Abstract Background Kidney function is associated with kidney volume. This study aims to explore automated segmentation for measuring total kidney volume (TKV) and to analyse the association between (changes in) TKV and acute kidney injury (AKI) incidence and/or severity in Intensive Care Unit (ICU) patients. Methods Patients were included in this retrospective pilot cohort study when at least two abdominal Computed Tomography (CT) scans were performed during ICU admission. If available, CT scans made before the ICU admission were included as a baseline scan. TKV was measured by automated segmentation of both kidneys using Data Analysis Facilitation Suite (DAFS, Voronoi Analytics Incorporated). All segmentations were visually checked and manually adjusted when necessary. ΔTKV was calculated between baseline CT and CT1 (ΔTKVCT1–baseline) and CT1 and CT2 (ΔTKVCT2–CT1). Primary outcomes were differences in kidney volume before and after manual correction and AKI incidence and severity, per the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, on the day of scanning. Results Twenty-six patients were included, of whom eighteen developed AKI during ICU admission. Analysis showed no significant differences in volumes before and after manual correction of the automated segmentations. TKV was not associated with AKI incidence or severity. Longitudinal intraindividual changes in TKV were observed. Median ΔTKVCT1–baseline was statistically significantly different for AKI versus non-AKI patients (−22 cm3 (−49–9) versus 42 cm3 (23–43), p = 0.03) and for different KDIGO stages. Conclusion This study demonstrates the possibility of measuring TKV on CT in ICU patients using automated segmentation. Longitudinal intraindividual changes in TKV were observed, however, no clear association between TKV and AKI was found. Clinical trial number Not applicable.
Abstract Introduction Follow-up for hematuria, often found incidentally on urinalysis, is critical as it may be an early sign of glomerular disease or malignancy. We evaluated nephrology and urology referral patterns for outpatients with hematuria, and factors associated with nephrology and urology referrals. Methods This retrospective, observational cohort study leveraged electronic health record data from a large, regional health care system in Pennsylvania, USA. Outpatients with hematuria (≥1+ blood) on dipstick urinalysis from January 1, 2022, to September 30, 2022, without nephrology/urology appointments in the prior 10 years or prior genitourinary cancer were enrolled. The primary objective evaluated the proportion of outpatients with hematuria who had nephrology or urology referrals or appointments within 6 months following initial presentation. Secondary objectives evaluated concurrent proteinuria and follow-up testing patterns. Results The mean (standard deviation) age of the 5,475 outpatients with hematuria on urinalysis was 60.5 (20.8) years, and most were female (78.0%). Overall, 774/5,475 (14.1%) patients with hematuria had a nephrology or urology referral/appointment within 6 months following presentation. Urine microscopy was performed at the time of hematuria detection for 3,324/5,475 (60.7%) patients, of whom 2,388 (71.8%) had ≥3 red blood cells (RBCs) per high-power field (HPF). Repeat urinalysis was performed for 1,582/5,475 (28.9%) patients. Increased referral likelihood was associated with male sex (odds ratio: 2.3; 95% confidence interval [CI]: 1.9–2.7) and ≥30 RBCs/HPF on microscopy (odds ratio: 1.7; 95% CI: 1.3–2.1). Of 4,952 patients with proteinuria data, 2,375 (48.0%) had hematuria and ≥1+ protein on urinalysis, and 373/2,375 (15.7%) had nephrology (n = 58; 2.4%) and/or urology (n = 332; 14.0%) referrals within 6 months. Conclusion This study provides insight into current outpatient hematuria management patterns. The low referral rates, particularly with concurrent hematuria and proteinuria, highlight opportunities to improve management moving forward.
Choon Chiat Oh, Boon Yee Lim, Elizabeth Chun Yong Lee
et al.
