Case Report: Uterine Anomalies in Girls With a Congenital Solitary Functioning Kidney

Unilateral renal agenesis and multicystic dysplastic kidney, resulting in a contralateral solitary functioning kidney (SFK), are part of the broad spectrum of congenital anomalies of the kidney and urinary tract (CAKUT). In girls with SFK, screening for asymptomatic Müllerian anomalies of uterus and vagina is not yet routinely performed, and therefore often overlooked until clinical complications in the menstrual cycle or fertility process occur. In this case series, we report on four teenagers with congenital SFK presenting with menstrual problems due to a Müllerian anomaly. Routine peri-menarchal screening for Müllerian anomalies in girls with SFK may provide timely counseling, surgical treatment and prevention of associated complications such as endometriosis, infertility and miscarriages.

Contemporary standards in UK nephrectomy practice: Analysis of the British Association of Urological Surgeons Complex Operations Reports, 2016–2018

Objective: To analyse the 2016–2018 British Association of Urological Surgeons (BAUS) Complex Operations Reports nephrectomy database, providing a comprehensive description of modern nephrectomy practice. Patients and Methods: Analysis of 2016–2018 data held on the BAUS Complex Operations Reports nephrectomy database was performed for 21,366 patients in England. Data are reported on patient, disease, operation and outcome variables. Results: Using Hospital Episode Statistics (HES) as a comparator, the database captured an estimated 88% of nephrectomies. Benign nephrectomies (BNs) accounted for 11%, 51% were radical nephrectomies (RNs), 14% were nephroureterectomies (NUs) and 22% were partial nephrectomies (PNs). Of the 2399 BNs, 10% were performed for stone disease, 9% for allograft donation and 9% for infective pathology. Aetiology was not specified further than non-functioning kidney in 51% of cases; 80% of cases adopted minimally invasive surgery (MIS). Histology was benign in 96% of cases. Of 10,843 RNs performed, 77% were performed using MIS. Final histology was renal cell carcinoma in 87% of cases and benign histology confirmed in 9% of cases. Of 3038 NUs performed, 88% were performed using MIS. Histology confirmed malignancy in 94% of cases with transitional cell carcinoma accounting for 82% of cases overall. Of 4708 PNs performed, 74% were performed using MIS; 85% of cases were performed for T1 disease; 16% of cases overall returned benign histology. Across the cohort, 30-day mortality was 0.36%. Transfusion rates were 3.3%, 6.1%, 3.3% and 2.0% for BNs, RNs, NUs and PNs, respectively. In malignant disease, positive surgical margins were present in 0.7% of RNs, 1.2% of NUs and 7.3% of PNs. Conclusions: The BAUS nephrectomy dataset provides a real-world description of nephrectomy practice across England, enabling surgeons to compare their practice against a national average. This dataset allows surgeons to share data with patients enhancing informed consent and facilitating shared-decision making. Overall, MIS is widespread, and early mortality after nephrectomy is low. Level of evidence: 2B

First experience of superselective embolization of renal arteries supplying the tumor with subsequent laparoscopic kidney resection

