Pub Date : 2020-12-11DOI: 10.33552/aun.2020.02.000539
Gupta A
This work is licensed under Creative Commons Attribution 4.0 License AUN.MS.ID.000539. Abstract Introduction: Ureteral obstruction caused by extrinsic compression is commonly associated with intra-abdominal malignancy. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. The limitation of polymeric ureteral stents in patients is that they get easily compressed and recurrence of obstruction is seen very quickly. The metallic stents were introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage due to extrinsic malignant obstruction/compression. Materials and methods: In this study, we described the functional outcomes of a Resonance metallic ureteral stent in patients with malignant ureteral obstruction done during August 2016 till August 2018. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional duration of each stent was calculated. Results: A total of 27 stents were successfully inserted in 20 patients with malignant ureteral obstruction. After insertion of metallic stents, hydronephrosis subsided or remained stable in 89% of the ureteral units. Serum creatinine decreased or remained stable in 90% of these patients. In 15% ureteric units metallic stents were required to be removed or changed .The Resonance stent exhibited a mean increase in functional response at minimal 1year follow up. Conclusion: Our results indicate that metallic ureteral stent placement is a technically feasible procedure with minimal complications, increased longevity and is well tolerated among patients.
本作品在知识共享署名4.0许可下授权，授权编号:ms . id .000539。摘要简介:外源性压迫引起的输尿管梗阻通常与腹内恶性肿瘤有关。输尿管支架内引流通常是缓解此类阻塞的一线治疗方法。聚合物输尿管支架在患者中的局限性是它们很容易被压缩，并且很快就会发现梗阻复发。金属支架的引入是为了提高慢性上尿路梗阻患者的通畅率，避免频繁更换支架。我们报告使用金属输尿管支架治疗因外源性恶性阻塞/压迫导致输尿管引流不良的临床经验。材料和方法:在本研究中，我们描述了共振金属输尿管支架在2016年8月至2018年8月期间用于恶性输尿管梗阻患者的功能结果。通过临床症状、影像学检查和肾功能检查来检测支架失效。计算每个支架的功能持续时间。结果:20例恶性输尿管梗阻患者共成功置入支架27枚。植入金属支架后，89%的输尿管单位肾积水消退或保持稳定。90%的患者血清肌酐下降或保持稳定。在15%的输尿管单元中，金属支架需要移除或更换。在至少1年的随访中，共振支架的功能反应平均增加。结论:我们的研究结果表明金属输尿管支架置入术是一种技术上可行的手术，并发症少，延长寿命，患者耐受性好。
{"title":"Evaluation of metallic stents for malignant ureteral obstruction- a single institution experience","authors":"Gupta A","doi":"10.33552/aun.2020.02.000539","DOIUrl":"https://doi.org/10.33552/aun.2020.02.000539","url":null,"abstract":"This work is licensed under Creative Commons Attribution 4.0 License AUN.MS.ID.000539. Abstract Introduction: Ureteral obstruction caused by extrinsic compression is commonly associated with intra-abdominal malignancy. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. The limitation of polymeric ureteral stents in patients is that they get easily compressed and recurrence of obstruction is seen very quickly. The metallic stents were introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage due to extrinsic malignant obstruction/compression. Materials and methods: In this study, we described the functional outcomes of a Resonance metallic ureteral stent in patients with malignant ureteral obstruction done during August 2016 till August 2018. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional duration of each stent was calculated. Results: A total of 27 stents were successfully inserted in 20 patients with malignant ureteral obstruction. After insertion of metallic stents, hydronephrosis subsided or remained stable in 89% of the ureteral units. Serum creatinine decreased or remained stable in 90% of these patients. In 15% ureteric units metallic stents were required to be removed or changed .The Resonance stent exhibited a mean increase in functional response at minimal 1year follow up. Conclusion: Our results indicate that metallic ureteral stent placement is a technically feasible procedure with minimal complications, increased longevity and is well tolerated among patients.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44516256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-23DOI: 10.33552/aun.2020.02.000538
M. Arya
The causes of chronic orchitis and Epididymo-orchitis are varied including, urinary tract infection (UTI), gonococcal or nongonococcal (chlamydia, ureaplasma) infections, genitourinary tuberculosis (GUTB), post-vasectomy and drug-induced. However, the Urology textbooks do not mention leprosy as a differential diagnosis in such cases [1]. Herein, we present a case of Epididymoorchitis caused by leprosy with a review of the literature. Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Leprosy affects mainly the skin and peripheral nerves. Its diagnosis is established on the skin and neurologic examination of the patient. Involvement of testis and epididymis is well described in dermatology literature with an incidence ranging from 23.6% to 68.3% [2,3]. Testicular involvement is more in lepromatous leprosy and may result in infertility and impotence. However, practicing urologist does not keep this condition as a differential diagnosis and many such cases might remain undiagnosed. There are several classification systems validated for leprosy. The most commonly used Ridley & Jopling classification system (1966) is based on the concept of spectral leprosy and uses clinical, immunological, and histopathological criteria [4]. The spectrum consists of tuberculoid form at one end and the lepromatous form at the other end. The borderline form is divided into borderline-tuberculoid, borderlinelepromatous, according to the greater proximity to one of the poles, and borderline-borderline. Multi-Drug Therapy is the cornerstone of the treatment of leprosy.
