Background: Mitomycin C (MMC) extravasation after transurethral resection of bladder tumor (TURBT) is a rare and highly morbid complication. Management of these cases may require a multidisciplinary approach with strategies ranging from conservative management to surgical intervention. Case Presentation: We present a 48-year-old woman who received a TURBT for a 5 mm bladder tumor. Procedure was uneventful and no bladder perforation was noticed. A single dose of instillation of MMC was performed after surgery resulting in extravasation, consequent ipsilateral pudendal neuralgia, and ureterohydronephrosis. Treatment included a second TURBT, Double-J stent placement, and multiple pain management schemes. After 8 months the patient had complete resolution of pain and ureterohydronephrosis. Conclusion: Perioperative chemotherapy is the standard of care in low-risk bladder cancer. Extravasation of MMC, although rare, can produce severe complications, sometimes irreversible. Other treatment options, such as gemcitabine, are less frequently used despite being less irritant and having similar efficacy. Further studies are needed to compare single-dose instillation regimens.

Background: Double-J stents (DJSs) are placed in the ureter to maintain urine flow from the kidney to the bladder. Extraurinary tract displacement of the stents is very rare, those observed in the literature are vascular displacement into inferior vena cava, into rectum after anticancer treatment of the cervix and a forgotten stent into third part of duodenum. We present a unique case of displaced DJS into the second part of the duodenum and its management laparoscopically. Case Presentation: A 59-year-old diabetic man on evaluation for right flank pain and intermittent episodes of fever with chills and rigors for 4 months was identified elsewhere on CT of kidney, ureter, and bladder (KUB) to have a retroperitoneal mass engulfing the right ureter with a small contracted kidney with mild hydronephrosis for which CT-guided retroperitoneal mass biopsy (reported as acute suppurative inflammation) and subsequent right Double-J stenting were done. He was lost to follow-up and presented to us 3 months later with similar complaints. On evaluation, CT of KUB with contrast revealed a shrunken, hydronephrotic, and poorly excreting right kidney but no mass. The right DJS was seen in the upper ureter and its proximal tip was seen to perforate the anterior wall of the right ureter, and it lay within the second part of the duodenum. The distal tip was seen in the bladder. Laparoscopic right nephrectomy was done with duodenal rent closure. During DJS retrieval, unfortunately, the smaller proximal end of the DJS slipped completely into the duodenum, but fortunately was expelled spontaneously by the patient (confirmed on postoperative day 10 with X-ray). Conclusion: It is ideal to place a DJS under fluoroscopic guidance or obtain a check X-ray to confirm its position postprocedure. Patients should always be counseled on the importance of follow-up and the complications of forgotten stents.

Background: Percutaneous nephrolithotomy (PCNL) is an effective minimally invasive surgical modality for the management of renal calculi. It is generally considered safe with commonly encountered complications being urinary extravasation, fever, and bleeding. Injury to the biliary tract or puncture of the gallbladder is an extremely rare but a grave complication of PCNL. Case Presentation: We present a case of a 70-year-old man who underwent PCNL for an obstructing right renal pelvic calculus. Upon middle caliceal puncture to access the pelvicaliceal system, an unexpected green aspirate suggestive of bile was noted egressing through the puncture needle when stiletto was detached. The needle was swiftly withdrawn and percutaneous renal access was effective on the second puncture to complete the procedure. In the postoperative period, biliary ascites was confirmed on imaging, which was managed in a minimally invasive manner with an ultrasonography-guided abdominal drain insertion. The patient recovered well and was discharged home. Conclusion: Biliary ascites with or without peritonitis is a rare but potentially fatal consequence of biliary tract injury that can occur during PCNL. If there is recognition of biliary aspirate during a percutaneous renal procedure, aggressive management, including diverting the biliary fluid in appropriately selected cases, can obviate the need for emergent open or laparoscopic surgical intervention as highlighted in our case.

Background: Intrauterine device (IUD) migration to the ureter is rare. Symptoms can vary, but often mimic renal colic. Radiographic imaging may aid the diagnosis of a foreign body in the ureter. Reports on endoscopic managements of a migrated IUD are not well described. Case Presentation: We present a 36-year-old woman with a history of IUD insertion. Her symptoms included hematuria, dysuria, and suprapubic/abdominal pressure. After the removal of her IUD by her gynecologist, her hematuria eventually stopped, but she presented again with persistent pain. CT revealed a radiopaque foreign body in the distal left ureter protruding into the bladder. A careful resection with a resectoscope uncovered a long cylindrical shaped foreign body, suspicious of a broken piece of the IUD. Conclusion: Although not always feasible and long-term results remain to be determined, endoscopic management is a safe and effective method of identifying and removing a retained IUD in the ureter. When evaluating a woman with abdominal pain who has an indwelling IUD, a spontaneous migration of the IUD should be considered in the differential diagnosis.

Percutaneous nephrolithotomy (PCNL) has become the standard of care for the removal of kidney stones >2 cm. Major complications, although rare, are between 1% and 7%. Splenic injury during PCNL is rare and can often be managed conservatively, but has the potential to be devastating, necessitating the importance of early diagnosis. Our team describes two cases of splenic injury during PCNL with emphasis on diagnosis and management. Although both cases were managed conservatively through close monitoring and prolonged nephrostomy tube presence, one case had a concurrent pneumothorax. Both cases were diagnosed primarily through postprocedure CT imaging. Risk factors primarily include supracostal access and splenomegaly. Splenic injury is a rare complication that can often be managed conservatively; however, prompt recognition of injury is important. We present in this study two cases of conservative splenic injury management sustained during PCNL.

