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Renal Units (renal + unit)
Selected AbstractsEPIDEMIOLOGY AND CONTROL OF VANCOMYCIN-RESISTANT ENTEROCOCCI (VRE) IN A RENAL UNITNEPHROLOGY, Issue 3 2000MacGinley R [source] SURVEY ON VIOLENCE AND AGGRESSION PREVENTION AND MANAGEMENT STRATEGIES IN EUROPEAN RENAL UNITSJOURNAL OF RENAL CARE, Issue 2 2010Alessandra Zampieron RN SUMMARY Goals: This descriptive survey aims to explore strategies for the prevention and management of violence and aggression in renal units in 12 European countries. Method: The convenience sample consisting of dialysis, nephrological and transplantation units in European countries was used. A questionnaire, developed with the collaboration of National Associations, was used. Data were analysed using STATA software. A preliminary descriptive variable analysis was performed followed by a verification of the association between variables; values of p < 0.002 were considered statistically significant. Results: A total of 436 completed questionnaires were received (participation rate: 22%). Written policies and procedures regarding violence and aggression are present in 18% of units. Educational strategies are available in less than 20% of units. Incidents are prevented by security staff (48%) or pharmacological treatment (66%). Incident reporting is mandatory for any violent and aggressive behaviour in 66% of units. There are differences between European countries. Discussion and conclusion: Violence and aggression prevention and management strategies are not widely implemented throughout Europe. The dissemination of information on the prevention and management of violence and aggression is vital. [source] Uncovering the evidence of non-expert nephrology nursing practiceINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 2 2006Ann Bonner BAppSc(Nurs) MA PhD RN MRCNA Expertise in nursing has been widely studied although there have been no previous studies into what constitutes expertise in nephrology (renal) nursing. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, provides evidence of the characteristics and practices of non-expert nephrology nurses. Using the grounded theory method, the study took place in one renal unit in New South Wales, Australia, and involved six non-expert and 11 expert nurses. Sampling was purposive then theoretical. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semistructured interviews was undertaken. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Non-expert nurses showed superficial nephrology nursing knowledge and limited experience; they were acquiring basic nephrology nursing skills and possessed a narrow focus of practice. [source] Independent risk factors for renal damage in a series of primary vesicoureteral reflux: A multivariate analysisNEPHROLOGY, Issue 2 2009JOSE MARIA P SILVA SUMMARY Aim: The aim of this study was to investigate risk factors associated with different extents of renal parenchyma involvement in a paediatric series of primary vesicoureteral reflux (VUR). Methods: A total of 549 patients with VUR were analyzed. The variable of interest was renal scar, assessed by technetium-99m dimercaptosuccinic acid scan, and classified into three subtypes: focal scar, multiple cortical scarring and diffuse scars with a contracted renal unit. The multinomial regression model was applied to identify independent variables associated with each subtype of renal damage. Results: After adjustment, four variables remained independently associated with a contracted renal unit: reflux grades III,V (odds ratio (OR) = 9.7; 95% confidence interval (CI) = 4.1,21.0), age at diagnosis (OR = 3; 95% CI = 1.6,5.1), unilateral reflux (OR = 2.1; 95% CI = 1.2,3.8), and male sex (OR = 2; 95% CI = 1.1,3.8). Two variables were associated with multiple scars: reflux grades III,V (OR = 13.8; 95% CI = 7.4,26.0) and age at diagnosis (OR = 1.9; 95% CI = 1.2,3.0). Two variables were associated with a focal scar: reflux grades III,V (OR = 7.9, 95% CI CI = 3.8,16.4) and male sex as a protective factor (OR = 0.5; 95% CI = 0.25,1.0). Conclusion: Our findings suggest that the development of a contracted renal unit is probably due to congenital malformation, more commonly observed in male infants with high-grade reflux. [source] Understanding the role of knowledge in the practice of expert nephrology nurses in AustraliaNURSING & HEALTH SCIENCES, Issue 3 2007Ann Bonner bappsc(nurs), mrcna Abstract This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the role of