1
|
Bruno V, Chiofalo B, Logoteta A, Brandolino G, Savone D, Russo M, Sperduti I, Mancini E, Fabrizi L, Anceschi U, Vizza E. Urological Complications in Radical Surgery for Cervical Cancer: A Comparative Meta-Analysis before and after LACC Trial. J Clin Med 2023; 12:5677. [PMID: 37685744 PMCID: PMC10488957 DOI: 10.3390/jcm12175677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND After the LACC trial publication in 2018, the minimally invasive approach (MIS) has severely decreased in favor of open surgery: MIS radical hysterectomy was associated with worse oncological outcomes than open surgery, but urological complications were never extensively explored in pre- versus post-LACC eras, even if they had a great impact on post-operative QoL. The purpose of this meta-analysis is to compare functional and organic urological complication rates before and after LACC trial. METHODS An independent search of the literature was conducted 4 years before and after the LACC trial and 50 studies were included. RESULTS The overall rate of urologic complications was higher in pre-LACC studies while no differences were found for organic urological complications. Conversely, the overall risk of dysfunctional urological complications showed a higher rate in the pre-LACC era. This is probably related to a sudden shift to open surgery, with potential lower thermal damage to the urinary tract autonomic nervous fibers. CONCLUSIONS This meta-analysis showed that the incidence of urological complications in radical cervical cancer surgery was higher before the LACC trial, potentially due to the shift to open surgery. Nevertheless, further studies are needed to shed light on the connection between minimally invasive surgery and urological damage.
Collapse
Affiliation(s)
- Valentina Bruno
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| | - Alessandra Logoteta
- Department of Maternal Infantile and Urological Sciences, University of Rome “Sapienza”, Policlinico Umberto I, 00161 Rome, Italy; (A.L.)
| | - Gabriella Brandolino
- Department of Maternal Infantile and Urological Sciences, University of Rome “Sapienza”, Policlinico Umberto I, 00161 Rome, Italy; (A.L.)
| | - Delia Savone
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| | - Mario Russo
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Isabella Sperduti
- Unit of Biostatistical, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Emanuela Mancini
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| | - Luana Fabrizi
- Anesthesia, Resuscitation and Intensive Care Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Enrico Vizza
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| |
Collapse
|
2
|
Puliyanda D, Barday Z, Barday Z, Freedman A, Todo T, Chen AKC, Davidson B. Children Are Not Small Adults: Similarities and Differences in Renal Transplantation Between Adults and Pediatrics. Semin Nephrol 2023; 43:151442. [PMID: 37949683 DOI: 10.1016/j.semnephrol.2023.151442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Kidney transplantation is the treatment of choice for all patients with end-stage kidney disease, including pediatric patients. Graft survival in pediatrics was lagging behind adults, but now is comparable with the adult cohort. Although many of the protocols have been adopted from adults, there are issues unique to pediatrics that one should be aware of to take care of this population. These issues include recipient size consideration, increased incidence of viral infections, problems related to growth, common occurrence of underlying urological issues, and psychosocial issues. This article addresses the similarities and differences in renal transplantation, from preparing a patient for transplant, the transplant process, to post-transplant complications.
Collapse
Affiliation(s)
- Dechu Puliyanda
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA.
| | - Zibya Barday
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Zunaid Barday
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrew Freedman
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Tsuyoshi Todo
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Allen Kuang Chung Chen
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Bianca Davidson
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
3
|
Davidov MI. [ Urological complications of N.A. Nekrasovs disease]. Urologiia 2022:128-132. [PMID: 35274874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
to study the medical history of N.A. Nekrasov and to determine the nature of his urological disease. The work was carried out from 1977 till 2021. He studied 2616 sources related to the biography of N.A. Nekrasov and medical history. The work was carried out in the archives of Moscow, St.Petersburg, Yaroslavl, Karabikha from 1998 till 2020. The Russian poet N.A.Nekrasov had an illness, which ended in death, during 3 years, from December 1874 till December 27, 1877. He was treated by famous doctors S.P. Botkin, N.V. Sklifosovsky, E.I. Bogdanovsky, N.A. Belogolovy and an operation was performed by Theodore Bilroth. Retrospective analysis revealed the following diagnosis of N.A. Nekrasov: rectal cancer at the stage of T4NXMOP4 with invasion of the sacrum, bladder and compression of the pelvic parts of both ureters, bilateral ureterohydronephrosis with the loss of the left kidney function, chronic renal failure, purulent cystitis, partial intestinal obstruction, suppuration of the wound after colostomy performed on April 12, 1877, Acute purulent paraproctitis, paranephritis, phlegmon of the left retroperitoneal space, purulent effusion to the thigh, phlegmon of the buttock area and the left thigh, sepsis, cerebral stroke. Urological complications of the rectal cancer accelerated the lethal outcome of the poet N.A. Nekrasov who died of sepsis and uremia.
