A rare case of uterine torsion with juvenile granulosa cell tumor in the pediatric patient Juvenile granulosa cell tumors (JGCT) of the ovary are rare sex cord-stromal ovarian tumors that are typically diagnosed during the first two decades of life. Most patients present with precocious puberty in the early stages of disease. We present a rare case of asymptomatic uterine torsion from a 15-centimeter JGCT in a 5-year-old girl with elevated inhibin B, breast development, vaginal bleeding and a palpable right-sided abdominal mass.
Left Kidney Within a Large Left Inguinal Hernia The patient is an 86-year-old male who presented with hematuria and discoloration of his left hemiscrotum. He had a past medical history significant for atrial fibrillation on apixaban, coronary artery disease, hypertension, diabetes, and a repaired 8-cm abdominal aortic aneurysm. He had recently been successfully treated for a urinary tract infection. He also had history of inguinal hernia for over three years for which he had consulted a general surgeon who recommended observation in view of the patient's multiple comorbidities and absence of symptoms.
Reply to: Letter-to-the-editor: Understanding the popcorn effect during holmium laser lithotripsy for dusting We thank the authors for their interest in our study. Our fundamental finding was that increasing the pulse frequency and the overall power led to significantly more fragmentation during popcorning. This was similar to what was also reported by Emiliani and colleagues.1 Moreover, we found that increasing the distance between the fiber tip and the stone decreased fragmentation. As noted, figure 2 showed that the percentage of submillimeter fragments when utilizing 40Hz and 80Hz at 0.5J was 67% and 73%, respectively.
Examining Trends in Underrepresented Minorities in Urology Residency To examine trends in underrepresented minority (URM) representation in urology residency. Comparison is made between URM representation in urology residency and URM representation in other surgical fields as well as all medical fields. We hypothesized that percentage of URM in urology has been limited when compared to both surgical fields and all other fields.
Malignant renal solitary fibrous tumor with two local recurrences and distant pulmonary metastasis A 53-year-old man presented to our hospital with right upper quadrant (RUQ) pain alongside nausea and vomiting. Physical examination revealed RUQ tenderness, Murphy sign, and fever. He otherwise had no significant past medical or surgical history. Subsequent abdominal ultrasound showed signs of cholecystitis and an incidental lobulated hypoechoic mass of the left kidney with heterogeneous echotexture and hypervascularity on Doppler. The patient had a cholecystectomy without complications during the postoperative period.
Rare Abdominal Cutaneous Presentation of Clear Cell Renal Cell Carcinoma: A Case Report Cutaneous metastasis from renal cell carcinoma is rare, typically involves the head and neck, and occurs in late stage disease, usually in the context of previously diagnosed and treated primary tumour, and after lymphatic spread.This patients’ initial presentation of clear cell renal cell carcinoma was a cutaneous lesion to the ipsilateral abdominal wall. The primary renal tumour was subsequently demonstrated on CT; this also showed no apparent lymph node involvement despite cutaneous metastatic disease.
BCG Renal Granuloma A 66-year-old gentlemen with a history of recurrent urothelial carcinoma in situ treated with endoscopic resection and induction BCG developed a new renal mass on surveillance computerized tomography (CT) and was referred to our institution for surgery. Biopsy was performed and pathology showed BCG granuloma. The patient was clinically asymptomatic. No surgical intervention was required. This is a rare entity in those undergoing intravesical BCG therapy. To avoid unnecessary surgery, a careful patient history and judicious use of renal mass biopsy is critical.
Medial Renal Ptosis: First Radiographic Documentation With Computed Tomography Medial renal ptosis is the abnormal mobility of the kidney towards or across the midline of the body. Historically, this phenomenon is evaluated by observing abnormal mobility in the lateral decubitus position during intravenous pyelography. Here, we present the first radiographic documentation of this anomaly on computed tomography on a 34-year-old female who experienced an intermittent abdominal bulge over her right upper quadrant. Nephropexy is the definitive treatment for symptomatic patients.
Botryoid Wilms Tumor: A Rare Diagnosis With an Atypical Presentation Wilms tumor commonly presents as an asymptomatic abdominal mass. In some cases, it can be accompanied with hypertension, constitutional symptoms, and hematuria when involving the collecting system. Below, we review the case of a child diagnosed with botryoid Wilms tumor involving the upper calyces and renal pelvis in which the presenting symptom was a concern for a foreign body in her left ear, and the only abnormality during initial history and physical examination was stage II hypertension.
