Renal artery pseudoaneurysm post-COVID-19 infection: An unusual delayed complication.

This case report discusses a rare and severe complication of COVID-19 recovery - renal mucormycosis leading to right renal artery pseudoaneurysm. A 59-year-old patient, previously treated for COVID-19, presented with dry cough, flank pain, and hematuria. He was diagnosed with renal artery pseudoaneurysm with renal mucormycosis. Successful management included urgent angioembolization, systemic liposomal amphotericin B, and subsequent radical nephrectomy post-stabilization. The case underscores the importance of vigilant post-COVID-19 follow-up, particularly in patients treated with steroids, and highlights the need for a multidisciplinary approach for timely diagnosis and effective management of mucormycosis related complications.

A Study of Ki-67 Immunostaining in Prostate Carcinomas and Its Correlation with Gleason's Score and Prognosis: An Experience at a Tertiary Centre in the Himalayan Foothills.

Prostate cancer is a significant cause of cancer-related mortality among men worldwide, necessitating the exploration of prognostic biomarkers to aid in accurate risk assessment and treatment decision-making. This cross-sectional study aimed to comprehensively evaluate the role of Ki-67 as a prognostic marker in prostate cancer by examining its association with clinicopathological parameters. A total of 102 archived cases of prostate core biopsy specimens, histopathologically reported as prostate carcinoma, were included in this study. Histopathological grading was conducted using Gleason's scoring and grading system based on morphology. The statistical software "R" was utilized for data analysis. Kruskal-Wallis test and Fisher's exact test were employed to analyze the association between Ki-67 expression and clinicopathological parameters. The study revealed significant correlations between Ki-67 expression and various clinicopathological parameters in prostate cancer cases. High Ki-67 expression levels were associated with higher Gleason scores, increased incidence of perineural invasion, advanced T stages, lymph node metastasis, presence of distant metastasis, and higher prognostic stage groups. The findings of this cross-sectional study support the potential of Ki-67 as a prognostic marker in prostate cancer. The significant associations observed between Ki-67 expression and clinicopathological parameters indicate its usefulness in risk stratification and treatment decision-making. The incorporation of histopathological grading, including Gleason scoring, and analysis of perineural invasion strengthens the validity of the study. Ki-67, in combination with morphological assessments, provides valuable prognostic information for prostate cancer patients.

Sleep quality and obstructive sleep apnea among male patients with lower urinary tract symptoms: A prospective observational study.

Introduction: Apart from nocturia, few reports have been published on the relationship between lower urinary tract symptoms (LUTS) and sleep disturbances in patients visiting urology outpatient clinics. This study assessed the association between our population's LUTS and sleep disturbances. Methods: This was a prospective observational study. A total of 123 male patients with a history of LUTS aged more than 40 years were recruited from urology outpatient clinic. International Prostate Symptom Score was utilized to assess LUTS. To determine the quality of sleep, the Pittsburgh Sleep Quality Index (PSQI) was used. Berlin questionnaire (BQ) was used for screening obstructive sleep apnea. Results: A total of 123 participants were enrolled in this study. The mean age of the participants was 61 ± 11.1 years. Nocturia >3 episodes were significantly more in patients with PSQI >5 (P < 0.05). There was a greater prevalence of severe LUTS in patients with PSQI >5 (P < 0.05). The association between LUTS and BQ score showed an increased prevalence of severe symptoms in patients with high BQ. Patients with PSQI >5 had more severe LUTS (53% of patients) compared to patients with PSQI ≤5 (5% of patients) (P = 0.000). Patients with PSQI >5 had overall poorer quality of life (QOL) scores, with QOL being 5 and 6 in 18% and 4.8% of the patients, respectively. Conclusions: There is a significant association between the prevalence of nocturia, moderate-to-severe LUTS, and the existence of sleep disorders. Therefore, screening for sleep disturbances may be performed on male patients who present with LUTS.

Therapeutic Leukocytapheresis to relieve priapism due to leukostasis in CML patients: Our experience in a tertiary care centre.

