Effects of hypothermia and pentoxifylline on the adnexal torsion/detorsion injuries in a rat testis model.

This study was designed to investigate the effects of separate and combined administration of hypothermia and pentoxifylline to preserve the effects on the testicles in an experimental model of testicular torsion/ detorsion injuries in rats. Forty male adult Wistar rats were randomly divided into five groups, control, torsion/detorsion (TD), torsion/detorsion/hypothermia (TD+ICE), torsion/detorsion received of pentoxifylline (40mg/kg, ip) (TD+PTX) and torsion/detorsion/hypothermia/PTX (TD+ICE+PTX). Left testicular torsion (TT) was performed for 4 and half hours, and ice fragments have been used at the beginning of torsion. After the reperfusion period (a week), oxidative maker's serum levels, testosterone hormone, sperm parameters, and histopathological and gene expression evaluations have been performed. Significant adverse changes were observed in the TD group for histological variables, sperm count, oxidative marker, testosterone hormone, Bax, BCL2 and caspase-3 expression. The parameters studied in the group receiving PTX improved in comparison with the TD group, while macroscopical parameters of both the hypothermia and PTX+ICE groups were not different compared with the TD group. The results revealed that PTX, as an antioxidant component, was protective against testicular torsion, while hypothermia and hypothermia plus PTX did not exhibit this property, which may have been due to the duration of hypothermia (4 hr) or reperfusion period.

Are Nephrostomy and Ureteral Stent Necessary after Multi-Access Percutaneous Nephrolithotomy?

INTRODUCTION: Totally tubeless percutaneous nephrolithotomy (PCNL) is a well-established technique used in single -access procedure nevertheless these results challenge the multi-access PCNL as a contra-indication to application of this technique. AIMS: To compare complication rates and safety of use of this technique after multi-access PCNL. METHODS: A Total of 130 patients with renal stones were enrolled in this cohort study. Totally tubeless PCNL with single access (Group A, n = 70) and multi-access (Group B, n = 60) were done and bleedings were assessed by measuring hemoglobin (Hb) drop, blood transfusion rate and need for angioembolization besides leakage rates which were also recorded. RESULTS: In the 130 patients who underwent totally tubeless PCNL, no leakage from puncture site nor angioembolization cases were identified. There was no significant statistical differences between 2 groups regarding Hb drop (1.91 in single access versus 2.20 in multi-access), transfusion rate and length of hospital stay (p > 0.05). Stone-free rate was increased from 91% in single access to 97% in multi access by adding percutaneous access sites (from 91% in single access to 97% in multi-access). CONCLUSIONS: Multi-access totally tubeless PCNL seems feasible and has comparable complication rates including Hb drop besides providing the advantage of higher stone-free rates using multi-access tracts.

Comparing Bleeding Complications of Double and Single Access Totally Tubeless PCNL: Is It Safe to Obtain More Accesses?

PURPOSE: To assess bleeding complications in totally tubeless double-access percutaneous nephrolithotomy (PCNL) and compare it with the single-access method. METHODS: One hundred and seven patients with large or scattered renal stones were enrolled in this cohort study. Totally tubeless PCNL with one access (group A, 70 cases) or two accesses (group B, 37 cases) was done and bleeding was assessed by measuring the hemoglobin drop of the patients, blood transfusion rate and need for performing angioembolization. RESULTS: The mean (SD) hemoglobin drops in groups A and B were 1.97 (1.24) and 2.31 (1.24), respectively; p = 0.176. Blood transfusion rates in two groups were 7.1 and 10.8% (p = 0.716), respectively. None of our patients required angioembolization. The average hemoglobin drop and blood transfusion rate with double tracts were approximately near to those in single tract group and in acceptable ranges. The average hospital stay in groups A and B were 3.1 and 3.2 days (p = 0.074), respectively. There was no leakage from puncture site/s and stone free rates in the two groups were 85.7 and 97.3% (p = 0.093). CONCLUSION: Totally tubeless double-access PCNL is feasible and bleeding complications are comparable to single access totally tubeless PCNL making it an effective strategy to achieve more stone free rates.