Painless Macroscopic Hematuria Research Articles

Rare Cause of Intestinal Obstruction After Laparoscopic Radical Nephrectomy: Internal Herniation via a Mesenteric Defect

A 43-year-old man had painless macroscopic hematuria and was diagnosed with a 9-cm renal carcinoma in the lower pole of the left kidney. He underwent laparoscopic transperitoneal left radical nephrectomy (LRN) with an uneventful recovery. Eleven days later, he developed intestinal obstruction (IO). Abdominal computed tomography scan showed dilated small bowels occupying the left renal fossa. Laparotomy revealed closed-loop small bowel obstruction resulting from internal intestinal herniation via a 5-cm mesenteric defect. It was repaired after the herniated bowels were reduced. This case illustrates a rare cause of IO after LRN, in which mesenteric defect is necessary.

Multidetector-row computed tomography (MDCT) in patients with a history of previous urothelial cancer or painless macroscopic haematuria

The sensitivity and specificity of MDCT for depiction and localization of urothelial carcinoma (UC) was determined retrospectively. Axial and coronal four-row MDCT of the urinary tract (unenhanced, contrast-enhanced nephrographic, CT urography) was independently reviewed for UC by a radiologist (R1) and a urologist (R2), without other patient information, in 27 patients (22 male, five female; age, 72 +/- 11 years) with previous UC and/or painless macroscopic haematuria. Urinary tract segments included bladder, right and left upper, middle, and lower caliceal groups, renal pelvis, uretero-pelvic junction, upper, middle, and lower ureter. MDCT findings were corroborated by surgery, other invasive procedures, and 1-year follow-up, including MDCT, intravenous urography, and cystoscopy. Receiver-operating characteristic analysis was undertaken and the the area under the curve (AUC) calculated. Eighteen of 27 patients had evidence of UC (pTa, n = 3; pT1-pT3, n = 15; TNM 2002). Tumor was correctly located by both R1 and R2 in 17 patients (sensitivity, 94%; 95% confidence interval, 84-100%) and ruled out in seven (specificity, 78%; 95% confidence interval, 51-100%), with complete agreement. Each detected ten of 11 upper urinary tracts affected by UC. For 35 urinary tract segments with UC and 308 without, the AUC was 0.910 +/- 0.035 (R1) and 0.74 +/- 0.055 (R2), z = 2.4772, Bonferroni-corrected P = 0.022. MDCT depicts urinary tracts affected by UC with high sensitivity and substantial agreement between readers with different training.

Laparoscopic Nephrectomy in a Patient with Ankylosing Spondylitis: Surgical and Anesthetic Challenges

A 55-year-old man with ankylosing spondylitis was referred with left sided loin pain, loin mass, and painless macroscopic hematuria. Physical examination revealed a palpable loin mass, fixed flexion deformity of the lumbar and cervical spines, with severely restricted cervical movement and mouth opening. An ultrasound and computed tomography scan confirmed a 7-cm solid mass in the left kidney. Following a multidisciplinary meeting he elected to undergo radical laparoscopic nephrectomy. An anesthetic opinion was sought in view of the expected difficulties with intubation. Mouth opening was restricted to 3 fingers and he was Mallampati grade 3 on airway examination. As the degree of spinal flexion deformity and restricted spinal movement was significant, the patient was placed in a lateral decubitus position, and surgery was performed using a transperitoneal approach. A five-port technique was employed and was carried out successfully with no complication. Operative time was 240 minutes and estimated blood loss was 700 mL. His postoperative inpatient stay was 4.5 days. Surgical margins were clear and the patient was disease-free at 2-year follow-up. Laparoscopic nephrectomy in a patient with ankylosing spondylitis is technically challenging for both the surgeon and the anesthetist, however, with the right preoperative planning, potential morbidity can be limited to ensure a good outcome for the patient.

IgA nephropathy in association with Crohn’s disease

Urological complications of inflammatory bowel disease are seen in up to 25% of patients, but renal parenchymal disease is rarely reported. The authors describe a case of a 29-year-old man with clinical and radiological features of ileocaecal Crohn's disease. He had previously been investigated for painless macroscopic haematuria and a renal biopsy had revealed IgA nephropathy. Despite medical treatment, regular exacerbations of Crohn's disease were associated with deterioration in renal function and the development of haematuria. The patient eventually underwent surgical resection of the terminal ileum and caecum. His renal disease has remained quiescent for the last 5 years following resection.

