The Evolution of Upper Tract Urothelial Carcinoma Management in Kidney Recipients.

INTRODUCTION: Urothelial cancers were one of the most common malignancies in patients with kidney transplants. Although radical nephroureterectomy is still the standard of care in current guidelines, studies have shown that significantly improved perioperative outcomes can be achieved for patients who underwent bilateral nephroureterectomy. Our study provides evidence on the outcome of bilateral nephroureterectomy and unilateral nephroureterectomy in kidney recipients with upper tract urothelial carcinoma. MATERIAL AND METHODS: In the study, the data of patients from a single center, Chang Gung Memorial Hospital Linkou branch, were collected retrospectively from 1981 to 2023. The patient's detailed information was collected through the medical records in the hospital. RESULTS: A total of 44 cases of kidney recipients with upper urinary tract urothelial carcinoma were collected in this study. Of the patients, 19 nephroureterectomies were performed before 2008 and 24 afterward. Incidental findings of contralateral tumors were noted in 3 out of 6 patients who underwent bilateral nephroureterectomy before 2008 and 3 out of 12 after 2008. Contralateral upper urinary tract urothelial carcinoma after unilateral nephroureterectomy was noted in 3 patients within a median of 8.1 years. The progression-free survival of bilateral nephroureterectomy was significantly better compared with a unilateral group (not reached, 15.8 years, respectively). DISCUSSION: Our study, along with previous studies, provides evidence that bilateral nephroureterectomy may be a better treatment option in kidney recipients with upper tract urothelial carcinoma. Our study has several limitations based on its retrospective nature.

Festivity: The Effects of Traditional Holidays on the Graft Function Among Stable Kidney Recipients.

PURPOSE: We observed transient elevations in creatinine levels among kidney recipients after three traditional holidays in Taiwan. This retrospective cohort study aimed to compare the changes in eGFR levels after Chinese New Year, Dragon Boat Festival, and Mid-Autumn Festival, all of which are associated with high-calorie and high-fat diets. MATERIALS AND METHODS: We conducted a retrospective analysis of 364 kidney recipients with stable graft function who were following at Chang Gung Memorial Hospital Linkou from 2018 to 2020. The graft function before and after the festival was determined by calculating the eGFR level using the serum creatinine measured during clinic visits prior to and following the festival. The patients were then categorized into subgroups based on their sex, BMI, and co-morbidities. The eGFR levels before and after the festival were evaluated and compared within these subgroups. RESULTS: A total of 301 kidney recipients have been finally included in this retrospective cohort study. The analysis showed a significant decrease in overall eGFR levels after Chinese New Year (from 56.92 ± 29.70 to 55.14 ± 24.79, P = .006), Mid-Autumn Festival (from 54.03 ± 24.61 to 53.35 ± 24.33, P = .008), and Dragon Boat Festival only in 2020 (from 50.98 ± 24.35 to 49.99 ± 23.45, P = .018). The analysis of subgroups suggested a tendency of renal function decline after all 3 traditional holidays in patient groups with DM or hypertension or nonoverweight status. CONCLUSION: In this study, we observed a significant decline in renal function among kidney recipients following traditional holidays in Taiwan, particularly among recipients with hypertension or diabetes mellitus or those who were not overweight.

Prediction of Early Kidney Transplant Graft Outcome: Insulin Resistance Index.

BACKGROUND: New-onset diabetes after transplantation and increased insulin resistance have both been shown to affect graft performance and survival after kidney transplantation. Thus, we aimed to evaluate the predictive roles of different insulin resistance indices on early graft function in kidney transplant recipients. MATERIALS AND METHODS: We conducted a retrospective analysis of non-diabetic patients who received kidney transplantation between January 1, 2018 and December 31, 2021. The primary outcome was the predictive role of different insulin resistance indices on early graft function of serum creatinine level and estimated glomerular filtration rate at 1, 3, 6, and 12 months. The secondary outcome analyzed was the possible clinical predictive factors for poor kidney graft function at 12 months. RESULTS: Among 123 kidney transplantation patients, stratification with homeostatic model assessment for insulin resistance showed no significant difference in kidney graft function outcome at 1, 3, 6, and 12 months. However, patients with a higher insulin-to-glucose ratio exhibited a significantly higher serum creatinine level at 3 and 6 months and a significantly lower estimated glomerular filtration rate level at 3, 6, and 12 months. Using multivariate logistic regression analysis, patients with a higher insulin-to-glucose ratio were associated with a poorer kidney graft function 12 months after transplantation. CONCLUSION: Patients with a higher baseline insulin resistance with an insulin-to-glucose ratio ≥of 0.092 exhibited a significantly worse early kidney graft function. Thus, with the identification of patients with increased insulin resistance, early intervention, and preventive measures can be implemented to enhance graft performance further.

