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BackgroundThe aim of this study was to evaluate the efficacy of superselective renal artery embolization in patients with bleeding into the urinary system.Material/MethodsFrom 2007 to 2012, 20 patients were treated with superselective renal artery embolization for bleeding after percutaneous nephrolithotomy (PCNL), nephron-sparing surgery (NSS), including 1 patient with AVF after PCNL. During the procedure, embolization material was injected through a microcatheter to stop the bleeding. Embolization materials included a mixture of cyanoacrylate and lipiodol, embolization coils, and Spongostan. Clinical evaluation included remission of hematuria and normalization of blood morphotic elements.ResultsThe cause of bleeding into the urinary tract was damage to vessels (all cases): with coexisting false aneurism (8 cases); with coexisting arterio-venus fistula (1 case); and with coexisting intrarenal hematoma (3 cases). The bleeding occurred 2–5 days after PCNL and NSS, and 10 days after PCNL with AVF. The mean hematocrit level was 22%–24%. Technical success was achieved in 20 cases. Clinical success was achieved in 19 cases. One patient with hematuria after PCNL with AVF needed a second endovascular treatment to stop bleeding.ConclusionsSuperselective renal artery embolization is an effective procedure in the treatment of iatrogenic bleeding into the urinary tract after PCNL and NSS.

BackgroundThe pathomechanism of acute hepatorenal syndrome (HRS), a particular form of acute renal failure that occurs in the course of acute liver injury, is still poorly understood. The aim of our study was to estimate the influence of the activation and inhibition of the nitric oxide pathway on the water/sodium balance and development of acute renal failure in the course of HRS.Material/MethodsWe used male Sprague-Dawley rats in the acute galactosamine (Ga1N) model of HRS. The nitric oxide synthase (NOS) inhibitors L-NAME and L-arginine were administered intraperitoneally before and after liver damage.ResultsHRS developed in all tested groups. L-NAME increased osmotic clearance and urine volume more effectively before liver injury. Furthermore, administration of L-NAME increased creatinine clearance both before and after Ga1N injection. A double dose of L-NAME did not yield further improvement before Ga1N injection, but improved creatinine clearance after Ga1N intoxication. Injection of L-arginine increased sodium excretion and urine volume, but only after liver injury. Moreover, L-arginine injected after Ga1N caused significant improvement of the creatinine clearance in a dose-dependent manner.ConclusionsOur study shows that inhibition of the nitric oxide pathway improves parameters of water and sodium balance and prevents development of acute renal failure in the course of acute liver injury and liver failure. Activation of the nitric oxide system also has a favorable influence on water/sodium balance and renal failure, but only after liver injury.

This study presents one institution's experiences in ureterolithotripsy (URSL)--a particular endoscopic treatment modality. The incidence and prevalence of urolithiasis in the paediatric population continues to increase. However, the choice of the most appropriate treatment remains a challenging problem for paediatric surgeons. Between January 2006 and June 2013, the Department of Pediatric Surgery performed 157 URSLs. The patient population consisted of 126 children (60 girls and 66 boys) aged 10 months-17 years and having a body mass >8 kg. Dilatation of the pyelocalyceal system along with dilatation of the ureter above the concrement was present in all patients. Pneumatic, laser (Ho:YAG--pulsed laser), ultrasonic lithotripters with rigid, flexible ureteroscopes of 4.5/6 and 6.5/8 Ch were used. URSL was performed in 157 cases. During the first session, excellent results were obtained in 134 of 157 cases (85.3 %). In 15 cases (9.6 %), a second URSL was required. In five cases (3.2 %), URSL was performed a third time. A final stone-free rate of 98.1 % was obtained within the ureter. In three cases (1.9 %), complications were observed. In ten cases (6.37 %), a pigtail catheter was placed and retained in the ureter. URSL is a very good and effective endoscopic treatment for the removal of concrements localized in ureters. These concrements cause alterations in flow from the upper urinary tract in children. Because of the relatively small diameter and volume of the urinary tract in children aged <5 years, URSL in this population requires great precision, experience, and technical skill.

Background To investigate the role of mpMRI and high PIRADS score as independent triggers in the qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy. Methods Between January 2017 and June 2019, 494 laparoscopic radical prostatectomies were performed in our institution, including 203 patients (41.1%) with ISUP 1 cT1c-2c PCa on biopsy. Data regarding biopsy results, digital rectal examination, PSA, mpMRI and postoperative pathological report have been retrospectively analysed. Results In 183 cases (90.1%) mpMRI has been performed at least 6 weeks after biopsy. Final pathology revealed ISUP Gleason Grade Group upgrade in 62.6% of cases. PIRADS 5, PIRADS 4 and PIRADS 3 were associated with Gleason Grade Group upgrade in 70.5%, 62.8%, 48.3% of patients on final pathology, respectively. Within PIRADS 5 group, the number of upgraded cases was statistically significant. Conclusions PIRADS score correlates with an upgrade on final pathology and may justify shared decision of radical treatment in patients unwilling to repeated biopsies. However, the use of PIRADS 5 score as a sole indicator for prostatectomy may result in nonnegligible overtreatment rate.