Autologous transobturator midurethral sling

OBJECTIVE

The aim of this study is to describe a novel transobturator midurethral sling surgery technique by using rectus abdominis fascia.

MATERIAL AND METHODS

A 54-year-old woman complaining of urinary leakage during effort was diagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry and measurement of residual urine volume. She was anxious about complications related to synthetic meshes. However, she was not interested in relatively morbid surgeries such as colposuspension and pubovaginal sling. Autologous transobturator midurethral sling was discussed with the patient. The patient approved the surgery and the surgery was planned. A 5 cm rectus fascia was harvested via suprapubic incision and non-absorbable stay sutures were placed on its' both edges. Anterior vaginal incision together with paravaginal dissection was performed, as in classical transobturator sling surgery. Groin puncture and blind dissection of adipose tissue was performed. C-shaped trocars were inserted, and advanced through groin punctures and brought up to midurethral incision by finger guidance. Stay sutures were transported via C-shaped trocars to the groin puncture in both sides. Graft was positioned on the midurethral part without any tension and stay sutures were tied to create a tissue bridge on obturator membrane. Incisions were closed and vaginal tampon was placed. Patient was discharged at the first postoperative day.

RESULTS

At postoperative third and sixth months, patient was totally dry and did not have any voiding complaints. Small abdominal and vaginal incisions were clean, as well.

CONCLUSION

Autologous transobturator midurethral sling surgery is a safe, effective and feasible surgical option for stress urinary incontinence in the era which mesh-related concerns are rising. Studies with larger volume and long-term follow up periods are needed.

Renal pyelocalyceal squamous cell carcinoma in a patient with an ectopic kidney presenting with chronic pyelonephritis: a case report

Background

Until now, few cases of pelvis squamous cell carcinoma in various renal anomalies have been reported. To our knowledge, primary squamous cell carcinoma arising from a pelvic ectopic kidney has never been described. In this report, we describe a case of renal pyelocalyceal squamous cell carcinoma in a patient with an ectopic kidney presenting with chronic pyelonephritis.

Case summary

A 73-year-old Caucasian woman presented to our hospital with pyelonephritis symptoms. Abdominopelvic computed tomography revealed heterogeneous and irregular minimal contrast enhancement in the pelvic ectopic kidney parenchyma. Radiologists reported that the images were consistent with chronic pyelonephritis. A Tc-99m dimercaptosuccinic acid renal scan demonstrated a nonfunctioning right pelvic ectopic kidney. The patient underwent open simple nephrectomy via modified Gibson incision. The whole mass was a distended, saclike structure without any grossly visible renal tissue. Pathological examination showed renal pelvis squamous cell carcinoma 8 cm in diameter infiltrating into the renal capsule and perinephritic fatty tissue. The patient was staged as T4N0M1 renal pelvis squamous cell carcinoma. The patient was being treated in the intensive care unit for respiratory distress on the seventh day after the operation. By the first-month follow-up visit, the patient had died of acute respiratory distress syndrome.

Conclusions

Although rare, renal pelvis squamous cell carcinoma should be considered in the differential diagnosis of a renal mass in patients who have renal anomalies and chronic pyelonephritis.

Transobturator tape material detected in the bladder neck: a case report

INTRODUCTION

Stress urinary incontinence surgeries (transobturator tape and tension-free vaginal tape) are safely performed with success rates over 90%. The transobturator tape procedure attracted more attention due to the lack of major complications, such as intraabdominal organ and vascular injuries, related to the tension-free vaginal tape procedure. Although there are no major or mortality-related complications, more lower urinary complaints, especially vaginal erosion, are reported in transobturator tape surgery. Here we present a rare complication of transobturator tape surgery: the accidental placement of mesh material in the bladder neck. With this case report, we aimed to discuss the diagnosis and management of misplaced transobturator tape material.

CASE PRESENTATION

A 38-year-old Caucasian woman who had stress urinary incontinence that had persisted for 6 years underwent transobturator tape surgery in a different clinic 2 years ago. Subsequently, she presented to our clinic with lower urinary tract complaints such as incontinence and dysuria. A physical examination was unremarkable besides total incontinence. A diagnostic cystoscopy was performed and sling material that crossed her bladder neck from 3 o'clock to 10 o'clock was identified. The misplaced transobturator tape material was cut endoscopically with an internal urethrotomy knife. Afterwards, a midurethral incision was made and mesh parts were removed bilaterally. After successful removal of the mesh material, a new transobturator tape was placed.

CONCLUSIONS

Even though transobturator tape surgery is a safe and effective procedure for stress urinary incontinence, certain complications can be encountered. Misplacement of the mesh material through the bladder neck is a rare complication and can be managed by successfully removing the mesh material and appropriately placing new transobturator tape material.

Congenital prepubic sinus presenting with purulent discharge after circumcision: a case report

BACKGROUND

Congenital prepubic sinus is a rare anomaly found in the midline of the lower abdomen. Congenital prepubic sinus is usually asymptomatic in neonates, and a diagnosis is often achieved later in life after spontaneous extrusion of purulent material from the pre-existing hole in the pubic region. We present a case of congenital prepubic sinus presenting with purulent discharge after circumcision. A 4-year-old Caucasian boy presented to our urology out-patient clinic with purulent discharge from the distal part of the dorsum of his penis. He had a history of circumcision performed at a different center, 6 months ago. His parents stated that although various antibiotics were used, the purulent discharge continued for 6 months and the child had no complaints before circumcision. His condition was reported as superficial dorsal venous thrombosis, known as penile Mondor disease, in magnetic resonance imaging that was performed in the previous hospital. A physical examination revealed a small pinhole lesion at the distal part of his penis and a rigid cylindrical tube extending to the proximal side of his penis. We performed fistulography by injecting contrast material through a small angiocatheter and confirmed the diagnosis of prepubic sinus. Surgical exploration was performed and a long sinus, apparently ending as a fibrous tract at the anterior surface of his pubic symphysis, was found and resected.

CONCLUSIONS

Before congenital prepubic sinus surgery, it is critically important to rule out penile Mondor disease and the possibility of a circumcision complication (especially infective complications) mimicking congenital prepubic sinus.

Solitary fibrous tumor/hemangiopericytoma of the penis

Solitary fibrous tumor/hemangiopericytoma (SFT-HMP) is a rare spindle-cell mesenchymal tumor, thought to be of myofibroblastic origin. Penile SFT-HMP was mentioned in the literature in two separate case reports which were published in 2015 and 2017. We present the first case of SFT-HMP which is localized on corpus cavernosum of the penis. A 55-year-old man presented to our clinic with a small and gradually growing lesion on his penis for the past year, which recently caused difficulties during sexual intercourse. On physical examination; a well-shaped, nodular non-fluctuant, solid, painless mass, measuring 4×4 cm was palpated. Magnetic resonance imaging showed 5×5 cm mass located on the right corpus cavernosa. Under spinal anesthesia, surgical excision was performed. Pathologically, the tumor had an irregular architecture patterns and was characterized by hypercellular areas separated by thin-walled, branching vessels, lined with a single layer of flattened endothelial cells. SFT-HMP rarely occurs in genital tract and penile presentation is among the rarest. It should be classified and considered under penile masses, especially if the mass is well circumscribed, painless and slowly growing in nature. After differential diagnosis, surgical excision is mandatory.