Effects of COVID-19 pandemics on urinary metabolites in kidney stone patients: our kidney stone prevention clinic experience

BACKGROUND@#The dietary habits and lifestyle changes during the COVID-19 pandemic could affect the urinary risk factors in kidney stone formers. In this study, we investigated the effects of the COVID-19 pandemic on 24-h urine metabolites, as a surrogate for dietary intake, in patients with kidney stones, in Tehran, Iran.@*METHODS@#We evaluated the medical records of all patients with urolithiasis who visited in our stone prevention clinic from the beginning of COVID-19 in Iran to 1 year later (Feb 2020-Feb 2021) and compared it with the patients' medical records in the same period a year before COVID-19 (Feb 2019-Feb 2020).@*RESULTS@#The results of our stone prevention clinic showed a decrease in the number of visits during COVID-19. Twenty-four-hour urine urea, sodium, and potassium were significantly lower, and 24-h urine magnesium was significantly higher during COVID-19. Higher 24-h urine oxalate was only shown in patients with the first-time visit, whereas lower 24-h urine uric acid and citrate were only shown in patients with the follow-up visits.@*CONCLUSIONS@#COVID-19 pandemics may change some of the dietary habits of the patients, including lower salt, protein, and fruit and vegetable intake. Although economic issues, restricted access, or sanitation issues may be the reason for the undesirable dietary changes, the importance of a quality diet should be discussed with all patients, as possible. Since the number of patients visited in the stone clinic was lower during COVID-19, virtual visits could be an excellent alternative to motivate patients with kidney stones.

Assessing the diagnostic value of plasma-Free DNA in prostate cancer screening

Background: Prostate cancer is the second form of cancer among men worldwide. For early cancer detection, we should identify tumors in initial stages before the physical signs become visible. The present study aims to evaluate the diagnostic value of cell-free DNA [cfDNA], its comparison with prostate-specific antigen [PSA] level in prostate cancer screening and also in patients with localized prostate cancer, metastatic form, and benign prostatic hyperplasia [BPH]

Methods: The participants of this study were selected from 126 patients with genitourinary symptoms suspected prostate cancer, rising PSA, and/or abnormal rectal examination results and 10 healthy subjects as controls. Peripheral blood plasma before any treatment measures was considered. cfDNA was extracted using a commercial kit, and PSA levels were measured by ELISA. The ANOVA test was used to compare the average serum level of PSA and plasma concentration of cfDNA between the groups. The correlation between variables was measured by the Pearson test

Results: The subgroups consisted of 50 patients with localized prostate cancer, 26 patients with metastatic prostate cancer, 50 patients with BPH, and 10 healthy subjects; the average concentrations of cfDNA in these subgroups were 15.04, 19.62, 9.51, and 8.7 ng/Mul, respectively. According to p < 0.0001 obtained from multivariate test, there was a significant difference between all the groups

Conclusion: Our findings indicated significant differences between cfDNA levels of patients with localized and metastatic prostate cancer, and differences of these two groups from BPH and healthy cases show the importance of this biomarker in non-invasive diagnostic procedures

[Assessment of factors affecting kidney transplant survival based on literature review between 2000 and 2014]

Background: Improvements in immune-suppressing drugs have a short-term effect on kidney transplants but do not have much long-term effect. In order to increase the duration of kidney transplant survival, understanding the significant parameters is of great importance. This study aims to identify key parameters [before the transplant occurs] which affect kidney transplant survival

Materials and methods: To conduct this review, the scientific databases was searched and more than 200 related titles were retrieved; and the abstracts were reviewed to determine which studies were relevant to the study. The literature analysis was based on the goals of the studies themselves, the number of citations, and the reliability of the sources cited. Ultimately, 60 studies included for further analysis

Results: Based on the frequency of each parameter which influenced graft survival, the following parameters were determined to have higher frequencies compared to other parameters, with regards to survival time of the kidney transplant: the ages of the donor and recipient, socioeconomic status, immune-suppressing drugs, HLA matching, time on the waiting list, live or deceased donor, the decade in which the operation occurred, cold ischemia time, and reaction to antibiotics

