Impact of kidney disease on perioperative outcomes of endoscopic BPH surgery: a propensity score matched analysis from the NSQIP database.

INTRODUCTION: To assess the impact of kidney function in patients with BPH undergoing surgery prior to Transurethral resection of prostate (TURP), Laser enucleation of the prostate (LEP), and Laser Vaporization of the prostate (LVP) on operative and post-operative outcomes using the ACS-NSQIP database. METHODS: The ACS-NSQIP database was reviewed for patients that underwent TURP, LEP and LVP for treatment of patients with BPH between the years of 2008 and 2021. Demographics, comorbidities, bleeding disorders, operative time, and surgical procedure performed were collected for comparison between Kidney function groups: G1, normal/high function; G2-G3, mild/moderate kidney disease; and G4-G5, severe kidney disease. The 30-day peri-operative complications were measured and a multivariate logistic regression analysis was performed while adjusting for all confounding variables. Propensity score matching was performed between the G1 and G4-G5 cohorts. RESULTS: A total of 83,020 patients were included. On multivariable regression, in the G2-G3 cohort, patients were at significantly increased risk for renal complications with OR = 2.43[1.56-3.79]. After propensity score matching, the G4-G5 cohort showed increased odds of pneumonia OR = 4.02[1.343-12.056], renal complications with OR = 7.62[2.283-25.411], cardiac complications OR = 4.53[1.531-13.411], and sepsis/septic shock OR = 1.76[1.091-2.834]. They also had a higher need for blood transfusion OR = 3.58[2.242-5.714], and prolonged hospital stay with OR = 1.49[1.296-1.723]. CONCLUSION: Pre-operative kidney disease may pose an increased risk of complications for patients undergoing endoscopic BPH surgery. The literature lacks information on the effect of pre-operative kidney disease on endoscopic BPH surgeries. Further studies are required to compare post-operative outcomes of LEP and LVP as compared to TURP across kidney function status.

Gastric Outlet Obstruction as a presentation of Metastatic Squamous Cell Carcinoma of the Bladder: A case report and review of the literature.

INTRODUCTION: Gastric outlet obstruction presents with a range of symptoms which include abdominal pain, early satiety, weight loss and vomiting caused obstruction secondary to tumors from outside the gastrointestinal tract or due to motility disorders. Bladder cancer is rarely associated with Gastric outlet obstruction. It usually presents with painless hematuria and urinary symptoms. Squamous cell carcinoma is a subtype of bladder malignancies that tends to present at a later stage and is associated with poorer prognosis in terms of metastasis and survival. CASE PRESENTATION: We present the case of a 79-year-old man, non-smoker, who presented to the emergency department with gastric outlet obstruction and was found to have non-bilharzial squamous cell carcinoma of the bladder metastatic to the retroperitoneal lymph nodes causing duodenal and small bowel obstruction. CLINICAL DISCUSSION: Squamous cell carcinoma of the bladder, tends to present at later stages and spread to adjacent organs or spread through lymphatics to lymph nodes, liver, bone, brain, lungs, and the gastro-intestinal tract. Diagnosis is made through cystoscopy, pathology and imaging. Non-Bilharzial Squamous cell carcinoma of the bladder is associated with increased morbidity and mortality than its Bilharzial counterpart. CONCLUSION: This is a unique case of non-bilharzial squamous cell carcinoma of the bladder, metastatic to retroperitoneal lymph nodes that lead to compression of the duodenum and small bowels and eventual gastric outlet obstruction. There are few reports of gastro-intestinal obstruction secondary to bladder cancer, however this is the first case metastatic non-bilharzial Squamous cell carcinoma of the bladder presenting as gastric outlet obstruction.

Florid Cystitis Glandularis with Intestinal Metaplasia in the Prostatic Urethra: a case report and review of the literature.

