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Giulioni C, Palantrani V, De Stefano V, Cicconofri A, Antezza A, Beltrami M, Milanese G, Ranghino A, Gauhar V, Castellani D, Galosi AB. Current Evidence on Surgical Management for Benign Prostatic Hyperplasia in Renal Transplant Recipients: A Systematic Review. J Endourol 2023; 37:1129-1138. [PMID: 37597196 DOI: 10.1089/end.2023.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Background: Patients who have undergone renal transplant may have a concomitant benign prostatic hyperplasia (BPH), a condition that can potentially hinder the recovery of the renal graft and necessitate surgical intervention. However, endoscopic treatment of BPH should be performed carefully because of the associated perioperative risks. We aimed to systematically assess the factors affecting surgical indications and perioperative outcomes of BPH surgical treatment in renal transplantation (RT) recipients. Methods: A systematic literature search was performed on January 28, 2023, using Scopus, PubMed, and EMBASE with no date limit. Preclinical and animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Results: Eighteen articles were accepted and included. Clinical BPH has a high incidence rate after RT, particularly in elderly men. Secondary events associated with BPH, such as acute urinary retention and urinary tract infections, can lead to a gradual decline of renal graft function and patient survival. BPH procedure can prevent these events and guarantee improvements in serum creatinine levels, voiding parameters, and lower urinary tract symptoms. When the urine culture is negative, the endoscopic procedure of the prostate may be performed within 1 month of the initial procedure, particularly in older patients, more prone to develop voiding dysfunction. Alternatively, a transurethral incision of the prostate may be recommended for patients with smaller prostates who wish to preserve ejaculatory function. Data on comparative BPH surgical procedures are lacking. Conclusions: BPH procedure should be offered in RT recipients who develop bladder outlet obstruction owing to BPH. Endoscopic treatment should be performed after a few weeks from RT to avoid further graft deterioration.
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Affiliation(s)
- Carlo Giulioni
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Vanessa Palantrani
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Virgilio De Stefano
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Cicconofri
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Angelo Antezza
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Mattia Beltrami
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Milanese
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Ranghino
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Benedetto Galosi
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
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Righetto M, Mancini M, Modonutti D, Calpista A, Beltrami P, Dal Moro F. Patients with renal transplant and moderate-to-severe LUTS benefit from urodynamic evaluation and early transurethral resection of the prostate. World J Urol 2021; 39:4397-4404. [PMID: 34480590 PMCID: PMC8602205 DOI: 10.1007/s00345-021-03799-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To assess long-term renal function and micturition pattern of males submitted to transurethral resection of the prostate (TURP) for moderate-to-severe lower urinary tract symptoms (LUTS) after renal transplantation (RT). To investigate the role of clinical and urodynamic (UD) parameters for bladder outlet obstruction (BOO) diagnosis in these patients. Methods Retrospective data analysis of ≥ 50 years old patients who underwent RT between 01/2005 and 12/2016. Patients with moderate-to-severe LUTS after RT who underwent a urologic evaluation and a UD study were included. TURP was performed in case of BOO diagnosis. Kidney function and micturition patterns were evaluated before, 3, 12, 24, 36, and 48 months after TURP. Predictors of BOO were assessed at univariable and multivariable logistic regression models. Statistical analysis was performed with STATA16. Results 233 male patients ≥ 50 years underwent RT. 71/233 (30%) patients developed voiding LUTS. 52/71 (73%) patients with moderate-to-severe LUTS underwent UD. TURP was performed in 36/52 (69%) patients, with BOO diagnosis. Median (interquartile range) follow-up was 108 (75–136) months. Maximum flow at flowmetry (Qmax), International Prostate Symptom Score and post-voided residual volume improved significantly after surgery. Serum creatinine decreased and glomerular filtration rate improved significantly at follow-up, especially when TURP was performed ≤ 6 months from RT. At the multivariable model, bladder capacity ≥ 300 mL (OR = 1.74, CI 95% 1.03–3.15, p = 0.043) and detrusor pressure at Qmax (OR = 2.05, CI 95% 1.48–3.02, p = 0.035) were the independent predictors of BOO. Conclusion RT patients with moderate-to-severe LUTS at risk for BOO and graft failure are better identified by UD than clinical parameters. Bladder capacity and voiding pressure are key for the early diagnosis of BOO.
