Prognostic Factors of Morbimortality in Patients Treated for Xanthogranulomatous Pyelonephritis.

Background: Nephrectomy is the treatment for xanthogranulomatous pyelonephritis (XGP), but the surgery is often technically complex and associated with a high incidence of postoperative complications. The objective of this study was to determine factors that can predict the probability of major postoperative complications, admission to intensive care, or mortality. Methods: We conducted a retrospective observational study of patients with XGP who underwent simple nephrectomy in a tertiary care hospital in Mexico from 2015 to 2022. We analyzed preoperative and transoperative variables to determine their relationship with postoperative complications. Results: A total of 39 patients with a mean age of 44.33 ± 12.6 years were included. In the comparative analysis of the variables, we found a significant difference in the amount of intraoperative bleeding between the types of surgical approaches-a median of 1,200 mL with the transperitoneal approach vs 525 mL with the retroperitoneal approach (P=0.02)-but we found no significant differences in the need for blood transfusion or other complications associated with surgical approach. In both the univariate and multivariate analyses, patients with positive urine cultures prior to surgery had a higher rate of complications requiring surgical, endoscopic, or radiologic intervention. No significant differences in outcomes were found between patients who underwent early vs delayed nephrectomy. Conclusion: The surgical approach for nephrectomy, transperitoneal or retroperitoneal, and early vs delayed surgery did not affect postoperative complications in our patients with XGP. However, the presence of positive urine cultures prior to surgery was associated with major complications.

Clinical Presentation, Microbiological Characteristics, and Their Implications for Perioperative Outcomes in Xanthogranulomatous Pyelonephritis: Perspectives from a Real-World Multicenter Practice.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic granulomatous infection of renal parenchyma. XGP is often associated with long-term urinary tract obstruction due to stones and infection. We aimed to analyze the clinical, laboratory, and microbial culture profiles from bladder and kidney urine of patients who were diagnosed with XGP. Databases of patients with histopathological diagnosis of XGP from 10 centers across 5 countries were retrospectively reviewed between 2018 and 2022. Patients with incomplete medical records were excluded. A total of 365 patients were included. There were 228 (62.5%) women. The mean age was 45 ± 14.4 years. The most common comorbidity was chronic kidney disease (71%). Multiple stones were present in 34.5% of cases. Bladder urine culture results were positive in 53.2% of cases. Kidney urine culture was positive in 81.9% of patients. Sepsis and septic shock were present in 13.4% and 6.6% of patients, respectively. Three deaths were reported. Escherichia coli was the most common isolated pathogen in both urine (28.4%) and kidney cultures (42.4%), followed by Proteus mirabilis in bladder urine cultures (6.3%) and Klebsiella pneumoniae (7.6%) in kidney cultures. Extended-spectrum beta-lactamases producing bacteria were reported in 6% of the bladder urine cultures. On multivariable analysis, urosepsis, recurrent urinary tract infections, increased creatinine, and disease extension to perirenal and pararenal space were independent factors associated with positive bladder urine cultures. On multivariable analysis, only the presence of anemia was significantly more frequent in patients with positive kidney cultures. Our results can help urologists counsel XGP patients undergoing nephrectomy.

Perioperative outcomes and risk factors for major complications associated with nephrectomy for Xanthogranulomatous pyelonephritis: a multicenter study.

PURPOSE: To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy. METHODS: A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed. RESULTS: A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications. CONCLUSION: Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible.

Giant congenital fibroepithelial polyp of the scrotum.

Fibroepithelial polyps are common tumors of mesodermal origin. However, only a few case reports of giant fibroepithelial polyps have been published, and they have mainly involved adults. This case report describes a 3-month-old boy with a pedunculated mass in the scrotum. To our knowledge, this is the first report of a giant congenital fibroepithelial polyp on this location.

In vitro encapsulation of heterologous dsDNA into human parvovirus B19 virus-like particles.

Virus-like particles (VLPs) have vast potential for applications in nanoscience and nanomedicine. These biological nanoparticles may be used for medical imaging, vaccination, or tissue-specific delivery of drugs or other bioactive molecules. VLPs of Human parvovirus B19 (B19 V) can be assembled in vitro from the recombinant VP2 protein. In this research, we describe a simple method for the encapsulation of heterologous linear dsDNA fragments of different sizes into B19 V-VP2 VLPs, in which the DNA and denatured VP2 protein are co-incubated and the assembly process is conducted by one dialysis step. Characterization of the particles by qPCR demonstrated the encapsulation of dsDNA, and indicates that the length of the dsDNA is critical for the encapsulation process. The strategy presented here opens the possibility to use this VLPs as a delivery system with future therapeutically applications.