Comparison of Centrifugal and Pulsatile Perfusion to Preserve Donor Kidneys Using Ex Vivo Subnormothermic Perfusion.

Objective We have previously demonstrated benefits of kidney preservation utilizing an oxygenated subnormothermic ex vivo perfusion platform. Herein, we aim to compare pulsatile versus centrifugal (steady and uniform flow) perfusion with the goal of optimizing renal preservation with these devices. Materials and methods: Pig kidneys were procured following 30 min of warm ischemia by cross-clamping both renal arteries. Paired kidneys were cannulated and underwent either: oxygenated pulsatile or centrifugal perfusion using a hemoglobin oxygen carrier at room temperature with our ex vivo machine perfusion platform for 4 hr. Kidneys were reperfused with whole blood for 4 hr at 37° C. Renal function, pathology and evidence of inflammation were assessed post-perfusion. Results: Both pump systems performed equally well with organs exhibiting similar renal blood flow, and function post-reperfusion. Histologic evidence of renal damage using apoptosis staining and acute tubular necrosis scores was similar between groups. This was corroborated with urinary assessment of renal damage (NGAL 1) and inflammation (IL-6), as levels were similar between groups. Conclusion: In our porcine model with added warm ischemia simulating the effects of reperfusion after transplantation, pulsatile perfusion yielded similar renal protection compared with centrifugal perfusion kidney preservation. Both methods of perfusion can be used in ex vivo kidney perfusion systems.

Subnormothermic Perfusion with H2S Donor AP39 Improves DCD Porcine Renal Graft Outcomes in an Ex Vivo Model of Kidney Preservation and Reperfusion.

Cold preservation is the standard of care for renal grafts. However, research on alternatives like perfusion at higher temperatures and supplementing preservation solutions with hydrogen sulfide (H2S) has gained momentum. In this study, we investigated whether adding H2S donor AP39 to porcine blood during subnormothermic perfusion at 21 °C improves renal graft outcomes. Porcine kidneys were nephrectomized after 30 min of clamping the renal pedicles and treated to 4 h of static cold storage (SCS) on ice or ex vivo subnormothermic perfusion at 21 °C with autologous blood alone (SNT) or with AP39 (SNTAP). All kidneys were reperfused ex vivo with autologous blood at 37 °C for 4 h. Urine output, histopathology and RNAseq were used to evaluate the renal graft function, injury and gene expression profiles, respectively. The SNTAP group exhibited significantly higher urine output than other groups during preservation and reperfusion, along with significantly lower apoptotic injury compared to the SCS group. The SNTAP group also exhibited differential pro-survival gene expression patterns compared to the SCS (downregulation of pro-apoptotic genes) and SNT (downregulation of hypoxia response genes) groups. Subnormothermic perfusion at 21 °C with H2S-supplemented blood improves renal graft outcomes. Further research is needed to facilitate the clinical translation of this approach.

Unusual suspects: Real-time physiological evaluation of stressors during laparoscopic donor nephrectomy.

INTRODUCTION: The purpose of this study was to document the variability of faculty surgeon electrodermal activity (EDA) peaks during laparoscopic donor nephrectomy (LDN) to determine the effect of case difficulty and learner expertise on the stress response. METHODS: EDA for a single faculty surgeon was captured over 15 LDN cases using an Empatica E4 wristband. During each case, one of three transplant fellows (novice, intermediate, or expert level LDN expertise) participated. Difficulty was rated preoperatively as "low/moderate/high" by the faculty. EDA peaks were collected and analyzed; the frequency and magnitude of EDA peaks, case difficulty, and fellow expertise were compared using a two-way factorial ANOVA. RESULTS: The main effects of learner expertise (F[2, 308]=11.27, p<0.001) and difficulty rating (F[2, 414]=15.13, p<0.001) were significant. The interaction between difficulty and expertise on faculty EDA peaks was also significant (F[3, 391]=14.29, p<0.001). The novice fellow resulted in higher faculty EDA levels compared to intermediate and expert fellows on low-difficulty cases, but not moderate- or high-difficulty cases. CONCLUSIONS: This is the first report examining faculty surgeon EDA across cases of varying difficulty and varying learner expertise during a high-stakes operation. EDA levels were inversely proportional to the expertise of the learner and case difficulty, suggestive of a significant impact of learner autonomy on faculty stress response.

