 5% at follow up was considered significant. RESULTS: The study included 63 patients, mean (SD) age was 35.1 (16.6) years. Conservative management was successful in 39 patients (62%), while the need for active bleeding control was required in 16 and 8 patients who underwent TAE and surgical exploration, respectively. Increased hematoma rim distance (HRD), laceration numbers > 3, parenchymal devascularization ≥ 25%, and presence of vascular contrast extravasation (VCE) were predictors for conservative treatment failure (P= 0.006, 0.02, 0.045 and 0.002, respectively). After a mean of 19 months follow up, patients were subclassified into 2 groups: patients with preserved RPV (28 patients) and patients with decreased RPV (29 patients). Renal parenchymal devascularization ≥ 25% was found a predictor for ipsilateral RPV decrease (P = 0.02). CONCLUSION: Increased HRD, laceration numbers > 3, parenchymal devascularization ≥ 25%, and presence of VCE are findings that reflect the necessity for active bleeding interventions after isolated blunt HGRT. Parenchymal devascularization ≥ 25% is an independent factor for RPV deterioration. Neither the grade of renal trauma nor the type of treatment is a predictor for such deterioration.

Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?

INTRODUCTION: Some patients with ureteropelvic junction obstruction (UPJO) have supranormal differential renal function (snDRF). We aimed to study the outcomes of pyeloplasty in adult patients with UPJO and either snDRF or normal differential renal function (nDRF) and to identify preoperative factors responsible for the snDRF phenomenon. MATERIALS AND METHODS: We retrospectively retrieved data for all patients who underwent pyeloplasty and had snDRF (differential renal function [DRF] ≥55%) and nDRF (DRF between 45 and 55%) preoperatively. Preoperative radiological data using computed tomography or magnetic resonance imaging were correlated with the presence of snDRF phenomenon. In addition, scintigraphic findings pre- and post-operatively were also assessed to evaluate the functional outcomes. RESULTS: Of a total of 856 patients, 31 had snDRF (group 1) and 42 had nDRF (group 2). After a mean of 37 months' follow-up in Group 1, 22 patients developed DRF reduction with non-obstructive pattern. Mean DRF % decreased from 59 ± 2.8 to 48 ± 13 (P < 0.0001). However, in Group 2, five patients had DRF decrease. Four patients developed snDRF phenomenon postoperatively. Increased renal pelvis volume ≥50 mm3 and increased anteroposterior pelvic diameter (APD) ≥37 mm were found to predict snDRF phenomenon. The same findings, in addition to preoperative snDRF, correlated with postoperative DRF decrease. CONCLUSION: SnDRF function could be expected in patients with increased renal pelvis volume and APD. The absolute value or changes in DRF are not reliable to judge treatment failure.

Report of two rare cases of adrenal incidentalomas with different origins: revisiting pathological and radiological findings with a short review of the literature.

BACKGROUND: Adrenal tumors can be detected incidentally in 4 to 8% of patients radiologically. Adenomas, pheochromocytomas, and adrenocortical carcinomas represent the most common tumors of the adrenal glands. Rare histopathological findings are uncommon. We aimed to report two rare primary adrenal tumors diagnosed initially as incidentalomas to identify clinical characteristics, management, and clinical outcomes after treatment. CASE PRESENTATION: The first case was a 52-year-old man presented with an incidentally discovered locally advanced primary adrenal angiosarcoma. The patient was managed surgically with no adjuvant therapy. The patient was followed up for 3 years without evidence of local recurrence. The second case was a 63-year-old woman, presented with an incidentally discovered primary diffuse B-cell lymphoma of the left adrenal gland. She was treated by adrenalectomy. Later on, adjuvant six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were given. After 6 months follow-up, the patient was alive and disease-free. CONCLUSION: The diagnosis of adrenal tumors increased nowadays because of the widespread use of imaging studies, though rare pathologies should be taken into consideration.

Role of pretreatment Doppler ultrasound in the prediction of factors affecting stone-clearance post-shockwave lithotripsy for ureteral stones: a prospective study.

