Adrenal adenomatoid tumor in a patient with human immunodeficiency virus

We present the clinical course of a patient with human immunodeficiency virus and an adrenal adenomatoid tumor (AAT). We describe the clinical course and laboratory, radiographic, and microscopic findings of a patient with human immunodeficiency virus (HIV) and an adenomatoid tumor of the right adrenal gland. A review of the literature was also done via electronic searches through PubMed for articles from 1965 to 2008 that contained the following search terms, adenomatoid tumor limited to the English language only. A 22 year-old African-American male with HIV was incidentally found to have a hypermetabolic right adrenal mass. The patient underwent laparoscopic adrenalectomy and the mass had morphological and immunohistochemical features that were consistent with an AAT. A review of the medical literature reveals that almost all cases of AAT were in male patients (96%) with a mean age of 41±11 years (range=22–64) with no significant difference in laterality (right side=46%, left side=50%, unknown=4%). AAT have an average size of 4.2±3.5 cm (range=0.5–14.3 cm). Pre-operative imaging studies do not appear to be able to reliably distinguish AAT from other types of adrenocortical tumors. For reasons that require further research, AAT typically occur in male patients and may be associated with immunosuppression. AAT can be safely removed laparoscopically with no evidence of long-term recurrence even with tumor extension beyond the adrenal capsule

Use of external ureteral catheters and internal double J stents in a modified ileal neobladder for continent diversion: A comparative analysis

Introduction: Open-ended straight ureteral stents are typically used for the support of the ureteroileal anastomosis during the creation of an orthotopic ‘S-pouch’ ileal neobladder. The use of double J stents as an alternative in this setting is evaluated. Materials and Methods: Medical charts from 43 patients undergoing radical cystectomy with formation of an ileal ‘S-pouch’ neobladder were retrospectively evaluated. In 30 patients (group A), a 6-Fr open-ended straight ureteral catheter was used to stent the ureteroileal anastomosis, while a double J stent was used for the same reason in 13 patients (group B). The ureteral catheter was removed 15 days afterthe procedure while the double J stent 3 weeks postoperatively. Hospital stay, early and late complications were evaluated for both groups during a mean follow-up period of 22.5 and 19.6 months respectively. Results: Stricture of the ureteroileal anastomosis was observed in 2 (6.6%) and 1 (7.6%) patient of groups A and B respectively. All complications presented with similar rates, except for an increased but not statistically significant incidence of urethrovesical anastomotic leakage and early urinary tract infections in group B. Hospital stay was significantly (p < 0.005) shorter for patients of group B (9.9 vs. 15.2 days). Conclusions:The use of double J stents to support the ureteroileal anastomosis can be used as an alternative to open-ended ureteral stents. With double J stents a shorter hospital stay was achieved with similar complication rates but a higher incidence of upper urinary tract infections. Copyright (c) 2005 S. Karger AG, Basel

Local steroid application during nerve-sparing radical retropubic prostatectomy

Objective To evaluate the effect on potency rates after surgery of applying local steroids to the neurovascular bundles (NVBs) of the prostate after bilateral nerve-sparing radical retropubic prostatectomy (BNS-RRP). Patients and Methods Sixty potent men undergoing BNS-RRP for clinically localized prostate cancer were prospectively randomized equally into two groups. In group 1, 10 mL of betamethasone cream 0.1% was applied locally to both NVBs, and group 2 had only the usual BNS-RRP with no corticoid cream. Complications and potency were evaluated at 3, 6 and 12 months in all patients and compared between the groups. Results At 12 months, 57% and 60% of patients were potent in group 1 and 2, respectively; the respective mean International Index of Erectile Function (5-item) scores were 14.76 and 15.43 (P = 0.59). Potency rates at 3, 6 and 12 months were not significantly different between the groups, and the continence rates at 12 months were also similar, with 93% and 90% of patients in groups 1 and 2 being continent, respectively. Ten and five patients in groups 1 and 2, respectively, required a blood transfusion (P = 0.23). There were no fistulae, wound dehiscence or rectal perforations. One patient in group 2 presented 4 months after RRP with a bladder neck contracture. Conclusions Local application of betamethasone does not improve or expedite the recovery of erectile function after BNS-RRP, but there were no complications associated with its use

Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus

Excision of renal cell carcinoma (RCC) with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass

The correlation between the electrode configuration and histopathology of irreversible electroporation ablations in prostate cancer patients

\u3cp\u3ePURPOSE: Irreversible electroporation (IRE) is a novel minimally invasive therapy for prostate cancer using short electric pulses to ablate prostate tissue. The purpose of this study is to determine the IRE effects in prostate tissue and correlate electrode configuration with the histology of radical prostatectomy (RP) specimens. We hypothesize that the area within the electrode configuration is completely ablated and that the area within the electrode configuration is predictive for the ablated area after treatment.\u3c/p\u3e\u3cp\u3eMETHODS: A prospective phase I/II study was conducted in 16 consecutive patients with histopathologically confirmed prostate cancer scheduled for RP. Focal or extended IRE treatment of the prostate was performed 4 weeks prior to RP. The locations of the electrodes were used to calculate the planned ablation zone. Following RP, the specimens were processed into whole-mount sections, histopathology (PA) was assessed and ablation zones were delineated. The area of the tissue alteration was determined by measuring the surface. The planned and the histological ablation zones were compared, analysed per individual patient and per protocol (focal vs. extended).\u3c/p\u3e\u3cp\u3eRESULTS: All cells within the electrode configuration were completely ablated and consisted only of necrotic and fibrotic tissue without leaving any viable cells. The histological ablation zone was always larger than the electrodes configuration (2.9 times larger for the 3 electrodes configuration and 2.5 times larger for the ≥4 electrode configuration). These ablation effects extended beyond the prostatic capsule in the neurovascular bundle in 13 out of 15 cases.\u3c/p\u3e\u3cp\u3eCONCLUSIONS: IRE in prostate cancer results in completely ablated, sharply demarcated lesions with a histological ablation zone beyond the electrode configuration. No skip lesions were observed within the electrode configuration.\u3c/p\u3e\u3cp\u3eCLINICAL TRIALS: ClinicalTrials.gov Identifier: NCT01790451 https://clinicaltrials.gov/ct2/show/NCT01790451.\u3c/p\u3