Bojeho9846

Background The inability to remove an indwelling urethral catheter in a postrobot-assisted laparoscopic radical prostatectomy (RALP) patient constitutes a serious problem to the urologist. Proteasome inhibitor If the proper deflation of the catheter balloon is not observed, forcible extraction can lead to devastating consequences such as urethral disruption and subsequent stricture formation. Case Presentation A 60-year-old male patient developed lower urinary-tract symptoms 20 months after robotic prostatectomy for early prostate cancer. Cystourethroscopy revealed a migrated Hemo-lok clip that was extracted near the anastomotic site, followed by insertion of an indwelling Foley catheter. Two weeks later, the patient accidentally pulled the catheter into the urethra. Several attempts were done to deflate the catheter, which failed. Subsequently, a transrectal ultrasound (TRUS)-guided transperineal puncture was done to deflate the catheter balloon followed by effective catheter removal. Conclusion TRUS-guided transperineal puncture (under local anesthesia) of an indwelling catheter balloon is a viable alternative for patients who have a history of RALP.Background Renal mass biopsy (RMB) is an increasingly utilized modality in the work-up of patients with suspicious renal masses. Recurrence of renal cell carcinoma (RCC) from biopsy tract seeding is exceedingly rare in the literature. We report a case of such a phenomenon. Case Presentation Our patient is a 75-year-old Caucasian man and former smoker with a functionally solitary left kidney, initially worked up for gross hematuria and left flank pain. Imaging revealed hydronephrosis and a left renal mass, which was biopsied. Pathology analysis demonstrated clear cell RCC, and a left robotic radical nephrectomy was performed with negative surgical margins. Sixteen months postoperatively, imaging revealed multiple small masses along the biopsy tract, suspicious for recurrence. These were biopsied and pathology analysis confirmed recurrent clear cell RCC. Conclusion Despite its rarity, biopsy tract seeding is a serious complication of RMB. This warrants thorough counseling and shared decision making between providers and all patients with renal masses planning to undergo a RMB.Here we present the case of a 78-year-old medically comorbid woman with an extremely large bladder stone burden treated by cystolithalopaxy performed using a Swiss LithoClast® Trilogy Lithotripter (Boston Scientific, Marlborough, MA, USA) through a nephroscope traversing a transurethral Amplatz sheath.Background Periureteral venous rings are a rare congenital anomaly involving the inferior vena cava (IVC) and the right ureter, where the ureter courses through a venous ring made by the duplication of the IVC during embryogenesis. This anatomic anomaly is also referred to as a transcaval ureter. Although most patients are asymptomatic and radiographic findings are incidental, some patients can be symptomatic. We present the first reported case of asymptomatic obstructive ureterolithiasis at the level of a periureteral venous ring that was effectively treated with endoscopic management. Case Presentation A 47-year-old woman was found to have right hydroureteronephrosis on MRI. Further CT imaging showed an obstructing ureteral stone at the level of a periureteral venous ring. After initial decompression with ureteral stenting, she underwent ureteroscopy that revealed the ureteral stone at the level of the venous anomaly. The stone was fragmented and removed with laser lithotripsy and stone basket manipulation. After a period of ureteral stenting and removal, she had improved hydroureteronephrosis, no symptoms of ureteral obstruction, and stable renal function. Given these findings, she elected for surveillance with imaging in lieu of any reconstructive procedure to transpose the ureter around the venous anomaly. Conclusions We present the first reported case of obstructive ureterolithiasis at the level of a periureteral venous ring. Our experience suggests that, with preoperative ureteral stenting, obstructing ureteral stones in the setting of an IVC anomaly can be managed with retrograde flexible ureteroscopy. Conservative laser settings and minimal torqueing of the ureteroscope are advised given adjacent vascular anomaly. Cases wherein the affected ureteral segment is too constricted or tortuous to allow for stone passage or for ureteroscopy may require management by percutaneous antegrade intervention. Surgical reconstruction of the ureter should also be considered.Background Intrauterine device (IUD) migration to the ureter is rare. Symptoms can vary, but often mimic renal colic. Radiographic imaging may aid the diagnosis of a foreign body in the ureter. Reports on endoscopic managements of a migrated IUD are not well described. Case Presentation We present a 36-year-old woman with a history of IUD insertion. Her symptoms included hematuria, dysuria, and suprapubic/abdominal pressure. After the removal of her IUD by her gynecologist, her hematuria eventually stopped, but she presented again with persistent pain. CT revealed a radiopaque foreign body in the distal left ureter protruding into the bladder. A careful resection with a resectoscope uncovered a long cylindrical shaped foreign body, suspicious of a broken piece of the IUD. Conclusion Although not always feasible and long-term results remain to be determined, endoscopic management is a safe and effective method of identifying and removing a retained IUD in the ureter. When evaluating a woman with abdominal pain who has an indwelling IUD, a spontaneous migration of the IUD should be considered in the differential diagnosis.Failure of mature kidney to reach its natural location in renal fossa is termed as renal ectopia. Ectopic kidney can be found in pelvic, iliac, abdominal, and thoracic