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We performed a systematic literature review of the psychological impact on donors of living kidney donation. We conducted a literature review in PubMed/Medline according to PRISMA guidelines which included both qualitative (based on interviews) and quantitative studies (based on standardized questionnaire). There were 15 quantitative studies and 8 qualitative studies with 2,732 donors. Given that the methodologies of qualitative and quantitative studies are fundamentally different, we narratively synthetized results of studies according to four axes: quality of life, anxiety/depression, consequences of donation on the donor/recipient relationship, overall satisfaction and regret. The quantitative studies reported that donor quality of life remained unchanged or improved. Donor regret rates were very low and donor-recipient relationships also remained unchanged or improved. Qualitative studies reported more complex donation experiences: one can regret donation and still decide to recommend it as in a social desirability bias. In both study types, donor-recipient relationships were closer but qualitative studies reported that post-donation rebonding was required. The qualitative studies therefore highlighted the psychological complexity of donation for donors, showing that living donation impacts the donor's life whether it is successful or not. A better understanding of the impact of donation on donors could provide better care for donors. [ABSTRACT FROM AUTHOR]

Purpose: Urothelial carcinoma has a higher incidence in renal transplanted patients according to several registries (relative risk × 3), and the global prognosis is inferior to the general population. The potential impact of immunosuppressive therapy on the feasibility, efficacy, and complications of endovesical treatment, especially Bacillus Calmette–Guerin, has a low level of evidence. We performed a systematic review that aimed to assess the morbidity and oncological outcomes of adjuvant endovesical treatment in solid organ transplanted patients. Methods: Medline was searched up to December 2021 for all relevant publications reporting oncologic outcomes of endovesical treatment in solid organ transplanted patients with NMIBC. Data were synthesized in light of methodological and clinical heterogeneity. Results: Twenty-three retrospective studies enrolling 238 patients were included: 206 (96%) kidney transplants, 5 (2%) liver transplants, and 2 (1%) heart transplants. Concerning staging: 25% were pTa, 62% were pT1, and 22% were CIS. 140/238 (59%) patients did not receive adjuvant treatment, 50/238 (21%) received mitomycin C, 4/238 (2%) received epirubicin, and 46/238 (19%) received BCG. Disease-free survival reached 35% with TURBT only vs. 47% with endovesical treatment (Chi-square test p = 0.08 OR 1.2 [0.98–1.53]). The complication rate of endovesical treatment was 12% and was all minor (Clavien-Dindo I). Conclusion: In solid organ transplanted patients under immunosuppressive treatment, both endovesical chemotherapy and BCG are safe, but the level of evidence concerning efficacy in comparison with the general population is low. According to these results, adjuvant treatment should be proposed for NMIC in transplanted patients as in the general population. [ABSTRACT FROM AUTHOR]

Purpose of the Review: To update the most relevant literature regarding complex vascular cases in kidney transplant setting involving the graft, especially during the harvesting procedure and back-table preparation from the subsequent implant. Recent Findings: Challenging situations affecting the kidney graft such as multiple vessels, renal artery aneurysms, kidney anatomical anomalies, or major injuries do not contraindicate the transplant, but require an exhaustive graft viability assessment and several bench surgery techniques. Graft vessel conditioning in the back-table might include simple anastomosis between them, enlarging with venous patch or reconstruction with donor or synthetic grafts. Compared with conventional transplant, literature reports longer warm ischemia time (40 vs 32 min) and slightly increased rates of delayed graft function (10.3% vs 8.2%) and vascular complications (10.8% vs 8.1%), but similar graft and patient survival. Summary: Kidney graft vascular complex cases require exhaustive assessment, meticulous harvesting, good surgical technique in the bench table, and proper surgery in the recipient. Despite its complexity, vascular complex kidney transplant offers comparable outcomes in the long term to conventional population when technically well performed, with slightly increased rates of vascular complications and delayed graft function. [ABSTRACT FROM AUTHOR]

Background and Objectives: Micronutrients may influence the development and differentiation of sperm cells. The aim of this study was to assess the possible association of deficiencies in several vitamins and trace elements with sperm abnormalities in men with obesity.Participants and Methods: Thirty male patients with moderate to severe obesity and ten lean controls who gave written informed consent were included. Anthropometric parameters were recorded. Hormonal and lipid profiles were analyzed, as well as serum concentrations of zinc, copper, retinol, α-tocopherol, 25-hydroxyvitamin D, cobalamin, and folic acid. For sperm analysis, we used the reference values proposed by the World Health Organization.Results: Fourteen of the thirty men (47%) presented abnormal sperm results. The most common abnormality was low motility in 33% of them, followed by low sperm concentration in 27% of the patients. Patients with abnormal sperm results showed lower serum folic acid (p = 0.005) and higher serum estradiol (p = 0.015) and copper (p = 0.033) than lean controls. The ejaculate volume inversely correlated with body mass index (BMI; r = -0.378, p = 0.016) and serum estradiol (r = -0.328, p = 0.041). Total number of sperm correlated inversely with BMI (r = -0.428, p = 0.006) and serum estradiol (r = -0.507, p = 0.001) and positively with serum folic acid (r = 0.356, p = 0.026) and retinol (r = 0.421, p = 0.009). Total motility of sperm inversely correlated with BMI (r = -0.433, p = 0.005), serum estradiol (r = -0.475, p = 0.002), and copper (r = -0.416, p = 0.012) and positively correlated with serum folic acid (r = 0.522, p = 0.001) and retinol (r = 0.350, p = 0.034).Conclusions: Sperm abnormalities in men with obesity are associated with excess body weight and micronutrient concentrations. [ABSTRACT FROM AUTHOR]