knowledge in expert practice. Using grounded theory methodology, the study involved 17 registered nurses who were practicing in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participants' observations and interviews. Having extensive nephrology nursing knowledge was a striking characteristic of a nursing expert. Expert nurses clearly relied on and utilized extensive nephrology nursing knowledge to practice. Of importance for nursing, the results of this study indicate that domain-specific knowledge is a crucial feature of expert practice. [source] Portal venous gas , case report and review of the literatureANAESTHESIA, Issue 4 2007A. H. Mohammed Summary A 74-year-old man with chronic renal failure was admitted to the renal unit with non-specific symptoms and positive blood cultures. He later deteriorated and was admitted to the Intensive Care Unit with septic shock, respiratory failure and deranged liver function. Initial improvement was followed by abdominal distension and discomfort. Portal venous gas (PVG) and thrombosis were diagnosed on computed tomography. A conservative line of management was adopted. Improvement was soon followed by deterioration with septic shock. Extensive portal venous gas and free intra-abdominal gas were now evident on repeat computed tomography. The patient was too unwell to withstand surgery and a decision was made not to escalate therapy. He died on day 16. Portal venous gas is not a disease; it is a diagnostic clue in patients who may be harbouring an intra-abdominal catastrophe. Successful management of these cases requires early identification of the underlying pathology and can range from simple observation to extensive surgical intervention. [source] A Thermoreversible Polymer Mediates Controlled Release of Glial Cell Line-Derived Neurotrophic Factor to Enhance Kidney RegenerationARTIFICIAL ORGANS, Issue 8 2010Yousof Gheisari Abstract Previously, we reported that human mesenchymal stem cells (hMSCs) that were cultivated in growing embryos differentiated in an appropriate developmental milieu, thereby facilitating the development of a functional renal unit. However, this approach required transfection with an adenovirus that expressed glial cell line-derived neurotrophic factor (GDNF) to enhance the development of hMSC-derived renal tissue, and safety issues restrict the clinical use of such viral vectors. To circumvent this problem, we tested an artificial polymer as a means to diffuse GDNF. This GDNF-polymer, which exists in liquid form at 4°C but becomes a hydrogel upon heating to 37°C, was used as a thermoreversible switch, allowing the injection of hMSCs at low viscosity using a mouth pipette, with subsequent slow diffusion of GDNF as it solidified. The polymer, which was dissolved in a solution of GDNF at 4°C and then maintained at 37°C, acted as a diffuser of GDNF for more than 48 h. LacZ -transfected hMSCs and the GDNF-polymer (at 4°C) were placed in the nephrogenic sites of growing rat embryos that were maintained at 37°C. Forty-eight hours later, the resultant kidney anlagen were dissected out and allowed to continue developing for 6 days in vitro. Whole-organ X-Gal staining and fluorescence activated cell sorter analysis showed that the number of hMSC-derived cells was significantly increased in developed anlagen that have been generated from hMSCs plus GDNF-polymer compared with those from hMSCs plus GDNF-containing medium and was comparable to those from adenovirus-transfected hMSCs. These findings suggest that the GDNF-polymer can be used as a diffuser of GDNF for kidney organogenesis. [source] Modified ureterosigmoidostomy (Mainz Pouch II): a nonrefluxing stented vs unstented laparoscopic porcine modelBJU INTERNATIONAL, Issue 2 2008Mitchell R. Humphreys OBJECTIVE To describe a rapid and reproducible pure laparoscopic cystectomy and nonrefluxing modified continent urinary diversion (Mainz Pouch II), and to determine whether ureteric stenting decreases ureteric obstruction after surgery. MATERIALS AND METHODS After institutional review and approval, six female pigs (51,55 kg) had a laparoscopic cystectomy and urinary diversion using a modified Mainz Pouch II. Imbricating bowel over the extra-intestinal ureteric segment created the nonrefluxing mechanism. All pigs had the same bowel preparation before a standard four-port transperitoneal laparoscopic procedure, but three pigs received bilateral J ureteric stents and three did not. Body weights, radiographic imaging, serum electrolytes and renal function were