The prophylactic omentectomy procedure in reducing the complication rate of continuous ambulatory peritoneal dialysis in pediatric: A systematic review and meta-analysis.

INTRODUCTION: The role of the omentectomy procedure on Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement in pediatric patients has been differently evaluated in the literature, with some studies showing improvement while others showing no difference. Our study aims to define the advantages of omentectomy compared to a procedure without omentectomy. METHODS: The literature searching in online databases (PubMed/MEDLINE, Cochrane Library, EMBASE, Scopus, and ClinicalTrial.gov) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, has been registered on PROSPERO (CRD42023412846). The protocol was performed through April 2023 and focused on pediatric patients treated with an omentectomy procedure and related complications. The risk of bias in each study was assessed using the risk of bias for the non-randomized control trials (ROBINS-I). The effect estimates were extracted as risk ratios with 95% confidence intervals (CI). The heterogeneity of the studies was considered as high heterogeneity if I2 values above 50% or p < 0.05. RESULTS: In the total of 676 articles identified in the database searching for screening, nine studies with 775 patients met the criteria for inclusion. The omentectomy procedure significantly showed a lower incidence of catheter obstruction compared to the control group, (OR 0.24 [95% CI, 0.12-0.49], p < 0.0001, I2 = 0%). Moreover, omentectomy demonstrated a similar trend in the rate of removal or reinsertion of the catheter with high heterogeneity, OR 0.25 [95% CI, 0.12-0.51), p = 0.0002, I2 = 70%). CONCLUSIONS: The omentectomy procedure showed a lower incidence of catheter obstruction and complications leading to removal or reinsertion of the catheter.

Immunologic response and seroconversion following third-dose COVID-19 vaccination in solid organ transplant recipients: A meta-analysis.

INTRODUCTION: The immunogenicity and efficacy of COVID-19 vaccination varied by demographic, including solid organ transplant recipients on immunosuppressive therapy. AIM: This purpose of this study is to assess seropositivity and seroconversion in solid-organ transplant recipients before and after third-dose COVID-19 vaccination. METHODS: This study is a systematic review and meta-analysis performed using PRISMA guidelines. To analyze clinical and cohort studies reporting immunologic response and seroconversion third-dose vaccination, a systematic search was performed using electronic databases (PubMed, Scopus, Cochrane, Directory of Open Access Journal (DOAJ), and Clinicaltrials.gov). RESULT: There were 18 full-text papers that could be analyzed qualitatively and quantitatively. After the third vaccination, the pooled rate seropositivity was 67.00% (95% CI 59.511; 74.047, I2 = 93.82%), and the pooled rate seroconversion was 52.51% (95% CI 44.03; 60.91, I2 = 92.15%). The pooled rate of seroconversion after the mRNA-based booster was 52.380% (95% CI 40.988; 63.649, I2 = 94.35%), and after the viral-vector-based booster was 42.478% (95% CI 35.222; 49.900, I2 = 0.00%). CONCLUSION: Based on the analysis of immunologic responses and seroconversion findings, the third-dose vaccination of solid organ transplant recipients is an effective method in establishing better immunity against COVID-19.

Method for determining predictor factor for worse outcomes in kidney transplant recipients infected with coronavirus disease 2019 in a systematic review and meta-analysis research.

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 test•PICOT Framework to determine the research scope•PRISMA strategy for study selection•Forest Plot for meta-analysis study.

Vagino-peritoneal fistula in pediatric patient with continuous ambulatory peritoneal dialysis and lupus nephropathy: An unusual case report.

INTRODUCTION AND IMPORTANCE: Continuous Ambulatory Peritoneal Dialysis (CAPD) is one of the major renal replacement therapies that is widely used, especially in children. Although CAPD patients do not need to visit the hospital on a regular basis, it is frequently followed by complications such as peritonitis, hernia, pain, and, rarely, vagino-peritoneal fistula. CASE PRESENTATION: A 13-year-old female was diagnosed with end-stage renal disease due to lupus nephritis and treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) for three months. She underwent a laparoscopic diagnostic procedure and removal of CAPD after being diagnosed with vagino-peritoneal fistula with signs of recurrent peritonitis. During this time, patient has no symptoms regarding the SLE condition. CLINICAL DISCUSSION: Vagino-peritoneal fistula is one of the complications in CAPD patients that cause a decrease in patient's quality of life. The vaginal discharge might be an alarm sign for the possibility of a vagino-peritoneal fistula. The aggravation of inflammation due to the SLE condition may facilitate the perforation. Vagino-peritoneal fistula should be treated as soon as possible to prevent peritonitis. CONCLUSION: A rare finding of vagino-peritoneal fistula as a result of peritonitis due to CAPD could be aggravated by severe inflammation in SLE patients.

