Urology Video Journal (Dec 2020)
Percutaneous treatment of pelvis-calyceal nephrogenic adenoma: Technique description
Abstract
Introduction & Objectives: Nephrogenic adenoma is a rare benign metaplastic lesion of the urothelium. The objective of this video is to describe the surgical technique in the case of a patient with persistent hematuria, presence of 25 mm filling defect in the pelvis and inferior calyceal region and histological result of nephrogenic adenoma after percutaneous resection, an exceptional location Materials & Methods: 30-year-old woman consulted for persistent hematuria. Urinary cystoscopy and cytology were negative. Urography CT scan showed a 25 mm filling defect in the right renal pelvis. After retrograde flexible ureteroscopy observing sessile tumor, percutaneous surgery is considered, because during flexible ureteroscopy the visualization and approach were not safe and good. The patient was placed in a modified Valdivia position. Ascending pyelography was performed observing pyelocaliceal filling defect of 25 mm. Needle puncture guided by x-ray and ultrasound, flexible guide step and expansion with metal dilators with Amplatz sheath passage 16.5/17.5 fr. We started with minipercutaneous tract due to the localization of lesion (pyelocaliceal) and to decrease the chance of bleeding during initial access. Access with nephroscope, biopsy and vaporization with holmium laser. Due to the size of the lesion, Amplatz sheath was removed and dilatation with high pressure balloon was completed up to 30 fr caliber. A resectoscope with bipolar energy was introduced and the lesion was resected to the tumor base. A nephrostomy tube and simple ureteral catheter were placed. Results: Twenty-four hours after surgery, a nephrostomy catheter was removed. Forty-eight hours after surgery, the bladder catheter and ureteral catheter were removed and the patient was discharged. The histological result confirmed the diagnosis of the initial biopsy: Nephrogenic adenoma. Six months after surgery, the patient is asymptomatic, and with normal CT Urography, without appreciating the defect of filling prior to surgery. Conclusions: Although holmium laser is the standard treatment, percutaneous treatment of symptomatic benign tumors of the upper urinary tract with bipolar energy is a viable choice, since it allows the preservation of the renal unit, with minimal morbidity and excellent results.
