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Congenital solitary functioning kidney (CSFK) is characterized by an anatomical or functional absence of one kidney from birth. When suspected on perinatal ultrasonography (US), repeat US after birth should be performed for confirmation. Although postnatal 99mTc-dimercaptosuccinic acid scintigraphy (DMSA scan) is the gold standard for confirming CSFK, it carries the risk of radiation exposure; US alone is sufficient when performed by an experienced radiologist. One-third of patients with CSFK have additional congenital anomalies of the kidney and urinary tract at the solitary functioning kidney, the most common of which is vesicoureteral reflux. As evidence regarding vesicoureteral reflux with normal kidney US is correlated with significant urinary tract infection is lacking, voiding cystourethrogram may be considered in patients with CSFK with abnormal US findings. Furthermore, approximately 30% of patients with CSFK have extrarenal malformations. Moreover, up to 10% of them have syndromic features. In particular, examining for female genitalia malformations, which can have potential for complications from untreated obstructive malformations, is important. In conclusion, DMSA scan and voiding cystourethrogram are not necessary for all patients with CSFK, and the risk of each patient should be assessed to determine which test is needed during follow-up. The presence of extrarenal manifestations should also always be considered. [ABSTRACT FROM AUTHOR]

Background: Evidence is sparse regarding the incidence or prevalence of renal or genitourinary injuries arising from contact sports. There are currently no World Health Organization or European consensus guidelines relating to the participation in sport for children and young athletes with a solitary (functioning) kidney. Purpose: To review the international literature and to make sport-specific recommendations for children and young athletes with a solitary (functioning) kidney participating in sports, based on the overall likelihood of potential renal or genitourinary injury. Study Design: Narrative review; Level of evidence, 4. Methods: A descriptive epidemiological study was conducted of current literature according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Embase, Google Scholar, Cochrane, and PubMed databases were queried from 1975 to 2023, to assess available evidence regarding the prevalence and risk of renal injury through sports participation and guidelines surrounding the participation in sports for children and young athletes with a solitary (functioning) kidney. Methodological quality and certainty of evidence were assessed according to the International Classification of Urological Disease guidelines. Results: A total of 28 publications were identified after database searches and exclusions, comprising 40,889 patients. The majority of papers providing recommendations arose from the United States. Of the recommendations, 79% permitted an unrestricted return to noncontact sports. A return to contact sports is permitted in most instances after physician consultation. Conclusion: There is a dearth of good-quality published evidence in the literature relating to sports participation with a solitary (functioning) kidney. Overall, the risk of genitourinary injury in sports is low, and after physician assessment, there is currently no strong evidence to exclude children and young athletes with a solitary (functioning) kidney from full participation in contact and collision sports. [ABSTRACT FROM AUTHOR]

Congenital solitary functioning kidney (CSFK) is characterized by an anatomical or functional absence of one kidney from birth. When suspected on perinatal ultrasonography (US), repeat US after birth should be performed for confirmation. Although postnatal 99mTc-dimercaptosuccinic acid scintigraphy (DMSA scan) is the gold standard for confirming CSFK, it carries the risk of radiation exposure; US alone is sufficient when performed by an experienced radiologist. One-third of patients with CSFK have additional congenital anomalies of the kidney and urinary tract at the solitary functioning kidney, the most common of which is vesicoureteral reflux. As evidence regarding vesicoureteral reflux with normal kidney US is correlated with significant urinary tract infection is lacking, voiding cystourethrogram may be considered in patients with CSFK with abnormal US findings. Furthermore, approximately 30% of patients with CSFK have extrarenal malformations. Moreover, up to 10% of them have syndromic features. In particular, examining for female genitalia malformations, which can have potential for complications from untreated obstructive malformations, is important. In conclusion, DMSA scan and voiding cystourethrogram are not necessary for all patients with CSFK, and the risk of each patient should be assessed to determine which test is needed during follow-up. The presence of extrarenal manifestations should also always be considered.

Unilateral Renal Agenesis (URA) is characterised by the absence of one kidney, and typically manifests asymptomatically due to compensatory hypertrophy of the remaining kidney. The condition is often detected incidentally because routine screening for renal anomalies is not universal globally. URA is generally associated with mixed or sensorineural hearing loss. A case involving contralateral conductive hearing loss is discussed in the present case report. The present case involves a eight-year-old female with isolated URA and no other concurrent abnormalities. The present report highlights an atypical audiological profile in URA, diverging (conductive type of hearing loss) from the commonly observed sensorineural or mixed hearing loss patterns. Understanding such variations contributes to the broader knowledge of the genetic and developmental links between the auditory and renal systems. This case underscores the importance of comprehensive audiological assessments in individuals with renal anomalies, potentially broadening diagnostic considerations and therapeutic approaches.

Key Clinical Message: Conservative nonsurgical therapy ensures that the resolution is nearly 80% for vesicoureteral reflux grades I and II and 30%–50% for vesicoureteral reflux grades III and V within 4–5 years of follow‐up. Open surgical reimplantation of ureters of grades IV and V is a highly successful procedure, with reported correction rates ranging from 95% to 99% regardless of the severity of vesicoureteral reflux. Patients with vesicoureteral reflux present with a wide range of severity. With an incidence of approximately 1%, vesicoureteral reflux is a relatively common urological abnormality in children. Postnatal diagnosis of vesicoureteral reflux is typically made following a diagnosis of a urinary tract infection and less frequently following family screening. Voiding cystourethrograms remain the gold standard for diagnosing vesicoureteral reflux. To preserve the kidney and prevent the need for potential renal replacement therapy, infants with a single kidney require significantly more assessments and prompt decision‐making. Surgical correction is advised for patients with vesicoureteral reflux grades IV and V, while vesicoureteral reflux grades I, II, and III are managed conservatively. [ABSTRACT FROM AUTHOR]

Background: The prevalence of Müllerian anomalies (MA) among patients with congenital solitary functioning kidney (SFK) is not well defined. A delay in diagnosis of obstructive MA can increase the risk of poor clinical outcomes. This study describes the prevalence of MA in patients with congenital SFK. Methods: A retrospective review was performed of patients within the Nationwide Children's Hospital system with ICD9 or ICD10 diagnostic codes for congenital SFK defined as either unilateral renal agenesis (URA) or multicystic dysplastic kidney (MCDK) and confirmed by chart review. Patients with complex urogenital pathology were excluded. Renal anomaly, MA, reason for and type of pelvic evaluation, and age of diagnosis of anomalies were evaluated. Results: Congenital SFK occurred in 431 girls due to URA (209) or MCDK (222). Pelvic evaluation, most commonly by ultrasound for evaluation of abdominal pain or dysmenorrhea, occurred in 115 patients leading to MA diagnosis in 60 instances. Among 221 patients ages 10 years and older, 104 underwent pelvic evaluation and 52 were diagnosed with an MA of which 20 were obstructive. Isolated uterine or combined uterine and vaginal anomalies were the most common MA. MA were five-fold more common in patients with URA compared to MCDK. In 75% of patients, the SFK was diagnosed prior to the MA. Conclusions: The prevalence of MA in patients with congenital SFK was 24% among those age 10 years or older, and 38% were obstructive. This justifies routine screening pelvic ultrasound in girls with congenital SFK to improve early diagnosis. [ABSTRACT FROM AUTHOR]

