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Background and aims the role of serum neutrophil gelatinase-associated lipocalin (NGAL) in predicting delayed graft function (DGF) after kidney transplantation is poorly defined. The objective of this study was to evaluate the serum NGAL expression in the early postoperative phase after kidney transplantation and compare it with serum creatinine (Cr). Methods We studied 32 patients who received kidney transplantation from deceased (n=24) and live (n=5) donors during October 2017 to December 2018 at the Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Serum NGAL, Serum Cr and urine output were measured at 1 to 7 day after transplantation. The need for dialysis in one week after transplantation was evaluated. Results Among 29 recipients with serum biomarkers measurements, 8 (27.5%) developed DGF (need to hemodialysis within 1 week of transplantation). Resulted in areas under ROC curves (AUCs) for serum NGAL at early hours following transplantation was (0.839, 95% CI: 0.69-0.98, P =0.005) that could accurately predict DGF compared to urine output (0.747, 95% CI: 0.55-0.93, P =0.045) and serum Cr (0.607, 95% CI: 0.34-0.86, P =0.398) at 24 hours after transplantation. Multivariate analysis revealed that only serum NGAL was significant independent predictor of DGF (OR: 0.996, 95% CI: 0.993-1.000, P =0.039). Conclusion Serum NGAL at early hours of post-transplantation was valuable biomarker for early accurate predictor of DGF in kidney transplantation compare with tradition biomarkers such as serum Cr and urine output.

Introduction: Penile torsion is a congenital malformation that causes a rotational deformity of the penile shaft. Several techniques have been considered for penile torsion repair. In this study, we described our experience using two separate “V” dartos flaps, which leads to a more satisfying result. Patient and methods: Two young men with severe penile torsion aged 24 and 28 years old were candidates for surgery. During our novel method for penile torsion repair, we degloved the penis and dissected the dartos fascia from the penis shaft, then cut it distally from the sub-coronal region with a longitudinal cut to make two dartos flaps in a “V” shape. With these two flaps, we corrected penile torsion in a more satisfying way without crossing the urethra. Results: Penile torsion and concurrent chordee were completely corrected after surgery. Urine culture was sterile and uroflowmetry indicated a maximal urinary flow of 12 ml/s 3 months after the operation. Both patients were satisfied with ejaculation and their follow-up indicated complete resolution of penile torsion. Conclusions: Penile torsion is a challenging congenital anomaly. We used a two “V” shaped flap passage method to complete penile rotation and chordee correction without performing any plication techniques. Our penile torsion correction procedure resulted in the successful repair of torsion and excellent outcomes. Level of evidence: Not applicable for this multicenter audit.

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