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The particular procedure regarding myocardial fibrosis is ameliorated by myocardial infarction-associated records with the PI3K/Akt signaling pathway to help remedy coronary heart failure.
Background Nephrolithiasis is increasingly becoming one of the most prevalent and costly urologic conditions in the United States. The most common type of kidney stone in humans is calcium oxalate, accounting for 75% of idiopathic stones in first-time stone formers. Stone formation is typically a gradual process; however, certain factors can accelerate stone development and recurrence. Case Presentation We present two cases of adult white men who were found to have rapidly recurrent symptomatic kidney stones that were ultimately determined to be comprised of an outer mineral shell with an inner core of blood clot. Both patients had a history of nephrolithiasis and recent hematuria. Urine supersaturation values at time of presentation supported formation of kidney stones. Conclusion Thrombi within the urinary tract can serve as a nidus for formation of multiple types of kidney stones, including calcium oxalate and uric acid stones. Stones arising from such a nidus may exhibit unusually rapid growth.Background Hydatid disease of urinary tract is most common in the kidney. In kidney, hydatid cysts are most commonly found in the renal parenchyma. Isolated hydatid cysts in the renal pelvis are extremely rare with only three cases reported in the literature. Case Presentation We present a case of isolated hydatid cysts in the renal pelvis masquerading as renal pelvic calculi, which were diagnosed during surgery and confirmed on histopathology. Conclusion Hydatid cysts can masquerade as renal calculi. Preoperative modalities may miss the correct diagnosis. Histopathology in suspected cases can confirm the diagnosis so that proper chemotherapy can be offered to patient to avoid recurrence.Percutaneous nephrolithotomy (PCNL), first described in 1976, is the gold standard for the management of large kidney stones, with stone-free rates as high as 95% in contemporary literature. Colonic injuries during PCNL are a rare complication with an estimated incidence of 0.3%-0.5%. However, given the high morbidity incurred and the necessity of prompt operative intervention, it is imperative that practitioners have a low suspicion threshold for such injuries, particularly in those patients with altered or complex anatomy. This case series addresses peri- and postoperative outcomes of colon perforation during PCNL in patients with complex anatomy and reviews the technical challenges of surgery with potential methods to avoid injury in the future. Herein we review three instances of colonic injuries and their subsequent management to highlight both the presentation and the optimal management of these rare occurrences.Background Ureteroiliac fistula is a rare cause of gross hematuria and lateralizing flank pain. Risk factors include previous pelvic surgery, pelvic radiotherapy, or chronic ureteral stentings. Diagnosis is challenging and requires arteriography and ureteroscopy. Management ranges from open surgery to minimally invasive means such as the use of an endovascular stent. Case Report A 62-year-old man with postradical cystoprostatectomy and cutaneous ureterostomy presented an intermittent gross hematuria with anemia that required blood transfusions. Some CT arteriographies were performed but none of them could identify the bleeding origin. Therefore, a flexible ureteroscopy was performed that showed a left ureteroiliac fistula. Subsequently, an endovascular stent was placed in the left common iliac without complications. Conclusion The ureteroiliac fistula is a life-threatening condition. CT arteriography or ureteroscopy might help in the diagnosis but the sensitivity is ∼64%. Arteriography with endovascular stenting is a viable and safe option. However, because of its rarity, long-term durable benefits still need to be documented.Background Chyluria is a rare diagnosis classically associated with milky-appearing urine. It involves the leakage of chyle into the urinary tract. Although the most common cause of chyluria worldwide is infectious in nature, other noninfectious etiologies have been described. Classically chyluria resolves spontaneously or with conservative management. Surgical treatments have been described but are not often required. We present a case of iatrogenic pyelolymphatic fistula after robot-assisted laparoscopic dismembered pyeloplasty that was treated with endoscopic electrocautery of the fistulous tract. Case Presentation A 50-year-old Caucasian man underwent a robot-assisted laparoscopic dismembered pyeloplasty with stent insertion for radiographically demonstrated left ureteropelvic junction obstruction. His postoperative course was uneventful until 4-week follow-up at which time he began to notice intermittent passage of milky-appearing urine. Urinalysis was notable for large protein and elevated urine triglycerides. He was initially managed conservatively dietary modifications without success. He then underwent endoscopic management with cystoscopy and ureteroscopy with fulguration of suspected pyelolymphatic fistula. He was maintained on a low-fat medium-chain triglyceride diet and octreotide injections while inpatient for 1 week postoperatively. His postoperative course was unremarkable and no return of chyluria was observed. His chyluria remained resolved at 9 months postoperatively. Conclusion Pyelolymphatic fistula after robot-assisted laparoscopic pyeloplasty is a theoretical complication of perirenal dissection and has not been previously described in the literature. It should be considered as a rare iatrogenic cause of chyluria. Endoscopic management with fulguration is technically feasible and may obviate the need for more invasive surgical management.Background Inflammatory pseudotumor of the kidney is a rare disease of unknown etiology. There are no specific clinical or radiologic findings. The lesion can mimic renal cell carcinoma or transitional cell carcinoma depending on the site of involvement. These tumors, if diagnosed