Unusual Cystic Mass of Retrovesical Space: A Retrovesical Kidney.

Retrovesical cysts are very rare, with more reported cases being hydatid or seminal cyst. To our knowledge, no case of pelvic kidney revealed as cystic mass of the retrovesical space has been reported. We provide images of a direct retrovesical kidney in a 24-year-old patient who presented with lower urinary tract symptoms.

One-shot dilation in modified supine position for percutaneous nephrolithotomy: experience from over 300 cases.

PURPOSE: To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in modified supine position percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A total of 320 PCNL in a total of 291 patients were performed between October 2008 and July 2011. There were no specific exclusion criteria. Patients with kidney anomalies or solitary kidney, with history of renal surgery or extracorporeal shockwave lithotripsy (SWL), those with staghorn calculi or needing more than one access, were eligible for inclusion. Data collected included patient demographics and stone characteristics, access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions. RESULTS: Mean stone size was 38 mm (16-110 mm). The mean time access was 2.1 min (range 0.7-6.2 min). Tract dilatation fluoroscopy time was 25 ± 17 sec. The targeted calix could be entered with a success rate of 97.81%. The mean hemoglobin decrease was -1.17 g/dL ± 0.84. There were no visceral, pleural, collecting systems or vascular injuries. Major complications included, transfusion in 4 (1.25%) patients, pseudoaneurysm with persistent bleeding necessitating nephrectomy in 1 (0.3%) patient and two deaths (0.62%) after surgery. There was no significant difference in successful access and complications between patients with and without previous open surgery and in those with or without staghorn stones (P > .05). CONCLUSION: The use of one shot and modified supine position combines the advantages of these both methods including less radiation exposure and shorter access and operative time. The one shot dilation is safe, easy to learn, cost effective and offers a potential alternative to the standard devices particularly in developing countries.

Tuberculosis of the Spermatic Cord: Case Report.

The spermatic cord tuberculoma is uncommon, especially in its lower portion. Most cases were described in Japanese literature. We report a case of tuberculosis of the spermatic cord in a sexually active young man, revealed by a scrotal mass mimicking a tumor of the testicle and discuss the suitable diagnostic and therapeutic procedures, with preservation of the testes and the other sexual organs.

Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position.

CONTEXT: The treatment for patients with large impacted proximal ureteral stone remains controversial, especially at institutions with limited resources. AIM: The aim of this study is to compare and to evaluate the outcome and complications of two main treatment procedures for impacted proximal ureteral calculi, retrograde ureterolithotripsy (URS), and percutaneous antegrade ureterolithotripsy (Perc-URS). SETTINGS AND DESIGN: Our inclusion criteria were solitary, radiopaque calculi, >15 mm in size in a functioning renal unit. Only those patients in whom the attempt at passing a guidewire or catheter beyond the calculus failed were included in this study. PATIENTS AND METHODS: Between January 2007 and July 2011, a total of 52 patients (13 women and 39 men) with large impacted upper-ureteral calculi >15 mm and meeting the inclusion criteria were selected. Of these, Perc-URS was done in 22 patients (group 1) while retrograde ureteroscopy was performed in 30 patients (group 2). We analyzed operative time, incidence of complications during and after surgery, the number of postoperative recovery days, median total costs associated per patient per procedure, and the stone-free rate immediately after 5 days and after 1 month. STATISTICAL ANALYSIS USED: Bivariate analysis used the Student t-test and the Mann-Whitney test to compare two means and Chi-square and Fisher's exact tests to compare two percentages. The significance level was set at 0.05. RESULTS: The mean age was 42.3 years (range 22-69). The mean stone sizes (mm) were 34 ± 1.2 and 29.3 ± 1.8 mm in group 1 and 2, respectively. In the Perc-URS group, 21 patients (95.45%) had complete calculus clearance through a single tract in one session of percutaneous surgery, whereas in the URS group, only 20 patients (66.7%) had complete stone clearance (P = 0.007). The mean operative time was higher in the Perc-URS group compared to group 2 (66.5 ± 21.7 vs. 52.13 ± 17.3 min, respectively; P = 0.013). Complications encountered in group 1 included transient postoperative fever (2 pts) and simple urine outflow (2 pts). Ten patients (33%) of group 2 experienced failure: Migration to the kidney (3 pts), ureteral perforation (2 pts), tortuosity of the ureter (2 pts), and epithelial polyps (2 patients). Group 1 patients had an average visual analog (VAS) pain score of 47 mm compared with 31 mm in group 2 patients. The mean hospital stay (days) in group 1 was higher than the group 2 (2.27 ± 0.8 vs. 1.67 ± 0.6, respectively; P = 0.01). The mean analgesia requirement for group 1 (paracetamol chlorhydrate + codeine 12 ± 3 g) was significantly more compared with group B (6.8 ± 2 g) (P < 0.01). The difference in average blood loss between the two groups was not statistically significant. Total costs was slightly higher in group 1 but the difference was not statistically significant between the two groups (15000 vs. 13400 MDH respectively; P > 0.05). After 1 month, the stone free-rate remained higher in group 1 (95.5% vs. 66.7%, respectively; P = 0.012). CONCLUSIONS: In our series, Perc-URS is a safe and efficient treatment option for proximal ureteral stone, especially when the stone size is superior to 15 mm with the presence of moderate or severe hydronephrosis.

