Urology, Nephrology and Andrology International

Urinary tract infection (UTI) is common in females. Recurrent UTI refractory to antibiotics should lead the practitioner to do further investigation in the form of imaging. Bladder stones in females are rare and the cause should be searched. Stone over foreign body in a female patient should lead a suspicion of migrated intrauterine contraceptive devices (IUCD). IUCDs are associated with many complications like perforation and migration into adjacent structures. We report a case of 40 year old female where we found that copper–T has eroded into the
bladder with formation of stone over it and partial penetration of bladder wall, many years after placement of the device and patient underwent hysterectomy before the detection of the migrated IUCD. In this case, we removed the IUCD with calculus via cystoscopic removal (cystolithotripsy).

Keywords: Intrauterine Contraceptive Device Migration; Forgotten IUCD; Urinary Bladder Stone over Foreign Body; Stone over Copper-T.
 

Introduction: Optimum calculi clearance particularly in staghorn and renal calculus relies heavily on proper preoperative renal access. Percutaneous nephrolithotomy (PCNL) has been the surgery of choice for large renal calculi. But it is pertinent to realise that not all stones can be cleared by the most favoured infracostal approach.To gain further insight we compared supracostal to infracostal approach of PCNL in terms of stone clearance, surgical ease and complications. Aims and Objectives: A prospective study was conducted to compare supracostal versus infracostal approach in PCNL for removal of complex renal calculi. Materials and Methods: A total of 90 patients with comple renal stones were recruited for PCNL in our Tertiary care referred between January 2018 to November 2019. Fourtyeight of them underwent supracostal, while Fourty two underwent infracostal puncture. The two
approaches were compared on various parameters like a total duration of surgery, intraoperative blood loss, infundibular/pelvic tear, rate of complete stone clearance and postoperative complications (pulmonary, bleeding, fever and sepsis, etc.). Observation and Results: In our study, the success rate was 72% for those in the infracostal 87% for those in the supracostal approach.21.4% required secondry puncture while 26% required so in infracostal approach. There was no statistically significant difference noted in terms of mean operative time and duration of inpatient stay. In terms of complication blood transfusion was more in infracostal approach.Thoracic complications (hydrothorax) which is most feared in supracostal approach happened in just 1 patient. Conclusion: Supracostal approach when judiciously used in properly selected patients can offer better calculi clearance with less rate of secondary punctures, peroperative complications and lesser need for ESWL.

Keywords: Percutaneous; Nephrolithotomy; Staghorn; Supracostal Puncture.
 

Aim: The aim of the study was to define the utility of restage TURBT and to evaluate the impact of restage TURBT on the incidence of tumour recurrence and progression in patients with non-muscle invasive bladder cancer. Materials and Methods: A prospective observational study was performed with an aim of analyzing the utility of restage TURBT at a tertiary care centre during July 2018-December 2019. Patients enrolled for restage TURBT were proven with histological diagnosis of non muscle invasive bladder cancer. All patients underwent restage TURBT within 4 to 6 weeks after the initial resection. Comparison of histological findings of initial TURBT and restage TURBT were done. Results:Total data available for 68 patients. Among them 27 patients (40%) were detected to have residual disease. Out of this in 11 patients (40%) high grade tumour residual disease was established and in 14 patients (52%) low grade tumour residual disease was established .Two patients (8%) were detected to have muscle invasive bladder cancer after restage TURBT. Conclusion:The study concluded that the restage TURBT is of clinical significance in non-muscle invasive bladder cancer as it helps in early detection, treatment and prognosis in cases of advanced bladder cancer.

Keywords: Restage TURBT; NMIBC; Residual bladder tumour.
 

