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"ABSTRACTBackground: resistive index (RI) is highly utilised to assess the graft function using Doppler ultrasonography. The RI has been shown as the best ultrasound parameter to assess kidney allograft dysfunction. Several studies have established the role of the RI as a predictor of transplant failure. However, these studies were using RI measurement in the later stages post transplantation. The present study has conducted to identify the association between early RI measurement and early graft function represented as delayed graft function (DGF) and immediate graft function (IGF), as well as long-term graft survival. Methods: an evidence based clinical review of studies published before May 2018 was conducted from Medline, Science Direct, EMBASE and Cochrane databases. Studies on early measurement of RI whereby the primary or secondary goals of the study related to graft function and/or graft survival were included. Studies using late RI measurement and without RI value groups were excluded. The Mantzel Haenzel method was used to analyse pooled risk ratio and 95% confidence interval, while the heterogeneity of the study was calculated through I2 value. Data analysis was performed using Review Manager 5.3. Results: nine studies with a total of 1802 patients who had undergone a kidney transplant were analysed. DGF was found in 19% (193/1015) of the low RI group and in 42.8% (337/787) of the high RI group (RR 2.04 (95% CI 1.72 - 2.41), p < 0.00001, I2 = 28%). IGF was found in 39.5% (62/157) of the low RI group and in 10.5% (28/268) of the high RI group (RR 0.26 (95% CI 0.17 0.40), p < 0.00001, I2 = 0%). Long term graft survival, with follow up between 60 144 months, was found in 83% (701/845) of the low RI group and in 69.4% (395/569) of the high RI group (RR 0.82 (95% CI 0.72 0.93), p = 0.002, I2 = 63%). Conclusion: the results of this study emphasise the association between early measurement of RI and early graft function, and longterm graft survival. An elevated RI provides the chance of recognizing the patients with poor longterm prognosis, from the first moment after kidney transplant."

"Baground: the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotrispy (ESWL), percutaneous nephrolithotomy (PNCL) and flexible ureteroscopy (fURS) are the therapautic methods for lower calyceal stones. the aim of this study was to identify the optimal management of 10-20 mm lower pole stones. Methods : a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were exclude. A fixed-effects model with Mantzel-Haenzel method was used to calculate the I2 statistic. All analyses were performed with review manager 5.3. Result : we analized 8 cohort studies. The stone free rate from 958 patient (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513)after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13-1.55) ; p<0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI.30-1.55); p=<0.001 and I2=85%). But if we compare between fURS and ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04-1.30; p=0.01 and I2=40%). Conclusion: percutaneous nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in makin decision of intervention in 10-20mm lower pole stone management."