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INTRODUCTION: Delayed graft function (DGF) is a common condition that necessitates dialysis during the first week after transplantation. Although DGF rarely occurs following living-donor kidney transplantation (LDKT), it may eventually lead to acute or chronic graft rejection. This study aimed to assess the risk factors for DGF in patients who underwent LDKT. METHODS: A systematic review and meta-analysis of studies published before August 2022 was conducted using the PubMed, Science Direct, Cochrane, and Directory of Open Access Journal (DOAJ) databases. The review included studies that assessed the incidence of DGF following LDKT, and examined its risk factors, while excluding studies involving deceased donors. Potential risk factors were analyzed using pooled mean differences or odds ratios with 95% confidence intervals (CIs). Review Manager 5.3 was used for the meta-analysis. RESULTS: Among the 13 included studies, 3685 cases of DGF were identified in a total of 113,261 patients (3.25%). Potential risk factors for DGF following LDKT were examined across several aspects, including donor, recipient, donor/recipient relationship, and immunological and intraoperative factors. The identified risk factors included older donors (P = 0.07), male recipients (P < 0.0001), higher recipient body mass index (BMI) (P < 0.0001), non-white recipients (P < 0.0001), pre-existing diabetes (P < 0.0001), pre-existing hypertension (P = 0.01), history of dialysis (P < 0.0001), re-transplantation (P = 0.004), unrelated donor/recipient (P = 0.02), ABO incompatibility (P < 0.0001), higher panel reactive antibody (PRA) levels (P < 0.0001), utilization of right kidney (P < 0.0001), and longer cold ischemia time (CIT) (P = 0.004). CONCLUSION: Several factors related to the donor, recipient, donor/recipient relationship, and immunological and intraoperative aspects were identified as potential risk factors for the development of DGF following LDKT. Addressing and optimizing these factors may improve the long-term outcomes of LDKT.
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INTRODUCTION: Scrotal and inguinal orchiopexy are two commonly used surgical approaches for palpable undescended testis (UDT), each with distinct advantages. However, the optimal approach remains a matter of debate, warranting a comprehensive meta-analysis of randomized controlled trials (RCTs) to guide clinical decision-making. MATERIALS AND METHODS: A comprehensive literature search was conducted, adhering to PRISMA guidelines, to select RCTs comparing scrotal and inguinal orchiopexy for palpable UDT. Eight RCTs were selected for meta-analysis. Outcome measures included operative time, hospitalization duration, total complications, wound infection or dehiscence, testicular atrophy or hypotrophy, and testicular re-ascent rate. The evaluation of the study's quality was conducted by utilizing the revised Cochrane risk-of-bias tool. RESULTS: Scrotal orchiopexy showed significantly shorter operative time compared to the inguinal approach (WMD: - 15.06 min; 95% CI: - 21.04 to - 9.08). However, there was no significant difference in hospitalization duration (WMD: - 0.72 days; 95% CI: - 1.89-0.45), total complications (OR: 1.08; 95% CI: 0.70-1.66), wound infection or dehiscence (OR: 0.73; 95% CI: 0.27-1.99), testicular atrophy or hypotrophy (OR: 1.03; 95% CI: 0.38-2.78), and testicular re-ascent (OR: 1.43; 95% CI: 0.67-3.06) between the two approaches. A small proportion of cases (7.3%) required conversion from scrotal to inguinal orchiopexy due to specific anatomical challenges. CONCLUSION: Both scrotal and inguinal orchiopexy are safe and effective for palpable UDT, with comparable outcomes in terms of hospitalization and complications. Scrotal orchiopexy offers the advantage of shorter operative time. Clinicians can use this evidence to make informed decisions on the surgical approach for palpable UDT.
