Background/objectives: Renal access remains a limiting factor in Retrograde Intrarenal Surgery (RIRS), particularly in non pre- stented patients. Hyoscine butylbromide (Hbb) is an antispasmodic agent which has not been studied in RIRS. This study evaluates role of intravenous Hbb at induction for facilitating renal access in non-pre-stented RIRS patients, benchmarking outcomes against pre-stented patients. Methods: Retrospective analysis of prospectively maintained data from 360 RIRS procedures (Jan 2018-Dec 2024). Patients were divided into two groups: Group A (nonpre-stented + intravenous Hbb at induction, n=151), Group B (pre-stented, no Hbb, n=209). Men on Tamsulosin were excluded in group A (n=15). Outcomes included failed renal access, ureteric injury, stent duration and strictures. Results: Failed kidney access: Group A 3.9% and Group B 1.9% (A and B, p=0.33). Ureteric injury was observed in 10.59% and 5.3% in Groups A and B, respectively (A vs B, p=0.069). Mean stent duration in group A and B was 18 ± 11.4 and 49.01 ± 9.5 days, respectively (p<0.05). One ureteric stricture occurred in each group. Conclusions: Intravenous Hyoscine butylbromide at induction in non-pre-stented patients achieves renal access rates comparable to pre- stented RIRS patients, with shorter stent duration, reducing National Health Service costs from additional procedures and improving QoL by minimizing stent symptoms-a safe single session alternative.
Background: Sarcomatoid carcinoma of the urinary bladder (SCUB) is a rare and aggressive malignancy with limited clinical data due to its infrequency. This case report contributes to the existing knowledge by presenting a patient with SCUB and highlighting the diagnostic workup, treatment course, and clinical outcomes. Case presentation: A 57-year-old man presented with lower urinary tract symptoms and hematuria. Imaging revealed a 4 cm bladder tumor. Transurethral resection of bladder tumor (TURBT) confirmed pT2 sarcomatoid carcinoma. Radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversion was performed. Pathological examination confirmed SCUB with no lymph node involvement. The patient remains disease-free at two years follow-up. Conclusion: SCUB is an uncommon malignancy with a poor prognosis. Radical cystectomy is the preferred treatment; however, outcomes remain poor. A multimodal approach may offer improved outcomes for locally advanced diseases. Further research is needed to establish more effective treatment strategies.
Objective: To evaluate the prevalence of LUTS and it’s association with comorbidities such as hypertension, diabetes and smoking in individuals seen at a referral clinic in Urology in the Federal District. Methods: Descriptive, cross-sectional and analytical study, conducted in 410 individuals aged 40 years or older, attended at the Urology outpatient clinic of the North Wing Regional Hospital, in Brasília, Brazil, on December 1 from 2018 to April 1, 2019. The questionnaires were applied to assess urinary symptoms. Results: 64.15% had LUTS. In diabetics, the prevalence of LUTS had no statistical difference between the groups. HAS and LUTS were not associated, for this sample. The prevalence of LUTS increased in parallel with advancing age. 7.25% of the individuals were smokers. Conclusion: The prevalence and severity LUTS increase with advancing age. LUTS has not a been associated with DM and SAH in this study.
The prostate gland secretes citrate, the levels of which vary in benign prostatic hyperplasia and tumors. Multiparametric MRI of the prostate, although sensitive, has limitations in its specificity. Spectroscopy can quantify these cellular metabolites. At the La Trinidad Teaching Medical Center, 46 studies were carried out with 3D spectroscopy in patients referred from the urology service from January to June 2023. The objective was to verify the diagnostic usefulness of 3D spectroscopy with multiparametric Magnetic Resonance of the prostate. The findings in the 3D prostate spectroscopy metabolite map were described, the results of the mpMRI PIRADS score and the metabolite map were analyzed, and the anatomical pathological and 3D spectroscopy results were compared. A 1.5T Philips Anchieva resonator was used with 3D prostate spectroscopy sequences in 36 patients. The metabolites in 3D spectroscopy showed correlation with the suspicious criteria according to SCORE PI-RADS, especially in the suspicious nodular areas. The sensitivity and positive predictive value were 88%, while the specificity and negative predictive value were 96%. However, more studies are needed to obtain more conclusive results.