BackgroundNephroureterectomy remains the gold standard treatment for upper tract urothelial carcinoma (UTUC). Considering the high risk of developing renal function impairment after surgery, the rationale for nephron sparing approaches in treatment of UTUC has been raised. In this case, renal cryoablation was able to achieve successful oncologic control while preserving renal function during 5 years of follow up without intraoperative or post operative complications.Case presentationA 79 year old male presents after three months of macroscopic hematuria. Imaging revealed a 3.6 × 3.1 × 2.7 cm endophytic mass in the interpolar region of the left kidney and an atrophic right kidney. After weighing the lesion's location with the patient's of complex medical history, he was counselled to undergo a minimally invasive percutaneous cryoablation as treatment for his solitary renal mass. A diagnostic dilemma was encountered as imaging suggested a diagnosis of renal cell carcinoma. However, the pre-ablation biopsy established an alternative diagnosis, revealing UTUC. Percutaneous cryoablation became an unorthodox treatment modality for the endophytic component of his UTUC followed by retrograde ureteroscopic laser fulguration. The patient was followed in 3 months, 6 months, then annually with cross sectional imaging by MRI, cystoscopy, urine cytology and renal function testing. After five years of follow-up, the patient did not encountered recurrence of UTUC or deterioration in renal function, thereby maintaining a stable eGFR.ConclusionAlthough evidence for nephron-sparing modalities for UTUC is mounting in recent literature, limited data still exists on cryotherapy as a line of treatment for urothelial carcinoma. We report successful management of a low-grade UTUC using cryoablation with the crucial aid of an initial renal biopsy and long-term follow-up. Our results provide insight into the role of cryoablation as a nephron-sparing approach for UTUC.

Unilateral Renal Agenesis (URA) is characterised by the absence of one kidney, and typically manifests asymptomatically due to compensatory hypertrophy of the remaining kidney. The condition is often detected incidentally because routine screening for renal anomalies is not universal globally. URA is generally associated with mixed or sensorineural hearing loss. A case involving contralateral conductive hearing loss is discussed in the present case report. The present case involves a eight-year-old female with isolated URA and no other concurrent abnormalities. The present report highlights an atypical audiological profile in URA, diverging (conductive type of hearing loss) from the commonly observed sensorineural or mixed hearing loss patterns. Understanding such variations contributes to the broader knowledge of the genetic and developmental links between the auditory and renal systems. This case underscores the importance of comprehensive audiological assessments in individuals with renal anomalies, potentially broadening diagnostic considerations and therapeutic approaches. [ABSTRACT FROM AUTHOR]

For high-risk patients with complex aortic aneurysms and post-dissection aneurysms, fenestrated and branched endovascular aortic repair (F/BEVAR) offers minimally invasive options customized to each individual’s anatomy. Company-manufactured devices or physician-modified endovascular grafts performed under the purview of an investigational device exemption are two United States Food and Drug Administration-approved avenues to perform fenestrated and branched endovascular aortic repair. This case report describes a creative use of physician-modified endograft to salvage renal function in a solitary kidney with a near immediate bifurcation of the renal artery in a patient with post-dissection extent II thoracoabdominal aortic aneurysm. In our patient, the immediate bifurcation (2 mm distal to the common left renal artery orifice) of the left renal artery in the setting of a known long-standing occlusion of a remotely placed right renal stent presented a clinical and technical challenge to maintaining this patient’s kidney function without sacrificing a significant portion of his remaining solitary kidney. Additionally, each branch was sizeable (5 and 7 mm), perfusing the cranial and caudal half of the kidney, respectively. Early bifurcation of renal arteries often results in sacrifice of the smaller branch to obtain adequate target vessel seal. Although some analyses have shown no change in glomerular filtration rate from coverage of accessory renal arteries, more recent studies have indicated clinically significant drops in both glomerular filtration rate and kidney length at 2-year follow-up. Herein, we describe use of a combination of an inner and external branch modification to stent both branches to preserve renal parenchyma and function. The patient has provided written informed consent for publication of this case report and their associated imaging studies.

Purpose: Treatment of renal cell carcinoma (RCC) in patients with solitary kidneys remains challenging. The purpose of this multicentre cohort study was to explore how renal function is affected by percutaneous image-guided cryoablation in patients with solitary kidneys. Material and Methods: Data from the European Registry for Renal Cryoablation database were extracted on patients with RCC in solitary kidneys treated with image-guided, percutaneous cryoablation. Patients were excluded if they had multiple tumours, had received previous treatment of the tumour, or were treated with more than one cryoablation procedure. Pre- and post-treatment eGFR (within 3 months of the procedure) were compared. Results: Of 222 patients with solitary kidneys entered into the database, a total of 70 patients met inclusion criteria. The mean baseline eGFR was 55.8 ± 16.8 mL/min/1.73 m2, and the mean 3-month post-operative eGFR was 49.6 ± 16.5 mL/min/1.73 m2. Mean eGFR reduction was − 6.2 mL/min/1.73 m2 corresponding to 11.1% (p = 0.01). No patients changed chronic kidney disease group to severe or end-stage chronic kidney disease (stage IV or V). No patients required post-procedure dialysis. Conclusion: Image-guided renal cryoablation appears to be safe and effective for renal function preservation in patients with RCC in a solitary kidney. Following cryoablation, all patients had preservation of renal function without the need for dialysis or progression in chronic kidney disease stage despite the statistically significant reduction in eGFR. Level of Evidence 3: Observational study. [ABSTRACT FROM AUTHOR]

