Isolated ureteric endometriosis presenting as a ureteric tumor

A 32 year old lady presented with recurrent left flank pain for 4 weeks and chronic lower back pain. CT without contrast showed no stones and mild left hydronephrosis. CT of the spine suggested an inflammatory process at L5-S1 vertebra. The diagnosis was supported by a bone scan. Incidentally, the scan showed nonfunctioning left kidney. Diuretic renography confirmed poor perfusion and no excretion. A retrograde study showed narrowing of the ureter at the pelvic brim. Ureteroscopy showed a papillary mass in the lumen of the ureter from which multiple cold cup biopsies were taken. The pathology however was not conclusive. A robotic nephroureterectomy was carried out. Definitive pathology showed intrinsic endometriosis of the ureter. We conclude that endometriosis should be considered in the differential diagnosis of unexplained ureteric obstruction and ureteric lumen filling defects in young women

Tunica albuginea free graft for corporoplasty in the baboon: hemodynamic and histopathological results at 6 months follow up

Introduction and Objective: correction of the penile deformity caused by Peyronie's disease by a variety of grafts varies in success. Long-term follow up shows a significant number of graft scaring with shortening, ED and recurrence of curvature. Autologous tunica albuginea probably provides the best grafting material with theoretically better integration and less reaction with the underlying cavernous tissue. We set out to study the effect of this graft on the hemodynamics of erection and histopathological outcome

Methods: under GA, 6 male sexually active Baboons weighing 15.1 +/- 1.3 kg, underwent cavernous pressure [CP] measurement, before and after intracavernous injection of 15 mg papavering HCl. Cavernosometry [CM] and caversopgraphy were then carried out. Through a perineal incision, we harvested a 3.5 by 1cm tunica albuginea from the right penile crus. These dimensions constitute the penile length and circumference of the penis. Implantation of the graft was carried out in the left lateral side of the penile shaft. After 6 months, the animals were evaluated for- the hemodynamics of erection and histopathology of the graft site

Results: all animals resumed sexual activity in the second postoperative months. At 6 months, surgery did not produce significant changes to the hemodynamics of erection. Cavernous pressure response to papaverine did not differ significantly before grafting [49.7k8.9 mmHg] and 6 months after surgery [5 7.7 +/- 1 7.7 mmHg, p = 0.43]. Cavemosometry pressure did not show significant changes before [1 15.5 +/- 119.7 mmHg] and 6 months after surgery [38.9 +/- 15.9 mmHg, p=0.41. Caver nosography however showed that 4 animals developed venous leakage, which was identity Bed at the graft site in one. Three animals developed a mild curvature at the site of the graft. Naked eye examination could determine-the graft site only by the four comer nylon sutures. Microscopic examination showed integration of the graft with no underlying fibrosis

Conclusions: a relatively large free tunica graft is associated with venous leakage at 6 months. Although statistically insignificant differences are found hemodynamically and no interference developed with sexual activity, follow up for 1 y and the use of smaller graft might produce better results

changing trend in the management of renal angiomyolipoma over the last 15 years in Saudi Arabia

Purpose: we report on 36 cases of renal angiomyolipoma followed for an average of 4 years

Materials and Methods: we retrospectively reviewed the charts of angiomyolipoma patients in the last 15 years. We compared patients with sporadic versus tuberous sclerosis complex [BC] associated lesions and patients who underwent surgical versus conservative treatment. We identified the changes in the management pattern over years

Results: the median age at presentation was 45 y [11.6-68]. The presenting symptom was pain [58.3%], incidentally discovered [25%] or hematuria [13.96]. We had 75 %females and 16.7% TSC patients. The median size of the lesions was 4.5cm [0.3-40] Conservative treatment was undertaken in 55.6%. We performed nephrectomy in 22.2%, partial nephrectomy in 16.7%, and embolization in 5.6% of patients. The indication for surgical or interventional treatment was hemorrhage in 19.4%, suspicion of malignancy in 16.7% and pain in 8.3%. Patients were followed up to a median of 37 months [1-145]. A total of 88.9% remained asymptomatic. Overall, lesions grew an average of 1.9 cm [SD=4.6] in 46.2 +/- 36.1 months. None of the patients developed renal impairment. Patients with TSC presented at a younger age, had larger, bilateral lesions, showed a higher growth rate and were symptomatic at follow-up. Patients managed surgically had larger tumors at presentation and higher growth rate. In the last 5 years, there was a significant change towards conservative treatment

Conclusions: renal angiomyolipoma has a slow growth rate and preservation of renal function. Less surgery is required in the recent years