18 research outputs found
Adenomatoid of the adrenal gland
Adenomatoid tumors are common in the genital tract but rare in the adrenal gland. These tumors can be difficult to diagnose when present in extragenital sites. This type of adrenal tumor lacks specific radiographic features and can be confused preoperatively with more common adrenal gland tumors. We present the case of a 54-year-old man with an incidental right adrenal mass with calcified components and elevated urinary levels of homovanillic acid that was found to be an adenomatoid tumor of the adrenal gland. © 2005 Elsevier Inc
Primary renal carcinoid tumor with liver metastases detected with somatostatin receptor imaging
If the final pathologic examination reveals a carcinoid tumor of the kidney, additional evaluation to rule out another occult primary tumor site is necessary. If the primary origin of the tumor is confirmed to be from the kidney, additional evaluation is required for the detection of metastasis. Renal carcinoid tumors are extremely rare; however, both primary and metastatic renal carcinoid tumors have been reported. We report a case of a 40-year-old woman with primary carcinoid of the kidney and metastatic disease in the liver not evident by computed tomography and magnetic resonance imaging but identified by somatostatin receptor scintigraphy. © 2005 Elsevier Inc
Pathological review of internal genitalia after anterior exenteration for bladder cancer in women. Evaluating risk factors for female organ involvement
To evaluate cancer involvement of internal female genitalia of patients
undergoing anterior exenteration for clinically organ confined
transitional cell carcinoma of the bladder, and identify potential
preoperative risk factors. Charts and anterior exenteration specimens
from 54 women with clinically organ confined transitional cell bladder
cancer were retrospectively reviewed. Emphasis was given to the presence
of internal genitalia involvement and or primary gynecologic pathology.
Unsuspected internal genitalia involvement was reported in only three
patients (5.7%). The vagina was involved in two cases (3.8%) while the
uterus in one (1.9%). In all cases involvement was due to direst
extension from bladder tumors of the base and dome respectively. No
preoperative variable could predict internal genitalia involvement in a
statistical significant manner. Benign pathology of the female
reproductive organs was observed in six patients and involved in all
cases the uterus (11.5%). Internal genitalia involvement after radical
cystectomy for TCC tumors of the bladder is rare (5.8%). Preoperative
risk factors could not be identified although all involved genitalia
were seen in tumors of the bladder dome and base. Therefore large
multi-institutional studies are needed in order to identify preoperative
risk factors for internal genitalia involvement in females with bladder
cancer
1177: Laparoscopic Assisted Nephrectomy with Inferior Vena Cava Tumor Thrombectomy: Preliminary Results
To evaluate the feasibility and outcome of laparoscopic-assisted radical nephrectomy and inferior vena cava (IVC) tumor thrombectomy in patients with renal cell carcinoma and level I IVC tumor thrombus.
The clinical, operative, and pathologic data were retrospectively obtained from patients undergoing the above-mentioned procedure for renal tumors involving the IVC. This approach involved laparoscopic dissection of the kidney and renal vasculature/IVC. After renal artery ligation, an 8 to 12-cm incision was made from the tip of the 11th rib extending anteriorly toward the midline. Through this incision, a Satinsky vascular clamp was placed on the IVC in such a way as to include all the caval thrombus. The tumor thrombus was removed en bloc with the kidney and the cavotomy repaired with a running suture.
Four obese patients underwent transperitoneal laparoscopic-assisted right nephrectomy with inferior vena cava (IVC) thrombectomy. The mean tumor size was 9 cm (range 6 to 13), with the thrombus extending 2 cm into the IVC in all cases. Patients had a mean body mass index of 32.8 (range 30.5 to 37.2) and a mean American Society of Anesthesiologists score of 2.8 (range 2 to 3). The mean operative time was 248 minutes (range 225 to 274). The mean estimated blood loss was 517 mL (range 250 to 900). No intraoperative or postoperative complications occurred. The mean hospital stay was 6.2 days (range 4 to 11, median 5).
Laparoscopic-assisted nephrectomy and IVC thrombectomy is a difficult but feasible procedure. This approach allows a smaller incision than a typical open approach. Additional studies are needed to examine the advantages of this approach over a pure open approach
Ureteroscopic removal of mildly migrated stents using local anesthesia only
Purpose: In the outpatient office setting we evaluated the feasibility
and efficacy of ureteroscopic removal of upward migrated ureteral stents
using local or no anesthesia.
Materials and Methods: Prospectively 37 patients with mild upward stent
migration underwent ureteroscopic stent removal under local or no
anesthesia. Stent migration was always below the pelvic brim. It was
diagnosed by plain x-ray of the kidneys, ureters and bladder, and
flexible cystoscopy. Semirigid ureteroscopy was performed in the office
outpatient setting. After each procedure patients graded the discomfort
and/or pain level experienced by completing 2 separate 5-scale visual
analog pain scores, including I for flexible cystoscopy and 1 for the
ureteroscopic procedure. Pain scores were compared between the 2
procedures.
Results: Stent removal was successful in 34 of 37 patients (91.9%).
Successful procedures were never interrupted due to pain intolerance. No
complications occurred. The mean visual analog pain score for
ureteroscopic stent removal was 1.73 and it was similar in men and women
(p=0.199). The mean visual analog pain score for flexible cystoscopy was
1.27. This procedure was significantly more painful in men than in women
(p=0.018). Ureteroscopic stent removal was more painful than flexible
cystoscopy overall and in women (each p<0.01) but not in men (p=0.3).
All patients were discharged home within 1 hour after the procedure and
no patient required hospital admission or a new hospital visit.
Conclusions: Ureteroscopic removal of a migrated stent using local
anesthesia is effective, safe and tolerable in select patients.
Preventing the complications and costs associated with general or spinal
anesthesia makes this option appealing to patients and it should be
offered when possible
The role of imaging in the management of renal masses.
The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed