A 47-year-old male complained of anuria for 2 days with elevated creatinine of 14 mg/dL on admission. Patient underwent emergent hemodialysis. Non-contrast CT showed a solitary ectopic pelvic kidney with a 2 cm. pelvolithiasis and a 1 cm upper pole calyceal stone with obstructive hydronephrosis. He therefore underwent ultrasound-guided nephrostomy tube placement. Once clinically stable, the patient underwent a multi-tract supine PCNL. Intraoperatively, the authors noted tense abdominal distention accompanied by hypotension during the procedure. A diagnosis of compartment syndrome secondary to hydroperitoneum was considered. An indwelling stent and a nephrostomy tube were placed. An abdominal pigtail drain was placed removing three liters of fluid. The patient remained intubated for 3 days. He underwent blood transfusion. He required two 2 sessions of hemodialysis postoperatively. The patient was discharged in stable condition on postoperative day 22. Hydroperitoneum is a potential complication of PCNL in ectopic pelvic kidneys. Its prompt recognition, followed by immediate aspiration of intraabdominal fluid and drain placement is life-saving.
solitary kidney ; hydroperitoneum ; compartment syndrome

Management of nephrolithiasis in patients with urinary diversions pose a unique therapeutic challenge for the following reasons: 1) retrograde ureteral access is difficult to perform through a bowel diversion and 2) percutaneous renal access becomes challenging because of inability to do a retrograde pyelogram. For this reason, image-guided access through a combined ultrasound and fluoroscopic guidance are both necessary. This clinical problem becomes even more complicated when dealing with a solitary functioning kidney. Treatment should be precise in order to avoid any complications that may progress to renal failure. Presented here is a 15-year-old male adolescent who had previously undergone a radical cystectomy with an ileal conduit for a rhabdomyosarcoma of the bladder last 2008, and complained of flank pain, fever and foul-smelling urine. Imaging studies showed left obstructive hydronephrosis with ureterolithiasis and nephrolithiasis, and an atrophic contralateral kidney. A preliminary nephrostomy tube drainage was done to recover renal function, followed later by percutaneous endoscopic stone management. Discussed here are the challenges involved in his therapy as well as the advantages of a stepwise approach including the short-term outcomes.
ileal conduit ; pediatric ; solitary kidney

A solitary fibrous tumor(SFT) is a rare spindle cell neoplasm that arises most commonly in the pleura but has recently been described in various extrapleural sites. SFTs occurring in the renal pelvis or peripelvis are extremely rare, and only 3 cases have been reported. We report here on a 71-year-old woman who presented with an incidentally detected left renal mass and underwent radical nephroureterectomy under the suspicion of renal pelvis cancer. The pathological examination of the tumor revealed a SFT occurring in the renal peripelvis. The patient has no evidence of disease 1 year after the surgery. Most SFTs appear to pursue a benign course, although, because some of them have the potential to recur or metastasize, careful long-term follow-up is necessary.
Aged ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Kidney Neoplasms ; Kidney Pelvis ; Pleura ; Solitary Fibrous Tumors*

OBJECTIVE: To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in the treatment of patients with solitary kidney stones. METHODS: The clinical data of 22 patients with solitary kidney stones treated with PCNL in Peking University People's Hospital from September 2008 to June 2014, with the follow-up data of more than 5 years were analyzed retrospectively. Perioperative indicators, postoperative stone free rate (SFR) and incidence of complications were recorded. Ultrasonography was used to evaluate the long-term stones recurrence rate. Serum creatinine and estimated glomerular filtration rate (eGFR) were used to assess the long-term renal function. RESULTS: In this group of 22 patients, the average age was (50.3±11.8) years, with 10 cases of anatomic solitary kidneys, 12 functional solitary kidneys, and the median stone diameter was 1.65 (1.1-3.9) cm. All the patients had multiple stones, including 7 cases of staghorn stones. The median pre-operative serum creatinine was 104.5 (60.0-460.0) μmol/L, and the mean eGFR was (60.3±29.4) mL/min, showing no statistically significant difference compared with that before surgery. The mean operative time was (88.2±42.0) min, and there were 11 cases of single-channel and double-channel PCNL. The median serum creatinine on the first day after surgery was 102.0 (63.0-364.0) μmol/L, and the mean eGFR was (58.0±25.1) mL/min. The mean postoperative hospital stay was (8.7±5.2) days. In this group, 5 patients (22.7%) presented short-term complications, among which 4 patients presented postoperative infection and massive hemorrhage at the same time, which improved after conservative treatment, and 1 patient presented pleural injury and improved after closed thoracic drainage. Two patients (9.1%) developed long-term complications, and ureteral stricture occurred 3 months after operation, which improved after balloon dilatation. The median follow-up time was 6.2 (4.7-11.1) years. The median serum creatinine at the last follow-up was 104.0 (72.4-377.0) μmol/L, and the mean eGFR was (60.1±23.7) mL/min, showing no statistically significant difference compared with that before surgery. Renal function decreased in 6 patients (27.3%). Initial and final SFR were 72.7% and 100%, respectively. During the 6.2-year follow-up, 9 patients (40.9%) experienced recurrence of kidney stone. After stone recurrence, 13 lithotomy surgeries were performed, and the SFR by the latest follow-up was 63.6%. CONCLUSION This study had the longest follow-up time for patients with solitary kidney stones after PCNL reported at home and abroad. Ultrasound-guided standard PCNL was safe and effective in the treatment of solitary kidney stones. Long-term follow-up results showed that the recurrence rate of kidney stones was still high, but the long-term renal function was stable after operation, and some patients showed mild renal function decline.
Adult ; Humans ; Kidney Calculi ; Middle Aged ; Nephrolithotomy, Percutaneous ; Retrospective Studies ; Solitary Kidney/surgery* ; Treatment Outcome

The solitary fibrous tumor, of rare mesodermal origins, primarily affects the pleura and occasionally occursin the peritoneum and at nonserosal sites. Although this is a pathologically well established entity, it isfrequently confused radiologically and pathologically with other tumors of mesenchymal origin. We report one case of a solitary fibrous tumor in the retroperitoneum. The 15X10X7cm mass, lacated in the left perirenal space just above the left kidney, had relatively homogeneous consistency and was well-delineated from surrounding organs inCT and MR images. It showed intense, gradual, centripetal enhancement during dynamic scans, and partially unenhanced areas which matched the high signal intensity portions in T2 weighted MR images, pathologically correlated to myxoid degeneration. Although not specific, when a large, well-delineated mass of strong contrast enhancement with lack of massive necrosis is encountered, solitary fibrous tumor must be included in the differential diagnosis of a refroperitoneal soft tissue mass.
Diagnosis, Differential ; Fibroma ; Kidney ; Mesoderm ; Necrosis ; Peritoneum ; Pleura ; Solitary Fibrous Tumors*

Solitary fibrous tumor (SFT) is a benign mesenchymal neoplasm usually occurring in the pleura. Kidney is one of the rarest sites for SFT. We report here on two cases of renal SFT found in 30-year-old and 33-year-old men with review of the literatures. Both cases manifested as well-enhanced solid masses in kidney and radical nephrectomies were done. The tumors consisted of bland-looking spindle cells arranged in short, ill-defined fascicles and storiform pattern with characteristic hemangiopericytoma-like blood vessels. The tumor cells were strongly positive for CD34 and CD99, focally positive for bcl-2, and negative for cytokeratin and human melanoma black-45 on immunohistochemical stainings. Possibility of SFT should be considered in the differential diagnosis of a renal mass which consists of benign-looking spindle cells and hemangiopericytomatous blood vessels. Immunohistochemical staining for CD34 is essential to confirm the renal solitary fibrous tumor.
Adult ; Blood Vessels ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Keratins ; Kidney ; Male ; Melanoma ; Nephrectomy ; Pleura ; Solitary Fibrous Tumors

Adult ; Carcinoma ; complications ; Female ; Humans ; Kidney Neoplasms ; complications ; Solitary Fibrous Tumors ; complications ; Thyroid Neoplasms ; complications

Solitary fibrous tumors (SFTs) are a rare spindle-cell neoplasm originating from mesenchymal fibroblast-like cells. Although they generally arise from submesothelial connective tissue in the pleura, many other locations have also been described, including the mediastinum, upper respiratory tract, orbit, salivary gland, thyroid, and prostate. SFT of the kidney, however, has rarely been described, and only 1 case has been reported in Korea. A 53-year-old female visited our hospital for abdominal pain, and abdominopelvic computed tomography showed a heterogeneous well-enhanced mass in the renal pelvis. She was treated with a laparoscopic radical nephroureterectomy, which revealed an SFT of the kidney.
Abdominal Pain ; Connective Tissue ; Female ; Humans ; Kidney ; Kidney Pelvis ; Korea ; Mediastinum ; Middle Aged ; Orbit ; Pleura ; Prostate ; Respiratory System ; Salivary Glands ; Solitary Fibrous Tumors ; Thyroid Gland

This experiment aimed to investigate the effect of adrenergic system in the subnucleus commissuriu of nucleus solitrius tractus (CNTS) on renal nerve discharges. Norepinephrine (NE) was microinjected into the CNTS of rabbits and mean arterial blood pressure (MAP) and renal nerve discharges (FRND) were synchronously recorded. The results indicated that (1) microinjection of norepinephine into the CNTS of rabbit could significantly attenuate the frequency of renal nerve discharge, and at the same time decrease markedly the mean arterial pressure. (2) Microinjection of 0.3 nmol yohimbin into CNTS had no significant influence on FRND and MAP, but could attenuate and even reverse the effects of NE on FRND and MAP. These results suggest that microinjection of NE into CNTS may activate the alpha-adrenorecptor located in CNTS and secondarily produce a depressor effect by attenuating the activity of periphenal sympathetic nervous system.
Blood Pressure/drug effects ; Depression, Chemical ; Kidney/*innervation ; Microinjections ; Norepinephrine/*pharmacology ; Solitary Nucleus/*physiology ; Sympathetic Nervous System/drug effects ; Sympathetic Nervous System/*physiopathology ; Vasomotor System/physiopathology

Objective: To explore the clinical diagnosis and treatment of seminal vesicle cyst (SVC) associated with ipsilateral renal agenesis (Zinner syndrome) in order to promote the understanding of the disease. METHODS: We retrospectively analyzed the clinical data about 1 case ofZinner syndrome diagnosed and treated in our hospital and reviewed the literature related to this disease in domestic and foreign authoritative databases. RESULTS: The patient was a 23-year-old male, diagnosed with Zinner syndrome, treated bytransrectal aspiration of SVC, and discharged from hospital 3 days postoperatively. Follow-upat 6 months after discharge found that the patient no longer felt perineal discomfort in the endstage of urination, but transrectal ultrasonography of the prostate revealedthe samevolume of fluid in the left seminal vesicles as before,which indicated recurrence. CONCLUSIONS SVC associated with ipsilateral renal agenesis can be considered asZinner syndrome. Transrectal aspiration of SVCcan relieve the local symptoms of the patient but relapse may easilyoccur. Therefore it is not recommended as the first-choice treatment of the disease.
Cysts ; diagnostic imaging ; therapy ; Genital Diseases, Male ; diagnostic imaging ; therapy ; Humans ; Male ; Perineum ; Recurrence ; Retrospective Studies ; Seminal Vesicles ; diagnostic imaging ; Solitary Kidney ; complications ; Syndrome ; Ultrasonography ; Young Adult