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PubMedID: 24821146 The worldwide shortage of organs available for transplantation has led to the use of living-unrelated kidney donors. In this context, spouses represent an important source of organ donors. We compared the allograft outcomes of spousal donor transplantation (SDT) with anti-thymocyte globulin (ATG) induction therapy and living related donor transplantation (LRDT) with triple immonosuppression and basiliximab, in addition. Among the 335 living and deceased donor kidney transplantations performed between April 2001 and June 2010, there were 274 living donor kidney transplantations including 34 SDT and 240 LRDT. The minimum follow-up period was 36 months. All recipients of SDT received ATG (1.5 mg/kg) induction therapy, which was stopped five to seven days after surgery. Maintenance immunosuppression included tacrolimus (TAC), mycophenolate mofetil (MMF) and prednisolone. LRDT recipients received triple immunosuppressive protocol consisting of cyclosporine or TAC, MMF and prednisolone, in addition to basiliximab. There was a significant difference between the two groups in recipient age, while pre-operative duration on dialysis, recipient sex and donor age and sex were not significantly different. There was also a significant difference between the two groups in the number of human leukocyte antigen (HLA) mismatches. The 1-, 3- and 5-year graft survival rates of SDT were 94.1%, 88.2% and 79.4%, respectively, and the frequency of acute rejection episodes was 5.8% (two cases). The 1-, 3- and 5-year graft survival rates of LRDT were 95.8%, 91.6% and 83.3%, respectively, with the frequency of acute rejection being 16.2%. The graft survival rates of SDT were as good as LRDT, while the acute rejection rates in SDT were lower than in LRDT, although the difference was not statistically different (P = 0.13).

WOS: 000249954000068 …

Introduction: Although rarely life-threatening, urological complications are associated with significant morbidity in the immunosuppressed patient and ultimately may be associated with long-term allograft dysfunction and loss. Urological complications of renal transplantation are relatively uncommon although the incidence differs among various. Herein therapies for urological diseases and complications which occured in renal transplant recipients were evaluated retrospectively. Materials and methods: Between 1989 and 2004, 242 consecutive renal transplantations were performed at our center. Patterns and incidence of urological complications and therapies which were applied for these complications were investigated in these cases. The data were collected from file enrollment of patients and compared with the findings reported in the literature. No change was done in immunosuppressive protocols. Antibiotic therapy was started preoperatively and was continued according to the urine cultures and antibiograms postoperatively. Complications in the posttransplantation period such as urine leakage from ureterovesical junction, necrosis of the distal ureter, stenosis of the ureterovesical junction and lymphocele were interfered by either endoscopical or open surgical techniques under general anesthesia. Results: Between 1989 and 2004, 57 urological interferences were applied to 46 renal transplant recipients (28 male and 18 female). The mean age of recipients was 35 years (range 9-67 years). Thirty two of these patients underwent renal transplantation in our center and the others (14 patients) underwent out of our center. Twenty four operations applied for complications were performed in the posttransplantation first month. When the interference were applied, graft age ranged between 1 day and 120 months (mean 14.4±27.1). Urological complications were detected in 32 of 242 patients (13.2%), including 10 urinary fistula (4.1%) (with 1 distal ureteral necrosis), 3 ureteric stenosis (1.2%), 1 renal calculus (0.4%), 1 bladder calculus (0.8%) 15 graft nephrectomy (due to acute and chronic rejection), 3 clinically significant renal arterial stenosis (1.2%) and 8 lymphocele requiring intervention. Renal allograft rupture due to accelerated rejection was developed in one pediatric case. Conclusion: Urological complications constitute significant problems following renal transplantation. The most important aspects concerning these complications are early diagnosis and prompt treatment. Delay in diagnosis and management may lead to deterioration of renal graft function or graft loss. Most common complications seen after renal transplantations are ureterovesical fistula, ureterovesical stenosis and lymphocele formation. All urological interventions were successful if the graft nephrectomies were ignored. This shows that endoscopical and open surgical methods can be performed successfully for the therapy of urological problems occurring in patients with renal transplantation and these methods result in success. We did not find any relationship between the appearance of urological complications and the graft survival.

