A seven-month-old female child presenting with a large abdominal mass was found on investigation to have a duplex right kidney with a non-functioning obstructed upper moiety and a right ureterocele. The grossly dilated and tortuous upper moiety ureter presented as a large cystic mass on ultrasound and computed tomographic scans.
Malignant fibrous histiocytoma is a mesenchymal tumour which can involve the genitourinary organs primarily or by secondary extension. Both conditions are rare. We report four cases of retroperitoneal malignant fibrous histiocytoma involving the kidney by local extension. Diagnosis was difficult because of diverse, non-specific clinical features and may only be reached at operation or post mortem. Prognosis is poor. Although en bloc tumour resection with nephrectomy was possible in two patients, they returned with recurrences.
This case report illustrates how a life-threatening renal bleeding which has failed to be controlled by open surgery can be elegantly managed by a minimally invasive technique of interventional radiology. It also allows maximal conservation of renal tissue so that the patient can avoid chronic dialysis or renal transplantation.
40 cases of major renal trauma over a period of five years in a peripheral hospital in Singapore were reviewed. 90% were due to blunt trauma with motor-cycle accidents forming the majority. There were five cases of superficial cortical injury, three cases of shattered kidneys, six cases of parenchymal injuries, one case of pedicle injury and one case of combined pedicle and parenchymal injury. Nephrectomy rate was 22.5% in this series. This is felt to be unduly high. Half of all the cases operated upon ended up with an immediate total nephrectomy. There was no mortality in this series. We recommend a more conservative policy of watchful waiting to achieve better chances of organ preservation without increasing mortality.
A prospective study was performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur. Over a period of 14 months from 1 January 1982, 12 new cases of analgesic nephropathy (AN) were documented. Contrary to the experience in the West and in Australia, AN in Malaysia tends to have a male preponderance and occurs even in the younger age groups. The common analgesics abused are paracetamol, Chap Kaki Tiga and Chap Harimau. The main reasons for analgesic abuse are headache and arthritis. In addition to radiological features of renal papillary necrosis patients have the other manifestations of the disease such as peptic ulceration, anaemia, neuro-psychiatric disorders and ischaemic heart disease.
Two to three percent of stone disease cases occur in the paediatric age group. It is common in some parts of the world, such as in Turkey, India and Thailand. More than 50 percent of stones in children are still managed through open surgery. Ureteroscopic intervention for children remains a challenging treatment option. However, in contemporary urology practice, this mode of intervention is becoming more common. In this retrospective study, we reviewed our experiences with ureteroscopy and pneumatic lithotripsy in the paediatric and adolescent age group.
Renal injury is observed in 10 percent of cases of abdominal trauma, and the majority (80 percent to 90 percent) of these are attributable to blunt trauma. Intravenous urography and ultrasonography of the abdomen were previously the modalities of choice in the imaging of renal injuries. However, computed tomography (CT) is currently the imaging modality of choice in the evaluation of blunt renal injury, since it provides the exact staging of renal injuries. The purpose of this article is to describe the CT staging of renal injuries observed in blunt abdominal trauma based on the Federle Classification and the American Association for the Surgery of Trauma renal injury severity scale.