Recurrent Hematuria Research Articles

Super-selective renal artery embolization (SRAE) for iatrogenic and traumatic renal hemorrhage

PurposeTo present the radiological and clinical outcomes of super-selective transcatheter renal artery embolization in patients with renal injury hemorrhage, and share our experience.Methods43 patients with renal injury hemorrhage who underwent 46 SRAEs were enrolled in this retrospective review study. Records, images, and outcomes were reviewed. The individual embolic method and its observed effects were investigated.ResultsAngiography showed free extravasation in 25 angiograms, pseudoaneurysm in 15 angiograms, and arteriovenous fistulas in 1 angiogram. Most patients achieved initial clinical success (38/43, 88.4%), and 41 patients achieved final clinical success (41/43, 95.3%). 9/11 patients who adopted empirical embolization achieved initial clinical success (81.8%). In our study, the combination of PVA particles and micro-coils has emerged as the most commonly utilized material combination (24/46, 52.2%). Significant differences in hemoglobin levels were observed before and after the embolization procedure (p = 0.026, 95%CI: 1.03–15.54). Post-embolization clinical follow-up showed no evidence of recurrent hematuria, progression of hematoma, hypertension, and no reflux of the embolic agent.ConclusionThough SRAE showed satisfactory results across a broad range of renal injury hemorrhage, there are still some aspects that need attention: (1) Surgical procedure should be understood, including the surgical site, access routes, and placement of implants, such as double-J stents. (2) In cases where identifying the bleeding point proves challenging, consider the possibility of an accessory renal artery.Trial registrationChinese Clinical Trial Registry ChiCTR2400085050, Registration Date: 30 May 2024, retrospectively, non-randomized.

Clinical evolution of bladder carcinosarcoma: A case report and literature review.

Bladder carcinosarcoma (BC) is a malignant tumor composed of a mixture of malignant epithelial and stromal components. Carcinosarcoma mostly occurs in the upper respiratory tract and upper gastrointestinal tract and is less common in the urinary system. The incidence of malignant tumors of the urinary system is <3%. It rarely occurs in the bladder and accounts for approximately 0.31% of all malignant bladder tumors. A literature review and this report will help to further improve our understanding, diagnosis, and treatment of bladder carcinosarcoma (BC). We describe the case of an 80-year-old female patient who was admitted to the hospital with a history of intermittent hematuria for 3 years. Furthermore, total cystectomy was refused when a BC was diagnosed. Palliative resection surgery was necessary because of the recurrent hematuria and abdominal pain. Pathologically confirmed BC after surgery. The patient's first transurethral resection of bladder tumor (TURBT) was diagnosed as BC. However, the patient refused a total cystectomy. Two months after intravesical treatment with epirubicin, bladder tumor recurrence was observed during follow-up cystoscopy. The patient underwent a second TURBT for hemostatic treatment due to persistent hematuria. Due to hematuria and abdominal pain, a third TURBT was performed to reduce tumor size and stop bleeding. Finally, tumor recurrence resulted in bilateral hydronephrosis, and the patient underwent bilateral renal catheter drainage guided by B-ultrasound. Bladder carcinosarcoma caused uremia, electrolyte imbalance, and sepsis. Approximately 19 months after the discovery of the tumor, the patient died. Radical bladder resection is recommended once a BC is diagnosed. By reporting the cases and reviewing the literature in the database, we will summarize the epidemiology, origin, etiology, clinical features, existing treatments, and prognostic factors of BC, and propose new prospects for BC therapy.

Renal artery embolization in a case of renal cell carcinoma with intractable hematuria with acute myocardial infarction

Introduction: Renal artery embolization is a valuable treatment option for various renal tumors, both malignant and benign. The indications for this procedure include preoperative arterial embolization of large and vascular renal cell carcinoma to reduce intraoperative hemorrhagic complications, management of malignant renal tumors in patients who are not suitable candidates for surgery, treatment of symptomatic hematuria and palliative care for metastatic renal cancer. Case Report: In this case report, we present the case of a 56-year-old female with a known history of hypertension and cerebrovascular accident, who presented with complaints of hematuria and urinary retention. A diagnosis of left renal mass suggestive of renal cell carcinoma was made. The patient was planned for left radical nephrectomy and advised to discontinue aspirin for a week. However, on the morning of surgery, she experienced acute myocardial infarction and had to be hospitalized in intensive cardiac care. Aspirin was restarted, leading to recurrent severe hematuria. The patient underwent renal artery embolization, which successfully controlled the hematuria. Following cardiac stabilization, radical nephrectomy was performed three months later. The surgery and post-operative period were uneventful. Conclusion: This case study demonstrates the use of renal artery embolization as an effective modality for controlling hematuria, and temporizing management in a case of renal cell carcinoma where surgery was not immediately feasible due to a medical emergency.

