Beware! A simple renal cyst could be a hydatid cyst.

Kidney is one of the most common sites for the cyst formation in the body, and the management of simple cysts is required entirely for its symptoms and complications. Surgical decortication is an established treatment for a large and symptomatic simple renal cyst. On the other hand, hydatid cysts of the kidney are usually multiloculated complex or calcified cysts and are quite rare. Their surgical treatment also differs and requires complete excision with pericystectomy or partial/complete nephrectomy depending upon residual functional parenchyma, using extreme caution to avoid spillage, recurrence or development of severe anaphylactic shock. A simple cyst harboring a hydatid cyst is highly uncommon and quite dangerous; as if not diagnosed preoperatively, it can create huge trouble for both the patient and the operating surgeon which happened in the present case.

Ureteric erosion and obstruction: A rare but dreaded complication of intrauterine contraceptive device.

Though intrauterine contraceptive device (IUCD) is a safe and most frequently used long-term contraceptive method, it has some complications. Uterine perforation and intra-abdominal migration have been reported often, but a retroperitoneal migration is exceptional. Here, we are reporting an IUCD which perforated the uterus and migrated to the retroperitoneum; impinging into and obstructing left ureter causing severe hydroureteronephrosis due to the development of the left lower ureteric stricture.

Lower Genitourinary Tract Trauma Caused by Cow Horn Injury.

INTRODUCTION: Lower genitourinary tract trauma in females caused by cow horn injury (goring) is rarely reported and discussed. MATERIALS AND METHODS: All (12) women who were managed over the past 5 years for genitourinary tract trauma inflicted by cow horn injury were retrospectively analyzed. RESULTS: Variable patterns of lower genitourinary trauma were observed due to cow horn injury. CONCLUSION: Treatment should be individualized and offered after thorough evaluation under anesthesia.

A clinicoepidemiological study of young age bladder tumors: An eastern Indian scenario.

INTRODUCTION: Though, bladder cancer is one of the most common urological malignancies, studies addressing the young age group bladder tumors are rare. Present study was done to determine the clinicoepidemiological aspects of bladder tumor diagnosed in young age patients and to compare these aspects with elderly patients. PATIENTS AND METHODS: Patients with urinary bladder tumor were selectively divided into two groups; young (<40 years) and elderly (>60 years). Groups were compared on various parameters and statistically analyzed using Fisher's exact two-tailed test. RESULTS: Smoking, tea and coffee intake and exposure of dye were found significantly associated with development of bladder tumor. Most of the tumors in young age were small, solitary, and papillomatous. Transitional cell carcinoma (TCC) was the most common histological subtype, though most were of low grade and were non-muscle invasive in comparison to the tumors in elderly group. CONCLUSION: The incidence of bladder cancer is common in younger age group. Active and passive cigarette smoking, tea, coffee intake, and exposure to organic dyes are major risk factor for younger age group bladder tumor in this part of world. TCC is most common histological subtype and most of them are in low grade without muscle invasion.

Genitourinary Fistula: An Indian Perspective.

BACKGROUND: In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed. PURPOSE: The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature. MATERIALS AND METHOD: During a 6-year period from January 2007 to December 2013, 41 cases of genitourinary fistula, who admitted and treated in the urology department of a tertiary care center, were retrospectively analyzed for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. The literature search was done using the Medline database. RESULT: Mean age of the patient was 27 years (range 16-51). Primary and simple fistulae were common. Obstetric trauma was the most common etiology (56.09 %) followed by iatrogenic (39.03 %). Vesicovaginal fistula was the most common type (78.37 %) and trigone was the most common site involved (51.72 %). 51.35 % of patients were approached successfully by the vaginal route. Ancillary procedures were required in patients for various other associated anomalies at the time of fistula repair. The success rate on follow up was 94.5 %. In the mean follow up of 3 years, 35 patients were sexually active. CONCLUSION: Genitourinary fistula is a frustrating entity with potentially devastating psychosocial consequence. Its management poses a tricky challenge to the surgeon. Accurate and timely diagnosis, adhering on basic surgical principle, and repair by an experienced surgeon provide the optimum chance of cure.

