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Fumarate hydratase deficient renal cell carcinoma (FHRCC) can exhibit a heterogenous immunoprofile. In the present case, a solitary 10.5 cm mixed cystic and solid left kidney tumor showed various growth patterns, involving renal sinus adipose tissue and the renal pelvis. Tumor cells showed prominent nucleoli and perinucleolar halos. Aberrant diffuse (>90%), strong, and membranous carbonic anhydrase 9 and variable GATA3 expression were present. Diagnostic loss of fumarate hydratase expression and 2-succinyl cysteine overexpression (cytoplasmic and nuclear) were identified. Carbonic anhydrase 9 and GATA3 expression in FHRCC is rarely reported in the literature, and may cause misdiagnosis of clear cell RCC and/or urothelial carcinoma. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to analyze the enhanced recovery protocol's (ERP) effectiveness in a comparative study of elective surgeries for ureteropelvic junction obstruction (UPJO). Methods: The prospective study included 30 patients with UPJO who underwent laparoscopic pyeloplasty in 2018-2021. Results: Postoperative complications developed rarely, and their frequency and severity were comparable. Independent predictors of UPJO recurrence were the spine osteochondrosis >II period (HR 13.97; 95% CI 1.26; 154.8; p=0.032), the concretions self-discharge (HR 28.49; 95% CI 1.78; 455.62; p=0.018), surgical operation duration > 110 minutes (HR 44.7; 95% CI 3.95; 505.4; p=0.002) and previous nephrostomy (HR 1.07; 95% CI 1.02; 1.13; p=0.002). Conclusions: In the surgical treatment of UPJO, it is advisable to use ERPs, as this allows achieving a better treatment quality with comparable results. [ABSTRACT FROM AUTHOR]

Background: Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease‐free survival (DFS), and overall survival (OS). Methods: Arizona Cancer Registry (2009–2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox‐regression hazard models were used to test DFS and OS. Results: Hispanic and AI patients with T1 tumors had a longer time to surgery than non‐Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02–2.31) and cT2 (OR 2.32, 95% CI: 1.13–4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99–3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17–1.99) and OS (HR 1.63, 95% CI: 1.26–2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07–2.57). Conclusions: High social vulnerability was associated with increased time to surgery and poor survival after surgery. [ABSTRACT FROM AUTHOR]

Objectives. Type 2 diabetes mellitus (T2DM) commonly complicates kidney stone disease (KSD). Our objective is to investigate the variations in the urinary microbiota between individuals with KSD alone and those with KSD plus T2DM. This exploration could have implications for disease diagnosis and treatment strategies. Methods. During lithotripsy, a ureterscope was employed, and 1 mL of urine was collected from the renal pelvis after bladder disinfection. Sequencing targeting the V3-V4 hypervariable region was performed using the 16S rRNA and Illumina Novaseq platform. Results. The Shannon index showed a significant decrease in the KSD plus T2DM group compared to the KSD-only group (false discovery rate = 0.041). Principal Coordinate Analysis (PCoA) demonstrated a distinct bacterial community in the KSD plus T2DM group compared to the KSD-only group (false discovery rate = 0.027). The abundance of Sphingomonas, Corynebacterium, and Lactobacillus was significantly higher in the KSD plus T2DM group than in the KSD-only group (false discovery rate< 0.05). Furthermore, Enhydrobacter, Chryseobacterium, and Allobaculum were positively correlated with fasting blood glucose and HbA1c values (P < 0.05). Conclusions. The urinary microbiota in the renal pelvis exhibits differences between patients with KSD plus T2DM and those with KSD alone. Further studies employing animal models are necessary to validate these distinctions, potentially paving the way for therapeutic developments based on the urinary microbiota. [ABSTRACT FROM AUTHOR]

The limited reproducibility of the grading of non-muscle invasive papillary urothelial carcinoma (NMIPUC) necessitates the search for more robust image-based predictive factors. In a cohort of 157 NMIPUC patients treated with Bacille Calmette–Guérin (BCG) immunotherapy, we explored the multiple instance learning (MIL)-based classification approach for the prediction of 2-year and 5-year relapse-free survival and the multiple instance survival learning (MISL) framework for survival regression. We used features extracted from image patches sampled from whole slide images of hematoxylin–eosin-stained transurethral resection (TUR) NPMIPUC specimens and tested several patch sampling and feature extraction network variations to optimize the model performance. We selected the model showing the best patient survival stratification for further testing in the context of clinical and pathological variables. MISL with the multiresolution patch sampling technique achieved the best patient risk stratification (concordance index = 0.574, p = 0.010), followed by a 2-year MIL classification. The best-selected model revealed an independent prognostic value in the context of other clinical and pathologic variables (tumor stage, grade, and presence of tumor on the repeated TUR) with statistically significant patient risk stratification. Our findings suggest that MISL-based predictions can improve NMIPUC patient risk stratification, while validation studies are needed to test the generalizability of our models. [ABSTRACT FROM AUTHOR]

We report the case of an 87-year-old woman with upper tract urothelial carcinoma at the left renal pelvis. She received stereotactic body radiotherapy of 35 Gy in five fractions for palliative treatment of hematuria that was delivered by a 1.5-T magnetic resonance (MR) imaging-guided linear accelerator. Her symptom was relieved after treatment, and posttreatment imaging revealed a complete response of the primary tumor. Thus, this case showed that stereotactic MR-guided radiotherapy could be an appealing option for inoperable patients although radiotherapy is infrequently mentioned in the current treatment guideline of upper tract urothelial carcinoma. Daily adaptive planning from MR images obtained before treatment could improve the target dose and minimize the organ at risk dose. This may lead to a decrease in radiation adverse effects including worsening renal function due to the renal pelvis tumor's proximity to the kidney. [ABSTRACT FROM AUTHOR]

