Role of 2D Strain in the Early Identification of Cardiac Dysfunction and in the Risk Stratification of Arteriogenic Erectile Dysfunction Patients.

BACKGROUND: Vasculogenic erectile dysfunction is a harbinger of vascular disease. Comprehensive cardiac workup is accepted to be beneficial in men with this condition, especially those with otherwise unrecognized cardiovascular disease. We aimed to evaluate the role of two-dimensional speckle-tracking echocardiography (2D-STE) for noninvasive evaluation in patients with documented arteriogenic erectile dysfunction. METHODS: 64 consecutive men with Doppler proven erectile dysfunction of more than 3 months of duration were recruited. Patients divided into 2 groups according to mean peak systolic velocity (PSV). Patients with PSV <20 cm/sn constituted Group 1 and patients with PSV ≥20 cm/sn constituted Group 2. All underwent echocardiography and were compared. According to the 2D-STE analysis for the left atrium (LA); strain during ventricular systole (LARes), during late diastole (LA-Pump), strain rate during ventricular contraction (LA-SRs), during passive ventricular filling (LA-SRe), during active atrial contraction (LASRa) values and for LV; global longitudinal strain (GLS), strain rate in systole (GSRs), strain rate in early diastole (GSRe), and strain rate in late diastole (GSRa) values were obtained. RESULTS: Beside diastolic parameters, LA-Res and LA-Pump were found to be significantly different between groups. GLS and GSR values were lower in Group 1. Moreover, correlation analysis revealed a significant correlation of GLS values with PSV (r = -0.4, P = .001). CONCLUSION: Myocardial deformation parameters by 2D-STE are valuable for detection of subclinical cardiovascular dysfunction in men with arteriogenic erectile dysfunction. This noninvasive method may be used as an emerging prognostic marker for risk stratification.

Extraordinary cause of complete colonic obstruction in children: urinary retention.

Complete colonic obstruction in children may occur secondary to congenital, and acquired factors related to the gastrointestinal system. Herein, we report an extraordinary presentation of complete colonic obstruction due to extensive urinary retention in a 3-year-old boy. The possible underlying mechanism was detected as urinary infection in a child with horseshoe kidney. The treatment of the bladder symptoms and urinary infection relieved the obstruction of the colon. To our knowledge, especially in children, colonic obstruction due to urinary retention has not been reported in the literature.

Effects of butein on renal ischemia/reperfusion injury: An experimental study.

OBJECTIVES: Renal ischemia/reperfusion (I/R) injury is a common cause of acute kidney injury. The aim of this study was to investigate the effect of butein on renal I/R injury. MATERIALS AND METHODS: Twenty-seven rats were randomly allocated to three groups (n = 9): a sham group, a renal I/Runtreated (control) group, and a renal I/R-butein group. The sham group underwent only opening and closing of the peritoneum. In the control group, an experimental I/R model was created and 1 cc isotonic saline was applied to the peritoneum. In the butein group, the experimental I/R model was created and 1 mg/kg butein was administered intraperitoneally 15 minutes before the beginning of ischemia. The left kidneys of the rats were histopathologically examined for tissue damage caused by I/R. RESULTS: Histopathological examination of the tissue damage revealed that all kidneys in the sham group were normal. By contrast, 2 in the control group (22.2%) had small focal damaged areas, 1 (11.1%) had < 10% cortical damage, 5 (55.6%) had 10-25% cortical damage, and 1 (11.1%) had 25-75% cortical damage. The butein group had 1 (11.1%) normal kidney, 2 (22.2%) with small focal damaged areas, 4 (44.4%) with < 10% cortical damage, and 2 (22.2%) with 10-25% cortical damage. Tissue damage was significantly lower in the sham group than in the control and butein groups (p < 0.01). No statistically significant differences were observed in the histopathology of the control and butein groups (p > 0.05). CONCLUSIONS: Intraperitoneal administration of butein had no significant effect on renal tissue injury.

Effects of Benign Prostate Hyperplasia on Allografts in Kidney Transplant.

