A rare presentation of deep infiltrating cervical endometriosis mimicking cervical cancer

Though endometriosis is a common progressive benign disorder of women, endometriosis of the cervix is rarely seen. It poses a challenge both for diagnosis and management. Most of the patients with Cervical endometriosis are asymptomatic, present with abnormal vaginal bleeding, post-coital bleeding or intermenstrual bleeding. In this paper, we report a rare case of deep infiltrating cervical endometriosis involving the ureter mimicking cervical cancer, the need for awareness to include cervical endometriosis as a differential diagnosis in case of menstural irregularities and its potential to cause serious complications.

A retrospective study on maternal and perinatal outcome in pregnancy requiring DJ stent and PCN during pregnancy

Background: Gestational hydronephrosis (GH) is result of dilatation effect of the progesterone and mechanical compression of the gravid uterus. Management during pregnancy is challenging as routine radiological investigations and surgical treatments cannot be applied due to the potential harm to the fetus. Intervention is indicated in women who fail to respond to conservative management. Acute hydronephrosis and renal colic are common etiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Ureteric stenting and percutaneous nephrostomy (PCN) during pregnancy are safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms.Methods: A retrospective study of pregnant women admitted under obstetric units with acute hydronephrosis requiring DJ stenting and/or PCN. Aim was to evaluate the course and pregnancy outcomes in a tertiary center of Southern India over a period of five years.Results: Descriptive statistical analysis was done in 12 women with acute hydronephrosis in pregnancy. 66.7% were nulliparous and mean gestational age at admission was 31 weeks. Diagnosis was done by USG. One-fourth had pyelonephritis and calculus being the main pathology (n=9;75%).Women requiring DJ stent and PCN were 41.6% and 58.4% respectively. 41.7% had preterm labour. 66.7% delivered vaginally, birth weight was more than 2.5kg in 50%.Conclusions: Maternal and neonatal outcome mainly depends on the early diagnosis. In this study we emphasize on the importance of multidisciplinary team approach in the management of women with acute hydronephrosis. DJ stent and PCN are efficient and safe modalities in women with refractory symptoms.

Retrocaval Ureter with Proximal Hydroureteronephrosis Presenting as Flank Pain in a Child: A Rare Case Report with Review of Literature

Retrocaval ureter also referred to as pre-ureteral vena cava or circumcaval ureter is a rare congenital anomaly with the ureterpassing posterior to the inferior vena cava. Although it is a congenital anomaly, patients do not normally present with symptomsuntil the 3rd and 4th decades of life after a resulting hydronephrosis. We present the report of a 12-year-old male child with ahistory of right flank pain and associated right proximal hydroureteronephrosis. Diagnosis was confirmed with computerizedtomography urography, and an open surgical repair was done for the anomaly. The case is discussed here along with reviewof recent literature.

Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Uretero–Renoscopic Lithotripsy (URSL) For Management Of Upper Ureteric Calculi, Our Experience At Tertiary Care Hospital.

