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Navratil P, Sahi S, Spacek J, Pacovsky J, Lesko M, Gunka I, Astapenko D. Pyelovesicostomy as an Alternative Surgical Treatment for Complex Ureteral Lesions After Kidney Transplant. EXP CLIN TRANSPLANT 2023; 21:712-716. [PMID: 37885285 DOI: 10.6002/ect.2023.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES We evaluated the feasibility, safety, and long-term outcomes of pyelovesicostomy as an alternative surgical treatment for complex ureteral lesions after kidney transplant. MATERIALS AND METHODS A single-center, retrospective, observational cohort study was conducted on 5 adult kidney transplant recipients who underwent pyelovesicostomy between January 2000 and June 2023. The collected data included patient demographics, surgery indication, time from transplant to pyelovesicostomy, procedure details, and kidney function at various time points after surgery. Primary outcomes were allograft function and complications. RESULTS The 5 patients (4 female, 1 male) had a mean age of 65.8 years and mean body mass index of 26.8. Indications were complex ureteral lesions. The time between transplant and reoperation ranged from 4 days to 12 years. Renal function improved for all patients, with a progressive decrease in mean serum creatinine concentration. The mean follow-up period extended to 7 years. One patient died with the graft still functional at 20 years after the operation, whereas the remaining 4 patients continue to live with functional grafts. CONCLUSIONS Our study suggests that pyelovesicostomy may provide a potent alternative for the management of complex ureteral lesions after kidney transplant. We have observed good short-term and long-term outcomes in specific patients, pointing toward a promising avenue oftreatment worth further exploration. This reaffirms the importance of a personalized approach in medicine, to consider each patient's unique conditions and characteristics during therapeutic decisions.
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Affiliation(s)
- Pavel Navratil
- From the Department of Urology, University Hospital Hradec Kralove, Czech Republic; the Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic
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Ureteral Complications Requiring Intervention After Kidney Transplant: A Single-Center Experience. Transplant Proc 2022; 54:2578-2583. [DOI: 10.1016/j.transproceed.2022.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Soylu L, Aydin OU, Atli M, Gunt C, Ekmekci Y, Cekmen N, Karademir S. Does early removal of double J stents reduce urinary infection in living donor renal transplantation? Arch Med Sci 2019; 15:402-407. [PMID: 30899293 PMCID: PMC6425203 DOI: 10.5114/aoms.2018.73524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/24/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Prophylactic use of double J (DJ) stents in recipients is highly accepted in renal transplantation. In this study, the association between the frequency of urologic complications (UC) and urinary tract infections (UTI), and the early or late removal of DJ stents was investigated. MATERIAL AND METHODS A total of 116 live-donor renal transplant patients were included in the study during a 4-year period, with a mean follow-up of 29.2 ±15.3 months. In all, DJ stents were used. All patients were clinically monitored for graft function by assessment of the complete blood count, renal biochemistry, urine analysis and blood drug level according to our follow-up protocol. RESULTS The patients were divided into 2 groups according to the time of their stent removal: group I (n = 44), removal within the first 14 days; and group II (n = 72), removal after 14 days. No urinary leaks were detected in either of the groups. Three patients suffered from anastomotic stricture (group I, n = 1; group II, n = 2). The rates of UTI were similar in groups I and II (13.6% vs. 16.6%, respectively, p = 0.79). The rate of UTI in women was found to be 3.8 times higher than in men. CONCLUSIONS The results of our study demonstrated that DJ stent removal within 14 days did not reduce the risk of UTI when compared to stent removal after 14 days. Similar effects on complication rates for ureteral stenting for these 2 removal periods were observed.
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Affiliation(s)
- Lutfi Soylu
- Department of General Surgery and Organ Transplantation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Oguz Ugur Aydin
- Department of General Surgery and Organ Transplantation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Muzaffet Atli
- Department of General Surgery and Organ Transplantation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Ceren Gunt
- Department of Anesthesiology and Reanimation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Yakup Ekmekci
- Department of Nephrology, Ankara Güven Hastanesi, Ankara, Turkey
| | - Nedim Cekmen
- Department of Anesthesiology and Reanimation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Sedat Karademir
- Department of General Surgery and Organ Transplantation, Ankara Güven Hastanesi, Ankara, Turkey
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Buttigieg J, Agius-Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J Transplant 2018; 8:142-149. [PMID: 30211022 PMCID: PMC6134271 DOI: 10.5500/wjt.v8.i5.142] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/21/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023] Open
Abstract
Urological complications, especially urine leaks, remain the most common type of surgical complication in the early post-transplant period. Despite major advances in the field of transplantation, a small minority of kidney transplants are still being lost due to urological problems. Many of these complications can be traced back to the time of retrieval and implantation. Serial ultrasound examination of the transplanted graft in the early post-operative period is of key importance for early detection. The prognosis is generally excellent if recognized and managed in a timely fashion. The purpose of this narrative review is to discuss the different presentations, compare various ureterovesical anastomosis techniques and provide a basic overview for the management of post-transplant urological complications.
