Ultrasound-guided percutaneous nephrolithotomy in patients with retrorenal colon: a single-center experience.

BACKGROUND: Retrorenal colon is a risk factor for colonic injury during percutaneous nephrolithotomy (PCNL). Our aim in this study is to report the feasibility and outcomes of ultrasound-guided percutaneous nephrolithotomy in patients with preoperatively known retrorenal colon by cross-sectional imaging. METHODS: In this prospective study, all patients with large renal stones and retrorenal colon in preoperative cross-sectional imaging from September 2020 to January 2022 who were candidates for PCNL were enrolled. Percutaneous access was established by ultrasonography guidance by the freehand method with dilation of the tract by a combination of fluoroscopy and ultrasonography. RESULTS: Of the 1123 patients (Male = 760 and Female = 363) who underwent PCNL, 13 patients (Male = 6 and Female = 7) had retrorenal colon in the preoperative computed tomography. The series included two patients with malrotated kidneys. Complete stone clearance was achieved in 11 patients. Patients were followed up for at least 3 months. No serious postoperative complications were observed during follow-up. CONCLUSION: In selected patients and experienced hands, ultrasound-guided PCNL can be an alternative option for the treatment of patients with large renal stones who have retrorenal colon in cross-sectional imaging.

Comparing the outcomes of papillary and non-papillary access in percutaneous nephrolithotomy.

BACKGROUND: Some publications have recently been released on the safety of non-papillary access (NPA) in percutaneous nephrolithotomy (PCNL) by a Greek group. The purpose of this study was to prospectively examine the outcome of NPA during two years in a referral center. METHODS: This prospective cohort study was conducted on PCNL operations performed from January 2020 to April 2022 in Labbafinejad Hospital. In cases in which obtaining papillary access (PA) was not obtainable after several attempts and NPA was obtained, or in cases in whom after entry to the pyelocalyceal system, a NPA was observed, the cases were categorized in the NPA group (n = 67). The control group (PA) was composed of patients who had undergone PCNL with papillary access with similar stone bulk (n = 67). The primary endpoints of interest were hemoglobin drop and transfusion frequency. The secondary endpoint included: stone free rate (SFR), operation duration, and complications. RESULTS: A total of 134 patients were enrolled during the study period which included 33 female patients (25%). The mean ± SD age of patients was 49.6 ± 13.2 years. The frequency of transfusion and residual stones was not different between NPA and PA groups: 6 (9%) versus 8 (11%), P = 0.29; and 16 (24%) versus 12 (18%), P = 0.26. Likewise, the operation time (87.6 ± 25.8 versus 90.2 ± 22.6 min, P = 0.45), and the frequency of intraoperative and postoperative complications were not different between the NPA and PA groups. CONCLUSION: The results of this prospective study did not reveal a higher frequency of residual stones, transfusion, or complications in the NPA group. Nevertheless, our study is not powered enough to reveal complications of low frequency including delayed bleeding.

New Molecular Markers for Prostate Cancer Diagnosis.

PURPOSE: Prostate cancer (PCa) is the second most commonly diagnosed cancer and the sixth leading cause of cancer death among men worldwide. Biomarkers are an important tool in the early detection of PCa. Prostate-specific antigen (PSA) is one of the oldest biomarkers for the early detection of PCa. Digital rectal exam (DRE) is another screening test for PCa detection, which is considered as an irritating experience for patients. Biopsy is still the most reliable method for PCa diagnosis; however, patients are prone to complications. Therefore, developing non-invasive and accurate methods for PCa screening seems urgent to avoid unnecessary biopsies. There has been remarkable development in PCa molecular biomarkers discovery, largely through progress in omics technologies. Due to the many benefits of liquid biopsies, a significant set of PCa diagnostic kits have been developed using urine samples. Despite the unique benefits of these kits, there are still many challenges to their widespread use in clinics. Here, we have reviewed the latest developments of PCa biomarkers in liquid biopsies. METHODS: Literature on biomarkers for diagnosis of PCa was reviewed during the past two decades. RESULTS: PSA, PHI, PCA3, and 4K score are among the commonly used markers for PCa diagnosis which have been used over a long-moderate length of time with multiple studies on their performance. We performed a review of their performance. Newer markers are among RNA and DNA markers. Multiple non-coding RNAs (mi-RNAs) were reviewed and their performance on Pca diagnosis was reviewed. Long noncoding RNAs (Lnc RNAs) including PlncRNA-1, HOTAIR, SchLAP-1, MALAT1, MEG3, and PRCAT17.3 were summarized. mRNA markers including TMPRSS2:ERG, and HOXC6 were presented. DNA-based markers including PTEN, HOXB13, and BRCA2 were reviewed. Finally, the use of CircRNAs was reviewed for PCa diagnosis. CONCLUSION: Many reviewed RNA-based biomarkers have promising results in the diagnosis of PCa.