Collapse
Affiliation(s)
- M I Davidov
- E. A. Vagner Perm State Medical University of MH RF, Perm, Russia
| |
Collapse
|
4
|
Varlas VN, Rhazi Y, Bors RG, Penes O, Radavoi D. The urological complications of vaginal birth after cesarean (VBAC) - a literature review. J Med Life 2021; 14:443-447. [PMID: 34621366 PMCID: PMC8485385 DOI: 10.25122/jml-2021-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
The appearance of urological complications is a major problem in obstetrics and gynecologic surgery; the bladder is the most common damaged organ. Due to a continuous increase in the rate of cesareans, the incidence of urologic complications will be potentially higher. We reviewed the most important risk factors for urinary tract injury and analyzed the strategies necessary to avoid these situations during vaginal birth after cesarean (VBAC). The risks and benefits of VBAC should be balanced before deciding the mode of delivery.
Collapse
Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania
- Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Yassin Rhazi
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Ovidiu Penes
- Department of Anesthesiology and Intensive Care, Bucharest Emergency University Hospital, Bucharest, Romania
| | - Daniel Radavoi
- Department of Urology, Prof. Dr. Theodor Burghele Clinical Hospital, Bucharest, Romania
| |
Collapse
|
5
|
Prionas A, Craddock C, Papalois V. Enhanced Recovery after Renal Transplantation Decreases Recipients' Urological Complications and Hospital Stay: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10112286. [PMID: 34070325 PMCID: PMC8197515 DOI: 10.3390/jcm10112286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to compare enhanced recovery after surgery (ERAS) against traditional perioperative care for renal transplant recipients. Outcome measures included complications, length of stay (LOS), readmission rates, graft and patient survival up to one-year post-transplant. We initially screened Medline, Cochrane, Scopus, Embase and Web of Science databases. We identified 3029 records. From these, 114 full texts were scrutinized for inclusion. Finally, 10 studies were included in the meta-analysis corresponding to 2037 renal transplant recipients. ERAS resulted in lower incidence of urological complications (95CI: 0.276, 0.855) (I2 = 53.08%) compared to traditional perioperative practice. This referred to ureteric stenoses (95CI: 0.186–0.868) (I2 = 0%) and urinary tract infections (95CI: 0.230–0.978) (I2 = 71.55%). ERAS decreased recipients’ LOS (95CI: −2.876, −0.835) (I2 = 86.55%). Compared to standard practice, ERAS protocols did not increase unplanned readmissions (95CI:0.800, 1.680) (I2 = 0%). Up to one-year post-transplant, graft survival rates were similar across the ERAS and the control groups (95CI:0.420, 1.722) (I2 = 0%). There was also no difference in recipients’ one-year post-transplant survival (95CI:0.162, 3.586) (I2 = 0%). Our results suggest that ERAS protocols can be safely incorporated in the perioperative care of renal transplant recipients, decrease their urological complications and shorten their length of hospital stay without affecting unplanned readmission rates.
Collapse
Affiliation(s)
- Apostolos Prionas
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK;
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, UK;
- Correspondence:
| | - Charles Craddock
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, UK;
| | - Vassilios Papalois
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK;
| |
Collapse
|
6
|
Visser IJ, van der Staaij JPT, Muthusamy A, Willicombe M, Lafranca JA, Dor FJMF. Timing of Ureteric Stent Removal and Occurrence of Urological Complications after Kidney Transplantation: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:E689. [PMID: 31100847 PMCID: PMC6572676 DOI: 10.3390/jcm8050689] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022] Open
Abstract
Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal after KTx. Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar (until November 2017). For this systematic review, all aspects of the Cochrane Handbook for Interventional Systematic Reviews were followed and it was written based on the PRISMA-statement. Articles discussing JJ-stents (double-J stents) and their time of removal in relation to outcomes, UTIs, urinary leakage, ureteral stenosis or reintervention were included. One-thousand-and-forty-three articles were identified, of which fourteen articles (three randomised controlled trials, nine retrospective cohort studies, and two prospective cohort studies) were included (describing in total n = 3612 patients). Meta-analysis using random effect models showed a significant reduction of UTIs when stents were removed earlier than three weeks (OR 0.49, CI 95%, 0.33 to 0.75, p = 0.0009). Regarding incidence of urinary leakage, there was no significant difference between early (<3 weeks) and late stent removal (>3 weeks) (OR 0.60, CI 95%, 0.29 to 1.23, p = 0.16). Based on our results, earlier stent removal (<3 weeks) was associated with a decreased incidence of UTIs and did not show a higher incidence of urinary leakage compared to later removal (>3 weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks post-operatively.