PURPOSE: To identify the role of Doppler US (DUS) in the prediction of factors affecting stone-clearance post-SWL for ureteral stones in addition to its role in prediction of pretreatment stone impaction. METHODS: We prospectively included patients with ureteric stone for SWL between October 2018 and September 2019. Patient's demographics were collected. Using DUS, resistive index (RI), Δ RI, and ureteric jets were evaluated in both kidneys. Also, stone site, volume, density, skin to stone distance, degree of hydronephrosis, ureteral wall thickness (UWT) were evaluated by NCCT. Univariate and multivariate logistic regression analyses were performed to identify factors that contribute to treatment success. Correlation between ipsilateral RI with other radiological findings predicting stone impaction was done. RESULTS: A total of 93 patients were finally included (61 males and 32 females). The mean age was 31.4 ± 7.7 years. The success rate (absence of significant residuals post 1 month by NCCT) was 51.6%. In multivariate analysis, the presence of ureteric jet, ipsilateral lower RI, and ipsilateral lower UWT were independent factors for treatment success (P = 0.0001, 0.002, and 0.03, respectively). Also, ipsilateral absence of ureteric jet, increased hydronephrosis, and increased UWT were correlated with higher ipsilateral RI in prediction of stone impaction. Ipsilateral higher RI was found to achieve higher accuracy in stone impaction prediction (PPV of 94.8%). CONCLUSION: Pretreatment DUS is a useful, non-invasive with a less irradiative tool for prediction of stone impaction and stone-free rate post-SWL for ureteric stones.

Spontaneous renal hemorrhage: critical analysis of different lines of management in non-traumatic patients: a single tertiary center experience.

PURPOSE: To assess clinical presentation and outcomes of different treatment strategies in cases of spontaneous renal hemorrhage (SRH). METHODS: A retrospective analysis of patients with SRH between 2000 and 2018 was performed. Patients' demographics, clinical presentation, laboratory and radiological investigations, and different lines of treatment were retrieved. The primary outcome was to assess the predictors of the success of conservative treatment. The secondary outcome was to assess the long-term renal function outcome comparing serum creatinine, e GFF, and CT-assessed renal volume at last follow-up with baseline values. RESULTS: The study included 42 (23 males and 19 women) patients with mean ± SD age was 48.1 ± 17.8 years. Conservative management was successful in 19 (46%) patients. Trans-arterial embolization (TAE) was performed in 13 patients (30%) to control active bleeding. Ten patients (25%) required surgical exploration and nephrectomy. Lower serum creatinine (P = 0.003), higher prothrombin concentration (P = 0.04), lower hematoma size (P = 0.02), and non-AML lesions (P = 0.03) were independent predictors of conservative management success. Unlike the TAE-treated group, serum creatinine increased significantly (P = 0.04) with a significant decrease in e-GFR (P = 0.02) and renal volume (P < 0.001) of affected kidneys at last follow-up after conservative treatment. CONCLUSION: Although SRH is a life-threatening condition, conservative treatment is successful in a certain subset of patients. However, it is associated with significant deterioration of the affected kidney function as well as renal volume.

Validation of the Arabic linguistic version of the Overactive Bladder Symptoms Score questionnaire.

Objective: To validate an Arabic version of the Overactive Bladder Symptom Score (OABSS) questionnaire. Patients and methods: In all, 301 patients were evaluated using the Arabic-translated OABSS. They were divided into four groups: 112 patients with OAB symptoms, 115 healthy individuals with no OAB symptoms, 38 with bladder outlet obstruction (BOO) associated with storage lower urinary tract symptoms (LUTS), and 36 with BOO without storage LUTS. The reliability of the Arabic version was evaluated for internal consistency using Cronbach's α test. Interdomain associations were examined using Spearman's correlation coefficient (r). The discrimination validity was evaluated using the Mann-Whitney test. Results: Higher internal consistency was found for all OABSS domains in the OAB and BOO groups. There were strong correlations between all domains in the OAB group (P < 0.001). Similarly, there were strong correlations between all domains in the BOO group. For discrimination validity, scores were statistically significant higher for all OABSS domains and overall total scores in the OAB and BOO groups compared with their control groups (P < 0.001). Conclusion: The Arabic version of OABSS is a reliable and valid instrument that can be used to evaluate symptoms and health-related quality of life in Arabic patients with OAB. Clinical trial no. (clinicaltrials.gov NCT03533062) Abbreviations : BOO: bladder outlet obstruction; OAB: overactive bladder; OABSS: Overactive Bladder Symptom Score questionnaire; (U)UI: (urgency) urinary incontinence.

Assessment of Anticholinergic Use After Fading of BTX-A Effects in Refractory Idiopathic Overactive Bladder: A Prospective Blinded Randomized Trial.