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Criptorquidismo , Infección de Heridas , Masculino , Humanos , Orquidopexia , Criptorquidismo/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , AtrofiaRESUMEN
BACKGROUND: Renal transplantation is the preferred treatment for end-stage renal disease because of its association with improved survival and quality of life. The debate over multiple renal arteries (MRA) vs a single renal artery regarding kidney function, posttransplant complications, and graft and patient survival remains ongoing. Our goal was to determine the 1-year graft survival rate among renal transplant recipients with MRA at Cipto Mangunkusumo Hospital in Jakarta. METHODS: A retrospective study was conducted between January 2012 and December 2020, including all kidney transplant candidates with MRA. Data on graft survival, patient demographics, previous renal transplantation, duration of hemodialysis, and delayed graft function were collected and analyzed using SPSS 24. Kaplan-Meier plots and Cox regression analyses were used to determine risk factors for 1-year survival. RESULTS: Among 752 renal transplant recipients, 104 cases had MRA. The majority were men (71.5%), and the median age of recipients was 47 years. One-year graft survival was observed in 96% of cases, whereas patient survival was 97.7%. No significant difference was found in graft survival based on the number of arteries (single renal artery vs MRA), length of hemodialysis, or previous renal transplantation. However, delayed graft function was significantly associated with graft survival. CONCLUSION: This study highlights that 1-year graft survival in renal transplant recipients with MRA is not significantly affected by the length of hemodialysis before surgery or previous renal transplantation.
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Enfermedades Renales , Trasplante de Riñón , Enfermedades Ureterales , Masculino , Humanos , Femenino , Persona de Mediana Edad , Trasplante de Riñón/efectos adversos , Estudios Retrospectivos , Arteria Renal/cirugía , Supervivencia de Injerto , Funcionamiento Retardado del Injerto/etiología , Indonesia , Calidad de Vida , Resultado del Tratamiento , Riñón/irrigación sanguínea , Enfermedades Renales/etiología , Enfermedades Ureterales/etiología , Receptores de Trasplantes , Tasa de SupervivenciaRESUMEN
The systematic review and meta-analysis were conducted for COVID-19 infections in kidney transplant patients. Recent research on this topic was still scarce and limited meta-analysis research discussion, specific to some risks or treatment in kidney transplantation patients with COVID-19 infection. Therefore, this article demonstrated the fundamental steps to conducting systematic review and meta-analysis studies to derive a pooled estimate of predictor factors of worse outcomes in kidney transplant patients with positive for the SARS-CoV- 2 testâ¢PICOT Framework to determine the research scopeâ¢PRISMA strategy for study selectionâ¢Forest Plot for meta-analysis study.
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A 14-months old female child was diagnosed with bilateral single system ectopic ureters opening into the urethra, with small bladder capacity, horseshoes kidneys, and bilateral hydronephrosis, presenting recurrent febrile UTI accompanied by continuous incontinence and elevated renal function. Early bilateral re-implantation of the ureters (modified Lich-Gregoir) was done in one setting, resulting jn no recurring febrile UTIs and continuous wetting, improving renal function parameter, competent bladder neck, and 10 folds increased in bladder capacity after 1-year follow up. We showed that earlier treatment enables patient to preserve both renal and bladder function without involving complex reconstructive surgery.
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INTRODUCTION: Ureteroceles are a congenital abnormality of the ureter that can cause significant complications. Endoscopic treatment is a commonly used treatment approach. The aim of this review is to assess the results of endoscopic treatment for ureteroceles with consideration to their location and system anatomy. METHODS: A meta-analysis was conducted by searching electronic databases for studies comparing outcomes of endoscopic treatment for ureteroceles. Newcastle-Ottawa Scale (NOS) was employed to evaluate the potential for bias. The primary outcome was the rate of secondary procedures required following endoscopic treatment. Secondary outcomes were inadequate drainage and post-operative vesicoureteral reflux (VUR) rates. A subgroup analysis was performed to investigate possible causes of heterogeneity in the primary outcome. The statistical analysis was conducted using Review Manager 5.4. RESULTS: There were 28 retrospective observational studies, published between 1993 and 2022, including 1044 patients with primary outcomes in this meta-analysis. The quantitative synthesis showed that ectopic and duplex system ureteroceles were significantly associated with higher rate of secondary operation compared to intravesical and single system ureteroceles, respectively (OR: 5.42, 95% CI: 3.93-7.47; and OR: 5.10, 95% CI: 3.31-7.87). The associations were still significant in subgroup analysis based on follow up duration, average age at surgery, and duplex system only. For secondary outcomes, incidence of inadequate drainage were significantly higher in ectopic (OR: 2,01, 95% CI: 1.18-3.43), but not in duplex system ureteroceles (OR: 1.94, 95% CI: 0,97-3.86). Post-operative VUR rates were higher in both ectopic (OR: 1.79, 95% CI: 1.29-2.47) and duplex system ureteroceles group (OR: 1.88, 95% CI: 1.15-3.08). CONCLUSION: Ectopic ureteroceles and duplex system ureteroceles were associated with worse outcomes following endoscopic treatment compared to intravesical and single system ureteroceles, respectively. It is recommended to carefully select patients, conduct pre-operative evaluations, and closely monitor patients with ectopic and duplex system ureteroceles.