OBJECTIVES: Benign prostate hyperplasia is frequently diagnosed in elderly chronic renal failure patients. Although it is asymptomatic because urine flow declines in those with chronic renal failure, it may become symptomatic when urine flow increases after renal transplant. Untreated benign prostate hyperplasia may lead to several complications that adversely affect the kidney allograft. MATERIALS AND METHODS: Our retrospective study investigated data from 286 male transplant patients. Data obtained included medical history, clinical examination, prostate-specific antigen, prostate volume, and residual urine volume results. Patients had completed an International Prostate Symptom Score questionnaire to assess the low urinary symptoms. Creatinine level, residual urine volume, International Prostate Symptom Score, and uroflow-metry results were reviewed. RESULTS: The average age of patients in our group was 54.8 years. Seven patients were diagnosed with benign prostate hyperplasia, and transurethral resection of the prostate was performed. The average creatinine levels before and after transurethral resection were 2.53 ± 0.76 mg/dL and 1.66 ± 1.12 mg/dL, respectively. Creatinine levels measured 6 months after transurethral resection versus before resection were statistically significant (P < .018). Furthermore, there was a statistically significant difference (P < .017) in the postmicturition residual urine volume between the preoperative and postoperative values, which were 132.14 ± 19.33 and 47.6 ± 18.6 mL, respectively. Maximum urine flow rates before and after transurethral resection were also significantly different (P < .017). CONCLUSIONS: Although the main reasons for graft function loss after renal transplant are rejection and infections, obstructive pathologies should also be considered. Especially for elderly patients, anamnesis, uroflowmetry, and digital rectal examination play critical roles in the evaluation of benign prostate hyperplasia before and after transplant.

Our experience in chordee without hypospadias: results of 102 cases.

PURPOSE: We present long-term surgical experience of 102 chordee without hypospadias cases. MATERIALS AND METHODS: This retrospective study included 102 chordee without hypospadias cases who were surgically treated between 1999 and 2012. Range of patients' age was from 1 month to 31 years. Seventy-two patients were adult, and 30 were children. Mean duration of follow up was 49.3 months. The patients were categorized into 4 groups including skin tethering (group 1), fibrotic dartos and Buck's fasciae ( group 2), corporeal disproportion ( group 3) and urethral tethering (group 4) with the aid of intraoperative artificial erection, according to the structural defect. RESULTS: Forty patients (group 1) were successfully treated with penile degloving. Except 3 (10%) of 31 (group 2) cases, extensive resection of the fibrotic dartos and Buck's fascia was needed to straighten the penis. Corporeal disproportion was identified in 27 patients of whom 2 cases (7%) had complica­tions. One of them developed urethrocutaneous fistula, and he was treated with buccal mucosal graft urethroplasty successfully. In other one, chordee persisted after two years, and we had to do Nesbit wedge resection after tunica albuginea plication to achieve penile straightening at the same session; otherwise we avoid tunica albuginea excision or incision. Overall 96 (94%) of 102 patients were suc­cessfully treated at first operation. CONCLUSION: We concluded that tunica albuginea plication is very effective for both prepubertal and postpubertal period and also in management of recurrence. We believe that, in experienced hands, early surgical correction can be done successfully in this condition.

Endoscopic guided additional access for staghorn calculi.

BACKGROUND AND PURPOSE: Flexible nephroscopy is an important technique in the management of staghorn renal calculi to reach peripheral calices. In this study, we present our experience with flexible nephroscopy and fluoroscopy-guided additional access creation for staghorn renal calculi. PATIENTS AND METHODS: We conducted a retrospective analysis of patients with staghorn renal calculi who were treated with multiple percutaneous renal tracts created with the guidance of flexible nephroscopy and fluoroscopy. Additional tracts were performed with combined flexible nephroscopy and fluoroscopy guidance. Flexible nephroscopy was used to help target the calix and ensure the safety of access. RESULTS: Additional percutaneous renal access was achieved using combined flexible nephroscopy and fluoroscopy guidance in 26 patients with complete staghorn (n=21) and partial staghorn (n=5) kidney stones. The cumulative stone size was 59.3 mm. The mean procedure times, fluoroscopy times, and hospitalization times were 91.5 minutes, 3.4 minutes, and 2.7 days, respectively. The postoperative hematocrit drop was 4.96±3.8. Upper and lower calices were the most common primary access tracts in 11 and 15 patients, respectively. Stone-free status was achieved in 22 (84.6%) patients with a mean 2.1±0.3 tract number. Postoperative complications were observed in six (23.1%) patients. CONCLUSIONS: In the requirement of additional access for staghorn renal calculi, use of flexible nephroscopy with fluoroscopy increases the safety of the procedure by confirmation of precise renal access.