Background: Nephron-sparing approaches are preferred for renal mass in a solitary kidney (RMSK), with partial nephrectomy (PN) generally prioritized. Thermal ablation (TA) also is an option for small renal masses in this setting; however, comparative functional/survival outcomes are not well-defined. Methods: A retrospective study of 504 patients (1975–2022) with cT1 RMSK managed with PN (n = 409)/TA (n = 95) with necessary data for analysis was performed. Propensity score was used for matching patients, including age, preoperative glomerular filtration rate (GFR), tumor diameter, R.E.N.A.L. ((R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of tumor, (N)earness of tumor deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines), and comorbidities. Functional outcomes were compared, and Kaplan-Meier was used to analyze survival. Results: The matched cohort included 132 patients (TA = 66/PN = 66), with median tumor diameter of 2.4 cm, R.E.N.A.L. of 6, and preoperative GFR of 52 ml/min/1.73 m2. Acute kidney injury occurred in 11%/61% in the TA/PN cohorts, respectively (p < 0.01). After recovery, median GFR preserved was 89%/83% for TA/PN, respectively (p = 0.02), and 5-year dialysis-free survival was 96% in both cohorts. Median follow-up was 53 months. Five-year recurrence-free survival (RFS) was 62%/86% in the TA/PN cohorts, respectively (p < 0.01). Five-year local recurrence (LR)-free survival was 74%/95% in the TA/PN cohorts, respectively (p < 0.01). Five-year cancer-specific survival (CSS) was 96%/98% in the TA/PN cohorts, respectively (p = 0.7). Local recurrence was observed in nine of 36 (25%) and five of 30 (17%) patients managed with laparoscopic versus percutaneous TA, respectively. For TA with LR (n = 14), nine patients presented with multifocality and/or cT1b tumors. Twelve LR were managed with salvage TA, and seven remained cancer-free, while five developed systemic recurrence, three with concomitant LR. Conclusions: Functional outcomes for TA for RMSK were improved compared with PN. Local recurrence was more common after TA and often was associated with the laparoscopic approach, multifocality, and large tumor size. Improved patient selection and greater experience with TA should improve outcomes. Salvage of LR was not always possible. Partial nephrectomy remains the reference standard for RMSK. [ABSTRACT FROM AUTHOR]

Key Clinical Message Conservative nonsurgical therapy ensures that the resolution is nearly 80% for vesicoureteral reflux grades I and II and 30%–50% for vesicoureteral reflux grades III and V within 4–5 years of follow‐up. Open surgical reimplantation of ureters of grades IV and V is a highly successful procedure, with reported correction rates ranging from 95% to 99% regardless of the severity of vesicoureteral reflux. Abstract Patients with vesicoureteral reflux present with a wide range of severity. With an incidence of approximately 1%, vesicoureteral reflux is a relatively common urological abnormality in children. Postnatal diagnosis of vesicoureteral reflux is typically made following a diagnosis of a urinary tract infection and less frequently following family screening. Voiding cystourethrograms remain the gold standard for diagnosing vesicoureteral reflux. To preserve the kidney and prevent the need for potential renal replacement therapy, infants with a single kidney require significantly more assessments and prompt decision‐making. Surgical correction is advised for patients with vesicoureteral reflux grades IV and V, while vesicoureteral reflux grades I, II, and III are managed conservatively.

Abstract Aim This study aims to compare the perioperative, functional, and oncological outcomes of cryoablation (CA) and partial nephrectomy (PN) for managing small renal masses in patients with solitary kidneys. The study seeks to assess the efficacy and safety of both interventions, evaluating their impact on kidney function and their ability to mitigate cancer recurrence. Methods Searches were systematically conducted on PubMed, Scopus, EMBASE, SinoMed, and Google Scholar, identifying seven observational studies. Statistical analysis was performed using Stata v.12.0 and Review Manager version 5.2. Results for dichotomous variables are expressed using odds ratios, and weighted mean differences are used for continuous variables. Results Our findings revealed that patients undergoing CA experienced significantly shorter operative time (p

Percutaneous nephrolithotomy (PCNL) has been widely applied in the treatment of isolated renal stones in recent years. However, its safety and effectiveness for patients with isolated renal stones remains controversial. In this work, "nephrolithiasis", "stones", "renal", "nephrolithotomy", "percutaneous", "PCNL", "solitary", "single", and "kidney" were taken as key words to search the relevant studies of PCNL in patients with solitary kidney stones in PubMed, Web of Science, and Embase. The type of literature included was case series study, and the search period was from January 1, 1990 to October 31, 2021. Basic data, stone size, stone removal rate (SFR), complications, mean operation time, and mean length of stays were extracted. The quality of the included literature was assessed using the National Institute for Health and Care Excellence (NICE) case series system, data were analysed using metan and metareg commands in Stata14.1, and sensitivity of the included literature was analysed using metaninf. Finally, 14 studies with a total of 1256 patients were included. The mean adjuvant rate of percutaneous nephrolithotomy for solitary kidney stones was 20.3% (95% CI: 11.8%, 28.9%), initial SFR was 71.8% (95% CI: 64.9%, 78.8%), and final SFR was 89.7% (95% CI: 86.0%, 93.4%). The overall complication rate was 25.5% (95% CI: 18.8%, 32.3%), the incidence of major complications was 6.3% (95% CI: 3.8%, 9.3%), the blood transfusion rate was 7.4% (95% CI: 5.3%, 9.9%), and the incidence of fever was 9.1% (95% CI: 5.3%, 13.7%). It is suggested that percutaneous nephrolithotomy has a low complication rate in the treatment of solitary kidney stones. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in patients with renal calculi with solitary kidneys (SKs). Materials and Methods: In this retrospective, multicenter study, a matched case–control study was carried out using the data from 522 RIRS patients treated between 2014 and 2021. Patients' demographic data, stone characteristics, operative outcomes, perioperative and postoperative complications, and surgical success were analyzed. All patients were evaluated with noncontrast-enhanced computed tomography (NCCT) preoperatively and 1 month after the surgery. Surgical success was defined as no evidence of remaining residual fragments of <3 mm in the first-month postoperative NCCT images. The case group of 29 patients with SKs (Group 1) treated with RIRS were matched with 76 control patients (Group 2) with bilateral kidneys, who underwent unilateral RIRS by propensity score–matched (PSM) analysis. Results: After PSM analysis, the demographic and clinical data did not differ significantly between the groups. The stone burden was similar between the groups: 733.6 mm3 (range: 50.4–7565.9) versus 991.1 mm3 (range: 201.2–4380.6) (P = .09), respectively. The perioperative complication rates were 13.8% (n = 4) in Group 1 and 11.8% (n = 9) in Group 2 (P = .78). There was no statistically significant difference between the groups for postoperative complication rates (minor complications, classified as Clavien 1 or 2), (6.9% [n = 2] versus 13.2% [n = 10; P = .34]), respectively. Surgical success was 82.8% (n = 24) in Group 1 and 83.6% in Group 2 (P = .92). There was no significant difference between preoperative and postoperative glomerular filtration rate and creatinine values (P = .005). Conclusions: Our results support that RIRS is a safe and effective treatment method in SK patients with similar complication and stone-free rates compared to patients who had bilateral functional kidneys and underwent unilateral RIRS. [ABSTRACT FROM AUTHOR]

