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Costa Silva A, Pina-Vaz T, Morgado A, Martins-Silva C, Antunes-Lopes T, Alturas Silva J. Prevalence of non-neurogenic male lower urinary tract symptoms after kidney transplantation. BJU Int 2024; 134:519-525. [PMID: 38520403 DOI: 10.1111/bju.16347] [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] [Indexed: 03/25/2024]
Abstract
OBJECTIVE This review investigates the prevalence of male non-neurogenic lower urinary tract symptoms (LUTS) after renal transplant, as kidney transplantation is a transformative intervention for patients with end-stage renal disease significantly enhancing quality of life that might be diminished by LUTS. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A systematic search in the PubMed and Scopus databases was performed using specific terms. Inclusion criteria considered male kidney transplant recipients, analysing outcomes in English-language studies. Discrepancies were resolved by consultation. RESULTS Among 18 studies involving 29 086 recipients, the prevalence of non-neurogenic LUTS ranged from 5.8% to 33.0%. Studies predominantly used the International Prostate Symptom Score for evaluation. Surgical interventions, mostly for benign prostatic obstruction, ranged from 2.5% to 20.0%. Voiding and post-micturition symptoms were under-represented. CONCLUSION This review found varied non-neurogenic LUTS prevalence and characteristics in male kidney transplant recipients, emphasising the need for standardised assessments, prospective studies, and improved understanding of LUTS mechanisms. Enhanced knowledge can guide interventions, additionally benefiting recipient quality of life.
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Affiliation(s)
- Alberto Costa Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Teresa Pina-Vaz
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Afonso Morgado
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carlos Martins-Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago Antunes-Lopes
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Alturas Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Zakri RH, Hevia V, Bossier R, Rodriguez-Faba O, Garcia EL, Budde K, Breda A, Olsburgh J, Figueiredo A. Benefits and Harms of Benign Prostatic Obstruction Treatments in Renal Transplanted Patients. Eur Urol Focus 2023; 9:913-919. [PMID: 37596113 DOI: 10.1016/j.euf.2023.05.001] [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: 11/14/2022] [Revised: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 08/20/2023]
Abstract
CONTEXT In an increasingly ageing transplant population, timely management of benign prostatic obstruction (BPO) is key to preventing complications that result in graft dysfunction or compromise survival. OBJECTIVE To evaluate benefits/harms of BPO treatments in transplant patients by reviewing current literature. EVIDENCE ACQUISITION A computerised bibliographic search of Medline, Embase, and Cochrane databases was performed for studies reporting outcomes on BPO treatments in transplanted patients. EVIDENCE SYNTHESIS A total of 5021 renal transplants (RTs) performed between 1990 and 2016 were evaluated. BPO incidence was 1.61 per 1000 population per year. Overall, 264 men underwent intervention. The mean age was 58.4 yr (27-73 yr). In all, 169 patients underwent surgery (n = 114 transurethral resection of the prostate [TURP]/n = 55 transurethral incision of the prostate [TUIP]) and 95 were treated with an un-named alpha-blocker (n = 46) or doxazosin (n = 49). There was no correlation between prostate volume and treatment modality (mean prostate size = 26 cc in the surgical group where reported and 48 cc in the medical group). The mean follow-up was 31.2 mo (2-192 mo). The time from RT to BPO treatment was reported in six studies (mean: 15.4 mo, range: 0-156 mo). The time on dialysis before RT was recorded in only three studies (mean: 47.3 mo, range: 0-288 mo). There was a mean improvement in creatinine after intervention from 2.17 to 1.77 mg/dl. A total of 157 men showed an improvement in the International Prostate Symptom Score (from 18.26 to 6.89), and there was a significant reduction in postvoid residual volume in 199 (mean fall 90.6 ml). Flow improved by a mean of 10 ml/s following intervention in 199 patients. Complications included acute urinary retention (4.1%), urinary tract infections (8.4%), bladder neck contracture (2.2%), and urethral strictures (6.9%). The mean reoperation rate was 1.4%. CONCLUSIONS Current literature is heterogeneous and of low-level evidence. Despite this, alpha-blockers, TUIP, and TURP showed a beneficial increase in the peak urinary flow and reduced symptoms in transplants patients with BPO. Improvement in the mean graft creatinine was noted after intervention. Complications were under-reported. A multicentre comparative cohort study is needed to draw firm conclusions about the ideal treatment for BPO in RT patients. PATIENT SUMMARY In this report, we looked at the outcomes for transplant patients undergoing medical or surgical management of benign prostatic obstruction. Although the literature was very heterogeneous, we found that medical management and surgery with transurethral resection/incision of the prostate are beneficial for improving urinary flow and bothersome symptoms. We conclude that further prospective studies are required for better clarity about timing and modality of intervention in transplant patients.