Comparative analysis of retro vs. transperitoneal laparoscopic pyelolithotomy for large renal stones.

The objective of this study is to compare the outcomes and complications of retroperitoneal and transperitoneal laparoscopic pyelolithotomy (RLP and TLP, respectively) in the treatment of large kidney stones. In this retrospective cohort effort, data of all patients who underwent laparoscopic pyelolithotomy for renal pelvic stone (N = 273) in three referral urology hospitals were retrieved. Operation duration, length of hospital stay, postoperative stone-free rate, hemoglobin (Hb) and creatinine (Cr) changes and complications were compared between the two groups before and after propensity score matching. A total of 199 TLP and 74 RLP cases were examined. Stone size was significantly higher in the TLP vs. RLP group (29.8 ± 10.9 vs. 26.5 ± 8.8 mm; P = .022). Length of operation and hospital stay were comparable (P = .672 and P = .396, respectively). Rate of conversion to open surgery, postoperative blood transfusion rate, postoperative urinary leakage, postoperative stone-free rate, Hb drop and Cr change were similar between the two groups (P = .348, 0.190, 0.828, 0.411, 0.780 and 0.134, respectively). Postoperative fever was significantly more prevalent in TLP compared to RLP (21.6% vs. 0.0%, respectively; P < .001). Propensity score matched analyses showed similar results in all aspects; particularly demonstrating higher postoperative fever in TLP compared to RLP (18.9% vs. 0.0%, respectively; P < .001). RLP can be considered as an alternative to TLP; especially owing to a lower chance of postoperative fever.

Predictors of Recurrent Urolithiasis in Iran: Findings from a Nationwide Study.

BACKGROUND: Prevention of urinary stone recurrence is the ultimate goal in urolithiasis patients. In this study, we aimed to investigate the national prevalence rate and possible determinants of increased urolithiasis recurrence risk in a nationwide study in Iran. METHODS: All data regarding stone occurrence and recurrence episodes were extracted from the cross-sectional Iran National Stone Survey (INSS) study, and the possible determinants of recurrence were evaluated in the subset of 2913 patients who had a positive history of at least one episode of urolithiasis. RESULTS: The national prevalence rate of recurrent urolithiasis was 2.6% (95% CI: 2.5, 2.8) in Iran. Moreover, the relative ratio of recurrent stone formers to all stone formers was 39.8% (95% CI: 38.0, 41.6). Our univariable truncated negative binomial regressions suggested that a positive history of urolithiasis in the patient's father (prevalence ratio [PR] [95% CI]=1.83 [1.39, 2.41], P<0.001), mother (PR [95% CI]=1.92 [1.39, 2.66], P<0.001) or brother (PR [95% CI]=1.32 [1.03, 1.69], P=0.026); and residence in urban areas (PR [95% CI]=1.27 [1.04, 1.55], P=0.016) were significant predictors of repetitive recurrence episodes. However, when incorporated into a multivariable truncated negative binomial regression model, the only significant predictors of more frequent recurrence episodes were a positive history in father (PR [95% CI]=1.66 [1.24, 2.22], P<0.001) and mother (PR [95% CI]=1.68 [1.20, 2.36], P=0.002); and urban residence (PR [95% CI]=1.24 [1.01, 1.51], P=0.031). CONCLUSION: Our results indicate that a positive family history of urolithiasis in mother and father and residence in urban areas are the significant predictors of recurrence risk in urolithiasis patients in Iran.

Familial aggregation of urolithiasis: findings from a Nationwide Middle Eastern study.

