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Purpose To identify the predictors of nadir serum creatinine (SCr) after drainage of bilaterally obstructed kidneys (BOKs) by different modes: double-J stent (JJ) versus percutaneous nephrostomy (PCN) and unilateral versus bilateral drainage. Methods A prospective non-randomized study was performed on patients with BOKs and raised SCr during December 2019–November 2021. Relevant variables were studied for improvement and non-improvement and for benign and malignant underlying obstructions (BUO and MUO). Results This study included 107 patients with BOKs including 68 (63.6%) males and 39 (36.4%) females. After drainage, 86 (80.4%) patients get improved, while 21 (19.6%) patients failed to reach a nadir SCr. Drainage by PCN was significantly higher in MUO, while JJ was significantly higher in BUO (p p = 0.03). In contrast, mode of drainage had no significant effect on improvement in BUO (p = 0.84), but bilateral drainage was a significant factor of rapid time to nadir (p = 0.02). Univariate analyses revealed no significant effects on the improvement in SCr from the studied variables, except the male gender (p = 0.01), old age (p p = 0.01), unilateral drainage (p p p = 0.01) and MUO (p Conclusions Male gender, old age, MUO, unilateral drainage, and drainage by PCN were significant predictors of non-improvement in SCr after drainage of BOKs. However, unilateral drainage and MUO were the only independent predictors of non-improvement.

Background Testicular ectopia is defined as a testis which is located away from the normal pathway of testicular descent and outside its ipsilateral hemiscrotum. Controversies have been raised about considering the abdominal and inguinal ectopic testes as undescended ones. Our purpose was to review our center’s experience with the diagnosis and management of testicular ectopia focusing on the inguinal ectopic testis. Retrospectively, we studied the clinical and surgical characteristics of a case series of testicular ectopia which was managed in our center during July 2001–June 2016. Results Out of 1132 patients with undescended testes, 44 cases (3.9%) had testicular ectopia. Twenty-three cases (mean age = 5.15 ± 5.79 years) fulfilled the criteria of inguinal ectopic testis. Clinically, testes were relatively mobile and superficial. Surgically, they were located in the superficial inguinal pouch, had relatively long spermatic cords, and commonly had average rather than small sizes. The other ectopic 21 cases (mean age = 10.56 ± 6.92 years) were perineal, anterior abdominal wall, femoral, prepubic, and transverse testes in 7 (33.3%), 4 (19%), 4 (19%), 3 (14.3%), and 3 (14.3%) cases, respectively. Congenital inguinal hernia was the commonest associated anomaly (22.7%). All cases were treated surgically with only 1 case of testicular atrophy (2.3%). Conclusions Testicular ectopia is rare with relatively delayed presentations. Different anatomical sites have been reported including the superficial inguinal pouch and anterior abdominal wall with variable complexities and controversies. The inguinal ectopic testis is the most controversial, but it might be characterized from other entities based on certain clinical and surgical criteria.

Background: Transurethral resection of the prostate (TURP) consider the golden treatment of benign prostatic hyperplasia (BPH). Aims: To evaluate the effect of pre-operative nursing instructions on the potential post-operative complications after TURP. Study design: A quasi-experimental research design (study-control) was utilized. Setting: Assiut Urology and Nephrology Hospital, Assiut University. Subjects: Eighty male patients undergoing TURP. Tools: Two tools were utilized for data collections including the following: Tool I: Patient assessment sheet: it contained demographic data, pre-operative clinical data, and assessment of postoperative complications. Tool II: Patient’s knowledge questionnaire. Results: the age of the majority of the patients in both study and control groups (95% and 92.5% respectively) and was between 50-65years old for study and control groups. The main pre-operative symptoms were terminal dribbling and inability to empty the bladder (75% and 67.5%) among the study group and (72.5% and 70% respectively). A significant differences between both groups regarding the total knowledge and postoperative complications (P = 0.001* and r.= - 0. 720). Conclusions: Pre-operative nursing instructions improve patients’ knowledge and reduce the rates of TURP complications Recommendations: Routine use of pre-operative nursing instructions for patients undergoing TURP.

