Gaurav Garg

Duplex Ultrasound-guided Direct Percutaneous Management of Pseudoaneurysm of Branch of Segmental Renal Artery: Technique and Its Outcome

OBJECTIVEnTo describe the role of duplex ultrasound imaging (DUI) in prompt diagnosis of pseudoaneurysm (PSA) of a branch of the segmental renal artery (b-SRA) and to evaluate outcomes of DUI directed percutaneous embolization.nnnMATERIALS AND METHODSnForty-five patients were referred to us for the management of intractable renal hematuria. A total of 20 cases (44.44%) had developed PSA after nephrolithotomy, 12 cases (12.66%) had developed PSA after guided renal biopsies, 6 cases (13.33%) had developed PSA following road side trauma, and 2 cases (4.44%) of the tuberous sclerosis complex had developed PSA. Three cases (6.66%) of arteriovenous and 2 cases (4.44%) of arteriocalyceal fistulae had been excluded from the study. DUI-guided direct percutaneous management (DPM) was done as a 4-step process. First is the identification of PSA sac in the neck and offending b-SRA. Second is the puncture of PSA sac with 18u2009g puncture needle under DUI. Subsequently, manual injection of temporary embolic agent was done followed by N-butyl cyanoacrylate glue. Thrombosis of the PSA sac was confirmed by absent flow on DUI.nnnRESULTSnForty cases of b-SRA were managed successfully in a single session and followed up by clinical findings, DUI, and computed tomography angiography. There was no need for the second session of DPM, transarterial embolization, or surgery in this cohort. Twelve cases (30%) had developed a mild fever and were managed conservatively. All 40 cases had no evidence of renal hematuria after follow-up of 3 months.nnnCONCLUSIONnDUI-guided DPM is a safe, feasible, cost-effective, and nephron-sparing promising alternative to TAE or surgery for management of PSA of b-SRA.

Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi

Purpose To see the 30-day unplanned readmission rates in patients underdoing endo-urological surgeries for upper urinary tract calculi we conducted this retrospective study at King Georges Medical University, Lucknow, India. Unplanned readmissions not only add to healthcare costs but also are bothersome for the patients. There are many studies on 30-day unplanned readmissions in general surgical patients. Although similar studies have been done in certain urological procedures, no study has reported readmission rates or its risk factors in patients undergoing surgeries for upper urinary tract calculi. Materials and Methods We retrospectively reviewed our prospectively maintained database from 1st January 2009 to 31st December 2017, for the patients who underwent endo-urological procedures for upper urinary tract calculi and identified the patients who were re-admitted within 30 days of discharge. Results Out of the total 3,209 patients undergoing endo-urological procedures for upper urinary tract calculi 56 were re-admitted. The readmission rate was 1.74% over the study period. The most common etiology for readmission was sepsis followed by hematuria. The significant risk factors for readmission in bivariate analysis included male gender, age >65 years, current smoking, chronic obstructive pulmonary disease, diabetes mellitus, bleeding disorder, prior cardiac disease, and American Society of Anesthesiologists (ASA) class ≥3. In multivariate risk adjusted logistic regression analysis ASA class ≥3 was the only independent risk factor for readmission. Conclusions The readmission rates in endo-urological procedures for urolithiasis are less compared to other procedures. ASA class ≥3 is the most important independent predictor of unplanned 30-day readmissions.

Giant vesicle calculi leading to spontaneous bladder rupture and acute renal failure: an unusual presentation

Spontaneous rupture of the urinary bladder is extremely rare. We report a case of a 70-year-old man with spontaneous bladder rupture secondary to neglected giant vesicle calculi who presented as acute renal failure. The patient was stabilised with per-urethral catheterisation and extravesical drain placement. About 700u2009mL pus mixed with urine was drained through the per-urethral catheter and approximately 2000u2009mL of pus was drained through the extravesical drain. Cystolithotomy showed two large calculi which were removed.

Foreign body urethra misdiagnosed as stricture leading to inadequate management and prolonged treatment duration: a lesson to learn

Misdiagnosis of a urethral foreign body (FB) as urethral stricture leads to inadequate management and prolonged treatment duration. A 55-year-old male patient was referred with complaints of difficulty in voiding and poor urinary stream for 2 months. He initially presented at a primary healthcare centre and was misdiagnosed as urethral stricture and was scheduled for urethroplasty. Surprisingly, intraoperative cystourethroscopy performed by us revealed that the urethra had been obstructed by an FB. The FB was gently pushed into the bladder and retrieved. The postoperative course was uneventful. The present case represents a rare occurrence of polyembolokoilamania or insertion of a FB into any bodily orifice for sexual gratification.