{"title":"Chronic Epididymo-Orchitis Mimicking Tuberculosis Turned Out to be Leprosy: A Case Report","authors":"M. Arya","doi":"10.33552/aun.2020.02.000538","DOIUrl":"https://doi.org/10.33552/aun.2020.02.000538","url":null,"abstract":"The causes of chronic orchitis and Epididymo-orchitis are varied including, urinary tract infection (UTI), gonococcal or nongonococcal (chlamydia, ureaplasma) infections, genitourinary tuberculosis (GUTB), post-vasectomy and drug-induced. However, the Urology textbooks do not mention leprosy as a differential diagnosis in such cases [1]. Herein, we present a case of Epididymoorchitis caused by leprosy with a review of the literature. Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Leprosy affects mainly the skin and peripheral nerves. Its diagnosis is established on the skin and neurologic examination of the patient. Involvement of testis and epididymis is well described in dermatology literature with an incidence ranging from 23.6% to 68.3% [2,3]. Testicular involvement is more in lepromatous leprosy and may result in infertility and impotence. However, practicing urologist does not keep this condition as a differential diagnosis and many such cases might remain undiagnosed. There are several classification systems validated for leprosy. The most commonly used Ridley & Jopling classification system (1966) is based on the concept of spectral leprosy and uses clinical, immunological, and histopathological criteria [4]. The spectrum consists of tuberculoid form at one end and the lepromatous form at the other end. The borderline form is divided into borderline-tuberculoid, borderlinelepromatous, according to the greater proximity to one of the poles, and borderline-borderline. Multi-Drug Therapy is the cornerstone of the treatment of leprosy.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69448851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-17DOI: 10.33552/aun.2020.02.000537
C. Ekpenyong
Background: Biological factors affecting the therapeutic doses of ascorbic acid (AA) against xenobiotic-induced oxidative stress (OS) and reproductive toxicity have been established, however, the effect of gender is yet to be thoroughly researched and ascertained. The present study aimed to assess gender disparities in the effect of AA against gasoline vapor (GV)-induced reproductive toxicity in rats. Methods: Thirty-five matured male and female Wistar Albino rats weighing between 200 and 250g were divided into 5 groups (n=7per group). Group 1 served as unexposed control, groups 2, 3, 4, and 5 were exposed to GV for 6 weeks. Groups 3, 4, and 5 in addition to being exposed to GV were treated with low, medium, and high doses of AA for 2 weeks of the 6 weeks of exposure and treatment. Animals were sacrificed and blood samples and reproductive organs were obtained for analysis and histopathological examination respectively. Results: Exposure to GV alone significantly P<0.05 decreased serum estrogen, progesterone, and testosterone levels. Serum levels of estrogen and progesterone were significantly (P<0.05) higher in the low-dose AA-treated female animals, whereas the highest serum level of testosterone was found in the high-dose AA treated male animals. A corresponding significant decrease in serum FSH and LH levels were also found in the low and high doses of AA treated female and male groups respectively. Conclusion: There is a gender difference in the effect of AA against GV-induced OS and reproductive toxicity. Therefore, gender-related dose adjustment should be considered when using AA to manage OS-related male or female reproductive disorders. dimorphism in OS and immune responsiveness and susceptibility to endocrine and reproductive disorders. The present study aimed to evaluate gender differences in the effect of AA against GV-induced OS and reproductive toxicity in rats.