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Uréter , Ureterocele , Reflujo Vesicoureteral , Humanos , Lactante , Ureterocele/cirugía , Ureterocele/complicaciones , Estudios Retrospectivos , Uréter/cirugía , Endoscopía , Reflujo Vesicoureteral/complicaciones , Estudios Observacionales como AsuntoRESUMEN
BACKGROUND: Donor-specific antibodies (DSAs) are recognized as an important factor of kidney allograft loss as a subsequent event of antibody-mediated rejection (AMR). The clinical relevance of de novo DSAs (dnDSAs) after kidney transplant, particularly in their ability to bind C1q, has been widely investigated to various extents among studies. A recent study was performed to examine the association between C1q-binding dnDSAs and succeeding clinical events after kidney transplant. METHODS: A meta-analysis of studies published before April 2021 was conducted from PubMed, Science Direct, and Cochrane databases. Publications on dnDSA after kidney transplant focusing on differentiation between C1q-binding and non-C1q-binding were included. The outcomes analyzed were AMR rate and allograft loss. Studies using preformed DSA were excluded. The pooled risk ratio and 95% confidence interval (CI) were analyzed using Mantzel-Haenzel method, and the I2 value was used to determine the heterogeneity of the studies. Data analysis was conducted using Review Manager 5.3. RESULTS: A total of 535 patients from 13 studies who developed dnDSA after kidney transplant were analyzed. Among these, 239 (44.7%) had C1q-binding and 296 (55.3%) had non-C1q-binding dnDSA. Acute AMR was found in 59.2% (97/164) of the C1q-binding group and in 28.8% (49/170) of the non-C1q-binding group (risk ratio [RR], 0.58 [95% CI, 0.39-0.85], P = .006, I2 = 58%). Chronic AMR was found in 50% (19/38) of the C1q-binding group and in 16.9% (11/65) of the non-C1q-binding group (RR, 0.39 [95% CI, 0.21-0.71], P = .002, I2 = 0%). Allograft loss was found in 62.2% (74/119) of the C1q-binding group and in 34.1% (60/176) of the non-C1q-binding group (RR, 0.57 [95% CI, 0.38-0.85], P = .006, I2 = 61%). CONCLUSIONS: This meta-analysis demonstrates that patients who developed C1q-binding dnDSA display an increased risk of AMR and allograft loss compared with those with non-C1q-binding dnDSA. Therefore, C1q-binding dnDSAs are associated with inferior outcomes after kidney transplant.
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INTRODUCTION: The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a massive impact on the health sector, especially in patients with pre-existing comorbidities. This study aims to define the predictor factors for worse outcomes in kidney transplant patients infected with SARS-CoV-2 and affected by coronavirus disease 2019 (COVID-19). We have analyzed in these patients their prior medical history, their clinical symptoms, and their laboratory results. METHOD: We assessed outcomes of kidney transplant patients with confirmed COVID-19 until July 2021 from PubMed, Medline, Science Direct, Cochrane databases, EMBASE, Scopus, and EBSCO. We performed meta-analyses of nine published studies to estimate predictor factors. The analysis was analyzed by the Newcastle-Ottawa Scale (NOS) and then using the Review Manager 5.4 software. RESULT: Our analysis demonstrated that the most significant risk factors for the worse COVID-19 outcomes for kidney transplant patients included: age of 60 and older [MD 9.31(95% CI, 6.31-12.30), p < 0.0001, I2 = 76%], diabetic nephropathy [OR 2.13 (95% CI, 1.49-3.04), p < 0.0001, I2 = 76%], dyspnea [OR 4.53, (95% CI, 2.22-9.22), p < 0.0001, I2 = 76%], acute kidney injury (AKI) [OR 4.53 (95% CI, 1.10-5.21), p = 0.03, I2 = 58%], and some laboratory markers. Many patients had two or multiple risk factors in combination. CONCLUSION: Age and several comorbidities were the most significant factors for COVID-19 outcomes for kidney transplant recipients.