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Affiliation(s)
- Jesmar Buttigieg
- Renal Division, Mater Dei Hospital, Msida MSD2090, Malta
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | | | - Ajay Sharma
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
- Department of Transplantation, Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
- Department of Transplantation, Sheffield Teaching Hospitals, Sheffield S10 2JF, United Kingdom
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Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, Kiraz K, Demirbas M, Kaya Furkan A, Aslan Sezer M, Demirbas A, Asuman YH. Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation. Transplant Proc 2017; 49:523-527. [PMID: 28340826 DOI: 10.1016/j.transproceed.2017.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Urologic complications (UC) have gradually decreased in recent years after advanced surgical experience. The incidence of urologic complications varies between 0.22% and 30% in different medical studies. There is no routine usage of double-J stenting (DJS) during renal transplantation (RT) in the literature. It is a necessity, and optimal timing for stent removal is an important question for many transplantation centers. METHODS This study includes 818 renal transplant patients whose ureteroneocystostomy anastomoses were completed by use of the Lich-Gregorie procedure during a 2-year period at a transplantation center. We performed 926 renal transplantations at Antalya Medical Park Hospital Renal Transplantation Center between January 2014 and January 2016. The patients were divided into four groups according to the timing of DJS removal. RESULTS For group 1, removal time for DJS was between 5 and 7 days; group 2, Removal time for DJS was between 8 and 14 days; group 3, removal time for DJS was between 15 and 21 days; and group 4, removal time for DJS was later than 22 days. The patients were divided into two groups according to removal time of stent as 5 to 14 days and >15 days. DJS was performed again in the patients whose urine output was reduced during the first 5 days after removal of the DJS, whose creatine level increased, and whose graft ureter and collecting tubules were extended as an ultrasonographic finding. CONCLUSIONS There is no declared optimal time for the removal of DJS. The removal time was reported between postoperative first week and 3 months in some of the reports of RT centers, according to their protocols. We emphasize that the optimal time for the removal of DJS is 14 to 21 days after RT, based on the findings of our large case report study.
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Affiliation(s)
- Y Yuksel
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey.
| | - S Tekin
- Kemerburgaz University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - D Yuksel
- Training and Research Hospital, Department of Anesthesia and Reanimasyon Unit, Antalya, Turkey
| | - I Duman
- Kemerburgaz University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - M Sarier
- Kemerburgaz University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - L Yucetin
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - K Kiraz
- Ataturk Goverment Hostpital, Department of Chest Diseases, Antalya, Turkey
| | - M Demirbas
- Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - A Kaya Furkan
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - M Aslan Sezer
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - A Demirbas
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - Y H Asuman
- Medical Park Hospital, Department of Nephrology and Transplantation, Antalya, Turkey
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Kwong J, Schiefer D, Aboalsamh G, Archambault J, Luke PP, Sener A. Optimal management of distal ureteric strictures following renal transplantation: a systematic review. Transpl Int 2016; 29:579-88. [PMID: 26895782 DOI: 10.1111/tri.12759] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/16/2015] [Accepted: 02/15/2016] [Indexed: 11/27/2022]
Abstract
Our objective was to define optimal management of distal ureteric strictures following renal transplantation. A systematic review on PubMed identified 34 articles (385 patients). Primary endpoints were success rates and complications of specific primary and secondary treatments (following failure of primary treatment). Among primary treatments (n = 303), the open approach had 85.4% success (95% CI 72.5-93.1) and the endourological approach had 64.3% success (95% CI 58.3-69.9). Among secondary treatments (n = 82), the open approach had 93.1% success (95% CI 77.0-99.2) and the endourological approach had 75.5% success (95% CI 62.3-85.2). The most common primary open treatment was ureteric reimplantation (n = 33, 81.8% success, 95% CI 65.2-91.8). The most common primary endourological treatment was dilation (n = 133, 58.6% success, 95% CI 50.1-66.7). Fourteen complications, including death (4 weeks post-op) and graft loss (12 days post-op), followed endourological treatment. One complication followed open treatment. This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures following renal transplantation. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post-transplant distal ureteric strictures. We also outline a post-transplant ureteric stricture evaluation and treatment algorithm.
