An Enhanced Indoor Positioning Technique Based on a Novel Received Signal Strength Indicator Distance Prediction and Correction Model.

Indoor positioning has become a very promising research topic due to the growing demand for accurate node location information for indoor environments. Nonetheless, current positioning algorithms typically present the issue of inaccurate positioning due to communication noise and interferences. In addition, most of the indoor positioning techniques require additional hardware equipment and complex algorithms to achieve high positioning accuracy. This leads to higher energy consumption and communication cost. Therefore, this paper proposes an enhanced indoor positioning technique based on a novel received signal strength indication (RSSI) distance prediction and correction model to improve the positioning accuracy of target nodes in indoor environments, with contributions including a new distance correction formula based on RSSI log-distance model, a correction factor (Beta) with a correction exponent (Sigma) for each distance between unknown node and beacon (anchor nodes) which are driven from the correction formula, and by utilizing the previous factors in the unknown node, enhanced centroid positioning algorithm is applied to calculate the final node positioning coordinates. Moreover, in this study, we used Bluetooth Low Energy (BLE) beacons to meet the principle of low energy consumption. The experimental results of the proposed enhanced centroid positioning algorithm have a significantly lower average localization error (ALE) than the currently existing algorithms. Also, the proposed technique achieves higher positioning stability than conventional methods. The proposed technique was experimentally tested for different received RSSI samples' number to verify its feasibility in real-time. The proposed technique's positioning accuracy is promoted by 80.97% and 67.51% at the office room and the corridor, respectively, compared with the conventional RSSI trilateration positioning technique. The proposed technique also improves localization stability by 1.64 and 2.3-fold at the office room and the corridor, respectively, compared to the traditional RSSI localization method. Finally, the proposed correction model is totally possible in real-time when the RSSI sample number is 50 or more.

Analysis for Joint Delay-Power Tradeoff with Buffer/Channel-Aware and its FPGA Implementation in Wireless Sensor Networks.

In this paper, we aim to investigate the delay-power tradeoff problem which is attracting widespread interest due to its importance in wireless technology. This research has two main objectives. First, to assess the effect of different system parameters on the performance metrics. Second, to provide a solution for this optimization problem. A two-state, slow-fading channel is categorized into good and bad channel states. An adaptive transmission and random data arrivals are considered in our model. Each channel category has its own Markov chain, which is used in modeling the system. A joint Buffer-Aware and Channel-Aware (BACA) problem was introduced. In addition, an enhanced iterative algorithm was introduced for obtaining a sub-optimal delay-power tradeoff. The results show that the tradeoff curve is piecewise linear, convex and decreasing. Furthermore, a channel-aware system was investigated to provide analysis of the effect of system parameters on the delay and power. The obtained results show that the dominant factors that control the system performance are based on the arrival rate and the channel goodness factor. Moreover, a simplified field programable gate array (FPGA) hardware implementation for the channel aware system scheduler is presented. The implementation results show that the consumed power for the proposed scheduler is 98.5 mW and the maximum processing clock speed is 190 MHz.

Pediatric kidney transplantation in Egypt: Results of 10-year single-center experience.

Pediatric kidney transplantation is a multidisciplinary therapy that needs special consideration and experience. In this study, we aimed to present CUCH experience; over a 10-year period, as a specialized center of kidney transplantation in children. We studied 148 transplantations performed at a single center from 2009 to 2018. Pretransplant and follow-up data were collected and graft/patient survival rates were evaluated. A total of 48 patients developed at least one rejection episode during 688 patient-years of follow-up. Infections, recurrence of original disease, and malignancy were the most important encountered medical complications (20%, 2%, and 1.4%, respectively). One-year patient survival was 94.1%, while graft and patient survival was 91.9%. Graft/patient survival at 5, 7, and 9 years was 90%, 77%, and 58%, respectively. Infections were the main cause (69%) of mortality. Death with a functioning graft and CR were the main causes of graft loss (48% and 33%, respectively). Pediatric kidney transplantation in Egypt is still a challenging yet successful experience. Rejections and infections are the most frequent complications. Short-term outcomes surpass long-term ones and graft survival rates are similar to the international standard.

Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife.

PURPOSE: To compare efficacy and safety of visual internal urethrotomy (VIU) using holmium laser (Ho:YAG) (group A) versus cold knife (group B) in children with urethral strictures. It may be the first comparative study on this issue in children. METHODS: This study compared Ho:YAG group, which was evaluated prospectively from January 2014 till January 2016, versus cold knife group, which was a historical control performed from March 2008 till February 2010. Children ≤ 13 years old with urethral strictures ≤ 1.5 cm were included successively. Recurrent cases, congenital obstructions and cases with complete arrest of dye in voiding cystourethrography were excluded. Scar tissue was incised at twelve o'clock. Outcome was compared using Student's t, Mann-Whitney, Chi-square or Fisher exact tests as appropriate. RESULTS: Each group included 21 patients. Mean age was 6.27 ± 3.23 (2-13) years old. Mean stricture length was 1.02 versus 1 cm in group A versus B, respectively (p = 0.862). Ten cases of penile/bulbous strictures and another 11 cases of membranous strictures were found in each group. There was no significant difference between both groups in preoperative data. Success rate for initial VIU was 66.7% in group A versus 38% in group B (p = 0.064). This was associated with significantly higher Qmax in group A (mean 16.52 vs 12.09 ml/s; p = 0.03). Success rate after two trials of VIU was 76.2% for group A and 47.61% for group B (p = 0.057). No complications were reported in both groups. CONCLUSION: Laser VIU has a higher success rate than cold knife VIU for urethral strictures ≤ 1.5 cm in children with significantly higher Qmax. Both are easy to perform, low invasive and safe.

Risk factors for urological complications following living donor renal transplantation in children.

The aim of this study was to detect possible risk factors for UC and UTI following pediatric renal Tx and effect of these complications on outcome. One hundred and eight children who underwent living donor Tx between 2009 and 2015 were retrospectively included. Extraperitoneal approach was used with stented tunneled extravesical procedure. Mean recipient age was 9.89 ± 3.46 years while mean weight was 25.22 ± 10.43 kg. Seventy-three (67.6%) recipients were boys while 92 (85.2%) were related to donors. Urological causes of ESRD were present in 33 (30.6%) recipients (14 [13%] posterior urethral valve, 16 [14.8%] VUR, and 3 [2.8%] neurogenic bladder). Augmentation ileocystoplasty was performed in 9 (8.3%) patients. Mean follow-up was 39.3 ± 17.33 months. UC were detected in 10 (9.3%) children (leakage 4 [3.7%], obstruction 3 [2.8%], and VUR 3 [2.8%]) while UTIs were reported in 40 (37%) children. After logistic regression analysis, UC were significantly higher in children with cystoplasty (44.4% vs 6.1%; P = .001). UTIs were significantly higher in girls (51.4% vs 30.1%; P = .001) and in children with urological causes of ESRD (51.5% vs 30.7%; P = .049). UC and UTI were not significantly associated with increased graft loss or mortality. UC were significantly higher in children with cystoplasty while UTIs were significantly higher in girls and children with urological causes of ESRD. Presence of UC did not affect the rate of graft loss or mortality due to its early detection and proper management.

The role of voiding cystourethrography in asymptomatic unilateral isolated ureteropelvic junction obstruction: A retrospective study.