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COVID-19 , Trasplante de Riñón , Humanos , SARS-CoV-2 , Pandemias , Receptores de TrasplantesRESUMEN
INTRODUCTION: Urinary tract infection (UTI) is more prevalent in boys with antenatal hydronephrosis (ANH). Circumcision is known to lessen the risk of UTI. This study was performed to examine the associations between circumcision and UTI among patients with ANH. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed for conducting this systematic review and meta-analysis. PubMed, ScienceDirect, EMBASE, and Cochrane Library databases were searched through August 4th, 2022 to identify eligible studies. The risk of bias was measured using the Newcastle-Ottawa Scale (NOS). Review manager 5.4 was used for all analysis. RESULTS: A total of 21 studies involving 8,968 patients with ANH were included in the meta-analysis. The incidences of UTI were 18.1% in the uncircumcised group and 4.9% in the circumcised group. From analysis, circumcision had significant protective effect against UTI with pooled OR of 0.28 (95% CI 0.23-0.32). The significant protective effects were also found in subgroup analysis of hydronephrosis etiology, including vesicoureteral reflux (pooled OR of 0.24; 95% CI 0.17-0.32), obstructive hydronephrosis (pooled OR of 0.34; 95% CI 0.21-0.53), and posterior urethral valve (pooled OR of 0.28; 95% CI 0.16-0.52). CONCLUSION: Our meta-analysis showed that circumcision was associated with a decreased incidence of UTI in children with ANH. This benefit was consistent irrespective of the underlying cause of hydronephrosis.
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Circuncisión Masculina , Hidronefrosis , Infecciones Urinarias , Masculino , Humanos , Niño , Femenino , Embarazo , Circuncisión Masculina/efectos adversos , Hidronefrosis/complicaciones , Hidronefrosis/epidemiología , Factores de Riesgo , Incidencia , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & controlRESUMEN
BACKGROUND: Hypospadias remains the most prevalent congenital abnormality in boys worldwide. However, the limited infrastructure and number of pediatric urologists capable of diagnosing and managing the condition hinder the management of hypospadias in Indonesia. The use of artificial intelligence and image recognition is thought to be beneficial in improving the management of hypospadias cases in Indonesia. OBJECTIVE: We aim to develop and validate a digital pattern recognition system and a mobile app based on an artificial neural network to determine various parameters of hypospadias. METHODS: Hypospadias and normal penis images from an age-matched database will be used to train the artificial neural network. Images of 3 aspects of the penis (ventral, dorsal, and lateral aspects, which include the glans, shaft, and scrotum) will be taken from each participant. The images will be labeled with the following hypospadias parameters: hypospadias status, meatal location, meatal shape, the quality of the urethral plate, glans diameter, and glans shape. The data will be uploaded to train the image recognition model. Intrarater and interrater analyses will be performed, using the test images provided to the algorithm. RESULTS: Our study is at the protocol development stage. A preliminary study regarding the system's development and feasibility will start in December 2022. The results of our study are expected to be available by the end of 2023. CONCLUSIONS: A digital pattern recognition system using an artificial neural network will be developed and designed to improve the diagnosis and management of patients with hypospadias, especially those residing in regions with limited infrastructure and health personnel. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42853.
