Heterotopic bone formation in renal cell carcinoma: A diagnostic challenge

Formation of bone in cases of renal cell carcinoma is a rare finding and only a couple of case reports from Japan and one from India are mentioned in the literature. Calcification inside renal mass has been reported earlier but the prognostic implications have not been clearly elucidated. We report a case which showed heterotopic bone formation (ossification) inside the renal mass and was managed by radical nephrectomy. The histopathology showed clear cell renal carcinoma with multiple centers of ossification in the region of calcification suggesting bone formation. In this case report we discuss bone morphogenetic proteins which have been implicated as a prognostic and causative factor, highlight the difficulties in distinguishing between calcification and bone formation on the basis of radiological investigations and mention the geographic implications of this rare phenomenon which has not been described earlier

From red to white urine: a patient's nightmare with a rather benign outcome

<p>Abstract</p> <p>Background</p> <p>Chyluria is a medical condition with presence of chyle in the urine. The disease is most prevalent in endemic regions of Africa and the Indian subcontinent where it is mostly caused by parasitic infections, particularly lymphatic filariasis due to wucheria bancrofti. Non-parasitic chyluria, however, is a very rare finding.</p> <p>Case Presentation</p> <p>We report the case of a 48 year old woman who developed a lymphorenal fistula with chyluria following ureterrenoscopy with biopsies taken for urological work-up of persistent macrohematuria. Renal biopsy confirmed the diagnosis of benign familial hematuria due to thin basement nephropathy, a condition frequently associated with episodes of macrohematuria.</p> <p>Conclusions</p> <p>This case highlights a rare case of non-parasitic chyluria as a complication of urological work-up for macrohematuria of benign nature.</p

Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption

<p>Abstract</p> <p>Background</p> <p>The purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobacco and/or <it>paan masala </it>on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, <it>paan masala </it>and tobacco chewing on the donor site morbidity has been documented.</p> <p>Methods</p> <p>Forty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth.</p> <p>Results</p> <p>Donor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene.</p> <p>Conclusion</p> <p>Patients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.</p

Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation

BACKGROUND: Partial ablation of the prostate using high-intensity focussed ultrasound (HIFU-PA) is a treatment option for localised prostate cancer. When local recurrence occurs, salvage robot-assisted radical prostatectomy is a treatment option for selected patients, but there is a paucity of data on the peri-operative safety, functional and oncologic outcomes of sRARP.. The objective of this study was therefore to describe peri-operative safety, functional and early oncologic outcomes following salvage robot-assisted radical prostatectomy (sRARP) for local recurrence after HIFU-PA. METHODS: Retrospective analysis of a prospective database of 53 consecutive men who underwent sRARP after HIFU-PA from 2012 to 2018. Continence and erectile-function were reported pre-HIFU, pre-sRARP, 3-months post-sRARP and 12-months post-sRARP. Complications, PSMs and need for subsequent ADT/radiotherapy were assessed. RESULTS: 45 men were suitable for inclusion and had sufficient data for analyses. Median duration from HIFU to sRARP was 30.0 months and median follow-up post-sRARP was 17.7 months. Median age, PSA and ISUP group were 63.0 yrs., 7.2 ng/mL and 2; 88.9% were cT2. Median operative-console time, blood loss and hospital stay were 140 min, 200 ml and 1 day respectively. Clavien-Dindo grade 1, 2 and 3 complications 90d) complications occurred in 13.2%. At sRARP pathology, ISUP 3-5 occurred in 51.1%, pT3a/b in 64.5%, and PSMs in 44.4% (37.5% for pT2, 48.3% for pT3). Of men with > 3-months follow-up after sRARP, 26.3% underwent adjuvant radiotherapy/ADT for residual disease or adverse pathologic features; 5.3% experienced BCR requiring salvage ADT/radiotherapy. Freedom from ADT/radiotherapy was 66.7% at 12-months. Pad-free rates were 100% pre-HIFU, 95.3% post-HIFU, 29.4% 3-months post-sRARP, and 65.5% 12-months post-sRARP. Median IIEF-5 scores pre-HIFU, post-HIFU, 3- and 12-months post-sRARP were 23.5, 16, 5 and 5, respectively. Potency rates were 81.8, 65.5, 0 and 0%, respectively. Bilateral/unilateral nerve sparing were feasible in 7%/22%. CONCLUSION: Salvage RARP was safe with acceptable but sub-optimal continence and poor sexual-function and poor oncologic outcomes. One in three men required additional treatment within 12-months. This information may aid men and urologists with treatment selection and counselling regarding primary HIFU-PA vs primary RARP and when considering salvage RARP

