Highlights We reported on the laparoscopic trans-peritoneal approach for giant hydronephrosis. No major peri-operative complications were reported. Pre-operative decompression using a nephrostomy tube facilitates the surgery.

Highlights The spontaneous rupture of the kidney, however, is rarely the first clinical presentation of RCC. Neoplastic causes for Wunderlich syndrome accounted for 61.2% of these cases, with benign and malignant causes approximately divided equally. In treating Wunderlich syndrome, some urologists favor an early or immediate exploratory surgery, others prefer interventional radiology. Spontaneous perinephric hematoma of unknown etiology should be followed up regularly with CT image for concerning of impending renal tumor.

A 44-year-old female presented to the urology clinic with flank pain and tenderness. After full assessment, the patient was booked for surgery for partial nephrectomy and the patient was diagnosed with renal cell carcinoma (RCC) chromophob type. Six months later, the patient came back for follow-up; a mass was detected on the same kidney. Radical nephrectomy was performed to excise what is thought to be a recurrence of RCC and the tissues were sent to pathology. The postoperative pathology report confirmed the presence of xanthogranulomatous pyelonephritis rather than RCC recurrence.