"Extreme Nephroptosis": A Kidney in the Inguinal Hernia.

We present an extremely rare case of renal ptosis from the normal orthotopic position into the cavity of inguinal hernia in a 93-year-old male patient. The following clinical case was accompanied by renal insufficiency, which was associated with the obstruction of the right ureter in the hernial sac and the stenosis of the left renal artery. The differential diagnosis between nephroptosis and dystopic kidney was based on MDCT scan images, which demonstrated the length of the right renal artery to be more than 20 cm. The patient underwent percutaneous nephrostomy through the right inguinal area and was successfully followed up for two years. We also analyzed six similar clinical cases described in the literature. This disease has, thus far, been observed exclusively in elderly men with long-standing and large inguinal hernias. The most frequent complications in these patients include ureteral strangulation in the area of the hernial gate and renal failure.

Comparison of four transdiaphragmatic approaches to remove cavoatrial tumor thrombi: a pilot study.

Introduction: Surgical treatment of kidney cancer with a tumor thrombus spreading through the inferior vena cava (IVC) up to the right atrium remains a challenge.The aim of this article was to 1. assess the safety and feasibility of four transdiaphragmatic surgical approaches to the right atrium from the abdominal cavity; 2. to evaluate the feasibility of palpation and displacement of thrombi below the diaphragm. Material and methods: Four cadaveric specimens preserved with the Thiel method to assess each surgical access: 1) extrapericardial T-shaped diaphragmotomy, 2) extrapericardial T-shaped + circular diaphragmotomy, 3) transpericardial T-shaped diaphragmotomy with longitudinal pericardiotomy, 4) transpericardial T-shaped + circular diaphragmotomy with longitudinal and circular pericardiotomy.Different diameters and density of tumor thrombus simulators, placed at various levels from the cava-diaphragm junction, were used to evaluate the palpation and displacement of the thrombus. Two surgeons performed each assessment independently. Results: Approaches 2, 3 and 4 were significantly better than approach 1, regarding the feasibility of palpation, according to both surgeons (surgeon 1 Chi-square 21.56, p = 0.001; surgeon 2 Chi-square 27.83, p <0.0001). Approach 1 also showed a significant higher number of impossible displacements recorded by both surgeons (surgeon 1 Chi-square 19.02, p = 0.004; surgeon 2 Chi-square 20.01, p = 0.003). Only surgeon 1 recorded a significant lower number of easy palpations at 4 cm from the cava-diaphragm junction (Chi-square 14.10, p = 0.007). There were no high-risk complications in any approach. Conclusions: The transdiaphragmatic access to the right atrium from the abdominal cavity is feasible using three of the four surgical approaches. They are an adequate alternative to sternotomy.

Structure Types of Kidney Stones and Their Susceptibility to Shock Wave Fragmentation.

BACKGROUND: The modern approach in the treatment of urolithiasis involves the use of non-invasive and minimally invasive techniques based on the stone fragmentation, among which shock wave lithotripsy (SWL) is considered as the first-line treatment for kidney stones < 2 cm and proximal ureter stones. OBJECTIVE: To study the microstructure and mineral composition of kidney stones and to evaluate their influence on the stones' susceptibility to fragmentation by shock waves. METHODS: The microstructure and mineral composition of kidney stone samples obtained from shock wave lithotripsy in 87 patients were studied using crystal optical analysis and infrared spectroscopy. The volume fraction of amorphous and crystalline phases of the stone composition, the quantitative and qualitative composition of mineral components were assessed. The fragmentation features of stones with different microstructure were retrospectively analyzed based on the total number of shock waves required for complete stone fragmentation. RESULTS: Three kidney stone structure types were identified: amorphous-crystalline structure stones predominantly including the amorphous phase (type A); amorphous-crystalline structure stones predominantly including the crystalline phase (type B); fully crystalline structure stones (type C). Significant positive correlation between the total number of shock waves required for complete stone fragmentation and the volume fraction of crystalline phase was found. CONCLUSION: The structure type of kidney stones is determined by the volume ratio between the amorphous and crystalline phases of their composition. The amorphous-crystalline structure stones with the predominant content of the amorphous phase are more sensitive to shock-wave exposure. The increase in the volume fraction of crystalline phase in the stone structure reduces the stone's susceptibility to fragmentation by shock waves.

