Leiomyosarcoma of the renal pelvis diagnosed by percutaneous endoscopic resection.

We present a case of leiomyosarcoma arising from the renal pelvis, which is a rare clinical entity. A percutaneous endoscopic resection led to the final histopathological diagnosis. The patient underwent radical nephrectomy and did not receive adjuvant therapy. Based on follow-up CT scans, he remains recurrence-free one year after surgery.

Furosemide Stress Test as a Predicting Biomarker for Delayed Graft Function in Kidney Transplantation.

BACKGROUND: Delayed graft function (DGF) could worsen early and long-term outcomes of kidney transplantation (KT). DGF is caused by several pre-transplantation and perioperative factors in both donors and recipients. At present, there are no biomarkers or tests during the immediate post-KT period that can accurately predict the development of DGF. MATERIALS AND METHODS: This prospective study was conducted in deceased donor KT (DDKT) at King Chulalongkorn Memorial Hospital, Thailand. All recipients underwent furosemide stress test (FST) by receiving a single dose of intravenous furosemide, 1.5 mg/kg at 3 h after allograft reperfusion. We determined the correlations between DGF (requiring dialysis within the first week after transplantation) and the values of urine volume recorded hourly after FST until 6 h, the parameters of postoperative dynamic tests, including resistive index (RI) of renal arteries and effective renal plasma flow (ERPF), and urine neutrophil gelatinase-associated lipocalin (NGAL). RESULTS: Of the 59 total DDKT recipients enrolled, 24 developed DGF. The FST is a more accurate biomarker than urine NGAL, RI of renal arteries, and ERPF in the prediction of DGF. The 4-h urine volume less than 350 mL (FST non-responsive) was the best cut-off value in predicting DGF with 87.5% sensitivity, 82.9% specificity, and 82.5% accuracy. Multiple logistic regression analyses showed an odds ratio of 0.993 (0.986-0.999, p = 0.035) for the 4-h urine volume to predict DGF. CONCLUSIONS: The FST is a simple and accurate biomarker for predicting DGF in early post-KT period. Close monitoring and well prepared dialysis are suggested in patients with urine volume < 350 mL after 4 h of FST. The FST non-responsive patients could be the target for further DGF preventive intervention. ClinicalTrials.gov identifier: NCT03071536.

Long-term lower urinary tract dysfunction after radical hysterectomy in patients with early postoperative voiding dysfunction.

INTRODUCTION AND HYPOTHESIS: To compare long-term lower urinary tract dysfunction after radical hysterectomy in patients with or without early postoperative voiding dysfunction. METHODS: Thirty patients at least 2 years after radical hysterectomy were evaluated with multichannel urodynamic studies. Fifteen patients (group A) had early postoperative voiding dysfunction (required urethral catheterization more than 1 month), and 15 patients (group B) had no early postoperative voiding dysfunction. RESULTS: Overall voiding dysfunction was more prevalent in group A than group B (73.3% versus 33.3%, p > 0.05). In particular, high postvoid residual urine and abdominal straining increased significantly in group A (40% versus 0% and 60% versus 13.3%, respectively). Total and all domains scores from Urogenital Distress Inventory and Incontinence Impact Questionnaire were not different between both groups. CONCLUSION: High postvoid residual urine and abdominal straining increased significantly in patients with early postoperative voiding dysfunction without impairment on quality of life.

The three years results of tension free vaginal tape (TVT) for the treatment of stress urinary incontinence in Thai women.

OBJECTIVE: To evaluate the three years result of TVT procedure in Thai women with genuine stress urinary incontinence (SUI). MATERIAL AND METHOD: Sixty three women, aged 35 - 71 years attending the gynecology clinic at King Chulalongkorn Hospital from February 2000 to May 2001 were recruited in the present study. Pre-operative evaluation included history taking and physical examination. All had stress urinary incontinence urodynamically confirmed genuine stress urinary incontinence and were treated with TVT Follow up at 3, 6, 12, 18, 24, 30 and 36 months were scheduled after surgery. RESULTS: The mean +/- SD of operative time for TVT was 32.3 +/- 10.0 min the mean +/- SD of hospitalization was 1.8 +/- 2.0 days. Two patients had bladder perforations by the trocar without severe bleeding and needed no reparation. No healing defect or rejection of the prolene mesh was found. The cure rate and improved rate were 95.2% and 4.8% respectively (60 from 63 cases) at 3 years follow up. CONCLUSION: The three years results revealed that TVT was effective and safe in the treatment of SUI in Thai women.

Case report of voiding difficulty after intravaginal slingplasty (IVS) procedure: the emphasize of pre-service training.

BACKGROUND: The Intravaginal slingplasty procedure (IVS) is a minimally invasive surgery for the treatment of stress urinary incontinence (SUI). Too much tension during pulling the tape and the incorrect placing of the tape can cause urinary retention that may require release of the tape. CASE REPORT: A fifty one years old women with SUI had undergone IVS procedure in a private hospital. After the surgery, urinary retention occurred with prolonged catheterization for 20 days. The patient came to King Chulalongkorn Memorial Hospital on the 21st day after the operation. Surgical release of the tape which was located at the urethrovesical junction rather than the midurethera was done. The patient remained stress continent after the tape was released confirmed by the videourodynamic study one month later. CONCLUSION: Too much tension, insertion of the tape too close to the urethrovesical junction or the tape migration may be the causes of prolonged urinary retention after IVS procedure. The authors found the surgical release of the tape to be the effective management for this complication. Pre-service training in models and practice under the supervision of an experienced surgeon are needed before attempting any on their own. From the authors extensive review, this is the first case report of urinary retention after IVS procedure that required tape incision.