{"title":"Gender Differences in the Effect of Ascorbic Acid against petroleum fume-induced Oxidative Stress and Reproductive Toxicity in Rats","authors":"C. Ekpenyong","doi":"10.33552/aun.2020.02.000537","DOIUrl":"https://doi.org/10.33552/aun.2020.02.000537","url":null,"abstract":"Background: Biological factors affecting the therapeutic doses of ascorbic acid (AA) against xenobiotic-induced oxidative stress (OS) and reproductive toxicity have been established, however, the effect of gender is yet to be thoroughly researched and ascertained. The present study aimed to assess gender disparities in the effect of AA against gasoline vapor (GV)-induced reproductive toxicity in rats. Methods: Thirty-five matured male and female Wistar Albino rats weighing between 200 and 250g were divided into 5 groups (n=7per group). Group 1 served as unexposed control, groups 2, 3, 4, and 5 were exposed to GV for 6 weeks. Groups 3, 4, and 5 in addition to being exposed to GV were treated with low, medium, and high doses of AA for 2 weeks of the 6 weeks of exposure and treatment. Animals were sacrificed and blood samples and reproductive organs were obtained for analysis and histopathological examination respectively. Results: Exposure to GV alone significantly P<0.05 decreased serum estrogen, progesterone, and testosterone levels. Serum levels of estrogen and progesterone were significantly (P<0.05) higher in the low-dose AA-treated female animals, whereas the highest serum level of testosterone was found in the high-dose AA treated male animals. A corresponding significant decrease in serum FSH and LH levels were also found in the low and high doses of AA treated female and male groups respectively. Conclusion: There is a gender difference in the effect of AA against GV-induced OS and reproductive toxicity. Therefore, gender-related dose adjustment should be considered when using AA to manage OS-related male or female reproductive disorders. dimorphism in OS and immune responsiveness and susceptibility to endocrine and reproductive disorders. The present study aimed to evaluate gender differences in the effect of AA against GV-induced OS and reproductive toxicity in rats.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42275302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-13DOI: 10.33552/aun.2020.02.000536
M. Arya
Introduction: Anastomotic urethroplasty in traumatic bulbar stricture is successful in 90-95% of cases, but for post-void dribble and ejaculatory dysfunction (EjD). Here, we present modified muscle and nerve-sparing urethroplasty to overcome these problems. Material and Methodology: A retrospective analysis (from January 2015- January 2019) of 55 patients with traumatic bulbar stricture managed by standard urethroplasty (Group 1, N=30) and modified urethroplasty (Group2, N=25) was done. The comparison also included their post-operative EjD and post-void dribble. Results: Mean age of patients was 31.12 (15-55) years. Mean length of stricture was 1.41 [1-2] cm. Mean Qmax was 27.8 and 26.4ml/s in the modified and standard urethroplasty group (P-value>0.05). EjD was calculated for each patient using questions from male sexual health questionnaire (MSHQ)and MSHQ mean scores pertaining to ejaculation had a significant difference between Group1 and Group2 with mean post- operative scores of 14.17 and 21.12 respectively (p-value- <0.005) At 1-year, ten patients (33%) from Group 1 while one patient (4%) in the Group 2 showed post-void dribbling respectively (P-value-0.007). Discussion: Success rate (patient not needing post-operative intervention) was 100% in modified and 96.66% in standard urethroplasty group. Results in terms of EjD and post-void dribble were statistically significant. Conclusion: In traumatic bulbar stricture, muscle and nerve-sparing urethroplasty is associated with statistically significant better outcomes in terms of EjD and post-void dribble.