Preventing Inadvertent Placement of Foley Catheter into Prostatic Urethra During Suprapubic Trocar Cystostomy: A Simple Face‑saver Trick

During suprapubic cystostomy using standard technique, there always remains a chance of accidental migration of foley catheter through bladder neck into prostatic urethra. We herein present a point of technique in which by keeping the direction of cannula slot toward umbilicus and making it vertical or slightly tilting its tip toward umbilicus during foley placement, prevents the inadvertent migration of catheter into prostatic urethra and further complications.Key words: Catheter migration, foley catheter, suprapubic cystostom

Anastomotic Urethroplasty in Female Urethral Stricture Guided by Cystoscopy – A Point of Technique

Purpose: During anastomotic urethroplasty for stricture urethra with false passage using standard technique, there remains a chance of anastomosis of normal distal urethra to proximal false lumen. Herein, we present a point of technique in which by using antegrade cystoscope, one cannot just identify and dissect normal anatomical proximal urethral lumen, but also perform some of the steps for anastomosis under direct vision. This will avoid making anastomosis to false lumen and thus leading to furthercomplications.Materials and Methods: We report a case of 35-years-female who was presented to us with total mid-urethral stricture with false passage following multiple urethral dilatation attempts. We used antegrade cystoscopy during anastomotic urethroplasty to identify and dissect the proximal end of urethra thereby avoiding anastomosis to false tract.Results: We successfully performed anastomotic urethroplasty avoiding false passage. Post-operative Uroflow showed Q max of 18 ml/sec. Voiding cystourethrogram post-operatively showed anastomosis between normalanatomical lumens. Conclusion: This modifi cation of using antegrade cystoscopy helps to identify proximal urethral end which in turn helps in avoiding anastomosis to false tract and ensures anastomosis between normal lumens.Key words: Anastomotic urethroplasty, antegrade cystoscopy, female urethral strictur

The Twin Amplatz Sheath Method: A Modified Technique of Percutaneous Cystolithotripsy for Large Bladder Stones in Female Patients

To minimize the operative time and to avoid open cystolithotomy in women with large bladder stone (&gt;5 cm), we present here a modifi cation of percutaneous cystolithotomy, a well-described standard procedure for urinary bladder stones. With this technique, suprapubic percutaneous access was achieved under cystoscopic guidance. The suprapubic tract was dilated and an Amplatz sheath of 30 Fr was placed. Simultaneously, the urethra was sequentially dilated with fascial dilators and a 28 Fr Amplatz sheath was guided into the bladder and the foot end of the table lowered to 20° to facilitate high-speed outfl ow of irrigant and stone particles. A 26.5 Fr nephroscope was passed through the suprapubic Amplatz sheath and the stone was fragmented by intracorporeal pneumatic device keepingthe stone close to the proximal end of the urethral Amplatz. These maneuvers help in washing out stone fragments periurethrally and keeping the endoscopic vision clear while breaking the stone.Key words: Amplatz sheath, bladder stone, percutaneous cystolithotrips

Issues in etiology and diagnosis making of chyluria

Chyluria, the passage of intestinal lymph in urine is common in the rural and economically weaker population of our country. Etiologically it has been classified as parasitic and nonparasitic (rare). By far the most important and most common cause effect relationship of chyluria is with Wuchereria bancrofti. The issues in diagnosis making of chyluria include: confirmation of chyluria, localization of site of leakage in urinary tract, identifying the cause of chyluria and assessing as to how bad is the disease? A number of biochemical and radiological diagnostic tests are available for the same. Since this is ′a disease of the poor′, there is a need to modify the approach of diagnostic evaluation and therapeutic protocols in order to curtail the overall cost of treatment