Increasing severity of haematuria with successive pregnancies in a woman with renal angiomyolipoma.

OBJECTIVE: To report a case of a 31-year-old woman with renal angiomyolipoma (RAML) who presented with progressive massive haematuria with successive pregnancies. CLINICAL PRESENTATION: A 28-year-old woman presented with mild haematuria in the third trimester of her second pregnancy. This was due to bleeding from a left RAML. Patient became pregnant for a third time. The RAML increased in size and patient bled more during the third trimester. After delivery she refused partial nephrectomy or renal embolisation. In the third trimester of the fourth pregnancy, she presented with massive haematuria, shock, severe anaemia (haemoglobin of 6gm/l) and required a total of 26 units of blood transfusion during a 4-week period. She required emergency Caesarian section at 36 weeks and simple nephrectomy 3 months postpartum. CONCLUSION: The risk of profuse haemorrhage from RAML may increase with successive pregnancies in women with RAML. This anomaly should be treated in between pregnancies by either angioembolisation or resectional surgery.

Two-trocar laparoscopic varicocelectomy: cost-reduction surgical technique.

OBJECTIVES: To describe the technique of two-trocar laparoscopic varicocelectomy and compare it with the standard three-trocar laparoscopic technique in terms of effectiveness, morbidity, and cosmesis. METHODS: Two matched groups of patients with left varicocele were recruited. Each group included 30 patients. One group underwent three-trocar and the other two-trocar laparoscopic varicocelectomy. The results of the two approaches were compared. RESULTS: No significant differences were found in terms of mean hospital stay or morbidity between the two-trocar and three-trocar techniques. A significant difference was found in the operative time and proportion of patients needing postoperative parenteral narcotic analgesia in favor of the two-trocar technique. In both approaches, the previously infertile patients had a significant improvement in sperm count and motility (P <0.05). Cosmetically, the trocar wound scars were aesthetically superior using the two-trocar technique. CONCLUSIONS: No significant difference was found between two-trocar and three-trocar laparoscopic varicocelectomy in terms of effectiveness and morbidity. The cost of an extra 5-mm disposable trocar in the three-trocar technique and the improved cosmesis after the two-trocar technique have made us prefer the latter technique.