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Affiliation(s)
- Marialaura Righetto
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
| | - Mariangela Mancini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy. .,Urological Clinic, University Hospital of Padova, Padova, Italy.
| | - Daniele Modonutti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
| | - Arturo Calpista
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
| | - Paolo Beltrami
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
| | - Fabrizio Dal Moro
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
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de Oliveira Marinho AC, Tavares-da-Silva E, Bastos CA, Roseiro A, Parada B, Retroz E, Marconi L, Moreira P, Nunes P, Simões P, Santos L, Romãozinho C, Figueiredo A. Acute Urinary Retention After Kidney Transplant: Effect on Graft Function, Predictive Factors, and Treatment. Transplant Proc 2021; 53:1933-1938. [PMID: 34275596 DOI: 10.1016/j.transproceed.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 04/03/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is common in older adults. Although BPH may be asymptomatic in patients with chronic kidney disease (CKD) with low diuresis, the condition may become troublesome when diuresis resumes after transplantation. This study evaluated the effect that developing acute urinary retention (AUR) in first 4 months after kidney transplantation (KT) can have on graft function at 6 months. The study identified predictive factors and analyzed treatment of AUR in these patients. METHODS This study retrospectively included 303 men who received KT. Independent samples Student t test was used to compare glomerular filtration rates (GFRs) at 6 months. Logistic regression was applied to identify predictors of AUR. RESULTS The study found that 14 patients developed AUR within the first 4 months after KT. This group had lower GFR at 6 months post-KT. Nine patients required transurethral resection of the prostate, and 2 of these patients developed acute graft pyelonephritis following resection. Residual diuresis and recipient age were predictive factors. Recipient age >55 years was a risk factor. Medical therapy of BPH before transplantation was a protective factor. CONCLUSIONS Developing AUR in the first 4 months after KT was associated with lower graft GFR at 6 months, and transurethral resection of the prostate was required in 64% of these patients, with good results. Medical therapy for BPH before the transplant was associated with a lower risk of AUR. Older patients and patients with pretransplant low urine output had a higher risk of AUR. These patients should be closely monitored in the posttransplant period for the presence of obstructive uropathy.
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Affiliation(s)
| | - Edgar Tavares-da-Silva
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Carlos Alberto Bastos
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - António Roseiro
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Belmiro Parada
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Edson Retroz
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Lorenzo Marconi
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Pedro Moreira
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Pedro Nunes
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Pedro Simões
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Lídia Santos
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Catarina Romãozinho
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Service of Urology and Renal Transplantation, Hospital and University Center of Coimbra, Coimbra, Portugal
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Sarier M, Yayar O, Yavuz A, Turgut H, Kukul E. Update on the Management of Urological Problems Following Kidney Transplantation. Urol Int 2021; 105:541-547. [PMID: 33508852 DOI: 10.1159/000512885] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
Urological problems in kidney transplant recipients are not limited only to posttransplantation urological complications. These problems are a cause of significant patient mortality and morbidity that have wide-ranging effects on graft survival throughout the entire life of the graft. Ultimately, the transplant comprises a major portion of the urinary system; therefore, the transplant team should be prepared for foreseeable and unforeseeable urological problems in the short and long terms. These mainly include postoperative urological complications (urine leakage, ureteral stenosis, and vesicoureteral reflux), bladder outlet obstruction, and graft urolithiasis. In recent years, significant advances have been made in the management of urological complications, especially due to advances in endourologic interventions. The aim of this review is to summarize the management of urological problems after kidney transplantation in the context of the current literature.