Giant hydronephrosis is rare and usually presents during childhood as a unilateral renal mass due to congenital anomalies such as pelvi-ureteral junction obstruction. In adulthood, however, other etiologies such as urolithiasis may supervene. We report on a 75-year-old female patient who presented with right-sided abdominal pain. She had a visible right renal mass with smooth surface and cystic consistency. Urine analysis showed 60–80 pus cells/HPF and serum creatinine level was 1.2 mg/dL. Imaging revealed hugely dilated kidneys with right severe hydronephrosis and lost renal parenchyma due to a large middle ureteral stone. The left kidney had variable parenchymal thickness which was better at the lower pole with multiple stones. After counselling of the patient, simultaneous left pyelolithotomy with placement of a left JJ stent and right nephrostomy tube were done. Then, renal isotope scanning revealed diminished total glomerular filtration rate (54.6 mL/min/1.73 m2) with better left split function (61.2 vs. 38.8%). Accordingly, a right ureterolithotomy was done and the patient was followed up for 1 year with variable serum creatinine level between 1.2 and 1.5 mg/dL.

Acute presentation of ureteral stump empyema after pretransplant nephrectomy has not been reported so far. We report on a 25-year-old male patient with end-stage renal disease due to congenital vesicoureteral reflux and a long-term history of management of infected kidneys including the last step of pretransplant right native nephrectomy. Within 2 weeks after operation, he presented with clinically visible ureteral stump empyema. Computed tomography and surgical exploration confirmed the diagnosis of a huge retentive stump of obstructive-refluxing megaureter which was excised with a smooth postoperative course. So, ureteral stump empyema may develop after a pretransplant nephrectomy and threaten the transplant process and the patient’s life. Consecutive nephrectomy and ureterectomy procedures to keep the iliac fossa fresh for kidney transplantation do not outweigh the risks of ureteral stump infections. Therefore, simultaneous nephroureterectomy is mandatory in the case of obstructive-refluxing megaureter.

Objectives: To compare the efficacy, complications, and costs of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) in the treatment of a 20 to 30 mm single renal pe...

Objectives To present our center's experience in the management of adrenal myelolipoma in the context of shifting from the open to the laparoscopic adrenalectomy approach. Materials and methods A retrospective search of our center's records was done for reported cases of adrenal myelolipoma during the period July 2001-June 2016. All the cases with histopathologically-documented adrenal myelolipoma diagnosis were included. Relevant demographic and clinical variables were studied with a comparison between the open and laparoscopic approaches. Results Of more than 82,000 urological surgeries, 238 adrenalectomies were done with only 22 cases of myelolipoma that had a mean age and body mass index of 52.4 ± 10.3 years and 30.23 kg/m2, respectively. The main clinical presentation was accidental discovery. The largest dimension of tumors varied from 6 to 16 cm. Computed tomography described a characteristic picture of hypodense heterogeneous adrenal tumors in all cases, while magnetic resonance imaging was indicated for malignancy suspicion in only 5 cases. Adrenal tumor markers were normal in all cases. Open and transperitoneal laparoscopic adrenalectomies were used in 14 and 8 cases, respectively. The latter approach was insignificantly advantageous in the need for blood transfusion, postoperative pain degree, need for analgesia, and hospital stay duration (p = 0.22). Histo-pathological examination revealed benign adipose tissue and myeloid cells and confirmed the diagnosis of adrenal myelolipoma in all cases. Conclusions Adrenal myelolipoma is a rare non-functioning benign tumor. Laparoscopic excision seems to be a promising alternative approach to the traditional open adrenalectomy, even in the context of large tumors and obesity.

[No Abstract Available].