Aim: This study aims to compare the perioperative, functional, and oncological outcomes of cryoablation (CA) and partial nephrectomy (PN) for managing small renal masses in patients with solitary kidneys. The study seeks to assess the efficacy and safety of both interventions, evaluating their impact on kidney function and their ability to mitigate cancer recurrence. Methods: Searches were systematically conducted on PubMed, Scopus, EMBASE, SinoMed, and Google Scholar, identifying seven observational studies. Statistical analysis was performed using Stata v.12.0 and Review Manager version 5.2. Results for dichotomous variables are expressed using odds ratios, and weighted mean differences are used for continuous variables. Results: Our findings revealed that patients undergoing CA experienced significantly shorter operative time (p < 0.0001), reduced estimated blood loss (p < 0.00001), a shorter length of stay (p = 0.0001), and fewer postoperative complications (p = 0.02) compared to those undergoing PN. Although the CA group exhibited a lower transfusion rate (p = 0.69) compared with the PN group, the difference was not statistically significant. The combined data analysis demonstrated a significantly lower increase in serum creatinine levels after surgery in the CA group compared with the PN group (p = 0.003). Similarly, there was a noteworthy decrease in the estimated glomerular filtration rate after surgery in the PN group compared with the CA group (p < 0.0001). While not statistically significant, the CA group showed a lower postoperative dialysis rate (p = 0.11). Regarding oncological outcomes, the analysis revealed no significant differences between CA and PN concerning local recurrence (p = 0.2) and distant metastasis (p = 0.12), respectively. Conclusions: Our analysis indicates comparable efficacy between PN and CA in controlling tumour recurrence and metastasis. However, CA is associated with superior preservation of renal function, significantly enhanced perioperative outcomes, and fewer postoperative complications. Based on our data, it can be inferred that the scope for applying CA might be expanded to encompass more patients seeking a less invasive treatment option. [ABSTRACT FROM AUTHOR]

We performed a meta-analysis to compare the safety and effectiveness of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating nephrolithiasis ≥ 2 cm in patients with solitary kidneys. This systematic review was registered on PROSPERO (registration ID: CRD42021270519). The search time was set from the establishment of the databases until April 30, 2021. A systematic search was performed in the PubMed, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Cochrane Library, and Embase databases. Stata 16 was used to perform the statistical analysis of the extracted data. After screening using strict inclusion and exclusion criteria, five studies with a total of 474 patients were included in the final meta-analysis. According to the literature quality assessment scale statistics, the five studies included were of high quality. The results of the meta-analysis showed that RIRS had lesser hemoglobin loss (HL), shorter length of hospital stay (LOS), lower initial (OR = 3.39, 95% CI [1.97, 5.83], P = 0.02) and final stone-free rates (OR = 2.24, 95% CI [1.24, 4.06], P = 0.03), but a higher incidence of grade III-IV complications (OR = 0.29, 95% CI [0.08, 0.97], P = 0.04) than PCNL. The difference between the two surgical methods was not statistically significant in terms of operation time (OT), grade I–II complication rate, and total complication rate. For nephrolithiasis ≥ 2 cm in patients with a solitary kidney, RIRS has the advantage of less HL and shorter LOS, while PCNL benefits from its higher SFR (both initial and final). Both RIRS and PCNL are effective treatments for nephrolithiasis in patients with a solitary kidney, and clinicians should choose the most appropriate option to achieve the best treatment outcome, taking into account the patient's underlying conditions and medical conditions. [ABSTRACT FROM AUTHOR]

Objective: Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors. Methods: A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes. Results: After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney. Conclusion: Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.

Zinner’s syndrome is a rare congenital urogenital anomaly characterised by the triad of seminal vesicle cyst, ipsilateral renal aplasia, and seminal duct obstruction. According to the published data, the incidence of seminal vesicle cysts with ipsilateral renal agenesis is 0.0046%, but the true incidence appears to be higher. The article presents a rare clinical case of patient K, 17 years old, followed since birth with a solitary right kidney. The patient was repeatedly examined (ultrasound, cystography, urography, abdominal MRI, pelvic CT). The boy was admitted to our clinic with the diagnosis of "Solitary right kidney" and pelvic cystic formation detected according to the last CT scan. MRI examination of the small pelvis, cystoscopy, diagnostic laparoscopy, puncture of the cystic mass were performed. The diagnosis of "Zinner's syndrome" was made. The size of the cyst did not change during follow-up.

Background: Partial nephrectomy (PN) is preferred for a renal mass in a solitary kidney (RMSK), although tumors with high complexity can be challenging. Objective: To evaluate the evolution of RMSK management with a focus on achievement of PN. Design, setting, and participants: Patients with nonmetastatic RMSK (n = 499) were retrospectively reviewed; 133 had high tumor complexity, including 80 in the pre-tyrosine kinase inhibitor (TKI) era (1999–2008) and 53 in the TKI era (2009–2022). After 2009, 23/53 patients received neoadjuvant TKI and 30/53 had immediate-surgery. Outcome measurements and statistical analysis: Functional outcomes, adverse events and complications, dialysis-free survival, and recurrence-free survival (RFS) were the measures evaluated. Mann-Whitney and χ2 tests were used to compare cohorts, and the log-rank test was applied for survival analyses. Results and limitations: Overall, the median RENAL score was 10 and the median tumor diameter was 5.2 cm. Demographic characteristics, tumor diameter, and RENAL scores were similar between the pre-TKI-era and TKI-era groups. In the TKI era, 23/53 patients (43%) with clear-cell histology were selected for neoadjuvant TKI. These 23 patients had a greater median tumor diameter (7.1 vs 4.4 cm; p = 0.02) and RENAL score (11 vs 10; p = 0.07). After TKI treatment, the median tumor diameter decreased to 5.6 cm and the RENAL score to 9, and tumor volume was reduced by 59% (all p

Introduction Megacalycosis is a rare disorder related to congenital underdevelopment of the renal papilla or structural defect of the renal calyces. Megacalycosis has a wide spectrum of clinical presentations ranging from simple variants without any significance on renal function to severe complications. Any prevention strategy is recommended yet since megacalycosis is mostly asymptomatic and usually discovered either accidentally or as result of its complications. Case presentation We observed megacalycosis progression in a young female with a single kidney toward progressive calyx dilatation for years, which ended in acute pyelonephritis. Conservative management, urinary drainage, and large‐spectrum antibiotics were unsuccessful and nephrectomy was required. Conclusion This rare case and literature review add evidence to identify prognostic factors to select patients with a high risk of complications (single kidney, bilateral disease, female gender, associated genetic syndromes, vesicoureteral reflux, and contralateral renal disorder). One o more factors should activate close monitoring and prophylactic therapy if needed.

