A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

A rare case of renal hydatidosis in a child with congenital solitary kidney

Hydatid cyst of a solitary congenital kidney is a rare entity because of the small percentage of cases with renal hvdatidosis and the reduced number of cases with this renal anomaly.We report a case presenting this extremely rare combination and having a favorable outcome.The diagnosis was confirmed based on an association of iniagistic techniques and positive serology.The case was managed using a minimal invasive surgical technique(PAIR) that reduced the operative risks.Additionally,an antihelminthic agent[albendazole) was administered.To our knowledge,this is the first case with such comorbidity and treated through percutaneous approach.

Benefits of Gum Arabic, for a Solitary Kidney Under Adverse Conditions:A Case Study

Gum Arabic(GA,called E-414 in the EU food industry),a natural biopolymer resin is a dried exudation obtained from the stems and branches of natural strains of Acacia Senegal(L)Willdenow.It consists mainly of high molecular weight polysaccharides and their calcium,potassium,and magnesium,which on hydrolysis yield arabinose,galactose,rhamnose,and glucuronic acid.Fermentable natural fiber of gum Arabic act as probiotics improves the absorption of minerals,especially calcium and helps to maintain a healthy balance of bacteria in the gastrointestinal(GI)tract.Extraction,transformation,or reprocessing of nitrogenous wastes(ammonia,urea,and uric acid)by the GI tract is a potentially low-cost means of switching for missing renal function.Binding of nitrogen compounds to be inert orally by administration of gum Arabic is the safe solution either in normal renal function or renal failures.In this study,clinically,we observed a case of solitary kidney under adverse condition long‑term treating with gum Arabic the vast potential of bioactive phytochemicals as a nontoxic,efficient with uric acid and bilirubin lowering agent and anti‑inflammatory effects,considering the gum Arabic as a potential therapeutic supplement,beneficial in chronic renal failure,cardiovascular disease,pain management,and dental health.Despite the nonexistent background concerning the benefits of gum Arabic,for a solitary kidney under adverse conditions,our study has confirmed that long‑term consumption of gum Arabic not only has no side effect but also protects multi-organs damage from drug adverse reactions and consequences of baseline disease,including renal,vascular,dental and inflammatory diseases.

Unilateral hypoplastic kidney in adults:An experience of a tertiarylevel urology center

BACKGROUND Unilateral small-sized kidney is a radiological term referring to both the congenital and acquired causes of reduced kidney volume.However,the hypoplastic kidney may have peculiar clinical and radiological characterizations.AIM To evaluate the clinical presentations,complications,and management approaches of the radiologically diagnosed unilateral hypoplastic kidney.METHODS A retrospective review of the records of patients with a radiological diagnosis of unilateral hypoplastic kidney between July 2015 and June 2020 was done at Assiut Urology and Nephrology Hospital,Assiut University,Egypt.RESULTS A total of 33 cases were diagnosed to have unilateral hypoplastic kidney with a mean(range)age of 39.5±11.2(19-73)years.The main clinical presentation was loin pain(51.5%),stone passer(9.1%),anuria(12.1%),accidental discovery(15.2%),or manifestations of urinary tract infections(12.1%).Computed tomography was the most useful tool for radiological diagnosis.However,radioisotope scanning could be requested for verification of surgical interventions and nephrectomy decisions.Urolithiasis occurred in 23(69.7%)cases and pyuria was detected in 22(66.7%)cases where the infection was documented by culture and sensitivity test in 19 cases.While the non-complicated cases were managed by assurance only(12.1%),nephrectomy(15.2%)was performed for persistent complications.However,symptomatic(27.3%)and endoscopic(45.6%)approaches were used for the management of correctable complications.CONCLUSION Unilateral hypoplastic kidney in adults has various complications that range from urinary tract infections to death from septicemia.Diagnosis is mainly radiological and management is usually conservative or minimally invasive.

Management of staghorn stones in special situations

Staghorn stones have always been a challenge for urologists,especially in some special situations,such as horseshoe kidney,ectopic kidney,paediatric kidney,and solitary kidney.The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications.The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function.Treatment methods for staghorn stones have developed rapidly,such as extracorporeal shock wave lithotripsy,retrograde intrarenal surgery,percutaneous nephrolithotomy and laparoscopy and open surgery.Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon.The decision should be made individually according to the circumstances of the patient.In this review,we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.