Bones, Stones, and Hematuria….Connecting the Dots

We report a 12 yr old boy who presented with recurrent gross hematuria, polyuria and rickets with growth failure. Investigations showed bilateral renal calculi with small kidneys on ultrasonography along with hypercalciuria; hypomagnesemia and reduced kidney function. His younger sibling also had nephrocalcinosis hypomagnesemia. The genetic analysis done in view of recurrent renal calculi with chronic kidney disease showed a homozygous missense variant (c.392G&gt;A) at exon 4 of CLDN 16 gene suggestive of Familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC). The younger sibling had a similar homozygous mutation and the parents were heterozygous carriers.

#2533 Real-world challenges associated with the use of systemic glucocorticoids in a US IgAN cohort

Abstract Background and Aims Immunoglobulin A nephropathy (IgAN) is the most common primary glomerular disease and up to 50% of patients progress to kidney failure within 10-20 years. Until early 2022, management of IgAN was primarily focused on supportive care. As outlined in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, patients at high risk of progressive chronic kidney disease despite maximal supportive care can be considered for a 6-month course of systemic glucocorticoids (SGC), although important risks of toxicity and contraindications must be considered. There is currently limited real-world evidence describing the impact of the use of SGC on treatment‑emergent toxicity and healthcare resource utilization (HCRU) in patients with IgAN. We report the incidence of adverse events (AEs) commonly associated with SGC, as well as HCRU rates and costs, in a real-world cohort of IgAN patients, comparing new initiators of SGC with patients who have never initiated SGC. Method This non-interventional, retrospective cohort study was conducted in the TriNetX Dataworks - United States of America Network, a database of de-identified, patient-level electronic medical records (EMR) of approximately 100 million patients. The cohort was selected from a total of 19, 687 patients with IgAN, identified using proxy ICD‑10 codes N02.8 (recurrent and persistent hematuria with other morphologic changes) or N04.1 (nephrotic syndrome) between January 1, 2011, and May 4, 2022. Eligible patients were required to have: an incident diagnosis of IgAN with the same diagnosis within 30-180 days; at least 12 months of EMR history available prior to and after initial IgAN diagnosis; not experienced kidney failure prior to or on the initial date of IgAN diagnosis; and not received SGC prior to the date of diagnosis. Data assessed included demographic and clinical characteristics, IgAN-directed medications, AEs, and HCRU. To promote balance between cohorts, new initiators of SGC (dexamethasone, prednisone, prednisolone, methylprednisolone) were matched with patients who did not receive SGC using a propensity score (PS) approach based on their characteristics at diagnosis. To avoid immortal-time bias, the index date was set as the time of SGC initiation in patients in the SGC cohort; for the non-SGC cohort, a pseudo-index date was assigned using the same lag from diagnosis to index date as their 1:1 PS-matched patient in the SGC cohort. Differences in the cumulative incidence of individual AEs were analyzed using the chi-square test or Fisher's exact test, and differences in HCRU rates and costs were analyzed using the Kruskal-Wallis test. Results After implementing the PS approach, the final analysis included 802 patients (401 PS-matched pairs), with a mean age of 41.2 years and 55% being male. Median duration of follow-up was 3.5 and 3.1 years for the SGC and non-SGC cohorts, respectively. Of AEs that occurred in at least ten of the 802 patients, patients who received SGC experienced a significantly increased incidence of all AEs except for fractures, new onset of diabetes, and reported onset of glaucoma (Table 1). Patients who received SGC had a 12-fold increased incidence of severe infections requiring hospitalization compared with the non-SGC cohort. Annualized mean HCRU rates and costs were significantly greater across all HCRU types for patients who received SGC vs those who did not receive SGC, including an 8-fold increase in inpatient visits, a 4-fold increase in emergency department admissions, and twice as many ambulatory visits (Fig. 1). Results were consistent when the cohort was restricted to patients with IgAN identified using only the ICD-10 code N02.8 (recurrent and persistent hematuria with other morphologic changes). Conclusion The findings of this real-world analysis demonstrate significant side effects and costs for IgAN patients treated with SGC compared with patients not treated with SGC, underscoring the recommendation in the 2021 KDIGO guidelines to carefully consider treatment-emergent toxicity before treating IgAN patients with SGC.