Abstract Background Vascular injury during laparoscopic partial nephrectomy is a dreadful complication. Though it is a commonly discussed complication, the literature on the circumstances leading to vascular injury, methods of managing the complication and reporting of final outcomes in those cases are limited. We report a case of vascular injury during laparoscopic partial nephrectomy for a hilar tumor in a solitary kidney. We highlight the management of the complication, present the outcome and review the surgical technique. Case presentation A 62-year-old male with solitary kidney presented with left renal hilar mass of size 4.4 × 3.8x3.6 cm. The renal nephrometry score was 10ph. The serum creatinine at the time of presentation to the hospital was 1.4 mg/dl. Laparoscopic partial nephrectomy was performed. The patient had severe intraoperative bleeding due to a segmental renal artery injury. The bleeding presented after hilar unclamping and was managed by intracorporeal vascular repair. The blood loss was around 500 ml. The postoperative period was uneventful without the need for hemodialysis. The histopathology report was suggestive of clear cell renal cell carcinoma with negative surgical margin. The follow-up magnetic resonance urogram did not show evidence of any arterial pseudoaneurysm or residual/recurrent tumor. At 18-month follow-up, the serum creatinine was 1.9 mg/dl and the patient did not have any complaints. Conclusions Complication of vascular injury while performing laparoscopic partial nephrectomy for complex hilar tumors should be anticipated beforehand. Contingency plans to tackle this complication must be in place before attempting the surgery. Intracorporeal repair of vascular injury during laparoscopic partial nephrectomy is feasible when expertise is available. Low threshold for using endoscopic ultrasound, employing cold ischemia techniques, careful usage of hot cut during tumor resection and complete defatting of the kidney can all be considered ‘safe surgical practices’ during laparoscopic partial nephrectomy for complex hilar tumors. Following aforementioned ‘safe surgical practices’ helps in improving the outcomes and reducing the possibility of complication of vascular injury and helps in managing the complication effectively if it happens despite the precautions.

Renal artery aneurysms are rare. Indications for management include size > 3 cm, female gender within childbearing age, pain, hematuria, medically refractory hypertension, thromboembolism, dissection, and rupture. Management options include endovascular, open repair, and ex vivo approaches. A 43-year-old female with a history of polycystic kidney disease, solitary kidney, and uncontrolled hypertension was found to have a proximal large renal aneurysm on imaging. The patient underwent an in situ open aneurysm resection, temporary shunt insertion, and patch repair with good postoperative outcomes. Whereas previous studies showed the success of ex vivo repair and autotransplantation in large aneurysms with solitary kidneys, our case demonstrated that in situ open repair and patch with the use of a temporary shunt is a feasible and effective option. In a patient with a solitary kidney and large proximal renal artery aneurysm, an in situ open approach and patch repair with shunt insertion should be considered. [ABSTRACT FROM AUTHOR]

Objectives: The perioperative, functional, and oncological outcomes of patients with solitary small renal tumors (SRMs) treated with ablation (AT) or partial nephrectomy (PN) remain controversial. The aim of this study was to compare the outcomes of these two surgical techniques. Methods: In April 2023, we conducted a literature search in several widely used databases worldwide, including PubMed, Embase, and Google Scholar. Review Manager was used to compare various parameters. The study was registered with PROSPERO (CRD42022377157). Results: Our final meta-analysis included 13 cohort studies with a total of 2,107 patients. Compared to partial nephrectomy (PN), ablation (AT) had shorter hospital stays (WMD-2.37 days, 95% CI -3.05 to -1.69; p < 0.00001), shorter operating times (WMD -57.06 min, 95% CI -88.92 to -25.19; p = 0.0004), less postoperative creatinine increases (WMD -0.17 mg/dL, 95% CI -0.29 to -0.05; p = 0.006), less postoperative glomerular filtration rate decreases (WMD -9.84 mL/min/1.73m2, 95% CI -14.25 to -5.44; p < 0.0001), less postoperative new-onset chronic kidney disease (OR 0.33, 95% CI 0.16 to 0.71; p = 0.005), and less intraoperative blood loss (WMD -285.92 ml, 95% CI -428.44 to -143.40; p < 0.0001). The transfusion rate was lower in the ablation group (OR 0.17, 95% CI 0.06 to 0.51; p = 0.001). The risk of local recurrence was higher in the ablation group (OR 2.96, 95% CI 1.27 to 6.89; p = 0.01), while the risk of distant metastasis was higher in the partial nephrectomy group (OR 2.81, 95% CI 1.28 to 6.18; p = 0.01). The intraoperative and postoperative complication rates were lower in the ablation group (OR 0.23, 95% CI 0.08 to 0.62; p = 0.004 and OR 0.21, 95% CI 0.11 to 0.38; p < 0.00001, respectively). However, overall survival, postoperative dialysis rate, and tumor-specific survival were not different between the two groups. Conclusions: Our data suggest that ablation and partial nephrectomy are equally safe and effective in the treatment of small solitary kidney tumors and are better options for patients with poor preoperative physical condition or poor renal function. [ABSTRACT FROM AUTHOR]

Background. Surgery for non-organ malignant retroperitoneal tumors poses a serious challenge. Long-term asymptomatic course of the disease leads to a delayed diagnosis, when tumors can reach massive size with potential involvement of adjacent organs and critical structures. In most cases, nephrectomy is often required during resection of retroperitoneal sarcomas. Recently, there has been growing interest in nephronsaving surgery for large retroperitoneal tumors.Description of the clinical case. A 70-year-old patient was admitted to Irkutsk Regional Cancer Center with right-sided giant primary retroperitoneal tumor and grade 1 hydronephrosis of solitary right kidney. The patient underwent extended resection of primary retroperitoneal tumor with right-sided hemicolectomy and nephradrenalectomy. Extracorporeal resection of the solitary kidney was then performed. After obtaining negative kidney smears (imprints), the kidney was replanted in the pool of right iliac vessels. No complications were observed in the postoperative period. Histopathology examination revealed was welldifferentiated liposarcoma. On follow-up examination 38 months after surgery, there were no signs of local tumor recurrence, and renal function was satisfactory.Conclusion. Extracorporeal resection of the kidney with heterotopic replantation is an effective nephron-saving method in surgery for primary retroperitoneal sarcomas. The patient’s solitary kidney with primary retroperitoneal sarcoma is an absolute indication for kidney’s saving, including the use of transplant technologies.