This study aimed to determine the potential effect of genetic factors and positive family history on the familial aggregation of urolithiasis in Iran. Of the total 44,186 participants in the Iran National Stone Survey (INSS) database, 34,953 individuals who were members of 8629 nuclear families were included in this study. The mean prevalence of urolithiasis was 5.7% [95%CI: 5.5 - 6.0%] in this subpopulation. Familial aggregation of urolithiasis was analyzed in 34,745 participants (99.6% of those originally included) utilizing a multivariable logistic regression with second order generalized estimating equations approach (GEE2) to adjust for sex, age, urbanization status and ethnicity. Recurrence risk ratios (λ) were used to evaluate the degree of familial aggregation. Our multivariable analysis demonstrated a strong familial aggregation of urolithiasis within sibling pairs (λs = 78.35), parent-offspring pairs (λo = 40.12) and spouse pairs (λsp = 21.62). The respective ORs were 5.65 [95%CI: 3.49, 9.14] for siblings, 2.85 [95%CI: 2.20, 3.68] for parents and 1.27 [95%CI: 1.06, 1.54] for spouses. Urinary stone disease tends to aggregate in families with a positive history of urolithiasis in either the parents or siblings. Siblings have a more prominent effect in inducing familial aggregation compared to parents. Despite the prominent role of familial genetic components in urolithiasis aggregation, shared environmental factors appear to partake in this phenomenon to some extent, as suggested by urolithiasis aggregation among spouse pairs.

Exploring the Impact of Family History, Demographics and Ecological Factors on Urolithiasis Prevalence: Insights from a Nationwide Study.

OBJECTIVE:  This study aimed to evaluate the potential risk factors of lifetime urolithiasis occurrence on a nationwide scale in Iran. METHODS:  All data regarding urinary stone events were extracted from the cross-sectional Iran National Stone Survey (INSS) study, and the possible determinants of urolithiasis incidence were evaluated. RESULTS:  Our multivariable logistic regression suggested that while older age at presentation, male sex, and a positive family history of urolithiasis in either of the patient's parents or siblings were all significantly associated with an increased odds of lifetime urolithiasis occurrence (all P < .001), a positive family history in one's sister (odds ratio; OR=5.56) or brother (OR=4.70) were the most significant predictors. Moreover, belonging to Baluch ethnicity (i.e., an ethnical group indigenous to the south eastern regions of Iran) and residing in regions with higher water hardness (i.e., total concentration of dissolved minerals) were also associated with an increased odds of urolithiasis occurrence (P < .001 and P=.023, respectively). Conversely, living in regions with higher mean humidity decreased the chances of developing a urinary stone event during one's lifetime (OR=0.62, P <.001). CONCLUSION:  Our results indicated that a constellation of demographic, ecological, and familial risk factors are associated with an elevated risk of developing urinary stones during one's lifetime. These findings can assist in implementing novel regional healthcare policies, considering the specific demographic and ecological characteristics. They also support tailoring personalized preventive strategies, particularly for individuals with multiple nonmodifiable risk factors.

Unroofing of Lower Pole Native Kidney Cysts in Patients with Autosomal Dominant Polycystic Kidneys at the Time of Kidney Transplantation.

To report our experience with unroofing of ipsilateral lower pole kidney cysts in five patients with adult-type polycystic kidneys [ADPKD] when free implantation of kidney allograft interfered with lower pole native kidney cysts. In all of these patients, the native kidneys extended to the ipsilateral pelvis and bilateral ADPKD caused enlargement of the abdomen on gross examination. Unroofing of lower pole kidney cysts was performed during the same session of allograft transplantation. The decision to unroof lower pole cysts of the ipsilateral kidney was made after observing interference of lower pole cysts with free implantation of the allograft. In patient A, bilateral native nephrectomy was performed 6 weeks after kidney transplantation after consultation with the patient, when there was evidence of the good function of the allograft and the recipient was on a low dose of immunosuppressive medications. In other patients, no need for native nephrectomy observed. This experience suggests the possibility that when large ipsilateral kidney cysts interfere with safe implantation of the allograft, there is an option of performing cyst unroofing at the same session and proceeding with allograft implantation. In many patients, there would be no need for native nephrectomy and of deemed necessary, it will be performed later, when there is evidence of the good function of the allograft and the patient is on good kidney function with a low dose of immunosuppressive medications and a less risk profile for the operation. To our best knowledge, there is no prior such report in the literature.

Importance of long non-coding RNAs in the pathogenesis, diagnosis, and treatment of prostate cancer.

