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Impact regarding enviromentally friendly activates on kids' actions to use ride-sharing solutions: the moderating role associated with identified chance.
Background Double-J stents (DJSs) are placed in the ureter to maintain urine flow from the kidney to the bladder. Extraurinary tract displacement of the stents is very rare, those observed in the literature are vascular displacement into inferior vena cava, into rectum after anticancer treatment of the cervix and a forgotten stent into third part of duodenum. We present a unique case of displaced DJS into the second part of the duodenum and its management laparoscopically. Case Presentation A 59-year-old diabetic man on evaluation for right flank pain and intermittent episodes of fever with chills and rigors for 4 months was identified elsewhere on CT of kidney, ureter, and bladder (KUB) to have a retroperitoneal mass engulfing the right ureter with a small contracted kidney with mild hydronephrosis for which CT-guided retroperitoneal mass biopsy (reported as acute suppurative inflammation) and subsequent right Double-J stenting were done. He was lost to follow-up and presented to us 3 months later with similar complaints. On evaluation, CT of KUB with contrast revealed a shrunken, hydronephrotic, and poorly excreting right kidney but no mass. The right DJS was seen in the upper ureter and its proximal tip was seen to perforate the anterior wall of the right ureter, and it lay within the second part of the duodenum. The distal tip was seen in the bladder. Laparoscopic right nephrectomy was done with duodenal rent closure. During DJS retrieval, unfortunately, the smaller proximal end of the DJS slipped completely into the duodenum, but fortunately was expelled spontaneously by the patient (confirmed on postoperative day 10 with X-ray). Conclusion It is ideal to place a DJS under fluoroscopic guidance or obtain a check X-ray to confirm its position postprocedure. Patients should always be counseled on the importance of follow-up and the complications of forgotten stents.Background Delayed postoperative bleeding after robot-assisted radical prostatectomy (RARP) is a rare life-threatening condition. We present such a case wherein a patient developed hemorrhagic shock from a ruptured pseudoaneurysm arising from the epigastric artery and discuss its management. Case Presentation A 71-year-old man with prostate cancer underwent RARP. The urethral catheter was removed on postoperative day 7; 80 minutes later, the patient suddenly lost consciousness and went into shock. Enhanced CT revealed intra-abdominal bleeding; however, the cause was unknown. Intraoperatively, bleeding was observed from the anterior abdominal wall, which likely corresponded to the epigastric artery. However, this was controlled with monopolar electrocautery. Because of unstable hemodynamics, hemostasis was immediately performed by laparotomy, and bleeding was noted from the previously coagulated right inferior epigastric artery. Therefore, the cause was considered to be the rupture of a pseudoaneurysm. Conclusion Our experience suggests that monopolar electrocautery may be inadequate for controlling bleeding that may be encountered during RARP, possibly leading to pseudoaneurysm formation, which may cause a delayed life-threatening hemorrhage. Meticulous and precise hemostasis is key to avoiding this complication.Background The presence of intra-calcular gas might indicate the coexistence of gas-forming bacterial infections, which are potentially severe and life threatening. Gas-containing renal stones are rare. Herein, we present a case of gas-containing renal matrix stone that was associated with emphysematous pyelitis and reflect on its management. Case Presentation A 30-year-old woman, with no underlying comorbidities, presented at 30 weeks of pregnancy with symptoms of pyelonephritis. Imaging showed no renal stones. Postdelivery, she presented again with similar symptoms in addition to pneumaturia. Imaging showed several large gas-containing renal matrix stones associated with emphysematous pyelitis, pneumoureter, and pneumobladder. She improved with oral antibiotics and underwent percutaneous nephrolithotomy 6 weeks later. Conclusion The presence of intra-calcular gas does not necessarily indicate a serious condition and the treatment can be planned according to the patient's symptoms and the presence and type of any emphysematous renal infection.Background The injection of hydrogel in between the anterior rectal wall and prostate protects the rectum from the radiation field in men undergoing radiotherapy for prostate cancer. Multicenter prospective trials have demonstrated safety of the material, and that liquefication and reabsorption of the material occur roughly 12 weeks after injection. Other studies have noted the presence of the hydrogel up to 24 weeks after injection and documented significant complications with its use. In this study we discuss a patient in whom hydrogel was discovered in the anterior rectal wall who was undergoing radical cystoprostatectomy 32 weeks after injection, and how this precluded creation of a neobladder. Case Presentation A 64-year-old Caucasian man with a history of diabetes mellitus and hypertension was diagnosed with unfavorable intermediate risk prostate cancer. He underwent injection of hydrogel followed by radiotherapy. He subsequently developed hematuria and carcinoma in situ and high grade T1 nonmuscle invasive bladder cancer were diagnosed. Thirty-two weeks later, he underwent robot-assisted radical cystoprostatectomy. The patient was originally planned for neobladder creation but intraoperative findings of persistent hydrogel in between rectum and prostate precluded this reconstruction and necessitated construction of an ileal conduit. Conclusion Urologists should be aware of the fact that SpaceOAR hydrogel can persist beyond