A 51 year old man presented with right lumbar pain and gross total Hematuria. There were no other voiding symptoms. He works as a police officer and has a history of 30 years of cigarette smoking. Also, a previously asymptomatic 2 cm stone in the right renal pelvis has been presented for 15 years. There had been two unsuccessful ESWL sessions several years ago. Due to the lack of effect the patient had decided not to have any more treatments and discontinued follow up.
Physical examination and routine clinical chemistry was normal. On urinalysis, marked leukocyturia as well as gross haematuria were seen. Urine culture and cytology were negative. A plain x-ray show a 25 mm dense opacity projecting to the right renal area. In addition, a CT scan was perfomed (the Figure above)
- What differential diagnosis should be consider ?
- Are further investigations neede?
- Which treatment is appropriate?
(European Urology Today, January/ February, Clinical challenge, Prof. Oliver Hakenberg)