Secondary hyperparathyroidism is an early-stage complication of CKD (Chronic Kidney Disease). It is associated with disorders in bone metabolism, calcium deposition in vessels and organs, significantly increased risk of cardiovascular disease, and death. In recent years, an increasingly important role has been attributed to fibroblast growth factor (FGF 23) in regulating calcium/phosphate homeostasis, hyperparathyroidism, and its relation to vascular calcification, and left ventricular hypertrophy. This study conducted with 110 patients with varying degrees of renal insufficiency shows an increase in FGF23 and PTH when there is a decrease in glomerular filtration, a direct dependency between the levels of phosphate and PTH and FGF23, and a lack of such between calcium and PTH and FGF23. Of particular interest is the fact that patients treated with Calcitriol and Paricalcitol show a reduction in PTH levels, yet maintain high levels of FGF23. PTH serves as a marker for the rate of bone remodeling in patients, where elevated levels indicate renal bone disease. The analysis of FGF 23 is crucial in evaluating cardiovascular risk.
Renal biopsy is an essential tool for diagnosing many conditions that affect the kidneys. It is the gold standard test for detecting glomerulopathies and parenchymal renal disease and, therefore, helps determine the best treatment for the diagnosed disease.1–4 Percutaneous renal biopsy, commonly performed under ultrasound guidance, is the most commonly used approach, as it is less invasive and can be performed on an outpatient basis. Because of the invasive nature of the procedure, complications are not uncommon. This study aims to analyze the results of biopsies collected at a tertiary referral center in Brazil. We evaluated whether the quality of the tissue sample obtained was sufficient to diagnose the focal lesion and, therefore, establish a diagnosis and treatment for the patient. An epidemiological analysis of the patients undergoing the procedure was also performed, as well as a survey of the main complications related to it.
Background: Elevated Body Mass Index (BMI) is a significant risk factor for developing hypertension (HTN). Other factors, including family history, smoking, and energy drinks consumption, can potentially increase the risk for HTN. Limited data are available on the risk factors for HTN in Coptic adolescent population. Hence, this study sought to investigate the association between these risk factors and HTN in Coptic adolescents. Methods: A screening survey was conducted on 140 high school students who attended church services. After signing a consent form, each participant was interviewed and asked to answer the survey questions. The blood pressure was measured twice after 15 minutes of rest using Omron device. Both weight and height were measured, and BMI was calculated using CDC BMI calculator. Descriptive statistics, univariate, and multivariable logistic regression analyses were used to explore the relationship between the HTN and other potential variables. Results: The cohort included 70 females (50%) and 70 males (50%) aged 16-21. The overall prevalence of HTN was 45.7% (73% in males and 18.6% in females). Participants were categorized by BMI into normal (n=78), overweight (n=44), and obese (n=18) groups. Compared to the normal weight group, the odds ratio (OR) for HTN in the overweight and obesity groups was 7.2 (95% C.I. 3.1 – 16.6, p<0.001) and 1.9 (95% C.I. 0.67 – 5.5, p=0.27), respectively. Among the total cohort, hypertensive individuals exhibited significantly higher BMI compared to normotensive individuals (26.3 [23.5, 28.3] vs. 22.5 [20.6, 25.7], p=0.001). However, there was no association between HTN and other covariates (p>0.05). In multivariable logistic regression, the association between HTN and elevated BMI remained significant (adjusted OR 3.8, 95% C.I. 1.6 – 9.3; p=0.002). Conclusion: our findings are consistent with accumulative evidence about the positive relationship between BMI and HTN, which is a part of the metabolic syndrome. Moreover, this is the first study to investigate the risk factor profile for HTN in Coptic adolescents. Larger scale epidemiologic studies are needed to assess the prevalence of HTN in this population and the best approach to manage the modifiable risk factors.
Introduction: This is an external validation study of the PRECE prostate cancer nomogram in a Central American population. Methods: We present 102 consecutive cases of robotic radical prostatectomy, performed with preservation of the anterior fascia and we use the PRECE nomogram as a guide to preserve the prostatic neurovascular pedicles. We compared the predicted extra-capsular extension from the PRECE nomogram to the final prostatectomy pathology. Results: Analysis of post-prostatectomy pathological samples revealed that 61% patients had pT2; 27% had a pT3a and 12% had a pT3b, respectively The ROC curve for the PRECE nomogram at one (1) mm showed a model AUC of 0.91 (95% CI), which implies a high agreement with the PRECE nomogram in the prediction of extraprostatic disease. Conclusion: This is the first report of external validation of the PRECE nomogram in a Central American population. PRECE demonstrated high discrimination for the prediction of extraprostatic disease in an independent Latin American cohort. More external validation studies, from different geographic settings, are expected to confirm the reliability and reproducibility of PRECE in other clinical settings.