Collapse
Affiliation(s)
- Isis J Visser
- Imperial College Renal and Transplant Centre, Imperial College NHS Healthcare Trust, Hammersmith Hospital, London W12 0HS, UK.
| | - Jasper P T van der Staaij
- Imperial College Renal and Transplant Centre, Imperial College NHS Healthcare Trust, Hammersmith Hospital, London W12 0HS, UK.
| | - Anand Muthusamy
- Imperial College Renal and Transplant Centre, Imperial College NHS Healthcare Trust, Hammersmith Hospital, London W12 0HS, UK.
- Department of Surgery and Cancer, Imperial College, London W12 0HS, UK.
| | - Michelle Willicombe
- Imperial College Renal and Transplant Centre, Imperial College NHS Healthcare Trust, Hammersmith Hospital, London W12 0HS, UK.
| | - Jeffrey A Lafranca
- Imperial College Renal and Transplant Centre, Imperial College NHS Healthcare Trust, Hammersmith Hospital, London W12 0HS, UK.
| | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Imperial College NHS Healthcare Trust, Hammersmith Hospital, London W12 0HS, UK.
- Department of Surgery and Cancer, Imperial College, London W12 0HS, UK.
| |
Collapse
|
7
|
Li F, Guo H, Qiu H, Liu S, Wang K, Yang C, Tang C, Zheng Q, Hou Y. Urological complications after radical hysterectomy with postoperative radiotherapy and radiotherapy alone for cervical cancer. Medicine (Baltimore) 2018; 97:e0173. [PMID: 29595646 PMCID: PMC5895433 DOI: 10.1097/md.0000000000010173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/09/2018] [Accepted: 02/22/2018] [Indexed: 11/03/2022] Open
Abstract
Radiotherapy is a reliable method to cure cervical cancer patients, but it could cause serious urological complications after the treatment due to the anatomical location of the cervix. The main purpose of this retrospective analysis is to study the incidence, latency, and therapeutic efficacy of urological complications caused by radical hysterectomy with postoperative radiotherapy or radiotherapy alone in patients with cervical cancer.A retrospective analysis was conducted on patients with cervical cancer who received radical hysterectomy with postoperative radiotherapy or radiotherapy alone at the First Hospital of Jilin University between January 2010 and May 2016. The urological complications were confirmed by clinical manifestation, ultrasound, computed tomography (CT), nuclear scintigraphy, and assessment of renal function. All the patients with urological complications received conventional treatment, including conservative, electrosurgery, ureteral stents, nephrectomy, and neoplasty. The onset time of radiation injury symptoms was confirmed according to the medical history and follow-up. The surveillance for the therapeutic effects for these complications was accomplished by cystoscopy, imaging, and laboratory assessment.The overall rate of urological complications after treatment was 3.26%, comprising 2.12% ureteral obstruction, 0.98% radiocystitis, and 0.16% vesicovaginal fistula. The incidence of ureteral obstruction in patients treated with radical hysterectomy with postoperative radiotherapy and radiotherapy alone was not statistically significant (2.18% vs 1.59%, P > .05). The median onset time of radiocystitis and ureteral obstruction was 10 months (0-75 months) and 12 months (2-66.3 months), respectively. The onset time of vesicovaginal fistula was 3.5 months. After the appropriate treatment, the majority of the complications were under control.The incidence of urological complications is acceptable. There was no statistical difference in the risk between patients treated with radical hysterectomy with postoperative radiotherapy and radiotherapy alone. The latency period between radiotherapy and the manifestation of urological complications may be relatively long. So it is crucial to underline long-term follow-up after radiotherapy. The majority of urological complications were alleviated after symptomatic treatment and the patients with cervical cancer achieved long-term remissions or cures.