Background Chronic kidney disease (CKD) is a worldwide public health problem due to its increasing prevalence worldwide. Endoplasmic reticulum (ER) stress has been shown to play a role in the pathogenesis of various renal diseases in humans. It leads to the activation of the unfolded protein response (UPR) which triggers three known trans membrane sensors in the ER: activating transcription factor 6 (ATF6), inositol-requiring enzyme I (IRE1), and PKR (double-stranded RNA-dependent protein kinase)-like ER protein kinase (PERK). The activation of these signal transduction pathways can result in cell death, inflammation, and fibrosis in the context of CKD. Objectives The aim of this study was to detect the level of gene expression of activating transcription factor 6 (ATF6), inositol-requiring enzyme I (IRE1), and PKR (double-stranded RNA-dependent protein kinase)-like ER protein kinase (PERK) in chronic kidney disease patients. Subjects and methods This study was carried out on eighty subjects, 50 patients with CKD (25 with hypertension and 25 without hypertension) and 30 healthy subjects served as controls. All studied subjects underwent laboratory investigations, including CBC, Serum Lipid profile: Total cholesterol, Triglycerides, HDL-cholesterol and LDL-cholesterol, liver and kidney functions, fasting and 2 h postprandial blood glucose and HbA1C, serum level of IL6 and gene expression of ATF6, IRE1 and PERK using real time PCR technique. Results There was a significant increase in relative quantitation (RQ) of gene expression of IRE1, ATF6 and PERK in chronic kidney patient groups with hypertension and without hypertension compared to control group. Also, there was a significant positive correlation of PERK and ATF6 gene expressions and a significant negative correlation of PERK gene expressions and GFR in groups I&II. Conclusion Endoplasmic reticulum (ER) stress occurs in CKD with activation of gene expression of three trans-membrane sensors in the ER: activating transcription factor 6 (ATF6), inositol-requiring enzyme I (IRE1), and PKR (double-stranded RNA-dependent protein kinase)-like ER protein kinase (PERK)., Highlights • Endoplasmic reticulum (ER) stress occurs in CKD. • A significant increase in gene expression of PERK, ATF6 and IRE1 was detected in chronic kidney patients. • Patients with CKD have a higher prevalence of dyslipidemias. • Serum pro-inflammatory cytokines (IL-6) may be predictive of the development of. • CKD patients should be considered as patients at very high risk for CVD.

BackgroundGiant hydronephrosis is rare with a controversy about the complete loss of renal functions. Our objective is to present our center’s experience with the management of cases of clinically visible giant hydronephrosis considering the potential residual functions. Our study is a retrospective case series of clinically visible giant hydronephrosis which was managed during the period July 2001–June 2016. Demographic and clinical variables were studied with specific considerations to the potential residual functions.ResultsOf more than 82,000 urological interventions, only 47 cases (0.057%) were operated upon for clinically visible giant hydronephrosis. Group 1 included 21 patients (mean age = 50.43 ± 13.71 years) who were treated initially by nephrostomy tube, and group 2 included 26 patients (mean age = 42.96 ± 15.16 years) who were treated primarily by nephrectomy. The main clinical presentation was abdominal distention (61.7%), while 13 patients (27.7%) were unaware of the swellings. The commonest underlying causes of hydronephrosis were urolithiasis (68.1%) and bilharzial ureteral strictures (23.4%). The contralateral kidney was diseased in 22 cases (46.8%) including the bilateral clinically visible hydronephrosis in 7 cases (15%). Indications of placement of a nephrostomy tube included uremia, infections, and evaluation of renal functions, where 5 cases of group 1 regained significant split function ranged 14–33%.ConclusionsClinically visible giant hydronephrosis is an extreme form of renal dilatation with different etiologies such as urolithiasis and bilharziasis. Initial placement of a nephrostomy tube may save significant residual functions in these kidneys.

