Situs inversus totalis is a rare anatomical variant in which all major organs and blood vessels are mirrored from left to right. We present a case of upper tract urothelial carcinoma in a patient with situs inversus who underwent robotic-assisted laparoscopic nephroureterectomy. We utilized conventional surgical approaches and a successful oncologic outcome was achieved.
Uric acid is the third most common stone composition and comprises 7 to 10% of all kidney stones sent for analysis. These stones are more common with increasing age and in men. Uric acid stone disease is associated with conditions such as the metabolic syndrome and type 2 diabetes mellitus. Uric acid is produced by the enzyme, xanthine oxidase and is the final product of purine metabolism in humans. Three main factors contribute to the formation of uric acid stones: low urine pH (the most important), hyperuricosuria (rare, includes conditions such as myeloproliferative disorders and Lesch-Nyhan syndrome), and low urine volume. Uric acid stones appear radiolucent on plain radiographs and are ultimately diagnosed via stone analysis. These stones may be treated with medical expulsive therapy, dissolution therapy, or surgical intervention depending on the size, location, and clinical presentation. Urine pH manipulation therapy with potassium citrate is the first-line treatment for the prevention of uric acid stones and attempts at dissolution. Allopurinol should not be offered as the first-line therapy for uric acid stones.
This review contains 3 figures, 1 table and 38 references
Key Words: ammonium, diabetes mellitus, epidemiology, management, metabolic syndrome, nephrolithiasis, pathophysiology, potassium citrate, uric acid, urine pH
6.7%) patients had positive SC only, 5 (16.7%) had both positive SC and USB, and 5 (16.7%) patients had USB positive only. The concordance between USB and SC result was moderate (K[0.43). USB brought a percentage increase in diagnosis of this population of 71%. In case of positive URS, 14/24 (58.3%) lesion biopsies, 13/24 (54.1%) SC and 13/24 (54.1%) USB were positive. Out of 10 negative lesion biopsies, 6 (60%) patients had a positive SC. Lesion biopsy histology resulted low-grade in 10/14 (71.4%), high-grade in 3/14 (21.4%) and CIS in 1/14 (7.1%). USB resulted positive in 9/14 (62.3%) of those who had positive lesion biopsies. Among patients with low-grade lesion biopsy, USB showed multifocal low-grade disease in 5/10 (50%) cases and CIS in 1/10 (10%) cases. 2/3 patients with highgrade disease at lesion biopsy showed multifocal UTUC at USB. USB and lesion biopsy were concordant in the diagnosis of the only case with CIS.CONCLUSIONS: The endoscopic diagnosis of UTUC should rely on lesion biopsy, SC and USB. In negative URS, USB may significantly increase the diagnostic rate of UTUC. In positive URS, SC may help providing a pathological diagnosis in negative biopsies. On the other hand, USB helps the characterization of the disease and, thus, may potentially influence its management.
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