Blunt Renal Trauma in a Pre-Existing Renal Lesion

A 70-year-old male presented with direct trauma to his loin with gross hematuria, as an isolated case of blunt renal trauma (BRT) due to a traffic accident. A pre-existing renal lesion (PERL) was strongly suspected by his past history of gross macroscopic hematuria and monotrauma to the kidney without other associated injuries. Spiral CT scan with contrast and a retrograde pyelogram (RGP) confirmed an occult complex renal cyst. The gold standard of CT diagnosis in this situation is stressed. Computed tomography is particularly useful in evaluating traumatic injuries to kidneys with pre-existing abnormalities. The decision on the initial course of conservative management, ureteral retrograde stenting to drain extravasation, and its final outcome are discussed. Radical nephroureterectomy was carried out by a transperitoneal approach with an early vascular control of the renal pedicle. A brief review of recent literature has been undertaken

Endometriosis Presenting as Hydronephrosis

The most serious urological complication of endometriosis is hydronephrotic renal atrophy secondary to ureteric involvement. As only half of these patients are symptomatic, it is commonly diagnosed late and more by the clinicians awareness and suspicion of this entity. We report a case of an unmarried young female who presented primarily with left loin pain of 2-year duration. She was found to have lower ureteric stricture by an IVU done by her referring doctor. Further workup at our center showed that she had pelvic endometriosis with hydronephrosis secondary to extrinsic ureteric endometriosis. She had a first-degree relative with the same disease. She had no menstrual problems. Diagnostic laparoscopy, biopsy of the lesion, ureteric dilatation with stenting, along with hormonal treatment was given to her as first line of treatment. There was no improvement of the ureteric obstruction even after 6 months of treatment. Finally, surgical excision of the endometrioma, left oophorectomy, along with resection of the ureteric stricture with uretero-ureterostomy was done. This case report includes details of her further management and outcome along with a brief review of literature

An unusual case of obstructive uropathy: Cystitis cystica with ureteritis cystica

A 45-year-old man presented with loin pain and burning micturation. He had a positive Bilharzial titre and impaired renal function. Ultrasonography (USG) revealed right hydroureteronephrosis and a thickened bladder wall with areas of calcification. A diuretic 99mTc - DTPA scan (technetium-99m diethylene triamine penta acetic acid) showed features of obstruction in both the kidneys. Cystoscopy showed polypoid transparent cystic lesions obscuring both the ureters. The obstruction was relived by percutaneous nephrostomy (PCN). Nephrostogram showed multiple scalloped filling defects in the right ureter with obstruction at the uretero vesical junction (UVJ), suspicious of ureteritis cystica (UC). Biopsy of the lesions showed features of Bilharzial proliferative cystitis with extensive cystitis glandularis and cystitis cystica (CC). Complete cure was achieved by semi-interventional methods and prompt treatment of the underlying infection. Diagnosis, management, and progression of this case with review of literature are discussed