Renal Surgery Research Articles

Overview of Anatomical Variations in the Vasculature of Suprarenal Gland and Its Applied Surgical Importance

Background: The suprarenal gland (SrG) presents a substantial circulatory supply compared to its size. The superior, middle, and inferior suprarenal arteries (SrA) have one or more duplicate major branches, which supply each gland. this study aimed to observe the variable arteries and veins of the SrG. As the vessels of SrG are forming extensive network, they may get damaged during different surgical procedures like adrenalectomy, renal transplant surgeries Methods: Present study conducted with Twenty five cadavers embalmed in 10% formalin. The inclusion criteria for study were intact blood vessels along with SrGs and the exclusion criteria included the damaged blood vessels and SrGs. Dissection was carried out as per standard dissection protocol. Results: Origin of right superior suprarenal artery from inferior phrenic artery and superior mesenteric artery, Origin of right superior suprarenal artery from aorta and some other findings were noted. Conclusions: This study highlights the critical importance of understanding the anatomical variations in the vasculature of the SrG, particularly in the context of surgical interventions such as adrenalectomy and renal transplantation. The intricate and variable nature of the blood supply to the SrG, including the SrA, as well as their venous drainage, presents significant challenges during surgery. KEY WORDS: Suprarenal Gland, Suprarenal Artery, Suprarenal Vein, Phrenic Vessels.

Comment on "Intravenous Lidocaine Compared with Quadratus Lumborum Block on Postoperative Analgesia Following Laparoscopic Renal Surgery: Protocol for a Randomized Noninferiority Trial" [Response to Letter

Comment on "Intravenous Lidocaine Compared with Quadratus Lumborum Block on Postoperative Analgesia Following Laparoscopic Renal Surgery: Protocol for a Randomized Noninferiority Trial" [Response to Letter

Development and evaluation of a kidney health questionnaire and estimates of chronic kidney disease prevalence in the Cooperative Health Research in South Tyrol (CHRIS) study.

Kidney diseases are a public health burden but are poorly investigated in the general population. In light of inadequate survey tools, we developed a novel questionnaire for use in population-based studies, to retrospectively assess kidney diseases. The questionnaire covered general kidney diseases, reduced kidney function, and renal surgeries. It was administered between 2011 and 2018 to 11,684 participants (median age = 45 years) of the Cooperative Health Research in South Tyrol (CHRIS) study. Fasting estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were measured. By factor analysis we contextualized the questionnaire content with respect to thebiochemical measurements. We estimated overall and sex-stratified prevalence of kidney diseases, including possible CKD, calibrating them to the general target population via relative sampling weights. Population-representative prevalence of glomerulonephritis, pyelonephritis, and congenital kidney diseases was 1.0%, 3.0%, and 0.2%, respectively, with corresponding odds ratios for females versus males of 1.4 (95% confidence interval: 1.0, 2.0), 8.7 (6.2, 12.3), and 0.7 (0.3, 1.6), respectively. Prevalence of kidney dysfunction (eGFR < 60mL/min/1.73m2 or UACR > 30mg/g) was 8.59%, while prevalence of self-reported CKD was 0.69%, indicating 95.3% oflack of disease awareness, with a similar figure in people with diabetes or hypertension. Overall, 15.76% of the population was affected by a kidney disease of any kind. In the Val Venosta/Vinschgau alpine district, CKD prevalence aligned with Western European estimates. Kidney health questionnaire implementation in population studies is feasible and valuable to assess CKD awareness, which we found to be dramatically low.

History of Renal Stone Surgery: A Narrative Review

History of Renal Stone Surgery: A Narrative Review

Pregnancy-related acute kidney injury leads to hypertension, reduced kidney function and cognitive impairment in postpartum rats.

