Laparoscopic removal of a pelvic cyst associated with obstructed megaureter and dysplastic renal remnant.

We report a case of a 41-year-old man with a solitary functioning left kidney and history of chronic pelvic discomfort associated with lower urinary tract symptoms. Imaging revealed a large cystic structure in the pelvis attached to a dilated tortuous ureter on the right with congenital absence of the right kidney. The patient underwent laparoscopic removal of the pelvic cyst and dilated right ureter. Pathological assessment revealed mesonephric remnants representing dysplastic renal tissue attached to a dilated and obstructed megaureter, extending into the bladder wall and forming a large pelvic cyst. The patient's symptoms resolved. A laparoscopic approach represents an excellent surgical option for pelvic pathology.

Clear cell myomelanocytic tumour: minimally invasive treatment of a rare bladder tumour.

Clear cell myomelanocytic tumours are extremely rare neoplastic growths considered to be members of the family of perivascular epithelioid cell tumours (PEComas), which have in common the coexpression of melanocytic and smooth muscle immunohistochemical markers. These tumours are known to be ubiquitous with uncertain tumour biology and to have unpredictable clinical behaviour. They have been reported in the genitourinary tract, including the kidney and prostate. There are only 3 reported cases of clear cell myomelanocytic tumours originating in the urinary bladder. We report a case of a 24-year-old woman with chronic pelvic pain who underwent laparoscopic partial cystectomy and total excision of a bladder mass. Pathological examination revealed primary PEComa of the urinary bladder. Subsequent follow-up procedures, including cystoscopy and imaging, have not revealed any evidence of disease recurrence. The patient remains clinically free of disease 3 months after surgery.

Long-term patient satisfaction following cadaveric pubovaginal sling incontinence surgery using the UDI and IIQ-7 questionnaires.

AIMS: The goal of any incontinence surgery is overall long-term patient satisfaction. The purpose of our study was to assess long-term patient satisfaction following cadaveric fascia lata pubovaginal sling surgery using the urogenital distress inventory (UDI) and the short form of the incontinence impact questionnaire (IIQ-7). MATERIALS AND METHODS: A total of 47 patients who underwent pubovaginal sling incontinence surgery with a minimum follow-up of 2 years were sent by mail the UDI (total score = 300) and the IIQ-7 (total score = 100). Thirty-seven responses (78.7%) were obtained, with a mean follow-up of 3.8 years (range 2.0-6.2). RESULTS: Of the 37 patients who responded, the mean UDI score was 75.8 and the mean IIQ-7 score was 21.4. There was no difference in the mean IIQ-7 score for patients with more than 4 years follow-up as compared to the entire group (28.8, P = 0.22). In contrast, the mean UDI score for patients with more than 4 years follow-up was greater compared to the entire group (99.1, P = 0.04). UDI subscale analysis revealed that patients mainly complained of both irritative and stress symptoms as opposed to obstructive/discomfort symptoms (P < 0.01). Patients with pre-operative mixed incontinence had greater mean UDI and IIQ-7 scores compared to patients with pre-operative pure stress incontinence (96.7 vs. 58.0, P = 0.04; 32.5 vs. 11.9, P = 0.03). CONCLUSIONS: Overall long-term scores assessing quality of life (IIQ-7) were good and those assessing symptom distress (UDI) were satisfactory following pubovaginal sling surgery. Patients with pre-operative mixed incontinence are at greatest risk for post-operative dissatisfaction.

Rare case of recurrent angiokeratoma of Fordyce on penile shaft.

Angiokeratomas are benign cutaneous vascular lesions characterized by dilated thin-walled blood vessels lying in the upper part of the dermis, mostly associated with an epidermal reaction such as acanthosis and/or hyperkeratosis. Angiokeratomas of Fordyce are predominantly located on the scrotum and are only rarely found on the penis and then usually on the glans penis. We report a rare case of angiokeratoma of Fordyce located on the shaft of the penis and associated with two recurrences after appropriate surgical excision.

Case report: renal lymphangiectasia.

Renal lymphangiectasia is a rare renal condition. We present a case of bilateral renal lymphangiectasia in a 52-year-old man who presented with bilateral flank pain and gross hematuria. The clinical features, diagnosis and characteristic imaging findings are reviewed. This condition should be considered in the differential diagnosis of cystic renal masses in both children and adults.

Wilms' tumor at the Children's Hospital of Eastern Ontario: 1990-2001.

BACKGROUND: Wilms' Tumor is the most common malignant neoplasm of the urinary tract in children. Since 1969, the National Wilms' Tumor Study Group (NWTSG) has contributed to improving the clinical management and outcome of children affected by Wilms' Tumor. We have managed our patients according to NWTSG protocols and report our results herein. METHODS: Retrospective chart review of consecutive patients presenting at the Children's Hospital of Eastern Ontario (CHEO) with a diagnosis of Wilms' Tumor between April 1990 and March 2001. RESULTS: Forty patients with Wilms' Tumor (18 M/22 F) were diagnosed at CHEO during this interval. Mean age at diagnosis was 28.5 months. The most common presenting feature was a palpable abdominal mass in 85%. An overgrowth syndrome was noted in 10%. Metastatic disease was present at diagnosis in 20%, with the lungs (75%) the most common site of involvement. Distribution of clinical stage: I = 40%, II = 20%, III = 20%, IV = 15%, V = 5%. Favorable histology (FH) was diagnosed in 82.5%, anaplasia in 12.5% and clear cell sarcoma (CCSK) in 5%. Nephrogenic rests were present in 43% (perilobar (PL) = 20%, intralobar (IL) = 18%, PL + IL = 5%). Recurrence of disease occurred in 10%, with lungs (100%) the most frequent site of relapse. Survival was significantly greater in stage I disease and in those patients with FH. Patient 4-year survival data: stage I (FH), 100%; stage II (FH), 80%; stage III (FH), 100%, stage IV (FH), 67%; stages I-IV (CCSK), 100%; stage V, 0%. Overall 4-year survival rates of patients with FH were 92% and of all patients in the study was 86%. CONCLUSIONS: The presentation of Wilms' Tumor at our institution mirrors that described in the literature. Importantly, by following NWTSG protocols we have achieved an outcome of overall 4-year patient survival comparable to the "gold standard". This demonstrates the utility of the NWTSG protocols as regards patient management of this relatively uncommon disease.