Supine tubeless PCNL in horseshoe kidney (a series of cases)

OBJECTIVE

Objective of this case series is accurate access to the respective calyx with stone in horseshoe kidney while performing percutaneous nephrolithotmy in supine position. Reducing operative time and anaesthetic morbidity while performing percutaneous nephrolithotomy in horseshoe kidney with nephrolithiasis in supine position.

MATERIALS AND METHODS

Four patient with one having bilateral renal calculi with horshoe kidney were selected randomly. There were no preference for age, gender; size, location and laterality of stone or BMI. All the patients fit into the AUA guideline criteria for management by percutaneous nephrolithotomy. Preoperative, perioperative and follow up data were collected.

RESULTS

Four patients with one having bilateral renal calculi underwent supine tubeless PCNL in 1 year in GMSV position. There was no intraoperative, post operative or on follow up complications in any patient. In all the patients stones were cleared completely in single setting.

CONCLUSION

Supine percutaneous nephrolithotomy in horseshoe kidney is an alternative to the standard prone percutaneous nephrolithotomy in the horseshoe kidney. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time, less anaesthesia related complications and less neuromusculoskeletal injury.

Barriers to implementation of guidelines for the diagnosis and management of undescended testis

Cryptorchidism or undescended testis (UDT) is one of the most common genital disorders identified at birth. The gold standard for treatment in the US is to surgically bring the UDT into the scrotal sac. In 2014, the American Urologic Association (AUA) presented a guideline for evaluation and treatment of cryptorchidism. We reviewed some of the most recent domestic and international studies examining the results of implementing the AUA and similar guidelines for the diagnosis and management of UDT. In addition, we reviewed some of the more common barriers to the implementation of the AUA guidelines and offered recommendations on how to increase the rate of early detection of UDT, thereby increasing the rate of surgical correction at the appropriate age.

Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline

PURPOSE

The purpose of this guideline is to provide a clinical framework for the use of radiotherapy after radical prostatectomy as adjuvant or salvage therapy.

MATERIALS AND METHODS

A systematic literature review using the PubMed®, Embase, and Cochrane databases was conducted to identify peer-reviewed publications relevant to the use of radiotherapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed.

RESULTS

Guideline statements are provided for patient counseling, the use of radiotherapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a re-staging evaluation.

CONCLUSIONS

Physicians should offer adjuvant radiotherapy to patients with adverse pathologic findings at prostatectomy (i.e., seminal vesicle invasion, positive surgical margins, extraprostatic extension) and should offer salvage radiotherapy to patients with prostatic specific antigen or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiotherapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiotherapy as well as the potential benefits of preventing recurrence. The decision to administer radiotherapy should be made by the patient and the multi-disciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. Please visit the ASTRO and AUA websites (http://www.redjournal.org/webfiles/images/journals/rob/RAP%20Guideline.pdf and http://www.auanet.org/education/guidelines/radiation-after-prostatectomy.cfm) to view this guideline in its entirety, including the full literature review.

Outcomes of targeted treatment for vesicoureteral reflux in children with nonneurogenic lower urinary tract dysfunction

PURPOSE

There is a known association between nonneurogenic lower urinary tract conditions and vesicoureteral reflux. Whether reflux is secondary to the lower urinary tract condition or coincidental is controversial. We determined the rate of reflux resolution in patients with lower urinary tract dysfunction using targeted treatment for the underlying condition.

MATERIALS AND METHODS

Patients diagnosed and treated for a lower urinary tract condition who had concomitant vesicoureteral reflux at or near the time of diagnosis were included. Patients underwent targeted treatment and antibiotic prophylaxis, and reflux was monitored with voiding cystourethrography or videourodynamics.

RESULTS

Vesicoureteral reflux was identified in 58 ureters in 36 females and 5 males with a mean age of 6.2 years. After a mean of 3.1 years of treatment reflux resolved with targeted treatment in 26 of 58 ureters (45%). All of these patients had a history of urinary tract infections before starting targeted treatment. Resolution rates of vesicoureteral reflux were similar for all reflux grades. Resolution or significant improvement of reflux was greater in the ureters of patients with dysfunctional voiding (70%) compared to those with idiopathic detrusor overactivity disorder (38%) or detrusor underutilization (40%).

CONCLUSIONS

Vesicoureteral reflux associated with lower urinary tract conditions resolved with targeted treatment and antibiotic prophylaxis in 45% of ureters. Unlike the resolution rates reported in patients with reflux without a coexisting lower urinary tract condition, we found that there were no differences in resolution rates among grades I to V reflux in patients with lower urinary tract conditions. Patients with dysfunctional voiding had the most improvement and greatest resolution of reflux. Additionally grade V reflux resolved in some patients.