Giant hydronephrosis (GH) is very rare in adults. We report a case of a 46-year-old man who presented with progressively increasing abdominal swelling. A contrast-enhanced CT scan of the abdomen and pelvis was used for the diagnosis. Left side open nephrectomy was performed and 22 L fluid was evacuated. UPJ obstruction was noted intraoperatively. No recurrence of abdominal swelling was noted on follow up examination.
Purpose: Obstructive uropathy (OU) is a potentially life-threatening urologic emergency that requires urgent decompression. Percutaneous nephrostomy (PCN) is a commonly performed procedure to decompress OU. The objective of this study is to assess disease patterns and treatment outcome at two urologic centers in Ethiopia. Methods: A cross-sectional study was conducted on 110 patients who underwent emergency PCN from October 1, 2019 to September 30, 2020. Data were collected by a retrospective chart review. SPSS 25 was used for analysis. Descriptive statistics and logistic regression were utilized to assess disease pattern and significant predictors. A p-value of <0.05 on multivariate logistic regression was considered statistically significant. Results: Females accounted for 70% of cases and mean age at presentation was 48 ± 12.9 years. Bilateral OU was diagnosed in 60% of patients and 77.3% of obstructions occurred at the level of the ureter. Malignancies were diagnosed in >80% of patients among which cervical cancer was the commonest (37.3%) followed by bladder cancer (17.3%). Acute kidney injury (AKI) accounted for 70% of the presenting indications for PCN. Success rate after emergency PCN was 75.5% and 41.8% of the cases developed post-procedure complications. Factors that predicted successful outcome include male gender [AOR = 5.72 (1.13-28.92), 95% CI; p = 0.035], severe hydronephrosis pre-operatively [AOR = 7.12 (1.32-38.45), 95% CI; p = 0.022], and use of combined imaging (ultrasound and fluoroscope) to guide , 95% CI; p = 0.039]. On the other hand, postoperative complication is a negative predictor [AOR = 0.26 (0.08-0.86), 95% CI; p = 0.027]. Conclusion:In this study, overall success of emergency PCN is low. Presence of severe hydronephrosis predicts technical ease and better outcome of PCN. Procedures performed under ultrasound and fluoroscope guidance also improve outcome. Postoperative complication rate is high in this study and mandates strict preventive measures as it predicts unfavorable outcome.
Background. Giant hydronephrosis is a rare urologic problem defined as a collection of more than one liter of urine in the collecting system. The radiologic appearance may mimic benign cystic disease of the kidney. We report a case of giant hydronephrosis in a 32-year-old female who presented with progressive abdominal swelling of two-year duration, caused by ureteropelvic junction obstruction with more than nine liters of urine in the collecting system. Conclusion. Giant hydronephrosis is a rare differential diagnosis for cystic intra-abdominal mass in adults with progressively increasing abdominal swelling. CT and MRI are important in confirming the diagnosis by localizing the origin of the swelling. Management depends on the underlying cause and appearance of the diseased kidney.
Background Adnexal teratoma involving the urinary bladder is a very rare condition. Presentation is variable ranging from irritative LUTS (lower urinary tract symptoms) to pilimiction or trichiuria (passage of hair in the urine). Case Presentation We report a case of a 42-year-old woman who presented with pilimiction and lower abdominal pain. Contrast-enhanced computed tomography scan (CECT) and cystoscopy were used for the diagnosis. Tumor markers were negative. Right side salpingo-oophorectomy and partial bladder wall excision were performed. Histopathology of the specimen showed features consistent with mature teratoma. The patient reported improvement of symptoms in the subsequent follow-up visits. Conclusion Pilimiction is a pathognomonic sign of bladder teratomas. This case represents a rare complication of ovarian teratoma. Therefore, a high index of suspicion is required in patients with ovarian teratoma presenting with urinary complaints. Transurethral resection is associated with a high recurrence rate and is not recommended for secondary bladder teratomas.