Hyperleukocytosis in leukemic patients may cause tumour lysis syndrome, disseminated intravascular coagulopathy, and leukostasis, resulting in decreased tissue perfusion and increasing the risk of mortality. Since the myeloid blasts are larger than lymphoid blasts and are less deformable, complications of leukostasis are seen more frequently in myeloid leukemia. Priapism is a less common complication associated with leukostasis in leukaemia patients that should be treated as soon as possible to avoid ischemic injuries. Although chemotherapeutic drugs such as hydroxyurea and imatinib are used to treat hyperleukocytosis in CML patients, leukocytapheresis (LCP) can achieve rapid cytoreduction. Prophylactic LCP could not offer any advantage over aggressive chemotherapy, but therapeutic leukocyte depletion has a proven role in patients having symptomatic leukostasis due to high tumour burden. Three patients with ischaemic priapism were reported at our institute's emergency department, where detumescence could not be achieved by distal shunting or aspiration with phenylephrine instillation. The procedure of therapeutic LCP was performed in all three patients on an emergency basis, which resolved painful priapism by rapid cytoreduction.

Small Tumor, Major Complication: A Case of Spontaneous Perinephric Hematoma From a Small Renal Angiomyolipoma.

A renal angiomyolipoma is a benign kidney tumor composed of muscle, fat, and blood vessels. It is the most common benign kidney tumor, and it affects women more frequently than men. Angiomyolipomas can be small and asymptomatic, or they can be large, presenting with symptoms such as discomfort, hematuria, and hypertension. Occasionally, the rupture of an angiomyolipoma can cause a perinephric hematoma. This case report discusses a patient who developed a spontaneous large perinephric hematoma alongside a small renal angiomyolipoma. Aneurysm was seen on imaging. Angioembolization was successfully used for treatment. We explore the significance of the presence or absence of an aneurysm in predicting the risk of hemorrhage, particularly in association with small lesions. Angioembolization is an excellent choice for treating angiomyolipomas associated with significant hematomas.

Metabolic evaluation of first-time uncomplicated renal stone formers: A prospective study.

Background: Nephrolithiasis is a global health problem. The recurrence rate after the first stone clearance is approximately 50% at 5 years. Metabolic abnormalities are an important factor responsible for stone recurrence. Our prevalidated study aimed to evaluate metabolic abnormalities associated with first-time uncomplicated renal stone formers (FTURSF). Materials and methods: In this prospective, exploratory, time-bound, descriptive study, 30 first-time renal stone formers were evaluated for metabolic abnormalities. High-risk stone formers were excluded from the study. Data were collected in a predefined proforma, transferred to an Excel sheet, and analyzed using the Statistical Package for Social Sciences 20 and Epi Info 7. Fisher exact test, Mann-Whitney U test, paired t test, and Pearson correlation coefficient were used for statistical analyses. Results: The mean age of the participants was 35.57 ± 11.07 years, with a male-to-female ratio of 1.72. The most common abnormality was a 24-hour urine volume of <2.5 L in 73.33% of the participants. One or more metabolic abnormalities were detected in 76.67% of the participants. Other common metabolic abnormalities detected were hypocitraturia (60%), hypercalciuria (16.67%), hyperoxaluria (13.33%), and hyperuricosuria (3.33%). Parathyroid adenoma was detected in one participant (3.33%). Conclusions: Our study documented significant metabolic abnormalities in FTURSF. Therefore, a simplified metabolic evaluation protocol should be adopted while evaluating FTURSF. Detection of an underlying metabolic abnormality would enable the early institution of preventive measures to reduce stone recurrence and related complications.

Effect of preoperative ibuprofen on pain after lower third molar removal: A randomized controlled trial.

Aim: The aim of the study is to predict the effect of preemptive analgesics in the third molar surgery and to analyze whether the number and frequency of postoperative analgesics are reduced following the administration of preemptive analgesics. Materials and Methods: The present study was carried out on 50 patients who reported to the Department of Oral and Maxillofacial Surgery for removal of their impacted mandibular third molar. The patients were randomly divided into two groups of 25 patients each - Group A (test group) patients receiving ibuprofen (400 mg) half an hour before the surgery and placebo half an hour after surgery and the Group B (control group) patients receiving placebo half an hour before the surgery and ibuprofen (400 mg) half an hour after surgery. Both groups of patients will be instructed to avoid any drug but those prescribed (ibuprofen 400 mg SOS and rescue medication of tramadol 50 mg SOS) and not to seek any medical help elsewhere for postoperative problems. The pain was recorded using a visual analog scale. Results: Demographic data in the study show females (8%) and male (92%) patients. The average time taken for surgery was more in the control group (58.36 min) as compared to the test group (55.64 min) with no statistically significant difference. Values of pain score, medication score, number of rescue medication, and frequency at different time intervals (at baseline, after 3 h, 6 h, 24 h, and 7 days) are expressed in terms of mean and standard deviation, respectively, and the result shows the statistically significant difference for pain score at baseline and 7th-day time interval only. The distribution of different types of impaction and different types of elevation/odontotomy shows a significant association in test and control groups. Conclusion: Preoperative ibuprofen decreases the frequency and intensity of the pain. We believe that since this preoperative ibuprofen seems to be beneficial without any adverse effects, it may be used routinely in the 3rd molar surgeries and even in routine extraction.