Daily use of a muscle pump activator device reduces duration of hospitalization and improves early graft outcomes post-kidney transplantation: A randomized controlled trial.

INTRODUCTION: Kidney and simultaneous pancreas-kidney (SPK) transplant recipients can have prolonged postoperative hospitalization due to edema. Thrombo-embolic-deterrent (TED) stockings with intermittent pneumatic compression devices (TED+IPC) have been used to improve venous return during the perioperative period. The objective of this trial was to evaluate the effects of TED+IPC vs. muscle pump activator (MPA) devices on factors that could reduce postoperative complications and duration of hospitalization. METHODS: In this single-center, prospective, randomized, controlled trial, 221 kidney and SPK transplant recipients were randomized to either wearing TED+IPC or MPA for six days postoperatively. Groups were compared with respect to postoperative urine output, lower limb edema, weight, days in hospital, mobility, serum creatinine, delayed graft function, need for dialysis, and lower extremity blood flow. RESULTS: Patients in the MPA group had significantly higher urine output and less increase in mid-calf leg circumference and weight gain compared to the TED+IPC group (p=0.003, p=0.001, and p=0.003, respectively). The MPA group also experienced shorter hospitalization (p=0.038), higher femoral vein velocity (p=0.001), and took more steps (p=0.009). Incidence of delayed graft function (p=0.72) and number of dialysis runs (p=0.39) was not different between study groups. Subgroup analysis of primary endpoints in donation after cardiac death recipients and SPK recipients did not yield any significance between the study arms. CONCLUSIONS: Postoperative use of the MPA device increases urine output, decreases leg edema, minimizes weight gain, and decreases duration of hospitalization after kidney transplantation. A larger and longer-term trial is needed to evaluate the impact on graft function.

Comparative Study Assessing Postoperative Renal Loss Using Two Different Partial Nephrectomy Techniques: Off-Clamp versus Standard On-Clamp Surgery.

OBJECTIVES: To evaluate a case-matched study comparing postoperative renal function using two surgical techniques: an off-clamp partial nephrectomy (PN) with the aid of the Altrus® device and a standard on-clamp laparoscopic PN. MATERIAL AND METHODS: A total of 36 patients underwent PN. Eighteen had the off-clamp technique and 18 had the standard laparoscopic on-clamp PN. Demographic, clinical, radiological, and perioperative data were collected for analysis. An emphasis on renal function was made by analyzing both the perioperative and follow-up with estimated glomerular filtration rate and MAG3. RESULTS: The median values did not signifcantly differ for age, Charlson Comorbidity Index, and hospital stay in the off-clamp versus on-clamp PN [62.5 (interquartile range, IQR 11) vs. 60 (IQR 16) years, 4 (IQR 2) vs. 5 (IQR 2) and 5 (IQR 1) vs. 4 (IQR 2) days], respectively. The median diameter of the tumors was 33 (IQR 23) versus 41 (IQR 28) mm (p = 0.63), with median R.E.N.A.L. nephrometry scores of 7 (IQR 2) versus 7 (IQR 2) (p = 0.33). There was greater blood loss in the Altrus® (375 vs. 200 ml, p = 0.037). The clamp time in the on-clamp group was 30 (IQR 6) minutes (range 22-68 minutes) compared to 0 minutes in the off-clamp group. There was no difference in hemoglobin or creatinine levels between the groups. However, the on-clamp group had a significant loss in ipsilateral renal function on the MAG3 scan (49 vs. 42%, p = 0.0001), whereas the off-clamp group had no difference (48 vs. 46%, p = 0.72). CONCLUSIONS: The off-clamp method for PN is a feasible and safe option with better preservation of ipsilateral renal function when compared with on-clamp PN in the treatment of small renal masses.

