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Garcia-Chairez LR, Franco-Gonzalez CD, Gonzalez-Guillermo CA, Mendez-Atoche M, Sosa-Olivares CM, Cruz Nuricombo E, Robles Torres JI, Flores-Tapia JP. Prognostic Factors for Residual Lithiasis in Patients With Staghorn Calculi Undergoing Percutaneous Nephrolithotomy in the Maya Region of Yucatan, Mexico: A Case-Control Study. Cureus 2024; 16:e57052. [PMID: 38681280 PMCID: PMC11050729 DOI: 10.7759/cureus.57052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico, placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient's collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula. METHODS A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate. RESULTS A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100). A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001). CONCLUSION Guy's Score Grade IV showed a higher incidence of residual lithiasis, seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.
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Robles-Torres JI, García-Chairez LR, Castellani D, Enrriquez-Ávila JV, Monzón-Falconi JF, Esqueda-Mendoza A, Flores-Tapia JP, Wroclawski ML, Duarte-Santos HO, Ragoori D, Gadzhiev N, Mahajan A, Kumar S, Farooq M, Ganpule A, Tanidir Y, Maheshwari PN, Gite VA, Sinha MM, Somani BK, Gutiérrez-González A, Gauhar V. Perioperative outcomes and risk factors for major complications associated with nephrectomy for Xanthogranulomatous pyelonephritis: a multicenter study. World J Urol 2023; 41:2905-2914. [PMID: 37171477 DOI: 10.1007/s00345-023-04415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/28/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy. METHODS A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed. RESULTS A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications. CONCLUSION Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible.
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Affiliation(s)
| | | | - Daniele Castellani
- Urology Unit Azienda Ospedaliero-Universitaria Delle Marche, Ancona, Italy
| | | | | | | | | | - Marcelo Langer Wroclawski
- Faculdade de Medicina Do ABC, Santo André, São Paulo, SP, Brazil
- BP - a Beneficência Postuguesa de São Paulo, São Paulo, SP, Brazil
| | | | - Deepak Ragoori
- Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Nariman Gadzhiev
- Saint Petersburg State University Hospital, St. Petersburg, Russia
| | - Abhay Mahajan
- Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | - Santosh Kumar
- Department Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mudasir Farooq
- Department Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | | | - Mriganka Mani Sinha
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | | | - Vineet Gauhar
- Ng Teng Fong General Hospital (NTFGH)/NUHS, Singapore, Singapore
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Gauhar V, Robles-Torres JI, Wroclawski ML, Trujillo-Santamaría H, Teoh JYC, Tanidir Y, Mahajan A, Gadzhiev N, Ragoori D, Kumar S, Ganpule A, Maheshwari PN, García-Chairez LR, Enrriquez-Ávila JV, Monzón-Falconi JF, Esqueda-Mendoza A, Flores-Tapia JP, Duarte-Santos HO, Farooq M, Arjunrao Gite V, Mani Sinha M, Somani BK, Castellani D. Clinical Presentation, Microbiological Characteristics, and Their Implications for Perioperative Outcomes in Xanthogranulomatous Pyelonephritis: Perspectives from a Real-World Multicenter Practice. Pathogens 2023; 12:pathogens12050695. [PMID: 37242365 DOI: 10.3390/pathogens12050695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic granulomatous infection of renal parenchyma. XGP is often associated with long-term urinary tract obstruction due to stones and infection. We aimed to analyze the clinical, laboratory, and microbial culture profiles from bladder and kidney urine of patients who were diagnosed with XGP. Databases of patients with histopathological diagnosis of XGP from 10 centers across 5 countries were retrospectively reviewed between 2018 and 2022. Patients with incomplete medical records were excluded. A total of 365 patients were included. There were 228 (62.5%) women. The mean age was 45 ± 14.4 years. The most common comorbidity was chronic kidney disease (71%). Multiple stones were present in 34.5% of cases. Bladder urine culture results were positive in 53.2% of cases. Kidney urine culture was positive in 81.9% of patients. Sepsis and septic shock were present in 13.4% and 6.6% of patients, respectively. Three deaths were reported. Escherichia coli was the most common isolated pathogen in both urine (28.4%) and kidney cultures (42.4%), followed by Proteus mirabilis in bladder urine cultures (6.3%) and Klebsiella pneumoniae (7.6%) in kidney cultures. Extended-spectrum beta-lactamases producing bacteria were reported in 6% of the bladder urine cultures. On multivariable analysis, urosepsis, recurrent urinary tract infections, increased creatinine, and disease extension to perirenal and pararenal space were independent factors associated with positive bladder urine cultures. On multivariable analysis, only the presence of anemia was significantly more frequent in patients with positive kidney cultures. Our results can help urologists counsel XGP patients undergoing nephrectomy.