Female Urethral Stricture Caused by Lichen Sclerosus: An Uncommon Presentation.

Lichen sclerosus is an inflammatory disease of the mucocutaneous region. The etiology of lichen sclerosus is not well explained. Lichen sclerosus is more common in females and generally involves the genital area. Urethral involvement in lichen sclerosus is uncommon in females. Males have a higher propensity for urethral involvement in lichen sclerosus. Here we report a case of a 50-year-old female with lichen sclerosus and urethral stricture. Buccal mucosal graft urethroplasty was done. The success rate of urethroplasty is low in patients with lichen sclerosus. Meatal sparing urethroplasty is usually not recommended in females with urethral strictures associated with lichen sclerosus. Our patient was asymptomatic at six months of follow-up.

Urodynamics in the evaluation of lower urinary tract symptoms in young adult men: A systematic review.

Introduction: This review aims to systematically evaluate the available evidence on the different urodynamic diagnoses of lower urinary tract symptoms (LUTS) in young adult men aged 18-50 years and to summarize the various urodynamic parameters based on these diagnoses. Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement and the search was performed in PubMed, Embase, and Cochrane library from inception till September 2021. A total of 295 records were identified using a combination of keywords such as LUTS, urodynamics (UDS), and young males. The review was registered in PROSPERO (CRD42021214045). Results: All the ten studies, which were included in this analysis, categorised the patients into either of the four primary diagnoses after the UDS - primary bladder neck obstruction (PBNO), dysfunctional voiding, detrusor underactivity (DU), or detrusor overactivity. Five of these studies used the conventional UDS, and in the other five a video UDS was performed. The most common abnormality on the conventional UDS was DU with a pooled estimate of 0.24 (95% confidence interval [CI] - 0.104-0.463, I2-95.35, (τ2-1.07). The most common abnormality on the video UDS was PBNO with a pooled estimate of 0.49 (95% CI - 0.413-0.580, I2-66.59, 2-0.09). The point estimates of various UDS parameters were also recorded. Conclusion: A urodynamic diagnosis was possible in 79% and 98% of the young men who underwent a conventional UDS or a video UDS, respectively. However, the men subjected to the conventional UDS and the video UDS had significant differences in their primary urodynamic diagnostic label. These results will help to plan future trials for the evaluation and management of LUTS in young men.

Interruption of BCG Therapy for NMIBC During COVID-19 Crisis, Dilemma in Its Continuation: a Review of Available Evidence and Suggested Management Strategies.

The COVID-19 disease, caused by SARS-CoV-2 virus, has been one of the worst pandemics ever to hit the human mankind. Undoubtedly the start of the second wave of COVID-19 has literally ripped apart the hearts of millions of people. Cancer patients have been left of the beaten track to their fate, with no access to treatments. Intravesical BCG instillation is the standard of care for patients with non-muscle invasive bladder cancer (NMIBC). Several patients were in the middle of their treatment regimen when this pandemic struck. As slowly the word is recuperating from concussion effect of this pandemic and routine health services are being restored, uro-oncologist will face a unique scenario with respect to intravesical BCG therapy i.e., whether to restart the course of BCG therapy or to continue course from where it was interrupted. There are no studies in literature to directly answer this peculiar question and to resolve this dilemma. So, we in this review article propose to explore the literature for the most appropriate therapeutic regimen for these patients with interruption of intravesical BCG therapy. We plan to divide the patients with interruption to BCG therapy into the following three groups:Group 1: Patients who had interruption during the induction period.Group 2: Patients who completed the induction course but maintenance course could not be started.Group 3: Patients who had interruption during maintenance phase of BCG therapy. We will compile the recent recommendations by NCCN, AUA, and EAU for the administration of intravesical BCG in non-muscle invasive bladder cancer. We herein want to review the literature to propose the most appropriate strategy, its safety profile for these subsets of patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-023-01742-8.

Pharmacological interventions for reducing catheter-related bladder discomfort in patients undergoing elective surgeries under general anaesthesia: A systematic review and meta-analysis.