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INTRODUCTION: Buried penis is a condition that causes the penis to appear entrapped in the subcutaneous fatty tissues. Its significant impact on quality of life affects children as well as adults. This study aims to determine the risk factors for short-term surgical complications and assess patient and surgeon satisfaction after buried penis reconstruction using complete degloving and excision of dartos tissue technique without penile anchoring suture. METHODS: A retrospective review was performed on all buried penis patients who underwent complete degloving and excision of dartos tissue by 3 different pediatric urologists at a single institution from July 2010-July 2020. The observation time point was taken from the last evaluation in the first 1 year postoperatively. Data were collected from questionnaires distributed to patients and surgeons. Patient demographics and perioperative data were extracted. Bivariate analyses were performed to identify the risk factors for short-term surgical complications. Patients' and surgeons' postoperative satisfaction was likewise assessed based on penis size, morphology, and voiding function. RESULTS: One hundred and thirty-three patients of median age 12 (2-35) years with median follow-up of 6 (1-12) months were included. The median penis length were 2 (1-3.5) cm before surgery with 3 (0.5-7) cm postoperative penile length enhancement. The postoperative penis size were reported as "satisfied" or "very satisfied" by 99% of involved surgeons and 92% of patients. The morphology were reported as "satisfied" or "very satisfied" by 99% of involved surgeons and 88% of patients. Voiding function were reported as "satisfied" or "very satisfied" by 100% of involved surgeons and 99% of patients. Prolonged edema (19.5%) was reported as the most frequent complication. Poor skin gliding occurred in 10.5% of patients. Subjective penis pain was reported in 6% of patients. Five (3.8%) patients who reported being unsatisfied with their penis size had postoperative penile length enhancement of 2 (0.5-2.5) cm (p = 0.04). Trapped penis, uncorrected penile curvature, and dissatisfaction with the morphology were reported by one patient each. The uncorrected penile curvature has a correlation with the preoperative penile curvature (p = 0.02). CONCLUSION: Buried penis reconstruction using complete dartos excision without penile anchoring suture is regarded safe and effective by both patients and surgeons. Prolonged edema is a reversible complication that can occur during early postoperative follow up (≤3 months) and obesity can be considered as one of the independent predictors for prolonged edema occurrence.
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Pene , Calidad de Vida , Adulto , Masculino , Humanos , Niño , Pene/cirugía , Estudios Retrospectivos , Encuestas y Cuestionarios , Factores de RiesgoRESUMEN
CASE: Vesicouterine fistula (VUF) is the rarest form of genitourinary fistulas. As lower-segment cesarean section becomes a more common mode of delivery, they have become the leading cause of VUF formation. We present four VUF patients with varied symptoms such as menouria, amenorrhea, with or without urinary incontinence. We diagnosed all of our cases through cystoscopy in conjunction with methylene blue dye test or hysteroscopy. OUTCOME: We successfully repaired VUF in three open surgery instances and one laparoscopic case. To diagnose VUF, cystoscopy and hysteroscopy are still the gold standard. An expert surgeon's open or laparoscopic repair is effective and safe. The patients no longer experienced incontinence, cyclical hematuria (menouria), discomfort, or sexual dysfunction. CONCLUSION: Cystoscopy and hysteroscopy remain the gold standard tool in diagnosing VUF. Open or laparoscopic repair performed by an experienced surgeon is an effective and safe technique with a successful outcome.
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Fístula , Laparoscopía , Fístula de la Vejiga Urinaria , Incontinencia Urinaria , Enfermedades Uterinas , Cesárea/efectos adversos , Femenino , Fístula/diagnóstico , Fístula/etiología , Fístula/cirugía , Humanos , Laparoscopía/efectos adversos , Embarazo , Fístula de la Vejiga Urinaria/diagnóstico , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Incontinencia Urinaria/cirugía , Enfermedades Uterinas/complicaciones , Enfermedades Uterinas/diagnóstico , Enfermedades Uterinas/cirugíaRESUMEN
OBJECTIVES: Kidney transplantation has become the chosen kidney replacement therapy for end stage chronic kidney disease. In Indonesia, no study about quality of life (QoL) in kidney transplantation recipient after surgery has been done. This study aims to determine whether there is a significant difference in the recipient's QoL before and after kidney transplantation surgery. METHODS AND MATERIALS: This was a prospective study using Kidney Disease QoL-Short Form (KDQoL-SF) questionnaire before and after surgery (first, third, and sixth month). Samples were consecutively taken from January 2016 until May 2016 and followed up to December 2016. KDQoL-SF has been validated in Indonesian language to assess recipient's QoL (Cronbach alfa >0,6). The data were analyzed using SPSS statistical software 21.0 version and repeated analysis of variance with posthoc comparison Bonferroni was used. RESULTS: There were 33 patients included in this study from January through December 2016. The average age was 44.6 ± 12.88 years old, and average body mass index was 23.8 ± 3.74 kg/m2. The most frequent comorbidity was hypertension (32, 97%). Compared to baseline, the QoL in recipients increased at the first, third, and sixth month after their operation. Major changes in the perceived QoL were noted only between the preoperative stage (median, 50%; interquartile range, [IQR]) ±20) and 1 month after operation (median, 90%; IQR, 0). CONCLUSIONS: This study showed that there were significant improvements in almost all aspect in recipient's QoL after kidney transplantation.
