Institute of Nephro Urology

This study aimed to evaluate the perioperative safety and functional outcomes of high-power holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and long-term indwelling urinary catheter (IUC) use, with a specific focus on the impact of catheter duration on postoperative outcomes. A retrospective analysis was conducted on 380 patients who underwent HoLEP between 2016 and 2022, stratified into two groups based on catheter duration: long-term (≥ 28 days; Group 1) and short-term catheterization (Group 2). Demographic, intraoperative, and follow-up data were collected. Functional outcomes, including International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual (PVR), were assessed preoperatively and during follow-up at 3 and 12 months. Both groups demonstrated significant and sustained improvement in voiding function and symptom scores following HoLEP. Although perioperative metrics, such as operative time, hospital stay, and catheter removal time, were comparable, Group 1 had longer enucleation times (p = 0.02). No difference in postoperative complication rate was noted. At 3 months, Group 2 exhibited superior symptom relief (IPSS: 10 vs. 12, p = 0.01), though Qmax and PVR were similar. No patients in either group required re-catheterization postoperatively. By 12 months, functional outcomes converged between groups. Multivariate analysis showed that catheter duration predicted poorer symptomatic recovery one year after surgery (OR 0.786, p < 0.001). HoLEP is effective and safe for patients with BPH and preoperative catheterization. However, prolonged catheterization negatively impacts early symptom recovery. Early surgical intervention should be considered to optimize long-term outcomes and prevent catheter-related complications.

Urinanalysis, considered the “liquid biopsy” of the kidney, is rapidly becoming a lost art among nephrologists. A well-performed urinanalysis provides information on the presence of kidney disease, identifies the affected compartment, and helps monitor disease activity. The three main components of urine analysis are gross examination, dipstick tests, and urine sediment examination under microscopy. The urine sediments should be analyzed under a bright-field, dark-field, phase-contrast, and polarization microscope for better visualization and categorization of cells, casts, and crystals. The Sternheimer-Malbin (SM) stain can enhance urine sediments under a microscope. The urine sediment, like in a kidney biopsy, should be systematically analyzed for evidence of glomerular (dysmorphic RBCs, acanthocytes, RBC casts, lipid casts) and tubulointerstitial (RTE cell casts, Granular casts, Leucocyte casts, broad waxy casts) injury. For crystal identification in sediments, knowledge of urinary pH, morphology, and birefringence features under polarized light is essential.

A 19-year-old girl from a consanguineous marriage showed signs of delayed motor developmental milestones since infancy, a protuberant abdomen, and failure to thrive. She suffered from cor pulmonale as a result of restrictive lung disease, pulmonary hypertension, and chronic interstitial lung disease. Diagnosed with resistant rickets elsewhere, she was on treatment with Joulie's solution. Physical examination revealed an undernourished state and features of rickets. Laboratory results were suggestive of proximal renal tubular acidosis (RTA), dyslipidemia, postprandial hyperglycemia, and elevated alkaline phosphatase. Skeletal X-rays confirmed rickets, and an abdominal ultrasound showed hepatomegaly. Whole-exome sequencing identified a homozygous missense variant in the SLC2A2 gene (p.Glu486Gly), confirming Fanconi-Bickel syndrome (FBS). Management included phosphorus, bicarbonate, vitamin D supplementation, dietary changes, and conservative care. Follow-up showed improvement in height. Fanconi and Bickel (1949) initially reported the rare disorder known as FBS, which is attributed to mutations in the glucose transporter 2 (GLUT2) transporter gene. Due to its autosomal recessive inheritance, genetic counseling and prenatal diagnosis are essential. To the best of our knowledge, this is the first reported case in the world of a novel genetic mutation causing FBS.

