Background Renal tumor is the 13th most common malignancy in the world and more than 90% of renal tumors are renal cell carcinomas. As there is no data available on renal cell carcinoma in Nepal, hence this study was undertaken to analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Objectives To analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Methods The case records of 50 consecutive patients with renal cell carcinoma presenting at the Tribhuvan University Teaching Hospital, Kathmandu from July 2006 to June 2011 were retrospectively evaluated for presenting symptoms, physical finding, investigation and histopathology report. Results Out of 50 patients, 64% were male and 36% were female. The age ranged between 11 to 78 years (mean ± SD: 55 ± 15 years). Fifty four percent of patients were smokers. Incidentally tumor was detected in 40% cases by ultrasonography and the typical triad was present in only 4%. The tumor was occupying upper pole in 40% of cases. The tumor size ranged from 3 to 15 cm (mean ± SD: 7.3 ± 2.9 cm). Histopathologically, 76% of the patient had organ confined renal cell carcinoma (T1-2 N0 M0). Clear cell was the most common type seen in 86%. Fuhrman’s nuclear grade 2 was found in 50%. ConclusionMany of the renal cell carcinoma are detected incidentally, at an early stage and are of clear cell subtype.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6302 Kathmandu Univ Med J 2011;9(3):185-8

Background Renal transplantation is a regular service at Tribhuvan University Teaching Hospital and complications have been known to occur after it. This study was conducted to assess complications after transplantation. Objectives To determine the incidence of urological complications after living related renal transplantation at Tribhuvan University Teaching Hospital. Methods A clinical study was performed (from August 2008 to July 2010) which included 50 living-related renal transplantations at Tribhuvan University Teaching Hospital. All the donors and recipients were evaluated preoperatively with necessary investigations and followed up postoperatively with standard hospital transplant protocol. The incidence of urological complications were documented and analyzed. Results Fifty living-related, renal transplantations were carried out during the study period. Seven doors had minor post operative complications; three had post operative fever, two had chest infections and each one had superficial surgical site infections and severe pain at incision site. Ureteroneocystostomy was performed with double J stent in all recipients. Urological complications were noted in 12 (24%) recipients. Clinical significant hematuria occurred in four cases. One patient had ureteric necrosis and urinary leak which required re-exploration post operatively. Two patients developed delayed ureteric stricture which were managed by antegrade Double J stenting and ureteric reimplantation. Peri-graft abscess occurred in two cases, which were drained percutaneously. surgical site infections was seen in one case. Conclusions Urological complications are inevitable in renal transplantation and our complications rate appears similar to that reported in literature.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6216 Kathmandu Univ Med J 2010;8(3):299-304

Introduction and Importance: Staghorn calculus usually fills the pelvis of the kidney, the infundibulum, and most of the calyces. It is a rarity for staghorn stones to be asymptomatic; in addition to that, the calculus discussed in this case report was of a very large size and was removed intact. Open pyelolithotomy, the procedure used, is one that comes with a wide range of complications but can be deemed effective in certain cases. In this scenario, it led to no impediments to normal physiology. Case Presentation: Here the authors report the case of a 45-years-old Nepalese male who presented with a large yet asymptomatic staghorn calculus. It was managed with an open pyelolithotomy, and the patient had no intraoperative or postoperative complications. Discussion: Staghorn stones can be complete or partial and often naturally progress to renal impairment. Thus, an aggressive therapeutic approach is crucial, with careful evaluation of the site and size of the stone, the patient’s preference, and the institutional capacity. Ideally, staghorn calculi are completely removed, and it is imperative that the functions of the affected kidney are preserved as far as possible and when applicable. Although percutaneous nephrolithotomy is recommended for the removal of staghorn stones, several clinical, technical, and socioeconomic factors contributed to the use of open pyelolithotomy in the management of the case discussed here. Conclusion: Open pyelolithotomy can prove highly effective in removing large stones intact and in a single setting, the importance of which was accentuated by its unique clinical presentation and pathological anomalies.

Introduction: Exit strategy at the end of percutaneous nephrolithotomy (PCNL) differs from center to center and patient to patient. Standard PCNL has been practiced so far with minor postoperative morbidities. Tubeless PCNL, which obviates most of the nephrostomy related morbidities, has been challenged for its safety. So this study was conducted to compare the safety and morbidity of tubeless PCNL with standard PCNL. Methods: Patients who had undergone PCNL, were randomized into group 1 (standard) and group 2 (tubeless) using computer generated random table. In group 1, nephrostomy tube was placed at the end of the procedure and tubes were omitted in group 2 patients. All preoperative, intraoperative and postoperative parameters were recorded and compared in between the groups. Results: Ninety six PCNLs were randomized into group 1 (47 patients) and group 2 (49 patients). Patients’ characteristics including age, sex, comorbidities, preoperative parameters, size and number of stones and mean operation time were comparable in between the groups. The incidence of postoperative fever, pain and analgesic requirement and urinary leak were found more in group 1 patients. The incidence of postoperative complications and events were comparable in both the groups except for blood transfusion. The mean length of postoperative hospital stay for patients in group 2 was significantly low as compared to group 1. Conclusion: Tubeless PCNL is safe and has less morbidity as compared to standard PCNL in selected cases.

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