Hydrocele Masking Testicular Tumour With Extensive Nodal Disease: A Case Report and Literature Review.

Hydrocele is one of the most common causes of scrotal swellings. Fluid accumulation within the tunica vaginalis, a remnant of the peritoneum covering the testicle, leads to scrotal swelling. It is known to be a benign condition with no subsequent complications apart from increasing in size causing discomfort. Some patients could cope with the swelling effect and continue their life with no desire for further management while others are not fit for surgical intervention and would be treated conservatively with the same concept. However, once the testicle becomes swollen by the surrounding fluid, it would be difficult to examine the testicle itself even by an expert physician. We present here a 46-year-old patient who has been diagnosed with right hydrocele for a long time. The patient noticed general weakness and loss of weight. Initial investigations showed iron deficiency anemia and imaging showed retroperitoneal lymphadenopathy. Eventually, testicular ultrasonography showed a right testicular tumour that was masked by a hydrocele, resulting in delayed presentation of metastatic testicular cancer.

Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed expectantly with acute ureteric colic: a quality improvement project.

Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putting pressure on urological services. The British Association of Urological Surgeons (BAUS) guidelines indicate that for patients managed expectantly, a clinic review should be undertaken within 4 weeks of presentation. This quality improvement project reports the benefit of a dedicated virtual colic clinic to facilitate an efficient care pathway and reduce patient waiting times. A retrospective cycle analysed patients referred from the emergency department (ED) with uncomplicated acute ureteric colic (excluding those admitted for immediate intervention) over 2 months in 2019. A further cycle was carried out 12 months later following the introduction of a new dedicated virtual colic clinic with updated ED referral guidance. The mean time from ED referral to urology clinic review fell from 7.5 to 3.5 weeks. The percentage of patients reviewed in clinic within 4 weeks increased from 25% to 82%. The mean time from referral to intervention including shockwave lithotripsy and primary ureteroscopy fell from 15 to 5 weeks. The introduction of a virtual colic clinic improved the time to definitive management of ureteric stones for patients managed expectantly as per BAUS guidelines. This has reduced waiting times for both clinic review and stone treatment which has enhanced patient experience within our service.

Ultramini-percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of 10-30 mm calculi: a randomized controlled trial.

The surgical management of renal stones 10-30 mm is usually performed with percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Standard form of percutaneous nephrolithotomy has paved the way for miniaturized PCNL in many centres. We wanted to evaluate the efficacy, safety and the cost-effectiveness of ultramini-percutaneous nephrolithotomy (UMP) versus RIRS in the treatment of renal stones with stone burden 10-30 mm. Patients with renal stone burden 10-30 mm were prospectively randomized into either UMP or RIRS. The demographic data, stone characteristic, operative time and cost of the equipment were recorded. The stone free status, analgesic requirement, deterioration of the renal function and hemoglobin and the postoperative complications as per Clavein-Dindo grade were recorded. One hundred and fifty patients met inclusion criteria. Out of these 98 underwent UMP and 46 RIRS. Six withdrew the consent before the procedure. Mean stone size was comparable in either of the groups. Mean laser time and stone extraction time was significantly less for UMP compared to RIRS (41.17 min versus 73.58 min p < 0.0001). Mean consumable costs in the UMP group were considerably less at US$45.73 compared to the RIRS group at $423.11 (p < 0.0001). The stone free rates at 1 month of follow-up were 100% for UMP group and 73% for RIRS group. There were insignificant changes to mean hemoglobin and glomerular filtration rate (GFR) in all patients and the average length of the stay was similar in both the groups. The postoperative complications revealed Grade I and II rate of 10% in the UMP group and 35% in the RIRS group, respectively. We concluded that UMP to be safe, effective and more economical to the RIRS for renal stones up to 3 cm in size.Trial registered with ISRCTN registry ID ISRCTN20935105, Retrospective.

An Unusual and Rare Metachronous Ipsilateral Ureteric Stump Metastasis Post Radical Nephrectomy.

We report a case of recurrence of chromophobe renal cell cancer in the ipsilateral ureteric stump eight years later after the primary tumor was excised successfully. Before this detection of the recurrence, the patient had presented with recurrent episodes of hematuria four years after the radical nephrectomy was performed and the investigations were inconclusive. Eventually, the lesion was detected on flexible cystoscopy in the area of the right ureteric orifice protruding in the bladder. Transurethral resection of the tumor surprisingly revealed a chromophobe renal cancer with similar features seen in the primary tumor specimen. The patient underwent robotic-assisted laparoscopic excision of the ureteric stump with a cuff of the bladder and has been recurrence-free for five years on regular surveillance scans.

Safety of "hot" and "cold" site admissions within a high-volume urology department in the United Kingdom at the peak of the COVID-19 pandemic.

OBJECTIVES: To determine the safety of urological admissions and procedures during the height of the COVID-19 pandemic using "hot" and "cold" sites. The secondary objective is to determine risk factors of contracting COVID-19 within our cohort. PATIENTS AND METHODS: A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high-volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a "cold" site requiring a negative COVID-19 swab 72-hours prior to admission and patients were required to self-isolate for 14-days preoperatively, while all acute admissions were admitted to the "hot" site.Complications related to COVID-19 were presented as percentages. Risk factors for developing COVID-19 infection were determined using multivariate logistic regression analysis. RESULTS: A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44-70) were admitted under the urology team; 101 (16.5%) on the "cold" site and 510 (83.5%) on the "hot" site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID-19 postoperatively with one (0.2%) postoperative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). CONCLUSIONS: Continuation of urological procedures using "hot" and "cold" sites throughout the COVID-19 pandemic was safe practice, although the risk of COVID-19 remained and is underlined by a postoperative mortality.

Obstructive Uropathy as an Initial Presentation of Primary Myelofibrosis: Case Report and Review of Literature.

Primary myelofibrosis (PMF) is a rare hematological disorder associated with progressive cytopenia and extra-medullary hematopoiesis. Acute kidney injury in this disease has been reported from diverse etiologies such as renal and peri-renal extramedullary hematopoiesis and tumor lysis syndrome. We report a patient who presented with obstructive uropathy from uric acid stones who was incidentally diagnosed with PMF during workup for persistent thrombocytosis and leukocytosis. Marrow histopathology was unique in presenting features of early PMF despite clinical picture mimicking essential thrombocythemia. Despite a common background of hyperuricemia in myeloproliferative neoplasms, AKI resulting from urate nephrolithiasis has seldom been reported in PMF. Published data on this association and clinical management is reviewed briefly.