Intraoperative Hemodynamic Parameters Associated With Delayed Graft Function in Kidney Transplant Patients.

PURPOSE: Intraoperative hemodynamic instability was proven to be associated with delayed graft function (DGF) after kidney transplantation. This retrospective study aims to find the specific intraoperative hemodynamic parameters as an efficient predicting factor of DGF. MATERIALS AND METHODS: Patients who underwent kidney transplantation between 2020 and 2022 were enrolled and classified into DGF and non-DGF groups. Pediatric and multiorgan recipients were excluded. Hemodynamic parameters such as central venous pressure, mean arterial pressure, cardiac output, and cardiac index (CI) at the timings of wound incision, graft reperfusion, and operation completion were recorded, respectively. A comparison of parameters between these 2 groups was analyzed. RESULTS: We enrolled 42 recipients, with 26 in the DGF group and 16 in the non-DGF group. Compared with the DGF group, CI around graft reperfusion was significantly higher in the non-DGF group (3.97 vs 4.67 L/min/m2, P = .043). Other hemodynamic variables revealed no statistical difference. In the results of multivariate analysis, the deceased donor source, the greater volume of blood loss, and the lower CI around graft reperfusion were considered independent risk factors for DGF. Using CI around graft reperfusion to conduct a receiver operating characteristic (ROC) curve for DGF prediction, the area under the ROC curve achieved a value of 0.739 (95% confidence interval, 0.579-0.900), with the optimal cut-point value at CI = 4.245 L/min/m2. CONCLUSION: The cardiac index value around graft reperfusion was statistically associated with the incidence of DGF and might be used as a valid predicting factor.

The Impact of Intraoperative Graft Blood Flow Measurement on Early Graft Function.

BACKGROUND: The aim of this study is to evaluate the impact of intraoperative allograft vascular flow on early kidney graft function. METHODS: A total of 159 patients underwent kidney transplantation from January 2017 to March 2022 at Linkou Chang Gung Memorial Hospital. Graft arterial and venous blood flow was measured separately with a transient time flowmeter (Transonic HT353; Transonic Systems, Inc, Ithaca, NY, United States) after ureteroneocystostomy. The early outcomes, including the postoperative creatinine level, were analyzed accordingly. RESULTS: There were 83 males and 76 females, with a mean age of 44.5 years. The mean graft arterial flow measured was 480.6 mL/min, and the mean venous flow was 506.2 mL/min. Delayed graft function (DGF) incidence was 36.5%, 32.5%, and 40.8% in total, living, and deceased donor groups, respectively. Living donor and deceased donor kidney transplantation were analyzed separately. In the DGF subgroup, there were lower graft venous flows, higher body mass index (BMI), and more male patients in the living kidney transplant group. Similarly, the deceased donor kidney transplantation group with delayed graft function tended to have higher body height, higher body weight, higher BMI, and more diabetes mellitus. The multivariate analysis showed that lower graft venous blood flow (odds ratio [OR] = 0.995, P = .008) and higher BMI (OR = 1.144, P = .042) were significantly correlated with delayed graft function in living donor kidney transplantations. In the deceased donor group, a multivariate analysis of risk factors showed that BMI had a significant correlation with delayed graft function (OR = 1.41, P = .039). CONCLUSIONS: Graft venous blood flow was significantly associated with delayed graft function in living donor kidney transplantation, and high BMI was correlated with DGF in all patients receiving kidney transplantation.

Obesity Affects Short-Term Renal Function After Renal Transplantation.

