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Trading Chanakya Group

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Clinical Urography !!TOP!!

Methods: One hundred urological patients who had undergone double-J ureteral stenting attending surgery department were taken. Patients were subjected to detailed history and clinical examination and other routine investigations and symptoms of any complications were recorded starting at the time of placement of double-J ureteral stent till its removal.

clinical urography

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Tuberculosis of the penis is a very rare condition, clinically manifesting as primary or secondary tuberculosis or tuberculide. (1) Penile involvement secondary to urethral tuberculosis is rare and its presentation with periurethral fistulas leading to "water can" penis is unknown. We report this rather intriguing condition in a patient.

A 68-year-old male patient was referred to the urology department for right hydronephrosis complicating an incidental distal ureter stricture, which was found during an abdominal computed tomography (CT) scan for distal esophageal cancer. The patient was recently diagnosed with a 1.2 cm round-shaped distal esophageal squamous cell carcinoma, clinically stage T1, and was receiving a two-week 6600 cGy proton therapy in 33 fractions. The patient had a past medical history of restrictive lung disease, alcoholic liver cirrhosis (Child A), and was a heavy ex-smoker.

The CT treatment-planning scan showed right hydronephroureterosis due to distal ureteral stricture and ureter kinking. A CT urography was further performed at the urology department showing an abnormal ureteral kinking lesion with a distal intraureteral enhancing mass, just above the ureterovesical junction of the bladder ( Figure 1A). Ureteral cancer was suspected given the findings in the right distal ureter: irregular wall thickening, and hydronephrosis with multiple small stones. Cystoscopy and microscopic urine analysis using the Nuclear Matrix Protein 22 test showed negative findings, except for benign hyperplasia of the prostate and a moderate trabeculated bladder without any voiding symptoms. Further, ureteroscopic biopsy with intraureteral urine cytology under general anesthesia found atypical cells, atypical pleomorphic cell nests, and chondroid tissue, consistent with sarcomatoid urothelial carcinoma ( Figure 1B).

In conclusion, this recurrent metastatic case of carcinoma is a rare variant of multifocal synchronous ureteral cancers which responded well to atezolizumab. Our findings will help in early diagnosis, treatment planning, and better management with immune checkpoint inhibitors in case the current chemotherapy fails; thus, ensuring improved prognoses. In future, a series of case reports and studies would highlight the clinical benefit of checkpoint inhibitors with/without immunomodulatory agents in this disease clearly. 350c69d7ab


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