Volume 6

Bilateral Metachronous Colon Cancer Metastasis to Kidneys: A Rare Case with a Treatment Dilemma

ABSTRACT

Colorectal cancer continues to remain one of the most common and lethal cancers, with well-established locations for metastases to the liver, lung, and peritoneum. Improved chemotherapy regimens have resulted in patients with advanced disease experiencing prolonged survival resulting in these patients experiencing new atypical locations for metastases. We report the first case of primary colorectal carcinoma metachronously metastasizing to the kidneys bilaterally in a patient who presented with stage II colorectal cancer 8 years prior to kidney metastasis. The appropriate management of patients with renal lesions in the setting of advanced systemic disease may be challenging. Treatment should be based on preventing dialysis dependence during palliative therapy, performing potentially curative surgery in the setting of decreased systemic disease after neoadjuvant chemotherapy, and providing options for palliative intervention for the symptomatic patient.


Zachary Klaassen, Radhika Prabhakar, Rabii Madi, W. Bruce Shingleton, Martha K. Terris

Submitted November 23, 2012 - Accepted for Publication January 6, 2013


KEYWORDS: Colon cancer, renal metastasis, nephron-sparing surgery

CORRESPONDENCE: Zachary Klaassen, MD, Department of Surgery, Section of Urology, Georgia Health Sciences University, 1120 15th Street, Augusta, GA 30912 ()

CITATION: UroToday Int J. 2013 February;6(1):art 11. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.11

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Chromophobe Subtype Renal Cell Carcinoma in Childhood: A Case Report and Overview of the Literature

ABSTRACT

Introduction: Renal cell carcinoma (RCC) is the most frequent renal tumor in adults, and chromophobe represents the third most frequent subtype, following clear cell and papillary. However, they are extraordinarily rare in childhood, accounting for less than 2% of all renal tumors, and chromophobe subtype in particular is almost anecdotal.

Methods and results: We report the case of a 14-year-old child presenting with hematuria. Imaging tests revealed a large renal mass. After a percutaneous biopsy to exclude other entities, the patient underwent radical nephrectomy with lymphadenectomy and was diagnosed with an eosinophilic chromophobe RCC. At the 6-year follow-up, there was no evidence of recurrence.

Conclusions: RCC in childhood may represent a different entity from adult RCC, with distinct morphologic characteristics and unique genetic abnormalities. The role of the pathologist is crucial, as the diagnosis and classification of RCC in children is still a matter of discussion. New protocols are being tested that will provide more accurate knowledge and therefore may change the clinical management of pediatric RCC.


Ignacio Puche-Sanz, Fernando Vázquez-Alonso, Carmen Carreras-Blesa, José Flores-Martín, José Manuel Cózar-Olmo

Submitted November 23, 2012 - Accepted for Publication January 6, 2013


KEYWORDS: Renal cell carcinoma, chromophobe renal cell carcinoma, pediatric oncology

CORRESPONDENCE: Ignacio Puche-Sanz, MD, Urology Department, Hospital Universitario Virgen de las Nieves, Av Fuerzas

Armadas 2, 18014, Granada, Spain ()

CITATION: UroToday Int J. 2013 February;6(1):art 12. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.12

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Tuberculosis of the Prostate: Four Cases and a Review of the Literature

ABSTRACT

Objectives: Tuberculosis of the prostate is a very rare disease. Most urologists are not familiar with it. Here, we wish to present our experience with 4 cases of this disease and a review of literature.

Methods: This was a retrospective study in a tertiary care center from January 2001 to December 2009.

Results: All the patients were in their fourth or fifth decade of life. Irritative voiding (100%) followed by hemospermia (50%) were the common presenting symptoms. A history of pulmonary tuberculosis was absent in all cases. Three out of 4 cases (75%) had a suspicious prostate on the digital rectal examination. PSA assays were slightly elevated with a mean of 8.26 ng/ml. Urine analysis revealed sterile pyuria in all patients, and the urine culture was negative. The urine and seminal fluid positivity rate was 33.33% for the AFB test, 66.6% for the M. tuberculosis culture test, and 100% for PCR. The transrectal ultrasonogram showed hypoechoic areas with irregular outlines in 3 cases (75%) and calcification in 2 cases (50%). All patients were scheduled to receive 6 months of chemotherapy with isoniazid, rifampicin, and Ethambutol or pyrazinamide.