Laparoscopic decortication of hilar renal cysts using LigaSure.

BACKGROUND AND OBJECTIVES: In this study, we evaluated the safety and efficacy of using the LigaSure sealing system (Valleylab, Boulder, Colorado) for laparoscopic decortication of symptomatic hilar renal cysts. METHODS: Seventeen patients underwent laparoscopic decortication of hilar renal cysts with the LigaSure system. Our study included only symptomatic, Bosniak type 1, simple and symptomatic renal cysts. The operative route, transperitoneal or retroperitoneal, was planned according to the location confirmed by computed tomography. The patients' symptoms were preoperatively and postoperatively evaluated by the Wong-Baker visual pain scale. Operative measures and radiologic outcomes were prospectively evaluated. RESULTS: The mean age of the patients was 56.4 years, and the mean follow-up period was 12.5 months. Preoperative computed tomography showed only a single cyst in 15 patients (88.2%) and showed two separate cysts in 2 cases (11.8%). The cysts were located in the perihilar region close to the vascular structure in all patients. A transperitoneal approach was used in 9 patients, and a retroperitoneal approach was used in 8 patients. The mean operative time and hospitalization time were 56.4 minutes and 1.2 days, respectively. Minor complications were observed in 3 patients. Symptomatic and radiologic success rates of 94.2% and 100%, respectively, were achieved. CONCLUSION: Laparoscopic decortication of symptomatic hilar renal cysts--first reported in the literature in this study--using the LigaSure sealing system is feasible, effective, and safe, even if the cyst is located in the perihilar area.

Comparison of flexible and rigid cystoscopy-assisted ureteral catheter insertion before percutaneous nephrolithotomy: a prospective randomized trial.

BACKGROUND AND PURPOSE: To compare the advantages of flexible and rigid cystoscopy-assisted ureteral catheter placement before prone percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: From March to September 2012, a total of 80 patients with kidney stones underwent PCNL by the same surgical team. The patients were randomly assigned into one of the groups according to the technique used for ureteral catheter insertion: Flexible cystoscopy (group 1, n=40) or rigid cystoscopy (group 2, n=40). Patient demographics and operation-related factors were compared. The preparation period included positioning, cystoscopy-assisted stent insertion, and patient repositioning for PCNL. In addition, discomfort scores of the operating room (OR) staff were measured. RESULTS: The demographic values of the groups in terms of patient sex, age, body mass index, and stone size were comparable. While the mean preparation period was calculated as 9.9±2.3 minutes in the flexible cystoscopy group, it was significantly longer (19.7±2.9 minutes) in the rigid cystoscopy group (P<0.0001). In addition, the discomfort score of the OR staff was found to be significantly higher in the rigid cystoscopy group (1.1±0.9 vs 2.05±0.68, P<0.0001). The rest of the operative and postoperative parameters were similar. CONCLUSIONS: The insertion of a ureteral catheter with a flexible cystoscope before prone PCNL shortens the preparation period and minimizes the discomfort of OR staff related to patient positioning and transfer.

Micropercutaneous nephrolithotomy in the treatment of moderate-size renal calculi.

PURPOSE: We present our initial experience with microperc in patients with moderate-size renal calculi. PATIENTS AND METHODS: A retrospective analysis of 30 patients (male 14, female 16) with moderate-size (1-3 cm) kidney stones who underwent microperc between August 2011 and July 2012 was performed. The demographic values, perioperative and postoperative measures including age, stone size and location, body mass index, operative and fluoroscopy time, hemoglobin decrease, success and complication rates were prospectively recorded into a patient entry system. RESULTS: The average stone size was 17.9±5.0 mm (10-30 mm). The mean age of the patients was 41.5±18.2 years (range 3-69 years). The duration of the operation was calculated as 63.5±36.8 minutes (range 20-200 min). Mean fluoroscopic screening time was 150.5±90.4 seconds (range 45-360 seconds). The patients were discharged after a mean hospitalization period of 35.5±18.6 hours (range 14-96 hours). An overall success rate of 93% (including 10% of insignificant residual fragment rate) was achieved. In the follow-up, residual stone fragments were detected in two (7%) patients. Conversion to miniperc was necessitated in three (10%) patients. The mean hemoglobin drop was found to be 1.1±0.8 mg/dL (range 0-2.8 mg/dL). Complications were observed in five (13.3%) patients. CONCLUSIONS: Our initial results provide that microperc is a feasible, safe, and efficacious treatment modality for moderate-size kidney stones as well as small ones with its minimally invasive nature. Technical refinements are needed to achieve better results and overcome the limitations of technique.