Urological malignancy as a complication of renal transplantation: Report of 9 clinical cases

To analyze the epidemiographic features of urological malignancy in renal allograft recipients (RAR) in a single center A retrospective analysis was made on 3150 patients who received renal allografts from June 1978 until the autumn of 2006 and anti-rejection treatment for at least 3 months. Of the 3150 recipients, 33 (1.05%) developed malignancies, including 12 patients (0.38%; eight males and four females) with urological tumors and 21 patients with skin carcinoma, right liver lobular cystic adenocarcinoma, hepatocellular carcinoma, gastric cancer, colorectal carcinoma, ileocecal adenoma, lip cancer, nasopharyngeal carcinoma, Kaposi's Sarcoma, pulmonary lymphoma, and breast cancer. The 12 cases of urological malignancies included one case of renal cell carcinoma, one case of transplanted kidney carcinoma, two cases of bilateral pelvic transitional cell carcinoma (TCC), three cases of unilateral pelvic TCC, one case of bilateral ureter TCC, one case of unilateral ureter TCC, and three cases of bladder TCC. The age at which the diagnosis was made ranged from 48 to 66 years with a mean of 58.3 +/- 4.6 years, and the mean course of immunosuppressive therapy ranged from 26 to 120 months with a mean of 62 +/- 18 months. Of the 12 patients who developed urological malignancies, six had been on a Oyclosporine A + Azaithioprine + Prednisone (OsA + Aza + Pred) protocol; five on a Oyclosporine A + Mycophenolate Mofetil + Prednisone (OsA + MMF + Pred) protocol; and one on a Tacrolimus + Mycophenolate Mofetil + Prednisone (FK506 + MMF + Pred) protocol. One of the 12 patients died soon after the diagnosis was made, and the remaining 11 patients received surgical resection. Of them, 10 patients survived well, and the other one died from cerebral hemorrhage soon after operation. Urological malignancies, especially TCC, are an important complication in renal transplanatation found in this center. The incidence of urological malignancy in renal allograft recipients (RAR) is about 10 times that found in the general population of Shanghai versus two times for other malignancies. The occurrence of the malignancies in PAR seems to be closely related to the use of immunosuppressive agents. lmmunosuppression results in the weakening of immnuologic surveillance function, leading to mutation, aberration, and carcinogenesis. The immunological status of patients after renal transplantation should be assessed regularly. Painless macroscopic hematuria should be considered a significant sign in assessing the potential occurrence of urological malignancy in RAR. Treatment includes early diagnosis, timely surgical resection, and reduction of immunosuppressive agents.

Metastatic renal carcinoma in a pediatric recipient of an adult cadaveric donor kidney

A 15-year old male with chronic renal failure secondary to obstructive uropathy received an adult cadaveric donor kidney. Evaluation for painless macroscopic hematuria occurring 2 years after transplantation disclosed a metastatic renal cell carcinoma, which by the use of restriction fragment length polymorphism analysis was shown to be of the donor's origin. Transplant nephrectomy and cessation of immunosuppressive therapy resulted in complete regression of multiple pulmonary metastases.

Transitional Cell Bladder Carcinoma Metastatic to the Skin

Since Kretschmer¹reported the first English language case, the rareness of metastatic cutaneous bladder carcinoma has been well documented. McDonald et al2 found only two cases of cutaneous metastases in 1,114 cases of primary bladder carcinoma. In their extensive review of metastatic carcinoma in the skin, Brownstein and Helwig3 did not mention such a case. We describe a patient who had several features typical of this disorder. <h3>Report of a Case</h3> A 76-year-old woman was admitted to St Luke's-Roosevelt Hospital, New York, with painful erythematous nodules of six weeks' duration on her abdomen and thighs. Painless macroscopic hematuria had developed 16 months prior to admission to the hospital. At that time, a Fig 1.—Photomicrograph showing transitional cell bladder cancer with densely packed malignant cells (hematoxylineosin, X240). Fig 2.—Close-up view of patient's eruption showing discrete papules on erythematous base. Fig 3.—Microscopic appearance of skin biopsy specimen disclosing tumor strands of