Surgical procedures often rely on unaided visual observation or endoscopic assistance, which may pose challenges in cases involving intricate anatomical relationships. Real-time imaging technologies capable of intraoperative visualization of target organs have the potential to enhance the precision of surgical procedures by facilitating accurate identification, separation, and protection of vital tissues or organs. Despite these advantages, the widespread adoption of such technologies has been hindered by factors such as the prohibitive cost of equipment. This study aims to optimize and develop a device based on Indocyanine Green (ICG) for fluorescence imaging. The objective is to monitor changes in the average fluorescence intensity of ICG in the bladder, offering valuable guidance for surgeries involving the bladder. 1. Male rabbits were administered 0.01 mg/ml ICG via the renal pelvis and ear vein to obtain fluorescence images of the ureter, bladder, and small intestine. 2. After ligating the bilateral ureters of male rabbits, a retrograde bladder perfusion of 5 ml 0.01 mg/ml ICG was conducted to capture fluorescence images of the bladder over time. The average fluorescence intensity was computed using Image Pro Plus 6.0, and the corresponding curve was generated using Prism 8.0. Using a similar methodology, the average fluorescence intensity of male rabbits without ureteral ligation was measured and plotted over time. 1. The developed device facilitated imaging of the ureter, bladder, and small intestine. 2. The bladder's average fluorescence intensity exhibited changes over time in response to urine production and ureteral ligation, contrasting with observations without ureteral ligation. We have successfully constructed and optimized a modular fluorescence imaging system for organs and tissues. This system proves effective in imaging experiments involving hollow organs in animals and offers valuable insights for relevant surgical procedures. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) is recommended in patients with upper tract urothelial carcinoma (UTUC) only when computed tomography (CT) is contraindicated. However, CT does not allow distinguishing ureter wall layers, making impossible to assess muscle invasion, a factor contributing to differentiate high- from low-risk UTUCs, which require different therapeutic approaches. We investigated the feasibility of MRI assessment of UTUC muscle invasion. Methods: From June 2022 to March 2023, we prospectively enrolled patients suspected of UTUC, i.e., with positive urinary tract ultrasound and/or ureteroscopy, or positive urinary cytology and/or hematuria but negative cystoscopy and bladder ultrasound at two Italian centers. They underwent CT followed by MRI (≤ 24 h apart), independently reported by two experienced radiologists, blinded from histopathology results. After imaging confirmation, they all underwent nephroureterectomy and histopathology analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. Results: Thirty-nine lesions were detected in 30 patients on both CT and MRI. Muscle-invasive UTUC prevalence was 81% (21/26) among patients with MRI suspicion and 8% (1/13) among those without MRI suspicion (p < 0.001). Considering the assessment of muscle-layer invasion, the more experienced reader achieved 95% sensitivity (95% confidence interval 82−100), 71% specificity (47−88), 81% PPV (63−93), 92% NPV (70−100), 85% accuracy (67−96), and 0.84 AUC (0.70−0.98). Inter-reader agreement was substantial (κ = 0.73). Conclusions: MRI showed a promising diagnostic performance for the assessment of UTUC risk of muscle invasion. Relevance statement: Resulting feasible both in technical and clinical terms, MRI could be helpful for upper tract urothelial carcinomas pre-operative risk stratification, to allow a personalized patients' management. These results play in favor of promoting preoperative MRI for UTUC, as already proven for bladder cancer. Key points: • Muscle invasion is a crucial information for tailored treatments of upper tract urothelial carcinomas. • CT does not distinguish ureter wall layers, making muscle invasion risk assessment not feasible. • MRI was shown to reliably diagnose muscle-layer invasion by upper tract urothelial carcinomas (sensitivity 95%, specificity 71%). [ABSTRACT FROM AUTHOR]

The purpose of the study was to introduce a novel surgical approach of combining laparoscopic pyelotomy with ultrasonic lithotripsy via a nephroscope for the treatment of complex renal stones. Between May 2021 and April 2023, 32 patients underwent laparoscopic pyelotomy combined with ultrasonic lithotripsy via a nephroscope and their perioperative variables were retrospectively collected and outcomes were assessed. Dissection and incision of the anterior renal pelvis wall was performed via a laparoscope. A 19.5 F nephroscope was introduced into the renal pelvis through a laparoscopic trocar from the incision. Stones were fragmented and sucked out using a 3.3 mm ultrasonic probe placed through the nephroscope. All operations were completed successfully and the stone-free rate at 3 days after operation was 87.5% (28/32). Four (12.5%, 4/32) patients with staghorn stones had a small residual stone in the lower calyx after operation and did not require reintervention. No patient required perioperative transfusion and four (12.5%, 4/32) patients with struvite stones developed postoperative fever, which was successfully treated with intravenous antibiotics. The mean follow-up time was 14.0 ± 7.2 months, with no patient developing long-term complications. This approach offers a safe and effective treatment option for complex renal stones, as the method exhibits a high clearance rate with few complications. [ABSTRACT FROM AUTHOR]

Introduction: Electromotive Drug Administration (EMDA) amplifies drug delivery deep into targeted tissues. We tested, for the first time, the ability of EMDA to deliver methylene blue into the urothelium of the renal pelvis. Materials and Methods: In an anesthetized female pig, both proximal ureters were transected two inches distal to the ureteropelvic junction. An 8F dual lumen catheter and a 5F fenestrated catheter with an indwelling silver wire were inserted into both renal pelvises following which methylene blue (0.1%) was infused at a rate of 5 mL/min for 20 minutes. In one pelvis, a 4 mA positive pulsed electrical current was applied to the silver wire. Results: In contrast to the control pelvis, the EMDA side macroscopically exhibited dense homogeneous staining; microscopy revealed penetration of methylene blue into the urothelium/lamina propria. Conclusion: In the porcine renal pelvis, application of EMDA increased the penetration of a charged molecule into the urothelium/lamina propria. [ABSTRACT FROM AUTHOR]

Introduction: Upper urinary tract stones combined with parenchymal infiltrative renal pelvic cancer are challenging to detect on imaging and to evaluate the differential diagnosis. Case Presentation: The symptoms and diagnoses in three cases of parenchymal infiltrative renal pelvic cancer and upper urinary tract stones that occurred between June 2019 and June 2022 were reviewed. Primary symptoms of lumbar discomfort and hematuria were evident in all 3 patients. Preoperative computed tomography (CT) abdominal imaging revealed that all three cases had hydronephrosis along with renal stones, while the other two cases only had localized hypoenhancement of the renal parenchyma, which was only thought to be limited inflammatory changes in the renal cortex as a result of the combination of renal pelvis infection. After percutaneous nephrolithotomy or ureteroscopic lithotripsy, a combined renal pelvis tumor was discovered in all of these instances. Radical tumor surgery was later performed. One patient who had several tumor metastases passed away 6 months after surgery. A case with multiple metastases was discovered 15 months after surgery and survived with the help of the current chemotherapy. A case with a bladder tumor recurrence was discovered 16 months after surgery and had transurethral bladder tumor electrosurgery and routine bladder perfusion chemotherapy. Conclusion: Upper urinary tract stones and parenchymal infiltrative pyel carcinoma have atypical imaging, easily confused with infectious diseases. CT or computed tomography urography (CTU) must be considered by urologists. Patients who have a CT with local renal parenchyma density should be suspected of having parenchymal invasive renal pelvis carcinoma; a needle biopsy ought to be performed; and repeat biopsies may be performed if necessary. High-risk individuals need multiple, sufficient biopsies as needed and a comprehensive intraoperative assessment of the renal pelvic mucosa. [ABSTRACT FROM AUTHOR]

Synchronous renal malignancies are seldom encountered or diagnosed post-renal resection. A combination of renal cell carcinoma (RCC) and urothelial carcinoma (UC) is most commonly reported. Typically, the RCC subtype is clear-cell RCC; however, a combination of collecting duct carcinoma (CDC) and UC has rarely been reported in the existing literature. Here, we present two cases of synchronous renal malignancy, specifically a combination of CDC and UC, in the ipsilateral kidney. [ABSTRACT FROM AUTHOR]

