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Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 32 year old female patient has an abdominal ultrasound requested by the GP following several urinary tract infections. The right kidney measures 8.2 cm in length and the left kidney measures 10.4 cm. The right renal artery to aortic velocity ratio is 3.7 and the left is 2.6. The kidneys appear structurally normal with no hydronephrosis and no renal calculi identified. There is a 13-mm simple right renal cyst. The urinary bladder appears thin walled.
Renal Cancer
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Nilay Patel (deceased), Vinodh Murali, David Cranston
All of the following are FALSE about Bosniak cysts, except:Hyperdense cysts always need follow-up.Nodular calcification without enhancement indicates Type 3 cyst.Type 1 cysts are malignant in 10% of cases.All type 2 cysts need follow-up for up to 5 years.Biopsy should always be considered in any renal cyst before contemplating on nephrectomy.
Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Renal cysts are easily detectable; an example is shown in Fig. 7.5b. These are very common and of no clinical significance in the absence of symptoms and if they have no internal structure. A renal cyst with internal content should be investigated further, and while CT scanning has long been the gold standard for staging of complex renal cystic masses using the Bosniak classification, recent studies are showing excellent results with CEUS [9].
The safety and efficacy of laparoscopic microwave ablation-assisted partial nephrectomy: a new avenue for the treatment of cystic renal tumors
Published in International Journal of Hyperthermia, 2023
Baoan Hong, Qiang Zhao, Yongpeng Ji, Yong Yang, Ning Zhang
According to current guidelines, partial nephrectomy remains the standard treatment for localized small renal tumors, intending to preserve kidney function and provide longer term tumor control [6]. Some theoretical questions regarding treating cystic renal tumors remain unanswered, especially concerns about cyst rupture and tumor implantation during surgery. Firstly, patients with renal cysts on preoperative imaging, receiving renal cyst unroofing, may be diagnosed as cystic renal cell carcinoma by postoperative pathology. Second, for patients with a high suspicion of cystic renal cell carcinoma, cyst rupture may occur during nephron-sparing surgery, and this carries the risk of tumor implantation and metastasis. The rate of cyst rupture during partial nephrectomy has been reported to be 20% [7,8].
How safe and effective is laparoscopic decortication of simple renal cysts in elderly patients?
Published in The Aging Male, 2020
Renal cysts are common kidney lesions. They are classified by Bosniak as simple (Bosniak type I and II) or complex (Bosniak type IIF and III and IV) cysts. Simple renal cysts are common benign lesion and their prevalence ranges from 7% to 10% [1,2]. They are found in at least 24% of those over 40 years of age and at least 33% by the age of 60 [3]. Most of them are detected incidentally and are peripheral in location without any symptoms. Simple renal cysts do not require intervention unless symptomatic while complex renal cysts require follow-up (Bosniak type IIF) or surgery (Bosniak type III and IV) in order to exclude malignancy. Simple renal cysts in large size (diameter >7 cm) are often symptomatic with several symptoms such as back pain, urinary tract infection, hemorrhage, pelvicalyceal obstruction, hydronephrosis, hematuria, hypertension and compression of adjacent organs [4,5]. Pain is the most common indication for intervene in simple renal cysts [6]. There are several options for the management of symptomatic simple renal cyst: medical management of pain; aspiration of cyst; transperitoneal and retroperitoneal laparoscopic decortication of cyst; robotic surgery and open surgery [7,8].
Renal and perinephric abscesses involving Lactobacillus jensenii and Prevotella bivia in a young woman following ureteral stent procedure
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Abhinav Mohan, Jacob Rubin, Priyank Chauhan, Juan Lemos Ramirez, German Giese
In the emergency department, she presented with fevers (38.3 ⁰C) and tachycardia (117). Significant right abdominal and costovertebral angle tenderness were present on the exam. Complete blood count showed mild leukocytosis (11.4). Urinalysis showed rare bacteria with negative leukocyte esterase, and urine culture was negative. CT abdomen/pelvis with contrast showed enlarged right kidney with a 4 cm renal cyst, as well as a complicated right-sided perinephric fluid collection, suspicious for abscess or hematoma (Figure 1). She was admitted for sepsis and started on cefepime and vancomycin. A percutaneous drain was placed into the renal cyst, and purulent fluid was removed. Cultures of the drained fluid grew Lactobacillus, Streptococcus viridans species, and ‘mixed anaerobes’. Blood cultures grew Lactobacillus jensenii on anaerobic media. This was confirmed by both rapid ANA sequencing and MALDI-TOF Mass Spectrometry.