Nephro-Urology Monthly
Volume:16 Issue: 4, Nov 2024

Varicocele is a leading cause of male infertility. Left-sided nephrectomy has been associated with an increased risk of varicocele.

This study aimed to report the frequency and investigate the association between physical examination, Doppler ultrasonography, histological findings, and varicocele diagnosis in kidney donors who underwent left-sided nephrectomy.

This cross-sectional study included adult males who underwent nephrectomy. The study compared the results of physical examination, ultrasound, and histological findings of the diameter of the left spermatic vein and pampiniform venous plexus. The chi-square test was used to assess differences in the diagnosis and grading of varicocele between the different methods.

Fifty males with a mean age of 36.6 years were included. Through physical examination, 42% were diagnosed with varicocele, with most cases classified as grade II. Ultrasound examination revealed that 46% had varicocele, with the majority also being grade II. Histological findings showed that most cases had intact valves (54%), followed by lax and incompetent valves (32%), and no valves (4%). There was a significant difference between the physical examination diagnosis of varicocele and the histological findings (P = 0.04), whereas the difference was not significant for Doppler ultrasound (P = 0.07).

In kidney donors, there was a notable discrepancy in varicocele diagnosis between physical examination and histological findings, unlike ultrasound. Larger observational studies are recommended to further assess this association and explore alternative methods for varicocele diagnosis.

This study investigated the efficacy of first-generation cephalosporin (cefazolin) and third-generation cephalosporin (ceftizoxime) as prophylactic antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL) surgery.

The study also examined the incidence of postoperative complications, hospitalization duration, and time to return to normal life.

This prospective cross-sectional study included patients (≥ 20 years) who underwent PCNL surgery at Razi, Golsar, and Pars Hospitals from January 1, 2013, to December 31, 2022. Patients were divided into two groups, receiving 1 mg/kg of either first-generation (cefazolin) or third-generation (ceftizoxime) cephalosporin intravenously, 30 minutes before surgery. The incidence of postoperative complications, hospitalization duration, and return to normal life were compared based on the type of prophylactic antibiotic. Risk factors were evaluated using chi-squared tests followed by multivariate logistic regression analysis.

The ceftizoxime group showed significantly lower rates of overall complications (13.0% vs. 31.4%) and postoperative fever (2.8% vs. 15.0%) compared to the cefazolin group. The ceftizoxime group also had a significantly shorter hospitalization duration (1.31 ± 1.18 days) compared to the cefazolin group (4.03 ± 1.57 days) (P = 0.000). Additionally, the ceftizoxime group had a significantly faster return to normal life (5.97 ± 3.37 days) compared to the cefazolin group (8.15 ± 2.93 days) (P = 0.001).

The third-generation prophylactic cephalosporin (ceftizoxime) was more effective than the first-generation (cefazolin) in reducing postoperative fever rates, shortening hospitalization duration, and expediting the return to normal life for patients.

Kidney transplant is the treatment of choice for chronic renal failure (CRF), significantly improving patient outcomes. Fluid administration during surgery can lead to the accumulation of acid ions and electrolytes, inducing pH changes from the pre-operative to post-operative period, which may compromise transplant success. The impact of acid-base balance changes on transplant outcomes is crucial, yet research on predictors and arterial blood gas (ABG) changes post-kidney transplant is limited. Understanding ABG changes can enhance perioperative management, early detection of complications, and long-term graft function, thereby optimizing patient care and increasing transplant success rates.

To assess ABG changes before and after kidney transplant and identify predictors of post-operative acidosis in patients with renal failure through cross-sectional studies.

In a retrospective cohort study, we included 97 patients who had undergone kidney transplant. During surgery, patients received crystalloid fluids, with 49 receiving only normal saline and 48 receiving only Ringer's lactate. Data collection involved the insertion of an arterial line after anesthesia induction, and the first ABG sample was obtained as a pre-operative measure. A post-operative measure was taken at the end of the surgery. Ethical considerations were followed throughout the study. Statistical analysis included paired t -test or Wilcoxon signed-rank test to compare pre- and post-operative ABG measures, with a significance level set at a P-value less than 0.05.