INTRODUCTION: The presence of concomitant vesicoureteric reflux (VUR) and ureteropelvic junction obstruction (UPJO) is uncommon. Nevertheless, the reported VUR coexisting with asymptomatic unilateral isolated hydronephrosis (AUIH) requiring pyeloplasty for correction of UPJO was of low grade and mostly resolved during conservative follow-up. Therefore, VCUG may be not indicated in these children except if voiding symptoms, urinary tract infection (UTI), dilated ureters, or bladder and ureteric abnormalities are suspected. OBJECTIVES: The aim was to evaluate the need for VCUG in infants <1 year old with AUIH for whom a dismembered pyeloplasty was indicated for correction of UPJO. METHODS: Ninety-six children <1 year old with pyeloplasty carried out from January 2012 to March 2014 were retrospectively included. Children with voiding symptoms or dilated ureter, duplex system, fused kidneys, bilateral dilatation, or any bladder abnormality on ultrasound were excluded. Anderson-Hynes pyeloplasty was performed through a flank incision. Preoperative VCUG was analyzed in relation to outcome and any UTI during follow-up. The Student t test, Mann-Whitney U test, or Fisher exact test were used to compare variables. RESULTS: Five children had concomitant VUR with UPJO. Most of the children were circumcised during the first postnatal week. The remaining few children were circumcised at the time of pyeloplasty. Side, grade of detected VUR, and complications (18.75%) (postoperative or during follow-up) are presented in the Table. Outcomes in children with and without VUR were not different. Dismembered pyeloplasty was successful in children with VUR and with no complications except for non-febrile UTI in one child only. Ureters were still not dilated at the last follow-up. DISCUSSION: The required imaging in infants with AUIH is still a subject of debate. As we expected, there was a low incidence of associated VUR in the present study. They were of low grade without any complications during follow-up and without affecting the outcome. The present study has its limitations, including the retrospective nature and short follow-up. However, as at least 2 years of follow-up were documented without any harm or ureteric dilation, VUR will mostly resolve. The present study is strengthened by inclusion of infants only. CONCLUSIONS: Our data suggest that VCUG is not indicated in infants with AUIH requiring pyeloplasty for correction of UPJO. VCUG will not affect the treatment decision, operative outcome, or postoperative complications. VCUG may be indicated in case of suspected voiding symptoms, UTI, dilated ureters, or bladder and ureteric abnormalities.

Dismembered Pyeloplasty in Infants 6 Months Old or Younger With and Without External Trans-anastomotic Nephrostent: A Prospective Randomized Study.

OBJECTIVE: To compare the outcome of dismembered pyeloplasty in infants with and without external nephro-ureteric stent (ENUS) for treatment of congenital ureteropelvic junction obstruction. METHODS: This is a parallel, randomized comparative study between October 2013 and September 2014. Thirty infants ≤6 months old with ureteropelvic junction obstruction indicated for dismembered pyeloplasty were randomly assigned (block randomization, closed envelope method) into two groups: group A (stentless) and group B (ENUS). Infants with solitary kidney, gross pyuria, huge pelvis, vesicoureteric reflux, or other renal anomalies were excluded. Operative data, complications, and ultrasonographic and nuclear scintigraphy criteria were compared after at least 18 months of follow-up using Student t, Mann-Whitney U, Kruskal-Wallis, chi-square, and Fisher exact tests when appropriate. Occurrence of urinary leakage was the primary outcome. RESULTS: Included patients completed the study with intention-to-treat analysis. All children had normal renal function. The mean operative time was 85.3 ± 6.3 (60-90) minutes in group A and 92.6 ± 15.3 (70-120) minutes in group B (P = .2). Although there was a significant postoperative improvement in each group in split renal function and anterior-posterior renal pelvis diameter, there was no significant difference between both groups. The mean hospital stay for group A and group B was 5.9 ± 2 (4-10) days versus 3.5 ± 0.8 (2-5) days, respectively (P < .001). Postoperative urinary leakage was reported only in group A (40%). All complications were managed by double J insertion. Auxiliary interventions were higher in group A. The overall success rate was 93.4%. Redo pyeloplasty was performed in one case in each group. CONCLUSION: ENUS significantly reduces hospital stay and complications. It saves the infant hazards of auxiliary interventions under general anesthesia for management of leakage or double J removal if placed at time of pyeloplasty.

A Prospective Evaluation of High-Resolution CT Parameters in Predicting Extracorporeal Shockwave Lithotripsy Success for Upper Urinary Tract Calculi.