PURPOSE: To evaluate the efficacy and safety of re-treatment with anticholinergics on refractory idiopathic overactive bladder (OAB) previously treated with intravesical botulinum neurotoxin type A (BTX-A) injections. METHODS: One hundred patients were initially managed by intravesical injections of 100 IU of BTX-A. After the effects of BTX-A faded, patients were randomized into 2 groups: group A patients received solifenacin (10 mg) for 12 weeks (study group), while group B patients received placebo treatment for 12 weeks (control group), then subsequently received solifenacin (10 mg) for another 6 weeks. All patients underwent preoperative urodynamic testing. Patients were asked to complete the validated overactive bladder symptoms score (OABSS) and incontinence quality of life (I-QoL) instruments after the effects of intravesical BTX-A faded and at 12 weeks of follow-up. Univariate and multivariate analyses of the factors affecting treatment response were conducted. RESULTS: At 12 weeks of follow-up, in group A, all OABSS items, including the total score, had improved significantly (P<0.0001). Group A had lower frequency and amplitude of detrusor overactivity and detrusor leak point pressure (P<0.0001, P=0.03, and P=0.01, respectively). Cystometric capacity also increased significantly (P=0.007), as did all I-QoL parameters. In a comparison of patients with failed treatment and patients with successful treatment, female sex, repeated intravesical BTX-A injections, and increased bladder capacity were statistically significant (P=0.001, P=0.0001, and P=0.002, respectively). Repeated intravesical BTX-A injections and increased bladder capacity were independent factors predicting treatment success. CONCLUSION: In patients with refractory idiopathic OAB, reuse of anticholinergics could be an effective treatment option in patients after the effects of BTX-A fade. Repeated intravesical BTX-A injections and increased cystometric capacity could affect treatment response.

Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial.

Purpose: To compare the safety and efficacy of xylocaine gel and ketorolac as opioid-sparing analgesia compared with pethidine for shock wave lithotripsy (SWL) pain. Materials and Methods: A single-blinded randomized controlled trial (RCT) was performed in 132 patients with renal and upper ureteral stones amenable to treatment with SWL. The first patient group received intravenous (IV) pethidine and placebo gel; the second group received IV ketorolac plus placebo gel; the third group received lidocaine gel locally plus normal saline IV. Stone disintegration was classified as none (no change from basal by kidney, ureter, bladder X-ray or ultrasound [US] imaging), partial (fragmented and >4-mm residual fragments), and complete (≤4-mm residual fragments). Stone disintegration was assessed by kidney-ureter-bladder X-ray and US imaging. Pain was evaluated by use of the Numeric Pain Rating Scale (NPRS). Results: The NPRS scores were highest in the xylocaine group at 10, 20, and 30 minutes (p=0.0001) with no significant difference between the ketorolac and pethidine groups, except at 10 minutes (p=0.03) and a near significant difference at 30 minutes (p=0.054) in favor of ketorolac. Results for stone disintegration (none, partial, and complete, respectively) were as follows: 25 (50.0%), 23 (46.0%), and 2 (4.0%) for pethidine; 19 (35.8%), 23 (43.4%), and 11 (20.8%) for ketorolac; and 26 (89.7%), 3 (10.3%), and 0 (0.0%) for lidocaine (p=0.008). Conclusions: Ketorolac is a safe and more effective alternative to morphine derivatives for SWL analgesia. Lidocaine gel should not be used as mono-analgesia for SWL.

Long Term Functional Success After Pyeloplasty for Pelvi-Ureteral Junction Obstruction in Unilateral Poorly Functioning Kidney in Exclusively Adults Population.

OBJECTIVES: To assess long-term clinical and functional outcomes postpyeloplasty in unilateral UPJO in poorly functioning kidneys in exclusive adult population. MATERIALS AND METHODS: We reviewed the database of all cases admitted with unilateral UPJO treated with pyeloplasty and preoperative split renal function (SRF) was <30% (by diuretic MAG-3 renography). We further subdivided patients into 2 groups; group (A) SRF ≤20% and group (B) SRF >20% and <30%. Renal function difference was evaluated by the changes in SRF at last follow-up, where 5% change was considered significant. Functional success was defined as absence of obstructive pattern on diuretic renogram with no decline in renal function. Clinical success is defined as no need of secondary intervention (redo pyeloplasty, nephrectomy, stenting, or endopyelotomy). RESULTS: Among 211 patients. The mean SRF was 20.5 ± 6.6%. After a median follow-up of 67.1 ± 11.8 months, SRF increased significantly to 23.5 ± 7.5 (P<.0001). In group (A) 92 patients, SRF increased from 14.3 ± 4.9 to 18.7 ± 7.1 (P <.0001). Functional success was achieved in 88 (95.6%) patients. Whereas, in group (B), SRF increased from 24.9 ± 3.3 to 27.2 ± 6.3 (P <.0001) at last follow-up. Functional success was achieved in 121 (95%) patients. Static SRF in serial follow-up renography had been observed after 12 months of follow-up. CONCLUSION: Pyeloplasty provides high rates of functional success in poorly functioning kidneys. After 12 months follow-up, SRF seems to be static without deterioration.

Could platelet to leucocytic count ratio (PLR) predict sepsis and clinical outcomes in patients with emphysematous pyelonephritis?