Inguinal bladder hernia: four case analyses.

A study of four cases presenting as inguinal bladder hernia was performed based on a review of the clinical presentation, circumstances of diagnostics, and surgical management. The mean age of patients was 66.5 years. Presenting symptoms included lower urinary tract symptoms (LUTS; three cases) and decrease in scrotal size after voiding (one case). The diagnostic circumstances were incidental finding during investigation for urethral stricture (one case), preoperative discovery on the basis of decrease in scrotal size after voiding (one case), perioperative discovery during standard herniorrhaphy (one case), and peritoneal effusion secondary to bladder injury in the early postoperative period. All patients were managed successfully by replacement of the bladder in its original position and inguinal herniorrhaphy, the Lichtenstein technique (two cases), Shouldice repair (one case), or modified Bassini repair (one case) through the same inguinal incision. For one patient, bladder injury was diagnosed at the time of inguinal herniorrhaphy and repair was promptly made. For another, bladder injury was discovered only at surgical abdominal exploration. Surgical repair led to the resolution of signs and urologic symptoms in all but one patient who needed medical therapy for residual LUTS. An awareness of this possibility on the part of general surgeons should guide preoperative evaluation and therapy appropriately. Even if the preoperative diagnosis is missed, a perioperative diagnosis is crucial to avoid bladder injury during surgery.

"Knot stent": an unusual cause of acute renal failure in solitary kidney.

The insertion of indwelling ureteric stents is a routine procedure in urology practice. Complications secondary to the insertion of these stents have also increased, such as stent encrustation, stent fragmentation, stone formation, and recurrent urinary tract infections. Knot formation within the renal pelvis or in the coiled portion of the ureteral stent is an extremely rare condition, with less than 15 cases reported in literature. The authors report a rare case of knotted stent, complicated by an obstructive acute renal failure and urosepsis, in a patient with a solitary functioning kidney.

La NLPC en décubitus dorsal modifié : notre expérience.

UNLABELLED: RéSUMé: INTRODUCTION ET OBJECTIF :: La NLPC est conventionnellement réalisée en décubitus ventral. Cette position présente de nombreux inconvénients. Notre objectif était d'évaluer de façon prospective le caractère sûr et efficace de la NLPC en position de décubitus dorsal modifié (DDM). MATéRIEL ET MéTHODES :: Entre novembre 2004 et janvier 2010, 159 NLPC ont été réalisées en DDM. Le patient a été mis en décubitus dorsal avec un billot sous le flanc permettant une rotation de 45 degrés du côté opposé. Une position de lithotomie modifiée était associée si un double accès antérograde et rétrograde simultané était nécessaire. Après ponction rénale, la dilatation a été faite selon la technique « one shot ¼ ou en utilisant les dilatateurs d'Alken. Les caractéristiques des patients et des calculs, la durée opératoire, le séjour hospitalier, les complications et le taux d'absence de calculs résiduels (« stone free ¼) ont été analysés. RéSULTATS :: L'âge moyen des patients était de 47 ± 13,1 ans (22-70). Vingt-et-un patients avaient des ATCD de chirurgie rénale du même côté. Vingt-six patients avaient un rein unique anatomique ou fonctionnel. Un patient avait un rein en fer à cheval et deux patients avaient une malrotation rénale. Le diamètre moyen des calculs était de 3,4 ± 1,9 cm (1,3-5,4) et 20 patients avaient des calculs coralliformes. Dix patients avaient des calculs urétéraux et ont eu une urétéroscopie simultanée. La durée moyenne de l'intervention était de 60 ± 29 min. Deux interventions ont été interrompues en raison d'un saignement important. Trois cas de fièvre postopératoire et 2 cas de fistule urinaire traités par sonde en double J ont été notés. Aucune plaie vasculaire ou viscérale n'a été rapportée ni de plaie pleuropulmonaire. Huit patients ont eu une seconde séance de NLPC durant la même hospitalisation. Après trois mois le taux d'absence de calculs résiduels était de 91,8 %. CONCLUSION: La NLPC en DDM a permis de traiter de façon sûre et efficace les calculs rénaux. Elle a offert plusieurs avantages : facilité d'installation et non-nécessité de changer la position, pas de compression thoracique, moins de contraintes anesthésiques, réduction du risque de plaie colique et possibilité d'accès simultané antérograde et rétrograde.

