Introduction After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN) can be a morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it may not address an infected graft or refractory hematuria or rejection. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN. Materials and Methods We performed a retrospective analysis of all patients who underwent non-emergent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL) during TN, transfusion rate and length of hospital stay. Results A total of 16 patients were identified. Nine had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN) was 143.9cc compared to 621.4cc in the non-embolized (NETN) group (p=0.041). Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN (5.4 days) compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN. Conclusion Embolization prior to TN significantly decreases the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer hospitalization with embolization due to the time needed for embolization. Larger studies are needed to determine if embolization before transplant nephrectomy reduces the transfusion rates and overall complications.

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The stone free patients and those with residual fragments have similar distribution in age, sex, stone laterality, American Society of Anaesthesiologists score and BMI. Overall stone free rate is 54.8%. Stone-free patients had significantly lower mean Guys's score (2.8 vs 3.3, p¼0.000), lower mean S.T.O.N.E nephrolithometry score (8.0 vs 8.7 p¼0.030) and higher mean CROES normogram score (170.6 vs 153.2 p¼ 0.000).Logistic regression analysis showed that all three scoring systems were significantly associated with stone free status.

Introduction: Penile strangulation injuries are rare but well-recognized entities in the medical literature. Prolonged edema and ischemia can lead to tissue and neurovascular damage that is sometimes irreversible. Aims:The aims of this case report are to discuss a novel treatment technique in reversing the ischemiareperfusion injury associated with a case of penile strangulation. Methods:We used hyperbaric oxygen treatments in a successful attempt for penile tissue salvage after a prolonged case of penile strangulation. Results:The patient was successfully treated with five ninety-minute hyperbaric oxygen treatments. He was discharged home with improved penile sensation and the ability to void without difficulty. Conclusion:Post-strangulation treatment varies based on the grade of injury incurred. Typically, when severe necrosis or gangrene is present a partial or total penectomy is performed. We propose hyperbaric oxygen treatments as a novel, minimally invasive method to attempt penile sparing in such an injury.