Objective: This study explores the potential causal association between proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors and tumor development using Mendelian randomization (MR) based on drug targets. Methods: Instrumental variables within ±100 kb of the PCSK9 gene locus, impacting low-density lipoprotein cholesterol (LDL-C), were utilized for MR analysis. Coronary heart disease (CHD) served as a positive control to validate the causal relationship between PCSK9 inhibitors and various cancers. We employed reverse MR to address the reverse causation concerns. Data from positive controls and tumors were sourced from OpenGWAS. Results: MR analysis suggested a negative causal relationship between PCSK9 inhibitors and both breast and lung cancers (95%CIBreast cancer 0.81~0.99, p = 2.25 × 10−2; 95%CILung cancer 0.65~0.94, p = 2.55 × 10−3). In contrast, a positive causal link was observed with gastric, hepatic, and oral pharyngeal cancers and cervical intraepithelial neoplasia (95%CIGastric cancer 1.14~1.75, p = 1.88 × 10−2; 95%CIHepatic cancer 1.46~2.53, p = 1.16 × 10−2; 95%CIOral cavity and pharyngeal cancer 4.49~6.33, p = 3.36 × 10−4; 95%CICarcinoma in situ of cervix uteri 4.56~7.12, p = 6.91 × 10−3), without heterogeneity or pleiotropy (p > 0.05). Sensitivity analyses confirmed these findings. The results of MR of drug targets suggested no causal relationship between PCSK9 inhibitors and bladder cancer, thyroid cancer, pancreatic cancer, colorectal cancer, malignant neoplasms of the kidney (except for renal pelvis tumors), malignant neoplasms of the brain, and malignant neoplasms of the esophagus (p > 0.05). Reverse MR helped mitigate reverse causation effects. Conclusions: The study indicates a divergent causal relationship of PCSK9 inhibitors with certain cancers. While negatively associated with breast and lung cancers, a positive causal association was observed with gastric, hepatic, oral cavity, and pharyngeal cancers and cervical carcinoma in situ. No causal links were found with bladder, thyroid, pancreatic, colorectal, certain kidney, brain, and esophageal cancers. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of pyeloplasty in pediatric patients with poor function kidneys, focusing on the split renal function (SRF) and anteroposterior diameter (APD) of the renal pelvis. Materials and Methods: A retrospective study included 47 pediatric patients with ureteropelvic junction obstruction (UPJO) who underwent open pyeloplasty with SRF< 20%. All patients were recruited from the Labbafinejad University Hospital center from April 2014 to October 2020. The results of preoperative ultrasonography and Diethylenetriamine pentaacetate (DTPA) scan compared with the results of the ultrasonography and DTPA scan 6 months and one year after surgery. Finally, Wilcoxon signed-rank test was used to test differences the SPSS (version 25) software statistical computer package. Results: The mean age of participants was 1.5 years. There were 34 cases with SRF between 10% and 20%, and 13 cases with SRF < 10%. The findings showed that pyeloplasty for UPJO leads to a significant improvement in renal function in poorly functioning renal units with 10% ≤ SRF < 20%. Although improvement in renal function occurred in the group with SRF of less than 10%, it was not statistically significant. The APD in both groups was statistically significantly improved. No correlation between genders and outcomes was found. Conclusion: Poorly functioning renal unit (SRF < 20%) can show functional improvement after the pyeloplasty. [ABSTRACT FROM AUTHOR]

Purpose: To compare medium-term stone recurrence between laparoscopic pyelolithotomy (LP) and percutaneous nephrolithotomy (PCNL). Material and methods: 98 patients who underwent PCNL or LP (2015-2019) for large single renal pelvis or staghorn stones (≥ 2 cm) were selected. The stone-free rate was evaluated using a computed tomography scan at one month and then, ultrasonography at six months intervals during the first year and annually thereafter for up to three years. Time-to-stone recurrence was compared using the Kaplan-Meier estimate. Hazard ratio was estimated by Cox regression. Results: The one month stone-free rate was 93.88% in the LP group vs. 79% in the PCNL group (P = .03). The mean overall time-to-stone recurrence was 31 (CI:24-34) months in the LP vs. 28 (CI: 23-32) in the PCNL groups (P = .02). Cox regression analysis showed that PCNL increased the risk of stone recurrence with a hazard ratio of 2.3 (CI: 1.1 - 5.3) compared to the laparoscopy. (p = .03) In subgroup analysis, time-to-stone recurrence in those without previous history of intervention was estimated at 31 (CI: 27 to 35) months in the LP vs. 25 (CI:16 to 34) in PCNL groups (= 0.04). Subanalysis with a BMI cutoff of 25 kg/m² showed an overall time-to-stone recurrence of 34 (CI:30 to 37) months in the LP group and 28 (CI:22 to 33) months in the PCNL group (= 0.04) in those with BMI higher than 25 kg/m². Conclusion: Medium-term time to stone recurrence was in favor of LP compared with PCNL for large single renal pelvis or staghorn stones. [ABSTRACT FROM AUTHOR]

Purpose: Cancer is a disease with high social costs, and policymaking through accurate statistics is very important. This study presents the national cancer statistics on the incidence of urological cancers in the Republic of Korea over 22 years, from 1999 to 2020. Materials and Methods: Through the Korean Statistical Information Service, data on the incidence of urological cancers by sex and age in each year was obtained. For each urological cancer, the number of cases, crude incidence rate (CIR), and age-standardized incidence rate (ASR) were calculated, and the statistical trends were confirmed by joinpoint regression analysis. Results: Urological cancers, which have increased ASR over 22 years, are as follows: prostate cancer (average annual percent change [AAPC]=6.72%, p-trend<0.05), testicular cancer (AAPC=5.26%, p-trend<0.05), ureter cancer (AAPC=4.16%, p-trend<0.05), kidney cancer (AAPC=4.14%, p-trend<0.05), renal pelvis cancer (AAPC=3.86%, p-trend<0.05), and total urological cancer (AAPC=4.37%, p-trend<0.05). Urological cancers, which has decreased ASR over 22 years, are as follows: penile cancer (AAPC= -2.93%, p-trend<0.05) and bladder cancer (AAPC=-0.31%, p-trend<0.05). Conclusions: It was confirmed that the ASR of all urological cancers increased for 22 years, except for bladder and penile cancer. With the aging of the population, the CIR increased for all urological cancers. This study will serve as basic data for future research and policy decisions. [ABSTRACT FROM AUTHOR]

Liver lobe torsion is a potentially fatal condition in rabbits, often necessitating diagnostic imaging such as ultrasonography or a computerized tomography scan for confirmation. Surgical intervention is frequently required for optimal outcomes. Renal cysts are uncommon in rabbits, making this case particularly unique. This case study describes the successful management of concurrent liver lobe torsion and multiple severe renal cysts in a single rabbit. A 2-year-old spayed female Mini Rex rabbit, weighing 1.33 kg with a body condition score of 2/5, presented with acute anorexia, depression, and reduced fecal output. Ultrasound imaging revealed a dilated left ureter and renal pelvis with multiple cysts, along with heterogeneous parenchymal echogenicity of the caudate liver lobe with no Doppler signal detected. Emergency surgery, including hepatic lobectomy and nephroureterectomy, was performed, and a blood transfusion was administered immediately. Postoperative management included pain control, monitoring of blood chemistry parameters, and clinical presentation, resulting in subsequent normalization. Ongoing follow-up is essential to assess for complications such as renal insufficiency or hepatitis. This case adds to our understanding of managing complex conditions in rabbits and underscores the importance of a comprehensive approach to optimize clinical outcomes. [ABSTRACT FROM AUTHOR]

Background and aim: The renal pelvicalyceal system consists of the renal pelvis and the two groups of calyces – the major and the minor. Wide variations in the formation of this system have been reported earlier. The study aimed to provide a clear picture of the morphology as well as the anatomical variations associated with the human renal pelvicalyceal system in the Northeast Indian population that can help to minimize injuries and complications associated with various surgical and radiological interventions in this region.Material and methods: The study was conducted on 160 formalin-fixed specimens collected after dissection from adult and perinatal cadavers above 36 weeks of age. All the specimens were numbered accordingly, and piecemeal dissection was done.Results: The study showed a predominance of the intrarenal pelvis, with the bicalyceal arrangement of major calyces being more than the tricameral pattern. 89.37% of specimens showed normal patterns as described by standard textbooks and authors of previous studies. Meanwhile, 10.62% of specimens had unusual variations, mainly on the right side. These include the absent pelvis, bifid pelvis, absent major calyx, mega calyx, elongated superior calyx, thick major calyx, four major calyx, and dilated calyces. The most commonly occurring variation was absent major calyx (3.75%), followed by absent pelvis (2.5%) and megacalyx (2.3%).Conclusions: The study showed that the renal pelvicalyceal system exhibits various variations. Proper knowledge of these structures' normal and variant anatomy is the key to safe radiological and urological interventions.

