Outcome of Rirs for Renal Pelvic Stones 1.5 to 2.0 cm using Semi-Rigid Uretero-Renoscopy

Background Retrograde Intrarenal Surgery (RIRS) is among the recommended treatment modality for stones located in renal pelvis and is of less than 2 cm. Renal Stones with Hounsfield units more than 1000 have low stone free rate with ESWL. Objective To determine the outcome of retrograde intrarenal surgery using semirigid ureteroscope in fragmentation of renal pelvic stone. Methods Patients with 1.5-2.0 cm stone located in renal pelvis of more than 1000 HU who underwent retrograde intrarenal surgery as primary procedure at Sindh Institute of Urology And Transplantation were included. Stone fragmentation was achieved with holmium-yttrium aluminum garnet laser. Secondary procedure was performed if complete stone fragmentation was not achieved. Statistical analysis was performed by SPSS version 20. Result Total 82 patients with mean size of pelvic renal stones 1.7 ± 0.53 cm were included. The mean operating time was 32.1±12.9 mins. The stone clearance rate at six weeks after the first procedure was 79.3%. Minor complications including flank pain, fever and hematuria were reported. Conclusion Retrograde intrarenal surgery performed with semi rigid ureteroscope in renal pelvic stones of more than 1000 HU is a technically safe and effective procedure. Keywords: Retrograde intrarenal surgery; Pelvic stone; Flexible ureteroscopy and holmium laser.

Recurrence of Aggressive Urothelial Carcinoma in an Ileal Neobladder without Involvement of Remaining Urothelium

We review a case of a 70-year-old male with a recurrence of urothelial carcinoma in an ileal neobladder without involvement of the remaining urothelium two years after a radical cystoprostatectomy. This case is extremely rare especially due to the lack of recurrence in the urethra or upper urinary tract. Abbreviations BCG: Bacillus Calmette-Guérin; CIS: Carcinoma in situ; CT: Computerized/computed tomography; NCCN: National Comprehensive Cancer Network; PE: Pulmonary embolism; PET: Positron emission tomography; RC: Radical cystectomy; TURBT: Trans-urethral resection of bladder tumor; UC: Urothelial carcinoma. Keywords: Urothelial carcinoma; Ileal; neobladder; Tumor; Recurrence; Metastasis.

The Effect of the Duration between Preoperative Bladder Urine Culture and Semirigid Ureteroscopic Lithotripsy on the Rate of Systemic Inflammatory Response Syndrome Postoperatively

Purpose The aim of this study is to analyze the preoperative and intraoperative factors that might induce systemic inflammatory response syndrome (SIRS) after semirigid ureteroscopic lithotripsy (SUL), and to evaluate the impact of duration between preoperative bladder urine culture (PBUC) and surgery on postoperative systemic inflammatory response syndrome (SIRS). Methods A retrospective review was conducted including patients who underwent SUL in our center between June 2015 and June 2020. Prior to surgery, PBUC were obtained from all patients and postoperatively patients were observed for signs of SIRS. Univariable and multivariable binary logistic regression analysis were implemented to demonstrate the factors that predict SIRS postoperatively. Results The entire study included a cohort of 572 patients. The rate of SIRS following SUL was 1.7%. Predictive factors for SIRS were listed as stone volume, surgical time, and history of recurrent urinary tract infection. No significant difference was detected in terms of the duration between PBUC and SUL when comparing the SIRS group with the other group. Conclusion The duration between PBUC and SUL is not efficacious factor for SIRS. It may be useful to conduct prospective studies to enlighten this issue as endourologists deal with this duration dilemma often in daily practice. Keywords: Semirigid ureteroscopic lithotripsy, Systemic inflammatory response syndrome, Preoperative bladder urine culture.

Acute Urinary Retention Following Primary VaricellaZoster Virus Infection

Background Acute urinary retention following primary varicella-zoster virus infection (chickenpox) is very rare. Case Presentation We present a case of 34 years old male patient presented with acute urinary retention following primary varicella-zoster virus infection (chickenpox), there was no lesion detected neither by MRI brain nor whole spinal cord imaging. There was a typical blistering rash over the face, trunk, back and upper limbs but sparing the perennial and perianal area. Conclusion Once herpes zoster is found in lumbar lumbosacral region be alert there is possibility of voiding dysfunction like acute retention of urine. The effective treatment plan includes antiviral therapy and urethral catheterization. Most of urological symptoms due to herpes zoster subsides in the very short duration with active guideline treatment. Keywords: Varicella-zoster virus infection; Blister-like rash; Acute urinary retention.

Fibrous Pseudotumor of Para Testicular Region; A Rare Clinical Entity

Background Para testicular pseudotumor is a rare benign tumour originating most commonly from tunica vaginalis, less commonly from tunica albuginea, epididymis, and the spermatic cord. Case Presentation We present a case of a 27- year old Asian male patient who presented with painless palpable mass in the left hemiscrotum. Scrotal ultrasonography showed well-defined lobulated solid left Para testicular lesion closely related to the tunica/epididymis with specks of calcification within the lesion. Scrotal exploration and excision of the tumour was performed. Histopathology Findings revealed fibrous pseudotumor. Conclusion Para testicular fibrous pseudotumor is a rare clinical entity in young adults, scrotal swelling mimics testicular tumour. Preoperative diagnosis is a pitfall. Histopathology is the only way to establish diagnosis. Keywords: Para testicular; Tumors; Surgical exploration; Orchiectomy.