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Affiliation(s)
- Justin Kwong
- Division of Urology in the Department of Surgery, Western University, London, ON, Canada
| | - Danielle Schiefer
- Matthew Mailing Center for Translational Transplant Research, Western University, London, ON, Canada
| | - Ghaleb Aboalsamh
- Division of Urology in the Department of Surgery, Western University, London, ON, Canada
| | - Jason Archambault
- Division of Urology in the Department of Surgery, Western University, London, ON, Canada
| | - Patrick P Luke
- Division of Urology in the Department of Surgery, Western University, London, ON, Canada.,Matthew Mailing Center for Translational Transplant Research, Western University, London, ON, Canada
| | - Alp Sener
- Division of Urology in the Department of Surgery, Western University, London, ON, Canada.,Matthew Mailing Center for Translational Transplant Research, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
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Pan XM, Xiang HL, Ding CG, Luo ZZ, Tian PX, Xue WJ. Comparative study of one-stitch versus Lich-Gregoir ureterovesical implantation for kidney transplants. World J Urol 2013; 32:1355-61. [PMID: 24306619 DOI: 10.1007/s00345-013-1217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To compare the outcomes of standard Lich-Gregoir technique and a modified one-stitch technique of ureteroneocystostomy in renal transplantation. PATIENTS AND METHODS Data from 645 transplant recipients by two different ureteroneocystostomy techniques were retrospectively reviewed at the first Affiliated Hospital, Medical College of Xi'an Jiaotong University, between January 2002 and December 2007. RESULTS There were 418 recipients in the Lich-Gregoir group and 227 in new one-stitch group. The overall ureteral complication rate for new one-stitch technique was 19.8 % (n = 45) as opposed to 15.79 % (n = 66) for the Lich-Gregoir technique. No significantly different rate of ureteral complications occurred in two groups (P > 0.05). In comparison, there was a higher proportion of hematuria at the limit of statistical significance in new one-stitch group (P < 0.05). Average operative time for the modified one-stitch and Lich-Gregoir techniques was 8.8 ± 1.4 and 21.9 ± 6.1 min, respectively (P < 0.05). Urinary tract infections, delayed graft function and rejection rates were not significantly different between the two groups (P > 0.05). CONCLUSION Although the modified one-stitch technique may predispose patients to higher rates of hematuria, it has no significant difference in ureteral complications compared with the Lich-Gregoir group. Based on this large series and data analyses, we believe that this new technique will become one of our multiple choices in our setting.
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Affiliation(s)
- X M Pan
- Center of Nephropathy, The First Affiliated Hospital, Medical College of Xi'an Jiaotong University, West 277 Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China,
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Mathe Z, Treckmann JW, Heuer M, Zeiger A, Sauerland S, Witzke O, Paul A. Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections? Eur J Med Res 2012; 15:297-302. [PMID: 20696641 PMCID: PMC3351954 DOI: 10.1186/2047-783x-15-7-297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation. Methods We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well. Results A total of 157 patients were enrolled to a stent (ST) and 153 patients to a no-stent (NST) group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65). Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%). Conclusion Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.
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Affiliation(s)
- Zoltan Mathe
- Department of General-, Visceral- and Transplantation Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Kim IY, Lee SB, Choi BK, Kim SR, Lee DW, Rhee H, Song SH, Seong EY, Kwak IS. Bladder rupture in immediate postrenal transplant period of uncertain cause. EXP CLIN TRANSPLANT 2012; 10:180-2. [PMID: 22432765 DOI: 10.6002/ect.2011.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bladder rupture in patients undergoing renal transplant is rare. A 26-year-old man underwent a deceased-donor renal transplant. Postoperatively, he showed a good clinical course, but after removal of the urethral catheter, he complained of pain in the lower aspect of the abdomen and in the left flank. Findings of abdominal computed tomography and retrograde cystography revealed an extraperitoneal bladder rupture. We did not identify specific causes for this condition and believe that the bladder rupture was spontaneous. However, we could not rule out the possibility of traumatic rupture by the double-J ureteral stent. We decided to manage this case conservatively, with an indwelling urethral catheter and antibiotics, instead of by surgical repair. Results of repeated serial cystography during the treatment showed decreased contrast extravasation, and cystographic findings at 6 weeks showed no leakage of contrast medium. We confirmed complete healing of the ruptured bladder and removed the urethral catheter. Since then, the patient has maintained good renal function without any complications.
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Affiliation(s)
- Il Young Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
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Khattak I, Naralawar R, Littler P, Meera S, Bakran A, Sharma A, Powell S. Minimally invasive mechanical thrombectomy: salvage of a renal transplant after pelvicaliceal clot retention. Cardiovasc Intervent Radiol 2010; 34:672-4. [PMID: 21069330 DOI: 10.1007/s00270-010-0023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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