Women with hypertensive disorders of pregnancy such as HELLP (hemolysis, elevated liver enzyme, low platelet) Syndrome are affected by acute kidney injury during pregnancy (PR-AKI) at higher rates than women without hypertension. Both hypertensive disorders of pregnancy and Acute Kidney Injury (AKI) outside the context of pregnancy have been associated with an increased risk of developing Chronic Kidney Disease (CKD) and cognitive impairment. In our current study, we set out to determine if PR-AKI led to the development of CKD and impaired cognition in the postpartum period and if HELLP syndrome exacerbates the impairments. Using timed-pregnant Sprague Dawley rats, on gestational day (GD) 12, mini-osmotic pumps infusing anti-angiogenic factors were surgically placed in the intraperitoneal cavity to induce HELLP. On GD18, AKI was induced via bilateral renal reperfusion ischemia surgery. Mean arterial pressure and birth outcomes were used to assess the global effects of AKI, and liver enzymes were used to assess HELLP. CKD was assessed by measuring glomerular filtration rate (GFR), urinary output, and renal fibrosis. Anxiety-like behaviors, object recognition memory, spatial memory, and avoidance memory were assessed via behavioral experiments. HELLP + AKI rats demonstrated more evidence of renal injury, hypertension, and behavioral deficits compared to normal pregnant animals. In addition, AKI had a negative impact on birth outcomes and maternal survival. HELLP + AKI together led to evidence of persistent hypertension, progressive renal dysfunction, and cognitive impairment, which were exacerbated compared to AKI or HELLP alone. These findings suggest that PR-AKI in the presence of a hypertensive disorder of pregnancy, such as HELLP, leads to the development of CKD, cognitive dysfunction, and hypertension.

Safety and Effectiveness Comparison of Epidural Block and Quadratus Lumborum Block in Patients Undergoing Renal and Urological Surgery: A Systematic Review and Meta-Analysis.

Safety and Effectiveness Comparison of Epidural Block and Quadratus Lumborum Block in Patients Undergoing Renal and Urological Surgery: A Systematic Review and Meta-Analysis.

Клінічна характеристика та особливості хірургічного лікування пацієнтів із простими кістами нирок

Simple renal cysts are quite common in adults with an incidence that increases with age. Renal cysts are composed of enclosed liquid or semisolid fluid and are commonly identified through abdominal imaging. The purpose of this study was to compare the clinical and laboratory characteristics of patients with simple renal cysts who underwent aspiration sclerotherapy or laparoscopic resection and establish the association between these parameters. The research was conduc­ted on the basis of the urology department of the St. Panteleimon Hospital between 2021 and 2023, 46 patients who underwent surgical removal of a renal cysts were analyzed. The main methods of treating kidney cysts were aspiration sclerotherapy and laparoscopic unroofing. Patients were divided into groups depending on the treatment method (aspiration sclerothe­rapy or laparoscopic unroofing). In order to establish the differences, a comparative analysis was carried out by age, sex, results of clinical parameters, cyst localization and recurren­ces. The association between clinical parameters and treatment methods was assessed using Pearson’s χ2 test. Statistical analysis of the obtained data was carried out with the help of software packages SPSS v. 25.0 and EXCEL. There were 13 men (62 %) and 8 women (38 %) among patients who underwent lapa­roscopic unroofing. Right renal cysts were found in 8 patients (38 %), and left renal cysts were found in 13 patients (62 %). The mean age of the patients was 56±2.6 years. Among the patients undergoing aspiration sclerotherapy, there were 11 men (44 %) and 14 women (56 %). The right kidney cyst was found in 14 patients (56 %), and the left kidney cyst was found in 11 patients (44 %). The mean age of the patients was 63±2.2 years. The mean size of kidney cysts in patients who underwent laparoscopic unroofing was 70±3.6 mm. In patients undergoing aspiration sclerotherapy, the size of kidney cysts was 72±5.4 mm. There was no statistically significant difference in age, sex, and size of kidney cysts in patients who underwent aspiration sclerotherapy and laparoscopic unroofing. It was established that there was no statistically significant difference in age, sex, or size of renal cysts in patients undergoing surgical treatment. In patients after laparoscopic unroofing, relapses have not been established in the clinic. However, the frequency of recurrence in patients after aspiration sclerotherapy is 74±9 % of the total number of patients, which is a fairly high rate of recurrence of renal cysts. We found that laparoscopic unroofing was associated with a lower recurrence rate compared with aspiration sclerotherapy. It should be noted that laparoscopic unroofing is a more effective method of treatment compared to aspiration sclerotherapy. We emphasize that laparoscopy is a modern approach to renal cyst surgery, which not only reduces trauma, shortens the recovery time of patients, but also ensures high accuracy and efficiency of treatment.

