Giant Urinary Bladder Stone in a Middle-Aged Male

Urolithiasis is a disorder that affects 10–15% of people at least once in their lives. Among the calculi affecting the urinary tract are the bladder stones. Giant urinary bladder stones are rare and can potentially lead to the onset of intense symptoms as well as life threatening repercussions. This disorder demands an accurate diagnosis with the use of imaging tools and laboratory tests, as well as an agile and appropriate therapeutic approach in order to prevent unfavourable outcomes. This paper reports on a bladder stone that was 18.5 cm in diameter and weighed 1.328 kg, which was extracted from a middle-aged male.

Pathogenesis and Treatment of Refractory Oedema in Nephrotic Syndrome

Oedema is a hallmark feature of nephrotic syndrome (NS) and can cause significant patient morbidity. The pathogenesis of oedema formation is complex and results from abnormalities in sodium retention, inter-play of neurohormonal factors, and changes in capillary filtration barrier. Salt retention is often primary (‘overfill’ theory) because of increased sodium-potassium adenosine triphosphatase activity in the collecting duct cells, increased direct epithelial sodium channel activation (ENaC) by urinary proteases (independent of aldosterone), and an overall increased effective arterial blood volume. However, a subset of patients with NS, especially children, demonstrate decreased effective arterial blood volume (‘underfill’ theory) and secondary sodium retention as the primary mechanism of oedema formation. Increased capillary permeability and vascular inflammation contributes as well. Loop diuretics with or without salt-poor albumin are the mainstay of therapy in adults, although no large clinical trials exist to guide diuretic choice or dosage. Combination diuretic therapy is recommended to achieve multi-site nephron blockade and overcome diuretic resistance, which is a frequent challenge. Use of direct ENaC inhibitors (amiloride) in combination with loop diuretics may be especially beneficial given the primary role of ENaC in sodium retention. Aquaretics such as vasopressin receptor antagonists may have a role in treatment as well. Well-designed clinical trials are essential to guide therapy of refractory oedema in NS. In this review, the authors discuss the pathogenesis of oedema formation in patients with NS and propose a treatment algorithm for management of resistant oedema based on the limited available evidence.

Robotic Surgery and Its Application in Urology: A Journey Through Time

Objectives: To evaluate an overview of the past, present, and future of robotic surgery. To provide insight and focus on the current status of the field of robotic systems for urological surgery with outcomes and discuss future perspectives in terms of other operative techniques and new robotic platforms. Evidence acquisition: The authors undertook a non-systematic literature review using PubMed, Medline, and Google search. They used the search terms “robotic uro-surgery”, “laparoscopic”, “minimally invasive surgery”, “future of robotics”, “global robotic market growth”, “geographical distribution”, and “cost-effectiveness”. Evidence synthesis: Robotic surgery has embraced and extended almost all aspects of uro-surgical fields since its introduction three decades ago. There are definite advantages of robots to the surgeons and patients. It has become new standard of care for many surgical procedures. Innovation and technological advances are continuing and new with more precise robots are emerging. The major downside is cost. Despite the high cost, robot market is growing. Conclusion: Over the past decade, minimally invasive approaches have virtually revolutionised surgery and robotic surgery has accelerated these changes. Without doubt, robotic urologic surgery is here to stay and will expand further in all surgical disciplines. Utilisation of robotics should be coupled with a reduction in costs to healthcare systems, and improved clinical outcomes for the general population rather than a privileged few. Therefore, making this expensive technology more affordable must be part of the equation.

The Microbiota and Kidney Transplantation: Influence on the Graft

The gut microbial community may be associated with complications after kidney transplantation. The indigenous microbiota has a significant and protective function that influences the transplant recipient response. Genetic or environmental factors may modify the indigenous microbiota and pathobionts appear. In this condition, several disturbances of the kidney graft may be observed. These include acute rejection, infection, diarrhoea, disturbance in the induction of tolerance, and modification of immunosuppressive drug metabolism. Recently, the use of prebiotics, probiotics, and synbiotics has been demonstrated to be effective in normalising these conditions and in restoring the generation of the normal indigenous microbiota. An improved understanding of the function and composition of the indigenous microbiota may help in finding further solutions to stabilise the microbiota after kidney transplantation.

Non-papillary Percutaneous Puncture: A Safe Approach to Consider

Percutaneous nephrolithotomy (PCNL) is the ‘gold standard’ treatment modality for renal stones larger than 2 cm. It can be also applied to manage smaller renal stones and large, impacted stones located in the proximal ureter. Nevertheless, even in experienced hands, the PCNL procedure is associated with the development of several complications. Despite the existing extensive research in this field, studies evaluating the effect of puncture site on perioperative bleeding are very few. In part, this can be explained by the dogma that the safest way to perform kidney puncture is through the renal papilla. In this paper, the authors summarise their experience of non-papillary PCNL and demonstrate this puncture technique for PCNL tract establishment.

Penile Reconstruction: Current Thoughts, Techniques, and Outcomes

Phalloplasty has matured considerably over the last decades in reconstructive options and technical refinements, thanks to increasing recognition of gender dysphoria. The primary goals of performing a phalloplasty are to facilitate sexual penetration, protective sensation, orgasm, standing micturition, and natural aesthetic, ideally in few stages and with minimal morbidity. Radial forearm free flap, anterolateral flap, and metoidioplasty are the most common options, each with a unique profile of complications, aesthetic, and functional outcomes. Choices for reconstruction must be tailored to the individual patient’s goals and available tissue characteristics.

A Review of Rare Associations of Horseshoe Kidney: Highlight of a Rare Clinical Case of Polycystic Horseshoe Kidney, Liver Cyst, and Uterine Prolapse

Horseshoe kidney is the most common renal fusion anomaly occurring in 0.15–0.25% of the general population. Horseshoe kidney is usually asymptomatic but may present with disease-like infections, urolithiasis, malignancy, polycystic disease, and other associated anomalies that may require intervention. Polycystic horseshoe kidney is rare, its association with uterine prolapse has not been reported in the literature, and it can only be postulated as an associated risk factor for uterine prolapse when found in the pelvis. The authors reviewed rare associations of horseshoe kidney and the management of these associated anomalies and disease conditions with the clinical vignette of a 60-year-old female with low-lying/lumbo-pelvic polycystic horseshoe kidney and hepatic cyst, and concomitant uterine prolapse requiring total abdominal hysterectomy at a Senegalese Hospital.