Tuberous sclerosis is a multisystem neurocutaneous genetic disease that might be seen in one live birth in 6,000-10,000. Angiomyolipomas (AML) are the most common renal lesions that could be seen in ...80% of tuberous sclerosis patients. Nephron-sparing surgery or selective arterial embolization are methods that could be used in the treatment of AML. Here in we present the case who has been admitted to our emergency department with retroperitoneal bleeding due to bilateral giant AML and treated with the endovascular method. A 55-year-old woman, who has been followed regularly in our hospital since 2016 with the diagnosis of tuberous sclerosis. The patient was admitted to the emergency department of our hospital with complaints of right upper quadrant pain and dizziness. On computed tomography, 4 cm of free fluid was observed at the posterior part of the right kidney posterior, consistent with hemorrhage. On renal angiography, selective arterial angioembolization (SAE) was performed on the inferior segmental artery, which is feeding the AML. Surgical intervention was not considered in the foreground because the patient has bilateral giant AML and would not be anephric. It was decided to begin the patient on everolimus (mTOR inhibitor) treatment. In the patient’s first year follow-up, imaging was performed with non-contrast computed tomograpy. Computed tomograpy showed no size change in giant AML in both kidneys. Although the patient’s creatinine levels increased to 3.04 mg/dL and urea to 148 mg/dL during the follow-ups, she did not need hemodialysis. AML, which is seen as a part of tuberous sclerosis, is one of the important causes of mortality in tuberous sclerosis, which causes life-threatening bleeding and requires surgical or endovascular treatments. Nephron-sparing surgery could be difficult in bilateral cases. Therefore, SAE should be considered an important treatment option in emergencies.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Voiding symptoms and penoscrotal mass with/without fistula are typical findings of urethral diverticulum. We present a case of 55-year-old male patient who was evaluated for voiding symptoms, soft ...palpable penoscrotal mass and fistula. Retrograde urethrography, scrotal ultrasonography and cystoscopy revealed a urethral diverticulum and fistula. The defect developed after excision of the diverticulum associated with the penile ventral urethra was closed with a penile skin flap. In the 6-month follow-up, the patient did not have any voiding complaints and no signs of recurrence. Urethroplasty using a penile skin flap may be preferred in the repair of penile ventral urethral defect.
Primary signet ring cell carcinoma of the bladder is a rare tumor and it has a poor prognosis and is more mortal than the urothelial cell carnioma. However, most patients apply with painless ...macroscopic hematuria; rarely do they could apply with urinary tract infection or lower urinary tract symptoms. In this study; a 47-yearold male was referred to our clinic with dysuria, which was antibiotic therapy and symptomatic treatment. In ultrasonography, bladder wall thickening has been seen then patient underwent with cystoscopy. After atypical lesions were seen on the bladder mucosa, random punch biopsies were taken. A pathological examination revealed infiltrative urothelial carcinoma with a poorly differentiated signet ring cell component. As in this case report, patients with signet ring cell bladder cancer, which is rare and has an aggressive course, might only present with non-specific complaints such as dysuria. If atypical lesions are observed during the diagnostic cystoscopy procedure, the threshold should be kept low to decide on biopsy.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Transitional cell cancer of the urinary bladder very rarely metastasize to the skin. Herein, we present a patient with urinary bladder cancer who underwent radical cystoprostatectomy and ileal ...conduit surgery. During follow-up, he developed lung and skin metastases. However, the latter presented as a solitary sessile polypoid lesion at the parastomal area.
Objective: To evaluate the effectiveness of caudal block and penile block methods, in patients who underwent circumcision surgery in preventing postoperative pain. Materials and Methods: Patients who ...underwent elective circumcision surgery between January 2019 and May 2022 were retrospectively evaluated. After the exclusion criteria, 56 patients were included in the study. They were divided into two groups as penile block (group P, n=31) and caudal block (group C, n=25). Anesthesia technique applied, anesthesia duration, postoperative first micturition time, postoperative complications, time of first analgesia, analgesia need in the first six hours, observer pain score and Modified Pediatric Objective Pain Scale scores (MPOPS) were scanned. Results: When the first micturition time in the postoperative period was compared, it was found that group P took a significantly shorter time than group C (p=0.001). It was determined that group C needed analgesia in a shorter time than group P (p=0.028). When the MPOPS at 30th min (p=0.031), 90th min (p=0.043) and 6th hour (p=0.016) were compared, group C higher scores than group P. Conclusion: As a result, both methods can be used effectively and safely for appropriate pain control in patients who will undergo circumcision surgery. Both methods have advantages and disadvantages over each other. The choice of methods may vary with the experience of the surgeon and anesthetist. Keywords: Caudal anesthesia, dorsal penile nerve block, male circumcision
Paratesticular Leiomyoma; A Rare Case Report Ekenci, Berk Yasin; Kokurcan, Alihan; Durak, Hüseyin Mert ...