ABSTRACT Background Cutaneous squamous cell carcinoma (cSCC) remains poorly understood at the molecular level, both in the immunocompetent and immunosuppressed population with skin of colour. Data on the diversity of viruses found in cSCC is also lacking. Objectives We aimed to characterise the immunological and molecular profiles of cSCC in organ transplant recipients (OTR) and non‐transplant recipients in an Asian cohort (n = 53) and explore the diversity of viruses detected. Methods Gene expression analysis was performed on snap‐frozen cSCC tissues using the NanoString PanCancer IO360 panel. Viral detection was performed using the Twist Comprehensive Viral Research Panel. Results cSCC presented dysregulation of immune response pathways and tumour microenvironment remodelling compared to adjacent normal skin tissue. Cell‐type profiling based on gene expression profiles showed higher levels of exhausted CD8 cells, neutrophils, and cytotoxic cells in tumour cells. Furthermore, three distinct clusters of cSCC gene signatures could be observed, where Cluster 3 with the highest Tumour inflammation signature (TIS) scores displayed distinct upregulation of most pathways suggesting a more inflamed or “hot” tumour phenotype. cSCC of OTR exhibited greater expression of tumour markers (AQP9, SERPINA1) and reduced expression of T‐cell cytokines (CXCL10, CXCL11). Viruses were particularly enriched in tumour tissue, as compared with normal skin. In addition, there was an enrichment of detectable viruses in transplant‐associated cSCC, with several tumours harbouring multiple viruses (HPV, EBV, MCV, and TTV). Conclusions cSCC is marked by a pro‐tumorigenic immune environment with altered immune cell populations. These findings support the potential for stratified, immune‐tailored treatment approaches for cSCC, especially in OTR who have a higher disease burden. Future studies on the possible oncogenic role of the detected viruses can be undertaken.
Dermatology, Diseases of the genitourinary system. Urology
Introduction. COVID-19 has been associated with both acute and chronic extrapulmonary complications, including renal dysfunction. Understanding the long-term effects of COVID-19 on renal function is essential for managing recovery in affected individuals.Objective. This study aimed to evaluate the long-term renal outcomes in patients who recovered from COVID-19, focusing on changes in glomerular filtration rate (GFR), blood urea nitrogen (BUN), and serum creatinine levels in Iran.Materials & methods. A retrospective cohort study was conducted using data from the Mashhad University of Medical Sciences cohort. The study included patients who had confirmed COVID-19 and a minimum follow-up period of six months post-recovery. Renal function was assessed by measuring the Glomerular Filtration Rate (GFR), Blood Urea Nitrogen (BUN), and serum creatinine levels both at baseline (when COVID-19 was initially diagnosed) and at follow-up. Statistical analysis was performed to explore the associations between renal outcomes and various factors, including gender, the severity of COVID-19, and blood pressure status.Results. In the study, 55.3% were male, and the mean age of 51.38 ± 13.41. Among the patients, 55.3% were male and 44.7% were female. The difference in mean creatinine level between baseline and follow-up was significant (p < 0.001). The difference in mean GFR between baseline and follow-up was significant (p < 0.001). In men, the mean blood urea nitrogen at the first visit and at the follow-up difference was not statistically significant (p = 0.241). In women, the mean blood urea nitrogen was a statistically significant decrease (p = 0.003). Other parameters, including creatinine and GFR, did not differ significantly in both male and female groups at the time of hospitalization and follow-up.Conclusion. Overall, the results of this study suggest that COVID-19 can affect kidney function, especially in association with underlying factors such as hypertension and diabetes, and female gender, which may be risk factors for more severe renal complications in patients with COVID-19. The decrease in GFR in patients with hypertension and diabetes highlights the importance of controlling these diseases in patients with COVID-19. Overall, this study showed that COVID-19 can have lasting effects on patients' kidney function.