For better management of acute kidney injury (AKI) and prevention of progressive renal injury, it is extremely important to manage infections such as gastroenteritis. In addition, anuria is considered a risk factor for AKI and even causes death in patients. An 18-month-old boy with vomiting and diarrhea for three days and anuria for 24 hours was referred to Farsan hospital. The patient had bulky and watery diarrhea about 7-8 times a day and vomited 3-4 times a day which was containing food particles. He had a fever on the first and second days. Ultrasound findings revealed that the right kidney did not exist, and the left kidney was affected by compensatory hypertrophy. Disorders in the patient’s blood biochemical factors were also observed. Acidosis and other biochemical disorders were treated with bicarbonate drip, allopurinol, Lasix drip, and dopamine drip. After about 18 hours, anuria was treated.

Objective:To define and discuss the new concept which using loop cutaneous ureterostomy (LCU) in patients with obstructing megaureter and solitary kidney.Materials and Methods:Two patients with solitary kidney with obstructive pattern were included. Both patients underwent LCU within the 1st month to reduce the obstruction and to relieve the pelvicaliceal system. Thereafter, parents were taught to dilate the ureter and irrigate the bladder with sterile saline by a disposable 6F catheter via antegrade fashion through the distal ureter. Initially, 10 cc saline was used once a day, then it was increased to 20 cc once a day after 2 months. When the bladder capacity was sufficient (50 mL capacity at the 6th month or by cystoscopic evaluation intraoperatively), we performed undiversion with ureteroneocystostomy and Double-J-stent placement.Results:Ureterorenal dilatations were followed-up by ultrasonography and renal function tests. No bladder dysfunction and renal insufficiency were observed during follow-up. At the postoperative controls, patients’ renal function tests were compatible with their ages and they had no voiding dysfunction.Conclusion:Patients with solitary kidney and obstructing megaureter require urgent diversion. After diversion, bladder cycling is required to prevent bladder dysfunction by protecting and developing bladder capacity. Using this concept, the kidney can be protected from further damage and treatment can be finalized around 6 months of age with minimum morbidity.

Aim: To present a patient with congenital bilateral hydronephrosis and the consequent unilateral afunctional kidney as one of the rare developmental anomalies of the urotract, and to point out the importance of using ultrasound for the purpose of early detection and prevention of further irreversible damage to the renal parenchyma. Case report: A male newborn was admitted to the Department of Intensive Care and Neonatology due to prenatally diagnosed bilateral hydronephrosis in the 26th week of gestation. During the stay, an ultrasound of the kidneys was performed, which showed hydronephrosis of the IV degree on the right, with dilated calyces and ballooned pyelon, and slightly reduced parenchyma. At the expected location of the left kidney, an irregular, bag-like formation was shown in the expected area of the duct system, while the kidney parenchyma was not discernible. At the age of 1 month, a dynamic scintigraphy of the kidneys was performed, which showed slow drainage from the right kidney in the area of the P-U junction. The left kidney was not shown during the examination. Given the described finding, the patient was treated with conservative methods. The boy was of regular growth and development. At the age of two years, a control scintigraphy was performed, which again showed significantly slowed spontaneous drainage in the area of the P-U junction, without improvement with the application of diuretics. Given that the findings deteriorated, the patient underwent surgical treatment. The method of choice was internal drainage with a “double J” prosthesis. This was followed by outpatient monitoring of renal function parameters. Conclusion: Hydronephrosis can be treated by double J surgical placement and thus potentially avoids more invasive methods of surgical treatment. However, it is necessary to approach each patient individually, taking into account the indications and possible complications. [ABSTRACT FROM AUTHOR]

Persons with acquired solitary kidney, including those who have had a unilateral nephrectomy for living kidney donation, renal malignancies, or trauma, have decreased renal mass that leads to increased intraglomerular pressure and glomerular hyperfiltration. These physiologic adaptations of solitary kidney may exacerbate other preexisting and genetic conditions that could create a predisposition to or worsen glomerular pathologies, leading to unfavorable renal outcomes. Hence, these persons may benefit from special care and lifestyle modifications, including nutritional interventions. There is a lack of consensus and evidence for proper surveillance and management after nephrectomy, and misconceptions in both directions of having a "normal" versus "abnormal" kidney status may cause confusion among patients and healthcare providers pertaining to long-term kidney health monitoring and management. We have reviewed available data on the impact of lifestyle modifications, particularly nutritional measures, and pharmacologic interventions, on short- and long-term outcomes after nephrectomy. We recommend avoidance of excessively high dietary protein intake (>1 g/kg per day) and high dietary sodium intake (>4 grams/d), adequate dietary fiber intake from plant-based foods, a target body mass index of

Purpose: The management of solitary kidney tumors is a surgical challenge, requiring irreproachable results on both oncological and functional outcomes. The goal of our study was to compare the perioperative results of robotic-assisted partial nephrectomy (RAPN) to open surgery in this indication. Methods: We led a multicentric study based on the prospectively maintained French national database UroCCR. Patients who underwent partial nephrectomy on a solitary kidney between 1988 and 2020 were included. Clinical and pathological data were retrospectively analyzed. The main outcome of the study was the analysis of the variation of the estimated glomerular filtration rate (eGFR) calculated according to MDRD at 3, 6, 12, and 24 months depending on the chosen surgical approach. The secondary outcomes were the comparison of Trifecta success, perioperative complications, and length of hospital stay. Results: In total, 150 patients were included; 68 (45%) in the RAPN group and 82 (55%) in the open surgery group. The two groups were comparable for all data. The variation of eGFR at 3, 6, 12, or 24 months was comparable without any significant difference between the 2 groups (p = 0.45). Trifecta was achieved in 40% of the patients in the RAPN group and 33% in the open group (p = 0.42). A significant difference was observed for the length of stay, 5 days for the robot group versus 9 days for the open surgery group (p < 0.0001). Conclusion: In our study, the surgical approach did not modify functional results and we noted a significant decrease in hospital stay and complications in the RAPN group. RAPN is a safe and efficient method for management of kidney tumors in solitary kidneys. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma (RCC) in solitary kidney (SK) represents a challenging scenario. We sought to compare outcomes of robot-assisted partial nephrectomy (RAPN) versus percutaneous thermal ablation (PTA) in SK patients with renal tumors cT1. We performed a multicenter retrospective analysis of SK patients treated for RCC. The PTA group included cryoablation or radiofrequency ablation. We collected baseline characteristics, intraoperative, pathological, and post-operative data. We applied an arbitrary composite "trifecta" to assess surgical, functional, and oncological outcomes, only for malignant histology. RFS analysis was performed using the Kaplan-Meier method. Multivariable regression analysis was performed to determine independent predictors of "trifecta" achievement. We included 198 SK patients (RAPN, n = 50; PTA n = 119). Mean clinical tumor size was not significantly different while R.E.N.A.L. score was higher for RAPN (p < 0.001). No differences in intra and major post-procedural complications. Recurrence rate was higher in PTA group but not statistically significant (p < 0.328). No difference in metastasis rate was found (p = 0.435). RFS was 96.1% in RAPN and 86.8% in PTA cohort (p = 0.003) while no difference in PFS was detected (p = 0.1). Trifecta was achieved in 72.5% of RAPN vs 77.3% of PTA (p = 0.481). Multivariable analysis has not detected predictors for Trifecta achievement. PTA offers good outcomes in the management of SK patients with RCC. Compared with RAPN, it might carry a higher risk of recurrence; on the other hand, re-treatment is possible. Overall, PTA can be safely offered to treat SK patients presenting RCC. In general, it should be preferred in more frail patients to minimize the risk of complications. [ABSTRACT FROM AUTHOR]