Renal Lymphangiectasia in the Transplanted Kidney: Case Series and Literature Review.

BACKGROUND: Renal lymphangiectasia is a rare and poorly understood lymphatic disease associated with lymphatic dilation and leakage. To our knowledge, no cases have been described in the context of a transplanted kidney. METHODS: We describe 2 cases of renal lymphangiectasia in transplanted kidneys, both from pediatric donors. RESULTS: The cases of allograft lymphangiectasia are characterized by severe, symptomatic ascites refractory to attempts at medical and surgical management, and ultimately requiring allograft nephrectomy. CONCLUSIONS: While lymphatic complications, particularly lymphoceles, are not uncommon in renal transplantation, lymphangiectasia is a distinct condition which should be considered in renal transplant patients with ascites, after all other sources have been ruled out.

Renal Protection Against Ischemia Reperfusion Injury: Hemoglobin-based Oxygen Carrier-201 Versus Blood as an Oxygen Carrier in Ex Vivo Subnormothermic Machine Perfusion.

BACKGROUND: The optimal method of oxygen delivery to donor kidneys during ex vivo machine perfusion has not been established. We have recently reported the beneficial effects of subnormothermic (22°C) blood perfusion in the preservation of porcine donation after circulatory death kidneys. Since using blood as a clinical perfusate has limitations, including matching availability and potential presence of pathogen, we sought to assess hemoglobin-based oxygen carrier (HBOC-201) in oxygen delivery to the kidney for renal protection. METHODS: Pig kidneys (n = 5) were procured after 30 minutes of warm in situ ischemia by cross-clamping the renal arteries. Organs were flushed with histidine tryptophan ketoglutarate solution and subjected to static cold storage or pulsatile perfusion with an RM3 pump at 22°C for 4 hours with HBOC-201 and blood. Thereafter, kidneys were reperfused with normothermic (37°C) oxygenated blood for 4 hours. Blood and urine were subjected to biochemical analysis. Total urine output, urinary protein, albumin/creatinine ratio, flow rate, resistance were measured. Acute tubular necrosis, apoptosis, urinary kidney damage markers, neutrophil gelatinase-associated lipocalin 1, and interleukin 6 were also assessed. RESULTS: HBOC-201 achieved tissues oxygen saturation equivalent to blood. Furthermore, upon reperfusion, HBOC-201 treated kidneys had similar renal blood flow and function compared with blood-treated kidneys. Histologically, HBOC-201 and blood-perfused kidneys had vastly reduced acute tubular necrosis scores and degrees of terminal deoxynucleotidyl transferase 2'-deoxyuridine, 5'-triphosphate nick end labeling staining versus kidneys treated with cold storage. Urinary damage markers and IL6 levels were similarly reduced by both blood and HBOC-201. CONCLUSIONS: HBOC-201 is an excellent alternative to blood as an oxygen-carrying molecule in an ex vivo subnormothermic machine perfusion platform in kidneys.

Subnormothermic Oxygenated Perfusion Optimally Preserves Donor Kidneys Ex Vivo.

INTRODUCTION: The current methods of preserving donor kidneys in nonoxygenated cold conditions minimally protect the kidney against ischemia-reperfusion injury (IRI), a major source of complications in clinical transplantation. However, preserving kidneys with oxygenated perfusion is not currently feasible due to the lack of an ideal perfusion mechanism that facilitates perfusion with blood at warm temperature. Here, we have designed an innovative renal pump circuit system that can perfuse blood or acellular oxygen carrier under flexible temperatures, pressures, and oxygenation. We have tested this apparatus to study optimal conditions of storage of our porcine model of donation after cardiac death (DCD) kidneys. METHODS: Porcine kidneys were retrieved after 30 minutes of cross-clamping renal pedicles in situ. Cessation of blood mimics postcardiac death in humans and simulates DCD warm ischemic injury. Procured kidneys were flushed and subjected to static cold storage (SCS) for 4 hours. For warm perfusion, kidneys were cannulated for pulsatile oxygenated perfusion with blood:PlasmaLyte for 4 hours at 15 °C, 22 °C, and 37 °C. To mimic posttransplant scenario, all kidneys were reperfused with blood for an additional 4 hours at 37 °C. RESULTS: Compared with all other groups, 22 °C perfusion resulted in significant reduction of acute tubular necrosis (ATN), apoptosis, kidney damage markers, Toll-like receptor signaling, and cytokine production. It was associated with maximal renal blood flow and urine output. Kidneys stored at 15 °C thrombosed within 2 hours under this condition. Martius Scarlet Blue staining confirmed that 22 °C was the optimal temperature to minimize hemorrhage and blood clots. CONCLUSION: Our novel study shows that oxygenated perfusion at near-room-temperature provides optimal donor kidney storage conditions.

