Percutaneous electroresection of the tumor was done. Histology was a pTa low grade urothelial carcinoma. A secondary resection was performed one week later which histologically was free of residual tumor. The patient tolerate both procedures well, serum creatinine did not deteriorate but even improved slightly, and eventually the percutaneous nephrostomy and the mono- J-tail were removed and the patient discharged in a good condition.
There was no additional tests needed. The CT scan showed a mass which compress the Rt. Upper ureter. Lumar open surgical exploration has been done. There was a well delineated mass with out significant adhesions but was attached by a small ligamentous structure to the spinal column. Inraoperative fresh frozen section was reported as a benign tumor which was completely excised. Definitive histology reported a ganglioneuroma without any sign of malignancy. The postoperative course was uneventful.
(European Urology Today, Clinical challenge, Prof. Oliver Hakenberg)
This is a case of urethral fish ( candiru fish)
It should be removed either by cystoscopy or surgically.
Candiru fish, is a species of parasitic freshwater catfish in the family Trichomycteridae native to the Amazon Basin where it is found in the countries of Bolivia, Brazil, Colombia, Ecuador and Peru.
Although some candiru species have been known to grow to a size of 40 centimetres (16 in) in length, others are considerably smaller. These smaller species are known for an alleged tendency to invade and parasitise the human urethra; however, despite ethnological reports dating back to the late 19th century, the first documented case of the removal of a candiru from a human urethra did not occur until 1997. a candiru “jumped” from the water into the urethra as the man urinated while thigh-deep in a river.
As the CT scan had shown increased adipose tissue that compressed the bladder and the rectum, the diagnosis of pelvic lipomatosis was made based on the clinical and the radiological findings. Since renal function was unimpaired and symptoms attenuated, the conservative management with close follow up was decided.
- The differential diagnoses : any pelvic mass that compress bladder and the ureters.
- No further investigations is needed.
- Pelvic lipomatosis is the likely diagnosis.
- No treatment should be done. conservative management with close follow up only.