Search Results (38)

Background: Adrenal glands are situated cranially and in close proximity to both kidneys. The rabbit is a preferred animal pet species and is also used as an experimental model in research. The aim of this study was to investigate the CT anatomical features of the rabbit adrenal glands, using the CT device SOMATOM. Methods: Ten sexually mature clinically healthy rabbits, with body weights from 2.5 to 3.0 kg were used. They were separated into two groups—five males and five females. CT algorithm: Transverse, sagittal, and dorsal CT studies were performed. The animals were positioned in supine recumbency. They were anesthetized with 15 mg/kg Zoletil^® 50. Helical CT was carried out. The body was scanned from the intrathoracic part of the abdominal cavity to the pelvic inlet. CCD, DVD, and MLD dimensions were measured. Results: Transverse CT scans at the Th12 and L1 level visualized the topography of the right and left adrenal glands. Sagittal CT scans of Regio abdominis, 10 mm to the right and to the left of the median plane, showed the right and left adrenal glands as findings with intermediate attenuation. The dorsal CT investigation of Regio abdominis 30 mm and 45 mm ventral to the spine demonstrated both glands in the vicinity of abdominal organs and large blood vessels. CCD of the right adrenal gland was 6.9 ± 0.5 mm, DVD of the same gland was 5.7 ± 0.7 mm, and MLD was—3.9 ± 0.3 mm. CCD of the left adrenal gland was 5.4 ± 0.6 mm, DVD was—4.0 ± 1.1 mm, and MLD was—4.1 ± 0.9 mm. Conclusions: CCD and DVD of the right adrenal gland were greater than the same parameters of the left gland. MLD of the right adrenal gland was lower than the same parameter measured for the left one. Full article

Background and Clinical Significance: Polycystic kidney disease (PKD) is the most common inherited kidney condition, affecting approximately 500,000 individuals in the US. It causes fluid-filled cysts to develop throughout the kidneys, leading to decreased kidney function. Autosomal dominant polycystic kidney disease (ADPKD) is the more prevalent form, subdivided into the PKD1 and PKD2 variants. PKD1 variants typically result in more severe symptoms and an earlier need for dialysis compared to PKD2. A prenatal diagnosis of ADPKD is rare due to its late-onset manifestations, but early detection can be crucial for management and family counseling. Case Presentation: A 24-year-old woman, during her first pregnancy, presented for her first prenatal ultrasound at 22 + 2 weeks gestation. The ultrasound revealed an increased echogenicity of the renal parenchyma in the left kidney, with pelvic dystopia, while the right kidney appeared normal. Follow-up scans showed significant progression, with both kidneys exhibiting thinning parenchyma and cyst formation. The baby was delivered via an elective cesarean section at 38 weeks, and a postnatal ultrasound confirmed ADPKD. Genetic testing identified a heterozygous variant of the PKD1 gene, NM_001009944.3 (PKD1):c.9157G>A p.(Ala3053Thr), classified as likely pathogenic. The baby displayed electrolyte abnormalities but improved after a week of hospitalization. Conclusions: This case highlights an unusual early presentation of ADPKD in a fetus with no family history of the disease. A prenatal diagnosis through ultrasounds and genetic testing can aid in early detection and management, providing valuable information for family counseling. Regular monitoring and genetic identification are essential for managing ADPKD and improving patient outcomes. Full article

Kidney and renal pelvic cancer are a significant cause of cancer-related deaths, with the most common malignant kidney tumor being renal cell carcinoma (RCC). Chromophobe renal cell carcinoma is a rarer form of RCC that poses significant challenges to accurate diagnosis, as it shares many histologic features with Oncocytoma, a benign renal tumor. Biopsies for histopathological and immunohistochemical analysis have limitations in distinguishing chromophobe RCC from Oncocytoma. Syndromic cases may also have tumors with overlapping features. Techniques such as infrared (IR) spectroscopic imaging have shown promise as an alternative approach to tissue diagnostics. In this study, we propose a deep-learning-based framework for automating classification in kidney tumor tissue microarrays (TMAs) using an IR dataset. Feature selection algorithms reduce data dimensionality, followed by a deep learning classification approach. A classification accuracy of 91.3% was observed for validation data, even with the use of 13.6% of all wavelengths, thereby reducing training time by 21% compared to using the entire spectrum. Through the integration of scalable deep learning models coupled with feature selection, we have developed a classification pipeline with high predictive power, which could be integrated into a high-throughput real-time IR imaging system. This would create an advanced diagnostic tool for the detection and classification of renal tumors, namely chromophobe RCC and Oncocytoma. This may impact patient outcomes and treatment strategies. Full article

