Ureters are muscular tubes that transport urine from the kidney to the bladder. The peristalsis wave is responsible for carrying urine to the bladder. With the regular appearance of peristalsis, areas with anatomic narrowing junctions are crucial for ureteral diseases. A three-dimensional flow analysis is performed for different time steps to understand the effect of the urine bolus formation and the reflux phenomenon on variable diameter ureters. For the constant and variable diameter ureter, the pressure is obtained behind and in front of the propagating bolus respectively. The peristalsis wave creates the high-velocity of a jet in the neck region of the ureter. The contraction produces the trapping of the bolus leading to adverse flow in the contraction region. By virtue tapering, the high-pressure gradient builds up, leading to high wall shear in the ureter. The main goal is to determine the pressure, velocity, gradient pressure, and shear force on the ureter wall during peristaltic motion. These parameters are very important for clinicians to understand its effect in the unobstructed variable diameter ureter. This article may help to build a medical device for engineers. The physical significance of this information lies in its profound insights into the biomechanics and functionality of the ureters, which are essential components of the human urinary system.
Forgotten ureteral stents (FUS) and stent-related symptoms (SRS) lead to increased postprocedural emergency department visits and add to the psychological and financial burden of the patients.To review the usage and benefits of ureteral stent tracking and symptom monitoring through a single smartphone-based application (App) platform with 2-way clinician-patient communication. This study also compared the features with other smartphone apps used for stent tracking.100 patients were included in this single-center prospective study conducted between September 2019 and December 2019. Patients who had metallic or long-term indwelling stents, noncomprehensible patients, and those not willing to share their data were excluded from the study.Of 100 patients, 92 downloaded the Urostentz application, and 72 (78.2%) patients answered the pictorial symptom questionnaire. Symptom score analysis suggested that 62 patients (86.1%) had stent-related symptoms of which 3 required readmission and underwent early stent removal. The mean stent duration was 17.2 + 3.5 days (range: 11-23 days), with 69% of patients having their stent removed on the scheduled date and 25% of patients requesting a change of their appointment via the App.In this study, there was no case of FUS encountered. The "Urostentz" App is a freely available patient safety stent tracking application that provides a secure and simplified interface, which can significantly reduce the incidence of FUS and provide digital remote assistance in the management of stent-related symptoms.
Primary small cell carcinoma of urinary bladder is a rare but aggressive disease with poor prognosis and a high mortality rate. It accounts for less than 1 % of all the primary cancers seen in the urinary bladder. Diagnosis and management of this entity poses a challenge to the clinician due to the lack of a standardized protocol for its treatment. Herein we discuss primary small cell carcinoma of the urinary bladder in its entirety.
Abstract Case A 67-year-old male with hematuria and diagnosed to have a left iliac fossa malrotated ectopic kidney with enhancing renal pelvic mass; which on histopathological examination was noted to be high grade UTUC- pT3N1. Conclusion This is the first documented high grade UTUC case of an ectopic kidney in literature. The treatment of this disease can be challenging due in part to its aberrant vascular morphology and due to its location.
Abstract Objective To compare efficacy and safety between superior calyceal access and inferior calyceal access for pelvic and/or lower calyceal renal stones. Methods Consecutive patients presenting with Pelvic and/or inferior calyceal renal calculi were allocated to the superior calyceal access (group 1) or inferior calyceal access (group 2) treatment arm. Allocation of treatment access was based on the surgeon’s preference. Variables studied included stone free rate, operating time, intraoperative and postoperative complications. Statistical analysis was executed using SPSS, Version 16.0. The statistical significance was evaluated at 5% level of significance ( p value < 0.05). Results Between July 2018 and February 2019, 63 patients were included in each group. The percutaneous inserted guidewire entered the ureter in 92% in group1 and 74.6% in group 2 ( p = 0.034). Stone fragments migrated to the middle calyx in 3.2% in group1 and 9.5% in group 2 ( p = 0.033). A second puncture was required in one patient in group 1 and in 5 patients in group 2 ( p = 0.04). The operative duration (minutes) was 13.46 ± 1.09 in the group 1 while 16.58 ± 1.44 in the group 2 ( p = 0.002). Thoracic complications (hydropneumothorax) occurred to 2 patients in superior calyceal access group managed with intercostal tube drainage ( p = 0.243).Post operatively blood transfusion was required in two patients in group 2 ( p = 0.169). Angioembolization was done in one patient among the inferior calyceal access approach ( p = 0.683). Complete stone clearance assessed at 3 months was 96.8% in group 1 and 85.7% in group 2 ( p = 0.046). Conclusions Superior calyceal access is a safe and most efficacious in terms of achieving complete stone clearance rate with reduced operative time, minimal blood loss, less need for a second puncture and auxiliary procedures at minimal complications. Study registration Clinical trials registry – INDIA; CTRI/2018/07/014,687.
Prostatic leiomyosarcoma is an exceedingly rare malignant tumour arising from smooth muscle cells in the prostate gland. It ranks quite low down on the possible differentials of bladder outlet obstruction. We present a case of a 38-year-old male who initially presented with acute urinary retention and was subsequently diagnosed with prostatic leiomyosarcoma. Following histopathological confirmation, metastatic work-up was performed and patient planned for radiation and surgical cure. Patient on follow-up is well and has resumed normal daily work. This case report aims to increase awareness of this rare malignancy, discuss the diagnostic challenges faced with a highly common clinical spectrum at the onset, present the treatment strategies employed, and discuss the patient's clinical outcomes. We emphasise the importance of reporting rare cases like this to contribute to the existing literature and enhance the understanding of prostatic leiomyosarcoma.
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