Early Continence and Extravasation After Open Retropubic Radical Prostatectomy – Interrupted vs Continuous Suturing for Vesicourethral Anastomosis

Purpose: To compare running suture (RS) and interrupted suture (IS) of vesicourethral anastomosis (VUA) during open retropubic radical prostatectomy (RRP) on early urinary continence and extravasation. Patients and methods: Single center analysis of 211 patients who underwent RRP performed by a single surgeon during 2008 to 2017 was retrospectively analyzed. For VUA, we used the standard interrupted suture technique (n=100) with a 3-0 PDS suture. The RS (n=111) was performed with 12-bite suture using 3-0 PDS. The primary endpoints were extravasation and early continence. Demographic and peri-operative data were collected and analyzed using Pearson's chi-square, t-Test and Mann-Whitney U-test. A binary logistic regression analysis was carried out to explore predictors that affected early continence after catheter removal. Results: The rates of early urinary incontinence (UI) were 7.7% vs 42.2% (p<0.001). The duration of catheterization and hospitalization was significantly shorter in the interrupted group (4 days vs 5 days, p<0.001 and 5 days vs 6 days, p<0.001). The groups did not differ significantly in body mass index or prostate volume. There were older patients and higher PSA levels in the group with RS technique. No significant difference was found in the postoperative extravasation rates between both groups (13.5% vs 12%, p=0.742). Conclusion: Running vesicourethral anastomosis increased the rate of early urinary incontinence. Both anastomosis techniques provided a similar rate of postoperative urine extravasation. VUA should only be one of the many criteria that must be considered for the preservation of urinary continence of patients after RRP

Should We Perform Old-For-Old Kidney Transplantation during the COVID-19 Pandemic? The Risk for Post-Operative Intensive Stay

Health care systems worldwide have been facing major challenges since the outbreak of the SARS-CoV-2 pandemic. Kidney transplantation (KT) has been tremendously affected due to limited personal protective equipment (PPE) and intensive care unit (ICU) capacities. To provide valid information on risk factors for ICU admission in a high-risk cohort of old kidney recipients from old donors in the Eurotransplant Senior Program (ESP), we retrospectively conducted a bi-centric analysis. Overall, 17 (16.2%) patients out of 105 KTs were admitted to the ICU. They had a lower BMI, and both coronary artery disease (CAD) and hypertensive nephropathy were more frequent. A risk model combining BMI, CAD and hypertensive nephropathy gained a sensitivity of 94.1% and a negative predictive value of 97.8%, rendering it a valuable search test, but with low specificity (51.1%). ICU admission also proved to be an excellent parameter identifying patients at risk for short patient and graft survivals. Patients admitted to the ICU had shorter patient (1-year 57% vs. 90%) and graft (5-year 49% vs. 77%) survival. To conclude, potential kidney recipients with a low BMI, CAD and hypertensive nephropathy should only be transplanted in the ESP in times of SARS-CoV-2 pandemic if the local health situation can provide sufficient ICU capacities

Contrast enhanced ultrasound (CEUS) in living kidney donors for evaluation of kidney function – a prospective study