The all-seeing needle instead of the Veress needle in pediatric urologic laparoscopy.

PURPOSE: To investigate the feasibility of the all-seeing needle for safe entry and creation of pneumoperitoneum in pediatric urologic laparoscopy. PATIENTS AND METHODS: A total of 14 children underwent various transperitoneal urologic laparoscopic procedures. The all-seeing needle, which is 4.85F in diameter, was used for safe entry into the abdominal cavity at the site of the umblicus in all cases. The microoptic was integrated with the light system and connected via a zoom ocular enabling direct visualization of the layers between the skin and the peritoneal cavity. Once the intraperitoneal access was obtained, CO2 pneumoperitoneum was created from one port of the three-way connector attached to the proximal part of the needle. Then the laparoscopic trocars were placed under vision of the microoptical system. RESULTS: Mean age of the children was 4.5 ± 2.9 years. In all children, the all-seeing needle was safely introduced into the abdominal cavity under direct vision. Then, CO2 pneumoperitoneum was succesfully performed. The mean time for optical puncture was calculated as 1.1 ± 0.8 minutes. No complication was encountered during the introduction of the needle, creation of the pneumoperitoneum, and placement of the trocars. CONCLUSIONS: The all-seeing needle appears to be beneficial in safe entry and for creating pneumoperitoneum in laparoscopic pediatric urology cases. It eliminates the disadvantages of the Veress needle, which is blunt insertion, and may possibly prevent complications.

The role of microperc in the treatment of symptomatic lower pole renal calculi.

BACKGROUND AND PURPOSE: The treatment of symptomatic lower pole (LP) calculi poses a challenge because of lower clearance rates. We present our experience with microperc in the treatment of LP renal calculi. PATIENTS AND METHODS: We retrospectively evaluated the symptomatic patients with LP renal calculi who underwent microperc between August 2011 and June 2012 from two referral hospitals. Patients were included only in cases of failure after shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) and according to patient preference. The percutaneous renal access was performed using the 4.8F "all-seeing needle" with C-arm fluoroscopy or ultrasonographic guidance with the patient in the prone position. Stone disintegration was established using a 200 µm holmium:yttrium-aluminum-garnet laser fiber. RESULTS: A total of 21 patients (mean age 37.3 ± 20.1 years) with LP stone underwent microperc. The mean body mass index was 28.6 ± 6.0 kg/m(2), and the mean stone size was 17.8 ± 5.9 (9-29) mm. The duration of surgery and fluoroscopic screening was 62.8 ± 25.2 minutes and 150.5 ± 92.8 seconds, respectively. The patients were discharged after a mean 37.5 ± 14.4 hours of hospitalization time. The mean hemoglobin drop was 0.8 ± 0.6 (0.1-2.3) g/dL. Conversion to miniperc was necessitated in one patient with loss of vision. Stone-free status was achieved in 18 (85.7%) patients. Clinically insignificant residual fragments were observed in only one (4.8%). The procedure failed in two (9.5%) patients. A total of two minor complications (renal colic necessitating stent insertion and urinary tract infection) were observed postoperatively, none severe. CONCLUSION: Microperc is a feasible and efficient treatment modality for symptomatic LP calculi. Our results provide that microperc might take a part in case of SWL and RIRS failures or as an alternative to percutaneous nephrolithotomy or RIRS in the management of symptomatic LP calculi.

Reconstruction of distal urethral strictures confined to the glans with circular buccal mucosa graft.