Conclusion: The influence of some of the kidney transplant survival parameters was acknowledged in the majority of studies; however, some parameters have been the subject of disagreement among studies. In order to resolve this issue, we suggest a search of international data and meta-analysis of current literature to better understand the parameters of kidney transplant survival

Neurologic Complications in Percutaneous Nephrolithotomy

PURPOSE: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. RESULTS: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. CONCLUSIONS: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

Drinking water composition and incidence of urinary calculus: introducing a new index

We searched for a pathophysiologically based feature of major water electrolytes, which may define water quality better than the water hardness, respecting urinary calculus formation. Utilizing a multistage stratified sampling, 2310 patients were diagnosed in the imaging centers of the provincial capitals in Iran between 2007 and 2008. These were composed of 1755 patients who were settled residents of 24 provincial capitals. Data on the regional drinking water composition, obtained from an accredited registry, and their relationships with the region's incidence of urinary calculi were evaluated by metaregression models. The stone risk index [defined as the ratio of calcium to magnesium-bicarbonate product in drinking water] was used to assess the risk of calculus formation. No correlation was found between the urinary calculus incidence and the amount of calcium, bicarbonate, or the total hardness of the drinking water. In contrast, water magnesium had a marginally significant nonlinear inverse relationship with the incidence of the disease in the capitals [R2 = 26%, P = .05 for a power model]. The stone risk index was associated nonlinearly with the calculus incidence [R2 = 28.4%, P = .04]. Urinary calculus incidence was inversely related with drinking water magnesium content. We introduced a new index constructed on the foundation of a pathophysiologically based formula; the stone risk index had a strong positive association with calculus incidence. This index can have therapeutic and preventive applications, yet to be confirmed by clinical trials

Familial relations and recurrence pattern in nephrolithiasis. New words about old subjects

While medical and surgical approaches to urolithiasis are different for single and recurrent stone former [RSF], the RSF definition itself is commonly overlooked. Moreover, despite consensus on association between family history [FH] and urolithiasis, more epidemiologic evidence is required to clarify the nature of this relationship. Our purpose was to propose a more precise definition of RSF, and also to investigate how family history may affect urolithiasis. Using a multistage stratified sampling in 4 seasonal phases, 6127 subjects with imaging-proven urolithiasis were detected in 12 Iranian regions. The FH of urolithiasis and the average interval between episodes [cycles] were determined by an informed interview. Of 6127 patients with the mean age of 41.8 +/- 15.1 years, 42% had FH, and 22.2% were RSF of whom 61% were men. The patients with FH had a greater chance of recurrence [OR = 1.2, 95% Confidence Interval [CI], 1.1 to 1.4]. Furthermore, patients with positive FH had more episodes [P = .0001], comparable cycles and younger ages at the onset [P = .02] than those patients without a FH. In the RSF group, the 90[th] percentiles of the cycle were 60 months and the estimated mean stone cycle for the population was 25.34 months [99% CI, 23.0 to 27.7]. Family history seems very common in Iranian population and is a risk factor for recurrence. Moreover, RSF could be identified by the estimated average cycle in the population [25.3 months] or by the percentiles

Expression of ROR1 in patients with renal cancer-a potential diagnostic marker

The ectopic expression of receptor tyrosine kinase Rorl has been reported in patients with hematological malignancies such as chronic lymphocytic leukemia and acute lymphoblastic leukemia. Here we report, for the first time, expression of ROR1 gene in both tumor tissues and peripheral blood mononuclear cells [PBMC] from patients with renal cancer [RC]. In the current study, the expression of ROR1 gene was semi-quantitatively measured in PBMC and tumor tissues from 16 RC patients as well as PBMC from 22 healthy individuals relative to the expression of the housekeeping gene phosphoglucomutase 1 by RT-PCR. Our results showed that ROR1 was expressed at gene level in 81.3% of renal tumor tissues [13 out of 16] whereas it was expressed in 94% of PBMC from RC patients [15 out of 16]. A weak expression of RORl was observed in PBMC of 4 out of 22 healthy individual. A significant expression of ROR1 was observed in PBMC from RC patients when compared to that in PBMC from normal healthy individuals [P<0.001]. The expression of ROR1 in PBMC may reflect a shedding of tumor cells into blood stream. We conclude that detection of a high level of ROR1 expression in blood cells might assist in early detection of renal malignancies, providing taking into consideration the clinical symptoms of the disease

