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Laparoscopic Pyelolithotomy for the Management of Large Renal Stones with Intrarenal Pelvis Anatomy.

PURPOSE: The role of laparoscopic pyelolithotomy (LPL) in the management of renal stones is evolving. One of the challenges in LPL for renal … atients and was managed conservatively in 2 patients. In one patient ureteral stent was inserted by cystoscopy. No conversion to open surgery or re-operation occurred. CONCLUSION: Laparoscopic pyelolithotomy is a feasible operation for patients with renal stones and intrarenal pelvis in centers with adequate experience in laparoscopy. However, the success o …

Intraoperative Decision-Making: Thermal Injury During Robotic Pyeloplasty.

OBJECTIVE: To describe how an intraoperative thermal injury to the ureter was handled during a robotic dismembered pyeloplasty. METHODS: The patient was a 5-year-old male who was undergoing robotic dismembered pyeloplasty for a symptomatic left ureteropelvic junction (UPJ) obstruction. The case started with cystoscopy and retrograde ureteral catheter placement prior to moving to the robotic part of the procedure. RESULTS: During initial proximal ureteral dissection, there was an inadvertent thermal injury to the ureter due to arcing of the activated monopolar scissors via the fenestrated bip…

Carcinoma in situ of the bladder: why is it underdetected?

PURPOSE OF REVIEW: The standard diagnosis of carcinoma in situ (CIS) of the bladder, based on white light cystoscopy and urine cytology, is limited because CIS can vary from normal-appearing mucosa to a lesion indistinguishable from an inflammatory process. Intravesical instillation of Bacillus Calmette-Guerin (BCG) remains first-line therapy; however, a significant proportion of cases persist or recur after BCG treatment. This review summarizes recent improvements in the detection and treatment of CIS. RECENT FINDINGS: The new optical technologies improve CIS detection, with a potential posi…

Metastatic Plasmacytoid Bladder Cancer Harboring a CDH-1 Mutation and Producing High Levels of CA 19-9. A Case Report and Literature Review.

BACKGROUND Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive variant of urothelial cancers. Herein, we report a patient with CDH-1 mutated PUC who presented with disseminated peritoneal metastasis and high levels of CA 19-9. CASE REPORT A 65-year-old female presented to the hospital with vomiting, obstructive jaundice, and acute renal failure. Imaging studies showed bilateral hydronephrosis, bladder wall thickening without masses, and dilation of both common bile and pancreatic ducts without pancreatic masses. Carbohydrate antigen (CA) 19-9 was elevated at >17 000 U/mL. Repeated

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… Cystoscopy with ureteroscopy revealed no masses to biopsy, but she had bilateral mid to distal ureteral stenosis, and bilateral ureteral stents were placed. Her renal function and creatinine slowly improved to 1.4 mg/dL. … She had a repeat cystoscopy with bilateral retrograde pyelograms and antegrade nephrostogram a couple of weeks later, which demonstrated a small capacity and poorly compliant rigid bladder. …

Labial synechiae in geriatric patients with turner syndrome: A case report.

INTRODUCTION: Turner syndrome (TS) is a chromosomal condition that affects development in females, resulted from a complete or partial absen … nation in the lithotomy position revealed labial agglutination involving the labia majora. We did a Cystoscopy to evaluate the bladder and urethra, and then biopsied the tissues. Vaginal Reconstruction was performed to repair the Labial Synechiae. The biopsy showed that this histological finding is consistent with Follicular Cystitis that could cause by chro …

A novel technique for complete laparoscopic excision of a transobturator sling with lower urinary tract mesh erosion.

INTRODUCTION AND HYPOTHESIS: To demonstrate a novel technique for complete laparoscopic removal of a transobturator sling for mesh erosion involving a large area of the urethra and bladder neck, without the need for concomitant vaginal dissection. METHOD: A 56-year-old woman had a transobturator sling inserted for stress urinary incontinence (SUI) in 2009. In 2017, 8 years following surgery, she experienced groin pain, exacerbated by exercise, and developed recurrent urinary tract infections with dysuria and urethral pain. A cystoscopy demonstrated mesh erosion from the midurethra to bladder …

Cystoscope-Assisted Laparoscopic Enucleation of a Large Progressive Bladder Leiomyoma.

