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Goodfellow M, Thompson ER, Tingle SJ, Wilson C. Early versus late removal of urinary catheter after kidney transplantation. Cochrane Database Syst Rev 2023; 7:CD013788. [PMID: 37449968 PMCID: PMC10347544 DOI: 10.1002/14651858.cd013788.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The optimal treatment for end-stage kidney disease is kidney transplantation. During the operation, a catheter is introduced into the bladder and remains in place postoperatively to allow the bladder to drain. This decreases tension from the cysto-ureteric anastomosis and promotes healing. Unfortunately, urinary catheters can pose an infection risk to patients as they allow bacteria into the bladder, potentially resulting in a urinary tract infection (UTI). The longer the catheter remains in place, the greater the risk of developing a UTI. There is no consensus approach to the time a catheter should remain in place post-transplant. Furthermore, the different timings of catheter removal are thought to be associated with different incidences of UTI and postoperative complications, such as anastomotic breakdown. OBJECTIVES This review aimed to compare patients who had their catheter removed < 5 days post-transplant surgery to those patients who had their catheter removed ≥ 5 days following their kidney transplant. Primary outcome measures between the two groups included: the incidence of symptomatic UTIs, the incidence of asymptomatic bacteriuria and the incidence of major urological complications requiring intervention and treatment. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 13 April 2023 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs comparing timing of catheter removal post-transplantation were eligible for inclusion. All donor types were included, and all recipients were included regardless of age, demographics or type of urinary catheter used. DATA COLLECTION AND ANALYSIS Results from the literature search were screened by two authors to identify if they met our inclusion criteria. We designated removal of a urinary catheter before five days (120 hours) as an 'early removal' and anything later than this as a 'late removal.' The studies were assessed for quality using the risk of bias tool. The primary outcome of interest was the incidence of asymptomatic bacteriuria. Statistical analyses were performed using the random effects model, and results were expressed as relative risk (RR) with 95% confidence intervals (CI). Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Two studies (197 patients) were included in our analysis. One study comprised a full-text article, and the other was a conference abstract with very limited information. The risk of bias in the included studies was generally either high or unclear. It is uncertain whether early versus late removal of the urinary catheter made any difference to the incidence of asymptomatic bacteriuria (RR 0.89, 95% Cl 0.17 to 4.57; participants = 197; I2 = 88%; very low certainty evidence). Data on other outcomes, such as the incidence of UTI and the incidence of major urological complications, were lacking. Furthermore, the follow-up of patients across the studies was short, with no patients being followed beyond one month. AUTHORS' CONCLUSIONS A high-quality, well-designed RCT is required to compare the effectiveness of early catheter removal versus late catheter removal in patients following a kidney transplant. At the present time, there is insufficient evidence to suggest any difference between early and late catheter removal post-transplant, and the studies investigating this were generally of poor quality.
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Affiliation(s)
- Michael Goodfellow
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Emily R Thompson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Samuel J Tingle
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Colin Wilson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
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Astolfi RH, Aguiar WF, Viana L, Cristelli M, Junior HTS, Pestana JM. A STENTLESS MODIFIED LICH-GREGOIR TECHNIQUE FOR SAFE EARLY BLADDER CATHETER REMOVAL IN LIVING AND DECEASED KIDNEY TRANSPLANTS. Urology 2022; 165:336-342. [PMID: 35065141 DOI: 10.1016/j.urology.2022.01.014] [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: 11/07/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe a stentless modified Lich-Gregoir technique (mLG) for ureteroneocystostomy in renal transplantation (RT), with early bladder catheter (BC) removal (under 48 hours), and compare the postoperative results with those of the traditional technique (LG) with routine bladder catheter removal (4 to 5 days). The modification consists of maintaining a thin layer of detrusor fibers covering the bladder mucosa during dissection, which is incorporated into the anastomosis to reinforce the ureteroneocystostomy. MATERIALS AND METHODS This retrospective cohort study compared the postoperative outcomes of 100 consecutive patients who underwent mLG with early removal of BC between October 2018 to November 2019 with those of a historical cohort of 165 consecutive patients transplanted using stentless LG and routine removal of BC, who underwent surgery between July 2017 and September 2018. All transplants were performed by the same surgeon. Follow-up was 6 months. RESULTS Demographic characteristics were comparable, although patients in the mLG group had a higher mean preoperative urine volume (911±753.8mL vs. 629±638.6mL, p=0.016). Patients in the mLG group successfully underwent early BC removal (2.2±0.9 vs. 4.8±4.8 days, p<0.001), with no differences in the incidence of surgical or clinical complications, including urine leaks (1 vs. 3%, p=0.284). In addition, mLG patients presented a shorter mean length of hospital stay (6.5±5.0 vs. 7.1±6.2 days, p=0.023). CONCLUSION This stentless modified Lich-Gregoir technique enables safe early bladder catheter removal and is associated with reduced hospital length of stay.