Suprome percutaneous nephrolithotomy, is it really effective? A systematic review of literature

This systematic review was performed to determine the clinical value of percutaneous nephrolithotomy in the supine position in comparison with the convention of performing the procedure in the prone position. A systematic review of the medical literature was conducted searching for studies on percutaneous nephrolithotomy in the supine position, limited to publications appeared in the PubMed between 1980 and July 2008. Non-English articles were considered if deemed relevant by providing additional data. In the retrieved articles, reference lists were hand-searched to identify additional relevant articles. There were 9 original articles on percutaneous nephrolithotomy in the supine position. Five studies were retrospective and 4 were prospective, of which only 1 was a well-designed randomized controlled trial published in 2008. The success rate of the procedure was reported between 69.6% and 95%. The risk of requiring blood transfusion was between zero and 8%. Duration of hospital stay was variable, but generally less than that in the prone position. No colon perforation was reported. In carefully selected patients with uncomplicated urinary calculi, percutaneous calculus removal in the supine position can yield similar outcomes to that in the prone position

Transperitoneal laparoscopic partial nephrectomy using a new technique

We report our experience with a new technique for transperitoneal laparoscopic partial nephrectomy with the kidney turned upside down intraoperatively. Laparoscopic partial nephrectomy was performed in 10 patients with upper pole lesions through a transperitoneal approach. Once complete mobilization of the kidney was achieved, it was rotated 180 degrees around the horizontal axis, so that the upper pole was positioned inferiorly. After performing partial nephrectomy, the resection bed was sutured by 2-0 polyglactin sutures and application of Hem-o-Lok clips. Then, the kidney was returned into its normal position and fixed to the abdominal wall. We performed laparoscopic partial nephrectomy on 9 patients with a contrast-enhancing upper pole kidney mass and 1 patient with a nonfunctioning upper pole. The median tumor size was 58 mm [range, 41 mm to 92 mm]. The median operative time was 206 minutes [range, 114 to 262 minutes] and the mean warm ischemia time was 30 minutes [range, 22 to 35 minutes]. One patient underwent surgical exploration due to bleeding 6 hours after the operation. Prolonged urine leakage [more than 7 days] was observed in 1 patient, which responded to ureteral stent insertion. Surgical margins were negative in all of the patients. Renal cell carcinoma was histologically diagnosed in patients with a kidney tumor. Laparoscopic upper pole partial nephrectomy had acceptable results while the kidney was turned upside down intraoperatively, in terms of operative time and complications. This approach facilitates the procedure by achieving a better field of vision

Posttransplant lymphoproliferative disorders in kidney transplant recipients. An Iranian multicenter experience

Limited data with adequate sample size exist on the development of posttransplant lymphoproliferative disorder [PTLD] in living donor kidney recipients. We conducted a retrospective cohort study on the data of 10 transplant centers to identify the incidence of PTLD in Iran. Data of 9917 kidney transplant recipients who received their kidneys between 1984 and 2008 were reviewed. Fifty-one recipients [0.5%] who developed PTLD were evaluated with a median follow-up of 47.5 months [range, 1 to 211] months. Patients with PTLD represented 24% of all posttransplant malignancies [51 out of 211 cases]. There was no relationship between PTLD and sex [P = .20]. There were no statistically significance differences considering the age at transplantation between patients with and without PTLD. The late-onset PTLD [70.6%] occurred more frequently compared to the early form. There was no signification relationship between early-onset and late-onset groups in terms of clinical course and outcome. In patients who received azathioprine, PTLD was more frequent when compared to those who received mycophenolate mofetil [P < .001]. The lymph nodes were the predominantly involved site [35.3%], followed by the gastrointestinal tract, brain, kidney allograft, lung, ovary, vertebrae, and palatine. Age at diagnosis and the time from transplantation to diagnosis were comparable for various involvement sites of PTLDs. The overall mortality in this series of patients was 51.0%. Posttransplant lymphoproliferative disorder is a rare but devastating complication and long-term prognosis can be improved with early recognition and appropriate therapy

Ureteral calculi in children: What is best as a minimally invasive modality?