Background/Objectives: This study evaluates and compares the surgical outcomes of open pyelolithotomy, laparoscopic pyelolithotomy, and retrograde intrarenal surgery (RIRS) in the management of pelvic ectopic kidney stones. Methods: A retrospective analysis was conducted on 47 adult patients with pelvic ectopic kidney stones who underwent surgery between January 2009 and January 2024. Patients were categorized as open pyelolithotomy (n = 15), laparoscopic pyelolithotomy (n = 14), or RIRS (n = 18). Stone-free (SF) rates were assessed in the early postoperative period (1st or 2nd day), in the 1st month, and in the 3rd month. Demographic data, stone characteristics, operative data, and complications were recorded. Results: RIRS had significantly shorter operative and hospitalization times but a lower SF rate in the 3rd month (44.4%) compared to laparoscopy (92.9%) and open pyelolithotomy (86.7%). Additional procedures were required in 50% of RIRS cases to achieve SF status, while none were needed in the other groups. Complications included three Grade 2 cases (two bleeding; transient creatinine elevation) in open pyelolithotomy, two Grade 2 (urinary leakage; infection) and two Grade 3 cases (conversion to open surgery; trapped stent removal) in laparoscopic pyelolithotomy, and one Grade 2 case (febrile infection) in RIRS. Conclusions: Laparoscopic pyelolithotomy demonstrated the highest efficacy and comparable complication rates; making it the preferred approach for pelvic ectopic kidney stones. Open pyelolithotomy remains a valuable alternative where laparoscopic expertise or resources are limited. Although less invasive, RIRS showed lower efficacy due to the challenging anatomy of pelvic ectopic kidneys. Full article

Background/Objectives: Pelvic kidney is a congenital anomaly characterized by the kidney’s failure to ascend to its normal anatomical location during early embryonic development. This anomaly complicates traditional surgical approaches for renal calculi due to the kidney’s atypical positioning and associated anatomical challenges. We sought to summarize our experience with robotic-assisted pyelolithotomy (RPPK) for pelvic kidney stones. Methods: A retrospective review of patients who underwent RPPK was conducted between 2014 and 2023. Demographic data on stone characteristics, operative details, and postoperative outcomes were analyzed. Results: Four patients (three male; mean age—51.2 years with a range of 45–54; mean BMI—26.6 with a range of 22.3–32.2) underwent RPPK. All had a right-sided pelvic kidney; two had prior failed ureteroscopy. The mean stone diameter was 27.7 mm (range: 17–35); the mean density was 1207.5 HU (range: 905–1500). The mean operative time was 265 min (range: 200–323); the time from incision to closure was 142.2 min (range: 95–225). No ureteral stents or drains were used. Blood loss was negligible. The mean hospital stay was 2.2 days. No immediate complications were recorded. The mean follow-up was 11.75 months (range: 3–30). Conclusions: RPPK is safe and effective for managing pelvic kidney stones. Challenging renal anatomy stone size and density are not obstacles to the robotic approach unlike other fragmentation methods Full article

Background: Vascular calcifications (VC) are increasingly prevalent in patients with chronic kidney disease. This study aimed to assess the incidence of iliac artery calcifications in kidney transplant (KT) patients and explore the relationship between iliac VC burden measured by pelvic calcification score (PCS) and renal transplant outcomes. Methods: This prospective study involved 79 KT recipients. VC quantification, using a pre-transplant computed tomography (CT) scan, was performed by assessing calcifications in the common and external iliac arteries bilaterally, resulting in an overall PCS ranging from 0 (no calcifications) to 44 (extensive calcifications). Based on PCS values, patients were divided into three equal-sized groups: PCS Group 1 (PCS 0–4), PCS Group 2 (PCS 5–19), and PCS Group 3 (PCS > 19). Post-transplant outcomes tracked for at least 1 year were patient and graft survival, graft function (urea, creatinine, MAG-3 clearance), and incidence of MACE during the first post-transplant year. Results: Calcifications were present in at least one arterial segment in 61 patients (77.2%). One-year patient survival was 95%, and one-year graft survival was 92.4%. Patients in PCS Group 3 had significantly lower one-year patient and graft survival compared to those in PCS Group 1 and 2 (p = 0.006 and p = 0.008, respectively). MACE and renal function indicators 1-year post-transplant were similar across all PCS groups. Conclusions: Our study demonstrated that a significant majority of KT recipients exhibited iliac VC during pre-transplant CT assessments. Patients in PCS Group 3 exhibited significantly lower one-year patient and graft survival rates compared to those in PCS Groups 1 and 2, indicating that this subgroup may require more intensive post-transplant monitoring and management. Full article