Background: A bladder leiomyoma is a rare and benign bladder tumor. There are no established guidelines for the surgical treatment of this t … Therefore, we chose to perform a laparoscopic enucleation of the tumor. Simultaneous intraoperative cystoscopy was utilized to observe the operative area from within the bladder, thus enabling us to perform the procedure relatively safely. Although there was a minor inadvertent injury to the bladder mucosa intraoperatively, the left ureteral orifice was pres …

Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines.

INTRODUCTION AND HYPOTHESIS: Interstitial cystitis (IC) and bladder pain syndrome (BPS) are challenging and encompassing hypersensitivity di … sure, discomfort and frequency, urgency and nocturia. Urinalysis is a prerequisite for diagnostics, cystoscopy for most and urodynamics not part of the routine assessment. Treatment options are recommended stepwise. The highest level of evidence and consensus was identified for oral therapies. Nine guidelines had an overall quality score ≥ 50% and three scor …

Primary signet-ring cell carcinoma of the urinary bladder: A report of two cases.

INTRODUCTION: Primitive bladder adenocarcinomas account for about 2% of urinary bladder tumors. Primary signet-ring cell carcinoma is a rare … ng intravesical lesion with a calculation of the lower left ureter measuring 5mm of great diameter. Cystoscopy showed an atypical tissular lesion frayed whitish and solid in the cut. Pelvic MRI performed in women showed a cervix ill-limited tissue mass invading the anterior vaginal wall. A transurethral resection of the bladder tumor was performed in one cas …

Is excision necessary in the management of adult urachal remnants?: a 12-year experience at a single institution.

OBJECTIVES: To determine the ideal management of uncomplicated adult urachal remnants and to confirm if conservative management with repeate … st be made on initial diagnosis to ensure that malignancy is excluded using CT imaging and flexible cystoscopy where possible. Long-term follow-up of this cohort is required to assess the natural history of observed urachal anomalies.

Appendicovesical fistula presenting as hypokalaemic hyperchloraemic metabolic acidosis: a case report.

A 52-year-old man was admitted with diarrhoea and faecaluria and referred recurrent urinary tract infections for over 20 years. He also reported a two-week hospital admission more than 20 years ago for right iliac fossa pain, which was managed conservatively. Computed tomography showed a fistulous tract extending from the bladder with an unclear connection to the bowel. Cystoscopy confirmed the presence of a vesical fistula and biopsy of the tract confirmed colonic mucosa. Flexible sigmoidoscopy was negative. A cystogram was requested as an outpatient procedure and the patient was discharged a…

[Diagnosis and treatment of ejaculatory duct cyst: A report of 2 cases and review of the literature].

OBJECTIVE: To investigate the diagnosis and treatment of ejaculatory duct cyst. METHODS: This study included 2 male patients present at the hospital for hemospermia and abnormal sensation in the perineal region in July and August 2014. Both underwent transrectal ultrasonography, routine semen examination, CT, MRI, cystoscopy, and vesiculography before transurethral fenestration of the cysts and pathological examination of the cyst wall specimens. Analyses were made on the clinical presentations, imaging features, pathological characteristics, differential diagnosis and treatment of ejaculator…

Incidence of Urethral Stricture in Patients with Adult Acquired Buried Penis.

Introduction. Concealed-buried penis is an acquired condition associated with obesity, challenging to both manage and repair. Urethral stric … or patients presenting with a buried penis. All patients were evaluated for urethral stricture with cystoscopy or retrograde urethrogram either prior to or at the time of repair for buried penis. Those that had surgical repair or biopsy were reviewed for presence of lichen sclerosus. Results. 39 patients met inclusion criteria. Of these, 13 (33%) had associa …

Y-type urethral duplication with rectal implantation of the urethra: Which is the best approach?