Minimally invasive treatment of ureteral calculi in children is a challenging topic. In an evidence-based review, we evaluated the efficacy and safety of extracorporeal shock wave lithotripsy [SWL] and ureteroscopic modalities for this group of patients. In this study, we performed a comprehensive systematic review on articles appeared in the PubMed from 1998 to March 2008. We selected all papers addressing SWL or ureteroscopic management of the ureteral calculi in children and determined the level of evidence of the presenting data. Thirty-nine articles were reviewed and 24 with valid information on SWL or ureteroscopic management of the pediatric ureteral calculi were analyzed. Six articles [25%] were randomized controlled trials and 18 [75%] were retrospective case-controls or case series. The following data were extracted from the 24 articles: in SWL groups, overall success rate was 84.1% [range, 71% to 100%] for the upper ureteral calculi and 76.2% [range, 19% to 91%] for the lower ureteral calculi. Only 61% of the patients had only 1 treatment course, while 8% and 31% of the cases required 2 and more than 2 sessions of treatment, respectively. With ureteroscopic management, the overall success rates were 93.2% [range, 81% to 100%] and 74.4% [range, 20% to 100%] in the lower and upper ureteral calculi, respectively. The main limitations of the series on minimally invasive treatment of pediatric ureteral calculi are lack of powerful randomized controlled trials or prospective data and insufficient patients numbers. Therefore, it is difficult to draw absolute conclusions about successful treatment based on current knowledge

Laparoscopic adrenalectomy ten-year experience, 67 procedures

The purpose of this study was to evaluate the short-term and long-term results of laparoscopic adrenalectomies carried out in our center. A total of 67 laparoscopic adrenalectomies were performed during the 10 years between 1995 and 2005 at Shahid Labbafinejad Medical Center. A transperitoneal lateral approach was used in 65 [97.0%] of the patients, and retroperitoneal approach was used in 2 [3.0%]. The clinical characteristics and the outcomes were reviewed in a retrospective study. Indications for laparoscopic adrenalectomy in our patients were as follows: pheochromocytoma in 28 patients [41.8%], aldosterone-producing adenoma in 15 [22.4%], pseudocyst in 6 [9.0%], Cushing syndrome [macronodular adrenocortical hyperplasia] in 5 [7.5%], nonfunctioning adenoma [incidentaloma] in 5 [7.5%], myelolipoma in 2 [3.0%], almost normal adrenal tissue in 2 [3.0%], adrenal cyst in 2 [3.0%], adenocarcinoma in 1 [1.4%], and schwannoma in 1 [1.4%]. The mean operative time for unilateral cases was 149.0 A +/- 36.1 minutes. The mean intraoperative blood loss was 126 A +/- 36 mL. Conversion rate to open surgery was 7.5%. Reoperation due to hemorrhage was performed in 1 patient. Laparoscopic adrenalectomy is a safe procedure in some adrenal tumors and a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion

Blind puncture in comparison with fluoroscopic guidance in percutaneous nephrolithotomy: a randomized controlled trial

