Nitin Sharma

Background: Upper tract urothelial carcinoma (UTUC) frequently exhibits hematuria, flank pain, clot colic, and flank pain. They are very rarely detected as incidental renal masses in imaging studies. On a computed tomography (CT) scan, they usually appear as soft tissue masses with low-grade enhancement and a filling defect. Radical nephroureterectomy is the standard treatment for high-grade UTUC or large-volume low-grade UTUC. Ureteroscopic laser fulguration can be offered to low-grade, ≤2 cm UTUC, or sometimes for high-grade high volume disease in those with solitary kidneys. We present a case study of an incidentally detected large UTUC (3 cm) that was fulgurated using a thulium fiber laser (TFL). Case Description: An 86-year-old female presented with symptoms of gastritis. CT scan done for further evaluation detected 3 cm urothelial mass arising left lower calyx and left renal pelvis. Endoscopic evaluation and biopsy confirmed left low-grade UTUC. Tumor adequately fulgurated using TFL. Because of patient’s advanced age and asymptomatic presentation, she refused radical nephrectomy and opted for endoscopic treatment and surveillance. She is undergoing 3 monthly surveillance cystoscopies with no evidence of recurrence over last 15 months. Conclusions: It is very unusual for large UTUC to have asymptomatic presentation. Appropriately selected patients who are not candidates for radical cystectomy can be managed with ureteroscopic laser fulguration.

Role of laparoscopic/robotic approaches for urologic surgeries

Introduction: Anastomotic pseudoaneurysm is one of the rarest vascular complications after renal transplant surgery. Therapeutic options include open surgical repair or endovascular stenting.Case presentation: Case 1 had pseudoaneurysm involving external iliac artery and was managed by jump graft to allograft using cadaveric donor iliac arteries and patch angioplasty repair of external iliac artery after excising pseudoaneurysm. Case 2 had undergone orthotopic renal transplant with spleno‐renal arterial anastomosis and developed a massive pseudoaneurysm proximal to spleno‐renal arterial anastomosis. This patient underwent endovascular stenting preserving allograft vascularity and graft function. Outcome in both patients was successful with normalization of renal function to baseline levels.Conclusion: Treatment of renal transplant anastomotic pseudoaneurysms is difficult and associated with high rates of graft loss. Open surgery is the gold standard providing several possibilities for arterial reconstruction preserving graft and limb circulation. Endovascular treatment should be considered in high‐risk surgical patients with favorable anatomy.