In addition to harming the respiratory system, COVID-19 can affect multiple organs. Children may develop a specific complication of COVID-19 called multisystem inflammatory syndrome in children (MIS-C) which could influence the vascular system of children and cause multiple coagulopathies in the body. Information on the use of thromboprophylaxis in this condition was collected via the review of various articles. In general, different factors in immune system responses can trigger the initiation of thrombotic events. Studies have shown that starting anticoagulant prophylaxis, which contributes to decreased thrombotic events, is dependent on the patient's condition and D-dimer levels. However, further studies on pediatric populations are needed to establish the role of anticoagulants in children with this condition.

Background and Objective: Benign prostatic hyperplasia (BPH) often necessitates surgical treatment, with open prostatectomy remaining a standard approach. However, this procedure carries a significant risk of intraoperative and postoperative bleeding, often requiring blood transfusions. Tranexamic acid (TXA), an antifibrinolytic agent, has shown potential in reducing surgical blood loss. This study aims to evaluate the effect of intraoperative local administration of TXA on perioperative blood loss in patients undergoing open prostatectomy for BPH. Methods: In this double‐blind randomized controlled trial, 140 patients with BPH were assigned to either a TXA group or control group. In the intervention group, 1 g of TXA was diluted in 100 mL of normal saline and injected into the prostatic fossa during surgery, followed by three additional postoperative doses. The primary outcome was total perioperative blood loss. Secondary outcomes included changes in hemoglobin, hematocrit, platelet count, transfusion requirement, and length of hospital stay. Baseline differences, including a significant age gap between the groups (mean age: TXA group 60.70 ± 7.44 years vs. control group 70.50 ± 6.68 years), were statistically adjusted during analysis. Results: Perioperative blood loss was significantly lower in the TXA group (116.65 ± 43.23 mL) compared to the control group (210.27 ± 87.94 mL, p value = 0.001). The mean hemoglobin drop was also significantly reduced in the TXA group at both 24 and 48 h postoperatively. Fewer patients in the TXA group required blood transfusion (2.85%) compared to the control group (10%, p value = 0.03). No major adverse events directly attributed to TXA were identified, although one patient in the TXA group developed a pulmonary embolism. Conclusion: Intraoperative local administration of TXA significantly reduces perioperative blood loss and the need for blood transfusion in patients undergoing open prostatectomy. TXA appears to be a safe and effective strategy for minimizing surgical bleeding in this setting. Trial Registration: Iranian Registry of Clinical Trials: IRCT20180625040232N8

Renal cell carcinoma with level IV inferior vena cava tumor thrombus is rare and associated with high recurrence risk despite complete resection. We report an 80-year-old man who underwent radical nephrectomy and inferior vena cava thrombectomy with initial negative postoperative imaging. One year later, imaging findings were equivocal, but tumor-informed circulating tumor DNA was detectable, prompting early surgical resection of recurrent disease. Postoperatively, circulating tumor DNA became undetectable. This case highlights the potential role of tumor-informed circulating tumor DNA surveillance in detecting molecular residual disease and guiding management in high-risk renal cell carcinoma.

Background: Non–muscle-invasive bladder cancer (NMIBC) accounts for the majority of newly diagnosed bladder cancer cases and is characterized by high rates of recurrence and progression. Intravesical Bacillus Calmette–Guérin (BCG) remains the standard of care for high-risk disease; however, treatment intolerance, failure, and global supply shortages have prompted investigation of alternative intravesical therapies. Objective: To summarize and critically appraise the existing clinical evidence evaluating sequential intravesical gemcitabine and docetaxel (Gem/Doce) in NMIBC, across different clinical contexts. Methods: We performed a narrative review of published clinical studies assessing sequential intravesical Gem/Doce in patients with BCG-unresponsive, BCG-exposed, and selected treatment-naïve NMIBC. Reported oncologic outcomes, including recurrence-free survival, progression, cystectomy rates, and treatment-related adverse events, were reviewed. Emerging exploratory approaches, including biomarker-based risk stratification, were also described. Results: Across multiple retrospective and prospective studies, Gem/Doce has demonstrates favorable recurrence-free survival, and acceptable safety profiles, particularly in patients with BCG-unresponsive or previously treated high-risk NMIBC. Reported rates of progression and cystectomy are generally low, and treatment discontinuation due to toxicity is uncommon. Exploratory studies have evaluated AI-assisted histologic biomarkers as potential tools for risk stratification and hypothesis-generating treatment selection; however, these approaches remain investigational and require prospective validation. Conclusion: Current evidence suggests that sequential intravesical Gem/Doce is a well-tolerated bladder-sparing option with encouraging oncologic outcomes, particularly in patients with recurrent or BCG-unresponsive NMIBC. While early data have explored its use in treatment-naïve settings, definitive conclusions regarding its role as first-line therapy require validation in prospective randomized trials.

Background Varicocele, which is defined as varicose veins in the scrotum, is associated with different complications, in particular infertility. However, the definite etiologies have not determined yet. Our objective was to investigate the association between left lumbar, renal, and gonadal veins diameters and varicocele occurrence and grading in kidney donors underwent left-sided nephrectomy. Also, the frequency of varicocele were evaluated three months after the surgery. Methods In this observational study, male kidney donors aged 18 to 65, who underwent open nephrectomy were included between 2022 and 2023. Baseline data on age, body mass index (BMI), and the presence or grade of varicocele were collected through medical records and physical examinations. During the procedure, the diameter of the left lumbar, renal, and gonadal veins were measured using a graded ruler on the back table. Three months after the nephrectomy, the patients were re-evaluated for varicocele recurrence. Results We included 30 kidney donor with a mean age of 38.2 years and BMI of 23.5 kg/m2. The renal vein diameter decreased with higher grading (p = 0.05) and the gonadal vein diameter increased with higher grading (p = 0.04). However, there was no significant association between varicocele grading and left lumbar vein diameter. Following three months of nephrectomy, the frequency of varicocele increased from 33.4–50.0%. Conclusions The diameter of the left lumbar vein was almost unchanged in varicocele, while the size of the left renal vein decreased, and the size of the left gonadal vein increased. Furthermore, occurrence of varicocele increased after three months of left-sided nephrectomy. Therefore, people undergoing nephrectomy are at a higher risk of developing varicocele which should be considered in follow-up visits.