Purple urine bag syndrome in neurological deficit patient: A case report.

INTRODUCTION AND IMPORTANCE: Purple urine bag syndrome (PUBS), described first in 1978, is a rare phenomenon with purplish discolorations in the urine collecting bag. This report aims to provide a general overview of PUBS, its pathogenesis, and the recommended treatments. CASE PRESENTATION: A woman patient, 27 years old, with prior history of congenital rubella infection complained of urinary retention. The patient routinely had foley catheterization due to neurogenic bladder accompanied by paraparesis inferior for 1.5 years. She also suffered bilateral lower extremities edema with infected wounds for two weeks, which showed a purple urine color in the urine bag. The laboratory examination demonstrated iron deficiency anemia, hypokalemia, and blood alkalosis. CLINICAL DISCUSSION: The cause of purplish discolorations of PUBS is the mixing of indigo, blue pigment, and indirubin, red pigment, which are results of dietary digestion, hepatic enzymes, and bacterial urine oxidation. The main risk factors are female patients, constipation, older age, recurrent UTI, renal failure, and urinary catheterization, dominantly on chronic treatment with polyvinyl chloride (PVC) urinary catheter or bag. CONCLUSION: The management should be promptly, rigorously, and appropriately because the complicated UTI has a high-risk progression of urosepsis.

Association Between De Novo C1q-Binding Donor-Specific Anti-HLA Antibodies and Clinical Outcomes After Kidney Transplantation: A Meta-Analysis.

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.

Predictor factor for worse outcomes in kidney transplant recipients infected with coronavirus disease 2019: A systematic review and meta-analysis.

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.

Spontaneous renal cyst rupture in a female patient: A case report.

INTRODUCTION AND IMPORTANCE: Spontaneous renal cyst rupture is a rare disease process. Renal masses are heterogeneous tumors that can be benign masses to cancers. This case report aims to provide a brief overview of the renal cyst, clinical symptoms, and management considerations for similar cases. CASE PRESENTATION: A previously healthy 30-year-old complained of left back pain a few days ago. There were no abnormalities in the physical and laboratory examination, so CT Scan Abdomen with contrast was performed. It was found that there was a 7.4 cm × 7.0 cm × 7.0 cm cyst. The patients undergo conservative management. Three months later, the patient suddenly fell with severe left back pain. Due to suspicion of spontaneous rupture of the renal cyst, the patient underwent exploration and bleeding control. CLINICAL DISCUSSION: The advice to wear an abdominal corset is mandatory to protect against the renal cyst. Atraumatic renal hemorrhage has been associated with a classic Lenk's triad (hypovolemic shock, flank mass, and severe flank pain). The definitive management of renal cyst rupture is initiated by resuscitation, followed by an angiographic embolization or surgical management. CONCLUSION: The conservative management should be accompanied by advice to use an abdominal corset to protect the left flank from unintentional pressure.

Instillation of Povidone-Iodine as A Management of Chyluria: A Case Report.

Background: Chyluria is usually associated with parasitic disease caused by Wuchereria bancrofti and is rare in non-endemic regions. The management of chyluria varies according to the severity of the condition. This report describes a case of mild chyluria and successful treatment using sclerotherapy. Case description: A 44-year-old man presented with a first episode of painless milky urine. The diagnosis of chyluria was established following retrograde pyelography showing a fistula between the right pelviocalyces and the retroperitoneal lymphatic systems. The patient had not travelled to any endemic regions. Sclerotherapy using povidone-iodine was carried out resulting in closure of the fistula. Conclusion: Sclerotherapy using povidone-iodine as the sclerosing agent was effective and safe for the management of a patient with mild chyluria. However, the best treatment for chyluria should be tailored to the patient's condition. LEARNING POINTS: Treatment of chyluria with instillation of povidone-iodine as a sclerosing agent provides an excellent outcome.The treatment of chyluria is should be tailored to disease severity.

Parameatal glans cyst: A case report.

