Gross prostatomegaly with seminal vesicle hematoma presenting as acute retention of urine

MORCELLATED PROSTATIC CHIPS


MRI SHOWING PROSTATOMEGALY WITH GROSS SEMINAL VESICLE DILATATION WITH MASS WITHIN

A 65 year old gentleman came with acute retention of urine.He was catheterised with 18 Fr Foleys catheter; around 1.2 litres of urine drained out.His imaging showed gross prostatomegaly with seminal vesicle dilatation and mass in the seminal vesicle.He further underwent MRI pelvis which demonstrated prostatomegaly with seminal vesicular cyst and hematoma/mass inside.His PSA value was normal and his previous TURPs(he underwent two TURPswithin a span of 2 years for acute retention of urine).The Histopathological analysis showed benign prostatomegaly only.He was taken up for laser prostatectomy and was planned for review imaging after 3 weks for seminal vesicular hematoma/mass.The catheter was removed on second day post-operatively and he passed urine in good stream with low residual urine volume.His histopathological analysis was again benign.In the post-operative period he presented with seconary bleeding on 7 Th day; so was taken up for cystoscopy and clot evacuation.There was organised clot in the prostatic fossa measuring around 6X6 cm.The mass had to be morcellated with the morcellator.After the procedure he was comfortable with clear urine.He was given catheter free trial two days later and passed urine freely.Review Imaging showed no seminal vesicular mass/dilatation.The prostatic mass was probably decompressed seminal vesicular hematoma which probably would have resulted in resolution of seminal vesicular dilatation.

LAPAROSCOPIC RADICAL NEPHRECTOMY FOR EXOPHYTIC MIDPOLAR RENAL MASSA

A 70-year old gentleman came with incidentally detected right renal mass( on USG scan done for urinary retention).He was investigated with staging work up including triphasic CT Scan which revealed enhancing mass around 5 cm in midpolar region with both exophytic and endophytic component.

After explaining to the patient the options of both laparoscopic partial nephrectomy and radical nephrectomy he opted for laparoscopic radical nephrectomy.

Laparoscopic surgery was done with 5 port approach and the specimen was removed by a small right iliac fossa incision.

Seminal Vesiculoscopy:recent case in prostatic utricular cyst

MRI SHOWING SEMINAL VESICULAR DILATATION

We operated a total 8 cases of seminal vesicle obstcruction over last year.

All had low volume ejaculate,azoospermia or severe oligospermia or hematospermia.Out of them;two cases of hematospermia totally resolved after the surgery.

Out of six cases of azoospermia(out of six); four improved- one couple even concieved.Two patients didnot improve.

This shows a great future for seminal vesiculoscopy in obstructive azoopsermia and also hematospermia.It helps in hematospermia.In one case it abated as we did removal of the seminal vesicle calculus in other case there was only congestive hematospermia.It probably helps in idiopathic hematospermia by decreasing the intraseminal vesicular pressures.

Ureterosigmoidostomy Follow up

We had operated 45 year old lady - radical cystectomy and ureterosigmoidostomy for TCC bladder.She underwent the surgery uneventfully.

Post-operatively on 1 year follow up she underwent CECT urogram.Here is the scan photograph showing the ureteral anatomy.

Her hematological/biochemical and VBG analysis was essentially normal.She was passing urine every 1 hourly as per our instrcutions and was leading a very good quality of life.

The ureterosigmoidostomy had fallen out of favour recently due to advent of newer continent diversions like orthotopic diversions.But in select cases ureterosigmoidostomy can offer equal quality of life like orthotopic diversion.

transitional cell carcinoma with staghorn calculus

We operated a case of renal tumor invading the descending colon .He underwent left radical nephrectomy with En Bloc Resection of the intestinal segment.

The patient was having staghorn calculus and nonfunctioning kidney.He was asymptomatic.

He underwent periodic imaging and blood biochemistry studies.This time he presented with signs of constitutional symptoms and dull continuous pain in the left flank.

His ultrasound showed mass in the kidney.He was further evaluated with Triphasic CT scan which revealed left renal mass with obscured planes with the descending colon and staghorn calculus.

He was taken up for surgery in view of his metastatic work up was essentially normal.

In 2 months postoperative period he is doing well and planned for palliative chemo/radiotherapy.