The not so 'simple' laparoscopic nephrectomy: Experience with 3D laparoscopy from a tertiary care centre.

Laparoscopic simple nephrectomy (LSNx) is among the gold standard options for management of selected poorly functioning and most non-functioning kidneys (PFK/NFKs). Our objective was to audit our patients who had undergone LSNx for benign causes and assess their perioperative outcomes and analyse the factors correlating with these outcomes. We reviewed our prospectively collected data of patients with PFK/NFKs due to benign causes who underwent a LSNx on a three-dimensional (3D) system via a transperitoneal approach between January 2017 and June 2023. Details on clinical profile, radiological findings and peri-operative details were recorded and analysed. A total of 302 patients underwent LSNx in the study duration. Urolithiasis was the most common cause of PFK/NFKs in 66.5% of patients followed by pelvi-ureteric junction obstruction in 14.9%. Rate of conversion to open surgery was 5.3%. Final histopathology revealed chronic pyelonephritis in 82% patients and Xanthogranulomatous pyelonephritis (XGPN) in 14%. Multivariate analysis revealed presence of pre-operative fat stranding on imaging, larger kidney size, presence of XGPN and pyonephrosis to be significantly associated with longer operation times. Prior renal surgery, positive urine culture, presence of XGPN and a higher body mass index was associated with a longer hospital stay and increased rate of post-operative complications. LSNx is commonly employed for management of PFK/NFKs from various aetiologies, the most common of which is urolithiasis in our experience. Multiple clinico-radiological factors as described correlated with longer operative times and prolonged hospital stay, which aids in surgical planning and patient counselling.

C-reactive Protein-albumin-lymphocyte Index as a Novel Biomarker for Progression in Patients Undergoing Surgery for Renal Cancer.

Some patients with renal cell carcinoma (RCC) develop early or late recurrence after surgery. However, there is no clear consensus on which patients with postoperative RCC should be treated. This study aimed to establish a biomarker for selecting patients who are at a higher risk of relapse following renal cancer surgery. A total of 378 patients who underwent nephrectomy or partial nephrectomy for a diagnosis of RCC at our hospital were included, with a focus on pT3 cases at high risk of recurrence. Factors associated with postoperative progression, including pathological and hematological parameters, were examined. Sarcomatoid features, Fuhrman grade 4, and C-reactive protein-albumin-lymphocyte (CALLY) index were statistically significant predictive factors for progression-free survival after surgery (p<0.0011, p=0.0047, and p<0.0001, respectively). In the multivariate Cox proportional regression analysis, the CALLY index was the most statistically significant predictor of the risk of postoperative recurrence (p=0.0002). In addition to the existing risk factors for RCC recurrence, such as sarcomatoid features and Fuhrman grade, we propose that the CALLY index is a predictor of postoperative recurrence and that patients with a low CALLY index are good candidates for postoperative treatment. Our study may help select patients with pT3 disease with a high risk of recurrence who require postoperative treatment.

3D augmented reality-guided robotic partial nephrectomy

The present study aims to provide a contemporary overview of the use of augmented reality (AR) in robotic renal surgery from the renal pedicle management to the demolition and reconstructive phases thanks also to the preoperative planning obtained with three-dimensional virtual models (3DVMs). Recently, the increasing use of the robotic approach extends the indication to partial nephrectomy also in cases of complex or large renal masses and maximizing functional and surgical outcomes. With this goal, new imaging technologies have increased in popularity, especially for laparoscopic and robotic approaches. In this scenario, hyper-accuracy 3DVMs of the kidney and tumor, based on computed tomography (CT) scans, have been developed as a new tool for preoperative planning and intraoperative surgical navigation via AR technology. However, a standardized production process of 3DVMs and dedicated guidelines on their use and application are still needed. A recent systematic review and metanalysis has shed light on the impact of 3D models on minimally-invasive nephron-sparing surgery (NSS). Specifically, lower rates of global ischemia and collecting system violation were observed within AR-robot-assisted partial nephrectomy (RAPN). However, these rates did not translate into significant improvements in terms of oncological or functional outcomes. This review provides a contemporary overview of the use of AR in robotic renal surgery from the renal pedicle management to the demolition and reconstructive phases thanks also to the preoperative planning obtained with 3DVMs.

