S. Ali Khan

Successful fibrinolytic therapy for superior vena cava thrombosis secondary to long-term total parenteral nutrition.

Thrombosis of the superior vena cava and other major central veins is an unusual and infrequent complication of total parenteral nutrition. When it does occur, it may be life threatening and prompt therapy is indicated. A case of superior vena cava thrombosis secondary to an indwelling Broviac catheter for long-term parenteral nutrition is presented, which was successfully treated with Streptokinase with reestablishment of flow through the catheter and veins.

Relationship of Blood Groups and Bladder Cancer

A retrospective study correlating the blood groups of 141 patients with bladder cancer showed that patients with blood group A had lower grade tumors with lower mortality rates, and those with blood group O(H) had higher grade tumors and higher mortality rates.

Female urethral cancer—An overview

Female urethral cancer is a rare urological malignancy. Here we discuss the clinical features, histopathology and management of this condition.

Gangrene of male external genitalia in a patient with colorectal disease

This is the report of a patient with gangrene of the skin and subcutaneous tissue of the scrotum and base of the penis secondary to diverticulitis of the sigmoid colon. Due to high mortality in such patients, the prompt recognition of the source of sepsis is of utmost importance. Computed tomography (CT) scanning facilitates delineating the extent of disease. Anatomy of the perineal body and pathways of spread are discussed.

Emergency management of the nondeflating foley catheter balloon

Inability to remove a self-retaining (Foley) catheter may result from failed attempts to deflate its balloon. In this article, the authors review the causes of inability to deflate Foley catheters as well as the various techniques for their removal.

Current diagnosis and management of syringocele: a review.

Cowpers syringocele is a rare but an under-diagnosed cystic dilation of the Cowpers ducts and is increasingly being recognized in the adult population. Recent literature suggests that syringoceles be classified based on the configuration of the ducts orifice to the urethra, either open or closed, as this also allows the clinical presentations of 2 syringoceles to be divided, albeit with some overlap. Usually post-void dribbling, hematuria, or urethral discharge indicates open syringocele, while obstructive symptoms are associated with closed syringoceles. As these symptoms are shared by many serious conditions, a working differential diagnosis is critical. Ultrasonography coupled with retro and ante grade urethrography usually suffices to diagnose syringocele, but supplementary procedures - such as cystourethroscopy, computed tomography scan, and magnetic resonance imaging - can prove useful. Conservative observation is first recommended, but persistent symptoms are usually treated with endoscopic marsupialization unless contraindicated. Upon reviewing the literature, this paper addresses the clinical anatomy, classification, presentation, diagnosis, and treatment of syringoceles in further detail.

Tumour in a giant bladder diverticulum: A case report and review of literature

We report an unusual case of a transitional cell carcinoma arising in a bladder diverticulum presenting as a giant abdominal mass and acute urinary retention. We have reviewed the literature and discuss the aetiology, diagnosis, and treatment of tumours arising in vesical diverticula.

Traumatic thrombophlebitis of the superficial dorsal vein of the penis : An occupational hazard

Several cases of thrombophlebitis of the superficial dorsal vein of the penis (TSDVP) have been reported in the literature. Etiologies may include any of the following: trauma associated with vigorous sexual intercourse; penile strangulation caused by a multitude of entities; penile injection; infection; neoplasm; or surgery. We report a rare case of traumatic TSDVP in a cab driver following repeated injury to the penis by a coin-filled pouch. We review the etiologies, mechanism, and treatment of traumatic TSDVP, and attempt to identify men who may be at similar occupational risk.

Metastases to the penis from renal cell carcinoma

Extensive venous communication among the pelvic, lumbar, penile and left renal veins may cause metastasis to the genitalia from left renal adenocarcinoma. To prevent this, we propose that during radical nephrectomy the spermatic and lumbar veins be ligated immediately following the ligation of the renal artery and vein.

A percutaneous subcostal approach for intercostal stones.

PURPOSE Percutaneous upper pole access may be obtained via the supracostal or subcostal approach. The more cranial the location of the percutaneous nephrostomy tract, the greater the risk of incurring intrathoracic complications. We describe a technique for safely accessing the upper pole calix via a subcostal approach, even when the stone is located well above the 12th rib. In our patient the stone was located between the 11th and 12th ribs, and the upper pole extended to above the 10th rib. METHODS A 78-year-old man with multiple medical problems had a symptomatic upper right pole stone located between 11th and 12th ribs. Due to its size (3 x 2.2 cm), neither a ureteroscopic nor shockwave approach was thought feasible. We elected to angle the access tract both laterally and cranially in order to course below the 12th rib, but still enter the upper pole calix. RESULTS Although this tract entered the calix obliquely, instruments were readily passed after sheath placement and the stone was completely removed. An ultrasonic lithotripsy device and suction was used to fragment and evacuate the stone. Postoperatively there were no intrathoracic or pulmonary complications. CONCLUSIONS The direct percutaneous approach to the upper pole of the kidney requires careful methodology based on a clear understanding of the anatomy of the kidney and surrounding structures. For upper-pole renal calculi located above the 12th rib that are not amenable to shockwave lithotripsy or ureteroscopy, a subcostal angled percutaneous approach can be safely made in selected cases. With this method, the risk of intrathoracic complications may be reduced.