OBJECTIVE: To report our results with 1-stage reconstruction in short distal urethral strictures using circular buccal mucosa graft (cBMG). METHODS: The data of 19 patients (median age 41.8 years, range 25-58) operated between 2001 and 2010 were reviewed. Patients were evaluated with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography (VCUG), and intraoperative urethroscopy. Stricture was limited to the glanular urethra (≤ 2 cm.) in all cases and 16 patients had lichen sclerosus. Strictured urethra was resected 0.5 cm proximal to the healthy urethra and a rectangular BMG with 4-cm length and 1.5- to 2.5-cm width (depending on the length of the defect) was rolled on a 24-Fr sound that calibrated the urethra. Proximal and distal edges of the cBMG were anastomosed circumferentially to the healthy mucosa and meatus, respectively. Foley catheter was removed within 10-14 days. Voiding symptoms, uroflowmetric parameters, and cosmesis were assessed at 1, 3, and 6 months, and yearly thereafter. RESULTS: With a median follow-up of 38 months (range 12-96), 16 (84.2%) patients were cured. One patient developed early graft loss, and 2 patients developed stricture at proximal anastomotic site. Mean Q(max) (mL/s) increased from 7.8 ± 5.4 preoperatively to 21.8 ± 9.2 postoperatively (P = .001), and mean AUA score decreased from 26.7 ± 3.9 preoperatively to 7.3 ± 3.8 postoperatively (P < .001). CONCLUSION: Our results suggest cBMG as a feasible alternative in 1-stage reconstruction of distal strictures confined to the glanular urethra because the glans penis has a good blood supply, providing an efficient circumferential graft take.

Impact of percutaneous renal access technique on outcomes of percutaneous nephrolithotomy.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is regarded as the gold standard for the treatment of patients with renal stones larger than 2 cm in diameter. Creating a percutaneous renal access is the initial and probably the most important step in performing a PCNL. Two primary methods of obtaining proper percutaneous renal access under fluoroscopic guidance are described: The "triangulation" and the "eye of the needle" techniques. In this article, we compare these two techniques in terms of success and complication rates. PATIENTS AND METHODS: From October 2010 to May 2011, 80 patients with simple renal stones were prospectively randomized into two groups according to the percutaneous renal access technique used for PCNL. Patients in group 1 (n=40) were assigned to the eye of the needle technique, and patients in group 2 (n=40) were assigned to the triangulation method. Patients needing multiple access points were excluded from the study. The preoperative, operative, and postoperative follow-up findings were thereafter analyzed and compared. RESULTS: No significant difference between the two groups was detected in terms of patient demographics (mean patient age, body mass index, stone size, or stone location). The operation time, fluoroscopic screening time (FST), and duration of hospitalization were similar in both groups (P=0.52, P=0.32, P=0.26, respectively). Patients in group 1 had a larger drop in hematocrit postoperatively than patients in group 2 (7.6 ± 3.7 vs 4.8 ± 2.1, P=0.001). The blood transfusion rate (7.5%) was similar in both groups, however. Although the complication rate was higher in group 1 than group 2, no significant difference was detected (20% vs 15%, P=0.76). CONCLUSIONS: The present study demonstrates that PCNL can be performed safely using two different percutaneous access techniques. The two techniques studied in this trial had similar FSTs, operation and hospitalization times, success rates, and complication rates.

Is fluoroscopic imaging mandatory for endoscopic treatment of ureteral stones?

OBJECTIVE: To present the feasibility and safety of fluoro-less endoscopic treatment of ureteral stones to diminish radiation exposure of the patient and operating team, and to determine circumstances where a fluoroscopic imaging is mandatory. METHODS: Between 2010 and 2011, 93 patients with ureteral calculi who underwent ureteroscopic treatment by experienced urologists were retrospectively evaluated. Manipulations, such as guidewire, ureteral stent insertion, and balloon dilatation were performed with visual and tactile cues. Patient demographics, need for fluoroscopic imaging, operation and fluoroscopy time, and complication and success rates were investigated. RESULTS: The mean age of patients was 34.03 ± 12.09 years (range, 9-63 years). The mean stone size was 10.64 ± 3.16 mm (range, 6-17 mm). The stones were localized in the proximal, middle, and distal segments in 11, 30, and 52 patients, respectively. The mean duration of the operation was 34.51 ± 7.94 minutes (range, 24-55 minutes). Stone-free status was achieved for 90 patients (96.77%). Fluoroscopic imaging was required for 7 patients with a mean fluoroscopy time of 9 ± 4.72 seconds (range, 4-16 seconds) for the following reasons: stone migration to the kidney (3 patients), double collecting system with 2 ureters (1 patient), and ureteral orifice stricture extending to the upper segment (1 patient). No major complications were observed, but minor complications were observed in 11 patients (11.8%). CONCLUSION: The ureteroscopic treatment of ureteral stones can be safely and effectively performed in experienced hands, with limited or no usage of fluoroscopy except in special circumstances, such as anatomic abnormalities, upper ureteral strictures, and impacted ureteral stones leading to ureteral tortuosity, kinking, and obstruction.