P207 The clinical challenge of local recurrence after renal surgery: Results from the Italian multicenter registry by AGILE group (Italian group for advanced laparoendoscopic surgery)

P207 The clinical challenge of local recurrence after renal surgery: Results from the Italian multicenter registry by AGILE group (Italian group for advanced laparoendoscopic surgery)

Case Volume Is Not Associated With Outcomes After Adrenalectomy Performed by Urologic Surgeons.

Our goal was to compare outcomes of adrenalectomy performed by low-volume and high-volume academic urologists with extensive experience in renal surgery. A single-center retrospective review identified patients undergoing adrenalectomy by urologists from 2009 to 2023. Data were gathered on demographics, tumor characteristics, surgeon volume, surgical outcomes including length of procedure, estimated blood loss, length of stay, and complications identified by the Clavien-Dindo complication classification system. Bivariable and multivariable analyses adjusting for BMI, size of mass, age, and surgical approach compared outcomes between low- and high-volume adrenalectomy surgeons. A total of 304 adrenalectomies were performed by 7 urologic surgeons during the study period. One surgeon was high volume, with an average of 15 adrenalectomies per year during the study period. The remaining 6 surgeons ranged from < 1 to 4 adrenalectomies per year on average during the study period and were considered low volume. On multivariable analysis, the rate of any complication was found to be significantly different between the groups (5.3% vs 13.5%, P = .01). However, on analysis of Clavien 3 or higher complications, the rate was not found to be different (1% vs 4%, P = .22). Procedure time (130 vs 134 minutes, P = .33), estimated blood loss (30 vs 50 mL, P = .86), positive margin rate (11% vs 7%, P = .35), and length of stay (2 days vs 2 days, P = .22) were not different when the surgery was performed by a high-volume or low-volume urologist. Surgical volume may not affect outcomes of adrenalectomy when performed by urologists experienced in retroperitoneal surgery at a high-volume, specialized center.

Implementation of surgical rehearsal utilizing patient specific hydrogel kidney phantoms prior to complex renal cancer surgery: a pilot study.

With the advancement of surgical technology, the opportunity to integrate novel surgical preparation is imperative to improve patient outcomes and enhance safety. Patient specific perfused kidney phantoms including the tumor, parenchyma, artery, vein, and calyx were fabricated using 3D-printing and hydrogel injection molding from scans of 25 patients scheduled for robotic partial-nephrectomy (RAPN). Models are validated for anatomical accuracy, mechanical, functional properties and surrounded by the other models of relevant anatomy in a body cast for a simulated surgical rehearsal. We investigated the impact of these preoperative rehearsals preceding complex RAPN by analyzing changes in surgeons' decisions following review of both axial-imaging and following rehearsal simulation. Predictive ability of these rehearsal platforms was compared to live surgery outcomes and trifecta of cases as an outcome was calculated. 25 patients with complex renal tumors, average 9.8 nephrometry score and 4.9cm mean tumor diameter were consented. Mean blood loss and WIT were 193.2ml and 19.8min. Two Clavien 2 complications were reported at 30-day postoperative. Trifecta was achieved in 17 (68%) of surgical cases. Surgeons' confidence in their ability to complete a partial nephrectomy and ability to predict WIT significantly increased from initial viewing the axial imaging to after the rehearsal. The correlation coefficient between the procedural clinical data collected during the rehearsals and live surgery were calculated. The application of this versatile method for creating authentic perfused kidney phantoms can result in increased confidence in surgical plan and thus improved surgical performance and outcomes.

