Primary Renal Synovial Sarcoma Presenting as Haemorrhagic Shock

Primary synovial sarcoma (PSS) of the kidney is considered the rarest type of all renal sarcomas with specific chromosomal translocation t (X; 18) (p11.2; q11.2). We report the case of a 65-year-old man with no medical conditions who presented to the emergency department with sudden severe right flank pain associated with haemodynamic instability and haemorrhagic shock. Computed tomography (CT) of the abdomen and pelvis revealed a right renal mass. A right open radical nephrectomy was performed. Histopathology revealed a monophasic synovial sarcoma. The patient received six cycles of docetaxel and gemcitabine as adjuvant chemotherapy. No sign of recurrence was seen on a follow-up CT urogram. This rare tumour often presents atypically, and clear guidelines regarding appropriate treatment are lacking. Our case showed that treatment with docetaxel/gemcitabine after an open radical nephrectomy is promising.

Mixed histology bladder cancer as a complication of clam ileocystoplasty

A 58-year-old woman with a previous clam ileocystoplasty was referred to the urology department for the investigation of haematuria. CT urogram showed a large left-sided soft tissue mass arising from the bladder. Histological analysis of the shavings from transurethral resection revealed a G3pT2 transitional cell carcinoma and T4N1Mx adenocarcinoma. The patient was referred to oncology for the discussion of palliative chemotherapy; however, in the interim she deteriorated and was admitted to hospital with a post-renal acute kidney injury. A right-sided nephrostomy was inserted relieving her obstruction and she subsequently made a good recovery. This case report illustrates the difficulties in the long-term follow-up of patients having undergone what is now a rarely performed procedure. In the absence of regular cystoscopic follow-up post ileocystoplasty, malignancy may present late and with complications from advanced disease.

Renal calyceal diverticulum mimicking a large renal cyst-A case report

Renal calyceal diverticulum are outpouching from renal calyx or pelvis into the renal cortex lined by transitional cell epithelium. We report a case of 35 years old male with history of accidental fall from bike, who presented with persistent right loin pain and hematuria. CT Urogram showed multiple large right renal cysts (BOSNIAK II). Patient was planned laparoscopic renal cyst deroofing. Due to suspicion of calyceal diverticulum, an intraoperative Retrograde Pyelogram (RGP) was done which showed calyceal diverticulum. Laparoscopic calyceal diverticulotomy with closure of communication was done. If only a cyst deroofing was done considering the CT finding alone, it would have ended up in post-operative complication of urinoma which may require a re-surgery. This case report emphasizes the importance of anticipating calyceal diverticulum and intraoperative attempts in the form of doing RGP to identify calyceal diverticulum which mimic renal cyst regardless of CT finding in suspected cases. Keywords: Calyceal diverticulum; large renal cyst; retrograde pyelogram; laparoscopic calyceal; Diverticulotomy.

Stone Formation on Suture Material Following Laparoscopic Pyeloplasty Causing Recurrent Puj Obstruction: A Case Report

Male patient 46 years of age presented with history of Laparoscopic A-H pyeloplasty with DJ stenting for left side hydronephrosis due to PUJ obstruction. After stent removed he experienced intermittent flank pain, discomfort with fullness sensation. On examination there was mild left renal angle tenderness. Urinalysis showed RBC. USG revealed moderate left hydronephrosis. CT urogram showed left side gross HDN with 5 mm PUJ stone. Tc-99m DTPA renal scan revealed partial obstruction. After counseled and exploration founded an impacted PUJ stone. During removal of PUJ stone, identified a suture material embedded by the stone. After removed the stone,PUJ still narrowed. Then A- H pyeloplasty done with placed a D-J stent in situ. The patient had a good post-operative recovery. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.164-165

Computed tomography urography findings of complete inguinoscrotal bladder herniation

Inguinoscrotal bladder herniation (IBH) is a rare type of inguinal hernia associated with significant urologic complications such as acute renal failure, hydronephrosis, obstructive uropathy, and sepsis. Diagnosis of this condition can be made with common imaging modalities including excretory urography, retrograde cystography, computed tomography (CT), and magnetic resonance imaging. We present the classic symptomatology and imaging findings of inguinoscrotal bladder herniation on CT urogram in two patients. Although the majority of IBH are diagnosed intraoperatively, radiologists and the surgical team should be aware of this diagnosis when working up a patient, as preoperative diagnosis is crucial to assist with surgical planning and avoid intraoperative complications. Level of evidence: 4.

Endourological Management of Iatrogenic Ureterovaginal Fistula following Obstetric and Gynecological Surgeries at Tertiary Referral Center

Aims: To evaluate the outcome of endourological management of iatrogenic ureterovaginal fistula caused by gynecological and obstetric surgeries. Methods: This is a retrospective analysis of uretorovaginal fistula (UVF) patients who underwent UVF management with endourology technique from February 2014 to November 2019. All data were taken from fistula database. All non-obstetric/gynaecological cases and open surgical procedures leading to UVF were excluded. Diagnostic evaluation by cystoscopy and ureterorenoscopy; and use of guide wire, C-arm and DJ stent were recorded. Three to six months post-operative follow up status was also recorded. Results: There were 14 cases managed by retrograde DJ stenting. Both hysterectomy (n=10) and Cesarean Sections (n=4) were the past surgeries. Diagnosis was made by history, methylene blue test, cystoscopy, intravenous urography and CT urogram. Treatment was retrograde DJ stenting. All of them had unilateral distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. All were continent at the end. Conclusions: Endourological approach with retrograde DJ stenting had successful outcome in iatrogenic UVF. Keywords: double J stent, endourological technique, iatrogenic ureterovaginal fistula, ureterorenoscope.

Retrocaval Ureter: Report of Two Cases

Retrocaval ureter (RCU) is a rare congenital anomaly in which the ureter passes posterior to the inferior vena cava (IVC). A little over 200 cases have been reported worldwide since Hochstetter’s first report in 1893. We present two cases of retrocaval ureter which were successfully managed at the Cape Coast Teaching Hospital in Ghana. Case 1. A 55-year-old woman presented with a history of dull right flank pain of 2 years duration. Physical examination and basic laboratory investigations performed on her were normal. Abdominal ultrasound showed right hydronephrosis and a retrograde right ureteropyelogram (RPG) showed right hydroureteronephrosis with an “S” shaped proximal ureter. A diagnosis of retrocaval ureter was made and confirmed at surgery. Case 2. A 25-year-old man presented with dull intermittent right flank pain of 1 year duration. Clinical examination and laboratory investigation were normal. Abdominal ultrasound showed right hydronephrosis and a CT urogram made a diagnosis of retrocaval ureter which was confirmed at surgery. Conclusion. Retrocaval ureter is a rare congenital anomaly that is now increasingly being reported. Surgical treatment of symptomatic cases successfully relieves symptoms.