{"title":"Traumatic Bulbar Urethral Stricture: Improvised Reconstruction with Muscle and Nerve Sparing Approach","authors":"M. Arya","doi":"10.33552/aun.2020.02.000536","DOIUrl":"https://doi.org/10.33552/aun.2020.02.000536","url":null,"abstract":"Introduction: Anastomotic urethroplasty in traumatic bulbar stricture is successful in 90-95% of cases, but for post-void dribble and ejaculatory dysfunction (EjD). Here, we present modified muscle and nerve-sparing urethroplasty to overcome these problems. Material and Methodology: A retrospective analysis (from January 2015- January 2019) of 55 patients with traumatic bulbar stricture managed by standard urethroplasty (Group 1, N=30) and modified urethroplasty (Group2, N=25) was done. The comparison also included their post-operative EjD and post-void dribble. Results: Mean age of patients was 31.12 (15-55) years. Mean length of stricture was 1.41 [1-2] cm. Mean Qmax was 27.8 and 26.4ml/s in the modified and standard urethroplasty group (P-value>0.05). EjD was calculated for each patient using questions from male sexual health questionnaire (MSHQ)and MSHQ mean scores pertaining to ejaculation had a significant difference between Group1 and Group2 with mean post- operative scores of 14.17 and 21.12 respectively (p-value- <0.005) At 1-year, ten patients (33%) from Group 1 while one patient (4%) in the Group 2 showed post-void dribbling respectively (P-value-0.007). Discussion: Success rate (patient not needing post-operative intervention) was 100% in modified and 96.66% in standard urethroplasty group. Results in terms of EjD and post-void dribble were statistically significant. Conclusion: In traumatic bulbar stricture, muscle and nerve-sparing urethroplasty is associated with statistically significant better outcomes in terms of EjD and post-void dribble.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49365318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-12DOI: 10.33552/aun.2020.02.000535
I. Singh
Background: Spermatoceles are extra testicular lesions caused by cystic dilation of the efferent ductules filled with clear/milky fluid containing spermatozoa usually diagnosed incidentally either as a scrotal swelling or by ultrasonography. Suspecting and diagnosing spermatoceles presenting at extra scrotal positions is extremely rare and very few cases have been described in literature thus far. This article attempts to depict a patient presenting with one such spermatocele at an unusual location which adds to the scarce literature on the subject. Case Presentation: A 60-year-old male presented with complaints of a gradually progressing left inguinal swelling for past 3 months with prior trivial scrotal trauma. Clinical evaluation and investigations revealed a 5 × 3 cm inguinal swelling extending up to the superior aspect of the left hemiscrotum that was confirmed as a spermatocele on pathological analysis at an unusual extra scrotal location. Conclusion: Spermatoceles presenting at extra scrotal locations are extremely rare occurrences as is evident by the scant available published literature. This report adds to the scarce literature and also alerts the practicing urologist/surgeon towards insisting on a complete physical examination including simple but effective examination techniques like the transillumination technique as an aid to diagnosis of spermatoceles that may present uniquely at uncommon (extrascrotal) locations as in the present case.
