ABSTRACT
@#Wilms tumor is very rare in adults. Even more infrequent is an adult Wilms tumor with an extensioninto the central nervous system.Reported here is a case of an adult Wilms tumor in a 38-year-old female. She was referred to theJRRMMC with a 2 month history of intermittent hematuria associated with a rapidly enlargingabdominal mass and right-sided facial asymmetry. Abdominal computed tomography revealed a largemass inthe rightkidney. CranialMRI showedmultiple brainmetastases. Thepatient underwentrightradicalnephrectomy.Pathologicalanalysisdemonstratednephroblastoma.Thepatientwasdischargedunremarkable and underwent adjuvant chemotherapy. After 2 months, the patient succumbed to thedisease.Adult Wilms tumor presents almost similarly with renal cell carcinoma and there is no definitivediagnostictesttoconfirmitpre-operatively.Eventhoughit’sararetumor,itshouldalwaysbeincludedin the differential diagnosis for any renal tumor.
ABSTRACT
@#In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications. OBJECTIVE: To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy METHODS: This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale. RESULTS: The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%). CONCLUSION: The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.
Subject(s)
Ureteroscopy , Ureteroscopes , Printing, Three-DimensionalABSTRACT
OBJECTIVE@#Specimen retrieval bags were used to remove cysts and masses in minimally invasiveurologic surgeries for more than 3 decades. This study aims to describe the steps in making a home-made specimen retrieval bag named JuRoLap and its safety and resiliency.@*MATERIALS AND METHODS@#The bag’s name was taken from the initials of the institution combined withthe department's short-name (uro) and laparoscopy (Lap). The bag is composed of a non-toxicpolyvinyl chloride (PVC) urine bag custom fitted according to the expected specimen size. The sideswere sealed using an impulse sealer leaving one side open. The bag ways rolled and introducedintracorporeally via the 12mm port. It was opened followed by specimen placement using standardlaparoscopic instruments. Purse-string suture at the one-side opening was tightened and extractedthrough the umbilical port extending the incision as necessary.@*RESULTS@#JuRoLap was used in 33 cases removing various organs such as adrenals, kidney, ureter,bladder and prostate. It was easily prepared, safe, resilient and economical costing approximatelyUSD 0.68. It was essential to routinely check its durability by doing a leak test prior to sterilization.Proper rolling, transparent plastic component of the bag and the use of two laparoscopic graspersprovided ease in bag deployment and specimen entrapment. It was also observed that smaller incisionon extraction site as compared to the specimen size was needed due to the resiliency of the bag.Despite the required learning curve in organ entrapment and extraction, there were no complicationsand specimen leakage noted.@*CONCLUSION@#JuRoLap specimen retrieval bag is organ size specific, safe, resilient and low cost specimenretrieval bag innovation.