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Affiliation(s)
- Rafael H Astolfi
- Department of Urology, Endourology Division, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil.
| | - Wilson F Aguiar
- Department of Urology, Endourology Division, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil; Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| | - Laila Viana
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| | - Marina Cristelli
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| | - Helio T S Junior
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| | - Jose M Pestana
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
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Dorschner P, McElroy LM, Ison MG. Nosocomial infections within the first month of solid organ transplantation. Transpl Infect Dis 2014; 16:171-87. [PMID: 24661423 DOI: 10.1111/tid.12203] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/24/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022]
Abstract
Infections remain a common complication of solid organ transplantation. Early postoperative infections remain a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients. Although significant effort has been made to understand the epidemiology and risk factors for early nosocomial infections in other surgical populations, data in SOT recipients are limited. A literature review was performed to summarize the current understanding of pneumonia, urinary tract infection, surgical-site infection, bloodstream infection, and Clostridium difficult colitis, occurring within the first 30 days after transplantation.
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Affiliation(s)
- P Dorschner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Becker S, Witzke O, Rübben H, Kribben A. [Urinary tract infections after kidney transplantation: Essen algorithm for calculated antibiotic treatment]. Urologe A 2011; 50:53-6. [PMID: 21174190 DOI: 10.1007/s00120-010-2470-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Urinary tract infections are the most common infection early after transplantation and can affect long-term graft function. Any urinary tract infection in renal transplant recipients should be seen as "complex" with regard to consequences for diagnosis and therapy. The increase in resistance to anti-infective agents seen among uropathogens is one of the central therapeutic problems. This means for routine clinical practice that contact isolation precautions should be consistently implemented for affected patients and the duration of introducing urinary tract instruments should be minimized. Detection of pyuria and urine cultures are required to confirm infection, to identify the corresponding pathogen, and to review the antibiotic therapy.The "Essen algorithm for calculated antibiotic treatment of urinary tract infections in renal transplant patients" takes into consideration the high incidence of Gram-negative pathogens in general and the increased incidence of enterococci in the early phase after transplantation. Within the first 2 months after transplantation quinolones should be used and later cephalosporins. In case of urosepsis, calculated antibiotic therapy should cover problematic Gram-negative pathogens such as pseudomonades. The calculated antibiotic therapy should be administered intravenously in severe infections. In any case the local and regional antibiotic susceptibility should be taken into account when deciding on the calculated antibiotic therapy.
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Affiliation(s)
- S Becker
- Klinik für Nephrologie, Zentrum für Innere Medizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Deutschland.
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Thorpe AC, Ramsden PD, Murthy LNS. The conservative management of obstructed renal transplants by endoscopic ureteric stenting. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709509152762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pellé G, Vimont S, Levy PP, Hertig A, Ouali N, Chassin C, Arlet G, Rondeau E, Vandewalle A. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 2007; 7:899-907. [PMID: 17286620 DOI: 10.1111/j.1600-6143.2006.01700.x] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Urinary tract infections (UTIs) and acute pyelonephritis (APN) often occur after renal transplantation, but their impact on graft outcome is unclear. One hundred and seventy-seven consecutive renal transplantations were investigated to evaluate the impact of UTIs and APN on graft function. The cumulative incidence of UTIs was 75.1% and that of APN was 18.7%. UTIs occurred mainly during the first year after transplantation and Escherichia coli, Pseudomonas aeruginosa and Enteroccocus sp. were the most frequent pathogens identified. The risk of developing APN was higher in female (64%) than in male recipients, and was correlated with the frequency of recurrent UTIs (p < 0.0001) and rejection episodes (p = 0.0003). APN did not alter graft or recipient survival, however, compared to patients with uncomplicated UTIs, patients with APN exhibited both a significant increase in serum creatinine and a decrease in creatinine clearance, already detected after 1 year (aMDRD-GFR: APN: 39.5 +/- 12.5; uncomplicated UTI: 54.6 +/- 21.7 mL/min/1.73 m(2), p < 0.01) and still persistent ( approximately - 50%) 4 years after transplantation. Multivariate analysis revealed that APN represents an independent risk factor associated with the decline of renal function (p = 0.034). Therefore, APN may be associated with an enduring decrease in renal graft function.