Background: A gymnasium is a place for physical activities and frequent consumption of hormonal and non-hormonal supplements by athletes in order to build muscles and gain strength in a short time. The gymnasium can be the cause of several renal diseases through different practices such as extensive exercises, consuming energy drinks, and insulin injection. In addition, the use of anabolic steroids has a direct and indirect impact on kidney health. Aims: The aim of this study was to assess people's awareness and knowledge of certain bad athletic behaviors leading to kidney disease. Young people could play a role in changing the behavior of their society and raising awareness. Methods: This study employed a cross-sectional survey design. Our questionnaire was used to assess levels of awareness and understanding about Gymnasium, body building, and the associated negative effects on kidney health and illness. An online questionnaire was created using Google Forms, and a link was sent. To fill out the questionnaire, each participant must first consent to participate. Following the coding of the questionnaire responses, statistical analysis was performed. Results: The participants were mostly in the western region of Saudi Arabia. Of the 191 individuals, 93.7% preferred to use the Survey in Arabic; 41.7% were female; and their ages ranged from 15 to 41 years old, with an average of 29 years old. The young age group of 21–25 constituted 33.3%, and 25% were > 41 years old. The majority of participants were from Jeddah, Saudi Arabia (66.7%). It was clear to us that most people had less knowledge about the relationship between exercise and kidney failure (57%). On the other hand, there was a high percentage of people who believed that steroid and hormone use was harmful to their health (69.8%). In addition, we found that the majority of people who exercise are over 41 years of age, which leads to a higher level of awareness of nutritional supplements and knowledge. Conclusion: Nephropathy in the gym is complex, and its prevention relies on public knowledge, support, and active engagement. We urge that health workers and medical students play an essential role in raising awareness and information about the risk of nutrition supplements on the kidney and those public lectures be presented regularly.
The presence of fungal infections in the urinary bladder is rare; there are no extensive reviews on this subject in current literature, even less with the presence of two different types of fungi in the same culture. We present a case of an 82-years-old male patient with a history of benign prostatic hyperplasia (BPH) and type 2 diabetes mellitus (DM2) who underwent a simple suprapubic prostatectomy. Shortly thereafter, he was readmitted to the emergency room with symptoms of fever and urinary distress, eventually diagnosed with a fungal infection caused by Candida tropicalis and Candida glabrata in the urinary bladder, secondary to prostatic hyperplasia. He was admitted for assessment and multidisciplinary management. Guided treatment with caspofungin 50mg every 12 hours for 14 days resulted in clinical improvement. Proper diagnostic approaches are crucial for effective management of bladder fungomas, ensuring optimal patient outcomes.
Introduction: Hypospadias management has seen various trends over the years, likely due to the diverse clinical presentations and evolving surgical techniques. However, there is a lack of consensus among pediatric urologists on many aspects of hypospadias management. To address this, our research aims to survey specialists and establish a consensus on hypospadias management. Methodology: In July 2021, a cross-sectional study was conducted using a Survey Monkey questionnaire consisting of 23 questions. The survey aimed to gather information about the generalities and management preferences of distal and proximal hypospadias from specialists belonging to the Ibero-American Society of Pediatric Urology (SIUP). The data collected was categorized into subgroups based on surgical techniques, perioperative preferences, and complications. Results: Most hypospadias surgeries are performed between 13-18 months. Penile curvature is evaluated with artificial erection and visual inspection. The Nesbit technique (36.1%) and ventral corportomies (26.9%) corrections are more common, while grafts corporoplasties are used less frequently (10.2%) for correction. For urethroplasty, the surveyed group prefers using a running suture or a combination of continuous and interrupted stitches (49.1% and 24.3%, respectively). The use of Polydioxanone 6-0 in a double-layer suture group yielded a higher response rate. The use of prophylactic antibiotics and their maintenance when the catheter is in place was also favored by most surgeons. Discussion: When repairing hypospadias, the surgeon must consider factors such as the quality of the urethral plate, the presence of penile curvature, and the location of the urethral opening. This study highlights the different strategies and technical preferences used for hypospadias repair by a group of specialists from different countries. Conclusion: The survey describes current trends in hypospadias management. Two-stage repair is commonly used for proximal hypospadias, while TIP repair is the most used technique for distal hypospadias. The most common complication is the development of an urethrocutaneous fistula.
