ABSTRACT

Supine percutaneous nephrolithotomy (PCNL) is a less practiced modality for the treatment of upper-tract calculi. We hereby present our single center experience in 100 patients treated by supine PCNL over a period of 18 months. We found the procedure simple and feasible. 

Sanjay Kolte, Parag Ingle, Vivek Bhargava, Meenal Kolte, Jalaj Jain

Submitted August 7, 2012 - Accepted for Publication January 6, 2013

KEYWORDS: Supine PCNL, calculi, kidney

CORRESPONDENCE: Dr. Sanjay Kolte, Sparsh Urology & Kidney Hospital, 35 Balraj Marg, Dhantoli, Nagpur, Maharashtra, India 440012 (spkolte5@gmail.com)

CITATION: UroToday Int J. 2013 February;6(1):art 8. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.08

ABSTRACT

Introduction: For more than a decade, adult laparoscopic donor nephrectomy (LDN) has been offered as a minimally invasive organ procurement modality for pediatric patients with end-stage renal disease. There is a paucity of literature reflecting pediatric recipient outcomes of adult LDN kidneys, and the objective of this study was to evaluate our institutional experience.

Methods: Thirty-six pediatric patients were identified as recipients of adult LDN from 2000 to 2009 at our institution.

Results: The most common renal disease was dysplasia (N = 6) for those 0 to 5 years of age and nephronophthisis (N = 7) for those 6 to 18 years if age. The mean operative time for those 0 to 5 years of age was 262 ± 38 min and 216 ± 69 min for those 6 to 18 years (P < 0.04). Perioperative complications were more common in those 0 to 5 years of age (73 vs 24%, P < 0.01) and the length of stay (19.3 ± 20.8 days vs 4.8 ± 2.7 days, P < 0.001) was longer compared with those 6 to 18 years.

Conclusion: Pediatric recipients of adult LDN kidneys present unique surgical and hemodynamic challenges. Although renal transplants in pediatric patients are associated with postoperative morbidity, graft survival is comparable to adult LDN recipients.

Zachary Klaassen, Prakash R. Paragi, H. Stephen Fletcher, Ronald S. Chamberlain, Stuart Geffner

Submitted November 24, 2012 - Accepted for Publication January 6, 2013

KEYWORDS: Pediatric, laparoscopic donor nephrectomy, adult kidney donor, outcomes

CORRESPONDENCE: Ronald S. Chamberlain, MD, MPA, FACS, Chairman and Surgeon-in-Chief, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, New Jersey 07039 USA (rchamberlain@barnabashealth.org)

CITATION: UroToday Int J. 2013 February;6(1):art 7. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.07

ABSTRACT

Purpose: This study intends to compare short-term outcomes of treatment of urethral stricture disease between human immunodeficiency virus (HIV) seropositive and HIV seronegative patients at the University Teaching Hospital (UTH) in Lusaka.

Methods: This was a prospective cohort study conducted on patients presenting with urethral stricture disease at the UTH, Lusaka, Zambia, between October 2009 and December 2010. One arm included HIV seropositive patients and the other arm had HIV seronegative patients. The recruited patients underwent urethral dilatation, anastomotic urethroplasty, and staged urethroplasty. They were followed-up postoperatively for 6 months, and recurrence and complication rates were compared between the 2 groups. Other parameters studied included patient demographics, cluster of differentiation (CD4) cell counts in positive patients, HIV World Health Organization (WHO) stages, stricture etiology, stricture sites, and stricture lengths. The collected data was analyzed using SPSS 16.

Results: A total of 71 patients with a mean age of 38.04 years who had urethral stricture disease were recruited for this study. Of the patients, 37% (26) were HIV seropositive while 63% (45) were seronegative, and 53.8% (14) of the seropositive patients were on highly active antiretroviral therapy (HAART). Of the urethral strictures, 45% (32) resulted from urethritis, and the prevalence of HIV in patients presenting with post-urethritis stricture disease was 50% (16/32). Of the strictures, 73.2% (N = 52) were located in the bulbar urethra, 19.7% (N = 14) were in the penile urethra, and 5.6% (N = 4) were located in the membranous urethra. Of the patients, 73% (N = 52) had urethral dilatation, 17% (N = 12) had anastomotic urethroplasty, and 10% (N = 7) had staged urethroplasty. The overall intraoperative complication rate was 2.8% (2) while postoperatively it was 12.7% (9); 55.2% (32/58) had urethral stricture disease recurrence after being followed-up for 6 months, with urethral dilatation accounting for most of the failures (28% (20/58)). Of the non-reactive patients, 47% (16/34) had recurrence while 67% (16/24) had recurrence. However, the 20% difference in recurrence between reactive and non-reactive patients was statistically insignificant (P = 0.139).