Background: Urinary stones are the third most common affliction of urinary tract, exceeded only by urinary tract infections and pathological conditions of prostate (BPH and Prostate cancer). Extracorporeal Shock Wave Lithotripsy (ESWL) and Uretero-renoscopic Lithotripsy (URSL) are among various treatment options available. Aims and Objectives:To compare ESWLand URSLprocedural and post procedural characteristics including outcome. Methods: A Prospective study was conducted in the department of Urology, SKIMS, on 100 patients with proximal Ureteric stone, from September 2015 to July 2017.By random selection, fifty patients were subjected to ESWL and another fifty to URSL. Various parameters were recorded on preformed proforma designed for the comparative study. Results: In our study, Parameters like Age and Gender distribution, symptoms at presentation and duration of symptoms, number of stones, laterality of stones (right/left) and grade of Hydronephrosis or Hydroureteronephrosis were uniformly distributed in the two groups (URSL VS ESWL). Spinal anaesthesia (SA) or General Anaesthesia(GA) was required in URSL group only, while as local anaesthesia and sedation was required in some patients in ESWLgroup. 72% and 88% patients achieved stone clearance in ESWLand URSLgroup respectively, (p=0.046). DJ stent was used in 20% of URSL patients and none in ESWL group. Procedure time was relatively less for URSL (p=0.001). Although statistically insignificant, Post procedure hematuria and urosepsis were higher in URSL group, where as pain/colic and fever was slightly higher in ESWL group. Steinstrasse was significantly higher in ESWL group (p=0.008). Hospital stay was significantly higher in URSL group (p<0.001). Cost involvement was higher in ESWLgroup (p=0.016). Conclusion: Although ESWL is regarded as the preferred choice of treatment for upper Ureteric stone, URSL is a safe alternative, with an advantage of obtaining an earlier or immediate stone free status in patients with stone size >10mm. In patients with smaller stones (<10mm), ESWL may be considered a reasonable alternative to URSL.

Retroiliac ureter presenting as right upper ureteric obstruction – report of a rare case.

Retroiliac ureter is an extremely rare urological entity in which the ureter passes deep to the iliac vessels. Congenital causes are most often secondary to vascular variants. A 39 year old lady presented with one month history of right loin pain. CECT showed right gross HUN till L3 and EC renogram showed 33% function in right kidney with obstructive pattern. RGP revealed Right Pelvic Ureteric Junction Obstruction (PUJO) obstruction, but at exploration was found to have retroiliac ureter. Ureteral division with anterior relocation and dismembered pyeloplasty was done. Anomalous vascular structures are often not diagnosed until surgical intervention for an obstruction of unknown etiology, unless vascular studies are considered, Most of these patients require surgical exploration to exclude tubercular stricture or malignant process

Urinothorax - A Rare Cause of Pleural Effusion.

Urinothorax is a rare cause of pleural effusion, which is mostly seen secondary to obstructive uropathy. We report a patient who had nephrolithasis and underwent percutaneous nephrostomy for treatment of hydroureteronephrosis. The patient developed right-sided pleural effusion, five days after percutaneous nephrostomy, which was later diagnosed as urinothorax. Although rare, urinothorax should be considered in the differential diagnosis of causes of pleural effusion, especially in patients with obstructive uropathy, any form of instrumentation of urinary tract or blunt abdominal trauma.The importance of recognizing this entity lies in the fact that the condition is completely reversible following relief of urinary tract obstruction.

Lupus cystitis with hydroureteronephrosis in a young female with lupus nephritis.

Systemic lupus erythematosus is an autoimmune, multisystem disorder. Lupus nephritis is a common manifestation of SLE. Though rare, SLE may also involve lower urinary tract in the form of lupus cystitis with associated complications like hydroureteronephrosis. Lupus cystitis may present with gastro intestinal (GI) symptoms as the initial manifestation. The case reported herein is concerned with concomitant lupus nephritis and cystitis in a young female who also had associated GI symptoms and hydroureteronephrosis.

Simultaneous Colonic Obstruction and Hydroureteronephrosis due to Mesenteric Fibromatosis

Mesenteric fibromatosis (MF) is a rare benign mesenchymal lesion that can occur throughout the gastrointestinal tract, especially small bowel. Its biological behavior is intermediate between benign fibrous tissue proliferation and malignant fibrosarcoma. In previously reported cases of MF, we could find colonic obstruction or ureter obstruction, but simultaneous involvement of colon and ureter was not able to be seen. We described a patient that presented with colonic obstruction and hydroureteronephrosis due to MF at sigmoid colon which mimicked submucosal tumor such as gastrointestinal tumor. This case resulted in a positive positron emission tomography scan suggesting malignant neoplasm, but beta-catenin positivity on immunohistochemical staining separated MF from gastrointestinal stromal tumor and sclerosing mesenteritis. The clinical course of the patient was improved after surgical resection.