Simultaneous Trans-Diaphragmatic Approach for Wedge Resection of the Solitary Ipsilateral Lung Metastasis in Renal Cell Carcinoma.

About one third of newly diagnosed renal cell carcinoma (RCC) patients present with synchronous metastatic disease. Twenty to 40 % with localized disease at diagnosis eventually develop metastases. Complete metastasectomy confers five year survival rate of 35 % to 50 %. Traditional thoracic approach for lung metastasectomy carries increased morbidity. We report a less morbid trans-diaphragmatic approach. Right cytoreductive nephrectomy with liver and simultaneous trans-diaphragmatic lung resection was performed with uneventful perioperative course in a 60 year male with metastatic RCC. Trans-diaphragmatic resection of peripheral lung metastasis can be considered electively approach in selective cases of RCC with ipsilateral resectable inferior lung metastases.

Forgotten Reminders: an Experience with Managing 28 Forgotten Double-J Stents and Management of Related Complications.

Combinations of extracorporeal shockwave lithotripsy (ESWL) and endourological and open surgery have been used for management of forgotten double-J (DJ) stents; however, there are only a few case reports or case series in literature. We present our experience of managing 28 cases of forgotten ureteric stents of whom three patients died because of complications after intervention. We retrospectively reviewed the hospital records of 28 cases of forgotten DJ stents from 2000 to 2013. The details reviewed included indications for stent placement, indwelling time, presenting complaints, laboratory, radiographic, nuclear scan findings, management techniques, and complications. Extensive review of literature was done. Mean patient age was 37.7 ± 14 years. Mean indwelling time was 102.9 months. The commonest presenting complaints were irritative voiding symptoms and hematuria. Nineteen (67.8 %) of the stents were complicated. The complicated stents were managed by a combination of endourological techniques and ESWL. Six (21.5 %) patients presented with renal failure. Three patients died of complications. Forgotten DJ stent can be a lethal yet entirely preventable complication. Preoperative imaging with a noncontrast CT is essential especially in long indwelling time, especially to evaluate stone burden at the upper end of the stent. A stepwise approach should be used for management. Where long operative times are expected, the procedure must be staged. Combined endourological procedures are almost always successful in managing these challenging cases.