Introduction: The COVID-19 pandemic, produced by a mutant strain of coronavirus SARS-CoV-2, which caused worldwide chaos never seen before, started in China in December 2019. In Brazil the first case was confirmed on February 26, 2020 with a 61-year -old patient and the World Health Organization declared a pandemic on March 11, 2020; the aggressiveness of the disease led to an accelerated search for treatments and vaccines, just in July 2021, there were 184 vaccine candidates against COVID-19; Along with immunization, several adverse effects generated by the various vaccines have been reported, ranging from mild to severe, from minor pain at the puncture site to headache, fever, arthralgias, etc. Severe cases have also been reported, such as anaphylaxis, heart disease, renal alterations, etc. which to date are not fully determined. Clinical case: It is related to a clinical case report in Brazil of a 16-year-old female patient, with no significant personal history, who received the first dose of the vaccine for COVID-19 (Pfizer-BioNtech) and 3 days later presented with headache, abdominal pain and arterial hypertension; when assessed and with complementary examinations was determined a rapidly progressive glomerulonephritis, she received treatment with corticosteroids for 3 days; with the biopsy resulted in focal and segmental collapsing glomerulosclerosis with moderate tubulointerstitial repercussion (30-40%). Evolution: The patient developed renal failure and nephritic/nephrotic syndrome. Conclusion: It is not determined with certainty, but there is the possibility of association of glomerular disease with vaccination for COVID-19, it is necessary to continue with the vaccination campaigns and to reduce the aggressiveness of this disease.
BACKGROUND . One of the congenital anomalies of the kidneys and urinary tracts (CAKUT) is renal hypodysplasia/aplasia type 3 (PHDA3), caused by pathogenic variants in the GREB1L gene not associated with steroid-resistant nephrotic syndrome (SRNS). PGDA3 leads to chronic kidney disease (CKD). Variants in the UMOD gene associated with autosomal dominant tubulointerstitial kidney disease (ATKD- UMOD ) also lead to CKD. The association of the GREB1L / UMOD genes with SRNS has not been previously described. THE AIM : to demonstrate a rare clinical case of SRNS in a child with CAKUT-syndrome. PATIENTS AND METHODS . A patient with CAKUT in the form of PGDA3 and ADTBP- UMOD is observed in the department of nephrology for 2 years. Post-infectious development of SRNS required a revision of the genetic screening. RESULTS. On the whole-genome sequencing were found a variability in the genes that cause CAKUT, with no candidate genes for SRNS. CONCLUSION. The described case stands out with clinical polymorphism of CAKUT and the variability of UMOD and GREB1L gene variants not associated with the development of SRNS. Infectious etiology of the development of SRNS is assumed. The patient has an intensive development of CKD stage 4, requiring a long-term follow-up in dynamics.
patient experience?To plan something different we need to understand our local reality, preceding a situational diagnosis, watching our local environment, the most prevalent diseases and the existing gaps.Otherwise, we cannot go anywhere.The Dialysis facility design is an important aspect of the long-term functional success of any unit so it is important that designing should be done with care. 4cently, we had the opportunity to be part of a team in charge of planning and build a new intra hospital dialysis unit in South Brazil, so that was the opportunity to redesign a dialysis unit.The current service now has 1053m², 38 chairs (17 private), an Isolation box for Hepatitis B and C, contact isolation, air isolation and unknown serologies, 2 multi-professional offices, one procedure room, peritoneal dialysis room, a local pharmacy (satellite), 2 administrative rooms and water treatment (double pace reverse osmose).Patients treated at this service have a predominance of males, with a mean age of 68 years (76.6% over 61 years).The most prevalent pathologies are hypertension (83.7%) and diabetes (53.5%).Quality indicators are mandatory to monitor infections, hand washing adherence, falls, and monthly exam results.Quality tools such as checklists, risk maps, and notifications are implemented.It was a wonderful time to bring all known concepts into practice.From the beginning, we consider staff and patient experience our major drive to design the architectural plants, flows, and processes.Discussing possible scenarios in a multidisciplinary team, including the high leadership institution, we were able to think about new ways of working, guided by a new mindset and some predominant questions Table 1.
Urachal abscess, a rare condition from fetal allantoic canal remnants, presents diagnostic challenges. We report a case in a 40-year-old man, emphasizing clinical, diagnostic, and therapeutic nuances. Imaging aids diagnosis, with prompt surgical intervention following antibiotic therapy. Early recognition is vital to prevent complications. Multidisciplinary management improves outcomes.