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Affiliation(s)
- Rhana Hassan Zakri
- Department of Transplantation, Renal & Urology, Guy's and St Thomas' Hospital, London, UK.
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Romain Bossier
- Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique, Marseille, France
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Enrique Lledo Garcia
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alberto Breda
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Jonathon Olsburgh
- Department of Transplantation, Renal & Urology, Guy's and St Thomas' Hospital, London, UK
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal
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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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Zamzami Z, Rayendra H, Az-Zahra N. Associations Between Kidney Dysfunction and Risk Factors in Patients with Transurethral Resection of the Prostate. Res Rep Urol 2021; 13:665-672. [PMID: 34522686 PMCID: PMC8434922 DOI: 10.2147/rru.s326836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Benign prostate hyperplasia (BPH) with urinary retention can result in kidney dysfunction. Several risk factors might influence deterioration in kidney function. The aims of this study were to assess the association between kidney dysfunction and risk factors in patients with transurethral resection of the prostate (TURP). Methods We reviewed medical records of BPH patients managed by TURP and having high levels of blood urea and creatinine. Data collected were age, history of hypertension, diabetes mellitus (DM), urinary tract infection (UTI), urinary retention, and urinary tract stones, duration of obstruction, and blood-urea and -creatinine levels before and after TURP. Chi-suare and paired t- tests were used. Results There were 64 patients in the study. More were aged 60-69 years (42.2%) than other age-groups, 53.1% had a history of hypertension, 12.5% DM, 35.9% UTI, all urinary retention, 14.1% urinary tract stones, and 92.2% obstruction duration <14 days. There were significant differences in blood-urea and -creatinine levels between before and after TURP (p<0.001). There were no significant differences between age-group, hypertension, DM, UTI, urinary retention, urinary stones, or duration of obstruction with kidney dysfunction after TURP (p>0.001). Conclusion Age, hypertension, DM, UTI, urinary retention, urinary tract stones, and duration of obstruction can be risk factors of kidney dysfunction in TURP patients, and TURP might improve blood-urea and -creatinine levels. There was no significant association between kidney recovery and kidney dysfunction with the number of risk factors in TURP and pre-TURP patients.