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Affiliation(s)
- Mehmet Sarier
- Department of Urology, Istinye University, Istanbul, Turkey,
| | - Ozlem Yayar
- Department of Nephrology, Medical Park Hospital, Antalya, Turkey
| | - Asuman Yavuz
- Department of Nephrology, Medical Park Hospital, Antalya, Turkey
| | - Hasan Turgut
- Faculty of Health Science, Avrasya University, Trabzon, Turkey
| | - Erdal Kukul
- Department of Urology, Medical Park Hospital, Antalya, Turkey
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Neri F, Di Bella C, Leone S, Bencini G, Silvestre C, Tuci F, Rigotti P, Furian L. Lower Urinary Tract Symptoms in Kidney Transplant Recipients and Timing of Treatment With TURP: Impact on Renal Graft Survival and Function. Transplant Proc 2019; 51:2921-2926. [PMID: 31627917 DOI: 10.1016/j.transproceed.2019.02.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/17/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND With the aging of recipients of renal transplantation (RT) one of the emerging issues is the incidence of low urinary tract symptoms (LUTS), which may have negative consequences on the graft survival and function. The aim of our study was to assess the influence of LUTS and the treatment with transurethral resection of the prostate (TURP) on the outcome of RT. MATERIALS AND METHODS We collected data from men over 55 who underwent RT at our center from January 2007 to December 2016. We analyzed the incidence of LUTS; the rate of treatment with TURP; the eGFR (estimated glomerular filtration rate) at 6 months and 1, 3, and 5 years from transplantation; and graft survival. RESULTS Fifty-five patients out of 268 experienced LUTS, and 19 of them had a bladder outlet obstruction (BOO). Patients experiencing BOO had a significantly higher hazard ratio (HR) of graft failure (HR 5.7, CI 1.56-21.4) compared to the other recipients. Of the 18 patients treated with TURP, 10 received the procedure within 6 months from the LUTS onset. They had a significantly absolute eGFR improvement at 6 months from the intervention (+14.25 mL/min ± 8.10) compared to the patients treated later (-8.4 mL/min ± 14.43). DISCUSSION We showed the negative effects of LUTS on kidney graft function and survival. Although TURP is the standard therapy for such an issue, the best timing for it still has to be defined. Our experience supports the need for an early treatment of the LUTS for promoting the outcome of the RT.
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Affiliation(s)
- Flavia Neri
- Kidney Pancreas Unit, University Hospital of Padua, Padua, Italy.
| | | | - Sara Leone
- Kidney Pancreas Unit, University Hospital of Padua, Padua, Italy
| | - Giulia Bencini
- Kidney Pancreas Unit, University Hospital of Padua, Padua, Italy
| | | | - Francesco Tuci
- Kidney Pancreas Unit, University Hospital of Padua, Padua, Italy
| | - Paolo Rigotti
- Kidney Pancreas Unit, University Hospital of Padua, Padua, Italy
| | - Lucrezia Furian
- Kidney Pancreas Unit, University Hospital of Padua, Padua, Italy
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Prise en charge de l’obstacle sous vésical lié à une HBP chez les patients à terrain particulier et/ou ayant une complication. Prog Urol 2018; 28:868-874. [DOI: 10.1016/j.purol.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022]
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Sarıer M, Duman İ, Demir M, Yüksel Y, Emek M, Kukul E. The outcomes of transurethral incision/resection of the prostate (TUIP/TURP) performed early after renal transplantation. Turk J Urol 2018; 44:172-177. [PMID: 29511589 PMCID: PMC5832381 DOI: 10.5152/tud.2018.98404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/19/2017] [Indexed: 08/21/2023]
Abstract
OBJECTIVE In the early period after renal transplantation, urinary retention stemming from bladder outlet obstruction (BOO) may directly affect graft success. The aim of this study was to evaluate the early and long-term outcomes of transurethral resection of the prostate (TURP) and transurethral incision of prostate (TUIP) procedures performed in the first month following RT due to BOO. MATERIAL AND METHODS Between February 2009 and March 2016, 38 male patients underwent TURP/TUIP due to BOO within the first 30 days of renal transplantation. The urodynamic and renal function assessment results of all patients were collected during the pre-and postoperative periods. All patients were followed up for a minimum of 12 