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Adriaenssens Z, Lamoury RPA, Tilborghs S, Wachter SD, Brits T. Bladder perivascular epithelioid cell neoplasm: Review on clinical features of this rare tumor. Urol Ann 2024; 16:28-35. [PMID: 38415228 PMCID: PMC10896323 DOI: 10.4103/ua.ua_40_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/13/2023] [Indexed: 02/29/2024] Open
Abstract
Perivascular epithelioid cell neoplasm (PEComa) is a rare mesenchymal tumor composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. They can arise in various localizations such as the bladder. A total of 36 case reports regarding bladder PEComa have been described in the literature. Eleven reviews regarding this tumor have been published in literature so far primarily focusing on anatomic pathology. Through these reviews, it is known that in bladder PEComa, the melanocytic marker Human Melanoma Black-45 is expressed in 100% of cases whereas variable expression can be seen in multiple other melanocytic and myoid markers such as smooth muscle actin, Melan-A, CD117, S100, CD31, and CD34. Since current reviews mainly emphasize anatomic pathology, we perform a review focusing on the clinical aspects of PEComa at the level of the clinician. A manual electronic search of the PubMed/Medline and Web of Science Core Collection databases was conducted. Search was done on (perivascular epithelioid cell neoplasms [MeSH terms]) AND (Bladder). All case reports and reviews were encompassed until March 15, 2023, to identify studies that assessed bladder PEComa. The age of presentation is relatively low with a median age of 37 years. There is a female predominance with a female/male ratio of 1.5. The tumor shows no preference in anatomical localization within the bladder. Even involvement of the bladder neck, proximal urethra, and distal ureter has been described. The clinical presentation consists in the majority of patients of symptoms related to the urinary tract such as hematuria, dysuria, passage of urine sediment, frequency, and urgency. Other symptoms include abdominal discomfort and dysmenorrhea. In clinical examination, an abdominal mass can be found based on the size and location of the tumor. Further examination usually encompasses cystoscopy due to the hematuria and radiological investigations such as ultrasound (US), computed tomography, and magnetic resonance imaging. These radiological investigations reveal a heterogeneous solid mass with clear borders. In our center, we performed a transvaginal US additionally in a patient with bladder PEComa, which was the only investigation in our patient that concluded the mass was located in the Retzius space. For treatment, transurethral resection of the bladder tumor and partial cystectomy were both described in equal numbers. The choice of treatment depends on the localization and size of the tumor. Follow-up consists of imaging, but clear guidelines on this matter are lacking. Bladder PEComa is a rare condition and usually presents itself with nonspecific symptoms. Radiological investigations will reveal the tumor, but the final diagnosis is based on cytological and immunohistochemical features. Since bladder PEComa is an entity with uncertain malignant potential, it is important to include this entity in the differential diagnosis when a patient presents with lower abdominal discomfort and lower urinary tract symptoms in combination with a mass in the pelvic region.
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Affiliation(s)
- Zeno Adriaenssens
- Department of Anatomy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Robby Peter Anna Lamoury
- Department of Anatomy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Sam Tilborghs
- Department of Anatomy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Stefan De Wachter
- Department of Anatomy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Tim Brits
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
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Vanderbruggen W, Brits T, Tilborghs S, Derickx K, De Wachter S. The effect of tranexamic acid on perioperative blood loss in transurethral resection of the prostate: A double-blind, randomized controlled trial. Prostate 2023; 83:1584-1590. [PMID: 37602525 DOI: 10.1002/pros.24616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/14/2023] [Accepted: 08/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Bleeding and bleeding-related complications remain common after bipolar transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. This may possibly lead to prolonged postoperative irrigation, catheterization, and hospital stay. The objective of this trial was to evaluate the effect of high-dose tranexamic acid (TXA) on perioperative blood loss in patients treated with bipolar TURP for prostate sizes between 30 and 80 g. METHODS We conducted a single-center, prospective, double-blind, randomized controlled trial. Eighty patients were screened for inclusion between March 2020 and January 2023. After exclusion, 65 patients were randomized in two comparable groups. The TXA group (31 patients) received a TXA intravenous loading dose of 10 mg/kg over 30 min before induction, followed by a maintenance dose of 5 mg/kg/h over 12 h. The placebo group (34 patients) received an equal dose of saline infusion. We measured age, weight, preoperative prostate size, anticoagulant use, 5-alpha reductase inhibitor use, preoperative urinary tract infection, American Society of Anesthesiologists score, difference in pre- and 24 h postoperative hemoglobin and hematocrit levels, operative time, resected adenoma weight, duration of postoperative irrigation, total amount of postoperative irrigation fluid, indwelling catheter time, duration of hospital stay, blood transfusion rate, and 4-week complication rate. RESULTS Baseline characteristics in both groups were comparable. Postoperative hemoglobin decrease in TXA versus placebo group was 1 versus 1.6 mg/dL, respectively (p = 0.04). In addition, the amount of postoperative irrigation fluid (10.7 vs. 18.5 L), irrigation time (24.3 vs. 37.9 h), catheterization time (40.8 vs. 53.7 h), and hospital stay (46.9 vs. 59.2 h) were statistically significant in favor of TXA use. No blood transfusions were carried out. Four-week complication rate was comparable between the two groups. CONCLUSIONS Perioperative high-dose TXA seems beneficial in reducing hemoglobin loss, postoperative irrigation, catheterization time, and hospital stay in bipolar TURP for prostate sizes between 30 and 80 g, without increased risk of TXA-related thromboembolic events.
