Indian Journal of Urology最新文献

Page kidney refers to the extrinsic compression of renal parenchyma causing renovascular hypertension. We present the case of a 58-year-old female with refractory hypertension and recurrent episodes of flash pulmonary edema following trivial trauma. Despite initial management with percutaneous drainage of the perinephric hematoma, she eventually required a nephrectomy due to persistent symptoms. The symptoms resolved post nephrectomy. The case highlights the importance of early diagnosis and timely intervention in Page kidney to prevent long-term complications.

Introduction: There are no reliable clinical markers to predict the size of the obstructing prostate and the success of trial without catheter (TWOC) in men with benign prostate enlargement (BPE) and acute retention of urine (AUR). TWOC fails in men with large prostates. Patients with a large prostate have a shorter extraurethral catheter length (EUCL). This prospective study was conducted to assess whether EUCL could be a surrogate clinical marker for prostatic enlargement and the success of TWOC.

Methods: Alpha-blocker naïve men with AUR due to BPE underwent clinical, laboratory, and ultrasound assessment, and EUCL measurement. They were started on alpha-blockers before being subjected to TWOC. Patients with a successful TWOC were followed on medical management till October 2024 and were classified as pass. Patients who had retention (immediately or during follow-up) were classified as failures. Relationship of EUCL with prostate dimensions was evaluated. Regression analysis was performed to determine the clinical factors predicting the success of TWOC.

Results: Amongst the 76 patients that were recruited, 43 failed the TWOC and 33 were voiding well with a median AUR-free time of 1059 days and a follow-up period of 2106 days. Patients in the failed group had larger prostates. EUCL had a significant negative correlation with the dimensions of the prostate. EUCL ≤170 mm had a significantly higher odds of failed TWOC (Odds ratio 7.92 [95% confidence interval 2.09-29.96], Z = 3.047, P = 0.002).

Conclusions: Shorter EUCL can be an important clinical marker of the prostate size and a predictor of failed TWOC. In resource-poor settings, EUCL can be used to plan referral to urology services or TWOC.

Introduction: Secondary hydronephrosis is an uncommon but potentially serious complication of lower urinary tract dysfunction. This study examines clinical associations of young men with lower urinary tract symptoms (LUTS) presenting with hydronephrosis.

Methods: Secondary analysis of multicentric study examining young men presenting with LUTS. LUTS, stool consistency, sexual dysfunction, bladder pain, nonbladder myofascial pain, perception of problems related to the bladder, and general well-being were captured by questionnaires along with basic clinical data. Hydronephrosis was presumed to be secondary to lower urinary tract dysfunction if there was ureteric dilatation, it was asymptomatic, and there was no other reason based on clinical judgment.

Results: Hydronephrosis was noted in 26/442 men (5.9%). Men with hydronephrosis had lower body mass index (BMI), longer duration of symptoms, larger postvoid residual (PVR), and were more likely to be diabetic and/or have a history of urinary infection (all P < 0.05). Association was noted with need to strain, reduced strength of stream, sense of incomplete evacuation, urgency, and urgency incontinence (all P < 0.05). On multivariate logistic regression analysis, BMI (P = 0.007) and PVR (P = 0.010) were independently associated. One-unit reduction in BMI was associated with 30% increase in odds of hydronephrosis, while 100 ml increase in PVR was associated with 82% increase. Receiver operator curve analysis yielded BMI ≤23 and PVR ≥80 ml as predictive of hydronephrosis.

Conclusions: Secondary hydronephrosis is seen in a small number of young men with LUTS. Such men show a distinct clinical profile that can offer clinical clues useful in the algorithm for evaluation.

Introduction: Renal transplantation relies on effective immunosuppression. Mycophenolic acid (MPA), the active moiety of mycophenolate mofetil (MMF), is a crucial component. We investigated the relationship between exposure to MPA and early posttransplant outcomes.

Methods: One hundred and twenty adult live-related renal transplant recipients receiving standard triple immunosuppression (Tacrolimus [Tac] tailored to C₀ target of 10-15 ng/ml, MMF 1.5-2 g/day and prednisolone) were enrolled. Blood samples were collected to assess MPA exposure, i.e., area under the concentration-time curve (AUC_0-12h), 4-weeks after transplantation. Clinical events like rejections and opportunistic infections were monitored during the first 4 weeks posttransplantation.

Results: About two-thirds of participants were males (77:23); the average age of the cohort was 35.86 ± 10.4 years. The mean MPA exposure was 63.7 ± 23.1 μg × h/mL. 66.6% of the participants had exposure outside the recommended therapeutic window (30-60 μg × h/mL); 55.8% were supra-therapeutic, whereas 10.8% subtherapeutic. Only 33.4% of patients had MPA concentrations within the therapeutic range. The MPA exposure was significantly high for participants who had infection (66.2 ± 26.6 μg × h/mL, n = 24) compared to those who did not (55.3 ± 20.1 μg × h/mL, n = 96, P = 0.02). Thirteen patients had rejection, and there was no difference in MPA exposure compared to those who did not (P = 0.8) at 4 weeks. However, it was observed that Tac C0 in patients with history of rejection was higher (13.6 ± 3.3 ng/ml) compared to those who did not (11.7 ± 3.1 ng/ml, P = 0.005) due to dose up titration at the time of rejection.

Conclusion: We found that standard doses of 1.5-2 g/day MMF lead to overexposure of MPA in the majority of Indian renal transplant recipients in the early posttransplant period, and the higher exposure is linked to infections, underscoring the need for personalized mycophenolate dosing.

Introduction: Gynecological issues are common in children presenting with urinary symptoms but are often misdiagnosed or under-reported. The main objective of this review is to provide clinicians with an understanding of the common gynecological conditions in the pediatric population that can present with urinary symptoms and to improve the knowledge of treatment principles for these conditions, with supporting level of evidence and strength of recommendation.

