Squamous Cell Carcinoma in Exstrophy of the Bladder

Exstrophy of the bladder is a rare congenital anomaly with an incidence of about 1 per 50,000 newborns. The malignant potential of the exstrophied bladder mucosa is well known; 95% are adenocarcinomas, and 3% to 5% are squamous cell carcinomas. Most of the malignant tumors (60%) associated with an exstrophy of the bladder occur during the fourth and fifth decades of life. Of the remaining, about 20% each occur after 60 years and before 40 years. Here we present a case in which squamous cell carcinoma developed in an unrepaired exstrophy of the bladder. We present the management of the case and a brief review of the literature.

Unusual presentation of duplex collecting system: a case report

Duplex collecting systems [also known as duplicated collecting systems] can be defined as renal units containing two pyelo-caliceal systems that are associated with a single ureter or double ureters. The two ureters empty separately into the bladder or fuse to form a single ureteral orifice. We came across a case in which the diagnosis was in dilemma until actual surgery when it was finally diagnosed as a case of duplex collecting system

Chylous leakage after donor nephrectomy: a rare complication and a nightmare for surgeons

To evaluate chylous drainage and its management in donor nephrectomy patients. Retrospective study. Institute of Post Graduate Medical Education and Research [IPGME and R], Kolkata, and Medica Superspeciality Hospital, Kolkata, Kolkata, India. Donor nephrectomy patients [open or laparoscopy procedure]. The first case of chylous drainage which occurred after open donor nephrectomy was treated with conservative management for a prolonged period after browsing through literature. Later three cases which occurred after laparoscopic donor nephrectomy, were also managed conservatively. Incidence and management of chylous ascites or drainage after open or laparoscopic donor nephrectomy. In our institute, only four donor nephrectomy patients developed chylous drainage. Three were laparoscopic surgeries using the transperitoneal approach whereas one case was done using open retroperitoneal approach. Chylous drainage and its management are discussed. Overall, our cases showed that chylous drainage can develop in laparoscopic transperitoneal procedures as well as in open retroperitoneal surgery, and that surgical dissection in the retroperitoneal area or the renal hilum is the most important risk factor for this complication. All our cases were well-treated only by conservative management and it has proven to be the main first line management for this condition

Laparoscopic ureteroneocystostomy for management of lower ureteric strictures

We assessed the results of laparoscopic transperitoneal ureteroneocystostomy with or without a psoas hitch for management of lower ureteral strictures. Between October 2005 and August 2008, 16 patients with lower ureteric strictures underwent laparoscopl uretroeocystostomy with or without a psoas hitch. Etiology of strictures was gynecological surgery in 11, surgery for stone disease in 3, ureterovaginal fistula in 1 and primary obstructive megaureter in 1. Transperitoneal 3- or 4-port laparoscopic ureteroneocystostomy was performed with or without psoas hitch. 1. All operations were successfully completed without any need for conversion to open. Mean operative time was171.56 min [range 130 to 260 min], mean blood loss was 93.44 cc [range 30 to 200 cc] and total hospital stay was 3.73 days [range 3 to 6 days]. Mean time to resume oral intake was 12.5 h [range 8 to 22 h]. Mean follow-up period was 21.83 months [range 6-39 months]. Postoperative follow-up investigations revealed successful outcome in all 16 patients, success being defined as relief of symptoms and radiological improvement, irrespective of the refluxing status. Non-refluxing status was achieved in 15 out of 16 patients as determined by micturition cystography. Laparoscopic ureteroneocystostomy is a safe and effective procedure, with inherent advantages of laparoscopic surgery