Lower Pole Research Articles

Is the nodule location a predictive risk factor for cancer in AUS/FLUS thyroid nodules? A retrospective cohort study

Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous category of thyroid nodules with uncertain cytology and controversial management. This study aimed to assess the association between nodule location and malignancy risk and whether the location can be used as a predictive risk factor for cancer in AUS/FLUS nodules. A cohort of 102 patients (79 [77.5%] women, 23 [22.5%] men) was retrospectively analyzed. Only patients with a final histopathology of benign or well-differentiated thyroid cancer and an available nodule location were included. Sociodemographic, histopathological, and sonographic data were statistically evaluated and correlated. Based on pathology findings, 54 (52.9%) and 48 (47.1%) nodules were benign and malignant, respectively. Most nodules were right-sided (54.9%). Considering the nodule location, 41.2% of nodules occupied the whole lobe, 20.6% only the lower pole, 15.7% only the upper pole, and 2.9% the isthmus. Cases with nodules occupying only the upper, middle, or lower pole showed significant associations with cancer risk (odds ratio, [95% confidence interval]: 2.6, [1.1-5.7]; 2.0, [1.0-4.7]; and 1.9, [1.0-3.9], respectively). Male sex and the presence of a peripheral halo were significantly associated with malignancy risk (3.3, [1.2-9.1], P=0.014; and 2.7, [1.0-9.5], P=0.049, respectively). Isthmic nodules had the highest malignancy level (66.7%). Nodule location is a promising predictor of malignancy in AUS/FLUS nodules. Furthermore, isthmic nodules had the highest malignancy level, emphasizing the significance of careful evaluation of these nodules. Further large prospective studies are required to confirm these findings.

The fate of clinically insignificant residual fragments following retrograde intrarenal surgery and factors affecting spontaneous passage.

The remaining stone fragments after retrograde intrarenal surgery (RIRS) can lead to stone recurrence/regrowth, or stone-related events (SRE). We aimed to delineate the clinical circumstances that are decisive for spontaneous passage of clinical insignificant residual fragments (CIRF) (primary outcome) and define risk factors for stone recurrence/regrowth and their clinical manifestation (secondary outcome). A total of 115 patients who had CIRF following RIRS were included in this study. Demographic, clinical data, stone, and anatomic characteristics including infundibulopelvic angle (IPA), infundibular length (IL) and follow-up data of patients were analyzed. The mean follow-up time was 27.5 ± 6.9months. 31 (26.9%) patients passed the CIRF spontaneously. Patients were divided into two groups as spontaneous fragment passage group and fragment remaining group and compared with respect to demographic, clinical, stone-related, and anatomic characteristics. 61.2% of patients had lower pole CIRF in fragment remaining group and 83.3% of patients in spontaneous fragment passage group (p = 0.031). In addition, IPA was wider in spontaneous fragment passage group (60.7° vs 51.4°, p = 0.001). A subanalysis was performed for fragment remaining group. In 84 patients, 44 (52.4%) patients were stable for their CIRF at their follow-up and included in stable group. 40 (47.6%) patients experienced stone re-growth (27 patients) or SRE (13 patients) at their follow up. Patients in re-growth/SRE group were older (49.1 vs 39.4years, p = 0.047), had higher body mass index (28.2 vs 27kg/m2, p = 0.03) and larger CIRF (2.8 vs 2.1mm). CIRFs may be not expelled spontaneously and they may lead to additional morbidity and lithotripsy interventions.

Comparative Analysis of Lower Island Flap Transposition (LIFT) in Wise-Pattern Mastopexy: Does It Improve Upper Pole Fullness and Breast Harmony?