Total of 97 patients, which 65 (69.4%) were male and 32 (30.6%) were female and mean age was 38.6 ± 12.2. Variables significantly associated with post-op acidosis were fluid administered (OR: 3.25, 95% CI: 1.45 - 4.58), post-op central venous pressure (CVP) (OR: 2.31, 95% CI: 1.23 - 2.62, p < 0.05), post-op base excess (BE) (OR: 2.16, 95% CI: 1.50 - 2.95, P < 0.05). HCO₃ (P = 0.010), BE (P = 0.002), pH (P = 0.023) were significantly lower in the normal saline group compared to the Ringer's group. Post-op pH and BE was also associated with increased post-op CVP. Post-op acidosis and post-op CVP were significantly associated with post-op BE.

Post-operative ABG changes, including decreases in pH and HCO 3 , are key indicators of transplant outcomes, reflecting graft function and patient stability. These findings highlight the critical need for prompt management of ABG abnormalities to optimize transplant success and minimize complications, making vigilant monitoring a vital part of post-transplant care.

Assessing renal volume as a potential indicator of renal function and related disorders is valuable for clinical decision-making. Computed tomography (CT) can accurately estimate actual kidney size.

This study aimed to evaluate the relationship between anthropometric parameters and renal dimensions measured by CT.

Renal CT scan evaluations were performed on 634 individuals (308 males and 326 females) who had undergone abdominopelvic CT scans for indications unrelated to renal disease. Renal parameters, including length, width, depth, volume, and cortex length, were measured.

The mean age of participants was 53.5 ± 13.7 years (range: 18 - 86 years). Renal dimensions in males were larger than those in females. Additionally, the left kidney showed larger dimensions than the right kidney in both genders. Renal dimensions increased with age initially, but began to decrease after the sixth decade of life. A significant negative correlation was found between age and renal length, cortex, and left renal volume. In contrast, a significant positive correlation was observed between weight and both renal depth, length, volume, and left renal cortex, as well as between height and both renal length and volume on both sides. All dimensions except renal length were greater with increasing Body Mass Index (BMI).

The results indicate a significant correlation between kidney dimensions and various anthropometric factors such as age, weight, height, and BMI. These findings provide valuable insights into kidney dimensions measured on CT scans, potentially aiding in the diagnosis and treatment of kidney diseases.

The correct diagnosis of sexually transmitted infections (STIs) is the first step in the monitoring and management of these diseases.

This study was conducted to investigate the clinical and laboratory positive predictive value (PPV) of STI symptom management in Iran.

This cross-sectional study was conducted on 5986 individuals (aged 18 to 50 years) from the general population of Marovdasht (Iran) in several stages: (1) self-reported symptoms of sexually transmitted diseases, (2) evaluation by a doctor, and (3) laboratory examination.

Among the population sample, 686 (17.68%) individuals reported at least one of the predefined symptoms. The clinical-based PPV of syndromes in men and women were 67.74 (62.34 - 73.14) and 85.36 (82.76 - 87.96), respectively. In men and women, the highest PPV was observed for abnormal discharge from the anus 32.35 (25.35 - 39.35) and abnormal secretions from the cervix 59.39 (56.39 - 62.39), respectively. The laboratory-based PPV for men and women was 0 and 5.04 (3.04 - 7.4), respectively.

The clinical and laboratory-based PPV of STI symptoms in the general population is extremely low. Accordingly, a syndromic-based screening or monitoring approach for STIs is not a reliable tool for screening or monitoring in the Iranian general population. We suggest focusing on special (core) groups for monitoring STIs using laboratory-based methods.

Spontaneous intraperitoneal rupture of pyonephrosis is an extremely rare condition. It leads to generalized peritonitis that mimics an acute abdomen caused by intraperitoneal visceral pathology. In most cases, the underlying cause is obstructive urinary tract stones, followed by pelviureteric junction obstruction, tumors, or connective tissue diseases. We report the first case of spontaneous intraperitoneal fistulization of pyonephrosis from a duplex kidney.

A 56-year-old female presented with an acute abdomen and was diagnosed with a right incomplete duplex kidney and intraperitoneal rupture of lower renal moiety pyonephrosis secondary to an obstructive ureteric calculus located proximal to the confluence of the two ureters. She was successfully managed with initial percutaneous drainage and nephrostomy, followed by a delayed lower moiety nephrectomy.

This case highlights the importance of considering renal etiology in the differential diagnosis of generalized peritonitis and underscores the rarity of such occurrences.