Long non-coding RNAs (lncRNAs) are regulatory transcripts with essential roles in the pathogenesis of almost all types of cancers, including prostate cancer. They can act as either oncogenic lncRNAs or tumor suppressor ones in prostate cancer. Small nucleolar RNA host genes are among the mostly assessed oncogenic lncRNAs in this cancer. PCA3 is an example of oncogenic lncRNAs that has been approved as a diagnostic marker in prostate cancer. A number of well-known oncogenic lncRNAs in other cancers such as DANCR, MALAT1, CCAT1, PVT1, TUG1 and NEAT1 have also been shown to act as oncogenes in prostate cancer. On the other hand, LINC00893, LINC01679, MIR22HG, RP1-59D14.5, MAGI2-AS3, NXTAR, FGF14-AS2 and ADAMTS9-AS1 are among lncRNAs that act as tumor suppressors in prostate cancer. LncRNAs can contribute to the pathogenesis of prostate cancer via modulation of androgen receptor (AR) signaling, ubiquitin-proteasome degradation process of AR or other important signaling pathways. The current review summarizes the role of lncRNAs in the evolution of prostate cancer with an especial focus on their importance in design of novel biomarker panels and therapeutic targets.

National Lifetime Prevalence and Demographic Factors of Urolithiasis in Iran.

PURPOSE: To estimate the current lifetime prevalence of urolithiasis at the national level in Iran and investigate the potential influential demographic factors in different geographical areas.   Materials and methods: An epidemiological study was conducted between October 2020 and November 2022 in 31 provinces of Iran at the national level. Data was obtained through telephone interviews with households. Items in the interview included questions about the current and past episodes of urolithiasis, family history of urolithiasis, and demographic and environmental variables of potential interest in urolithiasis.   Results: A total of 44186 participants were investigated from 31 provinces of Iran. The overall percentage of those with lifetime prevalence of urolithiasis was 6.6%, including 7.9% for males and 5.3% for females (P<.001). In addition, with regard to the residential location, men were 53% (7.9% vs. 5.2%) more susceptible than women to urinary stones in urban areas and 36% (7.8% vs. 5.7%) more susceptible in rural areas. Out of 31 provinces, the Sistan-baluchistan province had the highest lifetime prevalence (15.6%) and the Golestan province had the lowest (2.1%). The lifetime prevalence of urolithiasis in the rural areas was 6.8% versus 6.5% in the urban areas (P=.29). Regarding age differentiation, the lifetime urolithiasis prevalence has increased up to the age of 70 years. In addition, the most prominent increase in the lifetime prevalence was observed in the age range of 20 to 60 years (from 0.9% to 11.8%). The ethnicity with the highest lifetime prevalence rate of urolithiasis was the Baluch ethnicity (18%).   Conclusion: generally, 6.6% of Iranian population suffers from urinary stones during their lifetime. Urolithiasis prevalence has increased 0.06% annually compared to the latest national study that took place 15 years ago. This increasing trend seems to be less prominent than other countries. According to our findings, urinary stones are more prevalent in men than in women and in the third to sixth decade of life regardless of gender. Baluch ethnicity is associated with the highest lifetime prevalence rate of urolithiasis and there is no significant difference between rural and urban areas. However, the ratio of male to female risk of urolithiasis is higher in urban areas compared to rural areas.

The experience of a tertiary referral center with laparoscopic pyelolithotomy for large renal stones during 18 years.

This study aimed to evaluate the outcomes of laparoscopic pyelolithotomy, including its efficacy and feasibility in treatment of large renal stones. All patients who underwent laparoscopic pyelolithotomy operations in a referral center were enrolled from 2003 to 2020. The final analysis included 436 patients. The total stone free rate was 88.3% and the stone-free rate for staghorn/multiple stones versus other types of stones was 81% vs. 91% (P = 0.002). Likewise, the total operation duration was 158 ± 50 and the operation duration for staghorn/multiple stones versus other types of stones was 171 ± 51 min vs. 153 ± 49 min (P < 0.001). The operation duration (169 ± 51 vs. 155 ± 58 vs. 155 ± 42 min) and hospitalization (4.5 ± 2.3 vs. 4.0 ± 2.2 vs. 3.6 ± 1.8) decreased with increasing the surgeons' experience over time. The outcomes of laparoscopic pyelolithotomy for children versus adults versus geriatric patients and in patients with normal versus abnormal kidney anatomy did not reveal statistically significant differences. Laparoscopic pyelolithotomy could be employed as an alternative surgical approach for patients with large kidney stones of any age or with kidney abnormalities provided that appropriate expertise is available to carry out the procedure.