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Affiliation(s)
- Zuhirman Zamzami
- Urology Division, Surgery Department, Medical Faculty of Riau University, Pekanbaru, Riau, Indonesia
| | - Herman Rayendra
- Department of Internal Medicine, Consultant of Kidney and Hypertension, Medical Faculty of Riau University, Pekanbaru, Riau, Indonesia
| | - Nafisa Az-Zahra
- Medical Faculty of Riau University, Pekanbaru, Riau, Indonesia
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5
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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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6
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Drouin S, Defortescu G, Prudhomme T, Culty T, Verhoest G, Doerfler A, Goujon A, Branchereau J, Timsit MO. [Lower urinary tract symptoms and urinary incontinence in renal transplant recipients and candidates: The French guidelines from CTAFU]. Prog Urol 2021; 31:45-49. [PMID: 33423747 DOI: 10.1016/j.purol.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To propose surgical recommendations for the management of lower urinary tract symptoms (LUTS) and urinary incontinence in kidney transplant recipients and candidates. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU focusing on medical and surgical treatment of LUTS and urinary incontinence in kidney transplant recipients and candidates. References were assessed according to a predefined process to propose recommendations with levels of evidence. RESULTS Functional bladder capacity and bladder compliance are impaired during dialysis. LUTS, related to pre-kidney transplantion alterations, frequently improve spontaneously after kidney transplantation. LUTS secondary to benign prostatic hyperplasia (BPH) may be underestimated before kidney transplantation due to oliguria, low bladder compliance and low bladder capacity. In LUTS associated with BPH, anticholinergics require dosage adjustment with creatinine clearance. If surgery is indicated after kidney transplantation, procedure can be safely performed in the early post-transplant course after removal of ureteral stent. Surgical management of urinary incontinence does not seem to be associated with an icreased risk for infectious complications in kidney transplant recipients. Particular attention should be paid to the management of postvoid residual and bladder pressures in case of neurological bladder disease. Optimal care of neurological bladder should be provided prior to transplantation: with a cautious management, and despite an increased occurrence of febrile urinary tract infections, transplant survival is not compromised. CONCLUSION These recommendations must contribute to improve the management of lower urinary tract symptoms and urinary incontinence in kidney transplant patients and kidney transplant candidates.
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Affiliation(s)
- S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, Sorbonne université, , APHP-6, 47, boulevard de l'Hôpital, 75013 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université Aix-Marseille, hôpital de la Conception, 47, boulevard Baille 13005 Marseille, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Goujon
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université Aix-Marseille, hôpital de la Conception, 47, boulevard Baille 13005 Marseille, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 01, France; PARCC, Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, 56, rue Leblanc, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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7
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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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8
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Pelvic Surgery in the Transplant Recipient: Important Considerations for the Non-transplant Surgeon. Curr Urol Rep 2020; 21:2. [PMID: 31960158 DOI: 10.1007/s11934-020-0954-9] [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: 10/25/2022]
Abstract
PURPOSE OF REVIEW Classically, kidney transplantation (KT) consists of heterotopic implantation of the renal graft in the iliac fossa with vascular anastomosis on the iliac vessel and reimplantation of the graft ureter in the bladder of the recipient. However, a wide range of variations exist in both vascular anastomosis and urinary diversion that the non-transplant surgeon should know. RECENT FINDINGS For any pelvic surgery in a KT patient, the non-transplant surgeon should preoperatively evaluate the anatomy of the graft, its vascularization and its urinary tract. The transplant ureter should be identified and secured by preoperative JJ stenting whenever needed. For any surgery, maintenance and control of both immunosuppressive treatment and renal function is crucial. The advice or even the assistance of a transplant surgeon should be required because any damage to vascularization or urinary drainage of the renal graft could have dramatic and definitive consequences on graft function.
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9
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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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10