Utilization of autologous parenchymal flaps aims to attain enduringly favourable outcomes and uphold volume in the upper breast pole after mastopexy procedures. The objective of this study was to juxtapose and scrutinize postoperative upper pole fullness, upper/lower pole ratios, occurrences of bottoming-out deformity, and complication rates between two patient cohorts: those who underwent the wise-pattern superior pedicle mastopexy with the LIFT technique and those who underwent the conventional wise-pattern superior pedicle mastopexy. All the patients in this study were appropriately categorized as primary patients, signifying their lack of any prior breast surgery history. These individuals presented with grades II and III breast ptosis on both breasts, ranging from moderate to severe deformities per the Regnault classification. Importantly, all patients uniformly expressed their desire to achieve a firmer breast appearance without recourse to using breast implants. The patients' ages and preoperative breast measurements were recorded for analysis. Measurements, including the distance from the NAC to the inframammary fold and from the sternal notch to the NAC, were systematically measured both before the surgery and at the 1-year postoperative mark. The upper and lower pole ratios, defined by Mallucci and Branford, were found to be 45.22% ± 2.20% and 54.88% ± 2.20%, respectively, within the LIFT group. In 13 instances, a lower pole distance exceeding 55% indicated a potential bottoming-out deformity (value lower than 45%/55% ratio or 0.818). Conversely, within the control group, the upper and lower pole ratios were determined as 43.22% ± 2.80% and 56.88% ± 2.80%, respectively. These findings demonstrated statistical significance. Notably, in 39 cases within the superior pedicle wise-pattern mastopexy group, a lower pole distance surpassing 55% (value lower than 45%/55% ratio or 0.818) suggested a leaning towards a bottoming-out deformity (p: 0.003). A postoperative period of at least 12 months was essential to discern the emergence of upper pole fullness and the potential development of bottoming-out deformities. Among the cases within the LIFT group, 93% exhibited successful attainment of upper pole fullness, while in the control group, this outcome was achieved in 82% of cases (p>0.05). Implementing the LIFT technique alongside the wise-pattern superior pedicle mastopexy decreases the occurrence of bottoming-out deformity after 1 year. Although there is no statistically significant difference, the LIFT flap technique has contributed to some extent to upper pole fullness. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effects of Soft-Tissue Techniques and Exercise in the Treatment of Patellar Tendinopathy-Systematic Review and Meta-Analysis.

Patellar tendinopathy is a degenerative clinical disorder that causes load-related pain in the lower pole of the patella or patellar tendon. It predominantly affects young male athletes engaged in sports involving repetitive tendon loading, particularly explosive jumping. The combination of manual techniques with therapeutic exercise is hypothesized to provide greater benefits than exercise alone. The aim of this study is to analyze the scientific evidence regarding the effects of soft-tissue techniques combined with therapeutic exercise versus therapeutic exercise alone on pain intensity and function in individuals with patellar tendinopathy. A systematic review with meta-analysis was conducted following the PRISMA guidelines. PubMed, Lilacs, IBECS, CENTRAL, WOS, SciELO, Academic Search, CINAHL, SportDiscus, PEDro, and Google Scholar databases were consulted. Randomized controlled trials and quasi-randomized trials focusing on the effects of soft-tissue techniques combined with therapeutic exercise (experimental group) versus therapeutic exercise alone (control group) on pain and function in individuals aged 16 years and older with patellar tendinopathy were selected. The Cochrane tool for risk-of-bias assessment and the PEDro scale for methodological quality were used. A total of six studies (n = 309; age range = 16-40 years), considered to have a low risk of bias and moderate-to-high methodological quality, were included. The results showed improvements in function in the experimental group (mean of 60% on the Visa-P scale) and pain in the experimental group (mean decrease of 2 points in the VAS scale). There were improvements in 50% of the studies when comparing variables between the experimental and control groups. The combination of manual techniques, such as dry needling, percutaneous electrolysis, transverse friction massage, and stretching, along with a squat on a 25° inclined plane, appears to be effective in the treatment of patellar tendinopathy. Static stretching of the quadriceps before and after the squat five times per week, along with dry needling or percutaneous electrolysis sessions twice a week for 8 weeks, is recommended. However, future studies analyzing groups with passive techniques versus therapeutic exercise are needed to standardize the treatment and establish the optimal dose.

A gradient model of renal ischemia reperfusion injury to investigate renal interstitial fibrosis.