Background: To establish dual-energy-derived iodine density reference values in abdominopelvic organs in a large cohort of healthy subjects. Methods: 597 patients who underwent portal venous phase dual-energy CT scans of the abdomen were retrospectively enrolled. Iodine distribution maps were reconstructed, and regions of interest measurements were placed in abdominal and pelvic structures to obtain absolute iodine values. Subsequently, normalization of the abdominal aorta was conducted to obtain normalized iodine ratios. The values obtained were subsequently analyzed and differences were investigated in subgroups defined by sex, age and BMI. Results: Overall mean iodine uptake values and normalized iodine ratios ranged between 0.31 and 6.08 mg/mL and 0.06 and 1.20, respectively. Women exhibited higher absolute iodine concentration across all organs. With increasing age, normalized iodine ratios mostly tend to decrease, being most significant in the uterus, prostate, and kidneys (p < 0.015). BMI was the parameter less responsible for variations in iodine concentrations; normal weighted patients demonstrated higher values of both absolute and normalized iodine. Conclusions: Iodine concentration values and normalized iodine ratios of abdominal and pelvic organs reveal significant gender-, age-, and BMI-related differences, underscoring the necessity to integrate these variables into clinical practice. Full article

Endometriosis is one of the most common causes of chronic pelvic pain and infertility that affects 10% of women of reproductive age. It is currently defined as the presence of endometrial epithelial and stromal cells at ectopic sites; however, advances in endometriosis research have some authors believing that endometriosis should be re-defined as “a fibrotic condition in which endometrial stroma and epithelium can be identified”. microRNAs (miRNAs) are regulatory molecules that potentially play a role in endometriotic lesion development. There is evidence that suggests that miRNAs, including microRNA-21 (miR-21), participate in fibrotic processes in different organs, including the heart, kidney, liver and lungs. The objective of this study was to understand the role of miR-21 and the mechanisms that can contribute to the development of fibrosis by determining how IL-6 regulates miR-21 expression and how this miRNA regulates the transforming growth factor beta (TGF-β) signaling pathway to promote fibrosis. We investigated the expression of miR-21 in the baboon and mouse model of endometriosis and its correlation with fibrosis. We demonstrated that inflammation and fibrosis are present at a very early stage of endometriosis and that the inflammatory environment in the peritoneal cavity, which includes interleukin 6 (IL-6), can regulate the expression of miR-21 in vitro and in vivo. Full article

Introduction: Leukemia history affects some radical prostatectomy (RP) patients. Although its prevalence and effect as an adverse risk factor are well known in cardiac surgery, the number of RP patients with a leukemia history, as well as their rate of adverse in-hospital outcomes, are unknown. Methods: We identified RP patients (National Inpatient Sample 2000–2019), stratified according to the presence or absence of a leukemia history. Descriptive analyses, propensity score matching (PSM, ratio 1:10), and multivariable logistic regression models were used. Results: Of 259,939 RP patients, 416 (0.2%) had a leukemia history. Their proportion increased from 0.1 to 0.2% covering the study span (p < 0.01). Leukemia history patients were older (median age, 64 vs. 62 years, p < 0.001). After PSM for age, insurance status, ethnicity, pelvic lymph node dissection, and Charlson Comorbidity Index, leukemia history RP patients exhibited higher rates of acute kidney injury (<2.6 vs. 0.9%; Odds Ratio [OR] 2.0, p = 0.02), more frequently underwent dialysis (3.6 vs. 1.9%; OR 1.9, p = 0.03), and more frequently had a length of stay exceeding one week (4.8 vs. 2.5%; OR 2.0, p = 0.006). Conclusions: Although leukemia history RP patients are rare, their numbers have increased. Renal complications and extended hospital stays are more frequent in those individuals. Full article