Hintergrund: Der kontrastmittelunterstützte Ultraschall (CEUS) hat breite Anwendung in der Untersuchung von verschiedenen Organen zur Differenzierung von Pathologien gefunden. In der Niere wird der CEUS vornehmlich zur Beurteilung von fokalen Läsionen eingesetzt. Allerdings wurde der CEUS bisher nicht auf einen Zusammenhang mit der Nierenfunktion untersucht. Um einen möglichen Zusammenhang zwischen der Nierenperfusion im CEUS und der Nierenfunktion zu untersuchen, erhielten Nierenlebendspender im Rahmen dieser prospektiven Pilotstudie eine CEUS-Untersuchung der Nieren. Material und Methoden: Zwischen April 2018 und März 2020 wurden insgesamt 30 Nierenlebendspender eingeschlossen und 60 Nieren untersucht. Alle Patienten erhielten verschiedene Nierenfunktionsuntersuchungen. Unter anderem wurde bei allen Patienten eine MAG3-Szintigraphie durchgeführt und die DTPA-Clearance bestimmt. Zudem erfolgte bei allen eingeschlossenen Nierenlebendspendern präoperativ eine standardisierte CEUS-Untersuchung beider Nieren. Für die CEUS-Untersuchungen wurde das Ultraschall-Kontrastmittel (UKM) SonoVue® (Bracco Imaging, Milan) verwendet. Die Nierenperfusion wurde jeweils im Anschluss an die Untersuchung mithilfe der etablierten Perfusionssoftware VueBox™ (Bracco) analysiert. Die erhobenen CEUS-Parameter wurden anschließend auf einen Zusammenhang mit Funktionsparametern untersucht. Ergebnisse: Die durchschnittliche Signalintensität (MeanLin) des Cortex wies mitunter die stärksten Korrelationen auf. Es zeigten sich signifikante Korrelationen zwischen MeanLin und der eGFR nach Cockcroft-Gault (CG) (r = -0,345; p = 0,007). MeanLin wies weiterhin eine signifikante Korrelation mit dem Gesamtnierenvolumen auf (r = -0,409; p = 0,001). Allerdings konnte kein signifikanter Zusammenhang mit der Referenzmethode DTPA festgestellt werden. Nach der Selektion normalgewichtiger Patienten konnte ein starker und signifikanter Zusammenhang zwischen MeanLin und der DTPA festgestellt werden (r = -0,502; p = 0,005). In der Regression konnte allerdings kein Zusammenhang zwischen der DTPA-Clearance und dem BMI (b = - 0,327; p = 0,451) bzw. MeanLin (b = - 0,054; p = 0,655) gezeigt werden. Schlussfolgerung: Die Ergebnisse der Pilotstudie zeigen, dass MeanLin als Signalintensitätsparameter im CEUS mit der Nierenfunktion korreliert. Gerade bei normalgewichtigen Patienten könnte der CEUS zur Beurteilung der Nierenfunktion eingesetzt werden. Eine geringe Nierenfunktion war mit einem starken Signal assoziiert. Weitere Studien sind notwendig, um diesen Zusammenhang in größeren Patientenkohorten zu untersuchen und mögliche Störfaktoren zu analysieren.Background: Contrast-enhanced ultrasound (CEUS) is widely used as a diagnostic tool in order to analyze perfusion and to detect lesions in multiple organs. CEUS can also be applied for assessment of kidney lesions. However, to date it has not been investigated if there is a connection between CEUS and kidney function. This study aimed analyzing the potential relation between kidney function and CEUS in living kidney donors. Materials and Methods: Between April 2018 and March 2020 overall 30 living kidney donors has been included in the study and 60 kidneys were examined. All patients received various methods for evaluation of kidney function. Kidney function was measured by DTPA clearance and MAG3 scintigraphy. Moreover, CEUS was performed in all included living donors one day before nephrectomy. SonoVue® (Bracco Imaging, Milan) was used as a contrast medium. Quantification of kidney perfusion was conducted using VueBox (Bracco). Various perfusion parameters were provided by the software and were subsequently analyzed and compared with methods for evaluation of kidney function. Results: Mean signal-intensity (MeanLin) had the strongest correlation among all the provided perfusion parameters. MeanLin showed significant correlations with eGFR (CG) (r = -0,345; p = 0,007) and total kidney volume (r = -0,409; p = 0,001), respectively. However, no significant correlation was observed between MeanLin and DTPA. After selection of patients with normal weight, a strong and significant correlation between MeanLin and DTPA was detected (r = -0,502; p = 0,005). Linear regression analysis showed no association between DTPA and BMI (b = - 0,327; p = 0,451) or MeanLin (b = - 0,054; p = 0,655). Conclusion: The presented results indicate that MeanLin as a parameter for signal intensity in CEUS is associated with kidney function. Especially in patients with normal weight, CEUS could be used for evaluation of kidney function. Impaired kidney function provides a brighter and enhanced signal in CEUS. However, more research is needed in order to confirm these results in larger patient cohorts and for identification of factors which may influence and interfere signal intensities in CEUS

The Ureter in the Kidney Transplant Setting: Ureteroneocystostomy Surgical Options, Double-J Stent Considerations and Management of Related Complications