Background: The progression from acute kidney injury to chronic kidney disease poses a significant health challenge. Nonetheless, a constraint in existing animal models of renal ischemia/reperfusion (I/R) injury is the necessity for a severe injury, almost reaching a life-threatening level, to trigger the subsequent onset of renal fibrosis. Hence, we explored an adapted gradient approach to induce I/R injury, aiming to promote the progression of renal fibrosis while preserving the overall normal functioning of the kidney. Methods: In each group, 6-8 male C57BL/6 mice were used for model construction, with all undergoing sodium pentobarbital anesthesia and left kidney removal. Subsequently, a silk thread was passed beneath the lower renal branch, elevating the right kidney under a 20-g weight's tension via a pulley system for durations of 30, 40, or 60min. Afterwards, we lowered the kidney, sutured the wound, and administered intraperitoneal saline. Mice in different groups were euthanized following reperfusion for 1, 3, 7, or 28days. Results: We observed a complete cessation of blood flow in the lower pole, while an incomplete cessation in the upper pole in the elevated kidney. Significant renal impairment was evident on day 1 with a 60min ischemic period (187.0 ± 65.3 vs 17.9 ± 4.8μmol/L serum creatinine in normal; p < .001), but not with 30 or 40min. On day 1, tubular necrosis and hyaline cast formation was evident in both lower and upper poles. On day 3, renal function returned to normal and remained normal through day 28. Histologic damage resolved in the upper pole over days 3 to 7, resulting in normal histology on day 28. By contrast, there was sustained tubular damage tubular in the lower pole on days 3 and 7, which failed to resolve and led to significant renal fibrosis by day 28. Conclusion: We created a model demonstrating clinically "silent" renal fibrosis.

Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR).

To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.

Management of Upper Tract Urothelial Carcinoma in a Double Collecting System Kidney.

Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted a systematic search for all cases of UTUC in DCS from published literature using the following keywords: UTUC, urothelial carcinoma (UC), collecting duct carcinoma, and DCS. The cases were summarized based on demographics, clinical presentation, predisposing risk factors, tumor location, management, and follow-up. We present an additional case based on our experience with a 69-year-old female with high-grade (HG) UTUC of the upper moiety in complete DCS. The patient underwent a robotic upper pole hemi-nephroureterectomy (hemi-NU) with a common sheath distal ureterectomy and a bladder cuff, followed by lower pole ureteral reimplantation. Overall, 34 patients with 35 renal units of UTUC in DCS were included and analyzed. To conclude, UTUC of DCS is rare and underreported. Hence, it is difficult to define a standard treatment. Although hemi-NU has been previously described, to the best of our knowledge, this is the first case report of robot-assisted hemi-NU for complete DCS with single-moiety UC.

Hydatid Cyst at Unusual Location (Spleen) - A Case Report

Echinococcosis or Hydatid disease is a zoonosis endemic in agricultural areas of the world. It is caused by tapeworm of genus Echinococcus excreted in the faeces of infected dogs. Most common site of involvement is liver (50-77%) followed by lungs (18-35%), abdominal cavity and brain. Splenic hydatid cyst is a rare entity constituting 0.5 - 4% of abdominal hydatid disease. We report a case of 62 yrs old female who presented with vague abdominal pain and vomiting. Her abdominal CECT revealed a cystic lesion with peripheral calcified foci at lower pole of spleen. All other investigations were normal except for raised serum echinococcus IgG levels. Splenectomy specimen was received and histopathological examination confirmed it as hydatid cyst. Microscopy showed outer acellular laminated membrane, inner germinal layer with scolices along with eosinophilic inflammatory infiltrate. Patients presenting with hydatid disease are usually asymptomatic or can have vague abdominal pain. The disease is associated with recurrences, fatal anaphylaxis if neglected and high morbidity and mortality, therefore it should be considered as a differential for any cystic mass found in any part of the body.

Ureterocalicostomy for complex upper ureteral stricture: a narrative review of the current literature.

Upper ureteral stricture is a relatively rare but increasingly encountered condition in clinical practice. While simple stricture can often be addressed through endoluminal treatment or surgical reconstruction, complex upper ureteral stricture poses challenges, particularly in patients with ureteropelvic junction obstruction (UPJO) or perirenal pelvic fibrosis and scarring resulting from previous surgeries. These cases present difficulties for traditional endoluminal and ureteral reconstruction treatments, posing a significant problem for many clinical surgeons. Our study involved a thorough search and comprehensive analysis of the existing literature on Ureterocalicostomy (UC). The literature indicates that UC is a safe and effective treatment for ureteral stenosis. By resecting the renal lower pole parenchyma, it is possible to achieve mucosal anastomosis between the calyceal and ureteral mucosa, leading to the restoration of normal urinary excretion. This technique has emerged as an alternative for treating complex upper ureteral strictures. However, there is a lack of direct comparative studies between open surgery and minimally invasive surgery. Our findings revealed a scarcity of relevant review documents, with most being case reports or retrospective studies conducted in single centers with small sample sizes. Therefore, it is crucial to conduct large-scale, multicenter prospective studies and long-term follow-up to validate the long-term efficacy of UC. This article reviews the development history of UC and focuses on a comprehensive discussion of its indications, surgical techniques, and complications.