BACKGROUND: The literature has shown a significant association between body mass index (BMI) and patient and graft outcomes after renal transplantation. The purpose of this study was to reveal the effect of obesity on graft function in a Taiwanese kidney transplant cohort. METHODS: Two hundred consecutive patients who received kidney transplantation were enrolled in our study. Eight pediatric cases were excluded due to differing definitions of BMI among children. According to the national obesity criteria, these patients were divided into underweight, normal, overweight, and obese groups. Their estimated glomerular filtration rate (eGFR) was compared accordingly using t tests. Cumulative graft and patient survivals were calculated using Kaplan-Meier analysis. A P value of ≤ .05 was considered significant. RESULTS: The mean age of our cohort (105 men and 87 women) was 45.3 years. There was no significant difference comparing biopsy-proven acute rejection, acute tubular necrosis, and delayed graft function between the obese and nonobese groups (P values: .293, .787, and .304, respectively). Short-term eGFR was inferior in the overweight group, but this effect was insignificant beyond 1 month. The 1-month and 3-month eGFR were found to be correlated with BMI groups (P = .012 and P = .008, respectively) but not significant after 6 months post-kidney transplantation. CONCLUSIONS: Our study found that short-term renal function was affected by obesity and being overweight, possibly due to the higher prevalence of diabetes and dyslipidemia in obese patients and the increased surgical difficulty.

Incidental Tuberculosis Epididymitis/Epididymo-orchitis: A Retrospective Analysis at a Tertiary Center in Taiwan.

OBJECTIVES: To determine the earliest noticeable manifestation and diagnosis in patients diagnosed with tuberculosis (TB) epididymitis/epididymo-orchitis incidentally and to analyze their responses to surgical and medical treatment. METHODS: Patients who underwent surgery for the preliminary impression of chronic epididymitis/epididymo-orchitis or epididymal/testicular tumor from 2000 to 2019 were included in the study. The clinical presentations, laboratory data, radiological examinations, and operative findings were analyzed retrospectively. The outcomes were assessed by the responses to anti-TB chemotherapy and post treatment radiographic evaluations. RESULTS: All of our 25 patients with a mean age of 60.6 years were diagnosed incidentally with TB epididymitis (48.0%) and TB epididymo-orchitis (52.0%) according to the histopathological findings from their surgeries. The presence of a palpable scrotal mass (76.0%), was the major presentation. Nineteen (76.0%) patients had undergone complete chemotherapy after the surgery and 15 (78.9%) patients showed complete recovery. Four (21.1%) patients had unfavorable outcomes, 3 had TB autonephrectomies and 1 required re-surgery years after complete chemotherapy. Of the 3 (12.0%) patients who did not receive chemotherapy after their surgeries, 1 had a TB relapse in the spine and lung and 1 developed bladder cancer years later. CONCLUSION: Tuberculosis epididymitis/epididymo-orchitis is difficult to diagnose. However, some clinical clues can assist including aged patients, extragenital TB histories, poor responses to antibiotic treatment and scrotal skin lesion. Complete anti-TB chemotherapy is mandatory even after the total removal of TB lesion. Supplemental surgical interventions can be considered when the symptoms are not relieved after chemotherapy. Lifespan follow-up is recommended due to high relapse rate.

The Impact of Nationwide Allocation System on Kidney Transplantation: A Single-Center Experience.

OBJECTIVES: Organ allocation is of decisive importance in the current situation of organ shortage. The aim of this study is to compare the long-term graft outcomes of deceased donor recipients before and after the new nationwide allocation system in Taiwan. METHODS: From April 1, 2000 to March 31, 2010, 181 deceased kidney transplantations were reviewed retrospectively, and recipients were divided by the enforcement day (April 1, 2005) of nationwide allocation into group 1 (before) and group 2 (after). Baseline demographics were reviewed. Outcomes, including graft survival (GS) and patient survival, at 1-, 3-, 5-, and 10-years after transplantation were analyzed. RESULTS: The baseline demography was similar between the 2 groups except that group 1 is younger. Group 2 has less HLA-B (P < .001) and HLA mismatches (P = .005). There were significantly more 0-mismatch recipients in group 2 (6 vs 27, P = .001), as well as extended criteria donor (ECD) recipients (0 vs 7). Group 2 has less optimal 1-year GS (95.6% vs 86.8%, Log-Rank P = .037), which becomes nonsignificant at 3-, 5-, and 10-years after transplantation. By excluding ECD recipients, the GS were similar at all time. There was no difference in patient survival between the 2 groups. CONCLUSION: The new nationwide allocation system provided us more 0-mismatch kidneys. The nationwide scheme remains beneficial to kidney recipients after the acute adverse effects of ECD and aging vanish.

