Endoscopic combined intrarenal surgery in the prone split-leg position versus Galdakao-modified supine Valdivia position for the management of partial staghorn calculi.

OBJECTIVE: To evaluate and compare the outcome of ECIRS in the treatment of partial staghorn renal calculi in both prone split-leg positions versus GMSV positions with regard to; technical aspects, success rate, operative time, complications, safety, and effectiveness of both approaches. PATIENTS AND METHODS: Between October 2018 and August 2021, 66 patients with partial staghorn calculi were enrolled in this prospective comparative study. Patients were randomly divided according to a 1:1 ratio into two groups. Group A included 33 patients who were treated by (ECIRS) in the prone split-leg position, and group B included 33 patients who were treated by (ECIRS) in the Galdakao-modified supine Valdivia (GMSV) position. RESULTS: No significant statistical difference between both groups regarding the mean age (p = 0.448), mean body mass index (BMI) (p = 0.137), mean stone burden (p = 0.435), mean operative time (p = 0.541) and the number of calyces located in branched stones (p = 0.628). The mean hospital stay was 6.71 ± 1.12 days for group A and 6.66 ± 1.10 days for group B patients (p = 0.724). The final SFR was achieved in (29)87.87% and (30)90.9% of group A & B patients, respectively (p = 0.694). No significant difference was detected between both groups in perioperative complication rates. CONCLUSION: ECIRS is safe and effective in treating partial staghorn calculi either in the prone split-leg position or in the Galdakao-modified supine Valdivia position, with comparable outcomes and no statistically significant difference between both positions.

Extravesical Common Sheath Ureteral Reimplantation Versus Intravesical Techniques for Refluxing Duplex Systems in Children.

PURPOSE: Retrospective comparative study of the efficacy of extravesical non-dismembered common sheath ureteral reimplantation (ECSR) versus intravesical common sheath ureteral reimplantation (ICSR) techniques for the correction of vesicoureteral reflux (VUR) in complete duplex systems. MATERIAL AND METHODS: Between 2010 and 2019, ECSR was performed in 38 children (8 bilaterally), and the mean ages at presentation and at surgery were 31 and 57 months, respectively. The ICSR technique was performed in 25 units (25 patients). Voiding cystography and ultrasound of the kidney and bladder were performed 3 and 12 months postoperatively. We analyzed the surgical outcomes for both groups. RESULTS: The mean follow-up times for the ECSR and ICSR groups were 15 and 18 months, respectively. The success rate of the ECSR group was 93.5% at 3 months, improving to 95.7% at an average of one year; the rate of the ICSR group was 96% at 3 months and was the same after one year, with no significant difference between the two groups (p = .66). Postoperative complications were compared in the ECSR and ICSR groups: transient contralateral VUR was seen in 5 renal units versus 4, de novo hydronephrosis was seen in 3 units versus 2, and UTIs were observed in 3 patients versus 4. CONCLUSION: Both (ECSR) and (ICSR) surgeries are highly successful for the correction of VUR in uncomplicated complete duplex systems. The results of the extravesical approach are comparable with those of the intravesical technique with less morbidity and a shorter hospital stay. Thus, ECSR is our preferred technique when open surgical repair is indicated. ICSR should be reserved for complicated duplex systems necessitating concomitant reconstructive surgery.

Subsequent prostate cancer detection in patients with prostatic intraepithelial neoplasia or atypical small acinar proliferation.

INTRODUCTION: To evaluate the predictors of prostate cancer in follow-up of patients diagnosed on initial biopsy with high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP). METHODS: We studied 201 patients with HGPIN and 22 patients with ASAP on initial prostatic biopsy who had subsequent prostatic biopsies. The mean time of follow-up was 17.3 months (range 1-62). The mean number of biopsy sessions was 2.5 (range 2-6), and the median number of biopsy cores was 10 (range 6-14). RESULTS: On subsequent biopsies, the rate of prostate cancer was 21.9% (44/201) in HGPIN patients. Of these, 32/201 patients (15.9%), 9/66 patients (13.6%) and 3/18 patients (16.6%) were found to have cancer on the first, second and third follow-up biopsy sessions, respectively. In ASAP patients, the cancer detection rate was 13/22 (59.1%), all of whom were found on the first follow-up biopsy. There was a statistically significant difference between the cancer detection rate in ASAP and HGPIN patients (p < 0.001). Multivariate analysis showed that the independent predictors of cancer were the number of cores in the initial biopsy, the number of cores (> 10) in the follow-up biopsy and a prostate specific antigen (PSA) density of >/= 0.15 (odds ratio 0.77, 3.46 and 2.7,8 respectively; p < 0.04). Conversely, in ASAP patients none of these variables were found to be associated with cancer diagnosis. CONCLUSION: ASAP is a strong predictive factor associated with cancer when compared with HGPIN. The factors predictive of cancer on follow-up biopsy of HGPIN are number of cores on initial biopsy, more than 10 cores in rebiopsy and elevated PSA density. As the cancer detection rate on repeated biopsy of HGPIN patients is the same as that of patients without HGPIN, perhaps the standard of repeat biopsy in all patients with HGPIN should be revisited.

Recoverability of renal function after treatment of adult patients with unilateral obstructive uropathy and normal contralateral kidney: a prospective study.

OBJECTIVES: To study the methods of prediction of recoverability of renal function after the treatment of adult patients with unilateral obstructive uropathy and a normal contralateral kidney. METHODS: This prospective study included 91 consecutive adult patients with the diagnosis of unilateral obstructive uropathy and a normal contralateral kidney. All patients had a nonequivocal cause of obstruction that was successfully relieved after treatment. All patients underwent plain abdominal x-ray, gray-scale ultrasonography, Doppler ultrasonography, excretory urography, and technetium-99m-diethylenetriamine pentaacetic acid radioisotope renography before and after treatment. Patients were seen regularly at 3, 6, and 12 months for a mean duration of 13 +/- 6 months (range 6 to 36). At each visit, ultrasonography and renography were performed, and excretory urography was performed at least once during follow-up. Several renographic and ultrasound parameters were studied before and after treatment to evaluate their value in predicting the recoverability of renal function. The difference between the selective renographic glomerular filtration rate (GFR) of the ipsilateral kidney before treatment and its mean value after treatment was considered as the reference variable to which all other variables were compared. All prognostic parameters were evaluated by both univariate and multivariate analyses. RESULTS: On univariate analysis, the factors that significantly affected the recoverability of renal function after the relief of obstruction included preoperative renographic GFR, renal perfusion, parenchymal thickness, parenchymal echogenicity, corticomedullary differentiation, reduction of the renal resistive index of the corresponding kidney, and compensatory hypertrophy of the contralateral normal kidney. However, using multivariate analysis, only the preoperative selective renographic GFR and renal perfusion of the corresponding kidney sustained their statistical significance as independent factors affecting renal functional recovery. A preoperative GFR value of 10 mL/min/1.73 m2 was estimated as the cutoff point that can determine the best prediction of stabilization or improvement of renal function after the relief of obstruction. CONCLUSIONS: Preoperative renographic clearance and perfusion of the corresponding kidney were the only predictors of recoverability of unilateral renal obstruction. Kidneys with a renographic GFR of less than 10 mL/min/1.73 m2 were irreversibly damaged. Improvement or stabilization of function can be expected after relief of obstruction of kidneys with a renographic GFR of 10 mL/min/1.73 m2 or greater.