Gastric metastasis from renal cell carcinoma with submucosal invasion treated by surgical full-thickness resection: a case report

BackgroundMetastatic gastric tumors are rare and malignant melanoma, breast cancer, lung cancer, and esophageal cancer are common as primary lesions. On the other hand, renal cell carcinoma is easy to metastasize hematogenously to the whole body. However, metastasis to the stomach is rare and the detailed treatment of gastric metastasis is not mentioned. In this study, we report an uncommon case of gastric metastasis from renal cell carcinoma that underwent surgical full-thickness resection and reviewed the literature for treatment options.Case presentationThe patient was a female in her 60s and in January 2007, she underwent a transabdominal left nephrectomy for clear cell carcinoma of the left kidney. The pathological diagnosis was pT2N0M0 stage II. In October 2017, a total pancreatectomy with D2 dissection was performed for multiple pancreatic masses, in which the pathological diagnosis was pancreatic metastasis of renal cell cancer. In May 2019, an esophagogastroduodenoscopy for heartburn revealed redness and erosion in the greater curvature of the residual gastric body. The pathological diagnosis was gastric metastasis from renal cell carcinoma. No metastatic findings were observed and gastric wedge resection was performed. Pathological diagnosis of the resected specimen showed a 4-mm tumor, mainly within the mucosa and partly extended to the submucosal layer in 500 µm. The resected specimen had a clear resection margin.ConclusionsIn this study, we report a case in which a full-thickness resection was performed for gastric metastasis 12 years after renal cancer surgery and 2 years after pancreatic metastasis surgery. The patient survived 4 years and 8 months after gastric wedge resection. Although gastric metastasis often takes the form of submucosal tumors, it is necessary to select full-thickness resection for R0 resection, even in small and flat lesions.

Synoptic report: Interests of structured standardized operative report in renal surgery

The synoptic operative report (SOR) is a model with several advantages but still not enough adopted. We studied the performance of a SOR template (FileMaker Pro®, FMP) versus the usual narrative operative report (NOR) template on DxCare® software (DXC) of the urology department at the Georges-Pompidou European Hospital by comparing the number of completed data, the completeness rate, the writing time, and the writing speed and by analyzing the learning curve. Over an 11-week period between March and June 2021, 118 case-control OR for 59 laparoscopic or open, partial or total nephrectomy procedures, for all indications were prospectively created. The number of completed data was higher on FMP (113, IQR: 92–122 vs. 59, IQR: 54–70). SOR done on FMP were more complete (95.1%±4.1 vs. 85.5%±6.1; P<0.001). Creation time was longer on FMP (9.07±2.94 vs. 7.66±2.88min; P=0.008). However, FMP generated a database and an OR faster than NOR (9.07±2.94 vs. 12.9±3.2min; P<0.001). The speed of data-filling was higher on FMP (12.9±3.5 vs. 9.2±3.7 data/min; P<0.001). There was a progressive improvement in SOR creation with a Pearson correlation coefficient of −0.313 (P=0.044) independent of the writer. The use of the SOR FMP template seems to be more efficient on data recording but an improvement of the template to make it faster to use should be sought through recommendations from a panel of experts. Level of evidence3.