Introduction: Surgical fires are unique topics that belong to surgical never events and deserve urological attention. Materials and Methods: A retrospective search of our hospital records was done for the states of electrosurgical never events in the period from July 2001 to June 2016. The included events were classified according to the site of occurrence in relation to the patient's body and possibilities of human involvement. The events were studied for the type, extent, damages, personnel involvements, complications, and management. Results: Of more than 82,000 urological interventions, 18 cases (0.022%) of electrosurgical never events were detected. Four subcategories were differentiated: electrosurgical theater fires (33.3%), electrosurgical contact skin burns (38.9%), electrosurgical internal injuries (16.7%), and electrocutions (11.1%). Electrosurgical theater fires included 3 ignition fires with fire skin burns and 3 device explosions. Fires only occurred with the use of alcoholic skin disinfectants. Contact skin burns resulted from inadvertent direct electrosurgical contacts, with 2 burns on the back, 3 burns on the lower limbs, 1 burn at the penile shaft, and 1 burn at the suprapubic region. Only 1 case of contact skin burn required plastic surgery. Electrosurgical internal in-juries involved the intestine, spleen, and urethra and were followed by major complications. Electrocutions involved a doctor and a patient with multiple bone fractures in the former. Conclusion: Urological electrosurgical never events are very rare incidents and were differentiated into 4 clinical subcategories. Human involvements varied from absence to major devastating complications. Reduction of these events depends on the adjusted use of electricity-based armamentarium.

Introduction: Adrenal myelolipoma is a rare benign tumor. It is usually asymptomatic with variable sizes, where the small lesions are usually managed conservatively and the large and symptomatic ones indicate open or laparoscopic adrenalectomy. Observation: A 45-year-old obese male patient presented with an accidentally-discovered right adrenal mass during abdominal sonographic examination. The mass was clinically-palpable in the right lumbar region. Abdominal computed tomography described a well-circumscribed lesion displacing the right kidney downwards with compression and displacement of the inferior vena cava. It was heterogeneous with 16 cm × 14 cm × 8 cm dimensions and low attenuation appearance. Adrenal myelolipoma was suspected and the patient was counseled for the laparoscopic approach with high possibilities of conversion to open surgery. Laparoscopic excision was done by expert surgeons with demanding dissection from the surroundings, especially the liver and inferior vena cava, but, the mass was successfully removed. The postoperative course was short and uneventful. Histopathological examination confirmed the diagnosis of adrenal myelolipoma. Conclusions: Laparoscopic excision of giant adrenal myelolipoma is a challenging procedure, but it seems to be a feasible promising approach. Expert surgeons are recommended when operating large tumors, especially, in the obese patients. Keywords: Adrenal tumor; Laparoscopic adrenalectomy; Myelolipoma

Background To compare the results of urethral anastomosis to a button hole and to the lowest part of the anterior suture line during orthotopic neobladder substitution. Methods From January 2012 to December 2015, 87 consecutive male patients with invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder. Patients were randomly divided into two groups; group I (44 patients), the outlet was created as a button-hole at the most dependent part of the pouch, group II (43 patients), the lowest 1 cm of the anterior suture line of the pouch was left open as an outlet. Patients were randomly assigned to either group using computer-generated random numbers (JMP, Version 12.0.1; SAS Institute, Cary, NC, USA) via a sealed envelope. The functional outcomes of both groups were compared especially at the urethro-enteric anastomosis. Results There were no intraoperative complications. Early postoperative complications occurred in 9 patients (5 in group I and 4 in group II, p = 0.484). Prolonged urinary leakage persisted for 11 and 14 days in 2 patients in group I and 10 and 16 days in 2 patients in group II. Delayed postoperative complications occurred in 11 patients (5 [12.5%] in group I and 6 [15.6%] in group II) (p = 0.711). Three patients developed urethro-enteric strictures (2 in group I and 1 in group II) (p = 0.571). Conclusion The “non-hole” technique of urethral anastomosis was not associated with a significant increase in the complication rate when compared to the commonly performed “hole” technique.