Use of a Muscle Pump Activator Leads to Improved Lower Limb Edema, Lower Limb Blood Flow, and Urine Output Compared With Standard TED Stockings and Compression Devices Following Kidney Transplant: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to evaluate the effects of using thromboembolic deterrent (TED) stockings and intermittent pneumatic compression (IPC) vs a muscle pump activator (MPA) device on limb edema and patient satisfaction after transplant. METHODS: In this single-center randomized controlled trial, 118 patients were randomly assigned to wear TED + IPC (n = 64) or the MPA device (n = 54) from postoperative days 1 to 6. We measured patients' weight and lower leg and thigh circumferences daily. Ultrasonography of the allograft and lower limbs was carried out on postoperative days 1 and 5 to assess resistive index in the transplanted kidney and flow in the femoral vein. We monitored urine output and serum creatinine level. RESULTS: We observed a significant increase in calf and thigh circumference from baseline in the TED + IPC group but not in the MPA group (2.3 [SD, 1] cm vs 0.25 [SD, 0.8] cm, respectively, P < .002). Ultrasonography showed higher femoral vein velocities in the MPA group than the TED + IPC group (0.5 [SD, 0.2] cm, P < .001). The mean total urine output in 6 days was higher in the MPA group than the TED + IPC group (P = .05), which corresponded to large change in TED + IPC weight of 6.2 kg vs 2.1 kg in the MPA group (P = .04). Patients were more satisfied with the use of the MPA device than TED + IPC. No major complications were encountered in either group. CONCLUSIONS: This is the first study to show that the use of an MPA device in the immediate postoperative period following kidney transplant leads to decreased lower limb edema and increased total urine output. Patients were more satisfied with the use of the MPA device than TED + IPC.

The impact of a muscle pump activator on incisional wound healing compared to standard stockings and compression devices in kidney and kidney-pancreas transplant recipients: A randomized controlled trial.

INTRODUCTION: We aimed to evaluate the impact of thrombo-embolic-deterrent + intermittent pneumatic compression (TED + IPC) vs. muscle pump activator (MPA) on incisional wound healing in kidney and simultaneous pancreas- kidney (SPK) transplant recipients. METHODS: We conducted a single-centre, randomized controlled trial in which 104 patients (kidney n=94; SPK n=10) were randomly assigned to wear TED + IPC (n= 52) or MPA (n=52) for the first six days following surgery. Patient demographics, postoperative outcomes, and incisional wound images were taken using a HIPAA-compliant application on postoperative days (POD) 3, 5, and 30, and assessed using the validated Southampton Wound Care Score. RESULTS: There were no demographic differences between the groups. The MPA group had a significant improvement in wound healing on POD 3 (p=0.04) that persisted until POD 5 (p=0.0003). At POD 30, both groups were similar in wound healing outcomes (p=0.51). Bayesian inferential analysis revealed that the use of TED + IPC following transplantation had inferior outcomes compared to the use of MPA with sequential moderate evidence. The rate of complex wound infections was significantly greater in the TED + IPC group compared to the MPA group (29% vs. 12%, respectively; p=0.03). Patients were more satisfied with the use of a MPA device than TED + IPC. No major complications were encountered in either group. CONCLUSIONS: The use of a MPA device in the immediate postoperative period leads to a significant improvement in immediate and early wound healing, and decreased number of complex wound infections following kidney and SPK transplantation compared to standard TED + IPC therapy. Patients were more satisfied with the use of a MPA device than TED + IPC.

