Eng Hong Goh

Scrotal Mass: A Rare Complication of Ventriculoperitoneal Shunt

SUMMARY Ventriculoperitoneal shunts are associated with multiple complications. Among them are disconnection and migration of the tubing into the peritoneal cavity. Here we describe a case of a fractured ventriculoperitoneal shunt which migrated and coiled in the scrotum, masquerading as a scrotal swelling. Removal of the shunt via a scrotal incision was performed concomitantly with repair of the hernia sac.

Ureteral stricture formation after ureteroscope treatment of impacted calculi: A prospective study

Purpose Urinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases. Materials and Methods This was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures. Results Of the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures. Conclusions This prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones.

Encrusted and incarcerated urinary bladder catheter: what are the options?

Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated urinary bladder catheter include extracorporeal shock wave lithotripsy and lithoclast. We describe here another technique of dealing with a stuck and encrustated catheter, via direct crushing of the encrustations with a rigid cystoscope inserted through a suprapubic cystostomy tract.

Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate

PURPOSE This study aimed to determine the urethral stricture (US) rate and identify clinical and surgical risk factors associated with US occurrence after transurethral resection of the prostate using the bipolar Gyrus PlasmaKinetic Tissue Management System (PK-TURP). MATERIALS AND METHODS This was an age-matched case-control study of US occurrence after PK-TURP. Retrospective data were collected from the hospital records of patients who had a minimum of 36 months of follow-up information. Among the data collected for analysis were prostate-specific antigen level, estimated prostate weight, the amount of prostate resected, operative time, history of urinary tract infection, previous transurethral resection of the prostate, and whether the PK-TURP was combined with other endourological procedures. The resection rate was calculated from the collected data. Univariate and multivariate analyses were performed to identify clinical and surgical risk factors related to US formation. RESULTS A total of 373 patients underwent PK-TURP between 2003 and 2009. There were 13 cases of US (3.5%), and most of them (10 of 13, 76.9%) presented within 24 months of surgery. Most of the US cases (11 of 13, 84.6%) occurred at the bulbar urethra. Multivariable logistic regression analyses identified slow resection rate as the only risk factor significantly associated with US occurrence. CONCLUSIONS The US rate of 3.5% after PK-TURP in this study is comparable to contemporary series. A slow resection rate seems to be related to US occurrence. This should be confirmed by further studies; meanwhile, we must be mindful of this possibility when operating with the PK-TURP system.

An unusual cause of a penetrating injury to the anterior urethra: a thorny situation.

Concurrent penetrating injury to the male external genitalia and the anterior urethra is uncommon. This case illustrates an unusual cause of such an injury, and its subsequent management and outcome. A 69-year-old man had his scrotum and anterior urethra pierced by a long thorn when he fell in his farm. He presented with urine leakage from the scrotal wound each time he micturated. Cystoscopic examination confirmed the cause and extent of the injury, and also facilitated the extraction of the thorn. The injury was allowed time to heal by urinary diversion with a urinary catheter. There were no stricture or fistula formations and the patient remained symptom-free at 3 months follow-up. Careful cystoscopic examination was both diagnostic and therapeutic in this case. A conservative approach is a feasible option in the management of selected cases of penetrating anterior urethral injury.

Acute Symptomatic Hyponatremia After Computed Tomography Renal Protocol.

Computed tomography (CT) is a widely used imaging modality. Although hyponatremia after CT imaging is rare, its effects can be devastating. Hyperosmolar radiocontrast acts as effective osmoles and causes fluid migration from intracellular into extracellular compartment. Dilutional hyponatremia will ensue if translocation of fluid is in excess of diuresis. This case report detailed an unusual case of acute symptomatic hyponatremia after CT renal protocol and the treatments given after its recognition.

Aggressive renal tumour: squamous cell carcinoma with sarcomatoid differentiation

of the hernia. The defect was closed and reinforced by means of an on-laying mesh and the vitality of all enteric segments extracted was carefully checked before closing the trocar sites. Operative time was approximately 150 min and blood loss was minimal. The patient had an uneventful in-hospital stay and was discharged in the sixth postoperative day. He showed a significant clinical improvement and still continues to do well 12 months post-operatively. The diagnosis of BH in adulthood is usually made if complications occur. The high frequency of organ incarceration and strangulation points out the need for an early diagnosis and an effective operative management, which contribute to obtain satisfactory results. Owing to its rarity and varied presentation, it can represent a diagnostic challenge. Diaphragmatic hernias must be considered as possible aetiology in the differential diagnosis of patients presenting bowel obstruction symptoms, as early surgery may significantly affect and reduce both morbidity and mortality. Laparoscopic approach appears to be safe and feasible in the hands of experienced laparoscopic surgeons.

A rare case of renal and uterine clear cell carcinoma: Which is the primary tumour?

Renal cell carcinoma to the uterus is rare. We describe a 52-year old lady who presented with progressive abdominal distension and computerized tomogram scan of the abdomen showing two pathologies; uterine and right renal tumour. It was initially thought to be two distinct tumours (double pathology). Radical nephrectomy and total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed concurrently. Histopathological evaluation of the uterine and right renal tumour however surprised us with a rare form of metastasis from a renal tumour to the uterus. The method of differentiating primary renal cell carcinoma with uterine metastasis, from primary uterine carcinoma with renal metastasis, via immunohistochemistry, is described.