Introduction Gastric outlet obstruction caused by upper tract urothelial carcinoma is rare. Case presentation A 78‐year‐old man presented to the hospital with nausea and vomiting. No hematuria was observed. Computed tomography revealed a tumor in the right renal pelvis and duodenal stenosis. Gastrojejunostomy was performed to treat the symptoms of the gastric outlet obstruction so that the patient could resume oral intake and outpatient chemotherapy. Chemotherapy was unsuccessful, and the patient died 9 months after the gastrojejunostomy. Histological assessment of an autopsy specimen revealed plasmacytoid urothelial carcinoma with direct infiltration of the duodenal wall, which caused the stenosis. Conclusion Autopsy revealed a right renal pelvis cancer causing gastric outlet obstruction. Early gastrojejunostomy enabled oral intake and outpatient visits.

The article discusses the utility and potential pitfalls of GATA3 in the diagnosis of renal neoplasms. GATA3 is a protein that is expressed in various normal and neoplastic tissues, and it has a high sensitivity in urothelial carcinomas. It is also expressed in some renal neoplasms, such as papillary renal neoplasm with reverse polarity and clear cell papillary renal tumor. However, caution is needed when interpreting GATA3 expression in high-grade renal carcinomas, as it can be seen in other tumors as well. The article emphasizes the importance of using GATA3 along with other biomarkers in the diagnosis of renal neoplasms. [Extracted from the article]

This article discusses a rare and severe form of chronic pyelonephritis called xanthogranulomatous pyelonephritis (XGP). XGP is characterized by the destruction of the renal parenchyma and granulomatous inflammation. The article presents a case study of a 58-year-old man with XGP and renal sinus replacement lipomatosis, in which the renal parenchyma has almost completely disappeared. The patient had a history of diabetes mellitus and renal nephrolithiasis. The article describes the clinical presentation, imaging findings, and microscopic examination of the patient's condition. The authors propose the term "vanishing kidney" for this unique case, as the kidney parenchyma was not detectable radiologically or microscopically. The article also discusses the classification, stages, and complications of XGP, as well as the rare occurrence of Actinomyces infection in XGP. [Extracted from the article]

Toothpicks are commonly used but rarely ingested. Unlike most foreign bodies, if accidentally swallowed these rarely spontaneously pass. The duodenum has been reported as the most common site of toothpick foreign body lodgement in the upper gastrointestinal tract. We report the case of a 57-year-old presenting with recurrent urosepsis after non recognition of a toothpick impaction in the duodenum with fistulisation into the right renal pelvis. Endoscopic removal of the foreign body was successful in management of the urosepsis. [ABSTRACT FROM AUTHOR]

Crossed fused ectopic kidney is a rare congenital anomaly wherein the kidneys are present on the same side due to fusion. It is a rare disease that may remain undiagnosed throughout life. Its rarity and anatomical abnormality make any intervention challenging. A 32-year-old male patient presented with symptoms of pain in the abdomen and burning micturition for a year. Serum creatinine, along with other blood tests, was normal. X-ray KUB showed renal calculi in the region of the right kidney. However, a Computed Tomography (CT) scan showed that the left kidney was malrotated and fused with the lower pole of the right kidney, suggestive of crossed fused renal ectopia. A cystoscopy and retrograde pyelography were performed, followed by open pyelolithotomy, wherein calculi were removed, and a stent was placed. Through this case report, it is suggested that adequate presurgery evaluation is necessary for patients with such malformations. [ABSTRACT FROM AUTHOR]

Introduction: Anderson-Hynes (AH) dismembered pyeloplasty is the standard procedure performed for the management of Pelviureteric Junction Obstruction (PUJO). Ultrasonography (USG) and diuretic renography are of great importance for the diagnosis and follow-up of PUJO. Aim: To evaluate the morphological and functional outcomes of open dismembered pyeloplasty in children with unilateral PUJO and to find the correlation between functional and morphological outcomes. Materials and Methods: A retrospective observational study was conducted, assessing the clinical charts of 200 children under 10 years of age with congenital PUJO who underwent open AH dismembered pyeloplasty in the Department of Paediatric Surgery at a teritary teaching Institute, Government medical college, Thiruvananthapuram, Kerala, India from from June 2015 to June 2020. The preoperative radiological assessment included renal USG and diuretic renography for all patients. Morphological and functional surgical outcomes were measured one year after surgery. The morphologic parameters analysed were the Anteroposterior Diameter (APD) of the pelvis and Parenchymal Thickness (PT). The functional outcome was assessed by improvements in Glomerular Filtration Rate (GFR), Split Renal Function (SRF), and drainage curve. Success was defined as improvement in function and morphology in followup USG and renogram after one year of surgery. Paired t-test was applied for statistical analysis using Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: Among the total 200 patients,180 (90%) cases demonstrated improved renal function after pyeloplasty. Among the total 200 cases, males were 120 (60%) and females were 80 (40%). Morphologic outcome improved in 188 out of 200 (94%) cases. The overall outcome was good in 168 out of 200 (84%) patients. The results showed a moderate negative correlation for APD with respect to SRF (r=-0.677, p-value=0.01) and GFR (r=- 0.430, p-value=0.01), whereas a moderate positive correlation was observed between SRF and GFR (r=0.423, p-value=0.01). Conclusion: AH dismembered pyeloplasty is an effective treatment for PUJO in children, not only relieving obstruction but also improving renal function. The present study recommends considering both morphologic and functional parameters to assess the success of the surgery.

Increased intrapelvic pressure (IPP) due to irrigation during flexible ureteroscopy (f-URS) can pose a risk of postoperative severe urinary tract infection associated with pyelovenous backflow. An automatic regulation system for maintaining safe IPP levels could enable surgeons to perform f-URS safely without postoperative complications. This study aimed to assess the measurement accuracy of an ultra-miniature fiber-optic pressure sensor incorporated into a small-caliper ureteroscope for assessing IPP and to develop an automatic irrigation system linked to this sensor. A porcine kidney was used for the ex vivo experiment. The nephrostomy catheter, connected to the conventional pressure transducer, was placed on the renal pelvis to evaluate the actual IPP (a-IPP). For measuring IPP using the fiber-optic pressure sensor (fo-IPP) built into the f-URS, a diaphragm pressure sensor of Φ250 μm was used. To establish an irrigation system, the optimal proportional–integral–derivative (PID) controller was explored to accurately adjust the irrigation pump flow rate. A high correlation between a-IPP and fo-IPP was confirmed across irrigation pressure values of 60–180 mbar (all, r ≥ 0.7, p < 0.001). When performing bolus irrigation, although fo-IPP showed relatively a higher peak value than a-IPP, the response time of fo-IPP was equivalent to that of a-IPP. After PID parameter optimization, our automatic irrigation system based on fo-IPP smoothly and accurately regulated the intended IPP set in the 5–20 mmHg range without overshooting. We successfully developed and demonstrated an automatic irrigation system regulating IPP based on the PID controller for f-URS, utilizing a fiber-optic pressure sensor. Further research, including in vivo studies, will be needed to assess clinical feasibility. [ABSTRACT FROM AUTHOR]