First Canadian experience with robotic laparoendoscopic single-site vs. standard laparoscopic living-donor nephrectomy: A prospective comparative study.

INTRODUCTION: We aimed to compare the outcomes of robotic laparoendoscopic single-site living donor nephrectomy (R-LESS LDN) vs. standard laparoscopic living donor nephrectomy (LLDN). METHODS: Between October 2013 and November 2015, 39 patients were allocated to either standard LLDN (n=25) or R-LESS LDN (n=14). Patient demographics, perioperative outcomes, analgesic requirement, visual analogue scale of pain at postoperative days 1, 3, 7, and 30, and a health-related quality of life and body image questionnaire were prospectively collected. RESULTS: There were no significant differences in demographics and intraoperative outcomes between the two cohorts. The R-LESS LDN cohort had lower analgesic requirement (p=0.002) and lower visual pain scores on days 1 and 3 (p=0.001). Additionally, body image and satisfaction scores in the R-LESS group were also superior compared to the LLDN cohort (p=0.008). There was no significant difference in the postoperative complications according to the Clavien-Dindo system. Recipient graft functional outcomes were equivalent. CONCLUSIONS: This is the first evidence that R-LESS LDN is safe and associated with comparable surgical and early functional outcomes compared to LLDN, while pain, donor body image, and satisfaction scores were improved compared to LLDN.

Transplantation of pediatric renal allografts from donors less than 10 kg.

Few transplant programs use kidneys from donors with body weight (BW) < 10 kg. We hypothesized that pediatric en bloc transplants from donors with BW < 10 kg would provide similar transplant outcomes to larger grafts. All pediatric en bloc renal transplants performed at our center between 2001 and 2017 were reviewed (N = 28). Data were stratified by smaller (donor BW < 10 kg; n = 11) or larger donors (BW > 10 kg; n = 17). Renal volume was assessed during follow-up with ultrasound. Demographic characteristics were similar between the 2 groups of recipients. After mean follow-up of 44 months (smaller donors) and 124 months (larger donors), graft and patient outcomes were similar between groups. Serum creatinine at 1, 3, and 5 years was no different between groups. At 1 day posttransplant, mean total renal volume in the smaller donors was 28 ± 9 mm3 vs 45 ± 12 mm3 (P < .01). By 3 weeks, it was 53 ± 19 mm3 (smaller donors) versus 73 ± 19 mm3 (larger donors) (P = NS). Complication rates were similar between both groups with 1 case of venous thrombosis in the smaller group. With experience, outcomes are equivalent to those from larger pediatric donors.

First Canadian experience with donation after cardiac death simultaneous pancreas and kidney transplants.

BACKGROUND: Compared with neurologic determination of death (NDD) donor organs, donation after cardiac death (DCD) donor organs have traditionally been considered of inferior quality owing to warm ischemia experienced during procurement. We present, to our knowledge, the first analysis of simultaneous pancreas and kidney (SPK) transplants using DCD donor organs in Canada. METHODS: We carried out a retrospective cohort study of SPK transplants from 13 DCD and 68 NDD donors performed between October 2008 and July 2016. In all patients immunosuppression was induced with thymoglobulin and continued with tacrolimus, mycophenolate mofetil and prednisone maintenance therapy. RESULTS: Donor and recipient characteristics of DCD and NDD groups were similar with respect to age, sex, body mass index, kidney and pancreas cold ischemia times, and donor terminal creatinine. Mean DCD graft warm ischemia time was 0.5 (range 0.4-0.7) hours. Median follow-up was 2.2 (range 0.1-6.7) years and 2.7 (range 0.3-6.3) years for the DCD and NDD groups, respectively. The DCD and NDD groups were similar with regards to recipient percent panel reactive antibody and presence of human leukocyte antigen antibodies. The groups also received similar total doses of thymoglobulin. In total 38% of patients in the DCD group experienced renal delayed graft function (DGF) compared with 10% in the NDD group (p = 0.027). There were 7 cases of pancreas graft thrombosis requiring relaparotomy in the NDD group compared with none in the DCD group. No patients from either group required insulin at any time after transplant. Although the estimated glomerular filtration rate (eGFR) was lower in the DCD than the NDD group on postoperative days 7 and 14 (p = 0.025), no difference was noted on day 30 or through 4 years after transplant. No differences were seen between the groups with respect to amylase, lipase, or glycosated hemoglobin (HbA1c) up to 4 years after transplant, or in kidney, pancreas, or patient survival at any time after transplant. CONCLUSION: Our results show that, apart from a higher renal DGF rate, SPK transplants with DCD donor organs have comparable outcomes to standard transplants with NDD donor organs.

