Laparoscopic Reimplantation for Single-System Ectopic Ureter

INTRODUCTION Ureteral anomalies, ectopic ureter being one of them, are of the most important urogenital abnormalities because they directly affect kidney function.(1) Several techniques have been used for treatment of ectopic ureter. The goal of obstruction relief can be achieved by either ureteropyelostomy or common sheath ureteral reimplantation for a duplicated system, or reimplantation for a single system.(1) Heminephrectomy and ureteropyelostomy are well described elsewhere, but several technical points deserve

Supine Percutaneous Nephrolithotomy, Is It Really Effective? A Systematic Review of Literature

<p><strong>Introduction:</strong> This systematic review was performed to determine the clinical value of percutaneous nephrolithotomy in the supine position in comparison with the convention of performing the procedure in the prone position.</p><p><strong>Materials and Methods: </strong>A systematic review of the medical literature was conducted searching for studies on percutaneous nephrolithotomy in the supine position, limited to publications appeared in the PubMed between 1980 and July 2008. Non-English articles were considered if deemed relevant by providing additional data. In the retrieved articles, reference lists were hand-searched to identify additional relevant articles.</p><p><strong>Results:</strong> There were 9 original articles on percutaneous nephrolithotomy in the supine position. Five studies were retrospective and 4 were prospective, of which only 1 was a well-designed randomized controlled trial published in 2008. The success rate of the procedure was reported between 69.6% and 95%. The risk of requiring blood transfusion was between zero and 8%. Duration of hospital stay was variable, but generally less than that in the prone position. No colon perforation was reported.</p><p><strong>Conclusion:</strong> In carefully selected patients with uncomplicated urinary calculi, percutaneous calculus removal in the supine position can yield similar outcomes to that in the prone position.</p&gt

A novel surgical technique to localize small enteropouch fistula

BACKGROUND: One of the rare complications of ileal neobladder after radical cystectomy is pouch-to-intestine fistula. There isn't a classic method to intraoperative diagnosis of small fistula. CASE PRESENTATION: An entero-pouch fistula was occurred in a patient after radical cystectomy with illeal orthotopic pouch. Because of failed conservative management, the patient was candidate for surgery. The hidden small fistula in the small intestine was diagnosed by high intraluminal hydrostatic pressure (by intraluminal saline injection). CONCLUSION: Intraoperative diagnosis the intestinal opening of a small fistula is very important. At the time of surgery if the fistula tract becomes open (during releasing the adhesions), it may leak in the peritoneum in postoperative period. Intraluminal high pressure is a useful method for intraoperative small hidden intestine opening

Effect of Progressive Muscle Relaxation Technique on Fatigue in Patients Undergoing Hemodialysis

Background and Objectives: Fatigue is a common complaint among patients who undergo hemodialysis. Fatigue influences their somatic, mental, sentimental and cognitive states. This study aimed to determine the effect of progressive muscle relaxation technique on fatigue among patients treated with hemodialysis. Materials and Methods: In this clinical trial, 90 patients undergoing hemodialysis were recruited from two hemodialysis centers in Gonabad and Yazd and were randomly allocated into control (n=45) and trial (n=45) groups. The progressive muscle relaxation technique was presented to the trial group during three sessions. The patients were asked to make calm once a day for six weeks and at the end complete the relaxtion form. No trainings were provided for the control group patients. The intensity of fatigue was compared between the two groups. Data were collected using a questionnaire including demographic specifications, tools for assessing the severity of fatigue and self-reported checklists. Data was analyzed using the statistical methods in the SPSS. Results: The results showed no significant differences in the level of fatigue between the two groups before the intervention (p=0.12). There was significant difference in level of fatigue between the two groups after the intervention (p<0.001). Conclusion: Using the progressive muscle relaxation technique is recommended for patients of the hemodialysis ward

The effect of progressive muscle relaxation technique on blood pressure and dialysis adequacy in patients undergoing hemodialysis

Background and Aim: Dialysis inadequacy is a determinant of the patient’s life. Increased dialysis adequacy plays a significant role in improving awareness of dialysis patients. Blood pressure is also a significant factor in dialysis adequacy. This study aimed to evaluate the impact of Progressive Muscle Relaxation Technique on blood pressure and adequacy of dialysis in hemodialysis patients. Materials and Methods: This research was a clinical trial conducted in 2013. Hemodialysis patients from two hemodialysis centers in Gonabad (11 controls, 11 trials) and Yazd (34 controls, 34 trials) were chosen by the blocking method and allocated to two control (n=45) and trial (n=45) groups. Any trial received the Relaxation training by the investigator in 3 sessions and under similar circumstances. The patients performed the technique at home once a day for as long as 6 weeks. Then, the blood pressure and dialysis adequacy of the two groups were compared. The data was collected by a demographic questionnaire and a blood pressure checklist. KT/V formula was used to assess the adequacy of hemodialysis. Data was analyzed with SPSS software (version 14) using Independent T Test and Mann-Whitney U tests. Results: The results showed no significant difference in systolic and diastolic blood pressure between the two groups before intervention, but they were significantly different after the intervention (p<0.001). There was a significant difference in the mean difference of dialysis inadequacy before and after the intervention (p<0.001). After the intervention, dialysis adequacy increased in the intervention group (0.31±.0.12) but decreased in the control group (0.02±.0.1). Conclusion: Given the reduced blood pressure and increased adequacy in hemodialysis patients, this technique is recommended to be taught in hemodialysis ward