Üroonkoloji bülteni,
12/2022, Letnik:
21, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Paratesticular leiomyomas are rare tumors and originated from the subcutaneous smooth muscles and tunica dartos. Patients usually present with the complaint of a long-standing palpable painless mass ...and it is important to differentiate it from testicular masses. A 35-year-old male patient presented to our clinic with a palpabl mass, which he has realized since 15 year-old in scrotum that it growth 3-4 times over the last month. Physical examination revealed a palpable solid mass of approximately 3 cm, regular bordered, painless and localized inferiorly in the scrotum. Scrotal Doppler ultrasonography scan showed a 3x2.5 cm solid mass localized inferiorly in the scrotum, which has an internal blood supply. The inguinal exploration was planned due to malignancy risk. When the inguinal exploration was performed, we observed that the paratesticular mass was not connected with the testis. The mass, which was adherent to the scrotal skin, was excised together with the scrotal skin tissue with a safe surgical margin. In the pathology report, it was diagnosed as leiomyoma. The treatment for the vast majority of scrotal masses is radical inguinal orchiectomy. Testis preserving surgical procedures performing is critical for protecting both the fertility and the hormonal level of patients who have benign scrotal masses. Although physical examination suggests malignant neoplasms in patients presenting with a paratesticular mass, it should be kept in mind that benign neoplasms may also be present.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objective: The coronavirus disease-2019 (COVID-19) pandemic effect diagnosis and treatment of certain conditions, including bladder cancer (BC). This study aimed to evaluate the effects of the ...COVID-19 pandemic on BC diagnosis and treatment. Materials and Methods: Following the approval of the ethics committee for the study, data of 869 patients who underwent surgery for BC in the 2-year period between March 1, 2019 and February 28, 2021 were analyzed retrospectively. The number of surgeries performed for BC, the time elapsed between symptoms and diagnosis, the treatments performed, and the operative pathologies were compared before and during the COVID-19 pandemic. Results: During the COVID-19 period, there was a decrease in the total number of BC surgeries compared to the pre-COVID-19 period (p=0.004). It was observed that this decrease was due to a decrease in patients newly diagnosed with BC (p=0.001) as well as the decrease in the number of primary transurethral resection for bladder tumor procedures performed. There was no difference in the tumor stages of the patients at diagnosis (p=0.9). Intracavitary Bacillus Calmette-Guerin therapy use in high-risk non-muscle invasive bladder cancers (NMIBC) patients also decreased (p=0.008) during the pandemic period. It was observed that the time between symptom and diagnosis was longer in MIBC than in NIMBC during both periods (p<0.001). Conclusion: Diagnosis and treatment of BC have been adversely affected by the ongoing COVID-19 pandemic. The decrease in the number of new diagnoses may not reflect a true decrease in BC incidence, meaning that BC cases that arose during the pandemic are likely to be diagnosed at a more advanced stage. Keywords: Bladder cancer, COVID-19, diagnosis, treatment
In cases of testicular torsion (TT), prompt diagnosis and treatment are highly associated with organ salvage, and manual detorsion (MD) is a recommended maneuver as a first intervention. In our ...study, we aimed to investigate the effect of predictive factors of TT in predicting the success of MD.PURPOSEIn cases of testicular torsion (TT), prompt diagnosis and treatment are highly associated with organ salvage, and manual detorsion (MD) is a recommended maneuver as a first intervention. In our study, we aimed to investigate the effect of predictive factors of TT in predicting the success of MD.A retrospective, 2-center study was conducted on patients diagnosed with TT between January 2015 and 2024. Demographic, clinical, ultrasound, and laboratory characteristics at presentation were analyzed. MD was routinely performed as the first intervention in all patients. Predictive parameters were compared in the MD success and failure groups. Univariate and multiple logistic regression analysis was used to identify risk factors for MD failure.METHODSA retrospective, 2-center study was conducted on patients