Purpose: To evaluate the efficacy and safety of Tranexamic acid in reducing blood loss during PCNL. Materials and Methods: A total of 50 patients who underwent unilateral Percutaneous Nephrolithotomy from March 2017 to November 2017 were randomized into 2 equal groups; group (A) who received 1 gm (10 cc) of tranexamic acid ampule on call to surgery and group (B) who received (10 cc) normal saline. The Patients clinical data were collected and recorded in Microsoft Excel 2016 and analyzed using Statistical Package for the Social Science (SPSS) version 20 software program. Results: Fifty patients were included in the study: (33 males and 17 female). The mean age in group A patients was (48.12 ± 13.58) years, and in group B was (48.88 ± 16.17) with P value = 0.858. In group A the number of males was 16 (64%), and female was 9 (36%), and in group B male was 17 (68%) and female was 8 (34%). Mean body mass index (BMI) in group A was (28.58 ± 4.51) and in group B was (26.72 ± 3.71), with P value = 0.119 which is statistically not significant. The mean total blood loss in milliliters in group A was (73.80 ± 60.1), while in group B it was (117.24 ± 87.9) which is statistically significant with P-Value = 0.047. The mean hemoglobin drop in group A was (0.45 ± 0.35 g/dl) while in group B was (1.00 ± 0.46 g/dl), which is statistically significant with P value = 0.0001. The mean operative time was (48.4 ± 17) minute in group A, while it was (62.4 ± 15) in group B, with P-Value = 0.005, which is statistically was significant. Post-operative hematuria in group A; 20 (80%) patients had mild hematuria, 3 (12%) patients had moderate hematuria and 2 patients (8%) had no hematuria. In group B; 18 (72%) patients had mild hematuria, 6 (24%) patients had moderate hematuria and one patient (4%) had no hematuria, which is statistically not significant with P-Value = 0.487 (Table 2). One patient (4%) had intra operative bleeding in group A, in group B two patients (8%) had bleeding with P value of 0.

Highlights A well-recognized phenomenon in RCC is late metastatic recurrence after nephrectomy. Solitary contralateral adrenal metastatic recurrence of RCC is extremely rare. Early diagnosis of adrenal metastasis is challenging because they are usually silent. This paper is the delayed solitary metastatic recurrence of the renal cell carcinoma to the contralateral adrenal gland.

Background  Percutaneous nephrolithotomy is regarded as the treatment of choice for large and complex renal stones. Despite of its safety and efficacy, it remains a crucial challenge for endourologist in soiltary kidney patients Objectives  To assess the effect of percutaneous nephrolithotomy (PNL) on renal function measured by glomerular filtration rate (GFR) in solitary kidney patients Materials and Methods The records of 25 patients with age range of (18-66) years with a solitary functioning kidney that had undergone PNL from September 2015 October 2017 in Sulaymani Teaching Hospital were prospectively analyzed. Serum creatinine was measured preoperatively and 7 days postoperatively. Preoperative, operative and postoperative details were analyzed for each patient with respect to change in eGFR between pre and postoperative period. Multivariate analysis was done to find relations between variable, p-value < 0.05 was considered as significant. Results There was a significant increase in the mean postoperative eGFR in (P-value <0.001). Age, gender, BMI, DM, history of ipsilateral renal surgery, grade of hydronephrosis, stone complexity and location have no considerable impact on postoperative renal function impairment (p-value >0.05). Operative time, the number of working tracts and the size of amplatz sheath also have no impact on the deterioration of renal function. Hypertension caused a significant decrease in the postoperative eGFR (p-value 0.01) and blood loss more than average (Hb drop >1.072gm/dl) caused either stable or decrease in the postoperative eGFR (P-value 0.03). Conclusion Percutaneous nephrolithotomy is safe in solitary kidney patients and early renal function improvement is anticipated. History of hypertension and bleeding are the two blamed risk factors that cause acute postoperative renal function deterioration.