Oakleygraves3141

Where more sophisticated calibration technology is not available, use of an angiographic catheter during diagnostic endoscopy can improve preoperative assessment and surgical planning for complex ureteral reconstructive procedures.Background Inguinal lymph node dissection is performed in penile cancers and has a high complication rate with mostly wound-related complications. This case study demonstrates the use of robotic technique, tissue perfusion assessment, and negative pressure wound dressing to minimize wound-related complications. Case Presentation A 67-year-old Maltese man was diagnosed with squamous cell carcinoma (SCC) in situ on biopsy of a self-detected penile lump. The patient underwent a partial penectomy and histopathology report confirmed moderately differentiated SCC with clear surgical margins. Cyclophosphamide chemical structure A positron emission tomography/CT scan was performed preoperatively, which showed several nodes in the right inguinal region with increased metabolic activity and nonspecific findings in the left inguinal region. The patient had a robotic right inguinal node dissection the following month. Assessment of the skin flap was performed using indocyanine green (ICG) angiography with the SPY system and there was excellent vascularity. Further treatment was performed 3 months later with a robotic left inguinal node dissection. Again, assessment of the skin flap was performed using the SPY system but showed an area of poor perfusion in the left femoral triangle, which suggested a high risk of inadequate wound healing and tissue necrosis. The clinical decision to use the negative pressure PICO dressing was made intraoperatively to enhance perfusion of the skin. When the PICO dressing was removed it revealed excellent tissue viability and vascularity of the skin flap. Histopathology analysis showed no evidence of malignancy in the nodes removed and patient was discharged to the outpatient care of their urologist. Conclusion This case study demonstrates that the use of a tissue perfusion assessment tool avoided a potentially poor clinical outcome for the patient. Robotic inguinal lymph node dissection was performed in coordination with ICG angiography to guide the use of negative pressure wound therapy and facilitate good wound healing.Background Management of primary bladder neck obstruction (PBNO) in women is difficult. Surgical treatment in the form of bladder neck incision (BNI) is indicated in many cases. There is no defined consensus on the best surgical technique of BNI in women. We present a novel technique of BNI in such cases using pediatric cystoscope and holmium laser, which is a promising alternative to the existing management techniques. Case Presentation A 28-year-old lady complained of obstructive lower urinary tract symptoms. Serum biochemistry revealed azotemia. Further investigation utilizing a micturating cystourethrogram showed a closed bladder neck, and urodynamic studies revealed a high bladder outlet obstruction index suggestive of PBNO. BNI was effectively performed using pediatric cystoscope and holmium laser at 3, 9, and 12 o'clock positions. Postoperatively the patient had improving renal function and clinical improvement. Conclusion Use of pediatric cystoscope with holmium laser for BNI in females is a novel technique that offers the advantage of higher maneuverability in the female urethra, precise incision with protection of external sphincter from thermal damage, and avoidance of the complication of vesicovaginal fistula caused by posterior incisions.Background Ureterosciatic hernia (USH) is a rare benign disease. We report a case of USH treated with laparoscopic intraperitonization of the ureter. Case Presentation A 70-year-old woman was admitted to our hospital with right abdominal pain lasting for 2 months. CT showed right hydronephrosis and invagination of the right ureter into the right sciatic foramen. She underwent retrograde ureterography, which revealed abnormal tortuosity of the right lower ureter, and was found to have USH. We performed laparoscopic intraperitonization of the ureter and she presented good postoperative course. Conclusion Laparoscopic intraperitonization of the ureter can be a useful treatment for USH.Introduction Urethral stenting became popular two decades ago, but nowadays its frequency is slightly decreased because of the rising application of urethroplasty. Today urethral stenting is reserved only for failure after urethral reconstruction or in cases when the plastic surgery is unfavorable. The Memokath stent (Pnn Medical A/S, Kvistgaard, Denmark) is manufactured from a biocompatible alloy of nickel and titanium and known to be the most popular in this field. Case Description A 38-year-old man with a history of 9 years Memokath urethral stenting was admitted to our clinic with obstructive lower urinary tract symptoms. The indication for Memokath stenting was repeated recurrences after endoscopic and reconstructive operations. The plain radiography showed a normal position of the stent and only the endoscopic examination revealed its total calcification. New superpulse thulium fiber laser has been used to free the stent from the stones and safely remove it without additional urethral injury. Results The postoperative time was within normal limits, the catheter was removed on the fourth day after operation. Three months follow-up was without stricture recurrence. We continue active surveillance of the patient. Conclusion The calcification of the stent could be properly diagnosed endoscopically; the Memokath stent could be safely removed in 9 years after implantation; thulium fiber laser is effective and safe in the management of encrusted urethral stent.Background Encrusted uropathy (EU) is a rare disease caused by urea-splitting bacteria, most commonly Corynebacterium urealyticum, whose incidence is increasing. Standard treatment is based on pathogen-directed antibiotic therapy, urinary diversion, bladder instillations, and surgical resection of urinary calcifications. Case Presentation We present the case of a 60-year-old man with symptomatic bilateral encrusted pyelitis and cystitis with acute renal failure. We initially treated the patient with antibiotic therapy, urinary diversion, and oral acidification with acetohydroxamic acid, achieving negative urinary cultures. Because of the persistence of encrusted pyelitis, the patient was discharged on oral l-methionine 500 mg bid and 12 months later the encrustations had almost disappeared. Finally, we performed right retrograde intrarenal surgery to remove a persistent small calcification. Conclusion Oral urinary acidification with l-methionine is a valid treatment for urinary encrustations in EU, with no complications reported.