Giant paratesticular liposarcoma: A rare case report and literature review.

INTRODUCTION: Paratesticular liposarcoma is a rare variant of genitourinary malignancy. This malignancy accounts for less than 12 % of all liposarcomas. Approximately 200 cases of paratesticular liposarcoma have been reported. Giant paratesticular liposarcoma sizing over 10 cm is rarer, with only a few reported cases. Due to the rarity of this disease, there are no standardized guidelines regarding its incidence, diagnostic, recurrence, and treatment. CASE PRESENTATION: A 73-year-old male came to the hospital with a painless left scrotal mass three years ago. The patient had an ultrasound examination of the left scrotal, which proved a solid mass and hypervascular on the left testicular. Abdominopelvic computed tomography (CT) showed a solid-cyst masses, size ±16,6 × 9,6 × 18,2 cm, lobulated, contrast enhancement with no sign of metastatic disease. The patient had radical orchiectomy without any complications. Histopathological and immunohistochemistry examination (Vimentin, MDM2, dan CDK4) showed well-differentiated liposarcoma. CLINICAL DISCUSSION: Radical orchiectomy is the best curative therapy. Adjuvant chemotherapy and radiotherapy benefit is still inconclusive. The patient had followed up for two years after surgery found no recurrent mass and metastatic. The well-differentiated type has a better prognosis but has a high incidence of local recurrence if incompletely excised. The result showed that this approach produces excellent outcomes without any relapse. CONCLUSION: Giant Paratesticular Liposarcoma is a rare condition that can be managed by radical. Long-term follow-up is importance to observe the relapse of this malignancy.

A systematic review and meta-analysis on the efficacy of preoperative renal artery embolization prior to radical nephrectomy for renal cell carcinoma: Is it necessary?

INTRODUCTION: Radical nephrectomy for Renal Cell Carcinoma (RCC) is still the treatment of choice for all stages except for stage I and IV, which need patient selectivity. The purpose of Renal Artery Embolization (RAE) pre-operative before radical nephrectomy is to facilitate resection, reduce bleeding, and reduce the time to surgery, but the necessity of this procedure is still debatable. This study investigates the efficacy of pre-operative Renal Artery Embolization (PRAE) before radical nephrectomy for RCC patients. METHODS: The systematic searches based on PRISMA guidelines were conducted in Pubmed, Scopus, Web of Science, Medrxiv, and ScienceDirect databases with pre-defined keywords. Both analyses, quantitative and qualitative, were performed to assess blood loss, transfusion rate, surgical time, Intensive Care Unit (ICU) stay, and hospital stay. RESULTS: A total of 921 patients from 8 eligible studies were included. The blood loss was significantly lower in the PRAE group compared to the control group (p = < 0.00001; SMD -20 mL; 95%CI -0.29, -0.12). There is no statistically significant difference between RAE and without RAE in the transfusion rate nephrectomy (p = 0.53, OR 0.65; 95% CI 0.16, 2.57), mean operative time (p = 0.69; SMD 5.91; 95% CI -23.25, 35.07), mean length of hospital stay (p = 0.05; SMD 0.56; 95% CI 0.00, 1.12), and mean length of stay in the ICU (p = 0.45; SMD 11.61; 95% CI -18.35, 41.57) Conclusions: PRAE before radical nephrectomy significantly reduces blood loss in RCC patients but is similar in the surgical time, transfusion rate, and length of hospital stay and ICU stay.

A systematic review and meta-analysis on the efficacy of internal spermatic artery ligation during laparoscopic varicocelectomy in children and adolescents: Is it safe?

INTRODUCTION: Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and adolescent varicocele. The controversy over artery ligation (AL) and artery preservation (AP) during laparoscopic varicocelectomy (LV) is still debatable. This study investigates the effectiveness of AL and AP during LV in pediatric and adolescent varicocele cases. METHODS: The systematic searches based on PRISMA guideline were conducted in PubMed, Scopus, ScienceDirect, Web of Science and ProQuest databases with pre-defined keywords. Both quantitative and qualitative analyses were performed to assess catch-up growth, persistence, recurrence, hydrocele, operative time, post-operative testicular volume, and sperm analysis. RESULTS: A total of 1512 patients from 9 eligible studies were included. There were no significant differences in catch up growth (OR 0.89; 95%CI 0.53, 1.51; p = 0.68) or hydrocele incidence (OR 0.59; 95%CI 0.28, 1.24; p = 0.16). The recurrence rate and persistence rate in AP group is significantly higher compared to AL group (OR 2.95; 95%CI 1.53, 5.68; p = 0.001 and OR 5.13; 95% CI 2.04, 12.88; p = 0.0005, respectively). The mean operative time during laparoscopic varicocelectomy is significantly longer when arteries are preserved as opposed to when they are ligated (OR 5.33; 95%CI 2.05, 8.60; p = 0.001). AL and AP both improved testicular volume and post-operative sperm analysis. CONCLUSIONS: AL showed higher efficacy and comparable safety to AP. We recommend using AL with lymphatic sparing to minimize hydrocele complications.