Homeostatic Model Assessment in Kidney Transplantation.

INTRODUCTION: Long-term kidney transplantation survival has been limited to cardiovascular-disease-associated death, which may be related to insulin resistance. The aim of this study is to evaluate the association between homeostatic model assessment (HOMA) and renal graft function. MATERIALS AND METHODS: From January 2013 to March 2015, 55 nondiabetic kidney recipients were reviewed retrospectively with their baseline fasting serum insulin and glucose levels as the basis the following indexes: 1. HOMA insulin resistance (HOMA-IR), 2. HOMA-ß, and 3. insulin-glucose ratio (IGR). These patients were divided into 2 groups according to their HOMA indexes, and the serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) were analyzed on the basis of every 6 months up to 3 years after kidney transplantation. Finally, we evaluate whether these HOMA indexes are a determinant factor of eGFR at post-transplant 1 year, 2 year, and 3 year. RESULTS: There was no persisting difference in Cr and eGFR between high- and low-HOMA indexes except that the Cr and eGFR difference by HOMA-ß stratification increased with time and became nearly significant at 3 years after transplantation. Further univariate and multivariate linear regression models showed no factor affected the 1-year eGFR independently, while weight affected the 2-year eGFR and only HOMA-ß affected the 3-year eGFR independently. CONCLUSION: In non-diabetic kidney recipients, the eGFR difference between high- and low-HOMA-ß patients increases over time. In multivariate linear regression, HOMA-ß, but not HOMA-IR nor IGR, has independent significant association with eGFR at 3 years after transplantation.

Urine Albumin Creatinine Ratio May Predict Graft Function After Kidney Transplant.

BACKGROUND: The albumin to creatinine ratio (ACR) has been shown to be an important prognostic marker in kidney disease. The ACR has been shown to predict graft failure and patient death after kidney transplant. METHODS: From March 1, 2011, to December 31, 2013, we checked the urine ACR and blood for highly sensitive C-reactive protein in 93 kidney recipients who regularly follow up at out institute. We tested the linear correlations of these parameters with estimated glomerular filtration rate. Furthermore, we used multivariate linear regression to examine its value in predicting graft function. Finally, we used receiver operating characteristic curve analysis to validate their predictive value on creatinine clearance > 45 mL/min. RESULTS: With multivariate linear regression, the latest estimated glomerular filtration rate has a strong linear relationship with initial ACR (B = -0.032; P = .02), suggesting each unit rise in ACR with a decrease in creatinine clearance by 0.032 mL/min. To investigate their value in predicting good functional graft defined as creatinine clearance >45 mL/min, a receiver operating characteristic curve analysis was applied on these parameters. The area under curve for age is 0.496, for body weight is 0.539, and for highly sensitive C-reactive protein is 0.582, which are all around the chance of 0.5 by flipping coins. The area under ACR curve is 0.825, better than above parameters, and only second to serum creatinine level. CONCLUSIONS: Urine ACR is a simple and effective measure to predict graft function after a kidney transplant. It has similar independent strong correlations to creatinine clearance comparing with serum creatinine without requirement of a blood draw.

Endoscopic Treatment for Post-Transplant Vesicoureteral Reflux.

INTRODUCTION: Vesicoureteral reflux (VUR) is one of the most common ureteric complications after kidney transplantation that might cause symptomatic infections which deteriorate graft function. Surgical reimplantation has been the standard treatment; recently, endoscopic injection has been an alternative approach. We report our endoscopic treatment results and analyze the long-term outcome, even in patients with less optimal graft function. MATERIALS AND METHODS: A total of 16 patients and 19 symptomatic VUR were diagnosed at mean time of 88.3 months after their transplantation. The distribution of VUR grade was 1, 2, 8, 6, and 2 for grade I to V, respectively, with a mean VUR grade of 3.26 according to their voiding cystourethrogram images. Endoscopic Deflux injections were performed by a single urologist via rigid cystoscope with a beveled needle system. They were followed monthly thereafter. RESULT: The average number of admissions due to symptomatic urinary tract infection was 2.68/person, and the mean creatinine level before endoscopic treatment was 1.63 mg/dL. The amount of Deflux injection was 0.7 to 1.2 mL per affected ureter; the mean creatinine level after endoscopic treatment was 1.41 mg/dL. The eGFR remained stationary in both eGFR > 60 and eGFR < 60 mL/min groups with a clinical success rate of 75% in both groups. CONCLUSION: Endoscopic dextranomer-hyaluronic acid injection is a safe and feasible treatment option for VUR after kidney transplantation. Our data showed its efficacy in recipients whose eGFR is less than 60 mL/min.