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Prudhomme T, Marquette T, Péré M, Patard PM, Michiels C, Sallusto F, Rigaud J, Glémain P, Kamar N, Blancho G, Soulié M, Rischmann P, Karam G, Gamé X, Robert G, Branchereau J. Benign Prostatic Hyperplasia Endoscopic Surgical Procedures in Kidney Transplant Recipients: A Comparison Between Holmium Laser Enucleation of the Prostate, GreenLight Photoselective Vaporization of the Prostate, and Transurethral Resection of the Prostate. J Endourol 2019; 34:184-191. [PMID: 31588793 DOI: 10.1089/end.2019.0430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose: The main objective of this multicentric retrospective pilot study was to evaluate the 1-year follow-up safety (i.e., minor [Clavien-Dindo I-II] and major [Clavien-Dindo ≥III] complications) of holmium laser enucleation of the prostate (HoLEP), GreenLight photoselective vaporization of the prostate (GL PVP), and transurethral resection of the prostate (TURP) performed after kidney transplantation (KT). The secondary objectives were to evaluate the efficacy and to assess the impact of these procedures on graft function. Materials and Methods: We retrospectively included all KT recipients who underwent a HoLEP or GL PVP or TURP for benign prostatic hyperplasia (BPH) in three French university centers. Results: From January 2013 to April 2018, 60 BPH endoscopic surgical procedures in KT recipients were performed: 17 HoLEP (HoLEP group), 9 GL PVP (GL PVP group), and 34 TURP (TURP group). Age, body mass index, preoperative serum creatinine, preoperative International Prostatic Symptom Score, preoperative Qmax, preoperative prostate-specific antigen, medical history of acute urinary retention (AUR), urinary tract infection (UTI), and indwelling urethral catheter were similar in all study groups. Mean preoperative prostate volume was higher in HoLEP group. The rate of overall postoperative complications was statistically higher in the HoLEP group (11/17 [64.7%] vs 1/9 [11.1%] vs 12/34 [35.3%] in HoLEP group, GL PVP group, and TURP group, respectively, p = 0.02), with higher rate of long-term UTI and AUR. Qmax improved in all groups after operation. Delta postoperative month 12-preoperative serum creatinine was similar in the all groups. Conclusions: Although our study is underpowered, the rate of postoperative complications is higher with HoLEP procedure, in comparison with GL PVP, for the treatment of BPH after KT. One-year efficacy is similar in HoLEP, GL PVP, and TURP groups. Further prospective randomized controlled trials are needed to confirm our results.
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Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Thibault Marquette
- Department of Urology, Kidney Transplantation and Andrology, Bordeaux University Hospital, Bordeaux, France
| | - Morgane Péré
- Biostatistics Unit, Research Board, Nantes University Hospital, Nantes, France
| | - Pierre-Marie Patard
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Clément Michiels
- Department of Urology, Kidney Transplantation and Andrology, Bordeaux University Hospital, Bordeaux, France
| | - Federico Sallusto
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Jérôme Rigaud
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Pascal Glémain
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Michel Soulié
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Pascal Rischmann
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Georges Karam
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Xavier Gamé
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Grégoire Robert
- Department of Urology, Kidney Transplantation and Andrology, Bordeaux University Hospital, Bordeaux, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
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11
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Abstract
Urologic complications of renal transplant occur commonly and can have significant impact on graft function, survival, and patient morbidity. This review examines the prevalence of urologic complications, risk factors, diagnosis and options for management of the most common urologic complications.
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Affiliation(s)
- Hannah R Choate
- Presbyterian Transplant Services, Presbyterian HealthCare Services, Albuquerque, NM, USA
| | - Laura A Mihalko
- Division of Urology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Bevan T Choate
- Department of Urology, Raymond G. Murphy VA Health Medical Center, Albuquerque, NM, USA
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12
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Sarier M, Tekin S, Duman İ, Yuksel Y, Demir M, Alptekinkaya F, Guler M, Yavuz AH, Kosar A. Results of transurethral resection of the prostate in renal transplant recipients: a single center experience. World J Urol 2017; 36:99-103. [DOI: 10.1007/s00345-017-2094-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 11/24/2022] Open
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13
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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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14
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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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15
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[LOWER URINARY TRACT SYMPTOMS AND FUNCTIONS AFTER RENAL TRANSPLANTATION AT OUR HOSPITAL]. Nihon Hinyokika Gakkai Zasshi 2016; 106:249-54. [PMID: 26717783 DOI: 10.5980/jpnjurol.106.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We investigated lower urinary tract symptoms (LUTS) and function in patients who had undergone renal transplantation (RTx). METHODS Fifty patients (34 males and 16 females; age 16-68 years) undergoing RTx at our hospital were included in this study. Average follow-up after RTx was 6.1 years (range 0.5-28). The pre-transplant dialysis period averaged 2.5 years (range preemptive-18.6 years). We conducted the evaluation of lower urinary tract symptoms (LUTS) and function using uroflowmetry (UFM) , residual urine measurement, 24h bladder diary, International Prostate Symptom Score (IPSS), QOL score, Overactive Bladder Symptom Score (OABSS) and Core Lower Urinary Tract Symptom Score (CLSS). RESULTS Average first desire to void and maximum desire to void were 89.9 mL and 185 mL respectively in cystometry before RTx. Atrophy of the bladder before RTx showed a correlation with the dialysis period. UFM of post-RTx was maximum urinary flow rate of 21.8 mL/s and a voided volume of 287.6 mL. Severe cases of IPSS, QOL, OABSS and CLSS were not observed. Average 24h voided volume, urination times and nocturia were 2,329 mL, 8.2 times and 0.9 times respectively. Polyuria after RTx was observed in 21 patients (42%). Aging and vascular lesions such as diabetes and cardiovascular disease were the most important factor of LUTS. CONCLUSIONS After RTx, LUTS were present in a number of cases after RTx. Patients undergoing RTx has been aging, it is considered necessary to perform the evaluation of LUTS before RTx.