Conclusions: A high index of suspicion with a wide range of investigations may be required to achieve a complete diagnosis of prostatic tuberculosis. Although short-term multi-drug chemotherapy is an ideal mainstay of treatment, surgery has a definitive role in advanced disease.

Jitendra Singh, Pramod Sharma, Mukesh Kumar Vijay, Anup Kumar Kundu, Dilip Kumar Pal

Submitted September 17, 2012 - Accepted for Publication December 16, 2012

KEYWORDS: Chemothearpy, genitourinary, prostate, tuberculosis

CORRESPONDENCE: Ignacio Puche-Sanz, MD, Urology Departament, Hospital Universitario Virgen de las Nieves, Av Fuerzas Armadas 2, 18014, Granada, Spain ()

CITATION: UroToday Int J. 2013 February;6(1):art 13. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.13

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Congenital Bladder Diverticulum Presenting in an Adult: A Rare Case Report

ABSTRACT

Congenital bladder diverticulum is usually found in childhood, and its presentation in adults is very rare. We present a case of large congenital bladder diverticulum in a 60-year-old male, with a successful outcome after a diverticulectomy.


Nipun Kumar Awasthi, Hemant Kumar Goel, Vinod Priyadarshi, Praveen Kumar Pandey, Dilip Kumar Pal

Submitted October 16, 2012 - Accepted for Publication December 16, 2012


KEYWORDS: Congenital diverticulum, adult

CORRESPONDENCE: Dr. Nipun Kumar Awasthi, Department of Urology, Institute of Post Graduate Medical Education & Research, House no 135, Gayatri Nagar, Bareilly, Uttar Pradesh, India 243002 ()

CITATION: UroToday Int J. 2013 February;6(1):art 9. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.09

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Female Hypospadias and Urethral Stricture Disease in a Circumcised Postmenopausal African Woman: Diagnosis and Management

ABSTRACT

Globally, both female hypospadias and female urethral stricture are uncommon conditions. Female genital mutilation, on the other hand, is a common practice in the West African sub-region, with up to half of the female population circumcised. We report a case of female hypospadias with stricture in an elderly West African lady who had also been subjected to female genital mutilation during childhood. Urethral dilatation with long-term clean intermittent self-catheterization may suffice in these situations, with scarred vaginas avoiding the need for invasive, cumbersome, and difficult surgical reconstruction of the urethra. 


Jibril Oyekunle Bello, Bernard Itopa Ododo, Halima Sani Bello

Submitted October 3, 2012 - Accepted for Publication December 16, 2012 


KEYWORDS: Female hypospadias; female urethral stricture; female genital mutilation

CORRESPONDENCE: Jibril Oyekunle Bello, MD, Urology Division, Department of Surgery, University of Ilorin Teaching Hospital, Nigeria ()

CITATION: UroToday Int J. 2013 February;6(1):art 10. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.10

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Supine Access for Percutaneous Nephrolithotomy: A Simple and Feasible Option

ABSTRACT

Supine percutaneous nephrolithotomy (PCNL) is a less practiced modality for the treatment of upper-tract calculi. We hereby present our single center experience in 100 patients treated by supine PCNL over a period of 18 months. We found the procedure simple and feasible. 