Comparing the Frequency of Lymphoceles Which Needed Intervention in Recipients of Living Donor Versus Deceased Donor Kidney Transplants.

OBJECTIVE: In this study, we aimed to compare the frequency of lymphoceles that needed intervention in recipients who received kidneys from living versus deceased donors. MATERIALS AND METHODS: The records of all patients who underwent kidney transplantation at the Labbafinejad Hospital from 2012 to 2021 were retrospectively reviewed to determine the incidence of lymphoceles that needed intervention for management. RESULTS: From March 2012 to April 2021, 1752 patients received kidney transplantation in Labbafinejad Hospital including 975 transplantations from living donors and 777 transplantations from deceased donors. Symptomatic lymphoceles were observed postoperatively in 23 patients. Symptoms included compressive effect on the ureter, hydroureteronephrosis of the transplanted kidney, frequency, urinary retention, infection,  abdominal discomfort, or rise in serum creatinine. Out of 23 patients who needed intervention for symptomatic lymphocele, 15 patients were recipients of living donors and 8 patients were recipients of deceased donors [1.53% versus 1.03%, P=.40]. Intervention consisted of open surgical drainage in 6 patients [4 recipients of living donors and 2 recipients of deceased donors], and nephrostomy insertion in 17 patients. Open operation was necessary in 5 (47%) patients in whom arterial anastomosis was made to the internal iliac artery versus 1 (9%) patient in whom the anastomosis was not made to the internal iliac artery (P=0.15). CONCLUSION: Symptomatic lymphoceles which needed intervention were observed in low frequency (1.31%). Most cases can be managed by endoscopic drainage without relapse. Type of donation had no relationship with the need for open or endoscopic intervention in lymphoceles. A higher proportion of open surgeries to control lymphocele were observed in recipients in whom the internal iliac artery was used for arterial anastomosis however the difference was not statistically significant.

Medium-Term Outcomes of COVID-19 Infection After Kidney Transplantation for Ongoing Living and Deceased Kidney Transplantations within the COVID-19 Pandemic.

OBJECTIVES: To present the early to midterm experience of two referral kidney transplantation centers with living and deceased kidney transplantations that were performed within the COVID-19 pandemic. MATERIALS AND METHODS: All cases performed in two referral centers in Iran within the COVID-19 pandemic were investigated. Transplantations were performed from May 2020 to February 2021. The protocol for screening included nasopharyngeal RT-PCR with chest CT scan for living and deceased transplantations in center A and RTPCR for living transplantations and chest CT scan for deceased transplantations in center B. Patients were followed for 14-26 months after transplantation regarding COVID-19 infection and its outcomes in case of infection. RESULTS: 103 kidney transplantations were performed during the study period including 54 (52.4%) living and 49 (47.6%) deceased kidney transplantations. Twenty-four recipients (23.3%) and a living donor (1%) were infected with COVID-19. The severity of COVID-19 infection was mild, moderate, severe, and critical in 16 (66.6%), 4 (16.6%), 2 (8.4%), and 2 patients (8.4%), respectively. Two mortalities were observed within transplantation recipients with COVID-19 infection (1.9%). 87.5% (7/8) COVID-19 infections in center B were observed in recipients of deceased transplantations who were screened only by chest CT scan. CONCLUSION: The results of this study indicate a low frequency of COVID-19 mortality (1.9% for the whole cohort and 8.3% within COVID-19 infected patients) for recipients of living and deceased kidney transplantation that were performed within the COVID-19 pandemic. The above findings highlight for the first time in a large study the probability of living kidney transplantation during the COVID-19 pandemic in case strict screening of donors and recipients and close supervision of operating rooms and wards are implemented. We further hypothesize the inadequacy of chest CT scan for screening of COVID-19 in kidney transplantation surgery candidates.

Circular RNAs in renal cell carcinoma: Functions in tumorigenesis and diagnostic and prognostic potentials.

