“Nephron Sparing Surgery” in a Tumor Greater than 7 Cm

We present a case of nephron sparing surgery (NSS), in a patient,68 years olld, born in the Prizren, who had a tumor bigger than 7 (8.5 cm), meaning T2a staging tumor.Renal cell carcinoma (RCC) is a common malignancy with an increasing incidence1. NSS was proven feasible decades ago for patients with imperative indications to preserve maximum kidney function, for instance solitary kidney, bilateral renal tumors, or moderate/severe chronic kidney disease (CKD)2. The goal of partial nephrectomy is complete excision of potentially malignant tissue without malignant cells at the border of the surgical specimen, with maximum preservation of nearby normal renal parenchyma.It is known that nephron sparing surgery is preferred for T1a and T1b, or when the tumor is limited in kidneys and not greater than 7 cm.In this case, the tumor has passed T1 staging, it belonged to T2 staging .We succeeded doing the “nephron sparing surgery”, saving less than half of the kidney.The approach to a SRM( small renal masses) is based on tumor size, stage, and location.Most NSS requires renal vessel occlusion during the excision, and renal tubular tissue is particularly sensitive to ischemia; the WIT ( warm ischemia time ), therefore, should be minimized. Damage to renal tubular tissue is directly related to WIT. Although the upper limit of WIT is debatable, a limit of 20 minutes is a generally accepted guideline.The kidney can be approached with traditional “open” surgery or laparoscopically. For SRMs appropriate for NSS, open partial nephrectomy represents the gold standard. This approach has the most data regarding oncologic and renal function outcomes, with long-term cancer-specific survival rates exceeding 90%3. We can conclude that “nephron sparing surgery” in specific cases can be used also for patients with T2a staging tumor, for those patients were there is hope that they can benefit from this procedure.The patient has stayed in our clinic for ten days, and is released in a good health condition,unfortunately the remaining renal parenchyma was not sufficient to perform its function, because of the chronic pyelonephritis with an emphasized hypoplasia of the other kidney ( left kidney). So the only benefit of this procedure in this patient was that instead of doing the dialysis three times a week, he could do it two times a week

“Forgotten” stents in the urinary tract and procedures for their extractiion

Introduction and objectives After the start of the aplication of ESWL, percutaneous lithotripsy and URS-lithotripsy, to manage urolithiasis , indications forthe use the “JJ” ureteral stents are not uncommon. Meanwhile, tehere is a limit time for their keeping them in, because if retained for more than 6 weeks or two months , there is a possibiity for crystalization , especially in the upper and lower parts of the “J”, where crystallization occurs very often and this makës difficult to extract them. We present 12 cases of holding stents , lasting more than three months ( one case up to 8 years! )and how to manage them. Material and methods The material was taken from the protocol of the Urologic Clnic of Kosovo and Urological Polyclinic “ Pro-Ren “ in Ferizaj, during the period, from April 2017- April 2021. We present 12 cases of calcification of ureteral stents “JJ” and how to manage them. Of these 12 cases , in the 8 cases we see calcifications occur only in the upper “J” ( pyelon); in the 2 cases, calcifications occur mainly in the lower “J”( bladder) and in 2 other cases , calcifications occured in the upper and lower “J” ( pyelon and the bladder). Results For the first 8 cases , we use the ESWL as a management method , where , after one or two sesssions , we managed to destroy the calcification in the upepr “J” ; in sex cases aftr two sessions os ESWL, we managed to remove the stents , while in two cases ,even aftër 4 sessions, with 4000 strokes, we did not manage to destroy the calcifications, so we had to perform the pyelolithotomy, for extracting of stents. In 2 cases with calcifications in the uper and lower “J”, we manage to destroy the cacifications with ESWL in upper “J” and with cystolithotripsy in thë lower “J” and than easly extract the stents. Two other cases, with calcifications only in the lower “J”, we applied only cystolithotripsy and the stents were removed, wiathout any difficulty. Conclusion We can conclude that in cases when it comes to “forgotten” stents for a long time in the urinary tract , we should use less invasive methods to managing these cases , such as ESWL and cystolithotripsy, or a combination of both. But, in some cases , we are forced to performy more invasive procedurës, which are not preferred , but are necessasry, such as pyelolithotomy , to maintain kidney function