6871 Hungry Bone Syndrome After Parathyroidectomy in End-Stage Kidney Disease: A Case Report Analysis

Abstract Disclosure: R. Rani: None. C. Mullarkey-desapio: None. Introduction: Hungry Bone Syndrome (HBS) is a rare yet severe complication following parathyroidectomy, characterized by pronounced hypocalcemia subsequent to a rapid decline in parathyroid hormone (PTH) levels. Renal hyperparathyroidism (RHPT) carries a heightened risk of HBS compared to primary hyperparathyroidism (PHPT), with prevalence varying from 15% to 25% in PHPT to as high as 75-92% in RHPT. This elevated risk in RHPT is attributed to chronically elevated PTH levels, both in terms of duration and intensity as compared to PHPT. Preoperative predictors for HBS occurrence and severity include younger age, larger gland size, lower preoperative calcium levels, elevated bone turnover markers, and the magnitude of PTH elevation. Case Report: We present a case of a 36-year-old female with End-Stage Renal Disease (ESRD) requiring dialysis, complicated by renal osteodystrophy and a radial fracture, unresponsive to medical therapy, who was admitted for parathyroidectomy. Preoperative labs revealed calcium at 8.3 mg/dL, phosphate at 4.1 mg/dL, alkaline phosphatase (ALP) at 797 IU/L, and an extremely elevated parathyroid hormone (PTH) level at 4139 pg/ml. Within 24 hours of parathyroidectomy (three and a half glands were removed, the largest weighing 0.7gm), her PTH levels declined to the 130s, accompanied by symptomatic hypocalcemia (calcium 6.5mg/dL). Initial management involved intravenous calcium gluconate and subsequent high-dose oral calcium (up to 10-16gm daily) with Calcitriol 1 mcg twice daily. Despite repletion, her calcium levels remained low on postoperative day 4 (calcium 6.8mg/dL, phosphate 1.9 mg/dL, magnesium 1.7mg/dL) with PTH at 131 pg/ml, confirming Hungry Bone Syndrome. After seven days of aggressive intravenous and oral calcium supplementation with high-dose Calcitriol, she was discharged with a calcium level of 8.9mg/dL. Discussion: Management of HBS following renal hyperparathyroidism surgery presents significant challenges due to associated comorbidities and other electrolyte abnormalities, with limited literature providing guidance on prevention and management. Our case demonstrated that early suspicion and aggressive management improved patient outcomes. Suspecting HBS in high-risk individuals and initiating interventions pre and post-surgery, including pre-treatment with calcitriol, bisphosphonates, and early aggressive intravenous calcium supplementation post-surgery, could potentially reduce morbidity and length of hospital stay. Presentation: 6/1/2024

The association of anatomical renal mass complexity with surgical approach, Hb drop, and the rate of blood transfusion.

The third most prevalent malignant neoplasm involving the urinary tract is renal cell carcinoma (RCC), encompassing nearly 3.5% of the entire cancers afflicting the body. The aim of this research was to explore how the R.E.N.A.L. nephrometry score relates to the decisions made regarding surgery in individuals with localized RCC. This prospective study, assessed patients with localized parenchymal renal masses (stages I and II) tentatively diagnosed as RCC. Utilizing preoperative multiphasic renal CT scans and MRI, the R.E.N.A.L. score categorized masses for nephrometry values. Inclusion criteria involved collecting patient data, and data collection utilizing a structured format focusing on the nephrometry grading system. The study included 64 patients aged (mean ± SD) 49.78 ± 12.35 yrs. Undergoing renal mass surgery, there were 17 (26.5%) low, 28 (43.8%) moderate and 19 (29.7%) high-complexity lesions. All patients with a low Nephrometry score (n = 17) underwent partial nephrectomy, and all cases with a high score (n = 19) underwent radical nephrectomy. For those with a moderate Nephrometry score (n = 28), 13 (46.4%) underwent partial nephrectomy, while the remaining 15 (53.6%) cases underwent radical nephrectomy. Morbidity was low, and no mortality occurred at 180 days. Patients who had lesions fully above or below polar lines were less likely to need blood transfusions. A trend towards higher Fuhrman grades in patients receiving transfusions suggests a potential link between tumor aggressiveness and bleeding risk. Our findings provide insight on the utilization of the R.E.N.A.L. nephrometry score in forecasting perioperative, post-surgical, and oncological results. Such data might help optimize surgical methods and pre-operative patient counseling.

Intravenous Lidocaine Compared with Quadratus Lumborum Block on Postoperative Analgesia Following Laparoscopic Renal Surgery: Protocol for a Randomized Noninferiority Trial.