monitored during the 6-week survival period. RESULTS One stented pig developed bilateral pyelonephritis, renal obstruction and was killed. Including this pig, four of 12 renal units were obstructed, occurring more often in the stented pigs. There were no significant differences between the serum electrolytes before and after surgery or between the stented or unstented pigs. The surgery was quicker as experience increased. No pig developed hyperchloraemic metabolic acidosis. The nonrefluxing modification appeared to be effective, as reflux was only present in one renal unit. CONCLUSIONS Laparoscopic ureterosigmoidostomy, specifically the modified Mainz Pouch II, represents a viable and reasonable continent urinary diversion. The results suggest that there was no benefit in stenting in this pig model. [source] The change in renal function in the supranormal hydronephrotic kidney after pyeloplastyBJU INTERNATIONAL, Issue 6 2007Cheryn Song OBJECTIVE To investigate changes in the differential renal function (DRF) before and after pyeloplasty in renal units with unilateral pelvi-ureteric junction obstruction (PUJO) with supranormal function, and to evaluate the clinical significance. PATIENTS AND METHODS We reviewed the medical and radiographic records of 29 children (26 boys and three girls) with unilateral PUJO with a DRF (estimated by 99mTc-mercaptoacetyltriglycine renal scintigraphy) of ,,50% in the affected renal unit, who had pyeloplasty and were followed for >1 year after surgery. Patients were divided into two groups according to the degree of change in their DRF to compare the clinical variables, anteroposterior pelvic diameter and parenchymal thickness measured by renal ultrasonography. The mean (range) follow-up after pyeloplasty was 35 (12,89) months. RESULTS After pyeloplasty, although the mean DRF reduced from 53.8% to 51.4%, in seven (24%) patients the DRF decreased significantly (>5%) while most (76%) showed a change of ,,5% of the preoperative function, or further improvement. In the seven patients with a DRF of ,,55% before surgery, the DRF afterward was >55% in four and 50,55% in one. Between those with and with no significant reduction in DRF, only the preoperative renal parenchymal thickness differed significantly (2.78 vs 5.00 mm, P = 0.006). CONCLUSION Supranormal DRF exists and represents the true split function of the affected renal unit in patients with adequate renal parenchyma; these units maintained the supranormal function after pyeloplasty. Parenchymal thickness might be useful to differentiate between the true and false estimates and predict surgical outcome before surgery. [source] The long-term results of Anderson,Hynes pyeloplastyBJU INTERNATIONAL, Issue 4 2001P.H. O'Reilly Objectives To examine the durability of open pyeloplasty for pelvi-ureteric junction obstruction. Patients and methods The records of 56 Anderson-Hynes pyeloplasties undertaken by two surgeons between 1981 and 1994 were examined. Attempts were made to trace all patients and for them to undergo diuretic renography to examine the current status of the operated renal unit. Results In all, 41 evaluable patients were identified; 24 agreed to return for reassessment. The mean (range) time from surgery was 10.6 (6,19) years. The results showed an improvement over the preoperative split renal function in 19 patients (79%) and an improvement in drainage in 23 (96%). Conclusions The Anderson,Hynes pyeloplasty is an excellent procedure for treating pelvi-ureteric junction obstruction, and produces a lasting improvement in function and drainage in most patients. It is the ,gold standard' against which newer techniques should be compared. [source] Safety of supracostal punctures for percutaneous renal surgeryINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2006RAJIV YADAV Aim: Supracostal superior calyceal access has been shown to be the most suitable approach for staghorn calculi, calculi in the upper ureter and complex inferior calyceal calculi, as well as for antegrade endopyelotomy. However, many urologists hesitate in using this approach because of the potential for chest complications. The aim of this study was to analyze one institution's data regarding the safety and efficacy of this approach for percutaneous renal surgery. Methods: A total of 890 renal units (762 patients) were treated with percutaneous renal surgery (849 percutaneous nephrolithotomy, 41 antegrade endopyelotomy) from July 1998 to July 2004. Supracostal access was obtained in 332 (37.3%) patients. The