Objective:To evaluate the factors that may influence the prolonged urinary leakage following percutaneous nephrolithotomy (PCNL).Materials and Methods:A total of 936 consecutive patients underwent PCNL during the study period from April 2013 to December 2014 at our center, and data were recorded prospectively. Patients who required stage PCNL, chronic renal failure and diabetic patients, concurrent ureteric stone and patients in whom double-J stent was placed because of ureteropelvic injury, or pelvicalyceal extravasation were excluded from the study. After exclusion, 576 patients were included in the study. The predictive factors that may lead to prolonged urinary leakage after PCNL were broadly categorized into patient-related factors and procedure-related factors. Patients were divided into two groups: Group 1 (n = 32) – Required double-J stent placement due to prolonged urinary leakage (>48 h) after removal of the nephrostomy tube. Group 2 (n = 544) – Did not require double-J stent placement.Results:Patient-related factors such as stone complexity, grade of hydronephrosis, renal parenchymal thickness in access line, and intra-parenchymal renal pelvis were most important factors for prolonged urinary leakage (P < 0.05, P < 0.05, P < 0.05, and P < 0.05, respectively), while procedure-related factors such as multiple punctures, surgeon's experience, and residual stones were most important factors for prolonged urinary leakage (P < 0.05, P < 0.05, and P < 0.05, respectively).Conclusion:In the present study, several factors appear to affect post-PCNL prolonged urinary leakage. We suggest that patients who are at increased risk of prolonged urinary leakage double-J stent should be placed at the end of PCNL procedure.

A 60-year-old male was referred to medicine department, initially for difficulty in breathing with palpable painless left cervical mass, a chest X-ray was done, which showed COPD changes. He also complained of eight kg weight loss, anorexia and weakness for approximately four months. He denied any other subjective complaints including difficulty in swallowing, bone pain or urinary symptoms. Physical examination was unremarkable except for an approximately 2 cm nontender, firm mass in left cervical region, fixed to underlying structures. Patient's past history was unremarkable for any other surgical history or malignancy. His family history was non contributory. During initial evaluation Digital Rectal Examination (DRE) and serum Prostate Specific Antigen (PSA) was not done. Subsequently HRCT thorax and CECT whole abdomen was done which showed possibility of skeletal metastasis and left hydroureteronephrosis [ Detailed discussion with the patient was done and he declined any further investigations (bone scan) and opted for surgical treatment (bilateral orchidectomy). In addition to this, patient was also treated with tab bicalutamide 50 mg once daily. AbSTRACTProstate cancer is a common cancer in elderly men and it frequently metastasizes to regional lymph nodes and sometimes to bone. Very rarely in some of the cases it also shows involvement of non-regional lymph nodes like supra-diaphragmatic lymph nodes. In our report, we present a 60-year-old male, initially misdiagnosed as Chronic Obstructive Pulmonary Disease (COPD) with cervical lymph node involvement may be due to infective region or inflammatory pathology, which was later found to have prostatic adenocarcinoma metastatic to supraclavicular lymph nodes. Very less case reports are present which have shown similar presentations. So we would like to highlight that prostatic carcinoma can be present in an atypical form also.

I n d e x e d i n P u b M e d , W e b o f S c i e n c e a n d S c o p u s Yasemin Yuyucu Karabulut, et al.; The role of COL6A1 and PD-1 expressions in renal cell carcinoma.

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