Background: Hydatid disease is a parasitic zoonosis caused by Echinococcus granulosus. Dog and other carnivores are the definitive hosts, which harbor adult worm. Humans are the accidental and dead-end hosts that acquire the infection by ingestion of eggs released from the intestinal tract of these carnivores, mainly dogs. The primary organ of echinococcosis in humans is the liver and lung, while the kidney is the third most commonly involved organ. Occurrence of hydatid disease of kidneys in isolation or with multiple organ involvement and their management has been reported and well described. The concurrent hydatidosis and pregnancy are an unusual clinical condition and poses a clinical challenge. Case Details: In this study, we present a case of 36-year-old woman with symptomatic hydatid disease of the right kidney during the first trimester of pregnancy. A multidisciplinary team discusses the pros and cons of hydatid during pregnancy with the patient. After taking informed consent from the patient, she was effectively managed by medical termination of pregnancy followed by robot-assisted laparoscopic pericystectomy. Conclusion: The co-occurrence of symptomatic renal hydatid and pregnancy is quite unusual. Medical or surgical management of hydatid during pregnancy can have some detrimental effect on the fetus. Hence these patients could be managed with medical termination of pregnancy followed by robot-assisted nephron-sparing surgery. Robot-assisted surgery for the renal hydatids is safe and effective, and has a shorter learning curve.

Crossed fused renal ectopia (CFRE) is a rare fusion anomaly of the kidneys, with a predisposition to calculus disease. Management of renal calculi in CFRE is not standardized because of paucity of literature. We managed a 32-year-old man with left to right CFRE with multiple stones in both the kidneys by percutaneous nephrolithotomy for the right moiety and laparoscopic pyelolithotomy for the crossed moiety. Based on the stone burden and anatomy, we decided to go for a staged approach, to provide maximum clearance rate with least risk. We share our experience in this case, with regard to the use of two different but minimally invasive modalities for effective management of the patient. We also emphasize on the utilization of a staged approach whenever required for patient safety. We also reviewed the literature regarding the management of kidney stones in this rare anomaly.

Percutaneous nephrolithotomy (PCNL) remains the recommended intervention for large kidney stones, major complications, although rare, are between 1% and 7%. Literature regarding liver injury during PCNL is sparse, and many incidences occur unnoticed. In general, most liver injuries can be treated conservatively when compared with other organ injury sustained during PCNL. Despite this, there is still significant potential for intraperitoneal bleeding as well as possible hemodynamic instability that may result secondary to the inadvertent access. Our team describes two cases of liver injury during PCNL with focus on presentation and injury management. Both cases were treated conservatively through close clinical monitoring and delayed removal of nephrostomy tube. Both liver injuries were diagnosed primarily through postprocedure axial CT imaging. In general, risk factors include supracostal access, particularly at or above the 11th rib, as well as hepatomegaly. Despite that liver injury is a rare complication of right-sided PCNL, outcomes can result in significant blood loss not diagnosed. We present in this study two instances of effective conservative management of liver injury after PCNL.

Background: During percutaneous nephrolithotomy (PCNL) and endoscopic combined intrarenal surgery (ECIRS), obtaining renal access is the most critical step to achieving effective treatment without major intraoperative complications. Among a variety of methods attempted to improve the access, robot-assisted fluoroscopy-guided (RAFG) renal access has been introduced to mitigate technical human errors and overcome challenging learning curves. In this study, we present our first experience with an automated needle targeting with an X-ray (ANT-X) device for minimally invasive (mini-) ECIRS. Case Presentation: A 75-year-old healthy woman with a 6.0 cm3 left kidney stone was referred to our hospital for surgical treatment. The patient underwent mini-ECIRS utilizing RAFG renal access without complication, and the stone was completely removed. The ureteral stent and transurethral catheter were removed on postoperative day 2, and the patient was discharged on postoperative day 3. There were no residual fragments detected by CT as of 3 months after the surgery. Conclusion: To our knowledge, this is the first report of the effective use of RAFG mini-ECIRS for a kidney stone. The overall outcome was positive, indicating the feasibility of ANT-X use for PCNL and ECIRS.

Background: Cutaneous vesicostomy is a urinary diversion for chronic urinary retention caused by neurogenic bladder. In this procedure, urine is drained directly from the bladder into a pouch attached to the lower abdomen, where the use of a catheter is unnecessary. Although complications of this procedure have been described, such as stoma stenosis, bladder prolapse, bladder calculi, and peristomal dermatitis, it is useful for patients who have difficulty with permanent bladder catheterization. The laparoscopy-assisted technique for cutaneous vesicostomy has not been described in the existing literature. In this report, we describe the case of an adult patient with chronic urinary retention caused by a neurogenic bladder who underwent laparoscopy-assisted cutaneous vesicostomy. Case Presentation: A 61-year-old man with intellectual disability was referred to our department because of macroscopic hematuria and urinary retention. Abdominal ultrasonography and computed tomography images showed excessive bladder dilation and bilateral hydronephrosis. A left kidney tumor was found incidentally. We diagnosed left renal carcinoma and chronic urinary retention caused by a neurogenic bladder. We suspected that the hematuria resulted from the renal cancer or from mucosal or submucosal vessel injury caused by excessive dilation of the bladder. Because of the patient's intellectual disability, self-intermittent catheterization or management of a urethral catheter was not possible. Therefore, we performed left radical nephrectomy laparoscopically followed by laparoscopy-assisted cutaneous vesicostomy under general anesthesia. By using laparoscopy, we could construct the vesicostomy in the bladder dome with less tension, and no stomal complications had occurred at 7 months postoperatively. Conclusion: Laparoscopy-assisted cutaneous vesicostomy was a safe and feasible surgical technique in our adult patient with chronic urinary retention. This procedure may be considered effective for patients having difficulty with permanent urinary catheterization.