indications for a supracostal approach were ureteropelvic junction obstruction, staghorn and complex inferior calyceal calculi, and stones in the upper calyx or the upper ureter. All punctures were made by the urologist under C-arm fluoroscopic guidance in the prone position. Results: The interspace between 11th and 12th rib was used in all except four patients in whom the puncture was made above the 11th rib. Eleven patients (3.31%) had a pleural breach presenting with fluid in the chest. Insertion of a chest tube was required in seven patients, while other four were managed conservatively. No patient had injury to the lung or other viscera. Hospital stay was not significantly prolonged as a result of the pleural breach in any patient. Except for staghorn calculi where multiple tracts were a necessity for maximal clearance, a single supracostal superior or middle posterior calyceal access served the purpose in 86% (177/205) of patients who underwent percutaneous surgery for renal or upper ureteric calculi. Conclusions: The supracostal superior calyceal approach was found to be effective as well as safe, with an acceptably low risk of chest complications. [source] Isolated minimal renal pelvic dilatation detected antenatally in a non-tertiary setting is an uncommon predictor of significant vesicoureteric refluxJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2003GJ Rennick Objectives: To study in a non-tertiary centre the prevalence and grade of vesicoureteric reflux detected postnatally in infants already identified antenatally with isolated minimal renal pelvic dilatation. Methods: Retrospective review over the years 1998,2000 inclusive of a central computerized database in the single paediatric practice within Albury Wodonga. Results: Ninety-three (65 male) infants detected antenatally with isolated renal pelvic dilatation (,3 mm at 18 weeks gestation, ,5 mm at 32 weeks gestation,<10 mm dilatation at any gestation) had a Micturating Cystourethrogram result. Thirteen infants (seven male) had vesicoureteric reflux detected, with a total of 18 refluxing renal units. Of these 13 infants five had bilateral vesicoureteric reflux (two male), and eight had unilateral vesicoureteric reflux. The median reflux grade was 2.0, with significant vesicoureteric reflux (greater than grade II) occurring in 5.4% (5/93). Conclusions: Significant vesicoureteric reflux (greater than grade II) occurred in only 5.4% (5/93) of infants. It is concluded that isolated minimal renal pelvic dilatation detected antenatally is a poor screening test for clinically significant vesicoureteric reflux. [source] SURVEY ON VIOLENCE AND AGGRESSION PREVENTION AND MANAGEMENT STRATEGIES IN EUROPEAN RENAL UNITSJOURNAL OF RENAL CARE, Issue 2 2010Alessandra Zampieron RN SUMMARY Goals: This descriptive survey aims to explore strategies for the prevention and management of violence and aggression in renal units in 12 European countries. Method: The convenience sample consisting of dialysis, nephrological and transplantation units in European countries was used. A questionnaire, developed with the collaboration of National Associations, was used. Data were analysed using STATA software. A preliminary descriptive variable analysis was performed followed by a verification of the association between variables; values of p < 0.002 were considered statistically significant. Results: A total of 436 completed questionnaires were received (participation rate: 22%). Written policies and procedures regarding violence and aggression are present in 18% of units. Educational strategies are available in less than 20% of units. Incidents are prevented by security staff (48%) or pharmacological treatment (66%). Incident reporting is mandatory for any violent and aggressive behaviour in 66% of units. There are differences between European countries. Discussion and conclusion: Violence and aggression prevention and management strategies are not widely implemented throughout Europe. The dissemination of information on the prevention and management of violence and aggression is vital. [source] Peritonitis rates and common microorganisms in continuous ambulatory peritoneal dialysis and automated peritoneal dialysisPEDIATRICS INTERNATIONAL, Issue 2 2009Sema Akman Abstract Background:, The aim of the present study was to perform a multicenter investigation in Turkish children on chronic peritoneal dialysis by examining the rates of peritonitis as well as causative organisms according to year. Methods:, Twelve