rare complication of percutaneous nephrolithotomy: colonic lumbar hernia

Percutaneous nephrolithotomy has a success rate of 90%; however, its overall complication rate is approximately 83%, including urinary extravasation, bleeding necessitating transfusion, and postoperative fever. Septicemia, colonic and pleural injury are rare major complications. Neighboring organ injury, especially colonic injury, is frequently seen during tract dilatation procedure. In this study, we report a case of colonic lumbar hernia, which is a rare complication of percutaneous nephrolithotomy

High grade urothelial carcinoma of renal pelvis presenting as spontaneous urinoma

Perirenal urine extravasation, also known as urinoma, occurs usually after renal trauma. Spontaneous urinoma is a very rare pathology in daily urology practice. The patients with spontaneous urinoma usually present with flank pain, and radiologic imagings confirm the diagnosis. Ultrasonography, intravenous urography, and computed tomography are the radiologic modalites for the diagnosis. We report a case of spontaneous urinoma in a patient with renal pelvic tumor

Clinical importance of percentage free prostate-specific antigen [PSA] in the PSA level of 4-20 ng/ml

Objective: The current study aimed to evaluate the diagnostic efficacy of percentage free/total prostate-specific antigen ratio [%fPSA = free/total PSA*100] for prostate cancer diagnosis in different PSA levels [4.1 - 10 ng/ml and 10.01 - 20 ng/ml]

Design: Retrospective study

Setting: Department of Urology, Çorum Training and Resarch Hospital, Hitit University

Subjects: Patients who underwent prostate biopsy with a PSA level of 4.1 - 20 ng/ml

Intervention: Prostate biopsy was performed for patients who had PSA level > 4 ng/ml

Main outcome measures: The patients who underwent transrectal ultrasound guided prostate biopsy between January 2010 and January 2015 were evaluated retrospectively. The patients were divided into two groups according to the PSA levels. The PSA levels of patients in Group 1 was 4.1 - 10 ng/ml and 10.01 - 20 ng/ml in Group 2. The receiver operating characterictic [ROC] curves were analyzed for the diagnostic efficacy of %fPSA in different PSA levels.

Results: There were 1213 patients in the present study. Of these patients, 876 and 337 patients were in groups 1 and 2, respectively. The mean age and PSA level of the patients was 66.21 +/- 7.45 years, 6.48 +/- 1.58 ng/ml and 69.36 +/- 8.56 years, 13.63 +/- 270 ng/ml in groups 1 and 2, respectively. The ROC curve analyzes demonstrated the diagnostic efficacy of percentage fPSA and there was a significant difference between percentage fPSA and PSA in two groups

Conclusion: The %fPSA is effective for the diagnosis of prostate cancer in Turkish patients having both PSA level of 4.1 - 10 and 10.01 - 20 ng/ml. Clinicans should consider that %fPSA can predict biopsy outcomes

Hydrocalyx: uncommon complication of percutaneous nephrolithotomy

The success rate of percutaneous nephrolithotomy [PNL] is about 90%, but overall complications of this surgery have been reported in up to 83% cases. The complications are graded using Clavien classification system from grade 1 to 5. Grade 1 needs simple treatments without surgical, endoscopic, and radiologic interventions like antiemetics, antipyretics, and analgesics. Grade 5 denotes death of the patient. Calyx neck stricture is grade 3b complication with an incidence of 0.1%. In this study, a case of hydrocalyx, which is very rare complication after PNL, is presented. To the best of the authors' knowledge, there is no hydrocalyx case reported after PNL in the literature

Renal medullary carcinoma; a rare entity

Renal medullary carcinoma [RMC] is an uncommon aggressive neoplasm of the kidney. RMC is biologically aggressive with a very poor prognosis, and metastasis is seen in up to 95% of the patients at diagnosis or shortly thereafter. The common sites of metastasis are respectively lymph nodes, lungs, livers, and adrenal glands in order of frequency. The presence of poorly differentiated eosinophilic cells in a characteristic fibro-inflammatory stroma is seen in histological examination. The origin and pathogenesis of RMC are unclear. The radiographical and pathological findings suggest that RMC probably originates in the calyceal epithelium in or near the renal papillae, which could be the result of chronic ischemic damage in the renal papillae epithelium by sickled erythrocytes. Positivity of VEGF and HIF-1 alpha supports the chronic hypoxia that may be caused in the pathogenesis of RMC. Other factors such as genetic or environmental factors are important. Although hemoglobinopathy is very common, RMC is very rare. An understanding of the molecular and genetic factors of this rare disease is important for its prevention and treatment. We herein describe an adult Turkish patient, who presented with hematuria. The diagnosis was RMC after pathological examination

Does small prostate predict high grade prostate cancer?

