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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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Wu JH, Mo CB, Dong-Zhai L, Luo F, Ma QT, Yang SQ. Retrograde ureteric stent insertion from percutaneous suprapubic access to the bladder in renal transplant recipients with ureteric stenosis: a novel minimally invasive technique. BMC Urol 2020; 20:177. [PMID: 33138801 PMCID: PMC7607618 DOI: 10.1186/s12894-020-00748-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background Ureteric stricture is a common and salvaging complications after renal transplantation. Two treatment methods are usually used, retrograde ureteral stent placement and percutaneous nephrostomy. The former has a higher failure rate, the latter has a great risk. Therefore, a safe and reliable treatment is needed. Case presentation A technique of retrograde insertion of ureteral stent was established, which was applicable in three transplant recipients with post-transplant ureteral stenosis, and the data was retrospectively recorded. The patients are 2 men and 1 woman, ages 44, 27 and 32 years. These patients underwent a total of five times of retrograde insertion of ureteral stent between 2018 and 2019. None of these patients had any postoperative complication, but all patients had complete recovery from oliguric status within two weeks. Conclusions The retrograde ureteric stent insertion by percutaneous suprapubic access to the bladder (RUS-PSAB) was demonstrated feasibility and safety in a case series with short-term follow-up. However, larger prospective studies are needed.
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Affiliation(s)
- Jian-Hui Wu
- Department of Urology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Chun-Bai Mo
- Department of Renal Transplant, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Li Dong-Zhai
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Fei Luo
- Department of Urology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Qing-Tong Ma
- Department of Urology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Shi-Qiang Yang
- Department of Urology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
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Li X, Li B, Meng Y, Yang L, Wu G, Jing H, Bi J, Zhang J. Treatment of recurrent renal transplant lithiasis: analysis of our experience and review of the relevant literature. BMC Nephrol 2020; 21:238. [PMID: 32576135 PMCID: PMC7310338 DOI: 10.1186/s12882-020-01896-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal transplant lithiasis is a rather unusual disease, and the recurrence of lithiasis presents a challenging situation. METHODS We retrospectively analyzed the medical history of one patient who suffered renal transplant lithiasis twice, reviewed the relevant literature, and summarized the characteristics of this disease. RESULTS We retrieved 29 relevant studies with an incidence of 0.34 to 3.26% for renal transplant lithiasis. The summarized incidence was 0.52%, and the recurrence rate was 0.082%. The mean interval after transplantation was 33.43 ± 56.70 mo. Most of the patients (28.90%) were asymptomatic. The management included percutaneous nephrolithotripsy (PCNL, 22.10%), ureteroscope (URS, 22.65%), extracorporeal shockwave lithotripsy (ESWL, 18.60%) and conservative treatment (17.13%). In our case, the patient suffered from renal transplant lithiasis at 6 years posttransplantation, and the lithiasis recurred 16 months later. He presented oliguria, infection or acute renal failure (ARF) during the two attacks but without pain. PCNL along with URS and holmium laser lithotripsy were performed. The patient recovered well after surgery, except for a 3 mm residual stone in the calyx after the second surgery. He had normal renal function without any symptoms and was discharged with oral anticalculus drugs and strict follow-up at the clinic. Fortunately, the calculus passed spontaneously about 1 month later. CONCLUSIONS Due to the lack of specific symptoms in the early stage, patients with renal transplant lithiasis may have delayed diagnosis and present ARF. Minimally invasive treatment is optimal, and the combined usage of two or more procedures is beneficial for patients. After surgery, taking anticalculus drugs, correcting metabolic disorders and avoiding UIT are key measures to prevent the recurrence of lithiasis.
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Affiliation(s)
- Xiaohang Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Baifeng Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yiman Meng
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Lei Yang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Gang Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Hongwei Jing
- Department of Urology, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Jianbin Bi
- Department of Urology, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Jialin Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
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Fabbian F, Verzola A, Napoli N, De Giorgi A, Comai G, La Manna G, Gallerani M, Manfredini R, Rodríguez-Borrego MA, López-Soto PJ. Impact of hospital admissions subsequent to renal transplantation on Italian regional resources: a retrospective study in the Italian region of Emilia-Romagna. MINERVA UROL NEFROL 2019; 71:612-618. [PMID: 30654602 DOI: 10.23736/s0393-2249.19.03280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aim of this retrospective study was to investigate costs and resource consuming, expressed by diagnosis related groups (DRG), related only to hospitalizations of renal transplant recipients (RTRs) for all causes in the Region Emilia Romagna (RER) in Italy. METHODS We included all hospital admissions of RTRs (International Classification of Diseases 9th Revision, Clinical Modification [ICD-9-CM] code V420) between 2001 and 2015. We calculated number of admissions, RTRs and inhabitants of RER for each year, mean age, length of stay (LOS) in the hospital as total number of days, mean and median days, mean value of DRG and costs of admissions during the 15-year period of the study. RESULTS RTRs admitted in the 15 years study period were 9,197 and mean age 56.6±1.6 years. Admissions were 14,558, and mean rate of admitted RTRs (*100,000) was 14.21. Total, mean and median LOS were 122,966, 8.7 and 6 days, respectively. Total costs of admissions during the study period were €72,717,232 with mean DRG values of €3,409. Number of admissions and total number of days required for RTRs as well as mean age of admitted patients increased from 2001 to 2015, however mean and median LOS remained stable. CONCLUSIONS Costs due to admissions of RTRs appeared to gradually increase in the long term probably due to the increasing number of admissions and increasing mean age of admitted RTRs.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy -
| | - Adriano Verzola
- Management Planning and Control Service, Sant'Anna University Hospital, Ferrara, Italy
| | - Nicola Napoli
- Management Planning and Control Service, Sant'Anna University Hospital, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Internal Medicine, Sant'Anna University Hospital, Ferrara, Italy
| | - Giorgia Comai
- Unit of Nephrology, Dialysis and Renal Transplant, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Unit of Nephrology, Dialysis and Renal Transplant, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, Sant'Anna University Hospital, Ferrara, Italy
| | - Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - María A Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Pablo J López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
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