pediatric renal units participated in this study and data were obtained by review of the medical records. Results:, One hundred and thirty-two patients were on continuous ambulatory peritoneal dialysis (CAPD), 21 were on automated peritoneal dialysis (APD) and 59 were on CAPD and APD at different times. Mean durations of CAPD and APD were 24.2 ± 21.1 months and 22.9 ± 12.8 months, respectively. Seventy-one (33%) out of 212 patients had no peritonitis episode. Overall peritonitis rate was one episode per 15.5 patient-months. The peritonitis rate was one episode per 15.4 patient-months for APD and one episode per 15.6 patient-months for CAPD. Coagulase-negative staphylococcus was the most common cause of peritonitis among patients with positive culture (20.6%). While the incidence of Gram-negative infection remained unchanged according to year in patients on CAPD (P = 0.68), the rate of Gram-negative peritonitis in children on APD was significantly higher (P = 0.03). Conclusions:, Peritonitis rate was similar in CAPD and APD, but the risk of Gram-negative peritonitis in APD was higher than that of CAPD. [source] Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosisBJU INTERNATIONAL, Issue 5 2010Robert J. Stein Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To describe various approaches for ureterolysis with an omental wrap using minimally invasive techniques, as surgery for idiopathic retroperitoneal fibrosis includes tissue biopsy, ureterolysis, and intraperitonealization or omental wrap. PATIENTS AND METHODS Since 2006 we have performed ureterolysis in four patients diagnosed with retroperitoneal fibrosis in two institutions. The ureterolysis in two cases was bilateral, using a standard laparoscopic approach for one case and a hand-assisted technique for the other. Unilateral ureterolysis was completed using a standard laparoscopic approach in one case and was converted to a hand-assisted technique in the other due to difficulty with ureteric identification. An omental wrap was used after ureterolysis for all renal units. RESULTS A minimally invasive technique was used for all ureterolysis procedures and none required open conversion. There was fascial dehiscence after surgery at the hand-port site in one patient, and required re-operation for wound closure. The median (range) hospital stay for all patients was 2.5 (2,10) days and the median blood loss was 100 (50,550) mL. No patient required a blood transfusion. At a median 16.5 (12,32) months of follow-up, there was symptomatic and radiographic success in all patients. CONCLUSIONS Ureterolysis can be a challenging operation depending on the extent of the retroperitoneal mass. An understanding of various laparoscopic techniques can provide the flexibility for successful completion of nearly all of these procedures using a minimally invasive approach. [source] Long-term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injuryBJU INTERNATIONAL, Issue 4 2008Tarek Mohsen OBJECTIVE To assess the long-term morphological and functional outcome of superselective transarterial embolization (TAE) for treating traumatic renal vascular injury. PATIENTS AND METHODS The surgical records of 124 patients with traumatic renal vascular injury managed by TAE between 1990 and 2004 were reviewed, of whom 81 completed a long- term follow-up and were included in the final analysis. Patients were followed using serum creatinine levels, grey-scale ultrasonography, intravenous urography (IVU) and radioisotopic renography using 99mTc-mercapto-acetyl triglycine (MAG3) and 99mTc-dimercaptosuccinic acid (DMSA). RESULTS Embolization resulted in the cessation of haematuria in all patients but two (97.5%). At 3 months, serum creatinine levels increased in four of nine patients with a solitary kidney, but only one of them required haemodialysis. After a mean follow-up of 4.6 years, IVU showed a normal calyceal configuration in 70% of renal units, pyelonephritic changes in 26% and no dye excretion in 4%. DMSA scans showed no evidence of photopenic areas in 17 renal units (21%). The mean (sd) percentage of DMSA uptake by the corresponding kidney improved from 24 (9)% at the 3-month scans to 32 (10)% at the last follow-up scan (P < 0.001). Using MAG3, the mean (sd) glomerular filtration rate improved significantly from 26 (11) mL/min at the 3-month scan to 32 (9) mL/min at the last follow-up (P < 0.05). CONCLUSIONS Superselective TAE is safe and effective for traumatic renal vascular injury. The short-term deleterious effects were more