What Would a Suprapubic Catheter Indwelling for 4 Years Be Like? A Case Report A 35-year-old male of 165 cm height and weight of 65 kg, had a suprapubic catheter indwelling for 4 years without replacement for urethral stricture. The catheter became gradually obstructed, and urine leaked out around the suprapubic catheter. A lumbar abdominal distension, an inferior abdominal mass and renal failure prompted him to seek medical attention in our hospital in September 2018. This clinical case is hereby presented from 3 aspects of imaging, lab examination, and operation.
Magnetic-assisted Robotic Surgery to Facilitate Reduced-port Radical Prostatectomy Tissue retraction during minimally-invasive urologic surgery currently is achieved by either gravity via patient positioning or placement of additional ports for robotic arms or bedside assistant instrumentation. A novel magnetic retractor system (Levita Magnetic Surgical System, San Mateo, CA) was recently approved by the Food and Drug Administration for use in minimally invasive surgery.
Crossing Into the Unknown. A Peculiar Cause of Ureteropelvic Junction Obstruction in a 14-Year-Old Boy Ureteropelvic junction obstruction (UPJO) is a common cause of upper urinary tract obstruction and consequent hydronephrosis. We present a case of right UPJO caused by a crossing vessel suspected to be the right second lumbar vein. While crossing vessels are a common cause of UPJO in older children and adults, they are usually attributed to lower pole vessels. We believe that this is the first case report of UPJO caused by a lumbar vein. Recognition of crossing vessels requires knowledge of variant vasculature anatomy around the kidneys.
Predictors of Recurrence and Complications in Pediatric Pyeloplasty To assess the predictors of recurrence and complications, we retrospectively analyzed our experience in primary pediatric pyeloplasty. Management of pyeloplasty failure is challenging both for patients and for surgeons, especially in pediatric cases. Early detection of recurrence and early manipulation may help preserving renal function.
Ex-vivo Imaging of Upper Tract Urothelial Carcinoma Using Novel ICG-Var3 pHLIP Imaging Agent To improve visualization of upper tract urothelial carcinomas (UTUC). Previous studies using the novel pH low insertion peptide (pHLIP) variant 3 (Var3) conjugated to indocyanine green (ICG) have demonstrated high sensitivity and specificity for imaging of bladder urothelial carcinoma. Here, we describe a novel approach for the imaging of UTUC using ICG-Var3 pHLIP.
Metachronous Isolated Splenic Metastasis in a Young Patient With Renal Cell Carcinoma: Case Report and Literature Review Splenic metastasis is uncommon and is usually associated with widespread disease.1,2 Isolated splenic metastases from renal cancer are also rarer and are often an incidental finding. This eventuality may turn into a dangerous scenario due to a spontaneous splenic rupture leading to sudden death.2,3 At the best of our knowledge, only few cases of metastasis from renal cell carcinoma (RCC) have been documented in the literature.4-11 We hereby present a literature review of these cases and report a case of isolated splenic metastasis in a young man on active follow-up for a clear cell RCC clear cell Renal Cell Carcinoma (ccRCC).
Uncovering a Novel Stone in 27 Patients: Calcium Tartrate Tetrahydrate To further analyze calcium tartrate tetrahydrate stones after a recent case report described this novel stone. Prior to this, there was only one previously reported occurrence of this stone in a human. This unusual stone composition is not tested for routinely. True prevalence and possible causes of this stone are unknown.
Minimally-Invasive Ureteral Reconstruction for Ureteral Complications of Kidney Transplants To present the technique, feasibility and results of minimally-invasive reconstruction of the transplanted ureter using the native ipsilateral ureter in post-transplant ureteral strictures and vesicoureteral reflux (VUR) causing graft pyelonephritis. Ureteral complications after kidney transplantation represent a significant cause of morbidity potentially leading to graft dysfunction or loss.
The Urinary Microbiome: Implications in Bladder Cancer Pathogenesis and Therapeutics Recent investigation has proven that the bladder is not sterile. However, the implications of this finding in the pathophysiology and management of urothelial cell carcinoma have not been fully described. In this review, we summarize the literature relating to the urinary and gastrointestinal microbiomes in the context of urothelial cell carcinoma. The bladder microbiome may relate to urothelial cell carcinoma pathogenesis/progression, act as a noninvasive and modifiable urinary biomarker and have implications in treatment using immunotherapy agents such as intravesical bacillus Calmette-Guerin.
