Concurrent laparoscopic management of giant adrenal myelolipoma and contralateral renal cell carcinoma

Dear editor,Myelolipomas are uncommon,benign tumors of the adrenal gland that can occasionally attain a large size.These tumors,very rarely,can occur along with renal cell carcinoma[1].We describe the first case of a giant right sided adrenal myelolipoma co-existent with a contralateral renal cell carcinoma,both of which could be operated laparoscopically in the same sitting.

Encrusted cystitis and ascites due to urethral calculus

Dear editor,A 55-year-old man presented with dyspnea and involuntary dribbling of urine for 1 month.He had history of straining during micturition and weak urinary stream for a year.On examination,he was disoriented and had abdominal distension.Ultrasound revealed marked ascites,pleural effusion,bilateral hydroureteronephrosis,and distended bladder with prostatic urethral calculus.A non-contrast computerized tomography scan additionally showed thickened bladder wall with florid mucosal calcification suggestive of encrusted cystitis and a 2.9 cm×2.5 cm calculus in the prostatic urethra extending to the bulbar urethra(Fig.1).His hemoglobin was 6 g/dL;urea and creatinine were elevated(114 mg/dL and 8.4 mg/dL,respectively);and the leucocyte count was 16.3×109/L.After initial resuscitation,ultrasound guided supra-pubic catheterization was performed.The urine pH was 8.4 while the microscopy revealed numerous pus cells,bacteria,and inorganic crystals.A nephrology consultation was taken and considering the clinical picture of encrusted cystitis,he started on intravenous vancomycin.He also received a session of hemodialysis.The patient died of cardiovascular collapse on the second post admission day.The urine culture report,obtained posthumously,revealed Corynebacterium urealyticum corroborating the diagnosis of encrusted cystitis.The strain was multidrug resistant and showed only sensitivity to teicoplanin and vancomycin.

Assessment of the efficacy of reduced-radiation noncontrast computed tomography scan compared with the standard noncontrast computed tomography scan for detecting urolithiasis:A prospective single-center study

Background:Noncontrast computed tomography(CT)scan of the kidneys,ureter and bladder is the standard investigative modality for diagnosing and following up patients with urolithiasis.With each scan,a patient receives radiation of 18-34 mGy.Dose considerations become pertinent because of a 10%lifetime incidence rate and higher than 50%risk of recurrence,necessitating repeated imaging in the lifetime of a stone former.Hence,this study aimed to assess the sensitivity of"reduced-radiation"CT imaging by altering scan settings to lower than the"standard"norms.Materials and methods:Altogether,222 patients(255"kidney-ureter"stone-bearing units or"renal units")with urolithiasis and patients undergoing CT for other reasons with incidental findings of renal/ureteric calculi between 2017 and 2019 were included.All patients were subjected to 3 sequential scans at tube current settings of 250 mA(CT-N/Standard),100 mA(CT-100),and 50 mA(CT-50)at a constant voltage of 120 kV.Their clinicodemographic and radiological findings were recorded and assessed for significance.Results:Of the 255 renal units,117 were between 30 and 44 years of age,75%were men.Of the 255 patients,178(70.1%)reported a first stone episode and 77 had recurrence.Lower ureteric calculi were predominant(40.4%).All calculi were identified on CT-N;CT-100 failed to detect calculi in 1 patient,and CT-50 failed in 3 patients,where all calculi were<3 mm in size.Meanwhile,none were undetected among patients with obesity.The sensitivity was 99.61%for the CT-100 and 98.82%for the CT-50,which indicated a 2.5 and 5 times lower radiation and dose/length,respectively,than CT-N.Conclusions:The reduced-radiation CT scan is safe,sensitive,and accurate for the diagnosis and follow-up of patients with urolithiasis with significantly lower radiation exposures.Our study lays the foundation to accept low-dose CT in general and CT-50 in particular,as the new"standard of care,"and attempt further dose reduction without loss of diagnostic efficacy.

A retrospective analysis of the factors associated with increased risk of readmission within 30 days after primary transurethral resection of bladder tumor

Background:Transurethral resection of bladder tumor(TURBT)is associated with perioperative morbidity of 5%to 10%,which can lead to unplanned readmissions.In this study,we aimed to identify the factors that lead to an increased risk of unplanned readmissions within 30 days of primary TURBT.Materials and methods:A retrospective study was conducted to identify patients who underwent primary TURBT at our institute from 2011 to 2019.Clinical and demographic factors,history of smoking,antiplatelet drugs intake,comorbidities,tumor size(<3 or>3 cm),multifocality,and histopathological type were abstracted.Patients who were readmitted were identified,and reasons for admission were recorded.Results:A total of 435 patients were identified.The median age of the patients was 66 years.From 378 male patients(86.9%),110(25.3%)and 37(8.5%)had a history of smoking and antiplatelet agents intake,respectively.In the cohort,166 patients(38.2%)were diabetic,239(54.9%)were hypertensive,72(16.6%)had chronic obstructive pulmonary disease,and 78(7.9%)had hypothyroidism.A total of 206 patients(47.4%)had a tumor>3 cm;multifocality was seen in 140(32.2%)patients,whereas muscle invasive tumors were present in 161 patients(37%).A total of 22 patients(5.06%)had readmissions within 30 days,with hematuria being the most common etiology.On univariate and multivariate analyses,a history of smoking(p=0.006 and p=0.008,respectively)or antiplatelet agents intake(p<0.001 and p<0.001,respectively)was significantly associated with increased unplanned readmission.Conclusions:Our study revealed smoking and antiplatelet agents intake as factors leading to an increased risk of unplanned readmissions.