Sanjay Kolte, Parag Ingle, Vivek Bhargava, Meenal Kolte, Jalaj Jain

Submitted August 7, 2012 - Accepted for Publication January 6, 2013


KEYWORDS: Supine PCNL, calculi, kidney

CORRESPONDENCE: Dr. Sanjay Kolte, Sparsh Urology & Kidney Hospital, 35 Balraj Marg, Dhantoli, Nagpur, Maharashtra, India 440012 ()

CITATION: UroToday Int J. 2013 February;6(1):art 8. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.08

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Pediatric Recipients of Adult Laparoscopic Donor Nephrectomy: A Single-Institution Outcome Analysis

ABSTRACT

Introduction: For more than a decade, adult laparoscopic donor nephrectomy (LDN) has been offered as a minimally invasive organ procurement modality for pediatric patients with end-stage renal disease. There is a paucity of literature reflecting pediatric recipient outcomes of adult LDN kidneys, and the objective of this study was to evaluate our institutional experience.

Methods: Thirty-six pediatric patients were identified as recipients of adult LDN from 2000 to 2009 at our institution.

Results: The most common renal disease was dysplasia (N = 6) for those 0 to 5 years of age and nephronophthisis (N = 7) for those 6 to 18 years if age. The mean operative time for those 0 to 5 years of age was 262 ± 38 min and 216 ± 69 min for those 6 to 18 years (P < 0.04). Perioperative complications were more common in those 0 to 5 years of age (73 vs 24%, P < 0.01) and the length of stay (19.3 ± 20.8 days vs 4.8 ± 2.7 days, P < 0.001) was longer compared with those 6 to 18 years.

Conclusion: Pediatric recipients of adult LDN kidneys present unique surgical and hemodynamic challenges. Although renal transplants in pediatric patients are associated with postoperative morbidity, graft survival is comparable to adult LDN recipients.


Zachary Klaassen, Prakash R. Paragi, H. Stephen Fletcher, Ronald S. Chamberlain, Stuart Geffner

Submitted November 24, 2012 - Accepted for Publication January 6, 2013


KEYWORDS: Pediatric, laparoscopic donor nephrectomy, adult kidney donor, outcomes

CORRESPONDENCE: Ronald S. Chamberlain, MD, MPA, FACS, Chairman and Surgeon-in-Chief, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, New Jersey 07039 USA ()

CITATION: UroToday Int J. 2013 February;6(1):art 7. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.07

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The Short-Term Outcome of Urethral Stricture Disease Management in HIV and Non-HIV Infected Patients: A Comparative Study

ABSTRACT

Purpose: This study intends to compare short-term outcomes of treatment of urethral stricture disease between human immunodeficiency virus (HIV) seropositive and HIV seronegative patients at the University Teaching Hospital (UTH) in Lusaka.

Methods: This was a prospective cohort study conducted on patients presenting with urethral stricture disease at the UTH, Lusaka, Zambia, between October 2009 and December 2010. One arm included HIV seropositive patients and the other arm had HIV seronegative patients. The recruited patients underwent urethral dilatation, anastomotic urethroplasty, and staged urethroplasty. They were followed-up postoperatively for 6 months, and recurrence and complication rates were compared between the 2 groups. Other parameters studied included patient demographics, cluster of differentiation (CD4) cell counts in positive patients, HIV World Health Organization (WHO) stages, stricture etiology, stricture sites, and stricture lengths. The collected data was analyzed using SPSS 16.

Results: A total of 71 patients with a mean age of 38.04 years who had urethral stricture disease were recruited for this study. Of the patients, 37% (26) were HIV seropositive while 63% (45) were seronegative, and 53.8% (14) of the seropositive patients were on highly active antiretroviral therapy (HAART). Of the urethral strictures, 45% (32) resulted from urethritis, and the prevalence of HIV in patients presenting with post-urethritis stricture disease was 50% (16/32). Of the strictures, 73.2% (N = 52) were located in the bulbar urethra, 19.7% (N = 14) were in the penile urethra, and 5.6% (N = 4) were located in the membranous urethra. Of the patients, 73% (N = 52) had urethral dilatation, 17% (N = 12) had anastomotic urethroplasty, and 10% (N = 7) had staged urethroplasty. The overall intraoperative complication rate was 2.8% (2) while postoperatively it was 12.7% (9); 55.2% (32/58) had urethral stricture disease recurrence after being followed-up for 6 months, with urethral dilatation accounting for most of the failures (28% (20/58)). Of the non-reactive patients, 47% (16/34) had recurrence while 67% (16/24) had recurrence. However, the 20% difference in recurrence between reactive and non-reactive patients was statistically insignificant (P = 0.139).