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Affiliation(s)
- Wies Vanderbruggen
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Tim Brits
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Sam Tilborghs
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Katleen Derickx
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Stefan De Wachter
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium
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Lamoury RP, Pauwels J, De Wachter S, Brits T. Review of vasocutaneous fistulas and other rare complications after vasectomy. Cent European J Urol 2023; 76:155-161. [PMID: 37483862 PMCID: PMC10357828 DOI: 10.5173/ceju.2023.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/20/2023] [Accepted: 04/03/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy. Material and methods A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy. Results Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications. Conclusions Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians.
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Affiliation(s)
- Robby P.A. Lamoury
- Department of Urology, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Jasper Pauwels
- Department of Urology, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Tim Brits
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
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Smets H, Van Uytven Z, Brits T, De Wachter S, De Win G. Buccal mucosa endo-laparoscopic repair of bladder neck stenosis after radical prostatectomy. Urology Video Journal 2022. [DOI: 10.1016/j.urolvj.2022.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Martens F, De Wachter S, Van Breda J, Witte L, Brits T, Smits M, Padron O, Sutherland S, Toozs-Hobson P, Digesu A, Cline K, Dmochowski R, Heesakkers J. OASIS pivotal trial to evaluate the safety and efficacy of the RENOVA iStim System™ for the treatment of women with overactive bladder. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Henderickx MM, Brits T, Zabegalina NS, Baard J, Ballout M, Beerlage HP, De Wachter S, Kamphuis GM. Can operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy? Cent European J Urol 2022; 75:90-95. [PMID: 35591959 PMCID: PMC9074056 DOI: 10.5173/ceju.2022.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/10/2021] [Accepted: 01/15/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Fluoroscopy is routinely used during ureterorenoscopy. According to the ‘As Low As Reasonably Achievable’ (ALARA) principle, radiation exposure should be kept as low as reasonably achievable to decrease the risk of negative long-term effects of radiation for patients and medical staff. This study aims to assess if operator-controlled imaging during flexible ureterorenoscopy for nephrolithiasis could reduce fluoroscopy time when compared to radiographer-controlled imaging. Material and methods This study was a bicentric, retrospective comparison between patients treated for nephrolithiasis with flexible ureterorenoscopy with either operator-controlled imaging or radiographer-controlled imaging. A total of 100 patients were included, 50 were treated with operator-controlled imaging and 50 with radiographer-controlled imaging. Patients undergoing flexible ureterorenoscopy with a total stone burden <20 mm and data on radiation exposure were included. Patient characteristics, stone characteristics, surgical details and fluoroscopy time were recorded for each patient and both groups were compared. Patient data were expressed as median. A 2-sided p-value <0.005 was considered statistically significant. Results This study found no significant differences between both groups regarding the patient and stone characteristics. However, it found a significant shorter fluoroscopy time in the operator-controlled imaging group of 33.5 seconds (IQR 16.0–70.0) compared to 57.0 seconds (IQR 36.8–95.3) in the radiographer-controlled imaging group (p = 0.001). Conclusions This study shows that operator-controlled imaging in flexible ureterorenoscopy could reduce fluoroscopy time when compared to radiographer-controlled imaging. Operator-controlled imaging might therefore allow urologists to perform ureterorenoscopy with greater independence while additionally reducing fluoroscopy time and its consequent negative effects for medical staff and patients.
