Diagnosis and management of ureteral complications following renal transplantation

When compared with maintenance dialysis,renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life.Approximately 9% of patients will develop a major urologic complication following kidney transplantation.Ureteral complications are most common and include obstruction(intrinsic and extrinsic),urine leak and vesicoureteral reflux.Ureterovesical anastomotic strictures result from technical error or ureteral ischemia.Balloon dilation or endoureterotomy may be considered for short,low-grade strictures,but open reconstruction is associated with higher success rates.Urine leak usually occurs in the early postoperative period.Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression(nephrostomy tube,ureteral stent,and indwelling bladder catheter).Proximal,large-volume,or leaks that persist despite urinary diversion,require open repair.Vesicoureteral reflux is common following transplantation.Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment.Deflux injection may be considered in recipients with low-grade disease.Grade IV and V reflux are best managed with open reconstruction.

Long term outcomes of Cohen’s cross trigonal reimplantation for primary vesicoureteral reflux in poorly functioning kidney

BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.

Evaluation of Extracorporeal Shockwave Lithotripsy in the Management of Renal and Ureteral Calculi

Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.

Peroxisome Proliferator-activated Receptor-γ Agonist Pioglitazone Fails to Attenuate Renal Fibrosis Caused by Unilateral Ureteral Obstruction in Mice

Renal tubulointerstitial fibrosis is the common ending of progressive renal disease. It is worth developing new ways to stop the progress of renal fibrosis. Peroxisome proliferator-activated receptor-γ（PPARγ） agonists have been studied to treat diabetic nephropathy, cisplatin-induced acute renal injury, ischemia reperfusion injury and adriamycin nephropathy. In this study, unilateral ureteral obstruction（UUO） was used to establish a different renal fibrosis model. PPARγ agonist pioglitazone was administrated by oral gavage and saline was used as control. At 7th and 14 th day after the operation, mice were sacrificed for fibrosis test and T lymphocytes subsets test. Unexpectedly, through MASSON staining, immunohistochemistry for α-SMA, and Western blotting for α-SMA and PDGFR-β, we found that pioglitazone failed to attenuate renal fibrosis in UUO mice. However, flow cytometry showed that pioglitazone down-regulated Th1 cells, and up-regulated Th2 cells, Th17 cells and Treg cells. But the Th17/Treg ratio had no significant change by pioglitazone. Real-time PCR results showed that TGF-β and MCP-1 had no significant changes, at the same time, CD4＋ T cells associated cytokines were partially regulated by pioglitazone pretreatment. Taken together, pioglitazone failed to suppress renal fibrosis progression caused by UUO.

Extracorporeal Shock Wave Lithotripsy Treatment for Renal and Ureteral Stones in Duhok City

The present study reports the results of extracorporeal shock-wave lithotripsy treatment for renal and ureteral stones in Duhok city. The data were collected from the center of breakdown kidney stones in Duhok hospital. There were a total of 40 patients (25 males and 15 females) aged from 20 to 60 years old. The patients harboring (23 renal and 17 ureteral) stones of size ranged from 7.5 to 20 mm. Almost stones are of average size 9 mm and composed of uric acid, calcium and cystine stones. The study has been carried out by taking into consideration the parameters (type, sizes, composition and location of stone as well as region and ages of patients, also power, number of shock wave and sessions). The results show that the stones size increases according to increasing ages of patients (male and female) for uric acid ureter stone and calcium (renal, ureter) stones. Also (renal, ureter) stone size for patients aged from 20 to 30 years old increases from the minimum value for phosphate to maximum value for cystine stones, while for patients aged from 40 to 60 years old, the minimum size is obtained for calcium oxalate and the maximum size for calcium only. On the other hand, for uric acid stones of average size 9 mm, number of shock wave and sessions as well as the power required to breakdown the stones decrease nearly exponentially according to enhancing patients’ ages. At the same time, it's found that for adult patients (20 - 30 years old), number of sessions and the power of shock wave decrease also according to increasing size of calcium and cystine stones. Contrary to that, for the same ages and renal, uretral cysteine stones number of shock wave needed to breakdown large stones will be increased.