Introduction: Abdominoscrotal hydrocele is a rare hydrocele variant in pediatrics and adults. Besides the historical concerns, controversies in etiology and management of abdominoscrotal hydrocele warrant studying. Subjects and methods: A systematic review was conducted based on a multilingual search of the world literature of abdominoscrotal hydrocele through electronic engines (Google Scholar and MEDLINE/PubMed). The demographic and clinical characteristics are critically addressed and a clinical grading system is proposed. Results: From the 487 delivered articles, 320 articles were eligible to this review including only 21 case series. They delivered 579 abdominoscrotal hydrocele cases. Abdominoscrotal hydrocele affects pediatrics more than adults with significantly increased rate of reporting in the last decades. Full or incomplete case descriptions were found in 558 cases versus 21 cases with deficient description. Abdominoscrotal hydrocele has been reported from 45 countries and India has the highest rate. Eight proposed hypotheses were differentiated for etiology and grouped according to the direction of fluid formation and hydrocele growth. Associated congenital anomalies include contralateral hydroceles and cryptorchidism. Complications result from compression, hemorrhage, infection, torsion, and coincident malignancy. A clinical grading system considering the increased anatomical, pathological or clinical complexities has been proposed and provided two categories; simple and complex abdominoscrotal hydroceles with further sub-classes. Conclusions: Abdominoscrotal hydrocele is rare, but the number of the reported cases is far larger than the previously reported numbers. Etiology follows multiple hypotheses and management is speculative. Proposed clinical grading may support differentiation of severity of the associated cumulative risks. Keywords: Abdominoscrotal hydrocele; Dupuytren; Processus vaginalis; Testicular dysmorphism

Introduction Surgical never events are preventable harmful non-intentional human errors. Urology is a common surgical specialty for their occurrence. Patients and Methods A retrospective search of our center's data was done during the period 2006-2016 for surgical never events. Each included case was studied for the primary diagnosis, procedure, and subspecialty, never event type and timing, needed extra-interventions, urologist/procedure proportioning, outcomes, and possible underlying causes of the event. Results Of more than 55,000 different urological interventions, 61 patients were involved in never events. Wrong procedures represented 75% of the never events, and endourology and urolithiasis subspecialties were more often involved. The main detectable underlying factor was the disproportion between the levels of the procedure class and the qualification of the urologist (41%). Thirty-four cases had extra-procedures. The short-term harm effect represented the final outcome in 42% of all events. Death, permanent organ loss, and long-term harm represented 20, 15, and 23%, respectively. Conclusion Urological surgical never events are rare, but their final outcomes could be catastrophic, even leading to death.

Objective: The aim of this work is the presentation of a case of isolated renal hydatid cyst with novel findings and an unusual surgical scenario. Clinical Presentation and Intervention: A 54-year-old female patient presented with left loin pain and a palpable left renal mass. Imaging described a well-demarcated left renal cystic lesion with a double-layer wall. Radical nephrectomy was performed due to the possibility of malignancy. On retrograde revision, the double-layer wall represented the detached germinative membrane of a hydatid cyst that was confirmed by histopathology. Conclusion: Isolated renal hydatid cyst could be misinterpreted as a renal tumor. It should be considered in the differential diagnosis of renal cystic lesions.

Objectives: The study aimed to present our center’s experience with long-standing urethral stones in male children with normal urethra. Materials and Methods: Retrospective search of our center data was done for the cases of long-standing urethral stones with normal urethra in male children during the period July 2001 – June 2016. Demographic and clinical data were studied. Results: Of more than 54,000 urolithiasis procedures, 17 male children (0.031%) were operated for long-standing urethral stones with normal urethra. In 14 cases (82.4%), residence was rural and parental education levels were low or none. All children were regularly prompted voiding with a history of difficulty or dysuria. All the stones lodged in the posterior urethra with an approximate mean duration of 2 months. The mean stone size of 11.29 ± 3.88 mm and rough surfaces in 88.2% of cases represented the main predisposing factors. Major complications included rectal prolapse in 1 case and vesicoureteral reflux in 3 cases. Endoscopic push-back was followed by disintegration in 76.5% or cystolithotomy in 17.7%, while it failed in 1 case that was treated by cystolithotomy. Conclusions: Long-standing urethral stones in male children with normal urethra are very rare misdiagnoses. Stone topography and sociocultural factors predisposed to their lodgments and negligence. Endoscopic treatment is the best approach.