A Case of Primary Paratesticular Wilms Tumor in an Undescended Testis Extrarenal Wilms tumor is rare. We describe the first reported case of primary paratesticular extrarenal Wilms tumor with regional metastasis in 8-month old male with left undescended testis. Patient underwent left radical orchiectomy with regional lymph node excision. The inguinal node and paratesticular mass demonstrated the classic Wilms triphasic pattern, stained positively for WT-1 and demonstrated no loss of heterozygosity of chromosomes 1p and 16q. Work-up was negative for primary renal Wilms tumor or distant metastasis.
Primary Urethral Melanoma: A Case Report and Literature Review Patients with localized urethral melanoma have a high risk of recurrence and poor disease-specific survival. Multi-disciplinary approach including surgery, radiation therapy, and chemotherapy/immunotherapy is needed to maximize survival. Current research efforts include investigation of novel tyrosine kinases as well as the combination of targeted therapies with immunotherapies in this population. Combinations may provide a synergistic effect to overcome various obstacles to disease response.
Adult Wilms Tumor During Pregnancy: Case Report and Literature Review Adult Wilms tumor (WT) is a well-known, albeit rare entity and has historically been associated with worse overall clinical outcomes when compared to younger patients. Because WT is uncommon in adult patients, it is often misdiagnosed and treated off standardized pediatric protocols. WT associated with pregnancy is even more rare, and there is not a standardized approach to this small subset of patients. We present a case of an adult WT discovered and managed during the perinatal period and review prior published cases.
Acute Testicular Segmental Infarct Following Endovascular Repair of a Juxta-renal Abdominal Aortic Aneurysm: Case Report and Literature Review A 61-year-old male presented to our Accident & Emergency department with a 3-day history of nausea and vomiting. On examination, he had a soft non-tender abdomen but pronounced pulsation of his abdominal aorta. A computed tomography angiogram revealed a 6 cm juxta-renal abdominal aortic aneurysm with thrombus within the aneurysm sac and juxta-renal neck segment. There was also moderate atherosclerotic change of the common, internal, and external iliac arteries bilaterally. Given the lack of a suitable infrarenal sealing zone for the stent graft, he underwent a complex endovascular aortic aneurysm repair using a stent graft (Cook Medical, Limerick, Ireland) with suprarenal coverage with 4-vessel fenestrations (coeliac axis, superior mesenteric, and left and right renal arteries).
Dermatofibrosarcoma Protuberans in a Male Infant Dermtofibrosarcoma protuberans is a rare cutaneous malignancy known to be locally aggressive. It is uncommonly seen in the pediatric population and can be difficult to distinguish from other benign skin lesions. We present a case of dermatofibrosarcoma protuberans of the penis in a 6-month-old child managed with surgical resection. This case highlights the challenges of diagnosis of genital lesions in children and the complexities of genitourinary reconstruction following surgical resection.
Testosterone Therapy for High-risk Prostate Cancer Survivors: A Systematic Review and Meta-analysis A systematic review and meta-analysis were performed to determine the relationship between testosterone therapy and the risk of recurrence in testosterone-deficient survivors of curatively treated high-risk prostate cancer. Primary outcome was the risk of biochemical recurrence (BCR) in 109 high-risk patients in 13 included studies (1997-2017). Biochemical and symptomatic effects of therapy were also reviewed. The BCR rate was 0.00 (0.00-0.05), lower than the expected rate for high-risk prostate cancer survivors, suggesting that testosterone therapy may not increase their BCR risk.
The Prognostic Value of PIK3CA Copy Number Gain in Penile Cancer To determine whether phosphatidylinositol-4,5-bisphosphate 3- kinase, catalytic subunit alpha (PIK3CA) copy number gain in penile cancer has prognostic value and association with histopathological parameters, human papillomavirus (HPV), and clinical outcome.
Dual Pathology Causing Congenital Bladder Outlet Obstruction Anterior urethral syringocele is an uncommon congenital deformity characterised by cystic dilatation of bulbo-urethral gland ducts and is usually asymptomatic. We present a case on 4-day-old male neonate who presented with bilateral antenatal hydroureteronephrosis and renal impairment and found to have urethral syringocele and posterior urethral valves (PUV).
Author Reply The comments of the editor truly reflect the findings of our study on the surgical treatment of giant penoscrotal lymphedema. All the 19 patients described in the study were to be treated by surgery. Eight patients, however, defaulted, possibly because of their belief in alternative traditional herbal medicine and or financial constraint, because health insurance schemes are yet to be fully established in our environment.
WITHDRAWN: Stented or Unstented Distal Hypospadias Repair The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2017.04.057. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
WITHDRAWN: Reply The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2015.08.053. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
WITHDRAWN: Editorial Comment The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2013.02.086.The duplicate article has therefore been withdrawn.
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