The impact of climate factors on the prevalence of urolithiasis in Northern Taiwan.

BACKGROUND: Urolithiasis is a common disease with high prevalence and recurrence. Its incidence varies in different geographic locations, and there are evidences that meteorological factors also affect urinary stone formation. The aim of this study is to analyze the effects of climate parameters on the numbers of shockwave treatments for urinary stones in our hospital, in order to understand the effects of these parameters on the prevalence of urolithiasis in northern Taiwan. METHODS: We retrospectively reviewed the records of extracorporeal shockwave lithotripsy (ESWL) performed in our hospital from December 2006 to November 2011. Repeated ESWL performed in the same patient within 1 month was excluded, and we only counted as one ESWL in our study. Climate data of the corresponding months were collected from Central Weather Bureau. The available monthly meteorological data included highest, lowest, and average temperatures, humidity, rainfall, total rain days, sunshine hours, average atmospheric pressure, and wind speed. RESULTS: Monthly ESWL number was positively correlated to temperature (r = 0.696), sunshine hours (r = 0.515), and wind speed (r = 0.369), while it was negatively correlated to humidity (r = -0.441) and atmospheric pressure (r = -0.568). Average monthly temperature had the strongest correlation to ESWL number (r2 = 0.484). Monthly rainfall and rain days were not significantly correlated to ESWL number. To investigate the climate parameters together, we introduced these correlated factors into the multivariate linear regression model which demonstrated only temperature (ß = 1.438, 95% CI: 3.703-9.144, p < 0.001) and atmospheric pressure (ß = 0.803, 95% CI: 0.790-5.428, p = 0.010) to be independently related to monthly ESWL number. CONCLUSION: Temperature and atmospheric pressure are associated with monthly ESWL number. Ambient temperature is the most important climate factor affecting the prevalence of urolithiasis in northern Taiwan.

Impact of alfuzosin on sexual function in Taiwanese men with benign prostatic hyperplasia.

To assess the effect of alfuzosin (XATRAL) 10 mg once daily on sexual function in men with moderate to severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), patients with suggestive symptomatic BPH, an International Prostate Symptom Score (IPSS) >8 (range of scores, 0-35), and sexual attempts at least once per month were enrolled. All patients received alfuzosin 10 mg once daily for 24 weeks and were asked to complete the IPSS test and Male Sexual Health Questionnaire at weeks 0 (baseline), 1, 4, 12, and 24. Other assessments included the International Index of Erectile Function-five-item version (range of scores: 5-25), as well as onset of action and peak urinary flow rate (Q(max)). From September 2006 to May 2008, 279 patients were enrolled from nine centers in Taiwan. At 24 weeks, alfuzosin effectively improved LUTS and quality of life, as demonstrated by a reduction in the IPSS total score (17.3 vs. 9.9, p < 0.001) and the IPSS bother score (3.8 vs. 2.5, p < 0.001). The majority (85%) of patients perceived an improvement of urinary symptoms within 1 month of administration. In patients with an International Index of Erectile Function-five-item version score of ≤16, alfuzosin significantly improved erectile disorder and satisfaction subscores at each time point (p ≤ 0.02). Prolonged-release alfuzosin effectively improved LUTS, quality of life, erectile function, and sexual satisfaction in men with BPH and mild to severe erectile dysfunction. Alfuzosin is an effective treatment option for the management of patients with BPH/LUTS and concomitant sexual dysfunction.

Temporary vesicostomy-assisted urethroplasty for recurrent obliterated posterior urethral stricture.