Introduction Around 10%of renal cell carcinomas (RCC) are cystic, while some benign cysts have complex appearance in conventional diagnostic tests such as computed tomography (CT) or magnetic resonance imaging (MRI). These renal complex cystic masses (RCCMs) are a challenging entity in urological practice and sometimes have a difficult management, requiring surgical removal. Contrast-enhanced ultrasound (CEUS) is a very sensitive test detecting microvascularization in real time, and it has been used in the diagnostic workup of these kinds of lesions. The aim of our study was to assess the diagnostic power of CEUS in the evaluation of RCCM. Material and Methods This is a prospective observational study between April 2011 and July 2014. A total of 66 patients with 67 RCCMs were enrolled (Bosniak 2–4). Twenty-four patients underwent surgical removal of the RCCM. All participants underwent CEUS (experimental) and CT (control). All CEUS procedures were performed by a single highexperienced observer (urologist). Benign lesions were defined as those Bosniak 2–2F, and malignant were Bosniak 3–4. Statistical analysis was made measuring consistency (kappa index and Landis-Koch scale) and validity (sensitivity, specificity,positive and negative predictive values) of the study. Results Median size of RCCM measured by CEUS and CT was 3.8 cm (interquartile range (AIQ) 3.2–4.6) and 3.9 cm (AIQ 3.2–4.5), respectively. Kappa index shows good agreement between both tests (0.71; 95 % CI 0.57–0.85), both overall and stratified by categories according to Bosniak classification. CEUS has a sensitivity 100 %, specificity 81.4 %, positive predictive value 70.4 %, and negative predictive value 100 %. A total of eight RCCMs were discordant, and seven of eight classified as malignant by CEUS and not by CT. Of those seven lesions classified as malignant by CEUS, six (six of seven, 85.7 %) were malignant in the pathological exam. Conclusions CEUS is a very useful tool for assessing RCCM, with good results in terms of consistency and validity. It has a good diagnostic power, with a sensitivity of 100 % and anegative predictive value of 100 %. Its main limitations are the experience required, a special software, and being observer-dependent. [ABSTRACT FROM AUTHOR]

Kidney transplant is the best alternative of treatment for patients with end-stage renal disease (ESRD). At present, a significant part of patients admitted to waiting list are older and have previous transplants or severe vascular atheromatosis. In these cases, orthotopic kidney transplant (OKT) could be an option. The aim of the study is to present our results with this technique in terms of surgical steps, complications, and outcomes. Between January 1977 and August 2014, 1549 kidney transplants were performed in our transplant unit. Nine of them were OKT and were performed according to principles described by Gil-Vernet. All data were reviewed retrospectively. Nine OKTs were performed in seven males and two females, with a mean age of 49.3 years (range 24-67). Donor mean age was 40.5 (18.5-62.5) and the follow-up mean time was of 91.8 months (8-226). Seven cases were first transplants and two were third transplants, all of them from deceased donors. Indication for the OKT was an unsuitable iliac region in six (66.6 %) and abnormalities in the low urinary tract or urinary diversions in three (33.3 %). Delayed graft function (DGF) was present in 22.2 % (2/9). Three patients (33.3 %) developed early surgical complications: one bleeding (Clavien IIIb), one arterial thrombosis (IIIb), and one pancreatic leak (IIIb). Two patients (25 %) had late complications: one ureteral stricture (IIIb) and one reflux nephropathy (IIIa). Mean serum creatinine after OKT was 1.7, 1.5, and 1.8 mg/dl at 1 month, 1 year, and 5 years, respectively. Mean graft survival was 80.7 months (range 0-226). At present, three patients are alive with functioning graft, three patients died with functioning graft, two patients returned to dialysis many years after the transplant, and one lost the graft due to an arterial thrombosis in the early postoperative course. OKT is a valid option for patients with unsuitable iliac regions such as those with third transplants, severe atheromatosis, or vena cava thrombosis. It is also an option for those patients with urinary diversions. Functional results are good, although it is a technique not exempted from complications. Two thirds of the patients have a long-term survival of the graft, and a third of the patients die with functioning graft. [ABSTRACT FROM AUTHOR]