correctly, may respond to medical management. We present a case in which an inflammatory pseudotumor of the renal pelvis was misdiagnosed as a transitional cell carcinoma and unwarranted surgical intervention was performed. Case Presentation A 39-year-old man presented with left flank pain and gross hematuria. On MRI, there was a hypointense 2.4 × 1.8 cm lesion involving the left renal pelvis. The urine cytology and biopsy of the lesion were inconclusive. On follow-up cans the lesion increased in size and patient had repeated hematuria. The lesion was clinically presumed to be a transitional cell carcinoma of the left renal pelvis. A laparoscopic left side nephroureterectomy along with bladder cuff excision and para-aortic lymphadenectomy was performed. The histology report revealed the lesion to be inflammatory pseudotumor of the renal pelvis. Conclusion Inflammatory pseudotumor should always be considered in differential diagnosis of pelvic tumors, especially when image findings and biopsies are inconclusive.Background Because of the fear of being infected with coronavirus disease 2019 (COVID-19), patients with nephrolithiasis, who choose to stay home, may suffer serious complications such as obstructive uropathy, deterioration of renal function, sepsis, and death. We present such a case that led to renal failure and necessitated emergent urologic intervention. Case Presentation A 60-year-old Caucasian man presented with right flank pain, dizziness, and dyspnea at the emergency room. History was significant for a previous diagnosis of right renal pelvic stone that was scheduled for retrograde intrarenal surgery before the pandemic lockdown. Upon evaluation, he was found to have an elevated creatinine of 40.2 mg/dL, bilateral hydronephrosis, pericardial and pleural effusion. The patient underwent emergency hemodialysis, followed by preliminary bilateral percutaneous nephrostomy, and subsequently by ureteral stenting. He was discharged stable with the future plan for endoscopic stone management. Conclusions In the midst of the COVID-19 pandemic, urologists should follow up all known kidney stone patients, regularly assess their condition, and prioritize those who need urgent care. Patient education and telemedicine are useful tools for this purpose and may help minimize the risk of complications during a community lockdown.Introduction Amplatz sheaths are hollow tubes that serve as the portal for the insertion of the nephroscope during percutaneous nephrolithotomy (PCNL). Breakage of this tube during the procedure is rare, but when it does occur it should be recognized and addressed promptly. Case Presentation A 46-year-old Caucasian male patient was scheduled for PCNL. The Amplatz sheath was inserted in the usual manner over a balloon dilator and nephroscopy was performed. Profuse bleeding was encountered early. Upon meticulous endoscopic navigation, the broken Amplatz tube was recognized and replaced. This allowed us to identify and remove the fragment of the Amplatz tube, followed by stone fragmentation and removal. Conclusion Our experience highlights the importance of recognizing this rare complication of a broken Amplatz sheath that should be managed promptly and effectively through endoscopic means without the need to abort the planned PCNL.Background Calcium-based urinary stones rarely grow bacteria on stone culture. The presence of an anaerobic bacteria is even more uncommon. We present a case of Veillonella growth from a primarily calcium phosphate-based urinary stone culture. Case Presentation A 56-year-old Caucasian woman presented with urosepsis and bilateral nephrolithiasis. A nephrostomy tube was emergently placed in the left kidney. After resolution of her urosepsis, she underwent a left percutaneous nephrolithotomy. The stone culture grew Veillonella, a gram-negative anaerobe. Conclusion Growth of anaerobic bacteria, such as Veillonella, on stone culture of a calcium-based stone is a rare occurrence; the mechanism of this association remains unexplained.Background Renal cell carcinoma (RCC) recurrence can present in nearly any location. Rarely, recurrence is within the venous system. Previous reports of such recurrent tumor thrombectomy have all used an open approach. For the first time, we present robotic excision of recurrent RCC tumor thrombus. Case Presentation This is a 59-year-old man who was referred to us 3 years after right robotic radical nephrectomy and renal vein tumor thrombectomy with positive margins. He had been lost to follow-up after 1 year. He presented again 3 years after surgery and was found to have recurrence with inferior vena cava (IVC) tumor thrombus to the caudal margin of the liver. He was taken for robotic tumor thrombectomy, which was completed with 900 mL of estimated blood loss, requiring a single unit of packed red blood cells. The surgery was complicated by increased bleeding caused by an undiagnosed arteriovenous fistula between the right renal artery and vein remnants. Conclusion Robotic excision of recurrent RCC IVC thrombus is a potential treatment for selected patients under the care of experienced robotic surgeons.Percutaneous nephrolithotomy (PCNL) has become the standard of care for the removal of kidney stones >2 cm. Major complications, although rare, are between 1% and 7%. Splenic injury during PCNL is rare and can often be managed conservatively, but has the potential to be devastating, necessitating the importance of early diagnosis. Our team describes two cases of splenic injury during PCNL with emphasis on diagnosis and management. Although both cases were managed conservatively through close monitoring and prolonged nephrostomy tube presence, one case had a concurrent pneumothorax. Both cases were diagnosed primarily through postprocedure CT imaging. selleck chemicals Risk factors primarily include supracostal access and splenomegaly. Splenic injury is a rare complication that can often be managed conservatively; however, prompt recognition of injury is important. We present in this study two cases of conservative splenic injury management sustained during PCNL.
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