Kidney tissue targeted metabolic profiling of renal interstitial fibrosis rats induced by unilateral ureteral obstruction using NMR

Aim Renal interstitial fibrosis （RIF） is a common final pathological process in the progression of kid- hey disease. To investigate the pathogenesis of RIF and offer invaluable instructions for diagnosis and therapy treat- 1 ment of RIF. Method： H NMR based-metabolomics study on targeted kidney tissue of RIF rats induced by uni- lateral ureteral obstruction was conducted combined with multivariate data analysis to characterize the alteration of endogenous metabolites and elucidate the molecular mechanism of RIF. Results The combination of a variety of statistical methods was used to screen out 14 potential significantly changed metabolites, including increased levels of lactate, methionine, aspartate, allantoin, uracil, 3-HB and decreased levels of TMAO, leucine, valine, lysine, adenosine, adenine, tyrosine and phenylalanine in the left kidney of UUO rats, compared with SO rats. To gain ad- ditional insight about the relationship between metabolites, they were mapped to KEGG IDs and built compound network by Metscape reflecting the complex pathology and providing evidence for the involvement of such processes as altered amino acid metabolism, adenine metabolism, energy metabolism, osmolyte change and induced oxidative stress. In addition, we have explored the morphology and size, calculated the degree of fibrosis based on altered differential metabolites, and speculated the probable causes of moderate RIF of contralateral kidneys to help to un- derstand the disease, which was also supported by serum biochemistry and kidney histopathology results. In addi- tion, the correlation analysis of the pathological parameters （ clinical chemistry, histological and immunohistochem- istry results） with the significantly changed differential metabolites responsible for the cluster （different groups） was also performed. Conclusion Our work shows that target tissue metabolomics analysis can be used as a power-ful tool to gain a better understanding of the mechanism of the disease and provide a novel insight in the pathogene- sis of RIF.

Case Report: Primary Urothelial Carcinoma of Ureteral Stump Following Radical Nephrectomy for Renal Cell Carcinoma

PUC is common in the urinary tract. It may occur in the urinary bladder and the collecting system of the upper urinary tract, such as the renal pelvis and ureter. However, PUC of ureteral stump after a nephrectomy is rare, and it’s even rarer in patients undergoing a radical nephrectomy for RCC. We describe a female patient with painless gross hematuria that was secondary to PUC of ureteral stump after a radical nephrectomy for RCC diagnosed 6 years ago. We discuss the etiology, diagnosis and treatment for PUC of ureteral stump following radical nephrectomy for RCC.

Comparison of combined laparoscopic ureterolithotomy and flexible ureteroscopy with percutaneous nephrolithotomy for removing large impacted upper ureteral stones with concurrent renal stones

Objectives:The present study compared the safety and efficacy of combined laparoscopic ureterolithotomy(LU)and flexible ureteroscopy with percutaneous nephrolithotomy(PCNL)for removing large impacted upper ureteral stones with concurrent renal stones.Methods:This study included 52 patients who underwent combined LU and retrograde flexible ureteroscopy for removing renal stones(group A)or PCNL(group B)for removing large upper impacted ureteral stones and concurrent renal stones at our department from January 2014 to December 2016.Patient demographics,stone characteristics,and procedure-related parameters including stone-free rate,operation time,hospital stay after surgery,mean decrease in hemoglobin levels,visual analog scale(VAS)score,auxiliary procedure rate,and complication rate were compared between groups A and B.Results:Results of this study showed that both procedures were effective for removing large impacted upper ureteral stones with concurrent renal stones.The stone-free rate after a single procedure was 95.7%in group A and 89.7%in group B(p?0.62).The operation time was longer in group A than in group B(112.2±23.3 min versus 96.2±16.4 min,p?0.006).However,no significant difference was observed between the two groups with respect to the length of hospital stay after the surgery(5 days versus 6 days,p?0.06).The decrease in hemoglobin levels was significantly higher in group B than in group A(0.64±0.36 g/dL versus1.44±0.65 g/dL,p<0.0001).The mean VAS scores obtained at 24 hours(2.91±1.08 versus 5.10±1.01,p<0.0001)and 48 hours after the surgery(1.09±0.73 versus 2.28±0.96,p<0.0001)were significantly higher for group B than for group A.Moreover,the auxiliary procedure rate was higher in group B than in group A(6.9%versus 0%).Conclusion:These results indicate that both combined LU and flexible ureteroscopy and PCNL are suitable for removing large impacted upper ureteral stones with concurrent renal stones and are associated with a high rate of patients being stone free afterwards.Despite the longer operation time,the combined laparoscopic and endourological procedure may be associated with less postoperative pain and fewer major complications.However,the choice of treatment depends on the preferences of surgeons and patients.