Background and Aims: Catheter-related bladder discomfort (CRBD) is identified as a major concern after surgery as it can lead to increased morbidity and prolonged hospital stay. A suitable agent to prevent and treat postoperative CRBD is not yet established, and the literature is scarce in this regard. So, we aimed to find the efficacy of various drugs in preventing CRBD after elective surgery. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the study, and electronic databases like PubMed Central, Cochrane database and Embase were searched. The methodological quality of selected studies was assessed by the Cochrane Collaboration risk of bias tool. Review Manager 5.4.1 was used for statistical analysis. Results: The meta-analysis revealed that antimuscarinic agents were able to lower the incidence of CRBD significantly at 0 hour, 1 hour, 2 hours and 6 hours (P < 0.01) after the surgery. Tramadol was effective at 1 hour, 2 hours and 6 hours postoperatively (P < 0.01), whereas ketamine was effective at 2 and 6 hours (P < 0.01) postoperatively. Antiepileptic drugs (pregabalin and gabapentin) were able to lower the incidence of CRBD at 0 hour (P < 0.01), 1 hour (P < 0.05), 2 hours (P < 0.05) and 6 hours (P < 0.01) postoperatively while dexmedetomidine at 0 hour (P < 0.01) and 2 hours (P < 0.01) after the surgery. Injections paracetamol, amikacin and diphenhydramine were also shown to reduce the incidence of CRBD in separate randomised controlled trials. Conclusion: The current meta-analysis showed that antimuscarinic agents, tramadol, pregabalin, gabapentin, paracetamol and dexmedetomidine are effective in significantly reducing the incidence of postoperative CRBD.

Recurrent vesico-cervical fistula: our experience.

INTRODUCTION AND HYPOTHESIS: Vesico-cervical (VCxF) is an uncommon entity among the gamut of genitourinary fistulas. The common causes include prolonged labor, previous lower-segment cesarean sections (LSCS), difficult vaginal deliveries, and traumatic injuries. METHODS: A 31-year-old woman presented with a history of LSCS for prolonged labor 4 years ago followed by a failed robotic repair for diagnosed VCxF and vesico-uterine fistula (VUtF) 1 year ago. The patient developed a recurrence 4 weeks after catheter removal. The patient underwent cystoscopic fulguration 6 months after the robotic surgery, but this failed after 2 weeks. Now, the patient presented with continuous urine leakage through the vagina for 6 months. On evaluation, she was diagnosed with recurrent VCxF and a repeat transabdominal repair was planned. On cystovaginoscopy, there was difficulty in negotiating the fistulous tract from either end. With great difficulty, we placed the guidewire from the vaginal end, which reached a false paracervical passage. Although in the false tract, the guidewire helped with localization of the intraoperative fistula site. After docking, port placement, and localization of the fistula site (tug on the guide wire), a mini cystostomy was performed. A plane was created between the bladder and cervicovaginal layer and dissected up to 1 cm beyond the fistula. The cervicovaginal layer was closed. An omental tissue interposition was followed by cystotomy closure and drain placement. RESULTS: The postoperative period was uneventful, and the patient was discharged on the 2nd day after drain removal. The catheter was removed after 3 weeks and the patient is doing fine under regular follow-up for 6 months. CONCLUSIONS: It is challenging to diagnose and repair VCxF. Transabdominal repair is better than transvaginal repair owing to its location. Patients can opt for open or minimally invasive (laparoscopic/robotic) surgery, with better postoperative outcomes in minimally invasive techniques.

Cytomorphologic visualization of circulating tumor cells in urinary bladder cancer patients using ScreenCell™ technology: Potential as a simple cytology test.

Circulating tumor cells (CTC) are a recent technique which is a potentially important prognostic factor in many solid tumors. There are many techniques of detecting CTCs, but they usually implement costly techniques like EpCAM targeted detection, fluorescence-based diagnosis, or magnetic bead based positive or negative selection. The diagnostic utility of simple cytomorphological diagnosis after routine staining of CTCs have been rarely studied. We aimed to detect CTCs in 24 patients clinically suspected to have Urinary Bladder Cancer using a simple but efficient patented filtration technology (ScreenCell™), followed by optical microscopic visualization after routine May-Grunwald-Giemsa (MGG) staining. The detected CTCs were then tested for association with the histologic type, lamina propria invasion, deep muscle invasion and the T-stage. Out of the 24 patients tested, one was found to have papilloma, nine had low grade urothelial carcinoma, 13 had high grade urothelial carcinoma and one had poorly differentiated adenocarcinoma. Of these, two LGUC, eight HGUC and one adenocarcinoma had detectable CTC. Presence of CTCs had a statistically significant association with Lamina propria invasion (P = .006) and T-stage (P = .02), and a trend toward significance for differentiating LGUC from HGUC (P = .10). These results suggest that cytomorphological detection of CTC is likely to be clinically useful in diagnosis and prognostication of urinary blader cancers. These findings need to be confirmed on studies with larger sample sizes.

