INTRODUCTIONPreoperative alpha-blockers have been proposed to improve intraoperative outcomes and patient stone-free status following ureteroscopy for ureteric stones.MATERIALS AND METHODSWe searched 6 databases including Medline, Embase, and Web of Science for randomized controlled trials evaluating alpha-blocker use prior to planned ureteroscopy for the management of ureteric calculi. Meta-analysis was performed using DerSimonian and Laird method with inverse-variance weighting. Quality of evidence was summarized using the GRADE framework.RESULTSOf 3338 records, 26 were screened as full-text and 12 randomized controlled trials were included totaling 1352 patients. Meta-analysis demonstrated a 61% reduction in need for intraoperative ureteral dilatation in patients administered preoperative alpha-blockers (relative risk [RR]: 0.39 [95% CI: 0.31 to 0.48], p<0.00001), as well as increased stone-free status for patients at 4 weeks post-operatively (RR: 1.17 [95% CI: 1.08 to 1.26], p<0.00001) and at final follow-up (RR: 1.18 [95% CI: 1.11 to 1.24], p<0.00001; median final follow-up 4 weeks [range: 2 to 8 weeks]). Urologists were more likely to reach the stone with the ureteroscope in patients administered alpha-blockers (RR: 1.16 [95% CI: 1.10 to 1.23], p<0.00001). A statistically significant reduction in operative time (MD: -6.05 [95% CI: -10.17 to -1.93] minutes, p=0.004) and length of hospital stay (weighted mean difference [MD]: -0.34 [95% CI: -0.55 to -0.13] days, p=0.001) was also demonstrated. Main reported side effects of treatments were abnormal ejaculation, postural hypotension, and dizziness. Outcomes were robust to sensitivity analyses. Results were rated moderate quality evidence using the GRADE framework.CONCLUSIONSAmong patients scheduled for semi-rigid ureteroscopy of ureteric stones, use of preoperative alpha-blockers demonstrated a significant reduction in the need for ureteric orifice dilation, increase in patient stone-free status at follow-up, and facilitates higher rate of ureteroscopic access to stones while reducing operative time.

Decreased perfusion and trauma during laparoscopic harvesting are proposed causative factors for DGF and rejection in children following renal transplantation with laparoscopic donor nephrectomy (LDN) allograft. We performed a retrospective review of 11 children who underwent LDN transplant and 11 preceding patients who underwent ODN transplant. Intraoperative DUS findings, creatinine values and clearance, time to nadir creatinine and AR episodes were compared. There were no significant differences in the BMI, vascular anatomy, side of nephrectomy, or warm ischemia time in the two groups. Mean follow-up duration was 11.4 and 30.4 months in LDN and ODN groups. DUS showed initial turbulent flow in five of the LDN and four of the ODN group with an average RI of 0.59 and 0.66 in the ODN and LDN groups, respectively (NS). Three patients in the ODN group had an abnormal RI compared to none in the LDN group (p = 0.034). The creatinine values, creatinine clearances (at 24 h, one, four wk and last follow-up) and AR episodes were similar in both groups. Pneumoperitoneum during LDN does not appear to have an adverse impact on early graft reperfusion.

A young male sustained very serious head and soft tissue injuries in a motor vehicle accident (MVA). Three interesting problems developed in the sodium (Na) and water area in the second week in hospital.

The ovaries from mast cell-normal (+/+) and mast cell-deficient (W/Wv) mice were examined with light and electron microscopy. In addition the effect of ovariectomy and subsequent steroid treatment on total uterine histamine content, total mast cell numbers and surface and glandular epithelial cell heights was measured. The ovaries of +/+ mice were normal, displaying various stages of follicular growth and atresia and numerous corpora lutea; the ovaries of W/Wv mice lacked follicles and corpora lutea but contained numerous hyperplastic interstitial cells which contained numerous lipid droplets, vesiculated mitochondria and abundant endoplasmic reticulum suggestive of steroid synthesis. Steroid treatment of ovariectomized +/+ and W/Wv mice caused a significant increase in uterine wet weight and endometrial surface and glandular epithelial cell heights. In +/+ mice, steroid treatment caused a concomitant increase in total mast cells per uterine horn while mast cells were totally absent in W/Wv mice. The increase in uterine histamine in +/+ mice is consistent with the increase in mast cell numbers. Measurable amounts of uterine histamine, which increases slightly after steroid treatment, were demonstrated in W/Wv mice. Since the uteri of +/+ and W/Wv mice respond to steroids in a similar manner with the sole exception being histamine content and mast cell numbers, our results demonstrate the potential of using these animals to investigate the role(s) of uterine mast cells and non-mast cell uterine histamine in the process of implantation and the formation of a decidual cell response.