ARE DRAIN ESSENTIALS IN KIDNEY TRANSPLANTATION? ANALYSIS OF RISK FACTORS AFFECTING THE POSTOPERATIVE DRAINAGE.

OBJECTIVE: The routine drain placement following renal transplantation is currently under debate. Its benefit is uncertain and may cause complications, particularly infectious ones. Some renal transplant patients have low-productive drains, that might be unnecessary. The objective of this study is to bring to light factors influencing drain volume in kidney transplantation. MATERIALS AND METHODS: All kidney transplant patients in Tours between 2019 and 2020 were included. The characteristics of the two groups were analyzed: patients with low-productive redons (quantification less than 100 mL/24h,) and patients with productive redons (≥100 mL/24h). Univariate and multivariate analyses by logistic regression were performed to look for risk factors associated with productive drainage. RESULTS: One hundred and eighty-nine patients were included (67 in the low-productive group and 122 in the productive group). The results in the productive group showed a significantly higher proportion of retransplantation (p=0.015), overweight (p=0.012), low residual diuresis (p=0.041), and a significantly lower proportion of preemptive transplantation (p=0.008) and peritoneal dialysis (p=0,037). After an adjustment, the following variables remained significantly associated with greater drainage: overweight (OR= 2.42. p = 0.014 ; CI95% [1.2-4.94]) ; retransplantation (OR = 3.98. p = 0.027 ; IC95% [1.27-15.45]), and preemptive transplant (OR= 0.22. p = 0.013 ; CI95% [0.06-0.7]). CONCLUSION: The non-implementation of a redon in renal transplantation could be considered, in a selected population of non-overweight patients, with significant residual diuresis for a first transplantation which should be preemptive. This could lead to a randomized controlled trial to determine the real benefits of a routine drain replacement in kidney transplantation.

Cut-off time for surgery and prediction of orchiectomy in spermatic cord torsion: a retrospective multicentric study over 15 years.

PURPOSE: Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort. METHODS: We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain. RESULTS: 1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87). CONCLUSIONS: Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain.

Torsion of the spermatic cord in adults: a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion.

Acute scrotal pain (ASP) requiring surgical exploration is common in the pediatric population, but little has been reported on this subject with regard to the adult population. The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients. Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion (TT) at 14 French hospitals between January 2005 and December 2019 were included in this study. The main outcome measures were demographic characteristics, pathology found during scrotal exploration, and perioperative outcomes. Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT. Data for 1329 men were analyzed. The median age was 30 (interquartile range [IQR]: 25-35; range: 21-89) years. Regarding the clinical examination, 867 (65.2%) patients presented with an elevation of the testicle, 613 (46.1%) patients with scrotal edema or erythema, and 211 (15.9%) patients with nausea or vomiting. Operative findings identified TT in only 684 (51.5%) patients, epididymo-orchitis in 112 (8.4%) patients, a tumor in 16 (1.2%) patients, and no causes in 475 (35.7%) patients. Orchiectomy for nonviable testes was required in 101 (7.6%) patients. In multivariate analysis, an elevation of the testicle, erythema/swelling, and the presence of nausea/vomiting were found to be associated with the occurrence of TT. Testicular torsion is not exclusive to children and adolescents, so must be considered in males of any age with acute scrotal findings. However, one-third of scrotal explorations in adults did not lead to a diagnosis.

Contralateral Orchiopexy at the Time of Urgent Scrotal Exploration-Is It Safe? A Propensity Score Matched Analysis from the TORSAFUF Cohort.

PURPOSE: We evaluate the safety of immediate contralateral orchiopexy (ICLO) at the time of scrotal exploration for testicular torsion suspicion. MATERIALS AND METHODS: Patient data were retrieved from the TORSAFUF cohort project, which is a multicenter national study conducted at 14 academic French hospitals between 2005 and 2019. Each patient who underwent surgical exploration for testicular torsion suspicion was included. The primary study outcome was the safety of ICLO compared to ipsilateral scrotal exploration alone. The primary outcome of interest was the complication rate within 90 days of surgery. The end point was planned before data collection. RESULTS: Overall, 2,775 patients were included, of whom 1,554 (56%) underwent ICLO. After propensity score matching and multivariable analysis, ICLO was associated with a higher complication rate (OR 1.51, 95% CI 1.1-2.1, p=0.01), especially a higher rate of hematoma (OR 2.9, 95% CI 1.3-6.6, p=0.01), and delayed wound healing (OR 3.0, 95% CI 1.8-5.2, p <0.001). CONCLUSIONS: At the time of scrotal exploration for acute scrotum, ICLO was associated with an increased postoperative complication rate, with a particular increase in hematoma, and delayed wound healing. ICLO should not be performed systematically.

Trapping, gliding, vaulting: transport of semiflexible polymers in periodic post arrays.

The transport of deformable particles through porous media underlies a wealth of applications ranging from filtration to oil recovery to the transport and spreading of biological agents. Using direct numerical simulations, we analyze the dynamics of semiflexible polymers under the influence of an imposed flow in a structured two-dimensional lattice serving as an idealization of a porous medium. This problem has received much attention in the limit of reptation and for long-chain polymer molecules such as DNA that are transported through micropost arrays for electrophoretic chromatographic separation. In contrast to long entropic molecules, the dynamics of elastic polymers results from a combination of scattering with the obstacles and flow-induced buckling instabilities. We identify three dominant modes of transport that involve trapping, gliding and vaulting of the polymers around the obstacles, and we reveal their essential features using tools from dynamical systems theory. The interplay of these scattering dynamics with transport and deformations in the imposed flow results in the long-time asymptotic dispersion of the center of mass, which we quantify in terms of a hydrodynamic dispersion tensor. We then discuss a simple yet efficient chromatographic device that exploits the competition between different modes of transport to sort filaments in a dilute suspension according to their lengths.