OBJECTIVES: To study risk factors for sepsis and mortality evaluating the role of platelet to leucocytic count ratio (PLR) as a marker for urosepsis and clinical outcomes in cases of emphysematous pyelonephritis (EPN). MATERIALS: Patients with EPN were retrospectively reviewed. Patients' age, sex, diabetes mellitus (DM), Body Mass Index (BMI), hydronephrosis, types of EPN, air locules volume, serum creatinine, leucocytic count, and platelet count, PLR, albumin, INR and the line of treatment were analyzed as risk factors of sepsis. Correlation between PLR and other variables was done using Pearson correlation coefficient. Univariate and multivariate analyses for sepsis and mortality were performed. RESULTS: Of fifty four patients, 38 patients had SIRS ≥2 criteria on admission. Twenty patients developed sepsis requiring ICU admission. In univariate analysis, male gender, lower BMI, higher INR, higher WBCs count and lower PLR were associated with sepsis (P = 0.0001, 0.009, 0.04, 0.003 and 0.001, respectively). In multivariate analysis, PLR ≤18.4, male sex and BMI ≤24.2 were independent risk factors. Lower PLR directly correlated with serum albumin (P = 0.01) and inversely correlated with serum creatinine and random blood glucose level and Klebsiella infection (P = 0.001, 0.007 and 0.005, respectively). Also, it was correlated with a higher total score of qSOFA and SOFA (P = 0.02 and 0.04). Lower PLR was independent risk factors for death in EPN patients with (P = 0.003). CONCLUSION: EPN is associated with sepsis development. Lower PLR is an independent simple predictor for sepsis and mortality in patients with EPN.

Concomitant primary ovarian paraganglioma neuroendocrinal differentiated urothelial tumor in a BOTOX-injected bladder: A case report.

INTRODUCTION: There is no reported data for patients with malignant bladder Botox® injection related outcomes. Herein, we reported effect of Botox® injection in case of BCG cystitis. In addition, reporting of rare incidence of both primary neuroendocrine differentiation of bladder tumor and primary ovarian paraganglioma post cystectomy. PRESENTATION OF CASE: A-64 years old female presented with sever irritative lower urinary tract symptoms (LUTS) post vesical BCG installation for carcinoma in situ. Patient's symptoms were relieved after Botox® bladder injection after anticholinergics failure. One year later, she came back with hematuria. Cystoscopy showed nodular bladder lesion. Hypertension episodes were noticed during cystoscopic resection. Pathological examination showed presence of muscle invasive transitional cell carcinoma (TCC) with neuroendocrine differentiation. Patient underwent radical cystectomy and pathology was associated with incidentally discovered primary ovarian paraganglioma. DISCUSSION: Intravesical BCG is a standard adjuvant treatment for carcinoma in situ with 75% induced cystitis as a local side effect. The International Bladder Cancer Group's recommendation for BCG cystitis included many agents, these treatment options had very limited outcomes. The existence of paraganglioma in the female genital tract described rarely <1% in the vagina, uterus, vulva and ovary with only few reports. The same as paraganglioma small cell differentiation of vesical urothelial tumor is a rare entity with no reported cases of simultaneous occurrence and to differentiate each other as primary or metastatic. CONCLUSION: Bladder Botox® injection could be offered as a treatment for overactive bladder-like symptoms in malignant cystitis. Neuroendocrine tumors are with a rare entity could be happened instantaneously in urogenital tract.

Simultaneous peritoneal and retroperitoneal splenosis mimics metastatic right adrenal mass.

INTRODUCTION: Right retroperitoneal splenosis is rare with few reported cases. We report, here, the case of simultaneous peritoneal and retroperitoneal splenosis mimics metastatic right adrenal mass. PRESENTATION OF CASE: A 28-year-old man who had previously undergone post traumatic splenectomy at childhood and subsequently presented with an large incidental non-functioning right adrenal mass with presence of extra-hepatic peritoneal focal lesion diagnosed as metastasis by magnetic resonance imaging (MRI). Adrenalectomy with metatstectomy was performed, and both masses were identified to be splenosis. DISCUSSION: Adrenal incidentalomas (AIs) is defined as asymptomatic masses >1 cm. on cross-sectional imaging studies. AIs have significant malignant potential for masses > 6 cm. Splenosis are found most frequently in the left retroperitoneum in cases involving retroperitoneal splenosis. However, right retroperitoneal splenosis have been reported. Traditional imaging techniques cannot differentiate splenosis from malignancy. CONCLUSION: Large right adrenal incidentalomas present with other abdominal, peritoneal masses could be splenosis in patient following post-traumatic splenectomy.