Management of neglected and fragmented DJ stent with severe encrustation and stone: A case report.

INTRODUCTION AND IMPORTANCE: DJ stents are widely used in urological procedures and interventions. One of the main problems associated with DJ stent is encrustation and stone formation. The main risk factor for Forgotten, encrusted and calcified (FECal) stent is duration of the stent placement. In addition to high index of suspicion, Imaging like U/S and CT scan are important diagnostic modality. Multiple endourologic and open procedure may be needed for management of fecal stent. CASE PRESENTATION: This case report is to discuss a 23 years old female patient with a neglected stent after right pyelolithotomy was done 6 years back. The presence of the stent was identified incidentally after she visited local health facility for recurrent LUTS. The CT scan shows fragmented and encrusted stent with in the bladder and pelvis, stones in stent coils and isolated lower pole stone. She was managed by a procedure of cystolithotomy and right PCNL in separate sessions. CLINICAL DISCUSSION: Common complication of DJ stent placement especially if left for long duration is encrustation, stent migration, fragmentation and stone formation. Patient or relatives unawareness about the stent placement is the most important cause for neglecting stent. Multiple Endourologic procedures may be needed for the management of FECal stent. However some resource limited settings do combination of endourologic and open surgery. CONCLUSION: Minimizing the duration of the stent especially for patient with risk factors is advised to decrease encrustation. Since management of FECal stent is challenging both for patient and urologists, prevention is the way to tackle it. Multiple procedures may be required to manage FECal stent.

A case report on pyelovesicostomy of PUJO of pelvic crossed fused renal ectopia with single ureter.

INTRODUCTION: A pyelovesicostomy is a rare procedure that offers an alternative to difficult pyeloplasty or failed pyeloplasty in the case of PUJO of pelvic renal ectopia. In this case report, we utilized pyelovesicostomy for a dilated renal pelvis of a crossed fused ectopic pelvic kidney with a single ureter. CASE PRESENTATION: This is a 19-year-old male patient who received a diagnosis of pelvic ectopic kidney disease of 4 years duration. He was on a periodic DJ-stent exchange every 3 months at a different hospital. Upon presentation, the patient complains of pain in the right lower quadrant and a decrease in urine output. On physical examination, a palpable mass is detected in the right lower quadrant. The laboratory reveals an elevated creatinine level of 2.3 mg/dl. He was admitted with a diagnosis of acute kidney injury and a crossed fused ectopic pelvic kidney with Pelvic-Ureteric Junction Obstruction and a migrated Double-J stent. Initially, a semi-rigid ureteroscope guided the migrated DJ-stent, which was successfully removed and a new one was inserted. Later, an open surgery with a pyelovesicostomy was performed. Subsequently, the patient improved and was discharged. DISCUSSION: Pyelovesicostomy is an ideal treatment option for pelvic ureteral junction obstruction in congenital pelvic kidneys. The pyelovesicostomy should not be prone to strictures at the anastomotic site as long as it makes wide anastomosis, and the free reflux that results from the surgery shouldn't impair renal function. CONCLUSION: Pyelovesicostomy is feasible, safe, and a potential treatment option for congenital-ectopic pelvic kidney with ureteric obstruction.

Detection and management of a case of single system ectopic ureteral insertion to vagina with atrophic ectopic kidney.

INTRODUCTION AND IMPORTANCE: Ectopic ureter is defined as any ureter, single or duplex, that opens in a location other than trigone of bladder. Continuous urine leakage and regular intentional voiding must point to the diagnosis of an ectopic ureter, particularly in females (Singh et al., 2022). Following successful repair of ectopic ureter, the overall long-term continence rate is satisfactory. CASE PRESENTATION: This case is reported to discuss a case of 24 yrs. old woman presenting with a complaint of insensible continuous urinary leak with normal intentional voiding since childhood. Ultrasound and CTU showed left solitary kidney with normal insertion of its ureter; but failed to demonstrate right system. MRI showed Right EU with ectopic dysplastic right kidney. Renal scintigraphy was unavailable at the time of evaluation and IVP was suggestive of NEK. Nephroureterectomy done. Her subsequent follow up was satisfactory. CLINICAL DISCUSSION: Because many people with EU are asymptomatic and the diagnosis is frequently missed, the prevalence of EU is uncertain. Preferred mode of diagnosis is pelvic MRI. Ureteral duplication accounts for 80 % of ectopic ureter occurrences in women (Demir et al., 2015). Ectopic ureters draining a single-system ectopic ureter with dysplastic kidneys, on the other hand, are uncommon, particularly in females (Amenu et al., 2021) Despite this rarity, we have found single system with atrophic kidney. CONCLUSION: This instance suggests to us that in cases of urinary incontinence especially in women, congenital anomalies of the genitourinary tract should be taken into consideration. Surgical management depends on the degree of renal function and location of EU. Either nephroureterectomy or ureteric reimplantation are curative for incontinence.