BACKGROUND: We report the outcomes of temporary vesicostomy- assisted anastomotic urethroplasty in patients with recurrent obliterated posterior urethral stricture. METHODS: A review of the medical records identified 12 men (mean age 35.8 years) who had undergone anastomotic urethroplasty for recurrent obliterated posterior stricture. Preoperative evaluation of the urethral defect included a simultaneous retrograde urethrogram and cystogram. The mean estimated preoperative radiographic length of the urethral disruption was 4.25 cm. All patients underwent 1-stage bulboprostatic anastomotic repair which was assisted by an intraoperative temporary vesicostomy. RESULTS: The initial objective success rate was 83%. The mean follow-up was 22 months. Voiding cystourethrography performed postoperatively demonstrated a wide, patent anastomosis in all but two cases. Urethroscopy performed 1 month after surgery revealed a patent anastomosis with normal urethral mucosa in all but two patients. The mean peak flow rate at the last follow-up visit was 16.3 ml/s. Two patients developed an anastomotic stricture 6 weeks after surgery that was successfully treated by direct visual internal urethrotomy. Finally, all patients had a patent urethra after salvage treatment postoperatively. CONCLUSION: An open 1-stage temporary vesicostomy- assisted urethroplasty for recurrent obliterated posterior urethral stricture provides satisfactory outcomes and minimal morbidities.

Waist circumference is an independent risk factor for prostatic hyperplasia in Taiwanese males.

PURPOSE: Benign prostatic hyperplasia is a common disease affecting older males. As obesity becomes an increasing problem worldwide, its role in prostatic hypertrophy has been discussed recently. The purpose of this study is to evaluate the relationship between waist circumferences and prostatic hyperplasia in Taiwan. METHODS: There were 539 men enrolled in the study who had health examinations at the Healthcare Center of Chang Gung Memorial Hospital; 53 were excluded because of history of conditions affecting prostatic volume. Their anthropometry was measured and serum prostate-specific antigen (PSA) levels as well as lipid profiles were analyzed. Prostate volume was measured by transrectal ultrasonography performed by experienced urologists. RESULTS: The mean prostate volume was 26.43 mL, whereas mean body mass index (BMI) was 25.27 kg/m(2) and mean waist circumference (WC) was 90.81 cm. By age-adjusted logistic regression, PSA > 4 ng/mL, WC ≥ 90 cm, and BMI > 24 kg/m(2) are associated with increased risk of developing prostatic hyperplasia; only WC ≥ 90 cm can be validated by multiple logistic regression. Further analysis of obesity patterns showed that abdominal overweight/obesity places patients at increased risk independently rather than high WC or high BMI alone. CONCLUSIONS: Study results showed that waist circumference ≥ 90 cm is an independent risk factor of prostatic hyperplasia in Taiwan. Men with abdominal overweight/obesity (WC ≥ 90 cm and BMI > 24 kg/m(2)) have a twofold risk of developing prostatic hyperplasia.

A simplified preputial covering technique to correct buried penis.

OBJECTIVE: We report on refinements of a technique for preputial covering to prevent complications of redundant prepuce, possibly caused by inadequate surgery for buried penis. PATIENTS AND METHODS: From July 2006 to July 2008, 20 consecutive patients (mean age 4.3 years) underwent surgery for buried penis. The surgical techniques consisted of complete unfurling of the penile shaft, fixation of the penile base skin to Buck's fascia and 1 pedicle flap for skin coverage. Our method for preputial covering is novel in that we create a unique 1-flap covering for the ventral skin defect. Patients were monitored postoperatively at 2 weeks, 1 month and 3 months. RESULTS: All patients had good or excellent outcomes, with fewer postoperative complications. Two patients developed subcutaneous hematomas that resolved in 2 weeks with conservative treatment. The mean increase in length of penile projection after surgery was 1.7 cm, a statistically significant difference. All patients had good cosmetic results, with increased visualization of the penile shaft. CONCLUSIONS: The preputial covering technique we devised avoided postoperative bulky prepuce caused by residual redundant prepuce. Repeat surgery was also unnecessary for our patients. Furthermore, parents judged the cosmetic results as excellent.

Mixed epithelial and stromal tumor of the kidney--a case report.

A 45-year-old woman had gross hematuria without flank pain for two weeks. She visited our hospital and a renal echo showed a heterogenous mass on the left kidney. Abdominal computed tomography showed a multicystic tumor, about 7 cm, on the left renal pelvis and the proximal ureter. The tumor was enhanced after contrast injection. Ureteroscopy showed an intraluminal polypoid tumor. Cystic renal cell carcinoma or urothelial carcinoma was suspected preoperatively. We performed a hand-assisted laparoscopic nephroureterectomy, and the post-operative course was uneventful. The pathology report demonstrated that the tumor was composed of an admixture of stroma and flattened to cuboidal urothelium. The tumor stromal cells expressed both estrogen and progesterone receptors, and no malignant cells were found. There has been no recurrence or deterioration of the patient's renal function since surgery. We suggest keeping in mind the diagnosis of mixed epithelial and stromal tumor of the kidney when encountering perimenopausal women with renal cystic tumors.

