[41] Complications of temporary urinary diversion using nephrostomy tube or JJ ureteric stent in pregnant women with symptomatic urolithiasis

Objective: To report the complications of JJ stent and percutaneous nephrostomy (PCN) tube causing hospitalisation of pregnant women, as symptomatic urolithiasis is one of the most important causes of abdominal pain during pregnancy and in some situations it is better to implement temporary treatment and postpone any surgical procedures. Methods: In this cohort study, from August 2013 to September 2016, 23 pregnant women with urolithiasis were referred to our centre in whom temporary urinary diversion was performed. The mean (SD; range) patient age was 27.1 (4.8; 20–37) years and most of them (69.5%) presented in the first trimester. All the procedures were done under ultrasonographic guidance with local anaesthesia. All the patients were followed routinely in the Urology and Gynaecology and Obstetrics clinics. Results: We inserted a PCN tube in 12 patients (52.1%) and a JJ stent in 11 (47.8%). The mean (SD) age of the patients was 27.5 (5.4) years in the PCN Group and 26.7 (4.3) years in the JJ-stent Group (P = 0.710). Of these, seven patients (30.4%) developed complications including febrile UTI (two of 12 in the PCN Group and one of 11 in the JJ-stent Group) and bothersome stent-related symptoms (four of 11 in the JJ-stent Group).The occurrence of complications was not significantly different between the groups (two of 12 in the PCN Group vs five of 11 in the JJ-stent Group, P =  0.193); these patients were admitted and after stabilisation surgical treatment using ureteroscopy was performed. Surgical treatments were done in the second trimester. All the patients completed their pregnancies to full-term without any serious obstetric complications. Conclusion: Temporary urinary diversion using a JJ stent or PCN tube can be associated with some potential complications that can threaten the mother and her foetus. In these situations, we advise temporary management until the second trimester when the surgical procedure is safer

The role of renal autotransplantation in treatment of nutcracker syndrome

To report our experience with renal autotransplantation in treatment of gross hema-turia caused by nutcracker Syndrome (NCS). Between September 2005 and January 2008, four pa-tients of mean age 25.5 years (range: 23-28) with gross hematuria were diagnosed to have NCS. Investigations revealed isolated hematuria on urinalysis, a bloody efflux from left ureteral orifice by urethrocystoscopy, dilatation of left renal vein (LRV) with significant difference in peak sys-tolic velocity in Colour Doppler UltraSonography (CDUS) and dilatation and compression of LRV between aorta and superior mesenteric artery in MRA. After operation, hematuria dis-appeared in all patients. No vascular or urological complication was seen. Follow up ranged from 4 to 24 months. In conclusion, autotransplatation of left kidney is very effective for the treatment of symptomatic NCS

Subcosto-midline Abdominal Incision: A New Incision for Resection of Large Renal Masses with or without Vascular Involvement

Background: Renal cell carcinoma is the third most common urological cancer.Surgical resection is still the mainstay of treatment for this tumor. Here we present anew surgical approach for the management of locally advanced renal cell carcinoma.Methods: We chose ten patients with extensive renal masses. The patient, undergeneral anesthesia after preparation and draping, was placed in the supine position. Wemade either a right or left classic subcostal incision which was then extended as a midlineincision through the linea alba to the lower abdomen. After mobilization of the rightascending or left descending colon, the renal artery and vein were detected, ligated anddivided. Next, the involved kidney was released from the adjacent structures andremoved, including Gerota’s fascia.Results: The study included 6 men (60%) and 4 women (40%) with a mean ageof 57 years. Mean blood loss was 1500 mL and mean operative time was 180 minutes.The patients' surgical wounds were checked for two weeks after the operation; noneof the patients developed wound infections or dehiscence. At the time of writing thismanuscript, in January 2011, 7 patients (70%) were alive with no evidence of abdominalherniation at the surgical site.Conclusion: A subcosto-midline incision or anterior triangular flap incision is amodified abdominal incision. In our experience, this incision is useful for the resectionof locally advanced large renal masses

Predictive factors of delayed bleeding after percutaneous nephrolithotomy requiring angioembolization

Abstract Objectives To investigate the predictive factors of delayed post‐percutaneous nephrolithotomy (PCNL) haemorrhage because of arteriovenous fistula (AVF) or pseudoaneurysm (PA) and compare the factors between AVF and PA. Patients and methods This is a case–control study with a case‐to‐control ratio of 1:3. Out of 5077 patients who underwent PCNL from April 2015 to April 2018 in three different teaching hospitals, 113 had post‐PCNL haemorrhages because of AVF and/or PA. Seventy‐two patients met the inclusion criteria and entered the study as cases, while 216 patients without any postoperative complications were selected as controls. Results Of all 72 studied patients with complications after PCNL, 35 (48.6%) had AVF, and the rest had PA. The regression model revealed that a history of diabetes (odds ratio [OR]: 2.799, 95% confidence interval [CI]: 1.392–5.630, p‐value = 0.004) and renal anomalies (OR: 2.929, 95% CI: 1.108–7.744, p‐value = 0.03) were associated with developing delayed post‐PCNL haemorrhage. However, no differences were seen between AVF and PA regarding selected variables (p‐value > 0.05). Conclusion History of diabetes and renal anomalies were predictive factors for delayed post‐PCNL haemorrhage, but no predictive factors were found to differentiate PA and AVF from one another