Combined use of retroperitoneal laparoscopy and bladder resectoscope to treat renal and ureteral tumor occurring at the same side of transplanted kidney (report of 5 cases)

To evaluate the operative characteristics and efficacy of retroperitoneoscopic resection of renal,ureter and partial bladder for the treatment of native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.Methods In 5 cases of renal transplantation,there were 2 cases of right native renal pelvic cancer,1 case of right native renal pelvic and ureter cancer and 2 cases of right ureter cancer respectively.The transplanted kidney was in the same iliac fossa side of the tumor.All 5 patients were subjected to nephroureterectomy and bladder cuff excision by retroperitoneoscopic technique.Results Five operations were completed successfully.The operative time was 180 to 280 min,and the blood loss was 50 to 200 ml.The recovery of intestinal function after operation was 12 to 36 h.The urine output was 1 500 to 4 000 per day.Postoperative serum creatinine was still normal.The mean hospital stay after operation was 4.5 days.Conclusion Retroperitoneal laparoscopic nephroureterectomy and bladder cuff excision is a good method to treat the native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.The procedure is safe and less invasive,which provides a good protection of transplanted kidney.12 refs.

Ureteral calculi secondary to a gradually migrated acupuncture needle

We herein presented a case of calculi secondary to a migrated acupuncture needle.A 74-year-old woman with a history of acupuncture therapy for lumbago was referred to our hospital for treatment of ureteral and renal pelvic calculi.Abdominal multi-detector computed tomography scans showed ipsilateral hydronephrosis and two calculi secondary to a migrated acupuncture needle.First,a percutaneous nephrolithotomy was performed to extract two calculi and fine needle fragments from the pelvis.Subsequently,residual needle fragments and calculi in the ureter were then removed by flexible transurethral lithotripsy using a holmium laser.In the present case,the formation of the calculi was caused by a migrated acupuncture needle.Calculi and needle fragments were removed safely endoscopically because the whole calculi and needle fragments were located in the ureteral lumen.ª2021 Editorial Office of Asian Journal of Urology.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Effect of ureteric stents on urological infection and graft function following renal transplantation

AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.RESULTS: Overall, 196(183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3%(12/277) with no difference between those with or without stents- 7/183 vs 5/102, P = 0.746. Overall, 54%(99/183) of stented patients developed a urological infection compared to 38.1%(32/84) of those without stents(P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent(Wald χ2 = 5.505, P = 0.019) and diabetes mellitus(Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.

Effect of tamsulosin versus tamsulosin plus tadalafil on renal calculus clearance after shock wave lithotripsy:An open-labelled,randomised,prospective study

Objectives:To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil in achieving clearance of fragments after shock wave lithotripsy(SWL)to treat renal calculi.Methods:Between January 2016 to December 2017,140 patients with solitary,non-branched,non-lower calyceal renal calculus and measuring less than 20 mm and treated with SWL were randomized to tamsulosin(group A)or tamsulosin plus tadalafil(group B).Therapy was given for a period of 4 weeks.Stone clearance rate,analgesic requirement,occurrence of steinstrasse,need for auxiliary procedures(endoscopic treatment),and adverse effects of drugs were recorded.Results:The overall clearance rate was 72.5%(50/69)in the group A and 90.1%(64/71)in the group B(pZ0.007).For stones up to 12 mm,the difference in the clearance rate was significant(pZ0.039)while it was not so for stones larger than 12 mm(pZ0.151).There was no statistically significant difference between the two groups with regards to analgesic requirement(pZ0.94),occurrence of steinstrasse(pZ0.101),need for auxiliary procedures(pZ0.76),and adverse effects of the drugs(pZ0.148).Conclusion:Our study shows that adjunctive medical expulsive therapy with tamsulosin and tadalafil achieves better clearance rate than tadalafil alone in patients receiving SWL for renal stones.