diagnosed with TT between January 2015 and 2024. Demographic, clinical, ultrasound, and laboratory characteristics at presentation were analyzed. MD was routinely performed as the first intervention in all patients. Predictive parameters were compared in the MD success and failure groups. Univariate and multiple logistic regression analysis was used to identify risk factors for MD failure.A total of 94 patients were included in the study. The median age of the patients was 20 (IQR: 12-69) years, and the median symptom duration was 6 (IQR: 4-12) hours. MD confirmed by Doppler ultrasonography was successful in 52 (55.3%) patients and unsuccessful in 42 (44.7%). Age, symptom duration, Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, TWIST risk groups, WBC, neutrophil, monocyte counts, and Monocyte/Eosinophil ratio (MER) were statistically different between the two groups. In multiple logistic regression analysis, the risk factors for failure of MD were found to be being over 18 years of age, the duration of symptoms being longer than 9 h, and MER > 28.RESULTSA total of 94 patients were included in the study. The median age of the patients was 20 (IQR: 12-69) years, and the median symptom duration was 6 (IQR: 4-12) hours. MD confirmed by Doppler ultrasonography was successful in 52 (55.3%) patients and unsuccessful in 42 (44.7%). Age, symptom duration, Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, TWIST risk groups, WBC, neutrophil, monocyte counts, and Monocyte/Eosinophil ratio (MER) were statistically different between the two groups. In multiple logistic regression analysis, the risk factors for failure of MD were found to be being over 18 years of age, the duration of symptoms being longer than 9 h, and MER > 28.Current urology guidelines suggest that age, symptom duration, and MER are reliable predictors of the success of MD, which is recommended in all cases of TT.CONCLUSIONCurrent urology guidelines suggest that age, symptom duration, and MER are reliable predictors of the success of MD, which is recommended in all cases of TT.
To elucidate epidemiological data and hydrocele progression, we reviewed pediatric patients diagnosed with hydroceles in our institution retrospectively.
We reviewed data from 355 pediatric patients ...with hydroceles. Questionnaires regarding age at diagnosis, time of delivery, presence of hydroceles in the father and brothers, age at recovery, age at surgery, cause of hydrocele (if present), type of hydrocele, associated pathologies, treatments, and posthydrocelectomy complications were completed by reviewing patients' medical records and interviewing their families.
Patients with congenital hydroceles were more frequently born prematurely (32.5%) than were patients with noncongenital hydroceles (15.9%; P = .001). Fathers of 10 patients (3.7%) and brothers of 21 patients (7.7%) also had hydroceles. Hydroceles were associated with inguinal hernias on the same side (12.2%), cryptorchidism (7.5%), varicoceles (6.0%), and testis torsion (0.5%). Among patients aged >1 year (n = 185), 27 did not undergo operations and healed spontaneously at an average of 5.30 ± 3.36 months. For children aged >1 year who did not undergo surgery, the rate of spontaneous recovery within 6 months was 77.8% and that within 1 year was 96.3%.
Until strong evidence of hydrocele-induced testicular damage in children arises, we recommend following up congenital hydroceles until at least 1 year and preferably 2 years of age. We recommend following up noncongenital hydroceles for at least 6 months and preferably 1 year if there is no associated pathology indicating the need for earlier surgery such as an inguinal hernia, cryptorchidism, tense hydrocele, testis torsion, or testis mass.
Penetrating or blunt traumas can rarely lead to renal artery pseudoaneurysms (RAPs). Renal parenchymal lacerations usually accompany them, and nephrectomy is performed in these cases. Although ...angioembolization of the renal artery can negate the need for nephrectomy while treating the RAP, it is not a nephron-sparing procedure. Herein, we present a case of isolated (i.e. without accompanying renal laceration) left RAP. During conservative follow-up, the RAP enlarged, and subsequently, it was treated by renal artery stent insertion. An expandable covered stent was used during this procedure. The renal function was preserved without experiencing any complications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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