An unusual case of a peritoneal dialysis catheter causing hydronephrosis: A case report.

Peritoneal dialysis (PD) catheter migration is a common complication of PD which usually results in obstruction of dialysate outflow. We report the first known case in the literature of a 62-year-old male with end-stage renal disease on PD who presented with acute renal colic secondary to the PD catheter overlying right mid-ureter causing hydronephrosis with spontaneous resolution of pain and hydronephrosis two days later. The patient was discharged home with a functioning dialysis catheter and complete resolution of both symptoms and radiographic findings of hydronephrosis. While management of migrated PD catheters usually require surgical intervention, our case resolved without intervention.

Inflammatory Myofibroblastic Tumor of the urinary bladder: A case report.

Inflammatory Myofibroblastic Tumors represent a rare subset of spindle cell tumors that can occur in the genitourinary tract, most commonly within the bladder. These tumors are proposed to fall in a spectrum of benign inflammatory pseudotumors to true sarcomas. This, along with their rarity makes diagnosis and treatment challenging to clinicians. We present a 51-year-old female diagnosed with IMT of the bladder following a presentation for hematuria. Treatment consisted of transurethral resection of the tumor. This case, and the accompanying review of the literature highlight the need for further research due to lack of clarity for diagnosis and treatment.

A case of metastatic lung adenocarcinoma of the bladder in a patient with no documented history of lung cancer.

Metastatic lesions of non-urological malignancies to the bladder are rare and often secondary to spread from a contiguous site. Distant metastasis to the bladder is even more uncommon. There are less than 10 previously described cases of metastatic pulmonary adenocarcinoma to the bladder in the literature over the past 20 years. In this report, we describe a 73-year-old African American gentleman with a history of prostate cancer who presented to the urology department with gross hematuria. Follow up imaging suggested possible neoplastic changes to the bladder. Biopsy and histochemical staining revealed poorly differentiated adenocarcinoma of pulmonary origin.

Isolated prostate amyloidosis; a case report.

Identification of amyloidosis on a prostate biopsy specimen raises suspicion for systemic amyloidosis. For patients at risk of prostate adenocarcinoma, a transrectal MRI ultrasound fusion (MRI-TRUS) guided biopsy of the prostate is often needed for further investigation. Our patient is a 70 year old male presenting from his primary care provider with an elevated PSA. The patient underwent MRI-TRUS fusion biopsy of the prostate, which demonstrated AL (lambda)-type amyloidosis, confirmed by mass spectrometry in addition to prostatic adenocarcinoma. He was subsequently diagnosed with primary amyloidosis of the prostate without evidence of other amyloid deposition sites.

Improving practice patterns in patients with newly diagnosed bladder masses treated with transurethral resection.

CONTEXT: Transurethral resection (TUR) is the mainstay for diagnosis, staging, and treatment of both high-grade and low-grade nonmuscle invasive bladder cancer (NMIBC). It is reported that 51% of initial transurethral resection of bladder tumors (iTURBT) does not contain muscle, which results in higher rates of clinical upstaging on repeat transurethral resection (reTUR) and worse oncologic outcomes. Presence of muscle on iTURBT specimen and performing reTUR within 6 weeks in high-risk NMIBC aids in accurate staging and, therefore, guides proper treatment. OBJECTIVES: This study aimed to assess and improve TURBT quality by making surgeons aware of their practice patterns and setting improvement goals. METHODS: Patients who received TURBT for a newly diagnosed bladder mass were analyzed by retrospective chart review for 9 months prior to quality improvement (QI) intervention. Data were collected pertaining to muscle presence/absence on biopsy, pathology of the tumor, risk stratification, whether reTUR was indicated, and time to reTUR. The primary endpoints were the presence of muscle on initial TURBT, whether a reTUR was performed when clinically indicated, and time to reTUR. Tumors requiring reTUR were defined as being HGT1 or HGTa >3 cm. The QI intervention, physician education, was then implemented by presenting initial performance results to the physicians, and a second dataset was then collected by prospective analysis for another 9 months to assess for changes in practice patterns. A total of 101 patients receiving TURBT were reviewed, including 52 patients prior to and 49 patients following QI intervention. Patients with a history of, or treatment for, bladder cancer were excluded, along with those without assessment of muscle on pathological analysis. Fisher's exact test was utilized to determine differences in categorical data by comparing each of the following groups prior to and following QI intervention: percent of muscle presence on iTURBT, percent reTUR performed when indicated, and mean time to reTUR in days. A p<0.05 was considered statistically significant. RESULTS: After comparing the TURBT results before and after our QI intervention, we found a significant improvement in the number of patients receiving a reTUR when indicated, with 5/13 (38.5%) before compared to 15/19 (78.9%) after, p=0.03. The number of specimens on iTURBT with muscle present were not significantly different, with 38/52 (73.1%) before and 33/49 (67.3%) after, p=0.66. The average time to reTUR before (32.4 days; n=5; range, 21-50 days) and after (42.4 days; n=15; range, 11-77 days) QI intervention was also not significantly different, p=0.28. CONCLUSIONS: Our data suggest that critical analysis of physician practice patterns followed by education and setting improvement goals can significantly impact clinical practices and improve quality of care. Future studies will be performed to determine the impact that these changes have on oncologic outcomes.

