Nephro-Urology Monthly
Volume:15 Issue: 2, May 2023

 Malignant peripheral nerve sheath tumor (MPNST) of the kidney is an uncommon neoplasm. We present a rare case of MPNST successfully managed by surgical intervention.

 A 23-year-old male patient presented with dull aching pain in the right flank associated with hematuria. On examination, an abdominal mass with firm consistency occupied the right lumbar quadrant with the fullness of the right renal angle. Contrast-enhanced computed tomography (CECT) showed heterogeneously hypoenhancing lobulated mass (9.2 × 6.4 × 7.6 cm) arising exophytically from the anterior cortex of the middle and lower poles of the right kidney with necrosis. It was compressing the pelvicalyceal system causing mild hydronephrosis. Kidney function tests revealed normal results. Urine cytology for malignant cells was negative. The patient underwent an open radical nephrectomy. Renal mass was adhered to ascending colon and duodenum and was abutting the liver. The histopathological report suggested malignant peripheral nerve sheath tumors with margins microscopically clear of tumor cells. S-100 and Vimentin were stained positively. The patient has been under regular follow-up (every three months) for the last year.

 If feasible, wide local excision is considered the preferred approach, as prognosis mainly depends on the completeness of surgical resection.

 Numerous equations are applied in order to estimate the glomerular filtration rate (GFR).

 This study aimed to spot the optimal equation that accurately estimates GFR and, therefore, the chronic kidney disease (CKD) stage in renal transplant patients.

 This cross-sectional study was conducted on 58 renal transplant patients. Their venous blood samples were obtained for serum creatinine and cystatin C determination used to calculate estimated GFR (eGFR). The average contrast of GFR in each equation was calculated using the Bland-Altman method. The correlation, bias, imprecision, and 10% and 30% accuracy were compared between the eGFR cystatin C and creatinine. Concordance between both equations for CKD staging was assessed. The classification of patients was also investigated.

 Bland-Altman plots and bias demonstrated that eGFR by the abbreviated modification of diet in renal disease (Ab-MDRD) was the most accurate compared with chronic kidney disease epidemiology collaboration (CKD-EPI) cystatin C, followed by CKD-EPI eGFR creatinine. With reference to CKD-EPI cystatin C, the imprecision of the equations was approximately similar to Ab-MDRD, and CKD-EPI creatinine is still better than the Cockcroft-gault (CG) formula. They also showed good 30% accuracy. Finally, our finding suggested that Ab-MDRD and CKD-EPI eGFR creatinine might be the best-performing equation in the classification of the CKD stages in a cutoff of 60 mL/min/1.73 m2.

 Due to the high cost and potential delay in measuring cystatin C, it would be much more appropriate to measure Ab-MDRD; after that, CKD-EPI eGFR creatinine as an alternative approach in order to facilitate rapid clinical decision in renal transplant patients.

Ischemia of the penis is not common due to its excellent collateral vessels. Our patient was an 89-year-old man with dementia without any vascular disease wearing a condom sheath because of urinary incontinence for many months. Lack of precise genitalia care resulted in strangulation of the penis and complete necrosis probably in 10 days. Following resuscitation, we performed a complete penectomy and urethrostomy. The patient has acceptable voiding from the penis remnant after 6 months. Penile condom sheaths in neglected old patients must be used cautiously; however, diaper appliances may be safer.

 Breast cancer (BC) is the most frequently diagnosed malignancy (25% of all cancers) and the leading cause of cancer-related death in women; death is mainly attributed to the metastatic spread of the primary tumor. On the other hand, secondary tumors of the bladder are rare, representing 2% of all bladder neoplasms. Breast cancer rarely spreads to the urinary bladder. Patients in almost all previous reports have been diagnosed with BC several months before the bladder metastasis (BM) was discovered.

 A 67-year-old woman presented with irritative bladder symptoms with no history suggestive of BC. Normal breast examination and normal laboratory investigations with breast imaging reporting and data system 1 (BI-RADS 1) in mammographic evaluation challenged the pathological findings of the bladder biopsy that was positive for metastatized BC to the bladder.

 Metastatic BC may rarely initially present with irritative lower urinary symptoms and absent clinical and radiological features of BC-but positive histopathological findings.

 Non-invasive treatments, such as low-intensity extracorporeal shock waves treatment (Li-ESWT), can be a safe and effective alternative for patients with erectile dysfunction (ED) who are resistant to phosphodiesterase type 5 inhibitors (PDE5Is).

 This clinical trial study aimed to evaluate the effect of Li-ESWT on ED in non-responders to PDE5Is, its durability, and factors predicting its success.

