Is JJ Ureteral Stenting Inferior to Percutaneous Nephrostomy as a Drainage Method in Emphysematous Pyelonephritis?

INTRODUCTION: The aim of the study was to examine the efficacy of JJ stenting in comparison with percutaneous nephrostomy (PCN) as a drainage method in patients with emphysematous pyelonephritis (EPN). METHODS: We retrospectively identified patients with EPN between January 2000 and January 2021. Platelet-to-leukocytic ratio (PLR) at the time of hospital admission and discharge, time taken to clear air locules and to normalize leukocytic count, and air locule volume in mm3 were identified. Renal drainage by either PCN or JJ stent was required if symptoms persist for ≥3 days or in obstructed renal units. Failure of drainage method was defined as conversion to another method of drainage, need for intensive care unit admission, salvage nephrectomy, and mortality. RESULTS: Twenty-nine patients were managed by JJ stent. Treatment success was identified in 20 patients and 19 patients who were managed by PCN and JJ stent, respectively. Higher air locule volume ≥16.7 mm3 and lower PLR ≤18.4 increased the risk of drainage failure (p = 0.009 and 0.001, respectively). CONCLUSION: Ureteral JJ stenting is an effective method for EPN drainage with a comparable overall success to the PCN use. Higher air locule volume and lower PLR increased the risk of drainage failure.

Functional outcomes after pyeloplasty in solitary kidneys: structured analysis with the implication of Acute Kidney Injury Network (AKIN) staging criteria to predict long-term renal function recoverability.

OBJECTIVES: To assess the long-term functional outcomes after pyeloplasty in solitary kidney (SK) models and to define factors affecting postoperative renal function recoverability in adults. PATIENTS AND METHODS: We retrospectively evaluated all adult patients who underwent pyeloplasty for pelvi-ureteric junction obstruction (PUJO) in SK. Long-term renal function was assessed by diuretic scintigraphy and morphological changes were also determined, e.g. renal parenchymal volume (RPV) and parenchymal thickness (PT). We considered a >20% increase in glomerular filtration rate (GFR) as improvement, >20% decrease as deterioration, and changes within 20% as stationary renal function. Univariate and multivariate analysis for factors affecting renal function recoverability, including the Acute Kidney Injury Network (AKIN) Staging System postoperatively, were performed. RESULTS: The study included 62 patients with a mean (SD) age of 29 (10.5) years. At a median of 48 months, the mean (SD) GFR increased from 41.3 (17) to 48.5 (20.1) mL/min (P < 0.001), with a significant increase in RPV and PT (P = 0.02 and P = 0.001, respectively). Follow-up renal function was static, improved and decreased in 39 (63.4%), 17 (27%) and six (9.6%) patients, respectively. Functional success was achieved in 90.4%. Patient's age ≥39 years, PT ≤0.75 cm and higher early postoperative AKIN staging were predictors associated with a 4.8-, 3.2- and 2.7-fold deterioration in renal function. CONCLUSION: Pyeloplasty in SK preserved renal function in 90.4% of the present patients. Pyeloplasty in SK when associated with older age, decreased PT preoperatively, and early higher AKIN staging postoperatively was associated with poor renal function recoverability.

Report of two rare cases of adrenal incidentalomas with different origins: revisiting pathological and radiological findings with a short review of the literature.

BACKGROUND: Adrenal tumors can be detected incidentally in 4 to 8% of patients radiologically. Adenomas, pheochromocytomas, and adrenocortical carcinomas represent the most common tumors of the adrenal glands. Rare histopathological findings are uncommon. We aimed to report two rare primary adrenal tumors diagnosed initially as incidentalomas to identify clinical characteristics, management, and clinical outcomes after treatment. CASE PRESENTATION: The first case was a 52-year-old man presented with an incidentally discovered locally advanced primary adrenal angiosarcoma. The patient was managed surgically with no adjuvant therapy. The patient was followed up for 3 years without evidence of local recurrence. The second case was a 63-year-old woman, presented with an incidentally discovered primary diffuse B-cell lymphoma of the left adrenal gland. She was treated by adrenalectomy. Later on, adjuvant six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were given. After 6 months follow-up, the patient was alive and disease-free. CONCLUSION: The diagnosis of adrenal tumors increased nowadays because of the widespread use of imaging studies, though rare pathologies should be taken into consideration.

Long-term outcomes after pyeloplasty for pelvi-ureteric junction obstruction in adults associated with renal congenital anomalies: Age, sex and renal function matched analysis.

