Change in renal function post-nephrectomy for renal cell carcinoma in patients with and without hypertension and/or diabetes.

BACKGROUND: The standard of care for surgically resectable disease renal cell carcinoma (RCC) is a nephrectomy. Post-nephrectomy, these patients are at risk for the development of new onset chronic kidney disease or the progression of pre-existing chronic kidney disease. We aimed to report the changes in renal function in patients who had a nephrectomy for RCC. METHODS: This retrospective, descriptive, cross-sectional study identified 137 patients who had a nephrectomy for RCC from 1 January 2009 to 31 December 2017. The pre-nephrectomy and post-nephrectomy estimated glomerular filtration rate (eGFR) and the histological subtype of RCC on histopathological analysis of the resected specimen were recorded from the National Health Laboratory Services online results platform. All analyses were conducted using SPSS (Version 25) and the significance level was set at p < 0.05. RESULTS: After a mean follow-up period of 26.5 ± 22 months (median = 19 months), the patients' eGFR dropped by a mean of 4.82 ± 8.67 ml/min/1.73 m2 (95% CI 3.23-6.41) post-nephrectomy. The mean eGFR fall in patients' who had hypertension and/or diabetes (n = 63) was significantly larger compared to patients who had neither of these comorbidities (n = 54; p < .001; mean = 7.30 ± 8.40 ml/min/1.73 m2 (95% CI 5.19-9.42) and 1.93 ± 8.14 ml/min/1.73 m2 (95% CI 0.30-4.15) respectively. CONCLUSIONS: The decline in renal function in patients with hypertension and/or diabetes mellitus is more pronounced than in patients with neither of these comorbidities. In these high-risk patients, measures must be taken to prevent the development and limit the progression of chronic kidney disease.

Abdominoscrotal hydrocele causing upper urinary tract displacement and obstruction.

We report on a case of abdominal hydrocele in which the abdominal component caused displacement and obstruction of the upper urinary tracts. We review the surgical management of this rare condition.

Extensive condylomata acuminata of male urethra: management by ventral urethrotomy.

Between 1982 and 1990, 4 males with extensive intraurethral warts presented with marked inflammation of the external genitalia. When sepsis had settled all patients underwent ventral urethrotomy, in which the urethra was divided median as far back as was necessary to expose all of the warts. Surgical and electro-excision were the preferred methods of removal. Of 3 patients who developed recurrences 2 were lost to follow-up. A third remained without treatment for 1 year and when next seen the warts had spontaneously resolved and his urethra was closed. A fourth patient was lost to follow-up for 4 years before returning with destruction of his external genitalia by a verrucous carcinoma. The human immunodeficiency virus (HIV) did not appear to be a factor in the natural history of intraurethral warts in 2 patients who were negative for serum antibodies 2 and 8 years after presentation.

Ritual circumcision (Umkhwetha) amongst the Xhosa of the Ciskei.

The Umkhwetha is an ancient custom of ritual circumcision still practised by the Xhosa people of Southern Africa. In 45 consecutive youths who required hospital admission the mortality rate was 9%. The complication seen over the years are reviewed and their management discussed.

Bilharzial hydronephrosis causing renal failure in a child. A case report.

The clinical presentation and management of a young child with renal failure caused by bilharzial obstructive uropathy is discussed. Children from areas in which bilharzia is endemic have a high incidence of urological disease. Ureteric obstruction from inflammatory reaction will respond to medical treatment, whereas true mechanical obstruction from fibrosis will require surgical intervention.

Giant hydronephrosis causing contralateral ureteric obstruction. A case report.

Giant hydronephrosis is a rare condition that occurs predominantly in children. A young girl in whom a massive hydronephrosis compromised contralateral ureteric drainage is reported and the incidence, aetiology and presentation are discussed; guidelines for management are reviewed.

Use of the transverse colon conduit for vesicovaginal fistula in late-stage carcinoma of the cervix.

Fifty-five patients with advanced carcinoma of the cervix and vesicovaginal fistula were managed by urinary diversion using the transverse colon as a conduit. The surgical technique is described and this form of urinary diversion is recommended for these patients.

Human tails.

Two children and one infant with a "human tail" are presented. The patho-embryology of this medical curiosity is briefly discussed. Treatment is usually unnecessary but resection of part of the coccyx together with the "tail" may become indicated by coccygodynia or for aesthetic reasons.