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Fallo Renal Crónico , Trasplante de Riñón , Adulto , Hospitales , Humanos , Indonesia , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Encuestas y CuestionariosRESUMEN
Pelvic-ureteric junction obstruction (PUJO) is a common condition, and one of the lead causes of hydronephrosis in children. Currently, the gold standard treatment of PUJO is open surgery using the Anderson-Hynes-modified dismembered pyeloplasty technique. However, with the advancement of medical technology, several minimal invasive approaches were developed, including endoscopic, laparoscopic, and robotic approach, from which the best choice of surgical technique was yet to be determined. Considering the advantages and disadvantages of these methods, the recommended option is to tailor the best surgical approach to each individual patient, and to the surgeons' preference and experience. Considering these recent advances, a new algorithm is proposed to choose the best minimal invasive modalities invasive treatment to treat PUJO.
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Spinal cord injury often results in neurogenic bladder condition and eventually lead to an end-stage renal disease requiring kidney transplantation. However, transplantation in abnormal bladder carries special considerations. We report a case of an adult male with end-stage chronic kidney disease and small bladder capacity after having spinal cord injury. The evaluation of videourodynamic showed reduced compliance and detrusor overactivity during filling phase. Kidney transplantation and vesicostomy was performed. Eighteen months follow-up after surgery showed that kidney function could be maintained. The prevention of increasing bladder pressure and UTI should be monitored to prevent the damage of the graft kidney.
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INTRODUCTION: Leydig cell tumors (LCT) are the most common hormone-secreting testicular tumors; it is a rare cause for precocious pseudo-puberty in boys. The tumors secrete high amounts of testosterone. We present two cases of LCT in prepubertal boys presenting with precocious puberty. CASE REPORTS: Case 1. A 6-year-old boy was referred from the pediatric department with a diagnosis of precocious puberty. The patient had reported enlarged and painless swelling of the left testicle from a year ago. The puberty status of the patient was A1P3G4. Ultrasonography examination had found left testicular mass. Elective radical orchiectomy of the left testicle was performed. Histopathological analysis confirmed the diagnosis of benign LCT. Case 2. A 6-year-old boy presented with an enlarged left testicle for the last three months. Features of puberty were noted on the patient (appearance of pubic and facial hair). The puberty status of the patient was A1P3G3. Left testicle US had found homogenous, hypoechoic mass with calcification. Bone age had found increased bone maturation. Increased androgen hormones were detected through a blood test. Radical orchiectomy of the left testicle was performed. The histopathological examination showed malignant LCT. CONCLUSION: Leydig cell tumors uncommonly occur in children. Prepubertal-aged boys presented with asymmetrical, firm, painless testicular enlargement with signs of puberty should be evaluated for LCT. Histopathological analysis is the mainstay of diagnosis and radical orchiectomy is the treatment of choice of LCT.
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INTRODUCTION: Clitoromegaly is an abnormality condition commonly related to congenital adrenal hyperplasia; it is rare due to idiopathic. Until now, there is no report about idiopathic clitoromegaly who reach adulthood and evaluation of their sexual life after reconstructive surgery. PRESENTATION OF CASE: We presented an adult female patient with chief complain of enlarged clitoris since birth. The phenotypic appearance of ambiguous external genitalia resembling severe hypospadias with scrotal bifid. Other female secondary sexual characteristics were normal. The karyotype test result was 46 XX. We did genitalia reconstruction with nerve-sparing clitoroplasty, oral mucosal graft vaginoplasty, and labioplasty. DISCUSSION: Many factors contribute to clitoromegaly which emerge transiently during the intrauterine period. Our case was unique due to clitoromegaly persistence until adulthood and can not be explained by any hypotheses. Adult females with clitoromegaly and urogenital sinus (UGS) bring a specific problem, especially to their sexual life. The reconstructive surgery should consider the phenotype of genital anatomy, preservation of clitoral neurovascular bundles, and adequate dimension of the vagina. Oral mucosal graft is an option as substitutive materials that can be used for vaginal augmentation. CONCLUSION: This is a case report of adult female idiopathic clitoromegaly patient. Scrutinized evaluation is needed to confirm the diagnosis. Many aspects should be considered to perform feminizing genitoplasty. The surgery did not reduce the sensitivity of clitoris and allow the patient to do sexual activity after marriage during a one-year follow up.