Ureteroscopic Management of Ureteral Calculi: Pneumatic versus Holmium: YAG Laser Lithotripsy

Background: Among various intracorporeal lithotripters, pneumatic lithotripter has become the widely used tool for the treatment of urinary stones. Recently the holmium: YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of urinary calculi. Purpose: Compare the effectiveness and complications of treatment for ureteric stones between holmium laser lithotripsy and pneumatic lithotripsy. Material and Methods: Comparison of 100 patients presented with ureteric stones, group one (50) of whom were treated with pneumatic lithotripsy and group two (50) with holmium laser was done and the effectiveness and complications of both were analyzed. Results: There was no difference in patient age, sex, stone size and location of stones between the two groups. The immediate stone free rates were 88% in the holmium: YAG group and 66% in the pneumatic lithotripsy group (p < 0.05). The four weeks stone free rates were 98% and 94% respectively (p = 0.07). The mean ± SD operative time in the holmium: YAG group (40 ± 26 min) was shorter than those with pneumatic lithotripsy group (60 ± 40 min). Postoperative stay in hospital was less than 24 hours in holmium: YAG group (70.4%) and shorter than those for pneumatic group (29.6%) (p < 0.002). Post treatment complications such as ureteral perforation were encountered in only two patients who underwent pneumatic lithotripsy. Other complications, such as mucosal injury, ureteral perforation and postoperative fever;there was no statistically significant difference between the two groups. While light hematuria was found more frequently in the pneumatic group (14%) in comparison to laser group (12%) (p = 0.02). On the other hand, the overall complication rates between the two groups was statistically significant (8%) laser group vs. (32%) pneumatic group (p = 0.003). Conclusions: Holmium: YAG laser lithotripsy was associated with shorter operation time and postoperative hospitalization period. These data suggest that holmium: YAG lithotripsy was safe and more effective than Pneumatic lithotripsy in the aspect of immediate stone free rate. We believe that holmium: YAG is an excellent treatment modality for managing ureteral calculi.

Success Factors of Extracorporeal Shock Wave Lithotripsy (ESWL) for Renal &Ureteric Calculi in Adult

The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10 - 20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi;Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.

Carcinomas of the renal pelvis and ureter:a clinicopathological study of 63 cases with a review of literature

Objective： The aim of this study was to summarize the clinicopathological characteristics of patients with renal pelvis and ureteral carcinomas, and analyze the recurrence in the remaining urinary tract and metastasis outside the urinary tract after surgical treatment. Methods： The patients＇ characteristics, tumor stage and grade, recurrence and metastasis distribution were summarized by tables, respectively. Spearman rank test, Log-rank test, Kaplan-Meier survival curve, and Cox proportional hazards regression model were used to make statistical analysis. Results： A total of 63 patients with 30 men, 33 women, 30 renal pelvic tumors and 33 ureteral tumors was found. Seven had muttifocal lesions. Fifty-four underwent surgical operation, which contained 49 cases of pathologically confirmed transitional cell carcinoma, 4 transitional cell carcinoma with squamous differentiation, and 1 squamous cell carcinoma. Tumor stage and grade had positive correlation. Among the 34 followed-up cases, 21 had no metastasis, 10 had metastasis, in which stage T3-4 groups accounted for 90%, and 5 developed tumor recurrences. The metastasis-free survivals had no significant difference between renal pelvic carcinoma and ureteral carcinoma, but had significant difference between high, middle and low stage groups, and between high and low grade groups. Conclusion： The incidence rates of the renal pelvic carcinoma and ureteral carcinoma is similar and no gender difference. Multifocal lesions can be seen Jn any stage and grade, but this is not necessarily a symbol of poor prognosis. The bladder recurrences is often seen in the cases with initially multifocal lesions or lesions in the middle or lower portion of the ureter. The prognosis is good after resection of the recurrence lesion. The prognosis get worse with the increasing stages and grades. Stage is the main factor to influence the survival. Metastasis outside the urinary tract is often seen in patients with high stage tumors.