[Hydatid cyst of the kidney based on a series of 34 cases]. / Le kyste hydatique du rein. Traitement à propos de 34 cas.

AIM: Hydatid disease is endemic in some countries, where it constitutes a real public health problem. It can affect any, but the kidney is a relatively rare site, representing 2% to 4% of all visceral sites. Renal hydatid cyst only presents at the stage of complications. Laboratory tests may suggest the diagnosis, which is confirmed by radiology. Renal hydatid cyst raises therapeutic problems making conservative surgery difficult. The objective of this paper is the find the best adapted treatment. MATERIAL AND METHOD: 34 consecutive cases of renal hydatid cyst (1980-2001) were observed in 23 men and 11 women with a mean age of 42 years (range: 15-73 years). The clinical features were dominated by pain (63%), a mass (26%), hydaturia (11.4%), haematuria (31.4%), prolonged fever (23%) and hypertension (3%). Intravenous urography performed in all patients showed calcifications in 5 cases, a mass syndrome in 11 cases and silent kidney in 2 cases. Abdominal CT, performed in 8 patients, was necessary whenever the diagnosis remained uncertain, particularly in the case of pseudoneoplastic cysts. However, ultrasonography, performed in 30 patients, remains the preferred diagnostic examination. RESULTS: Treatment consisted of resection of the prominent dome in 23 cases, pericystectomy in 5 cases, 1 partial nephrectomy and 6 total nephrectomies. An associated procedure was performed during the same operation (hepatic, peritoneal hydatid cyst) in 3 cases, and was deferred (pulmonary hydatid cyst) in 1 case. The postoperative course was marked by urinary fistula in 2 cases and suppuration of the residual cavity in 1 case, treated by ultrasound-guided aspiration-drainage. CONCLUSION: The resection of the prominent dome is the most adapted treatment whenever possible.

Treatment of uretero-intestinal and ureterovesical strictures by Acucise balloon catheter.

OBJECTIVE: Acucise balloon catheter has been proposed as an alternative to open surgery for the treatment of strictures of the ureteropelvic junction because of its low morbidity and the short hospital stay following the endoscopic procedure. The objective of this study was to evaluate the results of this technique applied to patients developing strictures after surgical reimplantation of the ureterovesical (UV) or uretero-intestinal (UI) junction. MATERIAL AND METHODS: Between March 1997 and January 2000, 12 strictures (11 patients) were treated by Acucise balloon catheter via an antegrade and/or retrograde approach with double J stenting for an average of 6 weeks (range: 4-12 weeks): six uretero-ileal strictures (three Bricker, one uretero-ileoplasty, one enterocystoplasty and one Kock pouch) and six ureterovesical strictures (Lich-Grégoir or Paquin UV reimplantations after gynaecological, vascular or endoscopic surgery). The median postoperative follow-up was 16 months (range: 10-36 months). A good result was defined by the absence of recurrence of the stricture evaluated both clinically and radiologically (regression of stasis measured by IVU and/or ultrasonography). RESULTS: The mean operating time was 70 minutes and the mean hospital stay was 4.8 days (range: 3-14 days). Only one intraoperative complication was observed (migration of the double J stent to the kidney). The operation was successful in eight patients (75%). The success rate was 83% for ureterovesical strictures and 50% for uretero-ileal strictures. A history of previous irradiation appeared to be a factor of failure. CONCLUSION: The Acucise procedure is a minimally invasive and effective (75% success rate) treatment option for the treatment of postoperative stricture after ureteric reimplantations. In our department, this option is considered to be first-line treatment, as surgical reimplantation is reserved for failures of the endoscopic technique.

[Hydronephrosis arterial hypertension. Report of 4 cases]. / Hydronéphrose et hypertension artérielle. A propos de quatre observations.

Four cases of ureteropelvic junction syndrome associated with arterial hypertension were reported. The authors discuss the ethiopathogenic of hypertension, on the basis of these observations and a review of the literature. They conclude that union bilateral hydronephrosis can lead to hypertension and renal failure by both inappropriate production of renin and water chronic retention. The correction of ureteropelvic junction should return blood pressure to normal levels.