Notes

Dual concentration-dependent effect of ascorbic acid on Smear(248-286) amyloid formation and also SEVI-mediated Aids contamination.
Cuff erosion at the bladder neck of an implanted artificial urinary sphincter (AUS) needs complete explantation of the device. The subsequent scar tissues predispose to repeated cuff erosion, when another AUS is implanted with the cuff at a similar location. We describe a paraplegic patient with exstrophy-epispadias complex that suffered from an AUS cuff erosion at the bladder neck. We use a novel perineal-retropubic route for cuff placement, with preparation similar to a retropubic male sling. At 12 years follow-up the AUS is still functional and the patient continent.Bladder neck closure after severe polytrauma with an absent urethra poses a huge challenge for a young woman wanting to urinate normally. Considerations are reconstruction of a neourethra and operative means to gain continence. We describe a case of trigonal tubularization to function as a neourethra, together with the implantation of an artificial urinary sphincter. Eleven years after suffering from an open book pelvic rim fracture at 18 years, successful reconstruction of a trigonal neourethra enabled continence and residual-free spontaneous voiding at 29 years.Squamous cell carcinoma (SCC) of the penis is a rare cancer in the industrialized countries, including the United States. Risk factors for these cancers include inflammatory conditions as well as infection with the human papilloma virus (HPV). Treatment modalities are based on TNM staging and may include surgical management or chemoradiation. Patients with local or some regional disease can have a favorable prognosis; however, with extranodal metastasis, survival decreases sharply. Here, we present a case of long-term disease-free survival in a patient with widely metastatic SCC of the penis.Adrenal Ganglioneuromas are rare. Evaluation for hormone secretion followed by complete excision is the treatment of choice for such masses. We present our experience of a symptomatic large Adrenal Ganglioneuroma, which was removed with laparoscopic procedure. A 44-year gentleman presented with a symptomatic adrenal tumor. Under the impression of Adrenal Pheochromocytoma, tumor was excised laparoscopically without any untoward event. And to our surprise Adrenal Ganglioneuroma was detected in biopsy. Hence, Ganglioneuromas should be considered as a differential for a functional or symptomatic adrenal mass. And by following proper technique even such large functional adrenal masses can be removedlaparoscopically.A 65-year-old lady was admitted with urosepsis and imaging suggesting right sided hydronephrosis secondary to a filling defect consistent with a fungal bezoar. An indwelling urinary catheter and a right percutaneous nephrostomy tube were inserted. Candida glabrata cultured from urine was resistant to fluconazole. Amphotericin B was instilled into the renal pelvis via the nephrostomy tube while intravenous liposomal amphotericin was administered daily along with oral flucytosine. This multi-modal antifungal administration was continued for 14 days. Clinical and biochemical improvement was achieved and repeat imaging showed complete resolution of the filling defects and hydronephrosis.Among the various rare complications that occur in the treatment of urolithiasis procedures, stent migration is rare, and most of them are into the renal veins or inferior vena cava (IVC). In this report, we describe one case of PCNL stent misplacement into the heart, causing arrhythmia. After identifying the stent migration, based on the location, the DJS was taken out through supraclavicular vein.Giant multiple vesical calculi are rare entities in modern urological practice. Very few cases of vesical calculi of more than 100 g has been reported in English literature. Largest vesical calculus was of weight 6294 g by Arthur et al. Bladder stones may be asymptomatic and discovered as incidental finding. However, when symptoms occur, these include lower abdominal pain, difficult urination, frequent urination, painful urination and blood in urine. Our CASE report demonstrated two vesical calculi weighing 194 g and 292 g which is a rare finding in today's urological practice.Endometriosis involving the bladder is rare, but generally has a severe presentation with prominent lower urinary tract symptoms and can progress to renal failure. As endometriosis has a significant effect on quality of life and fertility, treatment plans must be centered on the patient's symptoms, expectations, and priorities. We present a case of a 37-year-old African American female with advanced bladder endometriosis and consequent renal failure, who desired to avoid extensive surgery and maintain her fertility. This case highlights the importance of shared decision making in balancing disease management with patient autonomy.A 78-year-old man was referred for investigation of prostate cancer following incidental uptake on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Despite normal PSA and benign digital rectal exam, he was referred for consideration of trans-perineal biopsy to exclude prostate cancer. It was only on review of imaging that it became clearly apparent that the 18F-FDG uptake was due to urinary tracer pooling in a trans-urethral resection cavity. Surgeons, oncologists and nuclear medicine physicians should be aware of this common pitfall in interpretation of 18F-FDG-PET in the prostate.Carcinosarcoma of the kidney and renal pelvis (CSKP) is a rare and highly-aggressive malignancy characterized by rapid progression and widespread metastases. To date, few studies describe the natural history of the disease. We present a patient placed on pembrolizumab therapy for suspected metastatic