To the Editor With interest, I read the article by Abd Elrahim.[1][1] The author described the morphometry of renal arteries according to the findings of computed tomography angiography. Retrospectively, he reviewed the data of 50 selected kidney donors to study the impact of age and gender on

Objectives : To evaluate the results of using a shorter ileal segment (40 cm only) in reconstructing Studer ileal neobladder after radical cystectomy. Subjects and methods : Radical cystectomy and modified Studer ileal neobladder was performed in 60 patients for invasive bladder cancer. Only 40 cm of the ileum was used; 32 cm segment for constructing the body of the neobladder, while the remaining 8 cm as an isoperistaltic intact limb for ureteral reimplantation. After one year, evaluation included clinical, laboratory, radiographic and urodynamic studies to determine the functional and oncological outcomes. Results : Early complications occurred in 5 patients (8.6%). According to the modified Clavien system, two patients had grade I complications, IIIb occurred in one patient and two patients had grade V complications. Late complications (8.6%) included incisional hernia in 2 patients, deep venous thrombosis, bilateral ureteroileal anastomotic stricture and intestinal obstruction each occurred in one patient. At one year, daytime and nighttime continence was 93.1% and 89.7%, respectively. Reflux was observed in 6 patients (10.3%) which was unilateral in 3 patients and bilateral in 3 without affecting the renal functions. Neobladder pressure was 7–18 cmH2O at half capacity and 13–38 cmH2O at full capacity with no uninhibited contractions. Conclusion : Minimizing the length of the ileum for Studer neobladder reconstruction is feasible and with acceptable results. Keywords: Neobladder; Reimplantation; Studer; Urinary diversion

Introduction: Adrenal myelolipoma is a rare tumor. Traditionally, open surgical adrenalectomy was the standard treatment for symptomatic myelolipoma. However, laparoscopic excision is a promising alternative approach. Observation: A 38-year-old obese male patient presented with right loin pain of many months duration. Imaging studies revealed a large well-defined high fat content right adrenal mass displacing the right kidney. Adrenal tumor markers were within normal suggesting a non-functioning lesion. In spite of some technical difficulties and adjustments, laparoscopic excision was done, successfully, with uneventful recovery and short convalescence. Histopathological examination described mature adipose tissue with myeloid cells and confirmed the diagnosis of adrenal myelolipoma. Conclusions: Laparoscopic excision of large adrenal myelolipoma may indicate some technical adjustments, but it seems to be a feasible and advantageous approach even in obese patients. Keywords: Laparoscopic adrenalectomy, Myeloid cells, Myelolipoma

Introduction: Psychic anuria is an old term, referring to a very rare psycho-urological event that has scarcely been studied so far. Materials and Methods: A retrospective study of the patients with psychic anuria presented to Assiut Urology and Nephrology Hospital during the period July 1991–June 2016 was done. Psychic anuria was defined, and the demographic and clinical characteristics including the methods of diagnosis and management were studied. Results: Of more than 3,800 cases of anuria, 9 female patients (0.24%) experienced psychic anuria in the age range of 17–43 years. Cardinal clinical findings included anuria for 36–72 h with absence of organic causes and normal renal function tests. Psychosocial risk factors were reported in the 9 cases. Anuria was documented by reliable history (56%) or observable urine collection (44%). Diagnosis was done by exclusion, where the investigations revealed no organic causes. Seven cases responded to the placebo intervention and 2 cases were self-limiting and resolved spontaneously. Conclusions: Psychic anuria is an extremely rare urological emergency that presents, mainly, in young adult females with unknown mechanisms. Renal vasoconstriction following psychosocial stressors is suggested. It is diagnosed by exclusion and resolves spontaneously or responds to placebo intervention as a mental distraction technique.