Methods: A review of meta-analyses, systematic reviews, randomized controlled trials, observational studies, and case series on pediatric gynecological conditions that could present with urological issues was conducted. Each condition was saliently explored and presented. Quality of evidence and recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation recommendations system.

Results: Common conditions that can present to the urologist with urinary symptoms include vulvovaginitis, interlabial masses, Mullerian duct anomalies (MDAs), and sexually transmitted infections. Thorough history taking with emphasis on menstrual and sexual history in selected cases is crucial in guiding the investigations. Physical examination should include palpation of the abdomen and genital inspection. Ultrasound of the pelvis and renal tract is indicated in cases with suspected MDAs and may require magnetic resonance imaging to plan the treatment in complex cases. Reassurance and conservative management are adequate in certain conditions while pharmacological and surgical intervention is required in specific cases. Most of the recommendations are strong despite a moderate level of evidence.

Conclusion: A multidisciplinary approach is desirable to optimize the outcomes in complex cases. Gynecological causes should be considered in girls presenting with dysuria, recurrent urinary tract infections, and urinary retention.

Renal cyst rupture secondary to trauma is an uncommon entity. It can rupture into the perinephric space, peritoneum, and extremely rarely into the pelvicalyceal system. We present the case of an 81-year-old male with traumatic left renal cyst rupture into the peritoneal cavity along with the computed tomography findings, who was managed conservatively.

Purpose: Disease-specific health awareness (HA) campaigns are a crucial opportunity to improve patient education and ideally outcomes. Our study aimed to understand the impact of genitourinary HA months on engaging public search interests in the United States of America.

Methods: We utilized Google Trends to examine public interest in genitourinary conditions during monthly awareness campaigns over 19 years (2004-2022). The relative search volume (RSV) differences between 2004 and 2022 for each term were examined using the Wilcox Signed-Ranked test, while HA months were compared to those of non-HA (NHA) months using Mann-Whitney U-test. Terms were categorized as oncological or benign. Regressions were used to examine differences between search terms in both categories.

Results: The median RSV, for the calendar year, increased significantly for "kidney stone" (+53.5; P < 0.0001), "Benign Prostatic Hyperplasia" (+24.5; P < 0.001), and "erectile dysfunction" (+21.5; P ≤ 0.01). Furthermore, the median HA-RSV increased significantly between 2004 and 2022 for "kidney stone" (+57, P < 0.001) and "Erectile dysfunction" (+20; P < 0.01). There were no statistically significant differences (P > 0.05) between HA-RSV and NHA-RSV for any search terms. Oncologic diseases had a higher median RSV (69 [interquartile ranges (IQR): 58-76]) compared to benign diseases (46 [IQR: 35-55.25]) (P < 0.001).

Conclusion: Public health interest in select terms increased over time. HA months did not significantly affect public interest. Oncologic diseases had higher RSV compared to benign diseases. Research is critical to improve campaign methodology inside and outside HA months for increased public health engagement.

Page kidney is a rare but reversible cause of secondary hypertension due to renin-angiotensin-aldosterone system activation from external renal parenchymal compression. We report acase of a 30-year-old male renal transplant recipient who developed oliguria and refractory hypertension in the early postoperative period. Imaging revealed a spontaneous subcapsular hematoma causing graft compression. Surgical capsulotomy with hematoma evacuation was performed. The patient had an uneventful recovery, with stable graft function at 1-year follow-up. This case highlights the importance of early recognition and timely surgical intervention to prevent irreversible graft dysfunction in posttransplant Page kidney.

Introduction: Existing retrospective evidence suggests cytoreductive nephrectomy (CN) may benefit patients suffering metastatic renal cell carcinoma, but optimal patient selection criteria are unclear. We evaluated outcomes following CN to identify factors influencing survival to guide patient selection.

Methods: We retrospectively reviewed patients who underwent CN from January 2011 to December 2023. Data on demographics, treatment, and survival outcomes were analyzed. Kaplan-Meier estimates calculated progression-free survival (PFS) and overall survival (OS). Cox regression models identified prognostic factors.

Results: Of 1346 surgeries performed for RCC during the study period, 63 were performed with cytoreductive intent. Median (IQR) age was 57 (50-65) years, and 79.4% were male. Median PFS was 13.0 (95% confidence interval [CI], 2.5-23.5) months. Diabetes mellitus (DM) (hazard ratio [HR] 2.4, 95% CI 1.1-5.5, P = 0.03) and presentation with systemic symptoms (SS) (HR 3.0, 95% CI 1.4-6.7, P = 0.01) were associated with shorter PFS. Median OS was 54.0 (95% CI, 22.7-85.3) months. Multiple metastatic sites (HR 4.5, 95% CI 1.4-14.3, P = 0.01), rhabdoid differentiation (RD) (HR 3.5, 95% CI 1.1-10.9, P = 0.03), sarcomatoid differentiation (SD) (HR 4.3, 95% CI 1.2-16.1, P = 0.03), and DM (HR 5.4, 95% CI 1.8-16.0, P < 0.01) predicted worse OS. Conversely, year of diagnosis ≥ 2019 was associated with better PFS (HR 0.9, 95% CI 0.8-0.9, P = 0.03) and OS (HR 0.7, 95% CI 0.6-0.8, P < 0.01).

Conclusion: The presence of a single site of metastasis is associated with better OS after CN and can serve as a useful criterion to select patients that are most likely to derive benefit from CN. Presentation with SS, RD/SD, and DM predicts poorer outcomes, informing decision-making for CN in metastatic renal cell carcinoma.