Background: Solitary kidney (SK) affects 1/1000 people worldwide, and there are controversies concerning renal outcomes in these patients. This study aimed to investigate clinical findings and renal outcomes in children with SK and to compare the results for congenital (CSK) and acquired SK (ASK) groups. Methods: The study included patients that presented to our pediatric nephrology department with SK between January 2010 and January 2021. Demographic and clinical data were recorded retrospectively. Results: Of the 101 patients with SK, 71 had CSK (55 had unilateral renal agenesis and 16 had a multicystic dysplastic kidney) and 30 had ASK (17 had previously undergone unilateral nephrectomy due to a renal tumor and 13 had urological structural anomalies). There were nine patients (9%) with renal injury. The serum uric acid level was significantly higher and the estimated glomerular filtration rate was significantly lower in the patients with ASK compared with those with CSK (p = 0.005 and p < 0.001, respectively). There was a positive correlation between renal injury and the uric acid level (p < 0.001, r = 0.45). Conclusion: In addition to the management of blood pressure and proteinuria, it is important to control uric acid levels in patients with SK, especially those with ASK, to prevent renal injury. The ASK group has a greater risk of renal injury than the CSK group. There is a need for new markers to predict early stage renal damage in SK. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to compare the treatment outcomes between suctioning flexible ureteroscopic lithotomy (SF-URL) with automatic control of renal pelvic pressure and minimally invasive percutaneous nephrolithotomy (MPCNL) for the management of 2–3-cm renal stones in patients with a solitary kidney. Materials and Methods: A total of 127 patients with a solitary kidney who underwent SF-URL (n = 57) or MPCNL (n = 70) for large renal stones (>2 cm) between June 2015 and October 2020 were consecutively analyzed. The stone characteristics, operative times, stone-free rate (SFR), hospital stays, and incidences of complications were compared. Results: There was a significantly shorter operative time with MPCNL than with SF-URL (43.4 ± 18.9 min vs. 61.8 ± 21.1 min, p = 0.012). SFR at 30 days were 80.7% (46/57) and 90.0% (63/70) for SF-URL and MPCNL, respectively (p > 0.05). The SFR at the 3-month follow-up was comparable in both groups (91.2% vs. 95.7%, p > 0.05). The hemoglobin decline value, hospital stay, serum cystatin C, and percentage of patients requiring blood transfusions in the SF-URL group were obviously better than those in the MPCNL group: (0.8 ± 0.4) versus (3.9 ± 2.7) g/dL (p = 0.007), (3.6 ± 1.5) versus (6.9 ± 3.1) days (p = 0.013), (1.02 ± 0.48) versus (2.54 ± 0.69) mg/L (p = 0.011), and 0 (0.0%) versus 7 (10.0%) (p = 0.016), respectively. The percentages of patients with thrombosis and perirenal hematoma in the MPCNL group were higher than those in the SF-URL group, but the difference was not statistically significant (p > 0.05). Conclusion: For the treatment of 2–3-cm renal stones in patients with a solitary kidney, both SF-URL and MPCNL are effective. MPCNL has the advantage of a shorter operation time. However, SF-URL is characterized by less bleeding, shorter hospital stay, and less damage to kidney function. [ABSTRACT FROM AUTHOR]

Abstract Background Given the importance of the function of the remnant kidney in children with unilateral renal agenesis and the significance of timely diagnosis and treatment of reflux nephropathy to prevent further damage to the remaining kidney, we aimed to determine the prevalence of reflux nephropathy in this subgroup of pediatric patients. Methods In general, 274 children referred to pediatric nephrologists in different parts of Iran were evaluated, of whom 199 had solitary kidney and were included in this cross-sectional study. The reasons for referral included urinary tract infection (UTI), abnormal renal ultrasonography, being symptomatic, and incidental screening. Demographic characteristics, including age and gender were recorded. History of UTI and presence of vesicoureteral reflux (VUR) were evaluated. Results Of the 274 children evaluated in this study with the mean age (SD) of 4.71 (4.24) years, 199 (72.6%) had solitary kidney. Among these, 118 (59.3%) were male and 81 (60.7%) were female, 21.1% had a history of UTI, and VUR was present in 23.1%. The most common cause of referral was abnormal renal ultrasonography (40.2%), followed by incidental screening (21.1%), being symptomatic (14.1%), and UTI (5.5%). In 116 children (58.3%), the right kidneys and in 83 (41.7%) the left kidneys were absent. Besides, 14.6% of the participants had consanguineous parents and 3% had a family history of solitary kidney. Upon DMSA scan, the single kidney was scarred in 13.1%, of which only 7.5% were associated with VUR. In addition, proteinuria and hematuria were observed in 6.5% and 1.5% of children, respectively. Conclusions The prevalence of reflux nephropathy was 7.5% in children with solitary kidney with a male predominance. Given the relatively high prevalence of reflux nephropathy in these children, screening for VUR in the remnant kidney appears to be essential in this population.