Introduction: In modern urology, ureteral stents are playing significant role in avoiding complications after endoscopic or open surgery. In this study, the association between double J stent and ureteral complications, urinary tract infections and creatinine levels in renal transplant recipients after renal transplantation was prospectively assessed. Materials and methods: Between January 2002 and March 2005, 60 recipients after renal transplantation from relative living donors in Cukurova University were observed prospectively. Lich-Gregoir reimplantation was used as ureteroneocystostomy technique. 4.8 French 12 cm double J stent was placed in 30 recipients (Group I). No double J stent was placed in 30 recipients (Group II). Double J stents were removed 14 days after renal transplantation. More than 105 colonies of bacteria in urine culture were considered as urinary tract infection. The creatinine levels and urine volumes of recipients were documented for 7 days postoperatively. Results: There was no difference between two groups according to age, sex, donor's age, operation time and cold ischemia time. Ureteral complications were seen in 6 recipients in group II (no double J) while no complication was seen in group I (p=0.024). Urinary tract infection occurred in 6 recipients in group I and in 3 recipients in group II (p=0.72). The average creatinine level in group I was lower than group II in postoperative 1st, 2nd and 3rd days (p=0.024, p=0.029 and p=0.041) while there was no significant difference preoperatively (p=0.688). There was no significant difference between two groups in after postoperative 4th, 5th, 6th and 7th days (all p>0.05). The average urine volume in group I was more than group II in postoperative 1st day (p=0.017). Conclusion: Ureteral complications after renal transplantation may cause graft loss and mortality. The ureteral stents were used successfully to avoid and reduce the complications. Some centers have suggested that brief stenting could stop minor leakage due to partial disruption of the ureterovesical anastomosis and prevent early obstruction secondary to anastomotic edema or small tunnel hematoma. However, using double J stent routinely was not suggested in some centers because of the stent complications like urinary tract infection, hematuria, stent migration, stone formation, frequency, flank pain, suprapubic pain, dysuria, reflux, stent fracture. As a result, we believe that the double J stents have a significant role in avoiding the ureteral complication and in forming the ureterovesical anastomosis. However, double J stents have to be removed as soon as possible in the recipients who are under serious immunosupressive treatment. Further studies with larger series are necessary to confirm these results.

PubMedID: 11989570 Purpose: To describe the angiographic signs found using scanning laser ophthalmoscopy for the early diagnosis of vitreoretinal interface syndrome. This method is useful to visualize the inner retinal layers, being more sensitive than fundus biomicroscopy. Material: 61 patients with vitreoretinal interfase syndrome were evaluated. All of them had evidence of this disease using scanning laser ophthalmoscopy but four patients were referred without diagnosis of vitreoretinal interfase syndrome. These patients showed no biomicroscopic signs and diagnosis was made with SLO. Methods: Confocal scanning infrared laser ophthalmoscope (Heidelberg Retinal Angiograph assembled by Heidelberg Engineering). This SLO uses an infrared diode laser source of 795 nm. Conclusion: Patients included were referred with another diagnosis and with this method the correct diagnosis was made. In conclusion scanning laser ophthalmoscopy allows early diagnosis of this pathology for follow-up and treatment.

Purpose: Percutaneous nephrostomy (PCN) is a safe and useful procedure used in urinary tract obstruction and its insertion was done by the help of radiologists in some hospitals. By the use of an ultrasound and fluoroscopy which are today available in most of the urology departments there is no longer need to radiologists. The aim of this study is to evaluate the results of PCN procedures performed by the urologists alone. Methods: In a five-year period between 1990-1994, a total of 116 PCNs were inserted in 93 patients (55 male and 38 female). Their ages were ranging from 40 days to 75 years (mean 41.3 years). Ultrasound and fluoroscopic guidance were used in the urinary access. Nephrostomy tubes were inserted because of urinary obstructions in 74 (63.8%), intrapelvic malignancies in 35 (30.2%), obstruction in transplanted kidneys in 4 (3.4%) and vesicoureteral reflux in 3 (2.6%). Results: Hemorrhage was observed in 3 (2.6%) patients but surgical intervention was done only in one patient (0.9%) in the early post-procedure period to control the massive hemorrhage from the puncture sites on parenchyma. Conclusion: The urologists perform different kinds of endourologic procedures and insertion of nephrostomy catheter is a simple procedure which can be done solely by urologists who are deciding for the PCN indication and able to treat the complications which may arise, and must be handled by the urologist.