Aim of the Study: To assess how virtual reality (VR) patient-specific simulations can support decision-making processes and improve care in pediatric urology, ultimately improving patient outcomes. Patients and Methods: Children diagnosed with urological conditions necessitating complex procedures were retrospectively reviewed and enrolled in the study. Patient-specific VR simulations were developed with medical imaging specialists and VR technology experts. Routine CT images were utilized to create a VR environment using advanced software platforms. The accuracy and fidelity of the VR simulations was validated through a multi-step process. This involved comparing the virtual anatomical models to the original medical imaging data and conducting feedback sessions with pediatric urology experts to assess VR simulations’ realism and clinical relevance. Results: A total of six pediatric patients were reviewed. The median age of the participants was 5.5 years (IQR: 3.5–8.5 years), with an equal distribution of males and females across both groups. A minimally invasive laparoscopic approach was performed for adrenal lesions (n = 3), Wilms’ tumor (n = 1), bilateral nephroblastomatosis (n = 1), and abdominal trauma in complex vascular and renal malformation (ptotic and hypoplastic kidney) (n = 1). Key benefits included enhanced visualization of the segmental arteries and the deep vascularization of the kidney and adrenal glands in all cases. The high depth perception and precision in the orientation of the arteries and veins to the parenchyma changed the intraoperative decision-making process in five patients. Preoperative VR patient-specific simulation did not offer accuracy in studying the pelvic and calyceal anatomy. Conclusions: VR patient-specific simulations represent an empowering tool in pediatric urology. By leveraging the immersive capabilities of VR technology, preoperative planning and intraoperative navigation can greatly impact surgical decision-making. As we continue to advance in medical simulation, VR holds promise in educational programs to include even surgical treatment of more complex urogenital malformations. Full article

Forty-eight Pelibuey × Katahdin male intact lambs (25.12 ± 3.79 kg LW) were used in a 70-d growing-finishing trial. Dietary treatments consisted of total mixed corn-based diet supplemented with: (1) no feed additives (Control); (2) 150 mg of essential oils blend plus 0.10 mg of 25-hydroxy-Vit-D3/kg diet offered throughout the 70-d experimental period (EOD3); (3) Control diet fed during the first 35 days and zilpaterol hydrochloride (ZH) supplementation at 6 mg/kg diet offered during the final 35 days of the experiment (32 days with ZH with a withdrawal 3-d before harvest), and (4) basal diet supplemented with EOD3 during first 35 days finishing, and EOD3 in combination with ZH (EOD3 + ZH) during the subsequent 32-days with ZH withdrawal 3 days before harvest. The temperature–humidity index during the experiment averaged 80.4 ± 3.2. There were no treatment interactions (p > 0.20) on growth performance and carcass measures. Supplemental EOD3 did not affect (p = 0.43) dry matter intake (DMI), but increased (p < 0.01) carcass adjusted average daily gain (ADG, 9.2%), gain efficiency (GF, 6.7%), and observed vs. expected dietary net energy for maintenance (NE_m, 4.8%) and for gain (NE_g, 6.4%). Supplemental ZH did not affect dry matter intake (DMI, p = 0.50) but increased (p < 0.01) carcass adjusted ADG (14.5%), GF (13%) and observed vs. expected dietary NE_m (9%) and NE_g (11.7%). Compared to control lambs, the combination of both additives increased ADG (24.9%), GF (21.2%), and observed vs. expected dietary NE_m and NE_g (14.2% and 18.9%, respectively). There were no treatment interactions on carcass characteristics, visceral organ mass, or on gene expression of IGF1, IGF2 and mTOR in longissimus muscle (LM). Supplemental EOD3 increased hot carcass weight (HCW; 4.0%, p < 0.01) but did not affect other carcass measures. Supplemental EOD3 decreased (3%, p = 0.03) intestine mass weight (g intestine/kg empty body weight). Supplemental ZH increased HCW (6%, p < 0.01), dressing percentage (1.7%, p = 0.04), and LM area (9.7%, p < 0.01), and decreased kidney-pelvic-fat percentage (16.2%, p < 0.01), fat thickness (14.7%, p = 0.03), and visceral fat. Compared to controls, the combination of EOD3 with ZH increased HCW (10.2%). It is concluded that growth performance responses to supplemental EOD3 and ZH are additive. Both supplements can be fed in combination without detrimental effects on expected benefits when fed separately. In addition, ZH supplementation improves carcass traits. Full article

Background: To investigate the geometry of the aortoiliac (AI) segment and its correlation with sex, age, and cardiovascular (CV) risk factors. Methods: Abdominal and pelvic CTA/MRA scans of 204 subjects (120 males; median age: 53 [IQR, 27–75] years) without AI steno-occlusive disease or scoliosis were retrospectively analyzed. The participants were enrolled consecutively, ensuring the representation of each age decade. An in-house written software was developed to assess AI elongation using the tortuosity index (TI) and absolute average curvature (AAC). Aortic bifurcation angle, common iliac artery (CIA) take-off and planarity angles, bifurcation asymmetry, and deviation from optimal bifurcation were calculated and evaluated. Demographic data, CV risk factors, and medical history were collected from electronic health records. Results: The elongation of the iliac arteries was more pronounced in males (TI: left CIA, p = 0.011; left EIA, p < 0.001; right CIA, p = 0.023; right EIA, p < 0.001; AAC: left EIA, p < 0.001; right EIA, p = 0.001). Age significantly influenced TI and AAC in all AI segments (all p < 0.001), but was also positively associated with the aortic bifurcation angle (p < 0.001), both CIA planarities (left, p < 0.001; right, p = 0.002), aortic bifurcation asymmetry (p = 0.001), and radius discrepancy (p < 0.001). Significant positive correlations were found between infrarenal aortic TI/AAC and chronic kidney disease (CKD) (p = 0.027 and p = 0.016), AAC of both CIAs and hypertension (left, p = 0.027; right, p = 0.012), right CIA take-off angle and CKD (p = 0.031), and left CIA planarity and hyperlipidemia (p = 0.006). Conclusion: Sex, age, and CV risk factors have a significant effect on the geometry of the AI segment. Full article

