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Flegar L, Huber J, Putz J, Thomas C, Apel H, Wullich B, Friedersdorff F, Fechner G, Ritter M, Kernig K, Weigand K, Heynemann H, Stöckle M, Zeuschner P. Multicenter evaluation of complex urinary diversion for renal transplantation: outcomes of complex surgical solutions. World J Urol 2024; 42:239. [PMID: 38630278 PMCID: PMC11023965 DOI: 10.1007/s00345-024-04934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/18/2023] [Indexed: 04/19/2024] Open
Abstract
PURPOSE An abnormal lower urinary tract poses significant challenges for transplant surgeons. Besides the ureteral anastomosis to an ileal conduit, there are diverse complex reconstructive solutions. Due to its rarity, standardization and teaching of complex urinary diversion is extremely difficult. METHODS The indications and outcomes of complex urinary diversions after kidney transplantation (KT) were retrospectively investigated at eight urologic transplant centers including a current follow-up. RESULTS Of 37 patients with 21 (56%) males, vesicoureteral reflux (24%), spina bifida (22%), and glomerulonephritis (12%) were the most common causes of terminal renal failure. In 30 (81%) patients, urinary diversion was performed before KT, at a median of 107.5 (range, 10; 545) months before. Transplantations were held at a median patient age of 43 (10; 68) years, including six (16%) living donations. Urinary diversion was modified during 12 (32%) transplantations. After KT, the ileal conduit was the most common incontinent urinary diversion in 25 (67%) patients; a Mainz pouch I and bladder augmentation were the most frequent continent diversions (each n = 3). At a median follow-up of 120 months (range 0; 444), 12 (32%) patients had a graft failure with a 5-year graft survival of 79% (95%CI 61; 90). The median overall survival was 227 months (168; 286) and the 5-year overall survival 89% (69.3; 96.4). CONCLUSION The mid-term kidney transplant function with complex urinary diversion appears to be comparable to transplants with regular urinary diversions. Hence, complex urinary diversion should always be considered as a surgical option, even during transplantation, if necessary.
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Affiliation(s)
- Luka Flegar
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany.
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
| | - Juliane Putz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hendrik Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Transplant Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Transplant Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Guido Fechner
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Manuel Ritter
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany
| | | | - Karl Weigand
- Department of Urology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Hans Heynemann
- Department of Urology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
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Reimold P, Aksoy C, Beckmann J, Zacharis A, Groeben C, Karschuck P, Eisenmenger N, Geks J, Huber J, Flegar L. Development and outcomes of surgical and urological kidney transplantation programs in Germany: a total population analysis from 2006 to 2021. World J Urol 2024; 42:65. [PMID: 38300367 PMCID: PMC10834564 DOI: 10.1007/s00345-023-04740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/08/2023] [Indexed: 02/02/2024] Open
Abstract
PURPOSE Kidney transplantation (KT) is the most frequently performed organ transplantation. In Germany, KT is performed in urology and surgery departments with unknown consequences of this parallel structure. The aim of the study was to compare the development and outcome of KT in urology and surgery departments. METHODS On an institutional level, we analyzed the annual caseload from 2006 to 2021 with the reimbursement. INFO tool based on hospitals' quality reports (Reimbursement Institute, Hürth, Germany). For outcome comparison we extracted raw data from the transplantation centers' quality reports (Deutsche Stiftung Organtransplantation, DSO). RESULTS A total of 23,599 cases (17,781 deceased donor and 5,818 living donor KTs) were included. The total number of KTs decreased from 1851 in 2006 to 1701 in 2021 (- 8%; p = 0.12). The total number of urological KTs decreased from 592 cases in 2006 to 395 cases in 2021 (- 33.3%; p = 0.01). Further analysis revealed no significant differences between intra- and postoperative complications and graft quality at one year for deceased donor KTs (DDKT) although differences in immediate renal function and graft quality at discharge could be observed. There were no significant differences in immediate renal function and graft quality at discharge for living donor KTs (LDKT) between the specialties. CONCLUSION KTs performed in urology departments declined between 2006 and 2021. Nevertheless, intra- and postoperative complications as well as long-term function did not differ between surgical and urological KT programs. Hence, an interdisciplinary approach, especially considering the upcoming challenges in KT as, e.g., robot-assisted surgery seems reasonable.
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Affiliation(s)
- Philipp Reimold
- Department of Urology, Philipps-University Marburg, Marburg, Germany.
| | - Cem Aksoy
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Jonas Beckmann
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Philipp Karschuck
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Josef Geks
- Department of Surgery, Philipps-University Marburg, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Marburg, Germany
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Zacharis A, Reimold P, Aksoy C, Jung J, Martin T, Eisenmenger N, Thoduka SG, Groeben C, Huber J, Flegar L. Trends in kidney transplantation and living donor nephrectomy in Germany: a total population analysis from 2006 to 2021. World J Urol 2024; 42:24. [PMID: 38198066 PMCID: PMC10781803 DOI: 10.1007/s00345-023-04737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/13/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE To analyze recent trends of surgical access routes, length of hospital stay (LOS), and mortality in kidney transplantation (KT) and living donor nephrectomy (LDN) in Germany. MATERIALS AND METHODS We studied the nationwide German hospital billing database and the German hospital quality reports from 2006 to 2021. RESULTS There were a total of 35.898 KTs. In total, 9044 (25%) were living donor transplantations, while 26.854 (75%) were transplantations after donation after brain death (DBD). The share of open LDN decreased from 82% in 2006 to 22% in 2020 (- 4%/year; p < 0.001). The share of laparoscopic LDN increased from 18% in 2006 to 70% in 2020 (+ 3%/year; p < 0.001). The share of robotic LDN increased from 0% in 2006 to 8% in 2020 (+ 0.6%/year; p < 0.001). Robotic-assisted KT increased from 5 cases in 2016 to 13 procedures in 2019 (p = 0.2). LOS was shorter after living donor KT, i.e., 18 ± 12.1 days versus 21 ± 19.6 days for DBD renal transplantation (p < 0.001). Moreover, LOS differed for open versus laparoscopic versus robotic LDN (9 ± 3.1 vs. 8 ± 2.9 vs. 6 ± 2.6; p = 0.031). The overall in-hospital mortality was 0.16% (n = 5) after LDN, 0.47% (n = 42) after living donor KT and 1.8% (n = 475) after DBD KT. CONCLUSIONS There is an increasing trend toward minimal-invasive LDN in recent years. Overall, in-hospital mortality was low after KT. However, 5 deceased healthy donors after LKD caution that the risks of this procedure should also be taken very seriously.
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Affiliation(s)
- Aristeidis Zacharis
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Philipp Reimold
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Cem Aksoy
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Jonas Jung
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Thomas Martin
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | | | - Smita George Thoduka
- Department of Nuclear Medicine, Philipps University of Marburg, Marburg, Germany
| | - Christer Groeben
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany.
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Pecoraro A, Li Marzi V, Sessa F, Boissier R, Hevia V, Prudhomme T, Andras I, Breda A, Serni S, Territo A, Campi R. Urologists and Kidney Transplantation: The First European Census. Eur Urol 2022; 82:336-337. [PMID: 35717360 DOI: 10.1016/j.eururo.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Urology Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Alcalá University, Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angelo Territo
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Madendere S, Değer MD, Demirkıran ED, Yıldız HA. Urologists Are No Longer the Primary Surgeons for Several Urologic Operations: A National Survey Among the Turkish Urologists. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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