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.

Emphysematous pyelonephritis: our experience with conservative management in 14 cases

Emphysematous pyelonephritis [EPN] is a rare, severe, acute, necrotizing infection of the kidney. In this study, we present the clinical details, the management strategies, and the outcome of fourteen patients of EPN managed at our center. A retrospective analysis of the hospital records was done. A total of fourteen patients with EPN were admitted in our hospital from August 2007 to February 2011. All the patients were managed conservatively. Follow-up ranged from six months to one year. Of the fourteen patients, four belonged to class I, five to class II, four to class III A and one to class III B. All the patients had history of fever, 43% had localized flank pain while 36% had vague abdominal discomfort. Renal angle tenderness was the most common sign, seen in 86% of the patients. E. coli was the most common bacteria, which was isolated from urine in 57% of the patients. On the risk factor stratification, three patients had simultaneous presence of 2 or more risk factors [thrombocytopenia-2 patients; renal function impairment-7 patients; shock-1 patient]. All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad spectrum antibiotics. Intervention, in the form of percutaneous drainage or DJ stenting, was done in six patients. One patient failed to respond to this minimally invasive modality of treatment and had to undergo an open drainage. Thus, the acute episode was managed with conservative management strategies in all the patients; however, three patients underwent nephrectomy due to poorly-functioning kidney during follow-up. EPN is now being more readily diagnosed, at an early stage, making conservative management of EPN a safe, effective, and feasible option.

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