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Affiliation(s)
- G Pellé
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
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Srivastava A, Sinha T, Madhusoodanan P, Karan SC, Sandhu AS, Sethi GS, Kotwal SV, Bhatyal HS, Sood R, Gupta SK, Verma PP. Urological complications of live related donor renal transplantation: 13 years' experience at a single center. Urol Int 2006; 77:42-5. [PMID: 16825814 DOI: 10.1159/000092933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 01/05/2006] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study is a retrospective analysis of urological complications and their treatment in our series of live-donor renal transplantation. MATERIAL AND METHODS The series comprised of 500 patients. All underwent extravesical ureteroneocystostomy and all except a few initial patients were stented. RESULTS There were 92 complications in 82 patients (18.4%). Urinary leakage occurred in 1.2%. There were no intrinsic ureteric obstructions. Extrinsic ureteric obstruction occurred in 0.8% of cases. The incidence of UTI was 15.4% and of urethral strictures 1%. CONCLUSION The technique of stented extravesical ureteroneocystomy has led to an extremely low rate of urological complications in our series, over a long time and in a substantial number of patients.
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Affiliation(s)
- Anand Srivastava
- Department of Urology, Army Hospital (Research and Referral), Delhi Cantt, Delhi, India.
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Gonzalo Rodríguez V, Rivero Martínez MD, Trueba Arguiñarena J, Calleja Escudero J, Müller Arteaga C, Fernandez del Busto E. Diagnóstico y tratamiento de las complicaciones urológicas del trasplante renal. Actas Urol Esp 2006; 30:619-25. [PMID: 16921840 DOI: 10.1016/s0210-4806(06)73503-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the incidence of urological complications, like fistula and stenosis in our series of 282 renal transplants and their management. MATERIALS AND METHODS Between December 1995 and October 2005, 282 adult recipients underwent renal transplant. The most common urological complication was urinary fistula. This complication was observed in 24 cases (8.5%), ureteral stenosis in 18 cases (6.4%) and both of them in 5 (1.7%). The items recorded on these patients included the time to diagnosis, the image technique, the type of ureteral stents and the clinical evolution. RESULTS Endourologic treatment with percutaneos nefrostomy, double-J catheter and metalic endoprotesis was performed successfully in 76.4% of urinary fistula, in 66.7% of ureteral obstruction and in 60% of patients who developed both of them. CONCLUSION Endourologic procedures have replaced open reconstructive surgery in most patients with ureteral obstruction or urinary fistula after renal transplant, because they may offer a definitive treatment with low morbidity.
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Osman Y, Ali-El-Dein B, Shokeir AA, Kamal M, El-Din ABS. Routine insertion of ureteral stent in live-donor renal transplantation: is it worthwhile? Urology 2005; 65:867-71. [PMID: 15882713 DOI: 10.1016/j.urology.2004.11.050] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Revised: 11/03/2004] [Accepted: 11/30/2004] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the impact of the routine use of double-J stents in live-donor renal transplantation at a single institute from a prospective randomized study. METHODS A total of 100 patients were prospectively randomized into two groups of 50 patients each. Group 1 received a routine double-J silicone ureteral stent and group 2 did not. A standard Lich-Gregoir ureteroneocystostomy was performed in both groups. In group 1, the patients were scheduled for stent removal after 2 weeks. RESULTS Both groups were comparable in terms of age, sex, ischemia time, number of renal arteries, and time to diuresis. In group 1, two grafts were lost in the early postoperative period and those patients were excluded from the final analysis. None of our patients in either group had developed a ureteral stricture at a mean follow-up of 10.8 +/- 3.6 months. In the stented group, 2 patients developed a urinary leak, but no leakage was reported in the nonstented group (P = 0.14). Although 19 patients in group 1 (39.6%) had a urinary tract infection, only 9 in group 2 (18%) showed evidence of a positive urine culture (P = 0.02). The presence of a ureteral stent and female sex were the independent predictors of postoperative urinary tract infection on multivariate analysis. The mean serum creatinine at discharge was 1.2 +/- 0.3 mg% and 1.2 +/- 0.4 mg% in groups 1 and 2, respectively (P = 0.2). CONCLUSIONS The results of our study have shown that routine ureteral stent insertion has no impact on the rate of vesicoureteral leakage or obstruction in live-donor renal transplantation, whereas it is significantly associated with an increased incidence of urinary tract infection. Stenting should be limited to patients with a pathologic and/or defunctionalized bladder.
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Affiliation(s)
- Yasser Osman
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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10
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Abstract
A 3-yr-old boy with posterior urethral valves underwent cadaveric renal transplant. On the ninth day after transplantation the patient developed a urinary leak, with complete ureteral necrosis. There was insufficient length of undamaged ureter to permit ureteroneocystostomy, unavailability of a native ureter to permit ureteroureterostomy, and an inability to mobilize the transplant kidney or bladder sufficiently to permit direct pyelovesicostomy. As the kidney was otherwise functioning perfectly, we decided to create an appendiceal conduit in the hope of salvaging the patient's renal allograft. At present, 7 months post-transplant, the child is clinically well with a serum creatinine of 0.7 mg/dL. Complete ureteral necrosis is an infrequent but devastating complication following renal transplantation. We report a novel method that allowed an otherwise normally functioning cadaveric graft to be salvaged.