INTRODUCTION: Y-type urethral duplication describes the condition in which a functional urethra is implanted in the rectum, and there is als … urinary flow per anus and minimal dribbling through the orthotopic urethra. We performed a combined cystoscopy with retrograde urethrogram and managed to catheterize the dysplastic urethra with a guide-wire that showed ectopic implantation in the prostatic urethra, below the bladder neck. We performed an ASTRA procedure to separate the urethra from the rectu …

Case report of gross hematuria in the nutcracker syndrome resolved by renocaval reimplantation.

INTRODUCTION: Nutcracker syndrome is defined as a set of signs and symptoms secondary to compression of the left renal vein (LRV) in the acute anatomic angle between the aorta and its superior mesenteric branch. CASE REPORT: A 38-year old woman with asymptomatic and “idiopathic” gross hematuria came to the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade. Hematuria was documented by cystoscopy and was found to be unilateral, located to the left urethral orifice. The contrast-enhanced multidetector computed tomography (MDCT) scan showed a stenotic LRV due to …

Robot-assisted extravesical vesicovaginal fistula repair utilizing laparoscopically mobilized omental flap interposition.

INTRODUCTION AND HYPOTHESIS: High vesicovaginal fistulas (VVF) in the setting of good apical support are best repaired via a transabdominal … eloped a VVF after a total abdominal hysterectomy for fibroids. Pre-operative CT urogram and office cystoscopy confirmed the diagnosis and ruled out ureteral involvement. She underwent a robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. RESULTS: The surgery was uncomplicated, and the patient was discharged on post-o …

High-pressure balloon assessment of pelviureteric junction prior to laparoscopic "vascular hitch".

AIM: To assess if calibration of the ureteropelvic junction (UPJ) using a high-pressure balloon inflated at the UPJ level in patients with suspected crossing vessels (CV) could differentiate between intrinsic and extrinsic stenosis prior to laparoscopic vascular hitch (VH). MATERIALS AND METHODS: We reviewed patients with UPJO diagnosed at childhood or adolescence without previous evidence of antenatal or infant hydronephrosis (10 patients). By cystoscopy, a high-pressure balloon is sited at the UPJ and the balloon inflated to 8-12 atm under radiological screening. We considered intrinsic PUJ…

Renal fungus ball: a challenging clinical problem.

INTRODUCTION: We describe a case of renal pelvi-ureteric fungus ball managed with placement of two nephrostomy tubes and amphotericin B irrigation through a nephrostomy tube with the other to free drain. CASE REPORT: A 46-year-old man with uncontrolled Type 2 diabetes mellitus was referred to the urology clinic for workup of recurrent urinary tract infection. Urine culture grew Candida albicans. The patient was started on oral fluconazole therapy. Cystoscopy and cystogram revealed a grade 3 left vesicoureteral reflux and right retrograde pyelogram revealed a filling defect in the right renal …

Suburothelial and extrinsic lesions of the urinary bladder: radiologic and pathologic features with emphasis on MR imaging.

OBJECTIVE: The purpose of this article is to present a contemporary review of the imaging appearance of diseases which affect the deeper layers of the urinary bladder, including both suburothelial and extrinsic pathologies, using radiologic-pathologic correlation. CONCLUSION: Compared to the more common urothelial lesions, at cystoscopy, suburothelial and extrinsic diseases of the urinary bladder wall often have a non-specific appearance or may be occult. Cross-sectional imaging, in particular MRI, plays an integral role in diagnosis. Mesenchymal tumors have distinct imaging features on MRI. …

Small Cell Carcinoma of the Urinary Bladder: KIT and PDGFRA Gene Mutations.

Primary small cell carcinoma of the urinary bladder is very rare. A 72-year-old was admitted to our hospital because of hematuria and dysuria. Cystoscopy revealed a bladder full of multiple, solid and papillary tumors. Biopsies from the deep and papillary tumors were taken. Histologically, tumor was pure small cell carcinoma. Immunohistochemically, the tumor cells were positive for cytokeratin, chromo-granin, synaptophysin, neuron-specific enolase, CD56, CD117 and Ki67 (labeling 70%). The tumor cells were negative for CK7, CK20, CD3, CD20, LCA, CDX2, uroplakin, thyroid transcription factor 1, …