{"title":"Extra Scrotal Spermatocele – A Unique Case Presentation & Brief Review of literature","authors":"I. Singh","doi":"10.33552/aun.2020.02.000535","DOIUrl":"https://doi.org/10.33552/aun.2020.02.000535","url":null,"abstract":"Background: Spermatoceles are extra testicular lesions caused by cystic dilation of the efferent ductules filled with clear/milky fluid containing spermatozoa usually diagnosed incidentally either as a scrotal swelling or by ultrasonography. Suspecting and diagnosing spermatoceles presenting at extra scrotal positions is extremely rare and very few cases have been described in literature thus far. This article attempts to depict a patient presenting with one such spermatocele at an unusual location which adds to the scarce literature on the subject. Case Presentation: A 60-year-old male presented with complaints of a gradually progressing left inguinal swelling for past 3 months with prior trivial scrotal trauma. Clinical evaluation and investigations revealed a 5 × 3 cm inguinal swelling extending up to the superior aspect of the left hemiscrotum that was confirmed as a spermatocele on pathological analysis at an unusual extra scrotal location. Conclusion: Spermatoceles presenting at extra scrotal locations are extremely rare occurrences as is evident by the scant available published literature. This report adds to the scarce literature and also alerts the practicing urologist/surgeon towards insisting on a complete physical examination including simple but effective examination techniques like the transillumination technique as an aid to diagnosis of spermatoceles that may present uniquely at uncommon (extrascrotal) locations as in the present case.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43032061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-12DOI: 10.33552/AUN.2020.02.000534
A. Ryan
Introduction: Post-prostatectomy incontinence affects anywhere from 1-40% of men after a radical prostatectomy, but treatment is often delayed and surgery is underperformed.1 Currently, the American Urological Association (AUA) and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) recommends post-prostatectomy patients are offered conservative therapies including pelvic floor muscle training in the immediate post-operative period, and surgical treatment may be offered to those who have confirmed stress incontinence (SUI) and fail to respond to conservative therapies. Surgical treatment options are based on the degree of stress urinary incontinence. The artificial urinary sphincter is typically recommended for moderate to severe SUI, while the male sling can be considered in those with mild to moderate SUI.2 However, the AUS is considered a more reliable treatment, particularly for severe SUI after prostatectomy. Methods: The study was conducted using the PubMed database for recent papers between 2001 and 2020 with variations of phrases such as post-prostatectomy incontinence, treatment, AUS, male sling [1]. articles were selected for review. The AUA/SUFU guidelines for incontinence after prostate treatment were also referenced. Result: The AUS is considered the gold standard of post-prostatectomy incontinence therapy. However, male slings are gaining popularity in the treatment of mild to moderate PPI. The overall consensus is a need for prospective research based upon standardized patient workup and outcomes reporting to better compare the surgical options for PPI. Conclusion: Standardized workup and outcomes reporting would benefit the patient in determining which surgical option best treats post- prostatectomy incontinence. As of right now, there is no standardized approach apart from history and physical exam of the patient. Cystoscopy and urodynamics could be a beneficial tool in evaluation patients pre- and post-operatively. Prospective randomized control trials could then utilize a standardized approach to better compare the surgical options for PPI.
{"title":"Surgical Options for Post-Prostatectomy Incontinence: A Review","authors":"A. Ryan","doi":"10.33552/AUN.2020.02.000534","DOIUrl":"https://doi.org/10.33552/AUN.2020.02.000534","url":null,"abstract":"Introduction: Post-prostatectomy incontinence affects anywhere from 1-40% of men after a radical prostatectomy, but treatment is often delayed and surgery is underperformed.1 Currently, the American Urological Association (AUA) and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) recommends post-prostatectomy patients are offered conservative therapies including pelvic floor muscle training in the immediate post-operative period, and surgical treatment may be offered to those who have confirmed stress incontinence (SUI) and fail to respond to conservative therapies. Surgical treatment options are based on the degree of stress urinary incontinence. The artificial urinary sphincter is typically recommended for moderate to severe SUI, while the male sling can be considered in those with mild to moderate SUI.2 However, the AUS is considered a more reliable treatment, particularly for severe SUI after prostatectomy. Methods: The study was conducted using the PubMed database for recent papers between 2001 and 2020 with variations of phrases such as post-prostatectomy incontinence, treatment, AUS, male sling [1]. articles were selected for review. The AUA/SUFU guidelines for incontinence after prostate treatment were also referenced. Result: The AUS is considered the gold standard of post-prostatectomy incontinence therapy. However, male slings are gaining popularity in the treatment of mild to moderate PPI. The overall consensus is a need for prospective research based upon standardized patient workup and outcomes reporting to better compare the surgical options for PPI. Conclusion: Standardized workup and outcomes reporting would benefit the patient in determining which surgical option best treats post- prostatectomy incontinence. As of right now, there is no standardized approach apart from history and physical exam of the patient. Cystoscopy and urodynamics could be a beneficial tool in evaluation patients pre- and post-operatively. Prospective randomized control trials could then utilize a standardized approach to better compare the surgical options for PPI.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46512979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Alataş, Y. Tabel, A. Elmas, Senay Zirhli Selcuk