A completely calcified prostate.

Prostatic calcification and prostatic calculus formation is commonly seen in adult population with chronic prostatitis, however, gross prostatic calcification which involves more than 3 cm2 of the gland is quite rare. We are presenting here one such case in which almost whole glandular prostate was converted into stone which is never reported so far.

Penile lichen sclerosus: An urologist's nightmare! - A single center experience.

PURPOSE: Penile lichen sclerosus (LS) is a nagging condition and its progression result in devastating urinary and sexual problems and reduction in the quality-of-life. This study has been carried out to present our experience about this disease with simultaneous review of the available literature. MATERIALS AND METHODS: This retrospective study has been done at a tertiary care center of eastern India. The data of 306 patients affected with LS were analyzed for clinical presentation, physical examination, investigations, and treatment offered. RESULTS: Presenting symptoms were non-specific. The prepuce was most commonly involved location followed by glans and meatus. Urethral involvement was not isolated as the primary site. Circumcision was done in 237 patients, while 63 patients underwent meatotomy. Thirty-six of 39 cases of LS induced stricture were treated with buccal mucosal graft (BMG) either in one stage or in two stages. CONCLUSION: LS varies from being a highly aggressive disease of the penis and anterior urethra to a burnt out condition affecting just the meatus and surrounding glans. Early diagnosis and treatment are required to prevent its complication and associated morbidity. Management depends on the anatomical location of lesion, extent of involvement, rapidity of progression and its severity. Use of BMG in LS induced urethral stricture has shown encouraging results.

Paraganglioma of urinary bladder.

Paraganglioma of the urinary bladder are tumors of chromaffin tissue originating from the sympathetic innervations of the urinary bladder wall and are extremely rare. Being functional, in most of the cases they are recognized by their characteristic presentation of hypertensive crisis and postmicturition syncope. A silent presentation of a bladder paraganglioma is very unusual but quite dangerous as they are easily misdiagnosed and adequate peri-operative attention is not provided. Here, we are presenting one such silent paraganglioma in adult women who presented with only a single episode of hematuria and severe hypertensive crisis occur during its trans-urethral resection.

Synchronous Jejunal Metastasis Presenting as Intussusception in a Case of Advanced RCC: a Rare Presentation.

Renal cell carcinoma (RCC) may metastasize to almost any organ, but metastasis to the small bowel is very rare. Factors responsible for a resistant behavior of small bowel wall are still not clear. Small bowel metastasis from RCC may cause obstruction, bleeding, and perforation. RCC metastasis to the small bowel presenting as intussusception is extremely rare. Only 20 cases of small bowel intussusceptions caused by metastatic RCC have been reported worldwide. Here, we are reporting this rare case of RCC with simultaneous solitary metastasis in jejunum which presented as intussusceptions and which was treated with simultaneous radical nephrectomy, jejunal resection, and anastomosis.

Angiosarcoma of penis: Case report of an aggressive penile cancer.

Angiosarcoma is a very rare mesenchymal tumor of penis. Though extremely unusual, it should be considered in the differential diagnosis in patients presenting with a penile growth or a localized subcutaneous penile lesions as they are very aggressive and there is a high chance of recurrence. One such case is reported here, which was aggressively treated with total penectomy and the patient did not show any recurrence in 2 years of follow-up.

Meatotomy using topical anesthesia: A painless option.