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Affiliation(s)
- Vineet Gauhar
- Department of Minimally Invasive Urology, Ng Teng Fong General Hospital, Singapore 609606, Singapore
| | - José Iván Robles-Torres
- Urology Department, Hospital Universitario "Dr. José Eleuterio González," Monterrey 64460, Mexico
| | - Marcelo Langer Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, BP-A Beneficência Portuguesa de São Paulo, Sao Paulo 05562-900, SP, Brazil
- Faculdade de Medicina do ABC, Santo André 09060-870, SP, Brazil
| | | | - Jeremy Yuen Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, Istanbul 34854, Turkey
| | - Abhay Mahajan
- Department of Urology, Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad 431003, India
| | - Nariman Gadzhiev
- Urology Department, Saint Petersburg State University Hospital, 199034 Saint Petersburg, Russia
| | - Deepak Ragoori
- Department Urology, Asian Institute of Nephrology and Urology, Hyderabad 500082, India
| | - Santosh Kumar
- Department Urology, Christian Medical College, Vellore 632004, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Ahemadabad 387001, India
| | | | | | | | | | - Antonio Esqueda-Mendoza
- Department of Urology, Hospital Regional de Alta Especialidad de la Penisula de Yucatán, Mérdida 97133, Mexico
| | - Juan Pablo Flores-Tapia
- Department of Urology, Hospital Regional de Alta Especialidad de la Penisula de Yucatán, Mérdida 97133, Mexico
| | | | - Mudasir Farooq
- Department Urology, Christian Medical College, Vellore 632004, India
| | - Venkat Arjunrao Gite
- Department Urology, Grant Medical College & Sir JJ hospital, Mumbai 400008, India
| | - Mriganka Mani Sinha
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy
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Dorantes-Carrillo LA, Basulto-Martínez M, Suárez-Ibarrola R, Heinze A, Proietti S, Flores-Tapia JP, Esqueda-Mendoza A, Giusti G. Retrograde Intrarenal Surgery Versus Miniaturized Percutaneous Nephrolithotomy for Kidney Stones >1cm: A Systematic Review and Meta-analysis of Randomized Trials. Eur Urol Focus 2022; 8:259-270. [PMID: 33627307 DOI: 10.1016/j.euf.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Although miniaturized percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) are both options for treating >1cm kidney stones, controversies exist on whether one is more effective and safer than the other. OBJECTIVE To systematically appraise randomized trials comparing the effectiveness and safety of mPCNL and RIRS for treating >1cm kidney stones. EVIDENCE ACQUISITION A systematic search on PubMed/Medline, Web of Science, Embase, and ClinicalTrials.gov was conducted in August 2020 following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Randomized trials comparing mPCNL and RIRS for >1cm kidney stones, and reporting stone-free rate (SFR), hemoglobin drop, transfusion rate, length of hospital stay (LOS), and/or complications, were included. EVIDENCE SYNTHESIS Eight studies compared mPCNL and RIRS, but one was not included due to its high risk of bias. SFR was higher for mPCNL (RR: 1.06 [95% coefficient interval {CI}, 1.01-1.10], p=0.008). Hemoglobin drop was higher for mPCNL (mean difference [MD]: 0.35 [95% CI, 0.05-0.65] g/dl, p=0.02); however, transfusion rates were similar (p=0.44). Complication rate was similar between mPCNL and RIRS (p=0.39), and the LOS was higher for mPCNL (MD: 1.11 [95% CI, 0.06-2.16] d, p=0.04). A subgroup analysis of lower pole stones showed that SFR was higher for mPCNL (RR: 1.09 [95% CI, 1.00-1.19], p=0.05). CONCLUSIONS Both approaches are effective and safe. Among these approaches, mPCNL has a higher SFR than RIRS for overall >1cm renal and lower pole stones, but longer LOS, and a higher hemoglobin drop that does not translate into higher transfusion rates. Complications are comparable. PATIENT SUMMARY Randomized trials have evaluated whether miniaturized percutaneous nephrolithotomy (mPCNL) or retrograde intrarenal surgery is more effective and safer for treating >1cm stones. After comparing the stone-free rate, hemoglobin drop, transfusion rate, length of hospital stay, and complications between both the approaches, mPCNL was found to be slightly more effective, but both were equally safe.