Objective: The current is study aimed to assess the patients who underwent radical prostatectomy for prostate cancer and investigate the association between prostate size and adverse outcomes at final pathology

Study Design: Comparative, descriptive study

Place and Duration of Study: Haydarpasa Numune Training and Research Hospital, Turkey, from January 2008 to January 2016

Methodology: The patients treated with open radical prostatectomy for prostate cancer were reviewed. Patient characteristics including prostate specific antigen [PSA], free PSA levels, age, biopsy, and radical prostatectomy results were recorded. The patients whose data were complete or prostate weight was equal to or less than 80 gm, were included in the study. Patients with <40 gm prostate weight was in group 1 and the patients in group 2 had a prostate weight from 40 to 80 gm. High grade prostate cancer was defined to have a Gleason score between 7 or higher at biopsy and final pathology. Pathology and biopsy results were compared within groups. MedCalc Statistical Software demo version was used for statistical analyses

Results: There were 162 patients in this study. Of these, 71 [43.82%] patients were in group 1 and 91 [56.17%] patients were in group 2. The age ranged from 49 to 76 years. Mean value of 62.70 +/- 6.82 and 65.82 +/- 5.66 years in group 1 and 2, respectively. Fifty [70.42%] and 68 patients [74.74%] had a Gleason score of 6 in group 1 and 2, respectively. Organconfined disease was reported in 53 patients [74.64%] in group 1 and in 78 patients [85.71%] in group 2. Gleason score concordance between biopsy and prostatectomy was reported in 61 patients [67.03%] and downgrading was detected in 4 patients [4.4%] in group 2. The median tumor volume of the patients was 4.47 cm3 in group 1 and 6 cm3 in group 2 [p=0.502]. High grade prostate cancer was reported in 52.11% and 45.05% of the patients in groups 1 and 2, respectively at final pathology [p=0.373]

Conclusion: The present study demonstrated that smaller prostates are more likely to compose higher percentage of the high grade prostate cancer, local advanced disease, and the Gleason upgrading. The positive surgical margin rate is higher in patients with small prostates when it is compared with the other patients

Bladder leiomyoma

Leiomyoma of the bladder is a very rare disorder that accounts for 0.43% of all bladder neoplasms. Although the pathophysiology of the bladder leiomyoma is unknown, there are some theories in it. The patients can be asymptomatic; and clinical symptoms, when present, are associated with the tumor size and location. Imaging techniques such as ultrasonography, intravenous urography, computed tomography, and magnetic resonance imaging are helpful but definitive diagnosis is made by histopathological examination. Surgical resection of tumor with transurethral, open, laparoscopic and robotic approaches is the main treatment. We present a case of leiomyoma of the bladder in an adult male patient

Bilateral Ureteral Stones and Spontaneous Perirenal Hematoma in a Patient with Chronic Idiopathic Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura (ITP) is an immune thrombocytopenia with a usually benign clinical course. Bleedings are mostly of the mucocutaneous type with mild symptoms. Massive bleedings requiring transfusion are rarely seen, unless the number of platelets decreases to extremely low levels. In this case, bilateral perirenal hematoma and bilateral distal ureteral stones were detected on a non-contrast computed tomography scan of a 57-year-old male patient who developed macroscopic hematuria during his treatment in the clinics of internal medicine because of left flank pain and diffuse petechial rashes all over his body. The patient, who had been receiving chronic ITP treatment for 1 year, had a very low platelet count (4,000/mm3). The patient was prescribed bed rest, and his platelet count increased to a safe level for surgical intervention of above 50,000/mm3 with administration of prednisolone, intravenous immune globulin, and platelet suspension. A stone-free state was achieved after bilateral ureterorenoscopy and pneumatic lithotripsy. A conservative approach was followed for the perirenal hematoma. Upon regression of the perirenal hematoma, the patient was discharged at 9 weeks postoperatively.

Significance of Atypical Small Acinar Proliferation and High-Grade Prostatic Intraepithelial Neoplasia in Prostate Biopsy

PURPOSE: In clinical practice, atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two common findings on prostate biopsies. Knowing the frequency of a prostate cancer diagnosis on repeat biopsies would aid primary treating physicians regarding their decisions in suspicious cases. MATERIALS AND METHODS: One hundred forty-three patients in whom biopsies revealed ASAP or HGPIN or both were enrolled in the present study; prostate cancer was not reported in the biopsy specimens and at least one repeat biopsy was performed. Age, digital rectal examination findings, prostate volumes, and free and total prostate-specific antigen (PSA) levels and the biopsy results of the patients were recorded. RESULTS: Of the 97 patients with ASAP on the first set of biopsies, prostate cancer was diagnosed in the second and third biopsies of 32 and 6 patients, respectively. Prostate cancer was not detected in the second or third biopsies of the 40 patients with HGPIN in the first biopsy. Of the 6 patients with ASAP+HGPIN in the first biopsy, prostate cancer was detected in 3 patients in the second biopsy and in 1 patient in the third biopsy. CONCLUSIONS: The diagnosis of ASAP is a strong risk factor for prostate cancer. A repeat biopsy should be performed for the entire prostate subsequent to the diagnosis of ASAP. In patients with HGPIN according to the biopsy result, the clinical decision should be based on other parameters, such as PSA values and rectal examination, and a repeat biopsy should be avoided if the initial biopsy was performed with multiple sampling.