Background: Urinoma, a rare condition resulting from urine leakage due to trauma to the kidney, bladder, or urethra, is typically diagnosed using enhanced computed tomography urogram with delayed imaging. This report presents two cases of urinoma likely caused by overdistention of the renal pelvis following excessive fluid intake and the presence of a ureteral stone. Case presentation: We present two cases of 36-year-old and 38-year-old patients who presented with flank pain. point-of-care ultrasound (POCUS) played a pivotal role in identifying perinephric fluid in Morrison's space and the splenorenal space, respectively. These ultrasound findings guided further investigations, leading to definitive diagnoses via abdominal pelvic CT scans. Treatment involved prophylactic antibiotics and the successful placement of a double J stent into the renal pelvis over the wire under fluoroscopic guidance, which resulted in significant clinical improvement for both patients. Conclusions: This study demonstrates the rare occurrence of urinoma from urolithiasis, the use of POCUS in expediting diagnosis and treatment, and the importance of interpreting sonographic images in the correct clinical setting. [ABSTRACT FROM AUTHOR]

To evaluate a population of children with non-refluxing primary megaureter (NRPM), we investigated spontaneous resolution of ureteral dilation and the pattern (proximal to distal or distal to proximal) in which it occurs. From our prospectively collected prenatal hydronephrosis (HN) database (0-24 months, 2008-2017), selecting those with NRPM (n = 92). We excluded patients who underwent surgery (n = 20), children with <6 months follow-up (n = 2) and without a voiding cystourethrogram (VCUG) (n = 4). Images were segregated into 198 ureteric segments (proximal/mid/distal). We defined resolution as Society for Fetal Urology (SFU) (0/1), anteroposterior diameter (APD) <10 mm, and ureteric dilatation <5 mm. Descriptive statistics and Kaplan-Meier curves were created for time-to-resolution analyses. Of 66 patients and 198 ureteral segments, median age at presentation was 2 months (0-12), 83% were male (33% circumcised). Mean APD at baseline was 11 ± 4 mm, and 79% had (SFU 3/4) HN. Mean dilatation of ureteral segments (mm) at baseline was: 9 ± 2 proximal, 9 ± 2 mid, and 11 ± 3 distal. At a median follow-up time of 26 (7-83) months, dilation of 55 (83%) proximal, 48 (72%) mid, and 22 (33%) distal ureteric segments had resolved. Overall, HN resolution occurred in 76% of patients. Resolution rates were similar for proximal/mid-ureters (83% vs 72%; P =.20); however, they were significantly different from distal segments (83% proximal vs 33% distal; 72% mid vs 33% distal, P <.01). Our data suggest that spontaneous resolution of NRPM follows a proximal to distal progression. Distal ureteric dilatation takes up to 10 months longer to resolve compared to that of proximal and mid-ureteric segments, as well as that of the renal pelvis. [ABSTRACT FROM AUTHOR]

Objectives: Ureteral obstruction is a common post‐renal cause of azotaemia in cats. The objective of this study was to describe clinicopathological and point‐of‐care ultrasound findings in azotaemic cats that may increase the index of suspicion of ureteral obstruction. Materials and Methods: A retrospective case–control study was conducted of azotaemic cats presenting to the emergency room of a referral teaching hospital. Cats were included if they were azotaemic and had point‐of‐care ultrasound and formal ultrasound performed. Cats were grouped into obstructed and non‐obstructed groups based on formal specialist ultrasound and pyelography. Point‐of‐care ultrasound findings were described, including renal size and symmetry, renal pelvis dilation, perinephric fluid, and visualisation of the proximal ureter or calculi. Univariate analysis was performed to identify historical, biochemical and point‐of‐care ultrasound findings associated with ureteral obstruction before multivariate analysis. Results: One hundred twenty‐two azotaemic cats met the inclusion criteria. Seventy‐four cats were included in the obstructed azotaemic group and 48 cats in the non‐obstructed azotaemic groups. Point‐of‐care ultrasound abnormalities were detected in 60 of 74 (81.1%) obstructed cats and 18 of 48 (37.5%) non‐obstructed cats. Renal pelvis dilation (odds ratio 38.8; 95% confidence interval 2.9 to 515), hyporexia (odds ratio 5.9; 95% confidence interval 1.15 to 30.13), hypercalcaemia (odds ratio 16.6; 95% confidence interval 1.2 to 223.0) and hypokalaemia (odds ratio 21.7; 1.33 to 354.62) were more likely to be associated with ureteral obstruction than non‐obstructive disease. Clinical Significance: Point‐of‐care ultrasound abnormalities are documented frequently in azotaemic cats with ureteral obstruction. Cats with renal pelvis dilation were 39 times more likely to have ureteral obstruction than non‐obstructive acute kidney injury. [ABSTRACT FROM AUTHOR]

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The existing ureteral reconstruction treatment methods are unable to meet the clinical needs due to complications such as stricture, ureteral fistula and lack of donor. Tissue engineering provides a new feasible method. The main construction strategies, material selection and preparation methods for the study of tissue-engineered ureter at home and abroad are reviewed. The review focused on the current status of the development of tissue-engineered ureter based on textile technology, and concluded that ureteral reconstruction suffered from the contradiction between good reconstructive effect and short-term preparation time, as well as limited local smooth muscle growth. Micro-nano fiber aggregates prepared by textile technology can control the multi-level structure of fibers, yarns and fabrics. Further design of multi-layered structures of different materials combined with textile technology and investigation of their modulating effects on the behavior of various types of cells will provide new directions for the optimal design of tissue-engineered ureteral scaffold structures. [ABSTRACT FROM AUTHOR]

Urolithiasis is a major public health issue due to its increasing prevalence. The objective of this study was to describe the spectrophotometric profile of upper urinary tract stones (UTS) in Senegal. We conducted a multicenter retrospective study of all patients treated for upper UTS whose chemical composition was analyzed from January 2014 to January 2020 in eight regions of Senegal. Socio-demographic, clinical, paraclinical, and prognosis data were collected and analyzed. Three hundred and thirty-four patients were included in this study with a mean age of 46.3 ± 18.4 years and a sex ratio of 1.38. About one-third of patients (31.1%) had a body mass index > 25 kg/m2 and 74.2% presented with lumbar pain was the main clinical symptom. Calcium oxalate and calcium phosphate stones were the predominant types found, respectively, in 37.7% and 24.5% of patients. Uric acid was the main stone constituent in 18.6% of patients and struvites represented 14.7% of cases. Stones were located in the renal calyces and pelvis in 71.2% of cases. Surgical lithotomy was performed in 62.7% of patients for UTS extraction. Upper UTS are frequent condition in Senegalese with predominance of males and young adults. Calcium and uric acid stones are the main types. Preventive dietary and lifestyle measures are needed to reduce their burden. [ABSTRACT FROM AUTHOR]