Ultraviolet running constraints on low mass dark sectors

We analyze the UV breakdown of Sub-GeV dark matter models that live in a new, dark U(1) sector. Many of these models include a scalar field, which is either the dark matter itself or a dark Higgs field that generates mass terms for the dark matter particle via spontaneous symmetry breaking. A quartic self coupling of this scalar field is generically allowed, and we show that its running is largely governed by the strength of the U(1) gauge field, αD. Furthermore, it consistently has a lower Landau pole than the gauge coupling. Link fields, which couple to both the dark sector and the Standard Model (SM), connect these Landau poles to constraints on SM charged particles. Current LHC constraints on link fields are compatible with αD ≲ 0.5 − 1 for most of the mass range in most models, while smaller values, αD ≲ 0.15, are favored for Majorana DM.

Efficacy of Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy In Treating Lower Pole Stones of 1-2 cms

Introduction Urologists are always inclined to find techniques with minimal complication and hospital stays with maximum stone-free rates to mitigate not only health concerns but financial burdens too. PCNL is known as the gold standard for large stones, however, RIRS is known for its less invasive and minor complications. Methodology This is a cross-sectional, prospective study conducted at the public hospital of Jamshoro. Patients with renal stones located at the lower pole, measuring 1-2 cm were included. Patients were evaluated before enrollment and detailed history was taken. Intraoperative and post-operative details were documented. SPSS 21 was used to analyze the data, and to assess significance chi-square test was used, a p-value &lt; 0.05 was considered significant. Results The mean age was 42.7 ± 12.8 and 43.2 ± 13.2 in the RIRS and PCNL groups respectively. The RIRS group showed 07 (17.5%) partial clearance cases while PCNL group showed 02 (5%). Hemoglobin drop was measured as minimal (&lt; 2.5ml) and excessive (&gt;2.5ml) after surgery, and only 01 (2.5%) cases of RIRS had excessive blood loss, PCNL group had higher hemoglobin drop cases with 3 (7.5%) cases. Blood transfusion was required in 1 (2.5%) and 2 (5%) cases in the RIRS and PCNL groups respectively. Conclusion RIRS can be beneficial in small stones while PCNL can be an ideal procedure for lower pole renal stones of 1-2 cm size.

Relocation of lower pole renal stones helps improve the stone-free rate during flexible ureteroscopy with a low complication rate

ObjectiveTo compare the efficacy and safety of relocating the lower pole stones to a favorable pole during flexible ureteroscopy with in situ lithotripsy for the treatment of 10–20 mm lower pole stone (LPS).MethodsThis study was a prospective analysis of patient outcomes who underwent an FURS procedure for the treatment of 10–20 mm lower pole renal stones from January 2020 to November 2022. The patients were randomized into a relocation group or in situ group. The LPSs were relocated into a calyx, during lithotripsy in the relocation group was performed, whereas the in situ group underwent FURS without relocation. All the procedures were performed by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, stone-free rate (SFR), complications, and overall costs were assessed retrospectively.ResultsA total of 90 patients were enrolled and analyzed in this study (45 per group) with no significant differences between the two groups in terms of age, gender, BMI, diabetes, hypertension, stone size, number, laterality, composition, and density. The mean operation time, total energy consumption, postoperative stay, and complications were similar between the groups. Both groups had similar SFR at 1 day postoperative follow-up (p = 0.091), while the relocation group achieved significantly higher SFR 3 months later (97.8% vs 84.4%, p = 0.026). The relocation group also had a significantly higher WisQol score than the in situ group (126.98 vs 110.18, p < 0.001).ConclusionA satisfactory SFR with a relatively low complication rate was achieved by the relocation technique during the FURS procedure.

Experts' recommendations in laser use for the treatment of urolithiasis: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group.