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Affiliation(s)
| | - Mario Basulto-Martínez
- European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy; Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico.
| | - Rodrigo Suárez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | | | - Silvia Proietti
- European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Juan Pablo Flores-Tapia
- Division of Nephrology, Urology and Transplant Surgery, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico
| | - Antonio Esqueda-Mendoza
- Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico
| | - Guido Giusti
- European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
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Basulto-Martínez M, Flores-Tapia JP, Conde-Ferráez L, Esuqeda-Mendoza A, Kantun Moreno N, Gómez-Carballo J, Gonzalez-Losa MDR. [Molecular detection of human papillomavirus among patients with benign prostatic hyperplasia and prostate cáncer.]. ARCH ESP UROL 2022; 75:27-33. [PMID: 35173074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze the presenceof human papillomavirus in prostate and its associationwith prostate cancer. METHODS: A case-control study was conducted.Tissue samples with benign hyperplasia and prostatecancer were collected. Risk factors related to prostatecancer and human papillomavirus were assessedby a medical interview. Prostate tissue was obtainedby transrectal biopsy or transurethral resection. Theidentification of viral genome was assessed by the amplificationof 450 pb., from L1 gene. Real time PCR wasused to identified HPV genotypes 16 and 18. For dataanalysis, the χ2 test, Student's T test or Mann-WhitneyU test and OR were computed. RESULTS: Thirty and 99 with benign prostatehyperplasia were included in a 1:3 ratio, with a meanage of 69.44±9.22 years. The global prevalence of humanpapillomavirus was 15.2% being similar in bothcases (15.6%) and controls (15.1%) with no significantdifference (p = 0.572). Forty percent of the infectionswere persistent. From all positive samples, only in the40% were identified some of the genotypes analyzed(16 and 18). The group of patients with Gleason scorede > 7 had a virus prevalence of 16%. CONCLUSIONS The results show the presence ofthe human papillomavirus genome in prostate tissuewith and without neoplasia; no association was foundbetween infection and prostate cancer.
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Affiliation(s)
- Mario Basulto-Martínez
- Servicio de Urología. Hospital Regional de Alta Especialidad de Yucatán. Mérida. Yucatán. México
| | - Juan Pablo Flores-Tapia
- Servicio de Urología. Hospital Regional de Alta Especialidad de Yucatán. Mérida. Yucatán. México
| | - Laura Conde-Ferráez
- Universidad Autónoma de Yucatán. Centro de Investigaciones Regionales "Dr. Hideyo Noguchi". Mérida. Yucatán. México
| | - Antonio Esuqeda-Mendoza
- Servicio de Urología. Hospital Regional de Alta Especialidad de Yucatán. Mérida. Yucatán. México
| | - Nuvia Kantun Moreno
- Universidad Autónoma de Yucatán. Centro de Investigaciones Regionales "Dr. Hideyo Noguchi". Mérida. Yucatán. México
| | - Jesús Gómez-Carballo
- Universidad Autónoma de Yucatán. Centro de Investigaciones Regionales "Dr. Hideyo Noguchi". Mérida. Yucatán. México
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Monzón-Falconi JF, Carballo-Magdaleno AA, Cueto-Vega GJ, Bastarrachea-Solis MA, Espinosa-Aznar JE, Flores-Tapia JP, Esqueda-Mendoza A, Guillermo-Herrera JC, Basulto-Martínez MJ. [The psychological impact of Covid-19 pandemic in medical residents]. Salud Publica Mex 2021; 63:465-466. [PMID: 35077094 DOI: 10.21149/12171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
No disponible.
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