Conclusion: Urethral stricture disease affects patients from all age groups. The prevalence of HIV in patients with post-urethritis stricture disease is high. Stricture recurrence following treatment is not affected by the HIV status of the patient and CD4cc, although it is affected by stricture site and stricture length. Time to recurrence and cumulative survival of urethral stricture disease following treatment are also not influenced by the HIV status of the patient.


Mohamed Awny Labib, Michael Silumbe, Kasonde Bowa

Submitted April 30, 2012 - Accepted for Publication December 27, 2012 


KEYWORDS: Aetiology, site, stricture, urethra

CORRESPONDENCE: Mohamed Awny Labib, FRCS (Ed), University Teaching Hospital, Lusaka, Central Zambia, Africa ()

CITATION: UroToday Int J. 2013 February;6(1):art 6. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.06

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Urethral Stricture Etiology Revisited: An Indian Scenario

ABSTRACT

Objectives: Urethral stricture disease remains a common cause of morbidity among men. Many questions about the etiology of urethral stricture disease remains unanswered till now. This study was done in a tertiary care center along with a review of the literature to evaluate the etiology of urethral strictures and to determine the factors that may influence possible preventive or curative strategies.

Methods: This was a retrospective and prospective study of 404 patients with urethral strictures. The case records of all these cases diagnosed as urethral stricture were analyzed to determine the possible cause of the stricture, demographic profiles, and clinical presentation. Data were entered both prospectively by a careful patient questioning and retrospectively from a detailed chart review. A subanalysis of the stricture etiology of patients aged less than 40 years vs patients aged 40 or more was done. Statistical analysis with the Fisher’s exact test was done, and a p value < 0.05 was considered statistically significant.

Results: The mean age of presentation was 41.2 years (range: 3 to 81 years). Overall, the iatrogenic cause was the most common (40.6%), but stricture etiology varied with age and the stricture site.

Conclusions: The etiology of urethral strictures is not uniform across the world. The iatrogenic and idiopathic strictures are surprisingly common. Avoiding unnecessary urethral catheterization and repeated urethral instrumentation can reduce iatrogenic strictures.


Jitendra Singh, Vinod Priyadarshi, Praveen Pandey, Mukesh Vijay, Malay Bera, Sudip Chakraborty, Anup Kundu, Dilip Pal

Submitted October 26, 2012 - Accepted for Publication December 16, 2012 


KEYWORDS: Aetiology, site, stricture, urethra

CORRESPONDENCE: Jitendra Pratap Singh, MS, Department of Urology, Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India ()

CITATION: UroToday Int J. 2013 February;6(1):art 5. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.05

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Hypertrophied Column of Bertin: A Mimicker of a Renal Mass

ABSTRACT

Introduction

Renal pseudotumors simulate malignancy but they are, in fact, comprised of normal renal tissue. Renal pseudotumors include both congenital as well as acquired causes, and they cause considerable anxiety. Many reports are available in the literature where the diagnosis has been clinched only after nephrectomy.

Case Report

We report the case of a 52-year-old male who was referred with the diagnosis of left renal-cell carcinoma upon ultrasound. A contrast-enhanced computed tomography scan finalized the diagnosis of hypertrophied column of Bertin, as there was uniform uptake of contrast noted in the entire kidney. The patient was reassured, and he was relieved of his anxiety. This case is highlighted because congenital hypertrophied columns of Bertin can mimic a renal mass lesion.

Conclusion

Renal pseudotumors are not uncommon, and if they are diagnosed preoperatively with appropriate imaging, invasive interventions like biopsy and radical surgeries can be avoided.