Objective: To assess the long-term outcomes after pyeloplasty for pelvi-ureteric junction obstruction (PUJO) associated with renal anomalies. Patients and methods: Data were collected for patients after pyeloplasty for PUJO associated with renal anomalies and analysed retrospectively. Long-term functional success was evaluated by comparing the renographic split renal function (SRF) and glomerular filtration rate (GFR) at last follow-up with baseline values. A change of 5% in SRF was considered significant. Factors affecting functional outcome were assessed. The outcomes were compared to an age, sex and renal function matched group with PUJO in otherwise normal kidneys (Group 2) to evaluate the pattern of difference in functional recoverability in both groups. This was assessed using repeated-measures analysis of variance. Results: The study initially included 70 adult patients, with a mean age of 31.8 years. At a median of 44 months, 55 patients completed follow-up (Group 1) and no statistically significant changes in GFR (P = 0.7) and SRF (P = 0.06) were found. In all, 17, four and 34 patients showed a decrease, increase and static SRF (functional success rate was 69%). Higher preoperative SRF (P = 0.02) and Anderson-Hynes (A-H) pyeloplasty (P = 0.003) were associated with functional preservation. In the comparison with the other matched group (Group 2), the patients in Group 2 had better functional recoverability after pyeloplasty than patients with associated anomalies [GFR (P = 0.001), SRF (P = 0.002) and functional success (P = 0.001)]. Conclusion: Functional preservation after pyeloplasty in associated renal anomalies could be achieved in 69% of patients, which was significantly lower than those with otherwise normal kidneys. A-H pyeloplasty and higher preoperative SRF were associated with better functional outcomes. Abbreviations: A-H: Anderson-Hynes; HSK: horseshoe kidneys; OR: odds ratio; PUJO: PUJ obstruction; SRF: split renal function; T1/2, half-time.

Spontaneous renal hemorrhage: critical analysis of different lines of management in non-traumatic patients: a single tertiary center experience.

PURPOSE: To assess clinical presentation and outcomes of different treatment strategies in cases of spontaneous renal hemorrhage (SRH). METHODS: A retrospective analysis of patients with SRH between 2000 and 2018 was performed. Patients' demographics, clinical presentation, laboratory and radiological investigations, and different lines of treatment were retrieved. The primary outcome was to assess the predictors of the success of conservative treatment. The secondary outcome was to assess the long-term renal function outcome comparing serum creatinine, e GFF, and CT-assessed renal volume at last follow-up with baseline values. RESULTS: The study included 42 (23 males and 19 women) patients with mean ± SD age was 48.1 ± 17.8 years. Conservative management was successful in 19 (46%) patients. Trans-arterial embolization (TAE) was performed in 13 patients (30%) to control active bleeding. Ten patients (25%) required surgical exploration and nephrectomy. Lower serum creatinine (P = 0.003), higher prothrombin concentration (P = 0.04), lower hematoma size (P = 0.02), and non-AML lesions (P = 0.03) were independent predictors of conservative management success. Unlike the TAE-treated group, serum creatinine increased significantly (P = 0.04) with a significant decrease in e-GFR (P = 0.02) and renal volume (P < 0.001) of affected kidneys at last follow-up after conservative treatment. CONCLUSION: Although SRH is a life-threatening condition, conservative treatment is successful in a certain subset of patients. However, it is associated with significant deterioration of the affected kidney function as well as renal volume.

Validation of the Arabic linguistic version of the Overactive Bladder Symptoms Score questionnaire.

Objective: To validate an Arabic version of the Overactive Bladder Symptom Score (OABSS) questionnaire. Patients and methods: In all, 301 patients were evaluated using the Arabic-translated OABSS. They were divided into four groups: 112 patients with OAB symptoms, 115 healthy individuals with no OAB symptoms, 38 with bladder outlet obstruction (BOO) associated with storage lower urinary tract symptoms (LUTS), and 36 with BOO without storage LUTS. The reliability of the Arabic version was evaluated for internal consistency using Cronbach's α test. Interdomain associations were examined using Spearman's correlation coefficient (r). The discrimination validity was evaluated using the Mann-Whitney test. Results: Higher internal consistency was found for all OABSS domains in the OAB and BOO groups. There were strong correlations between all domains in the OAB group (P < 0.001). Similarly, there were strong correlations between all domains in the BOO group. For discrimination validity, scores were statistically significant higher for all OABSS domains and overall total scores in the OAB and BOO groups compared with their control groups (P < 0.001). Conclusion: The Arabic version of OABSS is a reliable and valid instrument that can be used to evaluate symptoms and health-related quality of life in Arabic patients with OAB. Clinical trial no. (clinicaltrials.gov NCT03533062) Abbreviations : BOO: bladder outlet obstruction; OAB: overactive bladder; OABSS: Overactive Bladder Symptom Score questionnaire; (U)UI: (urgency) urinary incontinence.

Assessment of Anticholinergic Use After Fading of BTX-A Effects in Refractory Idiopathic Overactive Bladder: A Prospective Blinded Randomized Trial.

