Diffuse Large B-cell Lymphoma of Testis: a Case Report and Current Literature Review

Introduction: Testicular cancers detected in older males are mostly testicular lymphomas. Primary testicular lymphoma (PTL) is a rare, clinically aggressive form of extranodal lymphoma. In population-based studies, the  incidence of PTL is 0.09-0.26/100.000. The vast majority of PTL are diffuse large B-cell lymphoma (DLBCL). Case presentation: We present a case of PTL diagnosed in a 68-year-old male patient and also, we discuss the incidence, clinical presentation, prognostic factors and management of this rare pathology in the light of current literature. Histopathological and immunohistochemical exams of the patient confirmed the diagnosis of DLBCL after radical orchiectomy. According to the internal prognostic index (IPI), patients’ IPI score was evaluated as 5 and according to Ann Arbor staging, patients’ stage was interpreted as grade 3E. Cyclophosphamide, vincristine, etoposide, and prednisolone chemotherapy was planned for the patient and until now, the patient received his first chemotherapy regimen. Discussion: Primary testicular lymphoma should be kept in mind for every patient who admits with a testicular mass, especially in advanced age.  Misinterpreatation of the clinical findings can delay the definitive diagnosis. Primary testicular lymphoma should be managed with a multi-disciplinary team including urologists, medical and radiation oncologists.

An epidermal cyst of the penis after distal hypospadias surgery: a case report

Abstract Background Epidermoid cyst is a benign tumor that can occur anywhere in the body but is rarely seen in the penis. Congenital and previous penile surgeries have been reported to be involved in the etiology of the disease, which is usually asymptomatic. Here we describe a case of a patient with a penile epidermoid cyst, which occurred in the circumcision line on the left side of his penis, and urethral dehiscence following hypospadias surgery. Case summary A 3-year-old white boy who underwent primary distal hypospadias surgery 1.5 years ago presented with a slowly growing mass in the left ventrolateral portion of the penile circumcision line and urethral dehiscence. The histology of the excised mass revealed an epidermal inclusion cyst. Since then, he has remained healthy. Conclusions Epidermal inclusion cyst as a complication of hypospadias surgery is a very rare situation. The diagnosis is made histologically and surgical excision is sufficient for treatment

Skin to calyx distance is not a predictive factor for miniaturized percutaneous nephrolithotomy outcomes

ABSTRACT Objective To evaluate the predictive value of the distance from skin to calyx (SCD) on the outcome and complication rates of patients undergoing mPNL. Materials and Methods Patient’s charts, who had undergone mPNL between June 2012 and June 2015, were analyzed retrospectively. Patients who had a preoperative computerized tomography (CT) were enrolled into the study. Two separateurologists evaluated the CT scans and calculated the SCD defined as the distance between the skin and surface/lateral edge of the calyx, which was the preferred site of entry for percutaneous access. The average value of the two measurements was included inthe final analysis to avoid bias. The mean SCD was 75mm. According to the median SCD value, patients were divided into two groups: group 1 (SCD ≤75) and group 2 (SCD >75). Results A total of 140 patients and 130 patients were enrolled in groups 1 and 2, respectively. The mean operation time and the mean fluoroscopy time was significantly longer in group 2 (p:0.004 vs. p:0.021). The rate of blood transfusion was significantly higher in group 1 (6 patients). None of patientsin group 2required blood transfusion (p:0.017). Stone-free status after a single session of mPNL was 67.1% in group 1 and 75.4% in group 2 (p:0.112). After additional procedures, stone-free rates increased to 84.3% and 85.4% in group 1 and group 2, respectively (p:0.802). Conclusion Our study demonstrated that longer SCD was not a predictive factor for stone-free rates after mPNL. However, SCD over 75mm was associated with longer operation time and fluoroscopy time with lower rates of transfusion

A Major Complication in Micropercutaneous Nephrolithotomy: Upper Calyceal Perforation with Extrarenal Migration of Stone Fragments due to Increased Intrarenal Pelvic Pressure

Micropercutaneous nephrolithotomy is a safe and efficient technique for appropriate sized stones. It is performed through a 4.85 Fr all-seeing needle and stones are fragmented into dust, without the need for tract dilatation, unlike other percutaneous nephrolithotomy types. Even though micropercutaneous nephrolithotomy has many advantages, increase in intrapelvic pressure during surgery may cause rare but serious complications. Herein we report a case of micropercutaneous nephrolithotomy in a 20-year-old woman with a 20 mm right renal pelvis stone and present an undesired outcome of this complication, upper calyceal perforation. Right lower calyceal access was performed with 4.85 Fr all-seeing needle and 2 cm renal pelvis stone was fragmented by 272 μm Holmium-Yag laser system. Upper calyceal perforation and infrahepatic accumulation of stone fragments were detected by fluoroscopy during the surgery. Postoperative imagings revealed perirenal urinoma, perirenal and infrahepatic stone fragments, and lower calyceal stone fragments inside the system. On second postoperative day, minipercutaneous nephrolithotomy and double J catheter insertion procedures were applied for effective drainage and stone clearance. Risk of calyceal perforation and urinoma formation, due to increased intrapelvic pressure during micropercutaneous nephrolithotomy, should be kept in mind

