Clear Cell Renal Cell Carcinoma with Neovascularization and Ureteral Extension in a 63-Year-Old Female Unravelled by Pelvicalyceal Penetration.

Approximately 3% to 4% of all newly diagnosed cancers are kidney tumours, which can develop from either the renal parenchymal tissue or the renal pelvis. Kidney cancer is one of the 13 most prevalent kinds of malignancy worldwide. 85% of all malignant kidney neoplasms are renal cell carcinomas (RCC). We present a rare instance of an RCC that had a thrombus in the ureter and had directly extended into the renal pelvicalyceal system. A thorough diagnostic workup was required because the patient had a number of symptoms, including flank pain, hematuria, and weight loss. Imaging tests identified a renal parenchymal-derived infiltrative tumour with remarkable pelvicalyceal penetration. Neovascularization was found within the tumour as a result of additional search. The discovery of ureteral extension, a peculiar characteristic, raised questions regarding both local and distant metastases. R.E.N.A.L nephrometry score was 11 with high complexity. Multidisciplinary management of the intricate clinical problem was employed. After removing the tumour mass, the ureteral involvement was treated with surgical resection, adjuvant therapy, and CT monitoring over the three-month high-risk follow-up period. With surgery, targeted treatment was employed to stop the cancer from growing. Conclusion: The importance of identifying unusual RCC presentations and employing a comprehensive diagnostic and treatment strategy is emphasised by this study. The complex interaction of ureteral extension, neovascularization, and pelvicalyceal penetration highlights the aggressiveness of advanced RCC. Since we are not aware of any literature documented instances including this combination, there are few studies explaining pelvicalyceal system invasion that defies commonly recognised diagnostic and treatment paradigms for renal cell carcinoma.

Post-donation health-related quality of life, mood and life satisfaction in livingkidney donors; an explorative study from kidney transplant centre, Lahore Pakistan.

Objective: To explore post-donation life satisfaction, quality of life and mood status among kidney donors. METHODS: The cross-sectional study was conducted from February 5 to July 10, 2021, at the Department of Kidney Transplant Surgery, Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan, and comprised living kidney donors who had donated a kidney at least 6 months before the interview date. Data was collected through telephonic interviews, and, in addition to demographics, the questionnaire comprised the World Health Organisation Quality of Life Brief Version scale, the Satisfaction with Life Scale, and the Patient Health Questionnaire and General Anxiety Disorder. Data was analysed using SPSS 20. RESULTS: Of the 41 subjects, 22(53.7%) were females and 19(46.3%) were males. The overall mean age was 41.10±9.648 years (range: 19-62 years). The most common donor-recipient relationship was brother-sister 10(34.1%) and wife-husband 10(24.4%). Among the donors, there was a significant positive correlation between quality of life and satisfaction with life (r=0.381, p=0.014). Quality of life had a negative correlation with anxiety (r=-0.429, p=0.005), and a negative but non-significant association with depression (r=-0.283, p=0.073). Anxiety and depression were highly positively correlated (r=0.681, p=0.000). Quality of life was significantly associated with donor age (p=0.029) with a negative effect (Beta=-0.588), while satisfaction with life had a positive relationship with age (Beta=0.147). Conclusion: Higher life satisfaction among living kidney donors was associated with an improved quality of life, while increased anxiety levels were linked to a lower quality of life. Age was a critical determinant, with older donors reporting a lower quality of life.

Challenges and technical aspects in the management of muscle invasive bladder cancer as retrograde radical cystectomy with ileal conduit.

Objective: To evaluate long-term outcomes in patients homogenously treated with radical cystectomy and ileal conduit for muscle invasive bladder cancer. METHODS: The retrospective study was conducted at the Urology Department of Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan, and comprised data from December 25, 2017, to January 16, 2023, related to patients who underwent radical cystectomy with ileal conduit with or without neo-adjuvant and adjuvant radiation, chemotherapy, or immunotherapy for papillary urothelial carcinom of the bladder. Clinical trajectory, histopathological characteristics and long-term clinical outcomes were noted. Data was analysed using SPSS 20. RESULTS: In our study of 40 patients with muscle invasive bladder cancer, males predominated (32, 80%), with a median age of 57.4 years (IQR: 29-80). Diagnosis was early in 5 (12.5%) patients with varying haematuria durations, while 34 (85%) patients had a smoking history. Comorbidities included hypertension in 17 (42.5%) patients, diabetes in 1 (2.5%) patient, both hypertension and diabetes in 9 (22.5%) patients and a combination of hypertension, diabetes, and ischaemic heart disease in 3 (7.5%) patients. Transurethral resection was performed once in 13 (32.5%) patients and multiple times in 27 (67.5%) patients. Additionally, 5 (12.5%) patients received immunotherapy, 11 (27.5%) patients underwent non-adjuvant radiation, and 14 (35%) patients received non-adjuvant chemotherapy. Papillary urothelial carcinoma was the predominant histological subtype among 37 (92.5%) patients. Patients receiving chemotherapy had significantly better overall survival (p=0.02). No significant differences were noted in recurrence or survival by therapy modality (p>0.05). These findings highlight the significance of early diagnosis, tailored treatments, and comorbidity management in muscle invasive bladder cancer patients. Age stratification revealed significant survival differences across groups (χ²=10.923, df=3, p= 0.012). Analysis by complications did not show age-related survival variations (χ² =3.978, df = 3, p=0.264). Conclusion: Achieving excellent long-term survival in MIBC patients requires a multidisciplinary approach, emphasizing early diagnosis, tailored treatment, and adherence to guidelines and protocols.

Topical Anesthetics and Premature Ejaculation: A Systematic Review and Meta-Analysis.

This meta-analysis was conducted to assess the effectiveness of topical anesthetics in preventing premature ejaculation. We conducted an online database search for original studies comparing topical anesthetic agents with placebo in patients with premature ejaculation. After selecting relevant articles, we extracted data on baseline characteristics and predetermined endpoints. Intravaginal ejaculatory latency time (IELT) was the primary outcome for efficacy. Mean differences and corresponding 95% confidence intervals were used to present continuous data. A random-effects model was used to pool the data, and subgroup analysis was performed based on the type of anesthetic agent used. Eleven randomized controlled trials were examined, involving a total of 2008 participants. After analyzing the combined results, it was found that Severance Secret (SS) cream (CJ CheilJedang Corporation, Seoul, South Korea) demonstrated significantly higher effectiveness than a placebo in increasing IELT (P = 0.001). Similarly, the topical eutectic mixture for premature ejaculation (TEMPE), lidocaine, and the eutectic mixture of local anesthetics (EMLA) were significantly more efficient than a placebo (P<0.00001; P = 0.0001; P<0.00001). Additionally, it was found that lidocaine gel was more efficient than paroxetine or sildenafil (P = 0.04; P<0.00001). In conclusion, topical anesthetics increase IELT in men with premature ejaculation more effectively than placebo, sildenafil, tadalafil, paroxetine, and dapoxetine.

Primary retroperitoneal teratoma in a young woman: a case report.

Teratomas are usually seen in gonads but they do occur in other extra gonadal regions such as sacrococcygeal region, mediastinum, head and neck, and retroperitoneum. Rarely in the retroperitoneal area, such tumours mostly develop in the pararenal area and usually on the left side. They have bimodal presentation at the age of six months and then in early adulthood. They originate from the germ cells that have failed to migrate to normal anatomical destinations. Many of such patients are diagnosed incidentally. Here, we report a case of symptomatic primary retroperitoneal mature teratoma in a young lady managed at Pakistan kidney and Liver Institute, Lahore.