RESUMEN
Prostatic leiomyosarcoma is an exceedingly rare malignant tumour arising from smooth muscle cells in the prostate gland. It ranks quite low down on the possible differentials of bladder outlet obstruction. We present a case of a 38-year-old male who initially presented with acute urinary retention and was subsequently diagnosed with prostatic leiomyosarcoma. Following histopathological confirmation, metastatic work-up was performed and patient planned for radiation and surgical cure. Patient on follow-up is well and has resumed normal daily work. This case report aims to increase awareness of this rare malignancy, discuss the diagnostic challenges faced with a highly common clinical spectrum at the onset, present the treatment strategies employed, and discuss the patient's clinical outcomes. We emphasise the importance of reporting rare cases like this to contribute to the existing literature and enhance the understanding of prostatic leiomyosarcoma.
RESUMEN
Retrieval of high-volume renal stone fragments in percutaneous nephrolithotomy (PCNL) using graspers and baskets can lead to inadvertent renal mucosal trauma and prolonged operative times. We report a case of large right renal pelvic calculus measuring approximately 5.6�2�cm, which after fragmentation posed a challenge for fragment retrieval to ensure complete stone clearance. We used flush irrigation and suction through a 17 Fr cystoscope sheath inserted into the 30 Fr Amplatz for successful retrieval of the high volume of tiny stone fragments. To our surprise, just after two cycles of flush-irrigation and suction in a duration of approximately 30 seconds, we could achieve complete stone clearance. This technique of utilizing a small caliber cystoscope sheath through a large caliber Amplatz in PCNL could help in selected cases for efficient and safe retrieval of high-volume tiny stone fragments by minimizing renal mucosal trauma, operative times and ensuring complete stone clearance.
RESUMEN
Vesical calculi are infrequent in females, and the occurrence of giant vesical calculus is even rarer. We report a case of giant vesical calculus in an elderly female which was undiagnosed and empirically treated for six years for recurrent urinary tract infection. On presentation, it was managed by open cystolithotomy. Upon surgical retrieval, the stone measured 11x7.5x7.4 cm in largest dimensions and weighed 672 gm, which to the best of our knowledge, is the largest vesical calculus to be reported in a female patient. This case highlights the need for adequate evaluation of every case of recurrent urinary tract infection with good imaging. Early diagnosis allows for the management of vesical calculi by minimally invasive endoscopic techniques. If missed, it leads to the formation of giant vesical calculi, which require treatment by a much more invasive open surgical approach.
RESUMEN
Nephrostomy tubes were once the norm following a standard percutaneous nephrolithotomy (PCNL). Nowadays they are a rarity, since most PCNLs are performed without the use of a Nephrostomy tube in the post-operative period (tubeless PCNL). We present the use of a simple irrigation set tubing as a low-cost nephrostomy tube alternative in patients with post-PCNL hemorrhagic complications.
RESUMEN
Nephrostomy tubes were once the norm following a standard percutaneous nephrolithotomy (PCNL). Nowadays they are a rarity, since most PCNLs are performed without the use of a Nephrostomy tube in the post-operative period (tubeless PCNL). We present the use of a simple irrigation set tubing as a low-cost nephrostomy tube alternative in patients with post-PCNL hemorrhagic complications.
RESUMEN
Renal cell carcinoma (RCC) is the most common malignant tumour of the kidney, representing 3% of all adult malignancies. Among men it is the sixth most common cancer while among women it is the ninth most common cancer. The mainstay of treatment for localized RCC is surgical resection with curative intent. The aggressive and often insidious nature of RCC is reflected by high recurrence rates of upto 20-40% after nephrectomy. Most commonly encountered sites of recurrent metastases include the lung, followed by bone, liver, brain, and local recurrence. Atypical sites of delayed metastases of RCC, although rare, have been reported in literature. We present our series of five cases where delayed metastasis has occurred at atypical sites including right sartorius muscle, right atrium and ventricle, urinary bladder, shaft of tibia and distal phalanx of hand upto six years later from the time of initial curative treatment of primary. The metastatic lesions in sartorius muscle, right atrium and ventricle, urinary bladder and distal phalanx were primarily managed by metastatectomy while that in the tibial shaft was managed by palliative targeted therapy with tyrosine kinase inhibitors. The key takeaway from this case series is that any primary neoplastic lesion in a patient with history of RCC should be evaluated with histopathology before definitive intervention is undertaken keeping in mind the notorious tendency of RCC to cause delayed metachronous metastases at unusual sites. In presence of solitary metastatic lesions at resectable locations, curative treatment can be offered by metastatectomy.