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Varying sizes of renal angiomyolipoma (AML) have been reported in the literature, with the general consensus that a size greater than 10 cm can be termed a giant AML. Our patient presented with increasing abdomen girth since last 3 years. Contrast-enhanced computed tomography scan of the abdomen confirmed the presence of “AML” arising from the upper and mid pole of the right kidney with similar small foci in the contralateral kidney. The patient underwent nephron-sparing surgery with preserving the right lower pole with enucleation of multiple small foci in the right kidney. The surgical specimen, which was confirmed to be AML histopathologically, was 40 cm × 20 cm × 15 cm in size and 7000 g in weight. This represents the case of the largest AML with a dimension of up to 40 cm and managed by nephron-sparing surgery without prior angioembolization. AML larger than 10 cm is usually considered to be giant AML in the literature.

Introduction: Radical perineal prostatectomy was the first surgery described for prostatic carcinoma (Young, 1904) but it lost its eminent status after Walsh′s description in 1982 of anatomic radical retropubic prostatectomy followed by the enthusiasm in laparoscopy and now robotics. It made resurgence after it was realized in early 1990s that the pelvic lymph node dissection is needed only in selected cases. Last decade witnessed over 80 publications addressing the results and advances in the perineal approach. Strangely, centres from the subcontinent have chosen to ignore this resurgence. We describe our early experience with the technique in 35 patients and present the case for its more widespread usage. Patients and Methods: Thirty five patients of clinically localized carcinoma prostate were operated by perineal route in our institution from December 2006 onwards. All patients had serum prostate specific antigen levels less than 10 ng/ml. Results: Operating time was 2 to 3.5 hours (mean 2.5 hours). Rectal injury occurred in three patients but was closed primarily in all and none required a colostomy. Mean duration of hospital stay was four days. The disease was organ confined in 25(71%). Positive margins were seen in 5(14%) patients. Biochemical recurrence occurred in 17% patients at one year. Seventy six percent patients had achieved continence at one year. Conclusions: As the world is taking note of radical perineal prostatectomy again, with a very small learning curve, minimal invasion and good oncological control urologists from Indian subcontinent should also embrace this procedure in view of the relative limited resources available.

Objectives: To describe the use of a pedicled dartos flap between the pubic bone and bulbar urethra after elaborate perineal urethroplasty in complex pelvic fracture urethral distraction defect. This is to prevent the risk of entrapment of the anastomotic area within a fibrous scar and hence prevent the risk of urethral stricture recurrence. Our objective is also to theorise the entity of bulbar urethral entrapment to describe the trapping of the bulbar urethra by fibrosis after extensive bone resection in complex cases of pelvic fracture urethral distraction defect. Methods: Ten patients with complex pelvic fracture urethral distraction defect underwent perineal urethroplasty at our institution from 2017 to 2019. Urethroplasty was done using the elaborated perineal approach in the standard fashion. Pedicled fibrofatty tissue along with dartos from the scrotum was used to separate the site of urethral anastomosis from the bare pubic bone and fill the dead space. Results: All patients are asymptomatic with no stricture recurrence in follow-up. Conclusions: Vascularised pedicle flap should become an important tenant in the elaborated perineal repair of complex pelvic fracture urethral distraction defect. It provides an ideal option in this scenario by decreasing the risk of urethral stricture recurrence without adding morbidity and minimum extra operative time. Level of evidence: Not applicable. [ABSTRACT FROM AUTHOR]