Background: Ectopic kidney and median arcuate ligament syndrome are both rare conditions. The clinical presentation and diagnosis of these conditions are not well studied. There are no reports on the combination of these two rare conditions. Case presentation: We report a 24-year-old woman with fever, dysuria, urinary frequency and left flank pain for two days. The primary diagnoses in the clinic were left acute pyelonephritis and left hydronephrosis due to throbbing pain in the left costovertebral angle and pyuria. However, further computed tomography showed right ectopic pelvic kidney, left renal pelvis dilatation without definite ureteral lesion, good bilateral renal contrast enhancement, and compression of the celiac axis due to obstruction by the median arcuate ligament. Chronic abdominal symptoms were reported by the patient after repeat history taking. The patient's condition was fully explained and discussed with her and her family, but they refused further therapy. After the acute pyelonephritis began improving, the patient was discharged for follow-up at our outpatient clinic. Conclusion: We present an extremely rare case of a combination of two rare conditions: ectopic kidney and median arcuate ligament syndrome. No study to date has reported on the relationship between the two diseases. Given the rarity of the two conditions, no evidence or even a hypothesis exists to explain the possible etiology of their combination. More reports are required to enhance the understanding of these rare conditions. [ABSTRACT FROM AUTHOR]

Upper tract urothelial carcinoma and bladder urothelial carcinoma both belong to urothelial carcinoma, which is a malignant tumor occurring in the renal pelvis and ureteral urothelium. The incidence rate of UTUC is higher among Asians and it shows various pathogenic factors. Patients of UTUC have a short lifespan, and most of them have shown invasive malignant tumors at the time of initial diagnosis. The treatment of most UTUC patients is limited to surgical resection, radiotherapy and chemotherapy in clinical. Due to its rarity, the studies on targeted therapy are rare. With the development of the targeted therapy and immunotherapy, genomics exploration that affects the prognosis of UTUC becomes particularly important. In this paper, we intend to review the differential expression, clinical significance and some special types of UTUC genomes through the UTUC genome. [ABSTRACT FROM AUTHOR]

Income, a component of socioeconomic status, influences cancer risk as a social determinant of health. We evaluated the independent associations between individual‐ and area‐level income and site‐specific cancer incidence in Canada. We used data from the 2006 and 2011 Canadian Census Health and Environment Cohorts, which are probabilistically linked datasets constituted by 5.9 million and 6.5 million respondents of the 2006 Canadian long‐form census and 2011 National Household Survey, respectively. Individuals were linked to the Canadian Cancer Registry through 2015. Individual‐level income was derived using after‐tax household income adjusted for household size. Annual tax return postal codes were used to assign area‐level income quintiles to individuals for each year of follow‐up. We calculated age‐standardized incidence rates (ASIR) and rate ratios for cancers overall and by site. We conducted multivariable negative binomial regression to adjust these rates for other demographic and socioeconomic variables. Individuals of lower individual‐ and area‐level income had higher ASIRs compared to those in the wealthiest income quintile for head and neck, oropharyngeal, esophageal, stomach, colorectal, anal, liver, pancreas, lung, cervical and kidney and renal pelvis cancers. Conversely, individuals of wealthier individual‐ and area‐level income had higher ASIRs for melanoma, leukemia, Hodgkin's lymphoma, non‐Hodgkin's lymphoma, breast, uterine, prostate and testicular cancers. Most differences in site‐specific incidence by income quintile remained after adjustment. Although Canada's publicly funded healthcare system provides universal coverage, inequalities in cancer incidence persist across individual‐ and area‐level income gradients. Our estimates suggest that individual‐ and area‐level income affect cancer incidence through independent mechanisms. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the pressure range generated in the human renal collecting system during ureteroscopy (URS), in a large patient sample, and to investigate a relationship between intrarenal pressure (IRP) and outcome. Patients and Methods: A prospective multi‐institutional study was conducted, with ethics board approval; February 2022–March 2023. Recruitment was of 120 consecutive consenting adult patients undergoing semi‐rigid URS and/or flexible ureterorenoscopy (FURS) for urolithiasis or diagnostic purposes. Retrograde, fluoroscopy‐guided insertion of a 0.036‐cm (0.014″) pressure guidewire (COMET™ II, Boston Scientific, Marlborough, MA, USA) to the renal pelvis was performed. Baseline and continuous ureteroscopic IRP was recorded, alongside relevant operative variables. A 30‐day follow‐up was completed. Descriptive statistics were applied to IRP traces, with mean (sd) and maximum values and variance reported. Relationships between IRP and technical variables, and IRP and clinical outcome were interrogated using the chi‐square test and independent samples t‐test. Results: A total of 430 pressure traces were analysed from 120 patient episodes. The mean (sd) baseline IRP was 16.45 (5.99) mmHg and the intraoperative IRP varied by technique. The mean (sd) IRP during semi‐rigid URS with gravity irrigation was 34.93 (11.66) mmHg. FURS resulted in variable IRP values: from a mean (sd) of 26.78 (5.84) mmHg (gravity irrigation; 12/14‐F ureteric access sheath [UAS]) to 87.27 (66.85) mmHg (200 mmHg pressurised‐bag irrigation; 11/13‐F UAS). The highest single pressure peak was 334.2 mmHg, during retrograde pyelography. Six patients (5%) developed postoperative urosepsis; these patients had significantly higher IRPs during FURS (mean [sd] 81.7 [49.52] mmHg) than controls (38.53 [22.6] mmHg; P < 0.001). Conclusions: A dynamic IRP profile is observed during human in vivo URS, with IRP frequently exceeding expected thresholds. A relationship appears to exist between elevated IRP and postoperative urosepsis. [ABSTRACT FROM AUTHOR]

Objective: To document the histological changes observed in renal units subjected to elevated intrarenal pressures (IRPs) and postulate the possible mechanisms of infectious complications after ureteroscopy. Materials and Methods: Ex vivo studies were performed on porcine renal models. Each ureter was cannulated with a 10‐F dual‐lumen ureteric catheter. A pressure‐sensing wire was inserted through one lumen and with the sensor positioned in the renal pelvis for IRP measurement. Undiluted India ink stain was irrigated through the second lumen. Each renal unit was subjected to ink irrigation at target IRPs of 5 (control), 30, 60, 90, 120, 150, and 200 mmHg. Three renal units were subjected to each target IRP. After irrigation, each renal unit was processed by a uropathologist. Macroscopically, the amount of renal cortex stained by ink was calculated as a percentage of the total perimeter. Microscopically, presence of ink reflux into collecting ducts or distal convoluted tubules, and pressure‐related features, was noted at each IRP. Results: Signs of pressure, as represented by collecting duct dilatation, was first observed at 60 mmHg. Ink staining was consistently observed in the distal convoluted tubules at IRPs ≥60 mmHg, and all renal units above this pressure showed renal cortex involvement. At ≥90 mmHg, ink staining was observed in venous structures. At 200 mmHg, ink staining was observed in supportive tissue, venous tributaries in the sinus fat, peritubular capillaries, and glomerular capillaries. Conclusion: Using an ex vivo porcine model, pyelovenous backflow occurred at IRPs of ≥90 mmHg. Pyelotubular backflow occurred when irrigation IRPs were ≥60 mmHg. These findings have implications for the development of complications after flexible intrarenal surgery. [ABSTRACT FROM AUTHOR]