Pulmonary and hepatic metastases of low-grade urothelial cell carcinoma; A case report.

Bladder cancer is a commonly encountered malignancy of the genitourinary tract. Bladder cancer is categorized as high or low grade depending on histological analysis. Low grade urothelial cell carcinoma has an indolent clinical course as compared to high grade, with low rates of progression of disease. We present a case where a patient was identified to have low grade bladder cancer and subsequently found to have low grade bladder cancer metastases to the lung and liver. Although uncommon, low grade urothelial cell carcinoma has the potential for progression and metastasis, highlighting the importance of regular follow-up and surveillance.

Tensile force exerted by suture during renorrhaphy using current techniques.

Partial nephrectomy has become the preferred treatment option for small renal masses. In particular, minimally invasive partial nephrectomy (MIPN) using laparoscopic or robotic approaches has shown decreased blood loss, shorter hospital stay, and faster return to normal activity compared to open surgery. However, MIPN still carries risk of postoperative complications including hemorrhage and urine leakage. Closure of the renal remnant, often called renorrhaphy, is a critical step to avoid these complications. The purpose of the study was to provide quantitative data on suture properties during partial nephrectomy. Multiple suture techniques have been proposed for renal closure during robotic-assisted partial nephrectomy. There is no consensus for preferred closure technique and this decision is at the discretion of the surgeon. Simulated partial nephrectomies were performed on porcine kidneys. Renorrhaphy was completed with barbed suture using a simple running, interrupted sliding-clip, or horizontal mattress technique. Suture tension was obtained prior to tissue failure with force sensors measuring in newtons (N). The interrupted sliding-clip and horizontal mattress techniques performed similarly with median force values of 11.06 N and 12.20 N, respectively. The simple running technique performed with a median force of 3.62 N. ANOVA proved statistical significance. Interrupted sliding-clip and horizontal mattress sutures exert similar forces prior to tissue failure during renorrhaphy. Both techniques were able to achieve forces great enough to overcome the hydrostatic pressure of perfused renal tissue. Simple running sutures failed at significantly lower forces. When closing renal defects after partial nephrectomy, sliding-clip and horizontal mattress should be utilized over simple running sutures.

Rare soft tissue tumor presenting as inguinal swelling.

Cellular angiofibroma (CAF) is a rare, benign mesenchymal tumor found usually in the female vulvar and male inguinoscrotal regions. A 56-year-old Caucasian gentleman presented with left sided scrotal swelling after masturbating. The swelling was thought to be an inguinal hernia, although was found to be a soft tissue tumor upon dedicated cross-sectional imaging. Pathological evaluation of the mass revealed it to be a cellular angiofibroma. Diagnosis of CAF can only be made after resection and proper immunohistological staining. Ultrasonography and MRI are preferred for detailed soft tissue characterization. After surgical resection, follow-up imaging is recommended given potential risk of malignancy.

De novo minimal change disease in the renal allograft.

De Novo minimal change disease in the renal allograft is an infrequently reported cause of glomerulopathy. The paucity of reported cases in the medical literature and strict clinical-pathological criteria for diagnosis has made this entity an infrequently encountered disease process. We describe a case of MCD sixteen months post-transplant that has initially responded well to corticosteroid therapy.

BCG orchitis.

Intravesical immunotherapy with Bacillus Calmette-Guerin has been shown to decrease tumor recurrence and progression in urothelial carcinoma of the bladder. Its ubiquitous use is further substantiated by its low rates of complications. Our patient is a 63 year old male with a circuitous medical course who presents with epididymoorchitis and scrotal abscess after his second three week cycle of maintenance BCG prompting scrotal exploration which revealed a non-viable testicle and large scrotal induration with abscess. Pathological analysis and initial cultures were negative for mycobacterium but acid-fast cultures eventually demonstrated mycobacterium three months later.

A New Differential Diagnosis: Synthetic Cannabinoid-Associated Gross Hematuria.

Recreational use of synthetic cannabinoids (SCs), also known as "K2" or "Spice," is becoming a major public-health concern due to their potential for abuse and harmful consequences. New substances are constantly being added to the content of SCs. The dearth of information on these newly added contents as they are introduced into the black market hinders risk assessments of these compounds. We report a highly unusual case of gross hematuria in a 28-year-old male patient after SC use. He was found to have a supratherapeutic INR with no history of prior anticoagulation. His hematuria resolved after four units of fresh-frozen plasma were administered. We include a literature review of the clinical effects of SCs and their possible mechanism of gross hematuria and management.

Novel Role of Dehydrated Human Amnion/Chorion Membrane in Healing of Denuded Ureter in Robot-Assisted Excision of Endometriosis.

Ureteral injury is an uncommon but potentially morbid complication following any open or endoscopic pelvic procedure. Gynecologic surgeries alone make up 50 percent of nonurologic ureteral injuries leading to prolonged hospital stays, secondary interventions, and potential loss of renal function. The use of AmnioFix ® a processed dehydrated, immunologically privileged cellular amniotic membrane allograft has been well established in urologic and gynecologic procedures. These allografts contain human extracellular matrix components, growth factors, and cytokines that mediate inflammation and facilitate would healing. We report the first application of AmnioFix on a denuded ureter during a case of robotic-assisted excision of endometriosis. We include a literature review and discussion on the management outcomes of iatrogenic injury to the ureters.