ABSTRACT
INTRODUCTION: Retained ureteral stents may constitute a technical challenge. The purpose of this study was to analyze the patient population with retained ureteral stents with regards to stent sizes to better understand if these factors could play a pivotal role in their encrustation. METHODS: After institutional review board approval, we retrospectively analyzed the data of patients who underwent multimodal surgical procedures for the removal of retained ureteral stents from 2010-2018. The primary outcomes analyzed were ureteral stent length and diameter, location of stent placement, and patients' demographics as potential etiologies for encrustation. RESULTS: We included 30 patients with 32 encrusted ureteral stents and 37 patients with 46 forgotten non-retained ureteral stents. Indications for stenting included urolithiasis, malignancy, pregnancy, ureteral stricture, and ureteropelvic junction obstruction. Stent diameters ranged from 6-8.5 Fr. Stent lengths ranged from 22-30 cm, and multilength stents were used too. Smaller diameter stents were less likely to be retained when compared to larger diameter stents (>6 Fr) (p=0.002). Overall stent length was not found to be significant (p=0.251); however, the difference in stent surface area differed by over 1 cm (p<0.001). Patients who were uninsured were more likely to have retained stents (p=0.003). Patients who reside with longer commuting distance to the main academic medical center were more likely to have retained stents (p=0.010). CONCLUSIONS: Retained ureteral stents could be avoided. Taking into consideration ureteral anatomical variation among patients, smaller diameter stents and smaller surface area may prevent encrustation. Uninsured patients with farther distance to seek medical care and females are the most at risk.
ABSTRACT
PURPOSE: Hormone-refractory prostate cancer (PCa) has a high incidence of metastasis with common secondary site locations. Our case report describes a rare metastatic site of PCa infiltrating bilateral testicles in the absence of definitive radiologic evidence. MATERIALS AND METHODS: Following the patient's consent and IRB exemption, we report the clinical, radiological, and pathological presentation of the patient treated at our institution. We also conducted an inclusive literature review of PCa with bilateral testicular metastases. RESULTS: Our patient is a 54-year-old male who presented to the emergency room with lower urinary tract symptoms and failure to void. A full workup including digital rectal examination, PSA (580 ng/ml), and a transrectal ultrasound (TRUS) biopsy performed afterward revealed an adenocarcinoma of the prostate. The metastatic workup at presentation was negative. After failure to comply with treatment guidelines, the patient was referred back to us with bilateral testicular masses. Without clear evidence of the origin of the masses, bilateral orchiectomy was performed, and pathological analysis confirmed it was metastatic prostate adenocarcinoma. Post-orchiectomy, the patient was again lost to follow up. Three years later the patient returns and placed in palliative care. CONCLUSIONS: This case report highlights that PCa can have a highly variable course and progression can occur in the absence of adherence to treatment. Any evidence of disease relapse and clinical suspicion of metastasis should be investigated, especially in patients with advanced and metastatic disease or poor adherence to surveillance protocol.
ABSTRACT
The imaging modality used to diagnose and monitor brain gliomas is magnetic resonance imaging (MRI), with standard protocols including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) image sequences. Many clinical trials are currently using contrast-enhanced T1-weighted MR image sequences to evaluate tumor response to treatment, but it is our hypothesis that FLAIR sequences will detect higher tumor volumes and, therefore, should be the preferred image sequence for this purpose. In this retrospective study, a volumetric analysis was conducted on the post-contrast T1-weighted and FLAIR MR image sequences of 38 patients with confirmed brain gliomas. The two volumes were subsequently found to have a statistically significant positive correlation. The FLAIR volume was also found to be greater than the post-contrast T1-weighted volume in all 38 patients. As a result, FLAIR image sequences provide a more complete characterization of gliomas and may be more beneficial when observing tumor response after treatment.
