No abstract

Palliative procedures have been developed for use as an alternative to major surgery in patients with a short life‐expectancy due to advanced malignancy or other conditions. Authors from the UK describe a technique for ureteric embolization in such patients who have urinary fistulae, finding it to be safe and effective. OBJECTIVE To report experience with a minimally invasive technique for palliation of urinary fistula/incontinence complicating advanced pelvic malignancy or its treatment. PATIENTS AND METHODS We used ureteric embolization with permanent nephrostomy drainage in eight renal units in five patients for palliation of symptoms. All procedures were done under local anaesthesia as day‐case procedures. Nephrostomy tubes were changed at regular intervals on an outpatient basis. Embolization was repeated when required. RESULTS The follow‐up was 2–84 months; four patients died from the underlying malignancy during the follow‐up. All patients were continent and had effective palliation of their symptoms. Two patients required repeat embolization. There were no embolization‐related complications. CONCLUSIONS Ureteric embolization is a safe and effective minimally invasive palliative treatment option in urinary fistulae or incontinence complicating advanced pelvic malignancy.

IntroductionProstatic metastasis from a primary bowel adenocarcinoma has been only rarely reported in the medical literature. The case reported here is rare in the fact that the primary tumor was from a right-sided bowel adenocarcinoma. It is unusual because initial immunostaining was not fully conclusive, and so a relatively new method of immunostaining, CDX2, was used to ascertain its histopathology.Case presentationWe describe the case of a 54-year-old Caucasian man who had a right hemicolectomy for a primary cecal adenocarcinoma, which was completely excised. Following the procedure, he received adjuvant chemotherapy. Computed tomography scans showed no evidence of local recurrence or metastatic disease. Then, five years later, he presented to his general practitioner with urinary symptoms. An abnormal prostate was palpated on digital rectal examination. Trans-rectal prostatic biopsies were performed, which showed colorectal metastases within the prostate gland. This was confirmed with CDX2 immunohistochemistry. There was no further evidence of distant metastases on positron emission tomography-computed tomography scans.ConclusionsThis case demonstrates a rare isolated hematogenous spread to the prostate from a primary cecal adenocarcinoma, several years after definitive treatment and excision. This highlights the importance of accurate immunohistochemistry and imaging in planning further management and treatment.