Objective: Nephrotic syndrome (NS) is one of the most frequent occurring chronic kidney diseases in children. In this study, our aim was to assess the sociodemographic structure, determination of clinical data, diagnostic approaches, treatment methods applied and the factors effective on prognosis in patients followed with a diagnosis of nephrotic syndrome in our clinic. Method: The files of 256 patients diagnosed with primary nephrotic syndrome between the ages of 0 and 18 who were followed in Department of Pediatric Nephrology during a period of 15 years between 2004 and 2019 were examined retrospectively. 220 patients whose data were sufficient and who had a sufficient follow-up time were included in the study. Results: 137 of our patients were male, 83 were female and the ratio of male/female was 1.65. Average onset age of the cases was 4.8 ± 2.6 years (1 months-16 years). Renal disease history in the family was 16.4% and the rate of consanguineous marriage was 25.9%. 24% of our patients were found to have microscopic hematuria, 28.2% were found to have hypertension. Of the patients who received biopsy, 32 were determined as FSGS, 18 as MCD, 11 as MPGN, 3 as IgM nephropathy, 2 as hereditary nephrite, 2 as MezPGN, 1 as MGN, 1 as congenital NS and 2 as other reasons. While a total of 193 patients (87.7%) were sensitive to steroid, 27 patients (12.2%) were found to be resistant to steroid. While 78 (35.5%) of the patients were followed with no relapse, 120 (54.5%) patients were relapsing and 22 (10%) patients had frequent relapses. In their follow-up, mortality rate of our patients was found as 2.7%. Conclusion: With this study, we assessed children with primary nephrotic syndrome in our area comprehensively for the first time. Consanguineous marriage rate was higher in our patients. Our findings were also remarkable in terms of demonstrating that primary NS follows its own course in each child depending on the underlying genetic structure.
{"title":"Evaluation of Children with Nephrotic Syndrome: A Single- Center Experience","authors":"C. Alataş, Y. Tabel, A. Elmas, Senay Zirhli Selcuk","doi":"10.36959/832/404","DOIUrl":"https://doi.org/10.36959/832/404","url":null,"abstract":"Objective: Nephrotic syndrome (NS) is one of the most frequent occurring chronic kidney diseases in children. In this study, our aim was to assess the sociodemographic structure, determination of clinical data, diagnostic approaches, treatment methods applied and the factors effective on prognosis in patients followed with a diagnosis of nephrotic syndrome in our clinic. Method: The files of 256 patients diagnosed with primary nephrotic syndrome between the ages of 0 and 18 who were followed in Department of Pediatric Nephrology during a period of 15 years between 2004 and 2019 were examined retrospectively. 220 patients whose data were sufficient and who had a sufficient follow-up time were included in the study. Results: 137 of our patients were male, 83 were female and the ratio of male/female was 1.65. Average onset age of the cases was 4.8 ± 2.6 years (1 months-16 years). Renal disease history in the family was 16.4% and the rate of consanguineous marriage was 25.9%. 24% of our patients were found to have microscopic hematuria, 28.2% were found to have hypertension. Of the patients who received biopsy, 32 were determined as FSGS, 18 as MCD, 11 as MPGN, 3 as IgM nephropathy, 2 as hereditary nephrite, 2 as MezPGN, 1 as MGN, 1 as congenital NS and 2 as other reasons. While a total of 193 patients (87.7%) were sensitive to steroid, 27 patients (12.2%) were found to be resistant to steroid. While 78 (35.5%) of the patients were followed with no relapse, 120 (54.5%) patients were relapsing and 22 (10%) patients had frequent relapses. In their follow-up, mortality rate of our patients was found as 2.7%. Conclusion: With this study, we assessed children with primary nephrotic syndrome in our area comprehensively for the first time. Consanguineous marriage rate was higher in our patients. Our findings were also remarkable in terms of demonstrating that primary NS follows its own course in each child depending on the underlying genetic structure.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82910280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immunoglobulin (Ig)A nephropathy is the commonest type of primary glomerulonephritis (GN) in the world, with an estimated incidence of 2.5/100000 adults/year. It can co-exist with systemic conditions and is a common cause of crescentic GN. Antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis can present as necrotizing, crescentic GN with pauci immune features on immunofluorescence on renal biopsy. There have been previous case reports of the presence of ANCA and IgA nephropathy in the same patient. Such patients more often have systemic signs and tend to have worse kidney function at presentation as compared to ANCA negative IgA nephropathy patients. However, they tend to show better response to immunosuppressive medication. We report a case of a young Asian lady who presented with acute kidney injury secondary to crescentic GN. She was found to have positive serum anti myeloperoxidase antibodies and also IgA deposits in the mesangium on renal biopsy. She was managed with steroids and cyclophosphamide, but her renal function did not improve after 6 months of induction therapy. This case reiterates the conundrum faced by the clinician in the interpretation of a combination of positive anti MPO antibodies with mesangial hypercellularity, positive mesangial staining for IgA and presence of crescentic nephritis. It also describes the variation in response to therapy in such cases.