Techniques and results of urethroplasty for female urethral strictures: our experience with 17 patients.

OBJECTIVES: To report our experience with urethroplasty in women with urethral stricture and discuss the therapeutic considerations and outcomes of various flap- and graft-based techniques. METHODS: A total of 17 patients with mid to distal urethral stricture (urethral caliber <14F, maximal urinary flow rate <12 mL/s, and detrusor pressure >20 cm H(2)O during voiding) underwent urethroplasty from 2004 to 2010. Of the 17 patients, 7 had undergone previous instrumentation and 10 were repaired primarily. The preoperative workup included American Urological Association symptom score assessment, uroflowmetry, voiding cystourethrography, and urethrocystoscopy. Of the 17 patients, 10 received anterior vaginal wall mucosa inlay urethroplasty. Proximally, the dilated urethral mucosa was used in 1 patient. A Martius flap reinforced ventral buccal mucosa graft (BMG) onlay urethroplasty was used in 2 patients with previous synthetic midurethral slings. Two patients with an atrophic vagina received a dorsal BMG onlay. A circular BMG reconstruction was used in 2 patients with severe distal urethral stricture. The preoperative findings were compared with the postoperative data at the last follow-up using the Wilcoxon sign test. RESULTS: With a median follow-up of 24 months (range 6-78), an objective and subjective cure was achieved in 17 (100%) and 15 (88%) patients, respectively. At the last follow-up, the mean maximal urinary flow rate increased from 10.8 ± 3.2 mL/s preoperatively to 28.9 ± 7.4 mL/s (P = .001), and the mean postvoid residual urine volume had decreased from 120 ± 30 mL preoperatively to 30 ± 12 mL (P = .001). The mean American Urological Association score had decreased from 27.1 ± 3.9 preoperatively to 7.1 ± 3.5 postoperatively (P < .0001). CONCLUSIONS: Primary urethroplasty can be considered a first-line option for treatment of female urethral strictures. Local mucosal flaps will cure the problem in most situations. BMG offers an excellent alternative when viable local tissue is absent.

A rare renal epithelial tumor: mucinous cystadenocarcinoma case report and review of the literature.

Primary renal mucinous cystadenocarcinoma is a very rare lesion of kidney which originates from the metaplasia of the renal pelvic uroepithelium. Only one case with primary mucinous cystadenocarcinoma has been reported in the English literature. We report second case of mucinous cystadenocarcinoma which was radiologically classified as type-IIF Bosniak cyst in peripheral localization. We aimed to present this extreme and unusual entity with its radiological, surgical, and pathologic aspects under the light of literature.

Rectovesical fistula related to transurethral resection of a bladder lesion.

A rectovesical fistula (RVF) is an uncommon complication of urooncologic surgery. Although several RVFs have been reported, our case is the first reported RVF in the literature that iatrogenically occurred after transurethral resection of the bladder. A single-stage primary repair with omental flap interposition without a colostomy was successfully performed because of the persistence of the fistula during followup. After 6 months of followup, no fistula or bladder mass was detected.

Female urethral malignant melanoma with vesical invasion: a case report.

We report a 75-year-old female with a primary urethral malignant melanoma. Amass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4x2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+) malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery.

An unusual retroperitoneal sero-negative hydatid cyst presenting with lower urinary tract symptoms.

Hydatid cysts can be found in almost every structure in human body. Thus they can mimic numerous pathologies. Serological analyses are the best assistants in the diagnosis of hydatid cysts. But as serological investigations have limited sensitivity and specificity, they might misdirect our diagnosis. Lungs are the most common involved organ in this parasitic infection. But the brain, muscles, kidneys, bones, heart, pancreas, and rarely the retroperitoneum have also been reported to be involved. An unusual case of a sero-negative hydatid cyst located in the retroperitoneum presenting with lower urinary tract symptoms is reported in this paper.