Category Archives: Spot diagnosis

Spot diagnosis 45

An 86 year old women presents with acute urinary clot retention. This sis evacuated transurethrally and on endoscopy bleeding from the left ureteric orifice is seen. Retrograde ureteropyelography indicates a mass in the renal pelvis which confirmed by US (Fig.1) and CT scan (Fig.2). Ureteroscopy also confirmed the presence of a papillary tumor of about 3 cm in the renal pelvis originating from the lateral (parenchymal) area. Biopsy verified low grade transitional cell carcinoma.

Two years previously, this lady had undergone right nephroureterectomy for transitional cell carcinoma, Since then she had developed a mild degree of renal insufficiency with a stable serum creatinine of 120 micromol/l. When discussing the current diagnosis and options, she categorically stated that under no circumstances would she want to be dependent on dialysis at her age.

What treatment options –if any-can be offered?

 

(European Urology Today, Clinical challenge, Prof. Oliver Hakenberg, Department of Urology, Rostock University)

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Spot diagnosis 44

This 49 year old man was reffered for an asymptomatic right sided hydronephrosis which had been diagnosed on routin ultrasound. There was no relevant history. With normal urinalysis and normal cystoscopy, a right retrograde ureteropyelogram was performed wich showed a lateral displacement of the upper ureter and moderate dilatation of PCS of the right kidney. A double J stent was inserted and abdominal CT scan was performed (fig. 1 and 2).

  1. Are additional diagnostic tests needed?
  2. What are the relevant diagnoses to be considered?
  3. Which treatment is appropriate?

 

(European Urology Today, Clinical challenge, Prof. Oliver Hakenberg)

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Spot diagnosis 43

A fifty year old male patient presented with penile swelling and retention of urine. KUB (only the bladder is seen above) has been done.

What is your diagnosis? what is the treatment of choice?

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Spot diagnosis 42

This 50 year old man presented with left loin pain which he had for 3 months, associated with some hypogastric pain. The patient had normal body mass index and there was no urological history. Clinical examination was normal. Serum creatinine and blood urea were 0.9 mg/dl and 39 mg/dl, respectively. Abdominal ultrasound showed bilateral grade II hydronephrosis with bilaterally dilated ureters, but no other abnormalities.

There was no post-void residual. Intravenous urography confirmed bilateral grade II-III hydronephrosis and bilaterally dilated ureters and showed a marked deformation and compression of the bladder, with elevation of bladder base, giving the appearance of a “pear” or “ reversed teardrop” (Figure 1 and 2).

A cystoscopy was performed which was difficult due to angulation of the bladder neck which showed an elongated prostatic urethra, normal bladder mucosa and a cranial elongation of the bladder which made the visualization of the whole bladder difficult. The ureteric orifices were situated very close to the bladder neck.

  1. What differential diagnoses should be considered?
  2. Are further investigations needed?
  3. What are likely diagnosis?
  4. What treatment should be done?

The case provided by Dr. Justin Aurelian, Prof.Dr.Th.Burghele Hospital, Bucharest, Romania. European Urology Today)

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Spot diagnosis 41

A 77 year old man presented as an emergency with severe right inguinal pain of sudden onset radiating caudally and voiding difficulties. Due to the pain the patient was unable to lie still. The history consisted of 35 pack years of cigarette smoking and moderate alcohol consumption but was otherwise unremarkable. Current medication clopidogrel and Tamsulosin. Body mass index was 32 and on physical examination a mass was palpable in the middle lower abdomen. Urinalysis show microhaematuria but no sign of infection.

Ultrasound show a fluid filled non-echogenic structure in the middle lower abdomen and mild dilation of both renal pelvicalyceal systems, more pronounce on the right side. A plain abdominal x-ray showed calcifications in the lower pelvis (shown above) A transurethral catheter was inserted but drained only 30 ml of urine and did not alleviate the pain.

What are likely differential diagnoses?

What further diagnostic management is helpful?

 

(Case provided by Proph. Malte Böhm and Dr. Hans Peter Stockamp, Drill-Kliniken, Drillenburg, Germany. European Urology Today)

 

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Spot diagnosis 40

 

A middle age female presented with recurrent UTI . Urine culture show multiple gram negative  organisms. IVU was done. What is the most likely diagnosis?

 

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Spot diagnosis 39

A 52 year old female KUB . described what you see? what is the next step?

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