Renal cell carcinoma in autosomal dominant polycystic kidney disease: A case report.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the congenital cystic renal diseases with the highest incidence. ADPKD was suspected of being a risk factor for the emergence of RCC. A 65-year-old male complained of numbness in both knees for a week. The patient came to a neurosurgeon and was advised to perform a lumbosacral MRI. The patient had no complaints. The patient had a history of hypertension but was never treated. Computed tomography intravenous pyelogram (CT-IVP) revealed a heterogeneous lobulated mass in the upper to the middle of the right kidney to the right renal hilus. It also revealed multiple cysts, in both kidneys. The patient underwent an open radical nephrectomy in the right kidney with minimal bleeding. Three years revealed no pain at the surgery site or hematuria. Abdominal MRI revealed no recidive mass. This case report comprehensively described an autosomal dominant polycystic kidney disease that coexists with RCC. malignant lesions were found in ADPKD cases without any clinical symptoms of malignancy. M malignant lesions could be discovered by chance in nephrectomy specimens. Autosomal dominant polycystic kidney disease with renal cell carcinoma is a unique presentation. Despite the rarity of the situation, the patient was successfully treated.

The use of antibiotic prophylaxis in patients undergoing urologic procedures in an academic hospital Surabaya: A retrospective study.

INTRODUCTION: Prophylactic antibiotics in urological procedures are essential to prevent postoperative infections. A different approach in selecting antibiotic prophylaxis according to the type of procedure is needed. METHODOLOGY: A retrospective study was carried out at an academic hospital in Surabaya, Indonesia, by collecting medical records of patients who underwent urologic procedures within 2019- 2020, including microbiological data. RESULT: One hundred seventy-nine urological procedures were assessed. Antibiotic prophylaxis was administered in the clean-contaminated and clean procedures (93.2% and 6.8%, respectively). Ceftriaxone was commonly used (69.3%), single-dose, one day before the surgery. Gram-negative bacteria were widely found in the urinary culture of patients (75.2%). E. coli, K. pneumoniae, and P. aeruginosa were dominating with low susceptibility to cephalosporins. ESBL-producing bacteria were E. coli (64%) and K. pneumoniae (89%). CONCLUSIONS: The 3rd generation cephalosporins (ceftriaxone) are mostly used in urological procedures despite the low susceptibility against this antibiotic in cultured E coli, P. aeruginosa, and K. pneumonia. The aminoglycosides have relatively good activity and have been suggested in several guidelines for urologic procedures, such as prostate and urinary tract stone procedures. It is crucial to consider the incision site, type of procedure, and bacterial profile in the hospital to propose antibiotic prophylaxis guidelines.

Comparison of ureteral stent diameters on ureteral stent-related symptoms: A systematic review and meta-analysis.

Ureteral stents may induce complications that may disrupt the quality of life of patients. Several factors that may cause these symptoms are the design, material, diameter, length, and position of the stent. The impact of its diameter varies among current reports, thus we aimed to compare the symptoms between 6 Fr and 5 Fr or less ureteral stents. A systematic search and screening were performed in the Embase, Medline, and Scopus databases. Eligible studies included randomized controlled trials (RCTs). Cochrane risk of bias tool 2 was used to evaluate the studies. Seven RCTs were included in this review. Urinary symptoms were discussed qualitatively. From the included studies, the use of a relatively smaller stent diameter yielded an overall lower rate of Ureteral Stent Symptom Questionnaire score and urinary symptoms compared to a stent with a larger diameter. There was no significant difference in migration rate (OR: 1.55, 95% CI: 0.67-3.57, P » .31), visual analogue scale (MD: 0.42, 95% CI: 2.04 to 1.20, P » .61), analgesic use duration (MD: 0.06, 95% CI: 1.02 to 0.91, P » .91), and stone-free rate probability (OR: 1.29, 95% CI: 0.48-3.45, P » .62) between patients with 5 Fr or less and 6 Fr ureteral stents. Smaller ureteral stent size is suggested for reducing ureteral stent-related symptoms, without significant differences in the incidence of stent migration, pain, analgesic use, and stone-free rate.

Tubularized incised plate urethroplasty for megameatus intact prepuce hypospadias variant: First reported case in Indonesia.

INTRODUCTION AND IMPORTANCE: Megameatus intact Prepuce (MIP) is a rare variant of hypospadias characterized by a wide meatus with a normally conformed prepuce, no chordee, and usually no effects in micturition or sexual physiology. However, quality of life and psychosexuality may be affected. CASE PRESENTATION: A 6-year-old-boy was referred by a general practitioner to the hospital due to an abnormality of the urethral meatus. The patient did not have any complaints. A large external urethral orifice at the ventral area of the coronal glans was discovered. The prepuce was normally-conformed, and there weren't any signs of chordee. The patient was diagnosed with an MIP hypospadias variant and underwent a tubularized incised plate (TIP) urethroplasty. During the follow-up, one week after the procedure, the patient did not have any complaints. Physical examination showed excellent anatomical and functional outcome based on the cosmetic appearance resembling a normal penis and urinary stream. CLINICAL DISCUSSION: Awareness regarding this abnormality is necessary as MIP is often not diagnosed until circumcision. Even though MIP patients are usually asymptomatic, surgery should still be considered based on aesthetic and psychosexual reasons. TIP urethroplasty was chosen for this patient based on the clinical findings of this patient. TIP procedure for MIP patients could result in an excellent penile performance and function with a very low complication rate. CONCLUSION: TIP urethroplasty is able to fulfil satisfactory cosmetic and functional outcomes for the MIP hypospadias variant. Awareness of the disorder should be increased to prevent potential psychosexual disturbances.