{"title":"A Patient of Crescentic Glomerulonephritis with Positive Anti Myeloperoxidase Antibodies and Immunoglobulin a Deposits on Immunofluorescence: The Conundrum Continues","authors":"Chawla Mayank, Hoon Tan Puay, B. Shashidhar","doi":"10.36959/832/402","DOIUrl":"https://doi.org/10.36959/832/402","url":null,"abstract":"Immunoglobulin (Ig)A nephropathy is the commonest type of primary glomerulonephritis (GN) in the world, with an estimated incidence of 2.5/100000 adults/year. It can co-exist with systemic conditions and is a common cause of crescentic GN. Antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis can present as necrotizing, crescentic GN with pauci immune features on immunofluorescence on renal biopsy. There have been previous case reports of the presence of ANCA and IgA nephropathy in the same patient. Such patients more often have systemic signs and tend to have worse kidney function at presentation as compared to ANCA negative IgA nephropathy patients. However, they tend to show better response to immunosuppressive medication. We report a case of a young Asian lady who presented with acute kidney injury secondary to crescentic GN. She was found to have positive serum anti myeloperoxidase antibodies and also IgA deposits in the mesangium on renal biopsy. She was managed with steroids and cyclophosphamide, but her renal function did not improve after 6 months of induction therapy. This case reiterates the conundrum faced by the clinician in the interpretation of a combination of positive anti MPO antibodies with mesangial hypercellularity, positive mesangial staining for IgA and presence of crescentic nephritis. It also describes the variation in response to therapy in such cases.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81341367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-05DOI: 10.33552/AUN.2020.02.000533
M. Arya
by detumescence, and penile If the Buck’s fascia remains intact the hematoma is limited to shaft. If it is also disrupted the hematoma can reach to perineum and suprapubic area. Diagnosis is clinical and management is surgical. We report our experience of managing penile cases 6 with especial impression upon a group of patients having an unusual clinical presentation with unexplained recurrent nocturnal urethral bleeding without penile swelling. a retrospective analytical study of cases of penile with with Abstract Penile fracture is an emergency condition. Common presentation is classical history of trauma to erect penis followed by detumescence, penile swelling, ecchymosis and discoloration. Management is primarily surgical. We report our experience of such cases including a subgroup of patients with unexplained recurrent nocturnal urethral bleed without penile swelling and normal voiding. Materials and Methods: This a retrospective study performed at our institution. Records of penile fracture cases managed over last 6 years were reviewed. Total of 63 patients were managed either by surgical (53 patients) or conservative (10 patients) approach. Sexual outcomes were measured with abbreviated International Index of Erectile Function (IIEF 5) questionnaire and compared with preoperative scores. Results: Most common aetiology was coital trauma, seen in 88.9 % of patients. Mean age was 34.95 years. Urethral injury was present in 5 (9.4%) patients in the surgical group. Most common site of injury was ventrolateral {32 (60.4%)} over proximal shaft {49 (92.5%)}. Mean follow up was 19.27 months ranging from 6 to 41 months. Erectile function was preserved (no deterioration in IIEF 5 category) in 96.3 % and 100% of patients from surgical and conservative groups. Conclusion: Unexplained recurrent nocturnal urethral bleed as a presentation of penile fracture, should be kept in mind. Such peculiar presentation, to our knowledge, has not been reported in literature. This subgroup of patients can be managed conservatively with good sexual and voiding functional outcome.