This report explores the diverse spectrum of congenital anomalies of the kidney and urinary tract (CAKUT), ranging from asymptomatic presentations to the most severe form characterized by bilateral renal agenesis. Genitourinary anomalies, a prevalent subset within this domain, account for a significant proportion, constituting 15–20% of anomalies identified during prenatal screening. An ectopic kidney is defined by the presence of an empty renal fossa and the displacement of the kidney from the lumbar region to alternative locations, with the pelvic region emerging as the most prevalent site. The reported case involves bilateral renal ectopia with unilateral duplex kidney. Initial suspicions of a renal anomaly arose during the first trimester, leading to a definitive diagnosis in the second trimester. The patient underwent regular monitoring every four weeks, ultimately delivering a healthy baby at term. This case underscores the frequency of renal anomalies, emphasizing that a considerable proportion remains asymptomatic. These findings contribute to a broader understanding of congenital renal anomalies, their varied manifestations, and the importance of vigilant prenatal screening for early detection and management. Full article

Background: Robot-assisted pyeloplasty is widely used in pediatric surgery because of its well-known advantages over open or laparoscopic surgery. The aim is to explore our experience and evaluate the achievements we have made. Methods: We evaluated patients undergoing robotic pyeloplasty from January 2016 to November 2021, including those who presented with a ureteropelvic junction obstruction associated with other anomalies of the kidney. The parameters examined were: age, weight, associated renal malformations, conversion rate, operative time, and intra- and postoperative complications. Results: Of 39 patients, 7 (20%) were included, of whom 5 (71%) were male and 2 (29%) were female. The mean age at surgery was 84 months (range 36–180 months), and the mean weight at surgery was 24.4 kg (range 11–40 kg). In five (71%) patients the ureteropelvic junction obstruction (UPJO) was left-sided and in two (29%) it was right-sided. In four (57%) cases, UPJO was associated with a horseshoe kidney, right-sided in one (25%) patient, and left-sided in the other three (75%). A 180° rotation of the kidney was present in one (14%) patient. Nephrolithiasis was present in two (29%) patients. The mean operative time was 160 min (range 140–240 min). The average bladder catheter dwell time was 1 day (range 2–3 days), while the average abdominal drainage dwell time was 2 days (range 2–4 days). The mean hospitalization time was 4 days (range 3–9 days). On average, after 45 days (range 30–65) the JJ ureteral stent was removed cystoscopically. No intraoperative complications were reported, while one case of persistent macrohematuria with anemia requiring blood transfusion occurred postoperatively. Conclusions: Ureteropelvic junction obstruction might be associated with other congenital urinary tract anomalies such as a duplicated collecting system, horseshoe kidney, or pelvic kidney. These kinds of malformations can complicate surgery and require more attention and accuracy from the surgeon. Our experience shows that, with regards to the robotic learning curve required for pyeloplasty, the treatment of the ureteropelvic junction in these situations does not present insurmountable difficulties nor is burdened by complications. The application of robot-assisted surgery in pediatric urology makes difficult pyeloplasties easier. Full article

Sarcomas are a rare tumor of mesenchymal origin. The liposarcoma is the most common sarcoma of the retroperitoneum. Liposarcomas are typically low grade, and present at an advanced stage and a large size. We report a case of a large retroperitoneal liposarcoma, approximately 50 kg, encasing both kidneys, which was managed via a two-stage resection and staged renal auto-transplantation into the intra-peritoneal pelvis. The patient maintained normal renal function throughout, and remains disease free two years post-resection. Renal auto-transplantation with pelvic placement may facilitate improved margin-free resection. Renal relocation may allow the use of curative-intent ablative therapies such as radiofrequency ablation and radiation in cases of retroperitoneal recurrence. Full article