Is there still a role of balloon dilatation of benign ureteric strictures in 2019?

Introduction and Objectives: Reconstructive surgery for benign ureteric strictures and long term nephrostomy are often invasive and lead to poor quality of life. Balloon dilatation has the potential to bridge this gap. We present the outcome of our series and examine the risk factors of stricture recurrence.Materials and Methods: There were 109 strictures in our series from August 2012 to July 2018 in our single center retrospective cohort analysis. All strictures were dilated retrogradely or antegradely and followed by stenting. Follow-up imaging was done to assess stricture recurrence.Results: Mean patient age was 57.7-years-old (SD ± 12.6). Mean follow-up was 20.2 months (SE ± 1.8). All strictures were successfully dilated and stented. Overall, mean patency rate was 63.7% at mean follow-up of 20.2 months (SE ± 1.8). Strictures caused by stone/inflammation had 28.0% (21/75) risk of recurrence compared to iatrogenic causes, 63.6% (7/11), and radiotherapy, 100.0% (5/5) (p = 0.001). Non-incidental strictures also had significantly higher risk of recurrence at 57.4% (27/47) vs. incidental strictures at 13.6% (6/44) (p = 0.000). The mean length of strictures was 12.5 mm (SE ± 1.7) in the recurrence group vs. 9.6 mm (SE ± 0.7) in those without recurrence (p = 0.001). The presence of ipsilateral atrophic kidney was associated with 72.2% (13/18) risk of recurrence vs. non-atrophic kidney 27.4% (20/73) (p = 0.000). The mean age of stricture was 14.5 months (SE ± 4.6) and 5.2 months (SE ± 2.1) in the recurrence and non-recurrence groups, respectively (p = 0.013).Conclusions: Balloon dilatation of benign ureteric stricture is a feasible option. Its effect can be long-lasting in selected patients, that is, non-irradiated, incidental, short strictures with normal kidneys. This will benefit patients unfit for reconstructive surgery.

A Rare Case of Acute Urinary Bladder Diverticulitis Mimicking Acute Appendicitis.

BACKGROUND Urinary bladder diverticula are common. They are typically asymptomatic and usually discovered incidentally. Urinary bladder diverticulitis, in contrast to colonic diverticulitis, is an extremely rare occurrence. CASE REPORT We describe a case of a 52-year-old man who presented with isolated urinary bladder diverticulitis mimicking acute appendicitis. Focal inflammation of a urinary bladder diverticulum along the right lateral urinary bladder wall caused right iliac fossa pain. Predominant findings of red blood cells in the urine were not dissimilar to per rectal bleeding seen with colonic diverticulitis. Cystoscopy and uroflow dynamic study revealed features of chronic urinary bladder outlet obstruction despite a computed tomography scan showing a minimally enlarged prostate gland and the patient reporting no lower urinary tract symptoms. CONCLUSIONS Urinary bladder diverticulitis is a very rare condition with poorly understood underlying etiology. Hematuria is possibly an important presentation correlating with the per rectal bleeding seen with colonic diverticulitis. Depending on its position relative to the urinary bladder wall, it can mimic other more common presentations. Follow-up investigations using cystoscopy and uroflow studies are useful to evaluate for findings associated with chronic urinary bladder outlet obstruction.

Bacteria-ball in the urinary tract: a rare entity.

A bacterial mass in the urinary tract is a very rare entity. We report the first case of a bacterial ball within the urinary tract of a patient with diabetic cystopathy on long term urinary indwelling catheter. She presented with fever and gross haematuria. CT scan of abdomen and pelvis revealed a gas containing hyperdense mass within the bladder suspicious of bladder stone. The lesion was resected, and histopathology revealed a matrix of acellular materials with bacteria colony.

Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations.

PURPOSE: The use of ultrasound in percutaneous nephrolithotomy (PCNL) has not been shown to translate to better clinical and stone outcomes. To compare the operative outcomes, postoperative outcomes and complication rates of ultrasound-guided access PCNL (USGA-PCNL) versus fluoroscopy-guided access PCNL (FGA-PCNL). MATERIALS AND METHODS: A total of 184 consecutive patients who underwent PCNL from July 2008 to September 2014 were identified from our PCNL database. Seventy-two patients underwent USGA-PCNL and 112 FGA-PCNL. RESULTS: The patients were similar in age, sex, race, American Society of Anesthesiologists physical status classification, mean largest stone diameters, side of PCNL, number of stones and the degree of hydronephrosis between both groups. There were higher rates of upper pole (5.6% vs. 3.6%), mid pole (8.3% vs. 2.7%) and multiple pole punctures (4.2% vs. 0%) in USGA-PCNL compared to FGA-PCNL (p=0.027). There was no difference in the stone free rates of both groups in univariate analysis. Those who had FGA-PCNL were 2.26 (95% confidence interval, 1.09-4.75; p=0.029) times more likely to require a second-look procedure compared to USGA-PCNL on univariate analysis but not on multivariate analysis. There were no differences in Clavien-Dindo complications. No patient in the USGA-PCNL group experienced organ injuries during puncture compared to 1 patient in the FGA-PCNL group who had pneumothorax requiring urgent chest tube insertion. CONCLUSIONS: The use of ultrasonography to guide access puncture during PCNL eliminates the risk of inadvertent organ injuries. Similar operative and stone outcomes show that the learning curve for USGA is minimal compared to conventional FGA.

Spermatic cord abscess: a rare complication of epididymo-orchitis, the diagnosis and management.

We present a case of a 54-year-old man who had a history of poorly controlled diabetes and end-stage renal failure on haemodialysis. He presented with an acute left groin swelling that was diagnosed to be a rare occurrence of spermatic cord abscess. Two months prior to this, he had had an episode of bacterial epididymo-orchitis that was treated with oral antibiotics. An urgent CT of the abdomen and pelvis was performed to rule out incarcerated inguinal hernia. The spermatic cord abscess was initially managed with appropriate intravenous antibiotics and ultrasound-guided percutaneous drainage. When the pus eventually accumulated in the scrotum, an open incision and drainage of the scrotum was also performed. He achieved complete resolution after 2 months.