Whether or not children and adolescents with solitary kidney due to renal tumors can play the same sports as their peers has been a matter of extensive debate. This especially pertains sports bearing a potential risk of genitourinary injuries. Cancer patients are encouraged to live a normal life, yet children and adolescents with cancer have a reduced exercise tolerance matched with a lower energy expenditure compared to their peers. Engagement in sports could be a fundamental facilitator of living well also for individuals with one kidney or with a kidney disease. Exercising is important to counteract the impaired anabolic and activated catabolic pathways, chronic inflammation and oxidative stress resulting from chronic kidney disease.Guidelines, where available, addressing the safe participation of children and adolescents with a solitary kidney in middle or high-impact sports do not share a common vision worldwide. Our own experience and the literature suggest that some doctors feel that a renal cancer diagnosis leading to solitary kidney condition makes it unsafe to practice some team sports. In order to instigate action at a variety of levels, high-quality evidence on incidence of renal trauma in sports is required to achieve positive change at individual and systems levels. Oncology providers may contribute in informed counselling patients and their families on which sport is safe, in order to promote an active lifestyle.This paper reconsiders epidemiology on pediatric sport-related renal injuries and provides considerations for more evidence-based decisions, and proposes a renewed classification of sports at risk.

Background: The ureteral stent provides a conduit for urinary drainage from the kidney to the bladder and is integral to contemporary urologic practice. A ureteral stent is often utilized in acute conditions to prevent or overcome obstruction; however, in nonsurgical patients, because of disease or preference, a ureteral stent may be used as a last resort for long-term management of a stricture in lieu of a nephrostomy tube. This case highlights a patient whose chronic ureteral obstruction has been managed with an indwelling ureteral stent for 25 years; remarkably, stent exchanges are currently required only every 2 years. Case Presentation: A 33-year-old man initially presented with a solitary left kidney and a ureteropelvic junction obstruction. The patient's right kidney was nonfunctioning since childhood because of a presumed ureteropelvic junction obstruction with grade IV hydronephrosis. The patient underwent two failed open repairs of the left kidney in the 1980s, resulting in a totally intrarenal, constricted renal pelvis; an endopyelotomy in 1992 also failed and required angioembolizaton of a segmental renal vessel. The patient refused any further surgical procedures and thus has been managed exclusively with a 7/14F × 28 cm endopyelotomy stent (Boston Scientific®) for 25 years; the interval between stent changes was slowly expanded until they are now being done at 2-year intervals. The patient has not developed recurrent urinary tract infections, stent colic, or stent encrustation. Conclusion: Patients who require chronic indwelling ureteral stents are rare. In this situation, with careful monitoring, the interval between stent exchanges was extended to 2 years, thereby precluding a chronic nephrostomy tube.

Objective: To define and discuss the new concept which using loop cutaneous ureterostomy (LCU) in patients with obstructing megaureter and solitary kidney. Materials and Methods: Two patients with solitary kidney with obstructive pattern were included. Both patients underwent LCU within the 1st month to reduce the obstruction and to relieve the pelvicaliceal system. Thereafter, parents were taught to dilate the ureter and irrigate the bladder with sterile saline by a disposable 6F catheter via antegrade fashion through the distal ureter. Initially, 10 cc saline was used once a day, then it was increased to 20 cc once a day after 2 months. When the bladder capacity was sufficient (50 mL capacity at the 6th month or by cystoscopic evaluation intraoperatively), we performed undiversion with ureteroneocystostomy and Double-J-stent placement. Results: Ureterorenal dilatations were followed-up by ultrasonography and renal function tests. No bladder dysfunction and renal insufficiency were observed during follow-up. At the postoperative controls, patients' renal function tests were compatible with their ages and they had no voiding dysfunction. Conclusion: Patients with solitary kidney and obstructing megaureter require urgent diversion. After diversion, bladder cycling is required to prevent bladder dysfunction by protecting and developing bladder capacity. Using this concept, the kidney can be protected from further damage and treatment can be finalized around 6 months of age with minimum morbidity. [ABSTRACT FROM AUTHOR]

Diabetes mellitus significantly affects survival in patients with renal cell carcinoma undergoing nephrectomy, requiring personalized care. This case involved a 64-year-old man with type 2 diabetes (T2D) who underwent radical nephrectomy for renal cell carcinoma. He consented to a 1-year intensive lifestyle intervention (ILI), including a vegan diet (to lower calorie intake, reduce uric acid, support renal health, and promote weight loss), intermittent fasting, regular exercise, psychological support, and medical management. Quarterly biochemical assessments and monthly adherence evaluations were conducted. Post intervention, the patient achieved diabetes remission, maintaining glycated hemoglobin A1c (HbA1c) below 6.5% (48 mmol/mol) (reference range, <6.5%; <48 mmol/mol) without medication. He lost 36 kg (79.37 lb), reducing his body mass index from 35.3 to 25.1. His lipid profile normalized (total cholesterol, 175 to 127 mg/dL (4.53 to 3.29 mmol/L) (reference range, <200 mg/dL; <5.18 mmol/L); triglycerides, 155 to 73 mg/dL (1.75 to 0.82 mmol/L) (reference range, <150 mg/dL; <1.69 mmol/L), allowing the discontinuation of statins. Improvements in serum creatinine and high-sensitivity C-reactive protein levels were also observed. The patient exhibited normal glucose tolerance, consecutively passing an oral glucose tolerance test for 2 years. This case highlights the potential of lifestyle modifications in managing T2D in patients with a history of nephrectomy., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Caesarean section with associated ureteric injuries that damage kidney function is uncommon. Such injury in women with a solitary kidney has far-reaching effects if the diagnosis is delayed. The case report describes the successful acute management with stenting of ureteric damage after caesarean section in a woman with a solitary kidney.A 29-year-old woman presented with anuria, hypertension (174/101 mmHg) and flank pain 3 days after caesarean section. Physical examination was significant for peri-orbital oedema, left flank tenderness, pallor and delirium. A diagnosis of acute kidney injury was confirmed by elevated blood urea and creatinine levels. An ultrasound scan revealed a solitary hydronephrotic left kidney. She had successful acute management at a resource-deprived facility, with normal renal function at a 2-year follow-up. Proteinuria lasted for about three months after surgery.Recovery of solitary kidney function with acute kidney injury due to caesarean section ureteric injury may be associated with prolonged proteinuria without evidence of further functional deterioration.

Adult survivors of childhood Wilms tumor are at an increased risk of secondary malignant neoplasms. The presence of a solitary kidney further complicates clinical management in this population. Herein, we present the case of a 37 year old female with a history of childhood Wilms tumor presenting with a secondary renal neoplasm. We highlight important clinical considerations for renal function preservation and present a finding of predisposition to kidney stone formation due to urinary stasis from distorted ureter architecture secondary to tumor mass effect. [ABSTRACT FROM AUTHOR]