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16
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Nohara T, Matsuyama S, Shima T, Kawaguchi S, Seto C. Holmium Laser Enucleation of the Prostate With Percutaneous Nephrostomy Into the Transplanted Kidney in Patient With Severe Benign Prostatic Hyperplasia With Vesicoureteral Reflux - A Case Report. Urol Case Rep 2015; 4:33-5. [PMID: 26793574 PMCID: PMC4719790 DOI: 10.1016/j.eucr.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/03/2015] [Indexed: 11/13/2022] Open
Abstract
A 66-year-old male, who had received renal transplantation 10 years before, was admitted to our hospital with urinary retention. The prostate volume was 169.2 ml. Furthermore, grade 5 vesicoureteral reflux (VUR) was shown in the cystography. Holmium laser enucleation of prostate (HoLEP) was performed, and percutaneous nephrostomy to the transplanted kidney was performed simultaneously to prevent from severe perioperative infection. After that, renal graft function improved and no urinary retention reoccurred, although surgical repair against VUR was necessary 10 months after HoLEP. We conclude that surgical treatment for BPH after kidney transplantation should be strongly considered with care for infections.
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Affiliation(s)
- Takahiro Nohara
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
| | - Satoko Matsuyama
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
| | - Takashi Shima
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
| | - Shohei Kawaguchi
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
| | - Chikashi Seto
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
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17
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Putz J, Leike S, Wirth MP. [Management of urological complications after renal transplantation]. Urologe A 2015; 54:1385-92. [PMID: 26459581 DOI: 10.1007/s00120-015-3908-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Urological complications after kidney transplantation can cause a major reduction in renal function. Surgical complications like urinary leakage and ureteral obstruction need to be solved by a specialist in the field of endourological procedures and open surgical interventions. The article summarizes this and other common urological problems after kidney transplantation.
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Affiliation(s)
- J Putz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - S Leike
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - M P Wirth
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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18
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Stein K, Maruschke M, Protzel C, Hakenberg OW. [Allogeneic kidney transplantation. Preoperative, perioperative and postoperative management]. Urologe A 2014; 53:91-101; quiz 102. [PMID: 24389690 DOI: 10.1007/s00120-013-3375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Allogeneic renal transplantation is the best treatment for many patients with chronic renal failure and end-stage kidney disease. Especially the health-related quality of life markedly improves after renal transplantation and the side effects of dialysis treatment as well as the progression of organ and tissue deterioration related to renal failure which are not treated effectively by dialysis are greatly reduced. To achieve good results of renal transplantation, however, the best possible preoperative as well as perioperative and postoperative conditions have to be established and patients on waiting lists need to be well prepared. Interdisciplinary patient care is needed before and after renal transplantation in order to achieve durable and long-term success of renal transplantation.
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Affiliation(s)
- K Stein
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6 , 18055, Rostock, Deutschland,
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19
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Wein AJ. Functional urology in the BJUI. BJU Int 2013; 112:277. [DOI: 10.1111/bju.12326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alan J. Wein
- Perelman School of Medicine at the University of Pennsylvania; Philadelphia; USA
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