To assess the prevalence of pelvic ectopic kidneys (PEK) and compare renal parameters of the PEK to the orthotopic kidney following pubic bone approximation. In four Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome (OEIS) patients undergoing second-stage repair with known pelvic and orthotopic kidneys, changes in the renal pelvis pressure (RPP), peak systolic velocity (PSV), and resistive index (RI) were measured in the pelvic and orthotopic kidneys following pubic bone approximation. A paired t -test was performed for analysis. Prevalence was tabulated using a multi-institutional retrospective review. Mean rise in RPP was + 26.0 mmHg in the PEK and + 10.3 mmHg in the orthotopic kidney (P =.55). One patient had immediate increase in RPP of 66 mmHg in the PEK (7 mmHg in the orthotopic kidney) which decreased to + 17 mmHg in the PEK upon release of the pubic approximation stitch. Mean change in PSV was + 67.7 cm/s in the PEK compared to − 25.7 cm/s in the orthotopic kidney (P =.09). Mean change in renal RI was + 0.06 in PEK compared to − 0.01 in the orthotopic kidney (P =.29). Among 80 OEIS patients, 24 (30%) had a PEK. 3 (4%) had a solitary PEK. During second-stage OEIS closure, we witnessed patterns of higher change in RPP, PSV, and RI of the PEK compared to the orthotopic kidney. Furthermore, PEKs were found in nearly a third of our OEIS patients. Real-time RPP monitoring, especially those with solitary PEK, may aid in the management of OEIS patients during the perioperative period. [ABSTRACT FROM AUTHOR]

Introduction: Intrarenal pressure is emerging as an important monitoring parameter during flexible ureteroscopy (fURS). We measure how intraoperative conditions affect intrarenal pressure using a novel pressure sensing ureteroscope. Methods: The LithoVue Elite (LVE) single-use digital flexible ureteroscope (Boston Scientific) is the first commercial ureteroscope that senses pressure at its tip. LVE was used in a porcine model to measure intrarenal pressure with and without a ureteral access sheath (UAS) with various sizes and placement locations, irrigation methods, and working channel accessories. LVE pressure accuracy was measured in a bench model. This abstract shows the least-square means from multiway analysis of variances used for analysis. Results: Intrarenal pressures were the highest without a UAS (64 mm Hg), followed by the 11/13 UAS (51 mm Hg) and the 12/14 and 13/15, which were not statistically different (39–40 mm Hg). The pressures were highest with UASs placed at the ureteropelvic junction (61 mm Hg), and lowest if placed in the renal pelvis (24 mm Hg). Irrigation methods showed the highest pressures with syringe (57 mm Hg), while irrigation bags (pressurized at 150–300 mm Hg) produced 43 to 46 mm Hg and 25 mm Hg when applied with 80 cm of gravity. Placing a 200 μm laser fiber reduced pressures from 44 to 41 mm Hg. Finally, the bench model showed that LVE was 96% accurate up to 300 mm Hg. Conclusion: Intrarenal pressure significantly varied based on UAS sizes, placement, and irrigation methods. Accordingly, fURS with LVE is poised to be an invaluable tool for clinical decision-making and future studies of intrarenal pressure. [ABSTRACT FROM AUTHOR]

The dead body of a 54-year-old man was found at home by his partner. He was off work due to depression. A letter with suicidal intention was present on the scene. He was known to be a heavy drinker, and near the body, an empty bottle of whisky was found. In addition, 2 empty blisters of Eliquis (apixaban) 5 mg, corresponding to 40 tablets, were identified. Apixaban is an oral anticoagulant, acting as a factor Xa inhibitor. Autopsy findings were mostly unremarkable, except numerous bruises and some superficial self-inflected wounds. Histology showed hematomas of calyces and renal pelvis and in the liver, several areas of perivenular haemorrhagic necrosis. Others organs were congestive. Femoral venous blood alcohol was 0.11 g/L. In femoral venous blood, a toxic concentration of apixaban was measured at 1184 ng/mL using LC-MS/MS. Other drugs found at therapeutic concentrations included diazepam (99 ng/mL), nordiazepam (171 ng/mL), flecainide (447 ng/mL), and mianserine (65 ng/mL). Using liquid chromatography coupled to high-resolution mass spectrometry, 2 metabolites were identified, O-desmethyl-apixaban (61.8% of the apixaban response) and hydroxyl-apixaban (4.5% of the apixaban response). Long-term therapy was confirmed by a concentration of 10390 pg/mg in pubic hair. [ABSTRACT FROM AUTHOR]

Ketones are alternative energy substrates for the heart and kidney but no studies have investigated their metabolism simultaneously in both organs in humans. The present double tracer positron emission tomography (PET) study evaluated the organ distribution and basal kinetic rates of the radiolabeled ketone, 11C-acetoacetate (11C-AcAc), in the heart and kidney compared to 11C-acetate (11C-Ac), which is a well-validated metabolic radiotracer. Both tracers were highly metabolized by the left ventricle and the renal cortex. In the heart, kinetic rates were similar for both tracers. But in the renal cortex, uptake of 11C-Ac was higher compared to 11C-AcAc, while the reverse was observed for the clearance. Interestingly, infusion of 11C-AcAc led to a significantly delayed release of radioactivity in the renal medulla and pelvis, a phenomenon not observed with 11C-Ac. This suggests an equilibrium of 11C-AcAc with the other ketone, 11C-D-beta-hydroxybutyrate, and a different clearance profile. Overall, this suggests that in the kidney, the absorption and metabolism of 11C-AcAc is different compared to 11C-Ac. This dual tracer PET protocol provides the opportunity to explore the relative importance of ketone metabolism in cardiac and renal diseases, and to improve our mechanistic understanding of new metabolic interventions targeting these two organs. [ABSTRACT FROM AUTHOR]

In the case presented, we suspect the toothpick to have perforated the duodenal wall and completely migrated into the renal pelvis of the right kidney due to the location of the toothpick high up in the renal pelvis as has been described before [[4]]. Abdominal CT showed hypoperfusion of the right kidney and hydronephrosis II° with enhancement of the wall of the renal pelvis, as well as the upper third of the right ureter. Abbreviations URS ureterorenoscopy UUT upper urinary tract Introduction Foreign bodies in the upper urinary tract (UUT) represent a rare, but well-documented phenomenon. An abdominal CT scan showed a contrast enhanced renal pelvis and ureter, as well as an intraluminal, linear contrast media defect, adjacent to the wall of the ureter. [Extracted from the article]

Xanthogranulomatous pyelonephritis (XGPN) is an uncommon chronic granulomatous process that can result in significant destruction of renal parenchyma and propagation of inflammation into adjacent pararenal tissues. The presented patient had xanthogranulomatous inflammation of renal pelvis, peri- and paranephritic tissue, with formation of a large tumor-like mass which was in close relation to the base of urinary bladder. The findings of pathognomonic foamy macrophages and multinucleated giant cells showing diffuse positivity for CD68 confirmed the precise diagnosis. Having in mind that XGPN can mimic various clinically and pathologically benign and malignant conditions, a multidisciplinary diagnostic approach is required. Sometimes, careful clinical, imaging, nuclear and histopathological examinations are necessary to determine the type and degree of renal damage, which will dictate surgical approach, especially if nephrectomy is not planned. [ABSTRACT FROM AUTHOR]