Organization of urological care for patients with iatrogenic ureteral injury.

OBJECTIVE: Introduction: We conducted a retrospective assessment of diagnostic and therapeutic approaches in patients with iatrogenic ureteral injury, who were treated in a specialized medical center. The aim: The aim of the research was to determine the optimal treatment method for correction of iatrogenic ureteral defects. PATIENTS AND METHODS: Materials and methods: The study included 73 patients with iatrogenic ureteral injury. In 70 cases ureteral reconstruction was carried out with the help of Boari bladder flap. The effectiveness of this approach was assessed retrospectively by analysis of the complications and long-term results of the treatment. RESULTS: Results: The length of the bladder flap varied from 3 to 21 cm and averaged 9.8 ± 1.4 cm. In 6 (8.2%) cases a successful reconstructive surgery of the ureter up to the level of its upper third was performed. The overall frequency of intraoperative complications did not exceed 12.9%. The total frequency of early postoperative complications was high (75.8%), however, they were not severe and required surgical correction only in one (1.4%) case. The total number of positive long-term results (good + satisfactory) amounted to 91.5%. Nephrectomy was required only in 2 (2.3%) cases. CONCLUSION: Conclusions: The Boari bladder flap operation should be considered as the basis of the algorithm for providing medical care to patients with iatrogenic ureteral injury. This type of surgery makes it possible to completely replace the damaged or having doubtful blood supply portion of the ureter even with the defects extending to its upper third. The main advantages of this surgery technique are good blood supply of tubularized bladder flap and a high level of positive long-term results.

Fetus in the Bladder: Rare Complication of Vesicouterine Fistula.

The work presents a rare case of spontaneous migration of an 11-week fetus from the uterine cavity into the urinary bladder cavity through the long-standing vesicouterine fistula.

Surgical Approaches to Supradiaphragmatic Segment of IVC and Right Atrium through Abdominal Cavity during Intravenous Tumor Thrombus Removal.

Objective. The purpose of this study was to investigate safety and feasibility of some surgical approaches to the supradiaphragmatic inferior vena cava (IVC) and the right atrium through the diaphragm from the abdominal cavity. Materials and Methods. The material of the anatomical study included 35 fresh cadavers. Several options of surgical access to the supradiaphragmatic IVC were successively performed. Feasibility and risk level of each of the approaches were evaluated with the use of a special scale. Results. The isolation of the supradiaphragmatic IVC and cavoatrial junction was most easily performed via T-shaped or circular diaphragmotomy (grade "easy" was registered in 74.3% and 80% of patients, resp., compared to 31.4% for transverse diaphragmotomy and 40% for isolation of the IVC in the pericardial cavity). The risk analysis has demonstrated the highest safety level for T-shaped diaphragmotomy (grade "safe" was registered in 60% of cases). The intervention via transverse diaphragmotomy, circular diaphragmotomy, and IVC isolation in the pericardial cavity was graded as "risky" in 80%, 62.9%, and 82.9% of cases, respectively. Conclusions. In our opinion, T-shaped diaphragmotomy is the most safe and easy-to-perform access for mobilization of the supradiaphragmatic IVC through the abdominal cavity.

Formation of a Tunnel under the Major Hepatic Vein Mouths during Removal of IVC Tumor Thrombus.

THIS STUDY DESCRIBES A CLINICAL OBSERVATION OF SUCCESSFUL IMPLEMENTATION OF A NEW SURGICAL MANEUVER: formation of a cross tunnel under the mouths of the major hepatic veins during removal of a tumor thrombus of the inferior vena cava. This surgical technique helps avoid the usage of "piggyback" mobilization of the liver and the complications associated with it. However, for objective evaluation of this approach, a further clinical study is required.