location. Pelvic ectopia has been estimated to occur in 1 of 2100 to 3000 autopsies. In contrast, ectopic ureters are commonly associated with complete renal duplication. Commonest presentation in females in continuous urinary incontinence with normal voiding habits as ectopic ureter open below the bladder neck in urethra or vagina. An ectopic kidney with ectopic ureter is extremely rare congenital anomaly. We report a 36-year-old woman presenting with left lower abdomen pain with no history of fever, dysuria, or urinary incontinence. On evaluation, she was found to have left nonfunctioning ectopic pelvic kidney with ectopic ureter opening in the vestibule of the vagina, which was managed with laparoscopic nephroureterectomy. One should suspect an ectopic ureter in a female presenting with continuous urinary incontinence since birth. However, diagnosis is challenging when clinical presentation is unusual with no urinary incontinence as seen in the index case. Detailed local examination in correlation with imaging is key for diagnosis and rule out other congenital anomalies. Laparoscopic approach in such clinical scenario is a safe and feasible option.Purpose To report a rare case of secondary adrenal tumor with tumor thrombus in inferior vena cava (IVC) managed by three-dimensional laparoscopy and review the relevant literature. Case Report A 60-year-old male patient operated for left-sided renal cell carcinoma 7 years ago, presented with asymptomatic secondary right adrenal tumor with tumor thrombus extending into the IVC through the right adrenal vein. A three-dimensional laparoscopic adrenalectomy with en bloc tumor thrombus evacuation from the IVC was performed. Literature Review and Discussion The available literature was scanned and reviewed. There was a paucity of literature on the secondary adrenal tumors with IVC thrombus and to the best of our knowledge so far there is no reported case of secondary right adrenal tumor with IVC tumor thrombus that has been managed by three-dimensional laparoscopy. Conclusion Secondary adrenal tumors with IVC tumor thrombus are rare but challenging and can present after many years of primary surgery. The low-level vena cava tumor thrombus can be managed with three-dimensional laparoscopy.Background In selected cases cryoablation is a valid treatment option for small renal masses. The procedure is generally considered oncologically efficient with a low rate of severe complications. We report here a case of a 62-year-old man who after percutaneous cryoablation develops severe gangrene in the treated kidney. Case Presentation A 62-year-old man was incidentally diagnosed with a 45-mm renal cell carcinoma. The tumor was found on a CT scan performed on the suspicion of diverticulitis. An abscess in relation to the sigmoid was found and he was treated with aspiration and antibiotics. The tumor was treated with percutaneous cryoablation 20 days later. On the third postoperative day, he was readmitted with urosepsis. A CT scan revealed gangrene at the ablation site, and a nephrectomy was performed. Clinical progress was slow, and a new CT scan showed reformation of the abscess at the sigmoid and a suspicion of a colonic tumor was raised. This was confirmed by coloscopy and biopsy. The patient had a right hemicolectomy, and the pathology report described a T4 adenocarcinoma with positive margins. After 4 months follow-up, metastases to the lungs was found and the patient was referred to further oncologic treatment. Conclusion Renal cryoablation is generally a very safe procedure, but severe complications may occur. This case report highlights that attention should be given to recent abdominal infections and that delayed intervention might be in place in selected cases.Background Inguinal herniation of the urinary bladder is rare. Although in most patients it is an incidental finding during hernia repair, some patients present with complications related to herniated bladder. Case Presentation A 65-year-old man presented with recurrent lower urinary tract infections and multiple episodes of lithuria. He was found to have an incarcerated right inguinal hernia with a large part of the urinary bladder inside the hernial sac. He did not have any features of bladder outlet obstruction. The herniated bladder had multiple small secondary vesical calculi that had probably formed in this hernial sac. He was managed by open surgical mesh hernioplasty followed by cystoscopic stone evacuation. Conclusion Incarcerated bladder herniation, complicated by intravesical stone formation, is a rare clinical condition. Proper preoperative imaging with CT scan best confirms the diagnosis. Appropriate treatment includes reduction of the bladder, hernia repair, and endoscopic stone management.Background Despite concomitant bladder and upper urinary tract cancers are present in 17% of cases, the simultaneous affection of the urethra, bladder, and both upper urinary tracts is extremely rare. Treatment decisions in this setting could be challenging because of the lack of evidence in the literature. Case Presentation A 65-year-old Caucasian man with a history of nine low-grade (LG) and multifocal bladder tumor recurrences during the past 4 years is referred to our department with a newly diagnosed panurothelial carcinoma involving the bladder, urethra, and both upper urinary tracts. Because of the large and recurrent LG bladder tumor, the urethral involvement and the presence of bilateral pyelocaliceal tumors >4 cm the patient underwent a robot-assisted complete urinary tract extirpation (CUTE). Operating time was 360 minutes and blood loss 460 mL. No intraoperative complications were reported and blood transfusion was not required. The patient developed a surgical site infection in the glans that was solved with antibiotics without any other postoperative complication.