Suction devices such as flexible and navigable suction ureteral access sheath (FANS) are promising tools to reach the zero-fragment rate (ZFR) after flexible ureteroscopy (FURS) and laser lithotripsy. FANS could especially be useful for lower pole stones (LPS), avoiding postoperative retained stone dust. Using Machine Learning (ML) models, we aimed to predict the ZFR after FURS with FANS and secondarily the possible access to the lower pole (LP). Data from patients who underwent FURSin 25 centers worldwide were prospectively collected (Aug 2023-Jan 2024). Exclusion criteria were abnormal renal anatomy and ureteral stones. ZFR and LP access were respectively defined as the total absence of residual fragments on computed tomography at 1-month follow-up and the ability to place the FANS into a LP calyx. After data normalization and splitting (training-test (80-20%)), Eight ML models were evaluated to predict separately ZFR and LPS, using binary classification. A total of 390 patients were included with a median age of 49 (36-61)years. The median stone volume was 1440 (1006-2219)mm3. 70,5% and 59% of patients were first time stone formers and pre-stented. The FANS could access the LP in 75,1% of cases. At 1-month, the ZFR was 56,7% (221/390). Above all ML models, ExtraTreesClassifier presented the highest accuracy (0,83), F1-score(0,85) and AUC (0,83) for ZFR prediction from preoperative data. The LP access was best predicted by the RandomForestClassifier (accuracy (0,86), F1-score (0,91) and AUC (0,76)). Based on preoperative data and ML, we can accurately predict the ZFR and LP access during FURS with FANS. Our models could improve the elective indications for FANS utilization.

Background: Urolithiasis is a common, recurrent condition with a lifetime risk of 12% in men and 6% in women, contributing to a growing global health burden, and the high prevalence of idiopathic cases suggests a possible genetic basis that remains underexplored, particularly in the Indian context. The calcium-sensing receptor (CASR) gene, particularly the rs1801726 (Q1011E) polymorphism, has been implicated in calcium metabolism and stone pathogenesis. Objective: To investigate the association of CASR rs1801726 (Q1011E) genotype with urolithiasis and idiopathic hypercalciuria (IH). Materials and Methods: A total of 160 participants (80 urolithiasis patients and 80 healthy controls) were genotyped for rs1801726 using the TaqMan ® single nucleotide polymorphism genotyping assay. Among the cases, 22 had IH. Genotype frequencies were compared using the two-proportion Z -test, and the odds ratio with 95% confidence intervals was calculated to estimate the strength of association between Genotype and disease risk, with statistical significance at P &lt; 0.05. Results: The AA genotype was significantly more frequent in urolithiasis cases (17.5%) than controls (2.5%) ( P = 0.00158), and in IH patients (31.8%) compared to non-IH cases (12.1%) ( P = 0.03). Both dominant and recessive models showed significant associations with increased disease risk. Conclusion: The CASR rs1801726 (Q1011E) polymorphism, especially the AA genotype, is significantly associated with urolithiasis and IH. Genetic screening for this variant may help identify at-risk individuals and enable early preventive strategies, though larger studies are needed for confirmation.

Glomerular diseases represent a significant global health challenge, complicated by the intricate management required for their treatment. We examine the treatment burden associated with the immunosuppressive therapies used to manage these conditions, focusing on the efficacy, side effects, and financial implications of commonly used medications such as glucocorticoids, mycophenolate mofetil (MMF), cyclophosphamide, calcineurin inhibitors and Rituximab. Immunosuppressive treatments, while effective in controlling disease activity, can result in a variety of adverse effects ranging from gastrointestinal symptoms and bone marrow suppression to increased infection risks, necessitating careful monitoring and dose adjustments to mitigate these risks. Hence, the need for a balanced approach in therapy management, incorporating regular monitoring and potential dose modifications to enhance patient outcomes while minimizing side effects. Additionally, these treatments have an economic impact, particularly in lower-income regions where access to medication and the cost of medication can limit patient outcomes. There have been certain advancements in treatment modalities, such as the use of enteric-coated formulations and tailored dosing schedules, which aim to improve drug tolerability and adherence. By addressing these critical aspects, we aim to shed light on the ongoing challenges and developments in the management of glomerular diseases, emphasizing the need for continued research and innovation in therapeutic strategies to reduce the overall treatment burden and improve the quality of life for affected individuals.