Cyanoacrylate Glue Masquerading as an Obstructive Calculus: Rare Sequelae of Angioembolization for Renal Pseudoaneurysm.

Renal pseudoaneurysm is a well-known albeit rare vascular complication following renal trauma, percutaneous interventions, renal biopsy, and partial nephrectomy. Angioembolization has become an effective treatment option for pseudoaneurysm using Cyanoacrylate glue, Gel-foams, Micro-coils, polyvinyl alcohol, etc. We herein present a 20-year-old gentleman with infected left hydroureteronephrosis secondary to an impacted foreign body in a ureter, specifically, down-migrated cyanoacrylate glue. This is two weeks following glue angioembolization for a left upper polar segmental renal artery pseudoaneurysm secondary to stab injury. He underwent a successful left-side ureteroscopic extraction of this polymerized glue, following which his symptoms subsided. These complications of glue migration following angioembolization are infrequent, and reports of it are scarce in the literature. Stringent follow-up and timely intervention are essential to mitigate disastrous outcomes.

Inner ear barotrauma: A case report of rare post-operative complication following robot-assisted radical prostatectomy.

To highlight a rare case of inner ear barotrauma as a post-operative complication following robot-assisted radical prostatectomy (RARP). A 65-year-old man diagnosed with localised prostate carcinoma underwent elective RARP in a steep Trendelenburg position. Postoperatively, the patient complained of bothersome dizziness and spinning of surroundings associated with nausea. The patient was diagnosed to have vestibular symptoms secondary to inner ear barotrauma. He was started on prochlorperazine 12.5 mg and antibiotics, following which the patient improved. Vestibular rehabilitation exercises were taught to the patient. After 3 days of treatment, the patient did well with no episodes of dizziness. The patient was discharged on tablet cinnarizine 25 mg thrice daily for a week. On follow-up, the patient is asymptomatic. Inner ear barotrauma can be a rare complication of a combination of prolonged steep Trendelenburg during robotic surgery and pneumoperitoneum. Only further reporting of such incidents can help determine predisposing factors and precautions for preventing such incidents.

When to Avoid a Restaging Procedure for Non-muscle Invasive Bladder Cancer? Inferences from a Tertiary Care Center.

The increasing incidence of urinary bladder carcinoma is alarming. Approximately seventy percent of these patients are non-muscle invasive bladder cancer (NMIBC). Restage transurethral resection of bladder tumor (TURBT) is the current recommendation for any T1 and or high-grade non muscle invasive bladder cancers (NMIBC) to accurately stage the malignancy. The question whether a second surgery is always required as a restage procedure is still unanswered. The patient's concern about completeness, morbidity, and financial considerations of a major surgery cannot be overlooked. Moreover, it also puts a strain on the already overburdened healthcare system. To answer this question, whether it is oncologically sound to omit a second resection, the current study evaluated the outcomes of patients undergoing restage TURBT, and analyzed the preoperative factors predicting a change in the staging of this malignancy. The study design was a prospective observational including NMIBC patients from September 2018 to February 2020. A total of 72 patients underwent restage TURBT. Their demographic data, imaging and cystoscopic findings, and histopathological data were recorded. The objective was to study the clinico-pathological correlations and factors predicting recurrence and upstaging of tumor in NMIBC patients undergoing restage TURBT. A total of 101 patients were found eligible for restage TURBT. Eventually, 72 underwent restage TURBT. Twelve (16.7%) patient had recurrence at restage while 3(4.16%) were upstaged to T2. Presence of lower urinary tract symptoms (LUTS) was independently associated with the risk of recurrence of same stage compared to no recurrence (p-0.025, OR-8.793, 95% CI-1.316-98.773). Chemical exposure (p-0.042) was also significantly associated with the same. Presence of lymphadenopathy on CT was independently associated with the risk of upstaging compared to no recurrence (p-0.032, OR-18.25, 95% CI-1.292-257.85). The study concluded that in the presence of a well-performed and adequate initial TURBT, restage TURBT could be skipped for further management. However, in small subgroup of patients with lymphadenopathy on preoperative imaging having a higher risk of tumor recurrence and upstaging, and patients with a history of chemical exposure and previous lower urinary tract symptoms having a high risk of recurrence alone, restage TURBT should still be performed to accurately stage the disease. Further studies with large patient cohort are needed to confirm and reinforce the facts proposed. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-022-01516-8.

