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Ureteric Complications (ureteric + complications)
Selected AbstractsA systematic review of hand-assisted laparoscopic live donor nephrectomyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2004P. Dasgupta Summary We provide a systematic review of hand-assisted laparoscopic live donor nephrectomy (HALDN), a relatively new procedure. Medline search of HALDN between 1995 and 2002 was conducted. Published studies were scored by two independent assessors using a modified form of 11 generic questions. All questions required one of three responses: 0 , criterion not reported, 1 , criterion reported but inadequate, 2 , criterion reported and adequate. The studies were placed according to their scoRes in category A (score 20,22), category B (17,19) and category C (16 or less). Higher scores indicate better quality of studies. Where possible, statistical analysis of comparative data was performed. Most reports of HALDN are expert series, some comparative and a few prospective. There was good correlation between the assessors (r = 0.91), and of the seven published series on HALDN, two fell into category B and five into category C. At present, there is only one published randomised-controlled trial of HALDN vs. open donor nephrectomy; this is the only such trial in laparoscopic urology. HALDN allows kidneys to be harvested with short operating and warm ischaemia times and fewer ureteric complications. HALDN is a relatively new and effective technique, designed to make kidney donation more attractive and minimally invasive without affecting recipient outcomes. More prospective data of this technique is needed, and wide variation in reported outcome parameters need to be standardised to allow meaningful comparison. [source] Urological complications in 980 consecutive patients with renal transplantationINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2006HAMID R DAVARI Aim: To present the urological complications of renal transplantations performed in the last 14 years at one center and to briefly explain a modified method of Lich,Gregoir ureteroneocystostomy. Methods: The data of 980 patients receiving kidney transplants at the authors' institution from April 1991 to February 2004 were reviewed in a retrospective prospective study. In particular, surgical techniques and urological complications were noted. Results: A total of 980 patients had received kidney transplantation. Extravesical ureteroneocystostomy (Lich,Gregoir method) was used in the first 480 patients (group A). In the subsequent 500 patients, the authors' modified method of extravesical ureteroneocystostomy, using single layer anastomosis and small feeding tubes as stent, was used (group B). Overall urological complication rate was 2.8% (28 patients), including leakage (13 patients, 1.3%), stenosis (seven, 0.7%), obstruction (one, 0.1%), distal ureter necrosis (four, 0.4%), pelvocalyceal fistula (two, 0.2%) and implantation of ureter into the peritoneum (one, 0.1%). Urological complications were significantly more common in group A compared to group B (16, 3.3% and 9, 1.8%, respectively; P < 0.05). Conclusions: Preserving the adventitia, fat and blood supply of the ureter by delicate dissection of the ureter during donor nephrectomy, short ureters, and fixation of the adventitia, fat and blood supply of the ureter to the bladder wall, to prevent kinking or twisting, are important factors in decreasing urological complications. Additionally, the authors' method of ureteroneocystostomy is also effective in decreasing the incidence of ureteric complications. [source] Modified technique of ureteroureterostomy in rat kidney transplantationMICROSURGERY, Issue 4 2004Alexander Pietsch Dr. Med. Different strain combinations of rats are available to study immunological and transplant-related problems in the models of kidney transplantation. Although numerous modifications of surgical techniques for ureteric reconstruction are evaluated in order to reduce complications and to extend long-term survival, ureteric complications still occur frequently, especially when the difference in diameter of both donor and host ureters is disproportionate. Instead of using the current nonsplinted ureteroureterostomy (method A), a versatile and rapid technical modification (method B) was developed to perform reconstruction of ureters with disproportionate diameters. The overall incidence of ureteric complications was 80% (8/10) using method A, whereas this rate was significantly reduced to 15% (3/20) using method B (P < 0.001). Our modification proves the feasibility of nonsplinted ureteroureterostomy in a technical, highly demanding rat model of kidney transplantation with an acceptable rate of ureteric complication, considering the disproportionate difference in diameter between the host and donor ureters. © 2004 Wiley-Liss, Inc. [source] 46 Laparoscopic versus open living donor nephrectomy: a contemporary series from a single centreBJU INTERNATIONAL, Issue 2006R.E. POWER Introduction:, Laparoscopic living donor nephrectomy offers potential advantages to the donor and has become a routine procedure for live kidney procurement worldwide. Since 2000 our live donor patients have been offered a laparoscopic nephrectomy. Patients and Methods:, Between February 2000 and August 2005 we performed 183 donor-recipient operations at our institution (ODN = 83 and LND = 100). We prospectively collected information on all donors and recipients for the same period to audit our experience with the first 100 LDN,s. Patients made their operative choice following discussions regarding the unit experience and literature information. We present our findings with specific emphasis on donor operative details and early recipient graft outcome. Results:, Donor and recipient age, gender, body mass index, HLA mismatches, warm ischaemia and vascular anastomotic times did not significantly differ between the two groups. There were two conversions to an open operation in the LND group and neither impacted upon recipient graft outcome. The mean operative duration was 178 ± 38 for the LDN and 159 ± 34 min for the ODN (P < 0.05). The mean length of hospital stay was 4.7 ± 1.2 days in the LND group versus 6.8 ± 1.5 days in the ODN group (P < 0.05). There was one case of delayed graft function in both groups. Serum creatinine at 1, 6 and 12 months did not differ significantly between either groups. Vascular and ureteric complications and lymphocoele rates were similar in both groups. Conclusions:, Our contemporaneous series demonstrates the safe introduction of a laparoscopic living donor programme without compromise towards donor patient safety or allograft outcome. [source] | ||||||||||