INTRODUCTION: Cystitis glandularis is a proliferative disease of the bladder epithelium usually presenting in the setting of chronic inflammation, characterized by the formation of glands in the bladder mucosa and submucosa. Intestinal metaplasia is a described process in cystitis glandularis characterized by the presence of intestinal cells and mucin production which is rare as compared to cystitis glandularis. CASE PRESENTATION: We present a case of cystitis glandularis with intestinal metaplasia located in the bladder and concomitantly in the prostatic urethra. Patient underwent transurethral resection of the lesion which was unusually found in the prostatic urethra. CLINICAL DISCUSSION: Florid cystitis glandularis is a rare condition found in women more than in men. It usually presents with irritative lower urinary tract symptoms or hematuria which leads to its eventual diagnosis. It is usually causes by inflammation to the bladder mucosa due to infections or irritation. Patients are diagnosed through Transurethral resection of these bladder lesions found in the trigone and bladder neck region. Surgery is the standard treatment of choice. However, medical treatment may also be used to treat underlying inflammatory conditions using antibiotics, steroids, and non-steroidal anti-inflammatory agents. Radical or partial cystectomy may be performed for severe refractory cases. CONCLUSION: This article describes the rare occurrence of florid cystitis glandularis in the prostatic urethra and provides an overview on diagnosis, etiology, and management of the disease.

Adrenal Cystic Lymphangioma: An Unexpected Pathological Finding in a Constellation of Uncontrolled Hypertension and Hypercalcemia.

Adrenal cysts are rarely observed lesions. Adrenal cystic lymphangiomas are asymptomatic benign lesions of the lymphatic vessels with the vast majority occurring in women. We herein present a rare case of a middle-aged gentleman with labile blood pressure associated with an incidental finding of an adrenal mass of 4 x 3 x 3 cm. Following surgical resection, pathology revealed the diagnosis of adrenal cystic lymphangioma.

A yellow-colored lipomatous lesion of the bladder: An unorthodox finding seen upon investigation for microscopic hematuria.

Bladder lesions are almost always malignant where only 5% turn out to be benign. Among the benign lesions, bladder lipomas are rarely reported in the literature. Typically, they are incidentally discovered, after endoscopic resection, during an investigation for hematuria or other urinary tract symptoms. This submucosal lesion must be differentiated from its malignant counterparts, such as liposarcoma or pelvic lipomatosis both of which have higher chance of recurrence and invasion when inadequately resected. We hereby report another rare case of an incidentally discovered bladder wall lipoma in a patient presenting with microscopic hematuria.

Adrenal Cavernous Hemangioma: A Rarely Perceived Pathology-Case Illustration and Review of Literature.

Cavernous hemangiomas are endothelial tumors that rarely affect the adrenal glands. Most of these tumors remain silent and are incidentally found on abdominal imaging. Hardly ever, these tumors are endocrinologically functional. They may present as vague abdominal pain. Surgical resection remains the mainstay for large masses. In this paper, we are presenting a case of adrenal cavernous hemangioma in a 83-year-old male patient who initially presented for workup of vague abdominal and bilateral flank pain. A computed tomography scan of the abdomen showed an 8 cm right adrenal adenoma which was metabolically nonfunctional. The mass was completely resected through an open subcostal incision, with no encountered postoperative complications. A highlight of all published cases of adrenal hemangiomas since 1955 is also presented and reviewed.

Symphysis Pubis Osteomyelitis: An Uncommon Complication after Robotic Assisted Radical Prostatectomy-Case Description with Literature Review.

Prostate cancer is the most common solid cancer among American men. Although there are various modalities for treatment, including radical prostatectomy among many others, the former is, nevertheless, not without any accompanied complications. Other than the well-known surgical complications such as erectile dysfunction, urinary incontinence, and voiding dysfunction, osteomyelitis of the symphysis pubis is not a well-understood complication, with various hypotheses explaining its pathogenesis. Although osteomyelitis of the pubis symphysis has been reported after endoscopic urological procedures such as transurethral resection of the prostate, it has rarely been reported after robotic surgeries. We hereby report, to the best of our knowledge, the first osteomyelitis of the pubis symphysis, after robotic prostatectomy, in a patient with prostate cancer and no previous radiation therapy.