INTRODUCTIONThe aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis.METHODSThe imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery.RESULTSA total of 96 patients were identified for the study. Stone sizes ranged from 3mm to 20mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage.CONCLUSIONSOne in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.
Seven cases of ossified pseudomeningocele have been previously described in the literature and all were operated on. However, our case shows that ossified extradural pseudocysts do not require operation in every case.
IntroductionProstatic metastasis from a primary bowel adenocarcinoma has been only rarely reported in the medical literature. The case reported here is rare in the fact that the primary tumor was from a right-sided bowel adenocarcinoma. It is unusual because initial immunostaining was not fully conclusive, and so a relatively new method of immunostaining, CDX2, was used to ascertain its histopathology.Case presentationWe describe the case of a 54-year-old Caucasian man who had a right hemicolectomy for a primary cecal adenocarcinoma, which was completely excised. Following the procedure, he received adjuvant chemotherapy. Computed tomography scans showed no evidence of local recurrence or metastatic disease. Then, five years later, he presented to his general practitioner with urinary symptoms. An abnormal prostate was palpated on digital rectal examination. Trans-rectal prostatic biopsies were performed, which showed colorectal metastases within the prostate gland. This was confirmed with CDX2 immunohistochemistry. There was no further evidence of distant metastases on positron emission tomography-computed tomography scans.ConclusionsThis case demonstrates a rare isolated hematogenous spread to the prostate from a primary cecal adenocarcinoma, several years after definitive treatment and excision. This highlights the importance of accurate immunohistochemistry and imaging in planning further management and treatment.
Introduction:The imaging modality of choice for ureteric colic is non-contrast computerised tomography-kidneys, ureters and bladder (NCCT-KUB). Guidelines for follow-up of radiolucent calculi suggest 'periodic' imaging but with no modality advised. Availability of CT appears variable especially prior to ureteroscopy (URS). This study aimed to establish current imaging practice in the UK.
Introduction: Laparoscopy allows minimally invasive approaches for procedures traditionally performed openly, with associated lower morbidity. Nephron-sparing surgery (NSS) is mostly regarded as an open procedure because laparoscopic partial nephrectomy (LPN) is technically challenging. We evaluated our centre's experience with LPN and open partial nephrectomy (OPN). Methods: All patients over five years (2005)(2006)(2007)(2008)(2009)(2010) undergoing NSS were identified retrospectively from our operating room management information system. Case notes, diagnostic and post-operative surveillance imaging were reviewed. Post-operative morbidity, histopathology and serum full blood count and urea and electrolyte reports were recorded. Results: A total of 97 OPNs and 23 LPNs were performed. Median length of stay was six days for OPNs and three days for LPNs (p = 0.005). Mean drop in haemoglobin (Hb) was 2.6 g/dl for both OPNs and LPNs. No significant difference in transfusion rates was observed. Median warm ischaemia time (WIT) for OPNs was 14 minutes and 32 minutes for LPNs (p < 0.0001). No significant difference was seen in changes from baseline serum creatinine when comparing OPNs with LPNs at day 1 (p = 0.7572) and at 12 months (p = 0.7406) post-operatively. Surgical margins were positive in 20 (21.5%) OPNs and negative in all LPNs (p = 0.038). One patient developed local recurrence following OPN (clear margins) and two patients developed distant metastases. Conclusions: Benefits of LPN include shorter hospital stay and satisfactory long-term preservation of renal function, despite longer WITs. This demonstrates the benefits of LPNs in patients with single exophytic renal tumours performed by highly experienced, regionally selected laparoscopists.
Long-acting luteinizing hormone-releasing hormone (LHRH) agonists, such as goserelin, have been used for locally advanced and metastatic prostate cancer for many years and are the main forms of androgen deprivation therapy (ADT). Acting on pituitary LHRH receptors, they initially stimulate a transient rise in serum follicle stimulating hormone (FSH) and LH. Long-term administration of an LHRH analogue will eventually lead to down regulation of LHRH receptors, thus suppressing FSH and LH secretion. This in turn suppresses testosterone production hence achieving and maintaining androgen deprivation. This case highlights the potential anomaly of a sustained elevated serum testosterone in the context of newly diagnosed locally advanced prostate cancer with a co-existing pituitary macroadenoma after administration of LHRH analogues. Alternative methods of androgen deprivation must be considered in such patients.
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