Duplicated Renal System with H Shaped Ureter: An Extraordinary Anomaly

Duplex collecting systems are the most commonly encountered anomaly of the urinary system. Complete duplex system with an H shaped ureter is a very rare situation. There are only two reported H ureter cases in the literature. Herein, we aimed to present an H shaped ureter case, which was identified while performing ureterorenoscopy to a 48-year-old female patient due to a right distal ureteral stone

Skin to calyx distance is not a predictive factor for miniaturized percutaneous nephrolithotomy outcomes

<div><p>ABSTRACT Objective To evaluate the predictive value of the distance from skin to calyx (SCD) on the outcome and complication rates of patients undergoing mPNL. Materials and Methods Patient’s charts, who had undergone mPNL between June 2012 and June 2015, were analyzed retrospectively. Patients who had a preoperative computerized tomography (CT) were enrolled into the study. Two separateurologists evaluated the CT scans and calculated the SCD defined as the distance between the skin and surface/lateral edge of the calyx, which was the preferred site of entry for percutaneous access. The average value of the two measurements was included inthe final analysis to avoid bias. The mean SCD was 75mm. According to the median SCD value, patients were divided into two groups: group 1 (SCD ≤75) and group 2 (SCD >75). Results A total of 140 patients and 130 patients were enrolled in groups 1 and 2, respectively. The mean operation time and the mean fluoroscopy time was significantly longer in group 2 (p:0.004 vs. p:0.021). The rate of blood transfusion was significantly higher in group 1 (6 patients). None of patientsin group 2required blood transfusion (p:0.017). Stone-free status after a single session of mPNL was 67.1% in group 1 and 75.4% in group 2 (p:0.112). After additional procedures, stone-free rates increased to 84.3% and 85.4% in group 1 and group 2, respectively (p:0.802). Conclusion Our study demonstrated that longer SCD was not a predictive factor for stone-free rates after mPNL. However, SCD over 75mm was associated with longer operation time and fluoroscopy time with lower rates of transfusion.</p></div

A Rare Complication of Extracorporeal Shock Wave Lithotripsy: Intrarenal Hematoma Mimicking Pelvis Renalis Tumor

Extracorporeal shock wave lithotripsy (SWL) is a very commonly used treatment modality for appropriate sized stones. Even though it is a noninvasive treatment technique, major complications may occur following SWL sessions. Herein, we report a 17-year-old male patient, who received 2 sessions of SWL treatment for his left kidney stone, 4 months before his admission. Imaging methods showed an enhanced left renal pelvis mass with contrast-enhanced computerized tomography (CT) and this finding raised a suspicion of pelvis renalis tumor. Diagnostic ureterorenoscopy was planned for the patient and operation revealed a left intrarenal hematoma, which was drained percutaneously during the same operation. Careful history should be taken from patients with renal pelvis masses and intrarenal hematoma formation should be kept in mind, especially if the patient has a previous SWL history

Comparison of efficacy of laser lithotripter with ultrasonic lithotripter in mini percutaneous nephrolithotomy

Objective: The aim of the study was to compare the efficacy of the laser lithotripter with the ultrasonic lithotripter in mini percutaneous nephrolithotomy (miniperc). Material and Methods: From June 2013 to January 2014; medical records of 77 consecutive patients who underwent miniperc operation were retrospectively evaluated. Ultrasonic lithotripter was used in 22 patients (Group 1), while laser was used in 55 patients. In the laser group, 22 patients were randomly selected who had same characteristics compared to group 1 (Group 2). Success rate, total operative time, complications according to modified Clavien classification, fluoroscopy time, haemoglobin drop, hospital stays and cost analysis were assessed. Success rates were evaluated on the second postoperative day and after the first month. Results: Total operative time (p = 0.635) and fluoroscopy time (p = 0.248) were not significantly different between the two groups. In the laser group, the success rate (81.8%) was notably more than in the ultrasonic lithotripter group (68.2%) but there was no statistically significance (p = 0.296). Ten reusable ultrasonic probe were used for 22 patients, due to thinness and sensitiveness of the probe. Conversely, one single laser fiber (550 micron) was used for 22 patients. When the cost analysis of lithotripsy was considered, the cost per case was 190 dollar in group 1 and 124 dollar in group 2. (p = 0.154) Complication rate, hospital stay and haemoglobin drop were similar in both groups. Conclusion: Laser lithotripsy seems to be more cost effective than ultrasonic lithotripsy for miniperc but larger number of patients are required to confirm this estimation

Prediction of recurrence in non-muscle invasive bladder cancer patients. Do patient characteristics matter?

Purpose: To evaluate patients, diagnosed with non-muscle invasive bladder cancer, according to patient specific parameters including hemoglobin level, estimated glomerular filtration rate (eGFR), body mass index (BMI) and cigarette smoking and to identify if any of these parameters matters in terms of recurrence prediction