RESUMO
Upper tract urothelial carcinoma represents a small proportion (5%-10%) of all urothelial cancers. Although there are several management options, in undifferentiated or high-risk cases, surgery in the form of nephroureterectomy is the gold standard. Horseshoe kidney is the most common congenital renal fusion anomaly affecting 1 in 400-600 patients. We present the case of a smoker in her mid-50s with an incidental finding of a papillary lesion in the right renal pelvis of her horseshoe kidney on CT scan. She went on to have endoscopic assessment confirming no other foci of disease. She was definitively managed with a robotic nephroureterectomy.
Assuntos
Carcinoma de Células de Transição , Rim Fundido , Neoplasias Renais , Procedimentos Cirúrgicos Robóticos , Neoplasias Ureterais , Carcinoma de Células de Transição/diagnóstico por imagem , Carcinoma de Células de Transição/cirurgia , Feminino , Rim Fundido/complicações , Rim Fundido/diagnóstico por imagem , Rim Fundido/cirurgia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Nefroureterectomia , Neoplasias Ureterais/diagnóstico por imagem , Neoplasias Ureterais/cirurgiaRESUMO
A premenopausal patient in her late forties presented with a 15-year history of urinary incontinence starting shortly after a caesarean section performed for her fourth delivery and more recently associated episodic light haematuria and passage of clots per vagina. The haematuria was intermittent over several months and associated with per-vaginal bleeding. She had symptomatic anaemia. Flexible cystoscopy and MRI showed a vesicouterine fistula. She underwent a robotic-assisted hysterectomy and multi-layered repair of the bladder with omental interposition. She remained in the hospital for 4 days, though recovered well and underwent catheter removal at 14 days following a normal cystogram. At 3 months, she was well with no incontinence or urinary symptoms. This case demonstrates the need for vigilance in assessing patients with persistent incontinence, particularly in the context of prior caesarean section. It highlights the feasibility of robotic surgery for correcting these defects in a society where minimally invasive surgery is becoming the norm, and cosmesis is a priority for patients.
Assuntos
Cesárea , Diagnóstico Tardio , Complicações Pós-Operatórias/diagnóstico por imagem , Fístula Vesicovaginal/diagnóstico por imagem , Cistoscopia , Feminino , Humanos , Histerectomia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos , Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirurgiaRESUMO
Presented here is the case of an 86-year-old man who was found to have right-sided pelvicalyceal rupture and anuric renal failure, secondary to obstructive uropathy caused by life-saving extraperitoneal pelvic packing (EPP) in the settling of severe trauma. In efforts to control haemorrhage in this haemodynamically unstable patient, EPP placement deviated from the recognised method of three extraperitoneal packs bilaterally with seven surgical packs placed. Progress postoperative imaging revealed right-sided hydroureteronephrosis with obstruction evident at the level of the extraperitoneal pelvic packs, identified by delayed contrast excretion from the preceding CT angiography imaging. Urology performed bilateral retrograde pyelograms at his relook laparotomy, timed after removal of his extraperitoneal packs and haemostasis, which showed impression of the surgical pack on the distal ureter but no persisting obstruction or short-term complications. Anuric renal failure improved, and renal function returned to near premorbid levels on day 4 postoperatively.
Assuntos
Tamponamento Interno/efeitos adversos , Técnicas Hemostáticas/efeitos adversos , Hidronefrose/etiologia , Pelve/lesões , Ruptura/etiologia , Obstrução Ureteral/etiologia , Ferimentos e Lesões/cirurgia , Idoso de 80 Anos ou mais , Técnicas Hemostáticas/instrumentação , Humanos , Masculino , Pelve/cirurgiaRESUMO
Urethral steinstrasse is a rare finding. This case describes a 35-year-old man presenting with urethral steinstrasse 4 weeks following laser cystolitholapaxy of a large bladder stone.