OBJECTIVE To present the management of retained foreign bodies in the genitourinary system resulting from warfare, bomb blasts, and firearm-related injuries. STUDY DESIGN Descriptive case series. Place and Duration of the Study: Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan, from June 2017 to December 2023. METHODOLOGY Patients with retained foreign bodies in the genitourinary tract, resulting from previous exposure to bomb blasts, mines, and firearm-related injuries, were included in this study. All patients underwent surgical management. Descriptive statistics were determined for location, duration of retention, type of foreign body, outcome, length of hospital stay, and postoperative complications. RESULTS All 14 patients included in the study were male, with a mean age of 30.85 ± 13.38 years. The average indwelling time of these foreign bodies was 33.50 ± 16.34 months, ranging from 10 to 61 months. These foreign bodies were retained in the kidney (n = 5), urinary bladder (n = 4), and testes and ureter (n = 2; each); penis was involved in one case. The extracted foreign bodies were metal pellets (n = 12) and bullets (n = 2). The successful removal of pellets and bullets from kidneys and bladder was achieved endoscopically in nine cases. The mean length of hospital stays for open and endourological procedures was 4.0 ± 1.41 days and 3.5 ± 2.13 days, respectively (p = 0.630). Postoperative complications were reported in one case only, which required a blood transfusion; it was labelled as Clavien-Dindo Grade II. CONCLUSION Retained foreign bodies in the genitourinary tract in warfare injuries are uncommon and can be managed effectively with endourological as well as open surgery. KEY WORDS Retained foreign bodies, Genitourinary tract, Bomb blasts, Warfare.
Anukul Ghimire, Samveg Shah, Utkarsh Chauhan
et al.
Abstract Background There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. Methods Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Results Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). Conclusions High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.
Introduction. Currently, stents are used in the treatment of various benign and malignant diseases of the upper urinary tract and urethra. Modern stents made of a superelastic alloy, coated with a polymer, regardless of location, are characterized by higher and longer-lasting patency in terms of decompression and relief of obstruction, fewer irritative symptoms of the genitourinary system and no need for frequent replacement, which leads to improved quality of life in addition to cost savings. Despite promising results, there are few studies in the literature regarding their use, and these tend to be peer-to-peer, retrospective, involving small numbers of patients, and based on the surgeon's personal experience. Materials and methods. In literature review used data about using minimally invasive methods for treatment of ureteral strictures, published in PubMed’s base (https://www.ncbi.nlm.nih.gov/pubmed/), scientific electronic library of RF – Elibrary.ru (https://elibrary.ru/) and also professional endourological association websites. The databases were searched using the following keywords: «ureteral stent», «urethral stent», «allium», «uventa» and «memokath». At the first stage, 93 sources no older than 5 years were found that were relevant to the topic of the review. Conference abstracts, short communications, and duplicate publications were excluded. Then, based on the relevance of the data, the reliability of the sources, the impact factors of the journals and the sequence of presentation of the material in the manuscript, 43 articles in scientific international peer-reviewed journals, practical guidelines and clinical recommendations were selected directly for citation in the review. Results. The stent is one of the most common urological prostheses used in the treatment of obstructive uropathy. The main causes of obstruction of the ureter and urethra include benign and malignant factors. Active introduction of minimally invasive technologies into everyday urological practice using ureteral or urethral stents are effective and safe methods of urine diversion (especially in comorbid patients), however, unfortunately, side effects from the use of these prosthetic systems continue to reduce the quality of life of patients. The use of polymer materials in urology has made it possible to introduce a huge number of non-metallic stents used by urologists, however, due to the occurrence of various kinds of complications, an attempt has been made to introduce a new generation of stents – made of a superelastic alloy, coated with polymer. Stents made of superelastic alloy coated with polymer have been used in the treatment of various pathologies of the ureter and urethra for more than two decades. The need for reliable long-term urinary tract drainage has led to the development of improved urinary tract stent designs such as Memokath, Allium, and Uventa. The main advantages of the latter are a convenient delivery system, a self-expanding mechanism, low adhesive properties, no tissue ingrowth, ease of removal, and no need for frequent replacement. Despite the evolution of ureteral and urethral stent designs, complications continue to arise that limit their use and the search for «ideal» drainage systems continues. Conclusion. Today it is difficult to overestimate the role of drainage systems in the treatment of obstructive urological and oncological diseases. However, despite significant success in their use, prostheses are constantly subject to constant modifications and developments aimed at increasing their suitability, durability, ease of implantation and functionality, while reducing the complications associated with them. Future developments in the field of urogenital prosthetic surgery and urology in general continue to attract interest, and ongoing research into new biomaterials, stem cells and tissue engineering is expanding the boundaries of possible interventions in the human genitourinary tract.