Conclusion: Urethral stricture disease affects patients from all age groups. The prevalence of HIV in patients with post-urethritis stricture disease is high. Stricture recurrence following treatment is not affected by the HIV status of the patient and CD4cc, although it is affected by stricture site and stricture length. Time to recurrence and cumulative survival of urethral stricture disease following treatment are also not influenced by the HIV status of the patient.

Mohamed Awny Labib, Michael Silumbe, Kasonde Bowa

Submitted April 30, 2012 - Accepted for Publication December 27, 2012 

KEYWORDS: Aetiology, site, stricture, urethra

CORRESPONDENCE: Mohamed Awny Labib, FRCS (Ed), University Teaching Hospital, Lusaka, Central Zambia, Africa (mohamedlabib57@gmail.com)

CITATION: UroToday Int J. 2013 February;6(1):art 6. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.06

ABSTRACT

Objectives: Urethral stricture disease remains a common cause of morbidity among men. Many questions about the etiology of urethral stricture disease remains unanswered till now. This study was done in a tertiary care center along with a review of the literature to evaluate the etiology of urethral strictures and to determine the factors that may influence possible preventive or curative strategies.

Methods: This was a retrospective and prospective study of 404 patients with urethral strictures. The case records of all these cases diagnosed as urethral stricture were analyzed to determine the possible cause of the stricture, demographic profiles, and clinical presentation. Data were entered both prospectively by a careful patient questioning and retrospectively from a detailed chart review. A subanalysis of the stricture etiology of patients aged less than 40 years vs patients aged 40 or more was done. Statistical analysis with the Fisher’s exact test was done, and a p value < 0.05 was considered statistically significant.

Results: The mean age of presentation was 41.2 years (range: 3 to 81 years). Overall, the iatrogenic cause was the most common (40.6%), but stricture etiology varied with age and the stricture site.

Conclusions: The etiology of urethral strictures is not uniform across the world. The iatrogenic and idiopathic strictures are surprisingly common. Avoiding unnecessary urethral catheterization and repeated urethral instrumentation can reduce iatrogenic strictures.

Jitendra Singh, Vinod Priyadarshi, Praveen Pandey, Mukesh Vijay, Malay Bera, Sudip Chakraborty, Anup Kundu, Dilip Pal

Submitted October 26, 2012 - Accepted for Publication December 16, 2012 

KEYWORDS: Aetiology, site, stricture, urethra

CORRESPONDENCE: Jitendra Pratap Singh, MS, Department of Urology, Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India (jpims99@gmail.com)

CITATION: UroToday Int J. 2013 February;6(1):art 5. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.05

ABSTRACT

Introduction

Renal pseudotumors simulate malignancy but they are, in fact, comprised of normal renal tissue. Renal pseudotumors include both congenital as well as acquired causes, and they cause considerable anxiety. Many reports are available in the literature where the diagnosis has been clinched only after nephrectomy.

Case Report

We report the case of a 52-year-old male who was referred with the diagnosis of left renal-cell carcinoma upon ultrasound. A contrast-enhanced computed tomography scan finalized the diagnosis of hypertrophied column of Bertin, as there was uniform uptake of contrast noted in the entire kidney. The patient was reassured, and he was relieved of his anxiety. This case is highlighted because congenital hypertrophied columns of Bertin can mimic a renal mass lesion.

Conclusion

Renal pseudotumors are not uncommon, and if they are diagnosed preoperatively with appropriate imaging, invasive interventions like biopsy and radical surgeries can be avoided.

D Paul Vincent, Hari PS

Submitted October 2, 2012 - Accepted for Publication November 13, 2012

KEYWORDS: Renal pseudotumor, hypertrophied column of Bertin, renal mass

CORRESPONDENCE: D. Paul Vincent, MBBS, DNB (Surgery), DNB (Urology), Consultant Urologist, MIMS Hospital, Kottakkal, Malappuram District, Kerala, India 676503 (pauldevincent@rediffmail.com)

CITATION: UroToday Int J. 2013 February;6(1):art 4. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.04