Management of high-grade pediatric renal trauma in tertiary referral hospital in Indonesia: A case series and literature review

Introduction and importanceGenitourinary tract injuries constitute 10 % of all traumas, with renal injuries being common in pediatric cases due to reduced perirenal fat and abdominal wall muscle development. However, very few reports of pediatric renal trauma in Indonesia have been reported. In this case series, We present a case series of high-grade renal injury and review the literature on pediatric renal trauma in Indonesia. Case presentationWe present four cases with renal trauma as the subjects of this case study. The 13-year-old boy, who was the initial patient, complained of hematuria and abdominal pain after falling from a tree. The second patient, the 13-year-old boy, presented with left lower back pain and hematuria after being elbowed in the left waist. The third patient, a 14-year-old boy, had been in a motorcycle accident and got grade 5 renal injury according to AAST classification. The final case involved a 4-year-old boy who experienced recurrent hematuria caused by a pseudoaneurysm following blunt renal trauma. DiscussionTrauma is the leading cause of morbidity and mortality in children, with approximately 3 % of children assessed in pediatric hospital trauma departments having had trauma. With appropriate management according to guidelines, mortality can be avoided. ConclusionThe case series highlights the significance of treating pediatric renal trauma patients individually according to their hemodynamic state and degree of impairment.

Palliative surgery for metastatic prostate cancer

Androgen deprivation in combination with novel hormonal agents, docetaxel, or in combination with abiraterone/prednisone plus docetaxel or darolutamid plus docetaxel represent the standard therapeutic approach in metastatic hormone-sensitive prostate cancer (mHSPC). Patients with low-risk prostate cancer also benefit from additional radiation therapy or radical prostatectomy in terms of progression-free and overall survival. Despite favorable response rates, basically all patients will develop castration resistant prostate cancer (CRPC) within 2.5to 4years. In addition to systemic chemotherapy, second-line hormonal treatment of systemic application of radionuclides such as radium223 or 177Lu-PSMA represent salvage management options. However, nowadays about 50-65% of patients will develop symptoms due to local progression of prostate cancer which is the result of improved oncological outcomes with significantly prolonged survival times due to the new medical treatment options. Management of such symptomatic local progression will become more important in upcoming years so that all uro-oncologists need to be aware of the various surgical management options. Complications of the lower urogenital tract such as recurrent gross hematuria ± bladder clotting and with the necessity for red blood cell transfusions, subvesical obstruction and acute urinary retention, rectourethral or rectovesical fistulas might be managed by palliative surgery such as palliative transurethral resection of the prostate (TURP), radical cystectomy, radical cystoprostatectomy with urinary diversion, and pelvic exenteration. Symptomatic or asymptomatic obstruction of the upper urinary tract might be managed by endoluminal or percutaneous urinary diversion, ureteral reimplantation, ileal ureter replacement, or implantation of the Detour® system (Coloplast GmbH, Hamburg, Germany).

Recurrent hematuria involving urinary system with Klippel-Trenaunay syndrome: A case report.

Klippel-Trenaunay syndrome (KTS) is a rare congenital venous malformation, it had been found to be caused by mutations of the phosphatidylinositol 4, 5-diphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene. Currently KTS is defined as a triad of skin wine pigmented spots, varicose veins and malformations of the lower extremities, and hypertrophy of bone and soft tissue, involving urinary system up to 6% to 30%. When the urinary system is involved, KTS is often presented as painless massive gross hematuria. This article describes a woman who was hospitalized with painless massive gross hematuria. Physical examination revealed significant hypertrophy of the right lower limb with varicose veins, port-wine stains in the skin, and right perineal hemangiomatous changes with swelling. The patient was admitted to hospital 4 times for repeated hematuria and infection. By physical examination, CT urography, ureteroscopy and cystoscopy, the patient was diagnosed to have Klippel-Trenaunay syndrome, involving the urinary system. The patient hematuria improved after multiple indwelling D-J tubes and anti-inflammatory treatment. The final symptoms of hematuria improved significantly, follow-up so far has not recurred. This case presents the possibility of painless gross hematuria with KTS. Most of patients can be improved by conservative treatment. Cystoscopic laser therapy is the preferred treatment for poor bleeding control. Cystectomy and nephrectomy should be considered when life-threatening.