months for short and long-term complications. The results were evaluated retrospectively. RESULTS The mean age of the patients who underwent operations was 59.2±12 years. The median duration of dialysis was 41 months (range 0-180). Before the operation the mean serum creatinine (sCr) level was 1.8±0.7 mg/dL, the mean total PSA level was 1.6±1.1 ng/mL. Of the voiding parameters, the mean Qmax and Qave were measured as 8.2±4.5 mL/sec and 4.6±2.5 mL/sec, respectively. The median post-micturition residual urine (PMR) was 105 mL (range 10-400). TURP/TUIP operations were performed at a median of 19 days (range 8-30) after renal transplantations. None of the patients experienced major complications. In the early postoperative period, 5 patients (13.1%) developed urinary tract infection. The mean decrease in sCr in the first month following TURP/TUIP was 1.4±0.4 mg/dL (p<0.001). The mean Qmax (22.4±11.1 mL/sec), and Qave (11.7±5.4 mL/sec) increased significantly (p<0.001), while the median PMR (15 mL, range 0-205) decreased significantly (p<0.001). The mean follow-up period after the procedure was 46.8±23.3 months. During the follow-up period, 3 (7.8%) patients suffered from urethral stricture and 2 (5.2%) patients from bladder neck obstruction. CONCLUSION In the surgical treatment of urinary retention arising from BOO in the first month following renal transplantation, TURP/TUIP yield safe and successful results. In addition, regarding the short and long term outcomes, these procedures may be safely performed with low morbidity.
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Affiliation(s)
- Mehmet Sarıer
- Department of Urology, Altınbaş University School of Medicine, İstanbul, Turkey
| | - İbrahim Duman
- Department of Urology, Altınbaş University School of Medicine, İstanbul, Turkey
| | - Meltem Demir
- Department of Clinical Biochemistry, Altınbaş University School of Medicine, İstanbul, Turkey
| | - Yücel Yüksel
- Department of Transplantation Unit, Medical Park Hospital, Antalya Turkey
| | | | - Erdal Kukul
- Department of Urology, Medical Park Hospital, Antalya, Turkey
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Troubles du bas appareil urinaire et de la statique pelvienne chez les candidats et receveurs d’une transplantation rénale. Prog Urol 2016; 26:1114-1121. [DOI: 10.1016/j.purol.2016.09.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022]
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Ergesi B, Winkler Y, Kistler T, Grimm MO, John H, Horstmann M. Prevalence and Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Obstruction in a Contemporary Series of Renal Transplant Recipients. Nephrourol Mon 2016; 8:e35497. [PMID: 27231686 PMCID: PMC4879790 DOI: 10.5812/numonthly.35497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/11/2016] [Indexed: 01/27/2023] Open
Abstract
Background The kidney is the most frequently transplanted human organ worldwide. In patients with end-stage renal failure, renal transplantation improves both quality of life and life expectancy. The current literature indicates that the numbers of renal recipients over 60 years of age has increased in recent years. Objectives To evaluate the prevalence and management of lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO) in a contemporary series of male renal transplant (RTx) recipients. Materials and Methods We retrospectively evaluated 150 consecutive transplant recipients at the University of Jena 12 months postoperatively for the presence and treatment of LUTS related to BPO. Results The mean age of the patients was 59 years (range 27 - 82 years). By 12 months postoperatively, 91% (n = 137/150) were off dialysis with a functioning kidney graft. Two patients died during follow up. Six patients had undergone treatment for prostate cancer prior to RTx. Of the remaining 131 patients, 47% (n = 62/131) were considered as patients with BPO 12 months after RTx. Six percent (n = 8/131) of the patients experienced urinary retention due to BPO and 6% (n = 8/131) had a transurethral resection of the prostate (TURP) during the first year after RTx. No major complications were observed in those patients. A significant increase was noted in the use of α-blocker therapy after RTx (P = 0.004). Conclusions We observed a high prevalence of LUTS related to BPO in our cohort of patients. Due to the increasing age of transplant recipients, more attention should be paid to the evaluation and treatment of BPO prior to RTx.