Introduction:A supernumerary kidney is an extremely rare congenital anomaly, defined as the presence of one or more extra kidneys. Thus far, there have been less than 100 cases reported in the medical literature. It has its capsule, vascular supply, and collecting system. It frequently causes diagnostic challenges in clinical practice. The supernumerary kidney can be symptomatic due to the presence of stone. Case Presentation: We present a case of a 19-year-old male patient who came to our clinic with the complaint of abdominal pain. On computed tomography urography (CTU), he was found to have a caudally located left fused supernumerary kidney with a separate vascular supply. Both left kidneys had a separately draining calyceal systems uniting at the left renal pelvis and drained by a single ureter. Multiple left renal stones (largest measures 4cm x 2.2cm) in both kidneys were also seen. The stones were removed surgically by doing pyelolithotomy and radial nephrolithotomy. The patient was doing well during follow-up visits with the improvement of abdominal pain. Conclusion: Supernumerary kidney is a very rare congenital renal anomaly. This case is even unique, because of the fused supernumerary kidney and the presence of a single left renal pelvis and ureter. Imaging is very essential for planning surgical intervention. Stones in such kidneys can be managed with nephrolithotomy and/or pyelolithotomy.
Abstract:The ecological status of six selected rivers which are found around central Ethiopia and North Shewa Zone and exposed to environmental stresses at varied extent, was studied using biological quality elements (BQE). One thousand one hundred thirty three (1133) individuals of macroinvertebrates, from 22 families and 5 orders of insects, were collected from the rivers. Seven metrics that had low correlation (p>0.05) were selected to calculate the final B-IBI and the result showed that both sites of Akaki, Sebeta and Jemma Rivers had poor water quality whereas Beresa, Chacha and Mojo (upstream site) had relatively better water quality. Canonical Correspondence Analysis (CCA) showed that Tabanidae, Syrphidae, Culicidae, and Canidae was more strongly correlated with temperature but strongly and negatively with pH, Dissolve Oxygen (DO) and Nitrate. The result implied that the change in abundance of these groups of macroinvertebrates could indicate the change in pH, DO and Nitrate. pH and DO were significantly (p < 0.05) and positively correlated with % Ephemeroptera and % Baetidae. On the other hand, DO showed strong but negative correlation % Oligochaeta, % Non-Insect and Hillsenhoff Family Biotic Index which implied that that the change in pH and level of organic pollution can be easily monitored using these metrics
With nearly 500,000 new cases and over 150,000 deaths worldwide in 2020, renal cancers remain a significant component of the global burden of cancer. The aim of this study is to describe the clinical presentation, peri-operative condition and short-term outcome of patients operated with the primary diagnosis of renal cell carcinoma (RCC) at a large tertiary care referral center. Patients and Methods: A retrospective institution-based study was done. The study population consisted of all patients who were operated for a primary diagnosis of renal cell carcinoma from January 1st, 2015, to December 31st, 2020, at the Urology Unit of St Paul's Hospital Millennium Medical College. Results: The final cohort consisted of 107 patients (mean (standard deviation) age 49 (±14) years, 48% male, 46% residence in Addis Ababa). The most common presenting complaint was flank pain (65%), followed by hematuria (34%) and abdominal mass (6%). One patient had the classic triad of RCC. The median (IQR) duration of illness was 9(7-11) months. Fourteen (13%) patients were asymptomatic and diagnosed incidentally. Over half (57%) of the cohort were clinical TNM stage II, with the remaining 17%, 18% and 8% being stage I, III and IV, respectively. Nearly all patients (94%) underwent open radical nephrectomy with a transabdominal approach. Most patients (61%) had no Clavien-Dindo grade complications, and a minority (11%) experienced post-operative complications (7% postoperative bleeding, 6% hospital acquired pneumonia, 3% surgical site infection). The median (IQR) length of stay was 6 (5-7.6) days. Nearly all patients (94%) were discharged and improved. Conclusion:In this retrospective study, we have shown that patients operated for RCC are a low-risk cohort with few comorbidities, have a relatively short symptomatic course and good discharge outcome. Further prospective studies are needed to show the long-term outcome and factors associated with such outcomes in this patient population.
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