To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications. After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified. Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely. Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units

Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. The stone location was the upper pole in 28 (7.6%) patients, the middle pole in 44 (12%), the pelvis in 98 (26.6%), the lower pole in 139 (37.8%), and multiple locations in 59 (16%) patients. A stoneless state was achieved in 277 (75.3%) units, while 91 units (24.7%) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p=0.012) and stone location (OR, 3.142; p=0.018). RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100% success rate reported in various studies. A full stoneless state was achieved in 277 (75.3%) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6%. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

Analyzing 80 cases of conventional percutaneous nephrolithotomy A Retrospective Study

Objective: The goal of this study is to provide information on the safety and efficacy of percutaneous nephrolithotomy as a kidney stone treatment method in tertiary care facilities. Material and methods: A retrospective study was out from June 2022 to July 2023 at the urology department of the Ikd Peshawar This retrospective study included all patients who had percutaneous nephrolithotomy in the urology unit between June 2022 and July 2023. We analysed data that was retrospectively collected from the medical record system using IBM SPSS version 28. Results: The study included 80 patients, with 67.3% being male and 32.7% being female. A kidney stone history was present in 55% of the patients. As a result of pre-operative ultrasound, 54.3% of patients had several stones, 40.1% had one stone, 3.7% had staghorn stones, 1.2% had a duplex system, and 0.6% (n=1) had a horseshoe kidney. The majority (60%), with stone sizes between 15 and 30 mm, were less than 15 mm, while a sizable minority (16.7%) were larger than 30 mm. Stones were most often found in the renal pelvis (46.3% of cases), lower pole (18.5% of cases), pelvis and lower pole together (16.3% of cases), and staghorn (7.3%). The average hemoglobin level dropped by 1.1 g/dl between pre- and post-operative measurements, from 12.9 g/dl to 11.8 g/dl. Conclusion: A high clearance rate and manageable complication rate may be achieved using percutaneous nephrolithotomy, an efficient treatment for a variety of stone sizes and locations in the kidneys that are abnormal

A Comparative Study between Lower Pole Silk Ligation and Pillar Suturing Technique of Hemostasis in Tonsillectomy

A Comparative Study between Lower Pole Silk Ligation and Pillar Suturing Technique of Hemostasis in Tonsillectomy

A 36-year-old woman with a parathyroid cyst

Background: Parathyroid cysts are rare entities. They account for less than 0.5% of parathyroid lesions. They are divided into two main groups: functioning and non-functioning. Case description: We present a 36- year-old woman with complaints of palpitations, sweating, and nervousness of about 2 months’ duration. From an ultrasound of the thyroid gland with data on anechoic formation under the lower pole of the left lobe of the thyroid gland with dimension 14/16/24 mm. Fine needle aspiration (FNA) of the formation was performed with aspiration of about 5 ml of clear liquid and examination of washout. PTH from the washout of the extrathyroidal lesion-1040 pg/ml. A month later with ultrasound data on recurrence of the formation; repeated aspiration of about 5 ml of blood fluid was performed with subsequent application of 1 ml of absolute alcohol intranodal. Conclusion: Thirty days after the procedure with ultrasound data of slight regression in the dimension: 10/11/20 mm.

Urolithiasis in children; The importance of stone localization in treatment and follow-up.

To evaluate the demographic, etiologic, treatment, and follow-up differences in stones according to their location within the kidney. This retrospective study comprised 337 patients with urolithiasis between 2015 and 2019. Patients were classified into 2 groups according to stone location as lower pole stones (LPS) and upper-middle pole stones (UMPS). The patient's data were recorded at 3-month intervals for one year. One hundred and eighty-three (54.3%) female and 154 (45.7%) men were included in the study. One hundred and twenty-nine (38.3%) of the stones were in the LPS and 208 (61.7%) in the UMPS. UMPS was more common in patients aged > 12months (p < 0.01). At least one metabolic risk factor was present in 93 (72.1%) patients with LPS and 164 (78.4%) with UMPS. The most common urinary metabolic risk factors were hyperoxaluria (31.8%) in patients with LPS and hypocitraturia (34.1%) in patients with UMPS. ROC analysis results showed that cut-off values of 5.5mm for LPS and 6.1mm for UMPS did not provide improve with medical treatment. At the 6- and 12-month follow-ups, the improvement rates were higher in the UMPS group than in the LPS group (p < 0.05). During the follow-up, recurrence was detected in 43 patients: 29% of patients with LPS and 5.8% of patients with UMPS (p < 0.01). Patients with small stones can be followed up. Surgical treatment may be considered for small stones in the LPS. In addition, the risk of recurrence is higher in patients with LPS, and close follow-up is required.