Durable response to docetaxel in a case of primary seminal vesicle adenocarcinoma with zinner syndrome.

Primary adenocarcinoma of the seminal vesicles is a rare tumor. Congenital seminal vesicle cysts are often associated with unilateral renal dysgenesis or agenesis (Zinner syndrome). Zinner syndrome is a rare congenital malformation represented by a group of characteristics: ipsilateral renal agenesis, ejaculatory duct obstruction, and seminal vesicle cyst. There have been 214 cases in the literature with abdominal pain and lower urinary tract symptoms as the most common presentation. Most cases are diagnosed incidentally. We report a case of a 39-year-old male presenting with recurrent hematuria for 12 years, diagnosed as metastatic primary clear cell adenocarcinoma of seminal vesicle with Zinner syndrome. He was managed symptomatically with radiation therapy, hormonal therapy, and palliative chemotherapy. He is living with a well-controlled disease at present.

Role of Immunotherapy in Renal Cell Carcinoma; A Case Study

Introduction: The most common cancer of kidney is- renal cell carcinoma. Early diagnosis can make a hope from the recovery of the disease. The incidence of renal cell carcinoma is commonly found in elderly aged patients. Sometimes it occurs in one kidney whereas, sometimes it effects both kidneys. Smoking, overweight, taking excessive painkillers can increase the chance of renal cell carcinoma. Case Presentation: A 57 years old Bangladeshi diabetic male patient, was diagnosed as right sided renal cell carcinoma (stage pT3cN0G2) along with the chief complaint of recurrent gross hematuria came to outdoor in April 2020. After confirmed diagnosis surgery had done followed by medications. From 10/03/2022, patient started 1 cycle of oral therapy with tablet Sunitinib. After that, immunotherapy and targeted therapy were advised to start with injection Pembrolizumab 200mg every three weeks followed by tablet Axitinib 5mg for every two weeks. Patient received 17 cycles of Pembrolizumab followed by Axitinib and got the last cycle at 24/02/2024. Conclusion: With the minimal side effects, it is evident that, Pembrolizumab has shown a positive response to the patient. It has added the new standard care of treatment of renal cell carcinoma at intermediate-high or high risk of recurrence following nephrectomy or following nephrectomy and resection of metastatic lesions.

Our experience of forgotten double-J stents in a tertiary care center

Background: Double-J (DJ) stents have become an essential tool in the field of urology. Forgotten DJ stents are associated with significant morbidity and mortality, if not intervened timely. Aims and Objectives: In this study, we report our experience of forgotten stents related complications, along with its management and steps taken by us in preventing stent-related morbidity. Materials and Methods: We retrospectively analyzed the records of patients presented to the Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna with forgotten or long-term retention of DJ stents from January 2021 to December 2022. All cases were reviewed for age, gender, symptoms, indication of stent insertion, duration of stent insertion, radiological images, and procedures performed for management. Results: The mean age of the patients was 49.23 years. The mean duration of the indwelling stent in situ was 16.61 months. Presenting complaint was flank pain, recurrent urinary tract infection, dysuria, hematuria, and irritative lower urinary tract symptoms. Common indications of indwelling stents were ureteroscopic lithotripsy, percutaneous nephrolithotomy, and Laparoscopic pyeloplasty. Cystoscopy, ureteroscopy, cystolithotripsy, percutaneous nephrolithotomy, and open surgery were done to extract the forgotten DJ stent. Conclusion: Forgotten DJ stents are a source of severe morbidity. Patients and relatives counseling before and after the procedure is necessary in reducing stent-related complications.

Diagnostic value of repeated comprehensive investigation with CT urography and cystoscopy for recurrent macroscopic haematuria.