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Affiliation(s)
- Richard T Blaszak
- Department of Pediatrics and Surgery, Surgical Clinic of Central Arkansas, and St Christopher's Hospital for Children, University of Arkansas for Medical Sciences, AR, USA.
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11
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Abstract
Infection of the urinary tract is the most common infectious complication of renal transplantation. The microbiology of post-transplant urinary tract infections is similar to what is seen in the general population, although transplant patients may develop infections due to unusual or opportunistic pathogens. The optimal management of urinary tract infections in renal transplant recipients is poorly studied, but recommendations for treatment are available. Antibiotic prophylaxis can reduce the risk of bacterial infection of the urinary tract post-transplant but is not used in all transplant centers. The influence of urinary tract infection on graft survival requires further study.
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Affiliation(s)
- Patricia D. Brown
- Division of Infectious Diseases, Wayne State University School of Medicine, Harper University Hospital, 3990 John R, Detroit, MI 48201, USA.
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Streeter EH, Little DM, Cranston DW, Morris PJ. The urological complications of renal transplantation: a series of 1535 patients. BJU Int 2002; 90:627-34. [PMID: 12410737 DOI: 10.1046/j.1464-410x.2002.03004.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the incidence of urological complications of renal transplantation at one institution, and relate this to donor and recipient factors. PATIENTS AND METHODS A consecutive series of 1535 renal transplants were audited, and a database of donor and recipient characteristics created for risk-factor analysis. An unstented Leadbetter-Politano anastomosis was the preferred method of ureteric reimplantation. RESULTS There were 45 urinary leaks, 54 primary ureteric obstructions, nine cases of ureteric calculi, three bladder stones and 19 cases of bladder outlet obstruction at some time after transplantation. The overall incidence of urological complications was 9.2%, with that for urinary leak or primary ureteric obstruction being 6.5%. One graft was lost because of complications, and there were three deaths associated directly or indirectly with urological complications. There was no association with recipient age, cadaveric vs living-donor transplants, or cold ischaemic times before organ reimplantation, although the donor age was slightly higher in cases of urinary leak. There was no association with kidneys imported via the UK national organ-sharing scheme vs the use of local kidneys. The management of these complications is discussed. CONCLUSION The incidence of urological complications in this series has remained essentially unchanged for 20 years. The causes of these complications and techniques for their prevention are discussed.
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Affiliation(s)
- E H Streeter
- Department of Urology, and Oxford Transplant Centre, Churchill Hospital, Oxford, UK.
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13
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Abstract
Up to now one of the major problems for successful organ transplantation has been the reaction of the immune system of the recipient against the donor organ. This could lead to acute and chronic rejection, and in cases of unsuccessful treatment to the loss of the transplant. In organ graft recipients, immunosuppressive agents are used to prevent or treat rejection episodes and to maintain graft function. Although there is an increasing number of immunosuppressive substances, the immunosuppressive therapy currently in use is relatively unspecific and targets many immunological functions. The net state of immunosuppression is a complex function determined by the interaction of a number of factors, the most important of these are the dose, duration and temporal sequence in which immunosuppressive drugs are employed. Any kind of immunosuppressive protocol is thus associated with an increased infection rate. This has an important socioecological impact, because frequent hospitalizations resulting from infectious complications are necessary, having an overall mortality rate of 3.5% within 2 weeks of admission. The most common cause of septicaemia is urinary tract infection. Frequent urinary tract infections are associated with the early onset of chronic rejection, suggesting a pathogenetic relationship between these two features. The occurrence of chronic rejection has led to reduced transplant survival. The prevention of urinary tract infections, or the early diagnosis and accurate treatment of urinary tract infections is important in renal transplant recipients.
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Affiliation(s)
- Sabine Schmaldienst
- Division of Nephrology and Dialysis, Department of Medicine III, University of Vienna, Vienna, Austria.