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Affiliation(s)
| | - Tim Brits
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | | | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mansour Ballout
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Harrie P. Beerlage
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Guido M. Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Henderickx M, Zabegalina N, Brits T, Baard J, Ballout M, Beerlage H, De Wachter S, Kamphuis G. Does operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy? Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00643-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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De Block CEM, Shivalkar B, Goovaerts W, Brits T, Carpentier K, Verrijken A, Van Hoof V, Parizel PM, Vrints C, Van Gaal LF. Coronary artery calcifications and diastolic dysfunction versus visceral fat area in type 1 diabetes: VISCERA study. J Diabetes Complications 2018; 32:271-278. [PMID: 29310998 DOI: 10.1016/j.jdiacomp.2017.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 11/09/2017] [Accepted: 11/22/2017] [Indexed: 01/29/2023]
Abstract
AIMS Type 1 diabetic patients (T1DM) experience a higher cardiovascular disease and mortality risk than controls. We investigated whether visceral adipose tissue (VAT) contributes to coronary artery calcifications (CAC) and cardiac dysfunction in T1DM. METHODS A cross-sectional study of 118 T1DM patients without a history of cardiovascular disease (men/women: 68/50, age 46±12years, HbA1c 7.6±0.9%, BMI 25.8±4.1kg/m2) was conducted. CAC and VAT were measured using a CT scan. CAC was scored using the Agatston method. Cardiac functional abnormalities were assessed by echocardiography. RESULTS CAC scored ≥10 in 42% of patients. Systolic function was normal in all, but diastolic dysfunction was present in 75%. Forty-six percent had VAT≥100cm2. CAC score≥10 occurred more often in subjects with VAT≥100cm2 (54% vs 31%; p=0.01). Age (OR=1.10; p<0.0001), diabetes duration (OR=1.10; p=0.008), gender (OR=4.28; p=0.016), LDL-cholesterol (OR=1.03; p=0.009) and metabolic syndrome (OR=5.79; p=0.005) were independently associated with a CACS≥10. Subjects with CACS≥10 were more prone to have diastolic dysfunction (84 vs 54%; p=0.03). Factors independently associated with diastolic dysfunction were age (OR=1.11; p=0.002), waist circumference (OR=1.10; p=0.016) and VAT (OR=0.99; p=0.035). CONCLUSIONS Excess VAT in T1DM, present in 46%, is associated with diastolic dysfunction and CAC, present in respectively 75% and 42% of patients. Timely detection might improve future cardiovascular risk.
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Affiliation(s)
- Christophe E M De Block
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp, Belgium; Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Bharati Shivalkar
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Wouter Goovaerts
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp, Belgium
| | - Tim Brits
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp, Belgium
| | - Ken Carpentier
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp, Belgium
| | - An Verrijken
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp, Belgium; Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Viviane Van Hoof
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Chris Vrints
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Luc F Van Gaal
- University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp, Belgium; Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Edegem, Belgium.
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Henderickx MMEL, Brits T, Muilwijk T, Adams T, Vandeursen H. Localized prostate cancer and robot-assisted laparoscopic radical prostatectomy: a retrospective, comparative study between pre- and post-operative Gleason scores. Acta Chir Belg 2018; 118:15-20. [PMID: 28720050 DOI: 10.1080/00015458.2017.1353234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To compare the pre- and post-operative Gleason scores (GS) in patients with localized prostate cancer treated with robot-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS A single center, retrospective comparison between pre- and post-operative GS. Age, prostate volume, PSA, number of biopsies, number of positive cores, biopsy GS, cTNM, final pathology GS and pTNM of 286 patients were retrieved. They were divided into risk groups. RESULTS A total of 286 patients with a mean age at surgery of 64.64 ± 7.81 y and mean PSA-value of 9.35 ± 8.38 ng/mL. Mean prostate volume was 55.09 ± 24.93 mL, mean number of biopsies was 11.90 ± 4.63. Mean percentage of positive cores was 36.90 ± 22.42%. A GS of <7 was seen in 23.4%, 66.8% had a GS of 7 and 9.7% of >7 in final pathology. Of the total, 38.1% were pre-operative low risk, 58.7% of them had an upgrade in GS on final pathology, 45.1% were in the intermediate risk group, 5.4% showed a downgrade, 64.3% remained stable and 30.2% had an upgrade in GS. Also, 16.8% were high risk patients of which 35.4% had a downgrade, 39.6% remained stable and 25% showed an upgrade of the GS. CONCLUSIONS We found a substantial underestimation of the GS in the pre-operative setting when compared to the GS in final pathology.