Testicular cancer (TC) is among the specific clinical problems of our time. Current therapy is highly effective, confirming 5-year disease-free survival in approximately 95% of ill people. TC is a prevalent type of cancer diagnosed in males between 14 and 44 ages, with an incidence of less than 1 in 9.9 cases per 100,000 men nationwide, but the total number of TC. Increase worldwide. In addition, the danger of expanding cancer in people with cancer during 15 years after diagnosis is 2%. These complicated and different conditions must be found in the clinical evidence base. Genetic, environmental, and hormonal elements are related to developing diseases and disorders in response to treatment and danger of relapse. This research discusses current topics that explain the relative contribution of the problems mentioned above to TC development. Additionally, we pay attention to environmental chemicals and heat exposure, their function in cancer development, and recent advances at the molecular level have been studied.
Objective: The Kulkarni Technique of one-sided dissection with penile invagination allows for single-stage management of panurethral stricture. In this accompanying video, we demonstrate and discuss the use of this technique in urethral reconstruction. Patient and surgical procedure: The patient is a 60-year-old male with a history of stricture treated in the remote past with posterior auricular graft. His-stricture eventually recurred, and he was self-calibrating weekly for 15 years before presenting to us with obstructive lower urinary tract symptoms and recurrent urinary tract infections. Investigation with urethrography revealed an approximately 10 cm urethral stricture extending from the proximal bulbar urethra to mid-penile urethra. No evidence of lichen sclerosus was evident on physical examination.A perineal incision was made, and one-sided dissection carried out on the patient's left-side, dividing the bulbocavernosus muscle to access the urethra dorsally. This dissection was extended towards midline to rotate the urethra off to one side, leaving the right-side neurovascular attachments intact. Once the penis was invaginated, the dissection was extended proximally and distally beyond the extents of the urethral stricture.The urethra was then opened dorsally through the length of stricture and two oral mucosa grafts were quilted onto the adjacent tunica albuginea. The urethral edges are then sewn to the edges of the graft, de-rotating the urethra back into its orthotopic position. A catheter is inserted prior to completion of this urethral closure. The bulbocavernosus muscle edges are reapproximated and the bulbar incision is closed in multiple layers. Results: This patient had an uneventful recovery and a peri‑catheter urethrogram approximately 3 weeks after surgery demonstrated no extravasation, so the catheter was removed. The patient continues to do well with no evidence of recurrence at 3 years follow-up. Previously reported outcomes suggest this is a safe, reproducible, and durably effective technique. Conclusion: The Kulkarni Technique offers a minimally invasive, single stage approach to pan-urethral stricture. It allows for avoidance of a penile incision and minimization of impact on the neurovascular support structures of the anterior urethra.
Surgery, Diseases of the genitourinary system. Urology
Purpose: to determine the regional features of urological morbidity and its specific weight in the structure of the general morbidity of the adult population of the Dnipropetrovsk region. Materials and methods. Bibliosemantic, analytical, and medical-statistical methods were used, which make it possible to characterize the current state of health of the population and determine trends in the incidence and prevalence of diseases. The results. The average long-term indicator of the primary morbidity of the population of the Dnipropetrovsk region for all classes of diseases was 7,272.23 per 10,000 adult population, total morbidity was 22,250.84 per 10,000 adult population with a tendency to increase, hospital morbidity was 2,167.9 per 10,000 adult population, with a general tendency to decrease the level of hospitalization. Diseases of the genitourinary system rank second, fourth, and sixth in the structure of primary morbidity, prevalence of morbidity, and hospital morbidity of the adult population, respectively. The leading nosological groups of urological diseases registered for the first time in the adult population of the region are cystitis - 64.88 cases per 10 thousand population, kidney infections - 43.23 per 10 thousand population and kidney and ureter stones - 17.92 per 10 thousand population with a tendency to increase indicators during the studied period, with the exception of kidney and ureter stones. Similar trends persist for the prevalence of diseases. The level of hospitalization of the population of the region turned out to be the highest for kidney and ureter stones - 25.28 per 10 thousand population and kidney infections - 20.01 per 10 thousand population, remained relatively stable during 2012-2019, while during 2020- In 2021, a significant decrease was noted for kidney and ureter stones, kidney infections, while the indicator of hospital morbidity for kidney and ureter stones remained relatively stable. Conclusions. Significant levels of morbidity and prevalence of diseases of the genitourinary system, including urological diseases, negative trends towards their increase require improvement of monitoring of the health status of the population, prevention, timely and complete detection of urological pathology, and high-quality treatment.