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Maraha B, Bonten H, van Hooff H, Fiolet H, Buiting AG, Stobberingh EE. Infectious complications and antibiotic use in renal transplant recipients during a 1-year follow-up. Clin Microbiol Infect 2001; 7:619-25. [PMID: 11737086 DOI: 10.1046/j.1198-743x.2001.00329.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate infectious complications and antibiotic use in 192 renal transplant recipients. METHODS Infectious complications and antibiotic use were monitored in all patients receiving renal transplantation at our center from 1992 to 1997. Risk factors for infectious complications were evaluated. Transplants and patient survival were monitored. The follow-up period was 1 year. RESULTS One-hundred and ninety-two patients received renal transplants during the study period. The mean duration of urethral catheterisation after transplantation was 10.5 days (SD = 5). Seventy-one per cent (n = 137) of patients had at least one infectious episode. In all, 284 infectious episodes were monitored. The most frequent infections were: urinary tract infections 61%, respiratory tract infections 8%, intra-abdominal infections 7%, and cytomegalovirus infection 8%. Escherichia coli and Enterococcus faecalis were the most frequently isolated microorganisms. Seventy-four per cent (n = 142) of patients received 314 antimicrobial courses (284 for therapy, and 30 for prophylaxis). Female gender and duration of urethral catheterisation were risk factors for urinary tract infection. Cytomegalovirus reactivation was associated with acute graft rejection and additional immunosuppressive therapy. Overall mortality was 4%. Infection-related mortality was 2.6%. Mortality was associated with Enterobacteriaceae in three patients, with Pseudomonas aeroginosa in one patient and with Enterococcus faecalis in one patient. CONCLUSIONS The incidence of infectious complications remains high in renal transplant recipients. Most cases of mortality were associated with infections. Early removal of the urethral catheter to reduce the risk of urinary tract infections is recommended.
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Affiliation(s)
- B Maraha
- Department of Medical Microbiology St Elisabeth Hospital, PO Box 747, Tilburg, 5000 AS, the Netherlands.
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Rabkin DG, Stifelman MD, Birkhoff J, Richardson KA, Cohen D, Nowygrod R, Benvenisty AI, Hardy MA. Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplant Proc 1998; 30:4314-6. [PMID: 9865370 DOI: 10.1016/s0041-1345(98)01423-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- D G Rabkin
- Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
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Gassner R, Königsrainer A, Margreiter R. Penis- und Skrotalödem als erste Symptome eines Ureterlecks nach Nierentransplantation. Eur Surg 1994. [DOI: 10.1007/bf02619734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nicol DL, P'Ng K, Hardie DR, Wall DR, Hardie IR. Routine use of indwelling ureteral stents in renal transplantation. J Urol 1993; 150:1375-9. [PMID: 8411403 DOI: 10.1016/s0022-5347(17)35783-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
An extravesical ureteral implantation with the routine use of an internal stent was performed in 358 transplants (351 cadaveric and 7 living related). The 1-year patient and graft survival was 93% and 87%, respectively, with a minimum followup of 2 years. Ureteral complications developed in 9 patients (2.6%), with 3 fistulas, 2 of which resolved spontaneously, and 6 stenoses following stent removal. Nephrostomy drainage and antegrade stenting were initially attempted in all cases of stenosis, and were successful in 4. Revision of the ureteral anastomosis was required in 1 case of fistula and 2 cases of stenosis (0.9%). Extrinsic compression resulted in ureteral obstruction in 3 cases (2 lymphoceles and 1 hematoma), which resolved following drainage. Stent related complications occurred in 8 patients (2.2%), including obstruction due to the stent in 2 cases, breakage during removal in 3 leaving fragments in the upper urinary tract, proximal migration of 2 stents that were retrieved via percutaneous nephrostomy and calculus formation on 1 stent in a patient with hyperparathyroidism, necessitating extracorporeal shock wave lithotripsy for stent removal. In the cases with ureteral or stent related complications 1-year patient and graft survival was 100%. These results suggest that ureteral stents used routinely in renal transplantation are associated with a low incidence of urinary leaks, early postoperative obstruction and subsequent surgery for urological complications. However, a small number of unique problems related to stent use or malfunction may occur. Minimally invasive strategies using percutaneous nephrostomy and antegrade stenting are effective in managing the majority of complications that occur following ureteral stenting in renal transplant recipients.
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Affiliation(s)
- D L Nicol
- Department of Surgery, University of Queensland, Australia
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Mesrobian HG, Miller CG, Hatchett RL, Azizkhan RG, Lacey SR. Modified extravesical ureteral reimplantation in pediatric renal transplantation: 5 years of experience. J Urol 1992; 147:1340-2. [PMID: 1569679 DOI: 10.1016/s0022-5347(17)37559-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Numerous surgical procedures have been described to reimplant the ureter into the bladder during renal transplantation. Since November 1985 we have used a modified extravesical technique in 19 children. At the time of transplantation patient age ranged from 2 to 17 years (average age 10 years). Of these patients only 2 received a cadaveric kidney. Postoperative followup ranged from 4 to 54 months (average 32 months). No immediate or delayed urological complications were noted, and all but 1 graft has continued to function. This procedure is not only expeditious and safe but it also eliminates a long cystostomy suture line and requires a short ureteral length. Urinary leakage and ureteral obstruction, 2 of the most common urological complications, have not been observed in our patients. Although further experience and longer followup are required, this technique has become our procedure of choice for ureteral reimplantation in children undergoing renal transplantation.
