Investigating ESWL success rate in the treatment of renal and ureteral stones in children.

OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) is one of the most important methods of treatment for stone in children. Therefore, this study was conducted to determine the success rate of ESWL in the treatment of kidney and ureteral stones in children referred to Hasheminejad kidney center during the second half of 2018. PATIENTS AND METHODS: This observational prospective study was conducted on 144 children referred to Hasheminejad kidney center during the 2018. The patients were selected using the convenience sampling method. The study was investigating the success rate of ESWL in the treatment of kidney and ureteral stones and effective factors in this regard. RESULTS: A total of 133 patients (92.4%) had stone passage and 37.5% of patients had residual stones, 28.5% of which were less than 5 mm in diameter. Successful results were seen in 131 cases (91%). Successful results were significantly higher in males (p = 0.011) and lower in simultaneous stones in the middle calyx and lower calyx (p = 0.0001). CONCLUSION: According to the results of this study, it can be inferred that ESWL success rate was above 90% in the treatment of kidney and ureteral stones in children in such a way that with an ESWL session in patients who have been properly selected for this procedure, a success rate of about 62.5% will be available to remove any residual fragments, and nearly 28.5% have residual fragments with a diameter of smaller than 5 mm, which is basically hopeful for a high urinary passage. The present study shows that type and stone location are the factors contributing to the successful ESWL and shows the female gender and the presence of stone in the lower and middle calyx are the risk factors for the lower ESWL success rate.

Laser Treatment for Urethral Hemangiomas: Report of Three Cases.

To present our experience with coagulation/laser treatment of urethral hemangiomas. Three cases with small to medium sized urethral hemangiomas in penile and posterior urethra presented with hematuria or urethral bloody discharge. All patients were male. They were treated with thermal or Holmium-YAG laser coagulation in the first session. Recurrence of hematuria/bloody discharge happened in two patients within one month from the first treatment that was managed with a second session of laser coagulation. No third session of intervention for hematuria/bloody discharge was required in any patient during 10-39 months of follow up. In cases of relapse after thermal or laser coagulation of small to medium sized urethral hemangiomas, after appropriate consultation with the patient, a second session of laser coagulation can be successful before contemplating more invasive measures like open surgery.

Impact of dialysis access fistula on cardiac function after kidney transplantation.

INTRODUCTION: The cardiovascular impact of a patent arteriovenous fistula (AVF) following kidney transplantation has not been clearly described. This study aimed to evaluate the natural history of AVFs in kidney transplant recipients and the effect of spontaneous AVF closure after kidney transplantation on cardiac status. MATERIALS AND METHODS: Data on vascular access for dialysis were collected from medical charts of kidney transplant recipients between July 2009 and November 2010 at a single center. Echocardiographic re-assessment of the AVF flow and cardiac status was done in selected patients with functioning and nonfunctioning AVFs. RESULTS: Of 180 kidney transplant recipients, 142 had AVFs before transplantation and 99 (69.7%) had a functioning fistula at the time of study after kidney transplantation. Twenty-three patients with a functioning AVF were compared with 17 with spontaneously closed AVFs. The left ventricular ejection fraction improved in both groups posttransplant. In the group with patent fistulas, there was a trend towards lower value of left ventricular end-systolic and end-diastolic diameters, but it did not reach statistical significance. The mean fistula flow was 560 ± 405 mL/min in this group. A significant reduction was observed in the interventricular septum and left ventricular posterior wall diameters in the group with closed AVFs. CONCLUSIONS: Spontaneous AVF closure did not offer a significant cardiac beneficial effect. There are insufficient data to promote systematic closure of AVF after successful kidney transplantation.

Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? A randomized controlled clinical trial.

PURPOSE: To compare outcomes in two groups of patients with kept and discarded nephrostomy tube after percutaneous nephrolithotomy (PCNL) complicated with bleeding. MATERIALS AND METHODS: Two hundred patients who had undergone PCNL complicated with hemorrhage were recruited in this study. Patients were randomly allocated to two groups: group A, who underwent tubeless PCNL and tract port was packed for 3 to 4 minutes after removing Amplatz sheath, and group B, for whom a 24-F nephrostomy tube was left in place at the end of the procedure. Patients were followed up for 3 months to check if bleeding occurred. RESULTS: The mean operation time was 68 ± 4.3 minutes in group A and 74 ± 5.6 minutes in group B (P = .098). The mean stone size was similar in groups A and B (36.26 ± 5.3 mm versus 35.35 ± 5.85 mm; P = .613). The mean hemoglobin drop was 3.65 ± 1.20 g/dL in group A and 3.13 ± 1.06 g/dL in group B. There was no significant difference between the mean of stone free rate in groups A and B (92.58% ± 5.97 versus 89.60% ± 8.3; P = .210). Patients in group A experienced a significantly less duration of hospitalization than group B (2.42 ± 0.84 days versus 3.70 ± 0.80 days; P < .001). CONCLUSION: In the absence of clear indication, nephrostomy tube insertion after PCNL does not seem to be beneficial, and its removal does not pose patients at any additional risk.