Safety and efficacy of the Percutaneous Nephrolithotomy in Pediatrics; A 10-year single-center experience in Iran

Background: The aim of this study was to describe the one-decade experience in Percutaneous Nephrolithotomy surgery in children with kidney stones in Tehran, Iran. Methods: All patients (less than 18 years old) undergoing Percutaneous Nephrolithotomy at our referral medical center, were reviewed in this cross-sectional study. All the demographics, surgical data and post-operative information were obtained to identify the stone free rates and complications. Results: In a total, 119(56.4%) cases of 211 patients who underwent Percutaneous Nephrolithotomy in our study were male and 92(43.6%) cases were female. The mean age of participants was 137.15±60.11 months (range: 9-204). The most common presenting symptom was pain (62.6%). The mean stone burden was 23.5 ± 9.68mm and the mean operative time was 109.95±37.1 min. Overall, stone clearance rate was 73.9% after single PNL. Among those patients who had renal malformation, the stone free rate was (13/19) 68.4% for PCNL. The postoperative complication rate was 5/47 (10.6%) during all procedures and there were no major operative or postoperative complications. Conclusions: According to the findings, pediatric PCNL with the acceptable stone free rates could be considered as a safe and effective procedure among children with complex stones and renal malformation

Association between single nucleotide polymorphisms in the PI3K/AKT/mTOR pathway and bladder cancer risk in a sample of Iranian population

In the past few years several investigations have focused on the role of PI3K/AKT/mTOR pathway and its deregulations in different cancers. This study aimed to examine genetic polymorphisms of this pathway in bladder cancer (BC). In this case-control study, 235 patients with pathologically confirmed bladder cancer and 254 control subjects were examined. PIK3CA, AKT1 and mTOR variants were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The findings proposed that the PIK3CA rs6443624 SNP significantly decreased the risk of BC (OR=0.44, 95 % CI=0.30-0.65, p<0.0001 CA vs CC; OR=0.35, 95 % CI=0.16-0.78, p=0.0107, AA vs CC; OR=0.60, 95 % CI=0.46-0.79, p=0.0002, A vs T). The AKT1 rs2498801 variant is associated with a decreased risk of BC (OR=0.57, 95 % CI=0.39-0.82, p=0.003, AG vs AA; OR=0.74, 95 % CI=0.56-0.97, p=0.032, G vs A) while, AKT1 rs1130233 polymorphism considerably increased the risk of BC (OR=3.70, 95 % CI=2.52-5.43, p<0.0001, GA vs GG; OR=5.81, 95 % CI=1.53-21.97, p=0.010, AA vs GG; OR=2.71, 95 % CI=1.98-3.70, p<0.0001, A vs G). Additionally, mTOR rs2295080 variant notably increased the risk of BC (OR=2.25, 95 % CI=1.50-3.38, p<0.0001, GT vs GG; OR=4.75, 95 % CI=2.80-8.06, p<0.0001, TT vs GG; OR=3.10, 95 % CI=2.34-4.10, p<0.0001, T vs G). None of the other examined polymorphisms (AKT1 rs1130214, AKT1 rs3730358, mTOR rs1883965) revealed significant association with BC. In conclusion, our findings suggest that PIK3CA rs6443624, AKT1 rs2498801, AKT1 rs1130233, as well mTOR rs2295080 polymorphism may be related to bladder cancer development in a sample of Iranian population. Validation of our findings in larger sample sizes of different ethnicities would provide evidence on the role of variants of PI3K/AKT/mTOR pathway in developing BC

Safety and efficacy of the Percutaneous Nephrolithotomy in Pediatrics; A 10-year single-center experience in Iran

Background: The aim of this study was to describe the one-decade experience in Percutaneous Nephrolithotomy surgery in children with kidney stones in Tehran, Iran. Methods: All patients (less than 18 years old) undergoing Percutaneous Nephrolithotomy at our referral medical center, were reviewed in this cross-sectional study. All the demographics, surgical data and post-operative information were obtained to identify the stone free rates and complications. Results: In a total, 119(56.4%) cases of 211 patients who underwent Percutaneous Nephrolithotomy in our study were male and 92(43.6%) cases were female. The mean age of participants was 137.15±60.11 months (range: 9-204). The most common presenting symptom was pain (62.6%). The mean stone burden was 23.5 ± 9.68mm and the mean operative time was 109.95±37.1 min. Overall, stone clearance rate was 73.9% after single PNL. Among those patients who had renal malformation, the stone free rate was (13/19) 68.4% for PCNL. The postoperative complication rate was 5/47 (10.6%) during all procedures and there were no major operative or postoperative complications. Conclusions: According to the findings, pediatric PCNL with the acceptable stone free rates could be considered as a safe and effective procedure among children with complex stones and renal malformation

Neurologic complications in percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. Materials and Methods: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. Results: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. Conclusions: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injectio

Solo Sonographically Guided PCNL under Spinal Anesthesia: Defining Predictors of Success

Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. Tis study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL. Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day afer surgery using sonography and plain radiography. Results. Te mean age was 46 ± 15 years; 40% of kidneys had hydronephrosis. Te mean stone burden was 504 ± 350 mm2. Te mean duration of surgery was 43 ± 21 minutes. Te early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. Te mean residual stone size was 13 ± 8 mm. Logistic regression showed that a lower age and a larger stone burden signifcantly predicted positive residual stones. Fifeen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classifcation. Tere was no cases of organ injury or death. Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate

Rosai‐Dorfman disease: A case report of asymptomatic isolated renal involvement

Abstract A possible diagnosis of RDD should be kept in mind when encountering a patient with raised plasma creatinine levels and renal mass. Timely diagnosis and management of RDD will help prevent future kidney loss

Percutaneous re-surgical approach for delayed bleeding caused by pseudoaneurysm following percutaneous nephrolithotomy

Post percutaneous nephrolithotomy (PCNL) vascular complications included arteriovenous fistula and pseudoaneurysm can cause early or late bleeding and result in unstable condition. Selective trans-arterial embolization is the gold standard technique to manage arterial pseudoaneurysm. Herein, we present a case of pseudoaneurysm following PCNL and describe an alternative technique for its removal using a grasper under C-arm vision. Percutaneous re-surgical approach to post-PCNL hemorrhage due to pseudoaneurysm by using a nephro-grasper to pick up the renal artery pseudoaneurysm would be safe, effective and can provide a direct view of pyelocaliceal system for surgeons; And can be a proper alternative for angioembolization