No abstract
SummaryBackgroundSchistosomiasis or snail fever is an endemic parasitic infection caused by various trematodes of the genus Schistosoma. People acquire the disease through contact with water containing infected snails. It is one of the most widespread human parasitic infections in tropical and subtropical regions of the world such as Africa, South America, the Middle East, Asia and the Caribbean. In 1996, the World Health Organisation estimated that more than 200 million people living in rural areas are affected by this disease. However, the diagnosis is difficult in low prevalence areas because of a low index of suspicion.Case ReportHerein, we present a case of a 14-year old boy who had intermittent passage of blood in urine for the past 3 years. Clinical examination and initial investigations did not reveal any abnormality. Bladder schistosomiasis was suspected after contrast-enhanced computed tomography and later confirmed by cystoscopic biopsy.ConclusionsBladder schistosomiasis is a prevalent disease in the developing countries, but in non-endemic areas diagnosis may be often missed. The diagnosis should be considered in patients presenting with sporadic episodes of haematuria who have immigrated from or travelled to areas where this disease is endemic.
SummaryBackgroundForeign body in the lower urinary tract has a low incidence. Here we discuss a case of a safety pin within the bulbar urethra inserted by a young boy for sexual gratification, which was successfully removed under cysto-urethroscopic guidance.Case ReportHerein we present a case of a 14-year-old boy who presented with complaints of perineal pain and dysuria. On evaluation in detail and from clinical history, we came to know that he had inserted a safety pin within the urethra. Urine analysis revealed microscopic haematuria and few pus cells. X-ray of the pelvis and computerised tomography helped in confirming the presence of the safety pin within the urethra.ConclusionsThe method of extraction of a foreign body per urethra depends on the size and shape of the foreign body. Cysto-urethroscopic removal is successful depending on the physical characteristics of the foreign body. It has the advantage of minimising urothelial trauma and also helps in assessing any previous mucosal injury or thickening. Psychological evaluation and counselling may help to prevent further such episodes.
URS, with the drawback of longer operating time and low stone free rates with a single procedure in large renal calculi.We propose the use of Laparoassisted PNL (L-PNL) for complex renal stones of >2cm without an access to the kidney free of interpositioned organs.METHODS: We performed 15 L-PNL procedures in our centre in 3 years (2011)(2012)(2013)(2014). All patients were assessed previously by a CT scan in prone and lateral position, who showed the percutaneous path occupied by other abdominal organs (liver-colon in 6 cases, and spleencolon in 9). The medium stone size was 7.32 cm 2 .The technique starts in supine position, with ureteral catheterisation and pyelography to opacify the collect system. In lateral position, transperitoneal laparoscopic access with 5mm ports is performed to mobilize the "problem-organ". This also gives the advantage to control under direct vision all PNL's procedure. The puncture of the elected calix is made by the urologist in the same position, under C-arm fluoroscopic guidance. The energy used to break the stone is lithoclast or lithomaster, and a nitinol basket and tweezers are used to remove the fragments. At the end of the procedure, we leave a simple ureteral stent, removed during the following 24h, and a nephrostomy tube as drainage in all the accesses until its outflow is low. RESULTS: The medium operating time was 112.3min and the average descent of haemoglobin was 1.91mg/dL. The medium hospitalization was 5.6 days (range 3-11)We had no complications related to laparoscopic access. We observed 4 complications related to PNL's procedure that needed a placing of double J stent (1 urinary sepsis due to a small residual stone with ureteral obstruction and 3 urinary fistula due to mucosal oedema or blood clots, without ureteral residual calculi in the CT).12 patients were stone-free at 3 months, evaluated by simple X-ray, ultrasound or CT. 3 patient needed ESWL of small residual renal calculi.CONCLUSIONS: We believe that L-PNL gives us the possibility to perform percutaneous procedures of complex renal stones in patients without good access to the kidney, avoiding the morbidity of open surgery and with a high percentage of success in a single session compared to flexible URS.
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