Circular RNAs (circRNAs) are non-coding RNAs with closed ends which makes them resistant to degrading enzyme RNAse R. These RNA molecules show cell, tissue or organ specific expression. Regulatory functions have been reported for a number of circRNAs. Particularly, they have been found to affect cell cycle and control cell proliferation. CircRNAs are involved in physiological processes like natural organ development. Their dysregulation in high-throughput technologies have been shown in a growing number of diseases especially many types of cancers such as renal cell carcinoma (RCC). Differentially expressed circRNAs in RCC tissues compared to normal tissues may affect carcinogenesis process. Overexpressed circRNAs promote tumorigenic functions of RCC cell lines while down-regulated transcripts repress them. Both dysregulated circRNAs are correlated with clinicopathological features, prognosis and survival in RCC patients which along with their acceptable diagnostic values suggest them as potential biomarkers in diagnosis or prediction of prognosis of RCC patients. In this review, we have assessed tumorigenic or tumor-suppressing effects of circRNAs and also their diagnostic and prognostic potentials in RCC.

COVID-19 Infection and Mortality Rates within Medical Specialists and General Practitioners and Its Comparison with the General Population: A Longitudinal Nationwide Study.

BACKGROUND: We aimed to provide data regarding COVID-19 infection and mortality rates within different specialties of physicians and general medical practitioners in a longitudinal nationwide study and to compare the results with general population. METHODS: Data on COVID-19 infection and mortality of medical physicians in Iran was actively gathered through the Iranian Medical Council (IRIMC). Population COVID-19 cumulative incidence and mortality data were extracted from WHO situation analysis reports and data on Iranian population were obtained from the Statistical Center of Iran. RESULTS: As of Jul 27th 2020, COVID-19 infection and mortality rates were 0.680% and 0.0396% among 131223 physicians. The highest cumulative infection rates as of 27th July 2020, were observed in specialists of infectious diseases (3.14%) followed by neurology (2.18%), and internal medicine (2.13%). The highest cumulative mortality rates as of Nov 3rd 2020 were observed in specialties of forensic medicine (0.314%), anesthesiology (0.277%), urology (0.237%), and infectious diseases (0.20%). Male physicians comprised 95% of cumulative mortality as of Nov 3rd. The physicians' COVID-19 mortality in July and November were 49% and 23% higher than the general population respectively. CONCLUSION: Infection and mortality rates in Iranian physicians were higher than the general population, however the magnitude of difference was narrowing in longitudinal investigation. Provision of personnel protective equipment should be prioritized to specialists of infectious diseases, forensic medicine, anesthesiology, internal and emergency medicine, and urology.

X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance.

PURPOSE: Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, including lower anesthesia risk, shorter operating time, and better ergonomic position for the surgeon. It is also comparable to prone position regarding vascular and bowel injuries. This study was conducted to add some more benefits by omitting X-ray in PCNL in a supine position. METHODS: Nineteen consecutive adult patients underwent ultrasound-guided PCNL in supine position. All patients were placed under ultrasound guidance in supine position. The tract was dilated over a guidewire in a single shot technique under ultrasound guidance from anterior abdominal wall. Once the procedure ended, residual stone was controlled using ultrasound with anterior abdominal wall window. Residual stones less than 5 mm were considered insignificant. No X-ray was used in any setting of the procedure. RESULTS: The pelvicaliceal system could be successfully approached in all patients. The posterior calices were the most common sites of entry. Mean (range) of operation time was 111 (70-180) min. Mean + or - SD hemoglobin before PCNL was 14.0 + or - 2.2 mg/dl, and after the procedure it was 12.3 + or - 1.6 mg/dl. Only one patient required blood transfusion. Mean + or - SD creatinine before PCNL was 1.03 + or - 0.24 mg/dl, and after the procedure it was 1.11 + or - 0.22 mg/dl. None of the patients suffered visceral injury. The total stone-free rate was 84%. CONCLUSIONS: Even in our first report with limited experience, it seems that the efficacy of PCNL with ultrasonography in supine position is comparable to PCNL in prone position with fluoroscopy with no more complications.

Association between calcium-sensing receptor gene polymorphisms and recurrent calcium kidney stone disease: a comprehensive gene analysis.