 This study was conducted on 128 patients with ED who were resistant to PDE5Is. Before any intervention, written informed consent was obtained, demographic characteristics were collected, and the severity of the ED score was determined using the international index of erectile function (IIEF). Patients were treated with Li-ESWT, and ED severity was remeasured by the IIEF scale at the end of the intervention, three months, and six months after the intervention. The data were analyzed by chi-square, repeated measure ANOVA, Bonferroni post hoc, and binary logistic regression tests.

 A total of 128 patients with ED who had not responded to PDE5Is, with a mean age of 58.35 ± 8.28 and an average ED of 3.41 ± 1.78 years, were included. At the end of the intervention, the IIEF score significantly increased. Moreover, this score was significantly higher three months and six months after the intervention. Three and six months later, the IIEF score decreased significantly. However, the score was significantly higher all three times than before the intervention. Being younger than 60 years, having an ED duration of fewer than three years, being non-smoking, being non-diabetic, and having no lower urinary tract symptoms (LUTS) were the most prominent predictors of a successful ED treatment.

 Low-intensity extracorporeal shock waves treatment is a safe and effective method for short and long-term treatment of ED patients. Identifying predicting factors can be beneficial for urologists in selecting suitable patients and avoiding the overtreatment of those who are not suitable candidates.

Transurethral resection of bladder tumor (TURBT) has a role in the diagnostic evaluation and treatment of bladder cancer, which is traditionally conducted through monopolar electrocautery; however, bipolar electrocautery has gained attention these days. Cautery artifacts are known as the drawbacks of TURBT and can be seen in both monopolar and bipolar electrocautery but with varying severity. Studies comparing bipolar to monopolar TURBT have shown conflicting results.

This study was carried out to compare the occurrence of cautery artifacts and a number of important clinical outcomes between patients undergoing monopolar and bipolar electrocautery during TURBT.

This prospective study included adult patients with age 18 years old or higher diagnosed with primary bladder tumors with a size ≤4 cm. The patients were randomized into monopolar and bipolar groups (34 patients per group). The occurrence of cautery artifacts, duration of surgery, the incidence of urinary bladder perforation, fall in hemoglobin, need for blood transfusion, transurethral resection syndrome, and postoperative hospital stay were compared between the two groups.

In our study, the incidence of cautery artifacts was significantly lower in the bipolar group than in the monopolar group (P-value < 0.0001). The two groups were comparable in terms of the duration of surgery, urinary bladder perforation, fall in hemoglobin, need for blood transfusion, transurethral resection syndrome, and postoperative hospital stay.

Bipolar TURBT is superior to monopolar TURBT regarding a reduction in the incidence of cautery artifacts.

Percutaneous nephrolithotomy (PCNL) is one of the five interventions offered to patients with renal stones.

This study compared the effects of previous therapeutic interventions for renal stones on subsequent PCNL regarding success rate and complications.

In this descriptive-analytical study, the data from 375 patients who had undergone PCNL were reviewed retrospectively. Patients were categorized into four groups based on their previous therapeutic interventions as no history of open renal stone surgery (n = 196), PCNL (n = 64), extracorporeal shockwave lithotripsy (ESWL) (n = 88), and open surgery (n = 27). We compared surgery duration, the surgical procedure's success rate, complications, as well as the site and size of the stone between the groups.

The mean operation duration was significantly longer in the fourth group (61.66 ± 19.85), while there were no statistically significant differences in surgery duration between other groups (P = 0.88). The mean hospital stay, stone size, and site were also similar between the groups. All groups had a high number of pelvic stones, and the rate of upper calyceal stones was higher than middle calyceal and ureteral stones in all groups. Access time was higher in groups one and four, but no significant difference was observed (P = 0.31). Grade 1 and 2 complications were frequent among the patients. The overall immediate success rate was high in all groups.

The present study indicates that patients with a history of open surgery for kidney-related conditions may have higher blood loss and longer surgery duration, likely due to anatomical and histological changes in the kidney.

It has been shown that some cancers express the epidermal growth factor receptor (EGFR). Several variables influence bladder cancer prognosis, including stage, grade, and gene expression.

We used immunohistochemistry to measure the prevalence and prognostic significance of EGFR expression in bladder tumors in our population.

Thirty bladder tumors were the subjects of this cross-sectional study. To evaluate the biological behavior of the tumors, histopathological analysis was performed. We carried out EGFR immunohistochemical staining to evaluate gene expression.

EGFR was expressed in 25 (83.3%) patients. Expression of this biomarker was independent of tumor characteristics such as lymphatic invasion, muscle invasion, and tumor grade and stage (P value > 0.05).

Remembering each patient's tumor characteristics determine that prognosis is crucial. The prognostic value of EGFR expression in predicting aggressive behavior in bladder tumors is marginal, but it is necessary to evaluate therapeutic response.