Scrotal kidney: a gross case of "nephroptosis".

We radiologically illustrate a case of nephroptosis in an 82-year-old male whose right kidney had progressively descended into the right hemiscrotum. This was detected upon a recent visit to the accident and emergency department (A&E) where a computed tomography (CT) scan demonstrated the right kidney within the scrotum with a degree of hydronephrosis yet a stable renal function. The patient was managed conservatively as per the multidisciplinary team (MDT) meeting advice.

Keratinising squamous metaplasia of the bladder.

Keratinising squamous metaplasia of the bladder is a very rare entity that carries a risk of progression to malignancy. We present a case of a 62-year-old man found to have the condition and discuss the management dilemma with a review of the literature.

Inspection of Ureteral Orifices: The Pearl of Flexible Cystoscopy.

Cystoscopy is most common diagnostic investigation. The examination technique and the findings, both normal and pathological, were well described described a hundred years ago. With technological advances, there has been over-emphasis on imaging modalities for diagnostic purposes. A basic maneuver of examining the ureteral orifices is sometimes rushed through when in fact careful examination can clinch the diagnosis. The importance is exemplified by two cases, one of which is a rare case of Xanthoma of the ureter.

Primary osteosarcoma of the breast- a case report and review of literature.

Primary Osteosarcoma of the breast is an aggressive and relatively rare tumour whose prognosis is very poor.It is often a diagnostic dilemma to the pathologists and the surgeons are perplexed due to its aggressive behaviour as its pathology and prognostic factors are unclear. Due to its rarity we suggest pooling of tissue samples from various centres in biobanks for future studies (including molecular biological studies) so that its behaviour can be better understood.

Use of Memokath 051 metallic stent in the management of ureteral strictures: a single-center experience.

INTRODUCTION: Memokath 051 represents a nickel-titanium stent that has been used to treat patients with incurable ureteral strictures. In the current study we present our experience in using this technique. MATERIALS AND METHODS: Between 2003 and 2008, 19 metallic stents were placed in 13 patients. All of them had been previously treated by using JJ stents or dilatation. The etiology was benign in 10, while in 3 patients malignancy was involved. The mean age was 60.7 years. Mean stricture length was 3.2 cm while the median stent length was 6 cm. No severe complications were noticed postoperatively. Mean follow-up was 14.3 months. RESULTS: Six patients (46%) experienced a satisfactory result after first insertion. Stent migration was observed in 6 patients and in 3 it was replaced successfully. One patient was offered a simple nephrectomy due to a poorly functioning kidney. Eventually, 10 of 13 patients (77%) had a successful outcome after the final stent insertion. CONCLUSION: Memokath stents suggest a possible alternative in treating chronic/recurrent ureteral strictures. Their most important disadvantage seems to be migration. Their role in endourological practice remains to be validated.

Extracorporeal shock wave lithotripsy for ureteral stones: do decompression tubes matter?

OBJECTIVES: Extracorporeal shock-wave lithotripsy (SWL) offers an effective and minimally invasive method for treating ureteral stones. In the current study we investigated whether the presence of a double-J (JJ) stent or a percutaneous nephrostomy (PCN) has any impact on the SWL success rates for ureteral stones. METHODS: All adult patients with ureteral stones treated with the second-generation Siemens Lithostar® Multiline (Siemens, Erlangen, Germany) lithotriptor between 2002 and 2007 were included. Exclusion criteria comprised radiolucent or nonsolitary stones, calculi >10 mm in diameter in the lower ureter, stones that were pushed back into the kidney during JJ stent insertion and patients who had undergone stent or nephrostomy tube insertion after initiation of SWL therapy, though having started treatment as "tubeless." In total, 342 individuals were divided into 3 groups: group I (n = 56) consisted of patients with a PCN; group II (n = 73) included patients with a JJ stent; and group III (n = 213) comprised individuals without any decompression tubes. All patients were reviewed in the outpatient clinic. RESULTS: The mean age for all patients was 50.1 years (range 16-90 years) and the mean ureteral stone size was 9.4 mm (SD = 3.6 mm). Successful stone clearance was achieved in 60.7%, 47.9%, and 59.2% of the 3 groups, respectively. There was no statistically significant difference in success rates between the aforementioned groups. CONCLUSIONS: The results of the current study suggest that the presence of either a PCN or a JJ uretral stent does not exert any influence on stone clearance after SWL treatment.

Nonsecretory multiple myeloma.

Multiple myeloma is characterized by clonal proliferation of plasma cells usually of the B cell type. The skeletal manifestations are usually osteolytic lesions whose differential diagnosis includes primary and secondary bone tumor. This tumor is characterized by the presence of abnormal paraprotein 8 in blood and urine. However, one to five per cent of the cases do not have any protein. Hence they are termed nonsecretory. It often poses a diagnostic dilemma when it is presented to orthopedic surgeons with no clear features of the disease. Our case report exemplifies such a diagnostic dilemma. A high index of suspicion must be borne in mind when excluding multiple myeloma as a cause of pain, pathological fracture or lytic lesion.

Bardet-Biedl syndrome, renal transplant and percutaneous nephrolithotomy: a case report and review of the literature.

Bardet-Biedl syndrome is an autosomal recessive disorder with obesity, polydactly, retinitis pigmentosa, hypogenitalism, intellectual impairment and varying degree of renal abnormalities. Fewer than ten cases of paediatric renal transplantation for BBS have been reported in literature so far. This is the only case report of BBS transplant urolithiasis which was dealt with percutaneous nephrolithotomy and has been stone free for seven years. This is a complex case with a rare genetic disorder, renal transplant, renal stone, ileal conduit, long loop and inversely placed kidney. This case exemplifies the need for multidisciplinary management of complex cases and emphasises PCNL as the safe method.

Emphysematous cystitis: radiological diagnosis of complicated urinary tract infection.

Emphysematous cystitis is an uncommon condition characterised by the presence of gas in the bladder. It is an infection caused by gas forming organisms, usually in elderly women with a background of diabetes mellitus. The presentation is variable, however with increasing use of imaging more cases are being diagnosed in asymptomatic patients. Routine cross-sectional imaging is not advocated for specific diagnosis but its role in accurate assessment of the severity of the condition cannot be overlooked. As the mode and duration of follow-up in incidentally detected cases has not been addressed in the literature, follow-up should be tailored individually depending upon the severity and response to treatment. We describe two such incidentally detected cases of emphysematous cystitis in elderly diabetic patients and present a review of the literature. The triad of treatment is adequate control of diabetes, antibiotics and bladder drainage. One patient died in the hospital, while the other underwent a flexible cystoscopy 6 weeks later which was normal.