Parameatal glans cyst is unusual and only a few cases reported until currently. We presented a four-year-old boy with dysuria and inappropriate appearance of parameatal glans cyst. The cystic mass was slow-growing and was present since birth. Complete surgical excision was performed to prevent recurrencies and to achieve good cosmesis.

A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis.

BACKGROUND: Erectile dysfunction (ED) is one of the sexual dysfunctions that are often encountered as a complication of male patients with stage 5 chronic kidney disease (stage 5 CKD). ED can be caused by psychological factors in patients with regular dialysis therapy. Currently, Hemodialysis (HD) therapy is the first choice in dialysis therapy and only 2% of stage 5 CKD patients are using Continuous Ambulatory Peritoneal Dialysis (CAPD) as a dialysis therapy. ED in stage 5 CKD patients should become a part of the treatment of patients with dialysis, which hopefully will improve the quality of life of patients. This study aims to compare the improvement in ED degree in patients with HD and CAPD. METHOD: This study is an observational analytic comparative study involving 44 male patients with stage 5 CKD; 22 of whom underwent HD and the remaining 22 patients underwent CAPD. The differences evaluated were changes in the ED degree before and after dialysis, which were assessed using the International Index of Erectile Function-5 (IIEF-5). RESULT: There were significant differences in the improvement in ED degree and IIEF-5 scores in CAPD group. In the HD group, no significant difference was obtained in the improvement in ED degree and IIEF-5 score. A significant difference was obtained in the improvement in ED degree between the HD and CAPD groups by comparing the improvement in IIEF-5 score. CONCLUSION: Patients with CAPD have a better improvement in ED degree than patients with HD. Duarsa GWK, Kandarini Y, Winarta GK, et al. A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis. J Sex Med Rev 2021;18:920-925.

Sexual Dysfunction Reduction in Female Patients with Chronic Kidney Disease Undergoing Continuous Ambulatory Peritoneal Dialysis.

BACKGROUND: chronic kidney disease (CKD) is a major worldwide health problem. One key treatment for end-stage CKD patients is dialysis therapy such as Continuous Ambulatory Peritoneal Dialysis (CAPD). This study aimed to find out the differences in the incidence of sexual dysfunction in women with CKD by CAPD. METHODS: this study was a multicenter observational analytic study design in female samples before CAPD and after CAPD. It was conducted between November 2018 - January 2019 with 26 female respondents. They were assessed using the Female Sexual Function Index (FSFI) questionnaire at pre-CAPD and post-CAPD. RESULTS: the results of the FSFI score before CAPD were 32.77 (SD 19.72) and after CAPD was 48.88 (SD 20.29). Analysis of differences in FSFI scores before and after CAPD demonstrates that there was a significant difference (p = 0.003). CONCLUSION: women with CKD who underwent CAPD, had an increase in FSFI scores compared to before CAPD. Thus, the use of CAPD can be seen to reduce sexual dysfunction and therefore improve the quality of life of women with CKD.

Risk factors for urethrocutaneous fistula following hypospadias repair surgery in Indonesia.

INTRODUCTION: Hypospadias is one of the most common congenital malformations with a worldwide increasing trend over the years. Despite advancements in hypospadias repair, complications still occur. One of the most common complications of hypospadias repair surgery is Urethrocutaneous fistula. Studies attempting to analyze the association between the complication and risk factors are always beneficial, especially for studies performed in different areas of the world. We hypothesize that several evaluated risk factors among Indonesian hypospadias patients could be associated with the occurrence of urethrocutaneous fistula after the repair procedure. OBJECTIVE: To determine the risk factors associated with urethrocutaneous fistula after hypospadias repair surgery by collecting and analyzing data obtained from multiple centers in Indonesia. MATERIALS AND METHODS: A nationwide, retrospective study with 12 hospitals in Indonesia of children with a diagnosis of hypospadias was conducted. The collected data, taken from patients admitted in 2018, from each center's medical records consisted of patient identity, repair technique used, neourethra length, percutaneous cystostomy, and splint size as independent variables speculated to be possible risk factors correlated to the presence of urethrocutaneous fistulae. Binomial logistic regression analysis was performed using SPSS 21.0 to determine the relationship between urethrocutaneous fistulae as a post-repair complication and possible risk factors. RESULTS: We collected 591 hypospadias cases from 12 centers in 9 cities in Indonesia. Most patients came when they were already at the age of more than four years old (60.4%). The chordee-only and failed urethroplasty groups are excluded from the analysis as they are not classified as true hypospadias. Most repairs were performed by using the Tubular Incised Plate (TIP) with Thiersch-Duplay technique (44.16%). Most of the reconstructed neourethra are 2-3 cm in length (32.13%). The 8 Fr urethral splint (46.41%) was mostly used during the operation. Most surgeons decided not to perform cystostomy throughout the procedure (61.03%) based on personal preferences. Urethrocutaneous fistula was found in 80 patients (15.27%) out of the total patients who underwent the surgery. The binomial logistic regression analysis shows that age (OR = 1.398, p = 0.015), the decision to not perform cystostomy (OR = 2.963, p = 0.014), and splint size (OR = 1.243, p = 0.023) are significantly associated (p < 0.05) with the development of urethrocutaneous fistula. CONCLUSION: Age and splint size are significant risk factors for urethrocutaneous fistula after hypospadias repair in Indonesia, whereas performing percutaneous cystostomy during the repair decreases the risk for urethrocutaneous fistula occurrence.