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Affiliation(s)
- H G Mesrobian
- Section of Pediatric Urology, University of North Carolina, Chapel Hill 27599-7235
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21
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Thomalla JV, Leapman SB, Filo RS. The use of internalised ureteric stents in renal transplant recipients. BRITISH JOURNAL OF UROLOGY 1990; 66:363-8. [PMID: 2224430 DOI: 10.1111/j.1464-410x.1990.tb14955.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Since 1982, we have used internal indwelling ureteric stents for the management and prevention of ureteric reconstruction complications in 28 renal allograft recipients. A total of 30 stents were placed in 18 patients either diagnostically or therapeutically in the management of allograft ureteric obstruction. In 16 patients internal stents were placed at the time of reconstruction for primary ureteropyelostomy (3), secondary ureteropyelostomy (8), repeat reimplant (3) and repair of ureteric or pelviureteric junction injury (2). Complications included 3 episodes of transplant pyelonephritis, proximal stent migration (1), persistent bacteriuria (1) and prolonged healing of a ureteropyelostomy (1). Internalised ureteric stenting is a safe and effective means of managing or preventing ureteric reconstruction complications in renal transplant recipients.
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Affiliation(s)
- J V Thomalla
- Department of Surgery, Indiana University Medical Center, Indianapolis
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22
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Prompt CA, Manfro RC, Ilha DDO, Koff WJ. Caliceal-cutaneous fistula in renal transplantation: successful conservative management. J Urol 1990; 143:580-1. [PMID: 2304175 DOI: 10.1016/s0022-5347(17)40026-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Caliceal-cutaneous fistula is an uncommon complication of renal transplantation that frequently leads to graft resection. We report our experience with the successful conservative management of a case of caliceal-cutaneous fistula secondary to acute allograft rejection in a renal transplant recipient.
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Affiliation(s)
- C A Prompt
- Radiology Division, Hospital de Clinicas de Porto Alegre, Brazil
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23
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Alpenländisch-adriatisches Symposium für internationale zusammenarbeit in der rehabilitation. Eur Surg 1989. [DOI: 10.1007/bf02656242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Zaontz MR, Hatch DA, Firlit CF. Urological complications in pediatric renal transplantation: management and prevention. J Urol 1988; 140:1123-8. [PMID: 3054156 DOI: 10.1016/s0022-5347(17)41978-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
From 1973 through 1986, 166 consecutive renal transplants were performed in 143 patients. Urological complications included ureteral leakage/obstruction/necrosis, urinary tract infection, pyelonephritis, pelvic lymphocele, pelvic abscess, pelvic hematoma, infected hydrocele, bladder calculus, labial edema, renal artery/segmental stenosis, hydronephrosis, urinary incontinence, renal allograft malrotation and kidney rupture. Management options and preventive measures to avoid some of these dilemmas are highlighted.
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Affiliation(s)
- M R Zaontz
- Division of Urology, Children's Memorial Hospital, Chicago, Illinois
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25
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Witherington R, Benson DC, Humphries AL. Ureteroneocystostomy in renal transplantation: a simple transvesical technique. J Urol 1988; 140:270-2. [PMID: 3294440 DOI: 10.1016/s0022-5347(17)41580-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A simple transvesical technique for transplant ureteroneocystostomy is described. The method has been used in 245 transplants during a 6-year period. Only 4 significant complications (1.6 per cent) were recognized and no kidney was lost owing to a complication of ureteroneocystostomy.
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Affiliation(s)
- R Witherington
- Department of Surgery, Medical College of Georgia School of Medicine, Augusta
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26
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27
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Hickey DP, Glacken P, Gawley W, Carey J, Mulcahy M, McLean PA Hanson JS, Hanson JS, Murphy DM. Urological complications in 454 renal transplants. Ir J Med Sci 1988; 157:222-5. [PMID: 3049435 DOI: 10.1007/bf02949305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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28
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Ohl DA, Konnak JW, Campbell DA, Dafoe DC, Merion RM, Turcotte JG. Extravesical ureteroneocystostomy in renal transplantation. J Urol 1988; 139:499-502. [PMID: 3278129 DOI: 10.1016/s0022-5347(17)42503-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
From October 1970 to January 1986, 808 patients underwent renal transplant ureteroneocystostomy by an extravesical technique. Complications related to the anastomosis and/or ureter were reviewed. There were 23 total complications, for an over-all urological complication rate of 2.8 per cent. Of these complications 17 were related to the ureteroneocystostomy, for an anastomotic complication rate of 2.1 per cent. Complications were almost universally repaired by another operation. Two patients died and 1 lost the allograft because of urological complications.