This review provides updated knowledge on the long-term outcomes among children with antenatally diagnosed urinary tract dilatation (UTD), previously often referred to as antenatal hydronephrosis. Different definitions of UTD exist, which makes comparison between studies and generalized conclusions difficult. Roughly, one-third of antenatally diagnosed UTD, defined as a renal pelvis anterior posterior diameter (APD) of ≥ 4 mm in the second trimester and/or ≥ 7 mm in the third trimester, will resolve before birth, another third will resolve within the first years of life, and in the remaining cases, UTD will persist or a congenital abnormality (CAKUT) will be diagnosed postnatally. The risk of a postnatal CAKUT diagnosis increases with the degree of prenatal and postnatal dilatation, except for vesicoureteral reflux (VUR), which cannot be predicted from the degree of UTD. Urinary tract infections (UTIs) occur in 7–14% of children with UTD during the first years of life. The risk of UTI is higher in children with traditional risk factors for UTI, such as dilated VUR, hydroureteronephrosis, female gender, and intact foreskin. Continuous antibiotic prophylaxis may be considered in selected patients during the first years of life. In long-term follow-ups, permanent kidney damage is diagnosed in approximately 40% of children with moderate or severe UTD, but hypertension, proteinuria, and/or reduced eGFR are uncommon (0–5%). In children with mild UTD, the long-term outcome is excellent, and these children should not be subjected to unnecessary examinations and/or follow-up. [ABSTRACT FROM AUTHOR]

Background: Pathogenic mutations in EVC or EVC2 gene can lead to Ellis‐van Creveld (EvC) syndrome, which is a rare autosomal recessive skeletal dysplasia disorder. This study aimed to determine pathogenic gene variations associated with EvC syndrome in fetuses showing ultrasound anomalies. Methods: A 32‐year‐old pregnant woman from Quanzhou, China was investigated. In her pregnancy examination, the fetus exhibited multiple fetal malformations, including a narrow thorax, short limbs, postaxial polydactyly, cardiac malformations, and separation of double renal pelvis. Karyotype, chromosomal microarray analysis and whole exome sequencing were performed for prenatal genetic etiology analysis. Results: Chromosome abnormalities and copy number variants were not observed in the fetus using karyotype and chromosomal microarray analysis. Using whole exome sequencing, two compound heterozygous variants NM_147127.5:c.[2484G>A(p.Trp828Ter)];[871‐2_894del] in EVC2 gene were identified in the fetus as pathogenic variants inherited from parents. Conclusions: The study is the first to identify two rare compound variants in EVC2 gene in a Chinese family using whole exome sequencing. The application of whole‐exome sequencing would be helpful in fetal etiological diagnosis with ultrasound anomalies. [ABSTRACT FROM AUTHOR]

Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describe the intrinsic relationships of the renal pedicle (PR) from two coronal planes, the renal pelvis (PER) being the element that limits between both. Trivedi et al. (2011) showed relationships between the elements of the RP that do not coincide with the descriptions provided by these authors. Knowing the possible variants in the intrinsic relationships of the RP is of the utmost importance in surgical practices such as renal transplantation (García de Jalón Martínez et al., 2003). Therefore, the objective of this study is to analyze the variable relationships between the elements that make up the RP in the juxtahilar region of the kidney. 23 RP were studied, formalized at 10 % and provided by the Dissection Team of the Second Chair of Anatomy of the University of Buenos Aires. PRs were classified into two groups. In Group I, the tributaries of origin of the renal vein (RVOA) were in the same coronal plane. In group II, the AOVRs were in different coronal planes. Each group was subdivided into different patterns. Patterns I and II, with the highest incidence, were associated with group I and patterns III, IV and V with group II. In pattern I, the VROA were anterior to the renal pelvis (PER) and posterior to the prepelvic artery (PPA). In pattern II, AOVRs were prior to PER and APP. Patterns I and II make up group I and presented a higher number of incidence in our investigation. There are also variants that occur less frequently than these patterns, these comprise group II of the classification proposed in this work. [ABSTRACT FROM AUTHOR]

Objective: To compare the long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation under fluoroscopic guidance versus not using radioscopy during the procedure. Patients and methods: A comparative study between POM cases treated at our institution by endoscopic balloon dilation (EBD) under fluoroscopic guidance (FG) (n = 43) vs no fluoroscopic guidance (NFG) (n = 48) between the years 2004 and 2018 was conducted. The procedure in FG consisted of performing a retrograde pyelography before dilation. Then, a guidewire is introduced to the renal pelvis, and the dilation of the vesicoureteral junction is performed using high-pressure balloon catheters under fluoroscopic vision. Finally, a double-J stent is placed between the renal pelvis and bladder. The procedure in NFG was performed exclusively under cystoscopic vision without radiological exposure. Complications, outcomes, and success rates were analyzed using Spearman's correlation test. Mean follow-up was 12.5 ± 2.2 years in FG and 6.4 ± 1.3 years in NFG. Results: MAG-3 showed significant differences in renal drainage before and after endoscopic treatment in both groups (p < 0.001 T-test). Statistical analysis did not reveal differences between groups in initial technical failure (r: − 0.035, p = 0.74), early postoperative complications (r: − 0.029, p = 0.79), secondary VUR (r: 0.033, p = 0.76), re-stenosis (r: 0.022, p = 0.84), long-term ureteral reimplantation (r: 0.065, p = 0.55), and final outcome (r: − 0.054, p = 0.61). The endoscopic approach of POM had a long-term success rate of 86.5% in FG VS 89.6% in NFG. Conclusions: Endoscopic balloon dilation of POM can be done with no radiation exposure with similar results, effectiveness, and outcomes. [ABSTRACT FROM AUTHOR]

The capability of the urinary tract to undergo metaplastic changes such as squamous, intestinal, glandular, mucinous, or ciliated epithelium in renal pelvis has been previously reported, which hypothetically is due to the mechanical irritation of the transitional epithelium. However, transitional metaplasia is a rare presentation in the collecting ducts. The aim of this paper was to report this type of extremely rare metaplasia and to inform pathologists that they may encounter this kind of metaplasia. A 25-year-old man, a known case of vesicoureteral reflux (VUR), referred to the Imam Reza Hospital; affiliated to the Mashhad University of Medical Sciences, for bilateral nephrectomy. Gross evaluation of bilateral nephrectomy specimens showed atrophic kidneys and dilated pelvicalyceal systems. The light microscopic evaluation showed transitional metaplasia in the background of chronic pyelonephritis, confirmed by GATA3 nuclear immunohistochemical stain. In this study, we presented a rare case of a renal collecting duct with transitional epithelial lining replacing the normal epithelium as a metaplastic change, with the hypothesis that previous medical history including VUR, or hemodialysis could be the trigger for the metaplastic change, which should be confirmed by further studies. [ABSTRACT FROM AUTHOR]

In this study, we explored the incidence of double J (JJ) contamination of patients who underwent an endourological procedure for urinary stones and ureteral stenosis. We developed a prospective study between January 2019 and December 2021. Ninety-seven patients, 54 male and 43 female, were enrolled. Urine culture was taken during four steps: before stent insertion, a sample from selective renal pelvis catheterization, a sample two days after the JJ insertion and finally, after the stent removal procedure. At the time of the stent removal, 1 cm of proximal and distal ends were cut off and placed in the culture for bacterial evaluation. Cohen's kappa coefficient value (k) and concordance rates of microbiological culture results were evaluated. The study group comprised 56% of male patients. Proximal and distal stent cultures were positive in 81 and 78 patients. The concordance rate of microbiological cultures between proximal and distal double J stent is 88% (k 0.6). The most common pathogens isolated from urine and stent cultures were Enterococcus spp. in 52 cases and Klebsiella spp. in 27 cases. [ABSTRACT FROM AUTHOR]