In the Treatment of Lower Pole Kidney Stones Between 1-2 cm in Children, Which is the Best Approach? Retrograde Intrarenal Surgery or Mini Percutaneous Nephrolithotomy.

Kidney stones are treated with many methods, but there is no consensus on which method should be preferred for 1-2 cm lower renal stones. In our study, we aimed to investigate the results of mini (Percutaneous Nephrolithotomy) PCNL and (Retrograde Intrarenal Surgery) RIRS in lower renal pole 1-2 cm stones. Twenty-four mini PCNL and 55 RIRS patients were included in the study. Demographic data of the patients and information about stones on Non-Computed Tomography (NCCT) were recorded. Stone-free status (SFR), need for additional treatment and complications of both methods were compared. Operative time was 55.2±20.8 min in mini PCNL and 70.7±36.5 min in RIRS, which was statistically significantly lower (p=0.002). Length of hospital stay was 2.4±1.5 days in the mini PCNL and 1.3±0.7 days in the RIRS, which was statistically significantly longer (p=0.011). In the postoperative 1st month and 3rd month stone-free rates (SFR) were higher in the mini PCNL group. While the 1st month SFR was 91.6% and 54.5%, the 3rd month stone-free rates were 95.8% vs. 69.1%, respectively (p<0.001). The need for re-treatment was statistically lower in the mini PCNL group (p<0.001). In terms of complications, the incidence of complications was 16.6% (pain in 2 patients, fever in 1 patient, need for blood transfusion in 1 patient) in the mini PCNL group and 21.8% (pain in 2 patients, fever in 8 patients, sepsis in 2 patients) in the RIRS group. There was a significant difference between the two groups (p=0.008). Mini PCNL has a higher SFR, less need for re-treatment and fewer complications.

Renal Phaeohyphomycosis: Aureobasidium Pullulans Infection Caused by Instrument Inoculation in a Healthy Patient - A Case Report

Introduction: Aureobasidium pullulans, ablack yeast-like dematiaceous fungus. Most ofthese infections commonly affect the immunocompromised patients; however, post-instrument inoculation was extremely rare. This is the first report of renal phaeohyphomycosis by A. pullulans after stone surgeries reported worldwide, despite a thorough literature review. Case Report: A 29-year-old immunocompetent native lady, with underlying bilateral grade II renal parenchymal disease, was referred for right staghorn calculi and big left ureteric stone with bilateral hydronephrosis back in 2016. She underwent right percutaneous nephrolithotripsy (PCNL) and left ureteroscopic surgery (URS). Intra-operatively, 90% stone clearance for the right kidney and complete stone clearance was achieved over the left ureteric stone. Blood investigation showed Urea was 8.1 and Creatinine was 200 respectively. There was no growth in Urine C+S sent intraoperatively. Post-operatively, she did a DTPA scan which showed moderate impaired right kidney function (28ml/min-69%) with a non-functioning left kidney (13ml/min-13%). Her condition and renal function had been closely monitored during follow-up in the urology clinic. During follow-up, computed tomography urography (CTU) reassessment in 2018 showed residual right renal stones and resolved left hydronephrosis. Subsequently, she underwent right retrograde intrarenal surgery (RIRS) and ureteric stenting. Intraoperatively, complete stone clearance for the right upper and middle pole; there were a few blackish tubular foreign bodies seen at the right lower pole which were extracted and sent for investigations. Interestingly, the histopathology (HPE) reported as blood clots while the fungal PCR done by the Institute for Medical Research (IMR) showed Aureobasidium pullulans DNA detected. Post-operatively, she completed a one-month course of anti-fungal antibiotic and was discharged home well. Subsequent urine culture was cleared and CTU assessment showed no evidence of stone recurrence or foreign bodies. Discussion and Conclusion: Renal phaeohyphomycosis caused by Aureobadium pollulans secondary to post-instrument inoculation is first reported worldwide in an immunocompetent native lady.