Our aim was to evaluate blind puncture in percutaneous nephrolithotomy [PCNL] for decreasing the risk of radiation. One hundred candidates for PCNL were randomly assigned into 2 groups. Blind access was performed for the patients in group 1 and the standard access using fluoroscopy for those in group 2. In group 1, displacement of the targeted calyx in the prone position was estimated by fluoroscopy comparing to the image on intravenous urography. Puncture of the calyx was attempted 3 cm to 4 cm below the marked site of the targeted calyx with a 30 degree sign angle. If the access to the collecting system was felt and urine came out, the site of puncture would be controlled by fluoroscopy. If the access failed, we would repeat puncturing up to 5 times. The mean time to access was 6.6 +/- 2.1 minutes and 5.5 +/- 1.7 minutes in groups 1 and 2, respectively [P=.008]. The mean time of radiation exposure was 0.95 +/- 0.44 minutes in group 2. A successful puncture of the targeted calyx was achieved in 50% and 90% of the patients in groups 1 and 2, respectively [P<.001] and a successful calculus removal in 62% and 100% of the patients in groups 1 and 2 [P<.001]. Although about half of the patients benefited from blind access in our study, this technique can not be solely relied on, and fluoroscopy or ultrasonography should be available for prevention of complications

Extracorporeal shock wave lithotripsy and transureteral lithotripsy in the treatment of impacted lower ureteral calculi

We compared the efficacy of extracorporeal shock wave lithotripsy [SWL] with ureteroscopy followed by transureteral lithotripsy [TUL] for the treatment of impacted distal ureteral calculi. A total of 96 patients with solitary impacted distal ureteral calculi were assigned into 2 groups of treatment with SWL [42 patients] and TUL [54 patients] with a 6.9-F semirigid ureteroscope. Characteristics of the patients and the calculi, treatment parameters, clinical outcomes, and patients' satisfaction were assessed for each group as well as efficiency quotient. Demographic characteristics of the patients in the 2 groups were similar as well as the sizes of the calculi. The stone-free rate, 2 months postoperatively, was 71.4% in the patients of the SWL group and 88.9% in those of the TUL group. The efficiency quotient was 56% and 81% for the SWL and TUL groups, respectively [P =.004]. Retreatment rate was 26.2% [11 patients] and 9.3% [5 patients] for the SWL and TUL groups, respectively [P =.027]. Thirty patients in the SWL group [71.4%] and 52 in the TUL group [96.3%] were satisfied with their treatment [P =.001]. There were no major complications in neither of the groups. Minor complications [pain and hematuria] were more common in the TUL group. Based on the results of this study, TUL seems to be more effective than SWL in the treatment of impacted lower ureteral calculi sized smaller than 12 mm, and patients are more satisfied with this treatment method

effect of urine and blood metabolic risk factors on calcium stone formation

In spite of vast improvements in urinary stone treatment [ESWL, PNL, ureteroscopy, etc.], metabolic workup concerning the existence of stone forming risk factors are of great importance and can lead to control and even prevention of urinary stone formation in these patients. In this analytical case-control study performed on 266 persons [110 normal persons [56 males and 54 females], 76 patients with one episode of stone formation [40 males and 36 females], and 80 patients with recurrent stone formation [40 males and 40 females]] aged between 30 to 45 [with art average of 37.6] in Shahid Doctor Labbafinejad Medical Center from May to July 1999, serum parameters and 24-hour urine parameters have been investigated and compared among the three groups. Results of this study revealed considerable differences in urinary calcium levels of these three groups, with and without considering sex [p<0.05]. Averages of 24-hour urinary calcium calculated for normal, one episode and recurrent stone formers in male groups were 159 +/- 43, 219 +/- 71, and 283 +/- 74 mg/24h respectively, and for normal, one episode and recurrent stone formers in female groups were 124 +/- 37, 190 +/- 58, and 287 +/- 152 mg/24h respectively. Although 24-hour urine citrate in females obviously showed higher values than males, there was no significant difference among the studied groups of the same sex. Levels of serum calcium, potassium and magnesium between groups of females and 24hour urine magnesium and phosphate levels between groups of males had statistical differences also [p<0.05 for all of the cases mentioned above]. According to the results obtained from this study, it was realized that in the studied society levels of 24-hour urinary calcium which are higher than 200 mg/ 24h [sensitivity 80%, specificity 94% and FPR 6.4%] and calcium creatinine ratios of 24-hour urine which are higher than 0.17 [sensitivity 7.5%, specificity 88.1% and FPR 11.9%] can be regarded as hypercalciuria. However, the results of this study should be confirmed by more general and extended studies