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We report a scrotal epidermal inclusion cyst located outside the median raphe which a rare entity in the absence of trauma and few cases have been reported. 47 year old male presents with a complaint of right sided testicular swelling and discomfort. On examination a 3 cm mass was palpated between the scrotum and the medial thigh on the subcutaneous tissue with a positive slip sign. Complete surgical excision of the cyst was performed. Histopathology confirmed epidermal inclusion cyst with no evidence of malignancy.

AbstractPurpose:We evaluated percutaneous access for percutaneous nephrolithotomy (PCNL) that was obtained by interventional radiologists or urologists at a single academic institution and compared access outcomes and complications.Patients and Methods:The records of 233 patients who underwent PCNL at the University of Pittsburgh Medical Center between 2000 and 2008 were retrospectively reviewed. Patients were stratified according to percutaneous access by urologists (group 1) or a group of interventional radiologists (group 2) in 195 and 38 patients, respectively. Radiologist-acquired access was performed for collecting system decompression in 33.3% of patients in group 2. A predicted access difficulty score was calculated using demographic, stone, and operative variables. Percutaneous access complications and stone-free rates were compared between groups.Results:Mean patient age was 53 ± 16 years (51% male, range 19–90 y) and 58 ± 17 years (62% male, range 25–95 y) in groups 1 and 2, respectively. Use of multiple access tracts (4.3% vs5.4%; P= 0.54), mean stone diameter (3.5 ± 1.8 cm vs3.6 ± 1.9 cm; P = 0.97), and percentage of supracostal tracts (36% vs35%; P= 0.63) were comparable between groups. Mean access difficulty parameters were comparable between groups. The percentage of staghorn calculi (39% vs30%; P= 0.28) and number of obese (body mass index >30) patients (30% vs38%; P= 0.34) were also comparable between groups 1 and 2. The complication rate was the same in the two groups (14.3% vs13.5%; P= 0.52). The overall stone-free rate was significantly greater in the urology access group (99% vs92.1%; P= 0.033) on univariate analysis. Radiologist-obtained access could not be used in 36.8% of patients, necessitating additional access tract placement at the time of surgery.Conclusions:Urologist-obtained access is safe and effective for PCNL. Access obtained by radiologists for decompression of infected or obstructed systems often is not adequate for PCNL. Despite similar stone complexity and access difficulty, urologist-obtained access was associated with a statistically significant improvement in overall stone-free rate. [ABSTRACT FROM AUTHOR]

In the 1980s, the advent of shock wave lithotripsy (SWL) revolutionized pediatric stone management and is currently the procedure of choice in treating most upper tract calculi < 1.5 cm in children. However, with miniaturization of instruments and refinement of surgical technique the management of pediatric stone disease has undergone a dramatic evolution over the past twenty years. In a growing number of centers, ureteroscopy (URS) is now being performed in cases that previously would have been treated with SWL or percutaneous nephrolithotomy (PCNL). PCNL has replaced open surgical techniques for the treatment of large stone burdens> 2 cm with efficacy and complication rates similar to the adult population. Recent results of retrospective reviews of large single institution series demonstrate stone free and complication rates with URS comparable to PCNL and SWL but concerns remain with these techniques regarding renal development and damage to the pediatric urinary tract. Randomized controlled trials comparing the efficacy of SWL and URS for upper tract stone burden are needed to reach consensus regarding the most effective primary treatment modality in children. This report provides a comprehensive review of the literature evaluating the indications, techniques, complications, and efficacy of endourologic stone management in children.