Background Postoperative sepsis is a lethal complication for percutaneous nephrolithotomy (PCNL) An early predictive model combined local and systemic conditions is urgently needed to predict infectious events We aim to determine the preoperative predictors of sepsis after PCNL in patients with unilateral, solitary, and proximal ureteral stones Methods A total of 745 patients who underwent PCNL between January 2012 and December 2018 were retrospectively enrolled Sepsis was defined based on the International Sepsis Definitions in 2001, and the preoperative factors were compared between the non-sepsis and sepsis groups Univariable analysis and multivariable logistic regression analysis were conducted to determine the predictors for sepsis after PCNL A nomogram was generated using the predictors Results In this study, 35 patients (47%) developed sepsis after PCNL Univariate analysis showed that post-PCNL sepsis was associated with the female, lower albumin, higher globulin, lower albumin globulin ratio (AGR < 15), preoperative fever, leukocytosis (WBC ≥ 10,000 cells/μL), positive urine culture, leukocyturia (≥50 cells/μL) and positive urine nitrite Multivariate logistic regression analysis suggested that AGR < 15 (odds ratio [OR] = 5068, 95% confidence interval [CI] [1135-22624], P = 0033), positive urine culture (OR = 3243, 95% CI [1162-9047], P = 0025), leukocytosis (OR = 3706, 95% CI [1444-9512], P = 0006) and female (OR = 2529, 95% CI [1127-5672], P = 0024) were independent risk factors for sepsis A nomogram was generated and displayed favorable fitting (Hosmer-Lemeshow test P = 0797), discrimination (area under receiver operating characteristic curve was 0807), and clinical usefulness by decision curve analysis Conclusions Patients with certain preoperative characteristics, such as female, lower AGR, positive urine culture, and leukocytosis, who undergo PCNL may have a higher risk of developing sepsis A cautious preoperative evaluation and optimized treatment strategy should be considered in these patients to minimize infectious complications

/pdf/a-preoperative-nomogram-for-sepsis-in-percutaneous-47pj8k8sgp.pdf

A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones.

INTRODUCTION
Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instrumental, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy (URS) and can be done via natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age related anatomical differences impacts reported outcomes especially stone free rate (SFR) and complications.


MATERIALS AND METHOD
An electronic literature search from inception to 15 October 2021 was performed using Medical Subject Heading (MeSH) terms in several combinations on PUBMED, EMBASE and Web of science without language restrictions. 2022 articles were founded and 165 papers were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children.


RESULTS
RIRS as of today is well established as a superior modality for all stones in all locations compared to ESWL both in children and adults. The passive dilation have decreased the need of active ureteral dilation, but the need to perform pre-stenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean towards its placement in most cases, but we do not know its long-term effects over the growth of children. Finally the stone free rate has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased.


CONCLUSION
RIRS in pediatrics has crossed many milestones , yet many areas need further research and larger data is required to make RIRS the procedure of choice for renal stone management in children across all age group.

Retrograde intrarenal surgery in children: evolution, current status and future trends.

Management of staghorn stones in special situations.

Reducing postoperative morbidity of mini-invasive percutaneous nephrolithotomy: Would it help if blood vessels are left unharmed during puncture? A CONSORT-prospective randomized trial

Tumors significantly impact individuals’ physical well-being and quality of life. With the ongoing advancements in optical technology, information technology, robotic technology, etc., laser technology is being increasingly utilized in the field of tumor treatment, and laser ablation (LA) of tumors remains a prominent area of research interest. This paper presents an overview of the recent progress in tumor LA therapy, with a focus on the mechanisms and biological effects of LA, commonly used ablation lasers, image-guided LA, and robotic-assisted LA. Further insights and future prospects are discussed in relation to these aspects, and the paper proposed potential future directions for the development of tumor LA techniques.

