International Journal of Urology and Nephrology

International Journal of Urology and Nephrology ISSN: 2091-1252 Vol. 3 (5), pp. 097-100, May, 2015. © International Scholars Journals

Full Length Research Paper                                         

Adjunctive intralesional antifibrotics following transurethral incision of bladder neck contractures

David S Koslov¹, Robert Kovell¹, Kyle D Wood¹, Ilya Gorbachinsky¹, Ryan Terlecki¹

¹Wake Forest School of Medicine, Winston-Salem, NC

*Corresponding author. E-mail: [email protected]

Accepted 31 March, 2015

Abstract

Iatrogenic bladder neck contractures (BNC) represent a challenging problem for urologists and patients alike and may require several treatments to improve associated LUTS. Mitomycin C (MMC) injection as an adjunctive therapy to transurethral bladder neck incision (TUIBN) has shown promise in achieving durable bladder neck patency. We report outcomes from patients with BNC treated by TUIBN and subsequent injection of an adjunctive agent, either MMC and tacrolimus, an immunomodulator not previously tested but chosen for antifibrotic properties. This is a retrospective review of a single surgeon experience using MMC or tacrolimus injections after TUIBN for BNC. Thirteen patients with iatrogenic BNC were treated with TUIBN. Two were treated with laser incision alone.  Two received post-incision injection with tacrolimus, and nine received post-incision injection with MMC after incision. Both patients treated with tacrolimus failed treatment and had obliterated bladder necks, while all MMC patients had patent bladder necks at follow up cystoscopy. MMC, but not tacrolimus, demonstrated safety and efficacy as an adjunctive therapy after TUIBN for refractory BN. Use of adjunctive injection of antifibrotic agents with TUIBN may be an effective method of maintaining bladder neck patency compared to simple incision.

Key words: Bladder neck contracture, mitomycin c, tacrolimus, transurethral incision of bladder neck.

International Journal of Urology and Nephrology ISSN: 2091-1252 Vol. 3 (4), pp. 095-096, April, 2015. © International Scholars Journals

Full Length Research Paper

Knotted multilength ureteral stent proximal to impacted mid-ureteric stone

Harfeil MN and Hasan RM

Urology department, King Abdulla Medical City, Mecca, Kingdom of Saudi Arabia.

*Corresponding author. E-mail: [email protected]

Accepted 24 February, 2015

Abstract

The use of ureteral stents has become one of the most common utilized tools in the era of endourology armamentarium. The indications for their placement have expanded significantly; however, their use is not free of complications and consequences. Stent knotting is uncommon complication when using multilength coiled stents; hereby we present a case of using ureteroscopy and Holmium laser to manage a knotted stent proximal to a mid-ureteric stone. After we reviewed literature, we found that knotting of multilength ureteral stents represents a rare complication that might be a significant challenge to the endourologists. Selection of the correct length of stent and assuring good position with x-ray guidance during insertion and removal might help avoiding this complication.

Key words: Ureter, knotted ureteral stent, stones, urological complications.

International Journal of Urology and Nephrology ISSN: 2091-1252 Vol. 3 (3), pp. 090-094, March, 2015. © International Scholars Journals

Full Length Research Paper

Paraoxnase1 (PON 1) gene polymorphism  in Kuwaiti Arab children with idiopathic nephrotic syndrome

Amal Al-Eisa*^1,2, Jalaja Sukumaran¹ and Mohammad Z. Haider¹

¹Department of Pediatrics, Faculty of Medicine, Kuwait University; ²Pediatric Nephrology Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.

Corresponding author. Email: [email protected]. Tel. 965-25319486  Fax: 965-25338940.

Abstract

Paraoxonase1 (PON1) is a serum enzyme bound to high density lipoproteins and has antioxidant as well as anti-atherogenic effects. Molecular studies of PON1 revealed two polymorphic sites at amino acids 55 and 192 resulting in two different allozymes. These allozymes result from L- genotype (leucine/high activity) and M- genotype (Methionine /low activity) at residue 55 and A- (arginine/high activity) and B- (glutamine/low activity) at site 192 respectively. We have studied the association of  Paraoxonase1 (PON1) gene polymorphisms with the histopathological types of idiopathic nephrotic  syndrome (INS) in Kuwaiti Arab children. The PON1 gene, 55 and 192 polymorphisms were analyzed in 50 Kuwaiti children with INS and 50 healthy controls of a similar age, sex and ethnic background. The patients included 32 children with minimal change nephrotic syndrome (MCNS) and 18 with focal segmental glomerulosclerosis (FSGS). The PON1 gene polymorphisms were detected by using PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) methods. The incidence of LL genotype (Leucine residue) was detected in 25/50 (50%) of the INS patients group compared to 24/50 (48%) in the controls (p = 0.84). The heterozygous genotype LM was detected in 21/50 (42%) in the INS patients compared to18/50 (36%) in the controls (p = 0.68). The homozygous MM-genotype (methionine residue) was detected in 4/50 (8%) INS patients compared to 8/50 (16%) in the controls (p = 0.35). The combined L-allele frequency in homozygous LL and the heterozygous subjects was 71% in INS patients compared to 66% in the controls (p = 0.54). The L-allele in both its homozygous LL and heterozygous LM genotype was found to be significantly more common in FSGS patients compared to MCNS patients (p = 0.0001) and also when  compared  to the controls (p = 0.0007). PON-1 gene, 192 polymorphism, the AA-genotype (glutamine residue) was uniformly detected in all patients and controls. Our data demonstrate a strong association between the L-allele of PON1 gene ‘55’ polymorphism and pathogenesis of FSGS in Kuwaiti Arab children with idiopathic nephrotic syndrome.