A case report on the management of neglected and forgotten DJ stent for 15 years with severe encrustation and multiple renal and bladder stones.

INTRODUCTION AND IMPORTANCE: The placement of ureteral DJ stents is currently regarded as a common and indispensable urologic tool (Dyer et al., 2002 [1]). However, using them can lead to complications. Infection, stent migration, encrustation, stone formation, and stent fragmentation are some of these complications (Mahmood et al., 2018 [2]). Stent-related complications are inversely associated with time (Lombardo et al., 2022 [3]). In this case report, we present multimodal therapy, which also includes open surgery and endourologic procedures for the removal of severely encrusted DJ stents. CASE PRESENTATION: A 22-year-old male who underwent nonspecific flank surgery 15 years ago, had a stent placed, and was lost to follow-up. He had severe stent encrustation at the presentation. He also had a solitary bladder stone and many pelvic stones discovered. Initially, cytolithotrity and semirigid ureteroscopy with laser lithotripsy were performed, and the encrusted stent was removed. Subsequently, an open cytolitotomy was done. Followed by an ultrasound-guided PCNL at which time the remaining stones were removed. The patient was followed for eighteen months and has been in better condition. DISCUSSION: The key risk factor for the development of encrustation has been shown repeatedly to be the duration of stent indwelling time (Lombardo et al., 2022 [3]). In the absence of clear guidelines for the removal of retained stents, this problem has been approached with a variety of treatment modalities (Bidnur et al., 2016 [4]). A stepwise approach with combined endo-urology and open surgery can be used for the management. CONCLUSION: Forgotten and neglected DJ stentsfor a long time can cause multiple complications. The best treatment is the prevention of this complication with a stent registry and increase awareness among the patients and their attendants.

A case report on the atypical presentation of Renal tuberculosis as emphysematous pyelonephritis.

INTRODUCTION AND IMPORTANCE: Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection, that causes gas to build up in the collecting system, renal parenchyma, and perirenal tissues (Mahmood et al., 2020). Uncontrolled diabetes mellitus and urinary tract obstruction are the two main risk factors. We report the second case report of tuberculosis as a causative pathogen of EPN. CASE PRESENTATION: In this case report, a 60-year-old lady with poorly controlled type 2 diabetes was admitted to the emergency room due to left flank pain, a low-grade temperature, nausea, and vomiting. Emphysematous Pyelonephritis was diagnosed based on gas seen in the renal parenchyma on a CECT scan (EPN). She underwent conservative management, including the insertion of a nephrostomy tube and antibiotics. There is no growth detected in the nephrostomy drain's culture. She underwent a simple nephrectomy after deciding that she had not improved clinically after receiving conservative treatment. A biopsy of the specimen revealed a tuberculosis abscess. She received the proper care and made clinical progress over the course of a six-month anti-TB medication regimen. CLINICAL DISCUSSION: The majority of EPN patients are female (2:1) and diabetic (90 %) with a mean age of presentation of 55 years (El Rahman et al., 2011). The preferred method of diagnosis for EPN is CT (El Rahman et al., 2011). E. coli, Klebsiella, and Pseudomonas were the most prevalent species in many of the reported cases (Khaira et al., 2009). In contrast to prior investigations, we discovered a case of EPN caused by tuberculosis invasion. CONCLUSION: An essential lesson to learn from such cases is the importance of considering genitourinary tuberculosis when emphysematous pyelonephritis does not improve with conservative treatment, especially in areas with a high tuberculosis endemicity.

Evaluation of augmented reality technology in global urologic surgery.

BACKGROUND: The COVID-19 pandemic drastically reduced opportunities for surgical skill sharing between high-income and low to middle-income countries. Augmented reality (AR) technology allows mentors in one country to virtually train a mentee in another country during surgical cases without international travel. We hypothesize that AR technology is an effective live surgical training and mentorship modality. METHODS: Three senior urologic surgeons in the US and UK worked with four urologic surgeon trainees across the continent of Africa using AR systems. Trainers and trainees individually completed post-operative questionnaires evaluating their experience. RESULTS: Trainees rated the quality of virtual training as equivalent to in-person training in 83% of cases (N = 5 of 6 responses). Trainers reported the technology's visual quality as "acceptable" in 67% of cases (N = 12 of 18 responses). The audiovisual capabilities of the technology had a "high" impact in the majority of the cases. CONCLUSION: AR technology can effectively facilitate surgical training when in-person training is limited or unavailable.