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Kim DH, Park HS, Bang JS, Shin HJ, Yoon BJ, Kim S, Jeong JC, Park S, Lee T. Routine Ureteral Stenting in Kidney Transplant Reduces Postoperative Hydronephrosis and Percutaneous Ureteral Interventions: A Single-Center Experience. EXP CLIN TRANSPLANT 2024; 22:9-16. [PMID: 38284370 DOI: 10.6002/ect.2023.0349] [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: 01/30/2024]
Abstract
OBJECTIVES The effect of routine ureteral stenting on postoperative hydronephrosis and percutaneous ureteral intervention in kidney transplant remains unknown. This study aimed to evaluate the effects of routine ureteral stenting on hydronephrosis and percutaneous ureteral intervention and the cost benefit of ureteral stenting in kidney transplant. MATERIALS AND METHODS We retrospectively analyzed patients who underwent kidney transplant at a tertiary institution between 2005 and 2021. We adopted a ureteral stentingprotocol in2017, anda comparisonwas performed with previous patients without stents. RESULTS In total, 539 patients underwent kidney transplant(271 with stents [51.3%], 268 without stents [49.7%]). Hydronephrosis was detected in 16 cases (5.9%) and 30 cases (11.2%) of groups with and without stents,respectively (P = .041). Among patients with hydronephrosis, the number of patients who underwent percutaneous ureteral intervention was significantly lower in the stent group than in the nostent group (1 [6.25%] vs 10 [33.33%]; P= .014).Twenty patients (3.71%) experienced major urologic complications (19 [7.1%] in the no-stent group, and 1 [0.4%] in the stent group; P = .001). No significant differences between the groups were shown in the incidence of urinary tract infections within 3 months of transplant (24 [8.9%] vs 22 [8.2%]; P = .846). No differences were shown between the groups in ureterovesical anastomosis time (24.4 vs 24.03 min; P = .699) or 1-year graft survival (97% vs 97.8%; P = .803). The healthcare cost was significantly lower in the stent group than in the no-stent group by $1702.05 ($15000.89 vs $16702.95; P < .001). CONCLUSIONS Routine ureteral stenting in kidney transplant significantly decreased the incidence of postoperative hydronephrosis and percutaneous ureteral intervention. Stenting did notlead to increased urinary tract infections and was cost-effective.
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Affiliation(s)
- Dong-Hwan Kim
- >From the Department of Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
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He S, Bi Y, Ye C, Peng D, Xiao J, Wei H. Interdisciplinary Surgical Treatments and Long-Term Outcomes of Lumbar Spinal Tumors With Retroperitoneal Involvements: A Retrospective Case Series Study. Front Oncol 2022; 11:720432. [PMID: 35004269 PMCID: PMC8733943 DOI: 10.3389/fonc.2021.720432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Surgical treatments are technically challenging for lumbar spinal tumor (LST) with extensive retroperitoneal involvements. Our study aimed to report the experience and outcomes concerning interdisciplinary surgical collaborations in managing such LSTs. Patients and Methods Nine patients underwent interdisciplinary surgical treatments which were performed by specialists, namely, spinal, vascular, and urinary surgeries. Data on clinical characteristics were collected, and the Visual Analogue Scale (VAS) and the Japanese Orthopaedic Association Score (JOAS) were used in the evaluation before and after surgery. The postoperative complications and the long-term outcomes were reported as well. Results The interdisciplinary work included double J catheter indwelling (n = 9), nephrostomy (n = 5), replacement of the common iliac vein (n = 2), abdominal aorta repair (n = 3), and vital vessel repair (n = 8). The early-stage complications included complaints of moderate low back pain and slight implant shift (n = 1, 11.1%) and tardive ureterodialysis (n = 1, 11.1%). The 3- and 5-year disease-free survival rates were 76.2 ± 14.8 and 50.8 ± 23.0%, respectively, during the mean follow-up of 34.6 ± 17.9 months (range, 9.5–68.7). Besides this, more blood loss was associated with recurrent and metastatic tumor status (p = 0.043) and surgery time >5 h (p = 0.023). Remarkable pain relief and favorable quality of life were achieved based on the postoperative VAS (3.3 ± 0.9, p < 0.001) and JOAS (16.6 ± 0.5, p < 0.001). Conclusions The treatments of LSTs with wide-range retroperitoneal involvements require interdisciplinary surgical collaborations to lower the risks and improve the long-term outcomes. High-quality prospective cohort studies with large samples are warranted to establish general surgical protocols in managing LSTs with extensive retroperitoneal involvements.