the expected 12- to 24-week dissolution period. In a patient who requires a radical cystectomy, the persistent presence of that gel may preclude the creation of a neobladder. Preoperative imaging to identify persistence vs dissolution of the gel would facilitate better preoperative patient counseling.Background Although the prostatic urethral stents are no longer used in the United States for treatment of prostatomegaly, urologists will encounter patients with complications of previously placed permanent prostatic stents. We report two cases of persistent bothersome lower urinary tract symptoms (LUTS) after prostatic stent placement treated with simultaneous holmium laser enucleation of prostate (HoLEP) with endoscopic removal of the prostatic urethral stent using high-power holmium laser. We also reviewed the literature regarding the removal of prostatic stents with holmium laser combined with surgical management of benign prostatic hyperplasia. Case Presentation A 71-year-old man who presented with LUTS, recurrent gross hematuria, and urinary infection, which developed after placement of a prostatic stent 10 years prior for urinary retention secondary to prostatomegaly (80 g). He underwent combined HoLEP with endoscopic removal of the prostatic stent using 100 W holmium laser at a power setting of 2 J and 30 Hz. The surgical steps comprised fragmentation of the stent in situ by making incisions at 5, 7, and 12 o'clock positions followed by enucleation of the prostate. The stent was then separated from enucleated tissue in the urinary bladder. The remaining prostate adenoma was then morcellated and removed. The patient remained asymptomatic at 10-year follow-up. Another patient was 62-year-old man who developed recurrence of bothersome LUTS, 1 year after placement a prostatic stent for urinary retention. On investigation his prostate was 105 g and stent showed partial migration in the bladder with overlying calcification. HoLEP and stent removal was performed in a manner similar to the first patient. This patient also remained asymptomatic at a 1-year follow-up. Conclusion Combined HoLEP with removal of a prostatic urethral stent using a high-power holmium laser is safe and effective with long-term durable outcome.Background Alkaline-encrusted pyelitis (AEP) is rare and most often stems from a triad of immunodeficiency, urogenital tract trauma, and alkaline urinary infection. Corynebacterium Group D2 is the most common organism. It results in encrusting calcifications that adhere to most of the urothelial lining of the pelvicaliceal system and ureter. Left unchecked, or unrecognized, the disease process can progress to renal compromise. Studies suggest that management is based on elimination of the bacterium, acidification of the urine, and elimination of calcified plaques and encrustations. Herein, we report a case of a 56-year-old woman who developed AEP in her second transplanted kidney, and detail the diagnosis and treatment of the uncommon, yet potentially devastating, disease. Case Presentation A 56-year-old woman with a history of lupus, end-stage renal disease, who was on her second renal transplant presented with symptoms of urinary tract infection. Urine was consistently alkaline with cultures repeatedly growing urease-splitting Corynebacterium. Subsequent imaging showed large obstructing ureteral and renal stones concerning for AEP. She was treated with transplant kidney percutaneous nephrolithotomy, culture-specific antibiotics, and urinary acidification. Conclusion Clinical presentation, urinalysis, culture, and renal imaging, often with CT, are the mainstays for diagnosing AEP. Sapanisertib price If not addressed, AEP can advance to renal failure. Management often includes a multimodal approach involving treatment and prevention of the underlying infection, urinary acidification, and percutaneous or endoscopic removal of obstructing and large burden stones and encrustation.Omental wrap is commonly performed after ureterolysis to prevent ureteral obstruction from recurrence of periureteral adhesions and fibrosis. We present the case of a 37-year-old Caucasian woman with a history of two cesarean sections and laparotomy for the treatment of endometriosis. She subsequently developed right flank pain caused by a right distal ureteral stricture requiring a chronic indwelling ureteral stent. Diagnostic laparoscopy revealed extrinsic compression of the ureter for which robot-assisted ureterolysis was performed. Because of inadequate omentum, we report the initial use of a cryopreserved bioregenerative umbilical cord amniotic membrane allograft to perform a ureteral wrap to promote ureteral tissue healing and serve as an adhesion barrier to prevent recurrence of the fibrosis.Background Straight catheters are usually used for clean intermittent catheterization (CIC). Patients perform CIC without much difficulty. Spontaneous knotting of catheter is rare in large bore straight catheters and female patients. Case Presentation A 50-year old lady, case of neurogenic bladder on CIC inserted a 14F straight catheter, drained some urine but was unable to remove the catheter. She presented in emergency with retention of urine. Her X-ray and ultrasound examination revealed a knotted catheter. Conservative measures to remove the catheter such as forceful injection of radio-opaque contrast and passage of hydrophilic guidewire did not work. She was taken in the operating room. The knot was ablated using holmium laser through transurethral passage of an 8F ureteroscope. Conclusions Spontaneous knotting of urethral catheter is rare in adults. It should be suspected whenever a straight catheter cannot be removed. Inserting excessive length of catheter is an important risk factor. Holmium laser is an excellent tool to cut the catheter in a least invasive way when conservative measures have failed.
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