Siu-Wan Hung

Metallic stent in the treatment of ureteral obstruction: Experience of single institute

Background: The Resonance® metallic stent has been reported to be sufficient for the management of malignant extrinsic ureteral obstructions within a 12‐month time period. To determine the effectiveness in each specific patient group, we report our experience using the Resonance® stent in the treatment of ureteral obstructions. Methods: We retrospectively reviewed 20 patients (23 stents) who successfully received the Resonance® metallic stents and divided them into a patent group (n = 19) and an obstructive group (n = 4) according to the treatment results. Twenty‐one stents were inserted via cystoscopy or ureteroscopy in a retrograde fashion. The remaining two were inserted via percutaneous nephrostomy in an antegrade manner. Follow‐up serum creatinine measurements and sonography were performed. The overall ureteral patency rate and the risk of stent failure were evaluated. Results: The overall ureteral patency rate was 82.6% (19/23). Patients with previous radiotherapy had a 50% (4/8) patency rate which was significantly lower than non‐radiotherapy patients (100%, 15/15, p = 0.028). Malignant obstructions in those other than radiotherapy patients had a 100% patency rate (5/5). Benign obstructions in those other than radiotherapy patients had a 100% patency rate (10/10). In the radiotherapy patients, the mode of therapy did not dominate the stent outcome. Conclusion: Patients with ureteral obstructions can be treated sufficiently with the Resonance® metallic stent. Patients who had gynecological malignancies and received radiotherapy had a higher failure rate after Resonance® metallic stent insertion.

Invasive adenocarcinoma of the prostate with urethral tumor.

Metastases of prostate cancer to the penis and urethra are rare and often represent advanced disease. We describe a case of newly diagnosed prostatic adenocarcinoma with metastases to the corpus spongiosum, cavernosum, and the anterior urethra. A male patient, 77 years of age, initially had lower urinary tract obstruction symptoms. His prostate-specific antigen level was 5.02 ng/mL. Digital rectal examination disclosed stony hard tumors at both lobes of the prostate. Transrectal ultrasound-guided biopsy of the prostate revealed adenocarcinoma over both lobes; the Gleason score was 4 + 4 = 8. Cystoscopy showed a penile urethral tumor and biopsy disclosed metastatic adenocarcinoma of the prostate; the Gleason score was 4 + 4 = 8. The patient initially received hormone therapy. Biochemical failure developed after 15 months and rapidly progressed to a hormone-refractory stage. Docetaxel was then prescribed. The patient died in the 25(th) month after the diagnosis.

Laparoscopic excision of a ureteral diverticulum

Abstract  Ureteral diverticula are a rare anomaly of the ureteral structure and were reported as case reports in the literature. We report an acquired ureteral diverticulum that was managed with laparoscopic resection. The clinical presentation is demonstrated and the follow‐up image is illustrated. The laparoscopic application could be expanded to this area.

Nephroid metaplasia of a graft kidney.

Background. Nephroid metaplasia is a benign and rare lesion that is confined to the lamina propria of the urinary tract. The leading cause of these lesions is previous trauma to the urothelium. Method. We report a case of nephroid metaplasia of a graft kidney from a living-unrelated donor. This patient presented to our clinics due to painless gross hematuria 1 month after renal transplantation. Result. Although malignancy was suspected in the beginning due to a filling defect demonstrated by urography, only percutaneous excision of the tumor was performed to preserve the renal function. However, the pathological result disclosed nephroid metaplasia. Conclusion. Hematuria warrant aggressive evaluation because underlying malignancy in a immunocompromised patient might be relatively progressive.

Renal Tuberculosis Presenting as a Complicated Renal Cyst

A 74-year-old woman presented with a 3-day history of fever and left flank pain. The imaging study revealed a huge complicated cyst in the left kidney. The cyst had a mass effect to the abdomen. We performed laparoscopic renal cyst unroofing. The histopathologic examination disclosed renal tuberculosis of the cyst wall and cystic fluid. Renal tuberculosis is not uncommon; however, renal tuberculosis presenting as a renal cyst is very rare.

Unusual Clinical Manifestations of Congenital Renal Arteriovenous Malformation

Congenital renal arteriovenous malformation (ATM) is a rare clinical disease. Due to the recent availability of color-Doppler ultrasound and angiography, the successful detection rate of congenital renal ATM has increased. The treatments of choice range from transcatheter arterial embolization (TAE) to nephrectomy. However, the goal of treatment is to preserve a high degree of renal function. In this paper, we report on a case of congenital renal ATM presented with gross hematuria and right flank pain. Abdominal computed tomography revealed a huge cystic tumor mass over the right retroperitoneal space. Renal cell carcinoma was highly suspected. Following color-Doppler ultrasound and angiography, a right renal aneurysm was detected. Sever impairment of renal function and renal atrophy were noted as well. Finally, the patient received total nephrectomy. However, the histopathological analysis of the tumor found it to be a ruptured renal AVM. Neither hematuria nor flank pain were found during follow-up.