The outcome of kidney transplants with multiple renal arteries

BACKGROUND: The use of grafts with multiple renal arteries has been considered a relative contraindication because of the increased incidence of vascular and urologic complications The aim of this study is to determine whether the kidney grafts with multiple arteries have any adverse effect upon post-transplant graft and patient survival. METHODS: We reviewed the records of 225 adult kidney transplants done consecutively at our institution. Twenty-nine patients (12.8%) had grafts with multiple renal arteries. We analyzed the incidence of post-transplant hypertension and vascular complications, mean creatinine levels, patient and graft survival. In 17 cases reconstruction was done as conjoined anastomosis between two arteries of equal size, and in 6 cases as end-to-side anastomosis of smaller arteries to larger arteries. Multiple anastomoses were performed in 6 cases. RESULTS: In one patient postoperative bleeding occurred. Mean systolic blood pressures, creatinine levels at first year and last follow-up and complication rates were all in acceptable ranges. There was no significant difference in graft and patient survival between multiple and single renal artery allografts. CONCLUSION: Although the kidney grafts with multiple renal arteries have been considered a relative contraindication because of the increased risk of complications, in our study allografts with multiple arteries were used successfully in kidney transplantation

Successful transureteropyelostomy after heminephrectomy of a bilateral hydronephrotic horseshoe kidney: a case report

<p>Abstract</p> <p>Introduction</p> <p>Horseshoe kidney is a rare congenital malformation that is found in approximately 0.25% of the general population and usually remains asymptomatic.</p> <p>Case presentation</p> <p>We report a successful transureteropyelostomy after heminephrectomy of the non-functional right moiety in a 25-year-old man with horseshoe kidney who had a combined 50% functional loss and hydronephrosis due to multiple distal ureteral strictures on the functionally remaining left side. Continuous ureteral stenting of the remaining part of the former horseshoe kidney was avoided during a follow-up of 2 years.</p> <p>Conclusion</p> <p>Urologists are often faced with technically difficult cases that are not responsive to standard operative procedures, and this case illustrates an individual surgical approach in a clinical situation.</p

The relationship between the systemic inflammatory response and survival in patients with transitional cell carcinoma of the urinary bladder

The relationship between tumour stage, grade, elevated C-reactive protein concentration (<10/>10 mg l−1), adjuvant therapy and survival was examined in patients with biopsy proven bladder cancer (n=105). On multivariate analysis stage (HR 3.37, 95% CI 1.37–8.29, P=0.008), grade (HR 2.01, 95% CI 1.14–3.57, P=0.017) and preoperative C-reactive protein (HR 3.31, 95% CI 1.09–10.09, P=0.035) were independently associated with cancer-specific survival

Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma

This is the first series that suggests a prognostic benefit of neoadjuvant treatment in a consecutive series of patients who underwent perioperative chemotherapy plus surgery for advanced primary urethral carcinoma. Further studies should yield a better understanding of how perioperative chemotherapy exerts a positive effect on survival in order to selectively advocate its use in advanced primary urethral carcinom

Fluorescence in-situ hybridisation on biopsies from clam ileocystoplasties and on a clam cancer

The incidence of carcinoma following an enterocystoplasty increases with time and is a major concern after such procedures. The aim of this study was to investigate genetic instability (in the form of numerical chromosomal aberrations) at the enterovesical anastomosis in patients who had undergone a clam ileocystoplasty using fluorescent in-situ hybridisation (FISH). Fluorescent in-situ hybridisation was performed on touch preparation samples prepared from fresh endoscopic biopsies obtained from the enterovesical anastomosis and native bladder remnant (control specimens) of 15 patients who had undergone a clam ileocystoplasty. Fluorescent in-situ hybridisation was also performed on one squamous cell cancer specimen. Significant aneusomic changes were found at the enterovesical anastomosis in all 15 patients. Alterations in chromosome 18 copy number were the most frequent abnormal finding (trisomy 18, n=8; monosomy 18, n=7). Nine patients were monosomic for chromosome 9. Isolated monosomy 8 and trisomy 8 were each found in one patient. The control specimens were all normal. An unusually high incidence of polysomic cells was found in the clam tumour specimen, reflecting the aggressive nature of this cancer. Chromosomal numerical abnormalities occur at the enterovesical anastomosis following a clam ileocystoplasty and chromosome 18 appears to be a particularly good marker of genetic instability. The results of this study indicate that morphologically normal tissue obtained from the enterovesical anastomosis displays evidence of chromosomal instability that may predispose to tumour formation. However, further prospective, blinded, longitudinal studies are required to establish whether predetermined FISH signal patterns in enterocystoplasty cells in urine or obtained by biopsy predict the presence or absence of tumour

Radical Cystectomy and Orthotopic Bladder Substitution Using Ileum

Over the past decade, continent urinary diversion, especially orthotopic bladder substitutions, has become increasingly popular following radical cystectomy for bladder cancer. The ultimate goal of orthotopic bladder substitution is to offer patients the best quality of life, similar to that of patients with native bladders. To achieve that purpose, surgeons should be familiar with the characteristics of good candidates for neobladders, the possible intraoperative and postoperative problems related to the surgery, and the solutions to these problems. Postoperative surveillance and instructions given to the patients also contribute to successful, functional results. Here, we reviewed the indications, pitfalls, and solutions for orthotopic bladder substitutions and the patients' quality of life after surgery. When performed properly, orthotopic continent diversion offers good quality of life with few long-term complications. Therefore, we believe it is the best option for the majority of patients requiring cystectomy