High Volume Center Experience for Recurrent Primary Disease in Kidney Transplanted Pediatric

Introduction: Over the past 3 decades, kidney transplantation has been recognized as the treatment of choice for children with End Stage Renal Disease (ESRD) and stage 5 of chronic kidney disease (CKD). One of the most important drawbacks to this treatment is the recurrence of the primary disease in the transplanted kidney, which is considered the third most common leading cause of graft failure. Materials &amp; Methods: In this study, the data of 550 patients below 18 years who underwent kidney transplantation during a 33-year period from 1985 to 2017 due to kidney failure or ESRD were included to fill out a standard questionnaire. Those who suffered from primary disease relapse were included in the study to investigate the association of relapse with factors such as gender, age, and donor type, time to relapse with type of disease, and post-transplant immunosuppressive drugs with severity of pre-transplant kidney injury. Results: Of 31 pediatric patients with primary disease recurrence (out of 550 transplanted kidney), 62.5% were male with a mean age of 10.55 (± 0.665) years. Totally, 10 cases showed recurrence of the primary disease 18 (± 22.95) months after transplantation on average. The final status of these 10 patients was significantly undesirable compared with that of the other 21 patients without recurrence (p= 0.002). Of these 10 patients, 8 had graft failure. Conclusion: The results of this report confirm the necessity of follow-up considering the importance of the recurrence of the primary disease, especially FSGS, in children after kidney transplantation

Laparoscopic repair of iatrogenic long ureteral injury

Introduction: Transection of the ureter in laparoscopic retroperitoneal lymph node dissection (RPLND) is a rare iatrogenic complication. Its repair is possible by end-to-end anastomosis when the defect is short, but if there is a long defect, laparoscopic repair is a challenge. Methods: A 30-year-old man underwent modified RPLND of a clinically stage-A mixed germ cell of the left testis. While cutting the gonadal vein, 1.5 cm of the ureter was transected 2 cm below the renal pelvis and clipped by one of our residents. The injury was diagnosed immediately. After the completion of the modified RPLND, the clips were removed and a 20-mm defect of the ureter was seen precluding anastomosis. The kidney was dissected and pulled down 35 mm. The lower pole of the kidney was then fixed to the psoas muscle by a 2-0 vicryl, making anastomosis possible after an 8-mm spatulation of both sides. Anastomosis was done over a stent by interrupted sutures using 4-0 vicryl. Results: Leakage was 400 mL at the first postoperative day and ceased at the 4th day. On the control excretion urography, the kidney function was normal and a fullness of the caliceal system was seen. Conclusion: Long defect of the ureter that may occur in laparoscopic urological surgeries could be manageable laparoscopically using methods for shortening of the interval such as relocation of the kidney. Thus, a same approach as open surgeries can yield acceptable results in laparoscopic surgeries

Indoor location based services challenges, requirements and usability of current solutions

Indoor Location Based Services (LBS), such as indoor navigation and tracking, still have to deal with both technical and non-technical challenges. For this reason, they have not yet found a prominent position in people’s everyday lives. Reliability and availability of indoor positioning technologies, the availability of up-to-date indoor maps, and privacy concerns associated with location data are some of the biggest challenges to their development. If these challenges were solved, or at least minimized, there would be more penetration into the user market. This paper studies the requirements of LBS applications, through a survey conducted by the authors, identifies the current challenges of indoor LBS, and reviews the available solutions that address the most important challenge, that of providing seamless indoor/outdoor positioning. The paper also looks at the potential of emerging solutions and the technologies that may help to handle this challenge

Laparoscopic adrenalectomy: 10-year experience, 67 procedures

Introduction: The purpose of this study was to evaluate the short-term and long-term results of laparoscopic adrenalectomies carried out in our center. Materials and Methods: A total of 67 laparoscopic adrenalectomies were performed during the 10 years between 1995 and 2005 at Shahid Labbafinejad Medical Center. A transperitoneal lateral approach was used in 65 (97.0%) of the patients, and retroperitoneal approach was used in 2 (3.0%). The clinical characteristics and the outcomes were reviewed in a retrospective study. Results: Indications for laparoscopic adrenalectomy in our patients were as follows: pheochromocytoma in 28 patients (41.8%), aldosteroneproducing adenoma in 15 (22.4%), pseudocyst in 6 (9.0%), Cushing syndrome (macronodular adrenocortical hyperplasia) in 5 (7.5%), nonfunctioning adenoma (incidentaloma) in 5 (7.5%), myelolipoma in 2 (3.0%), almost normal adrenal tissue in 2 (3.0%), adrenal cyst in 2 (3.0%), adenocarcinoma in 1 (1.4%), and schwannoma in 1 (1.4%). The mean operative time for unilateral cases was 149.0 ± 36.1 minutes. The mean intraoperative blood loss was 126 ± 36 mL. Conversion rate to open surgery was 7.5%. Reoperation due to hemorrhage was performed in 1 patient. Conclusion: Laparoscopic adrenalectomy is a safe procedure in some adrenal tumors and a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion

Primary Adenocarcinoma of the Urethra: A Case Report and Review of the Literature

Abstract Primary adenocarcinoma of the urethra is rarely reported. We report a case of a 47-year-old male with symptoms of urinary obstruction started 2 years before diagnosis. Video-assisted urethrocystoscopy revealed a papillary mass almost obstructing the entire lumen with bleeding. Pathology report was consistent with primary adenocarcinoma of the urethra