Comparison of the curative effect and serum indexes of ultrasonic pneumatic and holmium laser technology for percutaneous nephrolithotomy treatment of complex renal calculus

Objective:To study the differences in the curative effect and serum indexes of ultrasonic pneumatic and holmium laser technology for percutaneous nephrolithotomy treatment of complex renal calculus.Methods: A total of 78 patients with complex renal calculus who accepted surgical treatment in our hospital between May 2011 and January 2016 were collected, the operation methods and test results were reviewed, and then they were divided into the observation group (n=34) who accepted ultrasonic pneumatic treatment and the control group (n=44) who accepted holmium laser treatment.Ⅰstage stone clearance rate of two groups of patients were recorded;serum was collected, sarcosine oxidase method was used to detect serum renal function indexes, and ELISA method was used to detect the levels of inflammatory factors and stress hormones.Results: The mean lithotomy time of observation group was shorter than that of control group;differences inⅠstage stone clearance rate were not statistically significant between two groups of patients. 3 d after operation, serum renal function indexes Scr, BUN and CysC levels of observation group were lower than those of control group;serum inflammatory factors PCT, IL-1β, IL-22 and IL-13 levels of observation group were lower than those of control group while IL-4 level was higher than that of control group;serum stress hormones AngⅠ, AngⅡ, Adr and NE levels of observation group were lower than those of control group.Conclusion:Both ultrasonic pneumatic and holmium laser technology can effectively remove complex renal calculus and ultrasonic pneumatic technology has the advantages of quicker operation and less injury.

Does delaying ureteral stent placement lead to higher rates of preoperative acute pyelonephritis during pregnancy?

BACKGROUND Pregnancy with renal colic may cause pyelonephritis,decreased renal function,systemic infection and even shock in pregnant women,and cause premature birth and other adverse pregnancy outcomes.When surgery is necessary,the relationship between timing of the operation and the outcome of the mother and child are not known.AIM To investigate the association between time to ureteral stent placement and clinical outcomes of patients with renal colic during pregnancy.METHODS In this retrospective study,pregnant women with renal colic who underwent surgery were studied.Maternal preoperative acute pyelonephritis(PANP),pregnancy outcome,and length of hospital stay(LOS)were compared between the two groups.RESULTS 100 patients were included in the analysis,median age was 30 years.Median time to ureteral stent placement was 48 h(interquartile range,25-96 h),and 32 patients(32%)were diagnosed with PANP.PANP was closely related to hospitalization costs,re-admission to the hospital due to urinary tract infection after surgery and premature delivery.Multivariate analysis found that stone location and time from pain to admission were related to PANP.CONCLUSION Both early and delayed surgery are safe and effective for the treatment of renal colic during pregnancy.Early surgery may be superior to a delayed procedure due to shorter LOS.For pregnant patients with renal colic,delayed surgery within 48 h is not related to the clinical outcome of the mother and child.However,the time from pain to hospital admission was related to PANP.

Effects of RIRS and Mini-PCNL on liver and kidney function,endocrine changes and trauma in patients with upper ureteral calculi

Objective: To investigate the effects of retrograde intrarenal surgery (RIRS) and Mini-percutaneous nephroscope lithoipsy (Mini-PCNL) on liver and kidney function, endocrine changes and trauma in patients with upper ureteral calculi. Methods: 100 patients with upper ureteral calculi admitted to our hospital from March 2016 to February 2018 were selected. They were randomly divided into observation group (RIRS group) and control group (Mini-PCNL group), with 50 cases in each group. The observation group was given RIRS, while the control group was given Mini-PCNL. At the same time, the expression levels of the liver function [including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma transpeptidase (gamma-GT)], renal function [including urea nitrogen (BUN) and serum creatinine (Scr) levels], endocrine changes [including corticotropin (ACTH), cortisol (Cor), norepinephrine (NE)] and trauma related indexes [Including soluble vascular cell adhesion molecule-1 (sVCAM-1) and erythrocyte sedimentation rate (ESR)] were analyzed and compared between the two groups. Results: There was no significant difference in ALT, AST, γ-GT, BUN and Scr before and after operation between the two groups. The difference was not statistically significant (P>0.05). After operation, the levels of ACTH (27.37±3.29) pg/mL, Cor (150.09±18.47) ng/mL, NE (165.48±26.74) ug/L and sVCAM-1, (596.55±56.24) ng/mL in RIRS group were significantly lower than those in Mini-PCNL group ((38.42±4.33) pg/mL, (222.37±28.70) ng/mL, (287.26±25.29) ug/L and (820.62±72) mL)The differences were statistically significant (P<0.05). While the ESR level in RIRS group (8.29±0.63) mm/h was significantly higher than that in Mini-PCNL group (7.16±0.68) mm/h, and the differences were statistically significant (P<0.05). Conclusions: There is no significant difference in the liver and renal function between RIRS and Mini-PCNL in the treatment of upper ureteral calculi. RIRS can better improve the endocrine status of patients and reduce the damage of the body, which is a more ideal way of operation.