pronounced in patients with a solitary kidney. The long-term follow-up showed functional and morphological improvements in the embolized renal units. [source] Modified ureterosigmoidostomy (Mainz Pouch II): a nonrefluxing stented vs unstented laparoscopic porcine modelBJU INTERNATIONAL, Issue 2 2008Mitchell R. Humphreys OBJECTIVE To describe a rapid and reproducible pure laparoscopic cystectomy and nonrefluxing modified continent urinary diversion (Mainz Pouch II), and to determine whether ureteric stenting decreases ureteric obstruction after surgery. MATERIALS AND METHODS After institutional review and approval, six female pigs (51,55 kg) had a laparoscopic cystectomy and urinary diversion using a modified Mainz Pouch II. Imbricating bowel over the extra-intestinal ureteric segment created the nonrefluxing mechanism. All pigs had the same bowel preparation before a standard four-port transperitoneal laparoscopic procedure, but three pigs received bilateral J ureteric stents and three did not. Body weights, radiographic imaging, serum electrolytes and renal function were monitored during the 6-week survival period. RESULTS One stented pig developed bilateral pyelonephritis, renal obstruction and was killed. Including this pig, four of 12 renal units were obstructed, occurring more often in the stented pigs. There were no significant differences between the serum electrolytes before and after surgery or between the stented or unstented pigs. The surgery was quicker as experience increased. No pig developed hyperchloraemic metabolic acidosis. The nonrefluxing modification appeared to be effective, as reflux was only present in one renal unit. CONCLUSIONS Laparoscopic ureterosigmoidostomy, specifically the modified Mainz Pouch II, represents a viable and reasonable continent urinary diversion. The results suggest that there was no benefit in stenting in this pig model. [source] The change in renal function in the supranormal hydronephrotic kidney after pyeloplastyBJU INTERNATIONAL, Issue 6 2007Cheryn Song OBJECTIVE To investigate changes in the differential renal function (DRF) before and after pyeloplasty in renal units with unilateral pelvi-ureteric junction obstruction (PUJO) with supranormal function, and to evaluate the clinical significance. PATIENTS AND METHODS We reviewed the medical and radiographic records of 29 children (26 boys and three girls) with unilateral PUJO with a DRF (estimated by 99mTc-mercaptoacetyltriglycine renal scintigraphy) of ,,50% in the affected renal unit, who had pyeloplasty and were followed for >1 year after surgery. Patients were divided into two groups according to the degree of change in their DRF to compare the clinical variables, anteroposterior pelvic diameter and parenchymal thickness measured by renal ultrasonography. The mean (range) follow-up after pyeloplasty was 35 (12,89) months. RESULTS After pyeloplasty, although the mean DRF reduced from 53.8% to 51.4%, in seven (24%) patients the DRF decreased significantly (>5%) while most (76%) showed a change of ,,5% of the preoperative function, or further improvement. In the seven patients with a DRF of ,,55% before surgery, the DRF afterward was >55% in four and 50,55% in one. Between those with and with no significant reduction in DRF, only the preoperative renal parenchymal thickness differed significantly (2.78 vs 5.00 mm, P = 0.006). CONCLUSION Supranormal DRF exists and represents the true split function of the affected renal unit in patients with adequate renal parenchyma; these units maintained the supranormal function after pyeloplasty. Parenchymal thickness might be useful to differentiate between the true and false estimates and predict surgical outcome before surgery. [source] Modified ureterosigmoidostomy (Mainz Pouch II) in different age groups and with different techniques of ureteric implantationBJU INTERNATIONAL, Issue 3 2004Patrick J. Bastian In this section there are papers on three types of urinary diversion which are in common use. Authors from Germany, Greece and Turkey describe their experience with the Mainz pouch II, S-pouch neobladder and modified Hautmann bladder, respectively. OBJECTIVE To examine the outcome of Mainz Pouch II urinary diversion in different age groups and with different techniques of ureteric implantation. PATIENTS AND METHODS Between March 1995 and August 2002 a Mainz Pouch II was created in 41 patients (27 male and 14 female, median age 56.3 years, range 2,75) with 81 renal units (RU). For analysis, the patients were divided