colon cancer. The patient was found to have a right renal mass with caval extension on surveillance and ultimately underwent radical surgery revealing carcinosarcoma with positive PD-L1 expression with no evidence of recurrence to date. To our knowledge, this is the first case describing PD-L1 expression in CSKP and presents a novel pathway for future treatment algorithms.Renal artery pseudoaneurysm (RAP) is a potentially life-threatening complication after partial nephrectomy (PN). Studies suggests that most cases present within 15 days post operatively with one of three classic symptoms gross hematuria, flank pain and/or anemia. However, there are a limited number of reports in the literature regarding delayed RAP (≥four months). To the best of our knowledge we report the first case of RAP six months following robotic-assisted PN.The page kidney phenomenon is often associated in patients with abdominal trauma. External compression from a renal hematoma can cause hypertension, and presentation can be delayed following the initial injury. For patients who have a kidney allograft, page kidneys may lead to renal insufficiency and acute renal failure due to the absence of a contralateral kidney to compensate. This case report discusses the identification and management of a page kidney in a kidney allograft recipient within three months following transplantation.Venous malformation (VM) of bladder is uncommon. We report the case of a VM involving bladder that was initially misdiagnosed as endometriosis based on symptomatology, histology and imaging. After failure of hormonal agent and increasing symptoms, a laparoscopic partial cystectomy was performed with a rapid improvement. Pathology diagnosis confirmed a VM. selleck products The 6-month cystoscopy showed the persistence of a vascularized lesion, reflecting an uncomplete resection. We decided to closely follow the patient and after 24 months, the lesion was stable and our patient remained asymptomatic. This case highlights the importance of considering VM in atypical urological symptoms and bladder lesion.Synchronous double primary RCC and TCC of the renal pelvis and bladder are extremely uncommon. Proper management is a medical dilemma, and no standard treatment strategy has been agreed upon for this rare situation. Our case involved a large mass in the right kidney and multiple masses in the left renal pelvis, ureter, and bladder. Aggressive management was adopted, including multiagent neoadjuvant chemotherapy, cystectomy and nephroureterectomy, which resulted in an excellent outcome, although our patient will require life-long hemodialysis.A 71-year-old male with history of clear cell renal cell carcinoma (RCC) 6-years status post nephrectomy presented for gross hematuria. Cystoscopy revealed a bulge of the right ureteral orifice, and transurethral resection confirmed RCC metastasis to the ureteral stump. Ureterectomy with bladder cuff excision was performed, and the patient is currently undergoing aggressive imaging surveillance. This is the 57th case of metastasis of RCC to the ureteric stump, and this case occurred beyond baseline surveillance recommendation of five years. Potential mechanisms of metastasis of RCC are reviewed, and RCC surveillance is discussed.Abdomino scrotal hydrocele (ASH) is a very rare condition in which the hydrocele sac extends beyond the scrotum to the abdomen via the inguinal canal. Although various ideas have been proposed regarding this disease, there is still controversy over its etiology. We report a case of abdominoscrotal hydrocele in a one year old boy (Mofid Children's hospital, Tehran, Iran) with history of right sided herniorrhaphy one month ago in other center. Slow growing mass in lower abdomen was noted by parents. For better diagnose, ultrasound and CT scan was performed. In operation missed large abdominalscrotal hydrocele was confirmed.Segmental infarction of the testicle secondary to epididymo-orchitis is a rare condition which can be difficult to diagnose and can lead to loss of the testis. We report a case of a 72-year-old man who presented with two weeks of worsening pain of his left testis despite oral antibiotic treatment for epididymo-orchitis. A testicular ultrasound initially revealed a suspected intra-testicular abscess. Despite intravenous antibiotics, his symptoms worsened. A repeat ultrasound demonstrated an increase in size of the lesion and a decision was made to take him to theatre. Intra-operative findings instead revealed a segmental area of testicular infarction requiring debridement.Necrotising Fasciitis, also known as Fournier's Gangrene (FG), is a condition that rarely affects children. FG was first described by French venereologist, Jean Alfred Fournier in 1883. It is more common in adults and is strongly linked to immunosuppression. Few paediatric cases of FG have been described and therefore we present a case of a ten month old infant with a FG perineum that only affected the external genitalia (scrotum and penis).In the Checkmate-025 trial, nivolumab treatment prolonged overall survival among patients with previously treated advanced renal cell carcinoma (RCC) compared with treatment with everolimus. Although effective, nivolumab is associated with immune-related adverse events (irAEs). However, the occurrence of hematological irAEs is rare. Some studies have reported on nivolumab-induced thrombocytopenia. Nivolumab associated thrombocytopenia in almost all patients improved with administration of various drugs. However, there have been only a few cases that have reported death owing to cancer aggravation. In this paper, we have described a case of nivolumab-induced thrombocytopenia after third-line treatment for metastatic RCC.
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