Background. Patients with signs of tumor lesions in a single kidney or in the only one functioning kidney, with bilateral renal tumors are at high risk of functional failure or insufficiency of the kidney after surgery. Joint discussions with specialists in X-ray endovascular surgeries resulted in the development of a treatment algorithm for patients with localized kidney cancer who require organ-sparing surgery without ischemic kidney resection.Objective: to evaluation of the immediate results of two-stage surgical treatment of localized kidney cancer in patients with signs of tumor lesions in a single kidney or in the only one functioning kidney, with bilateral renal tumors, including superselective embolization of the artery supplying the tumor at the first stage, and laparoscopic kidney resection without renal ischemia parenchyma at the second stage.Materials and methods. This study included 5 patients with localized kidney cancer, who underwent two-stage treatment at Moscow Regional Oncology Dispensary between 24.03.2021 and 19.04.2021. The first stage included superselective embolization of the artery supplying the tumor; the second stage implied laparoscopic kidney resection 6-7 days following the first stage.Results. The median age of the patients was 62 years (range: 42-73 years). Four patients (80%) had unilateral kidney lesions, while 1 patient (20 %) had bilateral (synchronous) kidney cancer. The mean RENAL score was 8 (range: 6-10); patients were distributed as follows: score 4-6 in 40 %, score 7-9 in 40 %, and score >10 in 20 % of patients. At the first stage, patients underwent endovascular embolization of the branches of the renal artery. Patients had superselective embolization of either middle (n = 3; 60 %), upper (n = 1; 20 %), or lower (n = 1; 20 %) segmental arteries supplying the tumor. In one of them (20 %), we identified 3 large arterial branches; in another one (20 %), we identified 2 large arterial branches.At the second stage, we performed laparoscopic kidney resection. None of the patients required renal artery clamping, because there was an excellent visualization of the demarcation zone and no significant blood loss. The resection area was sutured in 1 case (20 %). In 2 individuals (40 %), a hemostatic sponge was installed in the removed tumor bed. In the remaining 2 cases (40 %), hemostasis was ensured by coagulation. The median blood loss was 100 mL (range: 50-200 mL). The postoperative period was uneventful in all patients. None of the patients developed symptoms of acute renal failure.Conclusion. Thus, superselective embolization of arteries supplying a kidney tumor has undeniable advantages in organ-sparing surgeries for patients with localized kidney cancer and some additional kidney problems, when organ preservation is crucial for patient's life.

A Retrospective Review of Xanthogranulomatous Pyelonephritis - Our Experience at a Tertiary Care Center Located in Dharwad District, Karnataka

BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of chronic pyelonephritis that is characterized by extensive enlargement and destruction of the involved kidney which ultimately results in non-functioning kidney. It often mimics other inflammatory or neoplastic renal disorders. Unlike chronic pyelonephritis, it spreads to the perinephric space with formation of multiple abscesses and fistulas. It is now being recognized as an important cause of renal morbidity and mortality worldwide. METHODS This is a case series undertaken in a tertiary care center. Clinical data was collected from last 6 years. Clinical features, radiological findings, treatment, and its outcome were analysed and presented. RESULTS A total of 23 cases diagnosed clinically were included in our study. The disease is more prevalent in females than in males with ratio of 1.8 : 1, with mean age of 47.04 years. Most of the patients presented with flank pain and fever. 2 patients had unusual presentations that are nephrocutaneous fistula and necrotising fasciitis of flank region. In our study, disease was associated with urolithiasis in 43.47 % and diabetes mellitus (DM) in 60.8 %. E. coli was the most commonly grown organism in urine culture. Most of the patients underwent initial percutaneous nephrostomy (PCN) or double-J (DJ) stenting followed by definitive treatment that is nephrectomy (21 patients, 2 patients lost to follow up). Extraperitoneal flank approach was most commonly chosen compared to subcostal transperitoneal approach. Excess blood loss was the most common complication encountered during surgery; 8 patients required post-operative blood transfusion. 5 patients required intensive care unit (ICU) care with inotropic support postoperatively. 6 patients had post-operative superficial surgical site infection. CONCLUSIONS XGP is a rare form of chronic pyelonephritis resulting in enlarged non-functioning kidney. UTI (urinary tract infection) and urolithiasis are the most important factors involved in pathogenesis. Prompt diagnosis and treatment is essential. Initial antibiotic treatment with drainage procedure (PCN or DJ stenting) followed by nephrectomy is treatment of choice. Early diagnosis and treatment may limit the disease process and associated morbidity, thus leading to good outcome. KEYWORDS Xanthogranulomatous Pyelonephritis, UTI (Urinary Tract Infection), Urolithiasis, Nephrectomy