AIM: Urethral meatotomy is an office procedure often done under local anesthesia with or without penile block or under short general anesthesia. Whatever may be the method, the patient has to bear the pain of injection. To avoid painful injections, in the present study, topical anesthesia in the form of eutectic mixture of prilocaine and lidocaine anesthetics (EMLA/Prilox) has been used to perform such procedures and its effectiveness determined. MATERIALS AND METHODS: A total of 48 consecutive patients with meatal stenosis who attended urology outdoor were enrolled in this study. After exclusion, in 32 patients, 3-4 g of Prilox cream was applied over the glans and occlusive covering was maintained for 45 min before the procedure. Meatotomy was done in a standard manner with hemostat application at the stenosed segment for 2-3 min followed by ventral incision at meatus. The patient's pain perception was measured using visual analog score. RESULTS: Out of 32, only one patient that had inappropriate application of cream, had a perception of pain during the procedure. Rest all the patient had no discomfort during the procedure. Mean visual analog score was 1.8 which is not a significant percepted pain level. No patient had any major complication. CONCLUSION: Use of topical anesthesia in form of Prilox (EMLA) cream for meatotomy is safe and effective method that avoids painful injections and anxiety related to it and should be considered in most of such patients as an alternative of conventional penile blocks or general anesthesia.

Isolated hydatid cyst in a single moiety of an incomplete duplex kidney.

Isolated hydatid cyst of kidney is very rare. Hydatid cyst of a duplex renal system is even more rare. We report a 13-year old girl with duplex system of right kidney with isolated hydatid cyst in upper moiety. Right nephrectomy was done to cure the condition.

Plasma cell granuloma of the urinary bladder: A pseudotumor - A clinical dilemma.

Plasma cell granuloma is a rare benign proliferative lesion that often mimics a malignant mass clinically and radiologically and its presentation in the urinary bladder is exceptional. Presuming malignant mass, such lesions often receive radical treatment. We are presenting here one such tumor, which resembled as an urachal tumor and underwent partial cystectomy.

Forgotten DJ Stent with a Large Calculus at Its Distal End in an Ileal Conduit Diversion.

Calculus formation in an ileal conduit following cystectomy is a known complication. Encrustation and formation of calculus may also occur over a DJ stent retained for a long period; but this is never reported in patients with conduit diversion because of close surveillance of these patients. Here we report first case of a large calculus encrusted over a forgotten DJ stent within an ileal conduit in a man who had undergone urinary diversion following radical cystectomy for carcinoma urinary bladder 8 years earlier.

Transrectal impalement of an incense stick in a child presenting as foreign body in the urinary bladder.

The diversity of objects that can be found in the urinary bladder often surpasses the urologist's imagination and mostly they are introduced per urethrally. Impalement injuries of the rectum with bladder perforation have been rarely reported. A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. In this interesting case, a young male child presented with haematuria and dysuria. He had a history of accidentally sitting on an agarbatti (Indian incense stick) stand while playing, followed by perianal pain which subsided spontaneously. Next day he presented with haematuria and dysuria. Clinical examination was inconclusive. On thorough investigation, a linear echogenic foreign body was found in the urinary bladder. The child was operated and the foreign body (incense stick) was removed. This is the first reported case of rectal impalement injury with incense stick, migrated to the urinary bladder in a 2-year-old child.

Development of VVF following double J stent placement.

Double J stent (DJ stent) is commonly used in various urological conditions. Theoretically stent-induced tissue erosion can be a possibility, but fistula formation is rarely reported. The present case was a case of genitourinary tuberculosis diagnosed 4 years ago and had received complete treatment. Two months ago she presented with recurrent urinary tract infection and diagnosed to have vesicoureteric reflux with secondary obstruction for which DJ stent was placed, after 15 days of which the patient reported leakage of urine per vagina. She was diagnosed to have vesicovaginal fistula (VVF) with in situ stent eroding through the bladder wall. Stent was removed and fistula was corrected surgically. This is the first reported case of stent-induced VVF, a rare complication of ureteral stent placement.

Prostatic utricle cyst: a clinical dilemma.

Prostatic utricle cyst is a rare midline cystic lesion between the urinary bladder and the rectum, commonly associated with hypospadias. Along with its rarity, it presents a challenge in its diagnosis and proper management. We report a case of large prostatic utricle cyst that was managed conservatively.