into 29 (70%) aged <65 years and 12 (30%) aged >65 years. Ureteric implantation with the Goodwin-Hohenfellner (GH) technique was used in 55 RU, with the Abol-Enein (AE) modification in 23 and Le-Duc procedure in three. The median (range) follow-up (available for 36 patients, 88%) was 19 (1,80) months. An unvalidated questionnaire was used to determine specific urinary diversion items. RESULTS Early complications occurred in 7% of patients, none requiring surgical intervention. Pyelonephritis occurred in five of 36 patients and seven of 71 RU (14% of the patients, 10% of the RU); all patients were <65 years old. In five of seven RU pyelonephritis was caused by the development of upper urinary tract dilatation; none required surgical revision. Ureteric stenosis requiring reimplantation occurred in two RU (2%, one GH, one AE). All patients were continent in the daytime; all but one patient had to wake to urinate at night, with 36% having to do so more than six times. Of the patients, 63% were able to distinguish between stool and urine. Initially, alkalinizing drugs to prevent metabolic acidosis were taken by 30% of the patients. Of previously medicated patients with a follow-up of >1 year, 8% required oral alkalinizing medication. CONCLUSION The Mainz Pouch II is a safe and reproducible urinary diversion, and serves as a satisfying alternative to other forms of continent urinary diversion in all age groups. The follow-up shows a low complication rate with good results in terms of continence. There were no significant differences in complication rates for the different ureteric implantation techniques. The long-term results remain to be evaluated. [source] Renal damage in vesico-ureteric refluxBJU INTERNATIONAL, Issue 4 2004P. Caione OBJECTIVE To detect the different extent of renal parenchymal involvement in primary vesico-ureteric reflux (VUR), and to evaluate the relationship between VUR grade, patient age and different patterns of parenchymal damage. PATIENTS AND METHODS This blinded retrospective study included 197 consecutive children (mean age 4.26 years, range 1 month to 13 years) with primary VUR detected by voiding cysto-urethrography (VCUG), 99mTc-dimercaptosuccinic acid (DMSA; 120 MBq/1.73 m2) renal scintigraphy, with scanning for 3 h after intravenous injection. An abnormal DMSA scan was classified into three subtypes: cortical defects as a single scar (SS), multiple cortical scarring (MS) and diffuse reduced uptake with small renal size. Renal absolute uptake (AU), and split-kidney relative uptake were evaluated in refluxing and nonrefluxing renal units, and correlated with parenchymal damage and patient age. Student's t -test and the chi-square test were used for the statistical analysis. RESULTS In all, 282 refluxing and 112 nonrefluxing units were assessed. Renal damage was detected in 188 of 282 units with VUR (67%) and in 18 of 112 (16%) contralateral nonrefluxing kidneys. The mean AU was 18.7% in kidneys with VUR and 29% in nonrefluxing units (P < 0.001). The mean (sd) AU decreased from lower to higher grades of VUR, i.e. grade 0 VUR (group A), 28.97 (9.71); grade 1,3 (group B), 21.28 (8.33); grade 4,5 (group C), 14.78 (8.02). The differences were statistically significant (A vs B, B vs C, both P < 0.001). Renal damage was differently distributed in the three groups: 69 of 109 kidneys (63%) in group C (MS prevalent), 39 of 173 (22.5%) in group B (SS prevalent) and 17 of 112 (15.2%) in group A. There was no significant difference in the distribution of renal damage subtypes in patients aged <,or >,2 years (SS 19.6% vs 17.9%, MS 29.6% vs 30.1%, small size 48.2% vs 46.3%). The VUR was severe (group C) in 65% of patients aged <,2 years and in 46% aged >,2 years (chi-square, P= 0.016). CONCLUSIONS VUR is commonly associated with renal damage. Age (< or >,2 years) did not significantly influence the kidney lesion subtype. Reduced parenchymal function (AU) progressively decreased with the severity of VUR. Focal MS, reduced size and relative uptake were significantly more common in severe VUR, leading to multifocal lesions and hypo-dysplasia. Renal scarring was present in up to 15% of contralateral nonrefluxing kidneys. Severe VUR behaved differently from lesser VUR in the renal scan parenchymal uptake. [source] The urethral Kock pouch: long-term functional and oncological results in menBJU INTERNATIONAL, Issue 4 2003A.A. Shaaban The Department of Urology in Mansoura has a well-known experience in, among many things, urinary tract reconstruction