OBJECTIVE: To evaluate the ability of noncontrast CT parameters (stone size, stone attenuation, and skin-to-stone distance [SSD]) to predict the outcome of extracorporeal shockwave lithotripsy (SWL) in a prospective cohort of patients with renal and upper ureteric stones. PATIENTS AND METHODS: Patients with stones 5 to 20 mm were prospectively enrolled from 2011 to 2014. Patients had NCCT with recording of stone size, stone mean attenuation, and SSD, as well as various stone and patient parameters. The numbers of needed sessions as well as the final outcome were determined, with SWL failure defined as residual fragments >3 mm. Predictors of SWL failure were assessed by multiple regression analysis. RESULTS: Two hundred twenty patients (mean ± standard deviation [SD] age 41.5 ± 12.4 years) underwent SWL. Mean ± SD stone size was 11.3 ± 4.1 mm, while mean ± SD stone attenuation was 795.1 ± 340.4 HU. Mean ± SD SSD was 9.4 ± 2.1 cm. The average number of sessions was 1.64. SWL was effective in 186 (84.5%) patients (group A), while 34 (15.5%) patients had significant residual fragments (>3 mm). On univariate analysis, predictors of SWL failure included stone attenuation >1000 HU, older age, higher body mass index, higher attenuation value, larger stone size, and longer SSD. Increased SSD and higher stone attenuation retained their significance as independent predictors of SWL failure (p < 0.05) on multiple regression analysis both after first session and as final SWL outcome. A positive correlation was found between number of SWL sessions and mean stone attenuation (r = 0.6, p < 0.001) and SSD (r = 4, p < 0.001). CONCLUSIONS: Stone mean attenuation and SSD on noncontrast CT are significant independent predictors of SWL outcome in patients with renal and ureteric stones. These parameters should be included in clinical decision algorithms for patients with urolithiasis. For patients with stones having mean attenuation of >1000 HU and/or large SSDs, alternatives to SWL should be considered.

Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy.

OBJECTIVES: To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children. METHODS: From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ(2) -test or Fisher's exact test. RESULTS: Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9.4% and 1.9% of children in the extracorporeal shockwave lithotripsy and mini-percutaneous nephrolithotripsy technique groups, respectively. CONCLUSIONS: The mini-percutaneous nephrolithotripsy technique has significantly higher stone-free rates than extracorporeal shockwave lithotripsy for renal pelvic and lower calyceal stones (10-25 mm), with a lower retreatment rate and without a significant increase in complications.

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study.

OBJECTIVES: To compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. PATIENTS AND METHODS: A database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, Mann-Whitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. RESULTS: The mean ± sd (range) age of the study cohort was 5.05 ± 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean ± sd follow-up was 4.52 ± 1.55 and 4.07 ± 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. CONCLUSION: Acceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.

Outcome of Mini-percutaneous Nephrolithotomy for Renal Stones in Infants and Preschool Children: A Prospective Study.

OBJECTIVE: To assess the safety and efficacy of Miniperc for renal stones in preschool-age patients. To the best of our knowledge, this may be the first prospective study on this subject. Reports on Miniperc are still few and mostly retrospective using a sheath size of ≥ 18Fr, which is still relatively large for young children. PATIENTS AND METHODS: From January 2012 to May 2013, Miniperc was performed for 26 children (≤ 6 years old) with renal calculi <5 cm through 14Fr sheath using a 9.5Fr semirigid ureteroscope with Holmium:yttrium-aluminum-garnet laser lithotripsy. Effects of different factors on operative time, complications, and stone-free rate (SFR) were compared using chi-square, Fischer exact, or Mann-Whitney tests as appropriate using SPSS v15.0. RESULTS: Primary SFR, SFR after retreatment, and SFR after auxiliary extracorporeal shock wave lithotripsy (ESWL) were 77%, 85%, and 92%, respectively. Retreatment rate was 8%. Auxiliary ESWL was done in 11%. Complications were bleeding (8%), hematuria and blood transfusion (4%), renal pelvis perforation (4%), leakage (8%), and fever (15%). Operative time was significantly prolonged in multiple (>2) stones (P = .006), calyceal stones (P = .002), or stone size ≥ 30 mm (P = .022). SFR was significantly lower in children with >2 stones (P = .028) and increased stone size ≥ 30 mm (P = .014). CONCLUSION: Miniperc is a safe and effective minimally invasive procedure for pediatric renal stones using 14Fr access sheath. SFR was significantly lower in children with >2 stones or increased stone size ≥ 30 mm. This was overcome by retreatment and auxiliary ESWL.