Risk Factors for Prostate Volume Progression After Prostate-Transurethral Resection.

BACKGROUND: Many factors could contribute to the cases of residual benign prostate hypertrophy (BPH) volume after transurethral resection of the prostate (TURP), such as age, obesity, testosterone level, and inflammation. The goal of this study was to determine the risk of tumor necrosis factor-α (TNF-α), transforming growth factor-ß (TGF-ß) in prostate tissue, serum prostate-specific antigen (PSA), serum testosterone, and age in promoting prostate volume progression after TURP. PATIENTS AND METHODS: This was a prospective cohort study on 83 BPH patients who underwent TURP at five hospitals in Bali, Indonesia. Trans-rectal ultrasonography (TRUS) was carried out to examine the prostate's size. Three years after, we redo the TRUS examination to collect the data of the latest prostate size. TNF-α, TGF-ß, serum PSA, testosterone, and age were registered for analysis. We used Pearson's and Spearman's correlation tests and multivariate analytic linear regression test (coefficient ß) by SPSS 13.0 software. RESULTS: Age, testosterone, PSA, TNF-α, TGF-ß were positively correlated to prostate's volume progression. The prostate volume was strongly correlated with age (r= 0.749, p <0.001), PSA level (r=0.896, p <0.001), testosterone level (r=0.818, p <0.001), and TGF-ß (r=0.609, p <0.001). The TNF-α level has a weak correlation to prostate's volume progression (r=0.392, p <0.001). CONCLUSION: TNF-α, TGF-ß, PSA, testosterone, and age were significant as the risk factors in promoting the prostate volume progression after TURP.

Common Practice of Hypospadias Management by Pediatric Urologists in Indonesia: A Multi-center Descriptive Study from Referral Hospitals.

BACKGROUND: Hypospadias is the second most common congenital anomalies among human congenital disabilities. There are over 300 surgery techniques being introduced to treat hypospadias. The successful of hypospadias repair is assessed by several outcomes as well as complications following surgery. AIM: This study aims to show the multicenter hypospadias data in Indonesia descriptively. METHODS: All the data were compiled based on questionnaires, which were distributed to Indonesian pediatric urologists. The questionnaire includes several questions containing demographic aspect, preferred techniques being used, and complications being found regarding hypospadias repair. RESULTS: Eighteen Indonesian pediatric urologists from 12 centres involved in this study. The data were collected from June - September 2018 based on the surgeon's experience throughout 2017. From 591 cases based on the returned questionnaire, penile-type hypospadias was the most common type of hypospadias being treated (35.7%) followed by penoscrotal (28.9%) and scrotal-type (12.9%). Moderate severity of chordee was mostly seen among all cases (40.6%). Tubularised incised plate (TIP), + Thiersch Duplay, was the most common technique being used to treat hypospadias (44.3%), followed by onlay island preputial flap (14.9%) and two-stage technique (14%). The incidence of urethrocutaneous fistulae in this study was 13.9%. CONCLUSION: This study showed how Indonesian pediatric urologists dealt with hypospadias cases. TIP + Thiersch Duplay procedure being the preferred technique used by most participants and the rate of urethrocutaneous fistulae as one of the complications was comparable with previous studies.

Association between Early Resistive Index Measurement and Early Graft Function and Long-Term Graft Survival after Kidney Transplantation: an Evidence-based Clinical Review.

