Case Pres

Weekly case presentation
Department of urology
3rd septemper,2018
Total number of cases= 62
Cases Number
TURP 4
PCNL 5
TURBT 3
URS 6
Checkscope 8
JJ removal 14
Simple nephrectomy 1
Partial Nephrectomy 1
Open prostatectomy 1
Orcheictomy 1
Hernia repair 3
Orcheiopexy 3
Hypospadias repair 3
Varicocelectomy 7
hydrocelectomy 2
1st case
• A 29-year old male , presented with left
testicular pain after sport contact , for about 3
hours duration before admission to ER ,
associated with lower abdominal pain ,and
nausea , no vomiting , no haematuria .
• PMH: -ve
• PSH: cleft lip surgery during chilhood .
• Drug Hx: -ve , no allergy .
On examination
• Concious , alert , oriented , he is in agonizing pain .
Abdominal examination:
 normal skin , no any ecchymosis .
 Soft abdomen , no palpable mass .
 Bowel sound: +ve.
 DRE: normal tone , well formed stool , and no blood .
Genital examination :
 Enlarge left hemiscrotum , ecchymosis ,no blood at meatus, and
normal perinum .
 foley’s catheter easily passed , and no haematuria .
 On palpation :normal contra lateral testicle (RT) , but severe
tenderness of (LT) side , non-palpable left testicle , no palpable
inguinal LN .
Investigation
Operation note
• Under SA.
• Supine position .
• Left transverse scrotal incision done .
• Large scrotal haematoma found , haematoma drained
.
• Raptured tunica vaginalis found , with exposed
testicular tissue .
• Left orcheiectomy done .
• Haemostasis secured .
• Corrugate drain placed .
• Wound closed in layer with testicular elevation .
2nd case
• A 1-year old boy presented with redness ,and
swelling of left hemi-scrotum for 2 days duration .
• his condition started as crying during diaper
change , and poor feeding for 3 days duration, he
was ignored at start by the family , then he took to
paramedic ,and prescribed simple analgesia , and
then his condition start to deteriorate , swelling and
redness started , and presented to ER on 5th day .
• PMH : known case Thalassemia minor.
• PSH: -ve
• Drug hx : no allergy to drug .
On examination
• Conscious , alert , irritable , and in pain .
• BP =100/65 mmhg PR= 123 bpm RR= 17 cpm
SPO2= 98% -O2
• Genital examination ;
• Normal right testicle , no tenderness.
• Redness , swelling ,and high riding of left hemi scrotum.
• Normal left spermatic cord on palpation , no thickening .
• Severe tenderness , pain on elevation ,and absent cremasteric
reflex .
• transillumination test :-ve
CBC
Operation note
• Under G.A .
• Supine position .
• Left transverse scrotal incision done .
• Left testicle and left spermatic cord identified ,
gangrenous left testicle found , left
orcheictomy done .
• Through right transverse scrotal incision , right
orchidopexy done .
• Wounds closed in layers .
3rd case
• A 40-year old female ,presented with right loin
pain for several months duration ,pain
increased by lying down, and deep inspiration,
and relieved by taking analgesia, pain
radiating to back, associated with dysuria ,and
frequency , no haematuria , no nausea , and
no vomiting .
• PMH: no chronic illness.
• Past Obs and gyn hx : G4P4A0 , all by NVD .
• PSH: she had history of bullet injury 1 years ago , pistol injury
from short distance , to right and left flank (31-7-2017).
• 31 -7-2017 : laparotomy done ,had descending colon injury,
resected , and transverse colostomy done .right zone ll
hematoma with bullet not explored .
• 28 -8-2017: closure colostomy done .
• 26-9-2017: missed right upper ureteric injury , managed by
(ureteroureteric anastamosis).
• 1-11-2017: she had loin pain and perinephric collection ,
managed by nephrostomy (it was non- functioning ).
• 12-11-2017: did retrograde pyelography (show small
extravasation ) , then they put jj stent for 6 weeks ,and
nephrostomy removed.
• 10-1-2018 : diagnostic cystoscopy and URS done , she had
healthy and well healed ureter.
Investigations
Investigations
Investigation
IVU (before open ureteral surgery)
IVU (before open ureteral surgery)
JJ-stent
(after retrograde pyelography)
New U/S
CT-KUB
MDT decision
• Since a patient complaining a loin pain, so she
has been re-assessed by MDT ,and plan to
remove her bullet (as a possible cause for her
loin pain ).
Preoperative MX
• Full investigations.
• Blood preparation .
• Bowel preparation .
• Consent about nephrectomy .
• General surgeon consultation .
Operation note
• Under GA.
• Left lateral position .
• Right posterior sub-costal incision done .
• Gerota’s fascia opened .
• Right kidney identified , and kidney released.
• Under C-arm fluoroscopy, and manual check up bullet
found on medial aspect of kidney (without invasion of
renal parenchyma) .
• Bullet removed .
• Wound closed in layers .
4th case
• A 4-month female infant presented with
failure to thrive ,and poor feeding since
delivery , she is diagnosed during antenatal
period with right kidney problem , by
ultrasound showed right severe
hydronephrosis .
• PMH:-ve
• PSH:-ve
• Drug hx: -ve
On examination
• Conscious , alert , and oriented .
• Well hydrated , no jaundice , no palar , and no
LAP .
• Abdomenal examination : no scar of privios
operation , no dilated vessels , no hernia .
• Soft abdomen , no palpable mass , no organo-
megaly .
• +ve bowel sound .
• DRE: normal sphincters tone , well formed
stool .
Investigations
• Hbg= 12.8 mg/dl
• WBC =7000
• PLT= 138000
• BUN=12 mg/dl
• Sr.cretenine=0.9 mg/dl
• Sr.Na=136 meq/dl
• Sr.K=3.8 mg/dl
• PT,PTT,INR = Normal
Antenatal ultrasound
Postnatal ultrasound
IVU
IVU
Operation note
• Under GA , ETT .
• Left lateral position , right sub-costal incision done .
• Right kidney found , sack like contains multiple
small cyst , grossly in favor of (multi-cystic
dysplastic kidney).
• Right nephrectomy done .
• Specimen send for HPE .
• Tube drain placed .
• Wound closed in layers.
5th case
• A 38-year old female presented with right loin
pain , for two months duration . Associated
with haematuria ,on ultrasound found she has
renal pelvis stone , and small renal mass .
• PSH: right PCNL 1 year ago (no evidence of
mass during work up ) .
• PMH : -ve
• Gyne,and obes hx : G4P4A0 , all by C/S .
• Drug hx : -ve , no allergy to drug .
On examination
• Concious , alert , and oriented .
• BP= 130/80 mmhg , PR= 78 bpm
RR= 14 cpm , temp = 37.3 C
• No visible mass , no dilated vessels , no scar of
previous op ( except site of puncture of previous
PCNL ) .
• Soft abdomen , no palpable superficial or deep mass
, no organomegaly .
• + ve bowel sound , no venous hum , no arterial
bruits.
• DRE: normal tone , well formed stool , no blood
CBC
Operation note
• Under GA .
• Left lateral position .
• Right transcostal incision done .
• 12th rib resection done .
• Right kidney identified , renal pelvis found ,
pyelolithotomy done .
• Small renal exophytic mass found, excision done .
• JJ-stent placed antegradely.
• Tube drain placed .
• Foleys catheter placed.
• Specimen send for HPE .
• Wound closed in layers .
Thank you

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Weekly case presentation

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