{"title":"Unexplained Recurrent Nocturnal Urethral Bleeding: An Unusual Presentation of Penile Fracture","authors":"M. Arya","doi":"10.33552/AUN.2020.02.000533","DOIUrl":"https://doi.org/10.33552/AUN.2020.02.000533","url":null,"abstract":"by detumescence, and penile If the Buck’s fascia remains intact the hematoma is limited to shaft. If it is also disrupted the hematoma can reach to perineum and suprapubic area. Diagnosis is clinical and management is surgical. We report our experience of managing penile cases 6 with especial impression upon a group of patients having an unusual clinical presentation with unexplained recurrent nocturnal urethral bleeding without penile swelling. a retrospective analytical study of cases of penile with with Abstract Penile fracture is an emergency condition. Common presentation is classical history of trauma to erect penis followed by detumescence, penile swelling, ecchymosis and discoloration. Management is primarily surgical. We report our experience of such cases including a subgroup of patients with unexplained recurrent nocturnal urethral bleed without penile swelling and normal voiding. Materials and Methods: This a retrospective study performed at our institution. Records of penile fracture cases managed over last 6 years were reviewed. Total of 63 patients were managed either by surgical (53 patients) or conservative (10 patients) approach. Sexual outcomes were measured with abbreviated International Index of Erectile Function (IIEF 5) questionnaire and compared with preoperative scores. Results: Most common aetiology was coital trauma, seen in 88.9 % of patients. Mean age was 34.95 years. Urethral injury was present in 5 (9.4%) patients in the surgical group. Most common site of injury was ventrolateral {32 (60.4%)} over proximal shaft {49 (92.5%)}. Mean follow up was 19.27 months ranging from 6 to 41 months. Erectile function was preserved (no deterioration in IIEF 5 category) in 96.3 % and 100% of patients from surgical and conservative groups. Conclusion: Unexplained recurrent nocturnal urethral bleed as a presentation of penile fracture, should be kept in mind. Such peculiar presentation, to our knowledge, has not been reported in literature. This subgroup of patients can be managed conservatively with good sexual and voiding functional outcome.","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43165801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-23DOI: 10.33552/AUN.2020.02.000532
M. Arya
Urethral calculi are common in developing countries. There are only a few studies that have been conducted so far on these subsets of patients with very limited literature from developing countries. Urethral calculi are divided into primary which forms in urethra and secondary, which migrates from upper urinary tract. Primary urethral calculi are usually small and multiple, and secondary migratory calculi are usually large. Small calculus is commonly found in the anterior urethra and larger calculi usually occur in the posterior urethra. Primary urethral stones are generally composed of magnesium ammonium phosphate (struvite) or uric acid. Calcium oxalate and cystine stones originate from kidney. The causes of secondary stones are stricture, infection, and/or inflammation or within a poorly drained communicating cavity, with an obstruction, stagnation, acting as the predisposing factor. ISSN: 2692-532X DOI: 10.33552/AUN.2020.02.000532
{"title":"Urethral Calculi: Presentation, Evaluation and Management","authors":"M. Arya","doi":"10.33552/AUN.2020.02.000532","DOIUrl":"https://doi.org/10.33552/AUN.2020.02.000532","url":null,"abstract":"Urethral calculi are common in developing countries. There are only a few studies that have been conducted so far on these subsets of patients with very limited literature from developing countries. Urethral calculi are divided into primary which forms in urethra and secondary, which migrates from upper urinary tract. Primary urethral calculi are usually small and multiple, and secondary migratory calculi are usually large. Small calculus is commonly found in the anterior urethra and larger calculi usually occur in the posterior urethra. Primary urethral stones are generally composed of magnesium ammonium phosphate (struvite) or uric acid. Calcium oxalate and cystine stones originate from kidney. The causes of secondary stones are stricture, infection, and/or inflammation or within a poorly drained communicating cavity, with an obstruction, stagnation, acting as the predisposing factor. ISSN: 2692-532X DOI: 10.33552/AUN.2020.02.000532","PeriodicalId":93263,"journal":{"name":"Annals of urology & nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46634152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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