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Affiliation(s)
- D A Ohl
- Department of Surgery, University of Michigan Medical Center, Ann Arbor
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29
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McDonald JC, Landreneau MD, Hargroder DE, Venable DD, Rohr MS. External ureteroneocystostomy and ureteroureterostomy in renal transplantation. Ann Surg 1987; 205:428-31. [PMID: 3551859 PMCID: PMC1492728 DOI: 10.1097/00000658-198704000-00014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Reported are 204 primary external ureteroneocystostomies and 16 primary ureteroureterostomies in a series of 220 consecutive renal transplants. A total of 12 (5%) complications occurred; however, only seven (3%) required major operative repair, whereas five (2%) were minor and were repaired by cystoscopic or transvesical procedures. There was no mortality and no allograft loss from these complications, which tend to occur late and be amenable to prompt repair. Since the complications of external ureteroneocystostomy differ from those of the internal ureteroneocystostomy, a discussion of their treatment is provided. A review of literature shows that the external repair is growing in popularity because of its good results. The good results are attributable to the use of a short length of ureter, to the use of a continuous monofilament suture that produces an anastomosis less likely to leak, and to the need of a very small cystostomy.
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30
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Abstract
The surgical aspects of renal transplantation have now been studied thoroughly. Yet, technical complications are still common. This review may seem too complex, but proper attention to many small details means the difference between success and failure, or at least between large and small morbidity. Reduction of genitourinary complications is due to many innovations. The external ureteroneocystostomy is a primary method of urinary reconstruction which is simpler and produces fewer complications than the alternative procedures. Further, the complications that do occur are more easily and promptly treated. The end-to-side ureteroureterostomy, as currently performed, provides a ready secondary method of reconstruction if the primary method fails. The early exploration and operative correction of genitourinary complications substantially reduces long-term morbidity and mortality.
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31
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Rajfer J, Koyle MA, Ehrlich RM, Smith RB. Pyelovesicostomy as a form of urinary reconstruction in renal transplantation. J Urol 1986; 136:372-5. [PMID: 3525856 DOI: 10.1016/s0022-5347(17)44872-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The development of ureteral obstruction or ureteral fistula formation in the renal transplant recipient usually requires surgical repair. This involves reconnecting the donor ureter to either the recipient ureter (ureteroureterostomy) or bladder (ureteroneocystostomy), or creating an anastomosis between the renal pelvis and recipient native ureter (pyeloureterostomy). Occasionally, the donor or recipient ureter is absent, necrotic or diseased so that a ureteroureterostomy, ureteroneocystostomy or pyeloureteral anastomosis cannot be performed. In 8 such cases we have performed a direct anastomosis between the donor renal pelvis and recipient bladder (pyelovesicostomy) with a followup of between 2 months and 11 years. In all 8 patients there has been no deterioration in renal function attributed to obstruction at the anastomotic site or to the free reflux between the bladder and renal pelvis. Because of the excellent short-term and long-term results of pyelovesicostomy, this procedure should be considered as an excellent alternative to pyeloureterostomy, ureteroureterostomy and ureteroneocystostomy in the reconstruction of the upper urinary tract of the renal transplant patient.
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32
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Landau R, Botha JR, Myburgh JA. Pyeloureterostomy or ureteroneocystostomy in renal transplantation? BRITISH JOURNAL OF UROLOGY 1986; 58:6-11. [PMID: 3512020 DOI: 10.1111/j.1464-410x.1986.tb05417.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A retrospective comparison of pyeloureterostomy and external ureteroneocystostomy as methods of reconstructing the urinary tract in 128 renal transplants is presented. There was one urological complication in 52 pyeloureterostomies (1.9%) compared with 4 in the 76 ureteroneocystostomies (5.3%). 6/0 Polydioxanone (PDS) is preferred to Prolene for the anastomosis because of possible calculus formation on the latter. Wound sepsis is commoner in pyeloureterostomies undergoing concomitant nephrectomy, despite prophylactic antibiotics, though this is not statistically significant and the overall sepsis rate is higher for ureteroneocystostomy. Nephrectomy was avoided in 17 selected cases by simply ligating the recipient ureter where the pre-transplant urine output was low. Two of these patients developed hydronephrosis in the isolated kidney and required later nephrectomy.
