Urology News Feeds

Laparoscopic retroperitoneal lymph node dissection (RPLND) in metastatic testicular cancer is a technically challenging procedure.1 In right-modified RPLND, retrocaval lymph nodes are often not visible and cannot be adequately dissected using only the transperitoneal approach. In laparoscopic nephrectomy (LN) for horseshoe kidney, the kidney cannot be sufficiently moved due to its connection to the contralateral kidney, and the isthmus and lower poles have separate blood supplies arising from the aorta or iliac artery.

A 50-year-old Italian-American male with a past medical history of colon cancer presented to our urology clinic in Fall 2018 with an acute elevation in serum prostate specific antigen (PSA). In 2015, he had been diagnosed with stage III (T4a, pN1, cM0) cancer of the ascending colon and treated with right hemicolectomy followed by seven cycles of adjuvant combination of folinic acid, 5-fluorouracil, and oxaliplatin (FOLFox) therapy. Final pathology was consistent with signet ring cell carcinoma (SRCC) of the ascending colon with regional nodal metastasis.

Since our article detailing Urologists’ efforts in Singapore during its initial outbreak,1 COVID-19 has become a global pandemic. As incidence and mortality rises worldwide, countries have instituted crippling lockdowns. Singapore has not been immune, resulting in nation-wide restrictions and “circuit breaker” measures.2 It is evident that the medical community must prepare for a prolonged effort to not only contain COVID-19, but continue care for non-COVID-19 patients.

Myoepithelial carcinoma is a rare pathological variant, usually expressed in salivary gland. This case report describes a case of pediatric myoepithelial carcinoma in the urinary bladder. A 4-year-old male patient was admitted to a specialized hospital in Lima, Peru for hematuria. A CT scan showed a tumor lesion in the bladder wall, and biopsy revealed myoepithelial carcinoma of urinary bladder. 6 courses of chemotherapy + partial cystectomy + radiotherapy was completed. The treatment was defined based on the pathological variant and the tumor location.

To evaluate the incidence and impact of an “optimal cystectomy outcome” (OCO), a simplified performance metric that encompasses multiple patient-centered outcomes.

We present the case of a male with a fistula from an infrarenal aortic aneurysm to the left renal vein resolved with an endovascular prosthesis. Few cases have been reported in the literature.

To the Editor: The COVID-19 pandemic has led to significant disruptions in undergraduate and postgraduate Urology education and training. In this letter, we examine the wide-ranging impact of the COVID-19 pandemic on the Urology Residency Match in Singapore, and share strategies to proactively mitigate these consequences.

In a recent review of the differential diagnosis of declining renal function, the discussant states: “absence of hydronephrosis on renal ultrasonography rules out [urinary tract] obstruction.”1 Many urologists and nephrologists believe this. But it is not true. I learned this the hard way 35 years ago when I evaluated an elderly man with three days of anuric renal failure. Renal ultrasonography showed no hydronephrosis, so I inferred parenchymal disease. To my surprise, a renal biopsy showed only interstitial edema and normal glomeruli.

COVID-19 pandemic dramatically struck northern Italy during the last few weeks, causing a multi-regional health system crisis for the overwhelming number of patients who required hospital admission, particularly, with regards to the occupation of intensive care units (ICU) in case of acute respiratory syndrome. A survey among leading European urological centers showed a reduction in oncologic surgery of at least 40% to 50% in March.1 The following weeks of April saw a drastic reduction of the remaining elective surgery.

When operating in the robotic assisted radical prostatectomy (RARP) era, it is estimated that ureteric injuries happen in less than 0.05% of cases.1 Ureteral duplication is a risk factor for injury along with: previous pelvic surgeries, renal transplant, need for extensive adhesiolysis, previous pelvic irradiation, difficult posterior dissection, enlarged prostate glands and the presence of a median lobe. Given the incidence of less than 0.001%, management of ectopic ureters for patients undergoing a RARP is foreign to most urologists.

The implications of estrogen depletion on the lower urinary tract and vagina are relevant to the urologist treating women with genitourinary symptoms. The main symptoms of vaginal estrogen depletion that affect women are dyspareunia and vaginal dryness, recurrent UTIs and lower urinary tract symptoms. Vaginal estrogen can be used to effectively treat these conditions. Vaginal estrogen is available in a variety of formulations. Each formulation has different considerations regarding its use and patients should be actively involved in choosing the right product for them.

To determine if adenocarcinoma of the Skene's glands in women, which has a histological and immunohistochemical appearance similar to prostate cancer, can be evaluated and managed with the same tools we use for prostate cancer.

Transvaginal approach has long been described as a gold standard for Vesicovaginal fistula (VVF) repair . But, presence of ureteral orifice at or near the fistulous margin presents unique challenges during VVF repair irrespective of the approach. We present a video on our novel techniques in these difficult VVF repair to aid in avoidance of ureteric orifice entrapment during VVF repair.

Autologous pubovaginal sling is a surgical option for patients with stress urinary incontinence (SUI), either as primary treatment, or in those who have failed synthetic sling placement. It is also favourable for patients at high risk of mesh erosion, for example in those who are immunocompromised or post-radiation. This video reviews the technical considerations in performing an autologous pubovaginal sling fashioned from rectus fascia in an immunocompromised patient with multiple previous abdominal surgeries.

Pelvic organ prolapse is an increasingly reported complication following anterior pelvic exenteration and usually consists of an anterior enterocele [1-4]. We present the surgical management of a peritoneal-vaginal fistula in a woman who presented with an acute enterocele 16 months following vaginal sparing, robot-assisted laparoscopic (RAL) anterior pelvic exenteration.

Aggressive angiomyxoma (AAM) is a rare tumor with a high risk of local recurrence. Scrotal AAM mimics common pediatric pathologies including hernia or hydrocele. We present 11-year-old boy who underwent macroscopically radical excision of right scrotal AAM. The patient has been already followed up for 29 months utilizing US every 6 months and MRI every 2 years. Residual scrotal mass has been visualized in MRI 3 month after surgery however no further growth was reported. Long term follow up with reliable local imaging is mandatory.

To the Editor: The COVID-19 pandemic has affected Residency training worldwide in an unprecedented fashion.1-3 Residency Programs have been abruptly asked to respond in innovative and dynamic ways in the face of the pandemic.4 We share important lessons and insights about the impact on a Urology Residency Program in an Academic Medical Center in Singapore. We focus our discussion around the Academic, Administrative, Professional, and Personal Developmental aspects of Residency training.

To investigate the impact of age on the relationship between obstructive sleep apnea syndrome (OSAS), nocturia, and other lower urinary tract symptoms (LUTSs).

To investigate the impact of a mobile application (app) displaying a visualization of the internal anatomy of the pelvicalyceal system (PCS) and of kidney stones on patient understanding of their affected kidney anatomy and their upcoming percutaneous nephrolithotripsy (PCNL).

Ureteral extension of childhood renal tumors is exceedingly rare. Hematuria, hydronephrosis, poorly or non-functioning kidney should raise suspicion for ureteral tumor extension. Identifying ureteral extension on preoperative imaging or intraoperatively before ureteral transection is crucial to obtain good oncological outcome without unnecessary exposure to radiation therapy or more intensive chemotherapy. In this report, we present three children with cystic renal tumors extending into the ureter and review the relevant literature.