Comparative urologic complications of ureteroneocystostomy in kidney transplantation: transvesical Leadbetter-Politano versus extravesical Lich-Gregoir technique

BACKGROUND

The incidence of urologic complications after kidney transplantation remains high despite improvements in diagnosis and operative techniques. Urinary tract reconstruction is usually done by ureteroneocystostomy (UCNS), and several techniques are available. In this study, we evaluated the outcomes of 2 different UCNS techniques performed in our department, the transvesical Leadbetter-Politano (L-P) and the extravesical Lich-Gregoire (L-G) technique.

MATERIAL AND METHODS

We evaluated the outcomes of 2 different UCNS techniques, L-P versus L-G, performed in our department between July 1, 2006, and December 31, 2011. During this period, we performed 524 consecutive renal transplantations-264 cases using the L-P technique (50.3%) and 260 cases with L-G technique (49.7%). Renal grafts were obtained from cadaveric donors in 146 cases (27.86%) and from living-related donors in 378 cases (72.14%). Recipient mean age was 35.64 years and the male to female ratio was 1.63:1.

RESULTS

Urologic complications after kidney transplantation occurred in 22 cases in the L-P UCNS group (8.33%). The most common complications were ureteral stenosis (3.41%) and leakage (2.65%). Other complications recorded were lymphoceles (1.89%) and hematoma with secondary ureteral obstruction (0.38%). Compared with the L-P UCNS technique, the L-G technique was associated with fewer overall complications (6.15% vs 8.33%; P = .06), a lesser rate of ureteral stenosis (2.31% vs 3.41%; P = .08), and a similar rate of leakage. However, statistical analysis revealed no differences between the 2 techniques (P = .06). In addition, we did not note any differences in graft and patient survival between the 2 groups.

CONCLUSIONS

In our study, the extravesical L-G technique has a lower complication rate compared with transvesical L-P procedure, but without statistical differences. Furthermore, the L-G technique is easier and faster to perform, it avoids a separate cystotomy, and requires a shorter ureteral length. In conclusion, we recommend L-G technique as technique of choice in kidney transplantation.

Management of high-risk non-muscle invasive bladder cancer

Risk stratification is of paramount importance for the future treatment and follow-up of patients with transitional cell carcinoma (TCC) of the bladder. Transurethral resection (TUR) is the gold standard for initial diagnosis and treatment of non muscle invasive bladder cancer (NMIBC). Muscle must be present in the pathological specimen in order to correctly stage the tumor. When muscle is not present, the tumor has to be staged as Tx. A second TUR done after two-six weeks of the first resection reduces the rate of tumor left behind and improves staging. Re-TUR in these patients should be considered a must. Since BCG is toxic, an attempt to reduce toxicity was made by reducing the dose. CUETO group showed that 1/3 dose BCG was as effective as full dose in intermediate risk patients but not in high risk. Another study that evaluated the efficacy of low dose BCG is the trial 30962 from EORTC. The results showed a difference of 10% in the five-years recurrence free survival only when 1/3 dose BCG for one year (54.5%) was compared to Full dose BCG for three years (64.2%) suggesting that 1/3 dose or one year full dose are suboptimal treatments. Immediate radical cystectomy should be considered for high grade, multiple T1 tumors, T1 tumors located at a site difficult to resect, residual T1 tumors after resection or high grade tumors with CIS and lymphovascular invasion. Cystoscopy and cytology must be performed at three months. In the case of negative findings, following cystoscopy and cytology assessments have to be repeated every three months for three years, and every six months thereafter until five years, and then annually. For the group of patients with initial BCG induction therapy failure that are unfit or refuse radical cystectomy or have a low or intermediate grade disease an additional course of l BCG is a choice. For patients who failed before completion of maintenance BCG, radical cystectomy has to be considered in presence of a high grade T1 or CIS. BCG maintenance (full dose three years) after Re-TUR is the standard therapy in high-risk TCC of the bladder. Dose reduction to 1/3 dose or one year full dose are suboptimal treatments. Immediate radical cystectomy is indicated in young patients with high-grade T1 tumors who have at least one additional factor associated with a poor prognosis such as: multifocality, associated CIS, prostatic involvement, tumor located at a site difficult to resect, limphovascular invasion. Radical cystectomy is also indicated in patients who recur after three months of therapy as T1 high grade. Device assisted chemotherapy (EMDA, Synergo with MMC) may have a role in BCG failure or BCG resistant patients who cannot receive or refuse cystectomy. Postponing radical cystectomy until progression to muscle invasive disease may have a negative impact on survival.

[Congenital oropharyngeal tumors in the newborn: problems in team diagnosis and treatment]

There are a great variety of lesions of oral cavity which may require surgical intervention in neonatal period. The differential diagnoses include tumors (malignant, teratoma, cystic hygroma, lymphangioma, hemangioma), congenital epulis, dermoid cysts, ranula. Congenital epulis of the newborn is a rare tumour which is usually benign. Epulis is also known as a congenital gingival granular cell tumour because of its histological features. Female babies are affected 8-10 times more often than males. Epulis is located on the maxillary ridge twice as often as on the mandible, mostly as single tumours but rarely as multiple tumours. The histogenesis of the tumour is unknown. Spontaneous regression of congenital epulis has been reported in a few cases. However, surgical excision is generally indicated due to interference with feeding or respiration. Recurrence of the tumour after surgery has not been reported yet. We report two cases of congenital epulis, one in 2 hour female neonate and one in a 7 days male neonate. In spite of the rarity of this pathology, the interval between presentation in this two cases was ten days. In one case it was an antenatal diagnosis by ultrasonography, in the other it was associated a genital anomalies (hypospadias). The treatment was surgical excision. The intra- and postoperative course was uneventful.

[The results of the Sommerville-Petit procedure in the treatment of the typical congenital hip dislocation]

The studied group from the Pediatric Surgery and Orthopedics Clinic, Iaşi, consisted of 87 cases, which means that a total of 118 hips were treated between September 1998-September 2004. In 116 cases, the extension was performed with trans-femoral Kirschner wire, in a period of 3-7 weeks. After 7-14 days of extension, the authors performed adductor and sometimes psoas tenotomy. The stable orthopedic reduction was obtained in 34 hips, while the 15 cases with inadequate results required open reduction. This method, performed from the beginning after a period of extension, was applied to 69 cases. In 13 patients the iterative open reduction was required. None of the cases associated femoral diaphysis shortening resection.

[Profound necrosis--complication of the orthopedic treatment in congenital club foot. A case report]

The treatment of congenital club foot implies orthopaedic and operative methods. The complications of the treatment may result, in particular cases, from lack of follow-up and cooperation between the child parents and the doctor. These cases are a challenge for the orthopaedic surgeon, requiring multiple interventions and with a high morbidity. We present the case of a congenital club foot with profound necrosis secondary to a cast compression, which was not recognized by the parents.

Quantitative determination of rheumatoid factors in serum and synovial liquid of patients with rheumatoid arthritis using lyophilized standard products

The rheumatoid factors constitute one of the major autoantibodies in rheumatoid arthritis (RA). In this study, for the quantitative determination of the RF IgM class, in serum and synovial liquid of patients with RA and JRA, we used the hemagglutination principle and both liquid and lyophilized reagents. The results we obtained demonstrated the superiority regarding the stability, the reproducibility and the possibility of micromethod standardization with lyophilized reagent.