in patients with bladder cancer. They review their results in 338 male patients who had a radical cystectomy and Kock pouch. They found good functional and oncological outcomes in properly selected patients. However, they also drew attention to several valve-related complications. OBJECTIVE To evaluate our experience with men who underwent radical cystectomy and urethral Kock pouch construction between January 1986 and January 1996. PATIENTS AND METHODS Complications were classified as early (within the first 3 months after surgery) or late. Continence was assessed by interviewing the patient; they were considered continent if they were completely dry with no need of protection by pads, condom catheter or medication. The patients were followed oncologically and Kaplan-Meier survival curves constructed. Urodynamic studies were used to define the possible causes of enuresis. RESULTS Three patients died after surgery from pulmonary embolism. There were 67 early complications in 63 patients. The mean (sd) follow-up was 87.8 (49.1) months. There were 111 treatment failures from cancer; of these, four men only had an isolated local recurrence in the urethra. Late complications included 72 pouch stones in 55 patients, and 36 deteriorated renal units caused by reflux (17), uretero-ileal stricture (11), nipple valve eversion (four) or stenosis (four). Interestingly, 65 renal units that were dilated before surgery improved significantly afterward. Ileo-urethral strictures occurred in seven men and anterior urethral strictures in six. Nine patients were totally incontinent and two had chronic urinary retention. Daytime continence was complete in 94% of men, with nocturnal enuresis in 55; the latter had significantly more residual urine, and a higher amplitude and duration of phasic contractions. CONCLUSIONS Orthotopic bladder substitution after cystectomy for cancer is feasible, with good functional and oncological outcomes in properly selected patients. Nevertheless, the use of a hemi-Kock pouch is associated with many valve-related complications. [source] The management of paediatric urolithiasisBJU INTERNATIONAL, Issue 7 2000S. Choong Objective To evaluate the efficacy and safety of the management of paediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL), endoscopic ureterolithotomy, percutaneous nephrolithotomy (PCNL) and open nephrolithotomy. Patients and methods In a 3-year period (1997,1999), 59 children were treated for urolithiasis and underwent a total of 79 procedures. Thirty-two ESWL sessions were performed in 23 children (mean age 7.4 years, median 6.0). PCNL was undertaken in 30 renal units in 25 children (mean age 6.4 years, median 4.0). Eight patients (mean age 7.8 years, median 5) underwent 17 ureteroscopic procedures, six of which involved the use of a holmium laser. Three children with staghorn calculi underwent open nephrolithotomy under conditions of renal ischaemia and hypothermia. Results Of the 23 children treated using ESWL, 21 (91%) became stone-free; 17 underwent one ESWL session (74%), three had two sessions and three (13%) had three sessions. All eight patients who underwent ureteroscopy became stone-free. Four patients in whom the stone could not be reached by ureteroscopy initially had a JJ stent inserted, and the stone and stent subsequently removed. Stones were cleared using PCNL in 27 of 30 renal units (90%); three patients who had residual stone fragments were rendered stone-free by ESWL. Two of three children undergoing open nephrolithotomy were stone-free after surgery and the remaining one rendered stone-free with ESWL. Metabolic evaluation showed that 25 of 45 children (55%) had a urinary infection, eight (18%) had hyperoxaluria, three (7%) had hypercalciuria, two (4%) had cystinuria, and no identifiable cause was found in seven (16%). Treatment by a single modality rendered 52 of the 59 children (88%) stone-free; when the different modalities were combined, 57 of 59 patients (97%) were cleared of their stones. Conclusions Technological advances in ESWL, ureteroscopy and PCNL have had a significant effect on the management of urolithiasis in children, allowing a safe and successful outcome. The comprehensive care of children with urolithiasis should include a full metabolic evaluation. Anatomical anomalies contribute to the complexity of many cases, necessitating a close liaison between adult and paediatric urologists, nephrologists and radiologists to optimize stone management in children. [source] | |||||||||||||||||||||||||