Renal-Protective Urinoma Formation in a Newborn Boy With Posterior Urethral Valves.

Posterior urethral valves (PUV) are an uncommon urologic congenital anomaly in males often discovered antenatally and more rarely after birth. PUV can lead to obstructive nephropathy and voiding dysfunction, putting patients at increased risk for irreversible renal damage and subsequent progression to end-stage renal disease. Much of the renal damage caused by PUV is proportional to the amount of time that the kidney has been experiencing retrograde pressure. Although much debate exists within the field, spontaneous decompression within the collecting system (e.g., "pop-off" valve) such as urinoma formation or spontaneous ascites has been found to relieve pressure on and thus protect the kidney, decreasing the risk of progression to advanced stages of chronic kidney disease. Despite the significant mass effect on the renal parenchyma, the pressure-relieving function of urinoma formation is a net protective factor allowing renal function to be preserved. We report a unique case of antenatal detection of PUV in a male with postnatal complicated urinoma formation secondary to forniceal rupture. Remarkably, despite significant external compression of the kidney and the development of urosepsis from infection of the urinoma with a multidrug-resistant organism that required percutaneous drainage, renal function was preserved throughout the disease course. After ablation of the PUV and drainage of the septic urinoma, the patient recovered rapidly after intervention and was ultimately discharged in stable condition.

Neuraxial vs General Anesthesia: 30-Day Mortality Outcomes Following Transurethral Resection of Prostate.

OBJECTIVE: To examine the occurrence of 30-day mortality, and other procedure related morbidities in cohorts of patient receiving neuraxial anesthesia (NAX) or general anesthesia (GA) in the setting of transurethral resection of the prostate (TURP). Historically, NAX has been recommended for patients undergoing TURP permitting monitoring of consciousness and early diagnosis of absorption-related hyponatremia. We aim to analyze a broader comparison of mortality and other associated morbidities regarding the form of anesthesia utilized. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was accessed and queried from January 2010 to December 2016 for TURP. 28,486 TURP cases were identified and further stratified by the type anesthesia administration, NAX 7,261 and GA 21,225. Chi-square analyses and Kaplan-Meier tests were performed for univariate comparisons. Using propensity score, data were optimally (1:1) matched to account for potential confounding variables. Outcomes were then compared for NAX vs. GA with a primary endpoint of 30-day mortality, followed by secondary endpoint of adverse outcomes reported per NSQIP. RESULTS: Prior to matching, 30-day mortality was found to be 0.4% in the NAX cohort and 0.7% GA. 12,180 patients equally matched between the 2 groups. NAX was found to be superior to GA in terms of 30-day survival benefit (OR 0.55, 95% CI 0.33 -0.92, P <0.05), sepsis (OR 0.60, 95% CI 0.50 -0.73, P <0.001), and return to operating room (OR 0.76, 95% CI 0.60 -0.98, P <0.05) when comparing matched cohorts. NAX was associated with lower incidence of overall adverse clinical outcomes 12.4% vs 13.7% (P = 0.036). CONCLUSION: NAX was found to have statistically relevant advantage for 30-day postoperative outcomes when compared to GA for TURP based on NSQIP database reporting.

Testicular Metastasis From Prostatic Adenocarcinoma Presenting as Recurrent Epididymo-orchitis.

OBJECTIVE: To present a rare case of testicular metastasis from prostatic adenocarcinoma origin and to provide a meaningful discussion of currently available supporting literature. MATERIALS AND METHODS: Pertinent health information was obtained by retrospective analysis of hospital electronic medical records. RESULTS: A 93-year-old man with history of castration-resistant prostatic adenocarcinoma presented with recurrent episodes of epididymo-orchitis with initial symptoms responsive to oral antibiotics. Further investigation with testicular ultrasound revealed two 1-cm cystic lesions in the right testicle, one complex in nature, with bilateral mild-to-moderate hydroceles. Repeat ultrasound confirmed growth of lesions to 1.4 and 1.6 cm, respectively. Patient underwent bilateral orchiectomy with resultant symptomatic resolution. Surgical pathology returned with an isolated right testicular parenchyma infiltrated by adenocarcinoma from a primary prostatic neoplasm. Follow-up at 2 and 8 weeks postoperatively revealed prostate-specific antigen levels of 2.60 ng/mL and 4.14 ng/mL, and with no further complaints of pain. CONCLUSION: The most commonly documented sites for metastasis from a prostatic carcinoma origin are to regional lymph nodes and bone, followed by the lungs, liver, and adrenal glands. However, patients with a history of prostate cancer presenting with recurrent symptoms of epididymo-orchitis should have a high suspicion for testicular metastasis. Treatment with bilateral orchiectomy offers patients the possibility for both favorable symptomatic and oncologic outcomes.

Comparison of Radiation Exposure from Fixed Table Fluoroscopy to a Portable C-Arm During Ureteroscopy.

INTRODUCTION: Current treatment practices within the field of endourology require the routine use of radiation exposure to provide adequate imaging during urologic procedures. One such procedure requiring repeated radiation exposure during treatment is ureteroscopy. We set out to compare estimated fluoroscopic radiation exposures employing fixed table and portable C-arm fluoroscopy. MATERIALS AND METHODS: A cross-sectional dosimetry phantom model was placed supine on both fixed fluoroscopy and standard operating room tables. The models were then exposed to three separate 5-minute runs of fluoroscopic exposure. Metal oxide semiconductor field effect transistor dosimeters were utilized in organ-specific locations to determine specific radiation exposure dosages. Absorbed radiation was determined for each organ location for both fluoroscopy units. Organ dose volumetric corrections were performed for skin and red bone marrow, to correct for the nonirradiated portion. Organ dose rate (ODR, mGy/s) and effective dose rate (EDR, mSv/s) were calculated, with values reported as mean ± standard deviation. RESULTS: There were found to be statistically significant elevations for both total EDR and organ-specific dose rates with the use of fixed table fluoroscopy compared with C-arm fluoroscopy. EDR was found to be 0.0240 ± 0.0019 mSv/s for the fixed table unit and 0.0029 ± 0.0005 mSv/s for the C-arm unit (p = 0.0024). Internal organs exposed to the most radiation during fixed table fluoroscopy included the gall bladder and stomach in comparison to C-arm fluoroscopy, which found elevated exposure in the kidneys, pancreas, and spleen. CONCLUSION: The routine use of fixed table fluoroscopy results in significantly elevated estimated organ doses and EDR when directly compared with C-arm fluoroscopy in model trials. This difference should be taken into consideration by practicing urologists when patient treatment requires the use of fluoroscopy to maintain radiation exposure as low as reasonably achievable.