A direct association of polyomavirus BK viruria with deterioration of renal allograft function in renal transplant patients.

BACKGROUND: Polyomavirus BK virus (BKV) causes a BKV-associated nephropathy (BKVAN), frequently causing allograft dysfunction in renal transplant recipients. As BK viruria is a surrogate marker for early detection of BKVAN, the aim of this study was to clarify an association between BK viruria and allograft dysfunction in renal transplant recipients. METHODS: One hundred and six renal transplant recipients with average 5.9-yr transplant duration received screening for quantification of BK viruria detected by real time polymerase chain reaction and were followed up for 12 months. RESULTS: Twenty-six patients (25%) had detectable BK viruria. In comparison of the patients without BK viruria, more patients in the BK viruria group were treated with steroids and had a past history of acute rejection. There was no difference in sex, age, transplant duration, allograft type and previous cytomegalovirus infection. During follow-up, the patients with BK viruria had higher serum creatinine levels at the sixth, ninth and 12th month. Multiple logistic regression analysis revealed that BK viruria was the only risk factor for more than 25% or 50% rise of serum creatinine level above baseline at the end of one yr follow-up. CONCLUSIONS: BK viruria alone is associated with allograft dysfunction and early intervention is indicated.

Expanding the donor pool--preliminary outcome of kidney recipients from infected donors.

BACKGROUND: The number of cadaver donors is far beyond demand. The use of marginal donors may increase the number of organs available for transplantation. METHODS: We expanded our criteria for cadaver donors to include those with active infections. From January 2004 through August 2005, there were 25 cadaveric transplantations in our center. Infected donors accounted for 13 transplants and the remaining 12 that were not infected were used as the control subjects. Blood and infected locus cultures were performed before transplantation and the recipients were treated accordingly. RESULTS: There were no statistically significant differences between post-transplantation creatinine levels of the kidneys from infected and non-infected donors at 1 month (1.50 +/- 0.61 vs 2.21 +/- 0.77, p = 0.235) and 3 months (1.33 +/- 0.57 vs 2.31 +/- 0.92, p = 0.311) after transplantation. There were no differences in final creatinine levels (1.25 +/- 0.39 vs 1.81 +/- 0.89, p = 0.077), urinalysis white blood cell count (11.62 +/- 26.64 vs 1.91 +/- 3.30, p = 0.102) and blood white cell count (7677 +/- 1890 vs 8636 +/- 2390, p = 0.635). None of the recipients in the infected donor group developed systemic infections or complications. Graft and patient survival rates were both 100%. CONCLUSIONS: Our results seem to suggest that kidneys procured from infected donors might be suitable for transplantation without transmission of the infective organism. Nevertheless, prophylactic antibiotics, close monitoring for possible infection and great care are warranted to prevent related complications. However, longer follow-up periods are needed.

Absence of Epstein-Barr virus infection in squamous cell carcinoma of upper urinary tract and urinary bladder.

OBJECTIVES: To address whether Epstein-Barr virus (EBV) infection may be involved in the carcinogenesis of squamous cell carcinoma of the upper urinary tract and urinary bladder (SCC-UB). EBV has been implicated in the genesis of a variety of human cancers, including urothelial carcinoma of the urinary bladder. METHODS: Whether EBV infection is related to SCC-UB carcinogenesis was investigated by in situ hybridization for EBV-encoded RNA and immunohistochemistry for latent membrane protein-1 in 26 cases of SCC-UB. RESULTS: EBV-encoded RNA and latent membrane protein-1 were identified in the control case of nasopharyngeal carcinoma. None of the SCC-UB cases had a nuclear signal of EBV-encoded RNA, and the cancer cells, normal urothelial cells, and inflammatory cells were all negative for latent membrane protein-1, irrespective of the site of SCC-UB. CONCLUSIONS: This study is the first to explore the role of EBV infection in SCC-UB. Our results suggest that EBV infection is not involved in the carcinogenesis of SCC of the renal pelvis, ureter, and urinary bladder.