Immunoexpression of PD-L1 and PD-1 and Its Clinicopathological Correlation in Urothelial Carcinomas.

Introduction Urothelial carcinomas are the most common types of bladder tumors that have recently shown a changing trend in treatment protocols with the introduction and approval of immune checkpoint inhibitors. The most important immune checkpoint lies with the PD-1-PD-L1 axis. Although multiple drugs have been approved, there is uncertainty about patient selection criteria and diagnostic assays. Recent studies related to the laboratory-developed tests have opened up the horizon of PD-1 and PD-L1 immunohistochemistry even at resource-constrained laboratories. We propose to study these immunohistochemistry markers in our laboratory using newer clones. Materials and Methods We selected 116 consecutive cases of transurethral bladder tumor resection from our laboratory archive and applied PD-1 and PD-L1 immunohistochemistry. The study was approved by the institution's ethics committee. Results We found high expression of PD-1 and PD-L1 in urothelial carcinoma even with different cut-offs of PD-L1. Muscle invasion, lamina invasion, and grade of carcinoma had a statistically significant effect on the expression; however, age and sex did not affect the expression. Conclusion Based on our current study, we can conclude that the clones used in our study show high expression in urothelial carcinoma and can aid in patient selection and treatment protocol, irrespective of age and sex.

Small contracted bladders posing bigger problems: Etiology, presentation, and management and a short review of literature.

The purpose of this study was to assess various etiologies, diagnosis and management. This rare entity is a neglected condition which should always be under clinical suspicion by broad speciality of practitioners for early treatment. Retrospective data collected from 2018 to 2021 in the All India Institute of Medical Sciences Rishikesh was used. All patients diagnosed with the small contracted bladder in the given period were included. The primary outcome of the study was to find out the common causes, early tests used for diagnosis and management done in the patients of small contracted bladder attending this tertiary care centre. Between 2018 and 2021, a total of 12 patients were diagnosed to have small capacity bladder (SCB). The most common symptom was frequency (75%). On cystoscopy, 33.33% (n = 4) had less than 50 ml and 66.66% (n = 8) had 50-100 ml bladder capacity respectively. 37.5% (n = 3) were diagnosed by urine AFB culture, 62.5% (n = 5) were diagnosed by urine for PCR, 62.5% (n = 5) were diagnosed by radiological investigations. Eight patients (66.66%) underwent surgical treatment in cases diagnosed as tuberculosis like augmentation cystoplasty and supra-trigonal cystectomy. Other rare causes found were eosinophilic cystitis, radiation induced contracture and BCG induced contracture. Small capacity bladder is an unusual condition, with still dilemma on the definition of small capacity and only few literature mentioning the causes, diagnosis and treatment. Even though tuberculosis is a common cause of SCB, still rare causes should always be kept in mind for relieving patient symptoms at the earliest.

Urological Manifestations of Kindler Syndrome: A Case Report.

Kindler syndrome is a rare autosomal recessive skin disorder. It results from mutation of the FERM domain containing kindlin-1 (FERMT1) that leads to loss of function of kindlin-1, which plays a role in keratinocyte adhesion, polarization, proliferation, and migration. It is characterized by skin blistering, photosensitivity, progressive poikiloderma, and skin atrophy. The mucosae genitourinary system is commonly affected. The urological manifestations include meatal stenosis, urethral stricture, phimosis, and scarring of the glans penis. Skin biopsy with genetic analysis is the gold standard for diagnosis. Genetic counseling and a multidisciplinary approach are the mainstays of treatment.

Acute Pyelonephritis With Cullen's Sign Masquerading As Pancreatitis.

Cullen's sign is well described in the literature as subcutaneous ecchymosis in the periumbilical region. It is most commonly represented with acute pancreatitis. Recently, there have been many case reports associated with this sign to different clinical scenarios. A 61-year-old gentleman reported to the ED with left flank pain, intermittent fever, and a periumbilical ecchymosis on abdominal examination. Numerous tests were performed to rule out the likelihood of acute pancreatitis. The patient was diagnosed with acute pyelonephritis and received appropriate treatment. Cullen's sign should raise suspicions of retroperitoneal or intraabdominal abnormalities. While the pathophysiological process underlying the emergence of this symptom frequently signals retroperitoneal bleed, this is not always the case.