Complicated Flexible Behavior as well as Dexterous Motion

Mini-percutaneous nephrolithotomy (mini-PCNL) has been described as a safe and effective technique to eliminate stones in patients in whom a less-invasive approach is desired. It was originally developed to treat stones in the pediatric population, but has since been adapted to serve a role in the adult urologic community. This approach has been reported to result in less blood loss and postoperative pain when compared with traditional PCNL. Herein, we present a case in which a recurrent caliceal diverticulum containing stones was managed using a mini-PCNL technique in a patient who previously failed multiple other retrograde endoscopic approaches.Background Multiple large bladder calculi are traditionally managed through open cystolithotomy or transurethrally in patients who have an open bladder neck. Open procedures are technically challenging in patients who may have had multiple previous open surgeries, and may be associated with significant morbidity in patients with a high comorbid burden. Therefore, a percutaneous approach to such stones has been used especially when there is a closed bladder neck, and has been shown to be effective. There are a number of available devices for breaking stones in these approaches, the newest of which is the LithoClast Trilogy™ (EMS, Nyon, Switzerland) device, a probe that provides ultrasonic and mechanical calculi fragmentation and suction in a single instrument. Case Presentation We describe the first reported case of percutaneous cystolitholapaxy using the LithoClast Trilogy device in a 41-year-old woman with spina bifida, and multiple large bladder calculi with a history of ileocystoplasty and Mitrofanoff formation, and a bladder neck closure for neuropathic bladder. The calculi measured 31 and 25 mm, and had a volume of 19.6 and 7.9 cm3 and average HU of 408 and 462, respectively. The calculi were composed of 37% calcium phosphate and 63% magnesium ammonium phosphate. Conclusion We demonstrate that this approach can be used as a viable alternative to open surgery, which is of particular importance for complex patients who have undergone multiple previous open operations, and who may have a high comorbid burden.Background CT has become the gold standard for radiographic evaluation of urolithiasis. CT is highly sensitive for detecting kidney stones and provides valuable information regarding stone size, composition, location, and overall stone burden. Although CT can provide reliable estimations of stone size, we have encountered an instance in which it can be deceiving. Motion artifact in CT images can cause a warping distortion effect that makes renal stones appear larger than they actually are. Case Presentation We describe a case of a 37-year-old woman with a history of kidney stones and obesity presenting with intermittent flank pain and gross hematuria, found to have a large lower pole renal calculus that appeared deceptively large on CT imaging. Given the apparent size and location of the stone, the patient was counseled and consented for a percutaneous nephrolithotomy (PCNL). click here Although the stone was initially suspected to be >2 cm based on the preoperative CT scan, intraoperative pyelography revealed a much smaller than expected radio-dense stone. The patient was stone free after PCNL without any immediate postoperative complications. However, her course was later complicated by delayed bleeding causing significant clot hematuria, perinephric hematoma, and reactive pleural effusion. Conclusion Although CT is especially valuable in preparing for surgery based on its ability to outline collecting system anatomy, it is important to remember that it can be deceiving. Correlation with kidney, ureter, and bladder radiograph and ultrasound is critical to understanding the clinical case and planning the optimal surgical approach.Background Aquablation is a relatively new minimally invasive technology for the treatment of benign prostatic hyperplasia (BPH) that has shown significant promise in its clinical efficacy and utility. Larger prostates or prostates with a median lobe are a common limitation to other minimally invasive treatment options. There is evidence that Aquablation maintains efficacy for larger prostates and prostates with an intravesical median lobe. Herein, we describe 3-month follow-up results for a patient who underwent Aquablation for a large prostate with a significant intravesical median lobe. Case Our patient is a 72-year-old man with lower urinary tract symptoms secondary to BPH refractory to pharmacotherapy. Patient underwent Aquablation of the prostate, which was 110 cc in volume and had a large intravesical median lobe component. At 3-month follow-up patient had reduction in his AUA-SS from 21 to 12, improvement in uroflow from 8.2 to 16 mL/second, and improvement in postvoid residual from 90 to 13 mL. Conclusion Aquablation has been shown to be efficacious for the treatment of BPH in patients with large prostates and intravesical median lobes. This case report further demonstrates effective treatment for patients who fit this profile.Background In any age group, gross hematuria is an alarming symptom. A variety of diseases, including urinary tract tumors, urinary tract infections, glomerulonephritis, urinary stone disease, and urinary trauma, can cause gross hematuria. Neoplasms of the urinary tract are definitely the most bothersome among the differential diagnoses. Fibroepithelial polyps (FEPs), in contrast, are mesodermal-originated rare and benign tumors that can be observed in the urinary tract. In this case report, we present a child with an FEP at the bladder neck that was referred because of gross hematuria. Case Presentation A 5-year-old boy presented with intermittent gross hematuria for 2 weeks. Ultrasonography showed a 2 × 1 cm mucosal surface-borne polypoid lesion at the trigon. Patient underwent cystoscopic evaluation that revealed a polypoid mass located at the bladder neck; however, there were no signs of bladder outlet obstruction in the bladder. Transurethral resection revealed an FEP. Conclusion Hematuria should be evaluated carefully not only in adults but also in children. FEPs in bladder can mimic bladder carcinoma clinically and radiologically. It should be kept in mind in the differential diagnosis of bladder lesions on imaging modalities in pediatric population.