Purpose: Since the advance of endourologic techniques and instruments, treatment of the lower ureteral stones has become highly successful and safe. Ureteroscopy is a standard urologic endoscopic procedure in treating the stones. Methods: In this study, we have reviewed the results of 70 consecutive cases treated by the guidance of rigid ureteroscope between September 1994 and June 1995. Mean calculus diameter was 5.3 mm (between 3 to 10 mm). Results: In 63 patients (90%) were stones removed successfully. They were fragmented by electrohydraulic lithotripsy in 18 (28.6%), extracted by basket catheter in 16 (25.4%) and extracted by grasping forceps in 29 (46.0%). An ureteral stent was inserted following the procedure in 36 cases (51.4%). 57 patients (81.4%) were discharged from the hospital within two days. We did not observe any serious complications. Conclusion: Urologists enjoy a variety of treatment options to manage ureteral calculi. Continuing refinements in 'minimally invasive' techniques such as ESWL, ureteroscopic stone manipulation, ureteral stents, and intracorporeal lithotripsy using various energy sources have made open surgery nearly obsolescent. The choice of optimal ureteral stone treatment must be individualized to consider patient needs, physician expertise, and treatment facilities. Our experience shows that ureteroscopic lithotripsy provide a safe and effective means of performing intracorporeal lithotripsy for smaller ureteric stones. In skilled hands, ureteroscopic lithotripsy is by far the most expeditious and low morbidity means of clearing a distal ureteral stone burden. Thus, ureteroscopic treatment should be considered a treatment of choice for distal ureteral calculi.

PubMedID: 1499618 [No abstract available]

PubMedID: 16152998 Mycophenolate mofetil (MMF) is a potent immunosuppressive agent used in renal transplantation. Gastrointestinal and hematological side effects are commonly observed, but hepatotoxicity has not been reported. In this study, we assessed MMF-related hepatotoxicity in renal transplant recipients. A total of 124 renal transplantation recipients (RTRs) were evaluated for elevated liver enzymes associated with MMF, and 79 patients were enrolled to the study. Patients used MMF 2 g/day. The patients who had progressive increase in liver enzymes after renal transplantation and their AST, ALT, GGT, ALP, bilirubin levels, hepatitis, cytomegalovirus (CMV), abdominal ultrasonography, duration of hepatotoxicity, and decreased dosage or withdrawal of MMF were recorded. Also, we evaluated their liver enzymes while the patients were on the waiting list. Of the 79 patients, 11 patients (13.9%) had a progressive increase in liver enzymes. The median (min-max) age of the patients with MMF-hepatotoxicity was 29 (19-54) and 72.7% of them were male. None of the patients had hepatitis B or C, CMV infection, or other possible causes for elevated liver enzymes and their abdominal ultrasonography were normal. High liver enzyme levels regressed after the withdrawal (n=6) or reduce dosage (n = 5) of MMF. The median time of the increase in liver enzymes was 28 (4-70) days and after 50% reduction or withdrawal of MMF, returned to normal values in 16 (4-210) days. The median levels of ALT in waiting list (I), before (II), and after (III) reduction dosage or withdrawal of MMF were 22.0 (3-22), 222.0 (51-508), and 33.0 (21-64) U/L, respectively (p I-II = 0.004, p I-II = 0.013, and p II-III = 0.005). There were no differences for ALP, GGT, total bilirubin, and direct bilirubin levels. Also, the correlation between recovery time of ALT and persistence time of ALT elevation before adjustment of MMF was significant (r=0.739, p = 0.009). Consequently, after renal transplantation, hepatotoxicity can occur due to a lot of reason including MMF usage. If hepatotoxicity related to MMF is not considered, especially in the early period of renal transplantation, resolution of hepatotoxicity can be required long term. Copyright © 2005 Taylor & Francis Inc.