Collapse
|
8
|
ElSheemy MS, Ghoneima W, Aboulela W, Daw K, Shouman AM, Shoukry AI, Soaida S, Salah DM, Bazaraa H, Fadel FI, Hussein AA, Habib E, Saad IR, El Ghoneimy M, Morsi HA, Lotfi MA, Badawy H. Risk factors for urological complications following living donor renal transplantation in children. Pediatr Transplant 2018; 22. [PMID: 29082641 DOI: 10.1111/petr.13083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to detect possible risk factors for UC and UTI following pediatric renal Tx and effect of these complications on outcome. One hundred and eight children who underwent living donor Tx between 2009 and 2015 were retrospectively included. Extraperitoneal approach was used with stented tunneled extravesical procedure. Mean recipient age was 9.89 ± 3.46 years while mean weight was 25.22 ± 10.43 kg. Seventy-three (67.6%) recipients were boys while 92 (85.2%) were related to donors. Urological causes of ESRD were present in 33 (30.6%) recipients (14 [13%] posterior urethral valve, 16 [14.8%] VUR, and 3 [2.8%] neurogenic bladder). Augmentation ileocystoplasty was performed in 9 (8.3%) patients. Mean follow-up was 39.3 ± 17.33 months. UC were detected in 10 (9.3%) children (leakage 4 [3.7%], obstruction 3 [2.8%], and VUR 3 [2.8%]) while UTIs were reported in 40 (37%) children. After logistic regression analysis, UC were significantly higher in children with cystoplasty (44.4% vs 6.1%; P = .001). UTIs were significantly higher in girls (51.4% vs 30.1%; P = .001) and in children with urological causes of ESRD (51.5% vs 30.7%; P = .049). UC and UTI were not significantly associated with increased graft loss or mortality. UC were significantly higher in children with cystoplasty while UTIs were significantly higher in girls and children with urological causes of ESRD. Presence of UC did not affect the rate of graft loss or mortality due to its early detection and proper management.
Collapse
Affiliation(s)
| | - Waleed Ghoneima
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Waseem Aboulela
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Kareem Daw
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Sherif Soaida
- Division of Pediatric Anesthesia, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Doaa M Salah
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Hafez Bazaraa
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Fatina I Fadel
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Ahmed A Hussein
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Enmar Habib
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Ismail R Saad
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | | | - Hany A Morsi
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mohammed A Lotfi
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Hesham Badawy
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| |
Collapse
|
9
|
Maison POM, Smit S, McCulloch M, Gajjar P, Nourse P, Thomson D, Muller E, Millar A, Numanoglu A, Kahn D, Lazarus J. Urological complications following unstented pediatric renal transplantation. Pediatr Transplant 2017; 21. [PMID: 28834044 DOI: 10.1111/petr.13045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 11/29/2022]
Abstract
Urological complications which develop post-renal transplantation can be associated with significant morbidity especially in children. We evaluated the occurrence and management of all urological complications in a series of unstented pediatric renal transplants in a tertiary pediatric hospital. We reviewed the medical records of children who underwent unstented renal transplant between January 1996 and December 2014. Postoperative urological complications and the outcomes of their management were analyzed. A total of 160 unstented renal transplants were performed, and 32 urological complications were noted in 29 transplants (18%). There were 20 boys and nine girls with an age range of 2.5 years to 18.4 years. Nine (31%) of these patients had LUTD. The most common complication was VUR occurring in 17 patients (10.6%). Urine leaks occurred in six patients (3.8%) and ureteric obstruction in six patients (3.8%), and three patients (1.9%) had unexplained hydronephrosis. Loss of graft occurred in three patients (1.9%), and one patient died from sepsis post-uretero-ureterostomy. Patients with LUTD had more urological complications (P = .037). Unstenting is feasible in most pediatric renal transplants. LUTD is associated with a higher incidence of urological complications, especially VUR.
Collapse
Affiliation(s)
- Patrick Opoku Manu Maison
- Division of Urology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Shaun Smit
- Division of Urology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mignon McCulloch
- Division of Pediatric Nephrology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Priya Gajjar
- Division of Pediatric Nephrology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Peter Nourse
- Division of Pediatric Nephrology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Dave Thomson
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Elmi Muller
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alastair Millar
- Division of Pediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Alp Numanoglu
- Division of Pediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Delawir Kahn
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - John Lazarus
- Division of Urology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
10
|
Abstract
BACKGROUND Vesicoureteral reflux (VUR) is frequently found after transplantation, but its impact on graft function, urine tract infection, and graft loss remains uncertain. Therefore our objective was to evaluate the effects of VUR on the outcome of renal transplantation. MATERIAL AND METHODS We included 1008 adult renal transplant recipients of whom a 1-week posttransplant voiding cystourethrogram was available. Study end points included occurrence of bacteriuria, renal function, and graft survival. RESULTS In total, 106 (10.5%) of 1008 graft recipients had a diagnosis of VUR on voiding cystography. The incidence of bacteriuria was comparable in the reflux and nonreflux group (17% vs 17.4%, P = .91). There was no significant difference in renal function at 3 months and 1 year in patients with and without VUR. One- and 5-year graft survival in patients with VUR was 85.8% and 82.1% compared to 87.3% and 83.0% in patients without VUR ( P = .68 and P = .80). CONCLUSION Posttransplant VUR has no correlations with early bacteriuria, renal function, and graft survival.