PURPOSE: To evaluate the efficacy and safety of re-treatment with anticholinergics on refractory idiopathic overactive bladder (OAB) previously treated with intravesical botulinum neurotoxin type A (BTX-A) injections. METHODS: One hundred patients were initially managed by intravesical injections of 100 IU of BTX-A. After the effects of BTX-A faded, patients were randomized into 2 groups: group A patients received solifenacin (10 mg) for 12 weeks (study group), while group B patients received placebo treatment for 12 weeks (control group), then subsequently received solifenacin (10 mg) for another 6 weeks. All patients underwent preoperative urodynamic testing. Patients were asked to complete the validated overactive bladder symptoms score (OABSS) and incontinence quality of life (I-QoL) instruments after the effects of intravesical BTX-A faded and at 12 weeks of follow-up. Univariate and multivariate analyses of the factors affecting treatment response were conducted. RESULTS: At 12 weeks of follow-up, in group A, all OABSS items, including the total score, had improved significantly (P<0.0001). Group A had lower frequency and amplitude of detrusor overactivity and detrusor leak point pressure (P<0.0001, P=0.03, and P=0.01, respectively). Cystometric capacity also increased significantly (P=0.007), as did all I-QoL parameters. In a comparison of patients with failed treatment and patients with successful treatment, female sex, repeated intravesical BTX-A injections, and increased bladder capacity were statistically significant (P=0.001, P=0.0001, and P=0.002, respectively). Repeated intravesical BTX-A injections and increased bladder capacity were independent factors predicting treatment success. CONCLUSION: In patients with refractory idiopathic OAB, reuse of anticholinergics could be an effective treatment option in patients after the effects of BTX-A fade. Repeated intravesical BTX-A injections and increased cystometric capacity could affect treatment response.

Long Term Functional Success After Pyeloplasty for Pelvi-Ureteral Junction Obstruction in Unilateral Poorly Functioning Kidney in Exclusively Adults Population.

OBJECTIVES: To assess long-term clinical and functional outcomes postpyeloplasty in unilateral UPJO in poorly functioning kidneys in exclusive adult population. MATERIALS AND METHODS: We reviewed the database of all cases admitted with unilateral UPJO treated with pyeloplasty and preoperative split renal function (SRF) was <30% (by diuretic MAG-3 renography). We further subdivided patients into 2 groups; group (A) SRF ≤20% and group (B) SRF >20% and <30%. Renal function difference was evaluated by the changes in SRF at last follow-up, where 5% change was considered significant. Functional success was defined as absence of obstructive pattern on diuretic renogram with no decline in renal function. Clinical success is defined as no need of secondary intervention (redo pyeloplasty, nephrectomy, stenting, or endopyelotomy). RESULTS: Among 211 patients. The mean SRF was 20.5 ± 6.6%. After a median follow-up of 67.1 ± 11.8 months, SRF increased significantly to 23.5 ± 7.5 (P<.0001). In group (A) 92 patients, SRF increased from 14.3 ± 4.9 to 18.7 ± 7.1 (P <.0001). Functional success was achieved in 88 (95.6%) patients. Whereas, in group (B), SRF increased from 24.9 ± 3.3 to 27.2 ± 6.3 (P <.0001) at last follow-up. Functional success was achieved in 121 (95%) patients. Static SRF in serial follow-up renography had been observed after 12 months of follow-up. CONCLUSION: Pyeloplasty provides high rates of functional success in poorly functioning kidneys. After 12 months follow-up, SRF seems to be static without deterioration.

Could platelet to leucocytic count ratio (PLR) predict sepsis and clinical outcomes in patients with emphysematous pyelonephritis?

OBJECTIVES: To study risk factors for sepsis and mortality evaluating the role of platelet to leucocytic count ratio (PLR) as a marker for urosepsis and clinical outcomes in cases of emphysematous pyelonephritis (EPN). MATERIALS: Patients with EPN were retrospectively reviewed. Patients' age, sex, diabetes mellitus (DM), Body Mass Index (BMI), hydronephrosis, types of EPN, air locules volume, serum creatinine, leucocytic count, and platelet count, PLR, albumin, INR and the line of treatment were analyzed as risk factors of sepsis. Correlation between PLR and other variables was done using Pearson correlation coefficient. Univariate and multivariate analyses for sepsis and mortality were performed. RESULTS: Of fifty four patients, 38 patients had SIRS ≥2 criteria on admission. Twenty patients developed sepsis requiring ICU admission. In univariate analysis, male gender, lower BMI, higher INR, higher WBCs count and lower PLR were associated with sepsis (P = 0.0001, 0.009, 0.04, 0.003 and 0.001, respectively). In multivariate analysis, PLR ≤18.4, male sex and BMI ≤24.2 were independent risk factors. Lower PLR directly correlated with serum albumin (P = 0.01) and inversely correlated with serum creatinine and random blood glucose level and Klebsiella infection (P = 0.001, 0.007 and 0.005, respectively). Also, it was correlated with a higher total score of qSOFA and SOFA (P = 0.02 and 0.04). Lower PLR was independent risk factors for death in EPN patients with (P = 0.003). CONCLUSION: EPN is associated with sepsis development. Lower PLR is an independent simple predictor for sepsis and mortality in patients with EPN.