CONTEXTE: Comparativement aux organes prélevés après détermination de la mort cérébrale (ou détermination du décès neurologique [DDN]), les organes prélevés après détermination du décès cardiocirculatoire (DDC) sont en général considérés de moindre qualité en raison du phénomène d'ischémie chaude inhérent à ce type de prélèvement. Nous présentons, à notre connaissance, la première analyse sur la double greffe rein-pancréas effectuée avec des organes prélevés après DDC au Canada. MÉTHODES: Nous avons procédé à une étude de cohorte rétrospective sur les doubles greffes rein-pancréas effectuées entre octobre 2008 et juillet 2016, soit 13 après DDC et 68 après DDN. Chez tous les patients, l'immunosuppression a été induite par la thymoglobuline et a été maintenue au moyen d'un traitement d'entretien par le tacrolimus, le mycophénolate mofétil et la prednisone. RÉSULTATS: Les caractéristiques des donneurs et des receveurs des 2 groupes (DDC et DDN) étaient semblables sur les plans de l'âge, du sexe, de l'indice de masse corporelle, de la durée de l'ischémie froide du rein et du pancréas, et de la créatinine terminale (donneur). La durée moyenne de l'ischémie chaude des greffons prélevés après DDC a été de 0,5 (étendue : 0,4-0,7) heure. Le suivi médian a été d'une durée de 2,2 (étendue : 0,1-6,7) ans et de 2,7 (étendue : 0,3-6,3) ans, respectivement, pour les groupes DDC et DDN. Les 2 groupes étaient similaires pour ce qui est des pourcentages d'anticorps réactifs et de la présence d'anticorps anti-HLA (human leukocyte antigen) chez les receveurs. Les 2 groupes avaient aussi reçu des doses totales semblables de thymoglobuline. En tout, 38 % des patients du groupe DDC ont manifesté un retard de fonctionnement du greffon rénal, contre 10 % dans le groupe DDN (p = 0,027). On a dénombré 7 cas de thrombose du greffon pancréatique ayant nécessité une réintervention dans le groupe DDN, contre aucun dans le groupe DDC. Aucun des patients n'a eu besoin d'insuline après la transplantation. Le débit de filtration glomérulaire estimé (DFGe) était moins élevé dans le groupe DDC que dans le groupe DDN aux jours 7 et 14 (p = 0,025), mais on n'a plus noté de différence à ce chapitre au jour 30 ni au cours des 4 années suivant la greffe. On n'a observé aucune différence entre les groupes pour ce qui est de l'amylase, de la lipase ou de l'HbA1c jusqu'à 4 ans suivant la greffe, ni pour ce qui est de la survie des greffons rénaux ou pancréatiques ou celle des patients, peu importe le temps écoulé depuis la greffe. CONCLUSION: Selon nos résultats, si ce n'est un taux plus élevé de retard de fonctionnement du greffon rénal, les receveurs d'une double greffe rein-pancréas après DDC obtiennent des résultats semblables à ceux qui subissent une greffe standard d'organes prélevés après DDN.

Urinary stone composition in Oman: with high incidence of cystinuria.