BACKGROUND: resistive index (RI) is highly utilised to assess the graft function using Doppler ultrasonography. The RI has been shown as the best ultrasound parameter to assess kidney allograft dysfunction. Several studies have established the role of the RI as a predictor of transplant failure. However, these studies were using RI measurement in the later stages post transplantation. The present study has conducted to identify the association between early RI measurement and early graft function represented as delayed graft function (DGF) and immediate graft function (IGF), as well as long-term graft survival. METHODS: an evidence-based clinical review of studies published before May 2018 was conducted from Medline, Science Direct, EMBASE and Cochrane databases. Studies on early measurement of RI whereby the primary or secondary goals of the study related to graft function and/or graft survival were included. Studies using late RI measurement and without RI value groups were excluded. The Mantzel-Haenzel method was used to analyse pooled risk ratio and 95% confidence interval, while the heterogeneity of the study was calculated through I2 value. Data analysis was performed using Review Manager 5.3. RESULTS: nine studies with a total of 1802 patients who had undergone a kidney transplant were analysed. DGF was found in 19% (193/1015) of the low RI group and in 42.8% (337/787) of the high RI group (RR 2.04 (95% CI 1.72 - 2.41), p < 0.00001, I2 = 28%). IGF was found in 39.5% (62/157) of the low RI group and in 10.5% (28/268) of the high RI group (RR 0.26 (95% CI 0.17 - 0.40), p < 0.00001, I2 = 0%). Long-term graft survival, with follow up between 60-144 months, was found in 83% (701/845) of the low RI group and in 69.4% (395/569) of the high RI group (RR 0.82 (95% CI 0.72 - 0.93), p = 0.002, I2 = 63%). CONCLUSION: the results of this study emphasise the association between early measurement of RI and early graft function, and long-term graft survival. An elevated RI provides the chance of recognizing the patients with poor long-term prognosis, from the first moment after kidney transplant.

Urethral cavernous hemangioma in female: Surgical resection and reconstruction with ventral vaginal graft urethroplasty.

Urinary hemangiomas are uncommon and can predispose any part of the urinary system. The urethra is infrequently involved and usually affected male urethra. We reported a sixty-three-year-old female patient with intermittent urethral bleeding due to tumor arising at the edge of the urethra. Urethrocystoscopy was done prior to surgical resection and ventral vaginal graft urethroplasty was performed directly afterwards. Histopathological reported a urethral cavernous hemangioma. An individualized approach regarding the most appropriate procedure for a given patient should be recommended.

Epidermoid cyst on frenulum of the penis: A case report.

Epidermoid cyst in the penis is uncommon and only a small number of cases have been reported. We presented a thirty-two-year-old male patient with a case of slow growing, mobilized, non-tender frenulum of the penis mass that developed in 10 years period. Surgery treatment was taken under local anesthesia. Pathological examination was revealed as epidermoid cyst. Care must be given during examination of these lesions to rule out another entity. If there is any indication, complete excision is the best treatment as another treatment may lead to the risk of recurrence.

Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy: A comprehensive review.

Percutaneous nephrolithotomy (PCNL) using a nephrostomy tube as a drainage has been considered the standard procedure. However, recently many literatures have reported the use of tubeless and totally tubeless drainage following PCNL with excellent results. A literature search was conducted using MEDLINE databases to review each drainage technique following PCNL (tubeless, totally tubeless, or nephrostomy tube) and also to assess the most recent evidence that compare the safety of these drainage procedures with a clear-cut clinical parameter imposed. Tubeless or totally tubeless PCNL is significantly superior to standard PCNL in terms of length of hospital stay, postoperative pain (visual analog scale) score, demands or dosage of analgesics required, as well as faster return to activity for the patients. However, despite the many advantages of tubeless or totally tubeless PCNL over standard PCNL, there are a number of situations requiring the consideration of nephrostomy tube placement. Nonetheless, decision to use or not to use nephrostomy tube after PCNL depends on the surgeon's experience and clinical judgment.

Fibrous Pseudotumor of the Tunica Vaginalis Associated With Hydrocele and Testicular Atrophy.

Fibrous pseudotumors of the testicular tunics and paratesticular tissue are uncommon lesions. They typically arise as painless scrotal masses that may be associated with hydrocele or history of surgery, trauma, or infection. Although benign, these lesions often clinically indicate malignancy and usually remain undiagnosed preoperatively. Here, we report on a 59-year-old man with fibrous pseudotumor of the tunica vaginalis associated with hydrocele and testicular atrophy.