Purpose of Review: In the setting of kidney transplantation, the ureter is a common source for complications. As a result, prevention of ureteral complications and their management is of crucial importance. In this context, the purpose of this review is to summarize recent literature on the ureter in the kidney transplant setting with a special focus on new findings. We conducted a PubMed and Medline search over the last 10 years to identify all new publications related to ureteroneoimplantations, stents and management of complications in the kidney transplant setting. Recent Findings: Performance of the “Lich-Gregoir” technique for ureteroneocystostomy seems to be favourable in regard to postoperative complications when compared with other methods described in the literature. Moreover, major urologic complications can be further reduced by ureteral stenting. Summary: A new approach for management of ureteral strictures in renal transplants is presented. We discussed the usage of a ureteral stent covered with a biostable polymer aiming to prevent tissue ingrowth into the lumen as a new option for management of ureteral stricture in the kidney transplant setting

Nephron Sparing Surgery in Renal Allograft in Recipients with de novo Renal Cell Carcinoma: Two Case Reports and Review of the Literature

We report 2 cases of de novo renal cell carcinoma (RCC) in renal grafts after transplantation. Both patients underwent nephron sparing surgery (NSS) 211 and 167 months after transplantation, revealing papillary RCC with a tumour size >4 cm (pT1a). Within a follow-up of 25 and 32 months after NSS, a stable renal function without indication for dialysis was present. No recurrence of RCC in both cases was reported within the yearly routine examinations. NSS in kidney allografts is a safe procedure with preservation of renal function

Renal Allograft Compartment Syndrome: A Case Report and Review of the Literature

Kidney transplantation is the treatment of choice for patients with ESRD. One rare complication after transplantation is the development of renal allograft compartment syndrome (RACS). We present a case of 1 patient who developed RACS due to compression of the transplant vein, which was then treated by salvaging the kidney transplant using urgent decompression surgery with mesh fascial closure. We postulate that this technique is safe and should be the treatment of choice for patients with RACS

Native Nephrectomy before and after Renal Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD)

The aim of this study was 1) to evaluate and compare pre-, peri-, and post-operative data of Autosomal Dominant Polycystic Kidney Disease (ADPKD) patients undergoing native nephrectomy (NN) either before or after renal transplantation and 2) to identify advantages of optimal surgical timing, postoperative outcomes, and economical aspects in a tertiary transplant centre. This retrospective analysis included 121 patients divided into two groups&mdash;group 1: patients who underwent NN prior to receiving a kidney transplant (n = 89) and group 2: patients who underwent NN post-transplant (n = 32). Data analysis was performed according to demographic patient details, surgical indication, laboratory parameters, perioperative complications, underlying pathology, and associated mortality. There was no significant difference in patient demographics between the groups, however right-sided nephrectomy was performed predominantly within group 1. The main indication in both groups undergoing a nephrectomy was pain. Patients among group 2 had no postoperative kidney failure and a significantly shorter hospital stay. Higher rates of more severe complications were observed in group 1, even though this was not statistically significant. Even though the differences between both groups were substantial, the time of NN prior or post-transplant does not seem to affect short-term and long-term transplantation outcomes. Retroperitoneal NN remains a low risk treatment option in patients with symptomatic ADPKD and can be performed either pre- or post-kidney transplantation depending on patients&rsquo; symptom severity

Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors

Contrast-enhanced ultrasound (CEUS) is a widely used diagnostic tool for analyzing perfusion and characterizing lesions in several organs. However, to date, it has not been sufficiently investigated whether there is an association between CEUS findings and kidney function. This study aimed at identifying the potential relationship between kidney function and the renal perfusion status determined by CEUS in living kidney donors. A total of 30 living kidney donors examined between April 2018 and March 2020 were included in the study. All patients underwent various diagnostic procedures for evaluation of renal function. CEUS was performed in all 30 donors one day before nephrectomy. Kidney perfusion was quantified using a postprocessing tool (VueBox, Bracco Imaging). Various perfusion parameters were subsequently analyzed and compared with the results of the other methods used to evaluate kidney function. Of all parameters, mean signal intensity (MeanLin) had the strongest correlation, showing significant correlations with eGFR (CG) (r = &minus;0.345; p = 0.007) and total kidney volume (r = &minus;0.409; p = 0.001). While there was no significant correlation between any perfusion parameter and diethylenetriaminepentaacetic acid (DTPA), we detected a significant correlation between MeanLin and DTPA (r = &minus;0.502; p = 0.005) in the subgroup of normal-weight donors. The results indicate that signal intensity in CEUS is associated with kidney function in normal-weight individuals. Body mass index (BMI) may be a potential confounder of signal intensity in CEUS. Thus, more research is needed to confirm these results in larger study populations