Urinary stones are a common problem in Oman and their composition is unknown. The aim of this study is to analyze the components of urinary stones of Omani patients and use the obtained data for future studies of etiology, treatment, and prevention. Urinary stones of 255 consecutive patients were collected at the Sultan Qaboos University Hospital. Stones were analyzed by Fourier transform infrared spectrophotometer. The biochemical, metabolic, and radiological data relating to the patients and stones were collected. The mean age was 41 years, with M:F ratio of 3.7:1. The common comorbidities associated with stone formation were hypertension; diabetes, benign prostate hyperplasia; urinary tract infection; obesity; and atrophic kidney. The common presentation was renal colic and flank pain (96%). Stones were surgically retrieved in 70% of patients. Mean stone size was 9 ± 0.5 mm (range 1.3-80). Stone formers had a BMI ≥ 25 in 56% (P = 0.006) and positive family history of stones in 3.8%. The most common stones in Oman were as follows: Calcium Oxalates 45% (114/255); Mixed calcium phosphates & calcium oxalates 22% (55/255); Uric Acid 16% (40/255); and Cystine 4% (10/255). The most common urinary stones in Oman are Calcium Oxalates. Overweight is an important risk factor associated with stone formation. The hereditary Cystine stones are three times more common in Oman than what is reported in the literature that needs further genetic studies.

Molecular Evidence of Helicobacter Pylori Infection in Prostate Tumors.

OBJECTIVES: To determine whether Helicobacter pylori (H. pylori) is detectable in both benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Epidemiological studies have shown significant associations between infective chronic prostatitis and prostatic carcinoma. Many bacteria have been found in the prostate of patients with chronic prostatitis, BPH, and PCa. METHODS: One hundred consecutive patients with prostate diseases were enrolled in the study. Detection of H. pylori DNA in prostate tissue from patients with BPH and PCa was performed using both immunohistochemistry and PCR, and the results were confirmed by DNA sequencing. Odds ratios and the Fisher Exact test were used for the analysis of the associations between the variables. RESULTS: Among the patients, 78% had BPH and 19% had PCa. While immunohistochemistry showed no positive sample for H. pylori, PCR combined with sequencing detected H. pylori DNA in prostate tissue samples from 5 patients. However, statistical analysis of the data showed that BPH and PCa are not significantly associated with the presence of H. pylori DNA in prostate tissue (odds ratio = 0.94, 95% confidence interval = 0.09-23.34, one-tailed Chi-square value = 0.660, p > 0.05). The limitation of this study was the small number of PCa patients. CONCLUSIONS: This study provides, for the first time, molecular evidence of the presence of H. pylori DNA in prostatic tissue of patients with BPH and PCa. It paves the way for further comprehensive studies to examine the association of H. pylori infection with BPH and PCa.

Transplant renal artery false aneurysm: case report and literature review.

This is a case report of a 59 years old male who had a commercial non-related living renal transplantation for his end stage renal insufficiency secondary to adult polycystic kidney disease. He suffered an immediate and early post-operative bleeding, which was managed conservatively. He was presented at Sultan Qaboos University Hospital four months after his transplant with abdominal pain, nausea, loss of appetite and a rise in serum creatinine levels. Ultrasonography and angiography have shown a 4 cm false aneurysm of the transplant renal artery at the anastomotic site with the external iliac artery. Surgical exploration with resection of the false aneurysm and reanastomosis of the donor renal artery to the external iliac artery was carried out successfully with preservation of the renal allograft. This is a rare case of an extra-renal false aneurysm at the anastomotic site of the transplant renal artery to the external iliac artery four months after renal allotransplantation. Literature review on the management and outcome of false aneurysms after renal transplant was carried out.

Semirigid ureteroscopy and pneumatic lithotripsy as definitive management of obstructive ureteral calculi during pregnancy.