D Paul Vincent, Hari PS

Submitted October 2, 2012 - Accepted for Publication November 13, 2012

KEYWORDS: Renal pseudotumor, hypertrophied column of Bertin, renal mass

CORRESPONDENCE: D. Paul Vincent, MBBS, DNB (Surgery), DNB (Urology), Consultant Urologist, MIMS Hospital, Kottakkal, Malappuram District, Kerala, India 676503 ()

CITATION: UroToday Int J. 2013 February;6(1):art 4. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.04

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Adenosquamous Carcinoma of the Prostate: A Rare Aggressive Tumor with a Review of the Literature

ABSTRACT

Adenosquamous carcinoma (ASCC) of the prostate is an extremely rare, aggressive neoplasm with only few cases are reported in literature. Till now, it has no well-established therapeutic guideline. Here we are reporting a case of this rare entity and a review of literature for its management.


Jitendra Singh, Kaushik Sarkar, Mukesh Vijay, Debashis Chakraborty, Dilip Pal, Anup Kundu

Submitted July 28, 2012 - Accepted for Publication October 8, 2012


KEYWORDS: Adenosquamous, carcinoma, prognosis, treatment

CORRESPONDENCE: Jitendra Pratap Singh, Hno 166-b, Shakti Nagar, Faizabad Road, Lucknow, West Bengal India ()

CITATION: UroToday Int J. 2013 February;6(1):art 3. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.03

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Recreational Urethral Sounding with a Telephone Wire: An Unusually Complicated Case Report

ABSTRACT

Introduction: Urethral sounding is defined as the insertion of an object or liquid into the urethra. The most common reason reported in the medical literature for deliberate urethral insertion is erotic gratification. The most unexpected complication of this practice is the inability to retrieve the object after it becomes lodged in the urethra or the bladder.

Methods and Results: The aim of this report is to describe a rare complication of this practice. We present the case of a middle-aged male who presented to our emergency department with a telephone wire stuck in his bladder after he had introduced it through his urethra with masturbatory intentions. Although the majority of foreign body extractions are managed endoscopically, we describe an unusual case of recreational urethral sounding that required open surgery. No evidence of a psychological disorder was found in our patient. A review of the literature on this issue was made.

Conclusion: Some reports claim that certain segments of society engage more readily in recreational sounding and that this practice can lead to complications. Clinicians must be aware of these practices so that they can provide proper care to such patients, apart from the mere resolution of the acute problem. For patients who have complications and seek medical care, a psychological evaluation and advice for safe sexual practices may be useful for better managing this rare clinical situation.


Ignacio Puche-Sanz, Fernando Vázquez-Alonso, José Flores-Martín, José Manuel Cózar-Olmo

Submitted October 23, 2012 - Accepted for Publication November 19, 2012


KEYWORDS: Recreational urethral sounding, sexual gratification, urethral foreign body, masturbation, sexual behavior

CORRESPONDENCE: Ignacio Puche-Sanz, MD, Urology Departament, Hospital Universitario Virgen de las Nieves, Av Fuerzas Armadas 2, 18014, Granada, Spain ()

CITATION: UroToday Int J. 2013 February;5(6):art 01. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.01

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A Renal Abscess in the Isthmus of a Horseshoe Kidney

Abstract

Horseshoe kidney is a rare congenital malformation predisposing the patient to urinary tract infections. We present a case of a renal abscess occurring in an adult patient with a horseshoe kidney. A computed tomography scan confirmed the diagnosis of an abscess in the isthmus of the horseshoe kidney. A compete regression of the abscess was achieved by a prolonged course of antibiotics.


Satáa Sallami, Olfa Zrayer, Habiba Mizouni

Submitted July 28, 2012 - Accepted for Publication October 8, 2012


KEYWORDS: Horseshoe kidney, abscess, CT scan

CORRESPONDENCE: Satáa Sallami, MD, La Rabta Hospital-University, Tunis, Tunisia ()

CITATION: UroToday Int J. 2013 February;5(6):art 2. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.02

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