Bilateral renal robotic procedures at the same setting can be accomplished with 4 ports, including the umbilical camera port, a midline subxyphoid port, and 2 midclavicular lower quadrant ports.10 The use of the Y-to-V flap approach was determined by the

intrarenal location of the UPJ segment, which Epacadostat chemical structure made access challenging. Although her postoperative stay was prolonged because of an obstructed stent, her overall recovery was rapid and permitted a return to full activity with satisfactory long-term follow-up. A unique case of bilateral upper pole UPJ obstruction is presented to illustrate the imaging appearance and discuss various management options. Bilateral simultaneous robotically assisted upper pole pyeloplasties using a Y to V advancement technique

has been clinically successful. “
“The renal manifestations of tuberous sclerosis complex include tubular cysts, angiomyolipoma, and renal cell carcinoma; these 3 lesions are seen in aggregate in 20% of affected individuals and their frequency is 25%-50%, 60%-80%, and 3%-5%, respectively.1 and 2 All are potentially lethal in their own Selleck BLZ945 unique fashion. For instance, renal cystic disease is a cause of chronic renal failure; the latter complication may be seen as well with progressive replacement of the kidneys by angiomyolipomas (AMLs). However, the epithelioid angiomyolipoma (EAML), one of the pathologic subtypes and the subject of this report, may pursue a malignant course, even in affected

children and adolescents.3 It is important for the urologist to appreciate the malignant potential of the EAML in contrast to the generally indolent behavior of the more common classic triphasic AML. A 17-year-old girl with tuberous sclerosis complex (TSC) who was referred for evaluation of a left renal mass, had a history of severe developmental delay and bilateral AMLs that had been serially monitored, but never required treatment. Recent imaging revealed multiple bilateral AMLs, all of which were less than 1 cm, but a newly recognized 5 cm exophytic enhancing solid mass was identified and it was fat poor (Fig. 1). After discussions with her parents regarding the treatment options, about the decision was made to perform a left robotic-assisted laparoscopic partial nephrectomy. Her recovery was uncomplicated. A 7.5 × 6.5 × 3.5 cm yellowish-tan solid mass occupied a substantial portion of the resected kidney (Fig. 2). The mass was sharply demarcated from the surrounding renal parenchyma. The tumor was composed predominantly of polygonal epithelioid cells with abundant eosinophilic cytoplasm, mild nuclear atypia, and absence of mitotic activity (Fig. 3A). The adjacent kidney contained scattered tubular cysts and microfoci of classic AML. Immunohistochemical staining revealed positivity for vimentin (Fig. 3B), limited positivity for smooth muscle actin (Fig. 3C), and more diffuse positivity for MART-1/Melan-A (Fig. 3D).