One-stage versus staged ureteroscopy and percutaneous nephrolithotomy for simultaneous ureteral and renal stones

Objectives:This study is aimed to investigate the outcome of one-stage ureteroscopy(URS)and percutaneous nephrolithot(PCNL)for simultaneous ureteral and renal stones over 10years at a tertiary urology institute.Materials and methods:We retrospectively analyzed the data of patients who were operated on for simultaneous ureteral and renal stones from January 2011 to December 2020.Patients were divided into 2 groups:group A,who underwent one-stage URS and prone PCNL,and group B,who underwent staged procedures.The overall success,complications,operative time,and hospital stays were compared between the 2 groups.Results:Data for 190 patients were reviewed;mean age was 50±13 years old,and 146(77%)were male.The one-stage(A)and staged(B)groups included 102 and 88 patients,respectively.Group A included older patients,with a high The American Society of Anesthesiologists score,while group B included more patients with multiple or staghorn stones.The one-stage group recorded shorter operative time(120±12min vs.140±16min,p=0.02)and shorter hospital stays(3 days[2-6]vs.4 days[3-9],p=0.06).Otherwise,both groups had equal outcomes in terms of success rates and complications.Conclusions:PCNL and URS can be performed in one-session for simultaneous ureteral and renal stones,except for multiple renal and staghorn stones.The results are comparable to those of the staged procedure in terms of success rate and complications,with the advantage of a shorter operative time and hospital stay.

Comparison of urinary telomerase,CD44,and NMP22 assays for detection of bladder squamous cell carcinoma

Background:Squamous cell carcinoma(SCC)of the bladder is common in many regions around the world.Prognosis is very poor,as most cases are diagnosed at an advanced stage due to a lack of affordable and valid screening markers for this type of cancer.The diagnostic accuracy of urinary nuclear matrix protein-22(NMP22),telomerase activity,and CD44 were evaluated in urine samples of patients with bladder SCC.Materials and methods:We conducted a case-control study comprised of 60 consecutive newly diagnosed bladder SCC patients diagnosed by cystoscopy and histopathological examination,and controls were 60 outpatients with benign urologic conditions and healthy clinic visitors.Urine samples collected from each subject underwent testing for NMP22,telomerase activity,and CD44.Descriptive and correlational statistical analysis of cases and controls were carried out and receiver operating characteristic curve analysis was used to determine optimal cut-off points for the three assays.Results:Area under the curve was calculated at 0.96,0.93,and 0.62 for NMP22,telomerase,and CD44,respectively.Urine levels of NMP22 and telomerase activity were significantly higher in the SCC group compared to controls(p<0.001).Urine CD44 levels were not significantly higher in the SCC group compared to controls(p=0.111).The overall sensitivity of NMP22,telomerase,and CD44 was 96.7%,87%,and 45%,respectively,while the specificity was 85%,88.6%,and 86.7%,respectively.Conclusions:Urinary telomerase activity,followed by NMP22 urine levels,showed high diagnostic yield and could hold potential promise as urinary biomarkers for the diagnosis of bladder SCC.

Renal arterial embolization:Indications,angiographic findings,and outcomes in a series of 170 patients

Background:The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization(RAE)compelled us to report our overall experience on a series of patients.Materials and methods:A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019.History,physical examination,and laboratory data were reviewed for all patients.Abdominal ultrasound was the initial imaging study,and all patients underwent subsequent computed tomography or magnetic resonance imaging.The outcome of RAE was determined based on radiographic and clinical findings.Results:Data from 202 patients were analyzed,with a mean age of 45±15 years,and 71.3%of patients were male.Iatrogenic injury was the most common indication for RAE(54%),followed by renal tumors,trauma,and spontaneous,in 27.7%,10.4%,and 8.4%of patients,respectively.Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding(40.6%),whereas no lesions were identified on angiography in 32 patients(15.8%),after which RAE was subsequently aborted.Renal arterial embolization was successful in 158 of 170 patients(92.9%)after 1 or more trials(maximum of 4).Microcoil alone or with other embolic materials was the most commonly used material for embolization(85%).Conclusions:latrogenic injury was the most common indication for RAE.Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography;however,angiography showed a negative result in 16%of patients,even those with symptoms.When lesions are present on angiography,the overall success of repeated trials of RAE reached 92.9%.

Is the urinary kidney injury molecule an optimum biomarker for early detection of obstructive nephropathy? An experimental study

Objectives To evaluate the urinary kidney injury molecule-1(KIM-1)as a predictor for early detection of acute kidney injury in cases with obstructive nephropathy in an animal model and to correlate urinary KIM-1 with the progress of obstructive nephropathy on a histopathological basis.Materials and methods Three models of obstruction were induced in 90 male rats:unilateral partial ureteral obstruction with a normal contra-lateral kidney,with nephrectomy of a contralateral kidney(solitary kidney),and bilateral partial ureteral obstruction.Each group was further divided into 2 subgroups;the sham-group(10 rats)and the disease group(20 rats).Serum creatinine,blood urea nitrogen,and urinary KIM-1 were collected on days 0,7,and 14.Rats were sacrificed on the 7th and 14th day for histopathological examination of the obstructed kidney.Results By the end of first week,there was a significant rise of all biomarker levels in all groups when compared with basal levels.Similarly,biomarker levels at the 14th day were significantly higher than those obtained at the 7th day.The urinary KIM-1 level was not detected in the baseline condition.Expression of urinary KIM-1 showed a significant rise in all models ranging from 22 to 85 fold at the 7th day and even higher levels at the 14th day.Histopathological examination confirmed the presence of different forms of tubular injury.Conclusions Urinary KIM-1 is significantly elevated in obstructive uropathy.Such an elevation might be advantageous in the early diagnosis and subsequent early intervention of cases with partial ureteral obstruction.