Transurethral Holmium Laser Cystolithotripsy in Children: Single Center Experience.

PURPOSE: To evaluate prospectively safety and efficacy of transurethral cystolithotripsy (CL) in children using holmium:yttrium-aluminum-garnet (Ho:YAG) laser. This is important in developing countries, because the risk of bladder stones in children is high. Open cystolithotomy (OC) was the main line of treatment. A gradual shift has occurred toward endourologic treatment after improvement of pediatric endoscopes. PATIENTS AND METHODS: Between January 2010 and May 2011, 33 children <12 years old with vesical calculi were treated. Children with orthopedic deformities, urethral stricture, history of urethral operations or bladder reconstruction, or stones >4 cm were excluded. Cystoscopies were performed under general anesthesia using 9 to 11F cystoscopes. Stones were completely fragmented under video guidance. Ho:YAG was applied at a power of 30 W. RESULTS: Median age was 3 years (0.5-11). Mean stone size was 2.02±0.82 cm (1-4 cm). Mean operative duration was 31.21 minutes (20-50). All children were discharged within 24 hours. A single operative session was performed for each patient. No complications were detected. After a mean follow-up of 16.87±4.08 months, all children were stone free, without development of any urethral stricture or recurrence of stones. Operative duration was significantly longer in stones >20 mm (P<0.001). CONCLUSION: Ho:YAG laser CL is a safe and successful minimally invasive treatment option for bladder stones in children. Success rate was 100% without development of any complications or recurrence.

Ureteric stents vs percutaneous nephrostomy for initial urinary drainage in children with obstructive anuria and acute renal failure due to ureteric calculi: a prospective, randomised study.

OBJECTIVES: To compare percutaneous nephrostomy (PCN) tube vs JJ ureteric stenting as the initial urinary drainage method in children with obstructive calcular anuria (OCA) and post-renal acute renal failure (ARF) due to bilateral ureteric calculi, to identify the selection criteria for the initial urinary drainage method that will improve urinary drainage, decrease complications and facilitate the subsequent definitive clearance of stones, as this comparison is lacking in the literature. PATIENTS AND METHODS: A series of 90 children aged ≤12 years presenting with OCA and ARF due to bilateral ureteric calculi were included from March 2011 to September 2013 at Cairo University Pediatric Hospital in this randomised comparative study. Patients with grade 0-1 hydronephrosis, fever or pyonephrosis were excluded. No patient had any contraindication for either method of drainage. Stable patients (or patients stabilised by dialysis) were randomised (non-blinded, block randomisation, sealed envelope method) into PCN-tube or bilateral JJ-stent groups (45 patients for each group). Initial urinary drainage was performed under general anaesthesia and fluoroscopic guidance. We used 4.8-6 F JJ stents or 6-8 F PCN tubes. The primary outcomes were the safety and efficacy of both groups for the recovery of renal functions. Both groups were compared for operative and imaging times, complications, and the period required for a return to normal serum creatinine levels. The secondary outcomes included the number of subsequent interventions needed for clearance of stones. Additional analysis was done for factors affecting outcome within each group. RESULTS: All presented patients completed the study with intention-to-treat analysis. There was no significant difference between the PCN-tube and JJ-stent groups for the operative and imaging times, period for return to a normal creatinine level and failure of insertion. There were significantly more complications in the PCN-tube group. The stone size (>2 cm) was the only factor affecting the rates of mucosal complications, operative time and failure of insertion in the JJ-stent group. The degree of hydronephrosis significantly affected the operative time for PCN-tube insertion. Grade 2 hydronephrosis was associated with all cases of insertion failure in the PCN-tube group. The total number of subsequent interventions needed to clear stones was significantly higher in the PCN-tube group, especially in patients with bilateral stones destined for chemolytic dissolution (alkalinisation) or extracorporeal shockwave lithotripsy (ESWL). CONCLUSION: We recommend the use of JJ stents for initial urinary drainage for stones that will be subsequently treated with chemolytic dissolution or ESWL, as this will lower the total number of subsequent interventions needed to clear the stones. This is also true for stones destined for ureteroscopy (URS), as JJ-stent insertion will facilitate subsequent URS due to previous ureteric stenting. Mild hydronephrosis will prolong the operative time for PCN-tube insertion and may increase the incidence of insertion failure. We recommend the use of PCN tube if the stone size is >2 cm, as there was a greater risk of possible iatrogenic ureteric injury during stenting with these larger ureteric stones in addition to prolongation of operative time with an increased incidence of failure.

