An Unusual Presentation of Squamous Cell Carcinoma of Kidney.

Primary squamous cell carcinoma of the renal pelvis is an extremely rare entity representing only 0.5% to 0.8% of all urothelial malignancies. Clinical suspicion is difficult due to its rarity and inconclusive clinical and radiological features. A 67-year-old lady with a history of hematuria presented to the hospital in a state of shock. After proper workup, a mass with heterogeneous density was seen in the lower portion of the left kidney. After radical nephrectomy, histopathological examination revealed squamous cell carcinoma of renal pelvis. Squamous Cell Carcinoma should be suspected in a patient with a long history of renal calculus and associated mass in non-functioning kidney. Keywords: Calculus; mass; pelvis; squamous cell carcinoma.

Impact of Miniaturization on Early Outcome of Percutaneous Nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy has become the standard procedure for large renal stones but still remains highly challenging due to complications such as bleeding and sepsis, even though it has high stone free rate (SFR). We report the early outcomes of more than 1000 percutaneous nephrolithotomys done in our center. METHODS: A retrospective study of all patients undergoing percutaneous nephrolithotomy from January 2010 to December 2017 in single institution was conducted. All cases were stratified into three groups based on tract size; standard percutaneous nephrolithotomy with tract size ? 22 F, mini percutaneous nephrolithotomy with tract size 15 - 20 F and ultramini percutaneous nephrolithotomy with tract size ? 14 F. Age, gender, stone complexity using Guy's stone score, stone size, operative time, hemoglobin drop, hospital stay, early major and minor complications were reviewed. RESULTS: A total of 1074 patients had undergone percutaneous nephrolithotomy among which, 578 patients were standard percutaneous nephrolithotomy, 433 mini percutaneous nephrolithotomy and 63 had undergone ultramini percutaneous nephrolithotomy. There was even distribution of patients with Guy's stone score 1 and 2 in all three groups. However, majority of patients with Guy's stone score 3 underwent standard percutaneous nephrolithotomy or mini percutaneous nephrolithotomy and no patients with Guy's stone score 4 underwent ultramini percutaneous nephrolithotomy. Age group, gender and operative time were comparable between the groups; however, significant difference was noted in terms of less hemoglobin drop and shorter hospital stay (p-value < 0.05) in the miniaturized percutaneous nephrolithotomy group. Complications were found to be fewer in mini percutaneous nephrolithotomy and ultramini percutaneous nephrolithotomy group in comparison to standard percutaneous nephrolithotomy. CONCLUSIONS: Miniaturization of tract size significantly decreases post-operative complication rates, blood loss and hospital stay while maintaining high stone free rates in well selected patients undergoing Percutaneous nephrolithotomy.

Safety and Efficacy of Bilateral Simultaneous Percutaneous Nephrolithotomy.

BACKGROUND: To evaluate the safety and efficacy of bilateral simultaneous percutaneous nephrolithotomy in one tertiary hospital in Nepal. METHODS: Retrospective study was done for all patients that underwent bilateral simultaneous percutaneous nephrolithotomy in our center from January 2010 to December 2017. The study included 36 male and 16 female patients with totalof 104renal units at an average age of 37 years (range 3 -65 years). Five patients were planned for bilateral simultaneous Percutaneous nephrolithotomy, but intraoperatively the procedure was aborted after completion of only one side due to various factors. All PCNL were performed in prone position under general anesthesia. RESULTS: In91.2% of the patients, bilateral simultaneous percutaneous nephrolithotomy could be performed as planned. Average time required for bilateral simultaneous percutaneous nephrolithotomy was 94 ± 38.8mins (range 25 - 170 mins) with average hemoglobin drop of 1.85 ± 1.30gm% (range 0.1 - 4.2gm%) and no significant change in serum creatinine levels. Multiple access tracts (>1) had to be created in 3 renal units. Most of the renal stones were Guy's stone score (GSS) 1 and 2 whereas 15.4% were GSS of 3 and 4.Overall stone free rate was 94% with significant residual stones (>4mm) in 6 renal units which were subjected to extracorporeal shockwave lithotripsy (SWL) on a later date (Clavien-Dindo Grade: III-a). Bladder clot evacuation was done in one patient (Clavien-Dindo Grade: III-b). Blood transfusion was required in two patients and two patients developed postoperative sepsis (Clavien-Dindo Grade: II). One patient developed hydrothorax which was managed successfully (Clavien-Dindo Grade: III-a). CONCLUSIONS: Bilateral simultaneous Percutaneous nephrolithotomy is feasible and safe procedure, given that the patients are appropriately selected based upon Guy's stone score, stone burden, pelvi-calyceal anatomy and overall health status.