Key words:  Idiopathic nephrotic  syndrome(INS); Genotype; Glomerulosclerosis; Paraoxonase1(PON1); Polymorphism

International Journal of Urology and Nephrology ISSN: 2091-1252 Vol. 3(3), pp. 082-089, March, 2015. © International Scholars Journals

Full Length Research Paper

Comparison of inflammation effects in the patients with familial mediterranean fever and dialysis patients

Nilgül Akalin, Md¹, Cemal Bes, Md², OzlemHarmankaya, Md¹, Kayhan Ertürk, Md³, Yıldız Okuturlar, Md⁴ and Baki Kumbasar, Md⁴

¹Bakirkoy Dr. SadiKonuk Training and Research Hospital Nephrology Unıt, Turkey.

²Bakirkoy Dr. SadiKonuk Training and Research Hospital Romatology Unıt, Turkey.

³İstanbul University Medical School Oncology Unıt, Turkey.

⁴ Bakirkoy Dr. SadiKonuk Training and Research Hospital İnternal Medicine Unıt, Turkey.

E-mail: [email protected]

Accepted 30 December, 2014

Abstract

We aimed to assess the presence and clinical effect of inflammation in the patients with familial mediterranean fever who follow-up treatment regularly. All the patients were measured with C-reactive proteine, homocysteine, fibrinogene levels and biochemical parameters; the presence of atherosclerotic plaque was investigated in the carotid intima artery. Leucocyte, C-reactive protein and fibrinogene levels were found to be significantly higher in the familial mediterranean fever group patients. Homocysteine levels and the presence of atherosclerotic plaque in the carotid intima artery were found to be significantly lower in the familial mediterranean fever group patients. Increasing the odds ratio for homocysteine was found to be related to dialysis treatments. The correlation between the presence of proteinuria, microalbuminuria, inflammation and the presence of atherosclerotic plaque in the carotid intima artery were not determinate to the familial mediterrian fever group of patients. We demonstrated that inflammation might be present continuously despite regular treatment in the patients with familial mediterrian fever and that this inflammation can be the main reasons or contributory factor to the complications of the disease. 

Key words:  Familial mediterrian fever, hemodialysis, ınflammation, peritoneal dialysis. 

International Journal of Urology and Nephrology ISSN: 2091-1252 Vol. 3(3), pp. 078-081, March, 2015. © International Scholars Journals

Case Report

Chylous Ascites as a complication of Laparoscopic Living Donor Nephrectomy: A case report

Virginia del Rosario Rodríguez, Omar B. Halawa González, Sergio Fumero Arteaga, Cristina Gómez de Segura y Melcón, Javier Falcón Barroso, Balig F. Amir Nicolau and Jesús Monllor Gisbert

Department of Urology, Hospital Universitario Nuestra Señora de Candelaria. Santa Cruz de Tenerife

E-mail: [email protected]

Accepted 02 March, 2015

Abstract

Living donor kidney transplantation has increased the number of organs available due mainly to the introduction of laparoscopic kidney extraction. However, this has resulted in the onset of rare complications in the donor such as chylous ascites whose rate of resolution with medical management is 60- 100% with 6 weeks of parenteral feeding and fasting. To date only 22 cases of chylous ascites post-laparoscopic donor nephrectomy have been published. We present a 55 year old female patient who developed chylous ascites after left laparoscopic donor nephrectomy. She was discharged after 11 days of medical treatment based on parenteral feeding, diuretics and somatostatin analogues. Total centimetres in abdominal circumference reduction of 10 and disappearance of symptoms achieved.

Key words: chylous ascites, nephrectomy, living donor, MCTs, somatostatin.

International Journal of Urology and Nephrology ISSN: 2091-1252 Vol. 3 (2), pp. 074-077, February, 2015. © International Scholars Journals

Full Length Research Paper

Life-threatening lactic acidosis: Always a lost case? Key clues to the correct diagnosis: A case report

Van Huffel L¹MD, Benoit D² MD PhD and Van Biesen W³ MD PhD

¹Endocrinology Department, Ghent University Hospital, Belgium.⁴

² Intensive Care Medicine, Ghent University Hospital, Belgium.⁴

³ Nephrology Department, Ghent University Hospital, Belgium.⁴

E-mail: [email protected]

Accepted 23 October,2014

Abstract 

Lactic acidosis is a severe condition with a high mortality rate. We report a case of near-fatal lactic acidosis, secondary to an acute kidney injury in a patient on chronic treatment with metformin. In this case, fast recognition and adequate treatment of the entity lead to rapid recovery of the patient. The differences in presentation of type A and type B lactic acidosis are emphasized, because of the importance for treatment and prognosis. Considerations and new insights in the mechanism of Metformin Associated Lactic Acidosis(MALA) are discussed.With this case report we want to point out the aspects one should consider when treating or stop treating a patient with metformin and nuance the fear for MALA.

Key Words: Severe Lactic Acidosis, Metformin Associated Lactic Acidosis, Metformin, Acute Kidney Injury, Case Report.