Nephro-Urology Monthly
Volume:10 Issue: 5, Sep 2018

Context: Preforming an adequate and effective dialysis is essential to improve patients’ quality-of-life and decrease the complications of kidney failure. However, evidence regarding the effectiveness of dialysis among Iranian patients undergoing hemodialysis is inconclusive. The current study aimed at evaluating the effectiveness of dialysis in Iranian patients undergoing hemodialysis using a systematic approach. Evidence Acquisition: In the current meta-analysis, the search was performed using the keywords “Adequacy of Dialysis” and “Hemodialysis Adequacy” in SID, MagIran, ISI/Web of Science, PubMed, and Scopus databases from inception to July 2018. According to the heterogeneity of the studies, the data were analyzed using the random effects model with STATA version 14.

The mean urea kinetic modeling (Kt/V) and urea reduction ratio (URR) in Iranian patients undergoing hemodialysis were 1.11% (95% confidence interval (CI): 1.03 - 1.81) and 59.94% (95% CI: 58.33 - 61.54), respectively. There was no correlation between indices of dialysis adequacy, sample size, mean age of samples, and year of the paper publication. However, Kt/V and URR in articles with high methodological quality were higher than the ones with moderate methodological quality.

The mean adequacy of dialysis indices among Iranian patients was below the standard levels and it is necessary to consider measures to improve dialysis efficacy.

Several surgical reconstructive procedures are introduced to repair a hypospadiasis while post-operative complications have still remained high. Poor tissue handling, anastomotic site ischemia, tension on the anastomotic line, and distal obstruction are suggested as the main risk factors contributing to post-operative complications. This article is the introduction of a simple technical modification to perform a uniform straight tension free urethroplasty that is supposed to decrease post hypospadias repair complications. We used a 6F silicon Foley catheter and covered it by a part of 10 F Nelaton catheter at the most distal part of the Foley. To facilitate the covering and uncovering process, we incised the Nelaton catheter in one side through the whole length. We performed a two-layer closure urethroplasty over our double layer stent and finally uncovered the Foley catheter, which remains in the bladder as a trans-urethral stent and also for further bladder drainage. Results and In our innovative method of urethral stenting, we have suggested to replace the transurethral stent with a tension free lower size catheter easily and safely at the end of procedure, which helps decrease suture line tension and is supposed to improve the local circulation

Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly in pediatrics that may require surgical intervention performed by open, laparoscopic-assisted, laparoscopic, or robotic-assisted fashion. Laparoscopic pyeloplasty hasn't become popular due to instrument or skill limitations. Laparoscopic-assisted pyeloplasty could be the first step towards a minimally invasive approach to UPJO in pediatrics. The current study was conducted on 60 infants with UPJO treated with either laparoscopic-assisted extracorporeal or open pyeloplasty. In our modified approach, the ureteropelvic junction was exposed and released laparoscopically and pulled out of the abdominal cavity and pyeloplasty was performed simply over a JJ stent. The second group was treated by conventional posterior lumbotomy approach. All patients were followed up after the operation at least for six months and the results were compared between the two groups. Comparison of the pelvic anteroposterior diameter before and after the operation indicated a significant reduction after the operation in both groups. Diuretic scan after JJ catheter removal did not show signs of obstruction in almost all cases among both groups. Comparison of the postoperative complications revealed no significant differences between the two groups. The complication rate was also very low and almost the same in both groups. Full laparoscopic pyeloplasty demands advanced surgical skills and fine instruments, which made it time-consuming and less applicable widely. Laparoscopic-assisted pyeloplasty is more applicable while it showed acceptable results in the current study. The current approach is suggested as the first step toward MIS for UPJO in pediatrics

Vesicovaginal fistula is a type of female urogenital fistula. It is an abnormal tract between the bladder and vagina and causes discharge of urine into the vaginal cavity. In addition to the medical complications of vesicovaginal fistula, it can also deteriorate patient's quality of life. Here, we present the case of a 16-year-old girl who presented with a vesicovaginal fistula due to a vaginal foreign body (marbles) leading to stone formation in the vagina. According to our case, foreign body in the long-term leads to tissue necrosis and formation of fistula that cause urinary incontinence and stone formation.

Introduction: Urachal adenocarcinoma is an invasive and rare bladder carcinoma that usually presents at advances stages with poor prognosis. The symptoms often include abdominal pain and hematuria. The standard treatment method is surgical excision of the tumor and sometimes, in advanced cases, chemotherapy is needed, too. Case Presentation: We present a 35-year-old male patient, who referred with acute onset of painless macroscopic hematuria. Pelvic CT scan showed a large mass on the bladder dome, extending to the umblicus. Biopsy of the mass confirmed that the pathologic diagnosis was urachal adenocarcinoma. The patient was then treated surgically with partial cystectomy approach. Conclusions: Despite microscopic involvement of pelvic lymph nodes, adjuvant therapy was not intended. There were no local recurrence or distant metastasis in long term close follow up