Clinicopathological patterns of bladder carcinoma over 1 year: experience from University Hospital of Nepal.

PURPOSE: To define the clinical and pathological patterns of urinary bladder carcinoma from the University Hospital of Nepal. METHODS: This is a retrospective analytical study. Patients with bladder mass who underwent surgery over 1 year and who had data record were included in the study. Demographic profile, type of surgery, findings on clinical examination, cystoscopy findings, histopathological report, tumor stage, and post-surgery adjuvant therapy were analyzed. RESULTS: Out of 86 patients who underwent transurethral resection of bladder tumor, 77 patients had biopsy-proven malignant bladder tumor. Urothelial cancer was present in 96.1%. Male were 78.6%. The mean age of diagnosis was 65.5 ± 11.8 years. Non-muscle-invasive bladder cancer (NMIBC) was 3.7 times more common than muscle-invasive bladder cancer (MIBC). High-grade tumors (58.6%) were more common than low grade (41.4%). The detrusor muscle was present inthe biopsy specimen of 48 patients (64%). Re-TURBT within 2-6 weeks was considered based on histopathology reports for about half of the patients (45.3%). Upstaging and upgrading of the tumor was present in 5.8 and 5.8% of the patients, respectively. Residual tumor without upstaging and upgrading was present in 23.5%. One patient (1.3%) had Clavien-Dindo grade 1, three (4%) patients had grade 2 and two patients (2.7%) had grade 3b. CONCLUSION: In the present study, patients with bladder cancer are younger than reported in other studies. Smokers are strongly predisposed. The histological pattern is similar to the Western and Asian populations. NMIBC and MIBC occur in proportion to that described as in other studies. We had a lower rate of recurrence, upstaging and upgrading. We had a lesser rate of acceptance for radical cystectomy in our patients.

Renal Metastasis of Osteosarcoma with IVC Thrombus.

Renal metastasis from osteosarcoma is a rare entity, and tumour thrombus is even rarer. To date, only 15 cases of osteosarcoma with tumour thrombus have been reported in the literature. We present a case of an 18-year-old female diagnosed as having right distal femur osteosarcoma, later presenting with renal osteosarcoma with IVC thrombus.

Myxoid liposarcoma of bladder: a rare case.

INTRODUCTION: Myxoid liposarcoma of the bladder is a rare mesenchymal tumor which is difficult to diagnose and carries a poor prognosis. The primary treatment is complete surgical resection which is usually followed by adjuvant chemotherapy. PRESENTATION OF CASE: We report a case of 26 years female who presented with a large abdominal mass and was initially misdiagnosed to be arising from ovaries and subsequently discovered to be a mesenchymal tumor arising from the bladder. DISCUSSION: Myxoid liposarcoma is an exceedingly rare but aggressive mesenchymal tumor of the bladder often with misleading imaging appearances. CONCLUSION: Surgical resection, when feasible, plays the leading role in its management, and should be attempted in all potential patients.

Intra-abdominal mass with empty scrotum in adult male.

Cryptorchidism is one of the most common congenital anomaly affecting new born males. Early identification and management at 6-12 months is recommended. Occasionally adult male can present for the first time with intra-abdominal mass with empty ipsilateral scrotum. These tumors may present at advanced stage and management may be challenging at times.

Isolated renal hydatid cyst: A rare case report.

Hydatid disease in developing countries like Nepal is not uncommon but isolated renal involvement without liver and lung hydatid is rarely described in literature. It may create diagnostic dilemma at times. We describe a 22-year-old female with isolated renal hydatid disease managed with nephron sparing surgery (NSS).

Gestational choriocarcinoma presenting with bilateral kidney and lung metastases with unknown primary: An uncommon clinical scenario.

Gestational choriocarcinoma with kidney and lung metastases with delayed presentation after term pregnancy is rare event and not described frequently in literature. We describe a rare case of 24-year-old female with hematuria after 3 years of term delivery. Management includes chemotherapy and even renal embolization in case of life threatening hematuria.

Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial.

INTRODUCTION: Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. METHODS: This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. RESULTS: Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. CONCLUSION: Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.

Segmental renal artery and popliteal artery embolism in an adult patient with rheumatic heart disease and atrial fibrillation: A case report.

INTRODUCTION: Renal artery embolism is uncommon cause of flank or back pain. Of all embolic episodes in patients with atrial fibrillation, 2-4% are renal artery embolism. Early thrombolysis within 90 min has favorable renal outcome. Long term anticoagulation can prevent recurrent embolic episodes. Two different embolic phenomenon within short span in same patient is not described in literature. PRESENTATION OF CASE: We describe fifty-year-old female with rheumatic heart disease with atrial fibrillation presented as renal segmental artery emboli with popliteal artery emboli within seven-day interval. DISCUSSION: Embolic phenomenon is well known in atrial fibrillation. High index of suspicion in patient with risk factors of thromboembolism with appropriate use of contrast enhanced computed tomography can help early diagnosis. Renal artery embolism is managed with anticoagulation or thrombolysis based on duration of presentation. Peripheral artery embolism can be diagnosed with Doppler ultrasonography. Thrombus can be removed with endovascular procedure or open surgical technique. Holistic patient management includes cardiac workup and treatment of factors predisposing to embolization. CONCLUSION: Early identification and urgent treatment is key to the management of embolic episode in patient with atrial fibrillation. Long term prophylaxis can prevent further episodes.

Pediatric kidney transplantation in Nepal.

BACKGROUND: Success in pediatric kidney transplantation is great achievement for the emerging countries. This report is the first of its kind from Nepal. It demonstrates the status of pediatric kidney transplantation in Nepal. METHODS: This is a retrospective review of transplants done in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Living donor kidney transplant recipients ≤17 years transplanted till September 2018 were included. Demographic data, renal function, rejections, and other complications recorded in the charts were noted. Descriptive analysis was done in September 2018. RESULTS: A total of 517 living donor kidney transplants were done till September 2018 since August 2008. Twenty-three were ≤17 years. Eighteen (78.26%) were male. Mean ± SD age was 15.35 ± 1.7 years, and weight was 41.8 ± 9.8 kg. One received ABO-incompatible transplantation. Fifteen (65.22%) donors were female, 14 (60.87%) were mothers, and seven were fathers (30.43%). Mean donor age was 40.21 ± 8 years. Patient and graft survival at 1 year were 100% and 89.2%, respectively. One patient died on dialysis in second year after graft failure due to FSGS. One is on dialysis after losing graft to oxalate nephropathy. Three (13.3%) had biopsy-proven acute rejections. Two had acute cellular rejection, and 1 had antibody-mediated rejection. CONCLUSIONS: Children from poor countries are also entitled to the benefits of medical advancements.

Reduction of length of hospital stay after transurethral resection of prostate by early catheter removal: a retrospective analysis.

The aim of this study was to determine whether early catheter removal after transurethral resection of prostate significantly reduces the length of hospital stay. Fifty two consecutive patients who underwent transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patient's profile and all relevant data were noted from charts. The length of hospital stay was registered in days. These patients were divided into two group; Group I (n=20) includes patients whose catheter was removed within 2 days of operation and group II (n=32) includes beyond 2 days. Various parameters were analyzed in between the groups using statistical package for social sciences (SPSS) for Windows. The demographics of the patients, pre-operative morbidities and immediate post-operative complications in both groups were comparable. There was statistically significant difference noted in duration of resection, weight of resected prostatic tissue, catheter removal and length of hospital stay between group I and group II. Length of hospital stay strongly correlates with days on which catheter was removed. Further, correlation was found between the catheter removal and the weight of resected prostatic tissue; but not with duration of resection. In conclusion, early catheter removal significantly shortens the length of hospital stay, which not only helps the authorities for efficient bed management, but also saves cost. The weight of resected prostatic chips and duration of resection are few peri-operative factors which can guide for effective catheter management after TURP.