INTRODUCTION: Unintentional self-inflicted injuries mainly refer to those injuries which are inflicted by the patient himself with benign intentions. In urology, they may vary and result in significant morbidities. PATIENTS AND METHODS: A retrospective search of our patients' data records for the reported cases of patient's side-inflictor urological injuries during the period July 2006 - June 2016 was made. Each case was studied for age, gender, primary diagnosis, injury inflictor, involved organ, motivating factor, mechanism, diagnosis, management, and final outcome. RESULTS: Of more than 55,000 urological procedures, 26 patients (0.047%) were involved in unintentional patient's side-inflictor urological injuries. The age range was 8-76 years and included 23 males and 3 females. Fifteen patients (57.7%) had urological disorders before the injury. They could be differentiated into direct organ involvement injuries (53.8%) and catheter involvement injuries (46.2%). External male urogenital organs were involved in 69.3% of cases which were diagnosed on physical examination. The inflictor of the injury was the patient himself, a relative, and another patient in 73.1, 19.2, and 7.7% of cases, respectively. Motivating factors were relief of painful conditions (34.6%), psychiatric disorders (38.5%), and sexual purposes (27%). Final outcomes were short-term harm, long-term harm, and permanent disability in 50, 11.5, and 38.5% of cases, respectively. CONCLUSION: Unintentional patient's side-inflictor urological injuries are very rare events and mainly involve the external male urogenital organs under different motivating stressors. They could be differen-tiated into direct organ and catheter manipulation injuries with variable final outcomes from mild short-term harms to permanent disabilities.

Objective Presentation of our center's experience in the management of intracorporeally-retained urological surgical items. Materials and Methods Retrospective search of our center's data for cases of retained surgical items during the period July 2006 to June 2016. Each case was studied for the demographic and clinical variables including types, presentation, and management. Results Out of more than 55,000 different urological interventions, only 39 cases (28 males and 11 females) had retained surgical items. Urolithiasis-related urological subspecialties were more involved than others. Forgotten items and technically-retained items occurred in 38.5 and 61.5% of cases, respectively, and were immediately discovered or discovered up to 10 years later. Material types were textiles, biosynthetics, and metallics in 31, 51, and 18%, respectively. Possible predisposing factors included complex surgeries, emergent intraoperative events, and extra approaches. Occurrences of retained surgical items before and after implemented corrective actions were 74.6 and 25.4%, respectively. All the final outcomes were either short- or long-term harm without deaths, organ losses, or permanent disabilities. Conclusion Retained urological surgical items are surgical never events that result from forgetfulness or technical surgical human errors. Their sequels can be potentially fatal, but they are preventable and can be significantly reduced.

Introduction Preemptive (P) living donor kidney transplantation (LDKT) provides better survival rates, quality of life and economic saving. However, the extent of these advantages over those with a short period of pre-LDKT dialysis is not known. Objectives Evaluation of the patients’ characteristics and short-term outcomes of PLDKT and LDKT after a pre-transplant period of hemodialysis (HD) not >6 months. Patient and methods This study was conducted between June 2010 and June 2012 and included two groups. Group-I included recipients without HD before operation. Group-II included those who had a period of HD ≤6 months. Recipients and donors were evaluated according to the classic work up. Follow-up for 12 months was scheduled. Results Group-I included 30 recipients and group-II included 15 recipients. Demographic and clinical characteristics were similar except for mean recipient age (44 versus 34.3 years; p = 0.024), recipient donor age difference ( p = 0.03), job categories ( p = 0.047) and ABO distribution ( p = 0.01). Cumulative graft (0.88 versus 0.93) and recipient (0.92 versus 0.100) survival rates were non-significantly different. Graft function and mean serum creatinine level were within normal up to 12 months. Acute graft rejection (AGR) was significantly higher in group-II (16.7% versus 46.7%; p = 0.03). However, lymphoceles were significantly more common in group-I (40% versus 6.7%; p = 0.02). There was no delayed graft function (DGF), major urinary or vascular complications. Conclusion PLDKT has a lower rate of AGR. Despite it has a higher rate of lymphoceles, it saves the patient the morbidities of vascular access and inconveniences of HD. Hence, PLDKT is recommended as the first choice for each KT-candidate.