To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography urography (CTU) and cystoscopy negative for urinary bladder cancer (UBC) and upper tract urothelial cancer (UTUC) and to identify potential factors associated with occurrence of recurrent macroscopic haematuria. All patients older than 50 years who underwent urological investigation for macroscopic haematuria with both cystoscopy and CTU 2015-2017 were retrospectively reviewed. A descriptive analysis of the primary and later investigations for recurrent macroscopic haematuria was performed. To investigate the association between explanatory variables and the occurrence of recurrent macroscopic haematuria, a Poisson regression analysis was performed. A total of 1395 eligible individuals with primary standard investigation negative for UBC and UTUC were included. During a median follow-up of 6.2 (IQR 5.3-7) years, 248 (18%) patients had recurrent macroscopic haematuria, of whom six patients were diagnosed with UBC, two with prostate cancer, one with renal cell carcinoma and one had a suspected UTUC at the repeated investigation. Within 3 years, 148 patients (11%) experienced recurrent macroscopic haematuria, of whom two patients were diagnosed with low-grade UBC (TaG1-2), one with T2G3 UBC and one with low-risk prostate cancer. The presence of an indwelling catheter, use of antithrombotic medication, pathological findings at CTU or cystoscopy or history of pelvic radiotherapy were all statistically significant independent predictors for increased risk for recurrent macroscopic haematuria. In the case of recurrent macroscopic haematuria within 3 years of primary standard evaluation for urinary tract cancer, there was a low risk of later urological malignancies in patients initially negative for UBC and UTUC. Therefore, waiting 3 years before conducting another complete investigation in cases of recurrent macroscopic haematuria might be appropriate.

Treatment of refractory hematospermia with Finasteride: A prospective placebo-controlled study

Background: Finasteride is being used to treat recurrent hematuria due to BPH. Androgen has an essential role in the production of angiogenic factors such as VEGF. Vessel density &amp; VEGF decreases after finasteride treatment and thus improve haematospermia. Objective: To test the efficacy of finasteride to control refractory idiopathic hematospermia for which conservative treatment has failed. Methodology: This Prospective placebo-controlled study was carried out from July 2019 to June 2022 with 48 patients of hematospermia presented to the outpatient department of NIKDU. Twenty-two patients had refractory hematospermia of idiopathic nature. They were randomized into two equal groups, 11 patients in each group. One group received 5 mg finasteride daily for 3 months, and the other group received placebo. Patients were followed up with semen analysis and TRUS for 3 consecutive months and after 1 year. Result: In the finasteride-treated group, remission of hematospermia occurred in 5 patients (45%) within 1 month. Patients continued treatment for 3 months without the recurrence of hematospermia. After stopping finasteride treatment, hematospermia recurred in 3 out of 9 patients 12 months later. Two cases were not improved, but a significant decrease in frequency &amp; amount of bleeding was observed in semen analysis. In the placebo-treated group, cessation of hematospermia occurred in 3 cases (27%) versus 9 (81%) in the finasteride group (P = 0.03) after 3 months of treatment. Conclusion: Three months of treatment with finasteride for refractory idiopathic hematospermia significantly cures hematospermia with no undesirable side effects. Bangladesh J. Urol. 2022; 25(1): 33-66

Can a Single Glomerulus Morphology Implicate Successful Therapy?

Recurrent gross hematuria of glomerular origin is frequently encountered in clinical practice, and in absence of specific serological marker, renal biopsy is mandatory to address the definitive diagnosis, and set out an appropriate therapeutic protocol. Technical deficiencies associated with practice of renal biopsy are frequently encountered, as inadequate number of glomeruli or poor immunofluorescence staining of kidney biopsy specimen; however, these deficiencies can be offset by detailed electron microscopy analysis of a single abnormal glom.We present a single middle-aged Libyan woman, with a rare glomerular disease, related to abnormal activation of alternative complement pathway, where renal biopsy report was initially not adequate and lacking immunohistochemistry workup. However, electron microscopy reports a characteristic abnormal glomerular deposit, coupled with clinical and biochemical data that guided our therapeutic protocol.In a middle-aged female who presented with recurrent gross hematuria and nephrotic range proteinuria, we should suspect a glomerular pathology. Further to immunoglobulin A nephropathy or lupus nephritis, particularly in presence of complement abnormalities and negative serology for glomerulopathy-related autoantibodies, dense deposit disease and C3 glomerulonephritis that are rare complement mediated glomerulopathy should be considered as a seronegative lupus nephritis-equivalent, in terms of their membranoproliferative features on light microscopy, and when setting out appropriate therapeutic protocol. Patient and family counseling for C3 glomerulopathy is essential because this type of glomerulopathy has a recurrence rate after kidney transplant.