OBJECTIVES: To assess the results of semirigid ureteroscopy and intracorporeal pneumatic lithotripsy as a definitive treatment option for women presenting with obstructive ureteral calculi during pregnancy. METHODS: A retrospective analysis was performed of 19 pregnant patients referred to our tertiary care center with ureteral obstruction necessitating surgical intervention from 1997 to 2007. The mean patient age was 22 years (range 18-27), and the mean gestation period was 20 weeks (range 14-34). Of the 19 patients, 21% were febrile, 32% had positive urine cultures, and 63% had pyuria and microscopic hematuria. Abdominal ultrasonography was the principle diagnostic test used. Six patients had history of renal stones before conception. The mean stone size was 11 mm, (range 8-18). Of the 19 patients, 58% had stones located in the proximal and 42% in the distal ureter. The stones were fragmented using a Swiss pneumatic lithoclast through a 6.9F/8F semirigid ureteroscope with the patient under general anesthesia. None of the patients underwent limited intravenous urography or computed tomography except for 1, who underwent plain x-ray of the kidneys, ureters, and bladder. RESULTS: All patients had obstruction due to the ureteral calculi, and 79% patients had complete fragmentation of the calculi by ureteroscopy as the primary treatment. Of the 19 patients, 63% required ureteral stent insertion per operatively. No complications related to the procedure itself or the general anesthesia were recorded, and all patients completed the full term of pregnancy. CONCLUSIONS: The results of our study have shown that semirigid ureteroscopy to diagnose ureteral calculi and treat them with intracorporeal pneumatic lithotripsy and ureteral stent insertion, as indicated, is the most efficient and definitive treatment modality in expectant women.

Surgical Technique for Retroperitoneoscopic Nephrectomy: A case report.

A case of right non-functioning kidney secondary to chronic pyelonephritis is presented. The successful management through retroperitoneoscopic nephrectomy is described, emphasising the technique of this minimally invasive therapeutic option.

Laparoscopic nephrectomy: technique and outcome.

OBJECTIVE: To review case series of retroperitoneal laparoscopic nephrectomies. METHODS: Between May 2003 and May 2006, 60 laparoscopic nephrectomies were performed by a single surgeon. Laparoscopic route for nephrectomy was retroperitoneal in 50 cases and transperitoneal in 10 cases. RESULTS: The patients included 37 males and 23 females. The mean age was 18.5 +/- 16.6 years and ranged from 2 years to 60 years. Right sided nephrectomy was performed in 31 cases while left kidney was removed in 29 cases. The indications for nephrectomy were stones (n = 29), dysplasia (n = 11), chronic pyelonephritis (n = 8), pelvi ureteric junction obstruction (n = 4), tuberculosis (n = 3), vesicoureteric reflux (n = 3) and ureterocele(n = 2). Mean operating time for laparoscopic nephrectomy alone was 140 +/- 51.1 min (range 25-300 minutes). In our series, 19 additional surgical procedures were performed under the same general anaesthesia. The mean hospital stay for all patients was 3.1 +/- 2.39 days; however the mean hospital stay for those patients who underwent laparoscopic nephrectomy without any additional procedure is 2.2 +/- 0.92 days (1.5-4 days). The mean size of kidney removed was 7.4 +/- 3.13 cm (4.6-15.9 cm). Complications were seen in 2 patients (3%); one developed wound infection and the other was found to have a haematoma for which the wound was re-explored. Conversion to open nephrectomy was required in 7 patients (11.6%) due to bleeding from renal pedicle (n = 4), poor vision secondary to pus spillage from pyonephrotic kidney (n = 2) and failure to progress due to indwelling percutaneous nephrostomy. There was no mortality and none of the patients had prolonged ileus. Blood transfusion was not required in any case. There was no bowel injury or port site herniation. CONCLUSION: Laparoscopic nephrectomy is a feasible and safe technique. The length of hospital stay and convalescence is short and hence rapid return to normal activity is expected.

Laparoscopic assisted percutaneous nephrolithotomy (PCNL) in ectopic pelvic kidney.

We report the case of a patient with pain and an abdominal palpable mass whose tests showed a right pelvic kidney with a 4-cm stone in the renal pelvis. We describe the successful management through laparoscopic assisted percutaneous nephrolithotomy (PCNL) in ectopic pelvic kidney, stressing that this method is a minimally invasive therapeutic option in such cases.