Background: Evaluation of the functional and cosmetic results after repair of different cases with fossa navicularis stricture by different techniques of urethroplasty. Methods: This study included 43 male patients with different lengths of fossa navicularis stricture of different age groups (8-60 years). History, clinical examination, ascending urethrogram (AUG), and voiding cystourethrogram (VUG) were reported for all patients. Primary outcome was functional assessment using AUG and VUG. Secondary outcomes were cosmetic evaluation using the HOSE score and 90-day complications. Follow-up duration was 2 years (at the 6th month, the end of the first year, and the end of the second year) by clinical examination, flow rate, urethrogram, and urethrocystoscopy. Results: Cosmetic and functional success was achieved in 39 patients (90.6%). Follow-up was for 24 months. The flow rate had improved up to 15.3ml/sec. Four patients developed complications, one patient with restricture, two patients with subcoronal fistula, and one with glanular disruption. Conclusion: Different techniques were used for the repair of fossa navicularis stricture. The choice of suitable technique was according to different findings such as length of stricture, urethral caliber, associated Lichen sclerosus (LS), availability of penile skin, and hair distribution. The technique of repairing fossa navicularis stricture with the use of the transverse penile island flap with the glans cap keeps the glanular shape and configuration intact with optimum function.
Patients with diabetes mellitus (DM) have a lower risk of developing Prostate Cancer (PCa). This apparent "protection" is mainly due to a deficit in the insulin signal and a state of hypogonadism associated with insulin resistance (IR), which would bring about a decrease in available testosterone levels. On the other hand, the concomitance of DM in patients with PCa leads to higher morbidity and mortality, even in tumor stages with a good prognosis, in the context of a lower response rate to cancer treatments and a higher frequency of tumor recurrence. Glycemic control directly affects these prognostic factors, since an adequate clinical-nutritional approach is mandatory in this dual relationship pathology.
Introduction and objective: Refractory hematuria is a challenge in the urological practice. Reasons for bleeding are bladder tumors, radiation cystitis, prostate cancer, kidney cancer, among others. Most patients have an advanced age, many comorbidities and are in palliative care due to advanced malignancies. In such patients an aggressive surgical treatment is not feasible and might be the last option of treatment. Selective arterial embolization has been described as part of the treatment of refractory hematuria, being a less invasive procedure with acceptable results in the long term follow up. Our aim is to report our experience with selective embolization as a treatment for severe refractory hematuria of the urinary tract, its success rate and side effects. Methods: Medical charts of patients that underwent selective arterial embolization as the treatment of any cause of refractroy hematuria between 2013 and 2021 in our institution were reviewed; 21 patients were identified. Standard selective arterial embolization was made by the vascular surgery division. Success was defined as the need of additional procedures after embolization. A descriptive analysis was performed, and all data was analyzed using the R software version 3.6.3. Results: A total of 21 patients underwent selective arterial embolization for refractory hematuria between 2013 and 2021. The mean age was 71.3 years old and 76.2% of patients were male. Most patients, 47.6% had advanced prostate cancer, 14.3% had advanced bladder cancer, 28.6% of patients had radiation cystitis and 9.5% had advanced renal cell carcinoma. Patients underwent embolization in a mean period of 23.6 days after admission. The rate of complications after embolization was 4.7% corresponding to one patient who had a Clavien Dindo II complication. Hematuria didn’t resolve in 61.9% of patients and 52.3% needed additional procedures, 27.2% required cystectomy due to failed embolization. The mean time to cystectomy was 29.6 days. Patients who underwent cystectomy were characterized to have radiation cystitis, prostate and bladder cancer corresponding to 4.7% respectively. The success rate of embolization was 52.3% and no post embolization syndrome was noted. Conclusion: Selective arterial embolization remains a minimally invasive option for refractory hematuria, with low rate of complications and should be part of the treatment algorithm of refractory hematuria before aggressive surgical treatment, but with a high rate of patients requiring further treatments, in up to 52.3% of cases.
Primary hyperoxaluria (PH) is a rare disorder, resulting from an excessive production of calcium oxalate mainly by the liver, which can be deposited in different organs. Patients affected by PH can progress to recurrent lithiasis, nephrocalcinosis and end-stage renal disease, requiring a kidney transplant for the recovery of organ function, associated with liver transplantation, to correct the source of this metabolic defect.1 The case of MJB, female, 27 years old, was reported in this paper, which is the first recorded case of simultaneous transplantation of this nature in the transplant service of Hospital Santa Isabel - Blumenau and consequently the first in the state of Santa Catarina, Brazil. She discovered the disorder through genetic sequencing at the age of 24.2 The patient had already been on renal replacement therapy, hemodialysis, for 4 years. Due to the severe complications of the disease, simultaneous kidney and liver transplantation was indicated. Considering the evolution of the patient up to the present moment, the transplant in this case proved to be a very effective therapeutic alternative, and in agreement with the literature.1,3
Large renal masses are rare findings in pregnant patients and generate complex challenges regarding when and how to treat. We report a case of a 23-year-old woman found to have a large renal mass during twin pregnancy. Here we describe the evaluation and decision making for this patient who was ultimately treated with robot-assisted radical nephrectomy during her pregnancy.
