The Percutaneous Nephrolithotomy Global Study: Classification of Complications

Purpose: This study evaluated postoperative complications of percutaneous nephrolithotomy (PCNL) and the influence of selected factors on the risk of complications using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. Patients and Methods: The CROES PCNL Global Study collected prospective data for consecutive patients who were treated with PCNL at centers around the world for 1 year. Complications were evaluated by the modified Clavien classification system. Results: Of 5724 patients with Clavien scores, 1175 (20.5%) patients experienced one or more complications. The most frequent complications were fever and bleeding. Urinary leakage, hydrothorax, hematuria, urinary tract infection, pelvic perforation, and urinary fistula also occurred in >= 20 patients in each group. The majority of complications (n = 634, 54.0%) were classified as Clavien grade I. Two patients died in the postoperative period. The largest absolute increases in mean Clavien score were associated with American Society of Anesthesiologists (ASA) physical status classification IV (0.75) or III (0.34), anticoagulant medication use (0.29), positive microbiologic culture from urine (0.24), and the presence of concurrent cardiovascular disease (0.15). Multivariate regression analysis revealed that operative time and ASA score were significant predictors of higher mean Clavien scores. Conclusion: The majority of complications after PCNL are minor. Longer operative time and higher ASA scores are associated with the risk of more severe postoperative complications in PCNL

Renal Transplantation in Secondary Amyloidosis Associated with Tuberculosis

Although end-stage renal disease (ESRD) related to AA amyloidosis nephropathy secondary to tuberculosis is most common in our country, there are limited data concerning patient and graft outcome after renal transplantation (RTx). To the best of our knowledge, this is the first report of RTx in ESRD patient with secondary amyloidosis due to tuberculosis from India. A 30-year-old female with past history of pulmonary tuberculosis 3 years back was admitted with complaint of gradually progressive pedal oedema and nausea for 3 months. Renal biopsy was suggestive of secondary renal amyloidosis with vascular involvement and chronic tubulointerstitial involvement. She was transplanted with kidney from her 28-year-old brother with 3/6 human leukocyte antigen match. She had immediate good graft function without any perioperative complications (cardiovascular, infections, rejection and delayed graft function). She was discharged with serum creatinine of 0.8 mg/dL. Her last serum creatinine level was 0.9 mg/dL with cyclosporine level of 100 mg/dL at 9-month followup without any medical or surgical complication. The quality of life also improved after transplantation. With careful selection, ESRD patients with secondary amyloidosis due to tuberculosis are eligible for RTx with favorable outcome and improved quality of life

Pertinent issues in pretransplant recipient workup

Renal transplantation is recognized as the treatment of choice in most patients with end-stage renal disease. The evaluation of the candidate for kidney transplantation has been the recent subject of clinical practice guidelines published by the European Renal Association- European Dialysis Transplant Association and the American Society of Transplantation. The purpose of this article is to review the current literature for urological evaluation and treatment of patients prior to renal transplantation. In India, urologists are involved in evaluating not only the genitourinary problems but also vascular access and, vascular anatomy and pathology especially related to major pelvic vessels. Hence, evaluation of the transplant recipient should include assessment of vascular access for hemodialysis, access for peritoneal dialysis, assessment of pelvic vessels to which renal allograft vessels need to be anastomosed and genitourinary system. In addition, review of the serological tests for infective viral diseases like hepatitis and human immunodeficiency viruses should always be done before starting clinical evaluation. A note of the evaluation performed by other specialists like nephrologist, cardiologist, endocrinologist, pulmonologist, anesthetist etc. should always be reviewed

Unilateral dependant pulmonary edema during laparoscopic donor nephrectomy: report of three cases

Unilateral pulmonary edema of the dependant lung was observed in three patients during laparoscopic donor nephrectomy. Patients were treated with 02 supplementation by face mask, fluid restriction and diuretic. All the patients were relieved of symptoms with radiological improvement. The possible causes of this unusual complication following laparoscopic surgery appear to be prolonged lateral decubitus position and high intraoperative fluid infusion

Does Physical Frailty and Pulmonary Function Affect the Number of Hospital Stay Among Liver Cirrhosis Patients? - A Retrospective Study

Background and need of research: Cirrhosis is permanent scarring(fibrosis) of liver and its major complication is frailty, defined as deterioration in physical and physiological function. Other complications such as Ascites, Hepatopulmonary syndrome, Respiratory muscles and generalized muscle weakness cause alteration in pulmonary function which is associated with frequent hospitalization and delisting from transplantation. The main aim of this study is to evaluate physical frailty and degree of pulmonary function abnormalities among cirrhotic patient using Short physical performance battery (SPPB) and pulmonary function using forced based spirometry pulmonary test (PFT) and to determine its relation with hospitalizations in cirrhotics. Methods: After approval from the institutional ethical committee, data of one hundred and thirty-three liver cirrhotic patients were retrieved from Physiotherapy department and Abdominal Organ Transplant between January’22-November’22. Data available like demographic and clinical parameters, severity of frailty assessed by Short Physical Performance Battery (SPPB) and Pulmonary Function Test (PFT) were evaluated. Statistical analysis was done using SPSS V.25(IBM). Result: Out of 133 subjects, 18(8%), 8(21%), 52(39%) were severely, moderate, and mildly frail respectively. In PFT findings, 15(11%), 43(32%), 16 (12%) had mild, moderate, and severe restriction. 4-meter gait speed test was weakly correlated with number of hospital admissions (r=0.199, p&lt;0.05). Sit to Stand test (STS) was moderately correlated with number of hospital admissions (r=0.24, p&lt;0.05). Comparison with categories of PFT and hospital admissions was not significant (Kruskal-Walli’s test, p&lt;0.53). Conclusion and Clinical Implications: SPPB (4m gait speed and Chair STS test) showed weak correlation with number of hospitalizations. However, PFT showed no correlation with number of hospitalizations. Findings of this study imply that assessment of frailty can be used to guide future rehabilitation for such patients. Keywords: Short Physical Performance Battery, Liver cirrhosis, Pulmonary function Test, Frailty, Retrospective study.</jats:p