Patients undergoing laparoscopic renal surgery often experience significant postoperative pain. Quadratus lumborum block (QLB) provides effective postoperative pain control after laparoscopic procedures, while lidocaine administered intravenously also exerts analgesic effects for surgical patients. We design this trial to compare the effects of i.v. lidocaine infusion with QLB on postoperative analgesia in patients undergoing laparoscopic renal surgery. In this randomized noninferiority trial, a total of 120 adult patients undergoing laparoscopic renal surgery will be randomized to receive either i.v. lidocaine or unilateral QLB for postoperative pain management. Lidocaine will be i.v. administered at 1.5 mg/kg (ideal body weight) over 10min during anesthesia induction, followed by an infusion of 1.5 mg/kg/h intraoperatively and in a post-anesthesia care unit. Ultrasound-guided anterior QLB with 0.375% ropivacaine 30 mL will be conducted before the start of surgery. Patient-controlled i.v. sufentanil will be used for pain relief during the first 48h after surgery. The primary outcome is the cumulative sufentanil consumption during 0-24h postoperatively, with a noninferiority margin of 5μg. Secondary outcomes include pain intensity at rest and on coughing at 1, 6, 24, and 48h postoperatively; sufentanil consumption within 24-48h after surgery; rescue analgesic use within 0-48h after surgery; nausea and vomiting within 0-48h postoperatively; and quality of recovery at 24 and 48h after surgery. The results of this trial will add to the clinical evidence for improving postoperative pain management in patients who undergo laparoscopic renal surgery. Chinese Clinical Trial Registry (ChiCTR2400082974).

Prevalence of Erectile Dysfunction among Sudanese Patients at Gezira Hospital for Renal Disease and Surgery

Background: Erectile dysfunction (ED) is a disorder that makes it hard or impossible to keep or get an erection that is good enough for sexual activity. ED can be caused by physical, mental, or combined factors, and it is usually associated with a long-term health issue. Methods: The study is a prospective and cross-sectional research conducted in a hospital setting. It took place from December 2019 to December 2022 at Gezira Hospital for Renal Disease and Surgery. The study sample consisted of 246 patients. Results: The most frequently affected age groups were 30–40 years and 50–60 years, accounting for 26% and 25.2% of the sample, respectively, while the least affected age groups were &gt;20 years and &gt;70 years, representing 1.2% and 3.7% of the sample, respectively. The most common symptoms reported by the patients were ED alone (74%) and ED with penile curvature (22%). The most prevalent causes were psychogenic, Peyronie’s disease, and venogenic, affecting 54.1%, 24.4%, and 16.3% of patients, respectively. The most frequent comorbidities associated with ED were diabetes mellitus (DM) and hypertension, occurring in 12.2% and 4.1% of the patients, respectively. There was a statistically significant correlation between age and etiology (P-value = 0.00), age and symptom (P-value = 0.012), and symptom and cause (P-value = 0.000). Conclusion: The age group of 30–40 years was the most affected by ED, and ED alone was the most frequent symptom. Psychological factors were the main cause of ED, and DM was the most common comorbidity associated with ED.

Comparative Analysis of Mean Hospital Stay in Patients Undergoing Percutaneous Nephrolithotomy (PCNL) With Versus Without Nephrostomy Tube

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for the removal of large renal calculi. The use of nephrostomy tubes postoperatively is common; however, they may increase hospital stay and patient discomfort. Tubeless PCNL has emerged as a potential alternative.Objective: To compare the mean hospital stay in patients undergoing PCNL with and without a nephrostomy tube.Methods: A prospective cohort study was conducted on 60 patients undergoing PCNL at the Armed Forces Institute of Urology, Rawalpindi, from June to December 2020. Patients were divided into two groups: Group A (PCNL with nephrostomy tube) and Group B (tubeless PCNL). Both groups were assessed for mean hospital stay, postoperative complications, and stone size using SPSS version 25. Inclusion criteria were age ≥18 years, stone size of 2-3 cm, and ASA I-II. Exclusion criteria included prior renal surgeries and comorbidities.Results: The mean hospital stay was significantly shorter in Group B (1.90 ± 0.80 days) compared to Group A (2.46 ± 0.81 days, p=0.0001).Conclusion: Tubeless PCNL significantly reduces hospital stay compared to standard PCNL.