The state-of-the-art and perspectives of laser ablation for tumor treatment

Background & Objectives: Female urinary incontinence is a significant health issue affecting adult women, most suffering from stress incontinence. It affects the quality of life. Recurrence after surgery is difficult for the patients and the surgeon. There is no precise data to show how to treat failed Transobturator tape. Transobturator tape with tension may be an alternative method in applying proper tension in the mid urethra to correct the incontinence. We describe our experience to evaluated outcomes of the second mid-urethral sling with tension to treat recurrent incontinence after the failure of the first mid-urethral sling. Methods: A prospective cohort study was conducted between Oct. 2012 to March 2019. A total of 16 patients with failed Transobturator tape surgery underwent second trans-obturator Mid-Urethral Sling surgery. Preoperative data and postoperative complications were recorded. All patients were followed for one year. Results: Sixteen women after failed Mid-Urethral Sling surgery were evaluated. At a mean follow-up of 7.5 months, the cure rate was 62.5% (10 out of 16) patients. Partial cure (improvement) was achieved in 25% ( 4 patients out of 16) and failure in 2 patients, 12.5%. There were statistically significant improvements after surgery in the Q-tip test and the number of the pads. Conclusion: Repeat Transobturator tape with tension treatment tends to result in good outcomes with a reasonable physician-determined success rate.

Trans-Obturator Tension Appliance Tape for failed Mid-Urethral Sling when and how?

Background and Objectives: To identify the factors contributing to stone-free rates and postoperative complications of flexible ureteroscopy and laser lithotripsy in unilateral multiple renal stones. Methods: A total of 20 patients had retrograde intrarenal surgery procedures to treat unilateral multiple renal stones, less than 50 mm collectively were reviewed from May 2021 to December 2021. Stone numbers were calculated, and stone size was measured as the cumulative stone diameter of all intrarenal stones. The clinical insignificant residual stones were defined as the absence of stone fragments <4 mm in the kidney at the end of the procedures. Baseline patient characteristics, operation time, hospital stay, stone-free rates, and complications were recorded. Results: Retrograde intrarenal surgery was performed on 20 patients (12 males and 8 females). The overall success rate was 80%. Depending on the sizes of the stones, patients with stones <20 mm had a stone-free rate of 100% (10/10 patients) and patients with stone size? 20mm had a stone-free rate of 60% (6/10) with a (p < 0.003). The number of stones per renal unit was two in 13 patients with a stone-free rate of (92.3%), three in 7 patients, and a stone-free rate was (57.1%) with a (p= 0.06). Postoperative complications were encountered in 4 patients (20%), and all were treated conservatively. Conclusions: Retrograde intrarenal surgery provides a satisfactory stone-free rate with a low complication rate when treating multiple renal stones. However, the success rate, stone-free rate, and the number of sessions significantly depend on the size and the number of stones.

Flexible ureteroscopy and laser lithotripsy in unilateral multiple renal stones

Risk factors for fever and sepsis after percutaneous nephrolithotomy.

Background: Health-related quality of life (HRQOL) is an important outcome measure in patients with end-stage renal disease (ESRD). HRQOL is assumed to improve with kidney transplantation and compared to hemodialysis. However, there is no evidence regarding HRQOL to support the optimal treatment choice for patients on hemodialysis who hesitate opting for transplantation. Therefore, this study aims to compare HRQOL between patients with ESRD and healthy individuals. Materials and Methods: This case-control study was performed of 50 patients with ESRD under hemodialysis and 100 healthy participants as controls. HRQOL was assess using the SF-36 questionnaire. Data was analysis by using linear regression to compared HRQOL between groups, and adjusted for age, gender, dialysis duration. Results: Most of the patients were males (62%) and aged 21 to 60 years old (82%). The patients and healthy subjects were significantly different in terms of the presence of chronic diseases (P<0.05). ESRD patients had a significantly lower level of satisfaction with health and function, family and friends, and social and psychological functions. The patients’ quality of life was not significantly affected by their demographic characteristics, including age, gender, educational level, marital status, and financial status. However, there was a significant association between chronic disease and HRQOL among ESRD (P=0.0001). Conclusion: ESRD has a remarkably negative effect on the patients’ quality of life and satisfaction with important domains of life. HRQOL among patients with end-stage renal disease can be affected by the associated chronic diseases. [GMJ.2020;9:e1987] DOI: 10.31661/gmj.v9i0.1987

https://mail.gmj.ir/index.php/gmj/article/download/1987/pdf

Health-Related Quality of Life in End-Stage Renal Disease Patients and Healthy Individuals.

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Trans-Obturator Tension Appliance Tape for failed Mid-Urethral Sling when and how?

Flexible ureteroscopy and laser lithotripsy in unilateral multiple renal stones

Risk factors for fever and sepsis after percutaneous nephrolithotomy.

Health-Related Quality of Life in End-Stage Renal Disease Patients and Healthy Individuals.