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Affiliation(s)
- Shaohui He
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Yifeng Bi
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Chen Ye
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Dongyu Peng
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China.,Department of Orthopaedic Surgery, Chengdu Military General Hospital, Chengdu, China
| | - Jianru Xiao
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Haifeng Wei
- Spinal Tumor Center, Department of Orthopaedic Oncology, No. 905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, The Second Military Medical University, Shanghai, China
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Abstract
Due to atrophic bladder, patients undergoing long-term dialysis experience vesicoureteral reflux and complicated urinary tract infections after kidney transplantation. A 58-year-old woman underwent living donor kidney transplantation after 41 years of dialysis. She had no contraindications, with good cardiac function and minimal artery calcification despite the long history of hemodialysis. Immunosuppression was initiated with tacrolimus, mycophenolate mofetil, prednisolone, and basiliximab. Ureteroneocystostomy with an antireflux technique was carefully conducted as her bladder volume was 15 mL. The postoperative clinical course was uneventful with immediate graft function. The bladder volume gradually increased to 81 mL at discharge, 3 weeks postoperatively. The patient was initially depressed due to frequent urination early post-transplant but recovered soon after as the bladder volume gradually increased to 400 mL. The patient has not yet reported a urinary tract infection episode. This case highlights living donor kidney transplantation-induced recovery of bladder function with careful ureteroneocystostomy, despite the long dialysis history.
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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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Simsek C, Dogan S, Piskin T, Okut G, Cayhan K, Aykas A, Tatar E, Uslu A. Should Interventional Radiology or Open Surgery Be the First Choice for the Management of Ureteric Stenosis After Transplantation? Dual-Center Study. Transplant Proc 2017; 49:517-522. [DOI: 10.1016/j.transproceed.2017.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Argyrou C, Moris D, Vernadakis S. Steering between Scylla and Charybdis: Picking out the optimum time of double-J stent removal following renal transplantation. Transplant Rev (Orlando) 2016; 31:96-99. [PMID: 27884503 DOI: 10.1016/j.trre.2016.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Demetrios Moris
- Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Cienfuegos-Belmonte I, León-Dueñas E, Román-Martín A, Olmo-Ruíz M, González-Roncero F, Medina-López R. Evaluation of the Spanish Urological Association quality care indicators in a kidney transplantation programme. Actas Urol Esp 2016; 40:523-8. [PMID: 26992850 DOI: 10.1016/j.acuro.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Indicators show the presence of a phenomenon and its intensity. They assess the level of quality care and identify potential situations for improvement. Our objective is to assess the 2013 and 2014 quality care indicators of our department's kidney transplantation area. MATERIAL AND METHOD For 2013 and 2014, we reviewed 88 and 106 kidney transplants and 47 and 66 extractions. We evaluated the quality care indicators developed by the Spanish Urological Association, analysing the results with the SPSS v 21.0 programme. RESULTS The mean cold ischaemia time (CIT) was 14.96hours in 2013 and 18.07hours in 2014. The CIT was ≤18h in 53% and 56% of cadaveric donor kidneys in 2013 and 2014, respectively. The rate of relevant early onset urinary fistulae was 1.14% and 2.83% for each year. The rate of early transplantectomy due to a vascular complication was 3.41% and 2.83% for 2013 and 2014, respectively. Overall patient survival at 1 year was 100% for both periods, and graft survival at 1 year was 95% and 94.34% for 2013 and 2014, respectively. The rate of living-donor transplantation was 14.77% and 17.92%, and 92.31% and 68.42% of the living-donor extractions were laparoscopic for 2013 and 2014, respectively. Resident medical interns were the first surgeon in 6.67% and 12.64% of the transplantations and in 55.88% and 19.14% of the cadaveric extractions during 2013 and 2014, respectively. CONCLUSIONS During the evaluated period, all quality care standards in kidney transplantation were met, except for CIT in both years and resident medical intern participation in kidney implantation in 2013. This analysis promotes improvements in quality care, highlighting weak spots that need work.
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