Background Hypospadias is one of the most common congenital diseases of the genitourinary system in children. The European Association of Urology (EAU) Guidelines recommend that children undergoing hypospadias surgery should be between 6 and 18 months. In China, where many children have hypospadias, it remains unknown whether clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias. Methods We retrospectively analyzed children with hypospadias who underwent primary surgery at the Department of Pediatric Urology in Guangzhou Women and Children’s Medical Center between January 2010 and October 2021. Patients who had two-stage surgery or a second round of surgery due to complications were excluded to eliminate data duplication. The clinical characteristics and demographic information were collected. We defined delayed surgery as primary surgery performed after 18 months following the EAU Guidelines. Results A total of 4439 children diagnosed with hypospadias were included in the study. The median age (29.1 ± 16.7 months) of surgery for hypospadias in our study was much higher than the recommended age reported in the EAU guidelines, and 76.6% of the children underwent surgery after the age of 18 months. Children without comorbidities including cryptorchidism (odds ratio [OR] = 1.562; 95% confidence interval [CI] 1.199–2.034; p = 0.001), prostatic cyst (OR = 2.613; 95% CI 1.579–4.324; p 18 months). Comorbidities, living in a low economic area, too far from a main medical center and the COVID-19 pandemic were highly associated with delayed surgery. It is vital to improve the public awareness of hypospadias and strengthen the re-education of primary community doctors to reduce delayed surgery.
Urolithiasis is a disease which is characterized by the formation of stones in the urinary system and is one of the most actual problems in modern urology and medicine worldwide. Recently, there has been a steady spread of this disease. Urolithiasis ranks the second position in the structure of urological diseases in Ukraine, second only to infectious and inflammatory pathologies and accounts for 30-45 % of diseases of the genitourinary system. Urolithiasis is manifested by the appearance of stones in the urinary system (most often the kidneys). The most common type of kidney cancer (KC) is renal cell carcinoma. It accounts for about 97 % of all kidney tumors. With the increase in the number of patients with renal tumors and urolithiasis, there is a clear tendency to increase the number of patients with a combination of these two serious diseases. Unfortunately, the question of the relationship and interdependence between the development of urolithiasis and kidney tumor remains open today. The objective: to search, systematize and analyze scientific publications about the mechanisms of development and treatment of this combined pathology. Infection and chronic inflammation cause the development of urothelial proliferation and the emergence of malignant neoplasms. Inflammatory cells secrete cytokines and chemokines in response to a chronic recurrent infectious-inflammatory process that causes tumor cell growth and tumor progression. Special attention in the publications is paid to the role of endothelial dysfunction in the development of kidney tumors. The importance of vascular endothelial growth factor (VEGF) in the mechanism of neoangiogenesis of KC is demonstrated. Management of the patients with combined pathology of urolithiasis and KC involves the doctor’s choice of the optimal method. The analysis of literature publications demonstrates that today there are a number of issues devoted to the presence of KC and urolithiasis in one patient. These are the risks of such a combination, and the mechanisms of development, as well as determining the most rational and effective management in each case. All above mentioned cause the need for further study of the treatment of patients with urolithiasis and kidney tumor.
Jonathan Demeter, Advait Deshmukh, Bijan Salari
et al.
Xanthogranulomatous prostatitis (XGP) is a rare disease that can mimic the clinical and imaging findings of prostate cancer. Differentiation of these diseases is vital in order to offer the correct treatment. Histological examination of prostate tissue is the definitive manner in which XGP is distinguished from prostate cancer. This case demonstrates the rare possibility of concurrent findings of prostate abscess, prostate cancer, and XGP, further clouding diagnostic assessment. Percutaneous aspiration and antibiotic treatment of the abscess reduced lower urinary tract symptoms and eliminated XGP on subsequent prostate biopsy. Careful work up is necessary to prevent unnecessary interventions or missed diagnoses.