Renal Tract Stones - Diagnosis and Management

This chapter explores the diagnosis as well as various methods for stone clearance and recent advancements in each of the avenues, so as to provide the avid reader an understanding of the basis of each intervention and new exciting technology that lay on the horizon. Each section is further subdivided such that it would be easy for readers to search and look up relevant information at a glance without having to read through the entirety of the chapter. Firstly, diagnosis of renal calculi is explored, as renal tract pain can mimic a variety of abdomino-pelvic conditions and cause the same constellation of symptoms. Evidence based investigation modalities are discussed. Subsequently, management of renal tract calculi are divided into conservative management with analgesia and medical expulsion therapy, extracorporeal shock wave lithotripsy, ureteropyeloscopy and laser lithotripsy, as well as percutaneous nephrolithotomy. The different stone size, composition, location and patient factors have all contributed to the different surgical options as detailed above. Each section end with a discussion of new and exciting innovations in each of the areas that may lead to even more efficient and safer interventions for the Urology of the future

An uncommon mimicker of renal malignancy: IgG4-related disease

Abstract Background Increased usage of cross sectional imaging for a variety of indications, in particular CT imaging, has led to an increased detection of renal and ureteric masses. Benign ureteric masses are rare, with 95% of identified tumours consisting of transitional cell carcinoma (TCC). IgG4-related disease is a recognised clinical systemic autoimmune, inflammatory condition with a propensity for multi-organ manifestation. Nephritis and pseudo-tumour formation can occur when kidneys are involved. Ureteric involvement is more rare. Case presentation Forty nine-year-old Korean male was found to have an incidental invasive renal pelvis mass during investigation for chronic back pain and fatigue. Appearance of the tumour was consistent with an invasive malignancy, and consensus from multidisciplinary meeting was to have the tumour removed. Procedure involved a prolonged open surgery with reconstruction of contralateral renal blood supply and was complicated by a long recovery process. Final histopathology confirmed IgG4 renal pseudo tumour diagnosis. Conclusion IgG4-related disease is a rare but potentially morbid disease that can mimic various cancers, including lung, pancreas and renal malignancies. A high index of suspicion is required to accurately diagnose this condition, through a targeted history taking, examination and investigation which should include biopsies. Failing to do so may result in unnecessary procedures being performed and exposing a patient to its associated risks

BCG mycotic aneurysm: Case report on a rare entity

Mycotic aortic aneurysms (MAA) are rare, accounting for 0.6–2.0% of all aortic aneuryms. MAA secondary to intravesical BCG instillations are even rarer, with less than a hundred reported cases till date. Given the delayed presentation, non specific presenting symptoms and significant risk of mortality (90% without intervention, 10.3–22.7% with intervention), diagnosing this complication is challenging

Electrochemical synthesis and characterisation of alternating tripyridyl-dipyrrole molecular strands with multiple nitrogen-based donor-acceptor binding sites.

International audienceSynthesis of alternating pyridine-pyrrole molecular strands composed of two electron-rich pyrrole units (donors) sandwiched between three pyridinic cores (acceptors) is described. The envisioned strategy was a smooth electrosynthesis process involving ring contraction of corresponding tripyridyl-dipyridazine precursors. 2,6-Bis[6-(pyridazin-3-yl)]pyridine ligands 2a-c bearing pyridine residues at the terminal positions were prepared in suitable quantities by a Negishi metal cross-coupling procedure. The yields of heterocyclic coupling between 2-pyridyl zinc bromide reagents 12a-c and 2,6-bis(6-trifluoromethanesulfonylpyridazin-3-yl)pyridine increased from 68 to 95% following introduction of electron-donating methyl groups on the metallated halogenopyridine units. Favorable conditions for preparative electrochemical reduction of tripyridyl-dipyridazines 2b,c were established in THF/acetate buffer (pH 4.6)/acetonitrile to give the targeted 2,6-bis[5-(pyridin-2-yl)pyrrol-2-yl]pyridines 1b and 1c in good yields. The absorption behavior of the donor-acceptor tripyridyl-dipyrrole ligands was evaluated and compared to theoretical calculations. Highly fluorescent properties of these chromophores were found (ν(em)≈2 × 10(4) cm(-1) in MeOH and CH(2)Cl(2)), and both pyrrolic ligands exhibit a remarkable quantum yield in CH(2)Cl(2) (φ(f)=0.10). Structural studies in the solid state established the preferred cis conformation of the dipyrrolic ligands, which adopting a planar arrangement with an embedded molecule of water having a complexation energy exceeding 10 kcal mol(-1). The ability of the tripyridyl-dipyrrole to complex two copper(II) ions in a pentacoordinate square was investigated