Acute mechanical duodenal obstruction due to giant hydronephrosis: an unusual cause of acute abdomen

Giant hydronephrosis (GH) is a rare clinical entity with about 600 cases and defined as the adult renal pelvis containing greater than 1 L of fluid, or at least 1.6% of the body weight or kidney occupying the hemiabdomen. The pelvic-ureteric junction (PUJ) obstruction is the most frequent cause of GH. We thus report a case of massive abdominal distension due to GH secondary to PUJ obstruction who presented with acute duodenal obstruction due to extrinsic compression and was managed with percutaneous nephrostomy followed by open nephrectomy.

Chyluria in young child: a rare presentation

Chyluria, a chronic manifestation of lymphatic filariasis, is rare in children. Clinicians must have a high index of suspicion to diagnose this condition in children as it mimics nephrotic syndrome. We present an unusual case in which a 7-year-old boy hailing from a filarial endemic region presented with a passage of milky urine, which on evaluation was diagnosed as parasitic chyluria. The child showed remission after medical management that persisted until 1 year of follow-up.

Post-extracorporeal shockwave lithotripsy perirenal haematoma

A previously healthy 50-year-old man presented with intermittent left flank pain for 3 months. The patient denied any history of diabetes and hypertension. On evaluation with X-ray Kidney-Ureter-Bladder and ultrasound (USG) of abdomen, he was found to have left upper ureteric calculus (size: 13u2009mm) with left mild hydronephrosis and normal right kidney. He subsequently underwent uneventful extracorporeal shockwave lithotripsy (ESWL) with Dornier compact alpha electromagnetic lithotripter for the calculus. Three thousand shockwaves were delivered to the stone. The procedure was uneventful and the patient was discharged. Twenty-fouru2009hours later, the patient presented with severe left flank pain. On clinical examination, he had tachycardia (pulse rate: 100/min), normal blood pressure (138/76u2009mm Hg) and tenderness in the left flank region. Laboratory examination revealed the following parameters:

Auto-amputation of penis due to advanced carcinoma penis

A 82-year-old Indian male patient was referred with complaints of the wound in right inguinal region for the last 15u2009days. He initially presented to a primary care centre with complaints of a progressive ulcer over penis for 12 months and swelling in right inguinal region for thexa0last twou2009months. He also revealed sloughing of penile tissue 1u2009month back. The discharged card mentioned that thexa0patient received antibiotics and underwent incision/drainage of the inguinal abscess under anaesthesia. He also had difficulty in micturition. The patient denied any history …

Rare cause of gastric outlet obstruction: xanthogranulomatous cholecystitis

A 62-year-old Indian female patient presented with right upper quadrant pain and multiple episodes of vomiting for 10 days. She denied history of fever, jaundice, past anorexia/weight loss and previous surgeries. She was dehydrated, tachycardia (120/min) was present, and there was tenderness in the right upper quadrant. Routine investigations revealed presence of anaemia (haemoglobinxa09.1 g/dL), raised total leucocyte countsxa0(17xa0x10^9/L) and hypokalaemiaxa0(2.8 mEq/L). All other blood tests (liver function/kidney function/blood sugar and coagulation profile) were normal. Patient was stabilised with intravenous fluids, antibiotics and other supportive management. Imaging with ultrasound (USG) was suboptimal due to the massive intestinal gas and uncooperative nature of the patient. A collapsed gallbladder (GB) and a mass with a smooth curvilinear surface and posterior acoustic shadowing in the distal part of the duodenum were the only distinguishable findings. Due to repeated episodes of vomiting, the patient underwent an upper gastrointestinal endoscopy, which was suggestive of pyloric obstruction. For the further evaluation of GB mass in the USG …

Penile cutaneous horn: still an enigma

A 60-year-old man with history of Johanson’s staged urethroplasty for pan anterior urethral stricture due to lichen sclerosus et atrophicus 3 months previously presented to us with a cutaneous horn over his glans penis. This horn was previously excised superficially, and now had recurred over the same site in the last 1u2009month. It was initially small in size and then gradually increased to a size of around 2.5u2009cm (figure 1). The patient had no documents mentioning the histopathology of previously excised horn. The patient had been circumcised in childhood. He had no …