The effect of preoperative clinical variables on the 30- and 90-day morbidity and mortality after radical cystectomy: A single-centre study.

OBJECTIVE: To analyse the effect of preoperative clinical variables and comorbidity on the early, late and cumulative 90-day morbidity and mortality rates, as well as hospital re-admissions, after radical cystectomy (RC), in one centre. PATIENTS AND METHODS: All patients undergoing RC over a period of 3 months were included. Preoperative investigations included measurements of serum albumin, a complete blood analysis, body mass index (BMI), Charlson comorbidity index (CCI) and the age-adjusted CCI (ACCI). We recorded the length of hospital stay (LOS) and all postoperative events for 90 days, and graded them according to the five-grade modification of the original Clavien system. RESULTS: In all there were 31 patients undergoing RC (mean age 58.4 years). The mean preoperative serum albumin and haemoglobin level, BMI, CCI and ACCI were 3.82 g/dL, 12.53 g/dL, 29.29 kg/m(2), 3.0 and 4.58, respectively. The mean LOS was 20.03 days; seven patients needed re-admission and three died within the 90 days. There were postoperative complications in 20 patients. The age, CCI and ACCI were significantly associated with complications (P = 0.009, 0.001 and < 0.001, respectively). Preoperative haemoglobin, BMI and smoking had no effect on the morbidity or mortality rate. The LOS increased in older patients (P = 0.031) and those with a higher ACCI (P = 0.042). Postoperative mortality increased among patients with a lower serum albumin level (P = 0.048). CONCLUSIONS: Age, CCI and ACCI are related to early postoperative complications. Older patients and patients with a higher ACCI have a longer LOS. A low preoperative albumin level needs to be evaluated more thoroughly.

Holmium laser enucleation versus photoselective vaporization for prostatic adenoma greater than 60 ml: preliminary results of a prospective, randomized clinical trial.

PURPOSE: To our knowledge we report the first single center, prospective, randomized study comparing holmium laser enucleation and high performance GreenLight™ prostate photoselective vaporization as surgical treatment of prostatic adenomas greater than 60 ml. MATERIALS AND METHODS: A total of 80 patients with a large prostatic adenoma were randomly assigned to surgical treatment with holmium laser enucleation or photoselective vaporization. International Prostate Symptom Score, International Index of Erectile Function-15, maximum flow rate, post-void residual urine, serum prostate specific antigen and transrectal ultrasound volume were recorded. RESULTS: Patient baseline characteristics were similar for holmium laser enucleation and photoselective vaporization. Operative time and catheter removal time were almost equal in the 2 groups (p = 0.7 and 0.2, respectively). Eight vaporization cases were converted to transurethral prostate resection or holmium laser enucleation intraoperatively due to bleeding. A significantly higher maximum flow rate and lower post-void residual urine were noted in holmium laser cases during the entire followup (at 1 year each p = 0.02). However, no significant difference in International Prostate Symptom Score, quality of life or International Index of Erectile Function-15 was detected. Prostate volume and serum PSA decreased 78% and 88% in the holmium laser group, and 52% and 60% in the vaporization group, respectively. CONCLUSIONS: Holmium laser enucleation and photoselective vaporization are effective for lower urinary tract symptoms due to a large prostatic adenoma. Early subjective functional results (maximum flow rate and post-void residual urine) of holmium laser enucleation appear to be superior to those of photoselective vaporization. In our hands cases intended to be treated with photoselective vaporization were at 22% risk of conversion to another modality. This could reflect our determination to vaporize to the capsule in all vaporization cases.