OBJECTIVE: Comprehensive sequencing of the coding exons of the calcium-sensing receptor gene (CASR) was performed in a group of Iranian recurrent calcium kidney stone-formers and the results were compared with a control group. MATERIAL AND METHODS: Serum and urine parameters were evaluated in 99 males aged between 30 and 55 years old with idiopathic recurrent calcium urolithiasis and in 107 men as a control group. Products of polymerase chain reaction were sequenced using forward primer until a mutation was found in that exon. Then, other cases were analysed by single-strand conformation polymorphism. RESULTS: Four polymorphisms were detected in CASR exons, all in the coding region of exon 7. These polymorphisms and their minor allele frequency were P748P (100%), A986S (1%), R990G (3%) and E1011Q (98%). There was a significantly higher count of 986S (p = 0.006), 990G (p = 0.006) and E1011 (p = 0.02) alleles in patients. The odds ratio (95% confidence interval) was 2.55 (1.31-4.96) in those at risk of stone disease for the 986S allele and 8.06 (1.80-35.9) for the 990G allele. Men with the RR genotype at R990G showed a significantly higher serum ionized calcium than the RG or GG group (p = 0.03). A significantly lower serum total calcium was found in subjects with the QQ than the EQ genotype with respect to the 1011 locus (p = 0.005). Furthermore, the 1011Q allele was marginally associated with hypercalciuria (p = 0.05). CONCLUSION: The 986S, 990G and 1011Q alleles were associated with a recurrent calcium kidney stone-forming state. 986S and 1011Q alleles, but not 986S, were associated with hypercalcaemia.

Success of trigonoplasty anti-reflux surgery and its predictive factors.

INTRODUCTION: This study was designed to evaluate factors contributing to failure in Gil-Vernet antireflux operation. MATERIALS AND METHODS: 96 patients (150 refluxing units; median (range) age, 60 (12-180) months; M/F, 11/85) with primary vesico-ureteral reflux were included. Trigonoplasty was done according to a modified Gil-Verent procedure. Relapse was diagnosed on the postoperative direct radionuclide cystography (DRNC) 3 or 6 months after operation. Demographic and intraoperative data were used to assess factors contributing to failure. RESULTS: Resolution of reflux in postoperative DRNC was observed in 87 patients (90.6%) and in 138 refluxing units (92.0%). In patients who were followed 3-6 months, one relapse occurred (3%) versus 8 relapses in those who were followed 24-39 months (12%). Relapse in refluxing units was related to the history of voiding symptoms (30 vs. 3%, p < 0.001), history of breakthrough infections (20 vs. 3%, p = 0.001), golf or stadium like ureteral orifice appearance (15 vs. 4%, p = 0.02), and less distance of ureteral orifices from each other (p < 0.001). CONCLUSIONS: Trigonoplasty success rate may decrease with long-term follow-up. In multivariable analysis, patients with history of voiding dysfunction, breakthrough infection, golf/stadium like ureteral orifices, and less distant ureteral orifices are at a higher risk of relapse.

Laparoscopic Pyelolithotomy for A Staghorn Stone in A Patient with History of Cystectomy and Ileal Conduit.

Laparoscopic pyelolithotomy has recently been introduced for renal stones. However, the use of this technique is limited in patients with history of extensive abdominal surgeries. We present a case of right side staghorn renal stone with history of abdominal open cystectomy who underwent laparoscopic pyelolithotomy with uneventful outcome.

Laparoscopic Pyelolithotomy for the Management of Large Renal Stones with Intrarenal Pelvis Anatomy.

PURPOSE: The role of laparoscopic pyelolithotomy (LPL) in the management of renal stones is evolving. One of the challenges in LPL for renal stones is patients with intrarenal pelvis. Here we present our experience with laparoscopic pyelolithotomy for the management of renal stones with intrarenal pelvis anatomy. MATERIALS AND METHODS: Patients candidate for laparoscopic pyelolithotomy from February 2014 to March 2015 were included. Intrarenal pelvis was defined as > 50% of the renal pelvis area contained inside renal parenchyma. Laparoscopic pyelolithotomy was done by transperitoneal approach. Residual stones were checked by computed tomography and/or intravenous pyelography and ultrasonography 6 weeks after the operation. RESULTS: 28 patients were included in this study. The mean±SD of patients' age was 45.8±12.5 years. 19 patients (68%) were male. Stone locations were pelvis, multiple, and staghorn in 22, 3, and 3 patients respectively. The mean±SD of operation duration was 160±48 minutes. Residual stones were observed in 3 patients with multiple (n=2) or staghorn (n=1) stones. Urinary leak was observed in 3 patients and was managed conservatively in 2 patients. In one patient ureteral stent was inserted by cystoscopy. No conversion to open surgery or re-operation occurred. CONCLUSION: Laparoscopic pyelolithotomy is a feasible operation for patients with renal stones and intrarenal pelvis in centers with adequate experience in laparoscopy. However, the success of LPL decreases in patients with multiple stones and intrarenal pelvis.