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Aim : To identify the diagnostic difficulties and management issues of benign pelvic masses in males and high light the diagnostic protocol for these rare pelvic masses. Methods : A prospective single center study over a period of six years and three months. History, physical examination, operative findings and histopathological (HPE) diagnosis were recorded. Results : A total of 20 male patients presented with retrovesical mass, aged 17 to 65 years old (mean age 36.7 years) were evaluated. masses were found to be of prostatic origin in seven cases (5 prostatic utricle cyst and 2 prostatic abscess), connective tissue in seven, seminal vesicle origin in four, mullerian duct remnant in one case, and embryonic urogenital vestigial remnants in one case. Of these 20 patients, 19 presented with acute or chronic lower urinary tract symptoms and in one case, the mass was asymptomatic and found incidentally. Ultrasound showed cystic lesions in 17 patients and solid masses in three. Nine cases underwent exploratory laparotomy. Further biopsies of specimen demonstrated tissue of origin in all cases (8/9) except one. HPE report confirmed the same clinical and operative diagnosis in six cases. Conclusion : Benign retrovesical mass presents with lower tract obstructive symptoms, palpable pelvic mass and retention of urine. Needle or open biopsy is required in most cases to establish a histopathological diagnosis. Benign retrovesical mass is rare, we faces difficulty in diagnosis and management. Hence, diagnostic protocols can be helpful to manage retrovesical pelvic masses.
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Background: Pediatric urolithiasis results in significant morbidity in later life. Incidence as well as site and chemical composition of calculi varies according to the changes in socio-economic conditions over time and the subsequent changes in dietary habits leading to a marked variation in the spectrum of urinary stone composition. To evaluate the spectrum of urinary stone composition in pediatric population from North-western India.Methods: This was a prospective observational study conducted between October 2013 and February 2019 which included pediatric patients with urolithiasis. Demographic and epidemiological characteristics including age, sex, geography, religion, socio-economic status, dietary habits were recorded. The location and sizes of stones were documented. The data was collected, analyzed and presented using summary statistics.Results: A total of 163 patients with urolithiasis were enrolled, of which 86 (53%) aged between 6 and 10 years, 49 (30%) aged between 11 and 14 years and 28 (17%) were aged between 0 and 5 years. The majority of patients were male (n=134; 82.21%). The most common location of the stone was urinary bladder (n=106; 65.03%) followed by kidney (n=33; 20.25%), urethra (n=16; 9.82%) and ureter (n=8; 4.91%). The upper tract (kidney and ureter) to the lower tract (bladder and urethra) stone ratio was 1:4. Stones with mixed composition were more than pure stones (73.62% versus 26.38%). The most common composition was the mixed stone of calcium oxalate, calcium phosphate and uric acid (n=36; 22.09%) followed by mixed stone of calcium oxalate monohydrate and dihydrate with uric acid (n=29; 17.79%), calcium oxalate and uric acid (n=25, 15.34%), calcium oxalate and calcium phosphate (n=20; 12.27%). Calcium oxalate was present in 80% of the stones, followed by uric acid in 7%, struvite in 6%, cystine in 3% and calcium phosphate in 2%.Conclusions: These results suggest that the prevalence of mixed stones with calcium oxalate as the predominant chemical component in the urinary stones of pediatric patients studied.
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Background: Epidermal inclusion cyst, smegma stones and urethral calculi of the penis are rare and may result as a late complication of hypospadias repair. This study reported the presentation and management of these late complications.Methods: A prospective observational study included male patients aged more than 6 years of age, who had undergone hypospadias repair 3-15 years back and presented with slow growing, non-tender, mobile, firm to hard swelling. Histopathological and radiographic examination were done and surgery was used for management of epidermal inclusion cyst, urethral calculi and smegma stone. Patients were followed up for one year, postoperatively.Results: Out of 15 patients, two (13.3%), four (26.7%) and nine (60%) patients were diagnosed with smegma stones, epidermal inclusion cyst and urethral calculi, respectively. The median (range) age of patients was 17 (8-30) years. Patients were presented with slow growing, non-tender, mobile swelling measuring from 1 cm x 3 cm to 2 cm x 1.5 cm. The average size of epidermal inclusion cyst, and urethral calculi was 2 cm x 2.5 cm x 1.5 cm, and 2 cm x 3 cm, respectively. Treatment were complete excision of cyst and removal of smegma stones by surgery and urethral calculi by dorsal urethrotomy. All patients had an uneventful postoperative period and were asymptomatic up to one year of follow-up.Conclusion: Results suggest that these complications can be managed with complete excision and surgical removal and care must be taken while performing the hypospadias repair to avoid these unusual late complications in patients.