ABSTRACT

Crossed renal ectopia is a rare congenital malformation and is the second most common fusion anomaly after a horseshoe kidney. Crossed ectopic kidneys are fused to their ipsilateral mate in 90% of cases. crossed fused renal ectopia is usually diagnosed when other disease states are being investigated. It rarely causes significant clinical problems. Treatment is only indicated for the complication of the anomaly rather than for the anomaly itself. 

Atul Kumar Khandelwal, Ahsan Ahmad, Vijoy Kumar, Rajesh Tiwari, Mahendra Singh, Khalid Mahmood

Submitted January 7, 2013 - Accepted for Publication January 24, 2013

KEYWORDS: Crossed-fused renal ectopia, staghorn, nephrolithiasis

CORRESPONDENCE: Atul Kumar Khandelwal, MBBS, MS, Indira Gandhi Institute of Medical Sciences, Flat No 2, New MDH, IGIMS Campus, IGIMS, Sheikhpura, Patna, Bihar 800014, India (atulkhandelwal288@gmail.com)

CITATION: UroToday Int J. 2013 April;6(2):art 21. http://dx.doi.org/10.3834/uij.1944-5784.2013.04.08

ABSTRACT

A urinoma is a continued perinephric or peripelvic extravasation of urine leading to the formation of encapsulated retroperitoneal urine collection due to the disruption of the urinary collecting system. Non-obstetric urinomas are usually the result of trauma, a urologic procedure, infection, and nephrolithiasis. We report a case of perirenal urinomas that were detected during the postpartum period.

Atul Kumar Khandelwal, Mahendra Singh, Rajesh Tiwari, Vijoy Kumar, Shivani Khandelwal, Ahsan Ahmad

Submitted December 1, 2012 - Accepted for Publication February 12, 2013 

KEYWORDS: Urinoma, postpartum, perinephric

CORRESPONDENCE: Atul Kumar Khandelwal, MBBS, MS, Indira Gandhi Institute of Medical Sciences, Flat No 2, New MDH, IGIMS Campus, IGIMS, Sheikhpura, Patna, Bihar 800014, India (atulkhandelwal288@gmail.com)

CITATION: UroToday Int J. 2013 April;6(2):art 22. http://dx.doi.org/10.3834/uij.1944-5784.2013.04.09

ABSTRACT

Introduction: Despite good supporting evidence, the dogma still exists that patients with renal insufficiency are not good candidates for continent diversions. In this paper, we attempt to evaluate this relationship and investigate the short-term effects of continent and noncontinent diversions on patients with both normal renal function and preexisting renal insufficiency.

Methods: From Sept 2004 to June 2009, 212 adult patients underwent radical cystectomy and intestinal urinary diversion by a single surgeon (SD). Forty-four were excluded secondary to inadequate follow-up (41) or other factors leading to renal compromise (3). Continent diversions were performed either with a Studer orthotopic ileal neobladder (ONB) or a catheterizable stoma with right colon pouch. Evaluation of renal function included pre- and postoperative serum creatinine, bicarbonate, and estimated glomerular filtration rate (eGFR) using the National Kidney Foundation (MDRD) equation. A multivariable linear regression model was used to assess the influence of different urinary diversions on the change in renal function.

Results: Median follow-up for the 168 patients was 18.7 months (3 to 60 months). Forty-four patients underwent ileal conduit and 124 underwent continent diversion (109 ONBs; 15 continent cutaneous diversions). The mean preoperative eGFR between the conduit and continent groups was 63.8 and 73.3, respectively (P < 0.001). The mean decrease in eGFR between the 2 groups was -4.1 and -10.3, respectively (P = 0.41). In patients with preexisting renal insufficiency, the mean change in eGFR was 1.7 and -0.49, respectively (P = 0.49).

Conclusions: The mean change in eGFR, creatinine, and bicarbonate levels following urinary diversion with either conduit or continent diversions were not statistically different in patients with normal or preexisting renal insufficiency at short-term follow-up. This data suggests that mild preexisting renal insufficiency may not be a contraindication to continent diversion. 

Brian Winters, Jie Cai, Siamak Daneshmand

Submitted January 21, 2013 - Accepted for Publication February 19, 2013

KEYWORDS: Ileal conduit, orthotopic neobladder, renal function, urinary diversion

CORRESPONDENCE: Siamak Daneshmand, MD, Institute of Urology, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA 90089, United States (siadaneshmand@yahoo.com)

CITATION: UroToday Int J. 2013 April;6(2):art 20. http://dx.doi.org/10.3834/uij.1944-5784.2013.04.07

ABSTRACT

Complete transection of the female urethra without associated pelvic fracture is a very rare presentation. We report a case of isolated rupture of the distal female urethra causing complete transection due to a bull horn injury for the first time in the literature. A 42-year-old woman presented to the Emergency Department immediately following a bull horn injury with complaints of severe bleeding via her vaginum and lower abdominal pain. A detailed examination revealed full laceration of the anterior vaginal wall with complete transection of the urethra 1 cm proximal to the external meatus with no signs of pelvic trauma on imaging. A primary repair was completed in layers with an excellent outcome, and there was no long-term morbidity during her 1-year follow-up. Female urethral injuries may be difficult to identify but early detection and primary repair provide the best chances of a cure. End-to-end repair is the gold standard for management in such cases.

Raman Tanwar, Santosh Kumar Singh, Devendra Singh Pawar

Submitted January 16, 2013 - Accepted for Publication January 30, 2013

KEYWORDS: Isolated urethral injury, female urethral injury, bull horn injury, complete urethral transection

CORRESPONDENCE: Raman Tanwar, MS, FMAS, Department of Urology, Pt BD Sharma PGIMS, Rohtak, 1013, Sector 15, Part 2, Gurgaon, Haryana, India (dr.ramantanwar@gmail.com)

CITATION: UroToday Int J. 2013 April;6(2):art 19. http://dx.doi.org/10.3834/uij.1944-5784.2013.04.06

ABSTRACT

Introduction: Urodynamic findings in patients with post-prostatectomy incontinence (PPI) following either an open radial retropubic prostatectomy or a robotic-assisted laparoscopic prostatectomy are not well described.

Methods: After IRB approval, we performed a retrospective review of urodynamic findings in patients presenting to our institution with PPI following either an open or robotic prostatectomy from 1985 through 2009.

Results: One hundred and twenty-six patients were identified for analysis (74 robotic, 52 open). Intrinsic sphincter deficiency was the cause of PPI in the majority of patients in both groups. Detrusor pressure at peak flow was significantly higher, and peak flow rate was significantly lower in patients who had undergone an open procedure. Anastomotic stenosis (AS) was also higher following an open procedure. Detrusor over- and underactivity were similar between the groups.

Conclusions: Following an open compared to a robotic prostatectomy, patients experienced elevated voiding pressures and decreased peak flows, presumably secondary to the increased incidence of AS observed in those patients.

Katherine Henderson, Jack Matthew Zuckerman, Kurt A McCammon

Submitted January 2, 2013 - Accepted for Publication February 14, 2013

KEYWORDS: Post-prostatectomy incontinence, stress incontinence, urodynamics, bladder neck contracture

CORRESPONDENCE: Dr. Kurt McCammon, Department of Urology, Eastern Virginia Medical School, 225 Clearfield Avenue, Virginia Beach, VA 23462, United States (kmccam@aol.com)

CITATION: UroToday Int J. 2013 April;6(2):art 18. http://dx.doi.org/10.3834/uij.1944-5784.2013.04.05