单侧重度肾积水解除梗阻后肾功能恢复不佳的影响因素分析

目的 分析单侧重度肾积水患者解除梗阻后肾功能恢复不佳的影响因素,为预测肾功能恢复提供依据。方法 回顾性分析2015至2022年东莞东华医院收治的55例单侧重度肾积水且肾小球滤过率(GFR)<10 mL/min患者的病例资料,所有患者均采用经皮肾穿刺造瘘临时解除梗阻,根据肾功能的恢复情况分为肾功能恢复组和肾功能未恢复组,收集并分析解除梗阻后肾功能恢复的影响因素。结果 55例重度肾积水行经皮肾造瘘解除梗阻后,30例(54.5%)肾功能恢复,25例(45.5%)肾功能恢复不佳。单因素分析显示,2组患者的性别、患肾侧别、BMI、糖尿病史、高血压病史、造瘘前肾小球滤过率(GFR)、患肾尿液pH值等指标比较差异均无统计学意义(P均>0.05);2组患者的年龄、肾实质厚度、患肾GFR与总GFR比值、肾积水感染状态以及造瘘后患肾尿量比较差异有统计学意义(P <0.05)。多因素Logistic回归分析显示,造瘘前患肾GFR与总GFR比值(OR=0.24,95%CI 0.06~0.98)和造瘘后患肾尿量(OR=0.04,95%CI 0.01~0.25)为造瘘后肾功能恢复的影响因素。结论 GFR<10 mL/min的单侧重度肾积水使用经皮肾造瘘临时解除梗阻后,部分患者的肾功能可恢复;造瘘前患肾GFR与总GFR比值<10%和造瘘后患肾尿量<400 mL/d为患肾功能恢复不佳的影响因素,临床医师可根据患肾造瘘前的GFR与总GFR值和尿量预测患肾功能的恢复情况。

基于JAK/STAT3通路探讨补肾活血方改善单侧输尿管梗阻大鼠炎症和肾纤维化

目的:观察补肾活血方(BSHXF)对单侧输尿管梗阻大鼠(unilateral ureteral obstruction,UUO)肾纤维化和炎症的治疗效果,揭示其抗炎及延缓肾纤维化的机制。方法:32只8周龄雌性SD大鼠根据随机数字表分为假手术组(Sham组)、单侧输尿管梗阻组(UUO组)、补肾活血方低剂量组(BSHXF-L组)和补肾活血方高剂量组(BSHXF-H组)。造模后第2天开始,连续灌胃干预21 d,BSHXF-L组和BSHXF-H组给予相应剂量补肾活血方汤剂,Sham组和UUO组给予与BSHXF组等体积的生理盐水。干预结束后,记录24 h尿量,全自动生化分析仪检测血肌酐、尿素氮、尿蛋白、尿肌酐和肾功能指数;采用HE和Masson染色检测肾脏病理损伤和纤维化程度;通过免疫组化染色分析各组TGF-β和TNF-α;Western blotting检测各组TGF-β_(1)、α-SMA、JAK、STAT3、p-STAT3、TNF-α、Caspase-3和Bax的蛋白表达情况。结果:与UUO模型组相比,BSHXF-L组和BSHXF-H组能明显明显改善UUO大鼠的肾功能,降低大鼠肾组织中TGF-β_(1)和α-SMA蛋白表达水平,抑制JAK、STAT3和p-STAT3表达,减少炎症细胞浸润和纤维组织以及胶原的增生,显著降低大鼠的肾脏指数和TNF-α等炎症指标。结论:补肾活血方可通过抑制JAK/STAT3通路激活,改善UUO大鼠肾功能,减轻其肾脏炎症水平、肾脏指数,延缓肾纤维化进程。