Benign Prostatic Hyperplasia in a 13-Year-Old Boy

Benign prostatic hyperplasia (BPH) is most common in men 40 years and above. It rarely occurs in childhood. As a result of the scarcity of cases, the pathogenesis is not clear, and treatment of BPH in this age group is challenging. This report focuses on a 13-year-old patient diagnosed with a histologically confirmed BPH, having presented with a 2-year history of recurrent hematuria and acute urinary retention. Magnetic resonance imaging (MRI) revealed a 287 g prostatic mass, with no signs of malignancy nor metastasis detected. A decision for open suprapubic prostatectomy was made. Postoperative follow-up at 1 year was uneventful. The possible causes of juvenile BPH have been postulated as gonadotropin supplementation for cryptorchidism and human chorionic gonadotropin-containing agent use by the mother during pregnancy. Our case had a history of the right inguinal undescended testis with scrotal orchidopexy done at 11 years of age. However, the patient had no history of human chorionic gonadotropin use, endocrinologic abnormality, or other possible contributing factors. His antenatal history was normal, with no use of human chorionic gonadotropin by the mother. Due to the very few reported cases, there is insufficient data to help understand the pathogenesis of childhood BPH.

Clinical guidelines for diagnosis of hematuria

Background: Hematuria is a common condition caused by various factors, including infections, inflammations, stone diseases, and anatomical abnormalities. While hematuria can be mistaken for other conditions, its significance should not be overlooked, as studies have shown that some patients with hematuria are diagnosed with urological cancers.Current Concepts: Experts agree on the need for specific diagnostic tests such as cystoscopy, upper urinary tract imaging, and urine cytology for visible hematuria. However, opinions differ when it comes to microscopic hematuria. Delays in diagnosing bladder cancer can significantly impact mortality rates. Therefore, objective diagnostic criteria, as well as guidelines to reduce excessive evaluations, costs, and side effects, are required. As of 2020, the American Urological Association has released new guidelines for the diagnosis and management of microscopic hematuria, that focus on assessing the risk of urological malignancies in individual patients and recommend tailored evaluations based on risk levels. This article provides an overview of these guidelines, discussing diagnostic criteria, initial evaluations, risk stratification, and recommended evaluations of the urinary tract.Discussion and Conclusion: Guidelines on hematuria aim to reduce unnecessary invasive procedures, provide appropriate follow-up strategies to patients with persistent or recurrent microscopic hematuria, and improve patient outcomes while minimizing unnecessary tests and procedures.

Proliferative glomerulonephritis with monoclonal IgG deposits: a unique case with a clinical course of over 46 years

BackgroundProliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a rare entity first described in 2004. We present a case of PGNMID with recurrent hematuria and nephrotic range proteinuria with three biopsies over 46 years.Case presentationA 79-year-old Caucasian female presents with a history of two separate episodes of biopsy-proven recurrent GN over a course of 46 years. Both biopsies from 1974, and 1987 were reported as membranoproliferative GN (MPGN). The patient presented in 2016 for the third time with symptoms of fluid overload, slight worsening in renal function, and proteinuria along with glomerular hematuria. A third kidney biopsy was performed, and the final diagnosis was proliferative glomerulonephritis with monoclonal IgG/κ deposits.ConclusionWith three renal biopsies obtained over 46 years, our case opens a unique window into the natural history of PGNMID. The three biopsies demonstrate the immunologic and morphologic evolution of PGNMID in the kidney.

