Clinical reappraisal and state of the art of nephropexy

Laparoscopic ventral onlay ureteroplasty with buccal mucosa graft for complex proximal ureteral stricture

INTRODUCTION

There is lack of papers dedicated to the laparoscopic buccal mucosa graft (BMG) ureteroplasty of the complex upper ureteral stricture. The aim of this study is to evaluate the results of laparoscopic BMG ureteroplasty in patients with complex proximal ureteral stricture.

MATERIAL AND METHODS

Twenty-four patients underwent laparoscopic ventral onlay BMG ureteroplasty for long or recurrent proximal ureteral stricture not amenable to uretero-ureteral anastomosis over 2019-2022. Patient demographics, operative time, estimated blood loss, length of stay, follow-up, intra- and postoperative complication rate and percentage of stricture-free at last visit were analyzed.

RESULTS

The mean stricture length was 3.6 cm. The mean operative time was 208.3 min, while mean blood loss was 75.8 mL. The length of hospital stay was 7.3 days. No intraoperative complications were observed. Postoperatively, seven patients developed complications (29.2%). Five patients experienced a Grade II (according to Clavien nomenclature). Two patients developed a Grade IIIa complication, which included leakage of the anastomosis site. The mean follow-up was on the 22 months with stricture free rate 87.5%.

CONCLUSION

Patients with proximal ureteral strictures could be effectively treated by laparoscopic ventral onlay ureteroplasty with a buccal mucosa graft.

Late renal allograft torsion in a pediatric transplant recipient

BACKGROUND

Kidney allograft torsion is a rare complication of kidney transplant that can lead to allograft loss from prolonged ischemia if not quickly corrected with detorsion and nephropexy. We report a case of late intraperitoneal renal allograft torsion in a pediatric transplant recipient.

CASE REPORT

The patient is a 7-year-old male with a history of end-stage renal disease secondary to renal dysplasia in the setting of bilateral high-grade vesicoureteral reflux. He underwent bilateral native nephrectomies for recurrent pyelonephritis and right ureteral kink with urinary tract obstruction. Torsion occurred 3 years after transplant in the setting of one day of emesis, loose stool, severe abdominal pain, and decreased urine output. Diagnosis of transplant torsion was suspected on non-contrast CT scan done after transplant Doppler ultrasound showed no flow to the allograft. The CT scan showed that the kidney had been medialized and renal hilum was flipped from the expected orientation. The patient required a transplant nephrectomy.

CONCLUSIONS

Renal transplant torsion is a rare event but should be suspected in any renal transplant recipient with acute onset of abdominal pain, acute kidney injury, and decreased urine output, regardless of length of time from transplantation. Patients suspected to have renal torsion should be evaluated emergently with a transplant ultrasound Doppler.

Renal Doppler Ultrasound in the Evaluation of Renal Function in Patients with Sepsis

This study was aimed to explore the renal Doppler ultrasound in the evaluation of renal function in patients with sepsis. Fifty patients with sepsis or septic shock were classified into the acute kidney injury (AKI) group (n =25) and the non-AKI group (n =25) according to whether they had AKI. The measurements of renal resistance index (RRI) and power Doppler ultrasound (PDU) were performed on all patients within 7 days of admission to the intensive care unit (ICU). The patient's renal function was assessed. The results showed that the RRI of the two groups showed a slight upward trend over time, and the RRI of the AKI group was higher than that of the non-AKI group. After 7 days in AKI group, the areas under the receiver operating characteristic (ROC) curves of RRI were 0.745, 0.683, 0.729, 0.856, 0.793, 0.819, and 0.836 (P <0.05). There were no statistically considerable differences in areas under ROC curves between the two groups (P >0.05). The grouping of AKI and the time were both fixed effects, and the individual patients were randomized effects. Besides, the linear models were statistically analyzed. The results showed that the differences between the two groups were statistically insignificant (P >0.05). There was no significant difference in the PDU scores measured at different times within 7 days after ICU admission between the two groups (P >0.05). In conclusion, renal Doppler ultrasound had a good adoption effect in the evaluation of the renal function of patients with severe sepsis, which is worth promoting in clinical practice.