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Thomalla JV, Lingeman JE, Leapman SB, Filo RS. The manifestation and management of late urological complications in renal transplant recipients: use of the urological armamentarium. J Urol 1985; 134:944-8. [PMID: 3903218 DOI: 10.1016/s0022-5347(17)47540-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The incidence of urological complications in renal transplant patients is well documented. The majority of these complications occur in the early postoperative period; late occurrences (more than 3 months) are much less common. We have had experience with 7 patients who presented with late complications 3 months to 7 years after transplantation: ureteral obstruction occurred in 4 patients, ureteral disruption or laceration in 2 and neurogenic bladder with hydronephrosis in 1. Management of these patients has been varied and has included cystoscopic stent placement, Boari flap, ureteropyelostomy, ureteroneocystostomy, bladder augmentation and urinary undiversion. Grafts have been salvaged in 6 of 7 patients. Transplant patients who present with late urological complications can be challenging. However, the potential for intervention and graft salvage is excellent.
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34
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Abstract
A total of 43 consecutive renal transplant patients underwent extravesical ureteroneocystostomy via a parallel incision. The only urological complication (ureteral obstruction from a blood clot) did not appear to be related to this recently described technique. There were no instances of urinary leakage, extrinsic ureteral obstruction or reflux. This simplified technique of ureteroneocystostomy seems well suited to the special challenges presented by renal transplant patients.
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35
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Barry JM, Hatch DA. Parallel incision, unstented extravesical ureteroneocystostomy: followup of 203 kidney transplants. J Urol 1985; 134:249-51. [PMID: 3894690 DOI: 10.1016/s0022-5347(17)47113-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A parallel incision, unstented extravesical ureteroneocystostomy was used in 203 human kidney transplants. The reoperation rate was 1 per cent. Extravasation of urine occurred in 3 patients, 1 of whom required surgical repair. One patient required transurethral fulguration of a ureteral bleeder. Two patients had grade 1 reflux and none required repair. No patient had ureteral obstruction at the anastomosis. This simple technique is useful because ureteral length and bladder dissection are minimal, and no separate cystotomy is required. The adequacy of the submucosal tunnel is judged when the ureter is passed through it.
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36
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Carcillo J, Salcedo JR. Urinothorax as a manifestation of nondilated obstructive uropathy following renal transplantation. Am J Kidney Dis 1985; 5:211-3. [PMID: 3883762 DOI: 10.1016/s0272-6386(85)80053-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A 12-year-old patient developed prolonged nondilated urinary obstruction and pleural effusion shortly after undergoing renal transplantation. Renal sonography, angiography, and isotope renography failed to identify an obstructive process. On the 18th postoperative day, pleural effusion was noted in the right hemithorax, and by day 24, increased perinephric fluid was observed on renal scan. Following a nephrostomy, the pleural effusion resolved and renal function improved remarkably. A ureterovesical junction obstruction and renal pelvis tear that were later discovered were repaired. Whenever a ureteral obstruction is suspected the diagnosis should be pursued vigorously, despite normal radiologic findings, especially in the presence of pleural effusion. Consideration of the possibility of urinothorax in such cases may obviate the need for lung biopsy.
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Wahlberg J, Tufveson G, Frödin L. Urologic complications in 159 consecutive renal transplantations. Ups J Med Sci 1985; 90:157-62. [PMID: 3909594 DOI: 10.3109/03009738509178653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The urologic complications were reviewed in 159 consecutive renal transplantations. There were 23 major complications (14%) in 22 patients. One patient died as a consequence of urologic complications and two other grafts were lost. In the remaining cases the grafts could be saved by surgical revision or conservative treatment. The principles of diagnosis and treatment of these complications are discussed.
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38
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Sagalowsky AI. Editorial Comment. J Urol 1985. [DOI: 10.1016/s0022-5347(17)48767-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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Donnelly PK, Farndon JR, Roy RR. Donor ureteric calculus presenting as acute rejection in a renal transplant recipient. BMJ : BRITISH MEDICAL JOURNAL 1984; 288:1961-2. [PMID: 6428622 PMCID: PMC1442217 DOI: 10.1136/bmj.288.6435.1961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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40
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Sagalowsky AI, Gailiunas P, Helderman JH, Hull AR, Dickerman RM, Ransler CW, Atkins C, Peters PC. Renal transplantation in diabetic patients: the end result does justify the means. J Urol 1983; 129:253-5. [PMID: 6339741 DOI: 10.1016/s0022-5347(17)52036-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There were 49 insulin-dependent diabetics who received 52 renal allografts: 13 from living related and 39 from cadaveric donors. The mean age and time on dialysis were similar for both recipient groups. Patient survival at 1 and 2 years was 100 per cent for living related donor recipients, and 76 and 56 per cent at 1 and 2 years for cadaveric recipients. Renal allograft survival was 92 and 85 per cent at 1 and 2 years for living related donor recipients. Cadaveric allograft survival was 49 and 41 per cent at 1 and 2 years. The cumulative mortality rate was 39 per cent and the over-all surgical morbidity was low. Renal transplantation in diabetic patients is worthwhile from the standpoint of patient and allograft survival.
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