Use of oxidized cellulose hemostats (Surgicel™) to support parenchymal closure and achieve hemostasis following partial nephrectomy.

Elective nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) has gained general acceptance as an alternative to radical nephrectomy. To achieve hemostasis without risk of local ischemia and necrosis of kidney parenchyma after standard hemostatic suturing, we investigated oxidized cellulose hemostats' efficacy and safety as atraumatic hemostatic treatment and for the closure of a large parenchymal defect after kidney tumor resection. Our approach has been particularly helpful for repairing large and irregular renal parenchymal defects. This study demonstrates the use of oxidized cellulose hemostats is effective for rapid, hemostatic closure of the kidney in association with partial nephrectomy.

Low-grade endometrial stromal sarcoma with intravenous extension to the heart.

Endometrial stromal sarcoma (ESS) is a rare neoplasm of uterine origin. Intracardiac metastasis from this tumor is extremely infrequent. This report describes a 24-year-old woman from Yemen who had irregular vaginal bleeding shortly after spontaneous abortion. She developed left-lower-limb swelling, diagnosed by duplex scanning and magnetic resonance imaging as deep venous thrombosis in the inferior vena cava (IVC) that extended into the iliac veins on both sides, as well as the left femoral vein and right atrium. She developed acute respiratory distress, from which she recovered after transfer to the intensive care unit. Transesophageal echocardiography showed a large mass occupying the right atrium and ventricle and another mass in the right ventricular outflow tract with areas of cavitations. The tumor appeared to come from the IVC and extended through the right atrium and right ventricle into the pulmonary artery, ending in several digit-like projections. After surgical resection of the intracardiac mass, pathologic examination revealed a low-grade ESS that was confirmed by immunohistochemistry. The patient underwent panhysterectomy and IVC debridement. Pathologic examination revealed infiltrating low-grade endometrial sarcoma invading the myometrium and left adnexa, with intravenous extension into the pelvic veins and the IVC to the right side of the heart. This case shows that despite its well-known good prognostic nature, low-grade ESS may behave as an aggressive malignancy.

Long-term followup of dermal grafts for repair of severe penile curvature.

PURPOSE: There is some reluctance to use dermal grafts for augmenting the tunica albuginea to correct severe forms of chordee. The main concern is that by violating the integrity of the tunica albuginea venous leakage could presumably ensue and result in erectile dysfunction. We present our long-term followup of dermal grafts used to correct severe penile curvature associated with hypospadias or as an isolated malformation. MATERIALS AND METHODS: A total of 16 patients received a single dermal graft harvested from the nonhair bearing inguinal skin fold. Patient age was 1 to 19 years (average 7). Of the patients 14 had hypospadias, which was scrotal in 12 and perineal in 2, while 2 had congenital penile curvature. In the hypospadias group 13 patients underwent primary repair and 1 had undergone 2 previously failed repairs with persistent severe curvature. Additionally, 5 patients in the hypospadias group had associated penoscrotal transposition. Eight patients in the hypospadias group received testosterone injections preoperatively. RESULTS: Average followup was 10 years (range 6 to 15). At the time of the study all patients were postpubertal and 3 had married. Evaluation of the results was based on patient interview reporting of penile straightness, erectile quality and satisfaction with sexual relations, if present. Two of the 3 patients who married reported satisfactory sexual activity and 1 had fathered children. The other 13 patients reported rigid erections. Two patients had mild residual curvature that would not necessitate any further intervention. CONCLUSIONS: Some boys with severe penile curvature, particularly those with hypospadias and a borderline size phallus, need a dermal graft rather than a plication procedure to correct curvature. Our study suggests that using dermal grafts is safe for erectile function.