Search

Purpose: To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy. Methods: A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed. Results: A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications. Conclusion: Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible.

Malacoplakia is an inflammatory lesion which can affect any organ in the body but predominantly affects the genitourinary system and mainly the bladder. Malacoplakia of the bladder has variable presentations and is associated with urinary infection or immunosuppression. Mullerianosis of the bladder is a rare lesion that consists of two out of the three tissues, endometriosis, endocervicosis, or endosalpingiosis. It is usually associated with a previous cesarean section or pelvic surgery. The diagnosis is confirmed on histopathological examination. Malacoplakia and mullerianosis are usually isolated lesions of the bladder. We present a unique case of coexistence of malacoplakia and mullerianosis in the urinary bladder, reported for the first time in the literature.

Objectives There is an increased risk of vascular complications in kidney transplant for allografts with multiple renal arteries versus a single renal artery. We compared the clinical outcomes of living donor kidney transplant recipients who received allografts with a single renal artery versus multiple renal arteries. Materials and methods This retrospective analysis included all living-related donor kidney transplants that were performed by a single skilled urologist. All donor nephrectomies were performed by open method. The left kidney was preferred over the right for donor nephrectomy, except in cases of vascular problems or other contraindications, for which the right kidney was preferred. In most of the cases, kidneys were placed in the right iliac fossa for transplant by an extraperitoneal approach. Results Of 97 living donor kidney transplants, 82 had a single renal artery (group 1) and 15 had multiple renal arteries (group 2). Patients ranged in age from 18 to 76 years old. Recipient ages (33.00 vs 29.46 years) and baseline serum creatinine values (8.61 vs 8.82 mg/dL) were comparable in groups 1 and 2 (P > .05). However, mean operative time and total ischemia time were significantly higher in the multiple renal artery group (221 and 53.45 minutes, respectively) compared with the single renal artery group (202 and 77.6 minutes, respectively). Graft survival at 1 year was 95.12% in the single renal artery group and 93.33% in the multiple renal artery group. Patient survival at 1 year was 96.34% in the single renal artery group and 93.33% in the multiple renal artery group. Conclusions The safety of kidney transplants of allografts with multiple renal arteries is equal to the safety of transplants of allografts with a single renal artery in terms of vascular complications and acute tubular necrosis, as well as patient and graft survival.

Objective We aimed to established normal uroflowmetric values and subsequently derived nomograms of maximum flow rate (Qmax) and average flow rate (Qavg) against voided volume (VV) in children aged 5–15 years at our institute. Methods A total of 440 children underwent uroflowmetric evaluation with no history of urological, renal, psychiatric or neurological disorder between 5 and 15 years of age. Each subject data regarding maximum flow, average flow, flow time, VV, flow time along with age, weight, height were recorded. Of the 440 children around 300 (68%) children could produce a normal flow rate and VV of more than 50 mL. Of the remaining 140 (32%) children, 50% voided less than 50 mL, and remaining 50% had abnormal voiding pattern, staccato or interrupted (21% each), and plateau or tower shaped (3.57% each). Cases were divided into two age groups 5–9 years and 10–15 years and uroflowmetric analysis was done between boys and girls in both age groups to derive nomograms of Qavg and Qmax. Results Maximal and average flow nomograms were plotted for boys and girls. Mean maximal flow rate for boys was 16.68 mL/s and for girls, 20.69 mL/s. The mean Qavg values were 11.04 mL/s and 8.60 mL/s respectively for girls and boys. The Qmax and Qavg values were higher in girls. There was significant increase in flow rates with increasing age, body surface area and VV in both sexes. Conclusions Nomograms for maximal and Qavg maybe a useful tool in evaluation of lower urinary tract disturbances in children.

The incidence of renal cell carcinoma (RCC) is around 3% of all cancers. Venous tumor thrombus (VTT) formation and migration are unique aspects of RCC with an incidence of 4%–10%. Venous extension into the renal vein, inferior vena cava, and cardiac extension have been well documented in RCC. Various surgical approaches, including a cardiopulmonary bypass for tumor embolus extraction, may be needed. However, VTT extending into the lumbar vein at the initial presentation is very rare. We hereby report such rarity of RCC presentation of VTT involving renal vein and lumbar vein in a 50-year-old male.