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INTRODUCTION: Wilms' tumour remains the most common renal tumour in children (6% of all pediatric malignancies) and present as one of the most challenging tasks for paediatric urologists as its management requires an advanced procedure. The ultimate goal in these cases is to preserve as much renal parenchyma as possible whilst still achieving complete tumour resection. PRESENTATION OF CASE: Here we present a six year follow up report of a bilateral Wilms' tumour case in a 19-months old boy. This patient underwent neoadjuvant chemotherapy regimen, followed by right partial nephrectomy and left radical nephrectomy. Adjuvant radiotherapy was performed following the surgery. Follow-up imaging 5 months afterward revealed a firmly heterogeneous cystic lesion consist of fat and calcification at the upper pole of the right kidney, none of which created any problem for the patient. MRI was later performed on the 19th month after the surgery, showing marked decrease in the size of the cyst. DISCUSSION: According to SIOP and NWTSG classification, the patient presented as stage V of the disease. The patient was on neoadjuvant chemotherapy (Regimen I) as recommended by NWTSG. This strategy was shown to be effective, as the tumour on the left kidney was reduced to less than 70% of the initial size. A routine follow-up using chest x-ray, abdominal ultrasonography (USG), and contrast studies such as MRI and MSCT scan, was performed in our reports. CONCLUSION: From our experience, the combination of neo-adjuvant chemotherapy, renal salvage surgery and adjuvant radiotherapy is a feasible, safe and effective option for bilateral Wilms' tumour cases.
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BACKGROUND: Chordee correction, urethroplasty, and tissue reconstruction are performed to correct and retain standard functionality of the penis in hypospadias. Conventional reconstruction techniques, such as onlay island flap and the dorsal inlay graft, can be performed based on the classification of hypospadias. However, the outcomes and complication rates have not been widely studied. Thus, we aimed to provide preliminary evidence regarding the efficacy and safety of both approaches in hypospadias reconstruction. PATIENTS AND METHODS: A prospective study with two time evaluations of 14 and 180 days post-operatively was performed at the Urology outpatient clinic from October 2014 to September 2019. A proportion comparison of success rate, time to the complication, operation time, catheterization duration, uroflowmetry parameter post-surgery, and mean scores comparison of PPPS were measured as the intended outcomes. RESULTS: In a total of 59 pediatric hypospadias, patients who had undergone reconstruction are included in this study. Higher subjects' age and severe chordee severity were more common in the dorsal inlay graft group (age=7.50 [1-26] months; severe chordee 45.8%) compared to the onlay island flap group (age=4.0 [1-67] months; severe chordee 31.4%), both groups showed similar satisfaction regarding meatal shape and position (P=0.618), glands shape (P=0.324), penile skin shape (P=0.489), and general cosmetic appearance (P=0.526). Complication occurrence and time to complication duration of both groups were also not statistically significant (P=0.464 and P=0.413). There are no significant differences in Qmax, Qmean, voided volume, and PVR of both groups (P=0.125, 0.136, 0.076, 0.260, respectively). Significant differences in operation times and catheterization duration are found in this study (P<0001). CONCLUSION: Outcome evaluation regarding functional, complication and patient satisfaction comparing onlay flap and dorsal inlay graft for hypospadias patients is scarce. This study found that both procedures can be considered safe with comparable incidence of complications.
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Ureteral triplication is among the rarest congenital disorder of the urinary tract. A review of the literature has shown that only about one hundred cases have been reported worldwide. The reports on bilateral ureteral triplication cases, however, are extremely scarce. A female infant was presented with a history of recurrent febrile UTI since birth. Computed tomography urography scan revealed bilateral ureteral triplication. Combination of contrast studies and endoscopic procedure were utilized to establish the diagnosis. Management for this anomaly varies from conservative to interventional surgery. This patient underwent laparoscopic left ureteroneocystostomy and ureteral tailoring.