Plasmacytoid urothelial carcinoma of the bladder with extensive scrotal wall invasion.

Plasmacytoid urothelial carcinoma (PUC) is an extremely rare and aggressive variant of urothelial carcinoma. We report a case of a 62-year-old male who presented with a rapid spread of PUC to involve his entire scrotal wall after failed surgery and chemotherapy. The second course of chemotherapy was effective in providing symptom control. We believe this is the first case report of PUC causing such rapid and extensive scrotal invasion. This case highlights the important features of PUC including the pattern of tumor spread along fascial planes, the tendency for initial understaging, and the rapid recurrence after initially response to chemotherapy.

Complete stone clearance using a modified supine position: initial experience and comparison with prone percutaneous nephrolithotomy.

BACKGROUND AND PURPOSE: The recently described Galdakao-modified supine Valdivia position for percutaneous nephrolithotomy (PCNL) has become increasingly popular. We have made further modifications to this and describe our recent experience compared with our previous prone cases. PATIENTS AND METHODS: From April 2011, all patients undergoing PCNL have been placed in the modified supine position. A suction beanbag is used to secure the patient and improve renal access. Data on patient age, comorbidities, stone size, operative time, radiation exposure, complications, stone clearance, and length of stay was collected, analyzed, and compared with data from our previous year's prone surgery. RESULTS: Thirty-six patients in each group underwent 41 PCNLs. The groups were well matched for age, sex, and comorbidity. The supine patients tended to have a higher body mass index. Stones in the supine group were larger (32.6 vs 25.7 mm, P=0.0402), and the operative time was shorter (86.2 vs 116.6 min, P=0.003). Radiation time was similar in the two groups, but the dose was higher in the supine group. Stone clearance rates, length of stay (2.5 days), and complications were similar. Nineteen (46%) patients underwent simultaneous lower urinary tract procedures including 4 (10%) with complete staghorn calculi for which ureterorenoscopy was used to fragment ureteral and upper renal pole stones. CONCLUSIONS: The modified supine position for PCNL has a number of advantages for the patient and staff compared with the prone position. Despite a more obese study group with larger stones, we have maintained stone clearance rates and significantly reduced operative time with no increase in complications. The technique has been easy to learn and teach. A major advantage has been simultaneous access to the lower urinary tract for ureteroscopy and stent placement, and this has helped with complete stone clearance.

Superior mesenteric artery syndrome following small bowel resection.

Superior mesenteric artery syndrome is a rare cause of mechanical intestinal obstruction. It results from compression of the third part of the duodenum between the superior mesenteric artery and the aorta. It has been described in association with a variety of clinical conditions, including prolonged supine immobilization, application of a body cast, ileal pouch-anal anastomosis, abdominal aortic aneurysm, spinal surgery and severe weight loss. We present a case of superior mesenteric artery syndrome following resection of a primary adenocarcinoma of the small bowel.