Retrovesical hydatid cyst presenting with urinary retention and left kidney atrophy
We report the case of a 43 year-old male patient who presented to the clinic for left flank pain and progressive severe obstructive urinary symptoms for 6 months. His past medical history includes multiple laparotomies for abdominal bullet injuries in 1984, including splenectomy, appendectomy, and cholecystectomy.\nOn physical examination, he had left Costo-vertebral Angle (CVA) tenderness and a hard non-mobile suprapubic mass. A Foley catheter was inserted with difficulty, yet the mass persisted. Subsequently, a computed tomography (CT) scan of abdomen and pelvis was done, revealing a large pelvic cyst measuring 14.9 × 12.7 × 14.8 cm. The left ureter was encased by the large mass, with secondary left hydroureteronephrosis and severe thinning of the left renal cortex. The mass had an irregular wall with a soft tissue component seen at its right lateral aspect, measuring 2 cm in maximal thickness. The bladder was displaced anteriorly and superiorly to the right [].\nSerum creatinine level was 2 mg/dL. Indirect hemagglutination for Echinococcus granulosus was negative (titer < 1:32).\nThe patient underwent flexible cystoscopy, revealing a normal bladder with no diverticulae. He underwent an exploratory laparotomy, with excision of this large retrovesical cyst, along with a simple left nephroureterectomy. The pelvic cyst was unroofed after injecting citramide inside it and shielding the area around it with citramide-soaked pads. Because of excessive adhesions, we only performed an upper pericystectomy. Through the same incision, a left nephroureterectomy was done [].\nThe pathologic examination of the surgical specimen confirmed hydatid disease, and the remnant kidney was negative for the disease. The patient was started on albendazole for 2 months. He had a rapid resolution of urinary symptoms and improvement in serum creatinine. At 16-month follow-up, the patient is free of symptoms with no disease recurrence on repeated CT scan.