Primary signet ring cell carcinoma of the male urethra.

Malignant tumours of the male urethra are rare and commonly present at an advanced stage. The most common type of urethral cancer is urothelial carcinoma, followed by squamous cell carcinoma. Less than 5% of urethral cancers are adenocarcinoma. We report a young male with signet ring cell carcinoma of the membranous urethra who presented with recurrent lower urinary tract symptoms. Although he was initially treated for a urinary tract infection, the correct diagnosis was made with an appropriate imaging workup. He underwent radical urethrectomy with total pelvic exenteration with bilateral extended pelvic lymph node dissection. Ileal conduit and colostomy were performed as urinary and bowel diversions, respectively. The patient received adjuvant chemotherapy, however, succumbed to COVID-19 8 months after the procedure. This case has been presented to highlight the high index of suspicion required to diagnose this rare malignancy.

Ectopic Kidney Mimicking Appendicular Abscess.

Ectopic kidney is a congenital anomaly of renal position, which is commonly asymptomatic. Symptoms arising from pelvic kidneys can closely mimic pathological processes of nearby organs and vice versa. We report an 18-year-old girl who presented with acute onset of a painful lump in the right iliac fossa. Although the clinical features mimicked an appendicular abscess, the judicious use of cross-sectional imaging aided in the proper diagnosis. Pyonephrosis of a right-sided lumbar kidney was confirmed on further imaging and nephrectomy was performed. This case has been presented to highlight the significance of renal imaging in patients suspected of an appendicular abscess.

Trigonometric Concept of Fluoroscopy-Guided Percutaneous Renal Access.

Percutaneous nephrolithotomy is the standard surgical management of large renal calculi. Percutaneous renal access using the triangulation method has been an enigma for the endourologist to master and teach. This surgical conundrum is due to the uncertainty in the angle and depth required to puncture the target calyx. We describe a novel trigonometric method of renal access where both the angle and the depth of puncture are easily determined before the puncture.

An Unusual Cause of Vesical Calculi.

Intravesical migration is an uncommon but serious complication of intrauterine contraceptive devices. Calculus formation is common over such migrated intrauterine contraceptive devices. This dreaded complication usually presents with lower urinary tract symptoms such as suprapubic pain, frequency, and nocturia. We present a case of a 50-year-old woman with intravesical migration of copper-T device placed in the immediate postpartum period 25 years ago. She presented with dysuria, which was confirmed by computed tomography. The migrated device was encrusted with a 3.5-cm-sized stone around its vertical limb. Another stone of approximately the same size was present in the bladder. Surprisingly, the patient never had symptoms and hence she never followed up for 25 years. The stones could not be removed endoscopically, and therefore an open vesicolithotomy was performed. This case has been presented to highlight the significance of following up patients with intrauterine contraceptive devices to avoid potentially devastating complications.