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Affiliation(s)
- Bjorn Ergesi
- Department of Urology, Kantonsspital Winterthur, Brauerstr, Winterthur, Switzerland
- Department of Urology, Jena University Hospital, University of Jena, Lessingstr, Jena, Germany
| | - Yvonne Winkler
- Department of Urology, Jena University Hospital, University of Jena, Lessingstr, Jena, Germany
| | - Thomas Kistler
- Department of Nephrology, Kantonsspital Winterthur, Brauerstr, Winterthur, Switzerland
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, University of Jena, Lessingstr, Jena, Germany
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Brauerstr, Winterthur, Switzerland
| | - Marcus Horstmann
- Department of Urology, Jena University Hospital, University of Jena, Lessingstr, Jena, Germany
- Corresponding author: Marcus Horstmann, Department of Urology, Jena University Hospital, University of Jena, Lessingstr, Jena, Germany. Tel: +49-3641935199, E-mail:
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Silva DM, Prudente AC, Mazzali M, Borges CF, D'Ancona C. Bladder Function Evaluation Before Renal Transplantation in Nonurologic Disease: Is It Necessary? Urology 2014; 83:406-10. [DOI: 10.1016/j.urology.2013.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 09/05/2013] [Accepted: 09/11/2013] [Indexed: 11/16/2022]
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The current role of endourologic management of renal transplantation complications. Adv Urol 2013; 2013:246520. [PMID: 24023541 PMCID: PMC3760203 DOI: 10.1155/2013/246520] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/20/2013] [Accepted: 07/22/2013] [Indexed: 01/25/2023] Open
Abstract
Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter). Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common.
Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.
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Volpe A, Billia M, Quaglia M, Vidali M, Marchioro G, Ceratti G, Sogni F, De Lorenzis E, De Angelis P, Airoldi A, Stratta P, Terrone C. Transurethral resection of the prostate in kidney transplant recipients: urological and renal functional outcomes at long-term follow-up. BJU Int 2013; 112:386-93. [PMID: 23496755 DOI: 10.1111/bju.12030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess prospectively the safety and efficacy of transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms attributable to benign prostatic hyperplasia (BPH) in patients who have undergone renal transplantation (RT). To assess the impact of TURP on renal graft function. PATIENTS AND METHODS Urological and renal functional outcomes of TURP performed in RT recipients for treatment of lower urinary tract obstruction attributable to BPH were prospectively assessed in a series of 32 consecutive patients with follow-up of ≥48 months. Maximum urinary flow rate (Qmax ) at uroflowmetry, International Prostate Symptom Score (IPSS), post-void residual urine volume (PVR), haemoglobin and serum creatinine (sCr) levels were recorded before TURP and 1, 6, 24 and 48 months after the procedure. The trends in these variables after TURP were evaluated. Early and delayed complications were assessed and graded according to the Clavien classification system. RESULTS TURP was performed at a mean of 6 months after RT. No intraoperative complications occurred. Seven postoperative complications were observed (21.9%): two Clavien grade II and five Clavien grade IIIa. Qmax , IPSS and PVR improved significantly after surgery and the improvement was maintained until 48 months. No patient required a repeat TURP during follow-up. SCr levels significantly decreased 1 and 6 months after TURP and did not significantly increase at long-term follow-up. CONCLUSIONS TURP for lower urinary tract obstruction attributable to BPH in RT recipients is safe and effective since it improves urinary flow, bladder emptying and related urinary symptoms. TURP allows an early significant improvement of graft function that is maintained at a follow-up of 48 months.
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Affiliation(s)
- Alessandro Volpe
- Division of Urology, University of Eastern Piedmont, Novara, Italy.
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Current world literature. Curr Opin Urol 2012. [PMID: 23202289 DOI: 10.1097/mou.0b013e32835bb149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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