Strict imaging follow-up is mandatory after cryoablation of small renal masses (SRMs). Although it uses ionizing radiation and nephrotoxic iodinated contrast, computed tomography (CT) is still the gold standard test. Contrast-enhanced ultrasound (CEUS) is a novel technique that informs in real time about renal perfusion avoiding radiation and nephrotoxicity. The objective of this study is to compare outcomes between CEUS and CT in the follow-up of SRMs treated with cryoablation, as well as to assess degree of agreement between them. This is a prospective observational study (May 2012 to December 2013) comparing CEUS and CT in 16 patients with SRMs cryoablated. The on-going protocol of the study includes a CT and CEUS 3 months after treatment and then every 6 months during 5 years. Local relapse was defined as the presence of contrast enhancement in the mass. All the CEUS were performed by a single experienced observer (E.S.). Degree of agreement was measured with kappa index. CEUS detected contrast enhancement in three patients (3/16, 18.8 %) and CT in two patients (2/16, 12.5 %). Degree of agreement between CEUS and CT, according to Landis-Koch classification, was 0.76 (CI 0.33-1.19; p = 0.0165), which is excellent and higher than expected by random. Sensitivity of the test is 93.75 % (15/16). Median time of follow-up after cryoablation is 22 months (15.5-36.5). CEUS has an excellent agreement with CT and a high sensitivity in the follow-up of SRMs treated with cryosurgery, demonstrating its usefulness. Due to these encouraging results, it could become a reference test in the near future for monitoring SRMs after ablative treatment. [ABSTRACT FROM AUTHOR]

Purpose of Review: The alarming number of confirmed COVID-19 cases put a strain on the healthcare systems, which had to reallocate human and technical resources to respond to the emergency. Many urologists became integrated into multidisciplinary teams, dealing with this respiratory illness and its unknown management. It aims to summarize the epidemiological, clinical, diagnostical, and therapeutical characteristics of COVID-19, from a practical perspective, to ease COVID-19 management to non-physician staff. Recent Findings: We performed a narrative review of the literature regarding COVID-19, updated to May 8th, 2020, at PubMed and COVID resource platforms of the main scientific editorials. COVID-19, characterized by fever, myalgias, dyspnea, and dry cough, varies widely from asymptomatic infection to death. Arrhythmias and thrombotic events are prevalent. Lymphopenia and inflammatory reactant elevation on laboratory, as well as bilateral and peripheral ground-glass opacities or consolidations on X-Ray, are usually found in its assessment. Little is known about SARS-CoV-2 immunology. To date, no therapy has demonstrated efficacy in COVID-19. Of-level or compassionate-use therapies are prescribed in the context of clinical trials. We should become familiar with specific adverse events and pharmacological interactions. Summary: The COVID-19 pandemic has paralyzed the urological activity, and its long-term consequences are unpredictable. Despite not being used to deal with respiratory diseases, the urologists become easily qualified to manage COVID-19 by following protocols and being integrated into multidisciplinary teams, helping to overcome the pandemic. [ABSTRACT FROM AUTHOR]

Utility of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) has been questioned utilizing data from patients treated with tyrosine kinase inhibitor (TKI) therapy as first line. We sought to compare outcomes of CN in patients who underwent TKI versus those who underwent Immuno-Oncology (IO) therapy. Multicenter retrospective analysis of patients from the REMARCC (REgistry of MetAstatic RCC) database. The cohort was divided into patients receiving TKI vs. IO as first-line therapy [TKI-CN vs. IO-CN]. Primary outcome was all-cause mortality (ACM)/overall survival (OS). Secondary outcome was cancer-specific mortality (CSM)/cancer-specific survival (CSS). Cox proportional hazards multivariable analysis (MVA) was used to elucidate predictive factors for ACM, CSM, and RFS. Kaplan Meier Analysis (KMA) was performed to analyze 5-year OS and CSS between TKI-CN vs. IO-CN. 189 patients (148 TKI-CN vs 41 IO-CN; median follow-up 23.2 months). No inter-group differences were noted for primary tumor size (9.0 vs 9.3 cm, p=0.603) or median number of metastases;(p=0.354). MVA demonstrated increasing number of metastases;(HR=1.06, p=0.015), increasing primary tumor size (HR=1.10, p=0.043), TKI receipt;(HR=2.36, p=0.015), and post CN initiation of systemic therapy (HR=1.49, p=0.039) to be associated with worsened ACM. Increasing number of metastases at diagnosis (HR=1.07, p=0.011), increasing primary tumor size (HR=1.12, p=0.018), TKI receipt;(vs IO, HR=5.43, p=0.004), and post-CN initiation of systemic therapy (HR=2.04, p<0.001) were independently associated with worsened CSM. Comparing IO-CN vs. TKI-CN groups, KMA demonstrated greater 5-year OS (51% vs 27%, p<0.001) and 5-year CSS (83% vs 30%, p<0.001) for IO, which persisted in analysis of intermediate to poor risk patients: 5-year OS (50%;vs 30%, p<0.001). In patients who received cytoreductive nephrectomy, receipt of IO therapy was associated with improved survival outcomes compared to TKI therapy. Furthermore, initiation of pre-CN systemic therapy was associated with improved outcomes. Our findings call into question the applicability of clinical trial data from cytoreductive nephrectomy in the TKI era to cytoreductive nephrectomy in the IO era. [ABSTRACT FROM AUTHOR]