Csaba Berczi

Fertility preservation in cases of laparoscopic treatment of seminal vesicle cysts.

Seminal vesicle cysts can cause sub- or infertility. Minimally invasive techniques have the advantage of preserving the vas deferens by the treatment of symptomatic cases. After reviewing the published articles, only a few of them presented data on fertility before and after surgery. The authors now report the successful treatment of two patients with seminal vesicle cysts, in which laparoscopic cyst removal resolved the symptoms, preserving fertility and erectile function. Due to the rarity of seminal vesicle cysts, preoperative examinations and treatment modalities should focus not only on the relief of symptoms but also on the preservation of fertility and erectile function.

Acquired Hemophilia Caused by Ureteral Tumor

Acquired hemophilia is a rare and life-threatening disease that in some cases develops as a paraneoplastic syndrome of different malignancies. Acquired hemophilia caused by ureteral tumor has not been reported previously. The treatment of acquired hemophilia has 2 main goals: to achieve hemostasis during the bleeding period and to decrease the risk of bleeding by eradication of the inhibitor. We report a case of hematuria caused by ureteral tumor. Nephroureterectomy was performed, but continuous bleeding was observed after the operation. We thus administered blood transfusions and performed reoperations, but we could not stop the bleeding. Later, we realized that the prolonged activated partial thromboplastin time was caused by the low activity of factor VIII (2%), which indicated the presence of acquired hemophilia. We thus administered activated prothrombin complex concentrate and recombinant activated factor VII. Three months after the initial operation, an immune tolerance induction treatment was administered, after which the activity of factor VIII reverted to normal.

Renal Tumor in Pregnancy: A Case Report and Review of the Literature

The authors present their renal tumor cases observed during pregnancy and review the literature related to this topic. Between January 1, 2000 and January 1, 2015, altogether 3 patients were treated for renal tumor during pregnancy. Two of them had surgery performed during pregnancy, while in the other, premature birth of the baby preceded surgery. In the first case, a laparoscopic tumor resection was performed in the 29th week of the patients pregnancy. In the second case, a transperitoneal radical nephrectomy was carried out during the 10th week of pregnancy. In the case of the third patient, a caesarean section was performed during the 32nd week of gestation, and then followed later by surgery for the metastatic renal tumor. However, the tumor was found to be inoperable.

Surgical Management and Outcome of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus

Introduction: The authors of this paper assessed the surgical management and outcome of renal cancers when tumor thrombus extended into the inferior vena cava (IVC). Methods: From 2000 to 2015, 46 radical nephrectomies were performed on patients with tumor thrombus in the IVC. The mean age of the patients was 60 ± 11 years. Radical nephrectomy and thrombectomies were performed in a single session. There were 18 level-IV, 23 level-III, and 5 level-II tumor thrombi. The operations were performed using cardiopulmonary bypass in 14 patients, while deep hypothermic cardiac arrest was carried out in 4 cases. Results: The mean size of the tumors was 9.4 ± 3.5 cm. Histology showed the tumor stages to be pT3b in 21cases, pT3c in 22, and pT4 in 3 patients. The mean follow-up period of the patients was 3.6 ± 3.0 years. During the follow-up period, local recurrence was observed in 7 patients, while distant metastases occurred in 8 cases. The median time to progression was 37 ± 27 months. The 5-year overall survival was 43.7%. Conclusions: Radical nephrectomy and thrombectomy provided reasonable long-term survival for patients with renal cancer and IVC thrombus. However, tumor progression was detected in 41.6%. The presence of tumor thrombus had a negative effect on tumor progression and survival.

Responses: Re: Csaba Berczi, Ben Thomas, Zsolt Bacso, Tibor Flasko. Bilateral renal cancers: oncological and functional outcomes. Int Urol Nephrol 2016 (Epub ahead of print)

early and the long-term renal function is the remaining volume of renal parenchyma [1–6]. The 5-year overall survival was 53% in our study, while that of Watson et al. reported an 88% overall survival after a minimum 10-year follow-up. This discrepancy in overall survival between the two groups could be caused by several factors. One of them is the age difference of the patients in the two studies. The mean age of our patients was 60 years, while they reported a median age of 38 years. The other important factor for survival is the eGFR, because it well known that chronic renal disease is associated with increased morbidity and mortality [7]. In our series, the postoperative GFR was lower compared to their studies (39 mL/min/1.73 m vs. 57 mL/min/1.73 m) and that could have a more pronounced negative effect on survival. The 5-year tumor-specific survival was 80% in our series, while it was 97% in the study by Watson et al. However, we have to take into consideration as they pointed out that the tumor size was larger in our patients. They used the “3-cm rule” and performed operation when the largest tumor was 3 cm. It should be noted that some studies demonstrated that the malignant small renal tumors (≤4 cm) grow slowly and usually have a low grade and a low rate of progression. For this reason, the 5-year tumor-specific survival of the small renal tumors is excellent, at more than 90% [8–10]. Accordingly, the discrepancy in the tumorspecific survival could be caused by the difference in tumor sizes. We really appreciate the comments and remarks by Watson et al. regarding our manuscript. We also agree that the treatment of multifocal renal tumors is quite challenging.

Large benign retroperitoneal tumour in pregnancy

A 31-year-old female was in the 13th week of pregnancy when an abdominal ultrasound examination revealed a large retroperitoneal tumour. Magnetic resonance imaging was carried out and the imaging described a 10-cm mass in diameter extending from the right kidney. Given that the patient was in her first trimester and that there was a suspicion of malignancy, further surgical exploration of the tumour was warranted. During the operation, the tumour was removed, but nephrectomy was not necessary. Histologic analysis of the resected tumour showed a mucinous cystic adenoma, and no signs of malignancy were present. Following the surgery, the pregnancy was otherwise uneventful and further complications did not occur. This case illustrates that surgery is recommended in patients with a retroperitoneal tumour early during a pregnancy, when a malignancy cannot be excluded.

Percutaneous Endoscopic Ureterolithotomy of Two Different Stones in a Single Session

The authors report a rare case of percutaneous endoscopic ureterolithotomy of 2 ureteral stones. Extracorporeal shock-wave lithotripsy (SWL) treatment of the renal stone was performed. The stone was crushed into 2 pieces, with 1 of them located in the upper part, and the other in the middle part of the ureter. Further SWL treatments and ureteroscopy were unsuccessful. The authors then decided to perform a percutaneous ureterolithotomy. In conclusion, percutaneous ureterolithotomy is a good choice of treatment, when ureteral stones cannot be removed by SWL or ureteroscopy.