Background: Percutaneous renal surgery caused a revolution in the treatment of renal stone surgery.It is now considered the first line intervention for management of patients with asignificant stone burden. Percutaneous nephrolithotomy in the prone position allows better access to perform upper urinary tract endoscopy surgery with ability to clear the stones. This study represents a case series to evaluate how successful a standard percutaneous nephrolithotomy is, as a tool for clearance forrenal stones. Methodology: PCNL was carried out on 123 patients who were having renal stone size between 2 to 4cms from January 2014 to December 2017 at JJMMC, Davanagere, a tier 2 city in Karnataka. We have observed the site and number of the required access, the intra and postoperative complications. Results: The procedure was completed, using a single access tract in 110 patients, with the site of puncture being the lower calyx in 40 cases[ 36.36%], the posterior middle calyx in 60 cases[54.54%], 10 superior calyceal puncture (9%),Only in thirteen patients[ 10.5%], two access tracts (an upper and a lower calyceal) were required for completion. We had post op complications in 13 cases with 7 cases requiring ancillary procedures for stone clearance. Conclusion: Supine Percutaneous nephrolithotomy is a safe and successful procedure for the management of renal stones in terms of morbidity, convalescence, and cost replacing open surgical removal of renal calculi.

Keywords: Percutaneous Nephrolithotomy; Kidney; Renal Calculi; Horseshoe Kidney.
 

Introduction: Infections remain a major cause of morbidity and mortality in transplant recipients. Knowledge about the chronology of infections, their incidence and their mortality rates helps in delivering a better care to the transplant patients. Patients and Methods: This is prospective observational study was done between January 2017 and December 2018 and included all renal allograft recipients who suffered from an episode of infection. We analyzed spectrum of infection, the time of onset of infection and its influence on allograft function. Results: A total
of 30 patients were included. Majority of patients (22) were males (73.3%) and 8(26.7%) patients were females. Mean age at presentation in our study was 38 + 12.8 years. A total of 19(63.3%) underwent live related renal transplants and mother was the most common donor. Eleven(36.7%) were deceased donor transplants. Commonest cause of native kidney disease was presumed Chronic interstitial nephritis in eleven( 36.7%) followed by presumed Chronic glomerulonephritis in seven(23.3%). Induction was given in fourteen patients and commonly used agent was basiliximab(10 cases). A total of 55 episodes of infection were recorded in the 30 cases included. 56.6% cases had more than one episode of infection and on an average every patient had suffered from ~1.9 infection episodes during post transplantation period. Bacterial aetiology was most common followed by viral. Commonest infection was UTI and mean onset of infection was seen at twenty eight and half monthspost transplant.Infection leading to precipitation of graft dysfunction was seen in 14 cases(46.7%)and among them 4 (13.3%) patients had rejection. On follow up, 10 patients (71.4%) improved and 4(28.6%) patients died. Conclusion: Bacterial aetiology for infection was more frequent than viral. UTI was the most common infection seen. Mean onset of infection was seen at twenty eight and half months after transplant.Graft dysfunction was seen in 46.7% cases. Mortality rate was 28.6% and this had a direct relation with the number of infective episodes. Patients with higher infective episodes had greater mortality.

Keywords: Renal Transplant; Immunosuppression and Infections; Uti In Renal Transplant.
 

Introduction: Renal cortical necrosis (RCN) is characterized by patchy or diffuse ischemic destruction resulting in diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome (HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Aims: To study clinical features and laboratory parameters with outcome of acute cortical necrosis. Materials and methods: It is a prospective study carried out for a period of 2 years in 50 patients presenting with acute renal failure due to acute cortical necrosis.Age group ranged from 2 years to 65 years. Results: During this period the total 650 patients presented with acute renal failure . Out of which the biopsy proven renal cortical necrosis were 50 in number. Out of total 50 cases of biopsy proven acute cortical necrosis leading to ARF constitutes pregnancy related were 35 (70%), septicaemia cases were 6 (12%), post gastroentiritiscases were 3 (6%), HUS cases were 3 (6%), snake bite cases were 2 (4%), due to extensive burns was 1 (2%). Conclusion: Acute cortical necrosis is most common in female as the commonest cause is of obstetrical in nature. Management consisted of fluid balance and Dialyzes is life saving procedure during recovery period.

Keywords: Renal cortical necrosis; Dialyzes; Acute renal failure.