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Affiliation(s)
- Michaël M. E. L. Henderickx
- Department of Urology, GZA Sint-Augustinus, Wilrijk, Belgium
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Tim Brits
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Tim Muilwijk
- Department of Urology, GZA Sint-Augustinus, Wilrijk, Belgium
| | - Thomas Adams
- Department of Urology, GZA Sint-Augustinus, Wilrijk, Belgium
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Henderickx MMEL, Brits T, De Baets K, Seghers M, Maes P, Trouet D, De Wachter S, De Win G. Renal papillary necrosis in patients with sickle cell disease: How to recognize this 'forgotten' diagnosis. J Pediatr Urol 2017; 13:250-256. [PMID: 28341428 DOI: 10.1016/j.jpurol.2017.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/31/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Renal papillary necrosis is not commonly seen in daily practice, but can have severe consequences when it is not diagnosed in time. It is known to be associated with sickle cell hemoglobinopathies; however a wide range of etiologies are possible, and it is therefore not the first diagnosis clinicians consider in patients with sickle cell disease who present with hematuria. METHODS A literature search was performed to summarize the current knowledge about renal papillary necrosis associated with sickle cell disease. These findings are illustrated with a case of a 9-year old girl with sickle cell disease who was referred with painless gross hematuria. RESULTS Typical radiologic signs for renal papillary necrosis are necrotic cavities that fill with contrast, small collections of contrast peripheral to the calyces in the papillary region (ball-on-tee sign), calcification of the papillary defect, filling defects, hydronephrosis, blunted papillary tip, clefts in the renal medulla filled with contrast, hyperattenuated medullary calcifications, non-enhanced lesions surrounded by rings of excreted contrast, and clubbed calyces. DISCUSSION This study focuses on the pathophysiology of renal papillary necrosis associated with sickle cell disease, the possible symptoms, as well as the diagnostic steps, with a special interest in particular presentation on old (retrograde pyelography) and new (computed tomography) gold standard in radiologic imaging, and the management for this pathology. CONCLUSION This study aims to remind clinicians of this "forgotten" diagnosis and what signs to look for in pediatric patients with sickle cell disease who present with hematuria. In pediatric cases radiation protection is important, therefore knowing what radiologic signs can be found on retrograde pyelography can lead to early identification of this pathology without having to proceed to computed tomography.
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Affiliation(s)
| | - Tim Brits
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Karen De Baets
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Mattias Seghers
- Department of Radiology, University Hospital Antwerp, Edegem, Belgium
| | - Philip Maes
- Department of Pediatrics, University Hospital Antwerp, Edegem, Belgium
| | - Dominique Trouet
- Department of Pediatrics, University Hospital Antwerp, Edegem, Belgium
| | | | - Gunter De Win
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
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Hendriks JMH, Brits T, Van der Zijden T, Monsieurs K, de Bock D, De Paep R. U-Shape Kissing Chimney Thoracic Endovascular Aneurysm Repair for a Traumatic Arch Rupture in a Polytraumatized Patient. Aorta (Stamford) 2016; 3:41-5. [PMID: 26798756 DOI: 10.12945/j.aorta.2015.14-044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/31/2014] [Indexed: 11/18/2022]
Abstract
An 18-year-old male patient was admitted to our hospital because of a high impact trauma. A computed tomography scan showed massive mediastinal bleeding due to a posteriorly located rupture of the aortic arch with formation of a pseudoaneurysm. Although urgent repair was indicated, open cardiac surgery was not feasible, as this would involve full heparinization in a patient with subarachnoid bleeding. The chosen solution was to perform a percutaneous thoracic endovascular aneurysm repair (TEVAR) and a kissing chimney procedure using a U-shape configuration.
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Affiliation(s)
- Jeroen M H Hendriks
- Department of Thoracic & Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Tim Brits
- Department of Thoracic & Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thijs Van der Zijden
- Department of Interventional Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Koen Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Dina de Bock
- Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Rudi De Paep
- Intensive Care Department, Antwerp University Hospital, Antwerp, Belgium
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