Collapse
Affiliation(s)
- Nina M Molenaar
- 1 Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Robert C Minnee
- 1 Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- 2 Renal Transplant Unit, Department of Nephrology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Mirza M Idu
- 1 Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
11
|
Sabnis RB, Singh AG, Ganpule AP, Chhabra JS, Tak GR, Shah JH. The development and current status of minimally invasive surgery to manage urological complications after renal transplantation. Indian J Urol 2016; 32:186-91. [PMID: 27555675 PMCID: PMC4970388 DOI: 10.4103/0970-1591.185100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Introduction: In the past, urological complications after renal transplantation were associated with significant morbidity. With the development and application of endourological procedures, it is now possible to manage these cases with minimally invasive techniques. Materials and Methods: A MEDLINE search for articles published in English using key words for the management of urological complications after renal transplantation was undertaken. Forty articles were selected and reviewed. Results: The incidence of urological complications postrenal transplantation was reported to be 2–13%. Ureteric leaks occurred in up to 8.6%, and 55% were managed endourologically. The incidence of lymphocele was as high as 20%, and less that 12% of the cases required treatment. Ureteric stricture was the most common complication, and endourological management was successful in 50–70%. The occurrence of complicated vesicoureteral reflux was 4.5%, and 90% of low-grade reflux cases were successfully treated with deflux injections. Stones and obstructive voiding dysfunction occurred in about 1% of kidney transplant recipients. Conclusion: Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy.
Collapse
Affiliation(s)
- Ravindra B Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abhishek G Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Jaspreet S Chhabra
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Gopal R Tak
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Jaimin H Shah
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| |
Collapse
|
12
|
Abstract
Introduction: Urinary tract injuries are a known complication of obstetrical and gynecological surgeries because of their anatomical proximity. Delayed diagnosis and improper management leads to high morbidity and even mortality. This is our three year's experience of urological complications after obstetric and gynecological surgery, their treatment and follows up. Materials and Methods: We reviewed all cases of urological injuries managed in our department that were deemed to be of obstetric and gynecological origins. Results: Thirty seven women were treated in the department for urological complications secondary to obstetric and gynecological procedures from January 2012 to December 2014. The most common organ involved was urinary bladder, occurring in 54% patients followed by ureter in 35.13%. Vesicovaginal fistula (VVF) was the most common injury involving the bladder occurring in nineteen patients. Ureterovaginal fistula (UVF) occurred in nine patients and acute ureteric injury in three. Hysterectomy was the most common etiology occurring in 60% cases followed by obstetrical causes in 40% cases. All cases were successfully managed both with open surgery or laparoscopic surgery. Conclusion: Although obstetrical causes are still important in developing countries, gynecological procedures especially laparoscopic surgeries are on the rise. In these procedures the suspicion of urological injuries should be kept in mind and intra-operative detection and early repair should be attempted. Delayed diagnosis and improper treatment leads to severe complications.
Collapse
Affiliation(s)
- Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Varun Wats
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Bastab Ghosh
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| |
Collapse
|
13
|
Abstract
BACKGROUND The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups. MATERIALS AND METHODS 545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages. RESULTS The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization. CONCLUSIONS Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.
Collapse
Affiliation(s)
- Roop Singh
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
BACKGROUND The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups. MATERIALS AND METHODS 545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages. RESULTS The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization. CONCLUSIONS Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.
Collapse
Affiliation(s)
- Roop Singh
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India,Address for correspondence: Dr. Roop Singh, 9-J/ 52, Medical Enclave, PGIMS, Rohtak - 124 001, Haryana, India. E-mail:
| | - Rajesh Kumar Rohilla
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Sangwan
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Ramchander Siwach
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Narender Kumar Magu
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Sukhbir Singh Sangwan
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| |
Collapse
|
15
|
Fenster HN, Scarrow GD. Quadriplegia: urological complications. Can Fam Physician 1989; 35:297-299. [PMID: 21248886 PMCID: PMC2280251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Unlike the general public, quadriplegics are prone to various urological complications as a direct/indirect result of spinal cord lesions. These complications include neurogenic bladder, urinary tract infections, renal and bladder calculi, obstructive uropathy, renal failure, and bladder neoplasms. A significant portion of upper urinary tract disease, including pyelonephritis, hypernephrosis, and calculi are usually secondary to neurogenic bladder related to detrusor sphincter dysfunction. These complications will be discussed in some detail in the following report.
Collapse
|