Acute kidney injury following radical cystectomy and urinary diversion: predictors and associated morbidity

ABSTRACT Introduction: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients. Materials and Methods: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses. Results: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI. Conclusions: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.

What is the best drainage method for a perinephric abscess?

Purpose: To compare the results of percutaneous and open drainage for perinephric abscess. MATERIALS AND METHODS: The files of 86 patients who underwent drainage for perinephric abscesses from April 2001 through March 2008 were evaluated. The method of drainage for each patient was performed according to the clinical decision of the treating physician. Percutaneous tube drain (PCD) was used for drainage of the abscess in 43 patients (group 1), while the other 43 patients were managed with open drainage (group 2). Cure was defined as complete obliteration of the abscess cavity. The cure rates, complications, and hospital stay were compared between both groups. Results: The study included 50 males and 36 females with mean age 44.2 ± 17.3. The most common predisposing factors were diabetes mellitus and/or stones. Open drainage of perinephric abscesses resulted in a statistically significant higher cure rate (98 percent versus 69 percent, p < 0.001) and shorter hospital stay than PCD (3.6 versus 6 days, p < 0.001). Failure of complete drainage of multilocular abscess was observed in 8 of 13 cases (61.5 percent) in group 1 and one of 38 cases (2.6 percent) in group 2 (P < 0.001). Complications were observed in 7 percent of group 1 and 11.5 percent in group 2 (P = 0.45). After mean follow-up of 19 months, 9 of 46 patients (19.6 percent) had recurrence; 7 of them were in group 1. CONCLUSIONS: Percutaneous drainage of perinephric abscess is an effective minimally invasive treatment. However, PCD is not the optimal method for drainage of multilocular abscess because open surgical drainage provided higher cure rates and shorter hospitalization than PCD.

Schistosoma - associated bladder cancer: is there a change in the trend of cell type?

To compare the contribution of squamous cell and transitional cell types to the schistosoma - related and schistosoma - unrelated bladder cancer among Egyptian patients and to evaluate any significant association of carcinoma in situ [CIS] and stage T1 - TCC in schistosomiasis. A retrospective study in which the histopathologic records of 196 patients who underwent radical or salvage cystectomy for bladder cancer from August 1994 to December 2000 in Urology and Nephrology Center/ Mansoura University - Egypt, had been carried out. The age range of patients was [29 - 75] with a mean of [55.82 +/- 8.81] years. Histopathologic examinations of cystectomy specimens showed schistosomiasis in 81[41.32%] patients while in 115 [58.67%] patients; bladder cancer was schistosoma - unrelated. The cell type of cancer in [80] patients with schistosomiasis, was transitional cell carcinoma [TCC] in 40 [50%], squamous cell carcinoma [SCC] in 37 [46.25%], and adenocarcinoma in 3 [3.75%] patients. In schistosoma -unrelated bladder cancer, TCC was reported in 76 [66.08%], SCC in 34 [29.56%], undifferentiated carcinoma in 4 [3.47%] and adenocarcinoma in 1 [0.86%] patients. CIS associated with [stage T1 -TCC] was reported in 2 [15.38%] out of 13 patients with schitosoma - related bladder cancer, while it was reported in 3 [14.28%] out of 21 patients with schistosoma - unrelated bladder cancer. There was no significant statistical difference between the two groups. Schistosoma - related bladder cancer is still a problem in countries endemic with schistsomiasis. Although the major histological cell type in such cancer is SCC, there is a trend of increasing frequency of schistosoma - related TCC