Evaluation of Recurrent Gross Hematuria in a Patient With Metastatic Prostate and Concomitant Metastatic Kidney Cancer

Evaluation of Recurrent Gross Hematuria in a Patient With Metastatic Prostate and Concomitant Metastatic Kidney Cancer

Metanephric adenoma in a young female: a rare case report from Nepal

Introduction: Metanephric adenomas (MAs) of the kidney are rare benign epithelial lesions in the kidney that have been described in the literature, mainly through case reports, representing ~0.2% of renal masses. No prior case reports have been published from Nepal. We report one such case with MA presented to our center. Case presentation: A 25-year-old lady presented with complaints of recurrent hematuria for the past 6 months. Ultrasound of the abdomen revealed left gross hydronephrosis and reduced left renal parenchyma. A contrast-enhanced computerized scan of the abdomen and pelvis showed a heterogeneously enhancing soft tissue density lesion 65 mm×57 mm at the left renal pelvis extending into mid calyx and distally to proximal ureter, ~34 mm distal to pelviureteric junction causing moderate hydronephrosis, likely urothelial cell carcinoma. Urine cytology was negative for malignancy. Laparoscopic left nephroureterectomy with bladder cuff excision lymphadenectomy was done. The histopathology report came out to be consistent with MA and the lymph nodes were negative for malignancy. Immunohistochemistry study showed that the cells were positive for PAX8. During follow-up, she did not have hematuria and her postoperative period was uneventful. Discussion: From this report, we want to highlight the need to consider MA as a differential diagnosis of renal mass and differentiate MA from upper tract urothelial carcinoma, renal cell carcinoma, Wilms tumor, and papillary adenomas. Conclusion: MA is a rare renal lesion that may present as upper tract urothelial carcinoma. MA should be evaluated through histology and immunohistochemistry studies.

MP46-16 MUSCLE INVASIVE BLADDER CANCER - SURVIVAL AND HEALTH CARE BURDEN IN PATIENTS TREATED WITH NON-CURATIVE INTENT

You have accessJournal of UrologyCME1 Apr 2023MP46-16 MUSCLE INVASIVE BLADDER CANCER - SURVIVAL AND HEALTH CARE BURDEN IN PATIENTS TREATED WITH NON-CURATIVE INTENT Haim Herzberg, Yossi Ventura, Idan Zeeman, Shay Golan, Ofer Yossepowitch, and Roy Mano Haim HerzbergHaim Herzberg More articles by this author , Yossi VenturaYossi Ventura More articles by this author , Idan ZeemanIdan Zeeman More articles by this author , Shay GolanShay Golan More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , and Roy ManoRoy Mano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle-invasive bladder cancer (MIBC) in an aggressive disease; yet, many patients, especially those with advanced age and multiple comorbidities, do not receive optimal care. We evaluated the disease course of MIBC patients treated without curative-intent. METHODS: Bi-center, retrospective analysis of patients diagnosed with non-metastatic MIBC who did not undergo radical cystectomy or standard chemoradiation between 2016-2021. Patient characteristics and treatment burden were described. Metastasis free and overall survivals were estimated using the Kaplan-Meier method. RESULTS: The study cohort included a total of 66 patients at a median age of 86 years (IQR 78, 90). Thirty-two patients (48%) presented with locally advanced disease. Median Charlson comorbidity index at diagnosis was 7 (IQR 6,8). Patients were not treated with curative intent due to comorbidities and low performance status in 58 patients (88%) and patient refusal in 8 (12%). Median follow-up for survivors was 29 months (IQR 15, 52). Estimated metastasis free survival was 25% in one year and 14% in 2-years. Estimated overall survival was 32% in one year and 12% in 2-years. During follow-up patients received the following treatments: Chemotherapy 7 patients (11%), Immunotherapy 4 patients (6%), and radiation (without concurrent chemotherapy) 21 patients (32%). Forty-three patients (65%) suffered recurrent hematuria episodes and 17 (26%) required an emergent operation due to bleeding. Twenty-four patients (36%) required a nephrostomy tube and 39 (59%) required an indwelling urinary catheter. Overall, median emergency room visits number was 4 (IQR 2,5), and median overall admission length was 16 days (IQR 9,29). CONCLUSIONS: Untreated muscle invasive bladder cancer is associated with a high overall mortality rate and high disease burden for the patient and the health system, alike. Patients should be aware of these findings when curative intent treatment is avoided. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e638 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Haim Herzberg More articles by this author Yossi Ventura More articles by this author Idan Zeeman More articles by this author Shay Golan More articles by this author Ofer Yossepowitch More articles by this author Roy Mano More articles by this author Expand All Advertisement PDF downloadLoading ...